Spectacles in Fiji: need, acquisition, use and willingness to pay

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.

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.

Knowledge, attitude, practice and associated factors towards spectacles use among adults in Gondar town, northwest Ethiopia

Background

Refractive error is the main cause of visual impairment in the world. Spectacles are the most frequently used options for correcting refractive errors. In addition, they can be used for protection and fashion. It is the simplest, cheapest and only method used in developing countries like Ethiopia. This study aims to explore the knowledge, attitude, practice and associated factors towards spectacles use among adult population of Gondar town, northwest Ethiopia.

Methods

Community based cross sectional study was conducted on 780 participants using a pre-tested structured questionnaire in Gondar. Data were analyzed using Statistical Package for Social Sciences (SPSS) 20 version computer software. Association and strength between variables was determined using odds ratio with 95 % confidence interval.

Result

A total of 780 study subjects participated in this study. The male to female ratio was 1:2.4. The median age of the participants was 29 (±22 IQR) with a range of 18–86 years. About fifty percent of participants were married and 284 (36.4 %) were educated up to secondary school. Seven hundred and three (90.6 %) participants had adequate knowledge about spectacles and 90.4 % had favorable attitude towards spectacle use. About 25 % of the participants have been using spectacles during the study. Participants with primary school education (AOR: 2.79, 95 % CI 1.20–6.50) had good knowledge about spectacles. Housewives (AOR = 3.40, 95 % CI; 1.35–8.54) and participants who unable to read and write (AOR: 3.51, 95 % CI 14–10.72) had favorable attitude towards spectacles use.

Conclusion

Gondar town adult population has adequate knowledge and favorable attitude towards spectacles. However, practice of spectacles use is poor. Eye health education related to spectacles utilization need to be given due emphasis by eye care professionals in collaboration with University of Gondar and Gondar town administration.

Use of ready-made spectacles to meet visual needs in a low-resource adult population

PURPOSE

In affluent societies, distance and near vision problems are typically corrected with custom-made eyeglasses. Many persons in less affluent areas do not have the resources for such. The purpose of this study was to assess the use of less expensive ready-made (RM) bifocals and readers to correct distance and near refractive error and presbyopia in an outreach clinic in Nicaragua.

METHODS

This is a retrospective review of records of all patients older than 34 years who presented for an eye examination in an outreach clinic in Granada, Nicaragua, in 2010. A visual satisfaction questionnaire had been administered to patients before they were examined and after RM plus sphere bifocals or plus sphere reading spectacles were dispensed. The main outcome measures included pre- and post-distance and near visual acuities, vision satisfaction and difficulty ratings, and perceived cost and willingness to pay for replacement rating.

RESULTS

Ready-made plus sphere spectacles (bifocals or single-vision readers) were dispensed to 95.4% of those examined. The remaining 4.6% required custom prescriptions because of astigmatism, myopia, or anisometropia. The RM bifocals were very well accepted, with high visual satisfaction ratings with the bifocals improving from a presenting value of 11 to 89.4% at distance and from 6.6 to 89.4% at near. Percentage of patients achieving visual acuity of 20/40 or better improved from 60 to 84.5% at distance and from 44 to 97% at near. Percentage achieving functionally good near vision (20/40 or better) improved from 38 to 97% with RM readers. Patients reporting highest satisfaction with near vision improved from 6.3 to 86.6%. Patients indicated that, on average, they would be willing to pay US$18.39 to replace the bifocals and US$16.67 to replace the readers.

CONCLUSIONS

Ready-made bifocals and RM single-vision readers may be an acceptable and affordable alternative for many patients with hyperopia and/or presbyopia where access to custom-made eyeglasses is difficult.

Used glasses versus ready-made spectacles for the treatment of refractive error

BACKGROUND AND OBJECTIVE

To compare visual outcomes for used glasses versus ready-made spectacles in the treatment of refractive error.

PATIENTS AND METHODS

In this prospective, comparative case series, undilated refractive error screening examinations were conducted over a 5-week period. Patients with bilateral refractive error were treated with used glasses and ready-made spectacles powered to match their prescriptions. Snellen visual acuity was measured with no correction, best (manifest) correction, unrefined autorefraction, used glasses, and ready-made spectacles. Main outcome measurements were the mean visual improvement from uncorrected acuity and median final visual acuity after treatment with used and ready-made spectacles.

RESULTS

One hundred forty-one patients ages 18 and older with bilateral refractive error were examined. Uncorrected visual acuity in each eye improved an average of 4.5 lines with best correction, 4.0 lines with used glasses, and 3.5 lines with ready-made spectacles, with used glasses demonstrating a statistically significant advantage over ready-made spectacles (P < .001). The median visual acuity in the better eye improved from 20/60 uncorrected to 20/25 with all types of glasses. In patients with less than 1 diopter of anisometropia and greater than 1 diopter of astigmatism in each eye (49%), the ready-made spectacles performed equally as well as the used glasses (P = .95), improving vision an average of 3.9 lines for a median final visual acuity of 20/25 in the better eye.

CONCLUSION

Although both were effective, used glasses are better than ready-made spectacles for improving vision loss due to refractive error.

Treating uncorrected refractive error in adults in the developing world with autorefractors and ready-made spectacles

BACKGROUND

To evaluate a method for treating uncorrected refractive error in adults in the developing world.

DESIGN

Prospective, cross-sectional study in outpatient community health centres.

PARTICIPANTS

Eight hundred and forty subjects aged 18 and older from rural villages in Haiti and Belize.

METHODS

Undilated refractive error screening exams were conducted over a 5-day period in rural Haiti and Belize using portable autorefractors. Isometropic, spherical, ready-made spectacles were provided to patients with bilateral refractive error, astigmatism ≤ 1 dioptre in each eye and visual acuity worse than 6/9 in each eye. Visual acuity was measured with and without corrective spectacles.

MAIN OUTCOME MEASURES

  The mean visual improvement and median final visual acuity after treatment with ready-made glasses.

RESULTS

Eight hundred and forty patients aged 18 and older were screened with autorefractors. One hundred and eighty-nine subjects (22.5%) were found to have visually significant bilateral refractive error. Fifty-eight per cent (110/189) of these patients met criteria for treatment with ready-made spectacles. Visual acuity improved an average of 4.2 lines in the better eye and 4.1 lines in the worse eye with corrective glasses. The median visual acuity in the better eye was 6/6 after treatment.

CONCLUSION

Autorefractors and ready-made spectacles allow for effective treatment of uncorrected refractive error in adults in the developing world.