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Purpose: This study investigated the effects of an eye care protocol (ECP) on patients in the intensive care unit (ICU). Methods: This study utilized a randomized controlled design. Participants were patients who met the inclusion criteria and were admitted to the ICU (36 in the experimental group and 38 in the control group). The experimental group received an ECP, while the control group received standard eye care, starting the day after admission, for a duration of 10 days. The ECP classifies the degree of eyelid obstruction into three stages based on the degree of exposure to the lower eyelid conjunctiva and cornea. The protocol included cleansing with normal saline gauze, administering eye drops, applying silicone and polyurethane films, and recommending consultation with an ophthalmologist if necessary. The effectiveness of ECP was assessed by analyzing tear volume, hyperemia, chemosis, and eye discharge. Data analysis was conducted using SPSS 27.0, employing the Mann-Whitney U-test and generalized estimating equations. Results: On day 5, the experimental group demonstrated a significant increase in tear volume in both eyes compared with the control group. However, no statistically significant differences were observed in the incidence of hyperemia, chemosis, and eye discharge on days 5 and 10 of the intervention. Conclusion: The application of the ECP in this study increased tear volume in ICU patients, thereby reducing discomfort caused by dry eyes. It has the potential to prevent complications such as damage to the surface of the eyeball resulting from decreased tear volume. [ABSTRACT FROM AUTHOR]

Introduction: Preservation of life, preservation of limb, and preservation of eyesight are the priorities for military medical personnel when attending to casualties. The incidences of eye injuries in modern warfare have increased significantly, despite personal eye equipment for service members. Serious eye injuries are often overlooked or discovered in a delayed fashion because they accompany other life- and limb-threatening injuries, which are assigned a higher priority. Prehospital military ocular trauma care is to shield the eye and evacuate the casualty to definitive ophthalmic care as soon as possible, with exceptions for treatment of ocular chemical injury and orbital compartment syndrome. Retrospective analysis of eye injuries in recent conflicts identified gaps in clinical capabilities with up to 96% of ocular injuries being suboptimally managed. Ocular compartment syndrome (OCS) is a complication associated with orbital hemorrhage, where significant morbidity occurs as a result of increasing intracompartment pressure. The ischemic tolerance of the retina and optic nerve is approximately 90 minutes, so OCS must be rapidly diagnosed and aggressively treated through lateral canthotomy/cantholysis (LC/C) to prevent permanent vision loss. LC/C procedures consist of using hemostats to crush the lateral canthal fold and cutting the lateral canthal tendon from the inferior crus to relieve increasing intracompartment pressure. The purpose of this study was to examine the baseline capabilities of military physicians and surgeons to accurately and independently perform the LC/C procedures and identify performance gaps that could be closed through focused professional development activities.Materials and Methods: This study received institutional review board approval at our institution. A total of 60 subjects voluntarily participated in the study from emergency medicine (15), general surgery (28), and ophthalmology (17). All procedural assessments were performed 1:1 by expert faculty ocular trauma specialists using a high-reliability eye trauma simulator (Sonalysts, Inc.). The competency standard was set at independent and accurate completion of all procedural components and all critical procedural components. Analyses were performed using descriptive statistics and analysis of variance to examine between-group differences (P < 0.05).Results: There was a significant difference between the total score performance and the critical score performance for the three groups (P < 0.001). Outcomes indicate a significant linear relationship between the expertise level of the clinical provider and the procedural performance of LC/C. Outcomes demonstrate the baseline surgical capabilities of the general surgeons transferred to LC/C performance; however, they were unfamiliar with the anatomy and the procedural techniques and requirements. The group of emergency medicine participants demonstrated performance gaps not only in the same areas as the general surgeons but also in their baseline surgical abilities. This suggests that different professional development activities are necessary for surgeons and physicians tasked with performing LC/V procedures.Conclusions: We identified significant performance gaps among emergency medicine physicians, general surgeons, and ophthalmologists in their abilities to recognize and treat OCS through LC/C procedures. These sight-saving procedures are a critical competency for forward-situated clinicians in expeditionary contexts. We identified the need for targeted approaches to professional development for closing the performance gaps for both emergency medicine physicians and general surgeons. [ABSTRACT FROM AUTHOR]

Background: The ophthalmology workforce is an integral component of any health care system. However, the demand for eye care has imposed a heavy burden on this system. Hence, this study aimed to estimate the trends, demographic characteristics, distribution, and variation between Saudi and non-Saudi ophthalmologists and the future challenges of the ophthalmology workforce in the Kingdom of Saudi Arabia (KSA). Methods: This study was conducted in the KSA and included ophthalmologists practicing from 2010 to 2023. From the Saudi Commission for Health Specialties, we obtained the number, gender, nationality, and rank of ophthalmologists. The geographic distribution of ophthalmologists in the KSA was obtained from the Ministry of Health Statistical Yearbook 2021. Results: As of January 2023, the KSA had a total of 2608 registered ophthalmologists, with approximately 81.06 ophthalmologists per 1,000,000 people. Only 38% of all ophthalmologists in the country were Saudis. The percentage of Saudi female graduates increased from 13.3% to 37.2% over 12 years [Sen's estimator of slope for median increase per year = 1.33 (95% CI 1.22–1.57) graduates; trend test P < 0.001). Additionally, we found that the geographic distribution of ophthalmologists varied (test for homogeneity of rates, P < 0.0001), with the larger regions having a higher concentration of ophthalmologists than the smaller regions (75.6 in Riyadh versus 42.8 in Jazan per 1,000,000 people). However, the World Health Organization's target for the ophthalmologist-to-population ratio has been achieved in all 13 health regions of KSA. Conclusion: The recommended ophthalmologist-to-population ratio has been achieved in the KSA, and the number of Saudi ophthalmologists has almost doubled over the past 8 years. However, the majority of ophthalmologists are still non-Saudi, as Saudi ophthalmologists constitute approximately one-third of the ophthalmology workforce in the KSA. The geographical distribution of ophthalmologists varies, which might affect access to care in peripheral regions. In response to the growing demand for eye care in the KSA, several more effective measures might need to be considered. [ABSTRACT FROM AUTHOR]

Purpose: To provide a comparative analysis of rates of laser trabeculoplasty (LTP) among eye care providers in the USA. Methods: This retrospective cohort analysis utilized the Centers for Medicare and Medicaid Services (CMS) Public Use File (PUF), 2015– 2018. We used CPT code 65855 to select eye care providers who performed LTP in three key US states (KY, LA, and OK). Primary outcomes were eye provider differences in provider count, service count, unique beneficiary count, and Medicare-allowed payments. Asymptotic two-sided chi-squared tests were executed. Statistical significance was achieved at p< 0.05. Results: The sum of Medicare-allowed payments for LTP in all three states in 2018 was roughly 26% lower than in 2015. The proportion of Medicare-allowed payments furnished by optometrists increased from 11.3% to 17.9% between 2015 and 2018 (p< 0.001). Relative to ophthalmologists, we observed significant increases in optometric Medicare-allowed payments in KY, LA, OK, and the all-inclusive tri-state cohort (all p< 0.001). Furthermore, significant optometric increases in number of providers performing LTP (p=0.007), number of unique Medicare beneficiaries seen (p< 0.001), and number of LTP services billed (p< 0.001) were observed relative to ophthalmologists. Conclusion: The recent expansion of surgical authority by optometrists in key US states is creating a tangible impact on ophthalmologic and optometric practice patterns. The findings of this study may act as provision for policymakers in the context of continually evolving guidelines for optometric surgical expansion. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to identify the knowledge of and perceived barriers to providing low vision services among eye care practitioners in Goa. Methods: A pretested and predesigned questionnaire was sent to 72 eye care practitioners, which included the optometrists and ophthalmologists working in Goa, through offline and online (social media like WhatsApp, Instagram, etc.) platforms. Information was collected to understand the barriers that restrict eye care practitioners from providing low vision services. Results: Seventy-two participants took part in this study, of which 26.39% (n=19) were ophthalmologists and 73.61% (n=53) were optometrists. From the practitioner's point of view, lack of awareness (70.83%, n=51) and training (68.06%, n=49) were the major barriers to providing low vision services. Conclusion: A lack of awareness and training facilities among eye care practitioners acts as a barrier to providing low vision services. [ABSTRACT FROM AUTHOR]

(1) To identify if adults with uncorrectable sight loss would increase their physical activity (PA) following advice from general healthcare, eyecare or sight loss service professionals. (2) To identify what resources could be provided alongside advice from a professional to facilitate PA. Survey data from 100 UK adults with uncorrectable sight loss were analysed. Adjusted logistic regression models were used to examine the association between participant characteristics, and the likelihood that participants would increase PA if advised to by different professionals. Most of our sample would increase their PA if advised to by a general practitioner (GP) (n = 78), ophthalmologist or optometrist (n = 70) or a low vision rehabilitation officer (n = 75). Thirty-one participants would increase their PA if advised to by a dispensing optician. Participants with a history of anxiety and depression were less likely to report they would increase their PA based on advice from a GP (p = 0.002). Sight loss specific and community-based PA groups, exercise specialist support, a sighted guide, and a travel plan, were considered by most participants to be useful facilitators of PA. The results suggest eyecare and sight loss service professionals could facilitate increases in PA among adults with sight loss. Physical activity levels among populations with sight loss are critically low, and inactivity increases the risk of chronic conditions and premature mortality within these populations. GPs, optometrists, ophthalmologists, or low vision rehabilitation officers could play a pivotal role in increasing physical activity levels among people with sight loss, by providing physical activity advice during consultations. Professionals advising people about physical activity should have the knowledge, and opportunity, to refer people with sight loss to accessible physical activity groups or services. [ABSTRACT FROM AUTHOR]

Understanding approaches to sustainability in cataract surgery and their risks and benefits. In the United States, health care is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability. We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons. Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single-use supplies to reusables or implementing a hub-and-spoke–style operating room setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks. Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Background: Vision impairment (VI) affects people worldwide, and demographic factors like age are significantly linked to VI. Routine eye exams and other eye care treatments can detect and prevent common eye illnesses. However, many lack access to these services. Aim: This study’s major objective was to analyse the distribution and funding of eye care services by medical schemes in South Africa. Setting: The study was conducted in the private sector in South Africa for benefits paid by medical schemes to optometrists, ophthalmologists and orthoptists. Methods: A retrospective, longitudinal study of eye care services claim data from the Council for Medical Schemes (CMS) annual reports. The review period was 2020, and scheme-level data were gathered and analysed at the aggregated rather than benefit option level. Results: In 2020, eye care benefits comprised 3.1% of total benefits paid; this proportion remained at the same levels throughout the review period. Closed schemes spent more per beneficiary per year than open schemes for optometrists, orthoptists and ophthalmologists. Self-administered schemes had 11% copayment for ophthalmology services, whereas outsourced schemes had less than 10%. Conclusion: Optometrists had higher copayments than ophthalmologists and orthoptists. Medical schemes with capitated models had a lower average expenditure than other types of models, and the operating model affected expenditure; self-administered schemes spent less on optometry benefits when adjusted for beneficiaries. The study suggests reviewing eye care benefit funding models (risk vs savings), administration activities and managed care models for cost savings and health quality. Contribution: This research contributes to the discussion and implementation of universal health insurance coverage through national health insurance in South Africa. The research shows that there are not enough eye care services in the public sector and that there are different funding gaps in the private sector.

Objective: Indigenous Australians are nearly three times more likely to have diabetes than non‐Indigenous Australians. The prevalence of diabetes‐related vision impairment for Indigenous Australians is 5.5% compared to 1.5% for non‐Indigenous Australians, and treatment rates are lower for Indigenous Australians. Despite this situation, there is limited evidence on effective service delivery models for diabetic retinopathy care and treatment. This study seeks to identify best‐practice features of diabetic retinopathy care that could be used to inform current and future service delivery models for Indigenous Australians with diabetic retinopathy. Setting: All states, territories and geographic remoteness categories in Australia. Participants: Eight ophthalmologists engaged in providing eye healthcare to Indigenous Australians. Design: Semi‐structured interviews were conducted. The Framework Approach was used to conduct a thematic analysis of the interviews to facilitate identification of key themes and issues that emerged from these discussions. Results: Seven best‐practice features for service delivery of diabetic retinopathy treatment for Indigenous Australians were identified. These were: cultural safety, affordability and accessibility, partnerships with key stakeholders, timeliness, integration with primary care, clarity of guidelines, and clinician attitude and motivation. Conclusion: The findings from this study identified seven best‐practice features for diabetic retinopathy treatment. These have the potential to inform and influence how care is delivered to Indigenous Australians. Although further research is warranted to capture other service provider inputs and Indigenous end‐user perspectives, these features in the meantime can begin to inform the decisions of the Indigenous eyecare sector on policy reforms and best‐practice diabetic retinopathy treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Vision impairment (VI) affects people worldwide, and demographic factors like age are significantly linked to VI. Routine eye exams and other eye care treatments can detect and prevent common eye illnesses. However, many lack access to these services. Aim: This study's major objective was to analyse the distribution and funding of eye care services by medical schemes in South Africa. Setting: The study was conducted in the private sector in South Africa for benefits paid by medical schemes to optometrists, ophthalmologists and orthoptists. Methods: A retrospective, longitudinal study of eye care services claim data from the Council for Medical Schemes (CMS) annual reports. The review period was 2020, and scheme-level data were gathered and analysed at the aggregated rather than benefit option level. Results: In 2020, eye care benefits comprised 3.1% of total benefits paid; this proportion remained at the same levels throughout the review period. Closed schemes spent more per beneficiary per year than open schemes for optometrists, orthoptists and ophthalmologists. Self-administered schemes had 11% copayment for ophthalmology services, whereas outsourced schemes had less than 10%. Conclusion: Optometrists had higher copayments than ophthalmologists and orthoptists. Medical schemes with capitated models had a lower average expenditure than other types of models, and the operating model affected expenditure; self-administered schemes spent less on optometry benefits when adjusted for beneficiaries. The study suggests reviewing eye care benefit funding models (risk vs savings), administration activities and managed care models for cost savings and health quality. Contribution: This research contributes to the discussion and implementation of universal health insurance coverage through national health insurance in South Africa. The research shows that there are not enough eye care services in the public sector and that there are different funding gaps in the private sector. [ABSTRACT FROM AUTHOR]

Preventive eye care is a preferred practice that includes recommended regular eye examinations, which is not always followed. This study examined attitudes of ophthalmologists toward routine eye examinations, analyzed compliance with their own eye examinations, and described reasons for non-compliance. This was a cross-sectional study involving an online survey, sent to all members of the Israeli Ophthalmological Society (IOS) asking their personal opinions concerning routine eye care, self-performance of these tests, and reasons for non-compliance. A total of 243 responses were received (59% males, mean age 52 years) representing 40% of IOS members. 98% of respondents think that adults should be routinely screened for eye diseases, most commonly annually (52%) or every two years (36%); however, only 55% of ophthalmologists reported having themselves a routine eye check in the past 3 years, which is significantly lower than their spouse (68%, P = 0.003). Recommendations for routine eye examinations were always higher than their actual performance regardless of the responding ophthalmologists' gender, age or country of birth. Furthermore, female gender was found to be a negative predictor of having these examinations. Pupil dilation was performed in 38% of ophthalmologists' testing, even though 80% of them think it is necessary for a complete examination. 'Lack of time' (35%) and 'forgetfulness' (31%) were the main reasons provided by ophthalmologists as an explanation for not having regular eye testing. Ophthalmologists typically recognize the importance of preventive eye care, recommending periodic eye examinations for their patients; however, self-performance of these evaluations by the ophthalmologists themselves is much lower. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to analyze the clinical profile of patients with scleritis managed by a single ophthalmologist in a tertiary eye care center. METHODS: This was a retrospective analysis of 107 eyes of 96 patients with scleritis from January 2007 to December 2018. RESULTS: Female predominance (68%) with a relatively young-onset (46 ± 14 years) of scleritis was observed. Diffuse anterior scleritis (41%) was the most common subtype of scleritis, and the most common systemic association was rheumatoid arthritis (18%). Three-fourth of patients received immunosuppressive treatment (74%) along with corticosteroids. The mean follow-up period was 3 ± 2.5 (range: 0.6-10) years. Necrotizing scleritis was at a 3.5 times higher risk of developing ocular complications. Eighty percent of patients maintained the same vision. Recurrence of scleritis was noted in 25 eyes (23%). CONCLUSION: Diffuse scleritis is the most common scleritis in our population. Tuberculosis was commonly seen with diffuse scleritis. The likelihood of developing ocular complications (cataract and glaucoma) was higher in necrotizing scleritis, thus requiring periodic monitorization. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ophthalmologists/Optometrists have a high incidence of neck pain. Little research has been conducted on specific equipment that predisposes these professionals to cervical discomfort. OBJECTIVE: Primary purpose: to determine if neck position is altered by slit lamp table design. Secondary purpose: to confirm the prevalence of neck pain in eye care professionals. METHODS: A survey of work-related pain was administered to 36 subjects (8 ophthalmologist, 2 optometrists, 26 technicians). The craniovertebral (CV) angle was measured in each subject in three separate positions (resting posture, best posture, slit lamp posture) between two different slit lamps/tables: slit lamp-deep and slit lamp-shallow. RESULTS: 79% of subjects reported neck pain in the last 6 months. The mean CV angle of all subjects at resting posture, best posture, and both slit lamp postures differed significantly. There was also a difference in CV angle between slit lamps. CONCLUSION: Neck pain is more prevalent in eye professionals than in the general population. The use of slit lamps promotes a forward head posture which decreases the CV angle, putting the user at risk for neck pain. By altering slit lamp table design, the CV angle of eye care professionals can be increased, reducing the risk for neck injury. [ABSTRACT FROM AUTHOR]

The article explores the crucial connection between vision care and dementia, highlighting the increased risk of cognitive decline associated with impaired eyesight. Topics discussed include the pivotal role of optometrists in routine monitoring for age-related eye conditions, facilitating regular eye care for individuals living with dementia, and promoting awareness among healthcare professionals about the intersection of eyesight and cognitive health.

Objective: To assess safety practices among eye care workers in Nigeria during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This research was a cross-sectional study. A structured electronic questionnaire was distributed among eye care workers (ophthalmologists, optometrists, ophthalmic nurses) across the six geographical zones of Nigeria. Information on socio-demographics, COVID-19 infection, current working conditions and safety practices were obtained. Data analysis was done using Statistical Package for Social Sciences (SPSS Inc. Chicago Illinois, USA) for windows, version 22. Results: A total of 236 eye care workers participated in the study; their mean (±SD) age was 37.13 (±8.141) years, 125 (53%) were females, and 145 (61.4%) worked in a tertiary care hospital. All participants described COVID-19 as a viral disease and 98.3% agreed that the disease can affect the eyes. Outpatient clinic consultation was recorded as the highest (77.7%) service provided during the pandemic. Regarding preventive practices, 95% of eye care workers wore facemasks, 82.4% wore gloves during ophthalmic examination and Hazmat suit was the least used protective device (2.5%). About three-quarters (77.5%) reported feeling unsafe in their working environment and 63.9% were dissatisfied with the personal protective device provided by hospitals to eye care workers. Conclusion: COVID-19 pandemic presented an unprecedented challenge for eye care workers; with the practice of ophthalmology posing a high risk of transmission of the virus. Efforts should be made to provide the required personal protective devices needed for optimum protection of eye care workers in healthcare settings. [ABSTRACT FROM AUTHOR]

Purpose: To assess the ophthalmic practice pattern among ophthalmologists in India amidst the COVID-19 pandemic. Methods: An online questionnaire-based analysis was performed among members of the All India Ophthalmological Society (AIOS) and results were analyzed using SPSS software version 20. Results: A total of 2253 responses were received. The majority of the participants (72.6%) were between 30 and 60 years of age and were into private practice (64.7%). During the lockdown, over one-third of participant ophthalmologists reported not attending any OPD patients, whereas a majority (64%) provided only emergency ophthalmic services. During the COVID-19 pandemic, <15% surgeries were performed compared to the pre-COVID-19 era by 81% of participants, whereas elective surgeries were performed by only 4.3%. The proportion of participants utilizing telemedicine in ophthalmology showed a two-fold rise from the pre-COVID-19 era (21.9%) to the COVID-19 pandemic (46%). Over half of the participants reported following the AIOS guidelines, reducing clinic hours, use of screening questionnaires, minimizing staff, and use of breath shield on a slit lamp as precautionary measures to reduce the exposure. Over 95% of ophthalmologists were satisfied (score > 5/10) by the AIOS guidelines for ophthalmic practice during COVID-19. Conclusion: COVID-19 pandemic has adversely affected the ophthalmic care services across India with telemedicine emerging as a major rescue. The majority of practicing ophthalmologists are satisfied with guidelines provided by AIOS for ophthalmic care during the COVID-19 pandemic and have implemented the same in their setup. [ABSTRACT FROM AUTHOR]

Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25–0.25], 0.01 [95%-LoA: -0.86–0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1–0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4–4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82–0.91]; 0.97 [0.96–0.98]; 0.96 [0.95–0.97] and 0.88 [0.84–0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 contagion curve is steeply increasing again worldwide; however, this time we face the emergency with different knowledge.Areas covered: In this review article, we present international guidelines and updated literature merged with our experience from hospitals in Bergamo, the epicenter of the first European COVID-19 outbreak, and provide a protocol tailored for ophthalmology professionals for organizing ophthalmology services for the second-wave of COVID-19 pandemic, to satisfy ophthalmic care needs while minimizing viral spread. Results from this strategy are discussed. We have developed a protocol that can balance safety, costs and quality.Expert opinion: Re-shaping ophthalmology practice resulted in higher costs and longer working times, but this is necessary to ensure safety. Updating ophthalmology protocols should be a priority worldwide. [ABSTRACT FROM AUTHOR]

Purpose: To share a method of appropriately connecting patients directly to tertiary ophthalmology centers where subspecialist vitreoretinal (VR) surgical management is required during coronavirus disease 2019 (COVID-19). Methodology: We present our experience of a live teleophthalmology link directly connecting an optometrist to tertiary center VR team at the point of retinal detachment presentation within the community. Results: After the COVID-19 lockdown in National Health Service Forth Valley, Emergency Eye Care Treatment Centers have been set up where optometrists are the first point of contact for patients in the community. Live teleophthalmology link has enabled the optometrist in the community to connect directly with local ophthalmologists. From March 23 to June 15, 2020, five referrals were taken for a suspected retinal detachment, and one for submacular hemorrhage. From the receiving ophthalmologists' viewpoint, satisfaction for the quality of sound, video, and connection was 5/5 in all cases on a 5-point Likert grading; from the referring optometrists' viewpoint mean 4.6/5 for sound and video satisfaction, and 5/5 rating in all cases for connection reliability. On 5/6 occasions (83%) the receiving ophthalmologist connected directly with a VR surgeon in a tertiary center. Four-way communication between the patient, optometrist, receiving ophthalmologist, and VR surgeon enabled all five patients to be listed directly for VR surgery from the community, avoiding local ophthalmology department contact during the COVID-19 pandemic. Conclusion: Overall satisfaction and recommendation to others was rated 5/5 in all instances on a 5-point Likert grading, from the patient, optometrist, and ophthalmologist viewpoint. [ABSTRACT FROM AUTHOR]

Background: This article puts the emphasis on the notion of "creative abilities" in the context of its interpretation by eye care workers. Creative potential is essential for the general and professional culture of physicians, and personal creativity takes on a new meaning in the age of digitalization and dominance of artificial intelligence in routine medical practice. Purpose: To investigate eye care workers' percepts of creative abilities by conducting a psychosemantic analysis and considering these percepts as a source of health care workers' job satisfaction. Material and Methods: The study sample was composed of the eye care workers from the Filatov Institute of Eye Diseases. Two hundred and eleven eye care workers were requested to take part in the study, and the response rate was 85.8% (181/211). The 181 responders included 99 nursing staff members and 82 physicians (ophthalmologists). The study was conducted with the use of Hughes and Powell's Guiding Principles for Life (GPL) Questionnaire (adapted by Semeniuk), the Kim, Leong, and Lee's Job Satisfaction Scale (JSS) (adapted by Semeniuk) and the Lüscher 8-color test. Results: Eye care workers rated "Creativity" low among the 22 "Guiding Principles for Life". In physicians, such guiding principles as "Creativity", "Devout", and "Material wealth" were associated with each other, which indicates that the achievement of material wealth was associated with such a virtue as devout, and this achievement requires creativity. It was demonstrated that creativity as a guiding principle was more important for physicians than for the nursing staff, and in male physicians it was associated with unconscious satisfaction with working environment. [ABSTRACT FROM AUTHOR]

Background: Teleophthalmology programs are expanding, but have not been adapted into many emergency departments (EDs) in the United States. Introduction: Determining the potential demand for teleophthalmology services in the United States. EDs could enable development of new strategies to improve access to eye care in resource-limited regions. Methods: Telephone surveys were administered to ED physicians and nurses in Florida. Perceptions of ophthalmologist availability, equipment availability, and perceived utility of teleophthalmology services were measured. Results: Responses were from 104 of 207 facilities (50.2%); 88/181 (48.6%) designated as nonrural hospitals (NRHs) and 16/26 (61.5%) as rural hospitals (RHs). NRHs reported a median of 1 ophthalmologist available on call compared with a median of 0 at RHs (p < 0.001). NRHs were more likely to have a slit lamp (98.9% NRH, 50.0% RH; p < 0.001) and tonometer (100% NRH, 75.0% RH; p < 0.001). On a scale from 1 (lowest) to 5, most (68/93; 73.1%) perceived the value of teleophthalmology for remote consults as a 4 or 5. The most common perceived benefit of teleophthalmology use was to provide second/expert opinion (26.5% of responses). The most commonly cited perceived disadvantage was the physical unavailability of an ophthalmologist for examination and follow-up care (35.5% of responses). Discussion: RHs have less access to ophthalmologists and ophthalmic equipment when managing eye-related complaints in the ED. At both RHs and NRHs, providers face limitations in managing eye complaints and perceived teleophthalmology as a potentially valuable tool for remote expert consultation. Conclusions: Results suggest teleophthalmology services may be used to improve access to expert ophthalmic care, particularly in rural communities. [ABSTRACT FROM AUTHOR]

Background: Studies on eye care workers' time budget are relevant because a current ophthalmologist is challenged by a high caseload, necessity to have at least two part-time jobs to help his/her financial status, job-related burnout, stresses, interrole conflicts, etc. To our best knowledge this is the first study to investigate the relation between time budget allocations and social and demographic parameters, and the role of an adequate time budget in job satisfaction and combating stress and burnout. Purpose: To determine (1) the composition of time spent in different activities by different categories of eye care workers and (2) the relations between time budget parameters, stress reactions and job satisfaction. Material and Methods: Two hundred and eleven eye care workers from the Filatov Institute of Eye Disease and Tissue therapy were requested to respond to relevant questions. The response rate was 85.8% (181/211). The 181 responders included 99 nursing staff members and 82 ophthalmologists. The responders completed a specially designed questionnaire. In addition, we used the Rodina, Biron, Ukhanova, Semeniuk, and Kernas Interrole Conflict Scale for Eye-care Workers, the Tsekhmister, Daniliuk, Rodina, Biron, and Semeniuk's Stress Reaction Inventory for Eye Care Workers, and the Kim, Leong, and Lee's Job Satisfaction Scale (JSS). Results: Time spent working represented the largest component of the time budget for both physicians and nurses. It was demonstrated that ophthalmologists worked overtime, and both eye care doctors and eye care nurses self-reported sleep deprivation. Our principal component analysis demonstrated the presence of interrole conflicts (work-family and family-work conflicts) for eye care doctors, but not for eye care nurses. Adequate physical activity and adequate sleep duration appeared to provide protection against family-work conflicts and improve both the capacity to mitigate emotional responses to stressors and job satisfaction. There was a decrease in nurses' job satisfaction with an increase in their engagement in professional activities; this characterizes a vocational maladjustment mechanism (they worked just because they had to). Therefore, the time allocation study methodology enabled rather objectively assessing working conditions of care workers and approaches to meeting their needs. [ABSTRACT FROM AUTHOR]

Background: Retinal diseases are very difficult to treat. So, early diagnoses and preventions are very important. But, few eye doctors can treat patients with retinal diseases in Nepal. Retina Eye Care of Nepal (RECON) project was designed to strengthen retina eye care services in Nepal.Methods: RECON was implemented from May 2016 to February 2019 in Nepal. Four Master Eye Doctors (MED) received Training of Trainers (TOT) from Tokushima University, Japan. MEDs developed training materials for different cadres of ophthalmic human resources, enhanced retina eye care facilities, and conducted retina-screening camp in Nepal.Results: Twenty ophthalmologists, 16 optometrists, 48 ophthalmic assistants and 17 ophthalmic nurses, 76 physicians and 28 health workers were trained in retina care. Eight outreach retina camps were conducted.Conclusions: The project was a novel approach to strengthen retina services in Nepal. The aim of the project was accomplished with the ultimate benefits to the needy retina patients who otherwise were going to miss the retina services. [ABSTRACT FROM AUTHOR]

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Background: In ageing populations, the prevalence of chronic diseases such as glaucoma is projected to increase, placing additional demands on limited health-care resources. In the UK, the demand for secondary care in hospital eye clinics was inflated by high rates of false positive glaucoma referrals. Collaborative care models incorporating referral refinement, whereby glaucoma suspect referrals are triaged by suitably trained optometrists through further testing, can potentially reduce false positive referrals. This study examined the impact of a referral refinement model on the accuracy of glaucoma referrals in Australia.Methods: Optometrist-initiated glaucoma suspect referrals to the Glaucoma Management Clinic (Sydney, Australia) were prospectively recruited. Glaucoma suspect referrals arising from two pathways were eligible for inclusion, either directly from a community optometrist (standard care) or following comprehensive assessment at the Centre for Eye Health (referral refinement). Main outcome measures were the positive predictive value and false positive rate of referrals. The impact of referral letter content on management outcomes was also investigated.Results: Of 464 referrals received between March 2015 and June 2018, 252 were for treatment of naïve glaucoma suspects and eligible for inclusion. Following ophthalmological assessment, 45.6 per cent (n = 115/252) were prescribed treatment for open angle glaucoma or ocular hypertension. Positive predictive value of community optometry referrals was 33.8 per cent (n = 25/74) and 50.6 per cent (n = 90/178) following referral refinement. The first visit discharge (false positive) rate was 26 per cent (n = 19/74) for community referrals compared to four per cent (n = 8/178) with referral refinement. Positive predictive value increased with the number of abnormal clinical examination findings associated with referral (χ2 test, p < 0.0001). The number of abnormal findings reported in referrals was significantly higher with referral refinement compared to without (n = 1.9 versus 1.5, t-test, p < 0.0001).Conclusion: Referral refinement can improve the diagnostic accuracy of optometry-initiated referrals for glaucoma suspects in Australia, thereby decreasing unnecessary referrals to hospital and other secondary clinics. [ABSTRACT FROM AUTHOR]

Background: The New Zealand Ministry of Health provides funding for the delivery of health care across regions via 20 District Health Boards. Funding includes the subsidisation of therapeutic pharmaceutical agents/drugs. The distribution of optometrists and ophthalmologists across the regions was investigated to understand the accessibility of eye care in New Zealand. Changes made to the optometrists' scope of practice in 2005 and in 2014 increased the range of drugs that suitably qualified optometrists could prescribe. Therefore, the distribution of optometrists authorised to prescribe drugs and those not authorised to prescribe drugs was also investigated.Methods: Information from the New Zealand Optometrists and Dispensing Opticians Board register and information from the Medical Council's website were used to create a database of ophthalmic practitioners and their locations. The χ2 goodness-of-fit test was carried out to determine whether the distribution of the number of practitioners across the regions was in proportion to the population of the regions.Results: Ophthalmologists were distributed across the regions in proportion to the regional population size. However, optometrists were concentrated in Auckland and other regions with high populations. Optometrists authorised to prescribe drugs comprised over 74 per cent of optometrists and were the majority of optometrists in most regions. Many of the regions with populations less than 200,000 had high population-to-practitioner ratios, indicating that they may not have sufficient numbers of ophthalmic practitioners in order to provide for the ocular needs of the community.Conclusion: Better distribution of the optometric workforce could make eye care more accessible in many regions of New Zealand. [ABSTRACT FROM AUTHOR]

Background: Eye care workers are highly prone to the risk of psychological problems due to emotional demands of job and high stress loads. Because inter-role conflicts act as stress load factor, it is important to develop psychometrically adapted psychodiagnostic instruments for detecting them. Purpose: To develop a Ukrainian version of the psychometric scale as a tool for measuring inter-role conflicts for eye care workers, to psychometrically analyze it, and to estimate its relationships with stress reactions. Material and Methods: The study sample consisted of the eye care workers from the Filatov institute. Two hundred and eleven eye care workers were requested to respond to relevant questions. The response rate was 85.8% (181/211). The 181 responders included 99 nursing staff members and 82 ophthalmologists. The adapted version of the 1996 Netemeyer's et al Work-Family Conflict and Family-Work Conflict Scales and the Stress Reaction Inventory for eye care workers designed by Ukrainian researchers, Tsekhmister, Daniliuk, Rodina, Biron, and Semeniuk, were used in the study. Results: The Inter-role Conflict Scale was developed by adapting the Netemeyer's et al questionnaire. The modified version of the scale is comprised of the two subscales describing two forms of inter-role conflicts, Work-Family Conflict (WFC) and Family- Work Conflict (FWC); these subscales were found to have high internal consistency and test-retest reliability. The two-factor scale model was verified by a confirmatory factor analysis. The two forms of inter-role conflicts were found to be statistically more severe in the physician staff than in the nursing staff. The test norms were developed and presented using the quartile scale, as long as the sample was representative. Therefore, the adapted Ukrainian-language version of the Inter-role Conflict Scale for eye care workers showed evidence of internal consistency and construct validity. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the distribution of cataract surgery performed by ophthalmologists in China. Methods: A cross-sectional study was designed to investigate nationwide ophthalmological resources and capacity for cataract surgery in China⁠—The 2014 China National Eye Care Capacity and Resource Survey. Data analyzed in this report included regional distribution, urban-rural comparison, levels and types of medical institutions, and cataract surgery types and volume per surgeon. In China, only ophthalmologists at or above the level of attending are eligible to perform cataract surgery independently, so the ability of cataract surgery for ophthalmologists at or above the level of attending is analyzed in the current study. Descriptive statistics were used. Results: 36,333 ophthalmologists were included in this survey, which is an average of 1.33 ophthalmologists to every 50,000 population. Of the surgeons in this survey, 23,412 (50.22%) were attending or more senior ophthalmologists and were mainly distributed in eastern urban areas. Annual average cataract surgeries per ophthalmologist in China were 259 in 2017, less than 300 cases. Conclusion: The average number of ophthalmologists per population in China has achieved the goal of WHO's Vision 2020; however, these surgeons are concentrated in urban areas. Further, the ability of cataract surgery among ophthalmologists is unbalanced. The annual average cataract surgeries performed by ophthalmologists are insufficient, which is an important factor resulting in the current situation in China that ophthalmic service capacity has not met the requirements for eliminating cataract blindness. [ABSTRACT FROM AUTHOR]

Introduction. A study based on the Taiwanese National Health Insurance Research Database (NHIRD) to reveal the ocular diseases landscape. Materials and Methods. This study comprised all ophthalmological outpatient patient visits (n = 6,341,266) in the Taiwanese longitudinal NHIRD 2000. Descriptive analytics based on 15 disease categories of ICD-9-CM and 10 tiers of age categories was performed with SAS for Windows 9.3 (SAS Institute, Inc., Cary, NC, U.S.A.). Results. The average frequency of visits was 0.7 visits per year. The mean age was 36.2 years old. Bimodal peak of visits in the first, second, and eighth decade of life was revealed. Conjunctiva is the most dominant disease category throughout life while different categories play major roles in each decade of life. The most frequent disease code of each category was listed. Discussion. The bimodal peak of visits revealed the age group of the most prominent ocular disease burden. Peak in school age population can be partially explained by the nationwide vision screening program, while aging accounts for the lens disorder and glaucoma of the senile peak. The disease category frequency variation among age categories reflects the development and aging of the eye. The most frequent disease codes of each category highlight disease of importance for primary practitioners and ophthalmologists. Conclusion. Taiwanese longitudinal NHIRD was used to reveal the ophthalmological disease landscape. The epidemiological insight, while limited in clinical presentation and economic impact, enables physicians and policy makers to improve the overall vision health of the population. [ABSTRACT FROM AUTHOR]

Objective: To determine the current status and challenges of subspecialty eye care service delivery in Nigeria Study Design: Cross sectional descriptive study Setting: Ophthalmological society of Nigeria (OSN) conference Subjects or participants: Nigerian Ophthalmologists participating in the annual OSN conference. Interventions: Data of current status of eye care services and challenges of subspecialty practice were collected using a pretested self-administered questionnaire. Chi-square test was used to determine associations at a P-value of 0.05 Results: There were a total of 136 respondents; 60 males and 76 females. Highest age range of respondents was 41-50years. About 44.1% had undergone some form of subspecialty training. The commonest area of specialization was Glaucoma (13.2%) while the least area was Neuro-ophthalmology (1.5%). There were more subspecialists in the western region of the country. The major constraint for undergoing subspecialty fellowship was lack of funds. The major barrier to setting up subspecialty practice on completion of training was Lack of equipment for subspecialty practice. Majority of the present subspecialists got international sponsorship for their subspecialty training while those without subspecialty training cited cost as a major impediment to training. Conclusion: Subspecialty training and implementation is still developing in Nigeria. A major intervention has been put in place by CEHC, ICO and Fred Hollows foundation training some number of ophthalmologists. Subspecialty [ABSTRACT FROM AUTHOR]

To test a model of integrated pediatric eye care delivery and examine the prevalence and factors associated with childhood ocular morbidity in a peri-urban setting in Bangladesh. Cross-sectional, population-based study. The study was conducted in three phases among children aged ≤15 years. Trained community health workers (CHWs) conducted awareness intervention and identified children with ocular problems. These children were then referred to the base hospital for examination and treatment by ophthalmologists. A pediatric ophthalmologist further examined the children with complicated eye diseases and ensured treatment at a tertiary public eye hospital. Awareness, referral patterns, and health-seeking behavior were also examined. All data were analyzed statistically using Statistical Package for Social Sciences. CHWs screened 33,549 eligible children and identified 1887 cases with ocular morbidity. The prevalence of ocular morbidity and childhood blindness were 5.63% (95% confidence interval [CI] = 5.27–6.16) and 0.060% (95% CI = 0.03–0.11), respectively. The most commonly observed ocular morbidities were refractive error (3.24%; 95% CI = 3.11–3.45), allergic eye conditions (1.2%; 95% = CI 0.74–1.27), and nasolacrimal duct obstruction (0.52%; 95% CI = 0.25–0.74). Blindness was more frequently seen in children aged <5 years than in those aged 5–15 years (χ2 = 7.25; P = 0.007). The causes of blindness were corneal opacity, congenital eye anomaly, cataract, retinopathy of prematurity, and retinoblastoma. The prevalence of ocular morbidity was higher among older children, boys, children with low parental education and income, and children from households dwelling in slums. This study demonstrated that in a setting where screening and treatment for vision problems remain low, ocular morbidity among children could be easily identified through well-designed community-based screening programs involving appropriately trained CHWs. Community mobilization, awareness, and early detection of childhood eye diseases, with effective referral mechanisms for accessing appropriate care, are crucially important to improve service delivery. • Trained community health workers conducted awareness interventions, identified and referred children with ocular problems. • Refractive error was the most common ocular morbidity. • Ocular morbidity was associated with older children and slum dwellers. • Gender inequalities existed in care seeking; fewer girls sought care from the referral hospital. • Community mobilization, early detection and effective referral are important for improving eye care service delivery. [ABSTRACT FROM AUTHOR]

Recently, several professional groups have recommended a change from chart-based to instrument-based screening for preschool-age children, but the effect of this change on health care utilization is unknown. We performed a secondary analysis of a site-randomized quality improvement project on transitioning from chart-based to instrument-based vision screening for 3- to 5-year-old children in primary care. We analyzed visit rates to ophthalmologists and optometrists and costs of such care before and after implementation of instrument-based vision screening with comparison to nonparticipating practices. The implementation of instrument-based vision screening resulted in a decrease in visits to eye care specialists from 83.1 visits per 1000 children per year to 55.0, a reduction of 33.8%; no comparable reduction was seen in nonparticipating practices. The cost of services by eye care specialists fell from $65 715 per 1000 children per year prior to $55 740, a decline of 15.2%; similar costs among control practices rose 13.4%. [ABSTRACT FROM AUTHOR]

Background: Ophthalmologists - Eye Doctors working in academic eye hospitals confront various information demands for their services towards patient care, teaching, research, etc. The purpose of this study is to investigate how the ophthalmologists handle their situational information demands. Methodology: The study design is cross sectional and convenience sampling method is adopted. A structured questionnaire was used to collect data. SPSS 18 PASW Statistical package was used for statistical analysis. Frequencies, percentages, Mann-Whitney U test, Kruskal-Wallis test were used in the study. Findings: Around 633 ophthalmologists working in 47 academic eye hospitals from 16 states of India were included in the study. The study results revealed that majority of the ophthalmologists exhibit the attitude “seek the information during situation", followed by “I forecast such a need and gather information in advance", “Seek the information after handling the situation" and “I will not seek for any information". The statistical test results showed up that the ophthalmologists' attitude towards handling situational information demand doesn't differ by gender, age, designation, experience, and institution type. Conclusion: The study results revealed that when a situation demands information, the ophthalmologists will need a range of quality information resources within a short time span. This will be helpful to the ophthalmic librarians to understand nature of the ophthalmologist's information demand and build the resource collection and deliver information services accordingly. The ophthalmic institutions to provide appropriate infrastructure and facilities and equip the libraries to deliver efficient information services. [ABSTRACT FROM AUTHOR]

Background: The job-related burnout rate in eye care workers has been consistently rising. That is why it is important to develop psychodiagnostic instruments for detecting stress reactions, and to make them psychometrically adapted to the social and cultural realities of the Ukrainian professional environment. Purpose: To develop an inventory for measuring stress reactions, to customize it to eye care workers and the realities of our nation, to psychometrically analyze it, and to estimate its relationships with job satisfaction indices. Materials and Methods: The study sample consisted of the eye care workers from the Filatov institute. Two hundred and eleven eye care workers were included in the study. The response rate for the inventory was 85.8% (181/211). The 181 responders included 99 nursing staff members and 82 physicians (ophthalmologists). The study was conducted with the use of the modified version of the Student-life Stress Inventory (SSI) by Gadzella. Results: The Stress Reaction Inventory (SRI) for eye care workers was developed by adapting the SSI. The modified version of the inventory is comprised of four stress reaction scales (or categories), Physiological (F), Emotional (G), Behavioral (H), and Cognitive Appraisal (I), which were found to have high internal consistency and test-retest reliability. Both among the nursing staff member group and the physician group, the more acute emotional and behavioral reactions to stressors responders experienced, the lower was their job satisfaction. The test norms were developed and presented using the quartile scale, as long as the sample was representative. Therefore, the adapted Ukrainian-language version of the Stress Reaction Inventory for eye care workers showed evidence of internal consistency and construct validity. [ABSTRACT FROM AUTHOR]

Follow up from universal vision screening at four to five years has been shown to be low in England, potentially increasing the risk of vision disorders not being treated. This study explores vision specialists' views on the perceived barriers and facilitators encountered when engaging with parents and young children, and the strategies adopted to improve child/parent centred care. Fifteen semi-structured qualitative interviews were conducted with eye care professionals to explore perspectives on the challenges of treating children. Thematic analysis was performed to identify key barriers and the strategies eye care professionals adopt to enhance person-centred eye care when working with young children and their families. Two overarching themes were identified related to the professional-patient relationship. The first reflects the challenges which vision specialists experience when treating children, considering lack of eye health education and negative attitudes to diagnosis and treatment as major barriers. The second discusses the strategies adopted to tackle those barriers. Three strategies are proposed to enhance child-centred eye care: more eye health education, more personalised communication to enhance referral uptake and the development of better coordinated pathways of care between schools, communities and hospital services. [ABSTRACT FROM AUTHOR]

A wide range of stereotests are available to measure stereopsis. Because each test has its own advantages and disadvantages, opinions differ on which is the preferred test to use in clinical practice. We conducted surveys comparing the use of stereotests in the British Isles and in the United States and Canada. Two online surveys were developed following consultation with eye care professionals, one for each geographical area. Both surveys included two questions on the frequency of use of different stereotests, two questions on best practice stereotests, and two questions on the usefulness of stereotests. Researchers made distinctions between appointments with children below or above 6 years old for respondents from the British Isles and below or above 5 years old for respondents from the Unites Stated and Canada. The surveys were distributed through professional organisations. We found Frisby to be the most used stereotest on the British Isles for both age groups. In the US and Canada, Titmus and Randot stereotest are more frequently used. Respondents consider these tests as the best practice stereotests. Eye care professionals agree stereotests are useful in the diagnosis and treatment decision making and even more so in obtaining an accurate measure of stereoacuity, especially with older children. [ABSTRACT FROM AUTHOR]

India has done well in eye care delivery by recognizing visual impairment and blindness as a major medical challenge. Major contributions have come from ophthalmologists (mass cataract surgery in the early 1900s; major participation of non-government organizations), policy makers (National Program for Control of Blindness and Visual Impairment 1976; systematic development under the World Bank assisted India Cataract Project, 1995-2002), and the industry (manufacturing of affordable surgical instruments and medicines). Although the country could boast of higher cataract surgical coverage and near-total elimination of trachoma, there is increasing prevalence of diabetic retinopathy and undetected glaucoma. India is in the crossroad of adherence to old successful models of service delivery and adoption of new innovative methods of teaching and training, manpower development and skill-based training, relevant medical research and product development. In the absence of these new approaches, the initial gains in eye care could not be furthered in India. A new approach, that will combine the best of the "old" tradition of empathy and the "new" technology of analytics, is required to imagine the future of eye care in India. [ABSTRACT FROM AUTHOR]

Uveitis is defined as intraocular inflammation. It is an extraarticular manifestation of many forms of joint disease, which include spondyloarthritis, juvenile idiopathic arthritis, and Behçet's disease. Rheumatologists may be asked to consult on the ophthalmologic care of patients with uveitis in order to identify an associated systemic illness. Diagnoses such as spondyloarthritis, sarcoidosis, and interstitial nephritis with uveitis are frequently overlooked by referring ophthalmologists. Alternatively, rheumatologists may be asked to help manage the patient's immunosuppression, including biologic therapy, which can be required to treat a subset of patients with uveitis. This review is intended to provide rheumatologists with the necessary information to facilitate collaboration in the comanagement of patients with uveitis. [ABSTRACT FROM AUTHOR]