Impact of supervised student optometry consultations on the patient experience

Background

Understanding patient perceptions of having students involved in their clinical care is important as we strive to develop optimal models of care that integrate teaching with the best possible experience for the patient. The aim was to ascertain the impact of supervised optometry student consultations on the patient experience.

Methods

A survey comprising 45 questions was mailed to consecutive adult patients who had undergone a comprehensive eye examination at the Australian College of Optometry over a four‐week period.

Results

Responses were received from 193 patients who had a student involved in their care (44 per cent response rate; 156 completed correctly) and 177 who did not have a student involved (32 per cent response rate; 105 completed correctly). There was no significant difference in overall patient satisfaction between the teaching and non‐teaching clinics (p = 0.18). Over 87 per cent of patients in the teaching clinic felt completely comfortable with a student examining them, 44 per cent felt their care was better because a student was involved and 97 per cent rated the overall performance of the student as very good or good. Although 12 per cent would rather have seen only the optometrist and three per cent would not be happy to have a student involved in their eye care again, 100 per cent believed it is important for students to work with patients. The most common reason for student acceptance was the importance of students needing opportunities to learn. The main reasons for unwillingness to have a student involved in future were the additional time taken and prolonged testing.

Conclusions

The findings of this study suggest that most patients view supervised student involvement in their optometric care as an important and highly positive experience. However, efforts should be made to avoid excessively long consultations and prolonged testing. Concerns about patient satisfaction and acceptance are largely unwarranted and should not prevent optometry students being involved in patient care.     

Refractive error in Chinese with type 2 diabetes and its association with glycaemic control

Background

The aim of this study was to determine the prevalence of refractive errors and their association with glycaemic control among adults with type 2 diabetes mellitus (T2DM) in eastern China.

Methods

A community‐based survey, including 913 adults with T2DM aged 30 to 89 years, was conducted. Refractive error was assessed by autorefraction, after which subjective refraction was performed. Ocular biometric parameters were measured by non‐contact partial coherence laser interferometry. Myopia was defined as spherical equivalent (SE) less than ?0.50 dioptres (D), high myopia as SE less than ?5.00 D, hyperopia as SE greater than 0.50 D and astigmatism as cylinder less than ?0.50 D.

Results

After excluding participants who had undergone cataract surgery, 839 were included in the data analyses and 96.1 per cent were found to have refractive errors. The overall prevalences of myopia, high myopia, hyperopia and astigmatism were 28.2 per cent (95 per cent confidence interval [CI] 25.2–31.3), 6.3 per cent (95 per cent CI 4.7–8.0), 46.4 per cent (95 per cent CI 43.0–49.7) and 81.0 per cent (95 per cent CI 78.4–83.7) with no gender differences observed (all p > 0.10). In multivariate analysis, myopia was associated with decreasing age (odds ratio [OR] = 0.86, p = 0.01; per year increase), higher blood levels of haemoglobin A_1c (HbA_1c) (OR = 1.12, p = 0.05; per unit increase), higher education levels (OR = 5.10, p < 0.001; university or college versus illiterate or primary school) and the presence of nuclear cataract (OR = 2.36, p < 0.001).

Conclusions

Refractive errors may be associated with glycaemic control among T2DM patients. Longitudinal analyses are warranted to examine the relationship between changes in HbA_1c and the development of refractive errors.

     

Assessment of information included on the GOS 18 referral form used by optometrists

PURPOSE: To audit the information included on GOS 18 forms used by UK optometrists when referring patients to an ophthalmologist. METHODS: All GOS 18 forms received in a hospital ophthalmology department over a 10-week period were photocopied and the categories of information presented were recorded. RESULTS: A total of 444 forms were analysed. The two most common referral categories were cataract 36.7% (n = 163) and glaucoma 18.4% (n = 82). Only 7% (n = 11) of cataract referrals included details regarding effect on patient's lifestyle and willingness for surgery. Forty-seven per cent (n = 77) of referrals for cataract resulted in patients being listed for surgery. Eighty-two per cent (n = 67) of referrals for glaucoma included disc assessment, intraocular pressure and visual fields. Five per cent (n = 22) of optometrists gained the patients' consent for release of clinical information. Thirty-one per cent (n = 137) of forms had no practitioner name and 6% (n = 27) gave no practice address. CONCLUSION: Information included on GOS 18 forms could be improved with regard to cataract referrals. Feedback from ophthalmologists would be facilitated by inclusion of practitioner/practice details, and by completion of the consent section on the GOS 18.     

Revalidation and electronic cataract surgery audit: a Scottish survey on current practice and opinion

Purpose

To determine current knowledge and opinion on revalidation, and methods of cataract surgery audit in Scotland and to outline the current and future possibilities for electronic cataract surgery audit.

Methods

In 2010 we conducted a prospective, cross-sectional, Scottish-wide survey on revalidation knowledge and opinion, and cataract audit practice among all senior NHS ophthalmologists. Results were anonymised and recorded manually for analysis.

Results

In all, 61% of the ophthalmologists surveyed took part. Only 33% felt ready to take part in revalidation, whereas 76% felt they did not have adequate information about the process. Also, 71% did not feel revalidation would improve patient care, but 85% agreed that cataract surgery audit is essential for ophthalmic practice. In addition, 91% audit their cataract outcomes; 52% do so continuously. Further, 63% audit their subspecialist surgical results. Only 25% audit their cataract surgery practice electronically, and only 12% collect clinical data using a hospital PAS system. Funding and system incompatibility were the main reasons cited for the lack of electronic audit setup. Currently, eight separate hospital IT patient administration systems are used across 14 health boards in Scotland.

Conclusion

Revalidation is set to commence in 2012. The Royal College of Ophthalmologists will use cataract outcome audit as a tool to ensure surgical competency for the process. Retrospective manual auditing of cataract outcome is time consuming, and can be avoided with an electronic system. Scottish ophthalmologists view revalidation with scepticism and appear to have inadequate knowledge of the process. However, they strongly agree with the concept of cataract surgery audit. The existing and future electronic applications that may support surgical audit are commercial electronic records, web-based applications, centrally funded software applications, and robust NHS connections between community and hospital.     

Surgical checklist for cataract surgery: progress with the initiative by the Royal College of Ophthalmologists to improve patient safety

Purpose

The World Health Organisation (WHO) identified patient safety in surgery as an important public health matter and advised the adoption of a universal peri-operative surgical checklist. An adapted version of the WHO checklist has been mandatory in the National Health Service since 2010. Wrong intraocular lens (IOL) implantation is a particular safety concern in ophthalmology. The Royal College of Ophthalmologists launched a bespoke checklist for cataract surgery in 2010 to reduce the likelihood of preventable errors. We sought to ascertain the use of checklists in cataract surgery in 2012.

Patients and methods

A survey of members of the Royal College of Ophthalmologists seeking views on the use of checklists in cataract surgery. Four hundred and sixty-nine completed responses were received (18% response rate).

Results

Respondents worked in England (75%), Scotland (11%), Wales (5%), Northern Ireland (2%), the Republic of Ireland (1%), and overseas (6%). Ninety-four per cent of respondents support the use of a checklist for cataract surgery and 85% say that they always use a checklist before cataract surgery. Sixty-seven per cent of cataract surgeons stated they undertake a pre-operative team brief. Thirty-six per cent use a cataract surgery checklist developed locally, 18% use the college''s bespoke cataract surgery checklist, 39% use a generic surgical checklist, and 4% reported that they do not use a checklist.

Conclusion

Ninety-three per cent of cataract surgeons responding to the questionnaire report using a surgical checklist and 67% use a team brief. However, only 54% use a checklist, which addresses the selection of the correct intraocular implant. We recommend wider adoption of checklists, which address risks relevant to cataract surgery, in particular the possibility of selection of an incorrect IOL.     

The association of keratoconus with blepharitis

Background

Identifying potentially treatable risk factors for the progression of keratoconus is of great importance. The purpose of this study was to determine the association between blepharitis and keratoconus.

Methods

In this prospective, comparative, observational study, 50 keratoconus participants from the central district of the Clalit Health Services Health Maintenance Organization in Israel underwent comprehensive eye examination. Seventy‐two healthy medical personnel of similar ages were randomly chosen as a control group. The signs and symptoms of blepharitis in each participant were assessed. A thorough survey of the eyelids (scales and foam on the eyelashes, missing eyelashes and expression of meibomian gland contents) was performed. All participants were required to complete two questionnaires: the Ocular Surface Disease Index questionnaire and a questionnaire regarding symptoms, signs and risk factors for blepharitis.

Results

Blepharitis was more common in keratoconus participants than in the control group (24 per cent versus 2.8 per cent, p < 0.001). A higher proportion of keratoconus participants reported rubbing their eyes more than once a day (36 per cent versus 11.1 per cent, p = 0.002) as well as red and tired eyes (12 per cent versus zero per cent, p = 0.009). On external eye examination, signs of blepharitis and meibomian gland dysfunction were found more frequently in the keratoconus group (p < 0.05).

Conclusions

Signs and symptoms of blepharitis occur more often in keratoconus participants than in healthy individuals. Blepharitis‐related inflammation and associated eye rubbing may contribute to disease progression.

     

The prevalence and causes of visual impairment in seven‐year‐old children

Background

To report the prevalence and causes of visual impairment in seven‐year‐old children in Iran and its relationship with socio‐economic conditions.

Methods

In a cross‐sectional population‐based study, first‐grade students in the primary schools of eight cities in the country were randomly selected from different geographic locations using multistage cluster sampling. The examinations included visual acuity measurement, ocular motility evaluation, and cycloplegic and non‐cycloplegic refraction. Using the definitions of the World Health Organization (presenting visual acuity less than or equal to 6/18 in the better eye) to estimate the prevalence of vision impairment, the present study reported presenting visual impairment in seven‐year‐old children.

Results

Of 4,614 selected students, 4,106 students participated in the study (response rate 89 per cent), of whom 2,127 (51.8 per cent) were male. The prevalence of visual impairment according to a visual acuity of 6/18 was 0.341 per cent (95 per cent confidence interval 0.187–0.571); 1.34 per cent (95 per cent confidence interval 1.011–1.74) of children had visual impairment according to a visual acuity of 6/18 in at least one eye. Sixty‐six (1.6 per cent) and 23 (0.24 per cent) children had visual impairment according to a visual acuity of 6/12 in the worse and better eye, respectively. The most common causes of visual impairment were refractive errors (81.8 per cent) and amblyopia (14.5 per cent). Among different types of refractive errors, astigmatism was the main refractive error leading to visual impairment. According to the concentration index, the distribution of visual impairment in children from low‐income families was higher.

Conclusion

This study revealed a high prevalence of visual impairment in a representative sample of seven‐year‐old Iranian children. Astigmatism and amblyopia were the most common causes of visual impairment. The distribution of visual impairment was higher in children from low‐income families. Cost‐effective strategies are needed to address these easily treatable causes of visual impairment.

     

Anesthesia monitoring by registered nurses during cataract surgery: assessment of need for intraoperative anesthesia consultation

PURPOSE: To assess the frequency and risk factors for intraoperative anesthesia consultation when performing cataract surgery monitored by registered nurses. SETTING: Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA. METHODS: This retrospective review was of 270 cataract surgeries performed under local anesthesia from April 1, 2002, to April 1, 2003. RESULTS: The American Society of Anesthesiologists (ASA) classification of each patient was determined: 1 patient was classified as ASA 1. One hundred fifty patients were classified as ASA 2. One hundred nineteen patients were classified as ASA 3. The anesthesiology department was consulted 24 times. Nineteen consultations involved patients who were ASA 3, and 5 consultations involved patients who were ASA 2 (P<.001). In most cases (23 of 24), the anesthesia service provided a consultation (eg, increase oxygen flow rate, clarification of electrocardiogram, start intravenous line, equipment repair) and left the nurses to continue to monitor the patient. In only 1 case (ASA 3), the anesthesia service converted the case to monitored anesthesia care and relieved the nurse to monitor the patient. CONCLUSIONS: In this study, monitoring of routine cataract surgery by registered nurses was associated with a low rate of intraoperative anesthesia consultation. Most consultations resulted in little intervention. The ASA classification appears predictive of the need for intraoperative anesthesia consultation.     

The minimum test battery to screen for binocular vision anomalies: report 3 of the BAND study

Purpose

This study aims to report the minimum test battery needed to screen non‐strabismic binocular vision anomalies (NSBVAs) in a community set‐up. When large numbers are to be screened we aim to identify the most useful test battery when there is no opportunity for a more comprehensive and time‐consuming clinical examination.

Methods

The prevalence estimates and normative data for binocular vision parameters were estimated from the Binocular Vision Anomalies and Normative Data (BAND) study, following which cut‐off estimates and receiver operating characteristic curves to identify the minimum test battery have been plotted. In the receiver operating characteristic phase of the study, children between nine and 17 years of age were screened in two schools in the rural arm using the minimum test battery, and the prevalence estimates with the minimum test battery were found.

Results

Receiver operating characteristic analyses revealed that near point of convergence with penlight and red filter (> 7.5 cm), monocular accommodative facility (< 10 cycles per minute), and the difference between near and distance phoria (> 1.25 prism dioptres) were significant factors with cut‐off values for best sensitivity and specificity. This minimum test battery was applied to a cohort of 305 children. The mean (standard deviation) age of the subjects was 12.7 (two) years with 121 males and 184 females. Using the minimum battery of tests obtained through the receiver operating characteristic analyses, the prevalence of NSBVAs was found to be 26 per cent. Near point of convergence with penlight and red filter > 10 cm was found to have the highest sensitivity (80 per cent) and specificity (73 per cent) for the diagnosis of convergence insufficiency. For the diagnosis of accommodative infacility, monocular accommodative facility with a cut‐off of less than seven cycles per minute was the best predictor for screening (92 per cent sensitivity and 90 per cent specificity).

Conclusion

The minimum test battery of near point of convergence with penlight and red filter, difference between distance and near phoria, and monocular accommodative facility yield good sensitivity and specificity for diagnosis of NSBVAs in a community set‐up.

     

远程眼科会诊对青光眼检出效果影响的研究

目的探讨远程眼科会诊平台对青光眼患者检出率的作用。 方法回顾性病例系列研究。首都医科大学附属北京同仁医院眼科研究所建立远程眼科会诊中心，收集远程会诊中心患者和基础眼病筛查者。采用Pearson χ²检验，比较同期在北京进行的基础眼病筛查中青光眼的检出率，评价眼科会诊平台对青光眼检出效果的作用，并分析"青光眼"诊断的患者中早期青光眼所占的比例。 结果远程会诊平台共收集493 221例患者。其中，检索"青光眼"诊断患者11 538例，占2.34%；可疑青光眼者2174例，占0.44%；青光眼及可疑青光眼诊断的检出率为2.78%。其中，早期青光眼诊断在所有"青光眼"诊断中的构成比为12.50%。同一时期在北京某机关进行眼病筛查者20 861例，青光眼诊断检出417例，占1.79%；可疑青光眼诊断检出33例，占0.16%；青光眼及可疑青光眼诊断检出率为1.95%。其中，早期青光眼诊断在青光眼诊断中的构成比为33.60%。两种方式青光眼检出率比较，经Pearson χ²检验结果显示两者差异无统计学意义( χ²＝2.0，P>0.05)。 结论应用互联网技术及眼科影像诊断标准，通过远程眼科会诊平台，可实现与基础眼病筛查对青光眼检出等同的效果，且可以实现以信息技术流动代替患者或医师的流动。     

Refractive error and vision correction in a general sports‐playing population

Purpose

To evaluate, in an amateur sports‐playing population, the prevalence of refractive error, the type of vision correction used during sport and attitudes toward different kinds of vision correction used in various types of sports.

Method

A questionnaire was used for people engaging in sport and data was collected from sport centres, gyms and universities that focused on the motor sciences.

Results

One thousand, five hundred and seventy‐three questionnaires were collected (mean age 26.5 ± 12.9 years; 63.5 per cent male). Nearly all (93.8 per cent) subjects stated that their vision had been checked at least once. Fifty‐three subjects (3.4 per cent) had undergone refractive surgery. Of the remainder who did not have refractive surgery (n = 1,519), 580 (38.2 per cent) reported a defect of vision, 474 (31.2 per cent) were myopic, 63 (4.1 per cent) hyperopic and 241 (15.9 per cent) astigmatic. Logistic regression analysis showed that the best predictors for myopia prevalence were gender (p < 0.001) and location of sport practice (p < 0.001). Sports that present higher prevalence of outdoor activity have lower prevalence of myopia. Contact lens penetration over the study sample was 18.7 per cent. Contact lenses were the favourite system of correction among people interviewed compared to spectacles and refractive surgery (p < 0.001).

Conclusions

This study showed that sport was not associated with different levels of myopia prevalence in the adult population. However, subjects engaging in outdoor sports had lower rates of myopia prevalence. Penetration of contact lens use in sport was four times higher than the overall adult population. Contact lenses were the preferred system of correction in sports compared to spectacles or refractive surgery, but this preference was affected by the type of sport practised and by the age and level of sports activity for which the preference was required.

     

Investigation of attributes which guide choice in cataract surgery services in urban Sydney,Australia

Background

It is critical to consult patients to develop patient‐centred cataract surgery care. We aimed to identify attributes patients consider when making decisions about cataract surgery in an Australian context, where both publicly and privately funded surgery are available. This is the first step in investigating how decisions are made about cataract surgery services.

Methods

This observational qualitative study was undertaken in two public hospitals and one private practice in Sydney, Australia. The study involved 19 women and men with age‐related cataracts and no previous cataract surgery, aged > 18 years, able to speak conversational English or Mandarin. A multi‐stage attribute development process was followed, including: literature review, semi‐structured interviews with surgery candidates in three eye clinics, and review by an expert panel. The main outcome measures were primary attributes for making choices about cataract surgery.

Results

Wait time, cost, institutional reputation, surgeon experience and travel time were identified as principal attributes; lower value was placed on consultation length and accessibility. Non‐English speaking participants indicated greater interest in pre‐operative information than English speakers, but expressed trust in the Australian healthcare system.

Conclusions

Findings suggest individuals prioritise attributes which consume time or incur costs when accessing care (wait time, cost and travel time). They also consider factors associated with the outcome of their cataract surgery (surgeon experience and institutional reputation). Similar to other decision‐making processes, patients are likely to trade between these different attributes depending on their personal preferences and circumstances.     

Advanced imaging for the diagnosis of age‐related macular degeneration: a case vignettes study

Background

The aim of this study is to evaluate the diagnosis, staging, imaging and management preferences, and the effect of advanced imaging among practising optometrists in age‐related macular degeneration (AMD).

Methods

Up to 20 case vignettes (computer‐based case simulations) were completed online in a computer laboratory in random order by 81 practising optometrists of Australia. Each case presented findings from a randomly selected patient seen previously at the Centre for Eye Health for a macular assessment in the following order: case history, preliminary tests and colour fundus photography. Participants were prompted to provide their diagnosis, management and imaging preference. One additional imaging result (either modified fundus photographs and infrared images, fundus autofluorescence, or optical coherence tomography [OCT]) was then provided and the questions repeated. Finally, all imaging results were provided and the questions repeated a third time.

Results

A total of 1,436 responses were analysed. The presence of macular pathology in AMD was accurately detected in 94 per cent of instances. The overall diagnostic accuracy of AMD was 61 per cent using colour fundus photography. This improved by one per cent using one additional imaging modality and a further four per cent using all imaging. Across all responses, a greater improvement in the diagnostic accuracy of AMD occurred following the presentation of OCT findings (versus other modalities). OCT was the most preferred imaging modality for AMD, while multimodal imaging was of greatest benefit in cases more often misdiagnosed using colour fundus photography alone. Overall, the cohort also displayed a tendency to underestimate disease severity.

Conclusion

Despite reports that imaging technologies improve the stratification of AMD, our findings suggest that this effect may be small when applied among practising optometrists without additional or specific training.     

Contact lens trends over three decades in a hospital‐based practice in India

Background

Contact lens fittings in a hospital‐based practice are different from those in private practices because of specialised conditions. Few studies have been published on material preferences of such wearers, especially in long‐term wearers. The aim of this study is to document contact lens prescribing trends in a hospital‐based practice among long‐term lens wearers and to identify their demographic profile.

Methods

Subjects reporting to a contact lens clinic of a tertiary eye‐care centre in India from 1 January 2014 to 31 December 2014, with a minimum of five years of lens wear, were included in the study. Data were collected retrospectively from the electronic medical charts of these subjects.

Results

Three hundred and sixty subjects were included in the study. The average duration of contact lens wear among the subjects was 9 ± 5 years (range: 5–35 years). The average age of the subjects was 31.38 ± 11.75 years (age range: 5–78 years). Hydrogel material and soft spherical type were preferred by most of the soft lens wearers (53 per cent). Eighty per cent of subjects followed hand hygiene and cleaning regimen practices.

Conclusion

The preference for monthly replacement lenses and silicone hydrogel material increased over the years. Regular after‐care consultations could enforce the need for compliance with hand hygiene and cleaning regimens among lens wearers.

     

Urban diabetic retinopathy teleophthalmology screening: results and impact at the service corridor

ObjectiveTo assess real-world results and the impact on a hospital service corridor for screening for DR through an urban community teleophthalmology service.MethodsRetrospective analysis at the hospital service corridor of 148 diabetics referred to it following DR teleophthalmology screening of 1185 type II diabetics.ResultsOf the screened diabetics, 87.4% (n = 1036) were exempted from face-to-face clinical examination (FFCE) in a traditional hospital eye care pathway and continued monitoring through teleophthalmology under a watch-and-wait attitude, while 12.5% (n = 148) were recommended for an FFCE. The FFCEs revealed that significant DR was present in 48.2% or in 5.6% of this screened diabetic population. Reasons for referral were findings of significant DR in 40.5%, of which diabetic macular edema (DME) represented 86.6%, other incidental significant sight-threatening findings represented 32.4% (4% of the screened diabetics), and insufficient image quality was obtained for the other 27.0%. Optical coherence tomography (OCT) imaging at FFCE confirmed DME in 26.4% and led to treatment. Patients referred for insufficient image quality showed significant pathology in 90.2%, of whom 63.4% underwent further monitoring or treatment. The readers requested the FFCEs for 148 patients within 1 month of the reading in 19.6%, 3 months in 26.3%, 4–12 months in 47.3%, and 12 months in 6.7% over the 34 months of the study. Compliance with FFCEs was 91.9%, absolute in 78.4% and relative in 21.5%. The availability of OCT at the imaging site would have impacted 4.5% of the screened diabetics by enabling teleophthalmology monitoring of 91.6%, identifying just-in-time interventions for DME treatments in 26.4% and reducing by 25% the need for referral of OCT-negative reader-identified DME.ConclusionThe FFCEs generated at the hospital service corridor by an urban community DR screening teleophthalmology project did not impact negatively on its services; moreover, the service corridor was exempted from providing FFCEs to 87.4% of the diabetic population it serves. This study may help provide cost-efficiency indications for a screening protocol that would include OCT availability at the imaging site and measure its positive effects. While DR of which DME was the main cause of referral for FFCE, incidental significant sight-threatening findings were significant and approached DR as a cause of referral; this supports the recommendation of continued human intervention in DR teleophthalmology screening at this time and for this population, until automatic computer-aided diagnosis systems can recognise biomarkers associated with other significant fundus diseases. As a secondary gain this project benefited individuals in need of care who were lost to the traditional eye care pathway. Good compliance with the follow-up FFCE further supports teleophthalmology in its effort to provide better access to DR screening.     

Comparative study of femtosecond laser‐assisted cataract surgery and conventional phacoemulsification in vitrectomized eyes

Importance

To compare the safety and outcomes of femtosecond laser‐assisted cataract surgery (FLACS) and conventional phacoemulsification in post‐vitrectomy eyes.

Background

To compare visual outcomes and adverse outcomes of FLACS and conventional phacoemulsification in vitrectomized eyes.

Design

Single surgeon, retrospective study set in a private clinic in Auckland, New Zealand. Patients selected in a chronological manner, without masking or randomization.

Participants

Only patients undergoing cataract extraction following vitrectomy were included.

Methods

The last 25 surgeries performed prior to acquisition of the femtosecond laser and the first 25 surgeries performed following acquisition of the femtosecond laser were included. Patient demographic data, preoperative and postoperative visual acuities were collected. Intraoperative and postoperative complications were compared. Follow‐up ranged from 1 to 74 months.

Main Outcome Measures

The main outcome measures are postoperative visual outcomes and intra‐ and postoperative complications for both groups.

Results

Results of FLACS compared to conventional phacoemulsification are as follows: preoperative logMAR best corrected visual acuity (BCVA) (0.63 vs. 0.69), postoperative logMAR BCVA (0.17 vs. 0.19), posterior capsule complications (0% vs. 12%, P = 0.235), cystoid macular oedema (CMO) (12% vs. 20%, P = 0.705) and postoperative neodymium‐doped yttrium aluminium garnet (Nd:YAG) capsulotomy (16% vs. 48%, P = 0.032).

Conclusions and Relevance

FLACS demonstrates comparable visual outcomes to conventional phacoemulsification. Whilst outcomes measured were not statistically significant, except postoperative YAG capsulotomy, FLACS showed a trend towards a better intraoperative and postoperative safety profile. Femtosecond laser offers a theoretical advantage in reducing complication rates in post‐vitrectomy eyes, further larger studies are needed.     

Validity of first post‐operative day automated refraction following dense cataract extraction

Background: The aim of this study was to assess the refractive stability and validity of automated refraction obtained at day one after surgery for dense cataracts in a developing country setting, where patient follow‐up is often erratic. Methods: In a prospective study in rural Kenya, we compared automated refraction and visual acuity (VA) after manual small incision cataract surgery (SICS) and phacoemulsification cataract surgery (Phaco) at day one with autorefraction and subjective refraction obtained at a later visit. Results: Ninety eyes of 83 patients fulfilled the ultimate inclusion criteria (21 SICS eyes and 69 Phaco eyes). The correlation between refraction at day one and at a later follow‐up was moderately good for both SICS and Phaco (R1 = 0.61 and R2 = 0.58). Spherical equivalent (SE) values measured at day one were within one dioptre of those obtained later in 68 eyes (72 per cent); (SICS: 67 per cent; Phaco: 74 per cent) and within two dioptres in 83 eyes (92 per cent); (SICS: 86 per cent; Phaco: 94 per cent). At post‐operative days 14, 28 and more than 42 for SICS and Phaco eyes, the mean SE was 0.58 and 0.48, 0.55 and 0.19, and 0.9 and 0.31 more hypermetropic than the mean SE of post‐operative day one, respectively. First‐day accuracy was higher in eyes with better pre‐operative VA, softer cataracts and lower post‐operative prediction error. The surgical technique (SICS versus Phaco) had no influence on first‐day accuracy in our set‐up. Conclusion: Refractive data from the early post‐operative period can provide useful data for qualitative control and monitoring of post‐operative refractive outcomes in a setup, where ‘better’ data are often not available; however, its accuracy is limited and, ultimately, there is no alternative to good follow up of operated patients.     

How do Australian optometrists manage work‐related physical discomfort?

Background: Work‐related physical discomfort exists within the optometric profession. It is not well understood how optometrists manage this issue in their workplaces. Method: An online questionnaire was sent by e‐mail to approximately 1,700 Australian optometrists. Participants were asked if they experienced work‐related discomfort in any of eight nominated body regions. If so, they were asked to describe specific work tasks, which contribute to their work‐related discomfort, and strategies they have adopted to minimise their discomfort. These data were subject to qualitative and quantitative analyses. Results: There was a 25 per cent response rate and 416 optometrists participated in the questionnaire. Work‐related physical discomfort was reported by 339 respondents (81 per cent), most commonly with the use of the phoropter (n = 144, 35 per cent) and slitlamp (n = 94, 23 per cent). Males were more likely to report lower back discomfort with phoropter use (Chi‐squared, p < 0.01) and ophthalmoscopy (Chi‐squared, p < 0.01). To minimise discomfort, optometrists 41 years and older were more likely to report that they adjust their posture (Chi‐squared, p < 0.03) and females were more likely to report that they alter their work schedule (Chi‐squared, p < 0.05). A recurrent theme expressed by participants was an inability to make changes to improve their comfort due to room and equipment design, poorly maintained equipment, non‐supply of suitable equipment or furniture and inherent difficulties within optometric tasks. Conclusion: There is a need for all optometrists to have skills to evaluate their own personal risk of discomfort in the consultation room. Owners and managers of optometric practices also need greater awareness of the importance of room and equipment design and maintenance on work‐related discomfort. This has implications for the well‐being of optometrists, for their productivity and for compliance with health and safety legislation.     

The effectiveness of interventions for optometric referrals into the hospital eye service: A review

Purpose

Ophthalmic services are currently under considerable stress; in the UK, ophthalmology departments have the highest number of outpatient appointments of any department within the National Health Service. Recognising the need for intervention, several approaches have been trialled to tackle the high numbers of false-positive referrals initiated in primary care and seen face to face within the hospital eye service (HES). In this mixed-methods narrative synthesis, we explored interventions based on their clinical impact, cost and acceptability to determine whether they are clinically effective, safe and sustainable. A systematic literature search of PubMed, MEDLINE and CINAHL, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), was used to identify appropriate studies published between December 2001 and December 2022.

Recent Findings

A total of 55 studies were reviewed. Four main interventions were assessed, where two studies covered more than one type: training and guidelines (n = 8), referral filtering schemes (n = 32), asynchronous teleophthalmology (n = 13) and synchronous teleophthalmology (n = 5). All four approaches demonstrated effectiveness for reducing false-positive referrals to the HES. There was sufficient evidence for stakeholder acceptance and cost-effectiveness of referral filtering schemes; however, cost comparisons involved assumptions. Referral filtering and asynchronous teleophthalmology reported moderate levels of false-negative cases (2%–20%), defined as discharged patients requiring HES monitoring.

Summary

The effectiveness of interventions varied depending on which outcome and stakeholder was considered. More studies are required to explore stakeholder opinions around all interventions. In order to maximise clinical safety, it may be appropriate to combine more than one approach, such as referral filtering schemes with virtual review of discharged patients to assess the rate of false-negative cases. The implementation of a successful intervention is more complex than a ‘one-size-fits-all’ approach and there is potential space for newer types of interventions, such as artificial intelligence clinical support systems within the referral pathway.     

Changing perspective of reasons for not performing laser‐assisted in situ keratomileusis among candidates in a university eye clinic

Background: The aim was to retrospectively analyse the reasons for not performing laser‐assisted in situ keratomileusis (LASIK) surgery among refractive surgery candidates at a university eye clinic. Methods: Case records of patients who presented to a university eye clinic between June 2005 and June 2010 for consideration for LASIK surgery were examined. Cases that did not undergo LASIK were selected for analysis. Reasons for not performing surgery in these cases were analysed. Results: In total, 552 patients requested LASIK between July 2005 and June 2010 and 377 (68.3 per cent) of them received refractive surgery. Among 175 (31.7 per cent) patients who did not get LASIK, 62 (35.4 per cent) were male and 113 (64.6 per cent) were female, with a mean age at presentation of 36.4 ± 9.3 years (range: 19 to 78 years). The most common reasons for not offering LASIK were low corneal thickness (28.6 per cent), high myopia (15.4 per cent), large pupil (8.0 per cent) and keratoconus (7.4 per cent). Overall, 39 patients (22.3 per cent) changed their mind after their initial consultations with surgeons. The prevalence of rejection of LASIK decreased from 44.1 per cent between July 2005 and June 2006 to 3.5 per cent between July 2009 and June 2010. Conclusions: Reasons for not performing refractive surgery are quite diverse. Inadequate corneal thickness and change of mind after initial consultation were the most common reasons in the present study. There was a marked change in magnitude and trend of reasons for not performing LASIK over the study period. Further studies from settings other than university hospitals would be beneficial to compare the trend in patient selection.