1
|
Labkovich M, Paul M, Kim E, A. Serafini R, Lakhtakia S, Valliani AA, Warburton AJ, Patel A, Zhou D, Sklar B, Chelnis J, Elahi E. Portable hardware & software technologies for addressing ophthalmic health disparities: A systematic review. Digit Health 2022; 8:20552076221090042. [PMID: 35558637 PMCID: PMC9087242 DOI: 10.1177/20552076221090042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Vision impairment continues to be a major global problem, as the WHO estimates 2.2 billion people struggling with vision loss or blindness. One billion of these cases, however, can be prevented by expanding diagnostic capabilities. Direct global healthcare costs associated with these conditions totaled $255 billion in 2010, with a rapid upward projection to $294 billion in 2020. Accordingly, WHO proposed 2030 targets to enhance integration and patient-centered vision care by expanding refractive error and cataract worldwide coverage. Due to the limitations in cost and portability of adapted vision screening models, there is a clear need for new, more accessible vision testing tools in vision care. This comparative, systematic review highlights the need for new ophthalmic equipment and approaches while looking at existing and emerging technologies that could expand the capacity for disease identification and access to diagnostic tools. Specifically, the review focuses on portable hardware- and software-centered strategies that can be deployed in remote locations for detection of ophthalmic conditions and refractive error. Advancements in portable hardware, automated software screening tools, and big data-centric analytics, including machine learning, may provide an avenue for improving ophthalmic healthcare.
Collapse
Affiliation(s)
- Margarita Labkovich
- Department of Medical Education, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Megan Paul
- Department of Medical Education, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Eliott Kim
- Department of Medical Education, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Randal A. Serafini
- Department of Medical Education, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
- Nash Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | | | - Aly A Valliani
- Department of Medical Education, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Andrew J Warburton
- Department of Medical Education, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Aashay Patel
- Department of Medical Education, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Davis Zhou
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount
Sinai, New York, NY, USA
| | - Bonnie Sklar
- Department of Ophthalmology, Wills Eye Hospital, Philadelphia, PA, USA
| | - James Chelnis
- Department of Ophthalmology, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Ebrahim Elahi
- Department of Ophthalmology, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| |
Collapse
|
2
|
Poole KJ, Derouin A, Yap TL, Thompson JA. Implementation of Photoscreening to Improve the Preschool Vision Screening Process. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
3
|
Kapoor V, Shah SP, Beckman T, Gole G. Community based vision screening in preschool children; performance of the Spot Vision Screener and optotype testing. Ophthalmic Epidemiol 2021; 29:417-425. [PMID: 34423736 DOI: 10.1080/09286586.2021.1962918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children's vision screening children commonly uses optotype-based visual acuity or instrument-based methods measuring amblyogenic risk factors (ARFs). OBJECTIVE To compare the performance of the Spot Vision Screener (SVS) (PediaVision, Welch Allyn, NY) and a nurse-administered visual acuity screen (NVAS) in identifying ARFs and decreased visual acuity. METHODS A prospective, cross-sectional population-based study of preschool children in South-East Queensland, Australia. Eligible participants had both forms of screening by trained community nurses. All children with an abnormal result by either method as well as a cohort of randomly selected children who passed both assessments were assessed at a tertiary paediatric ophthalmology clinic. RESULTS Over a 10 month period, 2237 children (mean age; 64.4 ± 4.0 months) were screened from 38 schools. 6.4% of children failed SVS and 8.3% failed NVAS (with 3.8% overlap, failing both). The positive predictive value (PPV) in identifying either ARFs and/or reduced VA for the SVS and NVAS was 70.4% (95% Confidence Interval (CI): 61.6%-78.2%) and 60.5% (95% CI: 52.6%-67.9%) respectively. Highest PPV to detect either ARFs and/or reduced VA was achieved by a 'hybrid' method by combining failed NVAS and failed SVS: 91.0% (95% CI: 82.4 to 96.3) but this would risk children with sight impairment being missed in the community. CONCLUSION To our knowledge, this is the first population-based study providing detailed comparative measures of diagnostic accuracy for NVAS and SVS in preschool children. One in ten preschool children failed one or both screens. A number of children who required ophthalmic intervention were missed if only one screening method was utilized.
Collapse
Affiliation(s)
- Vishal Kapoor
- Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.,Department of Paediatric Medicine, QLD Children's Hospital, Brisbane, Australia
| | - Shaheen P Shah
- Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.,Department of Ophthalmology, QLD Children's Hospital, Brisbane, Australia
| | - Timothy Beckman
- Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.,Department of Ophthalmology, QLD Children's Hospital, Brisbane, Australia
| | - Glen Gole
- Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.,Department of Ophthalmology, QLD Children's Hospital, Brisbane, Australia
| |
Collapse
|
4
|
Vernacchio L, Trudell EK, McLaughlin SR, Bhambhani V. Effect of Instrument-Based Vision Screening for 3- to 5-Year-Old Children on Referrals to Eye Care Specialists. Clin Pediatr (Phila) 2019; 58:541-546. [PMID: 30781998 DOI: 10.1177/0009922819832020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recently, several professional groups have recommended a change from chart-based to instrument-based screening for preschool-age children, but the effect of this change on health care utilization is unknown. We performed a secondary analysis of a site-randomized quality improvement project on transitioning from chart-based to instrument-based vision screening for 3- to 5-year-old children in primary care. We analyzed visit rates to ophthalmologists and optometrists and costs of such care before and after implementation of instrument-based vision screening with comparison to nonparticipating practices. The implementation of instrument-based vision screening resulted in a decrease in visits to eye care specialists from 83.1 visits per 1000 children per year to 55.0, a reduction of 33.8%; no comparable reduction was seen in nonparticipating practices. The cost of services by eye care specialists fell from $65 715 per 1000 children per year prior to $55 740, a decline of 15.2%; similar costs among control practices rose 13.4%.
Collapse
Affiliation(s)
- Louis Vernacchio
- 1 Pediatric Physicians' Organization at Children's, Brookline, MA, USA.,2 Boston Children's Hospital, Boston, MA, USA.,3 Harvard Medical School, Boston, MA, USA
| | - Emily K Trudell
- 1 Pediatric Physicians' Organization at Children's, Brookline, MA, USA
| | | | - Vijeta Bhambhani
- 4 Children's Hospital Integrated Care Organization, Boston, MA, USA
| |
Collapse
|
5
|
Harvey EM, Miller JM, Davis AL, Twelker JD, Dennis LK. Spectacle Wear in Toddlers: Frequency of Wear and Impact of Treatment on the Child and Family. Transl Vis Sci Technol 2019; 7:43. [PMID: 30619663 PMCID: PMC6314227 DOI: 10.1167/tvst.7.6.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/19/2018] [Indexed: 12/05/2022] Open
Abstract
Purpose We assessed the frequency of spectacle wear and impact of spectacle treatment in toddlers. Methods Children 12 to <36 months old with significant refractive error were provided spectacles. After 12 (±6) weeks, parents reported the frequency of spectacle wear and completed the Amblyopia Treatment Index (ATI, modified for spectacle treatment). Factor analysis assessed usefulness of ATI for spectacle treatment. Spectacle wear and ATI results were compared across age (1- vs. 2-year-olds) and sex. Results Participants were 91 children (60% male; mean age, 22.98 [SD 6.24] months, 41 1- and 50 2-year-olds) prescribed spectacles for astigmatism (92%), hyperopia (9%), or myopia (1%). Reported frequency of wear was low (<2 hours/day) in 41%, moderate in 23% (2 to <6 hours/day), and high (≥6 hours/day) in 36% and did not differ across age or sex. ATI factor analysis identified three subscales: adverse effects, treatment compliance, and perceived benefit. One-year-olds had poorer scores on adverse effects (P = 0.026) and treatment compliance scales (P = 0.049). Low frequency of spectacle wear was associated with poorer scores on treatment compliance (P < 0.001) and perceived benefit scales (P = 0.004). Conclusions Frequency of spectacle wear was not related to age or sex. Younger children may have more difficulty adjusting to treatment. Parents of children with low spectacle wear reported less perceived benefit of treatment. Translational Relevance Data on factors associated with frequency of spectacle wear in toddlers is valuable for parents and clinicians and may lead to methods to improve compliance and reduce the negative impact of treatment.
Collapse
Affiliation(s)
- Erin M Harvey
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ, USA
| | - Joseph M Miller
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ, USA.,College of Public Health, University of Arizona, Tucson, AZ, USA.,College of Optical Sciences, University of Arizona, Tucson, AZ, USA
| | - Amy L Davis
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ, USA
| | - J Daniel Twelker
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ, USA
| | - Leslie K Dennis
- College of Optical Sciences, University of Arizona, Tucson, AZ, USA
| |
Collapse
|