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Purpose: The optometry profession has experienced massive changes amid lockdown in COVID 19 pandemic. This study gauges the impact of COVID-19 on optometry education and practices in India. Methods: The impact of COVID-19 among key stakeholders of Indian optometry that included educators, students, and practitioners was surveyed. The content validity of the survey tool was achieved through a focused group discussion with experts. Results: Of the 1408 responses, 118 were educators, 845 were students and 445 were practitioners. Post COVID-19 lock-down, a high percentage of students (96%) and educators (94%) were now using online mode of education to learn and teach. The blended learning methods were reported to be used by 81% of educators. Practical skills were the most difficult to teach by educators and to learn by students. Almost a third of the students were concerned about their internships and job opportunities amid the pandemic. Practitioners felt confident in performing routine eye examinations with personal protective equipment (PPE). Telemedicine was found to be adopted by 55% of the private practitioners and 49% of the eye hospitals. Conclusion: The COVID-19 pandemic has provided an opportunity to reform Indian optometry education through blended learning methods. Optometry practices changed and adapted instantly to the new hygiene norms that have raised the standard of care provided to patients. Telemedicine emerged as a mode of providing care by optometrists. Overall, all key stakeholders of optometry in India were found to have adapted well to the sudden changes due to COVID 19 pandemic.

Background There are a number of limitations to the present primary eye care system in the UK. Patients with minor eye conditions typically either have to present to their local hospital or GP, or face a charge when visiting eye care professionals (optometrists). Some areas of the UK have commissioned enhanced community services to alleviate this problem; however, many areas have not. The present study is a needs assessment of three areas (Leeds, Airedale and Bradford) without a Minor Eye Conditions Service (MECS), with the aim of determining whether such a service is clinically or economically viable. Method A pro forma was developed for optometrists and practice staff to complete when a patient presented whose reason for attending was due to symptoms indicative of a problem that could not be optically corrected. This form captured the reason for visit, whether the patient was seen, the consultation funding, the outcome and where the patient would have presented to if the optometrists could not have seen them. Optometrists were invited to participate via Local Optical Committees. Results were submitted via a Google form or a Microsoft Excel document and were analysed in Microsoft Excel. Results Seventy-five percent of patients were managed in optometric practice. Nine and 16% of patients required subsequent referral to their General Practitioner or hospital ophthalmology department, respectively. Should they not have been seen, 34% of patients would have presented to accident and emergency departments and 59% to their general practitioner. 53% of patients paid privately for the optometrist appointment, 28% of patients received a free examination either through use of General Ophthalmic Service sight tests (9%) or optometrist good will (19%) and 19% of patients did not receive a consultation and were redirected to other providers (e.g. pharmacy, accident and emergency or General Practitioner). 88% of patients were satisfied with the level of service. Cost-analyses revealed a theoretical cost saving of £3198 to the NHS across our sample for the study period, indicating cost effectiveness. Conclusions This assessment demonstrates that a minor eye condition service in the local areas would be economically and clinically viable and well received by patients.

BackgroundVision impairment is a growing global burden issue, and appropriately trained optometrists are essential for its management. However, there is a shortage of optometrists worldwide, which hampers eye care planning. Few studies have addressed this shortage quantitatively.AimThe study aimed to describe the distribution of the global optometric workforce.SettingGlobal and country level.MethodsFrom February 2017 to May 2020, a standardised questionnaire in English was utilised to collect data on the global number and distribution of optometrists from key informants. Optometrists were categorised based on the World Council of Optometry’s guidelines, from levels two to four. Optometrist-to-population ratios were calculated for all countries and regions and compared with targets of 1:50 000 (in developing contexts) or 1:10 000 (in developed contexts).ResultsAn 80.9% response was achieved with responses from 123 of the 152 countries invited. Most (40.7%) key informants were academics. The total number of optometrists across 21 Global Burden of Disease (GBD) regions was 331 781. Sixty-six (53.7%) countries met the 1:50 000 optometrist-to-population ratio. There was a noticeable positive correlation (r = 0.7) between the prevalence of blindness and vision impairment and the optometrist-to-population ratios. Strong inverse relationships existed between a country’s gross domestic product and optometrist-to-population ratio.ConclusionHigh-income countries met the target for optometrist-to-patient ratios, while low- to middle-income countries and low-income countries did not meet the targets. Low optometrist-to-patient ratios were strongly associated with a higher magnitude of blindness and vision impairment.ContributionThis article provides the first consolidation of the global optometry workforce.

Background Undetected depression is common in people with low vision and depression screening has been recommended. However, depression screening is a complex procedure for which low vision practitioners need training. This study examined the integration of routine depression screening, using two questions, and referral pathways into a national low vision service in Wales at 6 months following practitioner training, and identified key barriers to implementation. Methods This pre-post single group study employed a convergent mixed methods design to collect quantitative questionnaire and qualitative interview data on low vision practitioners’ clinical practice and perceived barriers to implementing depression screening. Forty practitioners completed questionnaires pre-, immediately post- and 6 months post-training and nine engaged in interviews 6 months post-training. Ordinal questionnaire scores were Rasch-transformed into interval-level data before linear regression analyses were performed to determine the change in scores over time and the association between perceived barriers and clinical practice. Thematic Analysis was applied to the interviews and the narrative results merged with the questionnaire findings. Results Before training, only one third of practitioners ( n  = 15) identified depression in low vision patients, increasing to over 90% ( n  = 37) at 6 months post-training, with a corresponding increase in those using validated depression screening questions from 10% ( n  = 4) to 80% ( n  = 32). Six months post-training, practitioners reported taking significantly more action in response to suspected depression (difference in means = 2.77, 95% CI 1.93 to 3.61, p  < 0.001) and perceived less barriers to addressing depression (difference in means = − 0.95, 95% CI − 1.32 to − 0.59, p  < 0.001). However, the screening questions were not used consistently. Some barriers to implementation remained, including perceived patient reluctance to discuss depression, time constraints and lack of confidence in addressing depression. Conclusions The introduction of depression screening service guidelines and training successfully increased the number of low vision practitioners identifying and addressing depression. However, standardized screening of all low vision attendees has not yet been achieved and several barriers remain. Healthcare services need to address these barriers when considering mental health screening, and further research could focus on the process from the patients’ perspective, to determine the desire for and acceptability of screening.

Background Underutilization of and lack of access to low vision services (LVS) has been reported internationally. The purpose of this study was to identify barriers and facilitators in LVS referral procedures and service delivery from both the perspective of people with visual impairment and professionals from different eye care providers in the Netherlands. Methods A qualitative study in the Netherlands was conducted. Barriers and facilitators were explored through semi structured interviews with older adults with macular degeneration, diabetic retinopathy and/or glaucoma ( n  = 14), and healthcare professionals including ophthalmologists and LVS professionals ( n  = 16). Framework analysis was used for analyzing the interviews with Atlas.ti software. Results According to both patients and professionals, facilitators in LVS access and utilization are having motivation, self-advocacy, high participation needs and social support, as well as being negatively impacted by the impairment. Both samples found having good communication skills and informing patients about LVS as a healthcare provider to facilitate access. A long patient-provider relationship and the Dutch healthcare system were also mentioned as facilitators. Professionals additionally found long disease duration and the presence of low vision optometric services in the ophthalmic practice to promote access. Barriers that were reported by patients and professionals are lack of motivation, self-advocacy and acceptance of the impairment in patients. In addition, having low participation needs as a patient, lack of information provision by providers and time constraints in the ophthalmic practice were mentioned as barriers. Professionals also reported lack of social support, short disease duration of patients, a short patient-provider relationship and lack of coordination of care in the ophthalmic practice to hinder access. Conclusions Findings suggest that providers’ lack of information provision about LVS, especially to patients who are less assertive, hamper referral to LVS. Providers should have attention for patients’ LVS needs and actively inform them and their social network about LVS to facilitate access. Educating and training providers about how and when to address LVS may help to reduce barriers in the referral pathways. In addition, referral procedures may benefit from tools that make providers more aware of LVS.

Background Telehealth and virtual supervision practices in health professions clinical education has grown rapidly, including in the Department of Veterans Affairs (VA) which oversees the largest interprofessional training effort in the United States. Telehealth is the provision of healthcare that is provided remotely through telecommunication technology, and virtual supervision is clinical supervision of health professions trainees (HPTs) that occurs through telecommunication technology. In this study we evaluate participation in telehealth and virtual supervision for physician, nursing, and associated health HPTs, and describe prevalent themes concerning HPT perceptions of telehealth and virtual supervision. Methods The survey study cohort included 10,865 HPTs that responded to the VA Trainee Satisfaction Survey in Academic Year 2023 (between July 2022 to June 2023). Descriptive and bivariate analyses were conducted to evaluate participation rates by profession. Responses to the open-ended question within the survey were coded and summarized using rapid qualitative analysis methods. Results Participation rates for telehealth and virtual supervision were: Associated health HPTs (47.2% telehealth, 33.8% virtual supervision), physician residents (31.1% telehealth, 21.5% virtual supervision), and nursing HPTs (22.9% telehealth, 21.5% virtual supervision) ( p  < .001). HPTs of all professions expressed positive views on their experiences, with profession-specific differences noted in location, frequency and depth of these practices. Conclusions Participation in telehealth and virtual supervision was common and well received by HPTs across multiple professions in VA. HPT responses suggest additional efforts are needed to refine profession-specific instructional methods tailored for defined educational needs and goals.

Purpose. To assess the learning curve of a novel practitioner with minor previous experience with scleral lenses (SL) fitting in the initial 156 consecutive fittings in irregular and regular corneas using a fitting trial. Methods. Prospective dispensing case series involving a total of 85 subjects (156 eyes), 122 eyes with irregular corneas (IC Group) and 34 eyes with regular corneas (RC Group). All lenses were fitted by the same practitioner with minimal previous knowledge and practice on SL fitting. The first 156 consecutive fits were studied to estimate the number of trial lenses required to achieve the optimal fit and the number of reorders required. The results were divided into 8 chronological groups of 20 fittings (eyes) each. Results. There was a decrease in the number of trial lenses required to achieve the optimal fit from 2.35±0.18 lenses in the first 20 fittings to 1.56±0.13 in the last fittings (p<0.05, Wilcoxon). There were no statistically significant differences between IC and RC groups. Regarding the number of reorders, there was also a decrease from 0.95±0.17 in the first fittings to 0.25±0.11 in the last fittings (p<0.05, Wilcoxon). Thought not statistically significant, there was an increase in the use of toric designs with increasing experience. Conclusions. Practitioner fitting experience reduced both the number of trial lenses required to achieve the best fit and the number of reorders with time. After the first 60 cases, there was a significant reduction in the trial lenses and reorders necessity.

The triage classification and diagnosis of eye diseases in primary care patients through teleophthalmology were performed by ophthalmologists, optometrists, and family physicians. The agreement in triage classification and diagnosis between observers, as well as the quality of referrals from primary care to ophthalmology, were evaluated. Study to compare methods using a non-inferiority method approach. The sample comprised 220 patients with suspected ocular problems evaluated by family physicians. These patients were examined by an optometrist (observer 1) using a Visionix VX650 multi-diagnostic platform. The optometrist provided a suspected diagnosis and a referral. The tests were forwarded electronically to an ophthalmologist (observer 2), who provided a diagnosis and referral. Subsequently, they were reviewed in person by an ophthalmologist (observer 3) who provided a diagnosis and referral. The observers worked independently and at different times, without knowledge of each other’s evaluations, ensuring the objectivity of the analysis. We analyzed interobserver agreement in triage referrals and diagnosis using the Kappa index. The triage classification of patients by teleophthalmology coincides with that of in-person ophthalmology in 91.2% of the cases (Kappa = 0.819). The optician’s triage classification coincided with in-person ophthalmology in 91.3% (Kappa = 0.858) and with teleophthalmology in 92.3% (Kappa = 0.851). The diagnostic categories, teleophthalmology and in-person ophthalmology coincided in 84.61% of the cases (Kappa = 0.80). The optician coincided with in-person ophthalmology in 90.65% (Kappa = 0.88) and with teleophthalmology in 90.9% of the diagnoses (Kappa = 0.87). There was a very high level interobserver agreement for both triage classification and diagnostic categories. This validates our teleophthalmology approach, conducted in a primary care setting by optometrists, family physicians, and ophthalmologists, for an effective triage classification of patients referred to ophthalmology services. This telemedicine also accurately categorizes patients based on their conditions, optimizing resources, reducing waiting times and waiting lists.

ObjectivesIn order to better understand the continued barriers to the provision of vascular endothelial inhibitor therapy, this study aims to investigate patients’ experiences with neovascular age-related macular degeneration (nvAMD) in Germany during the injection process and how they deal with it.Design and participantsThis analysis is part of the qualitative arm of a wider mixed-methods study. We recruited participants all over Germany via ophthalmologists, eye clinics, general practitioners, care bases and support groups between June 2018 and December 2020 and selected a subsample of study participants with nvAMD who were either undergoing or had previously undergone vascular endothelial growth factor inhibitor therapy. We conducted narrative, semistructured, face-to-face interviews at the participants’ homes, which were audio-recorded. The interviews were thematically analysed.ResultsTwenty-two participants were included in this analysis. Experiencing neovascular macular degeneration was dominated by the injection experience. Study participants perceived the treatment with vascular endothelial inhibitor injections as uncomfortable, and they described undergoing varying levels of anxiety during the whole injection process. After some years of receiving multiple injections, the pain and not experiencing any positive effects made participants with significant vision loss want to discontinue therapy. Furthermore, they narrated negative injection experiences in association with their interactions with medical staff and doctors.ConclusionAlthough time in the medical setting is limited, efficient and good doctor-patient relationships seem crucial for satisfying care experiences. A respectful and humane relationship may be one key to achieving treatment adherence.

Background Retinal diseases, including wet or dry age-related macular degeneration, diabetic macular edema, and diabetic retinopathy (DR), are underdiagnosed and undertreated in the United States. Clinical trials support the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) therapies for several retinal conditions, but real-world data suggest underuse by clinicians, resulting in patients experiencing poorer visual outcomes over time. Continuing education (CE) has demonstrated effectiveness at changing practice behaviors, but more research is needed to understand whether CE can help address diagnostic and treatment gaps. Methods This test and control matched pair analysis examined pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners (i.e., retina specialists, ophthalmologists, optometrists, primary care providers, diabetes educators, pharmacists/managed care specialists, and other healthcare providers, such as registered nurses, nurse practitioners, and physician assistants) who participated in a modular, interactive CE initiative. An additional medical claims analysis provided data on practice change, evaluating use of VEGF-A inhibitors among retina specialist and ophthalmologist learners (n = 7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis. Results Learners significantly improved knowledge/competence scores on early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P -values = 0.003 to 0.004). Compared with matched controls, learners’ incremental total injections for anti-VEGF agents for retinal conditions increased more after the CE intervention ( P  < 0.001); specifically, there were 18,513 more (new) anti-VEGF injections prescribed versus non-learners ( P  < 0.001). Conclusions This modular, interactive, immersive CE initiative resulted in significant knowledge/competence gains among retinal disease care providers and changes in practice-related treatment behaviors (i.e., appropriate consideration and greater incorporation of guideline-recommended anti-VEGF therapies) among participating ophthalmologists and retina specialists compared to matched controls. Future studies will utilize medical claims data to show longitudinal impact of this CE initiative on treatment behavior among specialists and impact on diagnosis and referral rates among optometrists and primary care providers who participate in future programming.