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Inaccessibility to eye-care services may have a negative impact on the quality of life. Financial constraints and a shortage of professional eye care practitioners are among the main hindrances to implementing comprehensive eye care in most countries. Vision screening is commonly used to identify those who may have undetected vision problems. However, the existing instrument-based vision screening is also less than ideal. Online Eye Screening: Questionnaire and Vision Tests (OES:QVT) is developed as a new alternative vision screening when existing vision screening is impractical due to the time-cost-labour practicality challenge of equipment-based vision screening. There were three phases of the OES:QVT innovation process: (1) idea generation to enhance eye care accessibility for underprivileged communities; (2) problem-solving tactic to remove the dependency on instruments in existing vision screening style; (3) implementation – by substituting inconvenient instrument-based vision screening with a hybrid of the questionnaire and online vision tests. OES:QVT harnesses both benefits of questionnaires and simple vision tests to cover major vision problems for wide-ranging age groups. OES: QVT consists of three versions – adult version, paediatric version and people with intellectual disabilities version. OES:QVT displays good consistency and accuracy of vision screening via solid content and criteria validation. OES:QVT lessens the burden of expensive equipment-based vision screening by forming a hybrid between questionnaires and online vision tests. OES:QVT offers an alternative option when an ideal sophisticated vision screening program and full eye examination are not feasible.

DESIGN. Retrospective Audit PURPOSE. To assess the impact of the recent introduction of OCT in one more of the digital surveillance clinics within the Birmingham, Solihull and Black Country Diabetic Eye Screening Programme. METHODS. Between April 2019 and September 2019 an audit was undertaken retrospectively of patients attending Digital Surveillance. All had M1 grading on digital photography and OCT (Heidelberg Spectralis) Images were graded as maculopathy with or without oedema. Other lesions such as age-related macular degeneration (ARMD) and epiretinal membrane (ERM) were documented. Outcomes for those with maculopathy were either referral to Hospital Eye Service (HES) or followed up in the Digital Surveillance (DS) clinic with OCT. RESULTS. 670 patients were included (M 374 F 300 U 23;mean age 60yrs). Ethnicity was not recorded reliably but was predominantly White, Afro/Caribbean, Asian. OCT images were adequate and gradable in 654 patients (97.6%). 139 (20.7%) reverted to annual recall. 433 (64%) were kept within DS. 5 (0.75%) patients were excluded as they were unsuitable for screening. 83 (12.4%) patients were referred to HES, 48 with macular oedema (mean 400μm range 319 to 625, SD 54.8) who remained in HES for treatment and review. 6 (0.9%) patients were referred to HES/GP for other eye pathology (wet ARMD/glaucoma). 4 (0.60%) patients were referred to slit-lamp because images were unassessable. CONCLUSIONS. OCT is effective in DS clinics, providing a definitive diagnosis and measure of macular oedema. This study showed that only a small proportion of patients with maculopathy needed HES referral. All referrals to HES were deemed appropriate and stayed in HES for management. Identification of false positive M1 can continue annual recall safely. OCT allows appropriate prioritising of patients needing treatment more urgently. It has helped ease the pressure in HES with major capacity issues especially during the recent Covid pandemic.

Aims: To study the feasibility and challenges for early vision screening of the 0-6 yr preverbal/ preschool children in both urban and rural settings of India using the simple Red Reflex test. Study Design:Operational research. Place and Duration of Study: Four settings (two urban and two rural) were designed to target the 0-6year old children. Model I .Pre School (Urban slum Population), Model II. Health Centre (Urban Hospital), Model III. Immunization OPD of Municipal Hospital (Rural hospital) Model IV. Anganwadi Centre (Rural Population) was designed and conducted July 2017 –Dec 2017 (6 months). Methodology: All models were conducted as single day vision screening camps except Model III which was an opportunistic screening for a period of 3 months (July – Sept 2017). Vision screening was done using Red Reflex test and follow up was done for three months. Data was analyzed on MS Excel and expressed in proportions / percentages. Results: Maximum children (155) were screened in Model I. Out of the 301 total children screened 33 (10.96%) had abnormal Red Reflex test. The yield was maximum 6 (17.14%) in Model III. Urban health centre Model I was the most time efficient model(average 0.74 minutes/child). Conclusions: Single day screening of population based cohort is time efficient but opportunistic screening using universal immunization programme model had maximum yield.

Zusammenfassung Hintergrund Wiederkehrende Schulreihenuntersuchungen dienen dazu, Kinder und Jugendliche mit erhöhtem Achslängenwachstum der Augen zu identifizieren und dafür zu sensibilisieren, dass die richtige Sehhilfe und ausreichend Aufenthalt im Freien präventive Faktoren gegen die Entwicklung einer hohen Myopie sind. Die erhobenen biometrischen Daten helfen außerdem, die epidemiologischen Datenlage zur Schulmyopie zu erweitern, die schließlich eine Grundlage für die Auswahl von Therapieoptionen bilden. Material und Methoden Mittels berührungsfreier Biometrie wurden Hornhautradius, zentrale Hornhautdicke, Vorderkammertiefe, Linsendicke und Achslänge der Augen ermittelt. Optische Kohärenztomographie (OCT) wurde zur Bestimmung der subfovealen Aderhautdicke eingesetzt. Zusätzlich wurden der mesopische und photopische Pupillendurchmesser bestimmt. Ergebnisse Biometrische Daten der Augen konnten von 257 (Alter 11,2 ± 1,1 Jahre, 31,9 % [82] weiblich, 68,1 % [175] männlich) der untersuchten 274 Schulkinder erhoben werden. Es zeigten sich ein mittlerer Hornhautradius (Mittelwert [MW] ± Standardabweichung [SD], weiblich/männlich) von 7,74 ± 0,23/7,89 ± 0,22 mm, zentrale Hornhautdicke von 556,80 ± 31,31/565,68 ± 33,12 µm, Vorderkammertiefe von 3,62 ± 0,28/3,71 ± 0,25 mm, Linsendicke von 3,48 ± 0,18/3,46 ± 0,17 mm sowie Achslänge von 23,03 ± 0,88/23,51 ± 0,88 mm. Die subfoveale Aderhautdicke konnte bei 240 Schulkindern ausgewertet werden und betrug 335,12 ± 60,5 µm. Die gemessene mesopische und photopische Pupillengröße betrug 6,38 ± 0,70 mm bzw. 3,11 ± 0,63 mm. Diskussion Die ermittelten Achslängen der Augen stimmen mit den Normwerten bei europäischen Kindern überein. Es zeigt sich ein Unterschied in der Biometrie zwischen weiblichen und männlichen Augen. Die geplanten Wiederholungsuntersuchungen werden das Erstellen von ersten Wachstumskurven ermöglichen.

Zusammenfassung Hintergrund Wir stellen ein Projekt zur Verbesserung der Augengesundheit bei Schulkindern vor: Jährliche optometrische Reihenuntersuchungen mit Fokus auf die Früherkennung der Schulmyopie. Die logistische Machbarkeit wird am Beispiel eines Pilotprojektes an einem staatlichen Gymnasium in Nordrhein-Westfalen beleuchtet. Die erhobenen biometrischen Parameter tragen außerdem zur Erhebung epidemiologischer Daten bei. Material und Methoden An organisierten Untersuchungstagen wurde bei den Schulkindern der 5. bis 7. Klassen (Alter 9 bis 16 Jahre) die objektive und subjektive Refraktion ermittelt, auf Auffälligkeiten im Binokularsehen getestet und der photopische und mesopische Pupillendurchmesser bestimmt. Mittels berührungsfreier Biometrie wurden die Hornhautradien, zentrale Hornhautdicke, Vorderkammertiefe, Linsendicke und die Achslänge der Augen gemessen. Mittels optischer Kohärenztomographie (OCT) wurde außerdem die zentrale Aderhautdicke der Augen bestimmt. Mit Fragebögen wurden die Sehgewohnheiten der Schulkinder erfragt. Ergebnisse Im Herbst 2019 nahmen 274 Schulkinder (11,2 ± 1,2 Jahre) freiwillig an den Untersuchungen teil; 22 % (61) zeigten eine Myopie (sphärisches Äquivalent ≤ −0,50 dpt), hiervon waren 11 % (7) bisher unkorrigiert (unkorrigierter Fernvisus Diskussion Die Notwendigkeit der optometrischen Reihenuntersuchung ist objektiv gegeben, da insgesamt 4,4 % (12) myope Schulkinder identifiziert werden konnten, die aufgrund ihrer Brillenkorrektion einen Fernvisus von kleiner 0,8 aufwiesen. Durch die Ermittlung der Achslänge und der Einordnung dieses Wertes in Abhängigkeit des Alters in die Literatur kann das individuelle Myopierisiko abgeschätzt und Eltern und Kinder können sensibilisiert werden, um dem Missstand zu begegnen. Die geplanten Wiederholungsuntersuchungen werden genauere Aussagen zum Bulbuswachstum bei Schulkindern liefern.

The aim of the English NHS Diabetic Eye Screening Programme (DESP) is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight-threatening diabetic retinopathy, at the appropriate stage during the disease process, with a long-term aim of preventing blindness in people with diabetes.For the year 2009–2010, diabetic retinopathy (DR) was no longer the leading cause of blindness in the working age group. There have been further reductions in DR certifications for WHO severe vision impairment and blindness from 1,334 (5.5% of all certifications) in 2009/2010 to 840 (3.5% of all certifications) in 2018/2019. NHS DESP is a major contributor to this further reduction, but one must also take into account improvements in glycaemic and blood pressure control, timely laser treatment and vitrectomy surgery, improved monitoring techniques for glycaemic control, and vascular endothelial growth factor inhibitor injections for control of diabetic macular oedema. The latter have had a particular impact since first introduced in the UK in 2013.Current plans for NHS DESP include extension of screening intervals in low-risk groups and the introduction of optical coherence tomography as a second line of screening for those with screen positive maculopathy with two dimensional markers. Future challenges include the introduction of automated analysis for grading and new camera technologies.

This study aimed to survey the factors influencing attendance to eye screening among Diabetes mellitus (DM) patients. This cross-sectional survey was carried out among 170 DM patients using self-administered questionnaires. Majority of participants, 45.9% (n = 78) highlighted that lack of information regarding diabetes and not understanding the significance of eye screening are the barriers to eye screening. Whereas, 10.6% (n = 18) reported lack of access to healthcare facilities, 6.5% (n = 11) experienced time limitation and 2.9% (n = 5) suffered financial issues. However, more than half of the participants (58.2%) have good knowledge related to diabetic eye complications. There was a significant difference between educational level with patients’ attendance in yearly eye screening. Lack of information received by the patients on the importance of eye screening and communication issues seems to be prominent and becomes the reason for patients not attending eye screening.

Purpose: To compare proportion of glaucoma and the associated factors among self-reported relatives and non-relatives of predominantly Igbo glaucoma patients Methods: An analytical cross-sectional survey of participants attending a free eye screening dedicated to relatives of glaucoma relatives in Enugu, Nigeria was carried out in July 2017. Non-relatives of glaucoma patients were expected to present for the free screening hence they were allowed to participate to prevent false claims. All participants were interviewed and underwent ophthalmic examinations. Glaucoma diagnosis was based on the ISGEO classification criteria adapted for Nigeria. Participants were subsequently grouped as glaucoma relatives and general population. Results: Forty-two and 56 participants were included in the relatives and general population groups respectively. The proportion of glaucoma in the relatives and general population groups was 43% and 20% respectively. The odds of having glaucoma was three times higher in relatives of patients than in general population (OR= 3.07, 95% CI; 1.25 – 7.5 p=0.013). About 52% of first-degree relatives were diagnosed with glaucoma. In the relatives’ group, 100% of siblings, 40% of children and 0% of parents had glaucoma. Proportion increased with age. Relatives were significantly younger than their probands at diagnosis (16years, p= 0.000). Only 5.6% of the relatives’ group were previously aware of diagnosis. Intraocular pressure and central cornea thickness were similar in both relatives and general population groups. Conclusions: In this screened Igbo population, over one-third of the relatives’ group and about one fifth of general population had glaucoma. Relatives were diagnosed at an earlier age. These findings will aid the advocacy for routine glaucoma family screening services.

PURPOSE The aim of this study was to review the literature on various screening programs, devices, and applications described for the early detection of retinoblastoma. DESIGN Systematic review article. METHODS A PubMed® search was performed to identify articles published with specific reference to screening of neonates, infants and children for retinoblastoma. RESULTS Various devices and mobile phone-based applications based on altered red reflex are finding their way into community screening. Diagnosis of retinoblastoma by newborn eye screening is emphasized in several countries, and red reflex is the most widely employed technique. CONCLUSIONS Several screening programs for early detection of retinoblastoma are evolving in the developing countries, but the practices are not uniform. Universal newborn screening should be the norm. Newer tools and software can be utilized to screen infants on a community scale. Focussed research on revolutionizing digital imaging for a versatile screening tool holds promise for early diagnosis of retinoblastoma.

This study estimated the prevalence of uncorrected refractive error (URE) and its determinants in a socially vulnerable older population living in Armenia.The study design used in the stidy is a cross-sectional study.A total of 485 people responded to a survey on sociodemographic characteristics, spectacle use, and ophthalmic services' use. All participants underwent a comprehensive ophthalmic examination including assessment of presenting and best-corrected visual acuity, measuring intraocular pressure and dilated eye fundus examination. Patients who had presenting visual acuity (6/12) but improved ≥ one line with/without available spectacles after refraction in the better eye were considered to have URE. Descriptive statistics described the sample and estimated the prevalence of the URE in the population. Logistic regression models were used to evaluate its determinants.The mean age of participants was 74.5 (7.27) years, ranging from 51 to 94 years. Women constituted the majority of participants (86%). The prevalence of URE in the better eye was 26%. In bivariate analysis, those who were older and who had less than 10 years of education had higher odds of URE than younger and more educated respondents. In multivariable analysis, only education remained associated with URE (OR = 3.71; 95% CI: 1.10-12.5). The rate of normal vision (≥6/12) improved from 58.9% to 81.5%, whereas the rate of visual impairment (6/12) decreased from 41.1% to 18.5% after best correction in the better eye.The prevalence of URE was high in this study population. The findings warrant the need for eye screening and provision of affordable spectacle correction to the target population in Armenia.

Background Prolonged use of computers led users to risk of computer vision syndrome (CVS). CVS is one of the occupational health problems. The aim of this study was to assess CVS and associated factors among secretaries working in government ministry offices in Addis Ababa, Ethiopia. Materials and Methods Institution-based cross-sectional study was conducted. Data were collected using interviewer administered pretested structured questionnaire and ophthalmic examinations. A total of 455 secretaries were participated in the study. Binary logistic regression analysis was applied to investigate determinants associated with CVS. Variables with p-value

Aim To determine the prevalence of diabetic retinopathy (DR) among diabetic patients at the primary health clinics in Selangor, Malaysia. Methods All diabetic patients were screened in Retinal Disease Awareness Programme (RDAP) and those who had significant DR changes were referred to the hospital for further management. Descriptive analyses were done to determine the prevalence of DR and sociodemographic characteristics among patients with diabetic. Univariate and multivariable analysis using Logistic regression were performed to find association and predictor factors in this screening. Results A total of 3305 patients aged 40y and above were screened for DR. Of the patients screened, 9% patients were found to have DR and other visual complication such as maculopathy (0.9%), cataract (4.8%) and glaucoma (0.4%). The mean age of patients without retinopathy was 57.82±8.470y and the mean age of patients with DR was 63.93±9.857y. About 61.5% of the patients screened were aged below 60y and 38.5% were aged 60y and above. Majority of the patients screened were women 58.5% and Malay in the age group of 50-59y, while 27% were aged 60-69y. Significant association were found between age, sex, race, visual loss and DR. Conclusion Although the prevalence of DR among patients is not alarming, effective interventions need to be implemented soon to avert a large burden of visual loss from DR.

1) To assess the utility of performing eye screenings for healthy basketball players. 2) To describe the traumatic injuries sustained by competitive college basketball players.The eye screening examinations of the Duke University Men's Basketball players over six seasons were reviewed retrospectively. Traumatic basketball-related eye injuries amongst Duke University Men's Basketball players over 16 seasons were also reviewed and described.Forty-four total players underwent screening examinations. Thirteen (29.5%) of athletes had uncorrected or under-corrected refractive errors. One athlete was found to have a severe monocular visual deficit secondary to a traumatic injury in childhood, which was significantly mitigated by a contact lens referral. Eight traumatic ocular injuries in eight different athletes, 8.6% of the total roster players in this interval, required ophthalmologic consultation. Most injuries, 7/8, resulted in no permanent visual impairment. However, two severe episodes of injury required operative intervention, and one episode involving a giant retinal dialysis and traumatic optic nerve head avulsion caused severe, permanent visual loss. Most injuries did not result in significant competition time loss, with a median time loss of 5 days (range 0 to 240 days).Screening eye examinations in healthy athletes are beneficial for the identification and treatment of refractive errors. Traumatic basketball-related eye injuries are common and result in a wide array of injuries. Although most basketball-related eye injuries do no result in permanent visual loss, given the potential for severe injury, many basketball-related eye injuries require expert ophthalmic consultation.

Introduction: Eye-glasses wear compliance is found to be low among children in school-based eye screening programs who are provided spectacles free of charge. Methods: Thirty-six schools from school visual acuity screening program in Nepal were randomly selected to receive no follow-up (standard) or follow-up by an optometry team at 3 months. In the intervention group (that received the follow-up), ophthalmic personal made unannounced visits to the schools at 3 months to determine spectacle compliance .Direct examination to determine compliance with spectacle wear 6 months was done. The primary reason for noncompliance from a list of possibilities was identified using a questionnaire. Results: Among 297 (145 control and 152 intervention) students that received glasses in the 36 schools, 128/152 (84%) were available for examination at 3 months in the intervention group. A total of 216/297 (73%) students were available for examination at 6 months (73 % and 72% of the control and intervention groups, respectively). Within the intervention group, 51% of children at 3 months and 57% at 6 months were wearing glasses during the unannounced visits. The main source of refractive error was myopia. Out of 66 children with astigmatism, 24 (36%) were wearing glasses. There was no statistically significant difference in compliance (p=0.85) between private and public schools, but compliance correlated better with the educational status of careers. Conclusion: A follow-up visit to the school by eye care personnel did not improve spectacle wear compliance among children .Other factors may also be responsible for poor compliance.

With an increasing percentage of retinal pathology because of diabetes, eye screening for diabetic retinopathy (DR) is in demand throughout the world. Haemorrhages (HEs) are one of the common signs...

The NHS diabetic eye screening (DES) programme is one of the young person and adult NHS population screening programmes that are available in the UK. The various NHS screening programmes identify those people who appear healthy, but could be at increased risk of a disease or condition. Screening is not the same as diagnosis and there will always be a possibility of some false positive and false negative results. This article in the series provides the reader with details about the DES programme. A brief overview of the anatomy of the eye is provided and the screening process is described. The healthcare assistant and assistant practitioner (HCA and AP) have a key role to play in encouraging and emphasising the importance of screening, as well as helping the individual maintain a healthy lifestyle.

Summary Background To examine the rural–urban differences in the prevalence of diabetes mellitus (DM) and diabetic retinopathy (DR) in the population aged 50 years and older in Hungary. Methods 105 clusters of 35 people aged 50 years or older were randomly selected. Standardized rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module was performed. Participants were classified as diabetic if they had a previous diagnosis of DM or a random blood glucose level ≥200 mg/dl. Each individual with DM who agreed underwent dilated fundus examination and DR grading. Results The prevalence of DM was higher in rural (21.8%) than in urban (18.6%) areas (p = 0.016). The prevalence of DR did not differ significantly between rural and urban areas in DM cases. Blindness (0.9% vs. 0.1%; p = 0.048) and blindness due to DM (0.3% vs. 0.0%; p = 0.021) in diabetic participants was significantly more common in rural than in urban areas. Diabetic eye screening coverage was significantly lower in rural than in urban areas (p ≤ 0,007). Conclusion Based on our results and the high rate of blindness and blindness due to DR in rural areas, primary eye care should be improved and a telemedical eye screening program should be undertaken, especially concentrating on rural areas.

PurposeTo estimate the total healthcare cost associated with diabetic retinopathy (DR) in type 2 diabetes in Indonesia and its projection for 2025.MethodsA prevalence-based cost-of-illness model was constructed from previous population-based DR study. Projection for 2025 was derived from estimated diabetes population in 2025. Direct treatment costs of DR were estimated from the perspective of healthcare. Patient perspective costs were obtained from thorough interview including only transportation cost and lost of working days related to treatment. We developed four cost-of-illness models according to DR severity level, DR without necessary treatment, needing laser treatment, laser +intravitreal (IVT) injection and laser + IVT +vitrectomy. All costs were estimated in 2017 US$.ResultsThe healthcare costs of DR in Indonesia were estimated to be $2.4 billion in 2017 and $8.9 billion in 2025. The total cost in 2017 consisted of the cost for no DR and mild–moderate non-proliferative DR (NPDR) requiring eye screening ($25.9 million), severe NPDR or proliferative DR (PDR) requiring laser treatment ($0.25 billion), severe NPDR or PDR requiring both laser and IVT injection ($1.75 billion) and advance level of PDR requiring vitrectomy ($0.44 billion).ConclusionsThe estimated healthcare cost of DR in Indonesia in 2017 was considerably high, nearly 2% of the 2017 national state budget, and projected to increase significantly to more than threefold in 2025. The highest cost may incur for DR requiring both laser and IVT injection. Therefore, public health intervention to delay or prevent severe DR may substantially reduce the healthcare cost of DR in Indonesia.

Background: Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability. Introduction: We assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program. Methods: Three readers evaluated digital retinal images in 100 cases (178 eyes from 90 patients with type 2 diabetes). Fisher's exact test, percent agreement, and the observed proportion of positive (Ppos) or negative agreement (Pneg) were used to assess variability. Results: Among cases deemed gradable by all three readers (n = 65), there was substantial agreement on absence of any retinopathy (88% ± 4.6%, Pneg = 0.91–0.95), presence of moderate nonproliferative or worse retinopathy (87% ± 3.9%, Ppos = 0.67–1.00), and presence of macular edema (99% ± 0.9%, Ppos = 0.67–1.00). There was limited agreement regarding presence of referable nondiabetic eye pathology (61% ± 11%, Ppos = 0.21–0.59) and early, nonroutine referral for a follow-up clinical eye exam (66% ± 8.1%, Ppos = 0.19–0.54). Among all cases (n = 100), there was acceptable agreement regarding which had gradable images (77% ± 5.0%, Ppos = 0.50–0.90). Discussion: Inclusion of multiple types of eye care providers as teleophthalmology readers is unlikely to produce significant variability in the assessment of diabetic retinopathy among high-quality images. Greater variability was found regarding image gradability, nondiabetic eye pathology, and recommended clinical referral times. Conclusions: Our results suggest that more extensive training and uniform referral standards are needed to improve consensus on image gradability, referable nondiabetic eye pathology, and recommended clinical referral times.

Objectives In Turkey, preventive medicine services are the responsibility of family physicians and vision screening is a key component of this responsibility. In this study, we aimed to investigate the approach of family physicians to vision screening in infants and children. Materials and methods Data were collected using a 16-item questionnaire administered to 100 family physicians working in the center and provinces of Diyarbakir. Results The results indicated that 88 (88%) physicians declared knowing what the red reflex test was, while 12 physicians declared that they had never heard of it. Only 16 (16%) physicians performed the test routinely and 36 (36%) physicians performed it only in suspicious cases. Ten (10%) physicians indicated that they did not refer the patients to an ophthalmologist even though they did not perform the red reflex test. Moreover, 5 (5%) physicians did not have an ophthalmoscope and 12 (12%) physicians reported not knowing how to use an ophthalmoscope. Forty (40%) of the physicians measured preschool visual acuity at least once. Sixty-six (66%) physicians referred younger children who could not express their vision problems to an ophthalmologist. Four (4%) physicians declared that they would delay surgery in children with strabismus until they were old enough for surgery. Ninety-three (93%) physicians suggested that educational seminars about vision screening would be beneficial. Conclusion Educational seminars about vision screening may have favorable outcomes. The medical devices in family medicine centers should be improved. Vision screening can be added to the negative performance-based compensation system in order to increase physicians’ attention to vision screening. To implement detailed eye screening programs like those in developed countries, an infrastructure should be established for this screening program.

Glaucoma is an incurable eye disorder and it is the second foremost reason for the visual deficiency. Commonly it is detected by the use of retina images. It is hard to anticipate glaucoma in beginning phases because the side effects of glaucoma can be identified only, once the sickness reaches at a high-level stage. Therefore, normal eye screening is fundamental and suggested. The manual method of glaucoma screening is a time-consuming and labor-intensive process. But deep learning-based glaucoma detection approaches diminish the manual effort and improve accuracy and speed. Optic cup to disc ratio is a major clinical pointer for glaucoma finding. For this ratio we need to perform segmentation of optic disc and cup and this can be performed via the segmentation methodologies based on deep learning. This paper presents a survey of different deep learning-based methodologies used for glaucoma detection.

Purpose To compare neonatal eye screening using the red reflex test (RRT) versus the wide-field digital imaging (WFDI) system. Methods Prospective cohort study. Newborns (n = 380, 760 eyes) in the Maternity Ward of Irmandade Santa Casa de Misericordia de Sao Paulo hospital from May to July 2014 underwent RRT by a paediatrician and WFDI performed by the authors. Wide-field digital imaging (WFDI) images were analysed by the authors. Validity of the paediatrician's RRT was assessed by unweighted kappa [κ] statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results While WFDI showed abnormalities in 130 eyes (17.1%), RRT was only abnormal in 13 eyes (1.7%). Wide-field digital imaging (WFDI) detected treatable retina pathology that RRT missed including hyphema, CMV retinitis, FEVR and a vitreous haemorrhage. The sensitivity of the paediatrician's RRT to detect abnormalities was poor at 0.77% (95% confidence interval, CI, 0.02%-4.21%) with a PPV of only 7.69% (95% CI, 1.08%-38.85%). Overall, there was no agreement between screening modalities (κ = -0.02, 95% CI, -0.05 to 0.01). The number needed to screen to detect ocular abnormalities using WFDI was 5.9 newborns and to detect treatable abnormalities was 76 newborns. Conclusion While RRT detects gross abnormalities that preclude visualization of the retina (i.e. media opacities and very large tumours), only WFDI consistently detects subtle treatable retina and optic nerve pathology. With a higher sensitivity than the current gold standard, universal WFDI allows for early detection and management of potentially blinding ophthalmic disease missed by RRT.

Diabetic retinopathy (DR) is the leading cause of adult blindness in the United States. It afflicted 7.7 million Americans in 2010, is anticipated to rise to 11 million by 2030, and will nearly double by 2050. Early DR is a microvascular complication of diabetes with no visual warning symptoms. Studies show that early detection with an annual dilated diabetic eye exam can prevent serious vision loss or blindness caused by advanced DR. Challenges to annual screening adherence include the lack of patient understanding of diabetic eye diseases and the low rate of timely diabetic eye referrals by clinicians. Research supports the use of visual aids to enhance patient education in outpatient settings. Implemented at a primary care clinic with predominantly non-English-speaking Vietnamese patients, this pilot project was an evidence-based initiative to place culturally-appropriate, English and Vietnamese-translated DR infographic posters in exam rooms as a tool to enhance patient education on the importance of annual dilated eye exam and to promote the rate of timely eye referrals by clinicians. Patient surveys confirmed that the presence of DR infographic posters had a positive impact on patient perspective, with 96% of diabetic patients declaring a positive intent to pursue annual DR eye screening. Almost 50% indicated that the presence of DR posters was the sole factor that influenced their decision. Prior to implementation, a review of the clinic’s EMR showed that only 19% of diabetic or pre-diabetic patients had a referral or eye exam report from an eye specialist. This rose to 30% during implementation and increased to 33% post-implementation. The results from this pilot demonstrated that the use of culturally-appropriate visual aids in primary care clinics can influence both patient and clinician behaviors positively towards early and annual DR screening.

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Proper eye screening and interventions, such as laser ablation and/or anti-vascular endothelial growth factor therapy, are useful in reducing disease activity and preventing blindness. Some eyes are refractory to these treatments and develop tractional retinal detachment, which requires vitrectomy. Vitrectomy for stage 5 ROP is beneficial in preventing total blindness in some eyes; however, its anatomical and functional results are unsatisfactory.

Diabetic Retinopathy (DR) is a threatening disease which causes blindness in diabetic patients. With the increasing number of DR cases, diabetic eye screening is a challenging task for experts. Adopting machine learning to create a high accuracy classifier will be able to reduce the burden of diabetic eye screening. Therefore, this paper aims to propose a high accuracy DR classifier using clinical attributes. This study was conducted using nine clinical attributes of 385 diabetic patients, who were already labelled regarding DR, where 79 patients did not suffer from DR (NODR), 161 patients had nonproliferative DR (NPDR), and 145 patients had proliferative DR (PDR). The data was then used to develop a DR classifier through the hybrid of optimised Support Vector Machine (SVM) and Artificial Neural Network (ANN). The experiment results showed that the hybrid classifier had a high accuracy of 94.55. The accuracy yield was higher compared to single classifier.

Objective Hydroxychloroquine (HCQ) is commonly used in the treatment of various autoimmune diseases related to its many benefits and favorable safety profile. Although HCQ retinopathy was considered to be uncommon, a prevalence of 7.5% was described in a recent study making early detection critical. The most updated screening guidelines by the American Academy of Ophthalmology were published in 2016; however, it lacked pediatric-specific recommendations and the overall compliance with screening guidelines was poor in previous studies. We developed a quality improvement (QI) initiative aiming to create institutional screening recommendations. Additionally, to increase eye screening in pediatric rheumatology clinic for patients receiving HCQ from 65% to 85% in 12 months and to sustain that rate for at least 6 months. Methods We formed a multidisciplinary team of pediatric rheumatologists and ophthalmologists, clinical pharmacist, clinic nurses, QI specialist, quality data technician and administrative staff. We included patients receiving HCQ and who were evaluated at Nationwide Children’s Hospital rheumatology clinic. A key driver diagram was formulated to identify barriers to compliance and determine possible interventions. Main interventions included summarizing screening guidelines in a step by step algorithm, increasing awareness of these guidelines among patients and providers, improving collaboration and communication with ophthalmologists, and initiating pre-visit planning. Results Baseline performance data included 164 patients. Fifty-four (33%) of those patients were at high risk for HCQ retinopathy. Of them, 50% were on HCQ dose of >5 mg/kg/day and 31.5% had been taking HCQ for ≥5 years. Two center line shifts were noticed over the course of the project. The target of 85% compliance was reached in February 2019 and was sustained until December 2019. Conclusions Our study highlights the importance of interdisciplinary communication to increase awareness of screening guidelines among medical providers and patients. Pre-visit planning played a major role in identifying patients and opportunities for optimizing eye screening in patients at risk for HCQ retinopathy. Collaboration between rheumatologists and ophthalmologists is crucial in managing patients on HCQ. The implementation of same-day eye screening allowed this collaboration to be more efficient. Future efforts are being directed at monitoring and improving utilization of the effective interventions.

To report eye examinations findings and cost-efficiency of mobile eye and vision care screening in underserved areas in north India. The Aloka Vision Program combines optometrical and ophthalmological screening as mobile eye camps with organized referrals to local eye hospitals. 402 people from urban (N = 191) and rural (N = 211) areas in the district of Uttarakhand, India, were screened for refractive error (RE), visual acuity (VA) and eye health. Statistical analysis was performed using ANOVA model and odd ratios. Costs were estimated based on the expenses of the camps. 44 % of the participants were male and 56 % were female and the age ranged from 7 to 72 years (urban) and 7 to 80 years (rural). Lack of accessibility of eye care was mentioned by 10% of the urban and 47% of the rural participants, why not attending regular vision test. Mild and severe visual impairment VA < 0.5 logMAR affected every fifth person, independent from the living environment. RE showed a myopic trend for the urban environment (Δ M = 0.67 D, p = 0.11). The risk for blindness was three times higher in rural compared to the urban area, mainly caused by cataract. The major costs are given by the treatments (58 %), followed by mobilization and organization (∼30 %), whereas personal costs are low (∼11%). Combined eye and vision care models reduce costs for separated screening’s organization and thus can increase the effectiveness of eye screening programs significantly.

Introduction Torch-light Eye Screening Test (TEST) is a simple eye screening technique designed for use by opticians to look for common anterior segment eye conditions. The TEACHES-Learning Electronic Module (TEACHES-LEM) is an e-learning platform that was developed to teach opticians to perform TEST. The objective of this study was to compare the effectiveness of TEACHES-LEM with face-to-face training (F2FT) in the training and assessment of knowledge among opticians. Methods Participants were randomly assigned in this experimental study to receive either the intervention group ((TEACHES-LEM, n = 60) or the control group (F2FT, n = 57). The conceptual knowledge of TEST was assessed with a 20-item clinical scenario-based multiple choice question (MCQ) test before and after teaching (immediately post-teaching and 1-month post-teaching). The MCQ test was developed by three ophthalmologists to give face validity. Results The pre-teaching test scores (TS), indicating prior knowledge, were comparable in both groups (10.02 ± 2.79 versus 10.40 ± 4.17, p = 0.563, independent t test). The mean immediate post teaching score for TEACHES-LEM was 13.3 ± 4.01 versus 12.3 ± 3.29 in the F2FT group (p = 0.170, independent t test). The mean post 1-month teaching score for TEACHES-LEM and F2FT groups were also comparable, 14.5 ± 4.19 versus 13.4 ± 3.90 respectively (p = 0.295, independent t test), indicating non-inferiority of TEACHES to F2FT. Conclusion The TEACHES-LEM e-learning tool is as effective as F2FT in teaching opticians to perform TEST. It is an alternative to face-to-face teaching in delivering knowledge and assessment. The obviation for physical contact will make it a useful teaching tool during the COVID-19 pandemic period.

Screening identifies apparently healthy people who may be at increased risk of a disease or condition, enabling earlier treatment or better-informed decisions. The NHS diabetic eye screening (DES) programme is one of the young person and adult NHS population screening programmes in the UK. The UK National Screening Committee (UK NSC), which makes independent, evidence-based recommendations to ministers in the four UK nations about the 11 population-based screening programmes. Public Health England (PHE)—Screening Quality Assurance Service (SQAS) ensures programmes are safe and effective by ensuring national standards are met.

Background Juvenile idiopathic arthritis (JIA) affects 1 in 1000 children. Around 10% to 30% of children with JIA develop anterior uveitis. Particularly in the oligoarticular subtype, this uveitis is chronic and therefore asymptomatic, without the classical red eye and pain of acute uveitis. This leads to insidious but progressive visual loss if unrecognised. Although young age, oligoarticular disease and positive ANA are risk factors for uveitis, these factors are not required, and it can occur at any point in disease course. Hence, it is essential that patients who are diagnosed with JIA have prompt and regular eye screening. Diagnosis of uveitis by slit-lamp examination is essential. Both British Society for Rheumatology and Royal College of Ophthalmologists guidelines recommend initial slit-lamp screening in asymptomatic patients within 6 weeks of initial diagnosis, and then every 3-4 months until the age of 12. A 2014 audit of paediatric rheumatology services in the East of England revealed significant variation between trusts (between 9%-100%) with an average 35.4% of patients with first visit within 6 weeks. In our hospital, less than 25% met this standard. These results showed the need for a more robust pathway. Methods The poor performance at Southend in 2012 was due to lack of capacity in general paediatric ophthalmology clinic, despite a prompt referral process, with delays and frequent non-attendance for follow-up screening in existing patients. A slit lamp was obtained to be kept in the Paediatric outpatient department. JIA eye screening clinic was set up in December 2017, running weekly alongside the Rheumatology clinic. This ensures that patients received timely and convenient eye screening as a ‘one-stop’ visit. It also frees capacity in the Eye Unit. New and follow-up patients with JIA are reviewed, with assessment of visual acuity, orthoptic assessment, followed by slit-lamp examination. Exclusions for this clinic include children under 3 years old, uncooperative youngerchildren, and those with uveitis, who are reviewed in the eye unit as previously. Results In the initial 18-month period (2017-2019), 41 separate patients were seen across 108 attended appointments. 75% new referrals were reviewed within 6 weeks, 66.6% were seen at 2 monthly intervals for the first 6 months post diagnosis. 7.3% were referred to paediatric ophthalmology consultant. Delays were mainly seen early on as the process was being established. Conclusion Issues with capacity in Ophthalmology resulted in significant delays to eye-screening appointments. The orthoptic-led clinic has improved our compliance with national guidelines, allowed for improved communication between the two specialities, ensured timely follow-ups, reduced school time missed and improved patient experience. Multi-disciplinary input is made easier by reviewing in one session, minimising non-attendances. Disclosures A. Bouraoui: None. L. roberts: None. A. Landells: None. E. Law: None. V. geh: None. A. Shrivastava: None. F. Borg: None.

Purpose To test in a 'real world' diabetic eye-screening programme, a computer-based personal risk evaluation for progression to sight-threatening diabetic retinopathy. Screening intervals were individualized, and clinical outcomes, safety and cost-effectiveness documented. Methods The RETINARISK algorithm was used in an ophthalmology clinic in Norway. The diabetes cohort was divided on voluntary basis into two groups: one with variable screening intervals based on their personal risk profile and the other group with conventional fixed interval diabetic eye screening. Compliance, clinical outcomes, safety and health economics were evaluated. A total of 843 diabetic patients participated in the program 2014-2019. A total of 63 had type 1 and 780 type 2 diabetes. A total of 671 patients had no diabetic retinopathy at baseline and 171 had retinopathy. Results A total of 444 (53%) diabetic patients were included in the personal risk profile program and 399 in the fixed interval group. The RETINARISK algorithm calculated 563 screening intervals for the variable interval group, which was 23 ± 16 months (mean ± SD), compared to 14 ± 5 months for the group with fixed screening intervals. Due to selection bias, the two groups could not be directly compared. We did not experience any delay in detecting diabetic retinal changes when using the personal risk profile program. Conclusion The RETINARISK algorithm was safe and effective in a diabetic screening program in an ophthalmology clinic over 5 years. The use of the program reduces the mean frequency of screening visits and liberates valuable time in ophthalmic practice to be used on high-risk diabetic patients or other patient groups.

OBJECTIVE: To determine the risk factors for having diabetic retinopathy (DR) in children and young people (CYP) with type 1 diabetes (T1DM) at first screening. METHODS: Records from the Diabetes Eye Screening Wales (DESW) service for people in Wales, UK, with T1DM diagnosed under age 18 years were combined with other electronic health record (EHR) data in the Secure Anonymised Information Linkage (SAIL) Databank. Data close to the screening date were collected, and risk factors derived from multivariate, multinomial logistic regression modelling. RESULTS: Data from 4172 persons, with median (lower quartile, upper quartile) age 16.3 (13.0, 22.3) years and duration of diabetes 6.6 (2.3, 12.3) years were analysed. 62.6% (n = 2613) had no DR, 26.7% (n = 1112) background DR, and 10.7% (n = 447) had referable DR (RDR). No RDR was observed under 19 years of age. Factors associated with an increased risk of DR were diabetes duration, elevated HbA(1c), and diastolic blood pressure. People diagnosed with T1DM at 12 years or older had an additional risk for each year they had diabetes compared to those diagnosed before age 12 controlling for the diabetes duration (odds ratios 1.23 and 1.34, respectively). CONCLUSIONS: This study found that 37.4% of the study cohort had DR at first screening, the risk being greater the longer the duration of diabetes or higher the HbA(1c) and diastolic blood pressure. In addition, people diagnosed at 12 years of age or over were more likely to have DR with each additional year with diabetes.

Purpose To determine uptake, adherence and influencing factors to follow-up care by newly diagnosed glaucoma patients from free eye screening exercise. Methods The study was a cross-sectional survey of newly diagnosed glaucoma patients during free eye screenings carried out in March and October, 2016 in Enugu, Nigeria. Data on participants were analyzed after a minimum of 6 months from the screening for uptake and adherence to follow-up care. Qualifying patients had questionnaires administered to them by phone interview. Information requested regards awareness, knowledge on diagnosis as well as reasons for non-uptake and non-adherence. Results 182 newly diagnosed glaucoma patients were included of which 121 (66.5%) were males, with median age of 50years.About 164 (90.1%) had at least a primary education. There were more self- employed persons 59 (32.4%) compared to other occupations. Uptake of follow up care was 17.6% (32/182). Adherence rate was 25% (8/32). Major reasons for non-uptake were lack of funds 54.9% (n = 50/91), distance 11% (n = 10/91) and receiving care from other facilities 11.0% (n = 10/91). Others include discourteous staff behavior and lack of information on diagnosis. Similarly, major reasons for non-adherence were lack of funds 44.4% (n = 8/18) and distance 22.2% (n = 4/18). Knowledge and prior awareness of glaucoma were found to be significantly associated with uptake of follow up care (p = 0.020). Conclusion Uptake and adherence to follow-up was found to be low in this study population mainly attributed to cost, distance and poor knowledge of glaucoma natural history. Reviewing cost/out of pocket expenditure, providing care closer to patients, adequate education of staff and patients may significantly improve uptake of care after initial diagnosis.

Age-related Macular Degeneration (AMD) is an eye condition that affects the elderly. Further, the prevalence of AMD is rising because of the aging population in the society. Therefore, early detection is necessary to prevent vision impairment in the elderly. However, organizing a comprehensive eye screening to detect AMD in the elderly is laborious and challenging. To address this need, we have developed a fourteen-layer deep Convolutional Neural Network (CNN) model to automatically and accurately diagnose AMD at an early stage. The performance of the model was evaluated using the blindfold and ten-fold cross-validation strategies, for which the accuracy of 91.17% and 95.45% were respectively achieved. This new model can be utilized in a rapid eye screening for early detection of AMD in the elderly. It is cost-effective and highly portable, hence, it can be utilized anywhere.

We report key findings and lessons learned from a health equity audit (HEA) of six National Health Service Diabetic Eye Screening Programmes (NDESPs) in Cumbria and the North East of England. Uptake of diabetic eye screening was analysed in relation to demographic variables including age, sex, socioeconomic deprivation and geography and a combinationof these in each of the six NDESPs. A total of 196,275 records of patients with diabetes aged 12 years and over on the NDESP registers were analysed. The key finding was a lower than acceptable screening uptake (70%) in the last year among the working age population, especially those living in the most socioeconomically deprived areas. The HEA process also highlighted the need for improvements in collecting data on ethnicity and sex. It informed action plans which address inequities in uptake of screening in each of the six NDESPs, especially those targeting the working age populations and individuals who never attended screening or never responded to screening invitations. We established a method of extracting the patient data from the local systems, pseudonymising and linking to lower super outputarea. This will be important for HEAs to become embedded in routine practice.

IMPORTANCE The novel intervention was effective at improving compliance to appropriate tertiary eye care after community eye screening. BACKGROUND Elderly individuals from low socio-economic background with visual impairment (VI) often do not attend tertiary care, even if significant eye diseases are detected while in the community. We evaluate a novel incentive care scheme (ICS) to improve compliance to appropriate follow-up after community eye screening. DESIGN Randomized controlled trial in a population-based setting was conducted. PARTICIPANTS A total of 140 elderly individuals with VI (visual acuity 0.05). Identified barriers for tertiary healthcare access included patient attitudes and financial- and health-related barriers. CONCLUSION AND RELEVANCE Our pilot RCT found that ICS improved adherence to appropriate tertiary eye care referrals after community eye screening in elderly people with VI.

Introduction: Covid-19 pandemic has changed the way of delivering health services worldwide into telemedicine and drive-through examination. Most schools also shift into online learning, including in Greater Jakarta, Indonesia. It has been reported that myopia prevalence is high in Southeast Asia, and refractive errors if not corrected properly may lead to amblyopia. Therefore, a regular eye screening is important. This study aims to report an outdoor drive-thru children eye screening utilizing Plusoptix A12 in Indonesia. Methods: A case series of consecutive subjects aged 4 to 17 years that underwent drive-thru eye screening using digital Snellen chart at 4 feet distance and Plusoptix A12 autorefractor photoscreening at 3 feet distance while seated inside a car in a 1 month period of July 2020 are included in the study. Results: A total of 47 children (19 males), aged 4-16 years (mean, 8.5;median, 10) were screened. Of these, 29 (61.7%) underwent further eye examination for subjective refraction in the clinic, while 18 (38.3%) were either determined not subjected to further eye examination or had their eye examination performed in another health facility. Myopia requiring spectacle correction was found in as early as 5 years of age (10%). The incidence of myopia detected was highest in the >10 years age group (67%) Conclusion/Relevance: The use of Plusoptix A12 in conjunction with visual acuity testing in an outdoor, drive-thru setting is an effective and safe method of children eye screening. This method is useful for myopia detection in Indonesia while maintaining physical distance during COVID-19 pandemic.

Introduction: Individuals with Diabetes Mellitus (DM) are at increased risk for developing diabetic ocular complications. Materials and Methods: A systematic approach was applied to find the relevant topic regarding the said issue. This literature review aimed to determine the system of eye screening, reasons for seeking eye screening and their treatment. Results: A total of 22 papers and one guideline were reviewed in this study. There were four main barriers found in this study regarding with factor influencing decision for eye screening among diabetes patients. Those were diabetic eye screening, management issues on diabetic eye screening and barriers to uptake diabetic eye screening. The details of these finding results were discussed further in the discussion section. Conclusion: The health care system, health care provider and patients itself could provide a clear explanation of factors influencing the decision for diabetic eye screening. A further study is recommended to validate these review findings

We aimed to report the results of fundus photography ophthalmic examinations among older adults in a rural community in South Korea. We used data from the Korean Social Life, Health, and Aging Project cohort study, which was designed to examine the entire population of individuals aged 60 years or older and their spouses living in a rural Village K of Ganghwa Island, South Korea. At baseline, a total of 860 people was targeted as the study population. From December 2011 to January 2019, five health examinations were conducted, including baseline and follow-up tests. During the fifth wave of the study, we performed fundus photography to assess eye health. Ophthalmic and physical examinations were conducted for 387 people who participated in the fifth wave by trained researchers. Systemic factors were evaluated via blood and diagnostic tests. After excluding eight people who did not undergo follow-up fundoscopy, a total of 379 participants was included for analysis. We classified the participants into two groups with either no (zero) or one or more suspicious ophthalmic diseases. The abnormalities included media opacity, suspected glaucoma, and suspicion of retinal disease as diagnosed by a trained specialist. We further categorized ophthalmic conditions as clinically insignificant, follow-up needed, semi-urgent, and urgent conditions. We included 379 participants, of which 225 (59.4%) were women. The mean age of the participants was 76.4 ± 6.2 years. Among all participants, 81% (n=307) had one or more abnormalities on fundus screening. Older age, living alone, high blood pressure, and high fasting insulin were associated with an increased risk of having ≥ one eye disease. In terms of triage, 3.7% (n= 14) of the observed conditions were urgent, and 25.9% (n= 98) were semi-urgent. Therefore, we documented fundoscopy results among the elderly population in a rural community in South Korea. Elderly people living alone were more likely to have eye disease. Policies to improve eye health are needed to prevent vision loss in this population.

This chapter provides a summary of key landmark clinical trials in ophthalmology and guidelines from the Royal College of Ophthalmologists (RCOphth). Additionally, information on Creutzfeldt-Jakob disease (CJD) and laser safety in hospitals is provided. The principles of screening with reference to the NHS diabetic eye screening programme is also provided.

An effective automatic diagnosis and grading of diabetic retinopathy would be very useful in the management of the diabetic retinopathy within the national health system. The detection of the presence of diabetic retinopathy features in the eyes is a challenging problem. Therefore, highly efficient and accurate image processing and machine learning techniques must be used in order to produce an effective automatic diagnosis of diabetic retinopathy. This chapter presents an up-to-date review on diabetic retinopathy detection systems that implement a variety of image processing techniques, including fuzzy image processing, along various machine learning techniques used for feature extraction and classification. Some background on diabetic retinopathy, with a focus on the diabetic retinopathy features and the diabetic retinopathy screening process, is included for better understanding. The chapter also highlights the available public databases, containing eye fundus images, which can be currently used in the diabetic retinopathy research. As the development of an automatic diabetic retinopathy screening system is a very challenging task, some of these challenges together with a discussion pertaining the automatic diabetic retinopathy screening are also presented in this chapter.

Background: Cataracts are a major cause of visual impairment and blindness in the United States and worldwide. Introduction: Risk factors for cataracts include age over 40 years, smoking, diabetes,...

Purpose To determine the rates and develop an initial risk prediction model for nonadherence to post screening ophthalmic referral (PSOR) in type 2 diabetes mellitus (T2DM) patients attending a national diabetic retinopathy screening program in Singapore. Methods Data from 2387 patients with T2DM (mean [standard deviation] age: 66.5 [11] years; 52.5% female patients) who underwent teleophthalmic screening between 2010 and 2014 under the Singapore Integrated Diabetic Retinopathy Program were extracted from electronic medical records. All were referred for tertiary ophthalmic management at the Singapore National Eye Centre (SNEC). Nonadherence was defined as not attending the SNEC appointment within 6 months of the assigned appointment date. Regression analysis using traditional modified Poisson and conditional inference models was used to construct and evaluate the discriminative ability of the preliminary risk prediction model to identify nonadherent individuals. Results Nonadherence rates to PSOR was 12.7% (95% confidence interval, 11.4%-14.1%). In traditional multivariable models adjusted for sociodemographic, lifestyle, and ocular factors, nonadherent individuals had higher triglyceride levels and were less likely to have a referable eye condition (P < 0.05). This model was able to identify nonadherent individuals with an accuracy (area under the curve) of 84%. In contrast, the conditional inference model was able to achieve similar discriminative ability using only participants' ocular health characteristics. Conclusions The rates of nonadherence to PSOR in Singaporean individuals with T2DM is low, with better ocular health being strongly predictive of nonadherence in our Asian population. Translational Relevance Our results may inform interventions to decrease nonadherence to PSOR.

Background: We investigated whether specific appointments for quality-assured care could increase referral uptake, often low in China, in children's vision screening. Methods: We randomized children aged 4-7 years in Yudu, Jiangxi, China, by school to Control (free school-based eye screening, parents of children failing screening recommended for further examination [usual practice]) or Intervention (identical examinations, with parents additionally provided with specific appointments for further examinations by quality-assured doctors at a designated local hospital). Both groups could select any hospital for referral exams, which were not free. Six months after screening, parents were interviewed on referral compliance and potential determinants. Findings: Among 9936 children at 63 schools randomized to Intervention (32 schools, 5053 [50·9%] children) or Control (31 schools, 4883 [49·1%] children), 1114 children (11·2%) failed screening. Among 513 referred Intervention children (46·1%, 32 schools, mean age 5·36 years, 53·0% boys) and 601 referred Control children (53·9%, 31 schools, mean age 5·30 years, 57·7 % boys), 104 (20·3%) and 135 (22·5%) were lost to follow-up respectively. Under Intention to Treat analysis, assuming children lost to follow-up were non-compliant, Intervention children had significantly higher compliance than Controls (308/513=60·0 % vs. 225/601=37·4%, P

mTEH (mobile Tele-Eye Health), a decision support system for teleophthalmology provides coordination among collaborators to conduct eye-screening events in community settings at southern Wisconsin with a mission to prevent vision loss as well as to educate people about diabetes and eye health. This system allows the collaborators to work in a time-efficient manner from remote locations and to manage data of the eye-screening participants securely.

PURPOSE OF REVIEW: We discuss opportunities to address key barriers to widespread implementation of teleophthalmology programs for diabetic eye screening in the United States (U.S.). RECENT FINDINGS: Teleophthalmology is an evidence-based form of diabetic eye screening. This technology has been proven to substantially increase diabetic eye screening rates and decrease blindness. However, teleophthalmology implementation remains limited among U.S. health systems. Major barriers include financial concerns as well as limited utilization by providers, clinical staff, and patients. Possible interventions include increasingly affordable camera technology, demonstration of financially sustainable billing models, and engaging key stakeholders. SUMMARY: Significant opportunities exist to overcome barriers to scale up and promote widespread implementation of teleophthalmology in the USA. Further development of methods to sustain effective increases in diabetic eye screening rates using this technology is needed. In addition, the demonstration of cost-effectiveness in a variety of billing models should be investigated to facilitate widespread implementation of teleophthalmology in U.S. health systems.

Background To document ocular abnormalities in healthy full-term newborn infants using wide-field digital imaging and to analyze factors associated with the findings. Methods A total of 1208 full-term newborn infants at a tertiary eye hospital (Cipto Mangunkusumo National Referral Hospital) and a district hospital in Jakarta (Koja Hospital) were enrolled to the study. All eligible newborns underwent fundus examination within 48 hours after birth using the RetCam shuttle (Natus Medical Incorporated, USA). All eye findings were documented and analyzed according to obstetric and neonatal risk factors. Results Of the 1208 newborn infants enrolled, ocular abnormalities were found in 150 infants (12.4%). Retinal hemorrhage (RH) was the most common findings (88%) in which 2.67% involved the macula, followed with chorioretinitis (4.67%). Univariate analysis showed caesarean section (C-section) (OR 0.27, 95% CI 0.18-0.41, p

Background Immigrants to Canada belonging to ethnocultural minority groups are at increased risk of developing diabetes and complications, including diabetic retinopathy, and they are also less likely to be screened and treated. Improved attendance to retinopathy screening (eye tests) has the potential to reduce permanent complications, including blindness. Objective This study aims to identify the barriers and enablers of attending diabetic retinopathy screening among ethnocultural minority immigrants living with diabetes in Quebec and Ontario, Canada, to inform the development of a behavior change intervention to improve diabetic retinopathy screening attendance. Methods The research question draws on the needs of patients and clinicians. Using an integrated knowledge translation approach, the research team includes clinicians, researchers, and patient partners who will contribute throughout the study to developing and reviewing materials and procedures, helping to recruit participants, and disseminating findings. Using a convenience snowball strategy, we will recruit participants from three target groups: South Asian and Chinese people, and French-speaking people of African descent. To better facilitate reaching these groups and support participant recruitment, we will partner with community organizations and clinics serving our target populations in Ontario and Quebec. Data will be collected using semistructured interviews, using topic guides developed in English and translated into French, Mandarin, Hindi, and Urdu, and conducted in those languages. Data collection and analysis will be structured according to the Theoretical Domains Framework (TDF), which synthesizes predominant theories of behavior change into 14 domains covering key modifiable factors that may operate as barriers or enablers to attending eye screening. We will use directed content analysis to code barriers and enablers to TDF domains, then thematic analysis to define key themes within domains. Results This study was approved for funding in December 2017, and the research ethics board approved the conduct of the study as of January 13, 2018. Data collection then began in April 2018. As of August 28, 2018, we have recruited 22 participants, and analysis is ongoing, with results expected to be published in 2020. Conclusions Findings from this study will inform the codevelopment of theory-informed, culturally- and linguistically-tailored interventions to support patients in attending retinopathy screening. International Registered Report Identifier (IRRID) DERR1-10.2196/15109