Effect of no eyeglasses sales on the quality of eye care: an experimental evidence from China.

BACKGROUND: Eye examinations and eyeglasses acquisition are typically integrated into a cohesive procedure in China. We conducted a randomized controlled trial using incognito standardized patient (SP) approach to evaluate the impact of separating eyeglasses sales on the accuracy of final prescription. METHODS: 52 SPs were trained to provide standardized responses during eye examinations, and undergoing refraction by a senior ophthalmologist at a national-level clinical center. SPs subsequently received eye examinations at 226 private optical shops and public hospitals in Shaanxi, northwestern China. The visits were randomly assigned to either control group, where SPs would typically purchase eyeglasses after refraction, or treatment group, where SPs made an advance declaration not to purchase eyeglasses prior to refraction. The dioptric difference between the final prescriptions provided by local refractionists and expert in the better-seeing eye was determined using the Vector Diopteric Distance method, and the completeness of exams was assessed against national standards. Multiple regressions were conducted to estimate the impact of no eyeglasses sales on the accuracy of the final prescription of local refractionists, as well as the completeness of examinations. RESULTS: Among 226 eye exams (73 in public hospitals, 153 in private optical shops), 133 (58.8%) were randomized to control group and 93 (41.2%) to no eyeglasses sales group. The inaccuracy rate of final prescriptions provided by local refractionists (≥ 1.0 D, experts' final prescription as the reference) was 25.6% in control group, while 36.6% in no-sale group (P = 0.077). The likelihood of providing inaccurate final prescriptions was significantly higher in no-sale group compared to control group (OR = 1.607; 95% CI: 1.030 to 2.508; P = 0.037). This was particularly evident in private optical shops (OR = 2.433; 95% CI: 1.386 to 4.309; P = 0.002). In terms of process quality, the no-sale group performed significantly less subjective refraction (OR = 0.488; 95% CI: 0.253 to 0.940; P = 0.032) and less testing SP's own eyeglasses (OR = 0.424; 95% CI: 0.201 to 0.897; P = 0.025). The duration of eye exams was 3.917 min shorter (95% CI: -6.798 to -1.036; P = 0.008) in no-sale group. CONCLUSIONS: Separating eyeglasses sales from optical care could lead to worse quality of eye care. Policy makers should carefully consider the role of economic incentives in healthcare reform.

Axial Symptoms and Spinal-pelvic Parameters After Degenerative Lumbar Spondylolisthesis.

Context: Degenerative spondylolisthesis (DS) is a prevalent degenerative condition affecting the lumbar spine. Local spinal parameters play a pivotal role in surgical complications and in the QoL that adults with spinal deformities experience. Treatment can effectively alleviate radicular symptoms, but it doesn't significantly mitigate postoperative axial symptoms (AS). Objective: The study intended to investigate the correlation between postoperative axial symptoms (AS) and spinal-pelvic parameters for patients with DS of the lumbar spine. Design: The research team conducted a prospective cohort study. Setting: The study took place at the Huai'an Hospital of Huai'an City in the Huai'an District of Huai'an City in JiangSu Province, China. Participants: Participants were 120 patients with DS who had been admitted to the department of orthopedics at the hospital between January 2016 and December 2022 and 120 healthy volunteers during the same period. Intervention: The research team created two groups, each with 120 participants: (1) the intervention group with DS who received posterior laminar decompression + pedicle-screw internal fixation + intervertebral-space bone grafting and fusion, and (2) the control group, the healthy volunteers. Outcome Measures: The research team: (1) measured both group's spinal-pelvic parameters at baseline and at 6 months postintervention, (2) evaluated both group's motor functions at baseline and at 6 months postintervention, using the Japanese Orthopedic Association (OAS) scale and the Oswestry Disability Index (ODI), (3) examined the intervention group's postoperative AS, and (4) analyzed the correlation between the intervention group's spinal-pelvic parameters and its postoperative AS and motor function. Results: At 6 months postintervention, the intervention group's spinal-pelvic parameters-lumbar lordosis (LL) and sacral slope (SS) were significantly lower-and-pelvic incidence (PI), pelvic tilt (PT), thoracic kyphosis (TK), segmental lumbar lordosis (SLL), and sagittal vertical axis (SVA) were significantly higher than those of the control group (all P = .000). The intervention group's JOA and ODI scores were significantly lower than those of the control group postintervention (both P = .000). Postintervention compared to the non-AS group, the AS group's LL (P = .000), PI (P = .000), and SS (P = .020) were significantly lower and PT (P = .002), TK (P = .000), SLL (P = .002), and SVA (P = .000) were significantly higher. Postoperative AS was negatively correlated with LL, PI, SS, and positively correlated with PT, TK, SLL, and SVA (all P = .000). The JOA and ODI scores were positively correlated with LL, PI, and SS, and negatively correlated with PT, TK, SLL, and SVA (all P = .000). Conclusions: Postoperative AS in patients with DS is significantly correlated with spinal-pelvic parameters, providing convincing evidence for the evaluation of postoperative dysfunction. However, generalizing to other patients is limited due to the small sample size, which might have resulted in bias in spinal-pelvic parameters. Hence, ongoing trials with large samples are warranted.