Evaluation of the Amblyopia tracker app.

PURPOSE: The Amblyopia tracker app has been developed to be a tool for parents to monitor changes in vision at home during amblyopia treatment. The aims of this study were to evaluate the feasibility and repeatability of parents testing their children at home and to compare home test results to an assessment in clinic by an orthoptist. METHODS: Children (age < 18 years) with amblyopia (interocular acuity difference of ≥ 0.2logMAR) were recruited. Parents were asked to test their child with the app three times during a two week period followed by an online questionnaire about the usability. Participants also tested within 48 h of their appointment where the measurement was repeated by an orthoptist. RESULTS: Out of 277 potential participants contacted, 37 completed three home measurements, mean age 6.8 years (SD 2.94). Home tests comparisons were made between test two and three to ensure familiarity with the process. Paired t-tests showed no statistically significant difference for either eye or the interocular acuity difference (IAD). However, 29% had a difference in IAD of more than 0.1logMAR on repeated testing, with a maximum of 0.4logMAR difference in the IAD. Questionnaire responses from the parents who participated were predominantly positive with 97% of respondents saying they would use it if were available. Comparison of home and clinical measurements (n = 23, mean age 6.72 SD 2.60) showed no statistically significant differences for either eye or interocular acuity difference (paired t-test, p > 0.3 in all cases). CONCLUSION: Results show no statistically significant differences for the Amblyopia tracker app when used by parents at home on repeated testing, or between the home test by a parent and the test by a clinician. However, variability in the results does indicate that further improvements are required to ensure the results can be used as a reliable clinical tool.

The efficacy of bupivacaine for the treatment of strabismus.

INTRODUCTION: Bupivacaine (BPX) is a widely used local anesthetic. Ophthalmologists have found a unique use of BPX to alter the elasticity and contractile properties of extraocular muscles to straighten strabismus. The utilization of BPX to treat strabismus has been well documented. The purpose of this review is to examine the overall efficacy of BPX when used in isolation for the treatment of strabismus, based on the published literature. METHODOLOGY: A literature search was carried out to identify papers published between the years 1980 and 2021, which examined the impact of BPX as a stand-alone treatment for strabismus. RESULTS: Eight articles were identified as matching the inclusion criteria. The authors reported that volumes of ≤1.00 mL are unlikely to be significant enough to improve ocular alignment and increasing volume strength is associated with greater changes in ocular alignment. The overall change in ocular alignment varied from 0-16PD between the different studies included, with similar effects being noted for deviations between 10 and 20PD and deviations as large as 55PD. It has been documented that there is no significant difference in the outcomes of BPX treatment for esotropia and exotropias, but some clinical differences have been noted with esotropia (or the lateral rectus) responding better to BPX. Bupivacaine has been demonstrated to be less effective in patients with chronic nerve palsies. All but one author documented increases in the injected muscle's volume and maximum cross-sectional area from month one to three followed thereafter by a gradual decrease in both measurements. It was noted that despite the reduction in both measurements, the change in ocular alignment continued to show improvements. No sight-threatening or persistent complications were reported within any of the studies or case reports included within this review. In the interest of patient experience, the majority of patients reported that BPX improved their eye alignment, while a third reported feelings of discomfort during the procedure. CONCLUSION: Bupivacaine is a viable option for the treatment of small angle deviations and is not recommended for use in long-standing cranial nerve palsies or those associated with atrophy. Care is needed in determining the required dose to avoid the need for re-injection and impacting patient experience.

The Impact of Preceptorship for Newly Graduated Orthoptists on Clinical Confidence and Attitudes towards Public Health.

BACKGROUND: Preceptorship has been found to ensure a positive and healthy start to a clinician's career. Evidence shows increased staff satisfaction and empowerment and decreased medical errors as a result of preceptorship. There is limited literature that includes allied health professionals, particularly new orthoptic graduates. This study aims to: 1) explore the effectiveness of the British and Irish Orthoptic Society (BIOS) preceptorship programme at providing support and confidence in newly graduated orthoptists, 2) explore new graduates' experience of embedding public health in their clinical practice. METHODOLOGY: Focus groups were organised for mentors and mentees to discuss their experiences with the BIOS preceptorship programme and how it facilitated embedding public health into clinical practice. Constant comparison analysis was used to identify key themes of discussion. FINDINGS: The preceptorship document promoted structure, reflection, and engagement all of which contributed to effective transition for the mentees. However, document navigation, lack of preceptorship exposure at undergraduate level and leadership engagement were potential barriers to using the programme. The programme encouraged public health engagement among new graduates but barriers such as time pressure, lack of experience and patient understanding were challenges that often prevented the adoption of public health skills and behaviours within their practice. CONCLUSION: The BIOS preceptorship successfully supports new graduates in their transition into an autonomous practitioner. The programme could be improved by the implementation of a guidance document to assist mentors in their role. Preceptorship engagement could be improved by increasing exposure to undergraduate orthoptic students and departments alike.