Dr Daksha Patel ( Lead Educator)
Associate Professor in International Eye Health. Ophthalmologist and Educator, focusing on research and education to eliminate avoidable blindness. Academic lead for the Open education for Eye Health
Location London School of Hygiene and Tropical Medicine
Activity
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@LydiaLevey we do look at that across the course
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@DoaaRamlawi That is a major challenge. Is this a priority to raise with the eye health systems for your setting to provide training e.g through fellowships
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@JosephOni The challenge for the health services is that they have a large glaucoma patient list on follow up along with assessment of new cases. Medical management needs the regular follow- but the question is: can it be done well closer to patients home? Can we raise the awareness in our patients about regular eye checks?
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@TashannMayers We have provided a transcript and power point for you to download. Do you need an additional description? Please email your specific needs to Romulo.fabunan@lshtm.ac.uk and we can try and help with accessibility.
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Yes, it can. However, it is important to provide adequate training and within the hospital setting.
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The use of AI is Ophthalmology is advancing at a rapid pace. Here is a paper that highlights its use, with considerably high sensitivity when tested on data. Further validation is required but this is certainly an exciting start.
https://www.thelancet.com/journals/landig/article/PIIS2589-7500(23)00050-X/fulltext#seccestitle160 -
Dr Daksha Patel ( Lead Educator) made a comment
As you go through this week, you may be asking yourself about the growing role of AI in the diagnosis and management. It is clearly an area of growth and we look forward to the application of AI in health. I have included a video link here on this topic on the use of AI in Diabetic retinopathy but also its growing potential in health....
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Dr Daksha Patel ( Lead Educator) made a comment
Dear All, As this is an "on demand" course, participants will log in to do the course at various times and also flexibly. This almost provides a personalised approach to learn at you own pace, select the key topics and engage repeatedly. If you wish to ask a specific question please put @name of person e.g @Daksha Patel and this alerts them to look at the...
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Dr Daksha Patel ( Lead Educator) made a comment
Thank you all for taking this course and we would love to know how you are able to apply your learning too
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@PARVEENREWRI Look forward to your paper
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@PARVEENREWRI Important point along with ongoing training support / supervision
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@FatoumataSillah Did this get sorted for you?
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@AbuAmare Absolutely and always keeping in mind the patient needs
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@EnochOLAGUNJU Individualised therapy plans are important and also a good use of time for eye health personnel. This has been used in the way forward project in the UK that was described in week 3 - step 3.10
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Dr Daksha Patel ( Lead Educator) made a comment
As you complete the course, there may be key areas in glaucoma management that would be useful to expand on with experts. Leave us your thoughts/ topics/ suggestions and we will continue to update the course.
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@VaridaHaarloo The EAGLE study had participants >50yrs. The clear lens extraction is not without its challenges but provides good results. I think this paper may provide some more insight into what the present views are: https://www.touchophthalmology.com/cataract-surgery/journal-articles/clear-lens-extraction-in-primary-angle-closure-disease-pros-and-cons/
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@AbuAmare What are the outcomes that you have experienced?
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@SelinaW Clear lens removal would mean replacing it with an IOL. However, to remove clear lens, it is important to have a skilled surgeon and team. It is not used in acute emergency management!
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@AbdallahKunja Excellent and hope you have many opportunities to keep advancing awareness creation.
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@FlorenceNkwogu When you introduce a change, allow yourself an opportunity to measure its impact, appraise if it is effective and if not modify. The challenge of glaucoma is that we are all learning all the time
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@MeleseKitu I think you should apply yourself to research too
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@MeleseKitu What are the research challenges in your local setting? Can that be part of your glaucoma programme?
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@AbuAmare Quality is certainly essential but also there remains a huge need to undertake context specific research which may provide evidence that is applicable locally.
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@ChiamakaEstherAkwuruoha @ZaherSultani @GertrudeMwansa Across many countries in Africa, there is a growing recognition that Diabetic services need to be part of the general health budget. We as eye health personnel need to advocate for diabetic eye care services and an allocation of some of that budget especially for infrastructure.
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@NishaneeRampersad Sometimes you need to start small - with people who want to be involved. Trying to get all stakeholders can become a challenge and hierarchical
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@NarendraKumar It is the basis of a process and has been applied across many eye health programme at a hospital, district and national level.
Often this starts with sitting down with your colleagues and proposing a situation analysis and then follow the steps. Even small changes can build towards a change. e.g. assess what is being done to raise glaucoma...
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@VaridaHaarloo Sorry to hear that, but perhaps it is better to take small steps than no steps at all.
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@BigirimanaDeus Completely agree with you but we need to start somewhere.
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Suggestion: Download the MI tool and practice it with your teams. It is not easy to undertake it and the practitioner has to be a good listener and not jump to providing answers.
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@VaridaHaarloo That is where a change is required. Access to good information about glaucoma can make patients into good partners for management of their disease. Can counselling be provided by trained non-medical personnel?
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@AbdallahKunja Doctors often are not a good resource to use in counselling services. Many places train non-medical persons to undertake this activity. Is that a possibility in your setting?
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@AminaHassan-Wali It would a good place to start to understand their challenges.
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@IbrahimWambaiUsman It certainly is not as satisfying a cataract programme which NGO s often undertake but also glaucoma was not a priority for action for a very long time. Infact, it was not part of Vision 2020 or the global action plan. So we are on a new trajectory with growing evidence for glaucoma.
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@FatimaKyari @AbuAmare The toolkit would provide the process to follow. But as this example shows the challenge for managing the service provision for glaucoma needs constant evaluation.
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@IbrahimWambaiUsman What do you think about stratification of patients and is that viable in your setting?
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@AbdallahKunja Whats the view on virtual clinics?
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@NarendraKumar @FatimaKyari Would optometrists work at the primary level and in rural community settings? Or are optometrists better placed higher within the pyramid.
You do raise an important point of discussion - which is acceptance of competency training, instead of professional cadre specifications! -
@MARGARIDACHAGUNDA I am surprised that Schiotz is still in use! it requires regular calibration. Is this also available? Can the eye health services prioritise applanation tonometry?
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@AbdallahKunja Once read what happens? Is there a working group that takes it forward or is it left as passive information?
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@VaridaHaarloo As a thought, Can the toolkit be adapted for your setting?
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@EnochOLAGUNJU It does need capacity but also it has to start with building a consensus amongst practitioners. Is that a possibility in your setting?
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@MARGARIDACHAGUNDA That is encouraging progress
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@NishaneeRampersad Nicely summarised.
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@VaridaHaarloo A multi-disciplinary team approach is essential.
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@FatimaKyari @BigirimanaDeus Thanks for sharing this experience. Hearing about glaucoma from a patients perspective would probably have a greater impact than someone in a white coat. If this health promotion on the national TV brings more people forward for an eye examination - will your services cope? what changes may be required?
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@NarendraKumar You raise some important points and if we are to have patient centered services then the number of appointments , costs and availability of services have to be considered. Fatima Kyari, considers it important to look at the whole pathway of care provision.
