Copyright restrictions may apply JAMA Ophthalmology Journal Club Slides: Awareness and Knowledge of Emergent Ophthalmic Disease Uhr JH, Mishra K, Wei C, Wu AY. Awareness and knowledge of emergent ophthalmic disease among patients in an internal medicine clinic. JAMA Ophthalmol. Published online February 18, doi: /jamaophthalmol

Copyright restrictions may apply Introduction Prior research demonstrates variable awareness and consistently low knowledge of common causes of progressive vision loss, including cataract, diabetic retinopathy, glaucoma, and macular degeneration. Despite the importance of early patient presentation for visual prognosis, awareness and knowledge of emergent ophthalmic diseases have not been previously studied. If awareness and knowledge are low, interventions to educate the public about these emergent ophthalmic diseases can be modeled on successful awareness campaigns in other areas of medicine, such as stroke. Objective: To assess awareness and knowledge of 4 emergent ophthalmic diseases—retinal detachment (RD), acute angle-closure glaucoma (AACG), giant cell arteritis (GCA), and central retinal artery occlusion (CRAO)—among patients presenting to an internal medicine clinic.

Copyright restrictions may apply Study Design: Cross-sectional survey administered to assess awareness and knowledge of RD, AACG, GCA, and CRAO. Awareness of each disease was assessed by responses to yes or no questions as to whether participants knew what the diseases were. Knowledge was evaluated by responses to 3 questions corresponding to each of the 4 diseases studied: 1 multiple-choice question each about basic pathophysiologic features, symptoms, and treatment options. Participants: 237 patients in the internal medicine resident clinic waiting rooms at Mount Sinai Hospital from June 1 to July 30, Demographic information, including age, sex, race, income, and education, was collected. Ocular history and time since the last dilated eye examination were collected. Data Analysis: Collected data were analyzed using χ 2 tests. Limitations: Survey questions not validated; cannot rule out guessing owing to multiple-choice format; respondents were predominantly racial minorities and of lower socioeconomic status, raising questions about generalizability. Methods

Copyright restrictions may apply Of 227 respondents, 151 (66.5%) were female; mean (SD) age was 51.3 (16.8) years; 58.6% had earned a high school diploma or a community college or 2-year associate’s degree; sample consisted largely of racial minorities, especially African American (46.3%) or Hispanic (37.7%); 59.8% reported an income of <$25 000/year. Awareness was low for all emergent ophthalmic diseases. –27.7% (95% CI, 21.8%-33.6%) of respondents were aware of RD. –14.6% (95% CI, 9.9%-19.3%) were aware of AACG. –5.1% (95% CI, 2.2%-8.0%) were aware of GCA. –4.6% (95% CI, 1.8%-7.4%) were aware of CRAO. For RD, awareness increased with higher levels of education (P =.004). Respondents who reported never having had a dilated eye examination were less likely than those who had an examination to report awareness of RD (P =.005) or AACG (P =.03). Results

Copyright restrictions may apply Awareness of one disease was significantly correlated with awareness of each other disease (P <.05) except for the pairing of RD and GCA, which was not significant (P =.06). Knowledge levels were low for all emergent ophthalmic diseases. Among all respondents, the proportion who were both aware and knowledgeable ranged from 14.6% aware of RD and knowledgeable about its pathophysiologic features to ≤1.0% aware of GCA and CRAO and knowledgeable about several of the knowledge categories. Results

Copyright restrictions may apply Respondent Characteristics Results

Copyright restrictions may apply Results Respondents Indicating Awareness of Each Disease

Copyright restrictions may apply Results Percentage of Respondents Answering Each Knowledge Question Correctly

Copyright restrictions may apply Awareness and knowledge of emergent ophthalmic disease were found to be very low for all diseases studied. These findings likely are important given the severity of the consequences of delayed presentation, including blindness. –Previous research demonstrates that patients often delay medical presentation after onset of symptoms for these emergent diseases, possibly owing to lack of awareness and knowledge. Because increased awareness and knowledge of disease can lead patients to seek appropriate medical care, improving awareness and knowledge of these emergent conditions may lead to better visual prognosis in some cases. Efforts to educate the public about these emergent ophthalmic diseases can be modeled after successful awareness campaigns in other areas of medicine, such as stroke. Comment

Copyright restrictions may apply If you have questions, please contact the corresponding author: –Albert Y. Wu, MD, PhD, Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1183, New York, NY Conflict of Interest Disclosures All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. Contact Information