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Taylor DJ, Alquiza PJ, Jones PR, Wilson I, Bi W, Sim DA, Crabb DP. Tablet-based tests of everyday visual function in a diabetic macular oedema (DME) clinic waiting area: A feasibility study. Ophthalmic Physiol Opt 2024; 44:388-398. [PMID: 38131130 DOI: 10.1111/opo.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE (1) To assess the feasibility of conducting tablet-based vision tests in hospital clinic waiting areas; (2) To test the hypothesis that increasing severity of diabetic macular oedema (DME) is associated with the performance of tablet-based surrogates of everyday tasks and self-reported visual function. METHODS Sixty-one people with mild (n = 28), moderate (n = 24) or severe (n = 9) DME performed two tablet-based tests of 'real-world' visual function (visual search and face recognition) while waiting for appointments in a hospital outpatient clinic. Participants also completed a tablet-based version of a seven-item, visual-functioning (VF-7) patient-reported outcome measure. Test performance was compared to previously published 99% normative limits for normally sighted individuals. RESULTS Thirty-four participants (56%; 95% confidence interval [CI] 43%-68%) exceeded normative limits for visual search, while eight (13%; 95% CI 65%-24%) exceeded normative limits for face discrimination. Search duration was significantly longer for people with severe DME than those with mild and moderate DME (p = 0.01). Face discrimination performance was not significantly associated with DME severity. VF-7 scores were statistically similar across DME severity groups. Median time to complete all elements (eligibility screening, both tablet-based tasks and the VF-7) was 22 (quartiles 19, 25) min. Further, 98% and 87% of participants, respectively, reported the search task and face discrimination task to be enjoyable, while 25% and 97%, respectively, reported finding the two tasks to be difficult. CONCLUSIONS Portable tablet-based tests are quick, acceptable to patients and feasible to be performed in a clinic waiting area with minimal supervision. They have the potential to be piloted in patients' homes for self-monitoring.
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Affiliation(s)
- Deanna J Taylor
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | | | - Pete R Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Iain Wilson
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Wei Bi
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Dawn A Sim
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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Jones L, Callaghan T, Campbell P, Jones PR, Taylor DJ, Asfaw DS, Edgar DF, Crabb DP. Acceptability of a home-based visual field test (Eyecatcher) for glaucoma home monitoring: a qualitative study of patients' views and experiences. BMJ Open 2021; 11:e043130. [PMID: 33820785 PMCID: PMC8030466 DOI: 10.1136/bmjopen-2020-043130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To explore the acceptability of home visual field (VF) testing using Eyecatcher among people with glaucoma participating in a 6-month home monitoring pilot study. DESIGN Qualitative study using face-to-face semistructured interviews. Transcripts were analysed using thematic analysis. SETTING Participants were recruited in the UK through an advertisement in the International Glaucoma Association (now Glaucoma UK) newsletter. PARTICIPANTS Twenty adults (10 women; median age: 71 years) with a diagnosis of glaucoma were recruited (including open angle and normal tension glaucoma; mean deviation=2.5 to -29.9 dB). RESULTS All participants could successfully perform VF testing at home. Interview data were coded into four overarching themes regarding experiences of undertaking VF home monitoring and attitudes towards its wider implementation in healthcare: (1) comparisons between Eyecatcher and Humphrey Field Analyser (HFA); (2) capability using Eyecatcher; (3) practicalities for effective wider scale implementation; (4) motivations for home monitoring. CONCLUSIONS Participants identified a broad range of benefits to VF home monitoring and discussed areas for service improvement. Eyecatcher was compared positively with conventional VF testing using HFA. Home monitoring may be acceptable to at least a subset of people with glaucoma.
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Affiliation(s)
- Lee Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Tamsin Callaghan
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Pete R Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Daniel S Asfaw
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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Invernizzi A, Haykal S, Lo Faro V, Pennisi V, Choritz L. Influence of electromagnetic radiation emitted by daily-use electronic devices on the Eyemate® system in-vitro: a feasibility study. BMC Ophthalmol 2020; 20:357. [PMID: 32867712 PMCID: PMC7461327 DOI: 10.1186/s12886-020-01623-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eyemate® is a system for the continual monitoring of intraocular pressure (IOP), composed of an intraocular sensor, and a hand-held reader device. As the eyemate®-IO sensor communicates with the hand-held reader telemetrically, some patients might fear that the electronic devices that they use on a daily basis might somehow interfere with this communication, leading to unreliable measurements of IOP. In this study, we investigated the effect of electromagnetic radiation produced by a number of everyday electronic devices on the measurements made by an eyemate®-IO sensor in-vitro, in an artificial and controlled environment. METHODS The eyemate®-IO sensor was suspended in a sterile 0.9% sodium chloride solution and placed in a water bath at 37 °C. The antenna, connected to a laptop for recording the data, was positioned at a fixed distance of 1 cm from the sensor. Approximately 2 hrs of "quasi-continuous" measurements were recorded for the baseline and for a cordless phone, a smart-phone and a laptop. Repeated measures ANOVA was used to compare any possible differences between the baseline and the tested devices. RESULTS For baseline measurements, the sensor maintained a steady-state, resulting in a flat profile at a mean pressure reading of 0.795 ± 0.45 hPa, with no apparent drift. No statistically significant difference (p = 0.332) was found between the fluctuations in the baseline and the tested devices (phone: 0.76 ± 0.41 hPa; cordless: 0.787 ± 0.26 hPa; laptop: 0.775 ± 0.39 hPa). CONCLUSION In our in-vitro environment, we found no evidence of signal drifts or fluctuations associated with the tested devices, thus showing a lack of electromagnetic interference with data transmission in the tested frequency ranges.
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Affiliation(s)
- Azzurra Invernizzi
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700, Groningen, RB, Netherlands.
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands.
| | - Shereif Haykal
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700, Groningen, RB, Netherlands
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | - Valeria Lo Faro
- Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700, Groningen, RB, Netherlands
| | - Vincenzo Pennisi
- Department of Ophthalmology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Lars Choritz
- Department of Ophthalmology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
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Abstract
In clinical glaucoma research, the measurement of patient reported outcomes, functional assessment of disability, and health economic impact is critical. However, valid, time-efficient and comprehensive tools are not available and several current instruments lack in the appropriate precision for measuring the various dimensions of glaucoma-related quality of life (QoL), including functioning and mobility. Furthermore, statistical methods are inconsistently and sometimes incorrectly used in otherwise sound clinical studies. Standardizing and improving methods of patient-centered data collection and analysis in glaucoma studies are imperative. This paper outlines recommendations and provides a discussion of some of the pertinent issues relating to the optimization of patient-reported outcomes research in glaucoma.
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Beyond intraocular pressure: Optimizing patient-reported outcomes in glaucoma. Prog Retin Eye Res 2019; 76:100801. [PMID: 31676347 DOI: 10.1016/j.preteyeres.2019.100801] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/02/2023]
Abstract
Glaucoma, an irreversible blinding condition affecting 3-4% adults aged above 40 years worldwide, is set to increase with a rapidly aging global population. Raised intraocular pressure (IOP) is a major risk factor for glaucoma where the treatment paradigm is focused on managing IOP using medications, laser, or surgery regimens. However, notwithstanding IOP and other clinical parameters, patient-reported outcomes, including daily functioning, emotional well-being, symptoms, mobility, and social life, remain the foremost concerns for people being treated for glaucoma. These outcomes are measured using objective patient-centered outcome measures (PCOMs) and subjective patient-reported outcome measures (PROMs). Studies using PCOMs have shown that people with glaucoma have several mobility, navigational and coordination challenges; reading and face recognition deficits; and are slower in adapting to multiple real-world situations when compared to healthy controls. Similarly, studies have consistently demonstrated, using PROMs, that glaucoma substantially and negatively impacts on peoples' self-reported visual functioning, mobility, independence, emotional well-being, self-image, and confidence in healthcare, compared to healthy individuals, particularly in those with late-stage disease undergoing a heavy treatment regimen. The patient-centred effectiveness of current glaucoma treatment paradigms is equivocal due to a lack of well-designed randomized controlled trials; short post-treatment follow-up periods; an inappropriate selection or availability of PROMs; and/or an insensitivity of currently available PROMs to monitor changes especially in patients with newly diagnosed early-stage glaucoma. We provide a comprehensive, albeit non-systematic, critique of the psychometric properties, limitations, and recent advances of currently available glaucoma-specific PCOMs and PROMs. Finally, we propose that item banking and computerized adaptive testing methods can address the multiple limitations of paper-pencil PROMs; customize their administration; and have the potential to improve healthcare outcomes for people with glaucoma.
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Fraenkel A, Lee GA, Vincent SJ, Vincent RA, Bourne RRA, Shah P. Lessons learned from the development and implementation of a patient-reported outcome and experience measure (POEM) in an Australian glaucoma practice. BMC Ophthalmol 2019; 19:192. [PMID: 31438884 PMCID: PMC6704624 DOI: 10.1186/s12886-019-1198-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/13/2019] [Indexed: 11/13/2022] Open
Abstract
Background A patient’s perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life. Methods Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient’s understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised. Results Two hundred and two patients (M:F 91:111) participated in the study. Mean ± standard deviation for subject age was 69 ± 13 years. Patient’s overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye. Conclusions The modified POEM demonstrates potential to capture the concerns of a practice’s glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.
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Affiliation(s)
- Alison Fraenkel
- City Eye Centre, 10/135 Wickham Terrace, Brisbane, Queensland, 4000, Australia
| | - Graham A Lee
- City Eye Centre, 10/135 Wickham Terrace, Brisbane, Queensland, 4000, Australia. .,University of Queensland, Brisbane, Queensland, Australia.
| | | | - Roslyn A Vincent
- City Eye Centre, 10/135 Wickham Terrace, Brisbane, Queensland, 4000, Australia
| | | | - Peter Shah
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Ophthalmology, University College London, London, UK.,Centre for Health & Social Care Improvement, University of Wolverhampton, Wolverhampton, UK
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Peterson KM, Huisingh CE, Girkin C, Owsley C, Rhodes LA. Patient satisfaction with care in an urban tertiary referral academic glaucoma clinic in the US. Patient Prefer Adherence 2018; 12:775-781. [PMID: 29785092 PMCID: PMC5953314 DOI: 10.2147/ppa.s162439] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the factors associated with glaucoma patients' satisfaction with their medical care by fellowship-trained glaucoma specialists in an urban tertiary referral clinic in the US. METHODS A total of 110 established patients aged ≥60 years with a diagnosis of either primary open angle glaucoma, glaucoma suspect, or ocular hypertension monitored by an ophthalmologist with fellowship training in glaucoma were enrolled at an academic, urban, tertiary referral eye clinic. Enrolled patients were administered a general demographics questionnaire along with a Patient Satisfaction Questionnaire-18 (PSQ-18), a Likert scale validated tool. The seven dimensions of patient satisfaction from the PSQ-18 were summarized for the sample overall and by the patients' age, race, employment status, education level, distance travelled from home address to clinic, and glaucoma therapy type. Two-sample t-tests were used to compare group means. Spearman correlation coefficients were used to correlate satisfaction scores with peripheral vision and visual acuity function. RESULTS Overall, the general satisfaction scores were high (mean 4.62). Patients ≥70 years of age had lower general satisfaction with their care (mean 4.5 vs 4.8, p=0.03), the interpersonal manner of their appointment (mean 4.7 vs 4.9, p=0.009), and with their time spent with their doctor (mean 4.4 vs 4.7, p=0.03) than patients aged 60-69 years. Non-European descent patients (47% African descent and 1% other of sample) were more satisfied with the time they spent with the doctor (mean 4.7 vs 4.4, p=0.04) and with the communication during the appointment (mean 4.8 vs 4.6, p=0.04) than European descent patients (52% of sample). Patients with a higher level of education (>high school degree) were less satisfied with the accessibility and convenience of the appointment (mean 4.3 vs ≤ high school, 4.6, p=0.02). There were no statistically significant differences in patient satisfaction based upon employment status, distance travelled to clinic, prior glaucoma therapy, or visual function. CONCLUSION Overall, across all dimensions of the PSQ-18, patients were highly satisfied with the care they received at the urban tertiary care glaucoma clinic.
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Affiliation(s)
- Kristen M Peterson
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carrie E Huisingh
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lindsay A Rhodes
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Correspondence: Lindsay A Rhodes, Department of Ophthalmology, University of Alabama at Birmingham, EFH 601, 1720 2nd Avenue South, Birmingham, AL 35294, USA, Tel +1 205 325 8635, Fax +1 205 325 8692, Email
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