Ocular Imaging Challenges, Current State, and a Path to Interoperability: A HIMSS-SIIM Enterprise Imaging Community Whitepaper.

Office-based testing, enhanced by advances in imaging technology, is routinely used in eye care to non-invasively assess ocular structure and function. This type of imaging coupled with autonomous artificial intelligence holds immense opportunity to diagnose eye diseases quickly. Despite the wide availability and use of ocular imaging, there are several factors that hinder optimization of clinical practice and patient care. While some large institutions have developed end-to-end digital workflows that utilize electronic health records, enterprise imaging archives, and dedicated diagnostic viewers, this experience has not yet made its way to smaller and independent eye clinics. Fractured interoperability practices impact patient care in all healthcare domains, including eye care where there is a scarcity of care centers, making collaboration essential among providers, specialists, and primary care who might be treating systemic conditions with profound impact on vision. The purpose of this white paper is to describe the current state of ocular imaging by focusing on the challenges related to interoperability, reporting, and clinical workflow.

Analysis of patient referrals from primary care to ophthalmology. The role of the optometrist.

PURPOSE: The aim of this study was to characterize the quality of primary care referrals of patients to ophthalmology at the Virgen Macarena Hospital in Seville. This will enable us to optimize ophthalmologic resources and to evaluate the role of the optometrist in improving referrals. METHODS: We performed a retrospective cross-sectional review of 220 ophthalmology consultations referred from primary care to the hospital from March to May 2022. The following data were extracted: age, sex, reason for consultation, diagnosis, priority level, whether it was an initial consultation or a follow-up visit, whether there was a secondary referral and whether the referral was appropriate. Excel (version 2312) was used for the data analysis. RESULTS: The age range of the patients was from 3 years to 91 years. The patients were 41.8 % male and 58.2 % female. The conditions found were grouped as follows: cataracts (27.27 %), refractive errors (20.9 %), anterior segment disease (18.8 %), posterior segment disease (14.07 %), normal examination (18.63 %) and others (0.9 %). The most common reason for consultation was blurred vision or loss of vision (43.63 %). In total, 41.36 % of the consultations were considered inappropriate. The age group requiring the highest number of consultations was over 65 years (38.64 %). CONCLUSIONS: With 41.36 percent of referrals deemed unnecessary, it is clear that referrals can be improved. This would reduce strain on the ophthalmology service and improve patient care. The importance of the optometrist in primary care is demonstrated by the fact that 20.9 % of the diagnoses were refractive errors.

Optometry Educators' Teaching Experiences and Opportunities Pre-, During, and Post-COVID-19 in South Africa.

Aim: The COVID-19 pandemic has impacted the higher education sector worldwide, and South Africa has faced unique challenges that continue to influence teaching beyond the pandemic. Purpose: The study investigated the South African optometry educators' teaching experiences and opportunities pre-, during, and post-COVID-19. Methods: The proposed study design was explorative and quantitative. Convenience sampling was used in recruiting participants. Optometry educators from four (4) universities training optometrists in South Africa were invited to participate in the study. An anonymous online questionnaire designed by the researchers was sent to participants to ensure that it captured relevant data. The questionnaire was sent electronically to the participants and SPSS was used to analyze collected data. Results: Face-to-face (F2F) teaching was found to be the preferred method pre-COVID-19 by all participants. During the COVID-19 pandemic, the F2F was not the teaching method of choice due to safety measures put in place by the government. Online learning (OL) was preferred by 80% (n=4), and blended methods by 100%, due to flexibility in terms of lecture time allocation and digital device infrastructure. A statistically significant satisfaction was indicated by the academics before and post-COVID-19 pandemic with p=0.04 and p=0.02 respectively. The dissatisfaction related to online and blended methods of teaching used during the COVID-19 pandemic could be attributed to a lack of preparedness and digital device infrastructure. Beyond the COVID-19 pandemic participants raised concerns related to the lack of personal interaction and challenges of self-discipline required for online learning including face-to-face lectures. Conclusion: Post the COVID-19 pandemic, there remains a need to address challenges related to the training of optometry educators in using online (OL) and blended methods (BM) of teaching, especially for those with more than 20 years of teaching experience. Whilst OL and BMs are beneficial, F2F teaching should not be neglected as it remains the cornerstone of effective education in optometry, especially in clinical training.

Silk-Derived Protein-4 versus vehicle control in treating patients with moderate to severe dry eye disease: a randomized clinical trial.

PURPOSE: In this study the safety and efficacy of silk-derived protein 4 (SDP-4), also known as amlisimod, eye drops against a vehicle control formulation in patients with moderate to severe dry eye disease (DED) was assessed. SDP-4 is a novel, naturally derived, anti-inflammatory wetting agent that enhances coating on the ocular surface. DESIGN: Exploratory Phase 2, 12- and 8-week, serial cohort, multicenter, double-masked, randomized, vehicle-controlled study. METHODS: In the first cohort (N=305), patients were randomized 1:1:1:1 to SDP-4 (0.1%, 1%, 3% wt./wt.) or vehicle control and dosed two times per day (BID), while in the second cohort patients were randomized 1:1 with 1% wt./wt. SDP-4, the best performing formulation from the first cohort, or vehicle control BID (N=151). Diagnosed DED patients were treated in the United States between April 2019 and May 2021. The first cohort of subjects had moderate to severe baseline symptoms, while the second cohort had moderate baseline symptoms to study the impact of baseline symptoms on SDP-4 performance. Key sign and symptom end points were mean change from baseline in TBUT and total SANDE score (0-100 visual analog scale) throughout the study. RESULTS: SDP-4 (1%) significantly increased TBUT vs the vehicle control (P<0.05) at days 28 and 56 in the first cohort, and patient symptomatology from baseline was reduced by 46% based on subject reported SANDE VAS scores at day 84. Patients with more severe baseline DED symptoms experienced a significantly greater amount of relief than when compared to patients with moderate DED (P<0.05). All treatment groups were well tolerated with a 2.6% total discontinuation rate. CONCLUSIONS: To the best of our knowledge, this was the first-in-human use of SDP-4 in a clinical trial. SDP-4 is a first-in-class protein ingredient that offers a safe and multi-modal treatment approach for alleviating severe DED symptoms within a novel formulation.

Long-term results of allogenic corneal lenticule of hyperopic SMILE for post-LASIK ectasia.

Post-laser-assisted in situ keratomileusis (LASIK) corneal ectasia is a severe complication of corneal refractive surgery, and cryopreserved lenticules from hyperopic small incision lenticule extraction (SMILE) may offer a promising treatment though their long-term safety and efficacy are still under investigation. In this prospective case series, six eyes from six patients with post-LASIK ectasia received lenticules (mean cryopreserved time: 63 days). The procedure involved lifting the corneal flap, implanting the lenticule, and repositioning the flap. Over a follow-up period of at least one year, uncorrected distance visual acuity (UDVA) improved from 1.52 ± 0.40 preoperatively to 0.74 ± 0.28 LogMAR. Two eyes gained one line of corrected distance visual acuity (CDVA), three gained two lines, and one gained over three lines. Spherical equivalents decreased from -14.67 ± 2.36 D to -8.75 ± 4.03 D (p = 0.02). Mean anterior K and total corneal refractive power decreased (p < 0.05). Thinnest corneal thickness increased from 359.2 ± 39.3 µm to 401.7 ± 53.4 µm (p = 0.02). These findings support the potential of cryopreserved lenticules for treating post-LASIK ectasia, though further refinement in refractive predictability is needed.

Antimicrobial stewardship and education in optometry.

CLINICAL RELEVANCE: Antimicrobial stewardship aims to improve how antibiotics are prescribed by clinicians and used by patients, to ensure safe appropriate use, and to prevent and contain antimicrobial resistance. BACKGROUND: Australian optometrists can prescribe a range of antimicrobial agents, but to what extent they consider antimicrobial stewardship is not known. This study evaluated what final-year optometry students and optometrists understood about antimicrobial stewardship in eye care and considered relevance to oral prescribing and education. METHODS: A knowledge, attitude, and practice (KAP) questionnaire was developed comprising four sections: i) demographic questions, ii) 10 multiple choice questions regarding Knowledge about antimicrobial agents and likely pathogens, diagnosis, treatment, and preventing resistance, iii) 10 Likert rating scale questions about thoughts and Attitudes, iv) mix of question types (5× MCQ: course of action, 16 Likert scale: confidence) related to Practice (diagnosis, management, and prescribing). Descriptive analyses were conducted (medians, mean±SD, and distributions). RESULTS: Thirteen students and 36 optometrists completed the survey. Both groups had a good understanding of microbial resistance and antibiotic prescribing for ocular conditions; average knowledge scores were 9.2 ± 0.7 and 8.7 ± 1.1 for students and practitioners, respectively. Scores were neutral to agree for questions related to the need for more educational programs. The answers of practice-related MCQs had a dichotomy of answers indicating a diversity of opinion, as can be the case in practice. Average total practice confidence scores were approximately 57/80 for students and 68/80 for optometrists. Optometrists and students were very confident in their ability to conduct an appropriate case history and use their knowledge and clinical skills, including slit lamp anterior eye assessment. The lowest confidence scores were for conducting microbial testing, i.e. taking swabs for pathology. CONCLUSION: Student and optometrist knowledge, attitudes, and practice around antimicrobial stewardship were high and in line with other health professions globally. There is scope for increased stewardship training.

Exploring the health and ocular hazards of gadget usage in optometry students after COVID-19 lockdown: A qualitative study.

BACKGROUND: Prolonged screen time and abnormal postures can cause backache, neck pain, headache, and finger pain. Studies have shown that excessive usage of gadgets has increased during the coronavirus disease 2019 (COVID-19) pandemic, causing health and ocular hazards. This study used qualitative research methods to understand the health and ocular effects of gadget usage following the COVID-19 postlockdown in optometry students. MATERIALS AND METHODS: A qualitative study using a semi-structured face-to-face interview was conducted for undergraduate and postgraduate students in different optometry institutes who underwent at least 3 months of online teaching learning during the pandemic after obtaining informed consent. The interviews were conducted online; the sessions were audio-recorded, transcribed, and analyzed. Thematic analyses were conducted to understand the challenges faced. RESULTS: Twenty participants were interviewed, of which 70% (n = 14) were females. Thematic analysis identified seven major themes: gadget usage (frequency of usage, type of device, and time spent), challenges during online classes (comprehension, distraction, and network issues), ocular effects (asthenopic symptoms and ocular symptoms), health effects (musculoskeletal disorders), ways to relieve symptoms, recreational activities (breaks and entertainment), and environment and ergonomics (posture and study area and preferred lighting). All the participants reported ocular/health-related symptoms, including eye strain, burning sensation, headache, back pain, finger pain, and neck pain post the lockdown period due to prolonged gadget usage and poor ergonomic postures. CONCLUSIONS: Given the significant increase in digital usage following the pandemic, the study's findings are currently relevant. The prolonged usage of gadgets and poor ergonomic postures have led to ocular and musculoskeletal problems among optometry students. To improve gadget usage without any health-related consequences, students should have access to information regarding ergonomics, increasing the blink rate, and taking regular digital breaks.

Ophthalmological screening guidelines for individuals with Osteogenesis Imperfecta: a scoping review.

BACKGROUND: Osteogenesis imperfecta (OI) is a connective tissue disorder in which the Type 1 collagen is defective. The eye is a structure rich in collagen Type 1 and is heavily impacted by the disease. Many vision-threatening eye diseases have been associated with OI. The onset of these diseases also tend to occur at an earlier age in individuals with OI. Despite the research on these risks, appropriate ophthalmological screening or care guidelines for individuals with OI remain unknown. As such, the purpose of this scoping review was to explore and describe existing ophthalmological screening and care guidelines to orient OI patient care. MAIN BODY: A scoping review based on the Joanna Briggs Institute (JBI) methodology was conducted. A search of databases (PubMed and Medline) was completed in consultation with a research librarian. A total of 256 studies were imported for screening. Primary sources matching the inclusion and exclusion criteria were screened, extracted, and analyzed using Covidence. CONCLUSION: A total of 12 primary articles met inclusion and exclusion criteria, containing case reports, case series and cohort studies. Despite the risk of blindness associated with the consequences of OI on the eye, the primary literature fails to provide detailed screening and care guidelines aimed at identifying disease early. We provide general recommendations based on the review findings to guide the ophthalmological care of patients with OI and call upon the experts to convene globally to create screening guidelines. Further investigations of ophthalmological screening are warranted to limit these vision-threatening risks with early detection and treatment. Standardized ophthalmological screening guidelines for OI remain an area for research.

Testing the Hard to Test: A Pilot Study Examining the Role of Questionnaires in Eliciting Visual Behaviours in Children with Autistic Spectrum Disorder.

PURPOSE: There is a higher prevalence of visual problems in children with Autistic Spectrum Disorder (ASD) compared with the neuro-typical population. Issues relating to visual perception can be evident as atypical visual behaviours (ViBes). The aim of the study was to compare findings of parents and eye health professionals using questionnaires to describe visual function in young children with ASD. MATERIALS AND METHODS: Parents/Caregivers of patients diagnosed with ASD attending routine hospital eye clinics were invited to participate. A questionnaire to draw out presence of ViBes was completed by the parent prior to attending clinic. The clinician independently completed the same questionnaire and undertook a clinical ocular assessment. RESULTS: 32 children were recruited (mean age 7 years, range 4-11). Most caregivers indicated they had noted at least one atypical ViBe (97%, median 5, range 0-8). Parental-reported ViBe8 scores were higher than clinician-reported scores (p = 0.04). The most commonly reported ViBes by both groups related to use of vision at the same time as other senses, and atypical fixation (e.g. looking away during speech or side viewing). There was weak correlation between visual acuity and parental ViBe8 score (rho = 0.364) and no correlation between refractive error and parental ViBe8 score (rho = 0.047). CONCLUSION: Clinicians were likely to under-report atypical visual function compared with parent. Refraction and visual acuity alone do not detect all visual problems in children with ASD. A Visual Behaviour (ViBe) questionnaire offers a structured approach and shared language to allow documentation of functional visual assessment for both parents, carers, and educational professionals. Use of the ViBe questionnaire may promote understanding between caregiver and professional and provide a baseline for visual behaviours.

Implementation of the optometry Aboriginal and Torres Strait Islander health curriculum framework.

CLINICAL RELEVANCE: There is now an Optometry Council of Australia and New Zealand (OCANZ) accreditation requirement for Australian and Aotearoa New Zealand optometry programs to ensure students can provide culturally safe care for First Nations Peoples. To assist programs, OCANZ developed the Optometry Aboriginal and Torres Strait Islander Health Curriculum Framework (Optometry Framework). BACKGROUND: The objective of this study was to evaluate early progress towards the implementation. METHODS: All seven Australian optometry programs were invited to complete a modified version of the OCANZ curriculum mapping tool. Where available, online unit outlines were reviewed to verify and supplement the data. Curriculum maps were synthesised using qualitative content analysis. RESULTS: None of the five participating programs had a standalone Aboriginal and Torres Strait Islander health unit; instead, programs were integrating content into core units. Only 25% of the units with relevant content had a directly related learning outcome. All programs had at least some content that was either directly or indirectly related to each of the Optometry Framework themes, and included some content related to novice and intermediate levels of learning. Four programs had content related to entry to practice levels of learning. The average total duration of directly related content in programs (excluding clinical placements) was 18 hours. Not all programs offered an Aboriginal and Torres Strait Islander health setting clinical placement opportunity. Directly related assessment was minimal in most programs, where the format was predominantly reflective journals or questions within written examinations. CONCLUSION: Progress has been made in implementing the Optometry Framework; however, further efforts are required. Programs need to integrate additional directly related learning outcomes, content (particularly entry to practice level learning), and assessment. Further curriculum enhancements will improve the likelihood of optometry students acquiring the necessary capabilities for providing culturally safe care.

Entry-level competency standards for optometry 2022.

The Entry-level Competency Standards for Optometry in Australia identify the required knowledge, skills and attributes for an optometrist to practise safely and competently. The 2022 competencies are the sixth generation of entry-level competency standards. To ensure the standards reflect contemporary practice and the expectations placed on optometrists, a full revision of the standards was commenced in late 2019. A steering committee was appointed by Optometry Australia to oversee the development of the Entry-level Competency Standards for Optometry. The development was informed by a review of best-practice design for health professional competency standards undertaken by Paul Hager on behalf of the Optometry Council of Australia and New Zealand (OCANZ) in 2019. To identify the changes required, workshops were held with optometrists and representatives from stakeholder organisations leading to the formation of draft Entry-level Competency Standards for Optometry in early 2020. The impacts of the COVID-19 pandemic meant development halted in March 2020, and resumed in late 2021. Consultation on the Entry-Level Competency Standards for Optometry 2022 was undertaken in two rounds with the first being targeted stakeholder consultation, followed by public consultation. Following consultation, feedback was considered by the steering committee and amendments were made to produce the final Entry-level Competency Standards for Optometry 2022. This document outlines the development process and the major changes in the updated standards. The major changes include a redesigning of the Domains, a reduction in the level of detail and a strengthening of the expectations around cultural responsiveness and culturally safe care. The revised standards capture the current entry requirements for the optometric profession as of 2022. The updated Entry-level Competency Standards for Optometry 2022 were endorsed by the national board of Optometry Australia and accepted by the Optometry Board of Australia in February 2023.

Establishment and review of educational programs to train optometrists in laser procedures and injections.

Current scope of practice for optometrists in many countries include topical and oral medication with injectable and lasers being added more recently to scope in the United States (US), Canada, the United Kingdom (UK) and New Zealand (NZ). This expanded scope of optometric practice improves access to eyecare and is critical since an ageing population with a higher prevalence of vision disorders and higher healthcare costs looms. Expanded scope has been shown alongside strong safety records. This review paper aims to investigate the expansion of optometric scope of practice regarding lasers and injectables in the US, UK, Canada, Australia and NZ. The design and delivery of post-graduation educational programs, curriculum frameworks for advanced skills and the metrics of laser procedures performed by optometrists will be discussed. The State of Oklahoma in the US was first to authorise optometrists to use lasers and injectables in 1988. As of 2024, qualified optometrists in the UK, in twelve states in the US, and specialist optometrists in NZ perform laser procedures. However, lasers and injectables are not within the current scope of optometric practice in Australia and Canada. Training courses such as Northeastern State University Oklahoma College of Optometry Advanced Procedures Course and Laser Procedures Course have been successfully designed and implemented in the US to train graduate optometrists. The outcomes of over 146,403 laser procedures performed by optometrists across the US have shown only two negative outcomes, equating to 0.001%. These metrics outline the effectiveness of these procedures performed by optometrists and show strong support for future optometric scope expansion. Eye health professionals, relevant educational institutions, advocacy groups, and policymakers are called upon to work collaboratively to expand the optometric scope of practice globally.

Clinical reading-related oculomotor assessment in visual snow syndrome / Evaluación oculomotora clínica relacionada con la lectura en el síndrome de nieve visual

Purpose: Visual snow syndrome (VSS) is a complex neurological condition presenting with an array of sensory, motor, and perceptual dysfunctions and related visual and non-visual symptoms. Recent laboratory studies have found subtle, basic, saccadic-based abnormalities in this population. The objective of the present investigation was to determine if saccadic-related problems could be confirmed and extended using three common clinical reading-related eye movement tests having well-developed protocols and normative databases. Methods: This was a retrospective analysis of 32 patients (ages 16–56 years) diagnosed with VSS in the first author's optometric practice. There was a battery of three reading-related tests: the Visagraph Reading Eye Movement Test, the Developmental Eye Movement (DEM) Test, and the RightEye Dynamic Vision Assessment Test, all performed using their standard documented protocols and large normative databases. Results: A high frequency of oculomotor deficits was found with all three tests. The greatest percentage was revealed with the Visagraph (56%) and the least with the RightEye (23%). A total of 77% of patients failed at least one of the three tests. Conclusion: The present findings confirm and extend earlier investigations revealing a high frequency of saccadic-based oculomotor problems in the VSS population, now including reading-related tasks. This is consistent with the more general oculomotor/motor problems found in these individuals.(AU)

A review study on forensic optometry: new insights in forensic science to solve crime scenes, domestic violence and sexual assaults.

Forensic science has made a lot of progress in the medical field, but still ocular signs are not so well known to forensic scientists, whereas ocular signs play a very important role in forensic science. The major goal of this study to describe the importance of eye related clues in forensic science to solve the crime scenes and know the actual cause of death for the conviction of the criminals and save an innocent persons. Narrative review was done to review the articles available on the PubMed, Google Scholar, Research Gate, Web of Science and Medline related to the forensic optometry about the various methods of identification and strategies to deal with the forensic cases. The review covered studies that focused on interventions for forensic optometry and eye-related clues to the current study target. Twenty-seven of the 54 studies that met the inclusion criteria yielded good results, and all examined the significance of eye-related clues in forensic optometry. Peer reviewed articles/studies were referred to ascertain the eye related clues in the forensic science. Some authors suggest that eye related clues are very important aspects towards the forensic science and done the clinical research on that aspects. Criminal cases, domestic abuse and sexual assault affect people of all socioeconomic backgrounds. As a result, these traits would be highly valuable in determining the way of death and the chronological history of events leading up to a crime.

The potential for using entrustable professional activities in assessing optometric clinical competence.

Qualifications required to practise optometry seek to provide assurance that those completing them have the necessary competencies to be safe and effective clinicians. Often, this assurance is gained via high stakes assessments such as objective structured clinical examinations. This paper introduces entrustable professional activities (EPAs) as a potential alternative approach to assessing optometric clinical competence. Entrustable professional activities are defined in the context of optometric practice and the potential advantages and challenges of using them are outlined.

The role of extended reality in optometry education: a narrative review.

The evolution of digitally based pedagogies, such as extended reality (XR) - a group of simulated learning environments that include virtual simulation, virtual reality, and augmented reality - has prompted optometry educators to seek evidence to guide the implementation of these teaching and learning activities within their curricula. Looking more broadly across the medical and allied health fields, there is a wealth of evidence to guide the incorporation of XR, as it is increasingly being integrated into the curricula of other select health professions disciplines. Educators from these disciplines continue to explore and embed XR in practice. This narrative review summarises the findings and appraises the literature on the use of XR in optometry education. It identifies the learning domains in which XR has been implemented in optometry education and proposes areas for further investigation. The review questions the technology-focused approach that has driven the literature within the review and calls for richer pedagogical foundations with suggestions for future research agendas. As such, this narrative review provides optometry educators with new ways of understanding XR and its relationship with the curriculum.

Dermoscopy can be safely and reliably used in ophthalmology.

Objective: To determine if dermoscopy, a technique widely utilized in dermatology for improved diagnosis of skin lesions, can be used comfortably for evaluating periorbital, eyelid, and conjunctival lesions. Design: Proof-of-concept study in which a technique for performing dermoscopy near the eye was developed, related educational material was prepared, and a protocol for dermoscopic image capture was created. Methods: Technicians used the developed materials to learn to take high-quality pictures with a 10x dermoscope attached to a standard cell phone camera. The images were assessed for diagnostic utility by an oculoplastic surgeon and two dermatologists. Participants: 115 patients recruited from ophthalmology clinics from July 2021 to April 2023 were photographed, yielding 129 lesions with high-quality dermoscopic images as assessed by an oculoplastic surgeon and two dermatologists. Results: Technicians reported a significant increase in confidence (measured on a 1-10 scale) with dermoscopy after training (pre-instruction mean = 1.72, median = 1, mode = 1, IQR = 1.25 vs mean = 7.69, median = 7.75, mode = 7 and 8, IQR = 1.5 post-instruction. Wilcoxon rank sum test with continuity correction, W = 0, p < 0.001, paired t = 13.95, p < 0.0001). Incorporating a contact plate with a 4 × 4mm reticule on the dermoscope aided in photographing ocular and periocular lesions. Conclusion: Medical support staff in eye-care offices can be taught to use dermoscopes to capture high-quality images of periorbital, eyelid, and conjunctival lesions. Dermoscopy illuminates diagnostic features of lesions and thus offers a new avenue to improve decision-making in ophthalmology. Dermoscopy can be incorporated into telemedicine evaluations by ophthalmologists, oculoplastic surgeons, or affiliated dermatologists for triage of or rendering advice to patients and for planning of surgery if needed.

Prescribing patterns for hyperopia: an insight of the optometrist perspective and practice.

BACKGROUND: To investigate the current prescribing patterns for correcting hyperopia among optometrists in clinical practice in Saudi Arabia and compare those to current international guidelines. And explore the factors that influence practitioners' prescribing decision. METHOD: This cross-sectional study employed 30 items online survey that encompass demographic data, current practice and cycloplegia use, numerical response to indicate the minimum level of hyperopia at which optometrists would consider prescribing spectacles to non-strabismic children and determine the diopter value required for prescribing correction for hyperopia if present with other factors. RESULT: A total of 104 optometrists responded to the survey (52 females and 52 males). They recruited from 35 cities across Saudi Arabia. Out of total, 44% of them considered cycloplegic refraction essential under 12 years and 56% of them extended the range to 18 years. Large variation were found between the optometrists' responses and current guideline recommendations. Several factors influenced the decision-making of the practicing optometrist including signs and symptoms, bilateral hyperopia, average dioptric value, reading difficulty, and accommodative function. CONCLUSION: There are some matches between the international guidelines and the practice patterns that followed by optometrists in Saudi Arabia, however, the optometrists did not report that they are following them purposefully. These findings highlight the need to improve optometrists' practice about spectacle prescription in pediatric population.

Role of Machine Learning and Artificial Intelligence in the Diagnosis and Treatment of Refractive Errors for Enhanced Eye Care: A Systematic Review.

A significant contributor to blindness and visual impairment globally is uncorrected refractive error. To plan effective interventions, eye care professionals must promptly identify people at a high risk of acquiring myopia, and monitor disease progress. Artificial intelligence (AI) and machine learning (ML) have enormous potential to improve diagnosis and treatment. This systematic review explores the current state of ML and AI applications in the diagnoses and treatment of refractory errors in optometry. A systematic review and meta-analysis of studies evaluating the diagnostic performance of AI-based tools in PubMed was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To find relevant studies on the use of ML or AI in the diagnosis or treatment of refractive errors in optometry, a thorough search was conducted in various electronic databases such as PubMed, Google Scholar, and Web of Science. The search was limited to studies published between January 2015 and December 2022. The search terms used were "refractive errors," "myopia," "optometry," "machine learning," "ophthalmology," and "artificial intelligence." A total of nine studies met the inclusion criteria and were included in the final analysis. ML is increasingly being utilized for automating clinical data processing as AI technology progresses, making the formerly labor-intensive work possible. AI models that primarily use a neural network demonstrated exceptional efficiency and performance in the analysis of vast medical data, rivaling board-certified, healthcare professionals. Several studies showed that ML models could support diagnosis and clinical decision-making. Moreover, an ML algorithm predicted future refraction values in patients with myopia. AI and ML models have great potential to improve the diagnosis and treatment of refractive errors in optometry.