Patient Perspectives on Acquiring Spectacles: A Cambodian Experience

Quality of Refractive Error Care in Cambodia: An Unannounced Standardized Patient Study

PURPOSE

Quality-of-care in refractive error services is essential, as it directly affects vision outcomes, wellbeing, educational attainment, and workforce participation. In Cambodia, uncorrected refractive error is a leading cause of mild and moderate vision impairment in adults. We evaluated the quality of refractive error care in Cambodia by estimating the proportion of prescribed and dispensed spectacles appropriate for people's refractive error needs and factors associated with spectacle quality.

METHODS

A cross-sectional protocol was employed with 18 Khmer-speaking adult participants observing testing procedures in 156 optical services across six provinces in 2022. A total of 496 dispensed spectacles were assessed against spectacle quality indicators.

RESULTS

The analysis revealed that 35.1% of dispensed spectacles were of optimal quality. The most common error observed in sub-optimal spectacles was the presence of horizontal prism outside of tolerance limits. The study also found that 44.0% of emmetrope visits involved unnecessary prescription spectacle recommendations, and 18.3% of written prescriptions did not correspond with dispensed spectacles. Sex differences were observed, with men predominantly providing refractive error care and women more likely to be unnecessarily recommended prescription spectacles.

CONCLUSION

The findings highlight the importance of prioritizing quality-of-care in refractive error services. A key recommendation is to consider regulatory mechanisms to ensure optical services employ appropriately qualified staff. Additionally, efforts should be made to eliminate unnecessary prescriptions -- especially for emmetropes and females -- standardize written prescriptions, ensure consistent pupil distance measurements, reduce reliance on autorefraction, and address the gender imbalance in the refractive error workforce.

Barriers to the Utilization of Low-Vision Rehabilitation Services among Over-50-Year-Old People in East and Southeast Asian Regions: A Scoping Review

East and Southeast Asia (ESEA) are facing age-related eye health issues. Low-vision rehabilitation (LVR), which is a special rehabilitation service for individuals with vision impairment, is a promising solution for these health issues; however, poor accessibility to LVR services has been reported globally, including ESEA. Therefore, this scoping review aimed to summarize and understand the barriers to accessing LVR services in ESEA. In total, 20 articles were ultimately considered eligible for this scoping review after an electronic database search using MEDLINE (PubMed), Web of Science, Academic Search Ultimate (EBSCO), and Ichushi-Web (Japanese medical literature database), and an independent review by two reviewers. Twenty-one potential barrier factors were identified in the full-text review. Notably, age, education, economic status, "previous experience using eye care service", and "knowledge, information, and awareness" were the possible barrier factors that were examined for their association with LVR utilization, with supportive evidence in many eligible studies. We also identified research gaps relating to geographical and ethnic diversity, the scope of LVR services, and barriers among eligible articles. Therefore, by conducting further studies addressing the research gaps identified in this scoping review, these findings can be used to make LVR services more accessible to people in ESEA.

Validating a tool to assess eye health knowledge, attitude and practice in Cambodia and Vietnam

AIM

To develop an eye health knowledge, attitude and practice (EH-KAP) field-based assessment tool for use in implementing effective eye health care services.

METHODS

An instrument development and validation study. A Vietnam EH-KAP dataset were used to identify and eliminate redundant questions to develop a standardized tool. Face validity was assessed by the KAP survey team. Internal validity (congruency/criterion) was assessed by comparing descriptive analysis of two datasets (n=531; n=38) collected from the same sampling frame at different time points. Weighted scores were calculated for each construct. Kappa values for test-retest and inter-observer agreement were calculated to check the reliability of responses. The modified version was assessed by analysing the raw and ungrouped data. Responses were weighted and agreement was tested by comparing construct scores.

RESULTS

Totally 38 respondents were included in this validation process (mean age 58.5y). Mean scores for knowledge were 9.15 (old questionnaire n=531) and 5.05 (modified version). For attitude, the scores were 2.23 and 2.42, and for practice the scores were 3.33 and 2.21. Test-retest agreement was between 62% to 93% (Kappa 0.24 to 0.86) for the ungrouped raw data, and 55% to 72% (Kappa 0.42 to 0.65) for KAP domain. Inter-observer Kappa value for ungrouped data was 0.37 and 0.45 for the weighted scores.

CONCLUSION

This standardized tool applied at critical time points can assess trends in KAP within the same population and for comparison across groups. If used alongside a Rapid Assessment of Avoidable Blindness (RAAB), this tool provides a comprehensive perspective on eye-health of a population.

Formative research for the development of an Eye Health Strategic Planning and Evaluation Framework and a Checklist: A health systems approach

This formative research process aimed to develop an Eye Health Strategic Planning and Evaluation Framework and indicator Checklist. The research process utilized a multi-phased multiple methods approach including literature review, initial expert review (n = 27), findings from a Cambodian Avoidable Blindness Initiative demonstration project (2009-2012), observation and analysis of four rural sites of the Indian LV Prasad Eye Institute Pyramid Model (n = 21), and finally, a critique by Cambodian government eye health professionals/staff (n = 15), health center staff and community representatives (n = 77) and patients (n = 62). Results from three Cambodian population-based surveys (KAP n = 599, patient follow-up n = 354, and RAAB 4650) also informed the development of the Framework and the Checklist. The Framework domains include: situation analysis, determinants of accessibility, service delivery systems, operation systems, networks and linkages, outcomes, and impact. Domains were subdivided into 59 components. The Checklist consists of 253 indicator items. The Eye Health Strategic Planning and Evaluation Framework and the Checklist can assist policy makers, program planners, and evaluators to develop a comprehensive whole of systems approach to eye health care to improve coverage and utilization of services.