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Alam K, Bentley SA, Connor H, Gentle A. Access to low vision rehabilitation services in Australia: practitioner perspective. Clin Exp Optom 2024:1-7. [PMID: 38880508 DOI: 10.1080/08164622.2024.2360544] [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: 05/06/2023] [Accepted: 04/11/2024] [Indexed: 06/18/2024] Open
Abstract
CLINICAL RELEVANCE The burden of vision loss is both personal and economic. Having reduced vision can restrict access to education, job opportunities, and other activities, and patients can require substantial government funds for treatment and rehabilitation. An in-depth investigation of barriers and enablers is required to improve access to low vision rehabilitation services. BACKGROUND Several clinical trials have demonstrated the effectiveness of low vision rehabilitation services, leading to improved clinical and functional abilities. However not all patients make use of these resources. METHODS A purposive sample of primary eyecare practitioners (optometrists and orthoptists who held a variety of roles in clinical practice, academia and low vision specific organisations) were invited to participate in focus groups that were audio-recorded and transcribed verbatim. The resulting data were de-identified, cleaned, independently coded by two researchers and compared. Data were analysed using an interpretative phenomenological approach that included inductive thematic analysis. RESULTS Of the 21 practitioners attending the five focus groups, 67% were female and 33% were male. The participants were optometrists and orthoptists with a wide range (4 to 20+ years) of clinical experience in eyecare service delivery. Four major themes emerged from the analysis: three themes focus on identifying barriers, while one theme highlighted potential enablers. These themes encompassed barriers impacting referral frequency, practitioner knowledge, patient experience, and enablers that suggest improvement options for enhancing low vision services. CONCLUSION Miscommunication between service providers, miscommunication between patients and clinicians, late referral, cost of services and social stigma were major barriers preventing patients from receiving low vision services. Most practitioners admitted limited knowledge of the scope of services provided by low vision organisations, suggesting there is a need for enablers such as professional development, improved communication between service providers, enhanced referral guidelines and increased public awareness.
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Affiliation(s)
- Khyber Alam
- School of Medicine, Deakin University, Geelong, Australia
- Department of Optometry, Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Sharon A Bentley
- Centre of Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Heather Connor
- School of Medicine, Deakin University, Geelong, Australia
| | - Alex Gentle
- School of Medicine, Deakin University, Geelong, Australia
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Stolwijk ML, van Nispen RMA, van der Pas SL, van Rens GHMB. Big data study using health insurance claims to predict multidisciplinary low vision service uptake. Optom Vis Sci 2024:00006324-990000000-00204. [PMID: 38856650 DOI: 10.1097/opx.0000000000002134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
SIGNIFICANCE There is a lack of research from high-income countries with various health care and funding systems regarding barriers and facilitators in low vision services (LVS) access. Furthermore, very few studies on LVS provision have used claims data. PURPOSE This study aimed to investigate which patient characteristics predict receiving multidisciplinary LVS (MLVS) in the Netherlands, a high-income country, based on health care claims data. METHODS Data from a Dutch national health insurance claims database (2015 to 2018) of patients with eye diseases causing potentially severe visual impairment were retrieved. Patients received MLVS (n = 8766) and/or ophthalmic treatment in 2018 (reference, n = 565,496). MLVS is provided by professionals from various clinical backgrounds, including nonprofit low vision optometry. Patient characteristics (sociodemographic, clinical, contextual, general health care utilization) were assessed as potential predictors using a multivariable logistic regression model, which was internally validated with bootstrapping. RESULTS Predictors for receiving MLVS included prescription of low vision aids (odds ratio [OR], 8.76; 95% confidence interval [CI], 7.99 to 9.61), having multiple ophthalmic diagnoses (OR, 3.49; 95% CI, 3.30 to 3.70), receiving occupational therapy (OR, 2.32; 95% CI, 2.15 to 2.51), mental comorbidity (OR, 1.17; 95% CI, 1.10 to 1.23), comorbid hearing disorder (OR, 1.98; 95% CI, 1.86 to 2.11), and receiving treatment in both a general hospital and a specialized ophthalmic center (OR, 1.23; 95% CI, 1.10 to 1.37), or by a general practitioner (OR, 1.23; 95% CI, 1.18 to 1.29). Characteristics associated with lower odds included older age (OR, 0.30; 95% CI, 0.28 to 0.32), having a low social economic status (OR, 0.91; 95% CI, 0.86 to 0.97), physical comorbidity (OR, 0.87; 95% CI, 0.82 to 0.92), and greater distance to an MLVS (OR, 0.95; 95% CI, 0.92 to 0.98). The area under the curve of the model was 0.75 (95% CI, 0.75 to 0.76; optimism = 0.0008). CONCLUSIONS Various sociodemographic, clinical, and contextual patient characteristics, as well as factors related to patients' general health care utilization, were found to influence MLVS receipt as barriers or facilitators. Eye care practitioners should have attention for socioeconomically disadvantaged older patients when considering MLVS referral.
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Terheyden JH, Ost RAD, Behning C, Mekschrat L, Bildik G, Wintergerst MWM, Holz FG, Finger RP. Evaluation of the test-retest and inter-mode comparability of the Impact of Vision Impairment questionnaire in people with chronic eye diseases. Graefes Arch Clin Exp Ophthalmol 2024; 262:1933-1943. [PMID: 38180569 PMCID: PMC11106107 DOI: 10.1007/s00417-023-06334-4] [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: 06/14/2023] [Revised: 11/03/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE The main objective of this study is to assess the test-retest and inter-administration mode reliability of the Impact of Vision Impairment profile (IVI), a common patient-reported outcome measure (PROM) for people with chronic eye diseases. METHODS The IVI was administered to adult patients with stable, chronic eye diseases two to four times per participant (average intervals between administrations 12 to 20 days; maximum two phone interviews, paper administration, electronic administration) by two trained interviewers. Rasch models were fit to the data. Intra-class correlation coefficients (ICCs), mean differences and Cronbach's alpha between test-retest administrations (two phone interviews) and inter-mode comparisons were calculated. RESULTS Two hundred-sixteen patients (mean age 67 ± 12 years, 40% male) were included in the study. The IVI met all psychometric requirements of the Rasch model, and the division into the domains of functional items (IVI_F) and emotional items (IVI_E) corresponded to the German validation study. ICCs (all for IVI_F and IVI_E, respectively) for the retest administrations were 0.938 and 0.912, and 0.853 and 0.893 for inter-mode comparisons phone/paper, 0.939 and 0.930 for phone/electronic, and 0.937 and 0.920 for paper/electronic (all p < 0.01). Mean differences (all for IVI_F and IVI_E, respectively) for the retest administrations were 2.8% and 0.7% and ranged from 2.0% to 6.2% and from 0.4 % to 4.9% between administration modes. Cronbach's alpha ranged from 0.886 to 0.944 for retest and inter-mode comparisons. CONCLUSION Due to the high test-retest reliability and the almost equally high comparability of different modes of administration of the IVI, the study endorses its use as a robust PROM to capture vision-related quality of life. Our results further support the use of the IVI as an endpoint in clinical trials and may simplify implementing it in both clinical trials or real-world evidence generation by offering multiple administration modes with high reliability.
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Affiliation(s)
- Jan Henrik Terheyden
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
| | - Reglind A D Ost
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Charlotte Behning
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Liza Mekschrat
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Gamze Bildik
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
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Saito T, Imahashi K. Barriers and enablers of utilization of low-vision rehabilitation services among people 50 years or older in East and Southeast Asia: a scoping review protocol. JBI Evid Synth 2023; 21:1687-1696. [PMID: 36974445 DOI: 10.11124/jbies-22-00429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVES This scoping review aims to explore and describe the barriers and enablers of low-vision rehabilitation service utilization among people 50 years or older in East and Southeast Asia. INTRODUCTION Vision impairment is strongly associated with aging. East and Southeast Asia are experiencing a rapidly growing aging population and the associated eye-related health burdens. Despite the benefits of low-vision rehabilitation services, they are underutilized in these regions. Identifying the barriers and enablers of service utilization could be a crucial first step in making the services more accessible and, ultimately, easing the burden of this health issue. INCLUSION CRITERIA This review will include published quantitative, qualitative, or mixed methods studies and reviews that examine the barriers and/or enablers of low-vision rehabilitation service utilization among people aged 50 years or older living in East and Southeast Asia. Low-vision rehabilitation services are defined as any kind of intervention that aims to mitigate the impact of disability induced by eye-related health conditions. METHODS A literature search of 4 databases (MEDLINE, Web of Science, Academic Search Ultimate, and Ichushi-Web), as well as a manual search of the reference lists of included articles, will be conducted to identify eligible articles. Two independent reviewers will assess the articles for inclusion. Data extraction will focus on general information of the study, demographic or descriptive information about the study population, the eye condition being studied, means of low-vision rehabilitation, and the barriers and/or enablers of service utilization. The information will be tabulated to depict the categories of barriers and enablers that influence access to services. REVIEW REGISTRATION Open Science Framework https://osf.io/8y2wp.
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Affiliation(s)
- Takashi Saito
- Department of Social Rehabilitation, Research Institute of National Rehabilitation Center for Persons with Disability, Tokorozawa, Saitama, Japan
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Ekemiri KK, Botchway EN, Ezinne NE, Sirju N, Persad T, Masemola HC, Chidarikire S, Ekemiri CC, Osuagwu UL. Comparative Analysis of Health- and Vision-Related Quality of Life Measures among Trinidadians with Low Vision and Normal Vision-A Cross-Sectional Matched Sample Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6436. [PMID: 37510668 PMCID: PMC10378830 DOI: 10.3390/ijerph20146436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023]
Abstract
This cross-sectional study investigated the health-related and vision-related quality of life measures of adults with low vision compared to healthy individuals in Trinidad and Tobago. The health-related quality of life (HRQOL-14) and the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) were administered to 20 participants with low vision caused by diabetic retinopathy, retinitis pigmentosa, glaucoma, and macular degeneration, as well as 20 participants with no visual problems (control). Participants were recruited from the University Eye Clinic in Trinidad and Tobago. Compared to the controls, more participants in the low-vision group had lower age-adjusted NEI-VFQ-25 scores (48.3% vs. 95.1%; p < 0.001), had poor general (47.5% vs. 10%, p = 0.004) and mental (100% vs. 10%, p < 0.042) health, experienced greater activity limitation due to impairment or health problems (85% vs. 20%, p < 0.001), needed help with personal care (27.5% vs. 0%, p < 0.009) and daily routine (67.5% vs. 0%, p < 0.001), and experienced sleep problems (97.5% vs. 65%, p < 0.001) and symptoms of anxiety (100% vs. 90%, p = 0.042). All the diabetic retinopathy participants (100%, p = 0.028) had two or more impairments or vision problems compared to none in the other low-vision participants. In summary, the HRQOL-14 and NEI-VFQ-25 scores were significantly reduced in low-vision participants, who also demonstrated a greater vulnerability to poor quality of life in the presence of diabetes retinopathy. These findings have important clinical implications regarding offering appropriate support and interventions to improve quality of life outcomes in individuals with low vision.
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Affiliation(s)
- Kingsley K Ekemiri
- Optometry Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, University of the West Indies, St Augustine Campus, St. Augustine 685509, Trinidad and Tobago
- Department of Optometry, College of Health Sciences, University of Kwazulu-Natal, Westville Campus, Durban 3629, South Africa
| | - Edith N Botchway
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia
- Department of Pediatrics, University of Melbourne, Parkville, VIC 3010, Australia
| | - Ngozika E Ezinne
- Optometry Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, University of the West Indies, St Augustine Campus, St. Augustine 685509, Trinidad and Tobago
- Department of Optometry, College of Health Sciences, University of Kwazulu-Natal, Westville Campus, Durban 3629, South Africa
| | - Nikolai Sirju
- Optometry Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, University of the West Indies, St Augustine Campus, St. Augustine 685509, Trinidad and Tobago
| | - Tea Persad
- Optometry Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, University of the West Indies, St Augustine Campus, St. Augustine 685509, Trinidad and Tobago
| | - Hlabje Carel Masemola
- Department of Optometry, Faculty of Health Sciences, University of Free State, Bloemfontein 9301, South Africa
| | - Sherphard Chidarikire
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Chioma C Ekemiri
- Department of Health Promotion, The University of the West Indies, St. Augustine Campus, St. Augustine 685509, Trinidad and Tobago
| | - Uchechukwu Levi Osuagwu
- Department of Optometry, College of Health Sciences, University of Kwazulu-Natal, Westville Campus, Durban 3629, South Africa
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
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Newman NJ, Yu-Wai-Man P, Biousse V, Carelli V. Understanding the molecular basis and pathogenesis of hereditary optic neuropathies: towards improved diagnosis and management. Lancet Neurol 2023; 22:172-188. [PMID: 36155660 DOI: 10.1016/s1474-4422(22)00174-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/30/2022] [Accepted: 04/13/2022] [Indexed: 01/25/2023]
Abstract
Hereditary optic neuropathies result from defects in the human genome, both nuclear and mitochondrial. The two main and most recognised phenotypes are dominant optic atrophy and Leber hereditary optic neuropathy. Advances in modern molecular diagnosis have expanded our knowledge of genotypes and phenotypes of inherited disorders that affect the optic nerve, either alone or in combination, with various forms of neurological and systemic degeneration. A unifying feature in the pathophysiology of these disorders appears to involve mitochondrial dysfunction, suggesting that the retinal ganglion cells and their axons are especially susceptible to perturbations in mitochondrial homoeostasis. As we better understand the pathogenesis behind these genetic diseases, aetiologically targeted therapies are emerging and entering into clinical trials, including treatments aimed at halting the cascade of neurodegeneration, replacing or editing the defective genes or their protein products, and potentially regenerating damaged optic nerves, as well as preventing generational disease transmission.
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MESH Headings
- Humans
- Optic Nerve Diseases/diagnosis
- Optic Nerve Diseases/genetics
- Optic Nerve Diseases/therapy
- Optic Atrophy, Hereditary, Leber/diagnosis
- Optic Atrophy, Hereditary, Leber/genetics
- Optic Atrophy, Hereditary, Leber/therapy
- Optic Atrophy, Autosomal Dominant/diagnosis
- Optic Atrophy, Autosomal Dominant/genetics
- Optic Atrophy, Autosomal Dominant/therapy
- Optic Nerve
- Mitochondria/genetics
- Mitochondria/metabolism
- Mitochondria/pathology
- DNA, Mitochondrial/genetics
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Affiliation(s)
- Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA.
| | - Patrick Yu-Wai-Man
- Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK; Moorfields Eye Hospital, London, UK; UCL Institute of Ophthalmology, University College London, London, UK
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Guo X, Boland MV, Swenor BK, Goldstein JE. Low Vision Rehabilitation Service Utilization Before and After Implementation of a Clinical Decision Support System in Ophthalmology. JAMA Netw Open 2023; 6:e2254006. [PMID: 36735257 PMCID: PMC9898817 DOI: 10.1001/jamanetworkopen.2022.54006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE Electronic clinical decision support systems apply clinical guidelines in real time and offer a new approach to improve referral and utilization of low vision rehabilitation (LVR) care. OBJECTIVE To characterize patients and factors associated with LVR service utilization with and without the use of an electronic health record (EHR) clinical decision support system (CDSS) alert. DESIGN, SETTING, AND PARTICIPANTS Quality improvement study using EHR data to compare patients who did and did not utilize LVR service after referral between November 6, 2017, and October 5, 2019, (primary) and to assess overall service utilization rate from September 1, 2016, to April 2, 2021, regardless of referral status (secondary). Participants in the primary analysis were patients at a large ophthalmology department in an academic medical center in the US who received an LVR referral recommendation from their ophthalmologist according to the CDSS alert. The secondary analysis included patients with best documented visual acuity (BDVA) worse than 20/40 before, during, and after the CDSS implementation. Data were analyzed from August 2021 to April 2022. EXPOSURES Number and locations of referral recommendations for LVR service according to the CDSS alert in the primary analysis; active CDSS implementation in the secondary analysis. MAIN OUTCOMES AND MEASURES LVR service utilization rate was defined as the number of patients who accessed service among those who were referred (primary) and among those with BDVA worse than 20/40 (secondary). EHR data on patient demographics (age, sex, race, ethnicity) and ophthalmology encounter characteristics (numbers of referral recommendations, encounter location, and BDVA) were extracted. RESULTS Of the 429 patients (median [IQR] age, 71 [53 to 83] years; 233 female [54%]) who received a CDSS-based referral recommendation, 184 (42.9%) utilized LVR service. Compared with nonusers of LVR, users were more likely to have received at least 2 referral recommendations (12.5% vs 6.1%; χ21 = 5.29; P = .02) and at an ophthalmology location with onsite LVR service (87.5% vs 78.0%; χ21 = 6.50; P = .01). Onsite LVR service (odds ratio, 2.06; 95% CI, 1.18-3.61) persisted as the only statistically significant factor after adjusting for patient demographics and other referral characteristics. Among patients whose BDVA was worse than 20/40 before, during, and after the CDSS implementation regardless of referral status, the LVR service utilization rate was 6.1%, 13.8%, and 7.5%, respectively. CONCLUSIONS AND RELEVANCE In this quality improvement study, ophthalmologist referral recommendations and onsite LVR services at the location where patients receive other ophthalmic care were significantly associated with service utilization. Ophthalmology CDSSs are promising tools to apply clinical guidelines in real time to improve connection to care.
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Affiliation(s)
- Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael V. Boland
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston
| | - Bonnie K. Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Judith E. Goldstein
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Stolwijk ML, van Nispen RMA, van der Ham AJ, Veenman E, van Rens GHMB. Barriers and facilitators in the referral pathways to low vision services from the perspective of patients and professionals: a qualitative study. BMC Health Serv Res 2023; 23:64. [PMID: 36681848 PMCID: PMC9860223 DOI: 10.1186/s12913-022-09003-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Underutilization of and lack of access to low vision services (LVS) has been reported internationally. The purpose of this study was to identify barriers and facilitators in LVS referral procedures and service delivery from both the perspective of people with visual impairment and professionals from different eye care providers in the Netherlands. METHODS A qualitative study in the Netherlands was conducted. Barriers and facilitators were explored through semi structured interviews with older adults with macular degeneration, diabetic retinopathy and/or glaucoma (n = 14), and healthcare professionals including ophthalmologists and LVS professionals (n = 16). Framework analysis was used for analyzing the interviews with Atlas.ti software. RESULTS According to both patients and professionals, facilitators in LVS access and utilization are having motivation, self-advocacy, high participation needs and social support, as well as being negatively impacted by the impairment. Both samples found having good communication skills and informing patients about LVS as a healthcare provider to facilitate access. A long patient-provider relationship and the Dutch healthcare system were also mentioned as facilitators. Professionals additionally found long disease duration and the presence of low vision optometric services in the ophthalmic practice to promote access. Barriers that were reported by patients and professionals are lack of motivation, self-advocacy and acceptance of the impairment in patients. In addition, having low participation needs as a patient, lack of information provision by providers and time constraints in the ophthalmic practice were mentioned as barriers. Professionals also reported lack of social support, short disease duration of patients, a short patient-provider relationship and lack of coordination of care in the ophthalmic practice to hinder access. CONCLUSIONS Findings suggest that providers' lack of information provision about LVS, especially to patients who are less assertive, hamper referral to LVS. Providers should have attention for patients' LVS needs and actively inform them and their social network about LVS to facilitate access. Educating and training providers about how and when to address LVS may help to reduce barriers in the referral pathways. In addition, referral procedures may benefit from tools that make providers more aware of LVS.
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Affiliation(s)
- M. L. Stolwijk
- grid.509540.d0000 0004 6880 3010Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - R. M. A. van Nispen
- grid.509540.d0000 0004 6880 3010Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - A. J. van der Ham
- grid.509540.d0000 0004 6880 3010Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - E. Veenman
- grid.509540.d0000 0004 6880 3010Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - G. H. M. B. van Rens
- grid.509540.d0000 0004 6880 3010Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
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Li S, Wang AP. Demand preferences for health management services in a population of older adults with visual impairment in China: a conjoint analysis. BMC Geriatr 2022; 22:252. [PMID: 35346071 PMCID: PMC8962070 DOI: 10.1186/s12877-022-02957-0] [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: 10/16/2021] [Accepted: 03/17/2022] [Indexed: 01/15/2023] Open
Abstract
Background Visual impairment (VI) seriously affects the quality of life of the older adults. It is important to formulate appropriate health management strategies for the older adults with VI to help delay the disease development and progression, and improve life quality. The aim of this study was to understand the demand preference for health management services of the older adults with VI, and to provide a reference for the development of future health management strategies in this population. Methods The conjoint analysis method was used to analyze demand preferences for health management services of the older adults with VI. 11 keywords were extracted after literature analyzed, 6 keywords were selected as the attributes of health management strategy after expert discussion and the level of each attribute was determined. Then 18 representative virtual health management strategies were formed by combination of different attribute levels through orthogonal design, and older adults with VI were asked to score. A total of 334 older adults with VI who attended the ophthalmology department of the First Affiliated Hospital of China Medical University and the Fourth People's Hospital of Shenyang from February 27, 2021 to June 30, 2021were enrolled in this study by stratified sampling. Of the 334 included people, 80 had grade 1 VI, 80 had grade 2 VI, 84 had grade 3 VI, and 90 had grade 4 VI. Results The relative importance of health management services ranked by older adults with VI was continuing care (24.033%), visual aid application (19.61%), health education (16.241%), preventive healthcare (15.667%), safety management (12.757%), and rehabilitation training (11.392%). The utility values of each level of continuing care, safety management and preventive healthcare were positive, whereas the utility values of each level of visual aid application, health education and rehabilitation training were negative. The relative importance and utility values of health management services were different for the older adults with different grades of VI. Conclusions From the whole group, the older adults with VI have a higher preference for continuing care and a lower preference for rehabilitation training. The preference of the older adults with different grades of VI is different, so medical workers can formulate corresponding health management strategies according to their different demand preferences, and carry out hierarchical health management. Services that they preferred should be satisfied as much as possible in the health management strategy, while the reasons for the services with lower preference can be explored and make targeted improvement to meet the demand preferences of them.
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Barriers to Low-Vision Rehabilitation Services for Visually Impaired Patients in a Multidisciplinary Ophthalmology Outpatient Practice. J Ophthalmol 2021; 2021:6122246. [PMID: 34881054 PMCID: PMC8648482 DOI: 10.1155/2021/6122246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/11/2021] [Indexed: 12/03/2022] Open
Abstract
Low-vision rehabilitation (LVR) has significant benefit in improving the quality of life of visually impaired patients. However, these services are highly underutilized in ophthalmology practices. A quality improvement study was performed to investigate barriers to LVR services for patients at the University of Texas Medical Branch (UTMB) between 2010 and 2020. Low vision was defined as the best corrected visual acuity of 20/70 or worse in the better-seeing eye or a visual field less than 20 degrees. Potential subjects were screened (n = 577) from the electronic medical record using International Classification of Disease (ICD) codes for legal blindness, impaired vision, and low vision. Chart review identified 190 subjects who met criteria for low-vision analysis. Patients who received LVR referrals to attend at least one LVR service visit from the eligible subjects were contacted for participation in phone interviews regarding their LVR experience. Practicing eye care providers (ECPs) at UTMB completed a questionnaire to capture their referral patterns. Of the eligible subjects, 64% were referred to LVR services by ECPs. Reported patient barriers included mental health issues (76%), denial of need for low-vision aid (71%), poor physical health (67%), lack of transportation (57.1%), and lack of referrals (36%). EPCs reported patient's overall health (67%), older age (44%), lack of social support (44%), poor cognitive function (44%), and low likelihood of follow-up (44%) as barriers to referring patients to LVR. This study identified several modifiable barriers that can be addressed to access LVR services for low-vision patients. Changing referral patterns, eliminating variations in referral criteria, and increasing patient awareness and knowledge of LVR resources may tremendously improve the quality of life of low-vision patients.
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Alam K, Connor H, Gentle A, Bentley SA. Developing consensus-based referral criteria for low vision services in Australia. Ophthalmic Physiol Opt 2021; 42:149-160. [PMID: 34637155 DOI: 10.1111/opo.12902] [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: 06/14/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To develop expert consensus on referral criteria for low vision services in Australia. METHODS In a modified online Delphi process, a panel of 38 Australian experts in low vision (including ophthalmologists, optometrists, orthoptists, occupational therapists, orientation and mobility professionals, researchers and managers) participated in three rounds of consensus building over a period of 5 months commencing in 2019. Initially, 90 statements were developed, addressing what should be included in best-practice low vision referral criteria, currently used criteria, timing of referral and responsibility for referral. By the third round, these had been reduced and refined to a total of four statements. RESULTS In three Delphi rounds, the expert panel produced three key recommendations for low vision referral: (1) that low vision referral should be based mainly on the impact of uncorrectable vision impairment on function and well-being; (2) clinical measures of visual acuity and visual field might be a secondary consideration and (3) it is important to fully inform a person about low vision services at an early stage of vision loss and to involve them in decision making about referral. There was consensus on the need for clear referral pathways and that both ophthalmologists and optometrists have primary responsibility to refer for low vision services. CONCLUSIONS Although recommendations and guidelines should not replace sound individual clinical judgement, promotion and adoption of these consensus recommendations could assist health care professionals in providing appropriate and timely referral for low vision services to the benefit of people with vision impairment.
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Affiliation(s)
- Khyber Alam
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Heather Connor
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Alex Gentle
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Sharon A Bentley
- Centre of Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Evaluating Well-being of Individuals With Chronic Visual Conditions Requiring Regular Eyecare During COVID-19 Lockdown: A Cross-Sectional Study. Eye Contact Lens 2021; 47:559-564. [PMID: 34542424 DOI: 10.1097/icl.0000000000000834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess health-related quality of life (HRQoL) and its predictors among individuals with chronic vision conditions during COVID-19 lockdown. METHODS A cross-sectional, survey-based study targeted Jordanian adults with a variety of chronic vision conditions requiring regular ophthalmic follow-up. Outcome measures included HRQoL measured by the 12-item Short-Form Health Survey (SF-12), mental health symptoms measured by the Depression Anxiety Stress Scale, and vision ability measured by the National Eye Institute Visual Functioning Questionnaire (VFQ-25) General Vision and Role Limitation subscales. Data were analyzed descriptively and using a multiple variable linear regression model to identify HRQoL predictors. RESULTS A total of 203 participants with a mean age of 52.09 (±15.41) years participated, and SF-12 mean scores were 58.15 for the physical component and 57.48 for the mental component. The level of HRQoL was significantly associated with VFQ-25 Role Limitation subscale, diabetes, the need of ophthalmic follow-up, and stress. The regression model explained 47.1% of the variance in HRQoL (r2=0.471, F=35.57, P<0.001). CONCLUSIONS Jordanian individuals with chronic vision conditions demonstrated low levels of HRQoL during COVID-19 lockdown. Participants also showed high levels of mental health symptoms and reported low accessibility to ophthalmic care. Access to nonurgent ophthalmic care in individuals with chronic vision diseases should be carefully planned in future pandemics.
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Somani N, Beukes E, Latham K, Andersson G, Allen PM. Designing an internet-based intervention for improving wellbeing in people with acquired vision loss: A Delphi consensus study. Ophthalmic Physiol Opt 2021; 41:971-984. [PMID: 34392552 DOI: 10.1111/opo.12849] [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: 02/18/2021] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Vision impairment (VI) may impact a person's functional ability resulting in a loss of independence, anxiety, depression, social isolation and reduced quality of life. Caregivers also experience similar problems due to the increased burden placed on them. Support to address these difficulties encountered by those with VI and their caregivers may not always be accessible. An internet-based intervention may provide more accessible support. The aim of this study was to obtain consensus regarding the content and accessibility features required to design an internet-based intervention to promote wellbeing for people with VI and their caregivers. METHOD A three-round Delphi review was conducted with a panel of 30 stakeholders. Three stakeholder groups were included, namely individuals with vision loss, experts in the field of vision loss and mental health and carers of individuals with vision loss. Conceptual wellbeing ideas were examined in round 1, the intervention modules and module content were proposed in round 2 and refined in round 3. RESULTS Consensus of 75% or more was reached to include 18 modules into the intervention. These were divided into seven sections: understanding vision loss, emotional wellbeing, functional wellbeing, social wellbeing, physical wellbeing, wellbeing for carers and maintaining wellbeing. The accessibility features deemed most important were font size, colour and contrast options, compatibility with low vision aids and layout of the intervention. CONCLUSIONS The Delphi process positively informed the design of an internet-based intervention for individuals with acquired VI and their caregivers. Suggestions provided by stakeholders should now be incorporated into the intervention. Future evaluation of efficacy and cost-effectiveness of such an intervention are necessary.
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Affiliation(s)
- Nurbanu Somani
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Eldre Beukes
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Keziah Latham
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
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Luu W, Zangerl B, Kalloniatis M, Palmisano S, Kim J. Vision Impairment Provides New Insight Into Self-Motion Perception. Invest Ophthalmol Vis Sci 2021; 62:4. [PMID: 33533880 PMCID: PMC7862735 DOI: 10.1167/iovs.62.2.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Leading causes of irreversible blindness such as age-related macular degeneration (AMD) and glaucoma can, respectively, lead to central or peripheral vision loss. The ability of sufferers to process visual motion information can be impacted even during early stages of eye disease. We used head-mounted display virtual reality as a tool to better understand how vision changes caused by eye diseases directly affect the processing of visual information critical for self-motion perception. Methods Participants with intermediate AMD or early manifest glaucoma with near-normal visual acuities and visual fields were recruited for this study. We examined their experiences of self-motion in depth (linear vection), spatial presence, and cybersickness when viewing radially expanding patterns of optic flow simulating different speeds of self-motion in depth. Viewing was performed with the head stationary (passive condition) or while making lateral-sway head movements (active conditions). Results Participants with AMD (i.e., central visual field loss) were found to have greater vection strength and spatial presence, compared to participants with normal visual fields. However, participants with glaucoma (i.e., peripheral visual field loss) were found to have lower vection strength and spatial presence, compared to participants with normal visual fields. Both AMD and glaucoma groups reported reduced severity in cybersickness compared to healthy normals. Conclusions These findings strongly support the view that perceived self-motion is differentially influenced by peripheral versus central vision loss, and that patients with different visual field defects are oppositely biased when processing visual cues to self-motion perception.
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Affiliation(s)
- Wilson Luu
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Stephen Palmisano
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Juno Kim
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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