Opportunities and threats to contact lens practice in Spain / Oportunidades y amenazas para la práctica de lentes de contacto en España

Objective: An international survey evaluated the opportunities and threats related to contact lens practice reported by eye care professionals worldwide. This study reports on the results specifically found in Spain and how these compare with those from other regions of the world. Methods: A questionnaire was distributed to eye care practitioners around the world through professional associations. The questionnaire consisted of 9, 5 and 12 questions about opportunities, interventions, and potential threats related to contact lens practice, respectively. Results: A total of 2,408 responses were obtained from practitioners worldwide, of which 436 responses were obtained from Spanish practitioners. Spain was found among the regions with the highest perception of opportunities (median: 6.5/10) along with Australasia, North America, Europe, and South America. Spanish (median: 7.3/10), along with South American practitioners, also reported the highest perception of threats. Continuously updating of knowledge/skills, recommending contact lens wearing options to potential patients, creating an efficient recall system for follow-up examinations and being competent in managing contact lens-related complications were reported as important interventions for contact lens practice growth by Spanish eye care practitioners. Conclusions: Spain is one of the regions in the world with the highest perception of both opportunities and threats regarding future contact lens practice. As such, Spanish practitioners consider it important to continuously update knowledge/skills and to recommend and educate patients on the benefits of contact lens wear. Online sales were found to be one of the most important concerns reported by both Spanish and eye care practitioners worldwide.(AU)

Opportunities and threats to contact lens practice in Spain.

OBJECTIVE: An international survey evaluated the opportunities and threats related to contact lens practice reported by eye care professionals worldwide. This study reports on the results specifically found in Spain and how these compare with those from other regions of the world. METHODS: A questionnaire was distributed to eye care practitioners around the world through professional associations. The questionnaire consisted of 9, 5 and 12 questions about opportunities, interventions, and potential threats related to contact lens practice, respectively. RESULTS: A total of 2,408 responses were obtained from practitioners worldwide, of which 436 responses were obtained from Spanish practitioners. Spain was found among the regions with the highest perception of opportunities (median: 6.5/10) along with Australasia, North America, Europe, and South America. Spanish (median: 7.3/10), along with South American practitioners, also reported the highest perception of threats. Continuously updating of knowledge/skills, recommending contact lens wearing options to potential patients, creating an efficient recall system for follow-up examinations and being competent in managing contact lens-related complications were reported as important interventions for contact lens practice growth by Spanish eye care practitioners. CONCLUSIONS: Spain is one of the regions in the world with the highest perception of both opportunities and threats regarding future contact lens practice. As such, Spanish practitioners consider it important to continuously update knowledge/skills and to recommend and educate patients on the benefits of contact lens wear. Online sales were found to be one of the most important concerns reported by both Spanish and eye care practitioners worldwide.

Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice.

OBJECTIVE: To investigate eye care practitioners' attitudes and perceptions toward potential interventions that can enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting. METHODS: A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies. RESULTS: In total, 2,222 responses from 27 countries with sufficient responses were analyzed (53% females, median age- 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from stand-alone/independent practices. Median working experience in CL prescribing was 11.0 years (IQR: 18.0, 4-22 years). Over two-third of them declared themselves to be very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice. Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P <0.05). National differences were also identified in eye care practitioner attitudes and perceptions ( P <0.05). CONCLUSIONS: The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels.

Opportunities and threats to contact lens practice: A global survey perspective.

AIM: To understand the views of contact lens (CL) practitioners across the globe regarding what they perceive as opportunities and threats in CL practice. METHODS: A self-administered anonymised questionnaire, constructed in English and translated in six more languages, was distributed through reputed international professional bodies and academic institutions worldwide. The questionnaire included items on demographic characteristics, type of practice, and questions designed to explore practitioners' perspective on the future of their CL practice over the next five years. RESULTS: A total of 2408 valid responses were analysed. Multifocal CLs for presbyopia, CLs for myopia control, use of daily disposable (DD) CLs for occasional wear, and biocompatible materials to improve comfort were identified as promising areas of opportunities by practitioners (all 8/10). Respondents from North America, and Europe valued DDCLs for occasional wear moderately more favourable (Median: 9/10 for all) as compared to colleagues in Asia (Median: 8/10, p < 0.001), South America (Median: 8/10, p < 0.01), and Africa (Median: 8/10p < 0.01). Multifocal CLs for presbyopia was perceived as a better opportunity by practitioners in North America and Europe (Median: 9/10 for both), as well as in Australasia (Median: 8/10), in comparison to Asia, Africa, and Middle East (for all Median: 6/10, p < 0.001). Practitioners expressed concerns about the availability of CLs and CL prescriptions online without direct professional involvement (both 9/10). CONCLUSIONS: Overall, the most appealing opportunities for CL practice growth were identified in occasional use of DD CLs, biocompatible materials to reduce CL discomfort, multifocal CLs for presbyopia correction and management of myopia control with CLs. Lack of regulation in CL sales, especially online, seemed to be a constant threat. The insights from this study can be used to design targeted strategies to enhance CL practice across the globe and in specific geographical areas.

COVID-19 guidelines for optometry and optical services post-lockdown.

The COVID-19 pandemic has caused disruption in everyone's lives globally. Optometrists, being primary health care professionals are at a higher risk of infection in their practices during these testing times. Optometrists and optical store owners need practically implementable guidelines as lockdown gets lifted in various parts of our country. As these practices gear up to provide eye examination and vision correction to people, they need to take necessary precautions to avoid any cross contaminations. Optometry Council of India guidelines were circulated among optometry and optical associations and among experts in various optometry specialty. A consensus among various bodies were arrived. These guidelines provide recommendation for optical and optometry practices.

International Association of Contact Lens Educators: Exceptional education-Exponential impact.

The International Association of Contact Lens Educators (IACLE) is the leading provider of educational and information resources essential to contact lens educators worldwide. The New IACLE Contact Lens Course is its most important resource, used by members around the world to teach their students, the contact lens practitioners of the future. In 2019, IACLE celebrated the 40th Anniversary of its founding meeting. In this article, we trace the early years of the organization and describes its impact on contact lens education in India.

Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update.

PURPOSE: A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later. METHODS: A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies. RESULTS: Of the 1336 respondents, concern was highest (9.0 ±â€¯1.6; p < 0.001) in Asia and lowest (7.6 ±â€¯2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ±â€¯2.3; p < 0.001), the North American practitioners being the least active (6.3 ±â€¯2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ±â€¯21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %). CONCLUSIONS: While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future.

Global trends in myopia management attitudes and strategies in clinical practice.

PURPOSE: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established.

Pattern of optometry practice and range of services in India.

PURPOSE: This study was conducted to evaluate the range of services provided by optometrists in various modes of optometric practice in India. METHODS: An online questionnaire was administered to 1674 optometrists to collect information on the range of optometric services offered. Data were analyzed based on variables including sex, educational qualification, and modes of practice. Two-sample Wilcoxon rank sum tests, χ tests, and Fisher exact text were used to conduct inferential statistics. RESULTS: A total of 563 valid and completed survey questionnaires were received from graduates of 41 optometry institutes working across 23 states of India. Of these, 225 (40.0%) were female, 288 (51.2%) had completed postgraduate education, and 340 (60.5%) were involved in more than one mode of practice. The top three modes of practice were hospital-based practice (44.8%), academia (42.8%), and optical retail (33.0%). Of the 441, out of 563 (78.3%) respondents involved in patient care, the majority (98.4%) performed refraction and routine eye examination, 70.3% dispensed contact lenses, and 66.9% practiced optical dispensing. Lower involvement was seen in providing binocular-vision (45.1%) and low-vision services (30.2%). Higher education was associated with advanced level of practice (p < 0.05) except clinical investigative procedures. There was a significant association between postgraduate studies and involvement in academics and research (p < 0.01). CONCLUSIONS: Most optometrists are engaged in multiple modes of practice, with optical practice, hospital-based practice, and academia being the leading modes. Optometrists need to be more involved in providing the core optometric services of binocular vision and low vision. Higher education has an impact on the level of optometric practice.

Barriers, motivators and enablers for dispensing multifocal contact lenses in Mumbai, India / Barreras, factores motivadores y factores facilitadores de la difusión de lentes de contacto multifocales en Mumbai, India

Purpose: To understand the potential barriers, motivators and enablers in dispensing multifocal contact lenses (MFCL). Method: Two focus group discussions were conducted to design questionnaires regarding the prescribing habits for multifocal contact lenses (MFCL). Questions on potential barriers and motivators were included. The questionnaires were distributed among 133 eye care practitioners across Mumbai, India. Practitioners fitting one or less patient per month with MFCL completed the survey describing potential barriers, while those who prescribed more MFCL’s per month completed the survey describing enablers and motivators. Results: Responses from 102 practitioners were received. Most common potential barriers in prescribing MFCL were increased chair time (75%), lack of readily available trials (69%) and limitation in power range (63%). Lack of awareness among patients (90%) was the most common barrier from patients’ outlook. Professional satisfaction (88%) and better business proposition (82%) were observed as main motivators while availability of the trials (84%) and correct patient selection (82%) were the major enablers. Graduate Optometrists felt dispensing MFCL did not offer a good business proposition (p = 0.02). Experienced practitioners were observed to be least motivated (p = 0.01) and believed that their patients found these lenses expensive (p = 0.02). Conclusion: To enhance the MFCL practice, barriers like lack of awareness and limitations in power range must be addressed. Trial lens availability may motivate practitioners to prescribe MFCL. Further probing is required to understand lack of motivation among experienced practitioners (AU)

Objetivo: Comprender las barreras potenciales y los factores motivadores y facilitadores de la dispensación de lentes de contacto multifocales (MFCL). Método: Se llevaron a cabo dos debates a fin de diseñar los cuestionarios relativos a los hábitos de prescripción de las lentes de contacto multifocales (MFCL). Se incluyeron cuestiones sobre las barreras potenciales y los factores motivadores. Dichos cuestionarios fueron distribuidos entre 133 profesionales de cuidados oculares en Mumbai, India. Los profesionales que adaptaban una o menos lentillas multifocales al mes completaron la encuesta que describe las barreras potenciales, mientras que aquellos facultativos que adaptaban más lentes de contacto al mes completaron la encuesta que describe los factores facilitadores y motivadores. Resultados: Se recibieron respuestas procedentes de 102 facultativos. Las barreras potenciales más comunes de la prescripción de MFCL fueron el incremento del tiempo de consulta (75%), la falta de disponibilidad de lentes de prueba (69%) y la limitación del rango de potencia (63%). La falta de concienciación de los pacientes (90%) fue la barrera más común desde la perspectiva del paciente. Como principales factores motivadores se observaron la satisfacción profesional (88%) y la mejor propuesta comercial (82%), mientras que la disponibilidad de lentes de prueba (84%) y la correcta selección del paciente (82%) fueron los principales factores facilitadores. Los Optometristas Graduados pensaron que la dispensación de MFCL no ofrecía una buena propuesta comercial (p = 0,02). Se observó que los facultativos experimentados estaban menos motivados (p = 0,01), y pensaban que sus pacientes consideraban que estas lentes eran caras (p = 0,02). Conclusión: Para mejorar la práctica de las MFCL, deben abordarse las barreras tales como la falta de concienciación y las limitaciones del rango de potencia. La disponibilidad de lentes de prueba puede motivar a los facultativos a prescribir MFCL. Hace falta investigación adicional para ayudar a comprender la falta de motivación entre los facultativos experimentados (AU)

Barriers, motivators and enablers for dispensing multifocal contact lenses in Mumbai, India.

PURPOSE: To understand the potential barriers, motivators and enablers in dispensing multifocal contact lenses (MFCL). METHOD: Two focus group discussions were conducted to design questionnaires regarding the prescribing habits for multifocal contact lenses (MFCL). Questions on potential barriers and motivators were included. The questionnaires were distributed among 133 eye care practitioners across Mumbai, India. Practitioners fitting one or less patient per month with MFCL completed the survey describing potential barriers, while those who prescribed more MFCL's per month completed the survey describing enablers and motivators. RESULTS: Responses from 102 practitioners were received. Most common potential barriers in prescribing MFCL were increased chair time (75%), lack of readily available trials (69%) and limitation in power range (63%). Lack of awareness among patients (90%) was the most common barrier from patients' outlook. Professional satisfaction (88%) and better business proposition (82%) were observed as main motivators while availability of the trials (84%) and correct patient selection (82%) were the major enablers. Graduate Optometrists felt dispensing MFCL did not offer a good business proposition (p=0.02). Experienced practitioners were observed to be least motivated (p=0.01) and believed that their patients found these lenses expensive (p=0.02). CONCLUSION: To enhance the MFCL practice, barriers like lack of awareness and limitations in power range must be addressed. Trial lens availability may motivate practitioners to prescribe MFCL. Further probing is required to understand lack of motivation among experienced practitioners.

Economic burden of diabetes in urban indians.

PURPOSE: To find out the average economic burden of medical care on a patient with diabetes in Pune, India. METHODS: A semi-open ended questionnaire followed by interview was conducted with patients attending diabetes and ophthalmic out-patient departments. They were asked regarding the duration of diabetes, methods undertaken for blood sugar control and the amount they spend on consultations, laboratory tests, medicines and procedures if any within past year. Expenditure was classified as direct cost (cost of medicines, doctor's fees, investigations, lasers and surgery) and indirect cost (travel, diet control, health classes and loss of wages). Data was collected regarding the socioeconomic status according to Kuppaswamy classification. RESULTS: 219 patients participated of whom 129 were males (58.9%). Average annual direct cost of diabetes treatment was Rs 8,822 of which 52.1% was spend on medicines, 3.2% was spend on lasers, 12.6% was spend on surgical procedures, 11.6% spent on investigations and 10.4% was spend on clinician fees. Average annual indirect cost was Rs. 3949 of which 3.4% was spend on travelling purpose, 0.4% was spent on health classes, 4.9% was spent on diet control and 91.3% was loss of wages. Average expenditure done by lower middle class was 23.7% of their income. Average percentage of income for direct and indirect cost was 3.6% and 1.4% respectively. The cost of the treatment formed1.3% of the annual income for those in Socio-economic class I, 1.7% in class II, 3.7% in class III and 23.7% in class IV. CONCLUSION: The cost of managing diabetes was a significant proportion of the patients' income, especially for those on lower socio-economic scale (class IV).

Contact lens prescribing pattern in India--2011.

PURPOSE: To understand the pattern of prescribing contact lenses (CL) among Indian practitioners. METHODS: Survey forms were sent to 257 practitioners across the country to collect information about their last 10 CL fits, location and type of practice, years of experience and educational qualification. A logistic regression analysis was performed to determine any association of various factors to the lens fitting pattern and chi-square test was used to compare proportions. The data were analyzed using SPSS v.16. RESULTS: CL fitting details from 227 practitioners were acquired representing a total of 2270 fits. The mean age of patients was 26.8±7.4 years and 67% of them were females. Ninety-eight percent of patients wore soft CL comprising 24% toric lenses. Ninety percent patients preferred disposable modality with 65% of these opting for monthly disposable lenses. Twenty-eight percent of the lenses dispensed were silicone hydrogel (SiH) lenses. Optometry practices located in metropolitan cities dispensed significantly higher numbers of disposable (p<0.001) and SiH lenses (p<0.001). Logistic regression analysis showed Fellowship of International Association of Contact Lens Educators (FIACLE) (OR: 13.79, 95% CI: 2.61-72.70), post graduate degree (OR: 3.87, 95% CI: 0.87-17.12) and years of experience were directly associated with fitting of advanced CL. CONCLUSION: The CL prescribing patterns in India elicited from this survey suggest the dominance (90%) of prescribing of disposable soft CL. Higher level of education, greater experience and a FIACLE status were significantly associated with advanced fitting.