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Zhang Y, Cao N. Integrating Nurse-Led Interventions in Ophthalmology Care: A Systematic Review. J Nurs Care Qual 2024:00001786-990000000-00144. [PMID: 38936403 DOI: 10.1097/ncq.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Nurse-led interventions in ophthalmology care can enhance the overall patient experience while optimizing health care system efficiency. PURPOSE The purpose of this study was to investigate the impact of nurse-led interventions in ophthalmology care. METHODS A comprehensive search was conducted across multiple databases for articles published from 2000 to 2023. Randomized controlled trials, quasi-experimental, and observational studies were included. Quality assessments were performed using the Cochrane Risk of Bias tool or Newcastle-Ottawa Scale, based on study design. RESULTS Nineteen studies were included. Nurse-led interventions positively impacted patient outcomes, improved efficiency and resource utilization, enhanced patient satisfaction and adherence, maintained safety and efficacy, and demonstrated notable diagnostic accuracy. Included studies originated from different countries and employed diverse methodologies, offering a global perspective on nurse-led interventions in ophthalmology care. CONCLUSION The findings advocate for the integration of nurse-led strategies in routine practice to realize equitable, efficient, and patient-centered eye care.
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Affiliation(s)
- Yufen Zhang
- Author Affiliations: Department of Ophthalmology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong Province, China
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Betzler BK, Chen H, Cheng CY, Lee CS, Ning G, Song SJ, Lee AY, Kawasaki R, van Wijngaarden P, Grzybowski A, He M, Li D, Ran Ran A, Ting DSW, Teo K, Ruamviboonsuk P, Sivaprasad S, Chaudhary V, Tadayoni R, Wang X, Cheung CY, Zheng Y, Wang YX, Tham YC, Wong TY. Large language models and their impact in ophthalmology. Lancet Digit Health 2023; 5:e917-e924. [PMID: 38000875 PMCID: PMC11003328 DOI: 10.1016/s2589-7500(23)00201-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 11/26/2023]
Abstract
The advent of generative artificial intelligence and large language models has ushered in transformative applications within medicine. Specifically in ophthalmology, large language models offer unique opportunities to revolutionise digital eye care, address clinical workflow inefficiencies, and enhance patient experiences across diverse global eye care landscapes. Yet alongside these prospects lie tangible and ethical challenges, encompassing data privacy, security, and the intricacies of embedding large language models into clinical routines. This Viewpoint highlights the promising applications of large language models in ophthalmology, while weighing up the practical and ethical barriers towards their real-world implementation. This Viewpoint seeks to stimulate broader discourse on the potential of large language models in ophthalmology and to galvanise both clinicians and researchers into tackling the prevailing challenges and optimising the benefits of large language models while curtailing the associated risks.
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Affiliation(s)
| | - Haichao Chen
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Ching-Yu Cheng
- Centre for Innovation and Precision Eye Health, National University of Singapore, Singapore; Department of Ophthalmology, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Cecilia S Lee
- University of Washington School of Medicine, Department of Ophthalmology, Seattle, WA, USA
| | - Guochen Ning
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Aaron Y Lee
- University of Washington School of Medicine, Department of Ophthalmology, Seattle, WA, USA
| | - Ryo Kawasaki
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan; Artificial Intelligence Center for Medical Research and Application, Osaka University Hospital, Osaka, Japan
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, VA, Australia; Ophthalmology, University of Melbourne Department of Surgery, East Melbourne, Melbourne, VA, Australia
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Mingguang He
- Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Dawei Li
- College of Future Technology, Peking University, Beijing, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Kelvin Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | | | - Sobha Sivaprasad
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Varun Chaudhary
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ramin Tadayoni
- Université Paris Cité, AP-HP, Lariboisière, Saint Louis, and Rothschild Foundation Hospitals, Paris, France
| | - Xiaofei Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yih Chung Tham
- Centre for Innovation and Precision Eye Health, National University of Singapore, Singapore; Department of Ophthalmology, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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Khanna S, Emerson GG, Shah GK. Role of physician extenders: more regulation is necessary before full integration into practice. Curr Opin Ophthalmol 2023; 34:386-389. [PMID: 37326218 DOI: 10.1097/icu.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE OF REVIEW To discuss the drawbacks and propose recommendations for integrating physician extenders in ophthalmologic practice. RECENT FINDINGS In this article, the role of utilizing physician extenders in ophthalmology is discussed. A role for physician extenders has been suggested as more and more patients will require ophthalmologic care. SUMMARY Guidance is needed on how to best integrate physician extenders into eye care. However, quality of care is of the highest importance, and unless there is reliable and consistent training of extenders, using physician extenders to administer invasive procedures (e.g., intravitreal injection) should be avoided due to safety concerns.
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"Comparing outcomes of advanced nurse practitioners to ophthalmologists performing posterior YAG capsulotomy, a six-year study of 6308 eyes". Eye (Lond) 2023; 37:554-559. [PMID: 35228691 PMCID: PMC8884414 DOI: 10.1038/s41433-022-01986-8] [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: 01/24/2021] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To primarily report the baseline characteristics and visual acuity (VA) outcomes of advanced nurse practitioners (ANP) compared to ophthalmologists following YAG posterior capsulotomy (YAGPC). We secondarily looked to characterise the risk factors that lead to a repeated YAGPC. METHOD Retrospective consecutive case series of 6,308 eyes attending the Birmingham and Midlands Eye Centre. RESULTS ANPs performed 33.1% of YAGPC compared to 66.9% ophthalmologists. Compared to ophthalmologists, ANPs performed YAGPC in lower proportion of patients with ocular co-morbidities (p < 0.001) and had lower proportion of patients requiring further YAGPC compared to ophthalmologists (p < 0.001). Median pre, post-operative and LogMAR gain in VA of 0.48 (IQR 0.30-0.78), 0.18 (IQR 0.10-0.40) and 0.30 (0.08-0.48) LogMAR units, respectively. Multivariate regression showed that ANPs had a significantly lower rate of repeat YAGPC compared to ophthalmologists even when adjusting for age, ethnicity, training grade and ocular co-morbidities. No difference in visual outcomes was found between operator grade and ethnicity on multivariate analysis. CONCLUSION YAGPC leads to excellent visual outcomes. ANPs can deliver safe and effective YAGPC.
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Comparing the outcomes of YAG laser anterior capsulotomies performed by an advanced nurse practitioner to ophthalmologists in the management of anterior capsular contraction syndrome. J Am Assoc Nurse Pract 2022; 34:1133-1138. [DOI: 10.1097/jxx.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/09/2022] [Indexed: 11/05/2022]
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Patel SV, Olsen TW, Hinchley RL, Whipple DC, Kor TM. Improving Patient Safety in a High-Volume Intravitreal Injection Clinic. Ophthalmol Retina 2022; 6:495-500. [PMID: 35151914 DOI: 10.1016/j.oret.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine root causes of patient safety events in a high-volume intravitreal injection clinic, and to assess the effect of interventions to reduce the rate of events. DESIGN Quality improvement study. SUBJECTS All cases of intravitreal injection in a designated injection clinic between January 1, 2016 and December 31, 2019. METHODS The injection clinic model involved an injecting physician who usually differed from a prescribing physician. The procedural injection area was also physically separate from the retina outpatient clinic. Root cause analysis was used to determine factors that contributed to possible patient safety events in an institutional quality improvement project. Specific interventions were implemented to address each specific root cause. The rates of patient safety events (never events and near misses), whether associated with patient harm or not, were compared before and after intervention. MAIN OUTCOME MEASURES Frequency (%) of patient safety-related intravitreal injection events before (January 1, 2016 to December 31, 2018) and after (January 1, 2019 to December 31, 2019) intervention. RESULTS Root cause analysis included complex treatment plans that could be difficult to interpret, insufficient time to adequately review designated treatment plans, and risk of human error given the pace and volume of scheduled injections. Quality improvement strategies included revision of the standardized treatment plan documentation template, scheduling block-time for injecting physicians to review treatment plans within 24 hours of the injection clinic, and requiring agreement between dual, independent, site and medication verifications of the treatment plan by the injecting physician and an allied health coordinator prior to site marking. The rate of events before intervention was 0.1% (28/27400, or 9.3 events per year) and decreased to 0.01% (1/9375, or 1 event per year) after intervention (p=0.01). Most events were classified as near misses and there were no instances of patient harm. CONCLUSIONS A high level of patient safety can be achieved in a complex, high-volume intravitreal injection practice by recognizing potential safety issues and root causes, and implementing relevant quality improvements. While most events were near misses and no patients were harmed, reducing near misses can reduce the likelihood of harm associated with never events.
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Affiliation(s)
- Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, MN.
| | | | | | - Daniel C Whipple
- Department of Management Engineering and Consulting, Mayo Clinic, Rochester, MN
| | - Todd M Kor
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
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Svetozarskiy SN, Andreev AN. [Capabilities of optical coherence tomography in examination of senile scleral plaques]. Vestn Oftalmol 2022; 138:31-34. [PMID: 35801877 DOI: 10.17116/oftalma202213803131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED Senile scleral plaque (SSP) is a degenerative disease of the sclera manifested by the appearance of gray spots with clearly defined borders anteriorly from the insertion site of horizontal rectus muscles. Even with minimal changes over time changes over time are minor, SSP weakens the structural function of the sclera and creates a risk of a complicated course associated with scleromalacia. Interest in the study of SSP is increasing due to the growing number of transscleral intravitreal injections. PURPOSE To assess the morphological characteristics of SSP using spectral optical coherence tomography (OCT). MATERIAL AND METHODS The study examined 13 patients (21 eyes) with average age of 77.1±6.3 years. OCT scanning was performed to determine OCT signs of SSP, the length (parallel to the limb), the width and height of the SSP, as well as the depth and thickness of the overlying sclera. RESULTS A combination of nasal and temporal SSP was observed in 14 eyes, and nasal only SSP was detected in 6 eyes. In all cases, OCT presented a characteristic picture of SSP observed as an intrascleral cavity with hyperreflective content with lower reflectivity than the surrounding tissues, and clear borders represented by unchanged scleral fibers. The length of the SSP parallel to the limb was 3296±820 µm, the width - 2312±436 µm, the height of the SSP cavity - 482±89 µm. The depth of SSP site was 213±36 µm, the thickness of the overlying sclera - 125±29 µm. CONCLUSION Updated information about SSP structure can be used in the development of standard surgical algorithms contributing to prevention of postoperative complications.
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Affiliation(s)
- S N Svetozarskiy
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- Volga District Medical Centre of the Federal Medical-Biological Agency, Nizhny Novgorod, Russia
| | - A N Andreev
- Volga District Medical Centre of the Federal Medical-Biological Agency, Nizhny Novgorod, Russia
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Bae YH, Kim HK, Bae SH, Yoon CK, Ma DJ. Short-term Safety Evaluation of Resident-performed Intravitreal Injection. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.11.1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: This study evaluated the short-term safety of resident-performed intravitreal injections.Methods: We retrospectively reviewed the medical records of 503 patients (503 eyes) treated for the first time in our hospital from January 2018 to October 2020 via intravitreal bevacizumab, ranibizumab, aflibercept, or triamcinolone acetonide injections by residents or retina specialists. In terms of short-term ophthalmic complications, patients were followed-up 1 day, 1 week, and 1 month after injection.Results: A total of 503 eyes of 503 patients were included. Intravitreal injections were given to 211 and 292 eyes by residents (the resident group) and retina specialists (the retina specialist group), respectively. There were no between-group differences in baseline characteristics except in terms of the indications for injection. Intraocular pressure elevation >5 mmHg occurred in two eyes (0.95%) in the resident group and five (1.71%) in the retina specialist group, but the difference was not statistically significant. Subconjunctival hemorrhage occurred in 29 eyes (13.74%) of the resident group and 32 eyes (10.96%) of the retina specialist group; again, the difference was not statistically significant. No case of noninfectious endophthalmitis occurred in the resident group but two (0.68%) cases occurred in the retina specialist group; again, the difference was not significant. There were two (0.95%) cases of infectious endophthalmitis in the resident group and one (0.34%) case in the retina specialist group; again, the difference was not significant. No corneal erosion, traumatic lens damage, vitreous hemorrhage, or retinal tearing or detachment were noted in either group.Conclusions: Resident-performed intravitreal injections appear to be safe.
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Silpa-Archa S, Limwattanayingyong J, Tadarati M, Amphornphruet A, Ruamviboonsuk P. Capacity building in screening and treatment of diabetic retinopathy in Asia-Pacific region. Indian J Ophthalmol 2021; 69:2959-2967. [PMID: 34708730 PMCID: PMC8725108 DOI: 10.4103/ijo.ijo_1075_21] [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] [Indexed: 11/04/2022] Open
Abstract
The focus of capacity building for screening and treatment of diabetic retinopathy (DR) is on health professionals who are nonophthalmologists. Both physicians and nonphysicians are recruited for screening DR. Although there is no standardization of the course syllabus for the capacity building, it is generally accepted to keep their sensitivity >80%, specificity >95%, and clinical failure rate <5% for the nonophthalmologists, if possible. A systematic literature search was performed using the PubMed database and the following search terms: diabetic retinopathy, diabetic retinopathy screening, Asia, diabetic retinopathy treatment, age-related macular degeneration, capacity building, deep learning, artificial intelligence (AI), nurse-led clinic, and intravitreal injection (IVI). AI may be a tool for improving their capacity. Capacity building on IVIs of antivascular endothelial growth factors for DR is focused on nurses. There is evidence that, after a supervision of an average of 100 initial injections, the trained nurses can do the injections effectively and safely, the rate of endophthalmitis ranges from 0.03 to 0.07%, comparable to ophthalmologists. However, laws and regulations, which are different among countries, are challenges and barriers for nonophthalmologists, particularly for nonphysicians, for both screening and treatment of DR. Even if nonphysicians or physicians who are nonophthalmologists are legally approved for these tasks, sustainability of the capacity is another important challenge, this may be achieved if the capacity building can be part of their career development. Patient acceptability is another important barrier for initiating care provided by nonophthalmologists, particularly in Asia. There are also collaborations between national eye institutes of high-income countries, nongovernment organizations, and local eye institutes to improve both the quality and quantity of ophthalmologists and retinal specialists in low-income countries in Asia. This approach may require more labor, cost, and time consuming than training nonophthalmologists.
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Affiliation(s)
- Sukhum Silpa-Archa
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Jirawut Limwattanayingyong
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Mongkol Tadarati
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Atchara Amphornphruet
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
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