Willingness to Pay for Spectacle: An Outreach-Based Cross-sectional Study

BCLA CLEAR Presbyopia: Epidemiology and impact

The global all-ages prevalence of epidemiologically-measured 'functional' presbyopia was estimated at 24.9% in 2015, affecting 1.8 billion people. This prevalence was projected to stabilise at 24.1% in 2030 due to increasing myopia, but to affect more people (2.1 billion) due to population dynamics. Factors affecting the prevalence of presbyopia include age, geographic location, urban versus rural location, sex, and, to a lesser extent, socioeconomic status, literacy and education, health literacy and inequality. Risk factors for early onset of presbyopia included environmental factors, nutrition, near demands, refractive error, accommodative dysfunction, medications, certain health conditions and sleep. Presbyopia was found to impact on quality-of-life, in particular quality of vision, labour force participation, work productivity and financial burden, mental health, social wellbeing and physical health. Current understanding makes it clear that presbyopia is a very common age-related condition that has significant impacts on both patient-reported outcome measures and economics. However, there are complexities in defining presbyopia for epidemiological and impact studies. Standardisation of definitions will assist future synthesis, pattern analysis and sense-making between studies.

Clinical performance and Willingness To Pay for soft toric contact lenses in low and moderate astigmats

PURPOSE

To determine clinical performance and the 'Willingness To Pay' for toric vs. spherical soft contact lenses in an astigmatic population.

METHODS

In the clinical study, subjects with binocular low to moderate astigmatism (-0.75DC to -1.50DC) wore pairs of soft toric (Biofinity toric) and spherical (Biofinity) contact lenses in random sequence. Visual acuity (high and low contrast, monocular and binocular), subjective comfort and subjective vision were recorded. In the economics study, first subjects who had participated in the clinical study were presented with a series of randomised economic scenarios in order to determine their Willingness To Pay a premium (i.e. an increase) for toric lenses. Then, a similar set of scenarios were presented to a much larger group of online respondents and again, Willingness To Pay was established.

RESULTS

For the four measures of visual acuity, the Biofinity toric lens out-performed the Biofinity spherical lens by 0.6 to 1.1 lines.. Subjective vision performance was statistically significantly better with the toric lens for the distance task only. Comfort scores were not significantly different. Similar findings for Willingness To Pay were established for the clinical subjects and for the online respondents. The Willingness To Pay premium (additional fee) for a monthly supply of toric lenses (over spherical lenses) was between £13 and £16, if a toric lens provides better vision and similar comfort, as shown in the clinical study.

CONCLUSION

Consumers are willing to pay a monthly premium of around 50% to benefit from the typical experience of better vision and similar comfort for toric vs. spherical lenses. The level of additional cost for toric lenses compared to their spherical equivalents is less than this in the market, so eye care professionals should consider that toric lenses are delivering a greater clinical return than anticipated by wearers for the relatively small increase in price.

Factors Affecting Unmet Need for Presbyopia Correction Among School Teachers in Debre Tabor Town, Northwest Ethiopia

Background

Uncorrected presbyopia is the leading cause of near visual impairment among working-age adults in the world. In Ethiopia, there was limited evidence on the magnitude of uncorrected presbyopia and its associated factors among school teachers. Therefore, this study aimed to determine the magnitude of untreated presbyopia and its associated factors among school teachers in Debre Tabor town, Northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted on 448 school teachers at Debre Tabor town using a simple random sampling technique. The data were collected using a face-to-face interview and a comprehensive ocular examination. A binary multivariable logistic regression model was conducted to identify associated factors of the uncorrected presbyopia.

Results

Generally, the prevalence of uncorrected presbyopia among school teachers was 63.62% (95% CI: 59.2-67.9). Age (35-45) (AOR: 4.56, 95% CI: 1.74, 11.91), female gender (AOR: 3.03, 95% CI: 1.75, 5.26), unaware of presbyopia (AOR: 2.35, 95% CI: 1.30, 4.25), unaware of refraction site (AOR: 4.21, 95% CI: 2.42, 7.33), no eye checkup history (AOR: 2.76, 95% CI: 1.52, 5.01), and no family history of spectacle use (AOR: 2.61, 95% 4.67) were significantly associated with uncorrected presbyopia.

Conclusion

In the current study, the magnitude of uncorrected presbyopia was high. Age below 45 years, female gender, lack of awareness of presbyopia and refraction site, lack of history of eye checkups, and family spectacle use were significantly associated with uncorrected presbyopia. The early correction of presbyopia, health education on presbyopia, and the provision of affordable spectacle corrections for school teachers were recommended.

Caretakers' stated willingness to pay for children's spectacles in cross river state, Nigeria and its implication for a cross-subsidisation scheme: a cross-sectional study

BACKGROUND

Understanding caretakers' willingness to pay (WTP) for their children's spectacles is essential to improving the sustainability of refractive error services and spectacle provision. Therefore, we investigated the willingness of caretakers to pay for their children's spectacles in a multi-centre study to develop a spectacle cross-subsidisation scheme in the Cross River State (CRS), Nigeria.

METHODS

We administered the questionnaire to all caretakers whose children were referred from school vision screenings to four eye centres for full refraction assessment and dispensing of corrective spectacles from 9 August to 31 October 2019. We collected information on socio-demography, children's refractive error types, and spectacle prescription and then asked the caretakers about their WTP for the spectacles using a structured questionnaire and bidding format (in the local currency, Naira, ₦).

RESULTS

A total of 137 respondents (response rate = 100%) from four centres were interviewed: with greater proportion of women (n = 92, 67.1%), aged between 41 and 50 years (n = 59, 43.1%), government employees (n = 64, 46.7%) and had acquired college or university education (n = 77, 56.2%). Of the 137 spectacles dispensed to their children, 74 (54.0%) had myopia or myopic astigmatism (equal to or greater than 0.50D). The mean stated WTP for the sample population was ₦3,560 (US$ 8.9) (SD ± ₦1,913.4). Men (p = 0.039), those with higher education (p < 0.001), higher monthly incomes (p = 0.042), and government employees (p = 0.001) were more willing to pay ₦3,600 (US$9.0) or more.

CONCLUSION

Combining our previous findings from marketing analysis, these findings provided a basis to plan for a children's spectacles cross-subsidisation scheme in CRS. Further research will be needed to determine the acceptability of the scheme and the actual WTP.

Potential productivity loss from uncorrected and under-corrected presbyopia in low- and middle-income countries: A life table modeling study

Objective

To estimate the burden of potential productivity losses due to uncorrected and under-corrected presbyopia in LMICs among the working-age population in both the cross-sectional and longitudinal manner.

Methods

We extracted data for the prevalence of presbyopia from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019. Data for the gross domestic product (GDP) per capita were extracted from the World Bank database and Central Intelligence Agency's World Factbook. We introduced life table models to construct age cohorts (in 5-year age groups) of the working-age population (aged from 40 to 64 years old) in LMICs, with simulated follow-up until 65 years old in people with and without uncorrected presbyopia. The differences in productivity-adjusted life years (PALYs) lived and productivity between these two cohorts were calculated. The potential productivity loss was estimated based on GDP per capita. The WHO standard 3% annual discount rate was applied to all years of life and PALYs lived.

Results

In 2019, there were 238.40 million (95% confidence interval [CI]: 150.92-346.78 million) uncorrected and under-corrected presbyopia cases in LMICs, resulting in 54.13 billion (current US dollars) (95% confidence interval [CI]: 34.34-79.02 billion) potential productivity losses. With simulated follow-up until retirement, those with uncorrected and under-corrected presbyopia were predicted to experience an additional loss of 155 million PALYs (an average loss of 0.7 PALYs per case), which was equivalent to a total loss of US$ 315 billion (an average loss of US$ 1453.72 per person).

Conclusions

Our findings highlight the considerable productivity losses due to uncorrected and under-corrected presbyopia in LMICs, especially in a longitudinal manner. There is a great need for the development of enabling eye care policies and programs to create access to eye care services, and more healthcare investment in the correction of presbyopia in the working-age population in LMICs. This study could provide evidences for some potential health-related strategies for socio-economic development.

Parents' willingness to pay for children's spectacles in Cambodia

Background/aim

To determine willingness to pay for children's spectacles, and barriers to purchasing children's spectacles in Cambodia.

Methods

We conducted vision screenings, and eye examinations as indicated, for all consenting children at 21 randomly selected secondary schools. We invited parents/guardians of children found to have refractive problems to complete a willingness to pay for spectacles survey, using a binary-with-follow-up technique.

Results

We conducted vision screenings on 12 128 secondary schoolchildren, and willingness to pay for spectacles surveys with 491 parents/guardians (n=491) from Kandal and Phnom Penh provinces in Cambodia. We found 519 children with refractive error, 7 who had pre-existing spectacles and 14 recommended spectacles for lower ametropias. About half (53.2%; 95% CI 44.0% to 62.1%) of parents/guardians were willing to pay KHR70 000 (US$17.5; average market price) or more for spectacles. Mean willingness-to-pay price was KHR74 595 (US$18.6; 95% CI KHR64 505 to 86 262; 95% CI US$16.1 to US$21.6) in Phnom Penh and KHR55 651 (US$13.9; 95% CI KHR48 021 to 64 494; 95% CI US$12.0 to US$16.1) in Kandal province. Logistic regression suggested parents/guardians with college education (OR 6.8; p<0.001), higher household incomes (OR 8.0; p=0.006) and those wearing spectacles (OR 2.2; p=0.01) were more likely to be willing to pay ≥US$17.5. The most common reasons for being unwilling to pay US$17.5 were related to cost (58.8%). The most common barrier to spectacle wear was fear that spectacles weaken children's eyes (36.0%).

Conclusions

With almost half of parents/guardians unwilling to pay for spectacles at the current average market price, financial support through a subsidised spectacle scheme might be required for children to access spectacles in Cambodia.

Near Vision Spectacle Coverage and Associated Factors Among Adults Living in Finote Selam Town, Northwest Ethiopia: Community-Based Cross-Sectional Study

Background

Near visual impairment leads to difficulty with near tasks at a working distance (40 centimeters) when near visual acuity is 6/12 (N8) or worse. High cost is the main barrier reported for low near vision spectacle coverage.

Objective

This study aimed to determine near vision spectacle coverage and associated factors among adults living in Finote Selam town, Northwest Ethiopia.

Methods

A community-based, cross-sectional study was applied from June 3 to 25, 2019. A total of 565 study participants aged ≥35 years were recruited using a systematic random sampling technique. A pre-tested questionnaire with adequate physical examination was used for data collection. The data were entered into EPI INFO software and exported to a statistical package for science for analysis. Mean (standard), frequencies, tables, and figures were used to present descriptive statistics. A bi-variable and multivariable logistic regression was used to determine the association between independent variables and outcome variable with a P-value of less than 0.20 and a P-value of less than 0.05, respectively. Odds ratios and a 95% confidence interval were used to show strength of association.

Results

A total of 549 adults participated, with a response rate of 97.20% and a mean age of 46.4±8.7 years. The near vision spectacle coverage was 156 (28.42%; 95% CI=24.65-32.31). Higher education level (AOR=2.8; 95% CI=1.21-5.21), history of eye examination (AOR=2.40; 95% CI=1.51-3.81), awareness about near vision problems (AOR=2.12; 95% CI=1.41-3.24), and need of a high plus lens (AOR=4.21; 95% CI=2.41-7.39) were associated with near vision spectacle coverage.

Conclusion

Near vision spectacle coverage was low among adults living in Finote Selam town. Higher educational level, history of eye examination, awareness about near vision problems, and need of a high plus lens were associated with near vision spectacle coverage.