Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)最新文献

{"title":"Investigating target refraction advice provided to cataract surgery patients by UK optometrists and ophthalmologists.","authors":"Emily Charlesworth,&nbsp;Alison J Alderson,&nbsp;Fiona Fylan,&nbsp;Richard A Armstrong,&nbsp;Aman Chandra,&nbsp;David B Elliott","doi":"10.1111/opo.12957","DOIUrl":"https://doi.org/10.1111/opo.12957","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether UK optometrists and ophthalmologists provide target refraction advice to patients prior to cataract surgery, and when this should first be discussed.</p><p><strong>Methods: </strong>Optometrists and ophthalmologists were asked to complete a survey of two clinical vignettes (both older patients with cataract; a pre-operative myope who routinely read without glasses and a patient using a monovision approach), plus multiple choice and short answer questions either using hard copy or online.</p><p><strong>Results: </strong>Responses were obtained from 437 optometrists and 50 ophthalmologists. Optometrists who reported they would provide target refraction advice were more experienced (median 22 years) than those who would leave this to the Hospital Eye Service (median 10 years). The former group reported it was in the patients' best interest to make an informed decision as they had seen many myopic patients who read uncorrected pre-operatively, and were unhappy that they could no longer do so after surgery. Inexperienced optometrists reported that they did not want to overstep their authority and left the decision to the ophthalmologist. The ophthalmologists estimated their percentage of emmetropic target refractions over the last year to have been 90%.</p><p><strong>Conclusion: </strong>Currently, some long-term myopes become dissatisfied after cataract surgery due to an emmetropic target refraction that leaves them unable to read without glasses as they did prior to surgery. Although experienced optometrists are aware of this and attempt to discuss this issue with patients, less experienced optometrists tend not to. This suggests that target refraction needs greater exposure in university training and continuing professional development. To provide patients with the knowledge to make informed decisions regarding their surgery, we suggest an agreed protocol within funded direct referral schemes of initial target refraction discussions by optometrists to introduce the idea of refractive outcomes and outline options, with further discussion with the ophthalmologist to clarify understanding.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"440-453"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9306962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39934639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referrals from community optometrists in England and their replies: A mixed methods study.","authors":"Krystynne Harvey,&nbsp;David F Edgar,&nbsp;Rishi Agarwal,&nbsp;Martin J Benwell,&nbsp;Bruce Jw Evans","doi":"10.1111/opo.12948","DOIUrl":"https://doi.org/10.1111/opo.12948","url":null,"abstract":"<p><strong>Purpose: </strong>Community optometrists, through routine eye examinations, identify patients with disease or ocular abnormalities requiring referral to the Hospital Eye Service. In many cases no reply to the referral letter is received, resulting in some patients being re-referred unnecessarily, potentially increasing the number of other patients who lose sight whilst on hospital waiting lists. This study investigated, qualitatively and quantitatively, factors influencing optometric referrals and replies.</p><p><strong>Methods: </strong>The three-phase, sequential mixed methods study started with a literature review and qualitative phase, interviewing stakeholders to identify issues for exploration in subsequent phases. The second, quantitative phase, undertook documentary analysis of 349 patient referral records from three optometric practice modalities (domiciliary, independently owned, and corporate chain) in England. A final qualitative phase obtained views from stakeholders to explore unexplained findings from the first two phases.</p><p><strong>Results: </strong>Phase 1 identified communication, financial, professional and technological issues for further exploration. In Phase 2, the referral rate was 22.2% for domiciliary provider, 2.1% for independent practice and 2.5% for the corporate chain, with the variation most likely explained by patient age and associated ophthalmic disease, illness and disability. The referral reply rate was 5.7% for domiciliary provider, 25.0% for independent practice and 4.9% for the corporate chain. The community optometrist remained unaware of the outcome of their referral in 72.8% of cases. Qualitative analyses indicate the main factors influencing referral reply rates are technology, the General Medical Practitioner, community optometrists' utility to and utility of the National Health Service and patient mobilisation.</p><p><strong>Conclusions: </strong>The low referral reply rate creates a break in the feedback loop required to raise the standard of referrals and avoid unnecessary re-referral. Of the factors identified that influence referral reply rates, technology is key in view of the increasing use of online referral platforms. Feedback to the referring optometrist should be embedded in such systems.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"454-470"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39756889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling the refractive and imaging impact of multi-zone lenses utilised for myopia control in children's eyes.","authors":"Raman Prasad Sah,&nbsp;Matt Jaskulski,&nbsp;Pete S Kollbaum","doi":"10.1111/opo.12959","DOIUrl":"https://doi.org/10.1111/opo.12959","url":null,"abstract":"<p><strong>Purpose: </strong>To develop an optical model of a child's eye to reveal the impact of target distance and accommodative behaviour on retinal image quality when fitted with multi-zone lenses.</p><p><strong>Methods: </strong>Pupil size, aberration levels and accommodative lag were adjusted for models viewing stimuli at 400, 100, 33 and 20 cm. Distributions of defocus across the pupil and simulated retinal images were obtained. An equivalent 16-point letter was imaged at near viewing distances, while a 0.00 logMAR (6/6) letter was imaged at 400 cm. Multi-zone lenses included those clinically utilised for myopia control (e.g., dual-focus, multi-segmented and aspherical optics).</p><p><strong>Results: </strong>Viewing distance adjustments to model spherical aberration (SA) and pupil radius resulted in a model eye with wider defocus distributions at closer viewing distances, especially at 20 cm. The increasing negative SA at near reduced the effective add power of dual-focus lenses, reducing the amount of myopic defocus introduced by the centre-distance, 2-zone design. The negative SA at near largely compensated for the high positive SA introduced by the aspheric lens, removing most myopic defocus when viewing at near. A 0.50 D accommodative lag had little impact on the legibility of typical text (16-point) at the closer viewing distances.</p><p><strong>Conclusions: </strong>All four multi-zone lenses successfully generated myopic defocus at greater viewing distances, but two failed to introduce significant amounts of myopic defocus at the nearest viewing distance due to the combined effects of pupil miosis and negative SA. Typical 16-point type is easily legible at near even in presence of the multi-zone optics of lenses utilised for myopia control and accommodative lag.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"571-585"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/43/OPO-42-571.PMC9544677.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39927729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author's Reply.","authors":"Alexander G Swystun,&nbsp;Christopher J Davey","doi":"10.1111/opo.12953","DOIUrl":"https://doi.org/10.1111/opo.12953","url":null,"abstract":"We thank Harper et al. for their interest in our paper. We agree that the safety of commissioned services is of importance, and we believe that novel services should be commissioned with inbuilt service evaluation, but we acknowledge the inherent barriers to doing this. We were grateful that the companies involved in our study were keen to have independent evaluation that enabled system learning and improvement of services. As Harper et al. note, clinical record abstraction has some downsides. This has further disadvantages for an acute eye service appointment for symptomatic individuals. For example, a practitioner could record no tear/detachment for a patient presenting with flashing lights and/ or floaters which, according to the records, the practitioner may appropriately decide not to refer the patient onwards for treatment. This does not tell us, however, whether the patient had a retinal tear or detachment that was simply not detected. It is likely that a practitioner's clinical record would justify their choice of action. Direct patient contact, therefore, may be an appropriate method of determining major errors in an acute eye care service. We therefore welcome Harper et al. bringing a discussion of the challenges in appropriately documenting the safety of primary eye care services. In addition to the lack of falsenegative data being an issue when determining the safety of a service, this also poses questions for the system's costeffectiveness. Despite work attempting to elucidate the costeffectiveness of optometryled acute eye care services, 5 without knowing the precise details of the erroneous management (e.g., falsenegatives), true costeffectiveness cannot be ascertained. For example, mismanagement of patients with early symptoms of stroke has the potential to incur a significantly larger cost to the health care system and society, relative to a falsepositive hospital referral. The lack of specifics in the methodology of Williams et al. makes comparison to other studies difficult. However, the results of a teleophthalmology service delivered at Moorfields Eye Hospital are interesting and in line with our study, when examining representation rates. Specifically, 35.5% of patients who had a teleconsultation by an ophthalmologist represented, unplanned, to the emergency eye service within one month of their initial consultation. For patients in our study, 26.8% reattended (11.1% to the phone line and 15.7% elsewhere) after teleconsultation. In both studies, rates of representation were lower after a facetoface appointment. Specifically, 19.8% fewer patients represented after a facetoface ophthalmology appointment (15.7% represent rate) and 26% fewer patients represented after a facetoface optometry appointment (0.7% represent rate). Whilst the teleophthalmology service differed markedly from that of the service in our study, one distinction is that in the service examined by Li et al., patients were able to choose whether they were seen","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"660-661"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39960763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Working principle and relevant physical properties of the Swiss Liquid Jet Aesthesiometer for Corneal Sensitivity (SLACS) evaluation.","authors":"Daniela S Nosch,&nbsp;Matthias Oscity,&nbsp;Peter Steigmeier,&nbsp;Emanuele Käser,&nbsp;Markus Loepfe,&nbsp;Roland E Joos","doi":"10.1111/opo.12962","DOIUrl":"https://doi.org/10.1111/opo.12962","url":null,"abstract":"<p><strong>Purpose: </strong>To describe and evaluate relevant physical properties of the Swiss Liquid Jet Aesthesiometer for Corneal Sensitivity (SLACS) for ocular surface sensitivity measurement.</p><p><strong>Methods: </strong>Characteristics of Liquid Jet (LJ) droplets (consisting of isotonic saline solution) were analysed: vertical and horizontal displacement and speed of LJ droplets were recorded with the aid of the High Speed Photron FASTCAM NOVA S6 camera (stimulus duration: 40 ms). Stimulus mass was assessed for 20 sets of 10 LJs with aid of a microbalance (pressure range of 100-1500 mbar).</p><p><strong>Results: </strong>Because continuous flow LJ disintegrated into droplets in the lower pressure range (<700 mbar), pulsed stimuli were applied in order to obtain similar stimulus characteristics across the applied pressure range. For all measurements, very little variability was observed. Vertical and horizontal displacement did not exceed 0.13 mm in either direction. The mass per shot showed an unexpected cubic dependency on pressure. Up to approximately 700 mbar, LJ speed showed an almost linear relationship. For the pressure range of >700-1500 mbar, variability increased and speed decreased compared to the expected in a linear manner. However, this may be caused by the difficulty of identifying pattern changes of LJ droplets from one high speed image frame to the next with increasing stimulus speed, when determining LJ speed via pixel count.</p><p><strong>Conclusions: </strong>Swiss Liquid Jet Aesthesiometer for Corneal Sensitivity was shown to deliver fine droplets with a pulsed stimulus mode, in a repeatable manner with precise localisation to the ocular surface. Very little variability was observed in LJ speed and mass for the typical pressure range required for clinical sensitivity measurements.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"609-618"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9305237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39613238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of image resolution of display types on accommodative microfluctuations.","authors":"Niall J Hynes,&nbsp;Matthew P Cufflin,&nbsp;Karen M Hampson,&nbsp;Edward Ah Mallen","doi":"10.1111/opo.12949","DOIUrl":"https://doi.org/10.1111/opo.12949","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether accommodative microfluctuations (AMFs) are affected by the image resolution of the display type being observed. The effect of refractive error is also examined.</p><p><strong>Methods: </strong>Twenty participants, (10 myopes and 10 emmetropes) observed a target on four different displays: paper, smartphone, e-reader and visual display unit screen (VDU), whilst their accommodative responses were measured using a continuous recording infrared autorefractor. The accommodative response and AMF measures comprising low frequency components (LFC), high frequency components (HFC) and the root mean square (RMS) of the AMFs were analysed.</p><p><strong>Results: </strong>A significant increase in LFC power was observed for the paper stimulus when compared to the VDU and smartphone conditions. Myopes demonstrated a significantly higher LFC and mean accommodative response compared to emmetropes across the four displays. A significant difference in the mean AR between the displays with the lowest and highest resolution was found. A higher mean AR was found with higher resolution of the image. The HFC and RMS accommodation were not affected by display type.</p><p><strong>Conclusion: </strong>The mean accommodative response and the mean LFC power appear to respond differently depending on the type of display in use. Higher resolution devices showed a reduced lag of accommodation to the accommodative demand; however, this may cause a lead of accommodation in myopes for higher resolution display types.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"514-525"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39756905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of autorefractors using the image-size principle in determining on-axis and off-axis refraction. Part 3: Theoretical effect of pupil misalignment on peripheral refraction for the Grand-Seiko Autorefractor.","authors":"David A Atchison","doi":"10.1111/opo.12964","DOIUrl":"https://doi.org/10.1111/opo.12964","url":null,"abstract":"<p><strong>Purpose: </strong>To determine, through simulations, the effect of lateral misalignment of the Grand-Seiko WR-5100K autorefractor on peripheral refraction.</p><p><strong>Methods: </strong>Using a Navarro schematic eye, into- and out-of-the eye raytracing was done for a Grand-Seiko autorefractor simulation. For comparison, conventional out-of-the eye raytracing simulated the use of a Hartman-Shack aberrometer. Peripheral refractions were determined out to ±40° along the horizontal visual field with lateral misalignments up to ±1 mm.</p><p><strong>Results: </strong>The effects are high, and greater when misalignment and the visual field are in opposite directions than when they are in the same direction. For example, 1 mm nasal misalignment causes mean sphere errors of -2.7 D and +1.3 D at 30° temporal field and 30° nasal field, respectively. These effects are approximately twice those occurring in a previous experimental study. Effects are small with the Hartmann-Shack simulation, with mean sphere errors not exceeding 0.03 D with 1 mm instrument misalignment.</p><p><strong>Conclusion: </strong>Misalignment of the Grand-Seiko WR-5100K autorefractor is predicted to cause considerable errors in peripheral refraction. The simulation produces about twice the errors found in an experimental study, and the reason for this is unknown.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"653-657"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39935073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of corneal topography, pachymetry and higher order aberrations for detecting subclinical keratoconus.","authors":"Sandeep Kandel,&nbsp;Meenu Chaudhary,&nbsp;Sanjeeb K Mishra,&nbsp;Niraj D Joshi,&nbsp;Manish Subedi,&nbsp;Prajjol R Puri,&nbsp;Parash Gyawali,&nbsp;Jeewanand Bist,&nbsp;Himal Kandel","doi":"10.1111/opo.12956","DOIUrl":"https://doi.org/10.1111/opo.12956","url":null,"abstract":"<p><strong>Purpose: </strong>To compare corneal topography, pachymetry and higher order aberrations in keratoconic and normal eyes; to investigate their association in keratoconic eyes; and to determine their diagnostic ability for detecting subclinical keratoconus in a Nepalese population.</p><p><strong>Methods: </strong>Ninety-six eyes of 48 keratoconus patients and 50 normal eyes of 50 control subjects were included in this study. The eyes of keratoconus patients were classified into four different study groups: subclinical, stage 1, stage 2 and advanced stage keratoconus. In each eye, corneal topography, pachymetry and corneal aberrometry indices were measured using a Sirius corneal tomographer. The study parameters of keratoconic eyes were compared with normal eyes, and the possible association of corneal aberrometry with topography and pachymetry indices was investigated. The area under curve (AUC) of receiver operating characteristic (ROC) curves along with optimal cutoff values with best sensitivity and specificity were also determined for each index to detect subclinical keratoconus.</p><p><strong>Results: </strong>All the indices except average keratometry measurements (K_avg and mm_avg ) and spherical aberration (SA) were found to be significantly different in subclinical keratoconus compared to the control group (p < 0.05). In keratoconic eyes, all corneal aberrations were significantly correlated with the topography and pachymetry indices (range of ρ: -0.25 to 0.96; all p < 0.05) except for trefoil and minimum corneal thickness (Thk_min ). All the indices except K_avg , mm_avg and SA showed excellent diagnostic ability (AUC > 0.90) in detecting subclinical keratoconus. The cutoff values proposed for the asymmetry index of the corneal back surface (SI_b ), Strehl ratio of point spread function (PSF), coma and Baiocchi-Calossi-Versaci index of corneal back surface (BCV_b ) each showed excellent sensitivity (100%) and specificity (≥97%).</p><p><strong>Conclusions: </strong>Corneal higher order aberrations were found to be significantly elevated in subclinical keratoconus compared to healthy controls. SI_b , PSF, coma and BCV_b were identified as the most powerful Sirius indices for the detection of subclinical keratoconus.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"594-608"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39771228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in rehabilitation needs and activity limitations over time of adults with acquired visual impairment following entry to a low vision rehabilitation service in England.","authors":"Jane Macnaughton,&nbsp;Marta Vianya-Estopa,&nbsp;Keziah Latham","doi":"10.1111/opo.12950","DOIUrl":"https://doi.org/10.1111/opo.12950","url":null,"abstract":"<p><strong>Purpose: </strong>Longitudinal changes in priority rehabilitation needs, vision-related activity limitation and importance of visual goals were evaluated in a sample of people with a visual impairment over a year following entry to low vision rehabilitation services in England.</p><p><strong>Methods: </strong>Participants were adults with newly registered visual impairment within Leicestershire. Priority scores, indicating the level of rehabilitative need, were determined from the importance and difficulty scores of the 48 goals of the Participation and Activity Inventory (PAI). Rasch analysis of the difficulty and importance scores examined activity limitation and importance separately. PAI outcome measures were assessed on entry to rehabilitation services and at 4 and 12 months thereafter.</p><p><strong>Results: </strong>Forty-eight participants (mean age 74.2, SD 14.1 years) completed three visits. Overall, there was a statistically significant reduction in the perceived need for rehabilitation over time (p < 0.001, η_p²  = 0.29), driven by reduced perceived difficulty (p < 0.001, η_p²  = 0.32) but stable importance (p = 0.73) of goals, with most change occurring between baseline and 4 months. PAI goals with greatest rehabilitative need at study entry were reading, mobility and writing, and these remained of highest priority over time. The greatest priority score decrease was for the goal 'Hobbies and crafts'. The largest decrease in importance was for 'Mobility outdoors', whereas 'Relationship with loved ones' increased most.</p><p><strong>Conclusions: </strong>Despite a decline in the perceived need for rehabilitation over the study period, there remains a need for continued support and intervention at 12 months following registration with rehabilitation services, particularly for the key goals of reading, writing and mobility. Early identification and support for individuals' important but difficult goals could prevent such goals being relinquished. Goals concerning relationships and communication became more important over time, indicating that re-evaluation of needs at follow-up is necessary to inform ongoing service provision.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"491-503"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39899041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological challenges and opportunities in evaluating clinical safety in primary eyecare services.","authors":"Robert A Harper,&nbsp;David F Edgar,&nbsp;John G Lawrenson","doi":"10.1111/opo.12954","DOIUrl":"https://doi.org/10.1111/opo.12954","url":null,"abstract":"To the Editor: The recent paper by Swystun and Davey is a welcome addition to literature on clinical safety in acute eyecare services in primary care. Their research raises important questions about how clinical safety in such services, and indeed primary eyecare services in general, should be determined. Evaluations of effectiveness of UK primary eyecare services have typically focussed on false positives, for example, false positive referrals to the Hospital Eye Service (HES), with false negatives rarely being considered. Indeed, there are interesting methodological challenges in examining for false negatives, but also, we suggest, some novel opportunities with the advent of greater digital interconnectedness in eyecare pathways. In terms of challenges, one difficulty is defining what constitutes a false negative, with different methodologies and their consequent different criterion options for what comprises a false negative potentially being a major source of difference when investigating similar services. In the absence of an established definition of what constitutes a COVID19 Urgent Eyecare Service (CUES) optometrist's incorrect diagnosis or an unsuccessful recommendation, Swystun and Davey were obliged to set their own definitions. They used direct patient contact via telephone following access to CUES, quantifying cases of missed pathology and/or failure to appropriately manage patients’ symptoms in a sample of over a thousand episodes. Their “incorrect” diagnoses were determined by patients’ accounts, but they also went on to define “major errors”, a definition which included errors or omissions judged to have the potential to cause harm. Although the precise definitions of CUES misdiagnoses and unsuccessful recommendations might be open for debate, consensus is more likely to be found regarding a potential for harm category. While the authors describe some limitations of reliance on patient reported outcomes, their point that the purpose of acute eyecare relates to resolving patients’ symptoms highlights the advantage such a direct approach can have in the context of urgent eyecare. Examining clinical records is another approach sometimes employed to establish safety. Interestingly, Sheen et al.’s study examining clinical safety in an urgent eyecare scheme used a combination of clinical record review and telephone interview outcomes to establish inappropriate management, reporting a substantially lower false negative rate than Swystun and Davey, albeit in a different service (not reliant on the substantive telemedicine element within CUES during the pandemic). Konstantakopolou et al. also employed record review to examine clinical safety in a minor eye conditions scheme (MECS), examining not only referred but also nonreferred patients’ records to assess for appropriate management; however, while this approach can be used to capture clinical management against guidelines, it is reliant on the veracity of recorded details, with potential","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"658-659"},"PeriodicalIF":2.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39960765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}