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Study of association between corneal shape parameters and axial length elongation during orthokeratology using image-pro plus software

The aim was to validate the correlation between corneal shape parameters and axial length growth (ALG) during orthokeratology using Image-Pro Plus (IPP) 6.0 software.

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Temozolomide-associated blepharoconjunctivitis: a case report

Temozolomide (TMZ) is an effective oral alkylating agent used in treating glioblastoma multiforme (GBM) and high-grade gliomas. It works by introducing methyl groups into DNA, inhibiting cell division. A case ...

Brimonidine as a possible treatment for myopia

Myopia is becoming a huge burden on the world’s public health systems. The purpose of this study was to explore the effect of brimonidine in the treatment of form-deprivation myopia (FDM) and the relationship ...

Comparative visual outcomes of the first versus second eye following small-incision lenticule extraction (SMILE)

This study aimed to compare the visual outcomes of the first operated eyes with those of the second operated eyes following small-incision lenticule extraction (SMILE).

Bilateral multifocal chorioretinitis as the only presentation of acute West Nile virus infection: a case report

To describe a case of bilateral multifocal chorioretinitis as the only presentation of acute West Nile virus (WNV) infection in the absence of neurological involvement.

The structure–function relationship between multifocal pupil perimetry and retinal nerve fibre layer in glaucoma

Multifocal pupillographic objective perimetry (mfPOP) is a novel method for assessing functional change in diseases like glaucoma. Previous research has suggested that, in contrast to the pretectally-mediated ...

Management of diabetic ocular complications: from cellular insights to community strategies

The editorial outlines an integrated approach to managing diabetic ocular complications, combining advanced scientific research with practical public health strategies to improve the prevention, diagnosis, and...

Outcome of illuminated microcatheter-assisted circumferential trabeculotomy following failed angle surgery in PAX6 aniridic glaucoma: a case report and literature review

Aniridia is a rare eye disorder with a high incidence of glaucoma, and surgical intervention is often needed to control the intraocular pressure (IOP). Here, we reported a case of illuminated microcatheter-ass...

Risk factors of internal carotid artery stenosis in patients with proliferative diabetic retinopathy: an analysis using optical coherence tomography and optical coherence tomography angiography

This research investigates the correlation between the severity of internal carotid artery (ICA) stenosis and retinal parameters in patients with proliferative diabetic retinopathy (PDR), aiming to uncover pot...

Insulin eye drops improve corneal wound healing in STZ-induced diabetic mice by regulating corneal inflammation and neuropeptide release

In recent years, insulin eye drops have attracted increasing attention from researchers and ophthalmologists. The aim of this study was to investigate the efficacy and possible mechanism of action of insulin e...

Comparison of complications of intrascleral fixation according to the extent of vitrectomy

Intraocular lens (IOL) fixation is performed after intraoperative anterior or total vitrectomy. This study aimed to compare the intraoperative and postoperative complications of these two techniques.

Traumatic terson syndrome with a peculiar mass lesion and tractional retinal detachment: a case report

To report a case with bilateral Terson syndrome presented with a unique mushroom-like mass lesion on the optic disc along with proliferative vitreoretinopathy and tractional retinal detachment.

Association between sleep quality and dry eye disease: a literature review and meta-analysis

The purpose of this article is to systematically review the association between dry eye and sleep quality.

Factors affecting anophthalmic socket reconstruction outcomes using autologous oral mucosal graft

Limited studies have reported surgical outcomes that are defined by strict criteria following grade 2 or 3 socket reconstruction using an oral mucosal graft (OMG). We aimed to determine factors influencing sur...

Two patients with Knobloch syndrome due to mutation in COL8A1 gene: case report and review of the literature

Knobloch syndrome (KNO, OMIM # 267,750) is a rare ciliopathy group sydrome characterized by a collagen synthesis disorder. It represents an uncommon cause of pediatric retinal detachment. This report presents ...

Closed head injury combined with orbital blowout fracture and displacement of the eyeball into the maxillary sinus in a 14-year-old boy: a case report

Trauma-induced orbital blowout fracture (OBF) with eyeball displacement into the maxillary sinus is rare.

A case report: co-occurrence of probable Vogt-Koyanagi-Harada disease and diabetic retinopathy

Bilateral retinal detachment and choroidal detachment in a patient are rare occurrences. The presence of bilateral diabetic retinopathy (DR) in such a case is even rarer and complicates the condition.

Long-term follow-up demonstrates change in conformation shape of the focal choroidal excavation lesions

This study aims to present long-term observation of 5 eyes with focal choroidal excavation (FCE), focusing on morphological changes in conformity of the lesion.

Factors affecting long-term myopic regression after corneal refractive surgery for civilian pilots in southwest China

The purpose of this study was to analyze myopic regression after corneal refractive surgery (CRS) in civilian pilots and to explore the factors that may cause long-term myopic regression.

IL-1β induced down-regulation of miR-146a-5p promoted pyroptosis and apoptosis of corneal epithelial cell in dry eye disease through targeting STAT3

To elaborate the underlying mechanisms by which IL-1β promote progression of Dry eye disease(DED) through effect on pyroptosis and apoptosis of corneal epithelial cells(CECs).

Correlation analysis of angles κ and α with the refraction and anterior segment parameters in children

To investigate the correlation of angles α and κ with the refractive and biological parameters in children.

A survey of perceptions of exposure to new technology in residents and practicing ophthalmologists

Incorporation of the rapid advances in ophthalmologic surgical and diagnostic techniques inherent in the field poses a challenge to residency training programs. This study investigates exposure to new technolo...

The efficacy of bandage contact lens in relieving the aggravation of dry eye disease after complicated cataract or/and IOL surgery

In the present study, we aimed to evaluate the efficacy of the bandage contact lens (BCLs) in the treatment of dry eye disease (DED) after complicated cataract or/and intraocular lens (IOL) surgery.

Congenital solitary osseous choristoma of the left lateral canthus: a case report

An ocular osseous choristoma is a growth of mature, compact bone in the ocular or periocular soft tissue, and it is the rarest form of ocular choristoma, accounting for only 1.7% of all epibulbar choristomas.

Six-month binocular stereopsis recovery and its influencing factors in children with intermittent exotropia

To investigate the recovery of binocular stereopsis recovery and its influencing factors in children with intermittent exotropia after successful correction of eye position.

A comparison of Scansys and Sirius tomography in healthy eyes

To assess the level of agreement and evaluate the reliability of measurements between two Scheimpflug imaging modalities, Scansys (MediWorks, China) and Sirius (CSO, Italy), in quantifying the anterior segment...

Internal limiting membrane separation and posterior vitreous hyperreflective dots: novel OCT findings in Purtscher-like retinopathy

Purtscher or Purtscher-like retinopathy is diagnosed by retinal hemorrhages and areas of retinal whitening on fundus examination, as well as a reduction in visual acuity due to microvascular occlusion of the p...

Subfoveal choroidal thickness in a general elderly population; Tehran geriatric eye study

To determine the distribution of subfoveal choroidal thickness (SFCT) and its associated demographic, ocular, and systemic factors in an elderly population.

Epithelial ingrowth in descemet membrane endothelial keratoplasty associated with vitreous loss

Epithelial ingrowth is a rare but potentially sight-threatening complication caused by the invasion of corneal or conjunctival epithelial cells into the eye during ocular surgeries. DMEK is emerging as a widel...

Retinal injury from a laser skin resurfacing device during medical tourism: a public health concern

Laser skin resurfacing is a popular cosmetic procedure for noninvasive skin rejuvenation. Since health insurance plans often do not cover these types of procedures, patients often pay out of pocket. Consequent...

Long-term real-life outcomes of the Clareon® hydrophobic intraocular lens: the Clarte study in 191 eyes

To describe and analyze the real-life refractive, functional and safety outcomes of the Clareon® intraocular lens (IOL) after 3 years.

One year monitoring of retinal morphologic and functional changes in traumatic optic neuropathy patients

To analyze the morphologic and functional change in traumatic optic neuropathy (TON) divided by the mechanism of optic nerve injury.

Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature

We describe the management of a case of severe corneal melting after corneal cross-linking (CXL) treated with a staged approach using a conjunctival flap followed by deep anterior lamellar keratoplasty (DALK).

Agreement in non-cycloplegic and cycloplegic refraction between a photoscreener and a calibrated autorefractor

Photoscreeners have been shown to provide excellent measurements of the refractive error. However, whether they could be used for assessing cycloplegic refraction has not been examied. This study aimed to eval...

Evaluation of therapeutic efficacy of Emustil drops for ocular discomfort and tear film osmolarity using different treatment management modes under dry environmental conditions

We aimed to check the efficacy of Emustil (oil in water emulsion) drops on tear film index and ocular surface dynamics in dry environments through protection and relief treatment modalities.

Incidence rates of retinal vascular occlusive diseases from 2011 to 2020 in South Korea: a nationwide cohort study

Retinal vascular occlusions, including retinal vein occlusion and retinal artery occlusion, are common causes of visual impairment. In order to evaluate the national medical burden and help improve ophthalmic ...

Dynamic stability evaluation of trunk accelerations during walking in blind and sighted individuals

Dynamic stability is a fundamental goal in standing activities. In this regard, monitoring, analysis, and interventions made to improve stability is a research topic investigated in the biomechanics of human m...

The effect of corneal power on the accuracy of 14 IOL power formulas

This study evaluates the impact of corneal power on the accuracy of 14 newer intraocular lens (IOL) calculation formulas in cataract surgery. The aim is to assess how these formulas perform across different co...

Characteristics of ocular injuries associated with mortality in patients admitted with major trauma

Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries.

Clinicopathological study of ophthalmic cutaneous and mucocutaneous non-langerhans cell histiocytic lesions

The “C group” of the histiocytic disorders is characterized by non-Langerhans-cell histiocytic lesions in the skin, mucosal surfaces, or both, out of which Juvenile xanthogranuloma (JXG) is the most common typ...

Preserving visual acuity: a compelling 12-year case study of controlling neovascular age-related macular degeneration

In neovascular age-related macular degeneration (nAMD) trials, anti-VEGF injection frequency decreases after the first year, while outcomes remain primarily related to the number of injections. To the best of ...

Minimally invasive micro sclerostomy (MIMS) procedure in the treatment of open-angle glaucoma

To evaluate the safety and efficacy of the Minimally Invasive Micro Sclerotomy (MIMS) procedure in the management of uncontrolled open-angle glaucoma.

Artificial intelligence in age-related macular degeneration: state of the art and recent updates

Age related macular degeneration (AMD) represents a leading cause of vision loss and it is expected to affect 288 million people by 2040. During the last decade, machine learning technologies have shown great ...

Effect of topical bromfenac on intraretinal cystoid lesion in simultaneous cataract and idiopathic epiretinal membrane surgery

To investigate the effect of topical nonsteroidal anti-inflammatory drugs (NSAIDs,) bromfenac on the intraretinal cystic lesions (IRC) when performing simultaneous cataract and idiopathic epiretinal membrane (...

Effect of silicone oil versus gas tamponade on macular layer microstructure after pars plana vitrectomy for macula on rhegmatogenous retinal detachment

To analyze structural changes in the macular retinal layers and sub-foveal choroidal thickness (SFCT) in eyes after macula-on rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy with either...

Long-term outcomes of anti-vascular endothelial growth factor therapy with and without posterior scleral reinforcement on myopic maculopathy in myopic choroidal neovascularization eyes

Anti-vascular endothelial growth factor (anti-VEGF) therapy is used for myopic choroidal neovascularization (mCNV). Patchy chorioretinal atrophy (pCRA) enlargement has been reported in mCNV cases associated wi...

Interface fluid syndrome caused by the corneal perforation injury after small incision lenticule extraction: a case report

To report a case of interface fluid syndrome (IFS) following traumatic corneal perforation repair after small incision lenticule extraction (SMILE).

Prevalence and risk factors for astigmatism in 7 to 19-year-old students in Xinjiang, China: a cross-sectional study

To investigate the prevalence and risk factors for astigmatism in 7-19-year-old students in Xinjiang, China.

Vogt-Koyanagi-Harada disease developed during chemotherapy for Hodgkin lymphoma: a case report

Ocular manifestations are known for non-Hodgkin lymphoma, but are rare for Hodgkin lymphoma. We report a case of Vogt-Koyanagi-Harada (VKH) disease presenting as serous retinal detachment and uveitis in both e...

Strabismus management in retinoblastoma survivors

To report the result of strabismus surgery in eye-salvaged retinoblastoma (Rb) patients.

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Research Topics

The Department of Ophthalmology and Visual Sciences offers medical students and residents a variety of research opportunities. Please browse the basic science, translational and clinical research projects currently underway below.

Research Topic: Corneal endothelial health judged by endothelial image analysis

Description.

Endothelium is critical for dehydrating the cornea and keeping it clear. With loss of its barrier and pump function, the cornea swells and corneal transplantation may be needed.

Changes in the number, shape and size of the cells may predict loss of function.

Key Research Question/Hypothesis 

Effect of drugs, surgery, devices, and preservation media on the endothelium.

Images of the endothelium captured with either a specular or confocal microscope that can take repeated pictures of the endothelial cells non-invasively in patients. Once images are captured, they can be analyzed with special software in the Cornea Image Analysis Reading Center (CIARC) of the Department.

Student learn these techniques working with both patients and technicians, depending on the project.

Ongoing projects.

Status of IRB/IACUC approval

Image analysis studies in CIARC approved; ongoing projects have IRB approval. If launching a new project, IRB approval will need to be obtained.

Prospects for Publishing and Presenting

Excellent; we have a long track record of publications in major journals and presentations at national and international conferences.

Contact Information

Tanisha Rankins

Secretary to Dr. Jonathan Lass

• Email:  [email protected]  
• Phone: 216.983.5164

Research Topic: Retinopathy of Prematurity and other Pediatric Studies

Effect of low birth weight on the eye’s development.

Data analysis, chart review.

Several ongoing projects—long-term data collection.

Current study has IRB approval. Any new studies will need IRB approval.

Excellent; the data base study has been presented at ARVO and is in preparation for publication in a major pediatric journal.

Dr. Faruk Orge

• Email:  [email protected]
• Phone: 440.684.1743

Research Topic: Cholesterol and function of the retina

Cholesterol is essential for life in mammal. Yet, if it is chronically in excess, it is a risk factor for cardiovascular and Alzheimer's disease and likely age-related macular degeneration.

To delineate the putative link between cholesterol and age-related macular degeneration.

Characterization of retinal function of mice deficient in different enzymes involved in cholesterol elimination. Animals are assessed by optical coherence tomography, electroretinography, fluorescein angiography and optomotor response.

Students learn these techniques working with post-doctoral researchers responsible for these projects.

All studies are approved by the IACUC.

Dr. Irina Pikuleva

• Email:  [email protected]
• Phone: 216.368.3823

Research Topic: Contact Lens Related Complications

Ongoing clinical trials related to corneal infiltrative events associated with daily or extended wear of soft contact lenses. Fungal and bacterial biofilm-contact lens models and susceptibility to contact lens care products.

Assessment of sub-clinical corneal inflammation with confocal microscopy. Assessment of bacterial endotoxin and relationship to infiltrative events with soft lenses.

• Ocular and lens cultures for assessment of bioburden
• Reading/Assessment of stored confocal images
• Collection of worn lenses for biofilm formation
• Lab Assays (in conjunction with Dr. Pearlman’s lab) for endotoxin on lens surfaces or within solution

Active approved IRB protocols exist for current clinical trials on infiltrative events, biofilm studies, and assays of previously collected lenses, tears and images.

Excellent chance for authorship on investigator initiated studies of biofilm and endotoxin assays. Listing of authors will follow standard publishing guidelines. 

Other corporate-funded work may or may not allow authorship.

Dr. Loretta Szcztoka-Flynn

• Email:  [email protected]

Research Topic: Mechanisms of retinal degenerations

How do mutations in the light receptor rhodopsin cause retinal degenerations like retinitis pigmentosa? How does the retina protect against oxidative stresses that can lead to retinal degenerations such as retinitis pigmentosa and age-related macular degeneration?

A multi-disciplinary approach is employed that includes biochemistry, molecular biology, animal models and biophysics.

All animal studies have approved IACUC protocols.

Excellent with track record of publications in major journals and presentations at national and international conferences.

Information about the laboratory can be found by browsing the Park Lab webpage.

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• Brief Communication
• Published: 01 March 2023

Big data in ophthalmology: a systematic review of public databases for ophthalmic research

• John C. Lin 1 , 2 ,
• Sophia Y. Ghauri 1 , 2 ,
• Matthew J. Lee 1 , 2 ,
• Ingrid U. Scott 3 &
• Paul B. Greenberg   ORCID: orcid.org/0000-0002-2305-6766 2 , 4  

Eye volume  37 ,  pages 3044–3046 ( 2023 ) Cite this article

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Public databases are often used in population health research to generate hypotheses and insights into disparities, diseases, treatments, and outcomes. They can help improve patient care through clinical decision support, strengthen understanding of ophthalmic diseases and treatments, and advance risk adjustment, billing, and reimbursement. However, it can be challenging to find, access, and analyse these large publicly available databases to answer hypothesis-driven research questions.

Previous reviews of big data research in ophthalmology have prioritised determining common research topics and listing commonly used databases over exploring new databases or understudied populations [ 1 , 2 , 3 ]. In addition, these reviews often lacked a systematic literature search, contributing to potential reporting bias [ 1 , 2 , 3 ]. Herein, we systematically reviewed the literature for large publicly available health databases available for ophthalmic research.

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Clark A, Ng JQ, Morlet N, Semmens JB. Big data and ophthalmic research. Surv Ophthalmol. 2016;61:443–65.

Article   PubMed   Google Scholar  

Moss HE, Joslin CE, Rubin DS, Roth S. Big data research in neuro-ophthalmology: promises and pitfalls. J Neuroophthalmol. 2019;39:480–6.

Article   PubMed   PubMed Central   Google Scholar  

Wang SY, Pershing S, Lee AY.AAO Taskforce on AI and AAO Medical Information Technology Committee Big data requirements for artificial intelligence. Curr Opin Ophthalmol. 2020;31:318–23.

Aagaard T, Lund H, Juhl C. Optimizing literature search in systematic reviews – are MEDLINE, EMBASE and CENTRAL enough for identifying effect studies within the area of musculoskeletal disorders? BMC Med Res Methodol. 2016;16:161. https://doi.org/10.1186/s12874-016-0264-6 .

Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6:245. https://doi.org/10.1186/s13643-017-0644-y .

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Acknowledgements

The authors thank Chelsea Misquith of the Brown University Library for her assistance with the search strategy for this review.

Author information

Authors and affiliations.

Program in Biology, Brown University, Providence, RI, USA

John C. Lin, Sophia Y. Ghauri & Matthew J. Lee

Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, RI, USA

John C. Lin, Sophia Y. Ghauri, Matthew J. Lee & Paul B. Greenberg

Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA

Ingrid U. Scott

Section of Ophthalmology, Providence VA Medical Center, Providence, RI, USA

Paul B. Greenberg

You can also search for this author in PubMed   Google Scholar

Contributions

JCL: conceptualisation, methodology, formal analysis, investigation, data curation, writing—original draft, writing—review and editing, visualisation. SYG: formal analysis, investigation, data curation, writing—original draft, visualisation. MJL: formal analysis, investigation, data curation. IUS: conceptualisation, methodology, writing—original draft, writing—review and editing. PBG: conceptualisation, methodology, writing—original draft, writing—review and editing, supervision, project administration.

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Correspondence to Paul B. Greenberg .

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Supplementary information

Table s1: search strategy for publicly available databases for ophthalmic research, table s2: publicly available databases for big data research in ophthalmology, rights and permissions.

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Lin, J.C., Ghauri, S.Y., Lee, M.J. et al. Big data in ophthalmology: a systematic review of public databases for ophthalmic research. Eye 37 , 3044–3046 (2023). https://doi.org/10.1038/s41433-023-02446-7

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Received : 18 September 2022

Revised : 31 January 2023

Accepted : 09 February 2023

Published : 01 March 2023

Issue Date : October 2023

DOI : https://doi.org/10.1038/s41433-023-02446-7

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American Academy of Ophthalmology’s Research Journals Ranked Highest in the Field

2022 impact factors show that the Ophthalmology family of journals continues to publish important and highly cited studies

SAN FRANCISCO, Calif. —  The recently released 2022 impact factor scores reveal that the research journals Ophthalmology , Ophthalmology Retina and Ophthalmology Glaucoma   are ranked highly in the field. The impact factor measures the importance of a journal by calculating the average number of times selected articles are cited within the two previous years.

Ophthalmology received a score of 13.7, making it the most highly rated journal in the field that publishes original research. Ophthalmology Retina received a score of 4.5 and Ophthalmology Glaucoma scored a 2.9, making both the leading journal in its respective subspecialty. This is the first year Ophthalmology Retina and Ophthalmology Glaucoma received impact factors.

“We are delighted with the strong initial impact factors for Ophthalmology Retina and Ophthalmology Glaucoma , as well as the continued high impact factor for Ophthalmology ,” said Russell Van Gelder, MD, PhD, editor-in-chief of Ophthalmology . “The success of these journals has allowed Ophthalmology to continue to publish the very highest impact work. While impact factors are an imperfect proxy for the true impact of our published papers on our patients' lives, they do demonstrate that our papers are being widely read and cited. The Ophthalmology family of journals are a great resource for Academy members and our specialty in general.”

Ophthalmology Science , the Academy’s newest journal, achieved PubMed/MEDLINE indexing last year. We anticipate its inaugural impact factor in June 2024. 

Journal impact factor scores are published annually by Clarivate Analytics.

About the American Academy of Ophthalmology

The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart ® program provides the public with the most trusted information about eye health. For more information, visit aao.org .

About  Ophthalmology Ophthalmology ® , the official journal of the American Academy of Ophthalmology, publishes original, peer-reviewed, clinically applicable research. The  Ophthalmology  franchise, owned by the Academy and published by Elsevier, also includes subspecialty publications, Ophthalmology ®  Retina and Ophthalmology® Glaucoma ,  and open access journal,  Ophthalmology® Science . For more information, visit www.aaojournal.org .

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Systematic Review of Community-Engaged Research in Ophthalmology

Kristen harris nwanyanwu.

Ophthalmology and Visual Science, Yale University, (475)441-0387

Holly K. Grossetta Nardini

Cushing/Whitney Medical Library, Yale University

Gabrielle Shaughness

University of Michigan

Marcella Nunez-Smith

Associate Professor of Medicine and Epidemiology, Director, Equity Research and Innovation Center, Deputy Directory of Health Equity Research and Workforce Development, Yale Center for Clinical Investigation, Yale University

Paula-Anne Newman-Casey

Ophthalmology and Visual Sciences, University of Michigan

Introduction

Community-engaged research (CEnR) allows researchers and community organizations to partner together to improve health outcomes and to decrease health disparities. While prevalent in other fields of medicine, it is rarely used in ophthalmology.

Areas covered

A comprehensive search of Ovid MEDLINE, NLM Pubmed, Ovid Embase, Scopus and the Cochrane Library for the Medical Subject Headings (MeSH) “Community-based participatory research” and text word variations including participatory research, community engagement, community research, partnered research, community-institutional relations, CENR, CBPR in addition to variations on ophthalmology, eye diseases, vision disorders and eye injuries yielded 451 unique references. Two ophthalmologists (KN, PANC) reviewed the titles and abstracts and identified 37 relevant studies. Expert consultation yielded an additional reference. After reviewing the full texts and excluding non-English texts, 18 articles met the necessary criteria. The eighteen articles all utilized at least one of the nine principles of CEnR.

Expert commentary

Ophthalmology is perfectly positioned to benefit from CEnR. Increased community engagement in ophthalmic research would expand the reach of our work and address some of the most difficult problems in vision disparities and outcomes.

1. Introduction

Community-engaged research (CEnR) brings community members and researchers together to solve health problems. While there are many research studies that are based in communities, CEnR requires a specific degree of stakeholder commitment to working together to address health issues. Community engagement is defined as “the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people”[ 1 ]. This process seeks to empower all parties involved to push towards more comprehensive, inclusive, and executable solutions to improve health through collaborative planning and processes.

In 1947, the Constitution of the World Health Organization (WHO) presented the idea that the environments people live in impact their health [ 2 ]. This served as the foundation for the Social Ecological Theory, which describes the interaction between a person, that person's community, and the environment in which that person lives [ 3 - 5 ]. Using this theory as a foundation, the CDC developed the Social-Ecological Model of health ( Figure 1 ) [ 6 ]. This model begins by discussing individual risk factors for disease based on that person's sociodemographic and biologic characteristics. The next level identifies how interpersonal relationships can both negatively and positively impact health. It then expands to include how one's community impacts health status, and lastly, how the societal influence around that particular community impacts health. This model serves as a framework to ensure that health promotion interventions address all levels of a person's risk factors for poor health from the level of the individual level to the level of society as a whole.

According to the CDC, “acknowledging diversity in background, experience, culture, income, and education and examining how society produces privilege, racism, and inequalities in power” is at the core of community engagement [ 7 ]. In 2011, the CDC described a continuum of increasing levels of community involvement that may facilitate longstanding, productive academic-community relationships ( Figure 2 )[ 7 ]. The interactions described begin as outreach to the communities and progress toward consultation . After consultation , increased involvement develops and groups become collaborative . The highest level of community involvement is shared leadership during which ventures are developed together, from the creation of the research question to the evaluation of the final results.

In 2011, the CDC published the Principles for Community Engagement [ 7 ], which outlines nine principles to CEnR ( Table 1 ). The first principle requires the research group interested in engaging the community to be clear about the goals of the work and about the population. The second principle advocates the use of qualitative and quantitative methods to learn more about the community the research team wishes to engage. Principle 3 involves building trust and relationships with the community and with the formal and informal leadership of the community. The next principle describes the self-determination of the community as the responsibility of the community and reminds those interested in engaging that empowerment comes from within. Principle 5 entails building partnerships with the community. Principle 6 requires the recognition of the diversity of the community in the planning, design, and implementation of engagement. Principle 7 requires the recognition and the utilization of community assets along with the expansion of the community's capacity. Principle 8 describes the release of control of interventions to the community and the flexibility that comes with seeing the community as a dynamic entity. Lastly, principle 9 is defined as the long-term commitment to improving the community's health through partnership.

Not only have the WHO and the CDC emphasized how important considering a person's environment is to their overall health status, but research has also demonstrated this important connection. Schulz and colleagues explored the social determinants of diabetes in Detroit, citing stressful life conditions, the built environment, the social environment, and educational opportunities as social determinants of health and mediators between the risk of diabetes and race[ 8 ]. Geraghty and colleagues found a significant association between higher hemoglobin A1c and living in lower income neighborhoods, when examining the distance patients with diabetes travelled to primary care visits[ 9 ]. In European studies, social deprivation has been associated with decreased screening uptake in diabetic retinopathy and an increase in sight-threatening diabetic eye disease [ 10 ]. These are just a few examples of how physical spaces and social support impact the health of those who live in a particular community. There has been a historical disconnect between researchers and the communities they study[ 11 ]. Engaging communities as a whole in research may bridge that interpersonal gap, allowing mutually beneficial partnerships to emerge.

Because there are numerous disparities in vision health outcomes among underserved communities[ 12 - 14 ], there is a need to improve the way in which public health interventions in ophthalmology are developed and implemented. Solutions developed by research should be accessible to the communities that they were created to benefit. In a recent report, the National Academies of Science, Engineering, and Medicine implores health experts to improve eye health from a population health perspective. They recommend that communities be included both in the identification of community-level barriers to vision health and the promotion of vision health screening services[ 12 ]. CEnR includes the community in the research process at various stages, which brings the community and researchers together to create implementable solutions. This systematic review identifies studies in ophthalmology that utilize tenets of CEnR to address issues in eye health.

In this systematic review of CEnR research in ophthalmology, we included all studies that utilized community engagement. We defined community engagement according to the nine principles established by the CDC in 2011[ 7 ]. We included primary research studies that utilized any of the nine principles defined ( Table 1 ). We excluded commentaries, meta-analyses, and reviews. We also excluded any studies that were not available in English.

On September 14, 2016, an experienced medical librarian performed a comprehensive search of multiple databases: Ovid MEDLINE (1946-September Week 2 2016), NLM PubMed for unindexed material, Ovid Embase (1974-2016 September 14), Scopus, and Cochrane Library. To formulate the search, we began with the Yale MeSH Analyzer ( http://mesh.med.yale.edu/ ) using key articles to produce relevant controlled vocabulary and keyword terms. We also read abstracts and full-text of key articles to generate concepts and synonyms. In each database we ran scoping searches and used an iterative process to translate and refine the searches. The key articles were also used for validating the success of the searches and the search strategies were peer-reviewed by a second librarian. Only English language articles were eligible. No date or other filters were applied. The Medical Subject Heading (MeSH) “Community-based participatory research” was only introduced in MEDLINE in 2009 so we combined controlled vocabulary (MeSH terms, Emtree) and with textword variations in combination, including participatory research, community engagement, community research, partnered research, community-institutional relations, CENR, CBPR and variations on ophthalmology, eye diseases, vision disorders and eye injuries . All search strategies are available from the authors.

The final search retrieved a total of 799 references. We pooled and de-duplicated those references in EndNote, which resulted in 451 unique records. Two separate screeners (KHN, PANC) evaluated the titles, abstracts, and full text of the eligible articles against the inclusion and exclusion criteria using Covidence. The screeners resolved conflicts by consensus. Review of the articles ensured a comprehensive, complete search. Based on title and abstract, the search identified thirty-seven relevant articles. After consultation with an expert in the field, the authors added an additional reference. After reading the full text of the articles, authors excluded two studies because the texts were not available in English. Authors also excluded sixteen studies because they did not include any of the nine principles of community engagement. Eighteen articles met the inclusion criteria and are included in this analysis.

All eighteen of the manuscripts demonstrated knowledge about the community being studied ( Table 2 ). Seventeen of the eighteen studies clearly described the target population and the goals of the effort. Boudville and colleagues detailed both of these principles as they evaluated access to eye care in a primary care setting in Aboriginal communities[ 15 ]. Their qualitative, mixed method study used knowledge of the community to further elucidate the role of primary care providers in eye health. The researchers described the population and sought answers from the community through focus group interviews. Burnett and colleagues also discussed these principles[ 16 ]. Their study of subjects attending ophthalmic outreach clinics in Papua New Guinea used a questionnaire-based approach to further understand barriers to eye care services. They used an iterative in-person process to develop their questionnaire to capture the opinions of community members and leaders for a better understanding of the communities in which they were working. Owsley and colleagues demonstrated the same principles when they facilitated focus groups for older African-Americans in Alabama[ 17 ]. An experienced facilitator helped uncover barriers to eye care in seventeen focus groups. Semi-structured interviews with questions tailored to this population described to uncover barriers to eye care in this community. Elam and colleagues evaluated barriers to care in African-Americans in Virginia and North Carolina in a similar fashion[ 18 ]. All of these studies described the characteristics of the participants and sought input from the community in characterizing the population's eye care needs.

Ten of the evaluated studies described trust and relationship building during the community engagement process. For example, Anderson and colleagues leveraged established relationships with community leaders and partnerships with carefully chosen organizations to conduct community-based eye disease screening in Detroit, Michigan [ 19 ]. In this case, authors detailed that it was especially prudent that the investigators were introduced to new community organizations by partners who had longstanding relationships with both the researchers and community organization leaders.

Owsley and colleagues also described trust building in their program: In Communities Helping African Americans Receive General Eye Care (InCHARGE) . They detailed a community-specific message promoting eye health to elderly African-Americans[ 20 ]. The researchers were familiar with the community and worked to build trust. They also partnered with the community to facilitate the pre/post design where they tailored messages that were community-specific, and highlighted the diversity within African-American communities.

Quigley and colleagues utilized technicians and community health workers to screen East Baltimore residents for eye disease[ 21 ]. They trained and employed seven full-time neighborhood health-workers in visual acuity assessment and visual field testing. In addition, they also trained and certified 150 volunteers. This research group detailed intimate knowledge of the community and the building of trust and relationships. Through their longstanding commitment to building trust and working with this particular population, they screened over 5300 participants.

Rhodes and colleagues designed the Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) , a glaucoma education program[ 22 ]. Researchers partnered with an eye clinic in the community to trial this education program and assessed its impact using questionnaires administered to participants during their visits. The program was designed after focus groups in the community demonstrated areas of opportunity for education[ 23 ]. This group of researchers clearly describe the population, knowledge about the community, trust-building, and reliance on the community partnership to design the intervention and to evaluate the administration of the program.

Ronanki and colleagues surveyed the Srikakulam district in India about corneal donation[ 24 ]. They used a largely semi-structured questionnaire to interview 350 participants. Participants included multiple different stakeholders: health assistant students, high school teachers, social service workers, and family members of those who had previously donated their corneas. This research team described knowledge of the community and building trust by engaging community stakeholders.

Winters and colleagues hired a community liaison to promote a vision health program in a senior apartment community[ 25 ]. This specific partnership required clarity about the population to be evaluated, knowledge of the community, and trust building between researchers and the population.

Dreer and colleagues were one of two groups to demonstrate the principle of community self-determination in the research process[ 23 ]. Self-determination is control or ownership over one's destiny. Self-determination must come from within the community and cannot be given to a community by anyone from the outside. In Dreer's research, the community-based advisory board created a culturally-specific health promotion program. It engaged community members with glaucoma to create educational materials for other glaucoma patients within their own community.

Eleven studies partnered with the community. Hark and colleagues detailed this in the development of their glaucoma screening program in Philadelphia[ 26 ]. The Philadelphia Glaucoma Detection and Treatment Project worked with over 40 community partners. These partner organizations each identified a site coordinator to work with their team. They describe how their team work allowed them to create culturally-appropriate materials for specific sites, which resulted in over 1500 scheduled glaucoma detection evaluations in the community setting. These partnerships facilitated the creation of community-specific materials and expanded their reach. In addition, Hark and colleagues also engaged a clearly defined population to be engaged and detailed knowledge of the community with whom they were working.

Marella and colleagues evaluated low vision services in Papua New Guinea[ 27 ]. They described knowledge of the community and partnered with the community to explore the needs of those with low vision and the public perception of those with low vision. They interviewed 50 stakeholders including eye care practitioners, special education teachers, rehabilitation service providers, disability-related service providers, those from the low vision community, and their family members.

A qualitative study explored the stakeholders involved in correcting refractive error and presbyopia in an indigenous population in Australia[ 28 ]. Anjou and colleagues used qualitative methods to examine barriers to eye care. They partnered with the community and multiple stakeholders including representatives from private practices, hospitals, the government, and non-governmental organizations. They described building trusting relationships in order to create partnerships.

Ives and colleagues executed a Community-based Participatory Research (CBPR) Photovoice project[ 29 ]. In order to execute this project, the researchers had to be clear about the population, have knowledge of the community, have a trusting partnership with the community, and a unique respect of the cultural aspects specific to this population. Their Vision Voice program was developed out of a long-standing academic-community coalition. They detail the facilitation of the community member narratives that expressed their experience with diabetes and vision loss.

Earle-Richardson and colleagues employed CBPR to decrease eye irritation among migrant farm workers[ 30 ]. This was the only research that created sustainable results and one of three to demonstrate long-term commitment to a community. The academic and community partners of the Hudson Valley region met and determined that eye irritation was a serious priority [ 31 ]. The migrant farm worker community ranked possible interventions to improve eye health. This informed how the researchers created a three-part intervention consisting of eye drops, protective eyewear, and an in-person presentation on eye health. Symptoms were evaluated among the migrant farm workers before and after the intervention using a survey. The intervention resulted in a significant decrease in eye pain (P=0.009). They described the population and the goals of the effort, detailed knowledge about the community being studied, utilized partnerships built on trust to sustain the intervention, and discussed the importance of recognizing and respecting the community.

Lugue and colleagues utilized community-based prevention marketing to create the Partnership for Citrus Worker Health , an eye safety peer-to-peer education program[ 32 ]. Community health aides facilitated the iterative process of creating the educational program using an analysis of field operations, focus groups, and written questionnaires. Researchers described going beyond knowledge of the population studied and their community to build trust. They not only detailed partnerships with the community and the acknowledgement of the diversity within the community, but also, the development of strong, long-term relationship by regularly evaluating and improving the program.

Williams and colleagues utilized the Participatory-Action-Research methodology to create solutions to improve accessibility to physical places for visually impaired community members and to adapt slide presentations for people with low vision[ 33 ]. The study described the transformative moments that came from the monthly meetings of this organization that included five dedicated visually impaired participants with diabetes. They detailed how research control was based in the community. They worked together to build something that belonged to the community members and were required to be flexible enough to meet the community's changing needs. The finished product greatly assisted in improving diabetic education for the Diabetes Association of Greater Cleveland.

4. Discussion

CEnR begins with “meaningful community participation [that] extends beyond physical involvement to include generation of ideas, contributions to decision making, and sharing of responsibility”[ 7 ]. Relationships with communities must be developed and nurtured to allow for the partnership to be consistent with the cultural framework of the particular community [ 34 ]. The strengths that currently exist in a community should be acknowledged. Communities should be evaluated not in terms of their problems, but in light of what is available to them and how they are able to use what they have [ 35 , 36 ]. Empowerment theory stresses that no external entity should assume that it can give a community the power to act in its own self-interest. Rather, those working to engage the community should, when appropriate, offer tools and resources to aid the community in its own empowerment journey [ 7 ]. We identified 18 studies in the ophthalmic literature that utilized various aspects of CEnR in their work. The most commonly used tenets of CEnR were clarity about the goals of the study and population to be engaged and knowledge about the community being studied.

Ten of the eighteen studies we identified made building trust and relationships through the community engagement process a priority. Given the history of human rights violations in health-related research within disenfranchised communities, overcoming mistrust of academic researchers remains an important barrier to conducting meaningful research in underserved communities [ 35 , 37 , 38 ]. To overcome these historic barriers, relationships must be nurtured from the very beginning as trust is an essential aspect of these partnerships [ 35 ][ 39 ][ 40 ]. This trust may be built by demonstrating competence in working with diverse cultures including a diversity of class, gender, ethnicity, age, and sexual orientation [ 41 ]. Because trust is such a central issue, many partnerships continue to monitor issues of trust and influence throughout all of the stages of development of the project. They continually review and re-assess issues of governance and decision making to ensure that both the academic and community members feel like equal partners in the research endeavor [ 42 ].

In 2010, the National Institutes of Health Director's Council of Public Representatives created a framework for CEnR to serve as a guide to educate the research community[ 43 ]. A CEnR relationship begins with a thorough understanding of CEnR by each party. The framework values an equitable, empowering, longstanding partnership that fosters effective communication. From a research perspective, the authors recommend clear research goals with a transparent process that benefits all parties involved. Working principles, ownership, and dissemination policies should be agreed upon at the outset of the project [ 44 ]. Once the project has been completed, it is highly recommended that the research findings be translated into policy, interventions, and programs that address the disparities identified. One of the studies examined in this review, Williams et al., used the recommendations from their research meetings to improve diabetes materials and programs for those with visual impairment and diabetes in Cleveland [ 33 ]. Their findings enhanced existing programs for community members in real, tangible ways.

Community analysis should be performed early in the partnership, as it was in all of the studies identified in our review. All eighteen studies demonstrated good knowledge of the communities researchers were studying. Communities must be interested in the research and in the priorities suggested[ 35 , 41 ] [ 45 ]. Community organizations and leaders who have the support and the respect of the community should be invited to participate [ 38 , 40 , 41 ]. For example, Anderson and colleagues described the longstanding relationships with community leaders and organizations in Detroit, which allowed them to evaluate over 1,000 community members through a culturally specific diabetic eye disease screening program. Ongoing evaluations of the communication processes throughout the partnership are encouraged [ 35 , 38 , 40 , 45 ] [ 46 ]. Recognition of the effort of community partners, who often have limited resources, helps to keep morale high [ 47 ] [ 37 , 38 , 41 ]. The goal is to build sustainable partnerships with firm commitments to cost and funding for implementation of designed solutions [ 40 , 42 , 44 ].

Community members bring important resources to the research process. Community partners and community staff have intimate, invaluable knowledge of community circumstances, culture, comfort levels, fears, and attitudes. They have important contacts that can be utilized in all project phases [ 47 ]. In 2009, public involvement in research was reviewed by Staley for the National Health Service. In her systematic literature review, she explores several instances of community engagement in research [ 48 ].

In Staley's review of the literature, involved communities identified topics for researchers to address, and proceeded further to shape the research agenda through their specific concerns. The study from our systematic review that comes closest to this is the CBPR work in the migrant farm worker community. Academic and community partners met and determined that eye irritation was a priority. Then, they worked together to design the study [ 31 ]. In Staley's review, sometimes the community initiated the research projects. Others times, communities shifted public discourse to focus on a particular topic, which lead to funding opportunities because of the increased attention. While traditionally, researchers have presented communities with their research questions of interest, community engagement can augment this process. Alternatively, the partnership may decide together what research topics should be addressed.

Lay community members add tremendous value to health education interventions. They are often great recruiters for studies; they know the prospective participants, and with the appropriate social capital, they may add validity to the work[ 49 ]. Communal ownership has also been found to increase response rates to questionnaires, which improves the validity of the research [ 50 ]. Lay community workers benefit through increasing their skills and capacity by participating in these research projects [ 47 ]. Participating in research can help build skills to better advocate for community needs, both by empowering community members and through having a collaborator who has credibility with policy makers [ 50 ]. Community partners help to refine research questions and make significant contributions to the interpretation and synthesis of results as they have the most insight into the particular issues in their community[ 49 ][ 51 ]. There is no description of community partners engaged at that level in the CEnR studies we identified in ophthalmology. Once the data are analyzed, communities may evaluate the conclusions from their perspective and speak to the next steps toward improvement in health outcomes or further interventions[ 49 ] [ 52 ]. This would be a wonderful next step for vision researchers to utilize to improve the likelihood that their public health interventions are both implemented and maintained, especially in communities who experience a disproportionate share of the burden of visual impairment and vision loss.

CBPR is a specific type of CEnR. It sits at the highest end of collaboration, creating research from shared leadership between communities and academia. Defined as, “A collaborative research approach that is designed to ensure and establish structures for participation by communities affected by the issue being studied, representatives of organizations, and researchers in all aspects of the research process to improve health and well-being through taking action, including social change”[ 53 ]. The goals of this type of research are to improve health outcomes and eliminate health disparities [ 3 , 8 ]. CBPR addresses health disparities among disempowered communities in at least three ways: through building capacity in underserved populations, through focusing attention on social justice, and through sharing of power and resources[ 50 ]. It not only requires community involvement from the development of a research question, it also requires participation throughout the entire process, usually stemming from a longstanding relationship between the two entities[ 50 ]. Both CBPR projects detailed in this review, the Photovoice project[ 29 ] and the project that improved the eye health of migrant farm workers[ 30 ], involved community members from the study design through implementation. CBPR approaches may enhance community capacity to address health inequities [ 54 ]. Nonetheless, the number of researchers with specific CBPR experience is limited[ 50 ].

There are numerous advantages of CEnR partnerships. In 2004, the Agency for Healthcare Research and Quality assessed the merits of CEnR. The advantages of the research partners included, “greater participation rates, increased external validity, decreased loss of follow-up, and increased individual and community capacity”[ 53 ]. In our literature review, Hark and colleagues were able to screen over 1500 Philadelphians with community involvement [ 26 ], Quigley et al. were able to screen over 5,300 with the employment of community health workers[ 21 ], and Winters et al. also hired a community liaison to facilitate the partnership[ 25 ]. When Staley evaluated advantages to communities and researchers, she found that community members, such as those in the Quigley and Winters studies, were often able to attain new skills and knowledge, further their own personal development, acquire support and friendship, find enjoyment and satisfaction, as well as benefit from financial rewards[ 48 ]. The new set of skills is often transferable, which may lead to employment elsewhere once the research has ended[ 47 ]. Community members are also able to push for better services with newly acquired skills and information [ 55 ]. For example, the InCHARGE and EQUALITY programs educate community members about eye disease, which arms community members with the knowledge to be better advocates[ 20 , 22 ]. In parallel, the researchers studied found an improved understanding of community, enjoyment and satisfaction, challenges to beliefs and attitudes, as well as career benefits [ 48 ]. Organizations involved found greater access to skilled labor, expertise, and resources than they would have otherwise[ 35 ].

There are significant disadvantages to using CEnR approaches. The work done through CEnR is done in a specific community, which raises concerns about applicability to other communities [ 53 ]. For example, the Vision Voice project that stemmed from the IMPACT Diabetes Center community-academic coalition is a very specific display of community member experiences[ 29 ]. Those experiences may not be generalizable to other groups. Personal disadvantages to community members involved in research were emotional burden, large work load, unsolicited media exploitation, and frustration with level of involvement[ 35 , 48 ] [ 56 ]. There are significant opportunity costs to organizations who must choose between furthering their mission through research or other endeavors [ 35 , 38 , 41 ]. Community partners and researchers endured stretched resources[ 40 , 41 , 44 , 48 ] and the need to renegotiate time schedules[ 48 ]. Partnerships require increased morale support to continue the work when funding decreases [ 44 ]. Researchers also reported loss of control, change in work flow, and a challenge in personal values and assumptions about how to complete the tasks at hand[ 48 ]. This may explain why in our literature review, only one of the studies we evaluated detailed the flexibility and release of control to the community[ 33 ]. In CEnR, community partners may be tired because of the arduous process of research and seek to implement interventions before they are completely vetted [ 38 , 40 , 41 , 49 ]. This may be mitigated by including community members in the intermediate processes, while maintaining open communication [ 38 , 49 ]. Language may become a challenge, whether different languages are being spoken, for example, Spanish and English, or the language of research, which may be new for the community[ 38 , 40 , 41 ]. These issues must be addressed early to ensure equal footing of both parties.

Community engagement requires a symbiotic relationship. When consents are created with community members at the table, they are often more clear and accessible, which may spur more research participation. When community partnerships are utilized, the goals of research returning to the community are clear and at the forefront. Ethical concerns are often identified sooner, which allows them to be addressed at an earlier point in the research timeline. These outcomes make it worth the additional resources required for researchers looking to improve community vision health outcomes to utilize community engagement as a central method in their research.

5. Conclusion

Although the studies employing CEnR have been limited in ophthalmology, the field would benefit from more of this type of research. Patients fear blindness and many of the blinding eye diseases are preventable with proper screening and treatment. We need to better address the needs of our patients; CEnR is one tool to bring research closer to program implementation. The National Eye Institute supports education programs for diabetic eye disease, glaucoma, and others and has supported research that has identified serious health disparities in those areas. However, traditional approaches to validate and implement proven interventions to improve community health and close disparities in outcomes have not been successful in ophthalmology[ 50 ]. CEnR brings research to the community; this research approach could make significant strides towards bridging the gap between research and implementation for addressing disparities in health outcomes in ophthalmology.

6. Expert commentary

This systematic review demonstrates how principles of community engagement may be used in vision health research. From engaging communities through trust-building, to self-determination, to long-term commitment and the creation of sustainable results, CEnR has augmented the field of ophthalmology. These eighteen studies demonstrate how communities could be engaged to uncover invaluable information, build partnerships, and push organizations forward towards better eye health. Some of the authors of the reviewed manuscripts describe tailored interventions for particular communities, while gathering information that is generalizable to other similar communities in different locations. Others were able to facilitate the expression of the community's voice, which may be more effective than messages from institutions alone. The only lament is that there were so few studies utilizing CEnR. We hope this review provides a glimpse into a very important research modality that would advance the field of public health in ophthalmology in novel ways. As demonstrated in these studies the CEnR spectrum is broad. There are multiple ways to engage communities in research. There are also many communities both locally and globally that are in need of improved eye health; community engagement seeks to find focused ways to assess those needs.

CEnR is designed to bridge the gap between research and those it is intended to help. The National Academies of Science, Engineering, and Medicine have emphasized the importance of involving communities in improving vision health[ 12 ]. The NIH and the CDC have taken a particular interest in CEnR. Not only have they funded research opportunities in this arena, they have also created guidelines and frameworks for the creation of the necessary precursor partnerships for this work and for the evaluation of this type of research in peer-reviewed spaces[ 7 ]. Eye health researchers need to increase their utilization of community-engaged approaches.

Ophthalmology is specifically suited for these partnerships because vision loss is ranked alongside memory loss, hearing loss, loss of speech and loss of limbs as one of the public's top health concerns [ 57 ]. As a top health concern, communities will prioritize vision and see a working relationship with eye health researchers as beneficial. The field would benefit from community member insight into barriers to the screening and treatment of preventable blindness to combat health disparities and vision loss[ 13 , 14 , 58 ].

It is no longer enough to treat patients, one must also strive for quality and great outcomes. CEnR is a natural extension for personalization of medicine for communities, as it asks for each community's input in designing ways to combat poor outcomes from disease. Although developing and maintaining community partnerships can be costly both in terms of capital investment and time, there is no better source for information on disparities in health outcomes and possible novel solutions than the people who are experiencing the problem. Community-based research networks already exist in many communities. With honest thoughtful relationship building, ophthalmology may begin to expand old partnerships and create new ones to bring the benefits of CEnR to ophthalmology research and outcomes.

It is not enough to understand disease processes and develop novel treatments and precise management guidelines. These advances must translate to patient care in the real world setting. CEnR may be a bridge that real world.

7. Five-year view

Ophthalmology will begin engaging communities in research. Both quantitative and qualitative methods will be used to improve health outcomes and decrease health disparities in sight-threatening diseases. This will demonstrate the return on investment of this work and spur others to become involved. As the partnerships between communities and researchers are strengthened, both parties will benefit from shared pursuit of the common goal of improving health outcomes in vision.

• Community Engaged Research (CEnR) begins with a balanced partnership between communities and research
• CEnR improves research quality and applicability
• Ophthalmology would benefit from establishing community partnerships in pursuit of CEnR

Acknowledgments

Funding : This research was funded by the following

• -National Center for Advancing Translational Sciences- Yale CTSA grant UL1TR000142
• -National Institutes of Health, National Eye Institute- 1K23EY025320
• - Research to Prevent Blindness

Declaration of interest : The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Contributor Information

Kristen Harris Nwanyanwu, Ophthalmology and Visual Science, Yale University, (475)441-0387.

Holly K. Grossetta Nardini, Cushing/Whitney Medical Library, Yale University.

Gabrielle Shaughness, University of Michigan.

Marcella Nunez-Smith, Associate Professor of Medicine and Epidemiology, Director, Equity Research and Innovation Center, Deputy Directory of Health Equity Research and Workforce Development, Yale Center for Clinical Investigation, Yale University.

Paula-Anne Newman-Casey, Ophthalmology and Visual Sciences, University of Michigan.

Papers of special note have been highlighted as:

* of interest

** of considerable interest

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

'Why do my eyes hurt?' Searches about eye injuries see massive spike amid solar eclipse

For some, special glasses to safely take in Monday's solar eclipse were a hot commodity.

The glasses let you see more detail as the moon passed in front of the sun in the solar eclipse that won't pass through the contiguous U.S. again until 2044. They also protected your eyes from the damaging effects of the sun's rays.

But as far as Google searches go, it appears not everyone dutifully wore their glasses as they tried to take in the solar eclipse, which stretched across the U.S. Monday in a northeast path from Texas to Maine.

According to Google Trends , which analyzes queries made across Google, there was a significant spike in searches for terms relating to the eclipse and eyes health on Monday, including the terms " why do my eyes hurt " and " my eyes hurt ."

If you delve further into the Google Trends data, and sort the "Interest by Subregion" tab by metro , searches for "my eyes hurt" almost follow the eclipse's direct path.

Related searches include "eyes hurt after looking at the eclipse" and "can the eclipse hurt your eyes."

How can the solar eclipse hurt eyes?

Staring directly at the sun without safety eyewear can cause irreversible eye damage within seconds , according to the  Adler Planetarium . Eclipse observers will likely not register pain as there are no nerve endings inside the eye.

If your eyes or vision feel off after doing this it could be a sign of solar retinopathy, when light damages the retina.

The pain of looking at the sun is not instant and the same goes for symptoms of damage.

Someone may not know they experienced solar retinopathy until hours after exposure, according to the National Center for Biotechnology Information.

Symptoms of eye damage after the solar eclipse

The American Academy of Opthamology (or AAO) said visual symptoms typically begin within few to six hours but some can experience them after 12 hours.

According to the AAO, these are the following symptoms of eye damage people can notice after starring at the sun:

• Blurry vision
• A blind spot in your central vision in one or both eyes
• Increased sensitivity to light
• Distorted vision such as a straight line appearing bent or a door jamb looking curvy
• Changes in the way you see color or dyschromatopsia

Contributing: Anthony Robledo, USA TODAY.