A Jonathan Jackson

Help needed in medication self-management for people with visual impairment: case-control study

BACKGROUNDnVisual impairment (VI) is rising in prevalence and contributing to increasing morbidity, particularly among older people. Understanding patients problems is fundamental to achieving optimal health outcomes but little is known about how VI impacts on self-management of medication.nnnAIMnTo compare issues relating to medication self-management between older people with and without VI.nnnDESIGN AND SETTINGnCase-control study with participants aged ≥65 years, prescribed at least two long-term oral medications daily, living within the community.nnnMETHODnThe study recruited 156 patients with VI (best corrected visual acuity [BCVA] 6/18 to 3/60) at low-vision clinics; community optometrists identified 158 controls (BCVA 6/9 or better). Researchers visited participants in their homes, administered two validated questionnaires to assess medication adherence (Morisky; Medication Adherence Report Scale [MARS]), and asked questions about medication self-management, beliefs, and support.nnnRESULTSnApproximately half of the participants in both groups reported perfect adherence on both questionnaires (52.5% Morisky; 43.3%, MARS). Despite using optical aids, few (3%) with VI could read medication information clearly; 24% had difficulty distinguishing different tablets. More people with VI (29%) than controls (13%) (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.6 to 5.0) needed help managing their medication, from friends (19% versus 10%) or pharmacists (10% versus 2.5%; OR = 4.4, 95% CI = 1.4 to 13.5); more received social service support (OR = 7.1; 95% CI = 3.9 to 12.9).nnnCONCLUSIONnCompared to their peers without VI, older people with VI are more than twice as likely to need help in managing medication. In clinical practice in primary care, patients needs for practical support in taking prescribed treatment must be recognised. Strategies for effective medication self-management should be explored.

Advancing low vision services: a plan for Australian optometry

Every optometrist in Australia has been trained to provide primary low vision services. However, many do not. Now is the time to change this. The Optometrists Association Australia Low Vision Working Group (OAA LVWG) presents a plan to advance low vision service provision by optometrists. The plan comprises four main priority areas for action: i) developing evidence-based policy; ii) supporting low vision education; iii) engaging with key stakeholders, and; iv) improving remuneration. It is the view of the OAA LVWG that no patient with low vision should be left without support and that all optometrists, together with all eye care practitioners and providers, have a central role in advancing low vision service provision in Australia.

Retinal Photography Screening Programs to Prevent Vision Loss from Diabetic Retinopathy in Rural and Urban Australia: A Review

ABSTRACT Purpose: This review assessed the effectiveness of diabetic retinopathy (DR) screening programs, using retinal photography in Australian urban and rural settings, and considered implications for public health strategy and policy. Methods: An electronic search of MEDLINE, PubMed, and Embase for studies published between 1 January 1996 and the 30 June 2013 was undertaken. Key search terms were “diabetic retinopathy,” “screening,” “retinal photography” and “Australia.” Results: Twelve peer-reviewed publications were identified. The 14 DR screening programs identified from the 12 publications were successfully undertaken in urban, rural and remote communities across Australia. Locations included a pathology collection center, and Indigenous primary health care and Aboriginal community controlled organizations. Each intervention using retinal photography was highly effective at increasing the number of people who underwent screening for DR. The review identified that prior to commencement of the screening programs a median of 48% (range 16–85%) of those screened had not undergone a retinal examination within the recommended time frame (every year for Indigenous people and every 2 years for non-Indigenous people in Australia). A median of 16% (range 0–45%) of study participants had evidence of DR. Conclusions: This review has shown there have been many pilot and demonstration projects in rural and urban Australia that confirm the effectiveness of retinal photography-based screening for DR.

The challenges of providing eye care for adults with intellectual disabilities.

This review is intended to raise awareness of the importance of providing high‐quality eye care for people with intellectual disabilities and the increasing need for this eye care to be community‐based. We describe the challenges to the provision of high‐quality community‐based eye care for people with intellectual disabilities and ideas, evidence and methods for overcoming them.This review is intended to raise awareness of the importance of providing high-quality eye care for people with intellectual disabilities and the increasing need for this eye care to be community-based. We describe the challenges to the provision of high-quality community-based eye care for people with intellectual disabilities and ideas, evidence and methods for overcoming them. n n n nThe prevalence of visual impairment in people with intellectual disabilities has been reported to be at least 40 per cent, rising to as high as 100 per cent in those with profound and severe disabilities. A progressive move toward deinstitutionalisation has shifted the provision of care for people with intellectual disabilities. Individuals can have the freedom to access health-care services of their choice. This has posed challenges to the health-care system, including how to deliver high-quality community-based eye care, creating a current significant unmet need for eye-care services. Undiagnosed refractive error and under-prescription of spectacles are major reasons for avoidable visual impairment among people with disabilities. There is an apparent reluctance of optometrists to engage in this work due to the perceived difficulties of working with people with intellectual and multiple disabilities. n n n nThere are challenges associated with diagnosis and management of ocular conditions in people with intellectual disabilities and the demand is clear. Small shifts in training, knowledge and awareness would place optometry well to meet the challenges of this specialised area of eye care.

Functional and perceived benefits of wearing coloured filters by patients with age-related macular degeneration

The aim was to investigate the visual effect of coloured filters compared to transmission‐matched neutral density filters, in patients with dry age‐related macular degeneration.

An update on the characteristics of patients attending the Kooyong Low Vision Clinic.

Since 1972, the Australian College of Optometry has worked in partnership with Vision Australia to provide multidisciplinary low‐vision care at the Kooyong Low Vision Clinic. In 1999, Wolffsohn and Cochrane reported on the demographic characteristics of patients attending Kooyong. Sixteen years on, the aim of this study is to review the demographics of the Kooyong patient cohort and prescribing patterns.

Breaking down barriers to eye care for Indigenous people: a new scheme for delivery of eye care in Victoria.

This report describes the implementation of and outcomes from a new spectacle subsidy scheme and de-centralised care options for Aboriginal and Torres Strait Islander peoples in Victoria, Australia. The Victorian Aboriginal Spectacle Subsidy Scheme (VASSS) commenced in 2010, as an additional subsidy to the long-established Victorian Eyecare Service (VES). The Victorian Aboriginal Spectacle Subsidy Scheme aimed to improve access to and uptake of affordable spectacles and eye examinations by Indigenous Victorians. The scheme is overseen by a committee convened by the Victorian Governments Department of Health and Human Services and includes eye-health stakeholders from the Aboriginal community and government, not-for-profit, university and Aboriginal communities. Key features of the Victorian Aboriginal Spectacle Subsidy Scheme include reduced and certain patient co-payments of

Evaluation of the Northern Ireland National Artificial Eye Service: A Regional Audit of Patient and Prosthetic Characteristics

10, expanded spectacle frame range, broadened eligibility and community participation in service design and implementation. We describe the services implemented by the Australian College of Optometry (ACO) in Victoria and their impact on access to eye-care services. In 2014, optometric services were available at 36 service sites across Victoria, including 21 Aboriginal Health Services (AHS) sites. Patient services have increased from 400 services per year in 2009, to 1,800 services provided in 2014. During the first three years of the Victorian Aboriginal Spectacle Subsidy Scheme program (2010 to 2013), 4,200 pairs of glasses (1,400 pairs per year) were provided. Further funding to 2016/17 will lift the number of glasses to be delivered to 6,600 pairs (1,650 per year). This compares to population projected needs of 2,400 pairs per year. Overcoming the barriers to using eye-care services by Indigenous people can be difficult and resource intensive; however the Victorian Aboriginal Spectacle Subsidy Scheme provides an example of positive outcomes achieved through carefully designed and targeted approaches that engender sector and stakeholder support. Sustained support for the Victorian Aboriginal Spectacle Subsidy Scheme at a level that meets population needs is an ongoing challenge.This report describes the implementation of and outcomes from a new spectacle subsidy scheme and de‐centralised care options for Aboriginal and Torres Strait Islander peoples in Victoria, Australia. The Victorian Aboriginal Spectacle Subsidy Scheme (VASSS) commenced in 2010, as an additional subsidy to the long‐established Victorian Eyecare Service (VES). The Victorian Aboriginal Spectacle Subsidy Scheme aimed to improve access to and uptake of affordable spectacles and eye examinations by Indigenous Victorians. The scheme is overseen by a committee convened by the Victorian Governments Department of Health and Human Services and includes eye‐health stakeholders from the Aboriginal community and government, not‐for‐profit, university and Aboriginal communities. Key features of the Victorian Aboriginal Spectacle Subsidy Scheme include reduced and certain patient co‐payments of

Profile of the Australian College of Optometry low vision clinic

10, expanded spectacle frame range, broadened eligibility and community participation in service design and implementation. We describe the services implemented by the Australian College of Optometry (ACO) in Victoria and their impact on access to eye‐care services. In 2014, optometric services were available at 36 service sites across Victoria, including 21 Aboriginal Health Services (AHS) sites. Patient services have increased from 400 services per year in 2009, to 1,800 services provided in 2014. During the first three years of the Victorian Aboriginal Spectacle Subsidy Scheme program (2010 to 2013), 4,200 pairs of glasses (1,400 pairs per year) were provided. Further funding to 2016/17 will lift the number of glasses to be delivered to 6,600 pairs (1,650 per year). This compares to population projected needs of 2,400 pairs per year. Overcoming the barriers to using eye‐care services by Indigenous people can be difficult and resource intensive; however the Victorian Aboriginal Spectacle Subsidy Scheme provides an example of positive outcomes achieved through carefully designed and targeted approaches that engender sector and stakeholder support. Sustained support for the Victorian Aboriginal Spectacle Subsidy Scheme at a level that meets population needs is an ongoing challenge.

Will optometry respond to the growing challenge of providing evidence-based low vision care?

ABSTRACT Purpose: The purpose of this study is to establish an up-to-date baseline of the profile of patients using the National Artificial Eye Service in Northern Ireland and to understand key areas of service provision, to contribute to patient and health-care provider education, and thus to improve patient outcomes for future researchers. Methods: A prospective audit of artificial eye wearers attending the Northern Ireland National Artificial Eye Service between May 18, 2015 and June 26, 2015 was conducted. Results: A total of 131 patients, who attended consecutively for appointments over the 6-week period, were included: males 68%; females 32%. The majority of eyes were lost secondary to trauma (54%). In recent decades, medical causes have now taken over as the primary referral cause for prosthetic eyes. Approximately, one-third of patients attending the service required further education on how to maintain the hygiene of their ocular prosthesis. Conclusion: Patients attending artificial eye services should be further educated about using lubricants to maintain the hygiene of their prosthesis. Primary care health professionals (General Medical Practitioners and Primary Care Optometrists) should be informed about artificial eye services and of how to contact the service for advice if required. Trauma remains the most common cause for referral; however, in recent decades more patients are attending secondary to a medical cause of eye loss. Health service providers should be aware of the changing profile of patients attending artificial eye services and of the medical and traumatic causes of eye loss.