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Kevin-Tang XH, Tajunisah I, Lott PPW, Reddy SC. Prevalence of visual impairment and eye diseases in Malaysia: A cross-sectional prospective study at the University of Malaya Medical Centre. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2024; 19:30. [PMID: 38855397 PMCID: PMC11162531 DOI: 10.51866/oa.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Introduction The prevalence of visual impairment and ocular diseases changes over time. This measure can help general practitioners in anticipating common eye disorders that may require ophthalmological referrals to government hospitals. This study aimed to evaluate the prevalence of visual impairment and ocular diseases in an outpatient ophthalmology clinic in a public hospital and the types of investigations frequently conducted to diagnose these diseases. Methods A cross-sectional prospective study was conducted over three weeks in the eye clinic of the University of Malaya Medical Centre. The electronic medical records of all patients who attended the outpatient clinic were assessed to collect data on sex, age, type of visit, visual acuity, ocular presentation, investigations conducted and diagnosis of eye diseases. Visual impairment and blindness were categorised as per the World Health Organization criteria. Results Among 1002 patients, 327 had visual impairments (32.63%), and nine had blindness (0.9%). Cataracts were the most common ocular disease diagnosed (n=294, 29.74%), followed by glaucoma (n=123, 12.28%) and diabetic retinopathy (n=84, 8.38%). Optical coherence tomography was the most common investigation performed (n=272, 64.9%), followed by Humphrey visual field testing (n=53,12.6%). Conclusion Untreated refractive error is the leading cause of visual impairment in children, while cataract, glaucoma and diabetic retinopathy are the main contributors to visual impairment and blindness in elderly individuals. Our study highlights the urgent need for general practitioners to recognise avoidable visual impairment in all age groups to help prevent blindness.
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Affiliation(s)
- Xuan Hong Kevin-Tang
- Final Year Medical Student, Newcastle University Medical Malaysia, Iskandar Puteri, Johor, Malaysia
| | - Iqbal Tajunisah
- MBBS, Masters Ophthal, FRCS, Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia.
| | - Penny Pooi Wah Lott
- MBBS, MS Ophth, FRCOPHTH, Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia
| | - Sagili Chandrasekhara Reddy
- MBBS, MS Ophth, Department of Ophthalmology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
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Jan C, He M, Vingrys A, Zhu Z, Stafford RS. Diagnosing glaucoma in primary eye care and the role of Artificial Intelligence applications for reducing the prevalence of undetected glaucoma in Australia. Eye (Lond) 2024:10.1038/s41433-024-03026-z. [PMID: 38514852 DOI: 10.1038/s41433-024-03026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
Glaucoma is the commonest cause of irreversible blindness worldwide, with over 70% of people affected remaining undiagnosed. Early detection is crucial for halting progressive visual impairment in glaucoma patients, as there is no cure available. This narrative review aims to: identify reasons for the significant under-diagnosis of glaucoma globally, particularly in Australia, elucidate the role of primary healthcare in glaucoma diagnosis using Australian healthcare as an example, and discuss how recent advances in artificial intelligence (AI) can be implemented to improve diagnostic outcomes. Glaucoma is a prevalent disease in ageing populations and can have improved visual outcomes through appropriate treatment, making it essential for general medical practice. In countries such as Australia, New Zealand, Canada, USA, and the UK, optometrists serve as the gatekeepers for primary eye care, and glaucoma detection often falls on their shoulders. However, there is significant variation in the capacity for glaucoma diagnosis among eye professionals. Automation with Artificial Intelligence (AI) analysis of optic nerve photos can help optometrists identify high-risk changes and mitigate the challenges of image interpretation rapidly and consistently. Despite its potential, there are significant barriers and challenges to address before AI can be deployed in primary healthcare settings, including external validation, high quality real-world implementation, protection of privacy and cybersecurity, and medico-legal implications. Overall, the incorporation of AI technology in primary healthcare has the potential to reduce the global prevalence of undiagnosed glaucoma cases by improving diagnostic accuracy and efficiency.
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Affiliation(s)
- Catherine Jan
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia.
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
- Lost Child's Vision Project, Sydney, NSW, Australia.
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Centre for Eye and Vision Research, The Hong Kong Polytechnic University, Kowloon, TU428, Hong Kong SAR
| | - Algis Vingrys
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Randall S Stafford
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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Gill ZS, Marin AI, Caldwell AS, Mehta N, Grove N, Seibold LK, Puente MA, De Carlo Forest TE, Oliver SCN, Patnaik JL, Manoharan N. Limited English Proficiency Is Associated With Diabetic Retinopathy in Patients Presenting for Cataract Surgery. Transl Vis Sci Technol 2023; 12:4. [PMID: 37796496 PMCID: PMC10561792 DOI: 10.1167/tvst.12.10.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Purpose To investigate the relationship between limited English proficiency (LEP) and diabetic retinopathy (DR) in patients presenting for cataract surgery. Methods This is a retrospective observational study of patients who underwent cataract surgery between January 2014 and February 2020. Patients who self-identified as needing or preferring an interpreter were defined as having LEP. Differences in demographics, characteristics, and outcomes including history of type 2 diabetes (T2DM), DR, preoperative best corrected visual acuity (BCVA), macular edema, and anti-vascular endothelial growth factor injections were analyzed. Statistical comparisons were assessed using logistic regression with generalized estimating equations. Results We included 13,590 eyes. Of these, 868 (6.4%) were from LEP patients. Patients with LEP were more likely to be Hispanic (P < 0.001), female sex (P = 0.008), or older age (P = 0.003) and have worse mean BCVA at presentation (P < 0.001). Patients with LEP had a significantly higher rate of T2DM (P < 0.001), macular edema (P = 0.033), and DR (18.1% vs. 5.8%, P < 0.001). Findings remained significant when controlling for age, sex, race/ethnicity, and type of health insurance. Patients with LEP and DR were more likely to have had later stages of DR (P = 0.023). Conclusions Patients with LEP presenting for cataract surgery had a higher rate of DR and associated complications compared to patients with English proficiency. Further studies are needed to understand how language disparities influence health and what measures could be taken to improve healthcare in this vulnerable population. Translational Relevance Our study highlights healthcare disparities within ophthalmology and emphasizes the importance of advocating for improved healthcare delivery for patients with LEP.
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Affiliation(s)
- Zafar S. Gill
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A. Itzam Marin
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne Strong Caldwell
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nihaal Mehta
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nathan Grove
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Leonard K. Seibold
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael A. Puente
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Scott C. N. Oliver
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer L. Patnaik
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Niranjan Manoharan
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Merga H, Amanuel D, Fekadu L, Dube L. A community-based cross-sectional study of eye care service utilization among the adult population in southern Ethiopia. SAGE Open Med 2023; 11:20503121231197865. [PMID: 37701796 PMCID: PMC10493053 DOI: 10.1177/20503121231197865] [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: 04/20/2023] [Accepted: 08/13/2023] [Indexed: 09/14/2023] Open
Abstract
Background Visual impairment, which is related to many eye diseases, is a major public health problem. If detected and treated early, it can be prevented; therefore, regular use of vision services is very important. Objective This study aimed to assess the proportion of utilization of eye care services and associated factors among the rural community population in southern Ethiopia. Methods A community-based cross-sectional study design with a two-stage cluster random sampling technique was conducted to collect data from adults aged 40 years and above using interviewer-administered questionnaires. Kebeles were randomly selected by the lottery method, and systematic random sampling with proportional distribution was used to select the households. An adult individual was randomly selected from a household when there was more than one adult available. A binary logistic regression model was used to establish the association between eye care service utilization and the variables that might affect it. Results Of the 551 study population, 510 responded to this study, and the response rate was 92.6%. The mean age of the respondents was 52.2 years. The rate of eye care service utilization was 29% (95% confidence interval (0.25, 0.33)). The study shows that older participants, aged 65 and above (adjusted odds ratio: 4.04; 95% confidence interval (2.20, 7.43)), having previous eye problems (adjusted odds ratio: 10.04; 95% confidence interval (5.81, 17.33)), the presence of systemic illness (adjusted odds ratio: 2.52; 95% confidence interval (1.21, 5.21)), and having awareness about regular checkups (adjusted odds ratio: 11.75; 95% confidence interval (6.62, 20.84)) were found to be the predictors of eye care service utilization. Conclusion In this study, utilization of eye care services was low. Older age, previous eye problems, systemic illness, and awareness about checkups were found to be predictors of eye care service utilization. Hence, there is a need to increase the absorption of existing ophthalmic services and create awareness of the use of ophthalmology services to reduce preventive blindness.
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Affiliation(s)
- Hailu Merga
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Lata Fekadu
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lamessa Dube
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
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Gill ZS, Caldwell AS, Patnaik JL, Marin AI, Mudie LI, Grove N, Ifantides C, Ertel MK, Puente MA, Seibold LK. Comparison of cataract surgery outcomes in English proficient and limited English proficiency patients. J Cataract Refract Surg 2023; 49:595-601. [PMID: 36779806 DOI: 10.1097/j.jcrs.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/31/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE To determine differences in cataract surgery outcomes between English proficient (EP) and limited English proficiency (LEP) patients. SETTING Sue Anschutz-Rodgers Eye Center, Aurora, Colorado. DESIGN Retrospective. METHODS Patients who underwent phacoemulsification at the Sue Anschutz-Rogers Eye Center between January 2014 and February 2020 were included. Patients who self-identified as needing or preferring an interpreter in medical encounters were defined as LEP. Differences in surgical characteristics and outcomes including cataract maturity, surgical complexity, and surgical complications were analyzed. RESULTS 868 eyes (6.4%) were identified from LEP patients. LEP patients were more likely to have mature cataracts (5.1% vs 2.3%, P < .0001). LEP patients' surgeries were more likely to be considered complex (27.8% vs 15.3%, P < .0001) and use higher cumulative dissipated energy (mean of 9.5 [SD = 9.5] vs 7.2 [SD = 7.1], P < .0001). Preoperative visual acuity was worse in LEP patients (logMAR 0.566 [SD = 0.64] vs 0.366 [SD = 0.51], P < .0001) but showed greater improvement after surgery (logMAR 0.366 [SD = 0.54] vs 0.254 [SD = 0.41], P < .0001). There were no significant differences in operative time, intraoperative or postoperative complications. More LEP patients were on steroids 4 weeks postoperatively when compared with EP patients (14.6% vs 10.1%, P < .0002). LEP patients were less likely to undergo subsequent YAG capsulotomy (7.3% vs 12.8%, P < .0001). CONCLUSIONS Disparities in cataract outcomes between EP and LEP patients was demonstrated. Further research into ophthalmic health disparities for LEP patients is needed to understand the root causes and how they can be addressed.
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Affiliation(s)
- Zafar S Gill
- From the Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Yeh TC, Lo KJ, Hwang DK, Lin TC, Chou YB. Evaluation of a remote telemedicine platform using a novel handheld fundus camera: Physician and patient perceptions from real-world experience. J Chin Med Assoc 2022; 85:793-798. [PMID: 35648158 DOI: 10.1097/jcma.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although teleophthalmology has gained traction in recent years, it is at the center of the coronavirus disease pandemic. However, most hospitals are not ready owing to a severe lack of real-world experience. Furthermore, a limited number of studies have evaluated telemedicine applications on remote islands. This study aimed to evaluate real-world clinical and referral accuracy, image quality, physician-perceived diagnostic certainty, and patient satisfaction with telemedicine eye screening using a novel handheld fundus camera in a rural and medically underserved population. METHODS This prospective study included 176 eyes from a remote island. All participants underwent a comprehensive ophthalmic examination. Nonmydriatic retinal images obtained using a handheld fundus camera were reviewed by two retinal specialists to determine image quality, diagnosis, and need for referrals. The agreement of diagnosis between image-based assessments was compared with that of binocular indirect ophthalmoscopic assessments. RESULTS Image quality of fundus photographs was considered acceptable or ideal in 97.7% and 95.5% of eyes assessed by two reviewers, respectively. There was considerable agreement in diagnosis between the indirect ophthalmoscopic assessment and image-based assessment by two reviewers (Cohen's kappa = 0.80 and 0.78, respectively). Likewise, substantial agreement was achieved in the referrals. The sensitivity for referable retinopathy from the two reviewers was 78% (95% confidence interval [CI], 57%-91%) and 78% (95% CI, 57%-91%), whereas specificity was 99% (95% CI, 95%-99%] and 98% (95% CI, 93%-99%), respectively. For physicians' perceived certainty of diagnosis, 93.8% and 90.3% were considered either certain or reliable. Overall, 97.4% of participants were satisfied with their experiences and greatly valued the telemedicine services. CONCLUSION Novel fundus camera-based telemedicine screening demonstrated high accuracy in detecting clinically significant retinopathy in real-world settings. It achieved high patient satisfaction and physician-perceived certainty in diagnosis with reliable image quality, which may be scaled internationally to overcome geographical barriers under the global pandemic.
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Affiliation(s)
- Tsai-Chu Yeh
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kang-Jung Lo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - De-Kuang Hwang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tai-Chi Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Bai Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Umar F, Odugbo OP, Mpyet CD. Utilization of orthodox eye care services among visually impaired adults in jos north local government area of Plateau State. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_75_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Allen P, Jessup B, Khanal S, Baker-Smith V, Obamiro K, Barnett T. Distribution and Location Stability of the Australian Ophthalmology Workforce: 2014-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312574. [PMID: 34886297 PMCID: PMC8656490 DOI: 10.3390/ijerph182312574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the ophthalmology workforce distribution and location stability using Modified Monash Model category of remoteness. METHODS Whole of ophthalmologist workforce analysis using Australian Health Practitioner Registration Agency (AHPRA) data. Modified Monash Model (MMM) category was mapped to postcode of primary work location over a six-year period (2014 to 2019). MMM stability was investigated using survival analysis and competing risks regression. DESIGN Retrospective cohort study. SETTING Australia. PARTICIPANTS Ophthalmologists registered with AHPRA. MAIN OUTCOME MEASURES Retention within MMM category of primary work location. RESULTS A total of 948 ophthalmologists were identified (767 males, 181 females). Survival estimates indicate 84% of ophthalmologists remained working in MMM1, while 79% of ophthalmologists working in MMM2-MMM7remained in these regions during the six-year period. CONCLUSION The Australian ophthalmology workforce shows a high level of location stability and is concentrated in metropolitan areas of Australia. Investment in policy initiatives designed to train, recruit and retain ophthalmologists in regional, rural and remote areas is needed to improve workforce distribution outside of metropolitan areas.
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Affiliation(s)
- Penny Allen
- Rural Clinical School, Hospitals’ Campus, University of Tasmania, Brickport Road, Burnie, TAS 7320, Australia
- Correspondence:
| | - Belinda Jessup
- Centre for Rural Health, Newnham Campus, University of Tasmania, Launceston, TAS 7250, Australia; (B.J.); (K.O.); (T.B.)
| | - Santosh Khanal
- The Royal Australian and New Zealand College of Ophthalmology, 94-98 Chalmers Street, Surry Hills, NSW 2010, Australia; (S.K.); (V.B.-S.)
| | - Victoria Baker-Smith
- The Royal Australian and New Zealand College of Ophthalmology, 94-98 Chalmers Street, Surry Hills, NSW 2010, Australia; (S.K.); (V.B.-S.)
| | - Kehinde Obamiro
- Centre for Rural Health, Newnham Campus, University of Tasmania, Launceston, TAS 7250, Australia; (B.J.); (K.O.); (T.B.)
| | - Tony Barnett
- Centre for Rural Health, Newnham Campus, University of Tasmania, Launceston, TAS 7250, Australia; (B.J.); (K.O.); (T.B.)
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Zarei E, Pakzad R, Yekta A, Amini M, Sardari S, Khabazkhoob M. Economic Inequality in Visual Impairment: A Study in Deprived Rural Population of Iran. J Curr Ophthalmol 2021; 33:165-170. [PMID: 34409227 PMCID: PMC8365585 DOI: 10.4103/2452-2325.288936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: To determine economic inequality in visual impairment (VI) and its determinants in the rural population of Iran. Methods: In this population-based, cross-sectional study, 3850 individuals, aged 3–93 years were selected from the north and southwest regions of Iran using multi-staged stratified cluster random sampling. The outcome was VI, measured in 20 feet. Economic status was constructed using principal component analysis on home assets. The concentration index (C) was used to determine inequality, and the gap between low and high economic groups was decomposed to explained and unexplained portions using the Oaxaca–Blinder decomposition method. Results: Of the 3850 individuals that were invited, 3314 participated in the study. The data of 3095 participants were finally analyzed. The C was −0.248 (95% confidence interval [CI]: −0.347 - −0.148), indicating a pro-poor inequality (concentration of VI in low economic group). The prevalence (95% CI) of VI was 1.72% (0.92–2.52) in the high economic group and 10.66% (8.84–12.48) in the low economic group with a gap of 8.94% (6.95–10.93) between the two groups. The explained and unexplained portions comprised 67.22% and 32.77% of the gap, respectively. Among the study variables, age (13.98%) and economic status (80.70%) were significant determinants of inequality in the explained portion. The variables of education (coefficient: −4.41; P < 0.001), age (coefficient: 14.09; P < 0.001), living place (coefficient: 6.96; P: 0.006), and economic status (coefficient: −7.37; P < 0.001) had significant effects on inequality in the unexplained portion. Conclusions: The result showed that VI had a higher concentration in the low economic group, and the major contributor of this inequality was economic status. Therefore, policymakers should formulate appropriate interventions to improve the economic status and alleviate economic inequality.
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Affiliation(s)
- Ehsan Zarei
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical sciences, Ilam, Iran
| | - Abbasali Yekta
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoomeh Amini
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Sardari
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jeon W, Trope GE, Buys YM, Wedge R, El-Defrawy S, Chen QS, Jin YP. The Effect of Government-Uninsured Optometric Services on the Use of Primary Care Providers. CLINICAL OPTOMETRY 2021; 13:119-128. [PMID: 33911907 PMCID: PMC8071696 DOI: 10.2147/opto.s303087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Eye care in many countries is provided by optometrists, ophthalmologists, primary care providers (PCPs, including family physicians and pediatricians) and emergency department (ED) physicians. In the province of Prince Edward Island (PEI), Canada, optometric services are not government-insured, while services provided by other eye care providers are government-insured. Clinics of optometrists, PCPs and ED physicians are widely distributed across the island. Clinics of ophthalmologists however are concentrated in the capital city Charlottetown. PURPOSE To investigate if more patients visited government-insured PCPs and EDs for eye care when local optometric services are government-uninsured and government-insured ophthalmologists are potentially distant. METHODS From PEI physician billing database, we identified all patients with an ocular diagnosis from 2010-2012 using International Classification of Diseases, 9th Revision (ICD-9) codes. The utilization of government-insured PCPs and EDs in five geographical regions was assessed utilizing patients' residential postal code. Of the five regions, Prince was the region farthest from the capital Charlottetown. RESULTS Compared to utilization of government-insured PCPs for ocular diagnoses in Charlottetown (13.5% in 2010, 95% confidence interval [CI] 12.9-14.0%), the utilization in Prince (22.4% in 2010, 95% CI 21.7-23.1%) was nearly double (p<0.05). The utilization of ED physicians for ocular diagnoses was similarly double in Prince (8.8%, 95% CI 8.3-9.3%) versus Charlottetown (4.1%, 95% CI 3.8-4.5%). The utilization of ophthalmologists however was significantly lower in Prince (43%, 95% CI 41.4-42.9%) versus Charlottetown (56.3%, 95% CI 55.6-57.1%). Similar trends remained throughout 2010-2012. CONCLUSION When optometric services are government-uninsured and government-insured ophthalmologist services are geographically distant, ocular patients utilized PCPs and ED physicians more frequently. Due to different levels of training and available equipment for eye examinations among PCPs, ED physicians and optometrists, the quality of eye care and cost-effectiveness of increased use of PCPs and ED physicians for ocular management warrant further investigation. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- William Jeon
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Graham E Trope
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Richard Wedge
- Health Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Sherif El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Ya-Ping Jin
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Da Soh Z, Yu M, Betzler BK, Majithia S, Thakur S, Tham YC, Wong TY, Aung T, Friedman DS, Cheng CY. The Global Extent of Undetected Glaucoma in Adults: A Systematic Review and Meta-analysis. Ophthalmology 2021; 128:1393-1404. [PMID: 33865875 DOI: 10.1016/j.ophtha.2021.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 01/30/2023] Open
Abstract
TOPIC Glaucoma is the leading cause of irreversible blindness, despite having good prognosis with early treatment. We evaluated the global extent of undetected glaucoma and the factors associated with it in this systematic review and meta-analysis. CLINICAL RELEVANCE Undetected glaucoma increases the risk of vision impairment, which leads to detrimental effects on the quality-of-life and socioeconomic well-being of those affected. Detailed information on the extent and factors associated with undetected glaucoma aid in the development of public health interventions. METHODS We conducted a systematic review and meta-analysis of population-based studies published between January 1, 1990, and June 1, 2020. Article search was conducted in online databases (PubMED, Web-of-Science), grey literatures (OpenGrey), and nongovernment organization reports. Our outcome measure was the proportion of glaucoma cases that were undetected previously. Manifest glaucoma included any form of glaucoma reported in the original studies and may include primary open-angle glaucoma (POAG), primary angle-closure-glaucoma, secondary glaucoma, or a combination thereof. Undetected glaucoma was defined as glaucoma cases that were undetected prior to diagnosis in the respective study. Random-effect meta-analysis was used to estimate the pooled proportion of undetected glaucoma. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines in our study. RESULTS We identified 61 articles from 55 population-based studies (n = 189 359 participants; n = 6949 manifest glaucoma). Globally, more than half of all glaucoma cases were undetected previously on average in each geographical region. Africa (odds ratio [OR], 12.70; 95% confidence interval [CI], 4.91-32.86) and Asia (OR, 3.41; 95% CI, 1.63-7.16) showed higher odds of undetected glaucoma as compared with Europe. Countries with low Human Development Index (HDI; <0.55) showed a higher proportion of undetected manifest glaucoma as compared with countries of medium to very high HDI (≥0.55; all P < 0.001). In 2020, 43.78 million POAG cases were projected to be undetected, of which 76.7% were in Africa and Asia. DISCUSSION Undetected glaucoma is highly prevalent across diverse communities worldwide and more common in Africa and Asia. Strategies to improve detection are needed to prevent excess visual disability and blindness resulting from glaucoma.
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Affiliation(s)
- Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Marco Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore.
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12
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O’day R, Smith C, Muir J, Turner A. Optometric use of a teleophthalmology service in rural Western Australia: comparison of two prospective audits. Clin Exp Optom 2021; 99:163-7. [DOI: 10.1111/cxo.12334] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/15/2015] [Accepted: 08/07/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Roderick O’day
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia,
| | | | | | - Angus Turner
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia,
- Lions Eye Institute, Perth, Australia,
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13
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Ocansey S, Abu EK, Abraham CH, Owusu-Ansah A, Acheampong C, Mensah F, Darko-Takyi C, Ilechie A. Socio-demographic factors modify awareness, knowledge, and perceived risk of glaucoma in rural and urban residents in Ghana: a population-based survey. Ther Adv Ophthalmol 2021; 13:2515841421998099. [PMID: 33796815 PMCID: PMC7968030 DOI: 10.1177/2515841421998099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate the awareness, knowledge and the perception of risks of glaucoma among rural and urban dwellers in Ghana, a high prevalent country, in order to provide information for health promotion planning. Method: In a population-based descriptive cross-sectional survey, 1200 adults were selected from household settings, using a two-stage cluster and simple systematic random sampling. Quantitative data collection, using interviewer-administered questionnaire, was employed. Descriptive statistics were performed using chi-square, ordinal univariate, multinomial and multivariate logistic regression models used to calculate odds ratio with 95% confidence interval (CI) to identify predictive factors. Results: Overall, only 326 (27.2%, 95% CI = 24.6–29.7) indicated they were aware of glaucoma, whereas 331 (27.6%, 95% CI = 24.6–29.7) had ever undergone an eye screening. Low knowledge was demonstrated in 152 (46.6%, 95% CI = 41.2–52.0) and high knowledge in 99 (30.4%, 95% CI = 25.4–35.4) glaucoma-aware participants. Only 238 (19.8%, 95% CI = 17.6–22.1) of respondents presumed themselves to be at risk of developing glaucoma. Having eye examination (within the last 6 months) was positively associated with knowledge (adjusted odds ratio (AOR) = 1.413; 95% CI = 0.9–1.896) and awareness (AOR = 1.13; 95% CI = 0.938–2.449). Three levels of education (no education (AOR = 0.041; 95% CI = 0.016–0.11), primary (AOR = 0.057; 95% CI = 0.018–0.179), and middle school (AOR = 0.254; 95% CI = 0.127–0.51)) were associated with low knowledge while all levels of education were inversely associated with awareness. Perceived risk of glaucoma was also influenced by area of residence (rural (AOR = 0.344; 95% CI = 0.21–0.57)), being young (18–24 years (AOR = 4.308; 95% CI = 2.36–7.88)) and having previously undergone screening for glaucoma (AOR = 13.200; 95% CI = 5.318–32.764). Conclusion: The main modifiers of glaucoma awareness and knowledge were education and previous eye examination, but awareness had additional factor of area of residence. Perceived risk of glaucoma was influenced by being young and living in urban areas.
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Affiliation(s)
- Stephen Ocansey
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast. PMB University Post Office, Cape Coast, Ghana, CC-167-5809
| | - Emmanuel K Abu
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Carl Halladay Abraham
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Andrews Owusu-Ansah
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana; Glaucoma Research Group, 2nd Xiangya Hospital of Central South University, Changsha, China
| | | | | | - Charles Darko-Takyi
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Alex Ilechie
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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Wang H, Kalloniatis M. Clinical outcomes of the Centre for Eye Health: an intra-professional optometry-led collaborative eye care clinic in Australia. Clin Exp Optom 2021; 104:795-804. [PMID: 33689627 DOI: 10.1080/08164622.2021.1878821] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Clinical relevance: This novel clinical model is the first of its kind in Australia and was designed to help reduce unnecessary referrals into overburdened public systems by utilising pre-existing community-based resources.Background: The Centre for Eye Health (CFEH) is an intra-professional optometry-led care clinic offering an alternative pathway to traditional ophthalmology-based pathways (public hospital clinics or private practices) for 'at-risk' patients requiring ocular imaging, diagnostic and management services. This study evaluates the CFEH integrated eye-care model in the identification of chronic eye diseases within the community.Methods: A retrospective random clinical audit of over 750 medical records of patients referred to the CFEH between July 2016 and June 2019 was conducted. Demographics of patients, referral type, final diagnosis and recommended management plans were extracted from this subset. Clinic key performance indicators (referral turnaround time, and net cost per patient appointment) were also extracted.Results: Of the 755 referrals associated with the audited records, 77.4% resulted in the identification of patients with or at-risk of developing eye diseases with 73.5% of this cohort requiring ongoing monitoring at CFEH or referral to ophthalmology. Although the CFEH model is not designed to diagnose or manage acute conditions, 1.5% of patients in this pathway required same day ophthalmological or medical intervention. The cost per patient was equivalent to hospital eye departments costs.Conclusion: This integrated care pathway has the potential to reduce unnecessary referrals from optometrists to hospital ophthalmological service by offering a safe and effective alternate pathway. The majority of patients seen within this pathway were able to be monitored within optometry-led services. This is a unique clinical model utilising inter-professional referrals within optometry which has the potential to reduce preventable blindness within the community through the early detection of eye diseases.
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Affiliation(s)
- Henrietta Wang
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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15
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Hashemi H, Pakzad R, Yekta A, Aghamirsalim M, Ostadimoghaddam H, Khabazkhoob M. Investigation of Economic Inequality in Eye Care Services Utilization and Its Determinants in Rural Regions Using the Oaxaca- Blinder Decomposition Approach. Semin Ophthalmol 2021; 36:373-378. [PMID: 33615980 DOI: 10.1080/08820538.2021.1890782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study was conducted to determine economic inequality in Eye Care Services Utilization (ECSU) and its determinants in the underserved rural population of Iran. METHODS In this population-based study, two underserved regions in the north and southwest of Iran were randomly selected and 3850 individuals living in these regions were invited to participate in the study. ESCU was defined as a history of at least one optometric or ophthalmologic visit during the lifetime. Concentration index (C) was used to evaluate economic inequality and the Oaxaca- Blinder decomposition was applied to decompose the gap between the rich and poor. RESULTS Of 3851 individuals, 3314 participated in the study (response rate: 86%). The data of 3094 participants were analyzed. The concentration index was 0.139 (95% CI: 0.218 - 0.590), indicating a pro-rich inequality in the ECSU. The ECSU was 12.38% (10.46 to 14.31) in the poor and 21.15% (18.38 to 23.92) in the rich, and the gap between them was about 90% in favor of the rich (p < 00.001). A marked percentage of the gap was due to the explained portion (b: -11.49; p < .001). The unexplained portion coefficient was b: 2.72 (p: 0.020). In the explained portion, economic status (b: -12.37; p < .001) and age (b: 0.90; p: 0.021) caused inequality in favor of the rich and poor respectively while only economic status (b:-21.1; p < .001) had a significant effect on inequality in favor of the rich in the unexplained portion. CONCLUSION There is a significant pro-rich inequality in ECSU in the rural areas of Iran. A major portion of this inequality is related to differences in age and economic status between the two groups. Economic status has direct and indirect effects on inequality in ECSU; therefore, health policymakers should focus on economic improvement to remove the gap.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohamadreza Aghamirsalim
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Akuffo KO, Sewpaul R, Dukhi N, Asare AK, Kumah DB, Addo EK, Agyei-Manu E, Reddy P. Eye care utilization pattern in South Africa: results from SANHANES-1. BMC Health Serv Res 2020; 20:756. [PMID: 32807155 PMCID: PMC7430111 DOI: 10.1186/s12913-020-05621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eye examinations are recommended for all persons throughout life. However, there is disparity in the uptake of eye care services in different populations. Using data from a nationally representative population-based cross-sectional study (the South African National Health and Nutrition Examination Survey, [SANHANES-1]), this paper investigates the utilization of eye care services and its associated factors in South Africa. METHODS Participants aged 15 years and older who participated in interviews and clinical examination were enrolled in the SANHANES from 2011 to 2012. Eye care utilization was assessed from participants' responses to whether they had their eyes examined by a medical professional and when they were last examined. Data were analysed using multiple logistic regression models employing a hierarchical approach to add predisposing (e.g. age, sex), enabling (e.g. health insurance) and need (e.g. hypertension) factors sequentially. RESULTS The study sampled 3320 participants, with 64.9% being females. 73.4% (95% CI [69.7-76.7]) of participants had never had an eye examination. After statistical adjustment, age groups (compared with 15-29 years: 30-44 years Odds Ratio [OR] = 1.76; 45-59 years OR = 2.13; 60-74 years OR = 2.74; ≥75 years OR = 3.22), ethnicity (compared with African descent: white OR = 4.71; mixed-race OR = 1.87; Indian OR = 7.67), high risk alcohol use (OR = 1.83), wealth index (compared with lowest quintile: third quintile OR = 1.75; fourth quintile OR = 2.23; fifth quintile OR = 2.49), health insurance (OR = 2.19), diabetes (OR = 1.75), high cholesterol (OR = 2.51), having assessed healthcare in the past 5 years (OR = 2.42), and self-reported vision problems (OR = 1.51) were significantly associated with eye care utilization. CONCLUSION Almost three-quarters of South Africans sampled were not utilizing eye care services. It is imperative to strengthen current public health measures (including eye health promotion programs) to address the alarmingly low uptake of eye care services as well as the disparities in eye care utilization in South Africa.
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Affiliation(s)
- Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Ronel Sewpaul
- Social Aspects of Public Health, Human Sciences Research Council, Cape Town, South Africa
| | - Natisha Dukhi
- Social Aspects of Public Health, Human Sciences Research Council, Cape Town, South Africa
| | - Akosua Kesewah Asare
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Ben Kumah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Kofi Addo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Ophthalmology and Visual Sciences, Moran Eye Centre, University of Utah, Salt Lake City, Utah, United States.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, United States
| | - Eldad Agyei-Manu
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Usher Institute for Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Priscilla Reddy
- Social Aspects of Public Health, Human Sciences Research Council, Cape Town, South Africa.,Research Associate, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
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Katibeh M, Sabbaghi H, Kalantarion M, Nikkhah H, Mousavi B, Beiranvand R, Ahmadieh H, Kallestrup P. Eye Care Utilization in A Community-oriented Mobile Screening Programme for Improving Eye Health in Iran: A Cluster Randomized Trial. Ophthalmic Epidemiol 2020; 27:417-428. [PMID: 32449414 DOI: 10.1080/09286586.2020.1768552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the effect of a mobile-based screening programme on eye care utilization in Iran. METHOD In this cluster randomized community trial, a representative sample of residents aged≥50 years from urban and rural areas in four districts in Tehran province were enrolled. The clusters were randomly assigned to one of the three parallel arms; the mHealth arm with digital data collection, vision screening test and retina evaluation using an integrated mobile application, the conventional arm with manual data collection and screening tests using Snellen chart and Fundus photography at the local primary healthcare facility, and the control arm with manual data collection without screening tests. The main outcome measure was eye care utilization which was defined as at least one visit to an optometrist or ophthalmologist. RESULTS Of 3312 eligible individuals, 2520 (76.1%) participated. In the first 3 months after the screening programme, eye care utilization was higher among those who were referred by the mHealth method (35.6% 95%CI: 31.1-40.4%) compared to those referred by the conventional method (32.7%, 95%CI: 27.5-38.2%) and to those observed in the control arm (4.5%, 95%CI: 3.2-6.0). Eye care utilization improved (OR = 1.5, 95%CI: 1.2-1.9) among the referred people after the screening programme compared to the utilization before this programme; however, this improvement was significantly higher in the mHealth method (OR: 1.7, 95%CI: 1.2-2.4) compared to the conventional method (OR: 1.2, 95%CI: 0.8-1.8). CONCLUSION AND RELEVANCE The mobile-based screening programme can significantly improve eye care utilization at the community level.
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Affiliation(s)
- Marzieh Katibeh
- Centre for Global Health, Department of Public Health, Aarhus University , Aarhus, Denmark.,Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Masomeh Kalantarion
- Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Batool Mousavi
- Department of Prevention, Janbazan Medical and Engineering Research Centre , Tehran, Iran
| | - Ramin Beiranvand
- Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus University , Aarhus, Denmark
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18
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MOHAMMADI SF, ALINIA C, GHADERI E, LASHAY A, JABBARVAND M, ASHRAFI E, NOURMOHAMMADI N, SHAHRAZ S. Ophthalmic Care Utilization and Out-of-Pocket Expenditure in Iran: Kurdistan Eye Health and Economics Survey-2015. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:1301-1309. [PMID: 31497552 PMCID: PMC6708551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to lack of information about ophthalmic economics in Iran, health policy makers unable to distribute resources optimally in terms of efficiency and equity. Therefore, we estimated the total and eye care utilization, out-of-pocket expenditures, and its association with social determinants of health in Iran in 2015. METHODS A multi-stage population-based, cross-sectional study in a random sample aged 50 yr or older in Kurdistan Province, Northwest Iran was used. The utilization rate of eye and general health care and related out-of-pocket expenditures was estimated during the recent last six months. To find the association between social factors and care out-of-pocket expenditures, we used a Heckman two-step regression model. RESULTS About 81% and 37% of participants were utilized the health and ophthalmic services, respectively. Statistically significant lower ophthalmic utilization rates were observed among men, middle-aged population, illiterate participants, rural residents, daily-paid workers, and the poorest participants. The average of vision and total health-related out-of-pocket expenditures among those used these services have estimated as US$43.7 (SE: 2.6) and US$439.9 (SE: 22.8), respectively. The highest (US$ 396.6) and lowest (US$ 10.4) ophthalmic out-of-pocket costs were related to patients with Glaucoma and Central Nervous System abnormalities, respectively. Multivariate analyses confirmed an unequal probability of having the ophthalmic out-of-pocket expenditures among different subgroups especially in favor of females, older, and those with more severe visual impairment. CONCLUSION Ophthalmic disorders reconstituted about 10% of all health services OOP expenditures on average among individuals older than 50 yr.
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Affiliation(s)
- Seyed-Farzad MOHAMMADI
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Cyrus ALINIA
- Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran,Corresponding Author:
| | - Ebrahim GHADERI
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Alireza LASHAY
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud JABBARVAND
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham ASHRAFI
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser NOURMOHAMMADI
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid SHAHRAZ
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
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Kirkman JM, Bentley SA, Armitage JA, Woods CA. Could adoption of the rural pipeline concept redress Australian optometry workforce issues? Clin Exp Optom 2019; 102:566-570. [PMID: 30801801 DOI: 10.1111/cxo.12873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/07/2018] [Accepted: 12/30/2018] [Indexed: 11/26/2022] Open
Abstract
People living in rural and remote areas have poorer ocular health outcomes compared with those living in metropolitan areas. Reasons for this are multiple and complex but access to care is consistently reported as a defining factor. The geographic maldistribution of eye-care professionals is a major obstacle for regional, rural and remote Australians seeking care. Research from the medical profession suggests adopting the 'rural pipeline' concept to address the issue of maldistribution. This approach appears to have had some success in medicine, and involves recruiting students from a rural background, exposing students to rural practice through placements and offering graduates incentives and support to practice rurally. Lessons could be learnt from the medical field as there is a dearth of literature describing the utilisation of the rural pipeline in allied health. However, given the differences between professions it cannot be assumed factors and results will be the same. A greater understanding is required to determine whether optometry is a profession which may benefit from the rural pipeline concept.
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Affiliation(s)
- Jacqueline M Kirkman
- Deakin Optometry, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Sharon A Bentley
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Craig A Woods
- Deakin Optometry, School of Medicine, Deakin University, Geelong, Victoria, Australia
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20
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Shah M, Noor A, Ormsby GM, Islam FA, Harper CA, Keeffe JE. Task sharing: Development of evidence-based co-management strategy model for screening, detection, and management of diabetic retinopathy. Int J Health Plann Manage 2018; 33:e1088-e1099. [PMID: 30052276 DOI: 10.1002/hpm.2590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 02/19/2018] [Accepted: 06/29/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The number of adults with diabetes is increasing worldwide and also the number of people with diabetic retinopathy (DR), a major complication of diabetes. Task sharing in eye care for people with diabetes could address the shortage in the number of ophthalmologists and increase access to eye care services. This study investigated the opinion of eye care professionals for a checklist of tasks, which are involved in DR management, to be possibly shared by optometrists and mid-level eye and health care workers with ophthalmologists. METHODS The study used a purposive sampling technique. All available eye and health care workers from five selected hospitals in two provinces in Pakistan were recruited. A cross-sectional survey was conducted to investigate the potential roles of various cadres in eye care delivery for people with diabetes. RESULTS Ninety-six (79%) participants including doctors (n = 56), optometrists (n = 29), and mid-level eye care workers (n = 11) responded to the survey. Two-thirds of the participants suggested mid-level eye care workers, while 88.5% stated that lady health workers could provide education and health promotion to people with diabetes. Most of the participants (88.5%) suggested that optometrists could share the task of dilated ophthalmoscopy with ophthalmologists for detection of DR and make referrals to ophthalmologists if needed. Ophthalmologists remained the recommended cadre to undertake the eye examinations of patients with proliferative DR and diabetic macular edema. CONCLUSION This research provided an insight on how task sharing in DR management can be implemented by optimizing the roles of eye care workers.
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Affiliation(s)
- Mufarriq Shah
- Department of Optometry, Pakistan Institute of Community Ophthalmology, Pakistan
| | - Ayesha Noor
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Gail M Ormsby
- Department of Education, Avondale College of Higher Education, Cooranbong, New South Wales, Australia
| | - Fakir Amirul Islam
- Statistics, Data Science and Epidemiology, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Colin Alex Harper
- Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, and Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Raznahan M, Emamian MH, Hashemi H, Zeraati H, Fotouhi A. Assessment of Horizontal Inequity in Eye Care Utilization in the Iranian Middle-aged Population. J Ophthalmic Vis Res 2018; 13:284-292. [PMID: 30090185 PMCID: PMC6058560 DOI: 10.4103/jovr.jovr_221_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/17/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The present study was designed to determine the extent that horizontal inequity was realized regarding eye care utilization in a middle-aged population as well as factors affecting this equity. METHODS Data were obtained from a population-based study (Shahroud Eye Cohort Study) in 2009 that included 5190 participants from 40 to 64 years of age. Horizontal inequity was determined based on the following variables: (i) economic status, (ii) eye care service needs, (iii) non-need variables, and (iv) eye care utilization (visiting an ophthalmologist or optometrist). Decomposition analysis of the concentration index based on a nonlinear model and indirect standardization was used to ascertain the contribution of each factor in inequity of eye care utilization. RESULTS After adjusting for need variables, the results of our study demonstrated that horizontal inequity in eye care utilization in a middle-aged Iranian population remained positive and significant (horizontal inequity: 0.19; 95% confidence interval: 0.17-0.23) indicating that use of services was focused among participants with a better financial situation. Furthermore, decomposition analysis demonstrated that educational level and economic status had the greatest contribution (54.1% and 41.1%, respectively) in comparison to other variables. CONCLUSION This study demonstrated that horizontal inequity exists in eye care utilization among the middle-aged Iranian population.
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Affiliation(s)
- Maedeh Raznahan
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
- Office of Deputy of Research, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Emamian
- Center for Health-Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Hojjat Zeraati
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Aljied R, Aubin MJ, Buhrmann R, Sabeti S, Freeman EE. Eye care utilization and its determinants in Canada. Can J Ophthalmol 2018; 53:298-304. [DOI: 10.1016/j.jcjo.2018.01.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 11/26/2022]
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Yu TY, Donovan T, Armfield N, Gole GA. Retinopathy of prematurity: the high cost of screening regional and remote infants. Clin Exp Ophthalmol 2018; 46:645-651. [DOI: 10.1111/ceo.13160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tzu-Ying Yu
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Tim Donovan
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Division of Neonatology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Nigel Armfield
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Glen A Gole
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Ophthalmology; Lady Cilento Children's Hospital; Brisbane Queensland Australia
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Ly A, Nivison-Smith L, Hennessy M, Kalloniatis M. The advantages of intermediate-tier, inter-optometric referral of low risk pigmented lesions. Ophthalmic Physiol Opt 2017; 37:661-668. [PMID: 29044669 PMCID: PMC6446908 DOI: 10.1111/opo.12413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/23/2017] [Indexed: 11/14/2022]
Abstract
Purpose Pigmented ocular lesions are commonly encountered by eye‐care professionals, and range from benign to sight or life‐threatening. After identifying a lesion, the primary care professional must establish the likely diagnosis and decide either to reassure, to monitor or to refer. The increasing use of ocular imaging technologies has contributed to an increase in the detection rate of pigmented lesions and a higher number of referrals, which may challenge existing pathways of health‐care delivery. Specialist services may be over‐burdened by referring all patients with pigmented lesions for an opinion, while inter‐optometric referrals are underutilised. The aim of this study was to describe the referral patterns of pigmented lesions to an optometry led intermediate‐tier collaborative care clinic. Methods We performed a retrospective review of patient records using the list of patients examined at Centre for Eye Health (CFEH) for an initial or follow up pigmented lesion assessment between the 1/7/2013 and the 30/6/2016. Analysis was performed on: patient demographic characteristics, the referrer's tentative diagnosis, CFEH diagnosis and recommended management plan. Results Across 182 patient records, the primary lesion prompting referral was usually located in the posterior segment: choroidal naevus (105/182, 58%), congenital hypertrophy of the retinal pigment epithelium (CHRPE; 11/182, 6%), chorioretinal scarring (10/182, 5%) or not specified (52/182, 29%). Referrals described a specific request for ocular imaging in 25 instances (14%). The number of cases with a non‐specific diagnosis was reduced after intermediate‐tier care assessment (from 29% to 10%), while the number of diagnoses with less common conditions rose (from 2% to 21%). There was a 2% false positive referral rate to intermediate‐tier care and a first visit discharge rate of 35%. A minority required on‐referral to an ophthalmologist (22/182, 12%), either for unrelated incidental ocular findings, or suspicious choroidal naevi. Conditions most amenable to optometric follow up included: 1) chorioretinal scarring, 2) choroidal naevus, and 3) CHRPE. Conclusions Intermediate‐tier optometric eye‐care in pigmented lesions (following opportunistic primary care screening) has the potential to reduce the number of cases with non‐specific diagnoses and to increase those with less common diagnoses. The majority of cases seen under this intermediate‐tier model required only ongoing optometric surveillance.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Sydney, NSW, Australia.,School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, Sydney, NSW, Australia.,School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Michael Hennessy
- Centre for Eye Health, Sydney, NSW, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, NSW, Australia.,School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
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Caffery LJ, Taylor M, Gole G, Smith AC. Models of care in tele-ophthalmology: A scoping review. J Telemed Telecare 2017; 25:106-122. [DOI: 10.1177/1357633x17742182] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The objective of this review was to identify and describe telehealth models of care for ophthalmic services. We conducted a scoping review of the literature to identify how ophthalmic care can be delivered by telehealth. We searched the PubMed database to identify relevant articles which were screened based on pre-defined inclusion criteria. For included articles, data were extracted, categorised and analysed. Synthesis of findings was performed narratively. The scoping review included 78 articles describing 62 discrete tele-ophthalmic models of care. Tele-ophthalmic models of care can be used for consultative service, screening, triage and remote supervision. The majority of services were for general eye care and triage ( n = 17; 26%) or emergency services ( n = 8; 12%). The most common conditions for disease-specific models of care were diabetic retinopathy ( n = 14; 21%), and glaucoma ( n = 8; 12%). Most models of care involved local clinicians capturing images and transmitting them to an ophthalmologist for assessment. This scoping review demonstrated tele-ophthalmology to be feasible for consultation, screening, triage and remote supervision applications across a broad range of ophthalmic conditions. A large number of models of care have been identified and described in this review. Considerable collaboration between patient-end clinicians and substantial infrastructure is typically required for tele-ophthalmology.
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Affiliation(s)
- Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
| | - Monica Taylor
- Centre for Online Health, The University of Queensland, Australia
| | - Glen Gole
- Children’s Health Queensland, Queensland Children’s Hospital, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
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Foreman J, Xie J, Keel S, Wijngaarden P, Crowston J, Taylor HR, Dirani M. Cataract surgery coverage rates for Indigenous and non‐Indigenous Australians: the National Eye Health Survey. Med J Aust 2017; 207:256-261. [DOI: 10.5694/mja17.00057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/27/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Joshua Foreman
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Jing Xie
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Peter Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Jonathan Crowston
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | - Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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Foreman J, Xie J, Keel S, Taylor HR, Dirani M. Utilization of eye health-care services in Australia: the National Eye Health Survey. Clin Exp Ophthalmol 2017; 46:213-221. [DOI: 10.1111/ceo.13035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/16/2017] [Accepted: 08/02/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Joshua Foreman
- Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
- Department of Surgery, Ophthalmology; The University of Melbourne; Melbourne Victoria Australia
| | - Jing Xie
- Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
- Department of Surgery, Ophthalmology; The University of Melbourne; Melbourne Victoria Australia
| | - Stuart Keel
- Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
- Department of Surgery, Ophthalmology; The University of Melbourne; Melbourne Victoria Australia
| | - Hugh R Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Mohamed Dirani
- Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
- Department of Surgery, Ophthalmology; The University of Melbourne; Melbourne Victoria Australia
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Foreman J, Xie J, Keel S, Taylor HR, Dirani M. Treatment coverage rates for refractive error in the National Eye Health survey. PLoS One 2017; 12:e0175353. [PMID: 28407009 PMCID: PMC5391052 DOI: 10.1371/journal.pone.0175353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/08/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To present treatment coverage rates and risk factors associated with uncorrected refractive error in Australia. METHODS Thirty population clusters were randomly selected from all geographic remoteness strata in Australia to provide samples of 1738 Indigenous Australians aged 40 years and older and 3098 non-Indigenous Australians aged 50 years and older. Presenting visual acuity was measured and those with vision loss (worse than 6/12) underwent pinhole testing and hand-held auto-refraction. Participants whose corrected visual acuity improved to be 6/12 or better were assigned as having uncorrected refractive error as the main cause of vision loss. The treatment coverage rates of refractive error were calculated (proportion of participants with refractive error that had distance correction and presenting visual acuity better than 6/12), and risk factor analysis for refractive correction was performed. RESULTS The refractive error treatment coverage rate in Indigenous Australians of 82.2% (95% CI 78.6-85.3) was significantly lower than in non-Indigenous Australians (93.5%, 92.0-94.8) (Odds ratio [OR] 0.51, 0.35-0.75). In Indigenous participants, remoteness (OR 0.41, 0.19-0.89 and OR 0.55, 0.35-0.85 in Outer Regional and Very Remote areas, respectively), having never undergone an eye examination (OR 0.08, 0.02-0.43) and having consulted a health worker other than an optometrist or ophthalmologist (OR 0.30, 0.11-0.84) were risk factors for low coverage. On the other hand, speaking English was a protective factor (OR 2.72, 1.13-6.45) for treatment of refractive error. Compared to non-Indigenous Australians who had an eye examination within one year, participants who had not undergone an eye examination within the past five years (OR 0.08, 0.03-0.21) or had never been examined (OR 0.05, 0.10-0.23) had lower coverage. CONCLUSION Interventions that increase integrated optometry services in regional and remote Indigenous communities may improve the treatment coverage rate of refractive error. Increasing refractive error treatment coverage rates in both Indigenous and non-Indigenous Australians through at least five-yearly eye examinations and the provision of affordable spectacles will significantly reduce the national burden of vision loss in Australia.
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Affiliation(s)
- Joshua Foreman
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
- Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Jing Xie
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
- Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
- Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Hugh R. Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
- Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia
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Marmamula S, Giridhar P, Khanna RC. Utilization of eye care services among those with unilateral visual impairment in rural South India: Andhra Pradesh Eye Disease Study (APEDS). Int J Ophthalmol 2017; 10:473-479. [PMID: 28393042 DOI: 10.18240/ijo.2017.03.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 07/13/2016] [Indexed: 02/04/2023] Open
Abstract
AIM To report on the utilization of eye care services and its associated factors among those with unilateral visual impairment (VI) in a rural South Indian population. METHODS A population based cross-sectional study was conducted in three districts (Adilabad, Mahbubnagar and West Godavari) in the state of Andhra Pradesh, India. A detailed interview and a comprehensive eye examination were conducted. Those with unilateral VI were asked questions about noticing any change in vision and on utilization of eye care services. The most important reason reported by the participant for not utilizing the services was used for the analysis. Multiple logistic regression models were used to examine the association between noticing a change in vision and socio-demographic variables such as age, gender, education and area of residence, severity and causes of VI. RESULTS Among the 4456 participants aged ≥16y who were administered the questionnaire, 53.2% were women, and 54.7% had no education. Of the 489 (11%; 95% CI: 10.1-11.9) people with unilateral VI, 399 (81.6%) participants reported noticing a change in their vision over the last five years but only 136 (34.1%) participants had sought eye care consultation. Those who had any education (OR: 1.9; 95% CI: 1.1-3.2), had blindness (OR: 2.7; 95% CI: 1.4-5.2), and cataract (OR: 2.1; 95% CI: 1.0-4.3) as a cause of unilateral VI were more like to seek eye care consultations. The most commonly reported reasons for not seeking eye care services were "do not have money for eye checkup" in 30.7% of the participants followed by "do not have a serious problem" (30.0%). CONCLUSION A large proportion of rural population though noticed a change in their vision did not seek eye care due to financial and person-related reasons. Eye care service providers need to address these barriers to enhance the uptake of eye care services among those with unilateral VI.
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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 500034, India; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India; Wellcome Trust/DBT India Alliance Fellow, L V Prasad Eye Institute, Hyderabad 500034, India; School of Optometry & Vision Science, University of New South Wales, Sydney NSW 2052, Australia; Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Pyda Giridhar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao, International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500034, 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 500034, India; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India; School of Optometry & Vision Science, University of New South Wales, Sydney NSW 2052, Australia
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Park YS, Heo H, Ye BJ, Suh YW, Kim SH, Park SH, Lim KH, Lee SJ, Park SH, Baek SH. Prevalence and Factors Associated with the Use of Eye Care Services in South Korea: Korea National Health and Nutrition Examination Survey 2010-2012. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:58-70. [PMID: 28243025 PMCID: PMC5327176 DOI: 10.3341/kjo.2017.31.1.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/21/2015] [Indexed: 11/26/2022] Open
Abstract
Purpose To estimate the factors and prevalence of eye care service utilization in the South Korean population. Methods This cross-sectional, population-based study included data from 22,550 Koreans aged ≥5 years who participated in the Korea National Health and Nutrition Examination Survey from 2010 to 2012. For people aged 5 to 11 years (young children), information was based on self-reports of contact with eye care service in the past year; for people aged ≥12 years (older population), the information was based on the self-reported lifetime contact with eye care service. Univariate and multivariate logistic regression analyses of the complex sample survey data were performed. Results The prevalence of eye care service use in young children during the past year was 61.1% (95% confidence
interval, 58.1%–64.1%), while that in the older population during their lifetime was 73.5%. Subjects aged 7 to 11 years were more likely to have had an eye examination in the past year than subjects aged 5 to 6 years (odds ratio, 3.83; 95% confidence interval, 2.37–6.19). Multivariate logistic regression analysis indicated that higher monthly household income, being a National Health Insurance holder, and having private health insurance were related to more frequent use of eye care services in young children. For the older population and women, those living in an urban area and those with a best-corrected visual acuity less than 20 / 40 in the worse-seeing eye were more likely to have had an eye examination during their lifetime. Low education level was associated with low lifetime use of eye care services in the older population. Conclusions There are sociodemographic disparities with use of eye care services in South Korea. This population-based study provides information that is useful for determining different intervention programs based on sociodemographic disparities to promote eye care service utilization in South Korea.
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Affiliation(s)
- Yong Seok Park
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hwan Heo
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Byeong Jin Ye
- Department of Occupational and Environmental Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Young-Woo Suh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Seung-Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Shin Hae Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Key Hwan Lim
- Department of Ophthalmology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Jin Lee
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Song Hee Park
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seung-Hee Baek
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Chan VF, Minto H, Mashayo E, Naidoo KS. Improving eye health using a child-to-child approach in Bariadi, Tanzania. AFRICAN VISION AND EYE HEALTH 2017. [DOI: 10.4102/aveh.v76i1.406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: Vision Champions (VC) are children trained to perform simple eye health screening and share eye health messages among their community. Our objectives were to assess the ability of VC in identifying and referring children and the community with refractive error and obvious ocular disease and to assess the change in knowledge and practice of eye healthseeking behaviour of the community 3 months after the introduction of the Vision Champion Programme.Methods: We purposively sampled 600 households and interviewed 1051 participants in two phases with a close-ended questionnaire. The numbers of children screened, referred by the VC and those who attended the Vision Centre were recorded. The percentage of people who answered the questions correctly were compared between Phase 1 (P1) and Phase 2 (P2).Results: The VC shared their eye health messages with 6311 people, screened 7575 people’s vision and referred 2433 people for further care. The community were more aware that using eye ointment not prescribed by doctors (P1 = 58.96% vs. P2 = 72.75%) can lead to blindness. Participants were more aware that they should not administer eye drops in stock (P1 = 44.18% vs. P2 = 61.37%) or received from a friend or relative (P1 = 53.23% vs. P2 = 72.35%) if their eyes are red and painful.Conclusion: Children have the potential to effectively share eye health messages and conduct simple vision screening for their families and peers. Efforts are needed to sensitise the community to improve the referral or follow-up rate.
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Hong H, Mújica OJ, Anaya J, Lansingh VC, López E, Silva JC. The Challenge of Universal Eye Health in Latin America: distributive inequality of ophthalmologists in 14 countries. BMJ Open 2016; 6:e012819. [PMID: 27864248 PMCID: PMC5128993 DOI: 10.1136/bmjopen-2016-012819] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND No comprehensive study currently exists on the supply of ophthalmologists across Latin America. We explored sociogeographic inequalities in the availability and distribution of ophthalmologists across 14 Latin American countries. METHODS The National Ophthalmologic Societies of Argentina, Bolivia, Brazil, Colombia, Costa Rica, Chile, the Dominican Republic, Ecuador, Guatemala, Mexico, Paraguay, Peru, Uruguay and Venezuela provided data on affiliated ophthalmologists by first-order subnational divisions in 2013. Human Development Index (HDI) estimates at the corresponding subnational division were used as equity stratifiers. Distributional inequality of ophthalmologists within each country was assessed by the health concentration index (HCI) and the index of dissimilarity (ID), along with the mean level of ophthalmologists per population. RESULTS Across all countries studied, there were 5.2 ophthalmologists per 100 000 population on average (95% CI 5.0 to 5.4) in 2013, with a mean HCI of 0.26 (0.16 to 0.37) and a mean relative ID of 22.7% (20.9% to 24.7%). There was wide inequality in ophthalmologist availability between countries, ranging from 1.2 (1.1 to 1.4) in Ecuador to 8.6 (8.5 to 8.8) in Brazil. All countries had positive (ie, pro-rich) HCI values ranging from 0.68 (0.66 to 0.71) in Guatemala to 0.02 (-0.11 to 0.14) in Venezuela. Correspondingly, redistributive potential to achieve equity was closest in Venezuela (ID: 1.5%) and farthest in Guatemala (ID: 60.3%). Benchmarked against regional averages, most countries had a lower availability of ophthalmologists and higher relative inequality. CONCLUSIONS There is high inequality in the level and distribution of ophthalmologists between and within countries in Latin America, with a disproportionate number concentrated in more developed, socially advantaged areas. More equitable access to ophthalmologists could be achieved by implementing incentivised human resources redistribution programmes and by improving the social determinants of health in underserved areas.
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Affiliation(s)
- Hannah Hong
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Oscar J Mújica
- Sustainable Development and Health Equity, Pan American Health Organization, Washington District of Columbia, USA
| | - José Anaya
- Instituto Mexicano de Oftalmologia, Mexico City, Mexico
| | | | - Ellery López
- Instituto Mexicano de Oftalmologia, Mexico City, Mexico
| | - Juan Carlos Silva
- Prevención de Ceguera y Salud Ocular, Organización Panamericana de la Salud, Bogotá, Colombia
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De-Gaulle VF, Dako-Gyeke P. Glaucoma awareness, knowledge, perception of risk and eye screening behaviour among residents of Abokobi, Ghana. BMC Ophthalmol 2016; 16:204. [PMID: 27855682 PMCID: PMC5114832 DOI: 10.1186/s12886-016-0376-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although glaucoma is the lead cause of irreversible blindness globally, the condition shows no signs or symptoms until later stages. Knowledge about the disease is known to influence utilization of eye screening services. This study aimed at understanding knowledge and perception of risk for glaucoma, as well as eye screening behaviour among residents of Abokobi, a peri-urban community. METHODS This was a cross-sectional study that employed quantitative data collection methods, with the use of a questionnaire. Descriptive statistics were used to describe the socio-demographic characteristics, knowledge about glaucoma and eye screening behaviour. Also, associations between socio-demographic factors and awareness as well as perception of risk were analysed using Chi-square test or Univariate Fisher's exact test. RESULTS Out of a total of 300 respondents, 60.3 % were females and 39.3 % were aware of glaucoma. Majority (99.1 %) of respondents aware of glaucoma also agreed the disease can result in blindness with only (28 %) affirming that blindness from glaucoma is irreversible. Nearly half (49.7 %) of the respondents perceived themselves to be at risk of developing glaucoma. The results showed that age and education (p <0.0001) were statistically significant with glaucoma awareness. Approximately, 20.7 % of the respondents have had their eye screened with just a few (4.3 %) screening for glaucoma. CONCLUSION Although glaucoma awareness was high, the findings display inadequate knowledge about glaucoma. There is a need to effectively inform and educate people about the disease.
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Affiliation(s)
- Virtue Fiawokome De-Gaulle
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
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Olusanya BA, Ashaye AO, Owoaje ET, Baiyeroju AM, Ajayi BG. Determinants of Utilization of Eye Care Services in a Rural Adult Population of a Developing Country. Middle East Afr J Ophthalmol 2016; 23:96-103. [PMID: 26957847 PMCID: PMC4759912 DOI: 10.4103/0974-9233.164621] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To describe the factors that determine the utilization of eye care services in a rural community in South-Western Nigeria. Methods: A descriptive cross-sectional survey using a multistage sampling technique was conducted. The main outcome measure was self-reported previous consultation of an orthodox medical facility for eye care. Results: The study sample included 643 participants. Only 122 (19%) respondents had previously visited orthodox facilities in search of eye care and 24% of those with presenting visual acuity <6/18 had sought eye care. Characteristics associated with previous utilization of eye care services were age of =70 years (odds ratio [OR] ≥ 1.7, P = 0.02); male gender (OR = 1.5, P = 0.04); literacy (OR = 1.7, P = 0.007); and residing close to an eye care facility (OR = 2.8, P < 0.001). Blind respondents were three times more likely to seek eye care (P < 0.001). Regression analysis revealed that factors associated with increased likelihood of utilization of eye care services included age ≥70 years; literacy; residence close to an eye facility; being diabetic or hypertensive; history of ocular symptoms, and blindness. Conclusions: These findings suggest that a significant proportion (75%) of adults in the study area are not utilizing eye care services and that blindness is an important determinant of utilization of eye care services. Health education and awareness campaigns about the importance and benefits of seeking eye care early, and the provision of community-based eye care programs are essential to boost the uptake of eye care services in this community as well as other rural areas of West Africa.
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Affiliation(s)
- Bolutife A Olusanya
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adeyinka O Ashaye
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Aderonke M Baiyeroju
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Benedictus G Ajayi
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Arinze OC, Eze BI, Ude NN, Onwubiko SN, Ezisi CN, Chuka-Okosa CM. Determinants of Eye Care Utilization in Rural South-eastern Nigeria. J Community Health 2016; 40:881-90. [PMID: 25787225 DOI: 10.1007/s10900-015-0008-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To determine the barriers and incentives to eye care utilization (ECU) in Abagana, a rural south-eastern Nigerian community. The study was a population-based cross-sectional mixed method (quantitative and qualitative) survey of adult inhabitants of Abagana, in July-August, 2011. Data on respondents' socio-demographics, barriers and incentives to ECU were collected, and analysed using descriptive and comparative statistics. A p < 0.05 was considered statistically significant. Qualitative data were obtained from focus group discussions and in-depth interviews and analyzed using ATLAS.ti software. The 549 respondents (males 224) were aged 49.8 ± 15.9 SD years (range 18-93 years). Overall, orthodox eye care had ever been sought by 42.4%, and 46.4% of those who reported change in vision. Lack of awareness-31.8%, cost-18.0%, and fatalistic attitudes-15.9% were the main ECU barriers. Possession of health insurance (OR 11.49; 95% CI 4.21-31.34; p = 0.001), family history of eye disorder (OR 3.27, 95% CI 2.03-5.26; p = 0.001), noticed change in vision (OR 11.30; 95% CI 1.42-90.09; p = 0.022), current eye disease (OR 4.06; 95% CI 2.29-7.19; p = 0.001) and systemic co-morbidity (OR 4.33; 95% CI 2.67-7.02; p = 0.001) were the incentives to ECU. To enhance the low ECU in Abagana community, educational interventions on eye health maintenance and eye health seeking behaviours, and measures to reduce eye care cost are recommended.
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Affiliation(s)
- O C Arinze
- Department of Ophthalmology, Federal Teaching Hospital, Abakiliki, Ebonyi State, Nigeria
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Martins AMEDBL, Muniz AB, Silveira MF, Carreiro DL, Souza JGS, Ferreira EFE. Avaliação da assistência oftalmológica na perspectiva dos usuários. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 19:390-402. [DOI: 10.1590/1980-5497201600020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/15/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Estimou-se as prevalências da necessidade, do acesso e da insatisfação com a assistência oftalmológica entre os que a obtiveram no último ano; identificaram-se os fatores associados a essa insatisfação. Considerou-se uma amostra probabilística complexa. Conduziu-se análises descritivas, bivariadas e múltiplas com correção pelo efeito de desenho. Dos 2.582 participantes, 76% necessitavam de assistência, dentre os que necessitavam, 82,5% tiveram acesso. Dentre os que obtiveram assistência no último ano, 13,1% estavam insatisfeitos. A insatisfação foi maior entre mais velhos, os que foram andando ou de bicicleta para o local da consulta e os que relataram que foi regular/ruim/péssima: a experiência de ter sido recebido e tratado com respeito, a clareza com que o prestador explicou as coisas e a liberdade que teve para escolher o seu prestador de assistência oftalmológica. A maioria necessitava e teve acesso à assistência. A insatisfação foi baixa. A idade do paciente, o meio de transporte utilizado para chegar ao local da consulta, o relacionamento paciente/profissional e a liberdade de escolha intervêm na insatisfação.
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Johnson D, El-Defrawy SR, Hollands S, Hurst J, Law C, Li C, Baxter S, Campbell EDL, Campbell RJ. Drug-prescribing patterns among optometrists and nonophthalmologist physicians at a tertiary care centre in Kingston, Ontario. Can J Ophthalmol 2016; 51:168-73. [DOI: 10.1016/j.jcjo.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/01/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
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Ibraheem WA, Ibraheem AB, Owonikoko M, Tijani A, Olamoyegun MA, AbdSalam S. Eye care services utilisation among pregnant women in Nigeria. J OBSTET GYNAECOL 2016; 36:611-4. [PMID: 27012975 DOI: 10.3109/01443615.2015.1110122] [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: 11/13/2022]
Abstract
One hundred and sixty-five pregnant Nigerian women attending the antenatal clinic of LAUTECH teaching hospital, Ogbomoso, Nigeria between January and April 2014 were interviewed using a structured questionnaire. Socio-demographic characteristics of the respondents were obtained. Respondents were also asked: if they had had their eye examined by an eye specialist during the index pregnancy, frequencies of visit to eye care centers and indications for their visitation. A history of previous eye examination by eye care specialist/visit to eye clinic was considered as eye care utilisation. Selection of eligible subjects who consented to participate in the study was done using simple random technique. Logistic regression model was used to control sociodemographic and obstetric factors in order to determine independent covariate factor influencing the use of eye care services. Among the population studied, only 46 (32%) had eye examination during the index pregnancy. Level of education and occupational status of the respondents were found to be statistically significant factors (p = 0.001 and 0.008, respectively). There is a need for a policy that will encourage regular eye care services usage during pregnancy.
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Affiliation(s)
- Waheed A Ibraheem
- a Department of Ophthalmology , LAUTECH Teaching Hospital , Ogbomoso , Oyo State , Nigeria
| | | | | | | | | | - Soliu AbdSalam
- e Department of Community Medicine , LAUTECH Teaching Hospital , Ogbomoso , Oyo State , Nigeria
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Razavi H, Copeland SP, Turner AW. Increasing the impact of teleophthalmology in Australia: Analysis of structural and economic drivers in a state service. Aust J Rural Health 2016; 25:45-52. [DOI: 10.1111/ajr.12277] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hessom Razavi
- Lions Eye Institute; Perth Western Australia Australia
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Shahbazi S, Studnicki J, Warner-Hillard CW. A Cross-Sectional Retrospective Analysis of the Racial and Geographic Variations in Cataract Surgery. PLoS One 2015; 10:e0142459. [PMID: 26540168 PMCID: PMC4635007 DOI: 10.1371/journal.pone.0142459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/21/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cataract surgery is the most common surgery performed on beneficiaries of Medicare, accounting for more than $3.4 billion in annual expenditures. The purpose of this study is to examine racial and geographic variations in cataract surgery rates and determine the association between the racial composition of the community population and the racial disparity in the likelihood of receiving necessary cataract surgery. METHODS Using the national prevalence rates from the National Institute of Eye Health and the 2010 Healthcare Cost and Utilization Project-Florida State Ambulatory Surgery Database, we determined the estimated cases of cataract and the actual number of cataract procedures performed, on four race/gender determined groups aged 65 and over in the state of Florida in 2010. The utilization rates and disparity ratios were also calculated for each Florida county. The counties were segmented into groups based on their racial composition. The association between racial composition and disparity ratios in receiving necessary cataract surgery was examined. The Geographic Information System was used to display county-level geospatial relationships. RESULTS African-Americans have a lower gender-specific cataract prevalence (African-American male = 0.246, African-American female = 0.392, white male = 0.368, and white female = 0.457), but they are also less likely than whites to receive necessary cataract surgery (utilization rate: African-American male = 7.92%, African-American female = 6.17%, white male = 12.08%, and white female = 10.54%). The statistical results show no overall differences between the disparity ratios and the racial composition of the communities. However, our geospatial analyses revealed a concentration of high racial disparity/high white population counties largely along the West Coast and South Central portion of the state. CONCLUSIONS There are racial differences in the likelihood of receiving necessary cataract surgery. However, there is no significant statewide association between the racial composition of the community population and the racial disparity in the likelihood of receiving necessary cataract surgery. Geospatial techniques did, however, identify subpopulations of interest which were not otherwise identifiable with typical statistical approaches, nor consistent with their conclusions.
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Affiliation(s)
- Sara Shahbazi
- Department of Health Services Research, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - James Studnicki
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Charles Wayne Warner-Hillard
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
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Johnson KA, Meyer J, Yazar S, Turner AW. Real-time teleophthalmology in rural Western Australia. Aust J Rural Health 2015; 23:142-9. [DOI: 10.1111/ajr.12150] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Karim A. Johnson
- Centre for Ophthalmology & Visual Science (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
| | - Joos Meyer
- Centre for Ophthalmology & Visual Science (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
| | - Seyhan Yazar
- Centre for Ophthalmology & Visual Science (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
| | - Angus W. Turner
- Centre for Ophthalmology & Visual Science (incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia Australia
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Abstract
PURPOSE Uncorrected refractive error remains a leading cause of visual impairment (VI) across the globe with Mozambique being no exception. The establishment of an optometry profession in Mozambique that is integrated into the public health system denotes significant progress with refractive services becoming available to the population. As the foundations of a comprehensive refractive service have now been established, this article seeks to understand what barriers may limit their uptake by the general population and inform decision making on improved service delivery. METHODS A community-based cross-sectional study using two-stage cluster sampling was conducted. Participants with VI were asked to identify barriers that were reflective of their experiences and perceptions of accessing refractive services. A total of 4601 participants were enumerated from 76 clusters in Nampula, Mozambique. RESULTS A total of 1087 visually impaired participants were identified (884 with near and 203 with distance impairment). Cost was the most frequently cited barrier, identified by more than one in every two participants (53%). Other barriers identified included lack of felt need (20%), distance to travel (15%), and lack of awareness (13%). In general, no significant influence of sex or type of VI on barrier selection was found. Location had a significant impact on the selection of several barriers. Pearson χ analysis indicated that participants from rural areas were found to feel disadvantaged regarding the distance to services (p ≤ 0.001) and adequacy of hospital services (p = 0.001). CONCLUSIONS For a comprehensive public sector refractive service to be successful in Mozambique, those planning its implementation must consider cost and affordability. A clear strategy for overcoming lack of felt need will also be needed, possibly in the form of improved advocacy and health promotion. The delivery of refractive services in more remote rural areas merits careful and comprehensive consideration.
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Hassan MB, Isawumi MA. Effects of fasting on intraocular pressure in a black population. Middle East Afr J Ophthalmol 2015; 21:328-31. [PMID: 25371639 PMCID: PMC4219225 DOI: 10.4103/0974-9233.142271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: There is a dearth of literature available on the effects of fasting on Intraocular pressure (IOP) among all races and worldwide. Objectives: To determine the effects of fasting on IOP in a black African population. Materials and Methods: A population-based survey utilizing multistage random sampling techniques was carried out among healthy adult Muslims who were examined before and during Ramadan fast in Osogbo, Nigeria. Demographics were obtained, visual acuities, clinical examination of both eyes, and IOPs were done. Weights and waist circumference were measured. Data were analyzed using Statistical Package for Social Sciences ( SPSS) Version 16. Analysis generated frequencies and cross tabulations, whereas statistical significant values were derived using paired sample t-test and P < 0.05. Results: A total of 60 subjects with 120 eyes were examined. Mean age was 42.3 years standard deviation (SD) 16.7, and the male to female ratio was 3:2. Majority were professionals (33.3%). Only 18.3% had less than secondary school education. Over 90% had normal vision (6/5-6/18). Before and during fasting, the mean weights were 65.92 kg SD 12.98 and 65.29 kg SD 12.41 with a reduction of 0.63 kg SD 3.82 (P = 0.214, 95% confidence interval (CI): 0.372-1.626); and the mean waist circumference was 87.20 cm SD 12.39 and 81.78 cm SD 11.65 (P = 0.000, 95% CI 4.128-6.720), respectively. Mean IOPs were 15.98 mmHg SD 3.11 and 14.08 mmHg SD 2.71 before and during fasting, respectively (P = 0.000, 95% CI 0.98558-2.82798). Conclusions: The study shows that fasting significantly reduced IOP in an ocularly healthy black African population.
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Affiliation(s)
- Mustapha B Hassan
- Department of Surgery, Ophthalmology Unit, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Michaeline A Isawumi
- Department of Surgery, Ophthalmology Unit, College of Health Sciences, Osun State University, Osogbo, Nigeria
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Emamian MH, Zeraati H, Majdzadeh R, Shariati M, Hashemi H, Fotouhi A. Economic inequality in eye care utilization and its determinants: a Blinder-Oaxaca decomposition. Int J Health Policy Manag 2014; 3:307-13. [PMID: 25396206 DOI: 10.15171/ijhpm.2014.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 10/11/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran. METHODS Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low- and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method. RESULTS Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31-17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69-32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51-2.14], the low-economic group (OR= 2.33, 95% CI= 1.90-2.87), the visually impaired (OR= 1.41, 95% CI= 1.05-1.90), and the uninsured (OR= 1.93, 95% CI= 1.45-2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93-0.96) and education (OR= 0.94, 95% CI= 0.92-0.96). In this study, 24.72% (95% CI= 22.30-27.14) of the low-economic group and 9.94% (95% CI= 8.75-11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality. CONCLUSION A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause.
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Affiliation(s)
- Mohammad Hassan Emamian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hojjat Zeraati
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. ; Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shariati
- Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran. ; Farabi Eye Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Hsueh YSA, Brando A, Dunt D, Anjou MD, Boudville A, Taylor H. Cost of close the gap for vision of Indigenous Australians: On estimating the extra resources required. Aust J Rural Health 2013; 21:329-35. [DOI: 10.1111/ajr.12066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 01/16/2023] Open
Affiliation(s)
- Ya-seng Arthur Hsueh
- Centre for Health Policy, Programs and Economics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - Alex Brando
- Centre for Health Policy, Programs and Economics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - David Dunt
- Centre for Health Policy, Programs and Economics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - Mitchell D. Anjou
- Indigenous Eye Health Unit; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - Andrea Boudville
- Indigenous Eye Health Unit; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - Hugh Taylor
- Indigenous Eye Health Unit; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
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Peng Y, Tao QS, Liang YB, Friedman DS, Yang XH, Jhanji V, Duan XR, Sun LP, Wang NL. Eye care use among rural adults in China: the Handan Eye Study. Ophthalmic Epidemiol 2013; 20:274-80. [PMID: 23988218 DOI: 10.3109/09286586.2013.823216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the use of eye care services in a rural population in North China and to analyze the factors associated with underuse of these services. METHODS In a cross-sectional population-based study, demographic, health and vision-related information including use of eye care services were determined during a face-to-face interview. A single visit to an eye care provider qualified as "use" of eye care services. RESULTS Of 6612 participants, 754 (11.4%, 95% confidence interval, CI, 8.7-14.1%) had used eye care services. The most common reason cited for not seeing an eye care provider was "no need" (n = 5754). Of the 5754 who thought that there was no need to see an ophthalmologist, 3458 (60.1%) were found to have one or more type of eye disease, including glaucoma (56, 1.0%), cataract (1056, 18.4%), age-related macular degeneration (AMD; 164, 2.9%) and refractive error (3048, 53.0%). Also, 74 (1.3%) and 409 (7.1%) of the 5754 participants had visual impairment (<20/60) according to best-corrected visual acuity and presenting visual acuity, respectively. In a multiple regression model, participants who had glaucoma (adjusted odds ratio, OR, 4.0, 95% CI 3.0-5.4), AMD (adjusted OR 1.6, 95% CI 1.2-2.3) or refractive error (adjusted OR 1.4, 95% CI 1.1-1.8), were more likely to visit an eye care provider. CONCLUSION A high proportion of the Chinese rural population had never used eye care services although three fifths had eye diseases. Further efforts towards better education of the general population about common eye problems as well as increasing the number of ocular health providers would be necessary in future.
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Affiliation(s)
- Yi Peng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Lab , Beijing , China
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Ajite KO, Fadamiro OC, Ajayi IA, Omotoye OJ. Utilization of Eye Care Services Among Staff of a Tertiary Hospital. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2013; 2:28-31. [PMID: 26107865 DOI: 10.1097/apo.0b013e31827f2d12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the level of utilization of eye care services and to identify the barriers to uptake of eye care services among the staff in a hospital. DESIGN A cross-sectional study conducted at a university teaching hospital. METHODS A total of 250 staff members were selected using a proportionate sampling among the segment of study population. Data were collected using semistructured questionnaires, including demographic data, awareness about eye clinic and the services rendered, facilities utilized by staff in receiving eye treatment, and reasons for not utilizing the hospital eye care services. Data analysis was done using SPSS version 15. RESULTS The majority (66%) of the staff were younger than 40 years. Around 229 staff members (91.6%) were aware of the clinic, whereas 222 (88.8%) were aware of at least 1 of the various services rendered. They received treatment from chemists (30.7%), private hospitals (26.3%), and optical shops (16.1%). The hospital eye clinic (11.8%) was the least chosen place to receive eye treatment. The reasons for nonutilization of eye care services were lack of finance (42.1%), poor staff attitude (23.7%), fear of damage to the eye (15.3%), high cost of treatment (9.7%), and ignorance of its existence (9.2%). Visual impairment was seen in 14 of the staff (5.6%), whereas blindness was seen in 1 (0.4%). CONCLUSIONS The level of utilization of eye care services in the hospital by the staff is poor and very low compared with other facilities, although the majority had previous history of eye complaints.
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Affiliation(s)
- Kayode Olumide Ajite
- From the Department of Ophthalmology, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
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Dickey H, Ikenwilo D, Norwood P, Watson V, Zangelidis A. Utilisation of eye-care services: The effect of Scotland's free eye examination policy. Health Policy 2012; 108:286-93. [DOI: 10.1016/j.healthpol.2012.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 09/12/2012] [Accepted: 09/17/2012] [Indexed: 11/25/2022]
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Chou CF, Zhang X, Crews JE, Barker LE, Lee PP, Saaddine JB. Impact of geographic density of eye care professionals on eye care among adults with diabetes. Ophthalmic Epidemiol 2012; 19:340-9. [PMID: 23088291 DOI: 10.3109/09286586.2012.722244] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the impact of the geographic density of eye care professionals (ECPs) on the receipt of annual dilated eye examinations among adults in the United States with diabetes. METHOD Data from the 2006 Behavioral Risk Factor Surveillance System were linked to the 2007 Area Resource File to examine the association between the density of ECPs (ophthalmologists and optometrists) per 100,000 people and self-reports of having had a dilated eye examination in the last year. The sample included adults aged 18+ years with diabetes (N = 29,495). Multivariate logistic regression was conducted to estimate adjusted odds ratios of annual dilated eye examinations, while controlling for age, sex, marital status and education, and stratifying by health insurance. RESULTS Approximately 10% of respondents with diabetes lived in counties with no ECPs. Prevalence of being uninsured was 7.4% and 15.5% in those with and without dilated eye exams, respectively. After controlling for covariates and stratifying by health insurance, diabetic adults with health insurance cover residing in areas with no ECPs were less likely to report having had a dilated eye examination in the past year than those with 20 or more ECPs/100,000 people (odds ratio 0.72, 95% confidence interval 0.58-0.91). CONCLUSION Residence in a county with a low density of ECPs reduced the likelihood of receiving annual dilated eye examinations among insured adults with diabetes. Enhancing the ability of ECPs to reach and care for those in need might better protect vision in people with diabetes. More research is needed to determine the mix of services that produces the best patient outcome.
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Affiliation(s)
- Chiu-Fang Chou
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3727, USA.
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