Community ophthalmology: an overview Community ophthalmology, also known as publichealth ophthalmology or preventive ophthalmology, has been attracting attention in the ophthalmological world. This delivery of eye care involves preventive, curative, promotive, and rehabilitative activities, making it a holistic approach (Figure 1).1 With clinical ophthalmology at its core, it incorporates basic, clinical, and public-health sciences in its dimension. It highlights the realignment from individualized care to community-based eye-care services (Table 1).1 Community ophthalmology is much more than ophthalmic practice in the hospital or clinic. It is foreseen as a health-management approach in preventing eye diseases, lowering eye morbidity rates, and promoting eye health through active community participation at the ground level. Comprehensive eyecare service must start where people live and work, and such is the thrust of community ophthalmology. Prevention and promotion should begin among the people. Thus, public eye health is evolving into one of the most challenging areas in eye care.

Objective: This study determined the capacity to treat retinoblastoma (RB) in the Philippines. Method: This was a cross-sectional study which included all Department of Health (DOH) hospitals and all government and private tertiary hospitals in the Philippines. An online modified questionnaire taken from the St. Jude Children’s Research Hospital study on RB assessment was emailed to 143 hospitals in all 17 regions. Primary outcome measures were human resources capacity, treatment capacity and education and network capacity. Availability, frequency and confidence of use were assessed for treatment capacity. An asset-based tier classification of hospitals was created based on the human resources capacity and treatment capacity. Results: This assessment survey had a 49% response rate. There were 3 regions that had zero correspondence. A general ophthalmologist, a subspecialized ophthalmologist, and a general pathologist were the most available physicians in the management of RB. Almost all respondents had the necessary diagnostic technology in their hospitals, but frequency and confidence of use were low. A quarter of the respondents (23%) used a standardized treatment protocol, while only 26% had established a referral network in their area. Tier classification was able to differentiate capacities for particular resources only. Only 23% of the participating hospitals have the capacity to treat RB through its trained human resources, available diagnostic and treatment technology, and education and network programs. Distribution of hospitals identified as tier I, II and III were 18%, 8%, and 41%, respectively. Conclusion Capacity to treat RB in the Philippines is evident only in a few hospitals, majority of which are located in the National Capital Region. However, tier 3 hospitals were identified in 10 other regions, making accessibility to RB care possible to patients in the provinces. Although human resource and technology are made available, utilization of these resources is low in many hospitals for the management of RB. Clinical practice guidelines for RB is still lacking. Connecting the different tiers in each region as a form of referral network can improve capacity and management of RB.
Retinoblastoma ; Therapeutics ; Surveys and Questionnaires

This document offers guidance to help the ophthalmologist plan for the safe resumption of elective surgical care. There are 4 sections: (I) COVID-19 Awareness, (II) Preparedness, (III) Patient Issues, and (IV) Delivery of Safe and High-Quality Care. Each section contains key issues to be addressed before elective surgery may be safely reinstituted. Understanding the capabilities of health facilities (e.g., testing, operating rooms) as well as the potential limitations in manpower and supplies will remain important, while keeping an eye out on subsequent waves of COVID-19.
COVID-19

With the resumption of elective surgeries during this COVID-19 pandemic, surgeons and facilities should implement infection prevention and control measures to ensure the safety of patients and health care workers. This advisory highlights the key principles, risk stratification considerations, and recommended approach regarding Covid-19 testing prior to elective ophthalmic surgeries.
COVID-19

OBJECTIVE: The aim of the study was to determine the prevalence of diabetic patients seeking an ophthalmic evaluation for diabetic retinopathy. Specific objectives were to describe the prevalence and risk factors for diabetic retinopathy (DR) in a group of diabetic patients referred for retinal evaluation from different internists in Laguna by screening using digital retinal photography.

METHODS: The study was a hospital-based mixed method study involving two portions: quantitative (cross-sectional) and qualitative. The cross-sectional portion involved patients diagnosed with type 2 diabetes by internists from San Pablo Colleges Medical Center referred for retinal evaluation using a non-mydriatic retinal camera. Retinal photographs were categorised for the presence and severity of diabetic retinopathy according to the international clinical DR severity scales recommended by the Global Diabetic Retinopathy Project Group. The qualitative portion involved a focus group discussion among diabetic patients and a short key informant interview with the referring internists.

RESULTS: Sixty-seven (67) diabetic patients were evaluated for diabetic retinopathy (DR) using digital retinal photography. The overall prevalence of any DR was 26% (n=18): 55% mild NDPR, 33% moderate NDPR, 6% severe NPDR and 6% PDR. Diabetic macular edema (DME) was present in 22% of patients with any form of DR. The focus group discussion reported the following reasons for consulting an ophthalmologist: presence of blurring of vision, availability of budget, knowledge of the need for ophthalmic evaluation, and order for evaluation by the internist. Interviews among the referring internists revealed three primary reasons for referring: history of visual disturbances, uncontrolled diabetes and finances of the patient.

CONCLUSION: This study presented a lower prevalence rate of diabetic retinopathy among patients who underwent digital retinal photography compared to that of other studies published in the Philippines. Nevertheless, it is important to continue patient education with regards to diabetic complications in the eye, and improve the referral system among medical practitioners.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Diabetic Retinopathy ; Diabetes Mellitus, Type 2 ; Macular Edema ; Prevalence ; Ophthalmologists ; Retina

Proper maternal nutrition evidently results in good pregnancy outcomes both for the mother and born infant. However, the process leading to good nutrition during pregnancy remains a challenge most especially during public health emergencies, such as the COVID-19 pandemic, which brought limitations on access to a variety of foods as well as nutrition services. Thus, nutrition education through the provision of contextualized information, education and communication (IEC) materials was explored as an alternative delivery strategy. The delivery strategy aims to increase the number of pregnant women in Barangay Palanan, Makati City, Philippines who have adequate nutrition knowledge through IEC materials-based nutrition education that is contextualized during public health emergencies. As an outcome, the delivery strategy intends to increase the number of pregnant women who have normal nutritional status as determined by weight per month of pregnancy. Results in determining the adequacy of nutrition knowledge through pre- and post-testing show that there is a 10% increase in the passing rate from 59% at baseline to 69% at endline. From the number of pregnant women who have taken the post-test, a remarkable 52% have either post-test scores that are maintained or improved. Meanwhile, for pregnant women who have normal nutritional status, an increase of 5% was seen given by 46% at baseline to 51% at endline. Ultimately, IEC materials-based nutrition education may serve as a supplementary approach in the continuous provision of nutrition services to attain good nutrition of pregnant women amid the COVID-19 pandemic.

Pregnancy ; COVID-19

Purpose: To determine the feasibility of telemedicine screening for diabetic retinopathy in a community setting and to determine the prevalence of diabetic retinopathy among Filipino patients with type 2 diabetes in the community. Study Design: Cross-sectional study among patients with type 2 diabetes in six community health centers in an urban city in the Philippines. Materials and methods: Subjects were examined from November 2018 to December 2018. A three-field non-mydriatic 45’ fundus photographs were taken for each patient and photographs were uploaded in cloud storage and read by a retina specialist in a tertiary hospital for assessment of diabetic retinopathy and grading of the fundus photographs. The results were sent back to local health centers. Results: A total of 387 eyes of 195 persons were examined. Overall, 288 out of 387 eyes (95.36%) had gradable quality fundus photo (grade 3 and higher) and did not need eye dilation. Prevalence of diabetic retinopathy among the respondents was 25.26% - 3.16% had mild diabetic retinopathy, 15.79% had moderate diabetic retinopathy, 3.68% had severe diabetic retinopathy, and 3.68% had proliferative diabetic retinopathy. Other fundus findings noted include hypertensive retinopathy glaucomatous optic nerve, age-related macular degeneration, posterior vitreous detachment, clinically significant macular edema, and epiretinal membrane. Conclusion Due to the significant number of patients with diabetic retinopathy among type 2 diabetics in the community, telemedicine screening was a feasible alternative to dilated fundus examination and may be considered as part of the local health program to prevent blindness due to diabetes.
Diabetes Mellitus, Type 2|diabetic Retinopathy|telemedicine