Alsusa, M., Ahmad, S., Smith, Z. et al. High patient acceptance of immediately sequential bilateral cataract surgery (ISBCS) as part of a one-stop see-and-treat pathway within an innovative NHS cataract unit. Eye (2025). https://doi.org/10.1038/s41433-024-03567-3

Abstract

Background

Constituting ~0.5% of all NHS cataract operations, national provision of immediately sequential bilateral cataract surgery (ISBCS) is limited. Combining offering ISBCS within a novel one-stop see-and-treat (S&T) cataract pathway would offer patients the opportunity for two cataract operations in a single hospital visit. Patient acceptance of ISBCS amongst urban populations has been investigated. However, little is understood about ISBCS acceptance rurally.

Methods

Retrospective observational study at the Nightingale Hospital, Exeter investigating patient acceptance of ISBCS within S&T; following the implementation of a S&T cataract pathway entailing a pre-operative patient-clinician telephone consultation and subsequently scheduled single date of assessment and surgery. Patient acceptance and factors potentially influencing decisions were investigated.

Results

200 patient telephone consultations between 22nd August 2023 and 9th January 2024 were evaluated. 198 (99%) patients referred were suitable for S&T cataract surgery, of whom 109 (54.5%) were deemed eligible for offering ISBCS S&T cataract surgery. Of the eligible participants, 78 (71.56%) favoured ISBCS. No significant differences in age, sex, distance from hospital or refractive data were identified between ISBCS accepting and declining participants.

Conclusions

Our results illustrate a high patient acceptance rate (71.56%) of ISBCS within our population in contrast with published national rates. Offering ISBCS within a S&T model would allow patients to benefit from having both cataracts assessed and treated within a single hospital visit.

VETERANS.HOUSE.GOV
H.R. 8371: The Senator Elizabeth Dole 21st Century
Veterans Healthcare and Benefits Improvement Act
Courtesy of the House Committee on Veterans’ Affairs Majority Staff

BACKGROUND:
The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act would ensure
that the men and women who have served have access to the modern, good care and services they have
earned. This bill includes a number of bipartisan proposals that would enhance and reform the delivery of
services at the Department of Veterans Affairs (VA) by ultimately putting all veterans, their families, and
their survivors – not bureaucracy – first.

HIGHLIGHTS:

• Includes the House passed VET-TEC Authorization Act (H.R. 1669) which would fully fund the VA VETTEC educational assistance program to expand high tech career opportunities for veterans and transitioning servicemembers. This program has an 84% graduation rate and an average starting salary
  of over $66,000.
• Includes the House passed Elizabeth Dole Home Care Act (H.R. 542) which would expand access to
  Home- and Community-Based Services at every VA medical center, which would allow severely ill and
  aging veterans the dignity of receiving their care at home rather than in institutions.
• Includes the Veterans Care Improvement Act (H.R. 3520) which would improve the timeliness and
  quality of care and services delivered to veterans under community care by improving the rate at which
  community care providers return medical records to the VA. This would streamline administrative
  processes to ensure veterans receive timely and high-quality care. It would also ensure that VA provides
  veterans with more information and transparency regarding their eligibility for community care.
• Includes the House passed HOME Act (H.R. 3848) which would raise the Grant and Per-Diem rate for
  veteran homelessness providers who partner with VA and provide rideshares to veterans for medical,
  housing, and employment appointments and ensure veterans can get the resources they need to be
  lifted out of homelessness.
• Includes the Veterans Education Assistance and Improvement Act (H.R. 3874) which would cut through
  red tape for the GI Bill and allow student veterans to use their benefits that best meet their needs.
• Includes the Servicemember Employment Protection Act (H.R. 3943) which would modernize USERRA
  protections and increase accountability at the Department of Labor so that deployed National Guard
  and Reservists have the proper employment protections in place back when they return home.
• Includes the House passed COPE Act (H.R. 3581) which would recognize the mental strain often
  experienced by caregivers of certain veterans by providing community mental health grants to help
  alleviate caregiver’s concerns about stigma.
• Includes Gerald’s Law Act (H.R. 234), which would allow survivors of certain veterans who choose to die
  at home or while in receipt of VA hospice care, to receive a certain burial and funeral allowance.
  Currently, this allowance is provided to survivors of those veterans who passed away at a VA facility.
• Includes the Commitment to Veteran Support and Outreach Act (H.R. 984), which would authorize VA to
  provide grants to state and Indian Tribes to support county Veteran Service Organizations (VSOs) and
  tribal VSOs to provide improved outreach and assistance to underserved, rural, and Native American
  veterans regarding VA benefits.
• Includes the Modernization of VA Disability Benefits Questionnaires Act (H.R. 4461), which would
  update IT systems and processes to ensure that disability examination reports completed by contracted
  disability examiners are standardized and machine-readable, which would improve efficiency in VA’s
  processing of disability compensation claims for veterans.
• Includes the VA Office of Inspector General Training Act (H.R. 2733) which would require all new VA
  employees to receive training on reporting wrongdoing and cooperating with the VA Inspector General.
• Includes the VA Medical Center Security Report Act of 2023 (H.R. 3504) which would require VA to
  conduct a survey of each of their facilities on security weaknesses and the status of their police force as
  well as provide a report on the results of these surveys to Congress.

• *NOTE: Each of these bills has gone through some form of regular order and the entire package is fully
  offset and would not add to the deficit.
  
• THE MESSAGE:
• The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act delivers on
  the promise House Republicans have made to create a modern, efficient VA for today and tomorrow’s
  veteran community.
• The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act expands
  economic opportunity for veterans, gives veterans a choice in where they choose to live out their
  sunset years or receive healthcare, modernizes the disability benefits claims process, and holds VA
  accountable to the taxpayers and veterans they serve.
• The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act effectively
  addresses rising crime in major cities by forcing VA to report to Congress on security weaknesses to
  ensure our nation’s heroes are safe every time they visit VA.

Jessica Oberoi, 13, can’t exactly remember when her eyesight started getting blurry. All she knows is that she had to squint to see the whiteboard at school.

It wasn’t until last fall when her eighth grade class in Bloomington, Indiana, got vision screenings that Jessica’s extreme nearsightedness and amblyopia, or lazy eye, were discovered. She’s been going through intense treatment since then, and her optometrist, Dr. Katie Connolly, said Jessica has made great improvements — but her lazy eye, which causes depth perception problems, may never go away. The chances of it being completely corrected would have been much higher if her condition had been caught earlier, said Connolly, chief of pediatric and binocular vision services at Indiana University’s School of Optometry. Jessica is one of the countless students falling through the cracks of the nation’s fractured efforts to catch and treat vision problems among children.

The Centers for Disease Control and Prevention estimates that more than 600,000 children and teens are blind or have a vision disorder. A recent opinion article published on JAMA Network notes that a large number of these children could be helped simply with glasses, but because of high costs and lack of insurance coverage, many are not getting that help. Yet the National Survey of Children’s Health, funded by the federal Health Resources and Services Administration, found that in 2016-17 a quarter of children were not regularly screened for vision problems. And a large majority of those vision impairments could be treated or cured if caught early, Connolly said. “Screenings are important for kids because kids don’t realize what’s abnormal,” said Connolly. “They don’t know what their peers around them — or even their parents — are seeing to realize their experience is different. ”Eye exams for children are required under federal law to be covered by most private health plans and Medicaid. Vision screenings are mandated for school-age children in 40 states and the District of Columbia, and 26 states require them for preschoolers, according to the National Center for Children’s Vision and Eye Health at the nonprofit advocacy organization Prevent Blindness.

Still, many children who are struggling to see clearly are being overlooked. The pandemic has only exacerbated the issue since classes moved online, and for many students in-school vision screenings are the only time they get their eyes checked. Even when campuses reopened, school nurses were so swamped with covid testing that general screenings had to be put to the side, said Kate King, president-elect of the National Association of School Nurses. “The only kids who were getting their vision checked were the ones who were complaining about not being able to see,” King said. The problem is most prevalent among preschoolers, according to the national center. It points out that the federal survey of children found that 61% of children 5 and younger had never had their vision tested. Kindergarten, Connolly said, is a critical time to check a child’s vision because not only are they old enough to cooperate with eye exams, but it’s when vision problems are more likely to be identifiable.

The CDC survey also found that 67% of children with private health insurance had their vision screened, compared with 43% of those who were uninsured. Optometrists, physicians, and school nurses are concerned not only about children’s visual acuity, but also their ability to learn and overall quality of life. Both are strongly linked to vision. “There seems to be an assumption that maybe if kids can’t see, they’ll just tell somebody — that the problems will sort of come forward on their own and that they don’t need to be found,” said Kelly Hardy, senior managing director of health and research for a California-based child advocacy group, Children Now. But that’s not the case most of the time because children aren’t the best advocates for their own vision problems. And when left untreated, those problems can worsen or lead to other serious and permanent conditions. “It feels like a pretty low-tech, pretty easy intervention to make sure that kids have a chance to succeed,” Hardy said. “And yet there’s kids going around that haven’t had their vision screenings or haven’t had an eye exam, and that seems unacceptable, especially when there’s so many other things that are harder to solve.

”Connolly’s visit to Jessica’s school last year marked the first time Jessica had her vision checked. Her brother, Tanul Oberoi, 7, tagged along on her follow-up visit to Connolly’s clinic and had his vision screened for the first time. His serious astigmatism was identified, and he now wears glasses. Since his condition was caught early, there is a good chance his eyesight with glasses will improve and that over time his prescription will be reduced. “It was surprising to me that they have trouble seeing because they didn’t say anything to me before,” said Sonia Oberoi, Jessica and Tanul’s mom. “They usually tell me when they have a problem, and I watch them when they read something. I didn’t know. ”Getting vision screenings is only part of the battle, Connolly said. Purchasing glasses is a stretch for many families lacking coverage since the average cost without insurance is $351 a pair. The JAMA article points out that in developing countries, sturdy glasses made from flexible steel wire and plastic lenses can be manufactured for about $1 a pair but that option is not generally available in the U.S. Since Jessica and Tanul are not insured, their mom said the family would have to pick up the cost of their glasses. Connolly’s clinic worked with several programs to completely cover their treatment and glasses, plus contacts for Jessica.

The issue goes beyond poor eyesight and overlooked vision problems. There is a strong link between children’s vision and their development — especially the way they learn. Struggling to see clearly can be the beginning of many downstream problems for children, such as low grades, misdiagnosed attention-deficit disorders, or lack of self-confidence. In a 2020 study by researchers in Spain published by the International Journal of Environmental Research and Public Health, students who had “bad academic performance” were twice as likely as those with “good academic performance” to admit that they can’t see the blackboard properly. Additionally, those who performed poorer academically were also twice as likely to get tired or suffer headaches while reading, according to the study. “Kids do better in school and they do better socially if they’re not going around with uncorrected vision problems,” said Hardy. “And so it feels like a no-brainer that we need to make sure that we’re doing better to make sure that kids are getting the care they need.

”King, who works at a middle school in Columbus, Ohio, said that even before the pandemic students’ vision problems were being overlooked. Of all the optometrist referrals she sends home, she said just around 15% of children are taken to an eye doctor without her having to reach out to parents again. “An overwhelming majority actually don’t follow up and don’t get a comprehensive exam,” King said. Another issue is that Medicaid and private insurance usually cover one pair of glasses every year or two, which King said is not ideal for growing and clumsy kids. “School nurses are experts at glasses repair,” King said, while chuckling. “Often we need to put in a new nosepiece or put in a new screw, or get them fixed because a classmate sat on them.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Abstract

SIGNIFICANCE 

Combining 0.01% atropine with soft multifocal contact lenses (SMCLs) failed to demonstrate better myopia control than SMCLs alone.

PURPOSE 

The Bifocal & Atropine in Myopia (BAM) Study investigated whether combining 0.01% atropine and SMCLs with +2.50-D add power leads to greater slowing of myopia progression and axial elongation than SMCLs alone.

METHODS 

Participants of the BAM Study wore SMCLs with +2.50-D add power daily and administered 0.01% atropine eye drops nightly (n = 46). The BAM subjects (bifocal-atropine) were age-matched to 46 participants in the Bifocal Lenses in Nearsighted Kids Study who wore SMCLs with +2.50-D add power (bifocal) and 46 Bifocal Lenses in Nearsighted Kids participants who wore single-vision contact lenses (single vision). The primary outcome was the 3-year change in spherical equivalent refractive error determined by cycloplegic autorefraction, and the 3-year change in axial elongation was also evaluated.

RESULTS 

Of the total 138 subjects, the mean ± standard deviation age was 10.1 ± 1.2 years, and the mean ± standard deviation spherical equivalent was −2.28 ± 0.89 D. The 3-year adjusted mean myopia progression was −0.52 D for bifocal-atropine, −0.55 D for bifocal, and −1.09 D for single vision. The difference in myopia progression was 0.03 D (95% confidence interval [CI], −0.14 to 0.21 D) for bifocal-atropine versus bifocal and 0.57 D (95% CI, 0.38 to 0.77 D) for bifocal-atropine versus single vision. The 3-year adjusted axial elongation was 0.31 mm for bifocal-atropine, 0.39 mm for bifocal, and 0.68 mm for single vision. The difference in axial elongation was −0.08 mm (95% CI, −0.16 to 0.002 mm) for bifocal-atropine versus bifocal and −0.37 mm (95% CI, −0.46 to −0.28 mm) for bifocal-atropine versus single vision.

CONCLUSIONS 

Adding 0.01% atropine to SMCLs with +2.50-D add power failed to demonstrate better myopia control than SMCLs alone.

Jones, Jenny Huang PhD, OD, MPH^1∗; Mutti, Donald O. OD, PhD, FAAO¹; Jones-Jordan, Lisa A. PhD, FAAO¹; Walline, Jeffrey J. OD, PhD, FAAO¹

Optometry and Vision Science: May 2022 – Volume 99 – Issue 5 – p 434-442doi: 10.1097/OPX.0000000000001884