Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review

INTRODUCTION@#Teleophthalmology may assist the healthcare sector in adapting to limitations imposed on clinical practice by a viral pandemic. A scoping review is performed in this study to assess the current applications of teleophthalmology for its suitability to diagnose, monitor or manage ophthalmological conditions with accuracy.@*METHODS@#A search of PubMed was conducted for teleophthalmology-related articles published from 1 January 2018 to 4 May 2020. Only articles that focused on the use of teleophthalmology in terms of diagnosis and management, as well as its benefits and detriments, were included. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included articles.@*RESULTS@#A total of 38 articles were assessed at the full-text level. There were 2 qualitative studies and 1 quantitative randomised controlled trial, while the majority were either quantitative descriptive studies (19, 50.0%) or quantitative non-randomised studies (16, 42.1%). Overall, 8 studies described reducing manpower requirements, 4 described reducing direct patient-doctor contact, 17 described storage of medical imaging and clinical data, and 9 described real-time teleconferencing. The MMAT analysis revealed limitations in appropriate sampling strategy in both quantitative non-randomised studies (9 of 16, 56.3%) and quantitative descriptive studies (9 of 19, 47.4%). Cost-effectiveness of teleophthalmology was not performed in any included study.@*CONCLUSION@#This current review of the various aspects of teleophthalmology describes how it may potentially assist the healthcare sector to cope with the limitations imposed by a viral pandemic through technology. Further research is required to evaluate the cost-effectiveness of the various strategies.

Unidades de atención primaria en oftalmología en Chile: historia y funciones / History and functions of Chilean ophthalmologic primary care units

The access to ophthalmological care in Chile has been historically a problem. Only at the end of the twentieth century concrete solutions were promoted. In 1960, Primary Care Ophthalmologic Units were created to ease the access to ophthalmology, due to the efforts of Professor Juan Arentsen. Their functioning was organized and standardized subsequently using a model proposed by the Chilean Ophthalmologic Society, leading to a better patient flow and reducing waiting lists. These units became an innovative initiative to reduce the gaps in Chilean public health, optimizing the professional and infrastructural assets of the public health care system and achieving a new organization for the ophthalmological health care net.

Changing Trends in Surgery for Retinal Detachment in Korea

PURPOSE: To analyze trends in rhegmatogenous retinal detachment (RRD) surgery among the members of the Korean Retina Society from 2001 to 2013. METHODS: In 2013, surveys were conducted by email and post to investigate the current practice patterns regarding RRD treatment. Questions included how surgeons would manage six cases of hypothetical RRD. Results were compared to those reported in 2001. RESULTS: A total of 133 members (60.7%) in 2013 and 46 members(79.3%) in 2001 responded to the survey. Preference for pneumatic retinopexy has decreased in uncomplicated primary RRD (p = 0.004). More respondents in 2013 selected vitrectomy as the primary procedure when mild vitreous hemorrhage (p = 0.001), myopia (p = 0.044) and history of successful scleral buckling on the fellow eye (p = 0.044) were added to the primary scenario. Vitrectomy was over twice as popular in cases of pseudophakic, macula-off RRD with posterior capsular opacity (p = 0.001). CONCLUSIONS: For RRD with myopia, pseudophakia and media opacity, surgical interventions over the last decade have drastically shifted from scleral buckling and pneumatic retinopexy to vitrectomy.

Sistema de aseguramiento de calidad en un servicio de oftalmología / Quality assurance system in ophthalmology

En la actualidad, la población muestra una expectativa y una demanda crecientes en lo que respecta a recibir una buena calidad en servicios de atención médica. Esta realidad es percibida como una condición importante a satisfacer en el mercado por las instituciones que brindan algún tipo de servicio de salud y que buscan diferenciarse para captar más pacientes y mejores clientes (obras sociales, instituciones, etc.). Éstas empresas toman éste requisito como dato de entrada para sus procesos de modo tal que el paciente obtenga como resultado una prestación del servicio acorde a sus expectativas. Ante esta realidad, no solo debe hacerse hincapié en el nivel de adecuación del equipamiento técnico y edilicio, sino también ser conscientes de que el factor humano y su organización, cumplen un rol muy importante. Para que una organización de éste tipo, en el caso de la presente Tesis, una institución encargada de brindar un Servicio de Oftalmología, logre suministrar al paciente una buena calidad de servicio, debe existir una aplicación sistemática de la gestión por procesos enfocada principalmente al paciente. Si además existe una visión genuina de la productividad y del rendimiento de recursos, es posible alcanzar aun mayores beneficios.

SUMMARY: Today, the population shows an increasing expectation and demand to receive good quality health care services. This reality is seen as an important condition to satisfy in the market for institutions that provide some type of health service and a good way to attract more patients and better clients. Companies take this requirement as input to their processes so that the patients obtain as a result a service that meets their expectations. Given this reality, not only a health care service should emphasize the appropriateness of the technical equipment and building conditions, but also be aware that the human factor and organization, play an important role. For an organization of this type, in the case of this thesis, an institution which provides an Ophthalmology Service, in order to give patients a good quality service, there must be a systematic application of process management focused mainly in their needs. When there is also a genuine vision of productivity and efficiency of resources, it is possible to achieve even greater benefits.

Vision-related research priorities and how to finance them.

A number of organizations have employed a consultative process with the vision community to engage relevant parties in identifying needs and opportunities for vision research. The National Eye Institute in the US and the European Commission are currently undergoing consultation to develop priorities for vision research. Once these priorities have been established, the challenge will be to identify the resources to advance these research agendas. Success rates for Federal funding for research have decreased recently in the USA, UK, and Australia. Researchers should consider various potential funding sources for their research. The universal consideration for funding is that the reason for funding should align with the mission of the funding organization. In addition to Federal research organizations that fund investigator-initiated research, other potential funding sources include nongovernmental organizations, for-profit companies, individual philanthropy, and service organizations. In addition to aligning with organizational funding priorities, researchers need to consider turn-around time and total funds available including whether an organization will cover institutional indirect costs. Websites are useful tools to find information about organizations that fund research, including grant deadlines. Collaboration is encouraged.

Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience.

Blindness is a major global public health problem and recent estimates from World Health Organization (WHO) showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS) provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP). It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI) developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion) in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.

Estudo do impacto de um curso MBA Gestão em Saúde na modernidade organizacional de clínicas oftalmológicas / Study of the impact of a MBA Administration in Health course on the organizational modernity of ophthalmologic clinics

OBJETIVO: Pesquisa no campo da aprendizagem de competências que busca investigar o impacto da aquisição de novas competências individuais dos responsáveis de clínicas oftalmológicas, por meio de um curso MBA Gestão em Saúde, na modernidade organizacional de clínicas oftalmológicas. MÉTODOS: Levantamento utilizando questionários aplicados a alunos e ex-alunos do curso e a gestores de clínicas oftalmológicas não vinculados ao curso (n=30 cada um). A análise foi feita por meio de métodos estatísticos: r de Pearson e Q de Yule; testes t de Student, da soma de séries, da mediana e teste U de Mann-Whitney. RESULTADOS: Observou-se correlação linear e positiva entre a excelência do MBA Gestão em Saúde e o desenvolvimento de capacidades dos alunos veteranos (correlação rho de Spearman em nível de 0,01); há diferença significativa (0,0364, pelo teste de Mann-Whitney), entre alunos veteranos e alunos calouros, quanto à necessidade de se ampliar as capacidades individuais que o curso MBA Gestão em Saúde fornece, aos demais funcionários operacionais das clínica oftalmológicas; e há diferença significativa (0,0057, pelo teste de Mann-Whitney), entre alunos veteranos do curso MBA Gestão em Saúde e alunos calouros quanto à importância da modernidade organizacional para as clínicas oftalmológicas. CONCLUSÕES: Os resultados obtidos são consistentes, de forma geral, com o modelo proposto: a excelência do MBA Gestão em Saúde contribui significativamente para a modernidade organizacional, para o desenvolvimento de competências dos alunos egressos e ainda de forma substancial para a percepção de hiatos organizacionais.

Atención oftalmológica en nivel de atención primaria en centro de salud Dr. Víctor Manuel Fernández de Concepción / Ophthalmologic care in primary care center of health Dr. Victor Manuel Fernandez of Concepcion

Objetivo: Evaluar atención oftalmológica en consultorio primario determinado resolución y causas de derivación al nivel terciario. Material y Método: Desde julio 1999 se atendieron 11.822 pacientes, registrados prospectivamente. Se cuenta con dos oftalmólogos generales y enfermera especialista. Los pacientes fueron resueltos a nivel primario o derivados al nivel terciario, clasificándolos según el departamento de derivación. Resultados: Del total, se resuelven 10.439 (88,3 por ciento) y se derivan 1.383 (11,7 por ciento) al nivel terciario. 4.15 (35 por ciento) eran mayores de 65 años con un 76 por ciento de consultas resueltas son refractivas (1.7 lentes/pacientes) y 582 (14 por ciento) son derivados, originando el 43 por ciento de las derivaciones. El número de derivaciones se mantiene sin variaciones. Sospecha de glaucoma (32,5 por ciento), afecciones retinales (21,7 por ciento) y catarata (16,8 por ciento) son las causas más frecuentes de derivación. Conclusiones: El oftalmólogo general tiene alto nivel resolutivo en nivel primario. Se mantiene el porcentaje de derivación, siendo glaucoma y retina lo más requerido.

Review of findings of the Andhra Pradesh Eye Disease Study: policy implications for eye-care services.

The Andhra Pradesh Eye Disease Study (APEDS) was conducted in order to design long-term strategies to reduce blindness in the background of non-availability of recent population-based data on various aspects of blindness. The objectives of APEDS were to determine the prevalence and causes of blindness and visual impairment, prevalence of and risk factors for major eye diseases, barriers to eye-care services, and quality of life among the visually impaired. Multistage sampling was used to select 11,786 subjects of all ages from 24 urban clusters and 70 rural clusters in one urban and three rural areas belonging to different parts of Andhra Pradesh, with the aim of obtaining a study sample representative of the urban-rural and socioeconomic distribution of the population of this state. A total of 10,293 subjects underwent a detailed interview and dilated eye examination by trained professionals. The adjusted prevalence of blindness (presenting visual acuity <6/60 or central visual field <20 degrees in the better eye) was 1.84%, and moderate visual impairment (presenting visual acuity <6/18-6/60 or equivalent visual field loss in the better eye) was 8.1%. Cataract and refractive error were responsible for 60.3% of blindness and 85.7% of moderate visual impairment. Increasing age, decreasing socioeconomic status, female gender, and rural area of residence were associated with higher risk of blindness. Projections from APEDS suggest that there were 18.7 million blind people in 2000 in India, and that this number is likely to increase to 24.1 million and 31.6 million in 2010 and 2020 respectively, if the current trend continues. This review summarizes the findings of APEDS and discusses the implications of these data on the policy and planning of eye-care services.

Projeto Araguaia Viver Vendo / Araguaia Project To live with sight

Projeto piloto de atendimento oftalmológico clínico/cirúrgico realizado no próprio local onde vive a populaçäo. Foram estudados 243 pacientes, 36 cirurgias realizadas, no período de 23 a 27 de julho de 1994, no município de Säo Félix do Araguaia (MT). Este estudo foi desenvolvido obedecendo a rotina de exame ocular completo, tendo sido realizado tratamento clínico/cirúrgico nos pacientes que deles mais necessitavam

Computación en oftalmología: un punto de vista diferente / Computer in ophthalmology: a different point of view

Se presenta un Fichero electrónico que permita ahorrar espacio y fácil acceso. Se almacenan historias clínicas de idéntica forma a un fichero clásico, con grandes diferencias en lo que se refiere al espacio requerido, fácil manejo, rapidez en la búsqueda. No se usa el computador directamente en la consulta oftalmológica. Se relata la experiencia de 5 años con una base de datos, ingresando alrededor de 34.000 historias clínicas oftalmológicas correspondientes a 16 años de ejercicio profesional en el área privada. Se enfatiza el concepto que la computación debe estar al servicio del hombre y no éste al servicio de la informática

Pavilhäo de oftalmologia Hilário de Gouvea / Pavilhäo de oftalmologia Hilario de Gouvea

O autor faz um retrospecto do Pavilhäo de Oftalmologia Hilário de Gouvea, uma instituiçäo municipal que, apesar dos relevantes serviços prestados às crianças das Escolas Públicas, no que diz respeito a uma exclusiva assistência oftalmológica, foi gradual porém definitivamente extinta