The situation of low vision services in Papua New Guinea: an exploratory study

Barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa within a global context

Low vision is an uncorrectable form of visual impairment that affect millions of people worldwide. Low vision care and rehabilitation are essential to improving the independence of affected individuals. Even though sub-Saharan Africa has one of the highest burdens of low vision globally, there are inadequate care and rehabilitation services in most countries and in some cases they are non-existent This scoping review aimed to identify the barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa and assess these within the global context. The review was conducted using the five-step Arksey and O'Malley framework. Search terms were formulated based on the research questions and a search strategy was designed to search for eligible research articles from electronic databases; Pubmed, Ovid, Medline, and Embase. The data was screened by two members of the research team in accordance with set inclusion and exclusion criteria. Twenty-five out of 260 articles satisfied the inclusion criteria for the study. Inadequate low vision care infrastructure and supplies, non-standardised training of low vision care providers, health system failure and poor awareness of low vision care were the main barriers noted by eye care practitioners. Patients living with low vision cited the cost and availability of low vision aids, societal stigma, and poor awareness of services as the main barriers. No direct enablers were identified in sub-Saharan Africa; however, practitioners suggested improved training in low vision as a potential enabler. The barriers to low vision care and rehabilitation services identified were not unique to sub-Saharan Africa when viewed within a global context. Adopting and adapting solutions from other countries may therefore assist in improving low vision care and rehabilitation in sub-Saharan Africa.

Barriers to Low-Vision Rehabilitation Services for Visually Impaired Patients in a Multidisciplinary Ophthalmology Outpatient Practice

Low-vision rehabilitation (LVR) has significant benefit in improving the quality of life of visually impaired patients. However, these services are highly underutilized in ophthalmology practices. A quality improvement study was performed to investigate barriers to LVR services for patients at the University of Texas Medical Branch (UTMB) between 2010 and 2020. Low vision was defined as the best corrected visual acuity of 20/70 or worse in the better-seeing eye or a visual field less than 20 degrees. Potential subjects were screened (n = 577) from the electronic medical record using International Classification of Disease (ICD) codes for legal blindness, impaired vision, and low vision. Chart review identified 190 subjects who met criteria for low-vision analysis. Patients who received LVR referrals to attend at least one LVR service visit from the eligible subjects were contacted for participation in phone interviews regarding their LVR experience. Practicing eye care providers (ECPs) at UTMB completed a questionnaire to capture their referral patterns. Of the eligible subjects, 64% were referred to LVR services by ECPs. Reported patient barriers included mental health issues (76%), denial of need for low-vision aid (71%), poor physical health (67%), lack of transportation (57.1%), and lack of referrals (36%). EPCs reported patient's overall health (67%), older age (44%), lack of social support (44%), poor cognitive function (44%), and low likelihood of follow-up (44%) as barriers to referring patients to LVR. This study identified several modifiable barriers that can be addressed to access LVR services for low-vision patients. Changing referral patterns, eliminating variations in referral criteria, and increasing patient awareness and knowledge of LVR resources may tremendously improve the quality of life of low-vision patients.

Human Anatomy: Teaching-Learning Experience of a Support Teacher and a Student with Low Vision and Blindness

In Brazil, a federal law ensures that all students with disabilities are entitled to enrollment in higher education institutions. Higher courses in human anatomy stand out for their complexity in both theoretical and practical contents. Therefore, adaptation is required to accommodate students with special educational needs. This study aimed to describe the experience of a Support Teacher in the development of inclusive pedagogical practices for the discipline of Human Anatomy offered in the physiotherapy course for a student with low vision and blindness. The challenges and learning difficulties faced by a visually impaired student are reported. Qualitative analysis was performed by interviewing a student with low vision and blindness and a Support Teacher. The audio recordings were transcribed, categorized, and analyzed using content analysis. The Support Teacher created schematics and drawings of anatomical structures, reviewed theoretical and practical contents, developed adaptations of the examinations, and applied palpatory anatomy to facilitate the student's learning process. The findings illustrate that the student faced the greatest difficulty in dealing with the emotional aspects, due to the inability to visualize the anatomical details in human cadavers. Thus, the presence of a Support Teacher was fundamental to ensure that the student could learn the content and overcome this limitation. In conclusion, personalized adaptation, commitment, and collaborative work between the Support Teacher and students with low vision and blindness improve their learning conditions.

Factors Influencing Disability Inclusion in General Eye Health Services in Bandung, Indonesia: A Qualitative Study

The Inclusive System for Effective Eye-care (I-SEE) is a pilot project for disability inclusion in eye health in Bandung district of Indonesia. The aim of this research was to investigate factors influencing the introduction, i.e., adoption, implementation and continuation of I-SEE. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 27) and users with disabilities (n = 12). A theoretical framework on the introduction of innovations in health care was used to guide data collection and thematic analysis. Factors related to the characteristics of the innovation (I-SEE) (e.g., infrastructure, equipment, engagement of people with disabilities, inclusive communication), service provider characteristics (e.g., motivation, attitudes, training), organizational characteristics (e.g., supervision, indicators, data), and the socio-political context of I-SEE (policy, motivation of users, family support, costs, transport) were essential for supporting the introduction process. Additionally, stakeholders proposed strategies for enhancing the introduction of I-SEE (e.g., awareness, collaborations). While there are specific disability related factors, most factors influencing the introduction of disability inclusive eye health were similar to introducing any innovation in general health care. Strategies for disability inclusion should be included from the planning phase of an eye health program and are reasonably simple to adapt.

Systematic Review of Community-Engaged Research in Ophthalmology

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.