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Arjun Jayantakumar Dirghangi, Brian K Lee, Amanda Allan, Krish Gandhi, Amanda Y Lehman; Stakeholder Perceptions and Practices Regarding the Ocular Effects of Hyperbaric Oxygen Therapy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5573.
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The purpose of this study is to determine the perceptions and practices of practitioners of hyperbaric oxygen therapy (HBOT) regarding its ocular effects. HBOT is a commonly used therapy with many indications (most commonly used for non-healing diabetic ulcers and burn injuries), but a highly limited evidence base regarding ocular risks and benefits. Patients receiving HBOT are referred to ophthalmologists to "clear" them prior to therapy based upon theoretical risks of oxidative stress; this incurs a significant burden upon the health system, with unclear benefits and clinical follow-up.
This study uses a combination of quantitative and qualitative research methods, primarily relying upon quantitative KAP (knowledge, attitudes, and practices) survey techniques administered to physicians and technicians evaluating and treating patients for HBOT (general surgeons, radiation oncologists, and ophthalmologists) in an urban academic teaching hospital. Additionally, focus group discussions (FGDs) were held with smaller groups, including HBOT patients, to collect complementary qualitative data. Finally, a retrospective chart review was conducted of all patients consulted for ophthalmic evaluation prior to initiation of HBOT over the past two years.
The knowledge base of surveyed practitioners was variable. Though 69% of respondents stated ophthalmic clearance was necessary prior to initiation of HBOT, 63% of respondents had only some or no knowledge of why such clearance was needed. Additionally, of those who felt clearance was necessary, none were able to correctly identify a contraindication to therapy without prompting. A significant percentage misidentified glaucoma (43%) and macular degeneration (14%) as contraindications to therapy. 60% felt HBOT causes either short- or long-term harm to the eye. Finally, an extremely low (2%) rate of outpatient follow-up of HBOT patients was found for subsequent ophthalmic evaluation.
The current study reveals practice patterns instructive to relevant practitioners involved with this common treatment. Gaps in knowledge identified in our study regarding HBOT's effects upon the eye present targets for intervention, as well as a low rate of outpatient follow-up examinations, and will inform a prospective study of the direct ocular effects of HBOT, and an evidence-based protocol regarding ophthalmic evaluation of these patients.
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