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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Subjective Verification of Refraction- A Quality Indicator: A Cross-sectional Study
Correspondence Address :
Dr. MC Chaitra,
#109, HSR Grand Apartment, Doddabanaswadi Main Road, Banaswadi, Bangalore-560043, Karnataka, India.
E-mail: drchaitramc@gmail.com
Introduction: Subjective refraction helps in establishing the suitable lens for a patient. But it also needs a patient’s cooperation for the proper estimation of the refractive error. Subjective refraction determines the combination of lenses to attain the best corrected visual acuity. The examination is conducted by orthoptists, optometrists and ophthalmologists. The advantages of subjective refraction are that it can be performed even in absence of special equipment and good pupillary reflex.
Aim: To determine the impact of counselling of Optometrists on subjective refraction and spectacle prescription to patients attending Ophthalmology Outpatient Department (OPD) at their first visit.
Materials and Methods: This was a cross-sectional study conducted for a period of two months from June 2020 to July 2020. All patients attending the OPD of Ophthalmology at R L Jalappa Hospital and Research Centre, Tamaka, Karnataka, India, were included in the study. A total of 120 patients, whose vision was <6/9, were included in each group. Group A, before counselling the Optometrists and group B, after counselling the Optometrists by systemic random sampling method. The number of patients who required spectacle correction and those who were given spectacle prescriptions at their first visit were identified. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 22.0.
Results: A total of 240 patients were included in the study, out of which 126 patients were females and 114 patients were males. The patients were divided into two groups, group A and B (120 patients in each group). In group A, out of 120 patients only 62 patients (51.7%), had undergone subjective refraction along with spectacle prescription at their first visit. In group B, (88.3%) 106 patients out of 120, underwent subjective refraction and spectacle correction was given on their first visit.
Conclusion: The present study shows a clear positive impact of counselling to Optometrists and the importance of counselling in achieving patient’s satisfaction.
Counselling, Optometrist, Patient satisfaction, Spectacle prescription, Vision
Eyesight is one of the most important special senses. Sight and vision help to connect people with their surroundings, learn things, etc. Best corrected visual acuity is must for a better quality of life (1). Refractive errors are present in nearly half of all the children and adults (2). In the recent years, patients expectations with respect to healthcare provision have changed significantly (3). Subjective refraction determines the combination of lenses to attain the best corrected visual acuity. The examination is conducted by orthoptists, optometrists and ophthalmologists. The advantages of subjective refraction are that it can be performed even in absence of special equipment and good pupillary reflex, for verifying objective refraction values and spectacle prescription can be prescribed at first visit. Only in certain cases as in hypermetropes, with excessive accommodation cycloplegic refraction is done, where spectacle prescription is not given in the same visit. In cases of uncontrolled diabetes mellitus also, spectacle prescription is not recommended until blood sugar is under control. Optometrists or any other healthcare providers must explain procedures that can be employed to enhance the overall patient experience, patient’s satisfaction, a regular review of office procedures and the development of alternative ideas (3). Waiting time helps in determining the quality of care and the resultant patient satisfaction (4).
Patients evaluation of care enhances strategic decision-making, reduce cost, meet patients’ expectations, frame strategies for effective management, monitor performance of health plans and provide benchmarking across healthcare institutions (5).
To the best of the authors knowledge the present study was the first study which was conducted on patient’s opinion/suggestion in order to improve patient satisfaction and improve the quality of life of the patient by decreasing the unnecessary revisits to the hospital. For this study, the participant Optometrists were counselled to make patient understand that every patient with less vision (<6/9 vision) should undergo subjective refraction and spectacle prescription needs to be given at their first visit. If not done, the uncorrected refractive error is associated with decreased vision related quality of life. High myopia is a predisposing factor for retinal detachment, myopic retinopathy, myopic maculopathy, and glaucoma (6). Hence, the present study aimed to determine the impact of counselling of Optometrists on subjective refraction and spectacle prescription to the patients attending OPD of Ophthalmology at their first visit.
The cross-sectional study was conducted in Ophthalmology OPD at RL Jalappa Hospital and Research Centre, attached to Sri Devaraj Urs Academy of Higher Education and Research, Karnataka, India, from June 2020 to July 2020. The study was conducted after obtaining the Ethical clearance from the Institutional Ethics Committee (IEC) (NoSDUMC/KLR/IEC/446/2020-21dated 30/02/2020).
Inclusion criteria: All patients aged above 10 years and who had vision <6/9 were included in the study.
Exclusion criteria: Difficult retinoscopy (children <10 years), ocular media opacity, small pupil, corneal ectatic conditions, mentally challenged patients were excluded from the study.
Study Procedure
There were 240 patients, divided into two group (considering 10 patients per OPD a total of 120 patients were included in each group). This study was conducted in two phases. In phase I, group A (120 patients) was studied. In phase II, the Optometrists were first counselled regarding the need for subjective correction and spectacle prescription for every patient in their first visit, wherever possible, so as to avoid unnecessary revisits to the hospitals for spectacle prescription, and then the study was conducted among group B patients (120 patients). The Optometry students included in the study were same in both the phases. (Phase I is before counselling the Optometrists and Phase II is after counselling the Optometrists).
As soon as the patient entered the Ophthalmology OPD, the patient’s demographic details and medical history were noted. Then the patients were subjected to visual assessment (distant vision by using Snellen’s chart and near vision by Jagger’s chart) and refraction by the Optometrist. Those patient who fit the inclusion criteria, were selected by systematic random sampling method (chit system). The subsequent patients were chosen by addition of three to the first chit number as per the systemic random sampling methodology. Informed consent was obtained from the patient. Patients were then subjected to a comprehensive eye examination of the anterior segment, by using slit lamp and posterior segment of eye/fundus by slit lamp biomicroscopy using 90 D lens or indirect ophthalmoscopy.
Statistical Analysis
The data obtained were entered in Microsoft excel and analysed using SPSS version 22.0. The statistical analysis was performed in terms of descriptive statistics (proportions and means).
A total of 240 patients were included in the study, out of which 126 patients were females and 114 patients were males (Table/Fig 1).
Irrespective of the chief complaint of patient, the Optometrist had to check vision and if vision was less than 6/9, both objective and subjective refraction was done along with spectacle prescription for best corrected visual acuity in their first visit. This method was followed among 62 patients, out of 120 patients in group A (Table/Fig 2) In the remaining 58 patients, though there was decreased vision noted, Optometrist did not give subjective refraction and spectacle prescription in their first visit. Among them, 12 patients were deferred due to co-morbidity (seven had uncontrolled diabetes mellitus, three had cataract, two had age-related macular degeneration). If the visit was for fundoscopy, (n=16) patient were dilated after checking vision without giving correction, and for those patients (n=30) who came for anterior segment diseases medical treatment was given (Table/Fig 3).
In phase II, after counselling the Optometrists the number of patients who received spectacle prescription in their first visit were higher (106/120) in group B. Due to the presence of uncontrolled diabetes mellitus (n=11) and unwillingness for refraction (n=3), 14 patients were deferred (Table/Fig 4).
In Phase I of the present study only 51.7% patients were given spectacle correction at their first visit but in Phase II, after counselling the Optometrists regarding the importance of subjective refraction and spectacle prescription at the patient’s first visit, the percentage of patient’s who received correction increased to 88.3%. The present study showed a positive impact of counselling the Optometrists, improving the patients satisfaction by avoiding unnecessary revisits to the hospital and most importantly corrected the refractive errors to improve the quality of life with best corrected visual acuity and also to prevent complications of uncorrected refractive errors.
Of 11.7% patients in group B who were deferred, uncontrolled diabetes mellitus were present in 11 of them. Their fluctuating blood sugar levels can alter the refractive power of the eye. Hence, these patient’s vision has to be corrected after the blood sugars are undercontrol. Three patients who refused correction, had asthenopic symptoms, discomfort with defective vision, which were associated with decreased quality of life.
Subjective refraction is considered the gold standard of refraction (7). It is based on comparing different lenses (i.e., spherical and cylindrical lenses) and measuring changes in visual acuity to arrive at the lens combination that maximises it. It is dependent on the patient’s responses to improvement or no improvement with different lenses. In this study subjective refraction was performed to give correction to patients, for improving their quality of life.
In phase I among group A, 58 patients deferred spectacle prescription in their first visit. Out of which 46 patients (16 dilated for fundoscopy and 30 missed) could have been given spectacle correction at their first visit itself, avoiding revisits to the hospitals and thereby improving the patient satisfaction. Similarly in this study, group B patients were studied in Phase II after counselling the Optometrist which improved the percentage of refraction and spectacle prescription among the patients, indeed improving the quality of life, reducing revisits and increasing patient satisfaction.
A study by Sun J et al., (8) showed a reducing effect on waiting time for filling prescriptions because of carefully designed continuous efforts, rather than a one-time campaign. Similarly, in the present study, there was a significant improvement in the percentage of patient’s refraction done in the first visit after intervention in Phase II.
This emphasises on continuous efforts to reinforce the importance of adherence to the standard quality checklist at the department level. Subjective verification of refraction is an indicator of quality of life. A study by Aeenparast A et al., (9) suggested a simulation model approach to reduce the out patient waiting time. Sundresh NJ and Nagmothe RV (10) studied the determinants of long waiting period in OPD and recommendations were given on reducing the waiting period in a tertiary hospital. In all these studies, the barriers were identified and aimed to improve patient satisfaction.
A comparative study of refractive assessment by Bennett JR et al., (11) showed a good co-relation between wavefront abberometer, subjective refraction and automated refractometer. Another study suggested that non cycloplegic refraction and subjective refraction are clinically accurate (12).
Limitation(s)
The patient satisfaction feedback was not taken.
The present study showed that counselling of Optometrists regarding the importance of correcting an individual’s vision by performing subjective refraction, not only improves the quality of life but also prevents the complications of refractive errors if left untreated. Optometrists play an important role in eliminating visual impairment and avoidable blindness along with Ophthalmologists. Hence, an adequate standardised and regulated training of Optometrists is essential.
DOI: 10.7860/JCDR/2023/58416.17989
Date of Submission: Jun 14, 2022
Date of Peer Review: Aug 27, 2022
Date of Acceptance: Nov 07, 2022
Date of Publishing: Jun 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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