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Ziemssen F. Large Gaps in Care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:720. [PMID: 27866567 PMCID: PMC5143791 DOI: 10.3238/arztebl.2016.0720a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Lowry EA, Hou J, Hennein L, Chang RT, Lin S, Keenan J, Wang SK, Ianchulev S, Pasquale LR, Han Y. Comparison of Peristat Online Perimetry with the Humphrey Perimetry in a Clinic-Based Setting. Transl Vis Sci Technol 2016; 5:4. [PMID: 27486554 PMCID: PMC4959820 DOI: 10.1167/tvst.5.4.4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/09/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose We determined the receiver operating characteristic (ROC) curves for Peristat online perimetry at detecting varying degrees of glaucoma and the correlation between Peristat online perimetry and Humphrey visual field. Methods A prospective, comparative study of Peristat online perimetry (an achromatic static computer threshold testing program) and Humphrey visual field (HVF) 24-2 SITA standard testing was performed by 63 glaucoma patients and 30 healthy controls in random order. The number of total adjacent abnormal test points were identified for each test, and compared with Spearman correlation. Receive operating characteristic curves were generated for Peristat online perimetry detection of mild and moderate-severe glaucoma patients using contrast sensitivity thresholds of −16.7, −21.7, and −26.7 dB. Results The area under the ROC curve for glaucoma detection ranged from 0.77 to 0.81 for mild disease (mean deviation [MD], >−6 dB on HVF) and 0.85 to 0.87 for moderate to severe disease (MD, <−6 dB on HVF) depending on contrast threshold. Peristat online perimetry and Humphrey visual field abnormal points were highly correlated with Spearman rank correlations ranging from 0.55 to 0.77 (all P < 0.001). Conclusions Peristat online perimetry exhibits a reasonable ROC curve without specialized equipment and exhibited significant correlation with the conventional 24° Humphrey visual field test. Translational Relevance Low cost widely available internet-based visual fields may complement traditional office-based visual field testing.
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Affiliation(s)
- Eugene A Lowry
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Jing Hou
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Lauren Hennein
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Robert T Chang
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | - Shan Lin
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Jeremy Keenan
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Sean K Wang
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | | | - Louis R Pasquale
- Department of Ophthalmology: Harvard Medical School, Boston, MA, USA ; Division of Network Medicine: Brigham and Women's Hospital, Boston, MA, USA
| | - Ying Han
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
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Callinan CE, Kenney B, Hark LA, Murchison AP, Dai Y, Leiby BE, Mayro EL, Bilson J, Haller JA. Improving Follow-Up Adherence in a Primary Eye Care Setting. Am J Med Qual 2016; 32:73-79. [PMID: 26656245 DOI: 10.1177/1062860615616860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lack of patient adherence with eye appointments can decrease ocular outcomes. This prospective, randomized, single-blinded controlled study assessed the effectiveness of multiple interventions in improving follow-up adherence to recommended eye appointments. Patients due for follow-up appointments were randomly assigned to usual care, automated intervention, or personal intervention. Automated-intervention patients and personal-intervention patients received a call one month prior to the recommended follow-up date, and a mailed appointment reminder letter. The call was automated for automated-intervention patients and personalized for personal-intervention patients. The primary outcome was adherence to the follow-up appointment. The secondary outcome was rate of appointment scheduling. Patients in the personal-intervention group had greater adherence to follow-up recommendations (38%) than patients in the usual care group (28%) and the automated-intervention group (30%). Personal intervention significantly increased appointment scheduling (51%) over usual care (32%) and automated intervention (36%). These results support systems-level changes to improve patient follow-up adherence in urban primary eye care settings.
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Affiliation(s)
| | | | - Lisa A Hark
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
| | - Ann P Murchison
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
| | - Yang Dai
- 1 Wills Eye Hospital, Philadelphia, PA
| | | | | | | | - Julia A Haller
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
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Hark L, Waisbourd M, Myers JS, Henderer J, Crews JE, Saaddine JB, Molineaux J, Johnson D, Sembhi H, Stratford S, Suleiman A, Pizzi L, Spaeth GL, Katz LJ. Improving Access to Eye Care among Persons at High-Risk of Glaucoma in Philadelphia--Design and Methodology: The Philadelphia Glaucoma Detection and Treatment Project. Ophthalmic Epidemiol 2016; 23:122-130. [PMID: 26950056 PMCID: PMC4924344 DOI: 10.3109/09286586.2015.1099683] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The Wills Eye Glaucoma Research Center initiated a 2-year demonstration project to develop and implement a community-based intervention to improve detection and management of glaucoma in Philadelphia. METHODS The glaucoma detection examination consisted of: ocular, medical, and family history; visual acuity testing; corneal pachymetry; biomicroscopy of the anterior segment; intraocular pressure (IOP) measurement; gonioscopy; funduscopy; automated visual field testing; and fundus-color photography. Treatment included laser surgery and/or IOP-lowering medication. A cost analysis was conducted to understand resource requirements. Outcome measures included; prevalence of glaucoma-related pathology and other eye diseases among high-risk populations; the impact of educational workshops on level of knowledge about glaucoma (assessed by pre- and post-test evaluation); and patient satisfaction of the glaucoma detection examinations in the community (assessed by satisfaction survey). Treatment outcome measures were change in IOP at 4-6 weeks and 4-6 months following selective laser trabeculoplasty treatment, deepening of the anterior chamber angle following laser-peripheral iridotomy treatment, and rate of adherence to recommended follow-up examinations. Cost outcomes included total program costs, cost per case of glaucoma detected, and cost per case of ocular disease detected. RESULTS This project enrolled 1649 participants (African Americans aged 50+ years, adults 60+ years and individuals with a family history of glaucoma). A total of 1074 individuals attended a glaucoma educational workshop and 1508 scheduled glaucoma detection examination appointments in the community setting. CONCLUSIONS The Philadelphia Glaucoma Detection and Treatment Project aimed to improve access and use of eye care and to provide a model for a targeted community-based glaucoma program.
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Affiliation(s)
- Lisa Hark
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | | | | | - Jeffrey Henderer
- Temple University School of Medicine, Department of Ophthalmology, Philadelphia, PA, USA
| | - John E. Crews
- Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jinan B. Saaddine
- Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeanne Molineaux
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | - Deiana Johnson
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | - Harjeet Sembhi
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | - Shayla Stratford
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | - Ayman Suleiman
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | - Laura Pizzi
- Thomas Jefferson University School of Pharmacy, Philadelphia, PA, USA
| | - George L. Spaeth
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | - L. Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
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Tsui E, Siedlecki AN, Deng J, Pollard MC, Cha S, Pepin SM, Salcone EM. Implementation of a vision-screening program in rural northeastern United States. Clin Ophthalmol 2015; 9:1883-7. [PMID: 26504372 PMCID: PMC4605244 DOI: 10.2147/opth.s90321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Rural populations comprise almost 20% of the US population and face unique barriers in receiving health care. We describe the implementation of a medical student-run free vision-screening clinic as a strategy to overcome barriers in accessing eye care in New Hampshire and Vermont. METHODS Medical students were trained by an ophthalmologist to administer screening eye examinations. Patients from New Hampshire and Vermont were enrolled through a free community clinic. Screening included a questionnaire, distance and near visual acuity, extraocular movements, confrontational visual fields, and Amsler grid. Patients who met predetermined screening criteria were referred to an ophthalmologist or optometrist for further evaluation. Data including patient demographics, appointment attendance, level of education, and diagnoses were recorded and analyzed. RESULTS Of 103 patients (mean age of 45.5±12.3 years, 63% female), 74/103 (72%) were referred for further evaluation, and 66/74 (89%) attended their referral appointments. Abnormal ophthalmologic examination findings were observed in 58/66 (88%) patients who attended their referral appointment. Uncorrected refractive error was the most common primary diagnosis in 38% of referred patients. Other diagnoses included glaucoma suspect (21%), retinal diseases (8%), amblyopia (8%), cataract (6%), others (6%), and normal examination (12%). Of the 8/74 (11%) referred patients who did not attend their appointments, reasons included patient cancellation of appointment, work conflicts, or forgetfulness. Patients traveled a mean distance of 16.6 miles (range: 0-50 miles) to attend screening examinations. Mean time for patients' last effort to seek eye care was 7.1 years (range: 1-54 years). CONCLUSION This study underscores the high prevalence of unmet eye care needs in a rural population. Furthermore, it demonstrates that using community health centers as a patient base for screening can yield a high referral attendance rate for this at-risk population and facilitate entrance into the eye care system in a rural setting.
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Affiliation(s)
- Edmund Tsui
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA ; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | | | - Jie Deng
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Sandolsam Cha
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Susan M Pepin
- Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Erin M Salcone
- Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Sloan FA, Yashkin AP, Chen Y. Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases. Ophthalmology 2014; 121:2452-60. [PMID: 25208856 PMCID: PMC4338994 DOI: 10.1016/j.ophtha.2014.07.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/24/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM). DESIGN Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS). PARTICIPANTS The sample consisted of 2151 Medicare beneficiaries who responded to the HRS. METHODS Medicare beneficiaries with ≥ 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination. MAIN OUTCOME MEASURES The primary outcome measure was the number of 15-month periods with an eye examination. RESULTS One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 follow-up periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations. CONCLUSIONS Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use.
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Affiliation(s)
- Frank A Sloan
- Department of Economics, Duke University, Durham, North Carolina.
| | | | - Yiqun Chen
- Department of Economics, Duke University, Durham, North Carolina
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Barriers to and Suggestions on Improving Utilization of Eye Care in High-Risk Individuals: Focus Group Results. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:527831. [PMID: 27379302 PMCID: PMC4897391 DOI: 10.1155/2014/527831] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
Abstract
Purpose. To understand barriers facing high-risk individuals and to solicit the suggestions of these individuals, especially nonusers, on how to change the eye care delivery system to better meet their needs. Methods. Four focus groups were conducted. All discussion was audiotaped and transcribed. Content analysis was performed by the authors and with the assistance of qualitative software, NUD(*)IST Vivo. Results. The most frequently cited barriers include (1) cost, (2) trust, (3) communication, (4) clinic accessibility (transportation/distance), and (5) doctor-patient relationship. In underutilizers, trust was the most identified barrier to care. Suggestions on increasing educational opportunities/awareness of eye care and addressing cost and insurance issues as a means of improving trust and communications were most frequently offered, including using the Department of Social Services as a focal point for eye care education and assessment. Discussion. Trust is a major barrier to eye care, especially among underutilizers of disadvantaged populations. Increasing trust and eye care education at the community and individual levels is essential to increasing eye care utilization.
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Michaud L, Forcier P. Prevalence of asymptomatic ocular conditions in subjects with refractive-based symptoms. JOURNAL OF OPTOMETRY 2014; 7:153-160. [PMID: 25000871 PMCID: PMC4087174 DOI: 10.1016/j.optom.2013.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/31/2013] [Accepted: 07/31/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND This study aims to determine the overall prevalence of ocular conditions in a population from 19 to 64 years old, presenting with refractive-based symptoms only. Results could impact clinical standard of eye care on a similar population. METHODS This is a retrospective study on patients seen for an eye examination at the Clinique Universitaire de la Vision (CUV), between January 2007 and 2009. Files of individuals who presented with refractive symptoms were only selected and classified by file number. Then, every third file from the beginning was kept and reviewed by a reader. A second reader did the same with every third file from the end. Both readers were trained to use the same analysis grid to classify the diagnosed ocular conditions. In the case of multiple findings, the most severe condition was considered. The overall prevalence of ocular conditions was determined by calculating their occurrence divided by the number of files analyzed. RESULTS A total of 860 charts were analyzed. In 26.1% of the cases an ocular condition was diagnosed. This work establishes a higher prevalence of ocular conditions compared to another study conducted in Canada in the past. This difference can be explained by a different analytical methodology and by the fact that all examinations, in this study, were made under pupillary dilation. CONCLUSION The presence of ocular conditions in 26% of asymptomatic patients supports the need to assess ocular health under pupil dilation as part of any eye examination. However, further cost-to-benefit analysis is required before establishing such a recommendation.
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