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Fan Y, Zuo L, Ma J, Peng Z, Li Y, Wang K, Zhao M. An investigation into the causes of abnormal waste of Ortho-K lenses. Front Public Health 2022; 10:981573. [PMID: 36045728 PMCID: PMC9421076 DOI: 10.3389/fpubh.2022.981573] [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: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 01/25/2023] Open
Abstract
Purpose To investigate the reasons for wasting orthokeratology (OK) lenses due to breakage or loss, provide more comprehensive guidelines for the clinical care of lenses and minimize time and costs for patients due to excessive broken and lost lenses. Methods A survey was administered to clinic outpatients who had broken or lost their OK lenses before the regularly scheduled replacement cycle (1-1.5 years). The association between the frequency of OK lens breakage and daily care was assessed using Fisher's exact test and multivariable ordered logistic regression analysis. Results A total of 306 valid questionnaires were collected. Among the subjects, 141 were male, and 165 were female, with a mean age of 10.57 ± 2.00 years (range: 6-18 years). In the investigation of the causes of OK lens waste, 81.4% of the patients reported lens breakage, 13.1% lost their lenses, and 5.6% of patients experienced both fragmentation and lens loss. More than half of the patients (52.90%) used incorrect lens cleaning techniques. In further analysis of the relationship between the frequency of OK lens fragmentation within a year and daily care habits, a significant difference was observed between the caregiver (P = 0.03) and whether the lenses were cleaned promptly after removal (P < 0.001). Mothers as daily caregivers of OK lenses had a lower frequency of fragmentation in a year compared to nanny or grandparents (P = 0.014, OR = 0.33, 95% CI = 0.13, 0.80). The failure to clean the lenses according to eye care practitioners' guidance was a risk factor for the frequent breakage of OK lenses (P < 0.001. OR = 5.29, 95% CI = 3.15, 8.89). Conclusions The causes of OK lens waste were mainly attributed to caregivers, care practices and some unexpected situations that can be avoided through optometrists' reminders. Regardless of the reasons for noncompliant behavior leading to breakage or loss of OK lenses, all of the complications can probably be addressed by better and more frequent reinforcement of care procedures by practitioners. Better clinical guidance measures and more frequent reminders could prevent a large proportion of abnormal waste of OK lenses.
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Affiliation(s)
- Yuzhuo Fan
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China,Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing, China,College of Optometry, Peking University Health Science Center, Beijing, China,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Lili Zuo
- Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing, China,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Jiahui Ma
- Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing, China,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Zisu Peng
- Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing, China,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Yan Li
- Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing, China,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Kai Wang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China,Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing, China,College of Optometry, Peking University Health Science Center, Beijing, China,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China,*Correspondence: Kai Wang
| | - Mingwei Zhao
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China,Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing, China,College of Optometry, Peking University Health Science Center, Beijing, China,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
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The Impact of Antibiotic Usage Guidelines, Developed and Disseminated through Internet, on the Knowledge, Attitude and Prescribing Habits of Orthokeratology Contact Lens Practitioners in China. Antibiotics (Basel) 2022; 11:antibiotics11020179. [PMID: 35203782 PMCID: PMC8868172 DOI: 10.3390/antibiotics11020179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 01/16/2023] Open
Abstract
It has been previously reported that the improper prescribing of antibiotic eye drops is common among orthokeratology (ortho-k) practitioners. Guidelines have since been developed and disseminated to improve their understanding and implementation of antibiotic prescriptions. This study aimed to investigate the influence of these guidelines on the knowledge, attitude, and prescribing habits of ortho-k practitioners by means of a questionnaire, which was administered nationwide via an official online account to eye care practitioners (ECPs) involved in ortho-k lens fitting, 548 of whom completed the survey. Differences in characteristics before and after the dissemination of the guidelines and between the groups were explored using χ2 tests. The relationship between prescribing habits and demographics was analyzed using stepwise logistic regression models. The implementation of the guidelines significantly improved the overall prescribing habits of ECPs (p < 0.001), especially for prophylactic antibiotic use before and after ortho-k lens wear (p < 0.001). Most ECPs who prescribed antibiotics properly displayed significantly better knowledge of correct antibiotic use, which in turn affected the compliance in their ortho-k patients (p < 0.001). The ECPs’ occupations (professionals other than ophthalmologists and optometrists, including nurses and opticians), clinical setting (distributor fitting centers), and age (younger than 25 years) were risk factors for the misuse of antibiotics. Although the implementation of the antibiotic guidelines significantly improved overall prescribing habits, some practitioners’ prescribing behavior still needs improvement. A limitation of this study was that all questions were mandatory, requiring ECPs to recall information, and therefore was subjected to selection and recall bias.
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Tuft S, Somerville TF, Li JPO, Neal T, De S, Horsburgh MJ, Fothergill JL, Foulkes D, Kaye S. Bacterial keratitis: identifying the areas of clinical uncertainty. Prog Retin Eye Res 2021; 89:101031. [PMID: 34915112 DOI: 10.1016/j.preteyeres.2021.101031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis is a common corneal infection that is treated with topical antimicrobials. By the time of presentation there may already be severe visual loss from corneal ulceration and opacity, which may persist despite treatment. There are significant differences in the associated risk factors and the bacterial isolates between high income and low- or middle-income countries, so that general management guidelines may not be appropriate. Although the diagnosis of bacterial keratitis may seem intuitive there are multiple uncertainties about the criteria that are used, which impacts the interpretation of investigations and recruitment to clinical studies. Importantly, the concept that bacterial keratitis can only be confirmed by culture ignores the approximately 50% of cases clinically consistent with bacterial keratitis in which investigations are negative. The aetiology of these culture-negative cases is unknown. Currently, the estimation of bacterial susceptibility to antimicrobials is based on data from systemic administration and achievable serum or tissue concentrations, rather than relevant corneal concentrations and biological activity in the cornea. The provision to the clinician of minimum inhibitory concentrations of the antimicrobials for the isolated bacteria would be an important step forward. An increase in the prevalence of antimicrobial resistance is a concern, but the effect this has on disease outcomes is yet unclear. Virulence factors are not routinely assessed although they may affect the pathogenicity of bacteria within species and affect outcomes. New technologies have been developed to detect and kill bacteria, and their application to bacterial keratitis is discussed. In this review we present the multiple areas of clinical uncertainty that hamper research and the clinical management of bacterial keratitis, and we address some of the assumptions and dogma that have become established in the literature.
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Affiliation(s)
- Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Tobi F Somerville
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Ji-Peng Olivia Li
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Timothy Neal
- Department of Clinical Microbiology, Liverpool Clinical Laboratories, Liverpool University Hospital NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK.
| | - Surjo De
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.
| | - Malcolm J Horsburgh
- Department of Infection and Microbiomes, University of Liverpool, Crown Street, Liverpool, L69 7BX, UK.
| | - Joanne L Fothergill
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Daniel Foulkes
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Stephen Kaye
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
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Yu Z, Zhu J, Jin J, Yu L, Han G. Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013-2019. Antibiotics (Basel) 2021; 10:916. [PMID: 34438966 PMCID: PMC8388675 DOI: 10.3390/antibiotics10080916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Abstract
Topical anti-infectives are important in the management of ocular infections, but little is known about their current status and trends in their use in China. Thus, we carried out a prescription-based, cross-sectional study using the database of Hospital Prescription Analysis Projection of China, and aimed to analyze the trend in the use of ocular topical anti-infectives for outpatients of the ophthalmology department from 2013 to 2019. A total of 2,341,719 prescriptions from 61 hospitals located in six major areas written by ophthalmologists for outpatients were identified, and 1,002,254 of the prescriptions contained at least one anti-infective. The yearly anti-infective prescriptions increased continuously from 126,828 prescriptions in 2013 to 163,434 prescriptions in 2019. The cost also increased from 4,503,711 Chinese Yuan (CNY) in 2013 to CNY 5,860,945 in 2019. However, the use rate of anti-infectives decreased slightly from 46.5% in 2013 to 41.1% in 2019. Patients aged between 19 and 45 years old had the highest anti-infective use rate. Levofloxacin was the most frequently used anti-infective and kept on increasing among all age groups, occupying 67.1% of the total cost at the end of the study. Tobramycin was more frequently used in pediatric patients than in adults, but the use still decreased. Ganciclovir was the preferred anti-viral drug over acyclovir. In conclusion, the prescriptions and cost of ocular topical anti-infectives for outpatients both increased progressively. The increasingly widespread use of levofloxacin raised concerns regarding safety in pediatrics and resistance development. The observed trends can lead to the more efficient management of ocular anti-topical anti-infectives in China.
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Affiliation(s)
- Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; (Z.Y.); (J.Z.)
| | - Jianping Zhu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; (Z.Y.); (J.Z.)
| | - Jiayi Jin
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;
| | - Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Gang Han
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; (Z.Y.); (J.Z.)
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