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McGuinness MB, Moo E, Varga B, Dodson S, Lansingh VC, Resnikoff S, Schmidt E, Ravilla T, Balu Subburaman GB, Khanna RC, Rathi VM, Arunga S, Limburg H, Congdon N. The Better Operative Outcomes Software Tool (BOOST) Prospective Study: Improving the Quality of Cataract Surgery Outcomes in Low-Resource Settings. Ophthalmic Epidemiol 2024:1-11. [PMID: 38635874 DOI: 10.1080/09286586.2024.2336518] [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: 10/13/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Post-operative vision impairment is common among patients who have undergone cataract surgery in low-resource settings, impacting quality of clinical outcomes and patient experience. This prospective, multisite, single-armed, pragmatic validation study aimed to assess whether receiving tailored recommendations via the free Better Operative Outcomes Software Tool (BOOST) app improved surgical outcomes, as quantified by post-operative unaided distance visual acuity (UVA) measured 1-3 days after surgery. METHODS During the baseline data collection round, surgeons in low and middle-income countries recorded clinical characteristics of 60 consecutive cataract cases in BOOST. Additional data on the causes of poor outcomes from 20 consecutive cases with post-operative UVA of <6/60 (4-12 weeks post-surgery) were entered to automatically generate tailored recommendations for improvement, before 60 additional consecutive cases were recorded during the follow-up study round. Average UVA was compared between cases recorded in the baseline study round and those recorded during follow-up. RESULTS Among 4,233 cataract surgeries performed by 41 surgeons in 18 countries, only 2,002 (47.3%) had post-operative UVA 6/12 or better. Among the 14 surgeons (34.1%) who completed both rounds of the study (1,680 cases total), there was no clinically significant improvement in post-operative average UVA (logMAR units ±SD) between baseline (0.50 ± 0.37) and follow-up (0.47 ± 0.36) rounds (mean improvement 0.03, p = 0.486). CONCLUSIONS Receiving BOOST-generated recommendations did not result in improved UVA beyond what could be expected from prospective monitoring of surgical outcomes alone. Additional research is required to assess whether targeted support to implement changes could potentiate the uptake of app-generated recommendations and improve outcomes.
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Affiliation(s)
- Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Elise Moo
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Beatrice Varga
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Sarity Dodson
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Van Charles Lansingh
- Help Me See, Jersey City, New Jersey, USA
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Elena Schmidt
- Evidence Research and Innovations, Sightsavers, Chippenham, UK
| | | | | | - Rohit C Khanna
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Hyderabad, India
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Simon Arunga
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hans Limburg
- Health Information Services, Grootebroek, Netherlands
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Orbis International, New York, New York, USA
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Philippin H, Morny EKA, Heinrich SP, Töws I, Maier PC, Guthoff RF, Qureshi BM, Reinhard T, Burton MJ, Finger RP. [Global ophthalmology : Update]. DIE OPHTHALMOLOGIE 2024; 121:157-170. [PMID: 38300260 DOI: 10.1007/s00347-023-01983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
The aim of global ophthalmology is to maximize vision, ocular health and functional ability, thereby contributing to overall health and well-being, social inclusion and quality of life of every individual worldwide. Currently, an estimated 1.1 billion people live with visual impairment, 90% of which can be prevented or cured through largely cost-effective interventions. At the same time, 90% of people affected live in regions with insufficient eye health coverage. This challenge drove the World Health Organization (WHO) and a group of nongovernmental organizations to launch "VISION 2020: the Right to Sight", a global campaign which recently concluded after 20 years. The achievements, challenges and lessons learned were identified and incorporated into the current campaign "2030 IN SIGHT".
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Affiliation(s)
- Heiko Philippin
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg i. Brsg., Deutschland.
- International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HTUK, London, Vereinigtes Königreich.
- CBM Christoffel-Blindenmission Christian Blind Mission, Bensheim, Deutschland.
| | - Enyam K A Morny
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg i. Brsg., Deutschland
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Sven P Heinrich
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg i. Brsg., Deutschland
| | - Ingrid Töws
- Institut für Evidenz in der Medizin, Universitätsklinikum und Medizinische Fakultät, Universität Freiburg, Freiburg i. Brsg., Deutschland
| | - Philip C Maier
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg i. Brsg., Deutschland
| | - Rudolf F Guthoff
- Klinik und Poliklinik für Augenheilkunde, Universität Rostock, Rostock, Deutschland
| | - Babar M Qureshi
- CBM Christoffel-Blindenmission Christian Blind Mission, Cambridge, Vereinigtes Königreich
| | - Thomas Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg i. Brsg., Deutschland
| | - Matthew J Burton
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg i. Brsg., Deutschland
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, Vereinigtes Königreich
| | - Robert P Finger
- Augenklinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland
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3
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Wong B, Singh K, Everett B, O’Brien KS, Ravilla T, Khanna RC, Chase H, Frick KD. The case for investment in eye health: systematic review and economic modelling analysis. Bull World Health Organ 2023; 101:786-799. [PMID: 38024247 PMCID: PMC10680113 DOI: 10.2471/blt.23.289863] [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: 02/24/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To assess how the returns on investment from correcting refractive errors and cataracts in low- and middle-income countries compare with the returns from other global development interventions. Methods We adopted two complementary approaches to estimate benefit-cost ratios from eye health investment. First, we systematically searched PubMed® and Web of Science™ on 14 August 2023 for studies conducted in low-and-middle-income countries, which have measured welfare impacts associated with correcting refractive errors and cataracts. Using benefit-cost analysis, we compared these impacts to costs. Second, we employed an economic modelling analysis to estimate benefit-cost ratios from eye health investments in India. We compared the returns from eye health to returns in other domains across global health and development. Findings We identified 21 studies from 10 countries. Thirteen outcomes highlighted impacts from refractive error correction for school students. From the systematic review, we used 17 out of 33 outcomes for benefit-cost analyses, with the median benefit-cost ratio being 36. The economic modelling approach for India generated benefit-cost ratios ranging from 28 for vision centres to 42 for school eye screening, with an aggregate ratio of 31. Comparing our findings to the typical investment in global development shows that eye health investment returns six times more benefits (median benefit-cost ratio: 36 vs 6). Conclusion Eye health investments provide economic benefits with varying degrees based on the intervention type and location. Our findings underline the importance of incorporating eye health initiatives into broader development strategies for substantial societal returns.
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Affiliation(s)
- Brad Wong
- Mettalytics, 23 Philip St, South Golden Beach 2483, New South Wales, Australia
| | | | - Bryce Everett
- Department of Economics, College of Arts and Sciences, University of San Francisco, San Francisco, United States of America (USA)
| | - Kieran S O’Brien
- Department of Ophthalmology, Institute for Global Health Sciences, University of California San Francisco, San Francisco, USA
| | - Thulasiraj Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Rohit C Khanna
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | | | - Kevin D Frick
- Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, USA
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Mohammed J, Assegid S, Fekadu L, Kabeta T. Cataract Surgery Visual Outcome and Associated Factors Among Adults Attended Jimma University Medical Center, Jimma, Southwest Ethiopia. Clin Ophthalmol 2023; 17:3341-3351. [PMID: 37941776 PMCID: PMC10629348 DOI: 10.2147/opth.s434453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
Background Cataract is the leading cause of blindness and the second leading cause of visual impairment worldwide, accounting for 51% and 33% of all cases, respectively, in low- and medium-income countries bearing a disproportionately high burden. Hence, this study aimed to assess the visual outcome of age-related cataract surgery and identify factors associated with patients' postoperative visual outcomes in Jimma University Medical Center, Southwest Ethiopia. Methods An institution-based cross-sectional study design was conducted among 386 cataract surgery patients from January 1, 2016, to December 30, 2017. The study participants were selected using a systematic random sampling technique. Data were collected by reviewing the selected patients' medical records using a pre-tested checklist, entered into EpiData version 3.1, and exported to SPSS 20 for analysis. Proportions, summary statistics, and tables were used for presentations of the findings. Binary logistic regression was carried out to identify independent predictors of visual outcome. Findings were presented with adjusted odds ratios and their 95% confidence interval. A p-value <0.05 was used to declare a statistically significant association. Results About 231 individuals (59.8%) had poor visual results following cataract surgery. Furthermore, age >70 (AOR = 3.64; 95% CI [1.35-9.82]), preoperative ocular co-morbidities (AOR = 2.34; [1.32-4.15]), incision-based cataract surgery (AOR = 7.11; [3.16-16.02]), compared phacoemulsification operated by resident surgeons (AOR = 2.19; [1.23-3.89]), presence of intraoperative complication (AOR = 3.41; [1.47-7.92]), lens remnant (AOR = 2.91; [1.11-4.92]), ocular inflammation (OR = 2.56; [1.34-4.92]), and striate keratopathy/corneal edema (AOR = 1.91; [1.07-3.44]) were significantly associated with poor visual outcome. Conclusion The visual outcome following cataract surgery fall below WHO recommendation. In this study, age, ocular co-morbidities, surgical method, surgeon status, intraoperative complication, SK, and ocular inflammation associated with post-operative Uveitis and anterior chamber reaction were associated with a poor visual outcome.
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Affiliation(s)
- Jemmal Mohammed
- Department of Ophthalmology, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sahilu Assegid
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lata Fekadu
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teshome Kabeta
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Ifantides C, SooHoo JR, Christopher KL. Impact of a formal manual small-incision cataract surgery curriculum in an American ophthalmology residency program. Indian J Ophthalmol 2023; 71:2474-2477. [PMID: 37322664 PMCID: PMC10417980 DOI: 10.4103/ijo.ijo_1339_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/02/2022] [Accepted: 10/20/2022] [Indexed: 06/17/2023] Open
Abstract
Purpose Global ophthalmology educational activities often include the ability of ophthalmology residents to partake in low-resource clinical care at home and abroad. Low-resource surgical techniques have become a pillar of education during formalized global ophthalmology fellowships. A formal manual small-incision cataract surgery (MSICS) curriculum was started in the University of Colorado's residency training program to meet the growing demand for this surgical skill and to allow for more sustainable outreach work from our graduates. The survey was conducted to collect evaluations on the value of formal MSICS training within a United States-based residency program. Methods This was a survey study in a US ophthalmology residency program. A formal MSICS curriculum was created that included didactic lectures on epidemiology of global blindness, MSICS technique, and how MISCS compared to phacoemulsification in terms of cost and sustainability in low-resource settings, followed by a formal wet lab experience. Residents were then exposed to MSICS procedures in the operating room (OR) under supervision of an experienced MSICS surgeon. An anonymous online survey was conducted on three consecutive cohorts of recently graduated senior ophthalmology residents from 2019 to 2021 with the aim of eliciting opinions about and outcomes from the new curriculum. Results Fifteen graduating senior residents comprised the three cohorts with a 100% survey response rate. All residents agreed or strongly agreed that "MSICS is a valuable skill to have". Eighty percent of respondents agreed or strongly agreed that "exposure to MSICS has increased my likelihood of doing any type of outreach work in the future" and 86.67% agreed or strongly agreed that "exposure to MSICS increased my understanding about sustainable outreach work". The average number of cases assisted or performed per resident was 8.2 (SD 2.7, range 4-12). Conclusion A formal MSICS curriculum for US-based ophthalmology residents was well-received by the trainees. The majority felt it increased their likelihood of pursuing and improved their understanding of sustainable outreach work. The curriculum, which included lectures, wet lab training, and formal teaching in the OR, could add value to a residency program's curriculum. Furthermore, a formal domestic program can avoid ethical pitfalls that can be seen with resident teaching during international mission work.
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Affiliation(s)
- Cristos Ifantides
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado, Aurora, CO, USA
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Bright T, Ramke J, Zhang JH, Kitema GF, Safi S, Mdala S, Yoshizaki M, Brennan-Jones CG, Mactaggart I, Gordon I, Swenor BK, Burton MJ, Evans JR. Prevalence and impact of combined vision and hearing (dual sensory) impairment: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001905. [PMID: 37192147 DOI: 10.1371/journal.pgph.0001905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/14/2023] [Indexed: 05/18/2023]
Abstract
Hearing and vision impairments are common globally. They are often considered separately in research, and in planning and delivering services. However, they can occur concurrently, termed dual sensory impairment (DSI). The prevalence and impact of hearing and vision impairment have been well-examined, but there has been much less consideration of DSI. The aim of this scoping review was to determine the nature and extent of the evidence on prevalence and impact of DSI. Three databases were searched: MEDLINE, Embase and Global Health (April 2022). We included primary studies and systematic reviews reporting the prevalence or impact of DSI. No limits were placed on age, publication dates, or country. Only studies where the full text was available in English were included. Two reviewers independently screened titles, abstract, full texts. Data were charted by two reviewers independently using a pre-piloted form. The review identified 183 reports of 153 unique primary studies and 14 review articles. Most evidence came from high-income countries (86% of reports). Prevalence varied across reports, as did age groups of participants and definitions used. The prevalence of DSI increased with age. Impact was examined across three broad groups of outcomes-psychosocial, participation, and physical health. There was a strong trend towards poorer outcomes for people with DSI across all categories compared to people with one or neither impairment, including activities of daily living (worse for people with DSI in 78% of reports) and depression (68%). This scoping review highlights that DSI is a relatively common condition with substantial impact, particularly among older adults. There is a gap in evidence from low and middle-income countries. There is a pressing need for a consensus position on the definition(s) of DSI and standardisation of reporting age groups to enable reliable estimates to be ascertained and compared and responsive services developed.
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Affiliation(s)
- Tess Bright
- Indigenous Health Equity Unit, Centre for Health Equity, University of Melbourne, Melbourne, Australia
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Justine H Zhang
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Gatera Fiston Kitema
- Ophthalmology Department, School of Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaffi Mdala
- Ophthalmology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Miho Yoshizaki
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Christopher G Brennan-Jones
- Ear Health Group, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of Audiology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bonnielin K Swenor
- The Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland, United States of America
- The Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Public Health, Queens University Belfast, Belfast, United Kingdom
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Flessa S. Cataract Surgery in Low-Income Countries: A Good Deal! Healthcare (Basel) 2022; 10:healthcare10122580. [PMID: 36554103 PMCID: PMC9778186 DOI: 10.3390/healthcare10122580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Cataract is a major cause of blindness worldwide. In particular, in low-income countries, the burden of disease as well as its direct and indirect economic cost are a major challenge for the population and economy. In many cases, it would be possible to prevent or cure blindness with a comparably simple cataract surgery, but many countries lack the resources to strengthen healthcare systems and implement broad cataract surgery programs reaching, in particular, the rural poor. In this paper, we analyse whether such an intervention could be cost-effective or even cost-saving for the respective health systems. We calculate the net value of the lifelong costs of cataract with and without surgery. This calculation includes direct costs (e.g., treatment, glasses, surgery) as well as indirect cost of the caregiver and the patient. We total all costs from the year of onset of cataract until death and discount the respective values to the year of onset. We define the surgery as cost-saving if the net-value of costs with surgery is lower than without surgery. If the cost per quality adjusted life year is lower than one gross national product per capita, we define the intervention as highly cost-effective. We find that the cost-effectiveness of cataract surgery depends on the age of onset of the disease and the age of surgery. If the surgery is performed with the beginning of severe impairment, even surgery of a 78-year-old patient is still cost-saving. Almost all possible constellations are highly cost-effective, only for the very old it is questionable whether the surgery should be performed. The simulations show that cataract surgery is one of the most cost-effective interventions. However, millions of people in low-income countries still have no chance to prevent or cure blindness due to limited resources. The findings of this paper clearly call for a stronger effort to reach poor and rural populations with this cost-effective service.
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Affiliation(s)
- Steffen Flessa
- Department of Health Care Management, Faculty of Law and Economics, University of Greifswald, 17487 Greifswald, Germany
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Sagemüller F, Bruns S, Mußhoff O. The effect of poor vision on economic farm performance: Evidence from rural Cambodia. PLoS One 2022; 17:e0274048. [PMID: 36083987 PMCID: PMC9462746 DOI: 10.1371/journal.pone.0274048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/21/2022] [Indexed: 11/24/2022] Open
Abstract
Roughly one-fifth of the global population is affected by poor visual acuity. Despite the fact that inhabitants of rural areas in low-income countries are most distressed by this, no prior research has studied the impact of poor visual acuity on the economic performance of farms. We conduct a standardized eye test with 288 farm managers in rural Cambodia and find that around 30 percent of our sample suffers from poor visual acuity in terms of nearsightedness (myopia). Our analyses indicate a statistically significant and economically meaningful association of poor visual acuity with economic farm performance. Our results show that gross margins for cropping activities per year could be, on average, around 630 USD higher if farm managers were able to correct for poor vision. Our results suggest that poor visual acuity impairs farm managers from tapping the full potential of their business, which in turn decreases their chance to break the vicious cycle of poverty.
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Affiliation(s)
- Frederik Sagemüller
- Department of Agricultural Economics and Rural Development, University of Göttingen, Göttingen, Germany
- * E-mail:
| | - Selina Bruns
- Department of Agricultural Economics and Rural Development, University of Göttingen, Göttingen, Germany
| | - Oliver Mußhoff
- Department of Agricultural Economics and Rural Development, University of Göttingen, Göttingen, Germany
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9
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Zhang JH, Ramke J, Jan C, Bascaran C, Mwangi N, Furtado JM, Yasmin S, Ogundo C, Yoshizaki M, Marques AP, Buchan J, Holland P, Ah Tong BAM, Evans JR, Congdon N, Webson A, Burton MJ. Advancing the Sustainable Development Goals through improving eye health: a scoping review. Lancet Planet Health 2022; 6:e270-e280. [PMID: 35219448 DOI: 10.1016/s2542-5196(21)00351-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
UN member states have committed to achieving the Sustainable Development Goals (SDGs) by 2030. This Review examines the published evidence on how improving eye health can contribute to advancing the SDGs (beyond SDG 3). We identified 29 studies that showed direct benefits from providing eye health services on SDGs related to one or more of poverty (SDGs 1, 2, and 8), education (SDG 4), equality (SDGs 5 and 10), and sustainable cities (SDG 11). The eye health services included cataract surgery, free cataract screening, provision of spectacles, trichiasis surgery, rehabilitation services, and rural community eye health volunteers. These findings provide a comprehensive perspective on the direct links between eye health services and advancing the SDGs. In addition, eye health services likely have indirect effects on multiple SDGs, mediated through one of the direct effects. Finally, there are additional plausible links to other SDGs, for which evidence has not yet been established.
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Affiliation(s)
- Justine H Zhang
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Manchester Royal Eye Hospital, Manchester, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Clinical Medicine, Kenya Medical Training College, Nairobi, Kenya
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Cynthia Ogundo
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Ophthalmology, Mbagathi Hospital, Nairobi, Kenya
| | - Miho Yoshizaki
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | | | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Centre for Public Health, Queen's University, Belfast, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nations, New York, NY, USA
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Malcolm J, Bako A. Reducing the costs per patient by increasing the volume of cataract surgery. COMMUNITY EYE HEALTH 2022; 35:14-15. [PMID: 36704531 PMCID: PMC9872216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jonathan Malcolm
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ahmed Bako
- Department of Ophthalmology, Specialist Hospital, Sokoto, Nigeria
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Mengistu M, Admassu F, Wondale T, Tsegaw A. Refractive Outcome of Cataract Surgery Done at University of Gondar Tertiary Eye Care and Training Center, North West Ethiopia. Patient Relat Outcome Meas 2021; 12:173-179. [PMID: 34140819 PMCID: PMC8203275 DOI: 10.2147/prom.s308816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE According to World Health Organization (WHO), cataract is the leading cause of blindness and visual impairment throughout the world. Post-operative refractive error is one of the commonest reasons for poor visual outcome after cataract surgery especially in developing countries where the standard modern biometry equipments are not available. The objective of this study was to assess the refractive outcome of cataract surgery done at University of Gondar (UoG) Tertiary Eye Care and Training Center, North West Ethiopia. METHODS A descriptive cross-sectional study was done on 66 patients who had undergone manual small incision cataract surgery (MSICS) and fulfilled the inclusion criteria at UoG Tertiary Eye Care and Training Center from July 15 2019 to October 15 2019. RESULTS From 90 post-operatively refracted eyes, 58 (64.4%) eyes achieved a target refraction of ±1.00 Diopter (D). The right and left eyes achieved mean post-operative refraction SE of -0.073±1.45D and -0.93±1.70 D, respectively. But only 54 (60%) eyes were implanted with the calculated IOL power and for the remaining 40% the calculated IOL was not available at the store. And the target (Good) post-operative uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) was achieved in 66.7% and 82.2% eyes, respectively. CONCLUSION The post-operative refractive outcome after cataract surgery at the center is low. For over one-third of operated eyes, the calculated IOL was not implanted due to the absence of the required IOL power at the store and, therefore, a wide range of IOL power should be available at the center.
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Affiliation(s)
- Masresha Mengistu
- Department of Ophthalmology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fisseha Admassu
- Department of Ophthalmology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Teshager Wondale
- Department of Ophthalmology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asamere Tsegaw
- Department of Ophthalmology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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12
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Time to recovery from cataract and its predictors among eye cataract patients treated with cataract surgery: A retrospective cohort study in Ethiopia. Ann Med Surg (Lond) 2021; 65:102275. [PMID: 33898037 PMCID: PMC8054098 DOI: 10.1016/j.amsu.2021.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background Cataracts is the major global causes of blindness and a vision-affecting disease of the eye. Cataract surgery is a curative and cost-effective intervention. The number of people who undergo cataract surgery has increased rapidly. Hence, this study was aimed to determine predictors and the time of recovery of cataract patients after cataract surgery by using Simi parametric models of survival analysis. Methods A retrospective cohort study was conducted from January/01/2015 and January/30/2019. STATA version14.0 statistical software was used for analysis. The Kaplan-Meier survival method and log-rank test curves were applied. Weibull regression was used and adjusted hazard ratio 95% CI with a value of p less than 0.05 was used to identify a significant association. Results Two hundred twenty three cataract patients were recovered from cataract, 72.6% (95% CI 69.8%–75.9%). The overall median survival time was 23 weeks (IQR = 16 to 35) with (95% CI, 21%–25%). aged between 16 and 30year (AHR = 1.20 CI; 1.07–2.36), age 31 to 45 (AHR = 1.24 CI; 1.08–1.54), urban dwellers (AHR = 1.59; 95% CI, 1.18–2.14), medium visual acuity (AHR = 4.14 CI; 2.57–6.67), high visual acuity (AHR = 5.23 CI; 3.06–8.93), Secondary cataract (AHR = 2.59 CI; 1.01–3.02), traumatic cataract (AHR = 1.75 CI; 1.01–3.02), extra capsular cataract extraction surgery (AHR = 1.43 CI; 1.07–1.94),and diabetes mellitus (AHR = 0.75, CI; 0.41–0.96) were notably associated with time to recovery. Conclusion Time to recovery in the study area was slightly higher as compared with the global cut of time. Cataract patients with comorbidity of DM had lower recovery time. A 72.6% cataract patients were recovered and 27.4% of were censored from cataract. The overall median survival time was 23 weeks and the mean recovery time of the patients was 23.24 weeks. A significant difference seen in the recovery rate among cataract patients with/out diabetes mellitus. Time to recovery in the study area was slightly higher.
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13
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Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021; 9:e489-e551. [PMID: 33607016 PMCID: PMC7966694 DOI: 10.1016/s2214-109x(20)30488-5] [Citation(s) in RCA: 500] [Impact Index Per Article: 166.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Damodar Bachani
- John Snow India, New Delhi, India; Ministry of Health and Family Welfare, New Delhi, India
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Tasanee Braithwaite
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; The Medical Eye Unit, St Thomas' Hospital, London, UK
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chimgee Chuluunkhuu
- Orbis International, Ulaanbaatar, Mongolia; Mongolian Ophthalmology Society, Ulaanbaatar, Mongolia
| | | | | | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alastair K Denniston
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Emerson
- International Trachoma Initiative and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - João M Furtado
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Eyu-Ethiopia Eye Health Research, Training, and Service Centre, Bahirdar, Ethiopia
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Peng Tee Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Van C Lansingh
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico; Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico; Help Me See, New York, NY, USA
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Milka M Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lizette Mowatt
- University Hospital of the West Indies, Kingston, Jamaica
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Indian Institute of Public Health, Hyderabad, India
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kenya Medical Training College, Nairobi, Kenya
| | - Daksha B Patel
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Solange R Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Bernadetha R Shilio
- Department of Curative Services, Ministry of Health Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nation, New York, NY, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Vision Institute, University of New South of Wales, Sydney, Australia
| | | | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria; Africa Vision Research Institute, Durban, South Africa
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Lin S, Ma Y, Hou Z, Congdon N, Lu L, Zou H. Andersen's utilization model for cataract surgical rate and empirical evidence from economically-developing areas. BMC Ophthalmol 2021; 21:107. [PMID: 33637052 PMCID: PMC7908707 DOI: 10.1186/s12886-021-01858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen’s utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China. Methods The study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately. Results Cataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn’t impact cataract surgical resources (β = 0.29, 95% CI: − 0.12, 0.75). In China, residents’ average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; βCSR-paying = 0.77, 95% CI: 0.25, 0.90; βpaying-GDP/P = 0.89, 95% CI: 0.82, 0.93). Conclusions In sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.
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Affiliation(s)
- Senlin Lin
- Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China.,Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Yingyan Ma
- Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China
| | - Zhiyuan Hou
- Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 S. Xianlie Road, Guangzhou, 510060, China. .,Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK. .,Orbis International, 520 8th Ave #12, New York, NY, 10018, USA.
| | - Lina Lu
- Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China. .,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China.
| | - Haidong Zou
- Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China. .,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China.
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15
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The Association between Socioeconomic Factors and Visual Function among Patients with Age-Related Cataracts. J Ophthalmol 2020; 2020:7236214. [PMID: 33335783 PMCID: PMC7722637 DOI: 10.1155/2020/7236214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background With the development of the economy, socioeconomic factors, such as inequalities in the status of regional economies and the subsequent effects on health systems, have influenced the status of health. We explored the association between age-related cataracts and socioeconomic indicators, including the regional economy, health systems, and energy industries. Methods This was a prospective, multicenter, Chinese population-based, cross-sectional study. A total of 830 participants from seven centers were enrolled. Data on the best-corrected visual acuity (BCVA), Lens Opacities Classification System III (LOCS III) score, Visual Function Index-14 (VF-14) score, total and subscale scores of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), per capita disposable income (PCDI), medical resource-related indicators, and investments in the energy industry were obtained. Associations among these parameters were analyzed. Results The PCDI ranking was correlated with the VF-14 score (R = -0.426, P < 0.01), total score of NEI-VFQ-25 (r = -0.500, P < 0.01), and BCVA (r = 0.278, P < 0.01). The number of health agencies (r1 = 0.267, r2 = -0.303, r3 = -0.291,), practicing or assistant practicing doctors (r1 = -0.283, r2 = 0.427, r3 = 0.502,), registered nurses (r1 = -0.289, r2 = 0.409, r3 = 0.469, P < 0.01), and health technicians (r1 = -0.278, r2 = 0.426, r3 = 0.500, P < 0.01) per 10,000 of the population was each correlated with the BCVA, VF-14 score, and total score of NEI-VFQ-25, respectively. Health expenditure per capita was correlated with the VF-14 score (r = 0.287, P < 0.01) and total score of NEI-VFQ-25 (r = 0.459, P < 0.01). The LOCS III P score was correlated with investments in the energy industry (r = 0.485, P < 0.001). Conclusions Patients in higher economic regions with greater medical resources show a greater demand to undergo cataract surgery at a better subjective and objective visual function. The energy industry has a significant effect on cataracts, especially the posterior subcapsular cataract, and thus more attention should be paid to people in regions with abundant energy industries.
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Yoshizaki M, Ramke J, Furtado JM, Burn H, Gichuhi S, Gordon I, Aghaji A, Marques AP, Dean WH, Congdon N, Buchan J, Burton MJ. Interventions to improve the quality of cataract services: protocol for a global scoping review. BMJ Open 2020; 10:e036413. [PMID: 32788187 PMCID: PMC7422650 DOI: 10.1136/bmjopen-2019-036413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Cataract is the leading cause of blindness globally and a major cause of vision impairment. Cataract surgery is an efficacious intervention that usually restores vision. Although it is one of the most commonly conducted surgical interventions worldwide, good quality services (from being detected with operable cataract to undergoing surgery and receiving postoperative care) are not universally accessible. Poor quality understandably reduces the willingness of people with operable cataract to undergo surgery. Therefore, it is critical to improve the quality of care to subsequently reduce vision loss from cataract. This scoping review aims to summarise the nature and extent of the published literature on interventions to improve the quality of services for primary age-related cataract globally. METHODS AND ANALYSIS We will search MEDLINE, Embase and Global Health for peer-reviewed manuscripts published since 1990, with no language, geographic or study design restrictions. To define quality, we have used the elements adopted by the WHO-effectiveness, safety, people-centredness, timeliness, equity, integration and efficiency-to which we have added the element of planetary health. We will exclude studies focused on the technical aspects of the surgical procedure and studies that only involve children (<18 years). Two reviewers will screen all titles/abstracts independently, followed by a full-text review of potentially relevant articles. For included articles, data regarding publication characteristics, study details and quality-related outcomes will be extracted by two reviewers independently. Results will be synthesised narratively and presented visually using a spider chart. ETHICS AND DISSEMINATION Ethical approval was not sought, as our review will only include published and publicly accessible information. We will publish our findings in an open-access peer-reviewed journal and develop an accessible summary of the results for website posting. A summary of the results will be included in the ongoing Lancet Global Health Commission on Global Eye Health. REGISTRATION DETAILS Open Science Framework (https://osf.io/8gktz).
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Affiliation(s)
- Miho Yoshizaki
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - João M Furtado
- Division of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ada Aghaji
- Department of Ophthalmology, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ana P Marques
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - William H Dean
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Ophthalmology, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Moorfields Eye Hospital, London, UK
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Chariwala RA, Shah SP, Patel D, Chaudhari SP, Gajiwala UR. Rapid Assessment of Avoidable Blindness and Willingness to Pay for Cataract Surgery in Tribal Region of Surat District of Gujarat State, India. Ophthalmic Epidemiol 2020; 28:152-159. [PMID: 32673143 DOI: 10.1080/09286586.2020.1792939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To estimate prevalence and causes of avoidable blindness among people ≥50 years and to assess willingness to pay (WTP) for cataract surgery in tribal region of south Gujarat, India. METHODS A cross-sectional population based survey was conducted with 44 randomly selected clusters each having 50 people aged ≥50 years selected by probability proportional to size of sampling. Adults identified with cataract causing visual loss (<6/18) in any eye were interviewed to assess their WTP for surgery. RESULTS Total of 2137 examined out of 2200 people enumerated (response rate 97.1%). The prevalence of blindness (Presenting Visual Acuity (PVA)<3/60 in better eye) was 2.23% (95% CI: 2.95%-1.51%). Cataract was main cause of blindness (67.3%) followed by corneal scarring (8.2%). Major barrier to cataract surgery cited by bilaterally blind people was lack of escort to the surgical facility (34.3%). Cataract surgical coverage (CSC) was 84.9% (eyes) and 92% (persons). Of the 492 people interviewed to assess WTP for their surgery, only 36.4% people were willing to pay. CONCLUSION The tribal population has a high poverty profile in India. Within this group, cataract remains the main treatable cause of blindness despite a high CSC. Assessment of barriers suggested that a well-coordinated outreach programme with free transport facilities to the surgical facility is required along with strategies to improve accessibility and prioritising cataract blind in the community. One-third of people were willing to pay for their surgeries implying that cross subsidization or tier system could be feasible for eye care programme sustainability.
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Affiliation(s)
- Rohan A Chariwala
- Department of Public Health and Research in Eye Care, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Gujarat, India
| | - Shaheen P Shah
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Daksha Patel
- International Center for Eye Health (ICEH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Sheetal P Chaudhari
- Department of Public Health and Research in Eye Care, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Gujarat, India
| | - Uday R Gajiwala
- Department of Public Health and Research in Eye Care, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Gujarat, India
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Essue BM, Jan S, Phuc HT, Dodson S, Armstrong K, Laba TL. Who benefits most from extending financial protection for cataract surgery in Vietnam? An extended cost-effectiveness analysis of small incision surgery. Health Policy Plan 2020; 35:399-407. [PMID: 32031615 DOI: 10.1093/heapol/czz181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2019] [Indexed: 11/15/2022] Open
Abstract
Treatment costs remain a barrier for having timely cataract surgery in Vietnam, particularly for females and the poor, despite significant progress in achieving universal health coverage (UHC). This study evaluated the potential impact, on health and financial protection, of eliminating medical and non-medical out-of-pocket costs associated with cataract surgery. An extended cost-effectiveness analysis (ECEA) was conducted with a societal perspective. The ECEA modelled how many more disability-adjusted life years (DALYs) and cases of catastrophic health expenditure (CHE) and medical impoverishment could be averted across income quintiles and between males and females. Two programmes were evaluated: (1) eliminating medical out-of-pocket costs for small incision cataract surgery and (2) Programme A plus a voucher programme covering non-medical out-of-pocket costs. Compared with current, the incremental cost per year of Programme A was estimated to be $833 396 and $1 641 835 for Programme B, each representing <0.01% of total health care spending in 2016. Males and females in the richest income quintiles would avert more DALYs than those in the poorest quintiles. For both programmes, most cases of CHE would be averted by individuals in the poorest income quintile. Programme B would avert the most CHE cases overall and females would have a greater share of benefits. All cases of impoverishing medical expenditure would be averted by individuals in the poorest quintile (A: 115 cases and B: 493 cases) for both programmes. The cost to avert each case of CHE with Programme A ranged from $67 to $292 and $100 to $232 for Programme B. We found a pro-rich health distribution and a pro-poor CHE distribution associated with eliminating out-of-pocket costs of cataract surgery in Vietnam. A programme that addressed both medical and non-medical out-of-pocket costs could have the greatest impact on improving financial protection in this population, particularly among the poorest income quintiles and for females. This study supports the concordance between the objectives of UHC and gender equity.
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Affiliation(s)
- Beverley M Essue
- Menzies Centre for Health Policy, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.,Centre for Health Economics and Policy Analysis, CRL Building, 282 McMaster University, 1280 Main Street, West Hamilton, Ontario L8S 4K1, Canada
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown New South Wales 2042, Australia
| | - Huynh Tan Phuc
- Fred Hollows Foundation, 130 Bạch Đng, Hải Châu 1, Hải Châu, Đà Nng 550000, Vietnam
| | - Sarity Dodson
- Fred Hollows Foundation, Level 2, 61 Dunning Ave, Rosebery New South Wales 2018, Australia
| | - Kirsten Armstrong
- Fred Hollows Foundation, Level 2, 61 Dunning Ave, Rosebery New South Wales 2018, Australia
| | - Tracey-Lea Laba
- Menzies Centre for Health Policy, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.,The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown New South Wales 2042, Australia.,The University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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Satpute SA, Canady JR, Klatzky RL, Stetten GD. FingerSight: A Vibrotactile Wearable Ring for Assistance With Locating and Reaching Objects in Peripersonal Space. IEEE TRANSACTIONS ON HAPTICS 2020; 13:325-333. [PMID: 31603801 DOI: 10.1109/toh.2019.2945561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This paper describes a prototype guidance system, "FingerSight," to help people without vision locate and reach to objects in peripersonal space. It consists of four evenly spaced tactors embedded into a ring worn on the index finger, with a small camera mounted on top. Computer-vision analysis of the camera image controls vibrotactile feedback, leading users to move their hand to near targets. Two experiments tested the functionality of the prototype system. The first found that participants could discriminate between five different vibrotactile sites (four individual tactors and all simultaneously) with a mean accuracy of 88.8% after initial training. In the second experiment, participants were blindfolded and instructed to move their hand wearing the device to one of four locations within arm's reach, while hand trajectories were tracked. The tactors were controlled using two different strategies: (1) repeatedly signal axis with largest error, and (2) signal both axes in alternation. Participants demonstrated essentially straight-line trajectories toward the target under both instructions, but the temporal parameters (rate of approach, duration) showed an advantage for correction on both axes in sequence.
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Buchan JC, Dean WH, Ramke J, Burton MJ. Response to: Comment on: 'The inverse-research law of global eye health'. Eye (Lond) 2020; 34:2350. [PMID: 32071403 DOI: 10.1038/s41433-020-0808-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- John C Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK. .,Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - William H Dean
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,Moorfields Eye Hospital, London, UK
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Mactaggart I, Maung NS, Khaing CT, Kuper H, Blanchet K. A case-control study of musculoskeletal impairment: association with socio-economic status, time use and quality of life in post-conflict Myanmar. BMC Public Health 2019; 19:1502. [PMID: 31711455 PMCID: PMC6849317 DOI: 10.1186/s12889-019-7851-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
Background Musculoskeletal impairments (MSI) are a major global contributor to disability. Evidence suggests entrenched cyclical links between disability and poverty, although few data are available on the link of poverty with MSI specifically. More data are needed on the association of MSI with functioning, socio-economic status and quality of life, particularly in resource-poor settings where MSI is common. Methods We undertook a case-control study of the association between MSI and poverty, time use and quality of life in post-conflict Myanmar. Cases were recruited from two physical rehabilitation service-centres, prior to the receipt of any services. One age- (+/− 5 years of case’s age) and sex- matched control was recruited per case, from their home community. 108 cases and 104 controls were recruited between July – December 2015. Cases and controls underwent in-depth structured interviews and functional performance tests at multiple time points over a twelve-month period. The baseline characteristics of cases and controls are reported in this manuscript, using multivariate logistic regression analysis and various tests of association. Results 89% of cases were male, 93% were lower limb amputees, and the vast majority had acquired MSI in adulthood. 69% were not working compared with 6% of controls (Odds Ratio 27.4, 95% Confidence Interval 10.6–70.7). Overall income, expenditure and assets were similar between cases and controls, with three-quarters of both living below the international LMIC poverty line. However, cases’ health expenditure was significantly higher than controls’ and associated with catastrophic health expenditure and an income gap for one fifth and two thirds of cases respectively. Quality of life scores were lower for cases than controls overall and in each sub-category of quality of life, and cases were far less likely to have participated in productive work the previous day than controls. Conclusion Adults with MSI in Myanmar who are not in receipt of rehabilitative services may be at increased risk of poverty and lower quality of life in relation to increased health needs and limited opportunities to participate in productive work. This study highlights the need for more comprehensive and appropriate support to persons with physical impairments in Myanmar.
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Affiliation(s)
- Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Nay Soe Maung
- University of Public Health (UPH), Myorma Kyaung Street, Yangon, Myanmar
| | - Cho Thet Khaing
- University of Public Health (UPH), Myorma Kyaung Street, Yangon, Myanmar
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Burton MJ, Faal HB, Ramke J, Ravilla T, Holland P, Wang N, West SK, Bourne RRA, Congdon NG, Foster A. Announcing The Lancet Global Health Commission on Global Eye Health. LANCET GLOBAL HEALTH 2019; 7:e1612-e1613. [PMID: 31606327 DOI: 10.1016/s2214-109x(19)30450-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Moorfields Eye Hospital, London, UK.
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Rupert R A Bourne
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Nathan G Congdon
- Centre for Public Health, Queen's University, Belfast, UK; Orbis International, New York, NY, USA; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Bastawrous A, Mathenge W, Nkurikiye J, Wing K, Rono H, Gichangi M, Weiss HA, Macleod D, Foster A, Burton M, Kuper H. Incidence of Visually Impairing Cataracts Among Older Adults in Kenya. JAMA Netw Open 2019; 2:e196354. [PMID: 31251374 PMCID: PMC6604086 DOI: 10.1001/jamanetworkopen.2019.6354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/11/2019] [Indexed: 01/10/2023] Open
Abstract
Importance Half of all the cases of blindness worldwide are associated with cataract. Cataract disproportionately affects people living in low- and middle-income countries and persons of African descent. Objective To estimate the 6-year cumulative incidence of visually impairing cataract in adult participants in the Nakuru Eye Disease Cohort Study in Kenya. Design, Setting, and Participants This secondary analysis of the Nakuru Eye Disease Cohort Study was conducted from February 2016 to April 2016. This cohort comprised citizens of Nakuru, Kenya, aged 50 years or older who consented to participate in the initial or baseline survey from January 2007 to November 2008, as well as the follow-up conducted from January 2013 to March 2014. All participants at baseline (n = 4364) and follow-up (n = 2159) underwent ophthalmic examination. Main Outcomes and Measures Six-year cumulative incidence of visually impairing cataract, risk factors of incidence, population estimates, and required cataract surgical rates to manage incident visually impairing cataract. Results In total, 4364 individuals (with a mean [SD] age of 63.4 [10.5] years and with 2275 women [52.1%]) had complete eye examinations at baseline, and 2159 participants (with a mean [SD] age of 62.5 [9.3] years and with 1140 men [52.8%]) were followed up 6 years later. The 6-year cumulative incidence of visually significant cataract in either eye was 251.9 per 1000 (95% CI, 228.5-276.8), with an increase with age from 128.9 (95% CI, 107.9-153.2) per 1000 for the group aged 50 to 59 years to 624.5 (95% CI, 493.1-739.9) per 1000 for the group aged 80 years or older. This equated to an annual incidence of visually significant cataract of 45.0 per 1000 people aged 50 years or older. Multivariable analysis showed alcohol consumption (risk ratio [RR], 1.4; 95% CI, 1.1-1.8), diabetes (RR, 1.7; 95% CI, 1.3-2.3), educational level, and increasing age (RR, 3.8; 95% CI, 2.6-5.5 for those aged ≥80 years) were associated with incident visually impairing cataract. Extrapolations to all people aged 50 years or older in Kenya indicated that 148 280 (95% CI, 134 510-162 950) individuals might develop new visually impairing cataract in either eye (visual acuity <6/18 in the worse-seeing eye) and that 9540 (95% CI, 6610-13 750) might become cataract blind in both eyes (visual acuity <3/60 in better-seeing eye). Conclusions and Relevance Adults in Kenya appeared to have a high incidence of visually impairing cataract, making cataract a priority for blindness prevention programs in the region; surgical interventions and awareness of these services are also required.
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Affiliation(s)
- Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr Agarwal’s Eye Hospital, Kigali, Rwanda
| | - John Nkurikiye
- Rwanda International Institute of Ophthalmology and Dr Agarwal’s Eye Hospital, Kigali, Rwanda
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hillary Rono
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Kitale Eye Unit and Trans Nzoia County, Kitale, Kenya
- Ministry of Health, Nairobi, Kenya
| | - Michael Gichangi
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Allen Foster
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Abstract
PURPOSE Severe corneal disease contributes significantly to the global burden of blindness. Corneal allograft surgery remains the most commonly used treatment, but does not succeed long term in every patient, and the odds of success fall with each repeated graft. The Boston keratoprosthesis type I has emerged as an alternative to repeat corneal allograft. However, cost limits its use in resource-poor settings, where most corneal blind individuals reside. METHODS All aspects of the Boston keratoprosthesis design process were examined to determine areas of potential modification and simplification, with dual goals to reduce cost and improve the cosmetic appearance of the device in situ. RESULTS Minor modifications in component design simplified keratoprosthesis manufacturing. Proportional machinist time could be further reduced by adopting a single axial length for aphakic eyes, and a single back plate diameter. The cosmetic appearance was improved by changing the shape of the back plate holes from round to radial, with a petaloid appearance, and by anodization of back plate titanium to impute a more natural color. CONCLUSIONS We have developed a modified Boston keratoprosthesis type I, which we call the "Lucia." The Lucia retains the 2 piece design and ease of assembly of the predicate device, but would allow for manufacturing at a reduced cost. Its appearance should prove more acceptable to implanted patients. Successful keratoprosthesis outcomes require daily medications for the life of the patient and rigorous, frequent, postoperative care. Effective implementation of the device in resource-poor settings will require further innovations in eye care delivery.
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25
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Barthélemy EJ, Park KB, Johnson W. Neurosurgery and Sustainable Development Goals. World Neurosurg 2018; 120:143-152. [DOI: 10.1016/j.wneu.2018.08.070] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 12/14/2022]
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Glick P, Luoto J, Orrs MS, Oliva MS, Tabin GC, Sanders DS, Thomas BJ, Ruit S, Belachew T, Tasfaw AK. The individual and household impacts of cataract surgery on older blind adults in ethiopia. Ophthalmic Epidemiol 2018; 26:7-18. [DOI: 10.1080/09286586.2018.1504310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Peter Glick
- Millennium Challenge Corporation, Washington, D.C., USA
| | - Jill Luoto
- Millennium Challenge Corporation, Washington, D.C., USA
| | - Mark S. Orrs
- Department of Political Science, Lehigh University, Bethlehem, Pennsylvania
| | - Matthew S. Oliva
- Cataract Himalayan Project, Waterbury, Vermont
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Geoffrey C. Tabin
- Cataract Himalayan Project, Waterbury, Vermont
- Department of Ophthalmology, Division of International Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - David S. Sanders
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
- School of Medicine & Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin J. Thomas
- Cataract Himalayan Project, Waterbury, Vermont
- Department of Ophthalmology, Division of International Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Sanduk Ruit
- Cataract Himalayan Project, Waterbury, Vermont
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Tefera Belachew
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
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Mactaggart I, Polack S, Murthy G, Kuper H. A population-based survey of visual impairment and its correlates in Mahabubnagar district, Telangana State, India. Ophthalmic Epidemiol 2017; 25:238-245. [PMID: 29281342 DOI: 10.1080/09286586.2017.1418386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To estimate the prevalence and correlates of visual impairment in Mahabubnagar district, Telangana, India. METHODS Fifty-one clusters of 80 people (all ages) were sampled with probability proportionate to size. Households within clusters were selected through the compact segment sampling. Visual acuity (VA) was measured with a tumbling "E" chart. An Ophthalmic Assistant or Vision Technician examined people with VA<6/12 in either eye. Other impairments (hearing, physical) were clinically assessed and self-reported functional difficulties measured using the Washington Group Extended Set. People with visual impairment and age-sex matched controls with normal vision were interviewed about poverty, employment and education. RESULTS 4,125 people were enumerated and 3,574 screened (86.6%). The prevalence of visual impairment (VA<6/12) was 8.0% (95% CI = 6.9-9.4%) and blindness was 0.4% (0.2-0.9%), and both increased rapidly with age. Uncorrected refractive error was the leading cause of visual impairment, and cataract the leading cause of blindness. Cataract surgical coverage (proportion of all cataracts that had received surgery) was relatively low (41% of people at VA<6/60), while the post-surgery outcomes were good (81% of operated eyes had presenting VA≥6/18). Among the 287 people with visual impairment, 15% had a moderate/severe physical impairment or epilepsy and 25% had a moderate/severe hearing impairment. Self-reported difficulties in vision were relatively closely related to visual acuity. People with visual impairment were more likely to be in the poorest quartile (OR = 1.9, 95% CI = 1.0-3.4) or unemployed (5.0, 2.2-10.0), compared to controls. CONCLUSIONS Visual impairment was common in Mahabubnagar district, was mostly avoidable, and was correlated with poverty markers.
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Affiliation(s)
- Islay Mactaggart
- a Clinical Research Department, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine , London UK
| | - Sarah Polack
- a Clinical Research Department, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine , London UK
| | - Gvs Murthy
- a Clinical Research Department, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine , London UK.,b Indian Institute of Public Health , Madhapur, Hyderabad , India
| | - Hannah Kuper
- a Clinical Research Department, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine , London UK
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Ramke J, Petkovic J, Welch V, Blignault I, Gilbert C, Blanchet K, Christensen R, Zwi AB, Tugwell P. Interventions to improve access to cataract surgical services and their impact on equity in low- and middle-income countries. Cochrane Database Syst Rev 2017; 11:CD011307. [PMID: 29119547 PMCID: PMC6486054 DOI: 10.1002/14651858.cd011307.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cataract is the leading cause of blindness in low- and middle-income countries (LMICs), and the prevalence is inequitably distributed between and within countries. Interventions have been undertaken to improve cataract surgical services, however, the effectiveness of these interventions on promoting equity is not known. OBJECTIVES To assess the effects on equity of interventions to improve access to cataract services for populations with cataract blindness (and visual impairment) in LMICs. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 3), MEDLINE Ovid (1946 to 12 April 2017), Embase Ovid (1980 to 12 April 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 12 April 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 12 April 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 12 April 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 12 April 2017. We did not use any date or language restrictions in the electronic searches for trials. SELECTION CRITERIA We included studies that reported on strategies to improve access to cataract services in LMICs using the following study designs: randomised and quasi-randomised controlled trials (RCTs), controlled before-and-after studies, and interrupted time series studies. Included studies were conducted in LMICs, and were targeted at disadvantaged populations, or disaggregated outcome data by 'PROGRESS-Plus' factors (Place of residence; Race/ethnicity/ culture/ language; Occupation; Gender/sex; Religion; Education; Socio-economic status; Social capital/networks. The 'Plus' component includes disability, sexual orientation and age). DATA COLLECTION AND ANALYSIS Two authors (JR and JP) independently selected studies, extracted data and assessed them for risk of bias. Meta-analysis was not possible, so included studies were synthesised in table and text. MAIN RESULTS From a total of 2865 studies identified in the search, two met our eligibility criteria, both of which were cluster-RCTs conducted in rural China. The way in which the trials were conducted means that the risk of bias is unclear. In both studies, villages were randomised to be either an intervention or control group. Adults identified with vision-impairing cataract, following village-based vision and eye health assessment, either received an intervention to increase uptake of cataract surgery (if their village was an intervention group), or to receive 'standard care' (if their village was a control group).One study (n = 434), randomly allocated 26 villages or townships to the intervention, which involved watching an informational video and receiving counselling about cataract and cataract surgery, while the control group were advised that they had decreased vision due to cataract and it could be treated, without being shown the video or receiving counselling. There was low-certainty evidence that providing information and counselling had no effect on uptake of referral to the hospital (OR 1.03, 95% CI 0.63 to 1.67, 1 RCT, 434 participants) and little or no effect on the uptake of surgery (OR 1.11, 95% CI 0.67 to 1.84, 1 RCT, 434 participants). We assessed the level of evidence to be of low-certainty for both outcomes, due to indirectness of evidence and imprecision of results.The other study (n = 355, 24 towns randomised) included three intervention arms: free surgery; free surgery plus reimbursement of transport costs; and free surgery plus free transport to and from the hospital. These were compared to the control group, which was reminded to use the "low-cost" (˜USD 38) surgical service. There was low-certainty evidence that surgical fee waiver with/without transport provision or reimbursement increased uptake of surgery (RR 1.94, 95% CI 1.14 to 3.31, 1 RCT, 355 participants). We assessed the level of evidence to be of low-certainty due to indirectness of evidence and imprecision of results.Neither of the studies reported our primary outcome of change in prevalence of cataract blindness, or other outcomes such as cataract surgical coverage, surgical outcome, or adverse effects. Neither study disaggregated outcomes by social subgroups to enable further assessment of equity effects. We sought data from both studies and obtained data from one; the information video and counselling intervention did not have a differential effect across the PROGRESS-Plus categories with available data (place of residence, gender, education level, socioeconomic status and social capital). AUTHORS' CONCLUSIONS Current evidence on the effect on equity of interventions to improve access to cataract services in LMICs is limited. We identified only two studies, both conducted in rural China. Assessment of equity effects will be improved if future studies disaggregate outcomes by relevant social subgroups. To assist with assessing generalisability of findings to other settings, robust data on contextual factors are also needed.
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Affiliation(s)
- Jacqueline Ramke
- University of AucklandSchool of Population Health, Faculty of Medicine and Health SciencesAucklandNew Zealand
| | - Jennifer Petkovic
- University of OttawaBruyère Research Institute43 Bruyère StAnnex E, room 312OttawaONCanadaK1N 5C8
| | - Vivian Welch
- Bruyère Research InstituteMethods Centre85 Primrose AvenueOttawaONCanada
| | - Ilse Blignault
- University of New South WalesSchool of Public Health and Community MedicineSydneyNew South WalesAustralia
| | - Clare Gilbert
- London School of Hygiene & Tropical MedicineDepartment of Clinical Research, Faculty of Infectious and Tropical DiseasesKeppel StreetLondonUKWC1E 7HT
| | - Karl Blanchet
- London School of Hygiene & Tropical MedicineDepartment of Global Health and Development15‐17 Tavistock PlaceLondonUKWC1H 9SH
| | - Robin Christensen
- Copenhagen University Hospital, Bispebjerg og FrederiksbergMusculoskeletal Statistics Unit, The Parker InstituteNordre Fasanvej 57CopenhagenDenmarkDK‐2000
| | - Anthony B Zwi
- University of New South WalesSchool of Social Sciences, Faculty of Arts and Social SciencesRoom G25, Ground Floor, Morven Brown BuildingSydneyNew South WalesAustralia2052
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
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Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
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Shrime MG, Sekidde S, Linden A, Cohen JL, Weinstein MC, Salomon JA. Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda. PLoS One 2016; 11:e0168867. [PMID: 28036357 PMCID: PMC5201287 DOI: 10.1371/journal.pone.0168867] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/06/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. METHODS Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. FINDINGS Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term "surgical mission trip". These results are robust to scenario and sensitivity analyses. INTERPRETATION The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems.
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Affiliation(s)
- Mark G. Shrime
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, United States of America
| | - Serufusa Sekidde
- Aspen Global Health and Development, Aspen Institute, Aspen, CO, United States of America
| | - Allison Linden
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Jessica L. Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Milton C. Weinstein
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Joshua A. Salomon
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Shrime MG, Dare A, Alkire BC, Meara JG. A global country-level comparison of the financial burden of surgery. Br J Surg 2016; 103:1453-61. [PMID: 27428044 DOI: 10.1002/bjs.10249] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/11/2015] [Accepted: 05/23/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Approximately 30 per cent of the global burden of disease is surgical, and nearly one-quarter of individuals who undergo surgery each year face financial hardship because of its cost. The Lancet Commission on Global Surgery has proposed the elimination of impoverishment due to surgery by 2030, but no country-level estimates exist of the financial burden of surgical access. METHODS Using publicly available data, the incidence and risk of financial hardship owing to surgery was estimated for each country. Four measures of financial catastrophe were examined: catastrophic expenditure, and impoverishment at the national poverty line, at 2 international dollars (I$) per day and at I$1·25 per day. Stochastic models of income and surgical costs were built for each country. Results were validated against available primary data. RESULTS Direct medical costs of surgery put 43·9 (95 per cent posterior credible interval 2·2 to 87·1) per cent of the examined population at risk of catastrophic expenditure, and 57·0 (21·8 to 85·1) per cent at risk of being pushed below I$2 per day. The risk of financial hardship from surgery was highest in sub-Saharan Africa. Correlations were found between the risk of financial catastrophe and external financing of healthcare (positive correlation), national measures of well-being (negative correlation) and the percentage of a country's gross domestic product spent on healthcare (negative correlation). The model performed well against primary data on the costs of surgery. CONCLUSION Country-specific estimates of financial catastrophe owing to surgical care are presented. The economic benefits projected to occur with the scale-up of surgery are placed at risk if the financial burden of accessing surgery is not addressed in national policies.
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Affiliation(s)
- M G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Massachusetts, USA. .,Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston Children's Hospital, Boston, Massachusetts, USA.
| | - A Dare
- Department of Surgery, University of Toronto, Toronto, Canada
| | - B C Alkire
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston Children's Hospital, Boston, Massachusetts, USA
| | - J G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Gilbert C, Murthy GVS. The Sustainable Development Goals and Implications for Eye Health Research. Ophthalmic Epidemiol 2016; 22:359-60. [PMID: 26653258 DOI: 10.3109/09286586.2015.1104365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Clare Gilbert
- a International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine , London , UK
| | - G V S Murthy
- a International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine , London , UK
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Mundy KM, Nichols E, Lindsey J. Socioeconomic Disparities in Cataract Prevalence, Characteristics, and Management. Semin Ophthalmol 2016; 31:358-63. [PMID: 27100947 DOI: 10.3109/08820538.2016.1154178] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To review the current literature on socioeconomic disparities relationship with cataract prevalence, characteristics, and management. SUMMARY Cataracts are an important cause of preventable visual impairment in both the developing and industrialized world. Cataract surgery is a highly effective operation with an excellent risk profile. Furthermore, cataract surgery has been shown to have significant positive functional, social, and economic implications for patients. Several medical conditions have been shown to have correlation with socioeconomic factors and cataract is among several forms of visual impairment that demonstrate this relationship. Disparities in prevalence, clinical characteristics, and management are documented in the ophthalmic literature. A better understanding of these socioeconomic factors and their clinical relevance is critical to alleviating the burden of cataract-related visual impairment in an aging population.
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Affiliation(s)
- Kevin M Mundy
- a Vanderbilt University Medical Center , Vanderbilt University, Nashville , TN , USA
| | - Erin Nichols
- a Vanderbilt University Medical Center , Vanderbilt University, Nashville , TN , USA
| | - Jennifer Lindsey
- a Vanderbilt University Medical Center , Vanderbilt University, Nashville , TN , USA
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Tafida A, Kyari F, Abdull MM, Sivasubramaniam S, Murthy GVS, Kana I, Gilbert CE. Poverty and Blindness in Nigeria: Results from the National Survey of Blindness and Visual Impairment. Ophthalmic Epidemiol 2016; 22:333-41. [PMID: 26395660 DOI: 10.3109/09286586.2015.1077259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Poverty can be a cause and consequence of blindness. Some causes only affect the poorest communities (e.g. trachoma), and poor individuals are less likely to access services. In low income countries, cataract blind adults have been shown to be less economically active, indicating that blindness can exacerbate poverty. This study aims to explore associations between poverty and blindness using national survey data from Nigeria. METHODS Participants ≥40 years were examined in 305 clusters (2005-2007). Sociodemographic information, including literacy and occupation, was obtained by interview. Presenting visual acuity (PVA) was assessed using a reduced tumbling E LogMAR chart. Full ocular examination was undertaken by experienced ophthalmologists on all with PVA <6/12 in either eye. Causes of vision loss were determined using World Health Organization guidelines. Households were categorized into three levels of poverty based on literacy and occupation at household level. RESULTS A total of 569/13,591 participants were blind (PVA <3/60, better eye; prevalence 4.2%, 95% confidence interval [CI] 3.8-4.6%). Prevalences of blindness were 8.5% (95% CI 7.7-9.5%), 2.5% (95% CI 2.0-3.1%), and 1.5% (95% CI 1.2-2.0%) in poorest, medium and affluent households, respectively (p = 0.001). Cause-specific prevalences of blindness from cataract, glaucoma, uncorrected aphakia and corneal opacities were significantly higher in poorer households. Cataract surgical coverage was low (37.2%), being lowest in females in poor households (25.3%). Spectacle coverage was 3 times lower in poor than affluent households (2.4% vs. 7.5%). CONCLUSION In Nigeria, blindness is associated with poverty, in part reflecting lower access to services. Reducing avoidable causes will not be achieved unless access to services improves, particularly for the poor and women.
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Affiliation(s)
- A Tafida
- a Department of Ophthalmology , Aminu Kano Teaching Hospital , Kano , Nigeria
| | - F Kyari
- b College of Health Sciences, University of Abuja , Nigeria
| | - M M Abdull
- c Ophthalmology Department , Abubakar Tafawa Balewa University Teaching Hospital , Bauchi , Nigeria
| | - S Sivasubramaniam
- d International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine , London , UK , and
| | - G V S Murthy
- d International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine , London , UK , and
| | - I Kana
- e Office of the Permanent Secretary, Federal Ministry of Health , Abuja , Nigeria
| | - Clare E Gilbert
- d International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine , London , UK , and
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Shrime MG, Verguet S, Johansson KA, Desalegn D, Jamison DT, Kruk ME. Task-sharing or public finance for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis. Health Policy Plan 2015; 31:706-16. [PMID: 26719347 DOI: 10.1093/heapol/czv121] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
Despite a high burden of surgical disease, access to surgical services in low- and middle-income countries is often limited. In line with the World Health Organization's current focus on universal health coverage and equitable access to care, we examined how policies to expand access to surgery in rural Ethiopia would impact health, impoverishment and equity. An extended cost-effectiveness analysis was performed. Deterministic and stochastic models of surgery in rural Ethiopia were constructed, utilizing pooled estimates of costs and probabilities from national surveys and published literature. Model calibration and validation were performed against published estimates, with sensitivity analyses on model assumptions to check for robustness. Outcomes of interest were the number of deaths averted, the number of cases of poverty averted and the number of cases of catastrophic expenditure averted for each policy, divided across wealth quintiles. Health benefits, financial risk protection and equity appear to be in tension in the expansion of access to surgical care in rural Ethiopia. Health benefits from each of the examined policies accrued primarily to the poor. However, without travel vouchers, many policies also induced impoverishment in the poor while providing financial risk protection to the rich, calling into question the equitable distribution of benefits by these policies. Adding travel vouchers removed the impoverishing effects of a policy but decreased the health benefit that could be bought per dollar spent. These results were robust to sensitivity analyses.
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Affiliation(s)
- Mark G Shrime
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA, Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA,
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, Bergen University, Bergen, Norway
| | - Dawit Desalegn
- Department of Obstetrics and Gynaecology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia and
| | - Dean T Jamison
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
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Ramke J, Zwi AB, Palagyi A, Blignault I, Gilbert CE. Equity and Blindness: Closing Evidence Gaps to Support Universal Eye Health. Ophthalmic Epidemiol 2015; 22:297-307. [DOI: 10.3109/09286586.2015.1077977] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SLM, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386:569-624. [PMID: 25924834 DOI: 10.1016/s0140-6736(15)60160-x] [Citation(s) in RCA: 2162] [Impact Index Per Article: 240.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA.
| | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Lars Hagander
- Pediatric Surgery and Global Pediatrics, Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Blake C Alkire
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Nivaldo Alonso
- Plastic Surgery Department, University of São Paulo, São Paulo, Brazil
| | - Emmanuel A Ameh
- Department of Surgery, Division of Peadiatric Surgery, National Hospital, Abuja, Nigeria
| | - Stephen W Bickler
- Rady Children's Hospital, University of California, San Diego, San Diego, CA, USA
| | - Lesong Conteh
- School of Public Health, Imperial College London, London, UK
| | - Anna J Dare
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | | | | | | | - Paul E Farmer
- Department of Global Health and Social Medicine, Division of Global Health Equity, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA; Partners in Health, Boston, MA, USA
| | - Atul Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Ariadne Labs Boston, MA, USA
| | - Rowan Gillies
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Medical College of Wisconsin, Milwaukee, WI, USA
| | - Caris E Grimes
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Russell L Gruen
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Thaim Buya Kamara
- Connaught Hospital, Freetown, Sierra Leone; Department of Surgery, University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ganbold Lundeg
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Nyengo C Mkandawire
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi; School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Johanna N Riesel
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Edgar Rodas
- The Cinterandes Foundation, Universidad del Cuenca, and Universidad del Azuay, Cuenca, Ecuador; Universidad del Azuay, Cuenca, Ecuador
| | - John Rose
- Department of Surgery, University of California, San Diego, CA, USA
| | | | - Mark G Shrime
- Department of Otology and Laryngology, Harvard Medical School, Boston, USA; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, King's Centre for Global Health, King's College London, London, UK
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - David Watters
- Royal Australasian College of Surgeons, East Melbourne, and Deakin University, Melbourne, VIC, Australia
| | - Thomas G Weiser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Iain H Wilson
- Department of Anaesthesia, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Gavin Yamey
- Evidence to Policy Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Winnie Yip
- Blavatnik School of Government, University of Oxford, Oxford, UK
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Verguet S, Alkire BC, Bickler SW, Lauer JA, Uribe-Leitz T, Molina G, Weiser TG, Yamey G, Shrime MG. Timing and cost of scaling up surgical services in low-income and middle-income countries from 2012 to 2030: a modelling study. LANCET GLOBAL HEALTH 2015; 3 Suppl 2:S28-37. [DOI: 10.1016/s2214-109x(15)70086-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Essue BM, Kimman M, Svenstrup N, Lindevig Kjoege K, Lea Laba T, Hackett ML, Jan S. The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review. Bull World Health Organ 2014; 93:102-12B. [PMID: 25883403 PMCID: PMC4339963 DOI: 10.2471/blt.14.139287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/30/2014] [Accepted: 10/30/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To determine the nature, scope and effectiveness of interventions to reduce the household economic burden of illness or injury. Methods We systematically reviewed reports published on or before 31 January 2014 that we found in the CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE and PsycINFO databases. We extracted data from prospective controlled trials and assessed the risk of bias. We narratively synthesized evidence. Findings Nine of the 4330 studies checked met our inclusion criteria – seven had evaluated changes to existing health-insurance programmes and two had evaluated different modes of delivering information. The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population. However, the reductions only represented marginal changes in the total expenditures of patients. We found no studies that had been effective in addressing broader household economic impacts – such as catastrophic health expenditure – in the disease populations investigated. Conclusion In general, interventions designed to reduce the complex household economic burden of illness and injury appear to have had little impact on household economies. We only found a few relevant studies using rigorous study designs that were conducted in defined patient populations. The studies were limited in the range of interventions tested and they evaluated only a narrow range of household economic outcomes. There is a need for method development to advance the measurement of the household economic consequences of illness and injury and facilitate the development of innovative interventions to supplement the strategies based on health insurance.
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Affiliation(s)
- Beverley M Essue
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
| | - Merel Kimman
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
| | - Nina Svenstrup
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
| | - Katharina Lindevig Kjoege
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
| | - Tracey Lea Laba
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
| | - Maree L Hackett
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
| | - Stephen Jan
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
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Congdon N, Thomas R. How can we solve the problem of low uptake of cataract surgery? Ophthalmic Epidemiol 2014; 21:135-7. [PMID: 24830650 DOI: 10.3109/09286586.2014.912333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nathan Congdon
- Translational Research for Equitable Eye Care (TREE) Center, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
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Danquah L, Kuper H, Eusebio C, Rashid MA, Bowen L, Foster A, Polack S. The long term impact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines. PLoS One 2014; 9:e94140. [PMID: 24747192 PMCID: PMC3991652 DOI: 10.1371/journal.pone.0094140] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/13/2014] [Indexed: 11/18/2022] Open
Abstract
Background Cataract surgery has been shown to improve quality of life and household economy in the short term. However, it is unclear whether these benefits are sustained over time. This study aims to assess the six year impact of cataract surgery on health related quality of life (HRQoL), daily activities and economic poverty in Bangladesh and The Philippines. Methods and Findings This was a longitudinal study. At baseline people aged ≥50 years with visual impairment due to cataract (‘cases’) and age-, sex-matched controls without visual impairment were interviewed about vision specific and generic HRQoL, daily activities and economic indicators (household per capita expenditure, assets and self-rated wealth). Cases were offered free or subsidised cataract surgery. Cases and controls were re-interviewed approximately one and six years later. At baseline across the two countries there were 455 cases and 443 controls. Fifty percent of cases attended for surgery. Response rates at six years were 47% for operated cases and 53% for controls. At baseline cases had poorer health and vision related QoL, were less likely to undertake productive activities, more likely to receive assistance with activities and were poorer compared to controls (p<0.05). One year after surgery there were significant increases in HRQoL, participation and time spent in productive activities and per capita expenditure and reduction in assistance with activities so that the operated cases were similar to controls. These increases were still evident after six years with the exception that time spent on productive activities decreased among both cases and controls. Conclusion Cataract causing visual loss is associated with reduced HRQoL and economic poverty among older adults in low-income countries. Cataract surgery improves the HRQoL of the individual and economy of the household. The findings of this study suggest these benefits are sustained in the long term.
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Affiliation(s)
- Lisa Danquah
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Liza Bowen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Allen Foster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Economic analysis of delivering primary health care services through community health workers in 3 North Indian states. PLoS One 2014; 9:e91781. [PMID: 24626285 PMCID: PMC3953597 DOI: 10.1371/journal.pone.0091781] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We assessed overall annual and unit cost of delivering package of services and specific services at sub-centre level by CHWs and cost effectiveness of Government of India's policy of introducing a second auxiliary nurse midwife (ANM) at the sub-centre compared to scenario of single ANM sub-centre. METHODS We undertook an economic costing of health services delivered by CHWs, from a health system perspective. Bottom-up costing method was used to collect data on resources spent in 50 randomly selected sub-centres selected from 4 districts. Mean unit cost along with its 95% confidence intervals were estimated using bootstrap method. Multiple linear regression model was used to standardize cost and assess its determinants. RESULTS Annually it costs INR 1.03 million (USD 19,381), or INR 187 (USD 3.5) per capita per year, to provide a package of preventive, curative and promotive services through community health workers. Unit costs for antenatal care, postnatal care, DOTS treatment and immunization were INR 525 (USD 10) per full ANC care, INR 767 (USD 14) per PNC case registered, INR 974 (USD 18) per DOTS treatment completed and INR 97 (USD 1.8) per child immunized in routine immunization respectively. A 10% increase in human resource costs results in 6% rise in per capita cost. Similarly, 10% increment in the ANC case registered per provider through-put results in a decline in unit cost ranging from 2% in the event of current capacity utilization to 3% reduction in case of full capacity utilization. Incremental cost of introducing 2nd ANM at sub-centre level per unit percent increase ANC coverage was INR 23,058 (USD 432). CONCLUSION Our estimates would be useful in undertaking full economic evaluations or equity analysis of CHW programs. Government of India's policy of hiring 2nd ANM at sub-centre level is very cost effective from Indian health system perspective.
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Habtamu E, Eshete Z, Burton MJ. Cataract surgery in Southern Ethiopia: distribution, rates and determinants of service provision. BMC Health Serv Res 2013; 13:480. [PMID: 24245754 PMCID: PMC3842739 DOI: 10.1186/1472-6963-13-480] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022] Open
Abstract
Background Cataract is the leading cause of blindness worldwide, with the greatest burden found in low-income countries. Cataract surgery is a curative and cost-effective intervention. Despite major non-governmental organization (NGO) support, the cataract surgery performed in Southern Region, Ethiopia is currently insufficient to address the need. We analyzed the distribution, productivity, cost and determinants of cataract surgery services. Methods Confidential interviews were conducted with all eye surgeons (Ophthalmologists & Non-Physician Cataract Surgeons [NPCS]) in Southern Region using semi-structured questionnaires. Eye care project managers were interviewed using open-ended qualitative questionnaires. All eye units were visited. Information on resources, costs, and the rates and determinants of surgical output were collected. Results Cataract surgery provision is uneven across Southern Region: 66% of the units are within 200 km of the regional capital. Surgeon to population ratios varied widely from 1:70,000 in the capital to no service provision in areas containing 7 million people. The Cataract Surgical Rate (CSR) in 2010 was 406 operations/million/year with zonal CSRs ranging between 204 and 1349. Average number of surgeries performed was 374 operations/surgeon/year. Ophthalmologists and NPCS performed a mean of 682 and 280 cataract operations/surgeon/year, respectively (p = 0.03). Resources are underutilized, at 56% of capacity. Community awareness programs were associated with increased activity (p = 0.009). Several factors were associated with increased surgeon productivity (p < 0.05): working for >2 years, working in a NGO/private clinic, working in an urban unit, having a unit manger, conducting outreach programs and a satisfactory work environment. The average cost of cataract surgery in 2010 was US$141.6 (Range: US$37.6–312.6). Units received >70% of their consumables from NGOs. Mangers identified poor staff motivation, community awareness and limited government support as major challenges. Conclusions The uneven distribution of infrastructure and personnel, underutilization by the community and inadequate attention and support from the government are limiting cataract surgery service delivery in Southern Ethiopia. Improved human resource management and implementing community-oriented strategies may help increase surgical output and achieve the “Vision 2020: The Right to Sight” targets for treating avoidable blindness.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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Yip JLY, Luben R, Hayat S, Khawaja AP, Broadway DC, Wareham N, Khaw KT, Foster PJ. Area deprivation, individual socioeconomic status and low vision in the EPIC-Norfolk Eye Study. J Epidemiol Community Health 2013; 68:204-10. [PMID: 24179053 PMCID: PMC4157999 DOI: 10.1136/jech-2013-203265] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Poor vision is associated with lower socioeconomic status, but less is known about its relationship to area deprivation. Methods The European Prospective Investigation into Cancer and Nutrition study Norfolk Eye Study was a cross-sectional study of 8563 participants with completed eye examinations. Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was measured using standard protocols and low vision (LV) was defined as Snellen equivalent (VA) ≤6/12 in the better eye. Uncorrected refractive error (URE) was defined as improvement of VA by 2 logarithm of the minimum angle of resolution lines with pinhole. The lowest 5% of index of multiple deprivation rank was used to define the most deprived areas. The index of multiple deprivation is a composite measure using routine data from seven domains of deprivation to identify the most disadvantaged areas in England. Logistic regression was used to examine univariable and multivariable associations with LV. Results Ninety-six participants with missing data were excluded, leaving 8467 for analysis (98.9%). The mean age of the study group was 68.7 years (SD=8.1, range=48–92), with 55.1% women. LV was present in 263 participants (3.1%, 95% CI 2.7 to 3.5%). LV was associated with deprivation after adjusting for age, sex, education, social class and cataract surgery (OR=1.7, 95% CI 1.1 to 2.6, p=0.03), but this effect was mitigated by additionally adjusting for URE (OR=1.5, 95% CI 1.0 to 2.4, p=0.09). Conclusions People with LV are more likely to live in the most deprived areas; this association was independent of socioeconomic status and partly mediated by URE. Targeting URE in deprived areas may reduce health inequalities associated with LV.
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Affiliation(s)
- Jennifer L Y Yip
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, , Cambridge, UK
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Bastawrous A, Dean WH, Sherwin JC. Blindness and visual impairment due to age-related cataract in sub-Saharan Africa: a systematic review of recent population-based studies. Br J Ophthalmol 2013; 97:1237-43. [PMID: 23696652 DOI: 10.1136/bjophthalmol-2013-303135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM We aimed to evaluate age-related cataract as a contributor to blindness and visual impairment (VI) in sub-Saharan Africa (SSA). METHODS A systematic review of population-based studies published between 2000 and October 2012. Prevalence and proportions of blindness and VI due to cataract, cataract surgical coverage (CSC), per cent intraocular lens (IOL) implantation and visual outcomes of surgery in accordance with WHO criteria were ascertained. RESULTS Data from 17 surveys (subjects mostly aged ≥ 50-years-old) from 15 different countries in SSA were included, comprising 96 402 people. Prevalence of blindness (presenting visual acuity <3/60 in better eye) ranged from 0.1% in Uganda to 9.0% in Eritrea, and the proportion of total blindness due to cataract ranged between 21% and 67%. Cataract was the principal cause of blindness and VI in 15 and 14 studies, respectively. There was a strong positive correlation between good visual outcomes and IOL use (R=0.69, p=0.027). Considerable inter-study heterogeneity was evident in CSC and visual outcomes following surgery, and between 40% and 100% of operations had used IOL. CONCLUSIONS Cataract represents the principal cause of blindness and VI and should remain a priority objective for eye care in SSA. However, the prevalence of blindness and VI due to cataract was variable and may reflect differences in the availability of cataract surgical programmes and cataract incidence.
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Affiliation(s)
- Andrew Bastawrous
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, , London, UK
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Abstract
PURPOSE OF REVIEW As the elderly population continues to grow in the USA, an understanding of the increasing burden of cataract is pivotal. This review seeks to iterate the presence of this burden and to understand it better in the context of race, sex, and socioeconomic factors. RECENT FINDINGS Although there have been multiple prevalence studies addressing the cataract burden in the USA, updated literature that directly elucidates the above issues has been sparse. Recent data support previous findings that the cataract burden among women is greater than that of men, likely predominantly due to greater longevity. With regard to race, there appears to be a slightly increased burden among Whites, although this increase may show regional variability and change over the next few decades, especially as the presently young Hispanic population continues to age and grow. It is likely that the significant divider responsible for unmet cataract surgery is socioeconomic, due to such factors as insurance coverage, income, and barriers to access such as transportation, service accessibility, and awareness. These latter barriers of income and access appear to be identical to those identified in developing countries. SUMMARY The cataract burden in the USA is significant and is expected to continue to grow. Further studies are warranted to help us better understand barriers to access, particularly with regard to race and socioeconomic factors. Local efforts to address education and logistical barriers as well as nationwide policy efforts to address insurance coverage appear to be a crucial factor in surmounting an ongoing but treatable chronic disease.
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du Toit R, Faal HB, Etya'ale D, Wiafe B, Mason I, Graham R, Bush S, Mathenge W, Courtright P. Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach. BMC Health Serv Res 2013; 13:102. [PMID: 23506686 PMCID: PMC3616885 DOI: 10.1186/1472-6963-13-102] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 03/02/2013] [Indexed: 12/03/2022] Open
Abstract
Background The impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective. Methods A scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework. Results Limited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care. Conclusion Evidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices. Multi-national research may provide guidance about how to scale up eye health interventions that are integrated into primary health systems.
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Ackland P. The accomplishments of the global initiative VISION 2020: The Right to Sight and the focus for the next 8 years of the campaign. Indian J Ophthalmol 2013; 60:380-6. [PMID: 22944746 PMCID: PMC3491262 DOI: 10.4103/0301-4738.100531] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In the first 12 years of VISION 2020 sound programmatic approaches have been developed that are capable of delivering equitable eye health services to even the most remote and impoverished communities. A body of evidence around the economic arguments for investment in eye health has been developed that has fuelled successful advocacy work resulting in supportive high level policy statements. More than a 100 national plans to achieve the elimination of avoidable blindness have been developed and some notable contributions made from the corporate and government sectors to resource eye health programs. Good progress has been made to control infectious blinding diseases and at the very least there is anecdotal evidence to suggest that the global increase in the prevalence of blindness and visual impairment has been reversed in recent years, despite the ever increasing and more elderly global population. However if we are to achieve the goal of VISION 2020 we require a considerable scaling up of current efforts–this will depend on our future success in two key areas: i) Successful advocacy and engagement at individual country level to secure significantly enhanced national government commitment to financing their own VISION 2020 plans.ii) A new approach to VISION 2020 thinking that integrates eye health into health system development and develops new partnerships with wider health development initiatives.
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Affiliation(s)
- Peter Ackland
- International Agency for the Prevention of Blindness (IAPB), London School of Hygiene and Tropical Disease, Keppel Street, London, UK
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