Assessing the role of visual dysfunctions in the association between visual symptomatology and the use of digital devices / Evaluación del papel de las disfunciones visuales en la asociación entre la sintomatología visual y el uso de dispositivos digitales

Purpose: To evaluate the association between visual symptoms and use of digital devices considering the presence of visual dysfunctions. Methods: An optometric examination was conducted in a clinical sample of 346 patients to diagnose any type of visual anomaly. Visual symptoms were collected using the validated SQVD questionnaire. A threshold of 6 hours per day was used to quantify the effects of digital device usage and patients were divided into two groups: under and above of 35 years old. A multivariate logistic regression was employed to investigate the association between digital device use and symptoms, with visual dysfunctions considered as a confounding variable. Crude and the adjusted odds ratio (OR) were calculated for each variable. Results: 57.02 % of the subjects reported visual symptoms, and 65.02% exhibited some form of visual dysfunction. For patients under 35 years old, an association was found between having visual symptoms and digital device use (OR = 2.10, p = 0.01). However, after adjusting for visual dysfunctions, this association disappeared (OR = 1.44, p = 0.27) and the association was instead between symptoms and refractive dysfunction (OR = 6.52, p < 0.001), accommodative (OR = 10.47, p < 0.001), binocular (OR = 6.68, p < 0.001) and accommodative plus binocular dysfunctions (OR = 46.84, p < 0.001). Among patients over 35 years old, no association was found between symptoms and the use of digital devices (OR = 1.27, p = 0.49) but there was an association between symptoms and refractive dysfunction (OR = 3.54, p = 0.001). Conclusions: Visual symptoms are not dependent on the duration of digital device use but rather on the presence of any type of visual dysfunction: refractive, accommodative and/or binocular one, which should be diagnosed.(AU)

Epithelial and stromal thickness profile and lens decentration in myopic orthokeratology / Perfil de espesor epitelial y estromal y descentrado del cristalino en ortoqueratología miope

Purpose: To study topographic epithelial and total corneal thickness changes in myopic subjects undergoing successful orthokeratology treatment in connection with the objective assessment of contact lens decentration. Methods: A prospective-observational and non-randomized study in 32 Caucasian myopic eyes undergoing Ortho-k for 3 months. Total, epithelial, and stromal thicknesses were studied before and after Ortho-k treatment, using optical coherence tomography with anterior segment application software. Central, paracentral, and mid-peripheral values are taken along 8 semi-meridians. Results: The central average total corneal thickness was 4.72 ± 1.04 μm thinner after Ortho-K. The paracentral corneal thickness showed no significant changes (p = 0.137), while the mid-peripheral corneal thickness was increased by 3.25 ± 1.6 μm associating this increase exclusively to the epithelial plot (p<0.001). When lens centration was assessed, a lens fitting decentration less than 1.0 mm was found for the whole sample, predominantly horizontal-temporal (87.5%) and vertical-inferior (50%) decentring. Corneal topographical analysis revealed a horizontal and vertical epithelial thickness asymmetric change profile with paracentral temporal thinnest values, and mid-peripheral nasal thickest values. Conclusions: The present study found a central corneal thinning induced by Ortho-k lenses in subjects with moderate myopia, only associated with a change in epithelial thickness, as well as mid-peripheral thickening, that seems to be mainly epithelial in origin. The authors also found a tendency of contact lens decentration toward temporal and inferior areas conditioning an asymmetric epithelial redistribution pattern.(AU)

Job satisfaction of Spanish and Portuguese optometrists / Satisfacción laboral de los optometristas españoles y portugueses

Purpose: Given the increase in demand for optometry services by society and the importance of the Optometry profession in Portugal and Spain, the objective of this study was to determine job satisfaction and important factors related to this satisfaction in a sample of Portuguese and Spanish optometrists. Methods: A prospective, cross-sectional, and observational study was carried out from June to December 2021. An adaptation of the 15-item job satisfaction in eye-care personnel (JSEP) questionnaire validated by Paudel et al. was administered to Portuguese and Spanish optometrists. The questionnaire was shared through different social media (Facebook, LinkedIn, WhatsApp, etc.) in a Google form during the months of June to December 2021 in Portugal and Spain. Results: A total of 530 surveys were collected in Portugal (42.3%; n = 224) and Spain (57.7%; n = 306). The factors that most influence overall job satisfaction are salary, career development opportunities, recognition/prestige in society, good work-life balance (all p<0.001), workplace equipment and facilities, and encouragement reward positive feedback (both p = 0.002). When comparing the determinants of job satisfaction of optometrists, it was found that Portuguese professionals were generally more satisfied than Spanish ones (p<0.001). However, Spanish optometrists reported feeling more supported by their colleagues (p<0.001). Conclusion: This study has shown that the level of job satisfaction was higher in Portugal than in Spain. The most important factors influencing job satisfaction were salary, job stability, and support from colleagues.(AU)

Quality of life assessment for nuclear, cortical, posterior subcapsular patients before and after cataract surgery / Evaluación de la calidad de vida de pacientes nucleares, corticales y subcapsulares posteriores antes y después de la cirugía de cataratas

Purpose: The impact of visual outcomes of cataract surgery can be measured using a questionnaire. The aim of our study was to evaluate how patient quality of life changes after cataract surgery and if there are differences between the responses of patients with nuclear, cortical, and posterior subcapsular cataracts, which has not been studied before. Method: We studied 210 cataract patients who were divided into 3 cataract groups based on their cataract type: nuclear (n = 80), cortical (n = 70), and posterior subcapsular (PSC) (n = 60). The patients completed the Visual Function Index (VF-14) questionnaire before, 2 weeks and 1 month after bilateral cataract surgery. The results were analysed using one-way ANOVA (significance level 5 %) and were compared over time and between the cataract groups. Results: Before the cataract surgery, cortical cataract patients had the lowest questionnaire score compared to nuclear and posterior subcapsular cataract groups (p = 0.08). After cataract surgery, cortical cataract patients experienced the greatest improvement in near distance daily activities, while PSC cataract patients experienced the greatest improvement in far distance daily activities (p = 0.38). Before surgery, nuclear cataract patients had the highest questionnaire scores compared to the other cataract groups (p = 0.08). Conclusion: At the 1 month follow-up, there were no statistically significant differences in questionnaire scores between the cataract groups for any of the questions. Overall, cortical cataract patients showed a trend to experience the greatest subjective improvement in quality of life after cataract removal, followed by nuclear and posterior subcapsular patients.(AU)

The influence of the tear film on the intraocular pressure and the corneal biomechanical properties analyzed with the Ocular Response Analyzer / La influencia de la película lagrimal sobre la presión intraocular y las propiedades biomecánicas corneales analizadas con el Analizador de Respuesta Ocular

Purpose: As ocular dryness and glaucoma are more prevalent with increasing age, understanding how the tear film affects tonometry is important. The present study aims to understand the impact that changes in the tear film have on intraocular pressure (IOP), corneal hysteresis, and corneal resistance factor measurements. Methods: Cross-sectional research was conducted and 37 patients were assessed. The tear film lipid layer and the non-invasive break-up time (NIBUT) were evaluated using the Tearscope Plus (Keeler, Windsor, UK). Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. IOP was measured using rebound tonometry and the Ocular Response Analyzer (ORA, Reichert). Corneal biomechanical properties were measured using ORA. Results: It was found that an increase in the IOP measured with the iCare was directly correlated with the subclass that evaluated symptomatology associated with environmental factors (r = 0.414, p<0.05, Spearman). Goldmann-correlated IOP (IOPg) and Corneal-compensated IOP (IOPcc) values were statistically significantly different between the various interferometric patterns (p<0.05). It was also found that an increase in the corneal biomechanical properties measured with ORA was directly correlated with the overall scores obtained when using the OSDI and some of its subclasses. Conclusions: Tear film interferometric patterns were shown to have some impact on the IOP measured using ORA. The IOP measured with iCare seems to be related to the symptomatology obtained from OSDI. Corneal biomechanical properties were related to the OSDI total score and some of its subclasses. An increase in symptomatology was associated with an increase in the measured biomechanical properties of the cornea.(AU)

Clinical reading-related oculomotor assessment in visual snow syndrome / Evaluación oculomotora clínica relacionada con la lectura en el síndrome de nieve visual

Purpose: Visual snow syndrome (VSS) is a complex neurological condition presenting with an array of sensory, motor, and perceptual dysfunctions and related visual and non-visual symptoms. Recent laboratory studies have found subtle, basic, saccadic-based abnormalities in this population. The objective of the present investigation was to determine if saccadic-related problems could be confirmed and extended using three common clinical reading-related eye movement tests having well-developed protocols and normative databases. Methods: This was a retrospective analysis of 32 patients (ages 16–56 years) diagnosed with VSS in the first author's optometric practice. There was a battery of three reading-related tests: the Visagraph Reading Eye Movement Test, the Developmental Eye Movement (DEM) Test, and the RightEye Dynamic Vision Assessment Test, all performed using their standard documented protocols and large normative databases. Results: A high frequency of oculomotor deficits was found with all three tests. The greatest percentage was revealed with the Visagraph (56%) and the least with the RightEye (23%). A total of 77% of patients failed at least one of the three tests. Conclusion: The present findings confirm and extend earlier investigations revealing a high frequency of saccadic-based oculomotor problems in the VSS population, now including reading-related tasks. This is consistent with the more general oculomotor/motor problems found in these individuals.(AU)

Silicone oil insulation effects on flash electroretinogram and visual evoked potential in patients with retinal detachment / Efectos del aislamiento del aceite de silicona sobre el electrorretinograma flash y el potencial evocado visual en pacientes con desprendimiento de retina

Background: Silicone oil is used as endotamponade following vitreoretinal surgery to maintain the retina reattached when indicated. This study investigates the hypothesis that silicone oil causes insulation effects on the retina by affecting its response to light. Methods: Electrophysiological responses to a flash stimulus were recorded using full-field electroretinography (ERG) and visual evoked potentials (VEP). Recordings were performed in 9 patients who underwent surgery for retinal detachment, before (1–2 days) and after (2–3 weeks) silicone oil removal (SOR) in both the study and the control eye. Flash ERG and VEP recordings were performed according to the ISCEV standard protocol. Results: Statistically significant differences were found in the study eye in the amplitudes of the ERG responses and their corresponding ratios, i.e. the amplitude after SOR over the amplitude before SOR, in all conditions tested. No differences were observed in the control eye. The mean ratio of photopic ERG response was 3.4 ± 2.4 for the study and 1.0 ± 0.3 for the control eye (p<0.001). The mean ratio of ERG flicker response was 3.1 ± 2.4 and 1.0 ± 0.3, respectively (p = 0.003). Scotopic flash ERG ratio was 5.0 ± 4.4 for the study and 1.3 ± 0.6 for the control eye (p = 0.012). No differences were observed for the amplitude and latency of flash VEP response after SOR. Conclusions: Silicone oil causes a reduction in flash ERG responses; no effect was found on flash VEP responses. ERGs in eyes filled with silicone oil should not be considered representative of retinal functionality, in contrast to VEPs, which are not affected by silicone oil presence.(AU)

Perception of optometrists on causes of professional discordance among eye care professionals and its impact on refractive error service delivery in Kenya.

PURPOSE: To evaluate the perception of optometrists on causes of professional discordance among eye care professionals and its impact on refractive error service delivery in Kenya. METHODS: This was a prospective qualitative case study conducted between January and June 2022 among optometrists registered with the Optometrists Association of Kenya. The data was collected through telephonic interviews. Purposive sampling was used to recruit the participants. Descriptive statistics were presented using frequency, percentages and with p values. Thematic analysis was carried out for qualitative data using the NVivo Software, Version 11. It was an iterative process consisting of both deductive and inductive processes. RESULTS: Out of the 100 respondents, 37 (37%) were female. The mean age for the participants was 30.5 years with majority being in the age group 30-34 years. There was no statistically significant difference between the ages of males and females (p = 0.132) Most participants 82 (82%) had practiced for more than 4 years. The participants reported; mistrust among eye care professionals, employment sector, specialty, undermining the potential of other cadres within the eye care ecosystem, confusion and misconception and negative attitude as the perception of optometrists on causes of professional discordance among eye care professionals on refractive error service delivery. All of the optometrists agreed that professional discordance exists among eye care professionals in Kenya which potentially impacts negatively on refractive error service delivery. CONCLUSION: Professional discordance remains an underrated barrier which negatively impacts on refractive error service delivery. However, to achieve effective refractive error coverage, a strengthened team approach among eye care professionals is desirable in a country with limited human resource such as Kenya.

A review study on forensic optometry: new insights in forensic science to solve crime scenes, domestic violence and sexual assaults.

Forensic science has made a lot of progress in the medical field, but still ocular signs are not so well known to forensic scientists, whereas ocular signs play a very important role in forensic science. The major goal of this study to describe the importance of eye related clues in forensic science to solve the crime scenes and know the actual cause of death for the conviction of the criminals and save an innocent persons. Narrative review was done to review the articles available on the PubMed, Google Scholar, Research Gate, Web of Science and Medline related to the forensic optometry about the various methods of identification and strategies to deal with the forensic cases. The review covered studies that focused on interventions for forensic optometry and eye-related clues to the current study target. Twenty-seven of the 54 studies that met the inclusion criteria yielded good results, and all examined the significance of eye-related clues in forensic optometry. Peer reviewed articles/studies were referred to ascertain the eye related clues in the forensic science. Some authors suggest that eye related clues are very important aspects towards the forensic science and done the clinical research on that aspects. Criminal cases, domestic abuse and sexual assault affect people of all socioeconomic backgrounds. As a result, these traits would be highly valuable in determining the way of death and the chronological history of events leading up to a crime.

Big data study using health insurance claims to predict multidisciplinary low vision service uptake.

SIGNIFICANCE: There is a lack of research from high-income countries with various health care and funding systems regarding barriers and facilitators in low vision services (LVS) access. Furthermore, very few studies on LVS provision have used claims data. PURPOSE: This study aimed to investigate which patient characteristics predict receiving multidisciplinary LVS (MLVS) in the Netherlands, a high-income country, based on health care claims data. METHODS: Data from a Dutch national health insurance claims database (2015 to 2018) of patients with eye diseases causing potentially severe visual impairment were retrieved. Patients received MLVS (n = 8766) and/or ophthalmic treatment in 2018 (reference, n = 565,496). MLVS is provided by professionals from various clinical backgrounds, including nonprofit low vision optometry. Patient characteristics (sociodemographic, clinical, contextual, general health care utilization) were assessed as potential predictors using a multivariable logistic regression model, which was internally validated with bootstrapping. RESULTS: Predictors for receiving MLVS included prescription of low vision aids (odds ratio [OR], 8.76; 95% confidence interval [CI], 7.99 to 9.61), having multiple ophthalmic diagnoses (OR, 3.49; 95% CI, 3.30 to 3.70), receiving occupational therapy (OR, 2.32; 95% CI, 2.15 to 2.51), mental comorbidity (OR, 1.17; 95% CI, 1.10 to 1.23), comorbid hearing disorder (OR, 1.98; 95% CI, 1.86 to 2.11), and receiving treatment in both a general hospital and a specialized ophthalmic center (OR, 1.23; 95% CI, 1.10 to 1.37), or by a general practitioner (OR, 1.23; 95% CI, 1.18 to 1.29). Characteristics associated with lower odds included older age (OR, 0.30; 95% CI, 0.28 to 0.32), having a low social economic status (OR, 0.91; 95% CI, 0.86 to 0.97), physical comorbidity (OR, 0.87; 95% CI, 0.82 to 0.92), and greater distance to an MLVS (OR, 0.95; 95% CI, 0.92 to 0.98). The area under the curve of the model was 0.75 (95% CI, 0.75 to 0.76; optimism = 0.0008). CONCLUSIONS: Various sociodemographic, clinical, and contextual patient characteristics, as well as factors related to patients' general health care utilization, were found to influence MLVS receipt as barriers or facilitators. Eye care practitioners should have attention for socioeconomically disadvantaged older patients when considering MLVS referral.

Assessing the reliability of tele-refraction for real time consultation with a remote optometrist.

INTRODUCTION: Uncorrected refractive errors pose a significant challenge globally, particularly in remote regions of low-middle income countries where access to optometric care is often limited. Telerefraction, which involves refraction by a trained technician followed by real-time consultation with remote optometrist, is a promising approach for such remote settings. This study aimed to evaluate the accuracy of this model. METHODS: This prospective study, conducted in New Delhi, compared tele-refraction to in-person examinations. Trained technicians used a simple device, Click-check, to perform objective refraction and a tele-refraction platform to enter the findings of objective refraction. Final prescription was made after consulting a remote optometrist on that platform. Masked face-to-face optometrists served as the gold standard. The study involved refraction in 222 patients and 428 eyes. RESULTS: Tele-refraction demonstrated a strong agreement with in-person optometry, achieving 84.6% in spherical correction and 81% conformity in spherical equivalent. The mean difference of spherical equivalent between the two arms was only 0.11 D. The consultation with a remote optometrist improved conformity of spherical equivalent by 14.8% over objective refraction. 82 percent eyes matched in best corrected visual acuity and 92 percent were within 0.1 logMAR difference. For cylindrical axis, 74% eye were within acceptable 10 degrees of difference. The mismatch amongst the individual trained technicians, in terms of difference between the tele-refraction arm and the face-to face optometrist arm was found to be significant for cylindrical axis and not for spherical power and spherical equivalent. CONCLUSION: Our study found tele-refraction by a trained technician comparable to refraction done by face-to-face optometrist. Tele-refraction, coupled with remote optometrist guidance can address the optometry resource gap in underserved areas. Thus, this model offers a transformative approach to enhancing the accessibility and quality of eye care services, which can significantly contribute to our efforts in achieving the global targets set by the World Health Organization for effective refractive error coverage. More standardized training for these technicians on ClickCheckTM for detecting the cylindrical axis with better accuracy, can improve this model further.

Confidence in low vision rehabilitation and attitudes towards further learning: A survey of UK optometrists.

PURPOSE: Optometrists are well positioned to help expand low vision (LV) services and improve their availability and accessibility. Determinants of participation in LV service provision must be well understood to facilitate successful service expansion. This survey aimed to investigate optometrists' professional confidence in the delivery of LV services and attitudes towards further learning. METHODS: An online survey was emailed to a sample of College of Optometrists members. Respondents rated their confidence in different areas of core optometric practice; confidence in LV was compared with confidence in other areas. Respondents also rated their confidence in undertaking multiple tasks involved in LV service delivery and in routine optometric practice; confidence was compared between optometrists who do and do not work in a LV service. Attitudes towards learning more about assessing and supporting patients with a vision impairment (VI) were recorded. RESULTS: The survey received 451 recorded responses (15.1% response rate). Optometrists who do not work in a LV service reported significantly lower confidence in LV than in other areas of core optometric practice, whereas optometrists who work in a LV service reported significantly higher confidence in LV than in other areas. Additionally, optometrists who do not work in a LV service reported significantly lower confidence in all tasks involved in LV service delivery than optometrists who work in a LV service (p < 0.001 for all tasks). Approximately 80% of respondents were interested in learning more about assessing and supporting patients with a VI. CONCLUSIONS: Optometrists who do not work in a LV service have relatively low confidence in LV, which could contribute to low motivation to participate in LV service provision. There is sizeable interest in learning more about assessing and supporting patients with a VI, which could help to increase motivation to participate in LV service provision.

What are the experiences of teleophthalmology in optometric referral pathways? A qualitative interview study with patients and clinicians.

OBJECTIVE: Implementing teleophthalmology into the optometric referral pathway may ease the current pressures on hospital eye services caused by over-referrals from some optometrists. This study aimed to understand the practical implications of implementing teleophthalmology by analysing lived experiences and perceptions of teleophthalmology in the optometric referral pathway for suspected retinal conditions. DESIGN: Qualitative in-depth interview study SETTING: Fourteen primary care optometry practices and four secondary care hospital eye services from four NHS Foundation Trusts across the UK. PARTICIPANTS: We interviewed 41 participants: patients (17), optometrists (18), and ophthalmologists (6) who were involved in the HERMES study. Through thematic analysis, we collated and present their experiences of implementing teleophthalmology. RESULTS: All participants interviewed were positive towards teleophthalmology as it could enable efficiencies in the referral pathway and improve feedback and communication between patients and healthcare professionals. Concerns included setup costs for optometrists and anxieties from patients about not seeing an ophthalmologist face to face. However, reducing unnecessary visits and increasing the availability of resources and capacity were seen as significant benefits. CONCLUSIONS: Overall, we report positive experiences of implementing teleophthalmology into the optometric referral pathway for suspected retinal conditions. Successful implementation will require appropriate investment to set up and integrate new technology and remunerate services, and continued evaluation to ensure timely feedback to patients and between healthcare professionals is received. TRIAL REGISTRATION NUMBER: ISRCTN18106677.