Complications of Adenoviral Keratoconjunctivitis in Ophthalmologists and Orthoptists: Epidemiology and Risk Factor, A Retrospective Questionnaire Analysis.

PURPOSE: The purpose of this study was to assess the medical history of adenoviral keratoconjunctivitis (AK) and subepithelial infiltrates (SEIs) among French ophthalmologists and orthoptists and the frequency of unreported occupational diseases. We also described short-term and long-term consequences of AK and evaluated associated factors. METHODS: The REDCap questionnaire was diffused online several times over 7 consecutive months, from October 2019 to May 2020, through mailing lists (French Society of Ophthalmology, residents, and hospital departments), social networks, and by word of mouth. RESULTS: Seven hundred ten participants were included with a response rate of 6.2% for ophthalmologists, 3.8% for orthoptists, and 28.3% for ophthalmology residents. The medical history of AK was found in 24.1% (95% confidence interval 21%-27.2%) of respondents and SEI in 43.9% (36.5%-51.3%) of the AK population. In total, 87.1% (82.1%-92.1%) of AK occupational diseases were not declared. In total, 57.7% of respondents took 9.4 ± 6.2 days of sick leave, mostly unofficial, and 95.7% stopped surgeries for 13.0 ± 6.6 days. Among the AK population, 39.8% had current sequelae, with 17.5% having persistent SEIs, 19.9% using current therapy, and 16.4% experiencing continuing discomfort. SEIs were associated with wearing contact lenses (odds ratio 3.31, 95% confidence interval 1.19-9.21) and smoking (4.07, 1.30-12.8). Corticosteroid therapy was associated with a greater number of sequelae (3.84, 1.51-9.75). CONCLUSIONS: AK and SEI affect a large proportion of ophthalmologists and orthoptists, possibly for years, with high morbidity leading to occupational discomfort. Few practitioners asked for either to be recognized as an occupational disease. Associated factors would require a dedicated study.

A Randomized Trial to Increase the Assessment Accuracy of Glaucoma and Optic Disc Characteristics by Orthoptists.

INTRODUCTION: The aim of this study was to determine the accuracy of orthoptists when examining the optic disc for signs of glaucoma, and to explore the impact of targeted clinical education on accuracy. METHODS: In this randomized controlled trial, 42 monoscopic color optic disc images were presented to 46 orthoptists who assessed the likelihood of glaucoma as well as optic disc size, shape, tilting, vertical cup-to-disc ratio, cup shape, depth, presence of hemorrhage, peripapillary atrophy, and retinal nerve fiber layer. The level of agreement with specialist ophthalmologists was assessed. Participants were then randomly assigned to an experimental group (targeted postgraduate education on optic disc assessment) or to no intervention. The educational program was designed to increase knowledge of the characteristic features associated with glaucomatous optic neuropathy. All participants re-examined the included optic disc images after a period of 6 to 8 weeks. The primary outcome measure was a change in agreement between attempts. RESULTS: The education group showed significant improvements between attempts for identifying hemorrhages (P = .013), retinal nerve fiber layer defects (0.035), disc size (P = .001), peripapillary atrophy (P = .030), and glaucoma likelihood (P = .023). The control group did not show any statistically significant improvement. The intervention group showed significantly more improvement when identifying hemorrhages (P = .013), disc size (P = .001), disc shape (P = .033), and cup shape (P = .020) compared with the control group. DISCUSSION: Orthoptists who received additional postgraduate online education based on principles of adult learning were more accurate at assessing the optic disc for glaucoma. These results highlight the value of continuing education to optimize clinical practice in allied health professionals.

Diagnosis and Management Practice Patterns among Pediatric Ophthalmology Personnel in Israel.

PURPOSE: To investigate the diagnosis and management practice patterns of different aspects of pediatric ophthalmology among pediatric ophthalmologists and orthoptists in Israel. METHODS: A 21-question survey was delivered to all registered pediatric ophthalmologists and orthoptists in Israel. RESULTS: The response rate was 58.3%. Most pediatric ophthalmology personnel in Israel do not document intermittent exotropia (IXT) with a control scale, do not use modalities other than patching for amblyopia, and do not use distance stereoacuity tests. There was no consensus regarding patching and over minus treatments in IXT. In contrast to frequent use of prism adaptation test (PAT) for evaluating strabismus, most Israeli pediatric ophthalmology personnel do not use postoperation diplopia test (PODT). While most orthoptists use a questionnaire when diagnosing convergence insufficiency (CI), most pediatric ophthalmologists do not. CONCLUSION: This study highlights the current areas of consensus and disagreement regarding pediatric ophthalmology diagnosis and management practices in Israel. Adopting a uniform approach regarding diagnosing CI, including using a questionnaire by pediatric ophthalmologists and orthoptic exercises in the management of IXT, is warranted to enable unified treatment by pediatric ophthalmologist and orthoptists in Israel.

Socioeconomic status and utilization of amblyopia services at a tertiary pediatric hospital in Canada.

OBJECTIVE: To evaluate whether socioeconomic status is associated with equal utilization of amblyopia services at The Hospital for Sick Children (SickKids), a pediatric tertiary hospital in Canada. DESIGN: This is a retrospective, cross-sectional study. PARTICIPANTS: The medical records of children aged under 7 years diagnosed with amblyopia at SickKids from 2007 to 2009 were reviewed. METHODS: Socioeconomic status was derived from patients' residential postal codes through linking with income data in the 2006 Canadian census report. Patients were divided into 5 income quintiles to compare with amblyopia service utilization. The main outcome measure was the observed distribution of amblyopia patients by socioeconomic status versus the expected distribution of 20% for each quintile. RESULTS: The analyses included 336 patients. Children with amblyopia at SickKids were more likely to come from the richest neighbourhood (32.5%), whereas children from each of the 3 lowest quintiles (14.6%-15.5%) were less likely to present at SickKids. These results differed significantly from the expected 20% for each quintile (p < 0.0001). All types of amblyopia were significantly under-represented for children from the lower socioeconomic groups. When analyses were stratified by travel distance to the hospital, a significant inequality between the lower and higher income quintiles remained for nonmetropolitan Toronto patients, but not for metropolitan Toronto patients. CONCLUSION: Despite a publicly funded health-care system in Canada, children from lower socioeconomic neighbourhoods in distant areas utilize the amblyopia services in a tertiary pediatric centre less often than those from higher socioeconomic status.

Use of atropine penalization to treat amblyopia in UK orthoptic practice.

PURPOSE: To compare clinical practice patterns regarding atropine penalization use by UK orthoptists to the current evidence base and identify any existing barriers against use of AP as first-line treatment. METHODS: An online survey was designed to assess current practice patterns of UK orthoptists using atropine penalization. They were asked to identify issues limiting their use of atropine penalization and give opinions on its effectiveness compared to occlusion. Descriptive statistics and content analysis were applied to the results. RESULTS: Responses were obtained from 151 orthoptists throughout the United Kingdom. The main perceived barriers to use of atropine penalization were inability to prescribe atropine and supply difficulties. However, respondents also did not consider atropine penalization as effective as occlusion in treating amblyopia, contrary to recent research findings. Patient selection criteria and treatment administration largely follow current evidence. More orthoptists use atropine penalization as first-line treatment than previously reported. CONCLUSIONS: Practitioners tend to closely follow the current evidence base when using atropine penalization, but reluctance in offering it as first-line treatment or providing a choice for parents between occlusion and atropine still remains. This may result from concerns regarding atropine's general efficacy, side effects, and risk of reverse amblyopia. Alternatively, as demonstrated in other areas of medicine, it may reflect the inherent delay of research findings translating to clinical practice changes.

Fresnel prism use among orthoptists.

PURPOSE: To better understand current uses of Fresnel prisms. METHODS: A seventeen-question survey was completed by members of the American Association of Certified Orthoptists (AACO). RESULTS: Surveys were emailed to 211 orthoptists with a 36% response rate (n = 76). Prisms are used preoperatively to determine the surgical angle for 72% of respondents, 94% use prisms for postoperative misalignment. Prisms are used for incomitant deviations by up to 96% of respondents. The greatest patient objection to Fresnel use is reduced vision and distortion, not diplopia out of primary position. Of orthoptists surveyed, 99% use Fresnel prisms for near-distance disparity, 36% splitting prisms for upper and lower segments, and 40% encourage separate spectacles for near and distance. When deciding to grind prism, 66% wait more than one month. Ninety-nine percent of orthoptists use Fresnel prisms with adults, 67% use them with children. When correcting vertical and horizontal deviations, 70% of orthoptists rotate a prism over one lens. CONCLUSION: Fresnel prisms have a wide use among North American certified orthoptists, including use with pediatric patients. Incomitance is not a contraindication to Fresnel use. Orthoptists prefer rotating one prism to bilateral Fresnel prisms.

Are rehabilitation services for patients in UK eye clinics adequate? A survey of eye care professionals.

PURPOSE: The purpose of this study is to determine whether specific services such as emotional and family support are currently available in the United Kingdom for people with visual impairment. METHODS: A validated online survey was created and distributed to clinical staff in eye clinics (for example, ophthalmologists and optometrists) and rehabilitation staff (for example, social and rehabilitation workers) in the community, who worked with people with visual impairment. A total of 67 clinical and 42 rehabilitation staff completed the entire survey online. RESULTS: Only 67% of the respondents claimed their clinics provide emotional support and 44% of respondent's clinics provided family support. Clinical and rehabilitation staff have differences in opinion over what constitutes an essential service for a visually impaired patient. Rehabilitation staff considered emotional support and referral to social services as essential more often than clinical staff (P<0.05). There is some confusion over the type of personnel who provides each type of service, with some services showing substantial repetition. CONCLUSION: In the clinics sampled, there appears to be an underprovision of emotional support (attentive listening plus constructive suggestions) and family support (emotional support and advice for family members) for visually impaired patients in the United Kingdom. There also seems to be some discrepancy in services that eye care professionals feel are available and previous reports by visually impaired patients of the service they receive. There is a need to develop standardised pathways across the United Kingdom, to solve some of these issues.

Objective survey of the prescription of occlusion therapy for amblyopia.

PURPOSE: To identify the variation within and consistency amongst orthoptists when prescribing occlusion therapy for amblyopia in an objective survey. METHODS: A questionnaire was designed with five case examples of amblyopic children and distributed at annual meetings of orthoptists in The Netherlands and Germany. It was filled in simultaneously within 15 min in complete silence to avoid any exchange of opinions between orthoptists that would reduce variability. For each case the orthoptists were asked to give their prescription of hours or days of occlusion. RESULTS: The questionnaire was filled in by 177 Dutch orthoptists and 227 German orthoptists. Their prescriptions of occlusion therapy were classified into five main regimens: part-time; part-time not every day; full-time; also occluding the amblyopic eye; alternating; and no occlusion therapy. The variation was large: the standard deviation was half the average prescribed hours of occlusion for each regimen in each of the five cases. All orthoptists were assigned a rank number for each of the five cases depending on whether their prescription was above or below average. These five rank numbers were not consistently above or consistently below average value per case. CONCLUSIONS: The number of prescribed hours of occlusion varied widely per regimen per case. Orthoptists were not consistently strict or lenient in their prescription of occlusion therapy.

The gatekeeper in vision care. An analysis of the co-ordination of professional services in The Netherlands.

Data from a national survey were used to explore the position of ophthalmologists, general practitioners, orthoptists, optometrists and opticians in the domain of vision care services. Options for organising the gatekeeper function were analysed. This was done on the basis of six cases that the five key occupations considered as their overlapping areas. Nearly all respondents reported to be consulted by patients with the given complaints, indicating rather unclear boundaries between the professions. Further, the opinions indicated preference for a medical gatekeeper (ophthalmologist, GP) rather than a non-medical one (optometrist). Lack of agreement on suggested gatekeeper options suggest other options to consider, like regional networks of GPs, ophthalmologists, orthoptists and optometrists who share the responsibility for a specified client population. At present, such innovative arrangements are being introduced. GPs and optometrists could share the responsibility for gate-keeping and for referring patients to more specialised services.

[The conservative treatment and evolution of intermittent divergent strabismus]. / Tratamentul conservator si evolutia strabismelor divergente intermitente.

We study 43 children with intermittent exotropia treated in Eye Clinic, Cluj. 83.7% shows excess divergence exotropia and only 16.3% convergence insufficiency exotropia. The children are treated with optical correction, prisms and orthoptics.