scholarly journals Smartphone-Guided Algorithms for Use by Community Volunteers to Screen and Refer People With Eye Problems in Trans Nzoia County, Kenya: Development and Validation Study

10.2196/16345 ◽  
2020 ◽  
Vol 8 (6) ◽  
pp. e16345 ◽  
Author(s):  
Hillary Rono ◽  
Andrew Bastawrous ◽  
David Macleod ◽  
Cosmas Bunywera ◽  
Ronald Mamboleo ◽  
...  
Keyword(s):  
Predictive Value ◽  
Unmet Need ◽  
Local Context ◽  
Clinical Officer ◽  
Eye Care ◽  
Community Screening ◽  
Referral Decisions ◽  
Care Services ◽  
Eye Problems ◽  
Community Volunteers

Background The provision of eye care services is currently insufficient to meet the requirements of eye care. Many people remain unnecessarily visually impaired or at risk of becoming so because of treatable or preventable eye conditions. A lack of access and awareness of services is, in large part, a key barrier to handle this unmet need. Objective This study aimed to assess whether utilizing novel smartphone-based clinical algorithms can task-shift eye screening to community volunteers (CVs) to accurately identify and refer patients to primary eye care services. In particular, we developed the Peek Community Screening app and assessed its validity in making referral decisions for patients with eye problems. Methods We developed a smartphone-based clinical algorithm (the Peek Community Screening app) using age, distance vision, near vision, and pain as referral criteria. We then compared CVs’ referral decisions using this app with those made by an experienced ophthalmic clinical officer (OCO), which was the reference standard. The same participants were assessed by a trained CV using the app and by an OCO using standard outreach equipment. The outcome was the proportion of all decisions that were correct when compared with that of the OCO. Results The required sensitivity and specificity for the Peek Community Screening app were achieved after seven iterations. In the seventh iteration, the OCO identified referable eye problems in 65.9% (378/574) of the participants. CVs correctly identified 344 of 378 (sensitivity 91.0%; 95% CI 87.7%-93.7%) of the cases and correctly identified 153 of 196 (specificity 78.1%; 95% CI 71.6%-83.6%) cases as not having a referable eye problem. The positive predictive value was 88.9% (95% CI 85.3%-91.8%), and the negative predictive value was 81.8% (95% CI 75.5%-87.1%). Conclusions Development of such an algorithm is feasible; however, it requires considerable effort and resources. CVs can accurately use the Peek Community Screening app to identify and refer people with eye problems. An iterative design process is necessary to ensure validity in the local context.

scholarly journals Smartphone-Guided Algorithms for Use by Community Volunteers to Screen and Refer People With Eye Problems in Trans Nzoia County, Kenya: Development and Validation Study (Preprint)

2019 ◽  
Author(s):  
Hillary Rono ◽  
Andrew Bastawrous ◽  
David Macleod ◽  
Cosmas Bunywera ◽  
Ronald Mamboleo ◽  
...  
Keyword(s):  
Predictive Value ◽  
Unmet Need ◽  
Local Context ◽  
Clinical Officer ◽  
Eye Care ◽  
Community Screening ◽  
Referral Decisions ◽  
Care Services ◽  
Eye Problems ◽  
Community Volunteers

BACKGROUND The provision of eye care services is currently insufficient to meet the requirements of eye care. Many people remain unnecessarily visually impaired or at risk of becoming so because of treatable or preventable eye conditions. A lack of access and awareness of services is, in large part, a key barrier to handle this unmet need. OBJECTIVE This study aimed to assess whether utilizing novel smartphone-based clinical algorithms can task-shift eye screening to community volunteers (CVs) to accurately identify and refer patients to primary eye care services. In particular, we developed the Peek Community Screening app and assessed its validity in making referral decisions for patients with eye problems. METHODS We developed a smartphone-based clinical algorithm (the Peek Community Screening app) using age, distance vision, near vision, and pain as referral criteria. We then compared CVs’ referral decisions using this app with those made by an experienced ophthalmic clinical officer (OCO), which was the reference standard. The same participants were assessed by a trained CV using the app and by an OCO using standard outreach equipment. The outcome was the proportion of all decisions that were correct when compared with that of the OCO. RESULTS The required sensitivity and specificity for the Peek Community Screening app were achieved after seven iterations. In the seventh iteration, the OCO identified referable eye problems in 65.9% (378/574) of the participants. CVs correctly identified 344 of 378 (sensitivity 91.0%; 95% CI 87.7%-93.7%) of the cases and correctly identified 153 of 196 (specificity 78.1%; 95% CI 71.6%-83.6%) cases as not having a referable eye problem. The positive predictive value was 88.9% (95% CI 85.3%-91.8%), and the negative predictive value was 81.8% (95% CI 75.5%-87.1%). CONCLUSIONS Development of such an algorithm is feasible; however, it requires considerable effort and resources. CVs can accurately use the Peek Community Screening app to identify and refer people with eye problems. An iterative design process is necessary to ensure validity in the local context.

scholarly journals Peek Community Eye Health - mHealth system to increase access and efficiency of eye health services in Trans Nzoia County, Kenya: study protocol for a cluster randomised controlled trial.

2019 ◽  
Author(s):  
Hillary Rono ◽  
Andrew Bastawrous ◽  
David Macleod ◽  
Emmanuel Wanjala ◽  
Stephene Gichuhi ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Health System ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Eye Care ◽  
Community Screening ◽  
Eye Health ◽  
Cluster Randomised ◽  
Eye Problems ◽  
Randomised Controlled

Abstract Background: Globally eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services, in addition, specialist services are over utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smart phone-based screening algorithm (Peek Community Screening App). The application (app) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteer (CVs) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients and carers and has a program dashboard for visualizing service delivery. We hypothesize that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. Methods: A single masked, cluster-randomised controlled trial. The unit of randomisation will be the “community units”, defined as a dispensary or health centres with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitization, where attendance will be ascertained. During triage participants will be assessed and treated, and if necessary referred onwards to Kitale eye unit. Discussion: We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. Trial registration: The Pan African Clinical Trials Registry (PACTR), 201807329096632. Registered 8th june 2018, https://pactr.samrc.ac.za. Keywords: Eye problems, Visual Impairement, Access, Primary eye care , Community Eye Health system, Community volunteres, Peek community screening app., cluster randomised controlled trial.

scholarly journals Peek Community Eye Health - mHealth system to increase access and efficiency of eye health services in Trans Nzoia County, Kenya: study protocol for a cluster randomised controlled trial.

2019 ◽  
Author(s):  
Hillary Rono ◽  
Andrew Bastawrous ◽  
David Macleod ◽  
Emmanuel Wanjala ◽  
Stephene Gichuhi ◽  
...  
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Eye Care ◽  
Community Screening ◽  
Eye Health ◽  
Cluster Randomised ◽  
Specialist Services ◽  
Eye Problems ◽  
Randomised Controlled

Abstract Background: Globally eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services, in addition, specialist services are over utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smart phone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteer (CVs) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualizing service delivery. We hypothesize that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. Study design: A single masked, cluster-randomised controlled trial design will be used. The unit of randomisation will be the “community unit”, defined as a dispensary or health centres with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitization, where attendance will be ascertained. During triage participants will be assessed and treated, and if necessary referred onwards to Kitale eye unit. Discussion: We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. Trial registration The Pan African Clinical Trials Registry (PACTR), 201807329096632. Registered 8th June 2018, https://pactr.samrc.ac.za

scholarly journals Utilization of Secondary Eye Care Services in Western Kenya

2019 ◽  
Vol 16 (18) ◽  
pp. 3371
Author(s):  
Hillary K Rono MMed ◽  
David Macleod ◽  
Andrew Bastawrous ◽  
Emmanuel Wanjala ◽  
Michael Gichangi ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Age Groups ◽  
Unmet Need ◽  
The Elderly ◽  
Vulnerable Groups ◽  
Age Group ◽  
Attendance Rates ◽  
Care Providers ◽  
Eye Care ◽  
Care Services

Background: Eye care provision is currently insufficient to meet the population’s eye health needs in Kenya. Many people remain unnecessarily visually impaired or at risk of becoming so due to treatable or preventable conditions. A lack of access and awareness of services are key barriers, in large part due to their being too few eye care providers in the health system for this unmet need. Methods: A hospital-based, retrospective analysis of patients who attended Kitale eye unit, Trans Nzoia County, Kenya from 1st January 2013 to 31st December 2015. Age and sex standardized hospital attendance rates by residence, age group, and sex were calculated for Trans Nzoia county and each subcounty. The changing trends in attendance rates were estimated by calculating the difference between base year and last year. Incidence rate ratios for attendance for each age-group, sex, and residence were estimated using a multivariable regression model. Results: 20,695 patients from the county were seen in Kitale Eye Unit in 2013, 2014 and 2015. In that period, 8.3% had either uncorrected refractive error, cataracts or glaucoma, the priority VISION2020 diseases, and 61.0% had allergic or other conjunctivitis or normal eyes, which could potentially be managed at primary eye care. During the study period, overall average annual attendance rate increased from 609 to 792 per 100, 000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26–1.35). Attendance rates increased more in females than males (34.7% vs. 25.1%, respectively), IRR 1.07 (1.04–1.10). Attendance rates increased with increasing age, (highest among the elderly compared to the young). We found that in extreme age groups (>75 years and <15years) females were less likely to attend than males and there was reduced utilization from those based furthest from the hospital. Conclusion: Specialist eye services are heavily utilized by people with conditions that could be managed at the primary health care level. Barriers to accessing eye services were distance and gender, especially among the most vulnerable groups (young and the elderly). Integration of primary and secondary eye care services could lower barriers to essential eye care services to the population whilst lowering pressure on the limited specialist services by ensuring more appropriate utilization.

scholarly journals Utilization of eye care services by elderly persons in the northern Ethekwini district of Kwa-Zulu-Natal province, South Africa

2011 ◽  
Vol 70 (4) ◽  
Author(s):  
K. P. Mashige ◽  
C. Martin
Keyword(s):  
South Africa ◽  
Visual Impairment ◽  
World Health ◽  
Eye Drops ◽  
Elderly Persons ◽  
Eye Care ◽  
World Health Survey ◽  
Awareness Campaigns ◽  
Care Services ◽  
Eye Problems

Although most of the causes of visual impairment and blindness in the developing world are treatable, many people do not receive eye care attention. The appropriate use of eye care services is a key factor to reducing visual impairment and blindness in any community. However, eye care services are not always provided, accessible or utilized and do not always meet the needs of specific groups; one such group is older adults. The purpose of this study was to evaluate the use of eye care services in adults aged 60 years and older living in the eThekwini district of KwaZulu-Natal, South Africa. Information regarding the use of eye care services was collected from 1008 participants through a questionnaire interview using items derived from the World Health Organization multi-country World Health Survey administered by trained field workers. The participants included 77.3% females and 22.7% males. Their mean age was 68.9 ± 7.4 years (range = 60 to 103 years). Less than half (38.7%) of the participants thought that they should have their eyes tested every year. Although many (57.4%) knew where to go to get treatment for eye problems or to have their eyes tested, a significant proportion (42.5%) did not know. Almost a third (32.8%) felt that they need to get treatment for an eye problem or to have their eyes tested. Less than one third(25.2%) indicated that they last visited a health facility for an eye test 2-5 years ago. Above one third (38.3%) reported that they were told they could not see at distance, 22% reported that theywere told that they had reduced capacity to see at near, while 23.4% and 9.2% respectively were told they had had eye infections or cataracts. Of these, 59.7% stated that new glasses were recom-mended to them as treatment, 22.7% were recommended eye drops and 7.8% had cataract surgery recommended. Most (80.5%) reported that they received the recommended treatment while 19.5% reported that they did not. Of those who reported not receiving the treatment, 36.4% stated that it was due to inability to afford the treatment recommended while 29.1% stated that they were unable to get the treatment due to long waiting times.The majority of participants (86.9%) agreed that the treatment they received solved their eye problems. Knowledge about regular eye examinations and available eye care services was poor amongparticipants in this study. This suggests the need for awareness campaigns and early intervention programmes. Furthermore, cost of services had a significant influence on the affordability of eye care services among participants. (S Afr Optom 2011  

scholarly journals Eye care delivery models to improve access to eye care for Indigenous peoples in high-income countries: a scoping review

2021 ◽  
Vol 6 (3) ◽  
pp. e004484
Author(s):  
Helen Burn ◽  
Lisa Hamm ◽  
Joanna Black ◽  
Anthea Burnett ◽  
Matire Harwood ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Service Delivery ◽  
Indigenous Peoples ◽  
Indigenous Communities ◽  
High Income ◽  
Eye Care ◽  
Service Delivery Models ◽  
Care Services ◽  
Delivery Models ◽  
Improve Access

PurposeGlobally, there are ~370 million Indigenous peoples. Indigenous peoples typically experience worse health compared with non-Indigenous people, including higher rates of avoidable vision impairment. Much of this gap in eye health can be attributed to barriers that impede access to eye care services. We conducted a scoping review to identify and summarise service delivery models designed to improve access to eye care for Indigenous peoples in high-income countries.MethodsSearches were conducted on MEDLINE, Embase and Global Health in January 2019 and updated in July 2020. All study designs were eligible if they described a model of eye care service delivery aimed at populations with over 50% Indigenous peoples. Two reviewers independently screened titles, abstracts and full-text articles and completed data charting. We extracted data on publication details, study context, service delivery interventions, outcomes and evaluations, engagement with Indigenous peoples and access dimensions targeted. We summarised findings descriptively following thematic analysis.ResultsWe screened 2604 abstracts and 67 studies fulfilled our eligibility criteria. Studies were focused on Indigenous peoples in Australia (n=45), USA (n=11), Canada (n=7), New Zealand (n=2), Taiwan (n=1) and Greenland (n=1). The main disease focus was diabetic retinopathy (n=30, 45%), followed by ‘all eye care’ (n=16, 24%). Most studies focused on targeted interventions to increase availability of services. Fewer than one-third of studies reported involving Indigenous communities when designing the service. 41 studies reflected on whether the model improved access, but none undertook rigorous evaluation or quantitative assessment.ConclusionsThe geographical and clinical scope of service delivery models to improve access to eye care for Indigenous peoples in high-income countries is narrow, with most studies focused on Australia and services for diabetic retinopathy. More and better engagement with Indigenous communities is required to design and implement accessible eye care services.

scholarly journals Impact on refractive surgery due to increasing use of personal protection equipment: Insights from EUROCOVCAT group

2021 ◽  
pp. 112067212110186
Author(s):  
Arthur B Cummings ◽  
Cian Gildea ◽  
Antoine P Brézin ◽  
Boris E Malyugin ◽  
Ozlem Evren Kemer ◽  
...  
Keyword(s):  
Refractive Surgery ◽  
Unmet Need ◽  
World Health ◽  
Eye Care ◽  
Personal Protection Equipment ◽  
Social Distancing ◽  
Vision Correction ◽  
Emerging Issues ◽  
Health Organization ◽  
Motivating Factor

Since the World Health Organization declared COVID-19 to be a pandemic on 11th March 2020, changes to social and sanitary practices have included significant issues in access and management of eye care during the COVID-19 pandemic. Additionally, the fear of loss, coupled with social distancing, lockdown, economic instability, and uncertainty, have led to a significant psychosocial impact that will have to be addressed. In the current COVID-19 pandemic, personal protective equipment such as face masks or face coverings have become a daily necessity. While “mass masking” along with hand hygiene and social distancing became more widespread, new issues began to emerge – particularly in those who wore spectacles as a means of vision correction. As we began to see routine patients again after the first lockdown had been lifted, many patients visited our clinics for refractive surgery consultations with a primary motivating factor of wanting spectacle independence due to the fogging of their spectacles as a result of wearing a mask. In this article, we report on new emerging issues in eye care due to the widespread use of masks and on the new unmet need in the corneal and cataract refractive surgery fields.

scholarly journals Public Awareness regarding the Differences between Ophthalmologists and Optometrists among Saudi Adults Living in Riyadh: A Quantitative Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Mohammed Hamad Aldebasi ◽  
Nasser Abdalazez Alsobaie ◽  
Abdulrahman Yousef Aldayel ◽  
Khalid Mousa Alwusaidi ◽  
Tariq Alasbali
Keyword(s):  
Saudi Arabia ◽  
Public Awareness ◽  
Multivariate Logistic Regression Analysis ◽  
Public Knowledge ◽  
Multivariate Logistic Regression ◽  
Eye Care ◽  
Online Questionnaire ◽  
Awareness Campaign ◽  
Care Services ◽  
Population Education

Awareness of the patients to the differences between ophthalmologists and optometrists has been recognized as an important factor influencing patient utilization of available eye care services. This study aimed at assessing the public’s knowledge of the differences between ophthalmologists and optometrists among the residents of Riyadh, Saudi Arabia. An online questionnaire was administered to adults in Riyadh, Saudi Arabia, from January to February in 2018. The number of the respondents was 1579. Results show that 50% (n=789) of the participants had fair knowledge of the differences between ophthalmologists and optometrists, while 32% (n=505) had poor knowledge. After multivariate logistic regression analysis, there was a significant association between satisfactory knowledge and visiting an optometrist (odds ratio (OR): 0.75, 95% CI: 0.57–0.98), age older than 26 (OR: 1.73, 95% CI: 1.17–1.19), higher level of education (OR: 1.92, 95% CI: 1.54–2.4), and wearing spectacles (OR: 0.57, 95% CI: 0.45–0.73). Given the low level of public knowledge regarding the differences in the duties between ophthalmologist and optometrists among a Saudi population, there is great potential for general population education through awareness campaign and social media regarding eye care provider’s duties and practices.

scholarly journals Perception of Eye Care Services among Patients Attending Mercy Eye Centre, Abak

2017 ◽  
Vol 7 (2) ◽  
Author(s):  
Chinawa Ndubuisi Elijah
Keyword(s):  
Eye Care ◽  
Care Services
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