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Rawlings A, Hobby AE, Ryan B, Carson-Stevens A, North R, Smith M, Gwyn S, Sheen N, Acton JH. The burden of acute eye conditions on different healthcare providers: a retrospective population-based study. Br J Gen Pract 2024:BJGP.2022.0616. [PMID: 38438268 PMCID: PMC10947371 DOI: 10.3399/bjgp.2022.0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The demand for acute eyecare exponentially outstrips capacity. The public lacks awareness of community eyecare services. AIM To quantify the burden of acute eyecare on different healthcare service providers in a national population through prescribing and medicines provision by GPs, optometrists, and pharmacists, and provision of care by accident and emergency (A&E) services. A secondary aim was to characterise some of the drivers of this burden. DESIGN AND SETTING A retrospective data-linkage study set in Wales, UK. METHOD Analysis of datasets was undertaken from the Secure Anonymised Information Linkage Databank (GP and A&E), the Eye Health Examination Wales service (optometry), and the Common Ailments Scheme (pharmacy) during 2017-2018. RESULTS A total of 173 999 acute eyecare episodes delivered by GPs (168 877 episodes) and A&E services (5122) were identified during the study. This resulted in 65.4 episodes of care per 1000 people per year. GPs prescribed a total of 87 973 653 prescriptions within the general population. Of these, 820 693 were related to acute eyecare, resulting in a prescribing rate of 0.9%. A total of 5122 eye-related and 905 224 general A&E attendances were identified, respectively, resulting in an A&E attendance rate of 0.6%. Optometrists and pharmacists managed 51.8% (116 868) and 0.6% (2635) of all episodes, respectively. Older females and infants of both sexes were more likely to use GP prescribing services, while adolescent and middle-aged males were more likely to visit A&E. GP prescribing burden was driven partially by economic deprivation, access to services, and health score. Season, day of the week, and time of day were predictors of burden in GP and A&E. CONCLUSION Acute eyecare continues to place considerable burden on GP and A&E services in Wales, particularly in urban areas with greater economic deprivation and lower overall health. This is likely to increase with a rapidly ageing population. With ongoing pathway development to better utilise optometry and pharmacy, and improved public awareness, there may be scope to change this trajectory.
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Affiliation(s)
- Anna Rawlings
- Swansea University Medical School, Swansea University, Swansea
| | - Angharad E Hobby
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, and University of the West of England, Bristol
| | - Barbara Ryan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | - Rachel North
- School of Optometry and Vision Sciences and PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | - Mathew Smith
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff
| | - Sioned Gwyn
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | - Nik Sheen
- Health and Education Improvement Wales (HEIW), Nantgarw
| | - Jennifer H Acton
- School of Optometry and Vision Sciences, Cardiff University, Cardiff
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Varas J, Campos MÁ, Tapia E, Sanhueza JL, Salazar C, Vergara N, Tapia N, Mantero G, Bustamante P. Visual-functional impact of people affected by severe ocular trauma during social protests in Chile in 2019. Int Ophthalmol 2024; 44:77. [PMID: 38351240 DOI: 10.1007/s10792-024-02969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/04/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE To determine the impact on the functionality associated with visual loss (VFIP) in people with severe ocular trauma (SOT) caused by kinetic impact projectiles used in police crowd control through a prioritization tool in people admitted to a rehabilitation program in Santiago de Chile from December 02, 2019, to November 13, 2020. METHODS A cross-sectional descriptive study of SOT victims (N = 85), average age 31.4 ± 11.9. The data were recorded through a new 9-item screening instrument for assessment and prioritization of rehabilitation created for this emergency scenario. RESULTS The impact of the use of kinetic weapons resulted in monocular blindness in the majority of those affected (n = 68; 80.0%). The highest VFIP observed was among young men from lower social strata. There were extreme difficulties in the performance of productive tasks (occupational and/or educational) (n = 42; 49.4%) and the pursuit of hobbies and pastimes (n = 23; 27.1%), as well as a high difficulty in adapting to changes in brightness (n = 29; 34.1%) and handling objects accurately (n = 22; 25.9%). CONCLUSION The use of kinetic weapons for crowd control resulted in high and extreme VFIP and, in most cases, monocular blindness, causing major difficulties in work, study, and development of hobbies and pastimes in the affected population, highlighting the urgent need for effective rehabilitative care, which requires special attention in order to generate an adequate rehabilitation program. The use of kinetic weapons for crowd control contravenes international goals, policies, and plans set by the WHO and the International Agency for the Prevention of Blindness on strategies to prevent avoidable blindness worldwide until 2020. It is essential to ban the use of these weapons in Chile and worldwide, as well as to revise police protocols for crowd control.
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Affiliation(s)
- Joaquín Varas
- Department of Occupational Therapy and Occupational Science, Faculty of Medicine, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - Miguel Ángel Campos
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Eric Tapia
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile
- Instituto de Investigación y Postgrado, Facultad de Medicina y Ciencias de la Salud, Universidad Central de Chile, Lord Cochrane 416, Santiago, Chile
| | - José Luis Sanhueza
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Claudia Salazar
- School of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - Nayadet Vergara
- School of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - Nicole Tapia
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Gianinna Mantero
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Patricio Bustamante
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile.
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Landau Prat D, Kapelushnik N, Zloto O, Leshno A, Klang E, Sina S, Segev S, Arazi M, Soudry S, Ben Simon GJ. Prevalence of common and rare ophthalmic findings in adults attending a medical survey institute. Int Ophthalmol 2024; 44:43. [PMID: 38334834 PMCID: PMC10857980 DOI: 10.1007/s10792-024-03026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To examine the ophthalmic data from a large database of people attending a general medical survey institute, and to investigate ophthalmic findings of the eye and its adnexa, including differences in age and sex. METHODS Retrospective analysis including medical data of all consecutive individuals whose ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects examined at a single general medical survey institute. RESULTS Data were derived from 184,589 visits of 3676 patients (mean age 52 years, 68% males). The prevalence of the following eye pathologies were extracted. Eyelids: blepharitis (n = 4885, 13.3%), dermatochalasis (n = 4666, 12.7%), ptosis (n = 677, 1.8%), ectropion (n = 73, 0.2%), and xanthelasma (n = 160, 0.4%). Anterior segment: pinguecula (n = 3368, 9.2%), pterygium (n = 852, 2.3%), and cataract or pseudophakia (n = 9381, 27.1%). Cataract type (percentage of all phakic patients): nuclear sclerosis (n = 8908, 24.2%), posterior subcapsular (n = 846, 2.3%), and capsular anterior (n = 781, 2.1%). Pseudophakia was recorded for 697 patients (4.6%), and posterior subcapsular opacification for 229 (0.6%) patients. Optic nerve head (ONH): peripapillary atrophy (n = 4947, 13.5%), tilted disc (n = 3344, 9.1%), temporal slope (n = 410, 1.1%), ONH notch (n = 61, 0.2%), myelinated nerve fiber layer (n = 94, 0.3%), ONH drusen (n = 37, 0.1%), optic pit (n = 3, 0.0%), and ON coloboma (n = 4, 0.0%). Most pathologies were more common in males except for ONH, and most pathologies demonstrated a higher prevalence with increasing age. CONCLUSIONS Normal ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects seen at a single medical survey institute.
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Affiliation(s)
- Daphna Landau Prat
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel.
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
| | - Noa Kapelushnik
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Ari Leshno
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Eyal Klang
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- The Sami Sagol AI Hub, ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Sigal Sina
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Shlomo Segev
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- Institute for Medical Screening, Sheba Medical Center, Tel Hashomer, Israel
| | - Mattan Arazi
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | | | - Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
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Owusu-Afriyie B, Gende T, Silki F, Ishmael B, Kuiaha J. Epidemiology of eye diseases: outcomes from a free provincial eye clinic in Papua New Guinea. Front Med (Lausanne) 2023; 10:1272337. [PMID: 38179281 PMCID: PMC10765577 DOI: 10.3389/fmed.2023.1272337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Aim To ascertain the prevalence and pattern of eye problems in Madang Province, Papua New Guinea. Materials and methods A six-month retrospective study was performed at Madang Provincial Hospital Eye Clinic. Convenience sampling was used in this study and all patient records from January to June 2020 were included. Data was extracted using Microsoft Excel and the data included gender, age, occupation, district where the patient lived, presenting visual acuity, and diagnosis. It was then analyzed using International Business Machines Corporation's Statistical Package for the Social Sciences version 26. A p-value of ≤0.05 was considered statistically significant. Results A total of 1,715 patients received services at the eye clinic between January and June 2020, and 1,664 were included in this study. The mean age of the patients was 39.3 ± 20.3 years. There were slightly more males (50.4%) than females. The overall leading ocular morbidities were corneal ulcers and keratitis (20.7%), refractive errors (17.4%), and cataracts (16.8%). More than half of the patients (56.2%) were either visually impaired or blind. Nearly half of the patients (41.8%) traveled long distances to seek services at the eye clinic. There was a significant association between demographic characteristics, diagnosis, and level of visual impairment. Conclusion There is a high prevalence of potential causes of visual impairment and blindness in Madang Province and these conditions affect all age groups and genders. It is essential to increase accessibility to eye care services in the country.
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Affiliation(s)
- Bismark Owusu-Afriyie
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | - Theresa Gende
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | - Frederick Silki
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Bolgii Ishmael
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Joelda Kuiaha
- The Fred Hollows Foundation PNG Inc., Madang, Papua New Guinea
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Chen J, Wu X, Li M, Liu L, Zhong L, Xiao J, Lou B, Zhong X, Chen Y, Huang W, Meng X, Gui Y, Chen M, Wang D, Dongye M, Zhang X, Cheung CY, Lai IF, Yan H, Lin X, Zheng Y, Lin H. EE-Explorer: A Multimodal Artificial Intelligence System for Eye Emergency Triage and Primary Diagnosis. Am J Ophthalmol 2023; 252:253-264. [PMID: 37142171 DOI: 10.1016/j.ajo.2023.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To develop a multimodal artificial intelligence (AI) system, EE-Explorer, to triage eye emergencies and assist in primary diagnosis using metadata and ocular images. DESIGN A diagnostic, cross-sectional, validity and reliability study. METHODS EE-Explorer consists of 2 models. The triage model was developed from metadata (events, symptoms, and medical history) and ocular surface images via smartphones from 2038 patients presenting to Zhongshan Ophthalmic Center (ZOC) to output 3 classifications: urgent, semiurgent, and nonurgent. The primary diagnostic model was developed from the paired metadata and slitlamp images of 2405 patients from ZOC. Both models were externally tested on 103 participants from 4 other hospitals. A pilot test was conducted in Guangzhou to evaluate the hierarchical referral service pattern assisted by EE-Explorer for unspecialized health care facilities. RESULTS A high overall accuracy, as indicated by an area under the receiver operating characteristic curve (AUC) of 0.982 (95% CI, 0.966-0.998), was obtained using the triage model, which outperformed the triage nurses (P < .001). In the primary diagnostic model, the diagnostic classification accuracy (CA) and Hamming loss (HL) in the internal testing were 0.808 (95% CI 0.776-0.840) and 0.016 (95% CI 0.006-0.026), respectively. In the external testing, model performance was robust for both triage (average AUC, 0.988, 95% CI 0.967-1.000) and primary diagnosis (CA, 0.718, 95% CI 0.644-0.792; and HL, 0.023, 95% CI 0.000-0.048). In the pilot test in the hierarchical referral settings, EE-explorer demonstrated consistently robust performance and broad participant acceptance. CONCLUSION The EE-Explorer system showed robust performance in both triage and primary diagnosis for ophthalmic emergency patients. EE-Explorer can provide patients with acute ophthalmic symptoms access to remote self-triage and assist in primary diagnosis in unspecialized health care facilities to achieve rapid and effective treatment strategies.
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Affiliation(s)
- Juan Chen
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Xiaohang Wu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Mingyuan Li
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Lixue Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Liuxueying Zhong
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Jun Xiao
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Bingsheng Lou
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Xingwu Zhong
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong; Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (X.Zho., Y.C., W.H., H.L.), Haikou, Hainan
| | - Yanting Chen
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (X.Zho., Y.C., W.H., H.L.), Haikou, Hainan
| | - Wenbin Huang
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (X.Zho., Y.C., W.H., H.L.), Haikou, Hainan
| | - Xiangda Meng
- Tianjin Medical University General Hospital (X.M., H.Y.), Tianjin
| | - Yufei Gui
- First Affiliated Hospital of Kunming Medical University, Kunming (Y.G.), Yunnan
| | - Meizhen Chen
- Guangzhou Aier Eye Hospital (M.C.), Guangzhou, Guangdong
| | - Dongni Wang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Meimei Dongye
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Xulin Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong (C.Y.C.), Hong Kong
| | - Iat Fan Lai
- Ophthalmic Center, Kiang Wu Hospital (I.F.L.), Macao SAR, Macao
| | - Hua Yan
- Tianjin Medical University General Hospital (X.M., H.Y.), Tianjin
| | - Xiaofeng Lin
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Yongxin Zheng
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Haotian Lin
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong; Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (X.Zho., Y.C., W.H., H.L.), Haikou, Hainan; Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University (H.L.), Guangzhou, Guangdong, China.
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Meer E, Ramakrishnan MS, Whitehead G, Leri D, Rosin R, VanderBeek B. Validation of an Automated Symptom-Based Triage Tool in Ophthalmology. Appl Clin Inform 2023; 14:448-454. [PMID: 36990454 PMCID: PMC10247304 DOI: 10.1055/a-2065-4613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Acute care ophthalmic clinics often suffer from inefficient triage, leading to suboptimal patient access and resource utilization. This study reports the preliminary results of a novel, symptom-based, patient-directed, online triage tool developed to address the most common acute ophthalmic diagnoses and associated presenting symptoms. METHODS A retrospective chart review of patients who presented to a tertiary academic medical center's urgent eye clinic after being referred for an urgent, semi-urgent, or nonurgent visit by the ophthalmic triage tool between January 1, 2021 and January 1, 2022 was performed. Concordance between triage category and severity of diagnosis on the subsequent clinic visit was assessed. RESULTS The online triage tool was utilized 1,370 and 95 times, by the call center administrators (phone triage group) and patients directly (web triage group), respectively. Of all patients triaged with the tool, 8.50% were deemed urgent, 59.2% semi-urgent, and 32.3% nonurgent. At the subsequent clinic visit, the history of present illness had significant agreement with symptoms reported to the triage tool (99.3% agreement, weighted kappa = 0.980, p < 0.001). The triage algorithm also had significant agreement with the severity of the physician diagnosis (97.0% agreement, weighted kappa = 0.912, p < 0.001). Zero patients were found to have a diagnosis on exam that should have corresponded to a higher urgency level on the triage tool. CONCLUSION The automated ophthalmic triage algorithm was able to safely and effectively triage patients based on symptoms. Future work should focus on the utility of this tool to reduce nonurgent patient load in urgent clinical settings and to improve access for patients who require urgent medical care.
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Affiliation(s)
- Elana Meer
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Meera S. Ramakrishnan
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Gideon Whitehead
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Damien Leri
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Roy Rosin
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Brian VanderBeek
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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Chen J, Chen CM, Zheng Y, Zhong L. Characteristics of eye-related emergency visits and triage differences by nurses and ophthalmologists: Perspective from a single eye center in southern China. Front Med (Lausanne) 2023; 10:1091128. [PMID: 37007786 PMCID: PMC10061012 DOI: 10.3389/fmed.2023.1091128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To describe characteristics of eye-related emergency department (ED) visits and investigate differences in priorities assigned to patients by triage nurses and ophthalmologists. METHODS A prospective survey was conducted at the ED of Zhongshan Ophthalmic Center from January 1, 2021, to May 31, 2021. Clinical data from patients with acute ophthalmic conditions lasting less than 7 days were collected via a standard questionnaire and the urgency levels assigned by nurses and physicians were also recorded. Binary logistic regression was performed to identify characteristics associated with truly emergency conditions and up- or down-triage. RESULTS A total of 1907 patients were enrolled, with 582 (30.5%) classified as "non-emergency." Red eye (69.7%), eye pain (53.0%), ocular trauma (44.1%), tearing (43.6%), and blurred vision (43.1%) were the most common complaints. Truly emergency tended to be male (OR 2.019, p < 0.001) and with unilateral eye involvement (OR 2.992, p < 0.001). Nurses prioritized conjunctival, scleral, closed ocular trauma and eyelid diseases over doctors while giving less priority to open ocular trauma, cornea, uveitis, and vitreoretinal diseases (p < 0.05). Overemphasis on mild blurred vision (OR 3.718, p = 0.001) and insufficient understanding of conjunctival diseases without red eye (OR 0.254, p = 0.001) were associated with conjunctival disease "up-triage." Insufficient awareness of moderate and severe blurred vision was associated with "down-triage" for ocular trauma (OR 3.475, p = 0.001 and OR 2.422, p = 0.020, respectively). CONCLUSION Ophthalmic EDs are typically flooded with patients suffering from acute ocular problems, with a considerable portion for non-emergency conditions. The identification of characteristics associated with truly emergency cases and nurses' triage preferences is valuable in providing target guidance for future ED practice and facilitating the proper allocation of emergency resources.
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Affiliation(s)
| | | | - Yongxin Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Liuxueying Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
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AlSamnan M, AlAmry M, aldossari S, Talea M, Khandekar R, AlGhadeer H. Validity of an Ocular Emergency Triage System Compared to the Existing Grading System at the Emergency Unit of a Tertiary Eye Hospital in Saudi Arabia. Clin Ophthalmol 2023; 17:527-534. [PMID: 36789291 PMCID: PMC9922481 DOI: 10.2147/opth.s397504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose To assess true ocular emergencies based on the ocular emergency triage system compared to the existing method of serving patients "first come first serve" by attending ophthalmology resident and review the validity of the triage system by ophthalmic subspecialty. Methods In this cross-sectional study of validity, new patients attending the ocular emergency department of a tertiary eye hospital in 2021-2022 were examined by ophthalmology resident. The time required for registration, an eye exam, and total time in the emergency unit was determined. Using ophthalmic triage criteria, same patients were reviewed by senior ophthalmologist to categorize them as "top emergencies", "emergencies", and "not an emergency." The reviewer was masked about grading by an ophthalmology resident. The agreement rate for true emergencies by both methods of grading was calculated by subspecialty. Results One thousand patients with ocular emergencies were evaluated. The median overall time spent in the emergency unit was 92 minutes [interquartile range (IQR): 56; 142]. The revised triage system estimated 85% were "true emergencies." Using both the revised triage and conventional methods, 172 (17.2%) patients were not considered as having an ocular emergency. The difference in patients grouped into "emergencies" (34.3% vs 21.4%) and "top emergencies" (46.5% vs 60.4%) was significant (P<0.001) between methods. Uveitis (72%) had the lowest agreement between methods and pediatric ophthalmology (100%) had the highest agreement. Conclusion The revised ophthalmic triage system seems to be more efficient than existing method. Subspecialist ophthalmologists may provide quicker and better treatment if ophthalmic emergency patients are prioritized utilizing the proposed redesigned triage method.
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Affiliation(s)
- Mazen AlSamnan
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohammed AlAmry
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Saif aldossari
- Ophthalmology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohammed Talea
- Ophthalmology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Huda AlGhadeer
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Correspondence: Huda AlGhadeer, Emergency Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966 1 4821234 ext. 2500, Email
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Park SS, Vij R, Wu J, Zarrin B, Moon JY, Oliveira J, Schultz JS, Shrivastava A. A Systematic Analysis of the Impact of an Ambulatory Ophthalmology Urgent Care Clinic. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0041-1741464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Importance A same-day ophthalmic urgent care clinic can provide efficient eye care, a rich educational environment, and can improve patient experience.
Objective The aim of this study was to systematically evaluate volume, financial impact, care metrics, and the breadth of pathology of urgent new patient encounters based on their site of initial presentation.
Design, Setting, and Participants A retrospective analysis was performed on consecutive urgent new patient evaluations in our same-day triage clinic at the Henkind Eye Institute at Montefiore Medical Center between February 2019 and January 2020. The cohort of patients who presented directly to this urgent care clinic were referred to as the “TRIAGE” group. Patients who initially presented to an emergency department (ED), and were subsequently referred to our triage clinic, are referred to as the “ED + TRIAGE” group.
Main Outcomes and Measures Visits were evaluated on a variety of metrics, including diagnosis, duration, charge, cost, and revenue. Furthermore, return to the ED or inpatient admission was documented.
Results Of 3,482 visits analyzed, 2,538 (72.9%) were in the “TRIAGE” group. Common presenting diagnoses were ocular surface disease (n = 486, 19.1%), trauma (n = 342, 13.5%; most commonly surface abrasion n = 195, 7.7%), and infectious conjunctivitis (n = 304, 12.0%). Patients in the “TRIAGE” group, on average, were seen 184.6% faster (158.2 vs. 450.2 minutes) than patients in the “ED + TRIAGE” group (p < 0.001). The “ED + TRIAGE” group were furthermore found to generate 442.1% higher charges ($870.20 vs. 4717.70) and were associated with 175.1% higher cost ($908.80 vs. 330.40) per patient. The hospital was found to save money when noncommercially insured patients with ophthalmic complaints presented to the triage clinic instead of the ED. Patients seen in the triage clinic had a low rate of readmission to the ED (n = 42, 1.2%).
Conclusions and Relevance A same-day ophthalmology triage clinic provides efficient care, while providing a rich learning environment for residents. Less wait time with direct access to subspecialist care can help improve quality, outcome, and satisfaction metrics.
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Affiliation(s)
- Sally S.E. Park
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Rohin Vij
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jeff Wu
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Bryan Zarrin
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Jee-Young Moon
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jason Oliveira
- Department of Financial Planning and Analysis, Montefiore Health System, Tarrytown, New York
| | - Jeffrey S. Schultz
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Anurag Shrivastava
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
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Pattnaik S, Panda BB, Swain SC. Spectrum of Ocular Findings in Closed Head Injuries, Correlation With Severity of Neurological Involvement, and Treatment Outcome: A Hospital-Based Cross-Sectional Study. Cureus 2021; 13:e16515. [PMID: 34295601 PMCID: PMC8293860 DOI: 10.7759/cureus.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: To study the various ocular findings in patients with closed head injuries, to find any association with the degree of neurological involvement, and to analyze the treatment outcome after the necessary intervention. Setting: Tertiary referral hospital in Eastern India. Design: Prospective observational study. Methods: Patients with closed head injuries attending our Outpatient department as well as referred from the Neurosurgery department for ophthalmic evaluation between October 2017 and September 2019 were recruited for the study. All patients meeting the inclusion criteria were examined by an experienced ophthalmologist. The Glasgow coma scale (GCS) was applied to grade the neurological involvement by the neurosurgery team. Ocular findings were recorded and necessary imaging was requested. Appropriate neurosurgery consultations were done in patients with neurological findings. All ocular injuries were managed as per institutional protocol. Descriptive statistics were used for analysis with p< 0.05 taken as statistically significant. Results: A total of 207 patients (414 eyes) were included in the study. The mean age was 33.82 years, with the prevalence of male patients (82.12%). The most common cause of head injury was RTA (57.01%) followed by assault (11.59%). The majority of patients (53.14%) were classified as having moderate, 46.37% patients with mild, and 0.48% with severe neurological involvement as per GCS scoring. Isolated ocular findings were seen in 70.04% of patients while 29.95% of patients had both neurological and ophthalmic features. Ocular adnexal involvement was observed in 38.6%, anterior segment involvement in 86%, neuro-ophthalmic manifestations in 33.3%, and posterior segment involvement in 38.6% of patients. Ocular signs were resolved over due course of time in 48.8% of patients, completely resolved in 28%, while there was no improvement in 6.28% of patients. The final best-corrected visual acuity of >6/18 was achieved in 51.69% of patients. Statistical significance was observed in the correlation between the GCS scoring and general ocular findings (p= 0.02) as well as a relative afferent pupillary defect (p=0.003). The association between age > 50 years and neuro-ophthalmic features was not found to be statistically significant (p=0.56). Conclusion: Poor visual acuity at presentation, optic canal fractures, the presence of multiple fractures of orbital walls, no improvement in vision within 48 hours of starting intravenous corticosteroids, were indicators of a poor visual prognosis in this study. The GCS, neuro-deficit, and ocular signs contribute significantly to the prediction of outcomes. Prompt treatment and referral can lead to a good resolution of symptoms and signs.
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Affiliation(s)
- Shradha Pattnaik
- Ophthalmology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Bijnya B Panda
- Ophthalmology, Sriram Chandra Bhanja Medical College, Cuttack, IND
| | - Suresh C Swain
- Ophthalmology, Sriram Chandra Bhanja Medical College, Cuttack, IND
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Akova B, Kıvanç SA. Ophthalmic Emergencies and Effects of Different Quarantine Models During the COVID-19 Pandemic. Med Sci Monit 2021; 27:e931967. [PMID: 33980807 PMCID: PMC8130502 DOI: 10.12659/msm.931967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The aim of this study was to evaluate the epidemiological features of the patients admitted to our emergency department (ED) during the COVID-19 pandemic in March, April, and May 2020, compare them with the patients in March, April, and May 2019, and to investigate the effect of various quarantine models. Material/Methods The records of 1206 eligible patients were reviewed. Age groups were divided according to their quarantine status. We recorded the reasons for patient presentation to the ED, the average number of patients in age groups according to quarantine days, and the problems reported by patients who presented to the ED according to quarantine days. Results We enrolled 3016 of 3123 patients. The mean age was 36.4±17.3 years in 2019 and 37.8±16.4 years during the pandemic period (P=0.031). While 73.1% of the ED presentations were due to ocular trauma in 2019, it decreased to 70.7% in 2020. The proportion of those who presented to the ED during the weekend was 30.6% in 2019, but decreased to 23.9% in 2020 (<0.001). While 84.8% of trauma patients were ages 19–64 years in 2019, this rate increased to 88.9% during the pandemic (P=0.067). Non-trauma emergencies were more common than trauma emergencies in both periods in those over the age of 65 years. During the pandemic period, admissions to the ED were decreased in the quarantined age groups (P=0.001). Conclusions The changes in the number and characteristic of admissions for ophthalmic emergencies during the pandemic period may help planning allocation of healthcare personnel and resources in outpatient and emergency clinics.
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Affiliation(s)
- Berna Akova
- Department of Ophthalmology, Bursa Uludağ University, School of Medicine, Bursa, Turkey
| | - Sertaç Argun Kıvanç
- Department of Ophthalmology, Bursa Uludağ University, School of Medicine, Bursa, Turkey
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