Virtual keratoconus monitoring clinic in a tertiary university hospital in the United Kingdom.

Purpose: To describe a new pathway for virtual keratoconus (KC) monitoring in the corneal department of a tertiary referral center in the UK during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A virtual outpatient clinic to monitor KC patients (KC PHOTO clinic) was created. All patients from the KC database in our department were included. At each hospital visit, patients' visual acuity and tomography (Pentacam; Oculus, Wetzlar, Germany) were collected by a health-care assistant and an ophthalmic technician, respectively. The results were virtually reviewed by a corneal optometrist to identify stability or progression of KC and discussed with a consultant if needed. Those with progression were contacted by telephone and listed for corneal crosslinking (CXL). Results: From July 2020 until May 2021, 802 patients were invited to attend the virtual KC outpatient clinic. Of them, 536 patients (66.8%) attended and 266 (33.2%) did not attend. After corneal tomography analysis, 351 (65.5%) were stable, 121 (22.6%) showed no definite evidence of progression, and 64 (11.9%) showed progression. Forty-one (64%) patients with progressive KC were listed for CXL and the remaining 23 patients deferred treatment after the pandemic. By converting a face-to-face clinic to a virtual clinic, we were able to increase our capacity by nearly 500 appointments per year. Conclusion: In pandemic times, hospitals have developed novel methods of delivering safe patient care. KC PHOTO is a safe, effective, and innovative method of monitoring KC patients and diagnosing progression. In addition, virtual clinics can increase the clinic capacity tremendously and reduce the need of face-to-face appointments, which is beneficial in pandemic conditions.

Myopia Control in the Republic of Ireland

Purpose: Tto estimate how many independent optical practices in the Republic of Ireland (ROI) are offering myopia control options to patients and parents. Method(s): 346 independent optical practices were identified in the ROI using a listing provided on the Association of Optometrists Ireland website. All practices identified were emailed to ask if they practised any myopia control. Practice websites (where available) were examined to see if myopia control was mentioned as a service offered. Some practices believed to be offering myopia control were phoned directly to ascertain if they were practising myopia control. This research was carried out between Feb and March 2019 (i.e. pre-covid restrictions in the ROI). Result(s): 17 independent practices in the ROI were identified as having fitted patients with contact lenses for myopia control. Five of the 17 were not advertising myopia control on their websites. Several practitioners who were not advertising myopia control on their websites reported that they still felt that they were in the early stages of learning about myopia control and were therefore only offering it to patients and parents who enquired about it directly. Conclusion(s): In spite of the increase in licensed contact lens options for myopia control in the ROI and the relative ease with which suitable patients could be fitted with myopia control lenses, practitioners still appear reluctant to engage in the practice. Copyright © 2022

Digital Media Effect on Diabetic Eye Care During COVID-19 pandemic

Purpose : To gauge the impact of healthcare technology in the management of diabetic retinopathy during the COVID-19 pandemic. Methods : The study was conducted at EyeCare Consultants of New Jersey's in their two locations in NJ, Woodland Park and Edison. Eye care professionals (ECPs-two ophthalmologists, one optometrist) surveyed 400 diabetic patients during the first year of the pandemic (March 2020- February 2021). The patients all received previous instructions with CheckedUp, a patient education digital platform utilizing audiovisual and touchscreen to further educate patients, during in-office visits. The 400 diabetic patients were divided equally into two groups. To ensure the adherence of dietary and behavioral modifications related to diabetes mellitus, Group 1 received traditional phone calls while Group 2 received video calls and supplementary education with CheckedUp. Both groups had a follow-up in person in September 2021. Surveys elicited responses to gauge consistency of HbA1C management. Results : Adherence was defined as HbA1C values which remained within a target value lower than or equal to their baseline and/or <7.0% as well as compliance with medications, dietary restrictions, regular physical activity and follow-up visits. The results found a significant difference between educating the patient with a phone call versus a video call and CheckedUp. At the next follow-up visit in person: Group 1 had an adherence of 48% (96 patients) and had several patients with HbA1C values exceeding the targeted value. Group 2 had an adherence of 69% (138 patients) and were more compliant with a healthier lifestyle. They also stated that their telehealth appointment with CheckedUp helped reinforce the importance of maintaining a normal HbA1C value. Conclusions : This study illustrates the ability of digital medicine platforms to supplement virtual and in-person consultations to manage diabetic retinopathy, especially during the pandemic. Compliance is an important matter in the management and preventing progression of diabetic retinopathy. Digital tools like CheckedUp assist with optimizing patient care in these unprecedented times.

Expansion of a teleophthalmology program for diabetic retinopathy screening during the COVID19 pandemic

Purpose : The COVID-19 pandemic prompted efforts to encourage social distancing and minimize non-urgent in-person eye care. Here, we report the outcomes of a teleophthalmology program for diabetic retinopathy screening at an integrated health system in California that was expanded during the pandemic. Methods : We performed a retrospective review of patients who underwent remote retinal imaging as part of a teleophthalmology program for diabetic retinopathy (DR) screening using Current Procedural Terminology (CPT) codes 92227 and 92228 at the University of California, Davis Health system between May 31st , 2019 and June 8th , 2021. Retinal images were captured at primary care locations using a Topcon NW400, Nikon RetinaStation, or Optos Primary fundus cameras, and image grading were performed by trained ophthalmologists or optometrists using a store-and-forward method. Patient records were reviewed to collect demographic, follow-up, and clinical outcomes information. Results : During COVID19 pandemic, the teleophthalmology program screened 570 individuals (mean age 63.2 ± 13.7). There was a significant increase in the number of patients screened per month prior to and following the COVID-19 lock-down in March 2020 (5.0 ± 3.1 patients screened per month prior to and 39.1 ± 34.8 patients per month following, P = 0.0004). Among these, 204 patients received a recommendation for in-person eye care referral, of which 127 received a referral to the UC Davis Eye Center, 85 appointments were scheduled, and 82 patients were followed in person, with a median time of 108 days between screening and in-person follow-up. Follow-up rates were generally lower during the initial months after the pandemic and increased over time. Among the patients who followed in person (mean age 63.9 ± 13.8), 10% of eyes had mild non-proliferative DR (NPDR), 5% had moderate NPDR, 3% had severe NPDR, 2% had PDR, and 4% had diabetic macular edema (DME), with similar proportions before and after the COVID-19 lockdown. Conclusions : Expansion of a teleophthalmology program during the COVID19 pandemic demonstrated improved DR screening rates, increased referrals, and improved follow-up for diabetic eye care at an integrated health system in Northern California.

COVID Involvement in Eyecare Professionals

Purpose : The SARS-CoV-2 pandemic has been an ongoing area of study in scientific, clinical, and pharmaceutical communities. Although it is known that many in medical fields developed COVID, it is unknown how COVID has involved eyecare professionals. The purpose of this study is to evaluate COVID involvement in eyecare professionals. Methods : In this cross-sectional study, an anonymous questionnaire survey was distributed among eyecare professionals. Their experiences with COVID exposure, testing, and infection were evaluated. Results : 92 eyecare professionals answered the survey, consisting of 25 ophthalmologists, 7 ophthalmology residents, 6 optometrists, 48 ophthalmic technicians, and 6 ophthalmology clinic administrative staff. These included 33 men and 56 women;3 preferred not to disclose their sex. The mean age was 42.0 ± 12.2 years (range, 21-75 years). Of these, 11 (12.0%) have been COVID positive with symptoms, and none were COVID positive without symptoms. The positive rate was 0% in ophthalmologists, ophthalmology residents, and optometrists, 20.8% in ophthalmic technicians, and 16.7% in administrative staff. Of people without COVID (n=81), 15 (18.5%) had been exposed to a COVID-positive individual, 39 (48.1%) had tested negative for COVID, and 27 (33.3%) had not yet been tested for COVID. Conclusions : Only a small percentage of eyecare professionals have developed symptomatic COVID. The rate of symptomatic COVID was significantly lower in ophthalmologists, ophthalmology residents, and optometrists evaluated in this study compared to the general population. Such low rates may be due to using proper protective measures, including suitable workplace protocols.

2022 iOS Apps and COVID-19: Can They Help Our Eye Patients?

Purpose : 85% of US adults have a smartphone with 87 million people using a health or wellness app monthly in 20201. There are 350,000 eHealth apps2. Roughly 33M adults in the US have the chief complaint of vision loss. An estimated 93M are at high risk for serious visual impairment3 . Only half have visited an eye doctor in the past 12 months, due to COVID 193. American adults over the age of 18 fall into the demographic of mobile app users. Do free apps help our eye patients during this pandemic? Methods : We used the search terms “vision test” and “eye exam” in the Apple App Store to compile a list of the top 10 free apps. We looked for how many free apps have eye charts that are “recognized” such as Snellen chart, Landolt C, LogMAR chart, Amsler grid & Visual Field. Control: Inclusion criteria: 1) free;2) English language;3) ≥50 reviews, ≥4 star rating in the Apple App store. Exclusion criteria: 1) foreign languages 2) paid apps. Results : Results: Top 10 iOS apps (from most downloads to least) in the Apple App Store seen in Table 1. For all iOS apps, Snellen vision test: 9/10;Landolt C: 1/10;LogMAR chart: 3/10;Amsler grid: 3/10;Visual field 1/10. Only 1 app connected you with a local optometrist or ophthalmologist. Only 3/10 apps had >1K reviews. iOS apps do not provide a number of downloads. Conclusions : Although many adults have not received an eye exam over the past 12 months, physicians can still connect with their patients through public education with the use of mobile apps. However, current eHealth apps can improve their content for eye patients.

CARES Act Aid to Ophthalmologists and Optometrists During the COVID-19 Pandemic

Purpose : Congress passed the CARES Act (Coronavirus Aid, Relief, and Economic Security) Provider Relief Fund to help healthcare providers recoup lost revenue during the pandemic. We aimed to determine how much of this federal aid was provided to ophthalmology and optometry practices, and whether the amount of aid received varied based on practice size. Methods : We used the Centers for Medicare and Medicaid Services (CMS) Physician Compare National Database to identify medical practices that provide eye care. We used practice names to link this database to the Health and Human Services (HHS) Provider Relief Fund (PRF) database to determine how much aid each practice received through the CARES Act. Results : We identified 2,625 optometry or ophthalmology practices that received funding through the CARES Act Provider Relief Fund that were not hospital-owned or affiliated with multi-specialty practices. Large practices with more than 10 clinicians accounted for only 268 of the 2,625 practices in our sample, but received nearly half of all funding ($182 million). Per-practitioner funding varied based on practice size (p=0.047), but differences in per-practitioner funds were not significant after adjusting for practice specialty (ophthalmology, optometry, or both). We also found that retina specific practices tended to receive more than their counterparts. Conclusions : This study demonstrates a relatively uniform distribution of per capita funds when adjusted for ophthalmologists, optometrists, and mixed-practices regardless of practice size. This policy demonstrates how federal aid is distributed to independent ophthalmology practices, and that smaller practices which are at higher risk may need larger per capita payments to remain viable during times of economic stress.

Coronavirus disease 2019 outbreak and associated public health measures increase the progression of myopia among children and adolescents: Evidence synthesis.

PURPOSE: Although studies have suggested that the coronavirus disease 2019 (COVID-19) outbreak increased myopia progression, they had different settings and analysis methods. This study compared myopia progression before and during the COVID-19 outbreak using meta-analysis. METHODS: Relevant literature was searched on EMBASE, PubMed, ClinEpiDB and Web of Science and reviewed until 8 October 2021. The Newcastle-Ottawa Scale was used to evaluate the quality of the original studies. The mean difference of change in spherical equivalent refraction (SER) was used for evaluation before and during the COVID-19 pandemic. RESULTS: The meta-analysis included eight studies with 773, 797 individuals aged 5-18 years. Pooled analysis indicated that the mean difference of annual myopia progression during the pandemic was 0.41 D higher (95% confidence interval [CI]: 0.35-0.48, p < 0.01) than before the pandemic. Subgroup analysis using cycloplegic (mean difference, 0.30 D; 95% CI, 0.22-0.38; p < 0.01) or noncycloplegic refraction (mean difference, 0.60 D; 95% CI, 0.27-0.93; p < 0.01) indicated that the mean difference of annual myopia progression during COVID-19 significantly increased in both refractive measurements. CONCLUSION: Our findings demonstrated that the COVID-19 pandemic accelerated myopic progression compared to the past. Government policies are urgently required to prevent and control myopia progression.

POSA249 Diagnostic Pathways, Genetic Testing, and Impact of COVID-19 on Patients in Europe with X-Linked Retinitis Pigmentosa: Results from the Cross-Sectional Explore XLRP 1 Physician Survey

Objectives: To understand the pathways by which European patients with X-linked retinitis pigmentosa (XLRP) arrive at retina specialists (RS) and geneticists for diagnosis, and the impact of COVID-19 on patient management. Methods: The EXPLORE XLRP 1 survey interviewed RS (n=20) and geneticists (n=5) in France, Germany, Italy, Spain, and the United Kingdom (UK) to record information about healthcare pathways and diagnostic approaches for patients with XLRP (n=80). Results: Patients (mostly male [91%] and aged 18–40 years [57%]) experienced an average time of 4 years between XLRP symptoms and diagnosis. In France, Spain, and Italy, patient pathways are linear: most patients see RS/geneticists by ophthalmologist referral. In Germany and the UK, patients see RS/geneticists through multiple routes, also including general practitioner and optometrist referrals. Genetic testing was used as part of XLRP diagnosis in 78% of patients. Genetic testing usually took >6 weeks to receive results, and some patients waited up to 6 months. Genetic testing was fully reimbursed for most patients, except those in Spain, where patients largely incurred the full cost. In the UK, testing costs were co-paid by 14% of patients. Despite barriers to genetic testing (e.g., costs, long waiting times for results), physicians agreed that genotypic diagnosis is helpful to predict disease progression and to enable patient involvement in clinical trials. The COVID-19 pandemic reduced the frequency of in-person clinic visits, but some physicians utilized tele-consultation and remote patient management. Conclusions: The pathways by which patients with XLRP in Europe visit RS and geneticists are complex, lengthy, and vary considerably by country. This survey reported high usage of genetic testing to confirm XLRP diagnosis, but long waiting times for test results accounts for incomplete uptake, especially among older patients. Tele-consultations and remote management have emerged as potential solutions for monitoring patients during the COVID-19 pandemic.

Outcomes of a pilot study of community-based, collaborative glaucoma care in a tertiary referral public glaucoma clinic

Purpose: To evaluate the outcomes of the Glaucoma Community Collaborative Care Program (G3CP) from the Royal Victorian Eye and Ear Hospital (RVEEH), Melbourne. Method: The program enrolled community optometrists in a shared care model with the RVEEH Glaucoma Unit. Patients classified as low risk and/or stable glaucoma patients were recruited according to RANZCO Collaborative Care Guidelines. The program's aims were to increase access and provide timely glaucoma care, contribute to the continuing education of optometrists and to be scalable to accommodate increased future demand. Results: The pilot program enrolled 104 patients between March 2019 and April 2020. The uptake rate by patients offered the G3CP was 73%. Clinical outcomes showed 93% of patients had stable glaucoma over the period and all had timely reviews. There was 95% agreement between the enrolled optometrists and a RVEEH Glaucoma Specialist. Surveys of patient and optometrist satisfaction demonstrated high acceptability. The challenges identified were frequent changes in the optometry network (up to 50% of originally enrolled), low recruitment (35% of predicted) and low quality of information shared (40% of optical coherence tomography tests reviewed were too degraded for adequate review). Conclusion: The G3CP pilot provided timely care to the patients enrolled and created additional capacity in outpatients, which has become even more important with the increased demand caused by the COVID-19 pandemic. With acceptability and feasibility of the project demonstrated, it is intended that this model of collaborative care will continue;however, to enable scalability, several challenges will need to be addressed. Genetics.

Risk factors for mental health symptoms during the COVID-19 pandemic in ophthalmic personnel and students in USA (& Canada): a cross-sectional survey study.

BACKGROUND: The COVID-19 pandemic poses mental health challenges to frontline healthcare workers. Eye care professionals may be especially susceptible to mental health problems due to high-risk exposures to patients. Yet, no prior research has studied mental health issues among eye care professionals during the COVID-19 pandemic. OBJECTIVE: The purpose of this study was to identify risk factors for mental health problems during the COVID-19 pandemic among eye care professionals. METHODS: We conducted a cross-sectional survey study among eye care professionals and students in the United States and Canada from June 23 to July 8, 2020 during the COVID-19 pandemic. A total of 8505 eye care professionals and students received email invitations to the survey and 2134 participated. We measured mental health outcomes including symptoms of depression, anxiety, and stress using validated scales, as well as potential risk factors including demographic characteristics, state-level COVID-19 case counts, participants' patient interactions, childcare responsibilities, and pre-pandemic stress levels. Linear multiple regression and logistic regression analyses were used to determine relationships between risk factors and mental health outcomes. RESULTS: We found that 38.4% of eyecare professional participants in the survey met screening threshold as probable cases of anxiety, depression, or both during the COVID-19 pandemic. Controlling for self-reported pre-pandemic stress level and state COVID-19 case daily cases, significant risk factors for depression, anxiety, and psychological stress during the COVID-19 pandemic included: being female, younger age, and being Black or Asian. Interestingly, we found two somewhat surprising protective factors against depression symptoms: more frequent interactions with patients and having a greater proportion of childcare responsibilities at home. CONCLUSIONS: This study showed a high prevalence of mental health problems and revealed disparities in mental health among eye care personnel and students: Female, younger, Black, and Asian populations are particularly vulnerable to mental health issues. These results indicate that it is critical to identify mental health issues more effectively and develop interventions among this population to address this significant and growing public health issue. The strategies and policies should be reflective of the demographic disparities in this vulnerable population.

Home Low Vision Ocular Rehabilitation Telehealth Expansion Due to COVID-19 Pandemic.

Background: In March 2020, the pandemic added a major barrier resulting in the cancelation of all low vision ocular rehabilitation services. To prevent delay of beginning low vision ocular rehabilitation services, all low vision care was switched to telerehabilitation to home. Methods: Case managers began to cancel all in-person services and offer Veterans Affairs (VA) video connect services to their home. Patients with video access scheduled a home VA video connect telerehabilitation evaluation and therapy assessment. Patients who did not have video access waited to schedule a future in-person low vision appointment (postpandemic). Results: Of the in-person canceled appointments, 54% who scheduled the new home telerehabilitation evaluation were delayed on average 25 calendar days. Patients who waited for in-person low vision care were delayed on average 98, 138, or 153 calendar days. Of the 56 new patients referred for low vision optometry services during this 4-month period (COVID-19), 91% scheduled home low vision ocular telerehabilitation evaluations without delay; 5% waited until in-person clinics were open; and 4% waited until rural VA's and community-based outpatient centers were open. Discussion: Veterans with low vision who live in rural communities have limited access to services unless they are able to travel several miles to a specialty low vision clinic. Low vision ocular rehabilitation telehealth services have been successfully provided at the VA Western New York Healthcare System (Buffalo, NY) low vision clinic. Conclusions: Home low vision ocular rehabilitation telehealth increases access as early as possible once diagnosed with ocular pathology resulting in low vision.

Acute community ophthalmology services provided by independent prescribing optometrists supporting hospital eye services during the COVID-19 outbreak.

BACKGROUND: Specialised Independent Prescribing (IP) community optometrists provided acute eye care during the COVID-19 crisis ensuring that over-stretched hospital emergency eye care was supported, therefore local overall urgent eye care provision was not affected. SUBJECTS/METHODS: Number of cases seen by hospital Rapid Access Clinic (RAC) between January 2020 and June 2020 were compared to number of cases seen by IP optometrists in community Acute Primary Care Ophthalmology Service (APCOS) during the same time period. Specifically, comparisons were made between the number of cases seen in RAC and the number of cases seen by APCOS during the period before COVID-19 emergency (January-March 2020) and for a similar timeframe thereafter (April-June 2020). Numbers treated by APCOS alone and those referred to RAC were also determined. The change in case numbers between the different healthcare settings was also studied. RESULTS: Increase in cases seen by APCOS between April (n = 391) and June (n = 641). Number of cases seen by RAC declined from 652 in March to 372 in April, increasing to 610 by June. This was still below maximum number of monthly cases seen by RAC pre-lockdown in January (861). Most of the cases seen by APCOS were managed in the community with 4% referred to RAC. CONCLUSIONS: Ophthalmology services delivered by IP specialised optometrists can safely and efficiently treat and manage the vast majority of urgent cases and mitigate the reduced capacity within hospital emergency eye clinics. Our experience provides insights into care pathways for urgent eye cases in the future.