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Herrod S, Sherief ST, Ahmed A, Mutati GC, Welling J, Wiafe B, Gyasi M, Crookston B, West J, Hall C. Ophthalmologists' Perspective on Barriers to Cataract Surgery and Surgical Productivity in Ethiopia, Ghana, and Zambia: A Descriptive, Mixed-Methods Survey. Ophthalmic Epidemiol 2024; 31:409-419. [PMID: 38237029 DOI: 10.1080/09286586.2023.2301581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 11/09/2023] [Accepted: 12/26/2023] [Indexed: 09/08/2024]
Abstract
PURPOSE While progress was made towards the Vision 2020: The Right to Sight goals, Ethiopia, Ghana, and Zambia fell short of the recommended cataract surgical rate (CSR) on a national level. Post-operative cataract surgical outcomes are also lower compared to other regions. This study aimed to describe perceived barriers to cataract surgical uptake, factors related to surgeon surgical productivity, and surgical offerings in each of these countries. METHODS An online survey was sent to ophthalmologists practicing in Ethiopia, Ghana, and Zambia. Responses were collected between June 25, 2021 and January 30, 2022. RESULTS Responses were received from 122 ophthalmologists from Ethiopia, Ghana, and Zambia. The estimated participation rate was 47% (122/257). Distance to cataract surgical centres, lack of surgical centres, and lack of surgical equipment were among the top 10 most agreed upon barriers by respondents within each country. Many respondents reported that current financial reimbursement does not incentivise maximum productivity in themselves (56%, 68/122) or their staff (61%, 74/122). Surgeons proposed several ways to improve productivity incentives. Private practice was perceived to have the best reimbursement incentives (77%, 94/122), whereas government hospitals were least agreed upon (4%, 5/122). Discrepancies in timely post-operative refraction and eyeglasses disbursement were reported. CONCLUSIONS Overcoming the identified barriers, improving surgeon productivity, and addressing identified deficits in cataract care will likely reduce the backlog of cataract blindness while ensuring increasingly improved patient outcomes.
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Affiliation(s)
- Scott Herrod
- Department of Public Health, Brigham Young University, Provo, UT, USA
- Harvard Medical School, Boston, MA, USA
- Daybreak Vision Project, Alpine, UT, USA
| | - Sadik Taju Sherief
- Himalayan Cataract Project, Waterbury, VT, USA
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Akwasi Ahmed
- Daybreak Vision Project, Alpine, UT, USA
- The Eye Centre, Komfo Anokye Teaching Hospital, Kumasi, Ashanti Region, Ghana
| | - Grace Chipalo Mutati
- Department of Ophthalmology, University Teaching Hospital, Lusaka, Lusaka Province, Zambia
| | - John Welling
- Daybreak Vision Project, Alpine, UT, USA
- Medical Eye Center, Oregon, USA
| | - Boateng Wiafe
- Operation Eyesight Universal, Accra, Greater Accra Region, Ghana
| | - Michael Gyasi
- St. Thomas Eye Hospital, Accra, Greater Accra Region, Ghana
- Unite for Sight, North Haven, CT, USA
| | | | - Joshua West
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - Cougar Hall
- Department of Public Health, Brigham Young University, Provo, UT, USA
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Sehrin F, Jin L, Naher K, Das NC, Chan VF, Li DF, Bergson S, Gudwin E, Clarke M, Stephan T, Congdon N. The effect on income of providing near vision correction to workers in Bangladesh: The THRIVE (Tradespeople and Hand-workers Rural Initiative for a Vision-enhanced Economy) randomized controlled trial. PLoS One 2024; 19:e0296115. [PMID: 38568883 PMCID: PMC10990163 DOI: 10.1371/journal.pone.0296115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/29/2023] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Presbyopia, the leading cause of vision impairment globally, is common during working years. However, no trials have assessed presbyopia's impact on income. METHODS In April 2017, we conducted a census among 59 Bangladesh villages to identify persons aged 35 to 65 years with presbyopia (presenting distance vision > = 6/12 bilaterally and correctable inability to see 6/13 at 40 cm with both eyes), who never had owned glasses. Participants were randomized (1:1) to receive immediate free reading glasses (intervention) or glasses delivered 8 months later (control). Visual demand of different jobs was stratified into three levels. Outcomes were between-group differences in the 8 month change in: self-reported monthly income (primary) and Near Vision Related Quality of Life (NVRQOL, secondary). RESULTS Among 10,884 census participants, 3,655 (33.6%) met vision criteria and 863 (23.6%) comprised a sample enriched for near vision-intensive jobs, but 39 (4.52%) could not be reached. All participants allocated to intervention (n = 423, 51.3%) and control (n = 401, 48.7%) received the appropriate intervention, and follow-up was available for 93.4% and 96.8% respectively. Groups were similar at baseline in all characteristics: mean age was 47 years, 50% were male, 35% literate, and about half engaged in "most near vision-intensive" occupations. Glasses wear at 8-month follow-up was 88.3% and 7.81% in intervention and control respectively. At baseline, both the intervention and control groups had a self-reported median monthly income of US$35.3. At endline, the median income for the intervention group was US$47.1 compared with US$35.3 for control, a difference of 33.4%. Predictors of greater income increase in multivariate models included intervention group allocation (OR 1.45, 95% CI 1.12, 1.88, P = 0.005), male sex (OR 2.41, 95% CI 1.84, 3.16, P <0.001), and not engaging in income-producing work at baseline (OR 2.35, 95% CI 1.69, 3.26, P<0.001). CONCLUSION Provision of reading glasses increases income in near vision-intensive occupations, and may facilitate return to work for those currently unemployed.
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Affiliation(s)
- Farzana Sehrin
- BRAC (Formerly: Bangladesh Rural Advancement Committee), Dhaka, Bangladesh
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kamrun Naher
- BRAC (Formerly: Bangladesh Rural Advancement Committee), Dhaka, Bangladesh
| | | | - Ving Fan Chan
- University of KwaZulu Natal, Durban, South Africa
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Dong Feng Li
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Susan Bergson
- VisionSpring, New York, New York, United States of America
| | - Ella Gudwin
- VisionSpring, New York, New York, United States of America
| | - Mike Clarke
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Tai Stephan
- Orbis International, New York, New York, United States of America
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- Orbis International, New York, New York, United States of America
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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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Ma X, Hao J, Jan C, Wan Y, Xie Y, Liu C, Shi Y, Hu A, Cao K, Congdon N, Rozelle S, Dong Z, Wang N. Barriers to uptake of cataract surgery among elderly patients in rural China: a cross-sectional study. BMJ Open 2024; 14:e076116. [PMID: 38171622 PMCID: PMC10773311 DOI: 10.1136/bmjopen-2023-076116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To investigate factors that differentiate elderly adults in rural China who accept free vision screening and cataract surgery from those who could benefit from vision care but refuse it when offered. DESIGN We conducted a population-based, cross-sectional study between October and December 2016. Logistic regression models were used to examine the predictors of accepting free vision screening and cataract surgery. SETTING Rural communities in Handan, China. PARTICIPANTS Adults aged 50 years or older, with presenting visual acuity ≤6/18 in the better seeing eye, suspected by examining ophthalmologist to be due to cataract. RESULTS Among 613 persons with cataract identified on a population basis, 596 (97.2%) completed the household survey (mean (SD) age, 71.5 (10.0) years; 79.8% female). A total of 214 persons (35.9%) refused participation, while 382 (64.1%) took part in the vision screening. A total of 193 (50.5%) participants were found eligible for surgery, while 189 (49.5%) were not. Among 99 randomly selected participants who were offered immediate free surgery, surgery was accepted by 77 participants (77.8%) and refused by 22 (22.2%). In the multivariate model, being engaged in income-generating activities (p<0.01), self-reported better physical capacity (p<0.001) and having had a recent physical examination (p=0.01) were significantly associated with acceptance of vision screening. The only variable significantly associated with acceptance of surgery was presenting visual acuity, with better vision inversely associated with acceptance of surgery (p<0.05) models. CONCLUSION Our results suggest that refusal of basic eye examinations may be at least as important a determinant of low surgical rates in rural China as lack of acceptance of surgery itself.
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Affiliation(s)
- Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jie Hao
- Beijing Tongren Eye Center, Beijing Tongren Hospital CMU, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Catherine Jan
- The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Carlton, Victoria, Australia
| | - Yue Wan
- Beijing Tongren Eye Center, Beijing Tongren Hospital CMU, Beijing, China
| | - Yuan Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital CMU, Beijing, China
| | - Chengfang Liu
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China
| | - Yaojiang Shi
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi'an, China
| | - Ailian Hu
- Beijing Tongren Eye Center, Beijing Tongren Hospital CMU, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Kai Cao
- Beijing Tongren Eye Center, Beijing Tongren Hospital CMU, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Nathan Congdon
- Ophthalmology and Public Health, Queen's University Belfast, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Scott Rozelle
- Freeman Spogli Institute of International Studies, Stanford University, Stanford, California, USA
| | - Zhe Dong
- Beijing Tongren Eye Center, Beijing Tongren Hospital CMU, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital CMU, Beijing, China
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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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Tan X, Han X, Zheng Y, Jin L, Qiu X, Zhu Y, Chen C, Zhang J, Dickey H, Wang D, Huang S, Liu B, Liang X, Zeng Y, Lin H, He M, Luo L, Huang W, Congdon N, Liu Y. Impact of Cataract Surgery on Income in Rural Southern China: The SUCCESS Randomized Controlled Trial. Asia Pac J Ophthalmol (Phila) 2023; 12:355-363. [PMID: 37523426 DOI: 10.1097/apo.0000000000000624] [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: 02/02/2023] [Accepted: 05/18/2023] [Indexed: 07/25/2023] Open
Abstract
PURPOSE Visual impairment from cataracts is closely associated with low income, but trial evidence regarding the impact of surgery on income is lacking. We investigated whether cataract surgery could increase personal income. DESIGN A 2-arm, parallel-group, open-label, randomized controlled trial (ClinicalTrials.gov, NCT03020056). METHODS Persons aged 50 years or older in rural Guangdong, China, with best-corrected visual acuity <6/19 in both eyes due to cataracts were randomly assigned (1:1) to receive surgery within 4 weeks (intervention group), or 1 year later (control group). All participants were interviewed at baseline and end-line regarding demographic characteristics, income, and quality of life. RESULTS Among the 292 eligible persons (5.40%, mean age = 74.0 y, 61.0% women) randomly assigned to intervention (n = 146) or control (n = 146) groups, 12 participants (8.22%) in the intervention group and 1 (0.68%) in the control did not receive the allocated intervention. By study closeout, 18 participants (6.16%) were lost to follow-up. The mean 1-year income increase of the intervention group ($2469-$3588; change = $1119) was significantly larger than that of the controls ($2258-$2052; change = $-206), a between-group difference of $1325 (relative increase = 54.0%; 95% CI = $739 to $1911; P < 0.001). In multivariable modeling, intervention group membership was associated with greater income increase (β = 1143.2; 95% CI = 582.0 to 1704.3; P < 0.001). Greater improvement in best-corrected visual acuity was associated with income increase in univariable modeling (β = 1626.9; 95% CI = 1083.6 to 2170.1; P < 0.001). CONCLUSIONS Cataract surgery substantially increases personal income in rural China, offering a strategy for poverty alleviation. The strong association between increased income and change in visual acuity enhances the biological plausibility of the result.
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Affiliation(s)
- Xuhua Tan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Xiaozhang Qiu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL, US
| | - Chuan Chen
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL, US
| | - Jiaqing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | | | - Decai Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Shengsong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Bin Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yangfa Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- Center for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK
- Orbis International, New York, NY, US
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
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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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Effective cataract surgical coverage in adults aged 50 years and older: estimates from population-based surveys in 55 countries. Lancet Glob Health 2022; 10:e1744-e1753. [PMID: 36240806 DOI: 10.1016/s2214-109x(22)00419-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cataract is the leading cause of blindness globally. Effective cataract surgical coverage (eCSC) measures the number of people in a population who have been operated on for cataract, and had a good outcome, as a proportion of all people operated on or requiring surgery. Therefore, eCSC describes service access (ie, cataract surgical coverage, [CSC]) adjusted for quality. The 74th World Health Assembly endorsed a global target for eCSC of a 30-percentage point increase by 2030. To enable monitoring of progress towards this target, we analysed Rapid Assessment of Avoidable Blindness (RAAB) survey data to establish baseline estimates of eCSC and CSC. METHODS In this secondary analysis, we used data from 148 RAAB surveys undertaken in 55 countries (2003-21) to calculate eCSC, CSC, and the relative quality gap (% difference between eCSC and CSC). Eligible studies were any version of the RAAB survey conducted since 2000 with individual participant survey data and census population data for people aged 50 years or older in the sampling area and permission from the study's principal investigator for use of data. We compared median eCSC between WHO regions and World Bank income strata and calculated the pooled risk difference and risk ratio comparing eCSC in men and women. FINDINGS Country eCSC estimates ranged from 3·8% (95% CI 2·1-5·5) in Guinea Bissau, 2010, to 70·3% (95% CI 65·8-74·9) in Hungary, 2015, and the relative quality gap from 10·8% (CSC: 65·7%, eCSC: 58·6%) in Argentina, 2013, to 73·4% (CSC: 14·3%, eCSC: 3·8%) in Guinea Bissau, 2010. Median eCSC was highest among high-income countries (60·5% [IQR 55·6-65·4]; n=2 surveys; 2011-15) and lowest among low-income countries (14·8%; [IQR 8·3-20·7]; n=14 surveys; 2005-21). eCSC was higher in men than women (148 studies pooled risk difference 3·2% [95% CI 2·3-4·1] and pooled risk ratio of 1·20 [95% CI 1·15-1·25]). INTERPRETATION eCSC varies widely between countries, increases with greater income level, and is higher in men. In pursuit of 2030 targets, many countries, particularly in lower-resource settings, should emphasise quality improvement before increasing access to surgery. Equity must be embedded in efforts to improve access to surgery, with a focus on underserved groups. FUNDING Indigo Trust, Peek Vision, and Wellcome Trust.
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Zhang X, Shang X, Seth I, Huang Y, Wang Y, Liang Y, Du Z, Wu G, Hu Y, Liu S, Hu Y, He M, Zhu Z, Yang X, Yu H. Association of Visual Health With Depressive Symptoms and Brain Imaging Phenotypes Among Middle-Aged and Older Adults. JAMA Netw Open 2022; 5:e2235017. [PMID: 36201210 PMCID: PMC9539722 DOI: 10.1001/jamanetworkopen.2022.35017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Vision loss and depression are common conditions with major health implications. However, mechanisms of the association of visual health (across the full acuity spectrum) with depression remain unclear. OBJECTIVE To characterize the association between visual health and depression and investigate the association between depression and brain microstructure and macrostructure in subgroups divided by visual acuity. DESIGN, SETTING, AND PARTICIPANTS In the UK Biobank Study cohort, 114 583 volunteers were included at baseline from March to June 2006 to July 2010. Habitual distance visual acuity was examined using the logarithm of the minimum angle of resolution (LogMAR) characters. Depression was identified based on Patient Health Questionnaire (PHQ) or through an interview-based psychiatric diagnosis. Subgroup participants completed multimodal magnetic resonance imaging (MRI) of the brain and PHQ evaluation during the imaging visit after 2014. Data were analyzed from May 5 to August 9, 2022. MAIN OUTCOMES AND MEASURES Depression, depressive symptoms, and imaging-derived phenotypes from T1-weighted and diffusion MRI. RESULTS Of the 114 583 participants from the UK Biobank Study, 62 401 (54.5%) were women, and the mean (SD) age was 56.8 (8.1) years (range, 39-72 years). A 1-line worse visual acuity (0.1 LogMAR increase) was associated with 5% higher odds of depression (odds ratio, 1.05 [95% CI, 1.04-1.07]) after adjustment for age, sex, race and ethnicity, Townsend index, educational qualifications, smoking, alcohol consumption, obesity, physical activity, history of hypertension, diabetes, hyperlipidemia, and family history of depression. Of the 7844 participants eligible for MRI analysis, there were linear associations between PHQ score and the left volume of gray matter in supracalcarine cortex (coefficient, 7.61 [95% CI, 3.90-11.31]) and mean isotropic volume fraction (ISOVF) in the right fornix (cres) and/or stria terminalis (coefficient, 0.003 [95% CI, 0.001-0.004]) after correction for multiple comparison. In addition, their association could be moderated by visual acuity, whereby increased PHQ score was associated with higher ISOVF levels only among those with poorer visual acuity (P = .02 for interaction). CONCLUSIONS AND RELEVANCE This study suggests an association between visual health and depression and that the diffusion characteristic of ISOVF in the fornix (cres) and/or stria terminalis is associated with depressive symptoms in participants with poorer visual acuity.
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Affiliation(s)
- Xiayin Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ishith Seth
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Yu Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yaxin Wang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingying Liang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zijing Du
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guanrong Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunyan Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shunming Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhuoting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Xiaohong Yang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Lens Epithelial Cell Removal in Routine Phacoemulsification: Is It Worth the Bother? Am J Ophthalmol 2022; 239:1-10. [PMID: 35081415 DOI: 10.1016/j.ajo.2022.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To review the literature on crystalline lens epithelial cell (LEC) removal in routine phacoemulsification and determine whether it should be incorporated as part of a surgeon's standard technique. DESIGN Perspective. METHODS Expert commentary with video demonstrations on techniques of removal of LECs and associated potential complications. Discussion incorporates the importance of LEC removal, a review of techniques to prevent posterior capsular opacification (PCO), and the effects of intraocular lens design on LEC proliferation and PCO. RESULTS The evidence suggests that LEC removal should be routinely performed as it can be carried out safely and with considerable short- and long-term benefits for patients. With effective cleanup, there is reduced anterior capsule opacification, fibrosis, and decentration of the capsular bag as well as reduced rates of posterior capsular opacification. Techniques for removal are easy to learn, with very low complication rates, and can reduce the risk of the long-term need for technically complex procedures such as intraocular lens explantation. CONCLUSIONS LEC removal from both the anterior and posterior capsule is part of a continuous, incremental improvement of cataract surgery and should be introduced to ophthalmology trainees during their formative years as part of their regular cataract surgery armamentarium.
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Gascoyne B, Jolley E, Penzin S, Ogundimu K, Owoeye F, Schmidt E. Vision impairment and self-reported anxiety and depression in older adults in Nigeria: evidence from a cross-sectional survey in Kogi State. Int Health 2022; 14:i9-i16. [PMID: 35385870 PMCID: PMC8986359 DOI: 10.1093/inthealth/ihab070] [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: 08/04/2021] [Revised: 09/22/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND More than 2 billion people are thought to be living with some form of vision impairment worldwide. Yet relatively little is known about the wider impacts of vision loss on individual health and well-being, particularly in low- and middle-income countries (LMICs). This study estimated the associations between all-cause vision impairment and self-reported symptoms of anxiety and depression among older adults in Kogi State, Nigeria. METHODS Individual eyes were examined according to the standard Rapid Assessment of Avoidable Blindness methodology, and anxiety and depression were assessed using the Washington Group Short Set on Functioning-Enhanced. The associations were estimated using multivariable logistic regression models, adding two- and three-way interaction terms to test whether these differed for gender subgroups and with age. RESULTS Overall, symptoms of either anxiety or depression, or both, were worse among people with severe visual impairment or blindness compared with those with no impairment (OR=2.72, 95% CI 1.86 to 3.99). Higher levels of anxiety and/or depression were observed among men with severe visual impairment and blindness compared with women, and this gender gap appeared to widen as people got older. CONCLUSIONS These findings suggest a substantial mental health burden among people with vision impairment in LMICs, particularly older men, underscoring the importance of targeted policies and programmes addressing the preventable causes of vision impairment and blindness.
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Affiliation(s)
- Ben Gascoyne
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BW, UK
| | - Emma Jolley
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BW, UK
| | | | | | - Foluso Owoeye
- University of Ilorin Teaching Hospital, Jebba Road, Ilorin, Nigeria
| | - Elena Schmidt
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BW, UK
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12
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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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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: 538] [Impact Index Per Article: 179.3] [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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14
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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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Spreckley M, Macleod D, González Trampe B, Smith A, Kuper H. Impact of Hearing Aids on Poverty, Quality of Life and Mental Health in Guatemala: Results of a before and after Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103470. [PMID: 32429252 PMCID: PMC7277678 DOI: 10.3390/ijerph17103470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 11/16/2022]
Abstract
There are 466 million people globally with disabling hearing loss, many of whom can benefit from hearing aids. The aim of the study was to assess the impact of providing hearing aids on poverty, mental health, quality of life, and activities, among adults in Guatemala. A nonrandomised before and after study was conducted, with a comparison group to assess for secular trends. Adult cases with bilateral hearing impairment were identified within 150 km of Guatemala City, as well as age- and sex-matched comparison subjects without disabling hearing loss. All participants were interviewed with a semistructured questionnaire, and cases were offered hearing aids. Participants were reinterviewed 6–9 months later. We interviewed 135 cases and 89 comparison subjects at baseline and follow-up. At baseline, cases were poorer than comparison subjects with respect to individual income (p = 0.01), household income (p = 0.02), and per capita expenditure (PCE) (p = 0.003). After provision of hearing aids, median household income improved among cases (p = 0.03). In the comparison group, median individual income (p = 0.01) and PCE (p = 0.03) fell between baseline at follow-up. At follow-up, there were also improvements in productive time use, quality of life, and depressive symptoms among cases, but these were less apparent in the comparison group. In conclusion, this study has demonstrated a positive effect of hearing aids in improving quality of life, economic circumstances and mental health among Guatemalan adults.
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Affiliation(s)
- Mark Spreckley
- Health and Social Care/Allied Health Sciences, London South Bank University, London SE11 0AA, UK;
| | - David Macleod
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | | | - Andrew Smith
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
- Correspondence: ; Tel.: +44-207-958-8333
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16
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Roba AA, Chagunda M, Machissa TS. Blindness above and below the Poverty Line: Reflections form Sofala, Mozambique. J Public Health Afr 2020; 11:1113. [PMID: 33209232 PMCID: PMC7649735 DOI: 10.4081/jphia.2020.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
Although the correlation between visual impairment and poverty has been established, economic assessment is not a standard component of blindness surveys. The purpose of this study was to determine the prevalence of avoidable blindness and its association with poverty in Sofala province of Mozambique. As part of a Rapid Assessment of Avoidable Blindness, 94% of a random sample of 3600 people >50 years responded to questions regarding daily per capita expenditure. The WHO definition of blindness (presenting visual acuity <3/60) was used to determine the visual status of participants, and the World Bank's threshold of living on <$1.25 International Dollar a day demarcated the poverty line. The prevalence of blindness was 3.2% [95% Confidence Interval (CI): 2.6, 3.8]. People living below the poverty line had significantly greater odds of being blind [Odds Ratio (OR): 2.6 (CI: 1.6 to 4.5)]. Age above 60 [OR: 7.0 [CI: 4.6 to 10.80] predicted blindness but the association with illiteracy, gender or rural residence was not significant. Blindness disproportionately affects people living below the poverty line. Development initiatives could augment the impact of blindness prevention programs. Measuring poverty should become a standard component of visual impairment surveys.
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Isaksson J, Jansson T, Nilsson J. Audomni: Super-Scale Sensory Supplementation to Increase the Mobility of Blind and Low-Vision Individuals-A Pilot Study. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1187-1197. [PMID: 32286992 DOI: 10.1109/tnsre.2020.2985626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Blindness and low vision have severe effects on individuals' quality of life and socioeconomic cost; a main contributor of which is a prevalent and acutely decreased mobility level. To alleviate this, numerous technological solutions have been proposed in the last 70 years; however, none has become widespread. METHOD In this paper, we introduce the vision-to-audio, super-scale sensory substitution/supplementation device Audomni; we address the field-encompassing issues of ill-motivated and overabundant test methodologies and metrics; and we utilize our proposed Desire of Use model to evaluate proposed pilot user tests, their results, and Audomni itself. RESULTS Audomni holds a spatial resolution of 80 x 60 pixels at ~1.2° angular resolution and close to real-time temporal resolution, outdoor-viable technology, and several novel differentiation methods. The tests indicated that Audomni has a low learning curve, and several key mobility subtasks were accomplished; however, the tests would benefit from higher real-life motivation and data collection affordability. CONCLUSION Audomni shows promise to be a viable mobility device - with some addressable issues. Employing Desire of Use to design future tests should provide both high real-life motivation and relevance to them. SIGNIFICANCE As far as we know, Audomni features the greatest information conveyance rate in the field, yet seems to offer comprehensible and fairly intuitive sonification; this work is also the first to utilize Desire of Use as a tool to evaluate user tests, a device, and to lay out an overarching project aim.
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18
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Isaksson J, Jansson T, Nilsson J. Desire of Use: A Hierarchical Decomposition of Activities and its Application on Mobility of Blind and Low-Vision Individuals. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1146-1156. [PMID: 32286991 DOI: 10.1109/tnsre.2020.2985616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Blind and low-vision individuals often have severely reduced mobility, affecting their quality of life and associated socioeconomic cost. Despite numerous efforts and great technological progress, the only used primary mobility aids are still white canes and seeing-eye dogs. Furthermore, there is a permeating tendency in the field to ignore knowledge of both mobility and the target group, as well as constantly design new metrics and tests that makes comparisons between solutions markedly more difficult. METHOD The Desire of Use model is introduced in an effort to promote a more holistic approach; it should be generalizable for any activity by any user, but is here applied on mobility of blind and low-vision individuals by a proposal and integration of parameters. RESULTS An embodiment of the model is presented and with it we show why popular mobility metrics of today are insufficient to guide design; what tasks and metrics that should provide better understanding; as well as which fundamental properties determine them and are critical to discuss. CONCLUSION Desire of Use has been introduced as a tool and a theoretical framework, and a realization has been proposed. SIGNIFICANCE Desire of Use offers both a structured perspective of pertinent design challenges facing a given solution, as well as a platform from which to compare test results and properties of existing solutions; in for example the field of electronic travel aids it should prove valuable for designing and evaluating new tests and devices.
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19
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Ahmed M, Whitestone N, Patnaik JL, Hossain MA, Husain L, Alauddin M, Rahaman M, Cherwek DH, Congdon N, Haddad D. Burden of eye disease and demand for care in the Bangladesh Rohingya displaced population and host community: A cohort study. PLoS Med 2020; 17:e1003096. [PMID: 32231365 PMCID: PMC7108691 DOI: 10.1371/journal.pmed.1003096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/28/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a growing awareness that addressing chronic as well as acute health conditions may contribute importantly to the well-being of displaced populations, but eye care service has generally not been prioritized in crisis situations. We describe a replicable model of eye care provision as delivered by Orbis International and local partners to the Rohingya and host population in Cox's Bazar, Bangladesh, and characterize the burden of vision impairment and demand for sight-restoring services in this setting. METHODS AND FINDINGS Orbis International and local secondary facility Cox's Bazar Baitush Sharaf Hospital (CBBSH) provide eye care support to the Rohingya population and the host community of all ages in Cox's Bazar, Bangladesh, with fixed vision screening locations established in Camps 4 and 11 of the Kutupalong refugee settlement. Structured outreach targets these camps and four surrounding local subdistricts, with referrals made as needed for refraction (glasses measurement) and cataract surgery to CBBSH. Between February 2018 and March 2019, 48,105 displaced Rohingya (70.3%, among whom 71.6% were children and 46.5% women) and 20,357 local residents (29.7%, 88.5% children, 54.4% women) underwent vision screening. Displaced Rohingya sought services from a total of 12 surrounding camps, within which coverage was 17.3%, including 43.3% (27,027/62,424) of children aged 5-11 years and 60.0% (5,315/8,857) of adults ≥ 60 years old. The prevalence of blindness (presenting acuity < 3/60) among Rohingya patients exceeded that among local residents by 3- to 6-fold in each 10-year age group between 18 and 59 years (P < 0.001 comparing vision between the two groups in this age range), and the prevalence of cataract requiring surgery was also higher in Rohingya patients (18-29 years: 4.67% versus 1.80%, P = 0.0019; 30-39: 7.61% versus 2.39%, P < 0.001; and 40-49 years: 7.91% versus 3.77%, P = 0.0014). A limitation of the study is lack of data on population prevalence of eye disease. CONCLUSIONS The burden of untreated eye disease is very high among the Rohingya, particularly those in their peak working years who could contribute most to the resiliency of their community. Demand for eye care service is also great among children and adults in this population with many competing healthcare priorities. Research is needed, building on strong evidence of benefit in settled populations, to explore the specific impact of vision care on the well-being of displaced populations.
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Affiliation(s)
| | - Noelle Whitestone
- Independent consultant, Orbis International, New York, New York, United States of America
| | - Jennifer L. Patnaik
- Orbis International, New York, New York, United States of America
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | | | | | | | | | | | - Nathan Congdon
- Orbis International, New York, New York, United States of America
| | - Danny Haddad
- Orbis International, New York, New York, United States of America
- * E-mail:
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20
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Aoki RH, Bezerra IMP, de Almeida-Júnior AD, de A. Barbosa RT, Valenti VE, Oliveira FR, Roque AL, Júnior HMFES, Garner DM, Raimundo RD, de Abreu LC. The effects of cataract surgery on autonomic heart rate control: a prospective cross-sectional and analytical study. Clinics (Sao Paulo) 2019; 74:e809. [PMID: 31508720 PMCID: PMC6724456 DOI: 10.6061/clinics/2019/e809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/10/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the effects of cataract surgery on cardiac autonomic modulation. METHODS A cross-sectional and analytical study was conducted at the Hospital Maria Braido in the city of São Caetano do Sul, São Paulo, between 2015 and 2016. We investigated 19 patients of both sexes who were all over 50 years old; all patients had a diagnosis of senile or bilateral cataracts and were recommended to undergo implantation of the intraocular lens. Heart rate variability (HRV) was evaluated before, during and after cataract surgery. RESULTS There were no significant changes in the time and geometric domains of HRV before, during or after surgery. The high-frequency (HF) band in normalized units (nu) on the spectral analysis significantly increased (p=0.02, Cohen's d=0.9, large effect size). However, the low-frequency (LF) band in nu significantly decreased during surgery (p=0.02, Cohen's d=0.9, large effect size). CONCLUSION Throughout the intraocular lens implantation cataract surgery, there was an increase in parasympathetic modulation and a decrease in the sympathetic component of the heart rate (HR). We propose that this result is attributable to the supine position of the patients during surgery and the trigeminal reflex.
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Affiliation(s)
- Ricardo H Aoki
- Laboratorio de Delineamento de Estudos e Escrita Cientifica, Centro Universitario Saude ABC, Santo Andre, SP, BR
| | - Italla Maria Pinheiro Bezerra
- Laboratorio de Delineamento de Estudos e Escrita Cientifica, Centro Universitario Saude ABC, Santo Andre, SP, BR
- Programa de Mestrado em Politicas Publicas e Desenvolvimento Local da Escola Superior de Ciencias da Santa Casa de Misericordia, Vitoria, ES, BR
- Programa de Mestrado em Ciencias da Saude da Amazonia da Universidade Federal do Acre, Bolsista CAPES Brasil, Rio Branco, AC, BR
| | | | - Renata Thaís de A. Barbosa
- Laboratorio de Delineamento de Estudos e Escrita Cientifica, Centro Universitario Saude ABC, Santo Andre, SP, BR
| | - Vitor E Valenti
- Centro de Estudos do Sistema Nervoso Autonomo, Faculdade de Filosofia e Ciencias, Universidade Estadual Paulista, Marilia, SP, BR
| | - Fernando R Oliveira
- Programa de Pos-Graduacao em Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Adriano L Roque
- Programa de Pos-Graduacao em Cardiologia, Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Sao Paulo, SP, BR
| | | | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, School of Health and Life Sciences, Oxford Brookes University, Headington Campus, Gipsy Lane, Oxford OX3 0BP, United Kingdom
| | - Rodrigo D Raimundo
- Laboratorio de Delineamento de Estudos e Escrita Cientifica, Centro Universitario Saude ABC, Santo Andre, SP, BR
| | - Luiz Carlos de Abreu
- Laboratorio de Delineamento de Estudos e Escrita Cientifica, Centro Universitario Saude ABC, Santo Andre, SP, BR
- Programa de Mestrado em Politicas Publicas e Desenvolvimento Local da Escola Superior de Ciencias da Santa Casa de Misericordia, Vitoria, ES, BR
- Programa de Mestrado em Ciencias da Saude da Amazonia da Universidade Federal do Acre, Bolsista CAPES Brasil, Rio Branco, AC, BR
- Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland
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21
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Furtado JM, Berezovsky A, Ferraz NN, Muñoz S, Fernandes AG, Watanabe SS, Cunha CC, Vasconcelos GC, Sacai PY, Cypel M, Mitsuhiro MH, Morales PH, Cohen MJ, Campos M, Cohen JM, Belfort R, Salomão SR. Prevalence and Causes of Visual Impairment and Blindness in Adults Aged 45 Years and Older from Parintins: The Brazilian Amazon Region Eye Survey. Ophthalmic Epidemiol 2019; 26:345-354. [DOI: 10.1080/09286586.2019.1624783] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- João M. Furtado
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
- Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Adriana Berezovsky
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Nívea N. Ferraz
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Sergio Muñoz
- Departamento de Salud Publica, Universidad de La Frontera, Temuco, Chile
| | - Arthur G. Fernandes
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Sung S. Watanabe
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Cristina C. Cunha
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
- Faculdade de Medicina, Universidade Federal do Pará (UFPA), Belém, PA, Brazil
| | - Galton C. Vasconcelos
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
- Faculdade de Medicina, Departamento de Oftalmologia e Otorrinolaringologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Paula Y. Sacai
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Marcela Cypel
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Márcia H. Mitsuhiro
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Paulo H. Morales
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Marcos J. Cohen
- Faculdade de Medicina, Departamento de Cirurgia, Divisão de Oftalmologia, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Mauro Campos
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Jacob M. Cohen
- Faculdade de Medicina, Departamento de Cirurgia, Divisão de Oftalmologia, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Rubens Belfort
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Solange R. Salomão
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
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22
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Chew FLM, Salowi MA, Mustari Z, Husni MA, Hussein E, Adnan TH, Ngah NF, Limburg H, Goh PP. Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII). PLoS One 2018; 13:e0198799. [PMID: 29944677 PMCID: PMC6019397 DOI: 10.1371/journal.pone.0198799] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 05/26/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Population-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique. METHODS Malaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling 'E' Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed. RESULTS A total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0-1.4%), 1.0% (95%CI: 0.8-1.2%) and 5.9% (5.3-6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively. CONCLUSION Increased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.
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Affiliation(s)
- Fiona L. M. Chew
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Mohamad Aziz Salowi
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Zuraidah Mustari
- Department of Ophthalmology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Mohd Aziz Husni
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Elias Hussein
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Tassha Hilda Adnan
- Clinical Research Centre, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Nor Fariza Ngah
- Department of Ophthalmology, Hospital Shah Alam, Shah Alam, Selangor, Malaysia
| | - Hans Limburg
- Health Information Services, Grootebroek, The Netherlands
| | - Pik-Pin Goh
- Clinical Research Centre, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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Zheng L, Wu XH, Lin HT. The effect of cataract surgery on sleep quality: a systematic review and Meta-analysis. Int J Ophthalmol 2017; 10:1734-1741. [PMID: 29181319 DOI: 10.18240/ijo.2017.11.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022] Open
Abstract
AIM To evaluate the effect of cataract surgery on sleep quality and to compare the difference between ultraviolet-blocking clear intraocular lens (UVB-IOL) and blue-filtering intraocular lens (BF-IOL) implantation. METHODS Electronic search was performed of PubMed, MEDLINE, Embase and the Cochrane Library up to January 2016. Studies were eligible when they evaluated the sleep quality before and after cataract surgery by Pittsburgh sleep quality index (PSQI). A random/fixed-effects Meta-analysis was used for the pooled estimate. Heterogeneity was assessed with the I2 test. RESULTS Six studies were selected from 5623 references. Cataract surgery significantly reduced the PSQI scores at postoperative 0-3mo [mean difference (MD) =-0.62, 95%CI: -1.14 to -0.11, P=0.02, I2=66%] and 3-12mo (MD=-0.32, 95%CI: -0.62 to -0.02, P=0.04, I2=0), respectively. Considering different intraocular lens (IOL) implantations, relative post-operative PSQI reduction was found for both UVB-IOL and BF-IOL, but a significant reduction was detected only for UVB-IOL. No significant difference was found with the effect of BF-IOL vs UVB-IOL on sleep quality. CONCLUSION This study found that cataract surgery significantly improved the PSQI score-derived subjective sleep quality irrespective of the IOL type implanted. These findings highlight a substantial benefit of cataract surgery on systemic health with photoreceptive restoration in addition to visual acuity improvements.
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Affiliation(s)
- Ling Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China.,Jieyang People's Hospital, Jieyang Affiliated Hospital, Sun Yat-sen University, Jieyang 522000, Guangdong Province, China
| | - Xiao-Hang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Hao-Tian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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24
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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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Ka A, Sow A, Diagne J, Ndoye Roth P, Kamara K, De Medeiros M, Ba E, Diallo H, Wane A, Kane H, Ndiaye J, Sow S, Sy E, Ndiaye P. Qualité de vie des patients après chirurgie de la cataracte. J Fr Ophtalmol 2017; 40:629-635. [DOI: 10.1016/j.jfo.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 03/16/2017] [Accepted: 03/29/2017] [Indexed: 10/18/2022]
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Ramke J, Gilbert CE, Lee AC, Ackland P, Limburg H, Foster A. Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage. PLoS One 2017; 12:e0172342. [PMID: 28249047 PMCID: PMC5382971 DOI: 10.1371/journal.pone.0172342] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/03/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome). METHODS All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated. FINDINGS Datasets from 20 countries were included (2005-2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1-66.6%), CSOGood was 58.9% (IQR 53.7-67.6%) and CSOPoor was 17.7% (IQR 11.3-21.1%). Coverage and quality of cataract surgery were moderately associated-every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2-50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5-7.1%) than for CSC (median 2.3% IQR -1.5-11.6%). CONCLUSION eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.
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Affiliation(s)
- Jacqueline Ramke
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Clare E. Gilbert
- Department Clinical Research, Faculty Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Arier C. Lee
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter Ackland
- International Agency for the Prevention of Blindness, London, United Kingdom
| | - Hans Limburg
- Health Information Services, Nijenburg 32, Grootebroek, Netherlands
| | - Allen Foster
- Department Clinical Research, Faculty Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Cinaroglu S, Hearld KR, İgici SO. Explanatory Factors of Quality of Care from Cataract Patients’ Perspectives. Semin Ophthalmol 2016; 32:321-325. [DOI: 10.3109/08820538.2015.1088553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Songul Cinaroglu
- Department of Health Care Management, Hacettepe University, Beytepe Campus, Ankara, Turkey
| | - Kristine Ria Hearld
- Department of Health Services Administration, University of Alabama, Birmingham, AL, 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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Porela-Tiihonen S, Kokki H, Kaarniranta K, Kokki M. Recovery after cataract surgery. Acta Ophthalmol 2016; 94 Suppl 2:1-34. [PMID: 27111408 DOI: 10.1111/aos.13055] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cataract surgery is the most common ophthalmological surgical procedure, and it is predicted that the number of surgeries will increase significantly in the future. However, little is known about the recovery after surgery. The first aim of this study was to evaluate the prevalence, severity and duration of pain and other ocular discomfort symptoms experienced after cataract surgery. The other objectives were to identify the factors associated with lower postoperative patient satisfaction and to measure the effect of cataract surgery on patients' health-related quality of life (HRQoL) and visual function in everyday life. The study design was a prospective follow-up study. The course of the recovery and the presence of ocular symptoms were evaluated by interviewing the patients via a questionnaire at 1 day, 1 week, 6 weeks and one year after surgery The visual functioning in everyday life was measured with Visual Functioning Index VF-7 and Catquest-9SF-questionnaires and furthermore the HRQoL was measured with the 15D-instrument before surgery and at 12 months after surgery. The patients returned the questionnaires by mail and were interviewed in the hospital on the day of the surgery. The same patients filled-in all the questionnaires. The patient reports were used to collect the data on medical history. A total of 303 patients were approached at Kuopio University Hospital in 2010-2011 and of these 196 patients were eligible and willing to participate, with postoperative data being available from 186 (95%) patients. A systematic review article was included in the study procedure and it revealed the wide range in the reported incidence of postoperative ocular pain. Some of the identified randomized controlled studies reported no or only minor pain whereas in some studies significant pain or pain lasting for several weeks has been described in more than 50% of the study patients. In the present study setting, pain was reported by 34% during the first postoperative hours and by approximately 10% of patients during the first six weeks after surgery. During the early recovery in the hospital, only a minority of the patients reporting pain were provided with pain medication. The ocular discomfort symptoms such as itchiness, burning, foreign-body sensation and tearing were common both before (54%) and after surgery (38-52%). These symptoms can also be described as painful symptoms and are often difficult to distinguish from ocular pain. The symptoms are also typical of ocular surface disease, and some patients may benefit from the postoperative administration of tear substitutes. The patients reporting postoperative ocular symptoms were less satisfied with the treatment outcome at 12 months after surgery (p = 0.001) compared to the patients who experienced no symptoms. Those patients reporting less disability in visual functioning before surgery were more satisfied than patients with more reported disability. The HRQoL improved significantly after cataract surgery (p = 0.002). However, when compared to an age-and gender-standardized control population, in cataract subjects the HRQoL remained slightly worse both before and at 12 months after surgery.
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Affiliation(s)
- Susanna Porela-Tiihonen
- Department of Anaesthesiology and Department of Intensive Care Medicine; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| | - Hannu Kokki
- Department of Anaesthesiology and Department of Intensive Care Medicine; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| | - Kai Kaarniranta
- Department of Ophthalmology; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| | - Merja Kokki
- Department of Anaesthesiology and Department of Intensive Care Medicine; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
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Porela-Tiihonen S, Roine RP, Sintonen H, Kaarniranta K, Kokki M, Kokki H. Health-related quality of life after cataract surgery with the phacoemulsification technique and intraocular lens implantation. Acta Ophthalmol 2016; 94:21-5. [PMID: 25975977 DOI: 10.1111/aos.12755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Disease-specific instruments have shown significant gains in measuring health-related quality of life (HRQoL) in subjects having cataract surgery. However, the usage of generic instruments has resulted in conflicting evidence. METHODS In this prospective study, we have evaluated the impact of cataract surgery on subjects' HRQoL measured with a 15-dimension generic instrument, the 15D. The HRQoL of cataract subjects was compared with that of an age- and gender-standardized sample of the general population in Finland. A total of 152 subjects (mean age 74 years, 66% females) with a first-eye cataract surgery completed the 15D questionnaire both before and 12 months after cataract surgery. RESULTS When compared with the general population, cataract subjects had much lower HRQoL at baseline (mean difference 0.037 (95% CI: 0.020, 0.054), p < 0.001). At 12 months after cataract surgery, the overall utility index improved from the mean of 0.837 to 0.855 (mean difference 0.018 (95% CI: 0.007, 0.029), p = 0.002). Significant improvement was observed on the following five dimensions: seeing, moving, hearing, usual activities and discomfort/symptoms in the 15D questionnaire. CONCLUSION Our data indicate that at 12 months after first-eye cataract surgery, patients' HRQoL is slightly better than that before surgery. However, patients' postoperative HRQoL may remain lower than that of an age-and gender-standardized control population.
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Affiliation(s)
- Susanna Porela-Tiihonen
- Department of Anaesthesia and Operative Services; Kuopio University Hospital; Kuopio Finland
- Department of Anaesthesiology and Intensive Care; School of Medicine; University of Eastern Finland; Kuopio Finland
- Department of Ophthalmology; School of Medicine; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| | - Risto P. Roine
- Research Centre for Comparative Effectiveness and Patient Safety; University of Eastern Finland; Kuopio Finland
- Research and Development, Group Administration; Hospital District of Helsinki and Uusimaa; Helsinki Finland
| | - Harri Sintonen
- Department of Public Health; Hjelt Institute; University of Helsinki; Helsinki Finland
| | - Kai Kaarniranta
- Department of Ophthalmology; School of Medicine; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| | - Merja Kokki
- Department of Anaesthesia and Operative Services; Kuopio University Hospital; Kuopio Finland
- Department of Anaesthesiology and Intensive Care; School of Medicine; University of Eastern Finland; Kuopio Finland
| | - Hannu Kokki
- Department of Anaesthesia and Operative Services; Kuopio University Hospital; Kuopio Finland
- Department of Anaesthesiology and Intensive Care; School of Medicine; University of Eastern Finland; Kuopio Finland
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Gonzalez-Salinas R, Guarnieri A, Guirao Navarro MC, Saenz-de-Viteri M. Patient considerations in cataract surgery - the role of combined therapy using phenylephrine and ketorolac. Patient Prefer Adherence 2016; 10:1795-1801. [PMID: 27695298 PMCID: PMC5029911 DOI: 10.2147/ppa.s90468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria®) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients' quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients' expectations regarding visual recovery are also increasing.
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Affiliation(s)
- Roberto Gonzalez-Salinas
- Department of Biomedical Research, Universidad Autónoma de Querétaro, Querétaro, Mexico
- Department of Research, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Adriano Guarnieri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Manuel Saenz-de-Viteri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
- Correspondence: Manuel Saenz-de-Viteri, Ave Pio XII 36, 31008 Pamplona, Navarra, Spain, Tel +34 948 948 25 54 00, Fax +34 948 296 500, Email
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Grimes CE, Billingsley ML, Dare AJ, Day N, George PM, Kamara TB, Mkandawire NC, Leather A, Lavy CBD. The demographics of patients affected by surgical disease in district hospitals in two sub-Saharan African countries: a retrospective descriptive analysis. SPRINGERPLUS 2015; 4:750. [PMID: 26693108 PMCID: PMC4666885 DOI: 10.1186/s40064-015-1496-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/02/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is a growing awareness of the importance of surgical disease within global health. We hypothesised that surgical disease in low income countries predominantly affects young adults and may therefore have a significant economic impact. METHODS We retrospectively reviewed all surgical admission data from two rural government district hospitals in two different sub-Saharan African countries over a 6-month period. We analysed all surgical admissions with respect to patient demographics (age and gender), diagnosis, and procedure performed. RESULTS Surgical admissions accounted for 12.9 and 19.8 % of all hospital admissions in Malawi and Sierra Leone respectively. 18.5 and 6.2 % of all hospital patients required a surgical procedure in Malawi and Sierra Leone respectively, with the low number in Sierra Leone accounted for in that many of the obstetric admissions were referred to a nearby Medicins Sans Frontiers (MSF) hospital for treatment. 17.9 and 10.5 % of surgical admissions were under the age of 16 in Malawi and Sierra Leone respectively, with 16-35 year olds accounting for 57.3 % of surgical admissions in Sierra Leone and 53.5 % in Malawi. Men accounted for 53.7 and 46.0 % of surgical admissions in Sierra Leone and Malawi respectively. An unexpected finding was the high level of patients who absconded from hospital in Sierra Leone after diagnosis but before treatment. This involved 11.8 % of all surgical patients, including 38 % with a bowel obstruction, 39 % with peritonitis and 20 % with ectopic pregnancy. CONCLUSIONS Most people affected by disease requiring surgery are young adults and this may have significant economic implications.
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Affiliation(s)
- Caris E Grimes
- King's Centre for Global Health, Weston Education Centre, King's College London and King's Health Partners, Cutcombe Road, London, SE5 9RJ UK
| | | | - Anna J Dare
- King's Centre for Global Health, Weston Education Centre, King's College London and King's Health Partners, Cutcombe Road, London, SE5 9RJ UK
| | - Nigel Day
- Oxford University Hospitals Trust, Oxford, UK
| | - Peter M George
- Bo Hospital, Bo, Sierra Leone ; Port Loko Government Hospital, Port Loko, Sierra Leone ; School of Community Health and Clinical Sciences, Njala University, Freetown, Sierra Leone
| | - Thaim B Kamara
- Connaught Hospital, Freetown, Sierra Leone ; Department of Surgery, College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Nyengo C Mkandawire
- College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi ; School of Medicine, Flinders University, Adelaide, Australia
| | - Andy Leather
- King's Centre for Global Health, Weston Education Centre, King's College London and King's Health Partners, Cutcombe Road, London, SE5 9RJ UK
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Lam D, Rao SK, Ratra V, Liu Y, Mitchell P, King J, Tassignon MJ, Jonas J, Pang CP, Chang DF. Cataract. Nat Rev Dis Primers 2015; 1:15014. [PMID: 27188414 DOI: 10.1038/nrdp.2015.14] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cataract is the leading cause of reversible blindness and visual impairment globally. Blindness from cataract is more common in populations with low socioeconomic status and in developing countries than in developed countries. The only treatment for cataract is surgery. Phacoemulsification is the gold standard for cataract surgery in the developed world, whereas manual small incision cataract surgery is used frequently in developing countries. In general, the outcomes of surgery are good and complications, such as endophthalmitis, often can be prevented or have good ouctomes if properly managed. Femtosecond laser-assisted cataract surgery, an advanced technology, can automate several steps; initial data show no superiority of this approach over current techniques, but the results of many large clinical trials are pending. The greatest challenge remains the growing 'backlog' of patients with cataract blindness in the developing world because of lack of access to affordable surgery. Efforts aimed at training additional cataract surgeons in these countries do not keep pace with the increasing demand associated with ageing population demographics. In the absence of strategie that can prevent or delay cataract formation, it is important to focus efforts and resources on developing models for efficient delivery of cataract surgical services in underserved regions. For an illustrated summary of this Primer, visit: http://go.nature.com/eQkKll.
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Affiliation(s)
- Dennis Lam
- State Key Laboratory of Ophthalmology, and Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China.,C-MER (Shenzhen), Dennis Lam Eye Hospital, Shenzhen, China
| | | | - Vineet Ratra
- C-MER (Shenzhen), Dennis Lam Eye Hospital, Shenzhen, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, and Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Paul Mitchell
- Department of Ophthalmology, Centre for Vision Research, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Jonathan King
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Jost Jonas
- Department of Ophthalmology, Ruprecht-Karls-University, Heidelberg, Germany
| | - Chi P Pang
- Department of Ophthalmology &Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - David F Chang
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Kennedy ED, Fairfield CJ, Fergusson SJ. A neglected priority? The importance of surgery in tackling global health inequalities. J Glob Health 2015; 5:010304. [PMID: 25969729 PMCID: PMC4416335 DOI: 10.7189/jogh.05.010304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ewan D Kennedy
- Medical student, The College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Cameron J Fairfield
- Medical student, The College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Stuart J Fergusson
- Specialty registrar in General Surgery, Wishaw General Hospital, Wishaw, Scotland, UK
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Nishi T, Saeki K, Obayashi K, Miyata K, Tone N, Tsujinaka H, Yamashita M, Masuda N, Mizusawa Y, Okamoto M, Hasegawa T, Maruoka S, Ueda T, Kojima M, Matsuura T, Kurumatani N, Ogata N. The effect of blue-blocking intraocular lenses on circadian biological rhythm: protocol for a randomised controlled trial (CLOCK-IOL colour study). BMJ Open 2015; 5:e007930. [PMID: 25968007 PMCID: PMC4431140 DOI: 10.1136/bmjopen-2015-007930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Blue light information plays an important role in synchronising internal biological rhythm within the external environment. Circadian misalignment is associated with the increased risk of sleep disturbance, obesity, diabetes mellitus, depression, ischaemic heart disease, stroke and cancer. Meanwhile, blue light causes photochemical damage to the retina, and may be associated with age-related macular degeneration (AMD). At present, clear intraocular lenses (IOLs) and blue-blocking IOLs are both widely used for cataract surgery; there is currently a lack of randomised controlled trials to determine whether clear or blue-blocking IOLs should be used. METHODS AND ANALYSIS This randomised controlled trial will recruit 1000 cataract patients and randomly allocate them to receive clear IOLs or blue-blocking IOLs in a ratio of 1:1. The primary outcomes are mortality and the incidence of cardiovascular disease, cancer and AMD. Secondary outcomes are fasting plasma glucose, triglycerides, cholesterol, glycated haemoglobin, sleep quality, daytime sleepiness depressive symptoms, light sensitivity, the circadian rhythm of physical activity, wrist skin temperature and urinary melatonin metabolite. Primary outcomes will be followed until 20 years after surgery, and secondary outcomes will be assessed at baseline and 1 year after surgery. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Institutional Review Board of Nara Medical University (No. 13-032). The findings of this study will be communicated to healthcare professionals, participants and the public through peer-reviewed publications, scientific conferences and the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) home page. TRIAL REGISTRATION NUMBER UMIN000014680.
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Affiliation(s)
- Tomo Nishi
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Keigo Saeki
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Kenji Obayashi
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Kimie Miyata
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Nobuhiro Tone
- Center for Academic Industrial and Governmental Relations, Nara Medical University School of Medicine, Nara, Japan
| | - Hiroki Tsujinaka
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Mariko Yamashita
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Naonori Masuda
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Yutarou Mizusawa
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Masahiro Okamoto
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Taiji Hasegawa
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Shinji Maruoka
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Masashi Kojima
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Toyoaki Matsuura
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
| | - Norio Kurumatani
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University School of Medicine,Nara,Japan
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