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Furtado JM, Jonas JB, Tapply I, Fernandes AG, Cicinelli MV, Arrigo A, Leveziel N, Resnikoff S, Taylor HR, Sedighi T, Flaxman S, Battaglia Parodi M, Bikbov MM, Braithwaite T, Bron A, Cheng CY, Congdon N, Del Monte MA, Ehrlich JR, Fricke T, Friedman D, Gazzard G, Hartnett ME, Kahloun R, Kempen JH, Khairallah M, Khanna RC, Kim JE, Lansingh VC, Leasher J, Naidoo KS, Nangia V, Nowak M, Pesudovs K, Peto T, Ramulu P, Topouzis F, Tsilimbaris M, Wang YX, Wang N, Bourne RRA, Furtado JM, Jonas JB, Fernandes AG, Cicinelli MV, Leveziel N, Briant PS, Vos T, Resnikoff S, Fischer F, Abate YH, Abdollahi M, Adal TGG, Addo IY, Adhikari K, Agarwal P, Agodi A, Agyemang-Duah W, Ahmad A, Ahmadieh H, Ahmadzadeh H, Alahdab F, Alfaar AS, Alhassan RK, Ali SSS, Almidani L, Androudi S, Anil A, Anyasodor AE, Arabloo J, Ashemo MY, Athari SS, Atnafu DD, Atreya A, Ayalew MK, Aynalem YA, Aynalem ZB, Azzam AY, Bagherieh S, Bai R, Barchitta M, Bardhan M, Bärnighausen TW, Bayileyegn NS, Bazvand F, Begde A, Behnam B, Bhagavathula AS, Bhaskar S, Bhatti GK, Bhatti JS, Bintoro BS, Birck MG, Braithwaite T, Burkart K, Bustanji Y, Caetano dos Santos FL, Carneiro VLA, Cenderadewi M, Chattu VK, Chu DT, Coberly K, Cruz-Martins N, Dadras O, Dai X, Dascalu AM, Dashti M, Dastiridou A, Dastmardi M, Deng X, Dervenis N, Devanbu VGC, Diress M, Djalalinia S, Ehrlich JR, Ekholuenetale M, Ekundayo TC, El Sayed I, Elhadi M, Emamverdi M, Emrie AA, Fagbamigbe AF, Fahim A, Farooq U, Farrokhpour H, Fatehizadeh A, Feizkhah A, Ferro Desideri L, Fetensa G, Feyisa BR, Flaxman S, Forouhari A, Foschi M, Fowobaje KR, Gandhi AP, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremariam B, Gebremeskel GG, Gela YY, Gesese MM, Ghasemi Falavarjani K, Ghassemi F, Ghozy S, Golechha M, Goleij P, Gupta S, Gupta VB, Gupta VK, Haile TG, Hailu SG, Haj-Mirzaian A, Halimi A, Hallaj S, Hammond BR, Hasan I, Hasani H, Hassanian-Moghaddam H, Heidari-Foroozan M, Hong SH, Hoogar P, Hosseinzadeh M, Hu C, Huynh HH, Immurana M, Iwu CCD, Jacob L, Jafarzadeh A, Jakovljevic M, Jayaram S, Jokar M, Joseph N, Joshua CE, Kabito GG, Kalankesh LR, Kamath S, Kandel H, Karaye IM, Kasraei H, Kayode GA, Kedir S, Khader YS, Khajuria H, Khatatbeh MM, Khatib MN, Khorrami Z, Kim YJ, Kisa A, Kisa S, Kosen S, Koyanagi A, Krishan K, Lahariya C, Laksono T, Lal DK, Lansingh VC, Le TDT, Leasher JL, Lee M, Lee SW, Lee WC, Lim SS, Liu X, Mahmoudi A, Mahmoudi R, Malhotra K, Mansouri V, Marzo RR, Maugeri A, McAlinden C, Mekene Meto T, Mersha AM, Mestrovic T, Mihretie ET, Mirzaei M, Mithra P, Mohamed NS, Mohammadi S, Mohammed A, Mokdad AH, Molavi Vardanjani H, Moni MA, Montazeri F, Moradi M, Mousavi P, Muhamed AN, Mulita A, Naidoo KS, Naik GR, Nargus S, Natto ZS, Nayak BP, Negaresh M, Negash H, Nejadghaderi SA, Nguyen DH, Nguyen HQ, Nguyen PT, Nguyen VT, Niazi RK, Noreen M, Nzoputam OJ, Odetokun IA, Olagunju AT, Olatubi MI, Onwujekwe OE, Ordak M, Osuagwu UL, Otstavnov N, Owolabi MO, Padubidri JR, Panahi P, Pandey A, Pardhan S, Patel J, Patthipati VS, Pawar S, Perianayagam A, Petcu IR, Pham HT, Qattea I, Raghav PR, Rahim F, Rahimi-Movaghar V, Rahman MHU, Rahman M, Ramasubramani P, Rashid AM, Rauf AU, Redwan EMM, Rezaei N, Roy P, Saadatian Z, Sabour S, Saddik B, Saeed U, Safi S, Safi SZ, Saghazadeh A, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sakshaug JW, Salahi S, Salahi S, Saleh MA, Samodra YL, Samuel VP, Samy AM, Saravanan A, Sawhney M, Saylan M, Sediqi SM, Selvaraj S, Sethi Y, Seylani A, Shah J, Shahid S, Shahwan MJ, Shaikh MA, Shamim MA, Shayan M, Shigematsu M, Shittu A, Shorofi SA, Siddig EE, Silva JC, Singh JA, Singh P, Skiadaresi E, Sousa RARC, Sreeramareddy CT, Starodubov VI, Taye BT, Ticoalu JHV, Tsegay GM, Tsilimbaris MK, Ullah S, Umair M, Valadan Tahbaz S, Wickramasinghe ND, Wondimagegn GS, Yang L, Yiğit A, Yon DK, Yonemoto N, You Y, Zastrozhin MS, Zhao H, Zheng P, Ziafati M, Zielińska M, Steinmetz JD, Bourne RRA. Global estimates on the number of people blind or visually impaired by age-related macular degeneration: a meta-analysis from 2000 to 2020. Eye (Lond) 2024; 38:2070-2082. [PMID: 38965321 PMCID: PMC11269688 DOI: 10.1038/s41433-024-03050-z] [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] [Received: 07/04/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND We aimed to update estimates of global vision loss due to age-related macular degeneration (AMD). METHODS We did a systematic review and meta-analysis of population-based surveys of eye diseases from January, 1980, to October, 2018. We fitted hierarchical models to estimate the prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness ( < 3/60) caused by AMD, stratified by age, region, and year. RESULTS In 2020, 1.85 million (95%UI: 1.35 to 2.43 million) people were estimated to be blind due to AMD, and another 6.23 million (95%UI: 5.04 to 7.58) with MSVI globally. High-income countries had the highest number of individuals with AMD-related blindness (0.60 million people; 0.46 to 0.77). The crude prevalence of AMD-related blindness in 2020 (among those aged ≥ 50 years) was 0.10% (0.07 to 0.12) globally, and the region with the highest prevalence of AMD-related blindness was North Africa/Middle East (0.22%; 0.16 to 0.30). Age-standardized prevalence (using the GBD 2019 data) of AMD-related MSVI in people aged ≥ 50 years in 2020 was 0.34% (0.27 to 0.41) globally, and the region with the highest prevalence of AMD-related MSVI was also North Africa/Middle East (0.55%; 0.44 to 0.68). From 2000 to 2020, the estimated crude prevalence of AMD-related blindness decreased globally by 19.29%, while the prevalence of MSVI increased by 10.08%. CONCLUSIONS The estimated increase in the number of individuals with AMD-related blindness and MSVI globally urges the creation of novel treatment modalities and the expansion of rehabilitation services.
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Galvez-Olortegui J, Bouchikh-El Jarroudi R, Silva-Ocas I, Palacios-Herrera H, Cubillas-Martin M, Zavaleta-Mercado M, Burgueño-Montañes C, Galvez-Olortegui T. Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion. Eye (Lond) 2024; 38:1722-1733. [PMID: 38467863 PMCID: PMC11156943 DOI: 10.1038/s41433-024-03008-1] [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] [Received: 09/13/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND/OBJECTIVES To assess the methodological quality of Clinical Practice Guidelines (CPG) for the diagnosis and management of Retinal Vein Occlusion (RVO). METHODS A systematic review of CPGs for the diagnosis and management of RVO was carried out with a search in databases, metasearch engines, CPG development institutions, ophthalmology associations and CPG repositories until April 2022. Search update was performed on April 2023, with no new record available. Five CPGs published in the last 10 years in English/Spanish were selected, and 5 authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. An individual assessment of each CPG by domain (AGREE-II), an overall assessment of the guide, and its use with or without modifications were performed. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes was carried out. RESULTS The lowest score (mean 18.8%) was for domain 5 'applicability', and the highest score (mean 62%) was for domain 4 'clarity of presentation'. The 2019 American guideline (PPP) presented the best score (40.4%) in domain 3 'rigour of development'. When evaluating the overall quality of the CPGs analysed, all CPGs could be recommended with modifications. In the meta-synthesis, anti-VEGF therapy is the first-choice therapy for macular oedema associated with RVO, but there is no clear recommendation about the type of anti-VEGF therapy to choose. Recommendations for diagnosis and follow-up are similar among the CPGs appraised. CONCLUSION Most CPGs for the diagnosis and management of RVO have a low methodological quality assessed according to the AGREE-II. PPP has the higher score in the domain 'rigour of development'. Among the CPGs appraised, there is no clear recommendation on the type of anti-VEGF therapy to choose.
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Affiliation(s)
- Jose Galvez-Olortegui
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru.
- Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain.
- Universidad Nacional de Tumbes, Tumbes, Peru.
| | - Rachid Bouchikh-El Jarroudi
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Service of Ophthalmology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Surgery, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Isabel Silva-Ocas
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Peru
| | - Hector Palacios-Herrera
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Servicio de Retina y Vitreo, EP Oftalmólogos asociados, Lima, Peru
| | | | - Miguel Zavaleta-Mercado
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Instituto de Investigaciones Oftalmológicas y Ciencias Visuales Avanzadas Zavaleta Mercado (Innovaz), Oruro, Bolivia
| | - Carmen Burgueño-Montañes
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Tomas Galvez-Olortegui
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Peru
- Department of Ophthalmology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
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Muma S, Naidoo KS, Hansraj R. Situation analysis on the integration of refractive error services provided by optometrists into the national health services in Kenya. BMC Public Health 2024; 24:1442. [PMID: 38811959 PMCID: PMC11138047 DOI: 10.1186/s12889-024-18960-6] [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] [Received: 02/01/2024] [Accepted: 05/27/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Even though the burden of uncorrected refractive error could potentially be addressed through innovative and cost-effective approaches, integration of the services into the National Health Services (NHS) is desirable. However, minimal information exists on the current situation warranting the need for evidence about the integration of refractive error service provided by optometrists into the national health services in Kenya. METHODS A situation analysis of the Kenyan refractive error services provided by optometrists within the NHS was undertaken based on access to service delivery, service coverage, and human resource. A strengths, weaknesses, opportunities, and threats analysis was undertaken based on the existent evidence to identify the core factors that could potentially facilitate or hinder the integration of refractive error services provided by optometrists within the National Health Services. The proportion of optometrists to be integrated in the NHS was estimated based on the minimum ratios recommended by the World Health Organization. RESULTS A section of tertiary and secondary healthcare facilities in Kenya have specific services to address refractive errors within the NHS with most facilities lacking such services. Treatment of refractive error occurs at the level of eye care general services. There are 11,547 health facilities offering primary care services in Kenya. However, none of them offers refractive error services and only a section of facilities offering county health referral services provides eye care services which is limited to refraction without provision of spectacles. The existing workforce comprises of ophthalmologists, optometrists and ophthalmic clinical officers, together with nurses and other general paramedical assistants. Optometrists, ophthalmologists and ophthalmic clinical officers are allowed to undertake refraction. However, optometrists majorly practices in the private sector. Centralization of eye care services in urban areas, weak referral systems, and a shortage in the workforce per population was observed. CONCLUSIONS The Kenyan NHS should advocate for primary care and reorient the current hospital-based delivery approach for refractive error services. This is attributed to the fact that provision of refractive error services at primary care remains effective and efficient and could translate to early detection of other ocular conditions. The existing human resources in the eye health ecosystem in Kenya should maximize their efforts towards addressing uncorrected refractive error and optometrists should be integrated into the NHS.
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Affiliation(s)
- Shadrack Muma
- College of Health Sciences, Department of Optometry, University of KwaZulu-Natal, Durban, South Africa.
- , PO Box 811, Kisumu, Kenya.
| | - Kovin Shunmugam Naidoo
- College of Health Sciences, Department of Optometry, University of KwaZulu-Natal, Durban, South Africa
- ONESIGHT EssilorLuxottica Foundation, Paris, France
| | - Rekha Hansraj
- College of Health Sciences, Department of Optometry, University of KwaZulu-Natal, Durban, South Africa
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Alnahedh TA, Taha M. Role of Machine Learning and Artificial Intelligence in the Diagnosis and Treatment of Refractive Errors for Enhanced Eye Care: A Systematic Review. Cureus 2024; 16:e57706. [PMID: 38711688 PMCID: PMC11071623 DOI: 10.7759/cureus.57706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/08/2024] Open
Abstract
A significant contributor to blindness and visual impairment globally is uncorrected refractive error. To plan effective interventions, eye care professionals must promptly identify people at a high risk of acquiring myopia, and monitor disease progress. Artificial intelligence (AI) and machine learning (ML) have enormous potential to improve diagnosis and treatment. This systematic review explores the current state of ML and AI applications in the diagnoses and treatment of refractory errors in optometry. A systematic review and meta-analysis of studies evaluating the diagnostic performance of AI-based tools in PubMed was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To find relevant studies on the use of ML or AI in the diagnosis or treatment of refractive errors in optometry, a thorough search was conducted in various electronic databases such as PubMed, Google Scholar, and Web of Science. The search was limited to studies published between January 2015 and December 2022. The search terms used were "refractive errors," "myopia," "optometry," "machine learning," "ophthalmology," and "artificial intelligence." A total of nine studies met the inclusion criteria and were included in the final analysis. ML is increasingly being utilized for automating clinical data processing as AI technology progresses, making the formerly labor-intensive work possible. AI models that primarily use a neural network demonstrated exceptional efficiency and performance in the analysis of vast medical data, rivaling board-certified, healthcare professionals. Several studies showed that ML models could support diagnosis and clinical decision-making. Moreover, an ML algorithm predicted future refraction values in patients with myopia. AI and ML models have great potential to improve the diagnosis and treatment of refractive errors in optometry.
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Affiliation(s)
- Taghreed A Alnahedh
- Optometry, King Abdullah International Medical Research Center (KAIMRC), National Guard Health Affairs, Riyadh, SAU
- Academic Affairs, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Mohammed Taha
- Ophthalmology, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
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Patil A, Gupta S, Venkatesh P, Banerjee M, Kumar V, Chawla R, Azad SV, Kumar A. First contact investigations and compliance to treatment in patients with uveitis. Int J Ophthalmol 2023; 16:1820-1826. [PMID: 38028517 PMCID: PMC10626353 DOI: 10.18240/ijo.2023.11.13] [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: 02/03/2023] [Accepted: 08/18/2023] [Indexed: 12/01/2023] Open
Abstract
AIM To ascertain the pattern of investigations at first contact in uveitic patients and evaluate compliance to treatment. METHODS An observational study comprised of 201 uveitic patients presenting for the first time to our centre from January 2019 to June 2020. Detailed information regarding systemic investigations undertaken by specialists at the time of first contact and the cost of these investigations were reviewed on the first visit to our centre. Compliance with the treatment was determined and reasons behind non-compliance were evaluated on the first follow-up in patients who had no improvement in clinical signs and symptoms. RESULTS The mean age of the study group was 35.35±14.1y and gender composition was 59.7% males and 40.3% females. Anterior uveitis was observed in 45.3% of patients, intermediate uveitis in 31.8% of patients, posterior uveitis in 14.9% of patients and panuveitis in 8.0% of patients. Association with a systemic disease was evident in 17.9% of patients. When compared with standard guidelines and uveitis patterns, systemic investigations were identified to be relevant only in 38.3% of patients. Non-compliance to treatment was documented in 22.4% of patients. Common reasons for non-compliance were inadequate counselling by the treating physician about treatment in 26.7% of patients and a busy schedule at work/school in 22.2% of patients. CONCLUSION Significant number of investigations performed at first contact is found to be contrary to standard guidelines and are not contributory to the care. About a quarter of patients in this study are found to be non-compliant with the treatment. Compliance is more challenging to achieve in school-going children and working adults. The availability of comprehensive, periodically updated, evidence-based guidelines on the role of investigations and the use of trained counsellors may help to channelize proper evaluation and improve compliance to treatment, respectively, in patients with uveitis.
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Affiliation(s)
- Anuja Patil
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sanjeev Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mousumi Banerjee
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shorya Vardhan Azad
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
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Tan TF, Thirunavukarasu AJ, Jin L, Lim J, Poh S, Teo ZL, Ang M, Chan RVP, Ong J, Turner A, Karlström J, Wong TY, Stern J, Ting DSW. Artificial intelligence and digital health in global eye health: opportunities and challenges. Lancet Glob Health 2023; 11:e1432-e1443. [PMID: 37591589 DOI: 10.1016/s2214-109x(23)00323-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
Global eye health is defined as the degree to which vision, ocular health, and function are maximised worldwide, thereby optimising overall wellbeing and quality of life. Improving eye health is a global priority as a key to unlocking human potential by reducing the morbidity burden of disease, increasing productivity, and supporting access to education. Although extraordinary progress fuelled by global eye health initiatives has been made over the last decade, there remain substantial challenges impeding further progress. The accelerated development of digital health and artificial intelligence (AI) applications provides an opportunity to transform eye health, from facilitating and increasing access to eye care to supporting clinical decision making with an objective, data-driven approach. Here, we explore the opportunities and challenges presented by digital health and AI in global eye health and describe how these technologies could be leveraged to improve global eye health. AI, telehealth, and emerging technologies have great potential, but require specific work to overcome barriers to implementation. We suggest that a global digital eye health task force could facilitate coordination of funding, infrastructural development, and democratisation of AI and digital health to drive progress forwards in this domain.
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Affiliation(s)
- Ting Fang Tan
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Arun J Thirunavukarasu
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Corpus Christi College, University of Cambridge, Cambridge, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Liyuan Jin
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Joshua Lim
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Stanley Poh
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Zhen Ling Teo
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - R V Paul Chan
- Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Urbana-Champaign, IL, USA
| | - Jasmine Ong
- Pharmacy Department, Singapore General Hospital, Singapore
| | - Angus Turner
- Lions Eye Institute, University of Western Australia, Nedlands, WA, Australia
| | - Jonas Karlström
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore General Hospital, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Jude Stern
- The International Agency for the Prevention of Blindness, London, UK
| | - Daniel Shu-Wei Ting
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
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Ghadiri N, Reekie IR, Gordon I, Safi S, Lingham G, Evans JR, Keel S. Systematic review of clinical practice guidelines for uveitis. BMJ Open Ophthalmol 2023. [DOI: 10.1136/bmjophth-2022-001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
To facilitate the integration of eye care into universal health coverage, the WHO is developing a Package of Eye Care Interventions (PECI). Development of the PECI involves the identification of evidence-based interventions from relevant clinical practice guidelines (CPGs) for uveitis.A systematic review of CPGs published on uveitis between 2010 and March 2020 was conducted. CPGs passing title and abstract and full-text screening were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and data on recommended interventions extracted using a standard data extraction sheet.Of 56 CPGs identified as potentially relevant from the systematic literature search, 3 CPGs underwent data extraction following the screening stages and appraisal with the AGREE II tool. These CPGs covered screening for, monitoring and treating juvenile idiopathic arthritis (JIA)-associated uveitis, the use of adalimumab and dexamethasone in treating non-infectious uveitis, and a top-level summary of assessment, differential diagnosis and referral recommendations for uveitis, aimed at primary care practitioners. Many of the recommendations were based on expert opinion, though some incorporated clinical study and randomised controlled trial data.There is currently sparse coverage of the spectrum of disease caused by uveitis within CPGs. This may partially be due to the large number of conditions with diverse causes and clinical presentations covered by the umbrella term uveitis, which makes numerous sets of guidelines necessary. The limited pool of CPGs to select from has implications for clinicians seeking guidance on clinical care strategies for uveitis.
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Keel S, Lingham G, Misra N, Block S, Bourne R, Calonge M, Cheng CY, Friedman DS, Furtado JM, Khanna R, Mariotti S, Mathenge W, Matoto E, Müeller A, Rabiu M, Rasengane T, Resnikoff S, Wormald R, Yasmin S, Zhao J, Evans JR, Cieza A, Chan VF, Chen Y, Chinnery H, Dodson S, Downie L, Gordon I, Ghadiri N, Govender Poonsamy P, Han X, Hui F, Jackson ML, Lawrenson J, Ning Lee C, McGuinness M, Murray C, Newsham D, van Nispen R, Prictor M, Puri L, Ramke J, Reekie I, Safi S, Scheetz J, Shen S, Silveira S, Thakur S, Virgili G, Yong AC, Zhang J, Ziaei M, Ali MA, AlObaida IA, AlShamlan FT, Alsulaiman SM, Amissah-Arthur KN, Ang M, Azad R, Bell K, Bharadwaj SR, Booysen DJ, Branchevski S, Bosch V, Brossard-Barbosa N, Chen Y, Craig JP, Dada T, Dichoso CA, Duerksen R, Ebri A, Erdmann I, Freddo T, Flanagan J, Gammoh Y, Gupta N, Hendicott P, Husni MA, Jonathan Jackson A, Jadoon MZ, Januleviciene I, Jeeva I, Jimenez MSS, Kocur I, Kreis A, Kyei S, Lan W, Loy MJV, Marmamula S, Minto LH, Muhit M, Nsubuga NH, Ogundipe A, Okonkwo ON, Olawoye OO, Ouertani AM, Ovenseri-Ogbomo G, Özkan SB, Patel B, Paula JS, Rahi JS, Ravilla RD, Senanayake NS, Sil AK, Solebo AL, Sousa RARC, Tennant MTS, van Staden DB, Wazir JF, Webber AL, Yorston D, Zin A, Faal HB, Keeffe J, McGrath CE. Toward Universal Eye Health Coverage-Key Outcomes of the World Health Organization Package of Eye Care Interventions: A Systematic Review. JAMA Ophthalmol 2022; 140:1229-1238. [PMID: 36394836 DOI: 10.1001/jamaophthalmol.2022.4716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Importance Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed. Objective To describe the key outcomes of the PECI development. Evidence Review A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review. Findings Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI. Conclusions and Relevance This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.
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Affiliation(s)
- Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Gareth Lingham
- Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland.,Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Australia
| | - Neha Misra
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Rupert Bourne
- Cambridge University Hospitals, Cambridge, United Kingdom.,Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Margarita Calonge
- Institute of Applied OphthalmoBiology, Universidad de Valladolid, Valladolid, Spain.,CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
| | - Ching-Yu Cheng
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rohit Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Silvio Mariotti
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | | | - Andreas Müeller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Mansur Rabiu
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | - Tuwani Rasengane
- Department of Optometry, University of the Free State, Bloemfontein, South Africa.,Universitas Hospital, Bloemfontein, South Africa
| | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Brien Holden Vision Institute, Sydney, Australia.,Organisation pour la Prévention de la Cécité, Paris, France
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Jialiang Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Eye Research Center Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Ving Fai Chan
- for the Package of Eye Care Interventions Development Group
| | - Yanxian Chen
- for the Package of Eye Care Interventions Development Group
| | - Holly Chinnery
- for the Package of Eye Care Interventions Development Group
| | - Sarity Dodson
- for the Package of Eye Care Interventions Development Group
| | - Laura Downie
- for the Package of Eye Care Interventions Development Group
| | - Iris Gordon
- for the Package of Eye Care Interventions Development Group
| | - Nima Ghadiri
- for the Package of Eye Care Interventions Development Group
| | | | - Xiaotong Han
- for the Package of Eye Care Interventions Development Group
| | - Flora Hui
- for the Package of Eye Care Interventions Development Group
| | | | - John Lawrenson
- for the Package of Eye Care Interventions Development Group
| | - Chan Ning Lee
- for the Package of Eye Care Interventions Development Group
| | | | - Craig Murray
- for the Package of Eye Care Interventions Development Group
| | - David Newsham
- for the Package of Eye Care Interventions Development Group
| | | | - Megan Prictor
- for the Package of Eye Care Interventions Development Group
| | - Lila Puri
- for the Package of Eye Care Interventions Development Group
| | | | - Ian Reekie
- for the Package of Eye Care Interventions Development Group
| | - Sare Safi
- for the Package of Eye Care Interventions Development Group
| | - Jane Scheetz
- for the Package of Eye Care Interventions Development Group
| | - Sunny Shen
- for the Package of Eye Care Interventions Development Group
| | - Sue Silveira
- for the Package of Eye Care Interventions Development Group
| | - Sahil Thakur
- for the Package of Eye Care Interventions Development Group
| | - Gianni Virgili
- for the Package of Eye Care Interventions Development Group
| | - Ai Chee Yong
- for the Package of Eye Care Interventions Development Group
| | - Justine Zhang
- for the Package of Eye Care Interventions Development Group
| | - Mohammed Ziaei
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | - Marcus Ang
- for the Package of Eye Care Interventions Development Group
| | | | - Kristin Bell
- for the Package of Eye Care Interventions Development Group
| | | | - Dirk J Booysen
- for the Package of Eye Care Interventions Development Group
| | | | - Vanessa Bosch
- for the Package of Eye Care Interventions Development Group
| | | | - Yi Chen
- for the Package of Eye Care Interventions Development Group
| | | | - Tanuj Dada
- for the Package of Eye Care Interventions Development Group
| | | | | | - Anne Ebri
- for the Package of Eye Care Interventions Development Group
| | - Irmela Erdmann
- for the Package of Eye Care Interventions Development Group
| | - Thomas Freddo
- for the Package of Eye Care Interventions Development Group
| | - John Flanagan
- for the Package of Eye Care Interventions Development Group
| | - Yazan Gammoh
- for the Package of Eye Care Interventions Development Group
| | - Neeru Gupta
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | - Irfan Jeeva
- for the Package of Eye Care Interventions Development Group
| | | | - Ivo Kocur
- for the Package of Eye Care Interventions Development Group
| | - Andreas Kreis
- for the Package of Eye Care Interventions Development Group
| | - Samuel Kyei
- for the Package of Eye Care Interventions Development Group
| | - Weizhong Lan
- for the Package of Eye Care Interventions Development Group
| | | | | | | | - Mohammad Muhit
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | | | - Seyhan B Özkan
- for the Package of Eye Care Interventions Development Group
| | - Bina Patel
- for the Package of Eye Care Interventions Development Group
| | - Jayter S Paula
- for the Package of Eye Care Interventions Development Group
| | - Jugnoo S Rahi
- for the Package of Eye Care Interventions Development Group
| | | | | | - Asim Kumar Sil
- for the Package of Eye Care Interventions Development Group
| | | | - Raúl ARC Sousa
- for the Package of Eye Care Interventions Development Group
| | | | | | | | - Ann L Webber
- for the Package of Eye Care Interventions Development Group
| | - David Yorston
- for the Package of Eye Care Interventions Development Group
| | - Andrea Zin
- for the Package of Eye Care Interventions Development Group
| | - Hannah B Faal
- for the Package of Eye Care Interventions Development Group
| | - Jill Keeffe
- for the Package of Eye Care Interventions Development Group
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9
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A Systematic Review of Clinical Practice Guidelines for Cataract: Evidence to Support the Development of the WHO Package of Eye Care Interventions. Vision (Basel) 2022; 6:vision6020036. [PMID: 35737423 PMCID: PMC9227019 DOI: 10.3390/vision6020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
The World Health Organization (WHO) is developing a Package of Eye Care Interventions (PECI) to facilitate the integration of eye care into Universal Health Coverage. This paper presents the results of a systematic review of clinical practice guidelines for cataract in adults, to help inform PECI development. We searched academic and guideline databases, and websites of professional associations, for guidelines published between January 2010 and April 2020. Guidelines were excluded if there was commercial funding or unmanaged conflicts of interest. Quality appraisal was conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. We identified 3778 reports, 35 related to cataract guidelines, four of which met the inclusion criteria (United Kingdom: 2, United States: 1, Iran: 1). The recommendations across the four guidelines covered pre-operative (43%), intra-operative (37%), and post-operative interventions (20%). Most ‘strong’ recommendations were supported by good quality evidence. Differences in recommendations across guidelines may be attributable to time of publication or regional differences in surgical practice. Few guidelines met the quality criteria, and only three countries were represented. The results of this step of the PECI development process will inform subsequent phases for development of the WHO’s package of evidence-based eye care interventions for cataract.
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10
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Evans JR, Lawrenson JG, Ramke J, Virgili G, Gordon I, Lingham G, Yasmin S, Keel S. Identification and critical appraisal of evidence for interventions for refractive error to support the development of the WHO package of eye care interventions: a systematic review of clinical practice guidelines. Ophthalmic Physiol Opt 2022; 42:526-533. [PMID: 35191063 PMCID: PMC9306966 DOI: 10.1111/opo.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The World Health Organization is developing a Package of Eye Care Interventions (PECI) to support the integration of eye health care into national health programmes. Interventions included in the PECI should be based on robust evidence where available. Refractive error is a leading cause of blindness and vision impairment and is a PECI priority condition. The aim of this study was to provide high-quality evidence to support the development of the PECI by identifying and critically appraising clinical practice guidelines (CPGs), and extracting recommendations for refractive error interventions. METHODS We searched for CPGs on refractive error published in the last 10 years. We conducted the searches initially in February and March 2019 and repeated them in March 2020. We evaluated the quality of potentially relevant guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS We identified 12 high-quality CPGs relevant to refractive error, written by six organisations from three high-income countries. Organisations used a variety of frameworks to assess the strength of recommendations based on available evidence, with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) being most common. Vision screening for children aged 3 to 5 years was recommended consistently. Evidence for screening and eye evaluations at other ages was weaker, although ophthalmic professional organisations consistently recommended regular evaluations. Recommendations on optical and laser correction of refractive error were limited and did not consider implications for low resource settings. Interventions for slowing myopia progression in children were recommended, but these will need regular updating as new evidence emerges. CONCLUSIONS Current high-quality guidelines on refractive error have been formulated in high-income countries. Recommendations focused on prevention and treatment of refractive error in low-and middle-income countries are lacking. Regular updating of systematic reviews and CPGs is essential to ensure that robust evidence is promptly appraised and incorporated into recommendations for eye health care practitioners.
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Affiliation(s)
- Jennifer R Evans
- Centre for Public HealthQueen’s UniversityBelfastUK
- International Centre for Eye HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - John G Lawrenson
- Division of Optometry and Vision ScienceCity, University of LondonLondonUK
| | - Jacqueline Ramke
- International Centre for Eye HealthLondon School of Hygiene and Tropical MedicineLondonUK
- School of Optometry and Vision ScienceUniversity of AucklandAucklandNew Zealand
| | | | - Iris Gordon
- Centre for Public HealthQueen’s UniversityBelfastUK
| | - Gareth Lingham
- Centre for Ophthalmology and Visual ScienceLions Eye InstituteUniversity of Western AustraliaPerthAustralia
| | | | - Stuart Keel
- Department of Noncommunicable DiseasesWorld Health OrganizationGenevaSwitzerland
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11
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Han X, Chen Y, Gordon I, Safi S, Lingham G, Evans J, Keel S, He M. A Systematic Review of Clinical Practice Guidelines for Age-related Macular Degeneration. Ophthalmic Epidemiol 2022; 30:213-220. [PMID: 35417274 DOI: 10.1080/09286586.2022.2059812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In response to the recommendations of the World Health Organization (WHO) World report on vision, the WHO is developing a Package of Eye Care Interventions (PECI) to support the integration of eye care into health systems within countries. This study was done to systematically review clinical practice guidelines (CPGs) related to age-related macular degeneration (AMD) to provide evidence-based recommendations. METHODS All AMD-related CPGs published between 2010 and 2020 were reviewed and evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS Of 3778 CPGs identified, 48 underwent full-text screening and eight underwent quality appraisal. Five National Institute for Health and Care Excellence (NICE, UK) guidelines for AMD were finally selected for data extraction. Intravitreal anti-vascular endothelial growth factor (VEGF) treatment was strongly recommended for advanced, active neovascular AMD based on high-quality evidence. Photodynamic therapy and laser photocoagulation were not recommended as an adjunct to anti-VEGF therapy as first-line treatment for AMD. Recommendations on other interventions, including epiretinal brachytherapy, miniature lens system implantation, and limited macular translocation, were weak and evidence mostly came from low-quality case series studies. Hence these interventions were recommended to be used only with special arrangements or research. Existing evidence on treating geographic atrophy was limited, an implantable miniature telescope might be an effective intervention to improve vision but was still under investigation. DISCUSSION Current CPGs recommend anti-VEGF therapy for patients with late active neovascular AMD, while other interventions should be used with caution and further researches are warranted.
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Affiliation(s)
- Xiaotong Han
- 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
| | - Yanxian Chen
- 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.,Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong province, China
| | - Iris Gordon
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Centre for Public Health, Queen's University, London, Belfast, UK
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jennifer Evans
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Centre for Public Health, Queen's University, London, Belfast, UK
| | - Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Mingguang He
- 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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12
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Keel S, Cieza A. Universal eye health coverage: from global policy to country action. Int Health 2022; 14:i3-i5. [PMID: 35385868 PMCID: PMC8986349 DOI: 10.1093/inthealth/ihab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/03/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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13
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Chen Y, Han X, Gordon I, Safi S, Lingham G, Evans J, Li J, He M, Keel S. A systematic review of clinical practice guidelines for myopic macular degeneration. J Glob Health 2022; 12:04026. [PMID: 35356661 PMCID: PMC8939288 DOI: 10.7189/jogh.12.04026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Myopic macular degeneration (MMD) is a primary cause of blindness and visual impairment in many parts of the world. A review of clinical practice guidelines (CPGs) for intervention selection are required with the increasing demand for MMD management in clinical practice as well as in national health services. Therefore, we aim to systematically review CPGs for MMD and assist the recommendations development of the Package of Eye Care Interventions (PECI) program of the World Health Organization. Methods A systematic review of CPGs published on MMD between 2010 and April 2020 was conducted. Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Cochrane systematic reviews were also included when the evidence from included CPGs were inadequate or contradict. Results After applying exclusion criteria and conducting the quality appraisal, two CPGs were finally included. The average of the AGREE II ratings for the identified Guidelines were 56 and 63 respectively (7 for each item). To provide further information on interventions for MMD, one Cochrane review on MMD was additionally identified and included in the study. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs were recommended for patients with myopic choroidal neovascularization (mCNV) as first-line therapy to improve vision and reduce central macular thickness, and ranibizumab showed significant effectiveness compared to photodynamic therapy (PDT). PDT was recommended to be performed in those resistant to the treatment by one CPG but lacked of adequate description and support. Data extracted from the Cochrane systematic reviews indicated that anti-VEGF therapy for mCNV had significant effectiveness in improving visual acuity and reducing CMT compared to PDT with moderate to low certainty of evidence. Ranibizumab and bevacizumab were considered as equally effective with moderate certainty. Conclusions The outcomes of this review suggest that high quality clinical practice guidelines for MMD management are limited. Intravitreal injection of anti-VEGF agents was recommended as an effective intervention to treat myopic CNV as the first-line treatment, while there was inadequate guidance for the application of PDT in myopic CNV management. The use of other interventions for MMD were not recommended at this time and additional evidence is called for.
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Affiliation(s)
- Yanxian Chen
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Iris Gordon
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Jennifer Evans
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jinying Li
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
| | - Mingguang He
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Stuart Keel
- Vision and Blindness Prevention Programme, World Health Organization, Geneva, Switzerland
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14
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Asturias AL, Gilbert C, Silva JC, Quinn GE. Implementation of telemedicine screening for retinopathy of prematurity in rural areas in Guatemala. J AAPOS 2022; 26:22.e1-22.e5. [PMID: 34973448 DOI: 10.1016/j.jaapos.2021.08.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/03/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To report findings of a telemedicine retinopathy of prematurity (ROP) screening program in six neonatal units in rural areas of Guatemala, using a portable, noncontact, 40° field digital fundus camera (Pictor Plus) operated by trained technicians. METHODS National ROP Program Guidelines screening criteria were used: gestational age <36 weeks and/or birth weight (BW) <2000 g, or GA <36 weeks but BW ≥2000 g, with qualifying medical history. Retinal images were obtained by two technicians and graded by ophthalmologists experienced in ROP. Infants with signs of pre-plus or plus disease in one or both eyes were referred for clinical examination. Screening was stopped when retinal vessels in anterior zone II were normal on two successive evaluations or the infant had reached 45 week's postmenstrual age. RESULTS A total of 418 of 1,890 eligible infants (22.1%) were screened. Mean GA was 33.9 ± 2.2 weeks (range, 27-36), and mean BW 1728.3 ± 379.3 g (range, 840-2830 g). Thirty-three infants (8.6%) developed plus or pre-plus disease, and 19 (58%) underwent ophthalmologic examination. Fifteen infants were confirmed with type 1 ROP, and 14 were treated. Mean GA of treated infants treated was 33.6 ± 3.0 weeks (range, 32-34.9), and mean BW was 1,646 ± 245.8 g (range, 1100-1774.1 g). CONCLUSIONS Imaging with a noncontact fundus camera can facilitate detection of treatable ROP in countries with limited resources. Strengthening the health systems, including motivation and continued training of neonatal intensive care personnel is essential to improve and maintain program effectiveness. Reasons for, and interventions to address the low uptake of screening need to be explored to extend coverage of ROP screening to district hospitals in Guatemala.
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Affiliation(s)
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Juan C Silva
- Pan-American Health Organization-PAHO, Bogota, Colombia
| | - Graham E Quinn
- Division of Ophthalmology, The Children's Hospital of Philadelphia and Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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15
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Lingham G, Thakur S, Safi S, Gordon I, Evans JR, Keel S. A systematic review of clinical practice guidelines for childhood glaucoma. BMJ Open Ophthalmol 2022; 7:e000933. [PMID: 35136841 PMCID: PMC8804684 DOI: 10.1136/bmjophth-2021-000933] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/18/2022] [Indexed: 12/19/2022] Open
Abstract
ObjectiveTo conduct a systematic review to identify and critically appraise clinical practice guidelines on the assessment, diagnosis and management of childhood glaucoma.Methods and analysisA systematic literature search of databases and professional websites for clinical practice guidelines published on eye conditions between 2010 and April 2020 in English was conducted. Identified guidelines were screened for relevance to childhood glaucoma and exclusion criteria applied. Guidelines that passed the screening and quality appraisal with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and, if they achieved a mean score of ≥45 and ≥3 on subsets of 9 and 5 AGREE II items, respectively, were selected for inclusion and data extracted using a standardised form.ResultsFollowing screening and critical appraisal, three guidelines were included for data extraction. None of the three guidelines was specifically developed for childhood glaucoma. A consistent recommendation was that children should undergo some form of eye screening examination or a comprehensive eye assessment to detect paediatric eye disease. Children at high risk of childhood glaucoma should undergo additional screening. One clinical practice guideline recommended interventions for childhood glaucoma consisting of tube surgery and topical beta-blockers or carbonic anhydrase inhibitors. Recommended interventions for childhood glaucoma were based on low-quality to moderate-quality evidence or expert opinion.ConclusionBased on our selection criteria, we did not identify any high-quality clinical practice guidelines specifically targeted at childhood glaucoma. This is compounded by the lack of high-quality evidence on childhood glaucoma.
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Affiliation(s)
- Gareth Lingham
- Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Sare Safi
- Ophthalmic Research Centre, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- World Health Organization Collaborating Centre for the Eye Care and Prevention of Blindness, Tehran, Iran
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Stuart Keel
- Vision and Blindness Prevention Programme, World Health Organization, Geneva, Switzerland
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Ramke J, Evans JR, Habtamu E, Mwangi N, Silva JC, Swenor BK, Congdon N, Faal HB, Foster A, Friedman DS, Gichuhi S, Jonas JB, Khaw PT, Kyari F, Murthy GVS, Wang N, Wong TY, Wormald R, Yusufu M, Taylor H, Resnikoff S, West SK, Burton MJ, Aghaji A, Adewole AT, Csutak A, Salam AS, Paduca A, Bron AM, Denniston AK, Lazo Legua A, Halim A, Tefera AW, Mwangi A, Jenkins AJ, Davis A, Meddeb-Ouertani A, Wali AH, Palis AG, Bastos de Carvalho A, Joshi A, Kreis AJ, Mueller A, Bastawrous A, Cooper A, Smith AF, Grzybowski A, Arvind A, Karanu AM, Orlina AO, Burnett A, Yashadhana A, Abeydeera AP, Abdurakhmanova A, Mohamed A, Bacchav A, Bernhisel A, Webson AW, Azuara-Blanco A, Hossain A, Ilhan B, Assumpta Lucienne B, Tousignant B, Shamanna BR, Wiafe B, Mueller B, Caglar C, Mpyet C, Abraham CH, Cheung CY, Thiel CL, Jan CL, Emedike C, Chuluunkhuu C, Chinyere C, Henein C, Gilbert CE, Bascaran C, Nitulescu CE, Patel D, Bachani D, Kiage D, Etya'ale D, Dahdal D, Woo Lawson D, Godin D, Nkanga DG, Ondeyo DM, O'Brien D, Mutie DM, Alalawi ESK, Mayorga E, Bin Hashim E, Ashrafi E, Kishiki EA, Kurian E, D'Esposito F, Masila F, Pena FY, Büsch F, Topouzis F, Bandello F, Oyediji FJ, Thumann G, Ezz Elarab G, Kitema GF, Schlenther G, Fefoame GO, Cochrane GM, Laganovska G, Awan HR, Ansari HM, Philippin H, Burn H, Dimaras H, Filipe HP, Monye HI, Kandel H, Randrianarisoa HL, Jones I, Murdoch IE, Fabian ID, Khan IA, Sharma IP, Elbeih I, Mactaggart I, Pastor JC, Keunen JEE, Ohuma JA, Pithuwa Nirwoth J, Hammou J, Vianna JR, Biao JE, Burr JM, Keenan JD, Blijkers J, Black JM, Barbosa Breda J, Furtado JM, Buchan JC, Lawrenson JG, Kempen JH, Ehrlich JR, Stern J, Zhang JH, Keskinbora KH, Knoll KM, Blanchet K, Schmid KL, Ono K, Ogundimu K, Balo K, Somda KP, Yeboah K, Amissah-Arthur KN, Nasehi L, Øverland L, Vijaya L, Keay L, Hamm LM, Mowatt L, Harrison-Williams LCM, Silva L, Bilotto L, Mörchen M, Rabiu M, Zondervan M, Chagunda M, Sandinha MT, Yee Melgar M, Salas Vargas M, Daniell MD, Katibeh M, Broom M, Collins ME, Alp MN, Kwarteng MA, Belkin M, Gichangi M, Sylvanowicz M, Wu M, Cano MR, Shalaby M, Duggal M, Khairallah M, Batur M, Bikbov MM, Ramappa M, Pamarathi N, Khachatryan N, Muhammad N, Kennedy N, Murray N, Beare NAV, Astbury N, Carnt NA, St Rose NA, Barker NH, Pehere NK, Uche NJ, Lois N, Awe OO, Mujica OJ, Okolo OE, Rani PK, Ruamviboonsuk P, Ndiaye PA, Dhakhwa P, Rozsival P, Mbulawa PK, Keane PA, Jones PR, Holland P, Nukella PB, Burgess PI, O'Dwyer PA, Piyasena P, Bastola P, Morjaria P, Nasimee Q, Rambacal RAT, Das R, Khandekar RB, Azad R, Bashshur R, Sousa RARC, Oenga R, Gurung R, Geneau R, Jacobs RJ, Finger RP, Guymer RH, Sevciuc R, Khanna RC, George R, Graham R, Kawasaki R, Ho SM, Mishra SK, Buttan S, Block SS, Talero S, Yoon S, Joseph S, Safi S, Dodson S, Munoz SR, Bakayoko S, Mohammadi SF, Muez SA, Pardhan S, Hopkins S, Sheu SJ, Coulibaly SM, Schellini SA, Arunga S, Bush SR, Sivaprasad S, Salomao SR, Marmamula S, Onwubiko SN, Misra SL, Kuyyadiyil S, Kulkarni S, khanal S, Yasmin S, Pavljasevic SN, Gilbert SS, Braithwaite T, Ghidirimschi T, Ravilla T, Fricke TR, Cogliati T, Kassa T, Peto T, Dibb U, Lansingh VC, Hu VH, Sheffield VM, Mathenge W, Dean WH, Nolan W, Hiratsuka Y, Mahsood YJ, Sapkota Y. Grand Challenges in global eye health: a global prioritisation process using Delphi method. THE LANCET. HEALTHY LONGEVITY 2022; 3:e31-e41. [PMID: 35028632 PMCID: PMC8732284 DOI: 10.1016/s2666-7568(21)00302-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. METHODS Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. FINDINGS Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. INTERPRETATION This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. FUNDING The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. TRANSLATIONS For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK,School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand,Correspondence to: Dr Jacqueline Ramke, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK,Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK,Eyu-Ethiopia: Eye Health Research, Training and Service Centre, Bahirdar, Ethiopia
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK,Kenya Medical Training College, Nairobi, Kenya
| | | | - Bonnielin K Swenor
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China,Orbis International, New York, NY, USA
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria,Africa Vision Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany,Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Peng T Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK,College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK,Indian Institute of Public Health, Hyderabad, India
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore,Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK,National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Hugh Taylor
- Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute and School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK,National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Limitations in cataract surgical services for children in Ethiopia: a nationwide survey of pediatric cataract surgeons. BMC Ophthalmol 2021; 21:437. [PMID: 34923960 PMCID: PMC8684671 DOI: 10.1186/s12886-021-02190-0] [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: 01/29/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
Background Bilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia. Methods A Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children (0–5 years). Results All nine responded. All but one had received either 12- or 3–5-month’s training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. The surgeons were based in seven health facilities: five in the capital (Addis Ababa) and eight in six public referral hospitals and one private center. Over 12 months (2017–2018) 508 children (592 eyes) aged 0–18 years (most < 15 years) were operated by these surgeons. 84 (17%) had bilateral cataract, and 424 (83%) had unilateral cataract mainly following trauma. A mean of 66 (range 18–145) eyes were operated per surgeon. Seventy-one additional children aged > 5 years were operated by other surgeons. There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country. Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 h. Conclusion Despite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped pediatric ophthalmology teams are urgently required, with deployment to under-served areas.
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Chan VF, Yong AC, Azuara-Blanco A, Gordon I, Safi S, Lingham G, Evans J, Keel S. A Systematic Review of Clinical Practice Guidelines for Infectious and Non-infectious Conjunctivitis. Ophthalmic Epidemiol 2021; 29:473-482. [PMID: 34459321 DOI: 10.1080/09286586.2021.1971262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To systematically review and critically appraise clinical practice guidelines (CPGs) and summarise the recommendations for non-infectious and infectious conjunctivitis. METHODS CPGs published on non-infectious and infectious conjunctivitis between 2010 and March 2020 were reviewed, evaluated, and selected using nine items from the Appraisal of Guidelines for Research and Evaluation II tool (4, 7, 8, 10, 12, 13, 15, 22 and 23). CPGs with an average score for items 4, 7, 8, 12, or 22 below 3 and/or a sum of the two researchers' average score for all nine items less than 45 were excluded. Two authors independently extracted and validated the data using standardised forms. RESULTS Fifteen CPGs from five sources remained for data extraction. CPGs consistently recommended non-pharmacological interventions (artificial tears, cold compress, avoidance or removal of allergens) for non-infectious conjunctivitis and pharmacological interventions (topical anti-histamine, mast-cell stabiliser and dual-acting agent) for allergy types. Observation without treatment was strongly recommended for non-herpetic viral and bacterial infections. Systemic and topical anti-viral was consistently recommended for herpetic viral conjunctivitis, while systemic and topical antibiotics were recommended for chlamydial and gonorrhoeal conjunctivitis. The methods used to assess the level of evidence and the strength of recommendation varied among CPGs. CONCLUSIONS There are a number of high-quality CPGs for non-infectious and infectious conjunctivitis. While there were a number of consistencies in the recommendations provided within these CPGs, several inconsistencies were also identified. Many of which related to the scope of practise of the targeted end-user of the particular guideline.
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Affiliation(s)
- Ving Fai Chan
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK.,College of Health Sciences, University KwaZulu Natal, Durban, South Africa
| | - Ai Chee Yong
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | | | - Iris Gordon
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sare Safi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Who Collaborating Centre for the Eye Care and Prevention of Blindness, Iran
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Jennifer Evans
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stuart Keel
- Department of Noncommunicable Diseases, Vision and Blindness Prevention Programme, World Health Organization, Geneva, Switzerland
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Yoshizaki M, Ramke J, Zhang JH, Aghaji A, Furtado JM, Burn H, Gichuhi S, Dean WH, Congdon N, Burton MJ, Buchan J. How can we improve the quality of cataract services for all? A global scoping review. Clin Exp Ophthalmol 2021; 49:672-685. [PMID: 34291550 DOI: 10.1111/ceo.13976] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cataract is a leading cause of blindness and vision impairment globally. Cataract surgery is one of the most frequently performed operations worldwide, but good quality services are not universally available. This scoping review aims to summarise the nature and extent of published literature on interventions to improve the quality of services for age-related cataract globally. METHODS We used the dimensions of quality adopted by WHO-effectiveness, safety, people-centredness, timeliness, equity, integration and efficiency-to which we added planetary health. On 17 November 2019, we searched MEDLINE, Embase and Global Health for manuscripts published since 1990, without language or geographic restrictions. We included studies that reported quality-relevant interventions and excluded studies focused on technical aspects of surgery or that only involved children (younger than 18 years). Screening of titles/abstracts, full-text review and data extraction were performed by two reviewers independently. Studies were grouped thematically and results synthesised narratively. RESULTS Most of the 143 included studies were undertaken in high-income countries (n = 93, 65%); 29 intervention groups were identified, most commonly preoperative education (n = 17, 12%) and pain/anxiety management (n = 16, 11%). Efficiency was the quality element most often assessed (n = 58, 41%) followed by people-centredness (n = 40, 28%), while integration (n = 4) and timeliness (n = 3) were infrequently reported, and no study reported outcomes related to planetary health. CONCLUSION Evidence on interventions to improve quality of cataract services shows unequal regional distribution. There is an urgent need for more evidence relevant to low- and middle-income countries as well as across all quality elements, including planetary health.
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Affiliation(s)
- Miho Yoshizaki
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Justine H Zhang
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ada Aghaji
- Department of Ophthalmology, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, United Kingdom
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Nathan Congdon
- Centre for Public Health, Queens University Belfast, Belfast, United Kingdom.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Orbis International, New York, USA
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Moorfields Eye Hospital, London, United Kingdom
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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20
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Evans JR, Gordon I, Lawrenson JG, Parker R, Rowe FJ, Virgili G, Li T, Ramke J. Identifying priority review questions for Cochrane Eyes and Vision: protocol for a priority setting exercise. BMJ Open 2021; 11:e046319. [PMID: 34172546 PMCID: PMC8237719 DOI: 10.1136/bmjopen-2020-046319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cochrane Eyes and Vision (CEV) is an international network of individuals working to prepare, maintain and promote access to systematic reviews of interventions to treat, prevent or diagnose eye diseases or vision impairment. CEV plans to undertake a priority setting exercise to identify systematically research questions relevant to our scope, and to formally incorporate input from a wide range of stakeholders to set priorities for new and updated reviews. METHODS AND ANALYSIS The scope of CEV is broad and our reviews include conditions that are common and have a high global disease burden, for example, cataract and dry eye disease, and conditions that are rare but have a high impact on quality of life and high individual cost such as eye cancer. We plan to focus on conditions prioritised by WHO during the development of the Package of Eye Care Interventions. These conditions were selected based on a combination of data on disease magnitude, healthcare use and expert opinion. We will identify priority review questions systematically by summarising relevant data on research in Eyes and Vision from a range of sources, and compiling a list of 10-15 potential review questions (new and/or updates) for each condition group. We will seek the views of external and internal stakeholders on this list by conducting an online survey. Equity will be a specific consideration. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of the London School of Hygiene & Tropical Medicine. We will disseminate the findings through Cochrane channels and prepare a summary of the work for publication in a peer-reviewed journal.
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Affiliation(s)
- Jennifer R Evans
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Iris Gordon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - John G Lawrenson
- Centre for Applied Vision Research, School of Health Sciences, City, University of London, London, UK
| | - Roses Parker
- Cochrane MOSS Network, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Gianni Virgili
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Department of Surgery and Translational Medicine, University of Florence, Firenze, Toscana, Italy
| | - Tianjing Li
- Anschutz Medical Campus, University of Colorado, Denver, Colorado, USA
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
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Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021; 9:e489-e551. [PMID: 33607016 PMCID: PMC7966694 DOI: 10.1016/s2214-109x(20)30488-5] [Citation(s) in RCA: 523] [Impact Index Per Article: 174.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Damodar Bachani
- John Snow India, New Delhi, India; Ministry of Health and Family Welfare, New Delhi, India
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Tasanee Braithwaite
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; The Medical Eye Unit, St Thomas' Hospital, London, UK
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chimgee Chuluunkhuu
- Orbis International, Ulaanbaatar, Mongolia; Mongolian Ophthalmology Society, Ulaanbaatar, Mongolia
| | | | | | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alastair K Denniston
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Emerson
- International Trachoma Initiative and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - João M Furtado
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Eyu-Ethiopia Eye Health Research, Training, and Service Centre, Bahirdar, Ethiopia
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Peng Tee Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Van C Lansingh
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico; Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico; Help Me See, New York, NY, USA
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Milka M Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lizette Mowatt
- University Hospital of the West Indies, Kingston, Jamaica
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Indian Institute of Public Health, Hyderabad, India
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kenya Medical Training College, Nairobi, Kenya
| | - Daksha B Patel
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Solange R Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Bernadetha R Shilio
- Department of Curative Services, Ministry of Health Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nation, New York, NY, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Vision Institute, University of New South of Wales, Sydney, Australia
| | | | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria; Africa Vision Research Institute, Durban, South Africa
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Mueller A, Keel S, Cieza A. Primary eye care: the WHO perspective. COMMUNITY EYE HEALTH 2021; 34:88. [PMID: 36033413 PMCID: PMC9412123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Andreas Mueller
- Consultant: Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
| | - Stuart Keel
- Technical officer: Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
| | - Alarcos Cieza
- Unit Head: Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
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