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.
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@AbuAmare The need for glaucoma strengthening glaucoma management is a global problem.
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@AbdallahKunja Thanks for sharing these views and i could not agree more
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@ItiyafaNjinaka Tracking data allows for making adjustments and changes. For example an individual clinician often would not be able to appreciate the patterns of delays in referral, unless this data is regularly collected for the whole service. This is much needed across health systems.
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@CANICEDIM Please download the resource and if you have access to visual field report it may be useful to use them to test yourself on that.
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@AbdallahKunja Download it and compare it to visual fields that you have. It is complex but central to assessing progression of glaucoma
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@MARGARIDACHAGUNDA Thanks for sharing. Do you provide any counselling on how to prevent falls and trauma to these patients?
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@GiftyNkum @UCHENNAAHUMAREZE We cover counselling in some detail in week 3- so perhaps you can reflect on the actions you can take forward into practice.
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@JoshuaSarai We cover review intervals guidance in week 4
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Suggestion is that you download the tool and apply it in practice within your setting for yourself or to share with your teams
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@JoshuaSarai True it is difficult and do non-opthalmologist use Van hericks test in your setting?
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@SudiptaMohanty Always good to have the SSI perspective on community care and thank you for joining this course
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@VaridaHaarloo Thanks for joining and we hope to learn about glaucoma care in Suriname too
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@kibirigeronald Thanks for joining and if there are clinical opthalmic aspects that are unclear, please put them in the comments and one of educators or even your peers maybe able to address them.
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@SayedMansoorSediqi Thank you for joining the course and we certainly hope that this is a one stop learning resource for everyone. It also is a good way to share practices with peers from around the world
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@AbdallahMAMahmoud Thanks for joining and whilst we do not discuss glaucoma in children in this course, we hope that you gain from the public health approaches for adult glaucoma
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@HanaMohamed We share your challenges and the issue of early detection and rate of progression are concerns we discuss within the course.
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@CANICEDIM You are absolutely right about rate of progression. This is what every patients wants to know and this is the question that eye health providers struggle to answer
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@UCHENNAAHUMAREZE Which country? Are you able to share?
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@CANICEDIM @OyekunleIdris The question raised on best treatment is as Oyekunle explained - it has to be individualised ( which could be medication/ surgery/ laser) and balanced with risk of vision loss and socioeconomic factors such as cost and follow up. Unlike cataract there is no single answer!
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@PARVEENREWRI Nicely summarised, and the point that you raise about access to comprehensive eye examination. Training personnel to diagnose the condition is important and it is not a simple condition to diagnose in the early stages. Furthermore the management challenge, especially for open angle glaucoma adds to the complexity.
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@IbrahimLeo 10 -21 mmHg but we discuss this in some detail in step 2.5 on how this was established and what does this mean when trying to manage glaucoma
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Dr Daksha Patel ( Lead Educator) made a comment
As you complete this first week, I hope you take a moment with me to acknowledge the loss of HM Queen Elizabeth 11, and but more specifically extend a gratitude. This course ( and the others in eye health from LSHTM) was only developed because of the funding received from the Queen Elizabeth Diamond Jubilee Trust. Her reach and wisdom penetrated into society...
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@CANICEDIM As you go through the week - do not hesitate to add questions to the webinar comment in step 2.16
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@GeorgeNgwee Interesting that you include Illiteracy as a key factor.
Do you mean at a patient specific level or at a societal level? -
Point raised by Melese Kitu
Mis-diagnosis is a challenge within the referral pathway. Typically, as glaucoma diagnosis is based on a combination of functional and structural parameters and measurements. What practical measures can/ are being taken to address mis-diagnosis? -
@MeleseKitu Interesting point on mis-diagnosis and not an isolated problem. It is also something that can be rectified. We can raise this in the webinar discussion too
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@BigirimanaDeus @GeorgeNgwee We look at supporting compliance in week 3 and many actions can be taken without requiring vast sums of money to finance change. Trained Glaucoma educators is worth considering as it frees up ophthalmic personnel too.
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@GeorgeNgwee Hi George, can explain this further. Is it stigma due to vision loss ? or stigma of dependency that Glaucoma causes?
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@WanipaulinologgaleLegge Glaucoma requires a multidisciplinary team and it is good to have the pharmacy perspective
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@MARGARIDACHAGUNDA Good to have you join us as please do share some of the excellent work you are undertaking
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@DieudonnéOdimbaLUMBI Thanks for joining and it will be good to know how services are supported by NGO sector for Glaucoma
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Thanks for the engagement on this step and if you have additional questions for our expert panel discussion please post them in chat in step 2.16 ( in week 2)
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@GeorgeNgwee True but complex to implement and sustain. It has to be supported with a robust referral scheme
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@JoshuaSarai In week 2 we discuss the complexity of assessment and diagnosis. Your suggestions 3 and 4 are useful and can be centralised with a trained team in place. However, the question of false positives in subjective tests always remains a concern. We do need an objective easy test but none is available as yet. Do join the webinar with teh experts and...
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@MeleseKitu Excellent suggestions and is there a local term for glaucoma? how would you describe it for health education? These have been some of the challenges of glaucoma.
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@RosemaryAsufi Health promotion activities often use this approach. The question that always arises is on ot effectiveness and how long people recall it.
In step 1.1 we shared the example of work done in Ealing in london. have a read of the paper which is linked in that step.
Baker H, Murdoch IE Can a public health intervention improve awareness and... -
@TabongaNaluondeZambia Raising awareness amongst health providers in the first instance is an important idea. Randomly ask your work colleagues ( out side of the eye department) on what they know about glaucoma? - would love to know what you find!
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@KwabenaJr Interesting idea , especially taking screening to the work place. The challenge for glaucoma screening is what will you look for? Raised IOP, Optic nerve assessment ( keep this in mind when you engage with week 2 on how to assess for glaucoma)
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@MeleseKitu This link is a video that explains what the WHO promotes as People centred pathways within a health system https://youtu.be/pj-AvTOdk2Q
Glaucoma is a chronic lifelong condition and management has to be in partnership with the patient. Throughout this course, especially in week 3 and 4 we look at factors that influence the health services and how... -
Question from :
MARGARIDA CHAGUNDA
I see some patients with psedoexfoliation and imature cataract without elevated IOP but ON cannot be seen due to catarat. What will you advise. Remove cataract early? I used to see my cataract case those who doesnot need surgery every 6 months. No gonio in my setting
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@MARGARIDACHAGUNDA I suggest we put it to the panel discussion webinar and see how this situation is tackled clinically.
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@MousindhaArjunan Thanks for joining and in this course we have looked at a range of examples from a public health perspective
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@AshrandraKumar Thanks for joining and we hope that the range of examples we provide are useful in expanding management options for glaucoma
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@SvenAretz Thanks for joining Sven and extending to the amazing work done by CBM
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@THOMASMBEZI Thanks for sharing and the challenge of lack of personnel is ever so important, and Glaucoma requires a multidisciplinary approach. We discuss this is week 3
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@JosephOni It certainly is a changing field and please share your experiences and local research too
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Thanks for sharing and having local names would help communicate with patients better.
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@JoyOuma Health workforce is a challenge. Can people from communities be trained as local champions?
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@YashSrivastava Why is access to water and health services, not prioritised for this marginalised group?
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@SaraHaboosh Thank you for your comment. We went with the WHO recommended values as this is a course for a global audience. I agree with you that a conversion table will be useful and we will insert one in.
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The complexity of type 2 diabetes management of blood sugars are the ongoing challenges in practice as so much of its progression is linked with life style and associate co-morbidities.
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Thanks Martin. It would be interesting to know more about your experiences. In the final week of the course we do look at low vision services and I am certain you will be able add to these from your experiences. Most importantly, how does referral work and the challenges of long term support.
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International Agency for the prevention of Blindness. This body work with WHO and collaboration with NGO sector @MundiaPule
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@emekaIkediugwu Thanks for highlighting this important point. Can you share your experiences and ideas on how this is managed locally?
