1
|
Marmamula S, Saha R, Khanna RC. Effective Cataract Surgical Coverage in Four Large Districts in Telangana, India - Results from Rapid Assessment of Visual Impairment Study. Ophthalmic Epidemiol 2024:1-7. [PMID: 38569085 DOI: 10.1080/09286586.2024.2336498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To report cataract surgical coverage (CSC) and effective Cataract Surgical Coverage (eCSC) from four districts in Telangana, India. METHODS Individuals aged ≥40 years were recruited from Adilabad, Mahbubnagar, Warangal and Khammam districts using two stage cluster sampling methodology. All participants had detailed eye examinations including visual acuity assessment using a standard Snellen chart at a distance of six meters, anterior segment examination and fundus imaging by trained professionals. CSC and eCSC were calculated for persons using a 6/12 visual acuity cut-off. RESULTS Of 12,150 individuals enumerated from four districts 11,238 (92.5%) were examined. The mean (standard deviation) age of the participants was 54.1 (±11.2) years (range: 40 to 102 years) and 54.6% (n = 6137) were women. Overall, the CSC (%) was 54.2%. It ranged from a highest of 59% in Khammam followed by 57.5% in Adilabad, 51.7% in Warangal, and a least of 49.7% in Mahbubnagar district. Overall, the eCSC (%) was 39.9%. It ranged from a highest of 46.1% in Adilabad followed by 43.2% in Khammam, 36.2% in Warangal district and a least of 35.8% in the Mahbubnagar district. CONCLUSIONS CSC and eCSC varied across the districts. A significant gap between CSC and eCSC is noted suggestive of challenges with quality of services. District-wise planning of cataract surgical services with a focus on quality care is recommended to improve coverage and contribute towards achieving the goal of universal eye health coverage in the Telangana State in India.
Collapse
Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Ranindita Saha
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Sandi F, Mercer G, Geneau R, Bassett K, Bintabara D, Kalolo A. Alternative community-led intervention to improve uptake of cataract surgery services in rural Tanzania-The Dodoma Community Cataract Acceptance Trial (DoCCAT): a protocol for intervention co-designing and implementation in a cluster-randomized controlled trial. Biol Methods Protoc 2024; 9:bpae016. [PMID: 38566775 PMCID: PMC10987207 DOI: 10.1093/biomethods/bpae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Age-related lens opacification (cataract) remains the leading cause of visual impairment and blindness worldwide. In low- and middle-income countries, utilization of cataract surgical services is often limited despite community-based outreach programmes. Community-led research, whereby researchers and community members collaboratively co-design intervention is an approach that ensures the interventions are locally relevant and that their implementation is feasible and socially accepted in the targeted contexts. Community-led interventions have the potential to increase cataract surgery uptake if done appropriately. In this study, once the intervention is co-designed it will be implemented through a cluster-randomized controlled trial (cRCT) with ward as a unit of randomization. This study will utilise both the qualitative methods for co-designing the intervention and the quantitative methods for effective assessment of the developed community-led intervention through a cRCT in 80 rural wards of Dodoma region, Tanzania (40 Intervention). The 'intervention package' will be developed through participatory community meetings and ongoing evaluation and modification of the intervention based on its impact on service utilization. Leask's four stages of intervention co-creation will guide the development within Rifkin's CHOICE framework. The primary outcomes are two: the number of patients attending eye disease screening camps, and the number of patients accepting cataract surgery. NVivo version 12 will be used for qualitative data analysis and Stata version 12 for quantitative data. Independent and paired t-tests will be performed to make comparisons between and within groups. P-values less than 0.05 will be considered statistically significant.
Collapse
Affiliation(s)
- Frank Sandi
- Department of Ophthalmology, The University of Dodoma Medical School, Dodoma, Tanzania
| | - Gareth Mercer
- Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada
| | - Robert Geneau
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Kenneth Bassett
- Department of Ophthalmology, The University of British Columbia, Vancouver, Canada
| | - Deogratius Bintabara
- Department of Community Medicine, The University of Dodoma Medical School, Dodoma, Tanzania
| | - Albino Kalolo
- Department of Public Health, St Francis University College of Health and Allied Sciences, Morogoro, Tanzania
| |
Collapse
|
3
|
Kafeel S, Fawwad A, Basit A, Nawab SN. Clinical Association of Biochemical Variations Among Multilocus Genotypes of Antioxidant Enzymes with Susceptibility of Cataract in Hyperglycemia. Appl Biochem Biotechnol 2022; 194:3871-3889. [PMID: 35556207 DOI: 10.1007/s12010-022-03957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
Hyperglycemia plays a pronounced role in accelerating the process of aging due to high oxidative stress which triggers dyslipidemia and subsequently led to the progression of cataract. The aim of this study was to investigate lipid profile and its relationship with genotypes of SOD1, GPX1, and CAT variants in cataract patients. Total n = 680 samples were screened in four groups: senile cataract (SC), diabetic cataract (DC), type 2 diabetes mellitus (DM), and controls (CL). Lipid profile was estimated and compared between groups, and its correlation was tested with glycemic markers. Association of SOD1 50 bp Indel, GPX1 (rs1800668), and CAT (rs1001179) genotypes with all clinical variables was investigated in cataract groups by regression statistics in SPSS® 16.0. Comparative analysis revealed that amount of total cholesterol and low-density lipoprotein parameters were significantly higher in both groups of cataracts when compared with controls (p < 0.01). Statistically higher levels of triglycerides were also evident in DM patients as compared with other three groups (p < 0.01). Significant weak positive correlation of glycated hemoglobin, fasting (FBG), and random blood glucose (RBG) levels was observed with triglycerides in DM (r = 0.16), SC (r = 0.15), and DC (r = 0.18) groups. Mutant genotype of SOD1 and CAT variants indicated significant association with TC, whereas GPX1 variant with FBG levels in accelerating predisposition of cataract in patients with diabetes (OR > 1.0). Outcomes suggested that TG may serve as a potential biomarker of lipid profile with manifestation of cataract in type 2 DM. Furthermore, hypercholesterolemia and hypertriglyceridemia demonstrated an inducing role in the pathogenesis of cataract with aging in hyperglycemia.
Collapse
Affiliation(s)
- Sanober Kafeel
- Ziauddin University, Faculty of Engineering, Science, Technology and Management (ZUFESTM), Department of Biomedical Engineering, Block B, North Nazimabad, Karachi, F-10374600, Pakistan.,The Karachi Institute of Biotechnology and Genetic Engineering (KIBGE), University of Karachi, Main University Rd, Karachi, 75270, Pakistan
| | - Asher Fawwad
- Baqai Institute of Diabetology and Endocrinology (BIDE), 1-2, II-B، Block 2 Nazimabad, Karachi, 74600, Pakistan.,Department of Biochemistry, Baqai Medical University, 51, Deh Tor, Gadap Road, Near Toll Plaza, Super Highway, Karachi, 75340, Pakistan
| | - Abdul Basit
- Baqai Institute of Diabetology and Endocrinology (BIDE), 1-2, II-B، Block 2 Nazimabad, Karachi, 74600, Pakistan.,Department of Medicine, Baqai Medical University, Karachi, 75340, Pakistan
| | - Syeda Nuzhat Nawab
- The Karachi Institute of Biotechnology and Genetic Engineering (KIBGE), University of Karachi, Main University Rd, Karachi, 75270, Pakistan.
| |
Collapse
|
4
|
Jarwar P, Waryah YM, Rafiq M, Waryah AM. Association of single nucleotide polymorphism variations in CRYAA and CRYAB genes with congenital cataract in Pakistani population. Saudi J Biol Sci 2022; 29:2727-2732. [PMID: 35531184 PMCID: PMC9073017 DOI: 10.1016/j.sjbs.2021.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of present study was to analyze the association of single nucleotide polymorphism (SNPs) variant in CRYAA and CRYAB genes with Congenital Cataract. Method Total 196 blood samples of children were collected, out of which 102 samples were congenital cataract (case group) and 94 samples were normal individuals (control group). Genomic DNA was extracted by using optimized inorganic method. Tetra primers for SNPs were designed and TETRA-ARMs assay was performed on both groups. Genotypic, allelic frequency and haplotype analyses were obtained by using SNPstats software. Results The coordination of genotypic and allelic frequencies of CRYAA and CRYAB genes variants and the association between case and control groups showed increased risk of congenital cataract in children who contained rs13053109 G > C variant of CRYAA in all models (all P > 0.05). This depicts the evident difference between the frequencies of case and control groups. The haplotype analysis of SNPs rs3761382, rs7278468 and rs13051039 of CRYAA gene showed weak linkage disequilibrium between the 3 SNPs (r2 < 0.8). The haplotype CTC indicated the high risk of congenital cataract in infants based of its p value (OR = 1.60 95% CI = 0.11-22.64, P > 0.05). Conclusion The variation in CRYAA gene can be the risk factor for congenital cataract in infants.
Collapse
Affiliation(s)
- Priya Jarwar
- Institute of Biotechnology and Genetic Engineering, University of Sindh, Jamshoro, Pakistan
| | - Yar Muhammad Waryah
- Scientific Ophthalmic and Research Laboratory, Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad 71500, Pakistan
| | - Muhammad Rafiq
- Institute of Biotechnology and Genetic Engineering, University of Sindh, Jamshoro, Pakistan
| | - Ali Muhammad Waryah
- Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
- Department Molecular Biology and Genetics, Medical Research Center, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| |
Collapse
|
5
|
Malik M, Strang N, Campbell P, Jonuscheit S. Exploring eye care pathways, patient priorities and economics in Pakistan: A scoping review and expert consultation study with thematic analysis. Ophthalmic Physiol Opt 2022; 42:694-716. [PMID: 35318687 PMCID: PMC9310639 DOI: 10.1111/opo.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
Purpose As the prevalence of eye diseases increases, demand for effective, accessible and equitable eye care grows worldwide. This is especially true in lower and middle‐income countries, which have variable levels of infrastructure and economic resources to meet this increased demand. In the present study we aimed to review the literature on eye care in Pakistan comprehensively, with a particular focus on eye care pathways, patient priorities and economics. Methods A systematic scoping review was performed to identify literature relating to eye care in Pakistan. Searches of relevant electronic databases and grey literature were carried out. The results were analysed through a mixed methods approach encompassing descriptive numerical summary and thematic analysis. To consolidate results and define priority areas for future study, expert consultation exercises with key stakeholders were conducted using qualitative semi‐structured interviews. Results One hundred and thirty‐two papers (published and unpublished) were included in the final review. The majority (n = 93) of studies utilised a quantitative design. Seven interlinked themes were identified: eye care pathways, burden of eye disease, public views on eye‐related issues, workforce, barriers to uptake of eye care services, quality of eye care services and economic impact of blindness. Research priorities included investigating the eye care workforce, the quality and efficiency of current eye care services, eye care services available in rural Pakistan and the costs and benefits related to eye care provision and sustaining eye care programmes. Conclusions To the best of our knowledge, this is the first review to synthesise evidence from papers across the field relating to eye care in Pakistan. As such, this work provides new insights into the achievements of the national eye health programme, challenges in eye care in Pakistan and priority areas for future research.
Collapse
Affiliation(s)
- Manal Malik
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Sven Jonuscheit
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
6
|
Tsou BC, Vongsachang H, Purt B, Srikumaran D, Justin GA, Woreta FA. Cataract Surgery Numbers in U.S. Ophthalmology Residency Programs: An ACGME Case Log Analysis. Ophthalmic Epidemiol 2021; 29:688-695. [PMID: 34913813 DOI: 10.1080/09286586.2021.2015395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe and assess the cataract experience of ophthalmology residents throughout the United States (U.S.). METHODS Cataract procedures logged by graduating ophthalmology residents nationwide and published by the Accreditation Council for Graduate Medical Education (ACGME) from 2009 to 2020 were analyzed using linear regression on log-transformed response variables with robust variance. RESULTS As primary surgeon, average numbers logged for phacoemulsification increased yearly by an average of 4.1% prior to 2019 and then decreased by 22.1% in 2019 for an overall average yearly increase of 2.9% (95% CI: 0.5, 5.4%, p = .03), non-phacoemulsification extracapsular extraction decreased yearly by an average of 4.6% (95% CI: -7.7, -1.5%, p = .01), other cataract/intraocular lens surgeries decreased yearly by an average of 8.4% (95% CI: -10.1, -6.6%, p < .001), anterior vitrectomies decreased yearly by an average of 12.5% (95% CI: -14.9, -10.1%, p < .001), and laser capsulotomies increased yearly by an average of 6.0% prior to 2019 and then decreased by 3.0% for an overall average yearly increase of 5.3% (95% CI: 4.5, 6.2%, p < .001). As assistant, average numbers logged in all ACGME minimum categories showed decreasing trends. CONCLUSIONS Over the last decade, the average numbers of phacoemulsification and laser capsulotomies logged by residents as primary surgeon increased while other ACGME cataract minimum procedures decreased. Surgical volume in 2019-20 was lower due to the coronavirus disease-19 pandemic but higher than from 2009 to 2013.
Collapse
Affiliation(s)
- Brittany C Tsou
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hursuong Vongsachang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Boonkit Purt
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Sukati VN, Mashige KP, Moodley VR. Knowledge and practices of teachers about child eye healthcare in the public sector in Swaziland. AFRICAN VISION AND EYE HEALTH 2021. [DOI: 10.4102/aveh.v80i1.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Vision-related problems have a negative impact on the learning abilities and school performance of a child. Adequate knowledge and practices of teachers enable the early identification and intervention of school children with visual deficits.Aim: This study aimed to investigate the knowledge and practices of teachers about child eye healthcare in the public education system in Swaziland.Setting: The setting for this study was Swaziland.Methods: This was a cross-sectional quantitative study using a survey instrument containing closed-ended questions to investigate the knowledge and practices of teachers about child eye health in the public sector.Results: Two hundred and forty-three (N = 243) teachers responded to the questionnaire. The majority (90.1%) of teachers indicated that they were able to detect signs and symptoms of eye diseases. Most teachers without a family member wearing spectacles were more likely to be informed about eye health (p = 0.001) than those who had family wearing spectacles. A significant proportion (44%) of teachers indicated that refractive errors were not serious among school children. Above one-third (38.7%) of the teachers indicated that they referred children with vision problems to public hospitals. One hundred and fifty-five (63.8%) reported that health officials have never visited their schools. One hundred and forty-nine (61.3%) teachers agreed that they did not monitor children wearing spectacles and 94 (38.7%) monitored them. Monitoring children wearing spectacles was significantly associated with teachers who indicated being well informed about eye health (p 0.001) and teachers who were more likely to advise parents to take their children for eye testing (p = 0.003).Conclusion: The lack of adequate knowledge by some teachers may contribute to the already existing barriers for children to access eye health. Addressing the broader issues of child eye health requires the participation of well-trained and knowledgeable teachers.
Collapse
|
8
|
Willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia. PLoS One 2021; 16:e0248618. [PMID: 33760830 PMCID: PMC7990211 DOI: 10.1371/journal.pone.0248618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction In Ethiopia, cataract surgery is mainly provided by donors free of charge through outreach programs. Assessing willingness to pay for patients for cataract surgery will help explain how the service is valued by the beneficiaries and design a domestic source of finance to sustain a program. Although knowledge concerning willingness to pay for cataract surgery is substantive for developing a cost-recovery model, the existed knowledge is limited and not well-addressed. Therefore, the study aimed to assess willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia. Methods A cross-sectional outreach-based study was conducted on 827 cataract patients selected through a simple random sampling method in Tebebe Gion Specialized Hospital, North West Ethiopia, from 10/11/2018 to 14/11/2018. The data were collected using a contingent valuation elicitation approach to elicit the participants’ maximum willingness to pay through face to face questionnaire interviews. The descriptive data were organized and presented using summary statistics, frequency distribution tables, and figures accordingly. Factors assumed to be associate with a willingness to pay were identified using a Tobit regression model with a p-value of <0.05 and confidence interval (CI ≠ 0). Results The study involved 827 cataract patients, and their median age was 65years. About 55% of the participants were willing to pay for the surgery. The average amount of money willing to pay was 17.5USD (95% CI; 10.5, 35.00) and It was significantly associated with being still worker (β = 26.66, 95% CI: 13.03, 40.29), being educated (β = 29.16, 95% CI: 2.35, 55.97), free from ocular morbidity (β = 28.48, 95% CI: 1.08, 55.90), duration with the condition, (β = -1.69, 95% CI: -3.32, -0.07), admission laterality (β = 21.21, 95% CI: 3.65, 38.77) and remained visual ability (β = -0.29, 95% CI (-0.55, -0.04). Conclusions Participants’ willingness to pay for cataract surgery in outreach Sites is much lower than the surgery’s actual cost. Early intervention and developing a cost-recovery model with multi-tiered packages attributed to the neediest people as in retired, less educated, severely disabled is strategic to increase the demand for service uptake and service accessibility.
Collapse
|
9
|
Poddar AK, Khan TA, Sweta K, Tiwary MK, Borah RR, Ali R, Sil AK, Sheeladevi S. Prevalence and causes of avoidable blindness and visual impairment, including the prevalence of diabetic retinopathy in Siwan district of Bihar, India: A population-based survey. Indian J Ophthalmol 2020; 68:375-380. [PMID: 31957732 PMCID: PMC7003600 DOI: 10.4103/ijo.ijo_1709_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: The aim of this study was to estimate the prevalence and causes of visual impairment (VI) and blindness and diabetic retinopathy (DR) in Siwan district, Bihar. Methods: A population-based cross-sectional study was done from January to March 2016 using the Rapid Assessment of Avoidable Blindness 6 (RAAB 6, incorporating DR module) methodology. All individuals aged ≥50 years were examined in 57 randomly selected clusters within the district. Results: A total of 3476 individuals were enumerated and 3189 (92%) completed examination. The overall prevalence of blindness and severe VI was 2.2% (95% confidence interval (CI): 1.6–2.8) and 3.4% (95% CI: 2.6–4.3), respectively. Untreated cataract was the leading cause of blindness (73%) and severe VI (93%). The cataract surgical coverage (CSC) at <3/60 was 71.5% for eyes and 89.3% for persons in this sample and the CSC was similar between the genders. Refractive error (71%) was the primary cause of early VI. The overall prevalence of known and newly diagnosed diabetes was 6.3% (95% CI, 5.4–7.2%). Prevalence of any DR, maculopathy, and sight-threatening DR was 15, 12.4, and 6%, respectively. Conclusion: To conclude, as compared to previous reports, the prevalence of blindness and DR in Siwan district of Bihar was found to be lower and the CSC was higher. However, the problem of avoidable blindness remains a major problem in this region.
Collapse
Affiliation(s)
- Ajit Kumar Poddar
- Department of Ophthalmology, Akhand Jyoti Eye Hospitals, Bihar, India
| | - Tanwir Ahmed Khan
- Department of Ophthalmology, Akhand Jyoti Eye Hospitals, Bihar, India
| | - Kumari Sweta
- Department of Ophthalmology, Akhand Jyoti Eye Hospitals, Bihar, India
| | | | - Rishi R Borah
- Orbis India Country Office, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| | - Rahul Ali
- Orbis India Country Office, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| | - Asim Kumar Sil
- Department of Ophthalmology, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| | - Sethu Sheeladevi
- Orbis India Country Office, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| |
Collapse
|
10
|
Chariwala RA, Shah SP, Patel D, Chaudhari SP, Gajiwala UR. Rapid Assessment of Avoidable Blindness and Willingness to Pay for Cataract Surgery in Tribal Region of Surat District of Gujarat State, India. Ophthalmic Epidemiol 2020; 28:152-159. [PMID: 32673143 DOI: 10.1080/09286586.2020.1792939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To estimate prevalence and causes of avoidable blindness among people ≥50 years and to assess willingness to pay (WTP) for cataract surgery in tribal region of south Gujarat, India. METHODS A cross-sectional population based survey was conducted with 44 randomly selected clusters each having 50 people aged ≥50 years selected by probability proportional to size of sampling. Adults identified with cataract causing visual loss (<6/18) in any eye were interviewed to assess their WTP for surgery. RESULTS Total of 2137 examined out of 2200 people enumerated (response rate 97.1%). The prevalence of blindness (Presenting Visual Acuity (PVA)<3/60 in better eye) was 2.23% (95% CI: 2.95%-1.51%). Cataract was main cause of blindness (67.3%) followed by corneal scarring (8.2%). Major barrier to cataract surgery cited by bilaterally blind people was lack of escort to the surgical facility (34.3%). Cataract surgical coverage (CSC) was 84.9% (eyes) and 92% (persons). Of the 492 people interviewed to assess WTP for their surgery, only 36.4% people were willing to pay. CONCLUSION The tribal population has a high poverty profile in India. Within this group, cataract remains the main treatable cause of blindness despite a high CSC. Assessment of barriers suggested that a well-coordinated outreach programme with free transport facilities to the surgical facility is required along with strategies to improve accessibility and prioritising cataract blind in the community. One-third of people were willing to pay for their surgeries implying that cross subsidization or tier system could be feasible for eye care programme sustainability.
Collapse
Affiliation(s)
- Rohan A Chariwala
- Department of Public Health and Research in Eye Care, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Gujarat, India
| | - Shaheen P Shah
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Daksha Patel
- International Center for Eye Health (ICEH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Sheetal P Chaudhari
- Department of Public Health and Research in Eye Care, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Gujarat, India
| | - Uday R Gajiwala
- Department of Public Health and Research in Eye Care, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Gujarat, India
| |
Collapse
|
11
|
Shen W, Cun Q, Zhong H, Pan CW, Li J, Chen Q. Ethnic variation in prevalence, self-reported barriers and outcome of cataract surgery in a rural population in southwestern China: the Yunnan minority eye study. BMC Public Health 2020; 20:893. [PMID: 32517668 PMCID: PMC7285510 DOI: 10.1186/s12889-020-09009-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a part of the Yunnan Minority Eye Studies, the purpose of this study was to determine the prevalence, barriers and visual acuity outcomes of cataract surgery in a multiethnic adult population in rural areas of southwestern China. METHODS A population-based cross-sectional survey was conducted with participants of Bai, Yi, and Han ethnicity aged ≥50 years in Yunnan. A detailed eye examination was performed. Information on the date, setting, type, and complications of cataract surgery were recorded in the examination of cataract-operated eyes. RESULTS Of 6546 subjects (2133 Bai ethnicity, 2208 Yi ethnicity and 2205 Han ethnicity), the prevalence of cataract surgery was 6.0%, with 4.6% in Bai, 7.0% in Yi, and 6.4% in Han ethnicity. Cataract Surgical coverage (CSC) among those with presenting visual acuity (PVA) < 20/200 in both eyes because of cataract was 53.3%, with 52.8% in Bai, 64.4% in Yi, and 45.3% in Han ethnicity. CSC was associated with Yi ethnicity, younger age, and higher education level, while unoperated cataract was associated with Han ethnicity, older age, and illiterate. The main barrier to cataract surgery was lack of awareness and knowledge, cost, and fear. Among the 525 cataract-operated eyes, PVA and best-corrected visual acuity (BCVA) of 20/63 or better was 44.5 and 67.2%, respectively, with 48.1 and 65.9% in Bai, 47.8 and 75.4% in Yi, 39.1 and 59.9% in Han ethnicity. Han ethnicity, aphakia, earlier year of surgery, lower-level surgical hospital and illiterate were associated with postoperative visual impairment defined by PVA, while Han ethnicity, aphakia, and illiterate were associated with that defined by BCVA. The principal causes of postoperative visual impairment were retinal disorders (26.8%), posterior capsule opacification (25.1%), refractive error(22.7%), and glaucoma (9.3%). CONCLUSIONS Han ethnicity had a lower CSC and relatively poor visual outcomes compared with ethnic minorities. Further effective effort to remove barriers and provide sight restoration is warranted.
Collapse
Affiliation(s)
- Wei Shen
- Department of Ophthalmology, the Fourth Affiliated Hospital of Kunming Medical University (the Second People's Hospital of Yunnan Province), Yunnan Eye Institute, Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmology, Kunming, 650032, People's Republic of China
| | - Qing Cun
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hua Zhong
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jun Li
- Department of Ophthalmology, the Fourth Affiliated Hospital of Kunming Medical University (the Second People's Hospital of Yunnan Province), Yunnan Eye Institute, Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmology, Kunming, 650032, People's Republic of China
| | - Qin Chen
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, People's Republic of China.
| |
Collapse
|
12
|
Female Gender Remains a Significant Barrier to Access Cataract Surgery in South Asia: A Systematic Review and Meta-Analysis. J Ophthalmol 2020; 2020:2091462. [PMID: 32411426 PMCID: PMC7201788 DOI: 10.1155/2020/2091462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/24/2019] [Accepted: 11/29/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To determine whether the female gender is a barrier for the access to cataract surgery services in South Asia in the last two decades. Methods Eligible cross-sectional studies were identified via computer searches and reviewing the reference lists of the obtained articles. The cataract surgical coverage (CSC) by sex based on person and eyes at visual acuity <3/60 and 6/18 is extracted. Pooled odds ratios (ORs) for males receiving cataract surgery in comparison with females were calculated by a random effect model. Results Sixteen studies with 135972 subjects were included in the final analysis. The pooled ORs of CSC by sex on a person basis at visual acuity <3/60 and at visual acuity <6/18 were 1.46 (95% CI: 1.23-1.75) and 1.14 (95% CI: 1.05-1.24), respectively. For CSC on a per-eye basis at visual acuity <3/60, the associations were statistically significant, with a pooled OR of 1.40 (95% CI: 1.16-1.70). The values of population attributable risk percentage at a per-person and per-eye basis at visual acuity <3/60 were 6.28% and 7.48%, respectively. Subgroup analyses by design and location types attained similar results as the primary analyses. There was no evidence of publication bias. Conclusions The female gender remains a significant barrier for the access to cataract surgery in South Asia. Visual impairment, including blindness, from unoperated cataract, could be reduced by approximately 6.28% with the elimination of gender disparities to access. More efforts are needed to increase eye care service utilization by female population.
Collapse
|
13
|
Khalid MK, Ahamad I, Khan MA, Sharjeel M, Irfan M, Marwat M. DISTRIBUTION OF PEDIATRIC CATARACTS BY SEX, AGE GROUPS, LATERALITY, TYPE AND PRESENTATION IN POPULATION OF D.I.KHAN DISTRICT, PAKISTAN. GOMAL JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.46903/gjms/17.04.2025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Pediatric cataracts cause significant visual disability worldwide. The objectives of this study were to determine the distribution of pediatric cataracts by sex, age groups, laterality, type and presentation in population of D.I.Khan District, Pakistan.
Materials & Methods: This descriptive study was carried out at Department of Ophthalmology, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2015. Sample was collected from Eye unit, DHQ Teaching Hospital, D.I.Khan. Pediatric cataract patients under 14 years of age were included in the study. Demographic variables were sex and age groups. Research variables were laterality, type and presentation. All variables being nominal were analyzed through frequency and percentages.
The observed and expected distribution of pediatric cataract by sex, age groups, laterality, type and presentation were respectively tested by chi-square goodness of fit test.
Results: Out of a sample of 47 patients, 29 (61.7%) were boys and 18 (38.3%) girls, 22 (46.81%) were <5 years and 25 (53.19%) 5-14 years of age. Thirty three (70.21%) had unilateral and 14 (29.79%) bilateral cataracts. Type was congenital/ developmental in 27 (57.45%) patients and traumatic in 20 (42.55%). Presentation was by defective vision in 23 (48.94%), leukocoria 14 (29.79%), strabismus 7 (14.89%) and screening in 3 (6.38%) cases.
The observed distribution of pediatric cataract by sex (p=.0158), age groups (p=.00002), laterality (p=<.00001) and type (p=<.00001) was similar to expected, while for presentation, it was different than expected (p=.1033).
Conclusion: The prevalence of pediatric cataract was higher for boys than girls and higher for older children (5-14 years) than younger (<5 years) children. Unilateral were more common than bilateral cataracts and the congenital/ developmental were more common than traumatic cataracts. Defective vision was the most common presentation of pediatric cataracts.
Collapse
|
14
|
Prasad N, Ormsby GM, Finger RP. Validating a tool to assess eye health knowledge, attitude and practice in Cambodia and Vietnam. Int J Ophthalmol 2019; 12:1767-1774. [PMID: 31741867 DOI: 10.18240/ijo.2019.11.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Noela Prasad
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3011, Australia.,VACCHO, Collingwood, VIC 3066, Australia
| | - Gail M Ormsby
- Professional Studies, Faculty of Business, Education, Law and Arts, University of Southern Queensland, West Street, Toowoomba, QLD 4350, Australia.,Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, NSW 2265, Australia
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Regina-Pacis-Weg 3, Bonn 53113, Germany
| |
Collapse
|
15
|
Jiachu D, Jin L, Jiang F, Luo L, Zheng H, Ji D, Yang J, Yongcuo N, Huang W, Yi J, Bright T, Yip JL, Xiao B. Prevalence and service assessment of cataract in Tibetan areas of Sichuan Province, China: population-based study. BMJ Open 2019; 9:e031337. [PMID: 31685508 PMCID: PMC6858214 DOI: 10.1136/bmjopen-2019-031337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the prevalence of visual impairment (VI) and blindness (BL) due to cataract and cataract surgical outcomes in remote dispersed and high-altitude Tibetan areas of China. DESIGN AND SETTING A cross-sectional study was conducted among people aged 50 and above in Tibetan Autonomous Prefecture of Kandze (TAPK), China, in 2017. The Rapid Assessment of Avoidable Blindness protocol was followed. PARTICIPANTS Of 5000 eligible participants, 4764 were examined (response rate 95.3%). PRIMARY AND SECONDARY OUTCOME MEASURES Cataract VI was defined as lens opacity at visual acuity (VA) levels of <3/60 (Blindness (BL)), ≥3/60 and <6/60 (severe visual impairment (SVI)), ≥6/60 and <6/18 (moderate visual impairment (MVI)), ≥6/18 and <6/12 (early visual impairment (EVI)). RESULTS The estimated prevalence of cataract BL was 0.61% (95% CI 0.42 to 0.87). With best corrected VA, the estimated prevalence of SVI from cataract was 0.86% (95% CI 0.63 to 1.17); MVI was 2.39% (95% CI 2.00 to 2.87) and EVI was 5.21% (95% CI 4.61 to 5.87). Women in TAPK had a significantly higher prevalence of cataract BL (0.82%, 95% CI 0.54 to 2.15) than men (0.34%, 95% CI 0.16 to 0.70). Women had lower cataract surgical coverage (CSC) by eyes (60.8%, 95% CI 55.5 to 65.8) compared with men (70.1%; 95% CI 63.7 to 75.7). The prevalence of cataract BL was higher among Tibetan (2.28%; 95% CI 1.98 to 2.62) than Han Chinese (1.01%%; 95% CI 0.54% to 1.87%). Overall CSC by person with BL (by better eye) was 82.0% (95% CI 75.2 to 87.6). Among cataract-operated participants, 71.2% had VA equal to or better than 6/18. CONCLUSIONS The study detected a low prevalence of VI and BL due to cataract with high CSC in the study area compared with many other places in China. Further actions should be taken to improve cataract surgical outcome.
Collapse
Affiliation(s)
- Danba Jiachu
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Ling Jin
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Feng Jiang
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Li Luo
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Hong Zheng
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Duo Ji
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Jing Yang
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Nima Yongcuo
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Opthalmic Centre, Sun Yat-sen University, Guangzhou City, China
| | - Jinglin Yi
- Nanchang University Affiliated Eye Hospital, Nanchang University, Nanchang, China
| | - Tess Bright
- International Centre for Evidence in Disablility, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer Ly Yip
- International Centre for Evidence in Disablility, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Baixiang Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Opthalmic Centre, Sun Yat-sen University, Guangzhou City, China
- Nanchang University Affiliated Eye Hospital, Nanchang City, China
| |
Collapse
|
16
|
Sukati V, Moodley VR, Mashige KP. Knowledge and practices of eye health professionals about the availability and accessibility of child eye care services in the public sector in Swaziland. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: International and African rights instruments stipulate that children have the right to access quality general and eye health care. Lack of access to quality eye care can have a significant negative impact on the child, family and society in general.Aim: To determine the knowledge and practices of eye care professionals about the availability and accessibility of child eye care services in the public sector in Swaziland.Setting: The study was conducted in Swaziland.Methods: This was a quantitative study design, and 15 public eye health professionals completed and returned the Questionnaire for Eye Health Professionals (QEHP).Results: Thirteen (86.7%) eye health practitioners reported that both standard practice guidelines and paediatric national guidelines for ophthalmic services were unavailable. The majority (66.7%) identified cost and unawareness of available services by parents as the most common barrier to accessing eye care services. Nine (60%) felt that they were less informed about eye health problems and 6 (40%) reported being well informed. Eight (53.3%) respondents indicated that there were no outreach programmes and 7 (46.7%) reported that their clinics offered these services. Thirteen (86.7%) eye health practitioners indicated that they were not part of teachers’ training for supporting visually impaired children, while 2 (13%) reported that they were.Conclusion: Formulation of guidelines to support eye health care service delivery in Swaziland is essential in order to improve availability, accessibility, affordability and effectiveness in the public health system.
Collapse
|
17
|
Moshirfar M, Wagner WD, Linn SH, Skanchy DF, Brown TW, Gomez AT, Goldberg JL, Ronquillo YC, Hoopes PC. Astigmatic correction with implantation of a light adjustable vs monofocal lens: a single site analysis of a randomized controlled trial. Int J Ophthalmol 2019; 12:1101-1107. [PMID: 31341799 DOI: 10.18240/ijo.2019.07.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/21/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the light adjustable lens (LAL) vs a standard monofocal lens in achieving target astigmatic refraction and improving postoperative uncorrected distance visual acuity (UDVA). METHODS This randomized controlled clinical trial included 40 patients with pre-existing astigmatism and visually significant cataract. Twenty-eight patients received the LAL and 12 control patients received a monofocal intraocular lens (IOL) after cataract extraction at a single institution. The patients with the LAL underwent adjustment by ultraviolet (UV) light postoperatively plus subsequent lock-in procedures and all patients returned to clinic for follow up of study parameters at 6, 9, and 12mo. Manifest refraction, distance visual acuity, and adverse events were recorded at each visit. RESULTS The mean cylinder before adjustment in eyes with the LAL was -0.89±0.58 D (-2.00 to 0.00 D) and -0.34±0.34 D (-1.25 to 0.00 D) after lock-in (P=1.68x10-8). The mean cylinder in patients with the monofocal lens was -1.00±0.32 D (-1.50 to -0.50 D) at 17-21d postoperatively, which was statistically different from the LAL cylinder post lock-in (P=1.43x10-6). UDVA in the LAL group was 20/20 or better in 79% of patients post lock-in with good stability over 12mo compared with 33% of the control patients with UDVA of 20/20 or better. CONCLUSION These results demonstrate that the LAL is more effective in achieving target refractions and improving postoperative UDVA in patients with pre-existing corneal astigmatism than a standard monofocal lens.
Collapse
Affiliation(s)
- Majid Moshirfar
- HDR Research Center, Hoopes Vision, Draper, UT 84020, USA.,John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.,Utah Lions Eye Bank, Murray, UT 84107, USA
| | - William D Wagner
- Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Steven H Linn
- HDR Research Center, Hoopes Vision, Draper, UT 84020, USA
| | - David F Skanchy
- McGovern Medical School at the University of Texas Health Science Center, Houston, TX 77030, USA
| | - Tanner W Brown
- McGovern Medical School at the University of Texas Health Science Center, Houston, TX 77030, USA
| | - Aaron T Gomez
- The University of Texas Rio Grande Valley School of Medicine, Edinburg, TX 78539, USA
| | - Jackson L Goldberg
- McGovern Medical School at the University of Texas Health Science Center, Houston, TX 77030, USA
| | | | | |
Collapse
|
18
|
Norris AJ, Norris CE. Factors influencing non-attendance to scheduled eye surgery in rural Swaziland. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
19
|
Abstract
Globally, 32.4 million individuals are blind and 191 million have moderate or severe visual impairment (MSVI); 80% of cases of blindness and MSVI are avoidable. However, great efforts are needed to tackle blindness and MSVI, as eye care in most places is delivered in isolation from and without significant integration with general health sectors. Success stories, including control of vitamin A deficiency, onchocerciasis, and trachoma, showed that global partnerships, multisectoral collaboration, public-private partnerships, corporate philanthropy, support from nongovernmental organizations-both local and international-and governments are responsible for the success of these programs. Hence, the World Health Organization's universal eye health global action plan for 2014-2019 has a goal of reducing the public health problem of blindness and ensuring access to comprehensive eye care; the plan aims to integrate eye health into health systems, thus providing universal eye health coverage (UEHC). This article discusses the challenges faced by low- and middle-income countries in strengthening the six building blocks of the health system. It discusses how the health systems in these countries need to be geared toward tackling the issues of emerging noncommunicable eye diseases, existing infectious diseases, and the common causes of blindness and visual impairment, such as cataract and refractive error. It also discusses how some of the comprehensive eye care models in the developing world have addressed these challenges. Moving ahead, if we are to achieve UEHC, we need to develop robust, sustainable, good-quality, comprehensive eye care programs throughout the world, focusing on the areas of greatest need. We also need to develop public health approaches for more complex problems such as diabetic retinopathy, glaucoma, childhood blindness, corneal blindness, and low vision. There is also a great need to train high-level human resources of all cadres in adequate numbers and quality. In addition to this, we need to exploit the benefits of modern technological innovations in information, communications, biomedical technology, and other domains to enhance quality of, access to, and equity in eye care.
Collapse
Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India.,Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Gullapalli N Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India
| |
Collapse
|
20
|
Ramke J, Petkovic J, Welch V, Blignault I, Gilbert C, Blanchet K, Christensen R, Zwi AB, Tugwell P. Interventions to improve access to cataract surgical services and their impact on equity in low- and middle-income countries. Cochrane Database Syst Rev 2017; 11:CD011307. [PMID: 29119547 PMCID: PMC6486054 DOI: 10.1002/14651858.cd011307.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cataract is the leading cause of blindness in low- and middle-income countries (LMICs), and the prevalence is inequitably distributed between and within countries. Interventions have been undertaken to improve cataract surgical services, however, the effectiveness of these interventions on promoting equity is not known. OBJECTIVES To assess the effects on equity of interventions to improve access to cataract services for populations with cataract blindness (and visual impairment) in LMICs. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 3), MEDLINE Ovid (1946 to 12 April 2017), Embase Ovid (1980 to 12 April 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 12 April 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 12 April 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 12 April 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 12 April 2017. We did not use any date or language restrictions in the electronic searches for trials. SELECTION CRITERIA We included studies that reported on strategies to improve access to cataract services in LMICs using the following study designs: randomised and quasi-randomised controlled trials (RCTs), controlled before-and-after studies, and interrupted time series studies. Included studies were conducted in LMICs, and were targeted at disadvantaged populations, or disaggregated outcome data by 'PROGRESS-Plus' factors (Place of residence; Race/ethnicity/ culture/ language; Occupation; Gender/sex; Religion; Education; Socio-economic status; Social capital/networks. The 'Plus' component includes disability, sexual orientation and age). DATA COLLECTION AND ANALYSIS Two authors (JR and JP) independently selected studies, extracted data and assessed them for risk of bias. Meta-analysis was not possible, so included studies were synthesised in table and text. MAIN RESULTS From a total of 2865 studies identified in the search, two met our eligibility criteria, both of which were cluster-RCTs conducted in rural China. The way in which the trials were conducted means that the risk of bias is unclear. In both studies, villages were randomised to be either an intervention or control group. Adults identified with vision-impairing cataract, following village-based vision and eye health assessment, either received an intervention to increase uptake of cataract surgery (if their village was an intervention group), or to receive 'standard care' (if their village was a control group).One study (n = 434), randomly allocated 26 villages or townships to the intervention, which involved watching an informational video and receiving counselling about cataract and cataract surgery, while the control group were advised that they had decreased vision due to cataract and it could be treated, without being shown the video or receiving counselling. There was low-certainty evidence that providing information and counselling had no effect on uptake of referral to the hospital (OR 1.03, 95% CI 0.63 to 1.67, 1 RCT, 434 participants) and little or no effect on the uptake of surgery (OR 1.11, 95% CI 0.67 to 1.84, 1 RCT, 434 participants). We assessed the level of evidence to be of low-certainty for both outcomes, due to indirectness of evidence and imprecision of results.The other study (n = 355, 24 towns randomised) included three intervention arms: free surgery; free surgery plus reimbursement of transport costs; and free surgery plus free transport to and from the hospital. These were compared to the control group, which was reminded to use the "low-cost" (˜USD 38) surgical service. There was low-certainty evidence that surgical fee waiver with/without transport provision or reimbursement increased uptake of surgery (RR 1.94, 95% CI 1.14 to 3.31, 1 RCT, 355 participants). We assessed the level of evidence to be of low-certainty due to indirectness of evidence and imprecision of results.Neither of the studies reported our primary outcome of change in prevalence of cataract blindness, or other outcomes such as cataract surgical coverage, surgical outcome, or adverse effects. Neither study disaggregated outcomes by social subgroups to enable further assessment of equity effects. We sought data from both studies and obtained data from one; the information video and counselling intervention did not have a differential effect across the PROGRESS-Plus categories with available data (place of residence, gender, education level, socioeconomic status and social capital). AUTHORS' CONCLUSIONS Current evidence on the effect on equity of interventions to improve access to cataract services in LMICs is limited. We identified only two studies, both conducted in rural China. Assessment of equity effects will be improved if future studies disaggregate outcomes by relevant social subgroups. To assist with assessing generalisability of findings to other settings, robust data on contextual factors are also needed.
Collapse
Affiliation(s)
- Jacqueline Ramke
- University of AucklandSchool of Population Health, Faculty of Medicine and Health SciencesAucklandNew Zealand
| | - Jennifer Petkovic
- University of OttawaBruyère Research Institute43 Bruyère StAnnex E, room 312OttawaONCanadaK1N 5C8
| | - Vivian Welch
- Bruyère Research InstituteMethods Centre85 Primrose AvenueOttawaONCanada
| | - Ilse Blignault
- University of New South WalesSchool of Public Health and Community MedicineSydneyNew South WalesAustralia
| | - Clare Gilbert
- London School of Hygiene & Tropical MedicineDepartment of Clinical Research, Faculty of Infectious and Tropical DiseasesKeppel StreetLondonUKWC1E 7HT
| | - Karl Blanchet
- London School of Hygiene & Tropical MedicineDepartment of Global Health and Development15‐17 Tavistock PlaceLondonUKWC1H 9SH
| | - Robin Christensen
- Copenhagen University Hospital, Bispebjerg og FrederiksbergMusculoskeletal Statistics Unit, The Parker InstituteNordre Fasanvej 57CopenhagenDenmarkDK‐2000
| | - Anthony B Zwi
- University of New South WalesSchool of Social Sciences, Faculty of Arts and Social SciencesRoom G25, Ground Floor, Morven Brown BuildingSydneyNew South WalesAustralia2052
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
| | | |
Collapse
|
21
|
Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
Collapse
|
22
|
Ramke J, Zwi AB, Lee AC, Blignault I, Gilbert CE. Inequality in cataract blindness and services: moving beyond unidimensional analyses of social position. Br J Ophthalmol 2017; 101:395-400. [PMID: 28228412 DOI: 10.1136/bjophthalmol-2016-309691] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/20/2016] [Accepted: 01/14/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Inequalities in cataract blindness are well known, but data are rarely disaggregated to explore the combined effects of a range of axes describing social disadvantage. We examined inequalities in cataract blindness and services at the intersection of three social axes. METHODS Three dichotomous social variables (sex (male/female); place of residence (urban/rural); literacy (literate/illiterate)) from cross-sectional national blindness surveys in Pakistan (2001-2004; n=16 507) and Nigeria (2005-2007; n=13 591) were used to construct eight subgroups, with disadvantaged subgroups selected a priori (ie, women, rural dwellers, illiterate). In each data set, the social distribution of cataract blindness, cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC) were examined. Inequalities were assessed comparing the best-off and worst-off subgroups using rate differences and rate ratios (RRs). Logistic regression was used to assess cumulative effects of multiple disadvantage. RESULTS Disadvantaged subgroups experienced higher prevalence of cataract blindness, lower CSC and lower eCSC in both countries. A social gradient was present for CSC and eCSC, with coverage increasing as social position improved. Relative inequality in eCSC was approximately twice as high as CSC (Pakistan: eCSC RR 2.7 vs CSC RR 1.3; Nigeria: eCSC RR 8.7 vs CSC RR 4.1). Cumulative disadvantage was observed for all outcomes, deteriorating further with each additional axis along which disadvantage was experienced. CONCLUSIONS Each outcome tended to be worse with the addition of each layer of social disadvantage. Illiterate, rural women fared worst in both settings. Moving beyond unidimensional analyses of social position identified subgroups in most need; this permits a more nuanced response to addressing the inequitable distribution of cataract blindness.
Collapse
Affiliation(s)
- Jacqueline Ramke
- University of New South Wales, School of Social Sciences, Faculty of Arts and Social Sciences, Sydney, New South Wales, Australia.,University of Auckland, School of Population Health, Auckland, New Zealand
| | - Anthony B Zwi
- University of New South Wales, School of Social Sciences, Faculty of Arts and Social Sciences, Sydney, New South Wales, Australia.,Health, Rights and Development, UNSW (@HEARDatUNSW), Sydney, Australia
| | - Arier C Lee
- University of Auckland, School of Population Health, Auckland, New Zealand
| | - Ilse Blignault
- University of New South Wales, School of Public Health and Community Medicine, Sydney, New South Wales, Australia.,Western Sydney University, School of Medicine, Centre for Health Research, Campbelltown, New South Wales, Australia
| | - Clare E Gilbert
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
23
|
Ackuaku-Dogbe EM, Yawson AE, Biritwum RB. Cataract Surgical Uptake Among Older Adults in Ghana. Ghana Med J 2016; 49:84-9. [PMID: 26339091 DOI: 10.4314/gmj.v49i2.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In sub-Saharan Africa, cataract surgical services are highly inadequate and surgical uptake for cataract is low. This paper describes cataract surgical uptake among older adults in Ghana. METHODS This work was based on World Health Organization's multi-country Study on global Ageing and adult health (SAGE), conducted in six countries including Ghana. Wave one of SAGE in Ghana was conducted in 2007-2008 as collaboration between WHO and Department of Community Health, University of Ghana Medical School. A nationally representative sample of 5571 older adults (≥50 years) and a small sample of persons 18-49 years were interviewed. Data was obtained on uptake of cataract surgery in older adults and analyzed using descriptive measures and chi square for associations in categorical outcome measures. RESULTS Overall surgical uptake was 48.9% among older adults and was slightly higher among older men (49.1%) than women (48%). Cataract surgical uptake was relatively higher in the 60-69 years group (55%), urban residents (52.6%) and those living without partners (50%). Educational and income levels of older persons did not affect cataract surgical uptake. Regional differences in cataract surgical uptake existed; was less than 60% in all ten regions (except one), and the two regions with most self-reported cataracts (Ashanti and Greater Accra) had less than 50% uptake. CONCLUSIONS Intensive public education, engagement of community groups and increased access to cataract surgery at health facilities and outreach services need consideration at national/sub-national levels. Further investigations to garner equity in national eye care efforts are recommended.
Collapse
Affiliation(s)
- E M Ackuaku-Dogbe
- Department of Surgery, Eye Unit, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - A E Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Accra, Ghana ; Public Health Unit, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - R B Biritwum
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| |
Collapse
|
24
|
Tafida A, Kyari F, Abdull MM, Sivasubramaniam S, Murthy GVS, Kana I, Gilbert CE. Poverty and Blindness in Nigeria: Results from the National Survey of Blindness and Visual Impairment. Ophthalmic Epidemiol 2016; 22:333-41. [PMID: 26395660 DOI: 10.3109/09286586.2015.1077259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Poverty can be a cause and consequence of blindness. Some causes only affect the poorest communities (e.g. trachoma), and poor individuals are less likely to access services. In low income countries, cataract blind adults have been shown to be less economically active, indicating that blindness can exacerbate poverty. This study aims to explore associations between poverty and blindness using national survey data from Nigeria. METHODS Participants ≥40 years were examined in 305 clusters (2005-2007). Sociodemographic information, including literacy and occupation, was obtained by interview. Presenting visual acuity (PVA) was assessed using a reduced tumbling E LogMAR chart. Full ocular examination was undertaken by experienced ophthalmologists on all with PVA <6/12 in either eye. Causes of vision loss were determined using World Health Organization guidelines. Households were categorized into three levels of poverty based on literacy and occupation at household level. RESULTS A total of 569/13,591 participants were blind (PVA <3/60, better eye; prevalence 4.2%, 95% confidence interval [CI] 3.8-4.6%). Prevalences of blindness were 8.5% (95% CI 7.7-9.5%), 2.5% (95% CI 2.0-3.1%), and 1.5% (95% CI 1.2-2.0%) in poorest, medium and affluent households, respectively (p = 0.001). Cause-specific prevalences of blindness from cataract, glaucoma, uncorrected aphakia and corneal opacities were significantly higher in poorer households. Cataract surgical coverage was low (37.2%), being lowest in females in poor households (25.3%). Spectacle coverage was 3 times lower in poor than affluent households (2.4% vs. 7.5%). CONCLUSION In Nigeria, blindness is associated with poverty, in part reflecting lower access to services. Reducing avoidable causes will not be achieved unless access to services improves, particularly for the poor and women.
Collapse
Affiliation(s)
- A Tafida
- a Department of Ophthalmology , Aminu Kano Teaching Hospital , Kano , Nigeria
| | - F Kyari
- b College of Health Sciences, University of Abuja , Nigeria
| | - M M Abdull
- c Ophthalmology Department , Abubakar Tafawa Balewa University Teaching Hospital , Bauchi , Nigeria
| | - S Sivasubramaniam
- d International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine , London , UK , and
| | - G V S Murthy
- d International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine , London , UK , and
| | - I Kana
- e Office of the Permanent Secretary, Federal Ministry of Health , Abuja , Nigeria
| | - Clare E Gilbert
- d International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine , London , UK , and
| | | |
Collapse
|
25
|
Khanna R, Murthy GVS. Inequities in cataract surgical coverage in South Asia. COMMUNITY EYE HEALTH 2016; 29:S06-S09. [PMID: 28289327 PMCID: PMC5340111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rohit Khanna
- Director, Gullapeli Pratibha Rao Internations Centre for Advancement of Rural Eye Care (GPRI CARE), Hyderabad
| | - GVS Murthy
- Vice-President, South, Public Health Foundation of India & Director, Indian Institute of Public Health
| |
Collapse
|
26
|
The Prevalence and Causes of Visaual Impairment and Blindness in a Rural Population in the North of Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:855-64. [PMID: 26258099 PMCID: PMC4524311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 04/21/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Visual impairment is a very important public health problem. In Iran, reports of visual impairment and blindness have been published from the urban population while the prevalence of visual impairment in the rural population has not been reported. The purpose of this study to determine the prevalence and causes of visual impairment, in a rural population in district of based on age and sex. METHODS In a cross-sectional population-based study, using random cluster sampling, 13 of the 83 villages of Khaf County in the north east of Iran were selected. Eye examinations were performed in a Mobile Eye Clinic (Nooravaran Salamat, 2011) and included optometric examinations such as measuring uncorrected and corrected visual acuity along with non-cycloplegic refraction. RESULTS The prevalence of visual impairment, low vision, and blindness was 6.3% (95% CI 5.3-7.3), 3.4% (95% CI 2.6-4.1), and 3.0% (95% CI 2.3-3.6), respectively. The prevalence of visual impairment ranged from 1.8% in the participant younger than 20 years of age to 28% in the subjects aged 60 and over (P<0.001). After matching for age, the prevalence of visual impairment and low vision was significantly higher in women. The most prevalent causes of visual impairment were uncorrected refractory error (54.5%) and cataract (17.6%). CONCLUSION The prevalence of visual impairment was significantly higher in the rural population of this study when compared to previous reports from Iran. It seems that provision of therapeutic facilities like cataract surgery and availability of eyeglasses in villages can considerably reduce the prevalence of visual impairment.
Collapse
|
27
|
Ren XT, Snellingen T, Gu H, Assanangkornchai S, Zou YH, Chongsuvivatwong V, Lim A, Jia W, Liu XP, Liu NP. Use of cataract surgery in urban Beijing: a post screening follow-up of the elderly with visual impairment due to age-related cataract. ACTA ACUST UNITED AC 2015; 30:1-6. [PMID: 25837353 DOI: 10.1016/s1001-9294(15)30001-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing. METHODS From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. RESULTS At the follow-up examination 116 of the 158 patients were available and 36 (31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery (OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function (P=0.11) or quality of life scores (P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need (50.0%), feeling of being "too old" (19.2%), and worry about the quality of surgery (9.6%). Cost was cited by 1 (1.9%) subject as the main reason for not seeking surgery. CONCLUSIONS The data suggest that in China's capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people's perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.
Collapse
Affiliation(s)
- Xue-tao Ren
- Sekwa Eye Hospital, Beijing 100088, China; Epidemiology Unit, Faculty of Science and Technology, Prince of Songkla University, Songkhla 90110, Thailand
| | | | - Hong Gu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Beijing Ophthalmology and Visual Sciences, Beijing 100730, China
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Science and Technology, Prince of Songkla University, Songkhla 90110, Thailand
| | - Yan-hong Zou
- Department of Ophthalmology, First Hospital of Tsinghua University, Beijing 100016, China
| | - Virasakdi Chongsuvivatwong
- Epidemiology Unit, Faculty of Science and Technology, Prince of Songkla University, Songkhla 90110, Thailand
| | - Apiradee Lim
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Songkhla 90110, Thailand
| | - Wei Jia
- Sekwa Eye Hospital, Beijing 100088, China
| | - Xi-pu Liu
- Sekwa Eye Hospital, Beijing 100088, China;Department of Ophthalmology, First Hospital of Tsinghua University, Beijing 100016, China
| | - Ning-pu Liu
- Sekwa Eye Hospital, Beijing 100088, China; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Beijing Ophthalmology and Visual Sciences, Beijing 100730, China
| |
Collapse
|
28
|
Khandekar R, Sudhan A, Jain BK, Deshpande M, Dole K, Shah M, Shah S. Impact of cataract surgery in reducing visual impairment: a review. Middle East Afr J Ophthalmol 2015; 22:80-5. [PMID: 25624679 PMCID: PMC4302482 DOI: 10.4103/0974-9233.148354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: The aim was to assess the impact of cataract surgeries in reducing visual disabilities and factors influencing it at three institutes of India. Materials and Methods: A retrospective chart review was performed in 2013. Data of 4 years were collected on gender, age, residence, presenting a vision in each eye, eye that underwent surgery, type of surgery and the amount the patient paid out of pocket for surgery. Visual impairment was categorized as; absolute blindness (no perception of light); blind (<3/60); severe visual impairment (SVI) (<6/60-3/60); moderate visual impairment (6/18-6/60) and; normal vision (≥6/12). Statistically analysis was performed to evaluate the association between visual disabilities and demographics or other possible barriers. The trend of visual impairment over time was also evaluated. We compared the data of 2011 to data available about cataract cases from institutions between 2002 and 2009. Results: There were 108,238 cataract cases (50.6% were female) that underwent cataract surgery at the three institutions. In 2011, 71,615 (66.2%) cases underwent surgery. There were 45,336 (41.9%) with presenting vision < 3/60 and 75,393 (69.7%) had SVI in the fellow eye. Blindness at presentation for cataract surgery was associated to, male patients, Institution 3 (Dristi Netralaya, Dahod) surgeries after 2009, cataract surgeries without Intra ocular lens implant implantation, and patients paying <25 US $ for surgery. Predictors of SVI at time of cataract surgery were, male, Institution 3 (OM), phaco surgeries, those opting to pay 250 US $ for cataract surgeries. Conclusion: Patients with cataract seek eye care in late stages of visual disability. The goal of improving vision related quality of life for cataract patients during the early stages of visual impairment that is common in industrialized countries seems to be non-attainable in the rural India.
Collapse
Affiliation(s)
- Rajiv Khandekar
- Department of Research, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Anand Sudhan
- Department of Research, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - B K Jain
- Department of Research, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Madan Deshpande
- Department of Research, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Kuldeep Dole
- Department of Research, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mahul Shah
- Department of Research, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Shreya Shah
- Department of Research, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
29
|
Stewart BT, Pathak J, Gupta S, Shrestha S, Groen RS, Nwomeh BC, Kushner AL, McIntyre T. An estimate of hernia prevalence in Nepal from a countrywide community survey. Int J Surg 2014; 13:111-114. [PMID: 25500564 DOI: 10.1016/j.ijsu.2014.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Herniorrhaphy is one of the most frequently performed general surgical operations worldwide. However, most low- and middle-income countries (LMICs) are unable to provide this essential surgery to the general public, resulting in considerable morbidity and mortality. This study aimed to estimate the prevalence, barriers to care and disability of untreated hernias in Nepal. METHODS Nepal is a low-income country in South Asia with rugged terrain, infrastructure deficiencies and a severely under-resourced healthcare system resulting in substantial unmet surgical need. A cluster randomized, cross-sectional household survey was performed using the validated Surgeons OverSeas Assessment of Surgical (SOSAS) tool. Fifteen randomized clusters consisting of 30 households with two randomly selected respondents each were sampled to estimate surgical need. The prevalence of and disability from groin hernias and barriers to herniorrhaphy were assessed. RESULTS The survey sampled 1350 households, totaling 2695 individuals (97% response rate). There were 1434 males (53%) with 1.5% having a mass or swelling in the groin at time of survey (95% CI 1.8-4.0). The age-standardized rate for inguinal hernias in men ranged from 1144 per 100,000 persons between age 5 and 49 years and 2941 per 100,000 persons age≥50 years. Extrapolating nationally, there are nearly 310,000 individuals with groin masses and 66,000 males with soft/reducible groin masses in need of evaluation in Nepal. Twenty-nine respondents were not able to have surgery due to lack of surgical services (31%), fear or mistrust of the surgical system (31%) and inability to afford care (21%). Twenty percent were unable to work as previous or perform self-care due to their hernia. CONCLUSIONS Despite the lower than expected prevalence of inguinal hernias, hundreds of thousands of people in Nepal are currently in need of surgical evaluation. Given that essential surgery is a necessary component in health systems, the prevalence of inguinal hernias and the cost-effectiveness of herniorrhaphy, this disease is an important target for LMICs planning surgical capacity improvements.
Collapse
Affiliation(s)
| | | | - Shailvi Gupta
- Surgeons OverSeas (SOS), New York, NY, USA; Department of Surgery, University of California San Francisco East Bay, Oakland, CA, USA
| | - Sunil Shrestha
- Department of Surgery, Nepal Medical College, Kathmandu, Nepal
| | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Benedict C Nwomeh
- Surgeons OverSeas (SOS), New York, NY, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
| | - Thomas McIntyre
- Program for Surgery and Public Health, Kings County Hospital Center, SUNY Downstate Medical School, Brooklyn, NY, USA
| |
Collapse
|
30
|
Ramke J, Welch V, Blignault I, Gilbert C, Petkovic J, Blanchet K, Christensen R, Zwi AB, Tugwell P. Interventions to improve access to cataract surgical services and their impact on equity in low- and middle-income countries. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jacqueline Ramke
- University of New South Wales; School of Social Sciences, Faculty of Arts and Social Sciences; Room G25, Ground Floor, Morven Brown Building Sydney New South Wales Australia 2052
| | - Vivian Welch
- University of Ottawa; Bruyere Research Institute; 43 Bruyere Street Ottawa ON Canada K1N 5C8
| | - Ilse Blignault
- University of New South Wales; School of Public Health and Community Medicine; Sydney New South Wales Australia
| | - Clare Gilbert
- London School of Hygiene and Tropical Medicine; Clinical Research Unit, Department of Infectious & Tropical Diseases; 9 Bedford Square London UK WC1B 3RE
| | - Jennifer Petkovic
- University of Ottawa; Centre for Global Health, Bruyere Research Institute; 85 Primrose Ave Ottawa ON Canada K1R 7G5
| | - Karl Blanchet
- London School of Hygiene & Tropical Medicine; International Centre for Eye Health; Keppel Street London UK WC1E 7HT
| | - Robin Christensen
- Copenhagen University Hospital, Frederiksberg, Copenhagen, Denmark; Musculoskeletal Statistics Unit (MSU), The Parker Institute, Dept Rheumatology; Nordrefasanvej 57 Copenhagen Denmark DK-2000
| | - Anthony B Zwi
- University of New South Wales; School of Social Sciences, Faculty of Arts and Social Sciences; Room G25, Ground Floor, Morven Brown Building Sydney New South Wales Australia 2052
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa; Department of Medicine; Ottawa ON Canada K1H 8M5
| |
Collapse
|
31
|
Li Z, Song Z, Wu S, Xu K, Jin D, Wang H, Liu P. Outcomes and Barriers to Uptake of Cataract Surgery in Rural Northern China: The Heilongjiang Eye Study. Ophthalmic Epidemiol 2014; 21:161-8. [DOI: 10.3109/09286586.2014.903499] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Zhijian Li
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University HarbinChina
| | - Zhen Song
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University HarbinChina
| | - Shubin Wu
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University HarbinChina
| | - Keke Xu
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University HarbinChina
| | - Di Jin
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University HarbinChina
| | - Haijing Wang
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University HarbinChina
| | - Ping Liu
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University HarbinChina
| |
Collapse
|
32
|
Katibeh M, Ziaei H, Rajavi Z, Hosseini S, Javadi MA. Profile of cataract surgery in Varamin Iran: a population-based study. Clin Exp Ophthalmol 2013; 42:354-9. [PMID: 23927430 DOI: 10.1111/ceo.12185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 07/26/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cataract is the most popular cause of blindness. This study addresses some aspects of cataract surgery in an Iranian population. DESIGN A cross-sectional study. PARTICIPANTS 3000 adults over 50 in Varamin district. METHODS Cataract surgical coverage was defined as the proportion of (pseudo) aphakic eyes of all operable and operated eyes with cataract. If there was obvious lens opacity in either or both eyes in combination with best corrected visual acuity less than 6/18, the person was asked why the operation for cataract was not done to find out about barriers of cataract surgery. Outcomes of cataract surgery were categorized as good, intermediate and poor using presenting visual acuity which were defined as visual acuity ≥ 6/18, 6/60 ≤ visual acuity < 6/18 and visual acuity < 6/60, respectively. MAIN OUTCOME MEASURES Cataract surgical coverage, barriers and outcomes of cataract surgery. RESULTS Out of 5638 examined eyes, 526 eyes (9.3%) had history of cataract surgery. 156 subjects (45.7%) had a unilateral and 185 subjects (54.2%) had bilateral operated eyes. Cataract surgical coverage was 66.4% in visually impaired eyes (visual acuity < 6/18), 90.4% in blind eyes (visual acuity < 3/60), 80.5% in visually impaired persons and 97.6% in blind persons. Cataract surgery in the majority of eyes (71.9%) had a good visual outcome. The main barrier of cataract surgery was unawareness of treatment. CONCLUSION Overall, the cataract services in the studied population were acceptable, although it should be improved, to achieve vision 2020 objectives.
Collapse
Affiliation(s)
- Marzieh Katibeh
- Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | | |
Collapse
|
33
|
Abstract
PURPOSE To determine the visual outcomes achieved in terms of efficacy and safety during a mass eye surgery campaign in a low-income developing country. METHODS Three hundred fifteen eyes of 305 patients underwent extracapsular cataract extraction with intraocular lens implantation in a prospective, analytical, experimental, and nonrandomized study on patients who underwent cataract surgery during the campaign that two Spanish nongovernmental organizations conducted in December 2008 in a district hospital in Bobo-Dioulasso (Burkina Faso). RESULTS Mean age was 61.97 ± 14.39 years. The mean uncorrected distance visual acuity before surgery was 2.17 ± 0.7 (20/3000), which improved to 0.86 ± 0.64 logMAR (20/150) 3 months after cataract surgery. The mean spherical equivalent at 3 months was -0.87 ± 1.90 diopters. The corrected distance visual acuity was 0.52 ± 0.44 logMAR (20/60) 3 months after surgery, 68.7% of the patients had good visual outcomes, and 9.16% had poor outcomes. A total of 41.4% of the operated eyes showed a spherical equivalent within ± 1.00 diopter of emmetropia. The most common intraoperative complication was posterior capsule rupture (incidence, 2.9%, 9 of 315), and the most serious complication was expulsive hemorrhage (incidence, 0.3%, 1 of 315). Three months after surgery, 2.9% (9 of 315) of the eyes was affected by posterior capsular opacity. CONCLUSIONS A mass cataract campaign performed in a developing country with the proper technique and standardized protocols of action improved the visual outcome of the patients. The rate of incidence of extracapsular extractions is comparable to that estimated for developed countries.
Collapse
|
34
|
Alam MF, Chongsuvivatwong V, Mahmud H, Gupta PS. Comparison of accessibility among Vision-impaired patients visiting mobile and stationary hospitals in rural Bangladesh. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2013; 31:223-230. [PMID: 23930341 PMCID: PMC3702344 DOI: 10.3329/jhpn.v31i2.16387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of this study is to compare accessibility of vision-impaired (VI) patients to other eyecare centres before attending the mobile and stationary hospitals. Under a cross-sectional study design, VI patients were consecutively enrolled if they visited one of the three Impact Foundation Hospitals--one mobile and two stationary hospitals. The cost and service output of all hospitals were also reviewed; 27.7% of patients at the mobile and 36.8% at the two stationary hospitals had sought eyecare at other health facilities in the past. Mobile hospital patients lived closer to the hospital but spent more time in travelling, bore less direct cost, needed less extra support, and had a higher level of satisfaction on the service. They also identified more barriers to access eyecare in the past. The mobile hospital had a higher percentage of patients with accessibility problems and should continue to help the remote population in overcoming these problems.
Collapse
Affiliation(s)
- Md Ferdaws Alam
- Impact Foundation Bangladesh, 3rd Floor, Cosmopoliton Centre, House 22/2, Block B, Babor Road, Muhammadpur, Dhaka 1207, Bangladesh.
| | | | | | | |
Collapse
|
35
|
Prevalence and outcomes of cataract surgery in adult rural Chinese populations of the Bai nationality in Dali: the Yunnan minority eye study. PLoS One 2013; 8:e60236. [PMID: 23577095 PMCID: PMC3618447 DOI: 10.1371/journal.pone.0060236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 02/23/2013] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To investigate the prevalence and visual acuity (VA) outcomes of cataract surgery in adults of the Bai Nationality populations in rural China. METHODS We conducted a population-based cross-sectional survey (from randomly selected block groups) of Chinese Bai Nationality aged ≥50 years in southwestern China. Presenting visual acuity (PVA), best corrected visual acuity (BCVA) were recorded and a detailed eye examination was carried out. For all aphakic and pseudophakic subjects identified, information on the date, setting, type, and complications of cataract surgery were recorded. In eyes with VA <20/63, the principal cause of visual impairment was identified. RESULTS Of 2133 (77.8% of 2742) subjects, 99 people (129 eyes) had undergone cataract surgery. The prevalence of cataract surgery was 4.6%. Surgical coverage among those with PVA <20/200 in both eyes because of cataract was 52.8%. Unoperated cataract was associated with older age. The main barrier to cataract surgery was lack of awareness and knowledge, cost, and fear. Among the 129 cataract-operated eyes, 22.5% had PVA of ≥20/32, 25.6% had PVA of 20/40 to 20/63, 23.3% had PVA <20/63 to 20/200, and 28.7% had PVA<20/200. With BCVA, the percentages were 42.6%, 23.3%, 10.9%, and 23.3%, respectively. Aphakia (odds ratio [OR], 8.49; P<0.001) and no education (OR, 10.18; P = 0.001) or less education (OR, 6.49; P = 0.014) were significantly associated with postoperative visual impairment defined by PVA, while aphakia (OR, 8.49; P<0.001) and female gender (OR, 4.19; P = 0.004) were significantly associated with postoperative visual impairment by BCVA. The main causes of postoperative visual impairment were refractive error, retinal disorders and glaucoma. CONCLUSIONS Half of those with bilateral visual impairment or blindness because of cataract remain in need of cataract surgery in Bai population. Surgical uptake and visual outcomes should be further improved in the future.
Collapse
|
36
|
Murthy GVS, John N, Shamanna BR, Pant HB. Elimination of avoidable blindness due to cataract: where do we prioritize and how should we monitor this decade? Indian J Ophthalmol 2013; 60:438-45. [PMID: 22944756 PMCID: PMC3491272 DOI: 10.4103/0301-4738.100545] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: In the final push toward the elimination of avoidable blindness, cataract occupies a position of eminence for the success of the Right to Sight initiative. Aims: Review existing situation and assess what monitoring indicators may be useful to chart progress towards attaining the goals of Vision 2020. Settings and Design: Review of published papers from low and middle income countries since 2000. Materials and Methods: Published population-based data on prevalence of cataract blindness/visual impairment were accessed and prevalence of cataract blindness/visual impairment computed, where not reported. Data on prevalence of cataract blindness, cataract surgical coverage at different visual acuity cut offs, surgical outcomes, and prevalence of cataract surgery were analyzed. Scatter plots were used to look at relationships of some variables, with Human Development Index (HDI) rank. Available data on Cataract Surgical Rate (CSR) was plotted against prevalence of cataract surgery reported from surveys. Results: Worse HDI Ranks were associated with higher prevalence of cataract blindness. Most studies showed that a significant proportion of the blind were covered by surgery, while a fifth showed that a significant proportion, were operated before they went blind. A good visual outcome after surgery was positively correlated with higher surgical coverage. CSR was positively correlated with cataract surgical coverage. Conclusions: Cataract surgical coverage is increasing in most countries at vision <3/60 and visual outcomes after cataract surgery are improving. Establishing population-based surveillance of cataract surgical need and performance is a strong monitoring tool and will help program planners immensely.
Collapse
Affiliation(s)
- Gudlavalleti V S Murthy
- Indian Institute of Public Health and South Asia Centre for Disability Inclusive Development and Research, Hyderabad, India
| | | | | | | |
Collapse
|
37
|
Zhang XJ, Liang YB, Liu YP, Jhanji V, Musch DC, Peng Y, Zheng CR, Zhang HX, Chen P, Tang X, Lam DS. Implementation of a Free Cataract Surgery Program in Rural China. Ophthalmology 2013; 120:260-5. [DOI: 10.1016/j.ophtha.2012.07.087] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 07/27/2012] [Accepted: 07/31/2012] [Indexed: 11/30/2022] Open
|
38
|
Ajibode H, Jagun O, Bodunde O, Fakolujo V. Assessment of barriers to surgical ophthalmic care in South-Western Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2012; 2:38-50. [PMID: 25453003 PMCID: PMC4220483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The prevalence of blindness and visual impairment are still of public health importance worldwide and yet underutilisation of available eyecare services are still rampant. Therefore, there is continuing need to study the barriers to eyecare uptake. AIM To identify barriers to eye surgical uptake in the only teaching hospital in Sagamu, Ogun State, in South-Western Nigeria. SETTING The study was done at the eye clinic of Olabisi Onabanjo University Teaching Hospital [OOUTH], Sagamu, Nigeria. This is the only state-owned tertiary eye centre in Ogun State. It serves an approximate population of 3 million. MATERIALS AND METHOD All patients who had attended at least 2 follow-up clinics between February and June 2010, and consented to be included in the study were interviewed, and additional information from their case notes were coded and recorded in the software SPSS version 16. This was then analysed for frequencies of variables. RESULTS One hundred and sixty-seven (167) respondents were interviewed, comprising 92 males and 75 females, with an age range between 1 and 90 years. 106(63.9%) indicated encountering one form of barrier or the other since attending the eye clinic, out of which 64 were females and 42 males. The types of barriers encountered were: Cost of hospital services [28.3%], fear of surgery [24.1%], long waiting time to see the doctor [23.5%], accessibility to the hospital [16.9%], lack of electricity in the hospital [10.8%], and frequent strikes by health workers [7.2%]. CONCLUSIONS The commonest barriers to eye surgical care in this study are comparable to those in previous studies but in different proportions and calls for an urgent need to ensure affordable and sustainable surgical care, so as to achieve the goals of vision 2020.
Collapse
|
39
|
Naeem SS, Siddiqui EU, Kazi AN, Khan S, Abdullah FE, Adhi I. Prevalence of hepatitis 'B' and hepatitis 'C' among preoperative cataract patients in Karachi. BMC Res Notes 2012; 5:492. [PMID: 22954334 PMCID: PMC3444920 DOI: 10.1186/1756-0500-5-492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 08/31/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To report the findings of preoperative screening regarding prevalence of hepatitis B and hepatitis C in patients presenting for cataract surgery. FINDINGS A descriptive study was conducted among 377 patients presenting for cataract surgery to Department of Ophthalmology Unit I, CHK from April 2010 to May 2011. Convenience sampling was done to recruit the participants aged 18 years and above. The patients were screened for hepatitis B and C infections and findings were recorded on a structured compilation sheet.The total prevalence of both hepatitis B and hepatitis C in preoperative Cataract patients was found to be 49 out of 377(12.99%). Overall, 8 out of 377 (2.1%) patients were HBsAg positive and 42 out of 377 (11.1%) were Anti-HCV positive. Only 1 patient was found with a co-infection with both HBsAg and Anti-HCV positive. CONCLUSIONS High proportions of hepatitis B and C are reported among preoperative cataract patients of Karachi. Routine serological screening prior to surgery should be made mandatory so that asymptomatic patients would no longer pose a threat to its spread.
Collapse
Affiliation(s)
- Syed Saad Naeem
- Dow Medical College, DUHS, 109/2, Popular Avenue, Phase 6, D.H. A, Karachi, Pakistan
| | | | | | | | | | | |
Collapse
|
40
|
Rajak SN, Habtamu E, Weiss HA, Bedri A, Zerihun M, Gebre T, Gilbert CE, Emerson PM, Burton MJ. Why do people not attend for treatment for trachomatous trichiasis in Ethiopia? A study of barriers to surgery. PLoS Negl Trop Dis 2012; 6:e1766. [PMID: 22953007 PMCID: PMC3429389 DOI: 10.1371/journal.pntd.0001766] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 06/22/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Trachomatous trichiasis (TT) surgery is provided free or subsidised in most trachoma endemic settings. However, only 18-66% of TT patients attend for surgery. This study analyses barriers to attendance among TT patients in Ethiopia, the country with the highest prevalence of TT in the world. METHODOLOGY/PRINCIPAL FINDINGS Participants with previously un-operated TT were recruited at 17 surgical outreach campaigns in Amhara Region, Ethiopia. An interview was conducted to ascertain why they had not attended for surgery previously. A trachoma eye examination was performed by an ophthalmologist. 2591 consecutive individuals were interviewed. The most frequently cited barriers to previous attendance for surgery were lack of time (45.3%), financial constraints (42.9%) and lack of an escort (35.5% in females, 19.6% in males). Women were more likely to report a fear of surgery (7.7% vs 3.2%, p<0.001) or be unaware of how to access services (4.5% vs 1.0% p<0.001); men were more frequently asymptomatic (19.6% vs 10.1%, p<0.001). Women were also less likely to have been previously offered TT surgery than men (OR = 0.70, 95%CI 0.53-0.94). CONCLUSIONS/SIGNIFICANCE The major barriers to accessing surgery from the patients' perspective are the direct and indirect costs of surgery. These can to a large extent be reduced or overcome through the provision of free or low cost surgery at the community level. TRIAL REGISTRATION ClinicalTrials.gov NCT00522860 and NCT00522912.
Collapse
Affiliation(s)
- Saul N. Rajak
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Esmael Habtamu
- The Carter Center, Bahir Dar, Ethiopia
- The Carter Center, Atlanta, Georgia, United States of America
| | - Helen A. Weiss
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amir Bedri
- Light For The World, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- The Carter Center, Bahir Dar, Ethiopia
- The Carter Center, Atlanta, Georgia, United States of America
| | - Teshome Gebre
- The Carter Center, Bahir Dar, Ethiopia
- The Carter Center, Atlanta, Georgia, United States of America
| | - Clare E. Gilbert
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul M. Emerson
- The Carter Center, Bahir Dar, Ethiopia
- The Carter Center, Atlanta, Georgia, United States of America
| | - Matthew J. Burton
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
41
|
Hashim Z, Zarina S. Osmotic stress induced oxidative damage: possible mechanism of cataract formation in diabetes. J Diabetes Complications 2012; 26:275-9. [PMID: 22609218 DOI: 10.1016/j.jdiacomp.2012.04.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 03/15/2012] [Accepted: 04/08/2012] [Indexed: 12/17/2022]
Abstract
Chronic hyperglycemia causes increased level of reactive oxygen species which is thought to be involved in the pathogenesis of diabetes associated complications including cataract. In diabetic cataractous lens, over production of free radicals and decreased capacity of antioxidant defense system are the major contributors to oxidative damage by polyol pathway and advanced glycation end products. The current study focused on analysis of factors associated with osmotic imbalance and oxidative stress in aging and diabetic human cataractous lenses. We examined activities of polyol pathway enzymes, G6PD and glutathione system in lenses from subjects suffering from cataract due to aging and diabetes. We observed elevated activities of aldose reductase and sorbitol dehydrogenase while G6PD and glutathione system enzyme activities were found to be lower in cataractous subjects suffering from diabetes. The findings from the current study support the premise that osmotic imbalance, AGEs formation and oxidative stress contribute synergistically to the development of lens opacity in hyperglycemia.
Collapse
Affiliation(s)
- Zehra Hashim
- National Center for Proteomics, University of Karachi, Karachi-75270, Pakistan
| | | |
Collapse
|
42
|
Waseem M, Humayun S, Farooq O, Humayun Q, Sadiq Sheikh S. Comparison of Patient's Satisfaction Level after Different Types of Posterior Chamber Intraocular Lens Implantation. ISRN SURGERY 2012; 2012:629158. [PMID: 22779003 PMCID: PMC3388380 DOI: 10.5402/2012/629158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 05/08/2012] [Indexed: 11/23/2022]
Abstract
Objective. To compare patient's satisfaction level in performing routine activities during daylight and night vision after implantation with rigid, foldable, or rollable posterior chamber intraocular lens implants in uneventful cataract surgery. Design. Retrospective, cross-sectional. Place and Duration of Study. PNS SHIFA Hospital, Karachi, from Nov. 2009 to Nov. 2010. Methodology. 91 cataract surgery patients who had uneventful phacoemulsification, within the bag placement of intraocular lens and achieved best corrected visual acuity 6/9 or better were included in the study. Patients who developed postoperative complications were excluded. A specially designed questionnaire was used to assess patient's satisfaction level of vision for those who underwent cataract surgery at least 3 months ago. Finally, they were categorized into five groups ranging from "very good" to "very poor." SPSS version 16 was used to analyze the results. Results. There was a difference in satisfaction level between three groups. Vision was good in the day and the night with foldable posterior chamber intraocular lens implants. Conclusion. It was concluded that visual satisfaction level of patients who had foldable posterior chamber intraocular lens implantation was better during the day and night as compared to patients who had rigid or rollable posterior chamber intraocular lenses implantation.
Collapse
|
43
|
Abubakar T, Gudlavalleti MVS, Sivasubramaniam S, Gilbert CE, Abdull MM, Imam AU. Coverage of Hospital-based Cataract Surgery and Barriers to the Uptake of Surgery among Cataract Blind Persons in Nigeria: The Nigeria National Blindness and Visual Impairment Survey. Ophthalmic Epidemiol 2012; 19:58-66. [DOI: 10.3109/09286586.2011.643271] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
44
|
Al-Shakarchi FI. Blindness in iraq: leading causes, target patients, and barriers to treatment. Middle East Afr J Ophthalmol 2011; 18:199-203. [PMID: 21887073 PMCID: PMC3162730 DOI: 10.4103/0974-9233.84044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To define the main causes of blindness, demographic characteristics and barriers to care of blind patients attending a teaching eye hospital in Iraq. Material and Method: Successive new patients, 6 years of age and older, who attended three outpatients clinics at Ibn Al-Haetham Teaching Eye Hospital (IAHTEH), Baghdad, Iraq, from September 1 to November 30, 2007, were included in this study. Inclusion criterion was fulfillment of the World Health Organization's definition of blindness. The cause of blindness was identified and subjects were interviewed for collection of data on demographic characteristics and barriers to treatment. Results: Of 18612 consecutive patients who attended the outpatient clinics, 497 (2.7%) patients were blind. Cataract (76.1%), diabetic retinopathy (12.9%), and glaucoma (5%) were the leading causes of blindness. The majority of blind patients had low socioeconomic status and poor educational level. In cases of cataract, the most important barrier to treatment was the waiting list at the hospital (53.7%). A lack of awareness was the most important barrier to treatment for patients with diabetic retinopathy (54.7%) and glaucoma (56%). Conclusions: The preliminary data from our study will aid in the development of blindness prevention programs in Iraq. Priorities include decreasing waiting lists for cataract surgeries at governmental hospitals. Active health promotion programs for early detection and treatment of diabetic retinopathy and glaucoma are also warranted.
Collapse
Affiliation(s)
- Faiz I Al-Shakarchi
- Department of Ophthalmology Medical College, Research Unit, Ibn Al-Haetham Teaching Eye Hospital, Al-Mustanserya University, Baghdad, Iraq
| |
Collapse
|
45
|
Hashim Z, Zarina S. Advanced glycation end products in diabetic and non-diabetic human subjects suffering from cataract. AGE (DORDRECHT, NETHERLANDS) 2011; 33:377-384. [PMID: 20842534 PMCID: PMC3168597 DOI: 10.1007/s11357-010-9177-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 08/18/2010] [Indexed: 05/29/2023]
Abstract
Advanced glycation end products (AGEs) play a pivotal role in loss of lens transparency, i.e., cataract. AGEs formation occurs as a result of sequential glycation and oxidation reaction between reducing sugars and protein. AGEs production takes place throughout the normal aging process but its accumulation is found to be more rapid in diabetic patients. In this study, we quantified AGEs and N-(carboxyethyl) lysine (CEL) in human cataractous lenses from non-diabetic (n=50) and diabetic patients (n=50) using ELISA. We observed significantly higher (p<0.001) levels of lens AGEs and CEL in diabetic patients with cataract as compared with their respective controls. The presence of AGEs and CEL was also determined by western blotting and immuno-histochemical analysis. Furthermore, isolated β-crystallin from cataractous lenses of non-diabetic and diabetic patients was incubated with different sugars to evaluate the extent of glycation in a time dependent manner. Our data indicated more pronounced glycation in patients suffering from diabetes as compared to non-diabetics subjects demonstrating the need to focus on developing normoglycemic approaches. Such studies may provide an insight in developing therapeutic strategies and may have clinical implications.
Collapse
Affiliation(s)
- Zehra Hashim
- National Center for Proteomics, University of Karachi, Karachi, 75270 Pakistan
| | - Shamshad Zarina
- National Center for Proteomics, University of Karachi, Karachi, 75270 Pakistan
| |
Collapse
|
46
|
Khan MD. The Duke Elder lecture: the challenge of equitable eye care in Pakistan. Eye (Lond) 2011; 25:415-24. [PMID: 21252948 PMCID: PMC3171255 DOI: 10.1038/eye.2010.186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 10/26/2010] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Pakistan, like many other developing countries, is caught in the vicious cycle of poverty, illiteracy, violence, and disease. Right from its inception, it has been facing serious challenges of fast growing population, longevity, unemployment, wars, floods, double burden of diseases including blindness, as well as earthquakes, insurgencies, and political instability. Despite such challenges, the country has managed to reduce the burden of blindness from 1.78% in 1987-88 to 0.9% in 2003.This paper will highlight the methods used to achieve such a difficult goal. METHODS The country used the report of the World Health Organization (WHO) temporary consultant as the initial tool for advocacy to obtain political and professional commitment. Results from the first National Blindness Survey 1987-1990 were used as baseline for development of the programme. Under the Ministry of Health, national and provincial committees with respective coordinators were constituted. To ensure access and equity, the national programme was developed on the basis of district comprehensive eye care services. The concept was carefully tested in a laboratory and then piloted in a real district before it was rolled over to the country. Strong national institutes for human resource development, research and development, and service delivery were established. A strong network of high-quality national institutes was set up and run by powerful national non-governmental organizations. The second National Blindness Survey evaluated the achievements of the programme in 2001-2003. CONCLUSION National prevalence of blindness was reduced by 100% by improving the uptake of services at the district level, especially by females.
Collapse
Affiliation(s)
- M D Khan
- CHEF International, Khyber Pakhtunkhwa, Pakistan.
| |
Collapse
|
47
|
Grimes CE, Bowman KG, Dodgion CM, Lavy CBD. Systematic Review of Barriers to Surgical Care in Low-Income and Middle-Income Countries. World J Surg 2011; 35:941-50. [DOI: 10.1007/s00268-011-1010-1] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
48
|
Zhang JS, Xu L, Wang YX, You QS, Wang JD, Jonas JB. Five-year incidence of age-related cataract and cataract surgery in the adult population of greater Beijing: the Beijing Eye Study. Ophthalmology 2010; 118:711-8. [PMID: 21146222 DOI: 10.1016/j.ophtha.2010.08.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 07/28/2010] [Accepted: 08/11/2010] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To estimate the 5-year incidence of cataract and cataract surgery in an adult Chinese population. DESIGN Population-based study. PARTICIPANTS The Beijing Eye Study 2006 included 3251 (73.2%) subjects (≥45 years) of 4439 subjects who participated in the 2001 survey and returned for re-examination. METHODS Nuclear, cortical, and posterior subcapsular lens opacities were assessed based on standardized slit-lamp-based photographs and retroilluminated photographs of the lens using a modification of the grading score of the Age-Related Eye Disease Study. MAIN OUTCOME MEASURES Incidence of any type of cataract and of cataract surgery. RESULTS The 5-year incidence of nuclear cataract was 5.98% (95% confidence intervals [CI], 5.96%-6.00%), that of cortical cataract was 11.14% (95% CI, 11.12%-11.17%), that of posterior subcapsular cataract was 5.47% (95% CI, 5.45%-5.48%), and that of cataract surgery was 2.01% (95% CI, 2.00%-2.02%). The incidence of any cataract (16.82%; 95% CI, 16.79%-16.86%) was significantly associated with higher age (P<0.001) and female gender (P<0.001). It was not significantly associated with the area of habitation (P = 0.78), smoking (P = 0.95), or alcohol consumption (P = 0.12). Differentiation into the 3 cataract types revealed that the incidence of nuclear cataract additionally was associated with rural region (P<0.001) and smoking (P<0.001). The incidence of cortical cataract additionally was associated with nonsmoking (P = 0.02). The incidence of cataract surgery was significantly (P<0.001) associated with age only. CONCLUSIONS As in white persons, the age-adjusted incidence of all types of cataract types increased with age and it was associated with female gender. When compared with data in the literature, the incidence rates of all cataract types did not vary markedly between Chinese in greater Beijing and white persons. In contrast, the incidence of cataract surgery was considerably lower in this Chinese population.
Collapse
Affiliation(s)
- Jing Shang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | |
Collapse
|
49
|
Murthy GVS, Vashist P, John N, Pokharel G, Ellwein LB. Prevalence and vision-related outcomes of cataract surgery in Gujarat, India. Ophthalmic Epidemiol 2010; 16:400-9. [PMID: 19995206 DOI: 10.3109/09286580903315809] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Investigate the prevalence and vision-related outcomes of cataract surgery in an area of high cataract surgical rate. METHODS Cluster sampling was used in randomly selecting individuals > or = 50 years of age in 2007. Participants were queried regarding year and place of previous cataract surgery. Cataract surgical procedures and evidence of surgical complications were recorded. The principal cause was identified for eyes presenting with visual acuity (VA) < or = 20/40. RESULTS A total of 4,738 persons were examined and 834 (17.6%) had cataract surgery. Intra-ocular lenses (IOLs) were used in 84.1% of the 1,299 cataract-operated eyes, with more than half of these having manual small incision surgery. Surgical coverage among the cataract blind (visual acuity [VA] < 20/200) was estimated as 72.2%. Coverage was associated with older age, literacy, and urban residence; gender was not significant. Among cataract-operated eyes, 18.7% presented with VA > or = 20/32 and 18.0% were < 20/200. With best-corrected acuity, the corresponding percentages were 55.7% and 11.0%. Presenting and best-corrected VA > or = 20/63 were associated with young age, literacy, and IOL surgery; urban residence and surgery in non-governmental organizations (NGO)/private facilities were also significant for presenting VA; and recent surgery was significant for best-corrected VA. Refractive error was the main cause of vision impairment/blindness in cataract-operated eyes. CONCLUSIONS Refractive error and posterior capsule opacification, easily treatable causes of visual impairment, are common among the operated. A greater emphasis on the quality of visual acuity outcomes along with sustained efforts to provide access to affordable surgery is needed.
Collapse
Affiliation(s)
- Gudlavalleti V S Murthy
- International Center for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | | |
Collapse
|
50
|
Athanasiov PA, Edussuriya K, Senaratne T, Sennanayake S, Selva D, Casson RJ. Cataract in central Sri Lanka: cataract surgical coverage and self-reported barriers to cataract surgery. Clin Exp Ophthalmol 2009; 37:780-4. [DOI: 10.1111/j.1442-9071.2009.02152.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|