Big data study using health insurance claims to predict multidisciplinary low vision service uptake.

SIGNIFICANCE: There is a lack of research from high-income countries with various health care and funding systems regarding barriers and facilitators in low vision services (LVS) access. Furthermore, very few studies on LVS provision have used claims data. PURPOSE: This study aimed to investigate which patient characteristics predict receiving multidisciplinary LVS (MLVS) in the Netherlands, a high-income country, based on health care claims data. METHODS: Data from a Dutch national health insurance claims database (2015 to 2018) of patients with eye diseases causing potentially severe visual impairment were retrieved. Patients received MLVS (n = 8766) and/or ophthalmic treatment in 2018 (reference, n = 565,496). MLVS is provided by professionals from various clinical backgrounds, including nonprofit low vision optometry. Patient characteristics (sociodemographic, clinical, contextual, general health care utilization) were assessed as potential predictors using a multivariable logistic regression model, which was internally validated with bootstrapping. RESULTS: Predictors for receiving MLVS included prescription of low vision aids (odds ratio [OR], 8.76; 95% confidence interval [CI], 7.99 to 9.61), having multiple ophthalmic diagnoses (OR, 3.49; 95% CI, 3.30 to 3.70), receiving occupational therapy (OR, 2.32; 95% CI, 2.15 to 2.51), mental comorbidity (OR, 1.17; 95% CI, 1.10 to 1.23), comorbid hearing disorder (OR, 1.98; 95% CI, 1.86 to 2.11), and receiving treatment in both a general hospital and a specialized ophthalmic center (OR, 1.23; 95% CI, 1.10 to 1.37), or by a general practitioner (OR, 1.23; 95% CI, 1.18 to 1.29). Characteristics associated with lower odds included older age (OR, 0.30; 95% CI, 0.28 to 0.32), having a low social economic status (OR, 0.91; 95% CI, 0.86 to 0.97), physical comorbidity (OR, 0.87; 95% CI, 0.82 to 0.92), and greater distance to an MLVS (OR, 0.95; 95% CI, 0.92 to 0.98). The area under the curve of the model was 0.75 (95% CI, 0.75 to 0.76; optimism = 0.0008). CONCLUSIONS: Various sociodemographic, clinical, and contextual patient characteristics, as well as factors related to patients' general health care utilization, were found to influence MLVS receipt as barriers or facilitators. Eye care practitioners should have attention for socioeconomically disadvantaged older patients when considering MLVS referral.

2017 National Optometry Workforce Survey.

SIGNIFICANCE: Planning for the effective delivery of eye care, on all levels, depends on an accurate and detailed knowledge of the optometric workforce and an understanding of demographic/behavioral trends to meet future needs of the public. PURPOSE: The purposes of this study were to assess the current and future supply of doctors of optometry and to examine in-depth trends related to (1) demographic shifts, (2) sex-based differences, (3) differences in practice behaviors in between self-employed and employed optometrists, and (4) the concept of additional capacity within the profession. METHODS: The 2017 National Optometry Workforce Survey (31 items) was distributed to 4050 optometrists, randomly sampled from a population of 45,033 currently licensed and practicing optometrists listed in the American Optometric Association's Optometry Master Data File. A stratified sampling method was applied to the population of optometrists using primary license state, age, and sex as variables to ensure a representative sample. RESULTS: With a response rate of 29% (1158 responses), the sample ensured a 95% confidence interval with a margin of error of <5%. Key results include finding no significant differences between men and women for hours worked (38.9 vs. 37.5), productivity (patient visits per hour, 2.0 vs. 1.9), or career options/professional growth satisfaction with 65% for both. The data indicate a likely range of additional patient capacity of 2.29 to 2.57 patients per week (5.05 to 5.65 million annually profession-wide). CONCLUSIONS: The optometric workforce for the next decade is projected to grow 0.6 to 0.7% more annually than the U.S. population. The study found additional capacity for the profession more limited than previously suggested. Findings also illustrate an evolving/equitable workforce based on sex, in terms of both productivity and satisfaction. The trend toward employed versus self-employed was marked with 44% reporting they are employed, up from 29% in 2012.

Opinión de los médicos de familia sobre las consultas de optometría del Servicio Navarro de Salud / What is the opinion of the family doctors on the optometry consultations of the Navarre Health Service?

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Optometry Compensation Study: Narrowing Down the Unexplained Gender Wage Gap in Optometry.

SIGNIFICANCE: Men earn at least 6.5% more than women in their first full-time jobs as optometrists. For current salaries, the gender wage gap is more than 13%. This study details the gender wage gap that remains after controlling for practice ownership, residency training, and employer-defined full-time work. PURPOSE: The purpose of this study was to measure the gender wage gap by region and practice type for full-time optometrists who did not complete a residency and do not own their practice. METHODS: Participants completed an online survey, providing data for their first and current optometry positions and demographic information. Respondents who reported full-time employment in the United States, not completing a residency, and not owning their practice were selected for further analysis by census region and practice type. In each category, the gender wage gap was calculated. RESULTS: In all regions and practice types, men were paid higher starting salaries than women. For current salaries, men were paid higher in almost all regions and practice types. The wage gap increased from starting salary to current salary, although not in all regions and practice types. CONCLUSIONS: When practice ownership, residency completion, and full-time work are controlled for, there remains a difference in the pay received by men and women in optometry. The salary data presented in this study may help optometrists narrow the wage gap.

Differences in characteristics of Medicare patients treated by ophthalmologists and optometrists.

PURPOSE: To quantify differences in the age, gender, race, and clinical complexity of Medicare beneficiaries treated by ophthalmologists and optometrists in each of the United States. DESIGN: Cross-sectional study based on publicly accessible Medicare payment and utilization data from 2012 through 2017. METHODS: For each ophthalmic and optometric provider, demographic information of treated Medicare beneficiaries was obtained from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services (CMS) for the years 2012 through 2017. Clinical complexity was defined using CMS Hierarchical Condition Category (HCC) coding. RESULTS: From 2012 through 2017, ophthalmologists in every state treated statistically significantly older beneficiaries, with the greatest difference (4.99 years in 2014) between provider groups seen in Rhode Island. In most states there was no gender difference among patients treated by the providers but in 46 states ophthalmologists saw a more racially diverse group of beneficiaries. HCC risk score analysis demonstrated that ophthalmologists in all 50 states saw more medically complex beneficiaries and the differences were statistically significant in 47 states throughout all six years. CONCLUSIONS: Although there are regional variations in the characteristics of patients treated by ophthalmologists and optometrists, ophthalmologists throughout the United States manage older, more racially diverse, and more medically complex Medicare beneficiaries.

Bibliometric study of scientific research on optometric visual therapy / Estudio bibliométrico de investigación científica sobre terapia visual optométrica

PURPOSE: To analyze scientific research in the field of visual therapy through a bibliometric study. METHODS: The database used in this bibliometric study was SCOPUS, the largest abstract and citation database of peer-reviewed literature, covering scientific journals, books, and conference proceedings. Using remote downloading techniques, articles published between 1946 and 2017 were selected by entering the main descriptors: "optometric vis* training", "optometric vis* therapy", "vis* therapy", "vis* training" limited to the title, key words and/or abstract. We applied the following bibliometric indicators: Price's index, doubling time and annual growth rate, Price's transience index, Lotka's Law, h factor, and Bradford's zones. RESULTS: The authors retrieved 294 original articles from the temporal interval 1946-2017 (articles, reviews, letters to the director, etc.), discarding 15 of them for not meeting the study requirements. Annual growth rate was 39.62%, the timeframe 1987-1983 containing the most number of documents. United States was the country with the highest production, with more than 60% of the records. The most productive institutions are State University of New York System, SUNY State College of Optometry, and Southern California College of Optometry. Classification of authors based on productivity is strongly concentrated in small producers, with a transient index of 80.53. The total number of authors was 488, representing a co-authorship index of 1.75. CONCLUSION: Bibliometric studies have become essential tools for assessing scientific publications

OBJETIVO: Analizar la investigación científica en el campo de la terapia visual, a través de un estudio bibliométrico. MÉTODOS: La base de datos utilizada en este estudio bibliométrico fue SCOPUS, la mayor base de datos de resúmenes y citas de la literatura revisada por pares, que cubre publicaciones científicas, libros y actas de conferencias. Utilizando técnicas de descargas remotas, se seleccionaron los artículos publicados entre 1946 y 2017 introduciendo los descriptores principales: "optometric vis* training", "optometric vis* therapy", "vis* therapy", "vis* training" limitados al título, las palabras clave y/o el resumen. Aplicamos los siguientes indicadores bibliométricos: índice de Price, tiempo de duplicado y tasa de crecimiento anual, índice de transitoriedad de Price, Ley de Lotka, factor h, y zonas de Bradford. RESULTADOS: Los autores recuperaron 294 artículos originales del intervalo temporal 1946-2017 (artículos, revisiones, cartas al director, etc.), descartando 15 de ellos por no cumplir los requisitos del estudio. La tasa de crecimiento anual fue del 39,62%, conteniendo el marco temporal 1987-1983 el mayor número de documentos. Estados Unidos fue el país más productivo, con más del 60% de los registros. Las instituciones más productivas son: State University of New York System, SUNY State College of Optometry, y Southern California College of Optometry. La clasificación de los autores basada en la productividad está fuertemente concentrada en pequeños productores, con un índice de transitoriedad de 80,53. El número total de autores fue de 488, lo cual representa un índice de co-autoría de 1,75. CONCLUSIÓN: Los estudios bibliométricos han resultado ser herramientas esenciales para evaluar las publicaciones científicas

Geographic availability to optometry services across Canada: mapping distribution, need and self-reported use.

BACKGROUND: This research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision services. METHODS: Optometrist locations were gathered from provincial regulatory bodies. Optometrist-to-population ratios (i.e. the number of providers per 10,000 people at the health region level) were then calculated. Utilization of vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013-2014 question regarding self-reported contacts with optometrists or ophthalmologists. Data from the 2016 Statistics Canada census were used to create three population 'need' subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Cross-classification mapping compared optometrist distribution to self-reported use of vision care services in relation to need. Each variable was converted into three classes (i.e., low, moderate, and high) using a standard deviation (SD) classification scheme where ±0.5SD from the mean was considered as a cut-off. Three classes: low (< - 0.5SD), moderate (- 0.5 to 0.5SD), and high (> 0.5SD) were used for demonstrating distribution of each variable across health regions. RESULTS: A total of 5959 optometrists across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada; they are predominantly concentrated in urban areas. The national mean ratio of optometrists was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services. CONCLUSION: This research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availability relative to "supply" and "need" factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies.

Bibliometric study of scientific research on optometric visual therapy.

PURPOSE: To analyze scientific research in the field of visual therapy through a bibliometric study. METHODS: The database used in this bibliometric study was SCOPUS, the largest abstract and citation database of peer-reviewed literature, covering scientific journals, books, and conference proceedings. Using remote downloading techniques, articles published between 1946 and 2017 were selected by entering the main descriptors: "optometric vis* training", "optometric vis* therapy", "vis* therapy", "vis* training" limited to the title, key words and/or abstract. We applied the following bibliometric indicators: Price's index, doubling time and annual growth rate, Price's transience index, Lotka's Law, h factor, and Bradford's zones. RESULTS: The authors retrieved 294 original articles from the temporal interval 1946-2017 (articles, reviews, letters to the director, etc.), discarding 15 of them for not meeting the study requirements. Annual growth rate was 39.62%, the timeframe 1987-1983 containing the most number of documents. United States was the country with the highest production, with more than 60% of the records. The most productive institutions are State University of New York System, SUNY State College of Optometry, and Southern California College of Optometry. Classification of authors based on productivity is strongly concentrated in small producers, with a transient index of 80.53. The total number of authors was 488, representing a co-authorship index of 1.75. CONCLUSION: Bibliometric studies have become essential tools for assessing scientific publications.

Are eye-care practitioners fitting scleral contact lenses?

BACKGROUND: To determine the extent of scleral lens fitting worldwide and to characterise the associated patient demographics. METHODS: Survey forms were sent to contact lens fitters around the world, every year for 20 consecutive years (2000 to 2019). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey. Data were analysed for those countries reporting ≥ 1,000 contact lens fits during this period. RESULTS: A total of 369,209 contact lens fits were recorded from 40 eligible countries, comprising 2,309 scleral lens fits and 366,900 other (non-scleral) lens fits. Overall scleral lenses represented 0.76 per cent of all contact lens fits with significant differences between countries (p < 0.0001), ranging from no fits in six countries: Hungary, Indonesia, Iran, Korea, Malaysia and Singapore, to 5.9 per cent in Switzerland. There has been an increase in scleral lens fitting over the survey period (p < 0.0001), with the rate of fits increasing from negligible (< 0.50 per cent) before 2006 and then increasing from 2011 onward (p < 0.0001). Scleral lenses were fit to older patients (38.5 ± 15.0 years) compared to other lenses (31.4 ± 13.7 years) (p < 0.0001), this age disparity increasing over the survey period (p < 0.0001) and were more likely to be males (scleral lens fits 53 per cent, non-scleral lenses 33 per cent, p < 0.0001). The increase in scleral lens fits is commensurate with the increase in related publications in the peer-reviewed literature over the same period (p < 0.05, r2 = 0.82). CONCLUSION: Scleral lens use has increased since 2011 with these specialised lenses more likely to be fitted to males and older patients than non-scleral lenses.

Journal of Optometry bibliometrics / Índices bibliométricos de Journal of Optometry

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U.S. Optometrists' Reported Practices and Perceived Barriers for Low Vision Care for Mild Visual Loss.

SIGNIFICANCE: Identification of modifiable barriers to low vision rehabilitation (LVR) can inform efforts to improve practice management of patients with low vision (LV), through, for example, targeted educational programs for optometrists who do not practice LVR. PURPOSE: Mild vision loss (20/25 to 20/70) is increasing in prevalence among the aging population, yet it is unclear whether near-reading complaints (the highest presenting chief complaint) are being addressed. Studies of LVR provision by U.S. optometrists are currently lacking. This study elucidated self-reported optometric practice patterns for patients with mild vision loss. METHODS: Anonymous surveys were completed by 229 actively practicing optometrists across the United States. The survey inquired about the frequency of providing LVR for mild vision loss patients and the top barriers that prevent them from offering LVR management (including optical aids or referral). RESULTS: Compared with those moderately actively practicing LVR, twice as many (2.08×) practitioners who do not practice any LVR reported that they never prescribe near-reading add power of 4 D or greater for mild vision loss (P < .001). Among those who do not practice LVR, 39 and 11% indicated that they never prescribe any LVR management strategies for patients with visual acuity of 20/25 to 20/40 and 20/50 to 20/70, respectively. The two most commonly reported barriers to LVR indicated by about half of respondents were "cost of the LV exam and/or devices" and that "patients are not interested or would not go to an LV exam." Nearly a third of providers reported that "it is not feasible to stock magnifiers in office." CONCLUSIONS: A sizable group of non-LVR providers in the United States may not be addressing the near-vision needs of patients with mild vision loss. Several of the reported top barriers are potentially modifiable through the development of targeted educational programs for providers.

The practise of paediatric optometry in a low-resource environment.

BACKGROUND: The role of optometrists in paediatric visual assessment must compliment the role of other eye-care practitioners at all levels of care. This study was undertaken to determine if optometrists in Ghana screen, diagnose and manage paediatric ocular conditions (for example, strabismus, amblyopia), and further assessed if optometrists in Ghana have the requisite paediatric instrumentation in their practices. METHODS: This was a cross-sectional descriptive survey involving optometrists in both public and private eye-care sectors in Ghana. A paediatric visual assessment questionnaire was sent to all registered optometrists in Ghana. The contents of the questionnaire evaluated areas of vision assessment, refraction, and previous diagnosis and management, which were matched with practice characteristics such as location, type of practice and type of employment. Chi-squared statistic was used to test associations between variables. RESULTS: Responses were obtained from 140 optometrists out of the 326 registered optometrists, representing a response rate of 46 per cent. Overall, less than half of respondents (64 which represents 46 per cent) assessed themselves as practising full-scope paediatric eye care. These self-assessment views were more common among optometrists at the regional level (111: 79.3 per cent), followed by the district (20: 14.3 per cent) and sub-district levels (nine: 6.4 per cent) (χ2 = 4.774, p < 0.05), but was not influenced by type of employment, type of practice and level of training (p > 0.05). In addition, the study revealed that many respondents were more likely to assess pre-schoolers' visual acuity (VA) (121: 96.0 per cent), do refraction (109: 88.6 per cent) and perform binocular vision (BV) assessment (93: 76.9 per cent) compared to the toddlers' VA (72: 55.4 per cent), refraction (57: 46 per cent) and BV assessment (68: 56.2 per cent). CONCLUSION: Full-scope paediatric eye care services among optometrists in Ghana is limited.

A needs assessment for a minor eye condition service within Leeds, Bradford and Airedale, UK.

BACKGROUND: There are a number of limitations to the present primary eye care system in the UK. Patients with minor eye conditions typically either have to present to their local hospital or GP, or face a charge when visiting eye care professionals (optometrists). Some areas of the UK have commissioned enhanced community services to alleviate this problem; however, many areas have not. The present study is a needs assessment of three areas (Leeds, Airedale and Bradford) without a Minor Eye Conditions Service (MECS), with the aim of determining whether such a service is clinically or economically viable. METHOD: A pro forma was developed for optometrists and practice staff to complete when a patient presented whose reason for attending was due to symptoms indicative of a problem that could not be optically corrected. This form captured the reason for visit, whether the patient was seen, the consultation funding, the outcome and where the patient would have presented to if the optometrists could not have seen them. Optometrists were invited to participate via Local Optical Committees. Results were submitted via a Google form or a Microsoft Excel document and were analysed in Microsoft Excel. RESULTS: Seventy-five percent of patients were managed in optometric practice. Nine and 16% of patients required subsequent referral to their General Practitioner or hospital ophthalmology department, respectively. Should they not have been seen, 34% of patients would have presented to accident and emergency departments and 59% to their general practitioner. 53% of patients paid privately for the optometrist appointment, 28% of patients received a free examination either through use of General Ophthalmic Service sight tests (9%) or optometrist good will (19%) and 19% of patients did not receive a consultation and were redirected to other providers (e.g. pharmacy, accident and emergency or General Practitioner). 88% of patients were satisfied with the level of service. Cost-analyses revealed a theoretical cost saving of £3198 to the NHS across our sample for the study period, indicating cost effectiveness. CONCLUSIONS: This assessment demonstrates that a minor eye condition service in the local areas would be economically and clinically viable and well received by patients.

Transformation Support Provided Remotely to a National Cohort of Optometry Practices.

PURPOSE: We describe the results of a practice transformation project conducted within a national cohort of optometry practices participating in the Southern New England Practice Transformation Network. METHODS: Participants were 2,997 optometrists in 1,706 practices in 50 states. The multicomponent intervention entailed curriculum dissemination through a preexisting network of optometrists supported by specialized staff and resources, and data collection through a web portal providing real-time feedback. Outcomes included practices reporting data, urgent optometry visits for target conditions, and projected cost savings achieved by reducing emergency department (ED) use through increased provision of urgent care for conditions amenable to management in optometry practices. RESULTS: Over 13 months, 69.9% of practices reported data for a mean of 6.7 months. Beginning with the fourth month, the number of urgent optometry visits increased steadily. Among reporting practices, the total cost savings were estimated at $152 million (176,703 ED visits avoided at an average cost differential of $860 per visit). Monthly projected cost savings per optometrist were substantially greater in rural vs urban practices ($10,800 vs $7,870; P <.001). CONCLUSIONS: Technical assistance to promote practice transformation can be provided remotely and at scale at low per-practice cost. Through the provision of timely, easily accessed ambulatory care, optometrists can improve the patient experience and reduce ED use, thereby reducing costs. The cost savings opportunities are immense because of the large volume and high expense of ED visits for ocular conditions that might otherwise be managed in ambulatory optometry practices.