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Recovering orthoptic and children's ophthalmology services from the effects of coronavirus is the next big challenge for our teams in @UHSFT . @FollowBIOS . @RDsouthampton
THREAD https://twitter.com/FollowBIOS/status/1256213401564590081
THREAD https://twitter.com/FollowBIOS/status/1256213401564590081
Since the start of social distancing measures in March, almost 5,000 "routine" appointments have been cancelled in Southampton alone. Patients with common but manageable conditions such as lazy eye (amblyopia) are likely affected the most
With schools closed, screening for children age 4 to 5 years with amblyopia has stopped - when schools reopen, departments can expect a glut of new referrals as nurse-screeners catch up
We cannot bring high volumes of patients into our clinics for "routine" appointments. So how can we address the problem of thousands of patients missing access to treatments?
A lot of management / treatment decisions in orthoptics are based on visual acuity measurement alone.
Lots of smartphone/tablet-based technology is available to test children's visual acuity without the need for special equipment / training
Lots of smartphone/tablet-based technology is available to test children's visual acuity without the need for special equipment / training
Why don't we tell parents to start using these apps straight away? - well, it's a bit more complicated than that
Many apps have been "validated", which usually means that a group of children used the app, were supervised by someone in the know and then the result was reasonably close to the professional, standard-of-care measure
Validation is different to clinical application: we need to know if parents/children will/are able to use it, that it is safe to use to make clinical decisions and that we know about unintended consequences
Unintended consequences?
Yes, a new intervention - in this case measuring children's VA at home - always has unintended consequences. For example, an incorrect result could raise parent's anxiety, falsely thinking their child's eyes are poor when they aren't
Yes, a new intervention - in this case measuring children's VA at home - always has unintended consequences. For example, an incorrect result could raise parent's anxiety, falsely thinking their child's eyes are poor when they aren't
A worse example is the other way round - false assurance that VA is OK when it isn't:
"we stopped the eye drop because we thought the VA was better"
"we stopped the eye drop because we thought the VA was better"
We need to know about these risks before we introduce it into clinical practice:
1. How accurate are the tests when done at home?
2. Can / will parents and children use it at home, what do they require from us to facilitate it?
3. What are the unintended consequences and risks?
1. How accurate are the tests when done at home?
2. Can / will parents and children use it at home, what do they require from us to facilitate it?
3. What are the unintended consequences and risks?
We open the CHildren's Eye Examination and Testing At Home (CHEETAH) Study soon to start learning.
Primary goal to help the thousands of amblyopia patients that are missing out on treatment during coronavirus
Primary goal to help the thousands of amblyopia patients that are missing out on treatment during coronavirus
