Gender and ethnic diversity in global ophthalmology and optometry association leadership: a time for change.

PURPOSE: To assess the diversity of leadership bodies of member organisations of the International Council of Ophthalmology (ICO) and the World Council of Optometry (WCO) in terms of: (1) the proportion who are women in all world regions, and (2) the proportion who are ethnic minority women and men in Eurocentric high-income regions. METHODS: We undertook a cross-sectional study of board members and chairs of ICO and WCO member organisations using a desk-based assessment of member organisation websites during February and March 2020. Gender and ethnicity of board members and chairs were collected using a combination of validated algorithmic software and manual assessment, based on names and photographs where available. Gender proportions were calculated across Global Burden of Disease super-regions, and gender and ethnicity proportions in the high-income regions of Australasia, North America and Western Europe. RESULTS: Globally, approximately one in three board members were women for both ICO (34%) and WCO (35%) members, and one in three ICO (32%) and one in five WCO (22%) chairpersons were women. Women held at least 50% of posts in only three of the 26 (12%) leadership structures assessed; these were based in Latin America and the Caribbean (59% of WCO board positions held by women, and 56% of WCO chairs), and Southeast Asia, East Asia and Oceania (55% of ICO chairs). In the Eurocentric high-income regions, white men held more than half of all board (56%) and chair (58%) positions and white women held a further quarter of positions (26% of board and 27% of chair positions). Ethnic minority women held the fewest number of board (6%) and chair (7%) positions. CONCLUSIONS: Improvements in gender parity are needed in member organisations of the WCO and ICO across all world regions. In high-income regions, efforts to address inequity at the intersection of gender and ethnicity are also needed. Potential strategies to enable inclusive leadership must be centred on structurally enabled diversity and inclusion goals to support the professional progression of women, and people from ethnic minorities in global optometry and ophthalmology.

Intraocular pressure and glaucoma: Is physical exercise beneficial or a risk? / Presión intraocular y glaucoma: ¿es beneficioso el ejercicio físico, o entraña un riesgo?

Intraocular pressure may become elevated with muscle exertion, changes in body position and increased respiratory volumes, especially when Valsalva manoeuver mechanisms are involved. All of these factors may be present during physical exercise, especially if hydration levels are increased. This review examines the evidence for intraocular pressure changes during and after physical exercise. Intraocular pressure elevation may result in a reduction in ocular perfusion pressure with the associated possibility of mechanical and/or ischaemic damage to the optic nerve head. A key consideration is the possibility that, rather than being beneficial for patients who are susceptible to glaucomatous pathology, any intraocular pressure elevation could be detrimental. Lower intraocular pressure after exercise may result from its elevation causing accelerated aqueous outflow during exercise. Also examined is the possibility that people who have lower frailty are more likely to exercise as well as less likely to have or develop glaucoma. Consequently, lower prevalence of glaucoma would be expected among people who exercise. The evidence base for this topic is deficient and would be greatly improved by the availability of tonometry assessment during dynamic exercise, more studies which control for hydration levels, and methods for assessing the potential general health benefits of exercise against any possibility of exacerbated glaucomatous pathology for individual patients who are susceptible to such changes (AU)

La presión intraocular puede elevarse con el exceso de trabajo muscular, los cambios de la posición del cuerpo y el incremento de los volúmenes respiratorios, especialmente cuando los mecanismos de la maniobra de Valsalva se ven implicados. Todos estos factores pueden presentarse durante el ejercicio físico, especialmente cuando se incrementan los niveles de hidratación. Esta revisión examina la evidencia de los cambios en la presión intraocular con anterioridad y posterioridad al ejercicio físico. El incremento de la presión intraocular puede derivar en una reducción de la perfusión ocular, con la posibilidad asociada de daño mecánico y/o isquémico de la cabeza del nervio óptico. Una consideración clave es la posibilidad de que, en lugar de ser beneficioso para los pacientes susceptibles de patología glaucomatosa, cualquier incremento de la presión intraocular podría resultar perjudicial. La disminución de la presión intraocular tras el ejercicio puede ser resultado de su elevación, originando la aceleración de una descarga del acuoso durante el ejercicio. También se ha estudiado la posibilidad de que las personas con menor debilidad sean propensas a realizar ejercicio, y tengan menor probabilidad de padecer o desarrollar glaucoma. Por tanto, cabría esperar una menor prevalencia del glaucoma en aquellas personas que realizan ejercicio. La base de la evidencia para esta cuestión es deficiente, y mejoraría si se dispusiera de pruebas de tonometría realizadas durante el ejercicio dinámico, un mayor número de estudios que controlen los niveles de hidratación, y métodos de evaluación de los beneficios potenciales y generales para la salud al realizar ejercicio, en contraposición a cualquier posibilidad de empeoramiento de la patología glaucomatosa en las personas susceptibles de dichos cambios (AU)

Perceptions of acceptable conducts by university students.

OBJECTIVE: To determine perceptions of acceptable conducts amongst under and postgraduate optometry students and to compare them with students from other disciplines. METHODS: Students (under/postgraduate) of optometry (n=156) and other courses (n=54) from University of Minho participated in a voluntary online questionnaire about perception of conducts, classifying as acceptable or unacceptable 15 academic or professional scenarios. RESULTS: 210 questionnaires were analyzed. Differences in perceptions were found between optometry under and postgraduates in scenario 5, Chi-square(2,156)=4.3, p=0.038, and scenario 7, Chi-square(2,156)=7.0, p=0.008 (both with cheating more acceptable for postgrads). Differences between under and postgraduates from other courses were found in scenario 9 (taking supplies from classroom more acceptable for undergrads), Chi-square(1,54)=5.0, p=0.025, and scenario 14 (forging a signature more acceptable for postgrads), Chi-square(1,54)=3.9, p=0.046. Differences between optometry and other courses undergraduates were observed in scenario 2 (plagiarism more acceptable for optometry undergrads), Chi-square(1,154)=8.3, p=0.004 and scenario 9 (taking supplies from classroom more acceptable for other undergrads), chi-square(1,54)=7.8, p=0.005. Differences between optometry and other courses postgraduates were observed in scenario 7, Chi-square(1,56)=5.8, p=0.016, scenario 10 (both with cheating more acceptable for optometry postgrads), chi-square(1,54)=8.1, p=0.004 and scenario 14 (forging a signature more acceptable for other postgrads), Chi-square(1,54)=6.1, p=0.026. CONCLUSION: Academic misconducts were mainly considered more acceptable than professional misconducts. Our results show that perceptions of acceptable conducts amongst optometry students are not very different from other students, and, against our initial prediction, do not show a general change in misconduct perception when students become more mature. Universities should pay more attention to this problem and take action.

Optometrists' perspectives on cross-cultural encounters in clinical practice: a pilot study.

BACKGROUND: There is growing awareness that cultural background influences health beliefs and practices and can impact on the patient-practitioner encounter. However, in relation to optometry there is little known about the implications of cultural diversity for clinical decision-making and how optometrists address culturally based understandings of health. This pilot study examines how culturally based differences in health practices and beliefs impact on patient-optometrist interactions and how optometrists negotiate and manage these differences. METHODS: Semi-structured interviews were conducted with 10 optometrists. A qualitative analysis was undertaken regarding the optometrists' experiences of cultural diversity and how these impact their decision-making and clinical interactions. RESULTS: Emergent themes were: 1 Culture can influence and impact on patient-optometrist clinical encounters. 2 Culturally based differences in health practices and beliefs can have a negative impact on clinical encounters. 3 Culturally based differences, beliefs and values (related to eye health) can be difficult to negotiate. 4 Optometrists might benefit from additional training and strategies to deal with culturally based differences in health beliefs and practices. CONCLUSIONS: This pilot study provides data about some of the issues that arise as a result of cultural differences between patients and health care practitioners. The findings from this study contribute to an understanding of the impact of cultural diversity and might assist the development of training and further research in the area.