Isaac Samuels

Dry eye disease is a multifactorial condition characterised by tear film instability, hyperosmolarity and ocular surface inflammation. Understanding the epidemiology of dry eye disease and recognising both modifiable and non-modifiable risk factors can assist eye care practitioners in assessing, treating, and managing patients with the condition. This review considers current knowledge surrounding its incidence and prevalence, as well as associated demographic, systemic, ocular, and iatrogenic, and lifestyle-related modifiable risk factors. Population-based prevalence estimates vary according to the diagnostic criteria used to define dry eye disease, as well as severity and demographic characteristics of the population. Considering recent data and variable population demographics, conservative prevalence estimates suggest that 10–20% of the population over 40 years of age report moderate to severe symptoms and/or seek treatment for dry eye disease. Individuals with specific non-modifiable demographic risk factors may be at increased risk of developing dry eye disease. Advanced age, female sex and East Asian ethnicity have been identified as key non-modifiable demographic features predisposing individuals to dry eye disease. Systemic conditions that have been associated with an increased risk of dry eye disease include migraine, Sjögren syndrome, connective tissue disorders, mental health disorders, diabetes mellitus and androgen deficiency. Medications that may contribute to this risk include antidepressants, antihistamines, and hormone replacement therapy. Ocular and iatrogenic risk factors of dry eye disease include blepharitis, Demodex infestation, ocular surgery, blink completeness, contact lens wear, and topical ophthalmic medications. A range of modifiable lifestyle factors that can increase the risk of dry eye disease have also been identified, including low humidity environments, digital screen use, quality of sleep, diet, and eye cosmetic wear. Dry eye is a common disease affecting millions globally. Increasing knowledge regarding its associated risk factors can better prepare the eye care practitioner to successfully manage patients with this ocular surface disease.

Development of an Indigenous eye health framework could offer the opportunity for eye health professionals to enhance engagement with Indigenous populations. Indigenous populations globally experience disproportionately poorer eye health outcomes than non-Indigenous peoples. Incorporating Māori perspectives of eye care and pre-existing Indigenous models of health offers potential to enhance Māori experience and engagement with eye health services. This study seeks to develop and refine a practical framework for eye health care that incorporates nine established Indigenous health principles. Qualitative methodology, guided by Indigenous Māori research principles, was used to evaluate interviews with five leading senior Māori academics surrounding the ongoing development and refinement of a Kaupapa Māori (Māori worldview centric) framework for eye care in Aotearoa New Zealand, created following Māori health consumer consultation. Interviews were semi-structured and analysed using reflexive thematic analysis. Seven key themes arose in relation to the development of a Kaupapa Māori framework for eye care in Aotearoa New Zealand: 1) vision is critical to Māori well-being, 2) cultural safety is important, 3) Māori health beliefs must be upheld, 4) achieving pae ora (healthy futures) is important, 5) key concepts and focus of the framework must be clear, 6) pūrākau (traditional Indigenous stories) are valuable resources in developing health frameworks and 7) embedding Matariki (fundamental Māori) principles is valuable. Using Kaupapa Māori principles allowed development and refinement of a framework that encourages clinicians to consider Indigenous health principles when engaging with Māori patients who seek eye care. Application of this framework may contribute to enhancing cultural safety and responsiveness of eye care for Māori.

BackgroundEvidence indicates that disparities in ocular health outcomes between Maori and non-Maori are pervasive in the New Zealand health system. Evidence shows the cause of these inequities is often multifactorial; due to factors such as colonisation, ongoing marginalisation, racism, socioeconomic status, poverty and culturally unsafe practice between health professionals and Maori patients.MethodsThis project used kaupapa Maori methodology to identify the perceptions of Maori surrounding ocular healthcare within a Maori context in Aotearoa New Zealand. Three focus groups with Maori community members and three individual interviews with Maori eyecare practitioners were conducted. Participants discussed sub-topics relating to Maori health, ocular health consultations, ocular examination and access to ocular health services in Aotearoa New Zealand. Reflexive thematic analysis was undertaken using NVivo qualitative research software.ResultsFive key themes were derived from the data: (1) the importance of effective clinician-patient communication; (2) historical experiences of patients inform their health attitudes; (3) barriers to access are systemic; (4) Maori health is important to Maori and (5) Te Ao Maori, Tikanga and Tapu are significant cultural concepts for Maori. Overall, Maori patients recognise the value of ocular healthcare and the importance of acknowledging Maori models of health within services.ConclusionThe key issues Maori patients face within ocular health services resonate strongly with wider concepts intrinsically important to Maori. These are the right to cultural safety within clinical settings, the right to accurate and pertinent communication of information between clinician and patient and the respect of cultural beliefs and acknowledgement of power imbalances within the wider healthcare system. Participant discussions and suggestions raise possible pathways to begin addressing ocular ethnic disparities in healthcare delivery.

Childbearing trans and nonbinary people are confronted with the heteronormative and cisgender frameworks that underpin “maternity” services. We explored the educational needs of 108 perinatal staff in the United Kingdom as related to the needs of trans and nonbinary service users. Participants were most confident in formulating care plans and least confident about the provision of colleagues’ perinatal care in this context. While the majority of participants were positive toward the trans and nonbinary communities, they considered that those communities remain marginalized in perinatal services. Transphobic, anti-trans, and nonbinary attitudes were highlighted by our respondents. Our findings suggest that caregivers witnessed transphobia among colleagues and were apprehensive themselves about providing care to childbearing trans and nonbinary people. They reported a cisheteronormative model of care that lacked awareness of trans and nonbinary issues. The educational needs identified included information about the practicalities of childbearing as a trans or nonbinary person, how to use inclusive language effectively, and creating policies and processes for supporting childbearing trans and nonbinary people. These caregivers’ preferences included hearing from trans and nonbinary people and sharing best practices among themselves, with open discussions about how to be inclusive.