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Gupta V, Vashist P, Sarath S, Gupta N, Senjam SS, Shukla P, Grover S, Shamanna BR, Vemparala R, Wadhwani M, Bhardwaj A, Gupta P, Titiyal JS. Effective cataract surgical coverage in India: Evidence from 31 districts. Indian J Ophthalmol 2024; 72:S650-S657. [PMID: 38622863 DOI: 10.4103/ijo.ijo_2835_23] [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: 10/25/2023] [Accepted: 01/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Effective Cataract Surgical Coverage (eCSC) is a core outcomes domain indicator to assess accessibility and quality of eye care services with limited available information. PURPOSE To generate baseline estimates of eCSC for India. METHODS We performed the analysis of data pooled from Rapid Assessment of Avoidable Blindness surveys conducted in 31 districts of India during 2015-2019 among persons aged 50+ years. eCSC was calculated at various thresholds, the primary being operable cataract at best corrected visual acuity <6/12, good outcome at presenting visual acuity of 6/12. RESULTS Age-sex standardized and weighed eCSC in India was 36.7% (95% CI: 33.6, 39.9), and cataract surgical coverage (CSC) was 57.3% (95% CI: 53.3, 61.2), a relative quality gap in cataract surgery being 36.0%. eCSC in males was higher at 38.0% than females (35.6%). eCSC increased with education from 31.0% in illiterate participants to 59.7% in class 10 educated. On multivariate analysis, rural setting, increasing age, and residence in eastern or northeastern zones of India continued to be associated with poor/worse eCSC, while female gender was associated with higher eCSC. District-wide variations in eCSC were observed. CONCLUSION Developmental factors have an important bearing on eCSC in India. Geographical variations point toward the need for targeted, locally relevant strategies.
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Affiliation(s)
- Vivek Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Praveen Vashist
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S Sarath
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Noopur Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Suraj Singh Senjam
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pallavi Shukla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sumit Grover
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - B R Shamanna
- School of Medical Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Rajshekhar Vemparala
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Meenakshi Wadhwani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
- Department of Ophthalmology, Guru Nanak Eye Center, New Delhi, India
| | - Amit Bhardwaj
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Promila Gupta
- National Program for Control of Blindness and Visual Impairment, Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi, India
| | - Jeewan S Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Gupta S, Vardhan A, Ambalam V, Rajendran V, Joseph S, Ravilla TD. Cataract surgery workload estimates in Theni district, India. Br J Ophthalmol 2024; 108:915-920. [PMID: 37673466 DOI: 10.1136/bjo-2023-323182] [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: 01/04/2023] [Accepted: 07/29/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND/AIMS To estimate the annual cataract surgery workload in Theni district, Tamil Nadu, India based on current utilisation of cataract services, prevalence of blindness and vision impairment (VI), and cataract burden-reduction goals. METHODS We conducted a population-based longitudinal study between January 2016 and April 2018. We recruited 24 327 participants based on a random cluster sampling method; 7127 participants were ≥40 years. During the year following initial enrolment, we tracked utilisation of eye care services; and at the end of the 1-year period, we conducted a detailed eye examination of participants age ≥40. RESULTS In the sample age ≥40 years, 13.0% had a visually significant cataract, and 17.8% had prior cataract surgery in at least one eye. The prevalence of cataract blindness based on presenting visual acuity in the better eye (PVABE)<3/60 was 0.34% and VI (PVABE<6/12) was 9.92%. 3.10% of the study population had obtained cataract surgery during 1 year, resulting in a cataract surgical rate of 9085. We estimated the effective cataract surgical coverage (eCSC) to be 54.5% and the CSC to be 75.7%, implying a sizeable quality gap. Prevalence, utilisation and coverage varied by age and gender. We estimated that a goal of eliminating the backlog of VI (PVABE<6/12) in 5 years would increase the annual cataract surgery workload by 11.5% from the current level. CONCLUSIONS Our estimates of cataract surgery workloads under different scenarios can provide a useful input into planning of eye health services in Theni district.
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Affiliation(s)
- Sachin Gupta
- Cornell University SC Johnson College of Business, Ithaca, New York, USA
| | - Ashok Vardhan
- Aravind Eye Hospital, Tirupati, Andhra Pradesh, India
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Penzin S, Jolley E, Ogundimu K, Mpyet C, Ibrahim N, Owoeye JF, Isiyaku S, Shu’aibu J, Schmidt E. Prevalence and causes of blindness and visual impairment in Kogi state, Nigeria-Findings from a Rapid assessment of avoidable blindness survey. PLoS One 2024; 19:e0294371. [PMID: 38776330 PMCID: PMC11111056 DOI: 10.1371/journal.pone.0294371] [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: 11/03/2023] [Accepted: 03/13/2024] [Indexed: 05/24/2024] Open
Abstract
PURPOSE To determine the prevalence and causes of blindness and visual impairment among adults in Kogi, Nigeria. METHODS A Rapid assessment of avoidable blindness (RAAB) protocol was used with additional tools measuring disability and household wealth to measure the prevalence of blindness and visual impairment (VI) and associations with sex, disability, wealth, cataract surgical coverage and its effectiveness. RESULTS Age- and sex-adjusted all-cause prevalence of bilateral blindness was 3.6% (95%CI 3.0-4.2%), prevalence of blindness among people living with additional, non-visual disabilities was 38.3% (95% CI 29.0-48.6%) compared to 1.6% (95%CI 1.2-2.1%; [Formula: see text] = 771.9, p<0.001) among people without additional disabilities. Cataract was the principal cause of bilateral blindness (55.3%). Cataract surgical coverage (CSC) at visual acuity (VA) 3/60 was 48.0%, higher among men than women (53.7% vs 40.3%); 12.0% among people with non-visual disabilities; 66.9% among people without non-visual disabilities, being higher among people in the wealthiest two quintiles (41.1%) compared to the lowest three (24.3%). Effective Cataract Surgical Coverage at Visual Acuity 6/60 was 31.0%, higher among males (34.9%) than females (25.5%), low among people with additional, non-visual disabilities (1.9%) compared to people with no additional disabilities (46.2%). Effective CDC was higher among people in the wealthiest two quintiles (411%) compared to the poorest three (24.3%). Good surgical outcome (VA>6/18) was seen in 61 eyes (52.6%) increasing to 71 (61.2%) eyes with best correction. Cost was identified as the main barrier to surgery. CONCLUSION Findings suggest there exists inequalities in eye care with women, poorer people and people with disabilities having a lower Cataract Surgical Coverage, thereby, underscoring the importance of eye care programs to address these inequalities.
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Affiliation(s)
- Selben Penzin
- Sightsavers, Nigeria Country Office, Kaduna, Nigeria
| | | | | | | | | | | | | | - Joy Shu’aibu
- Sightsavers, Nigeria Country Office, Kaduna, Nigeria
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Dong Y, Wang A. Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review. J Multidiscip Healthc 2024; 17:2239-2250. [PMID: 38751666 PMCID: PMC11095522 DOI: 10.2147/jmdh.s463894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024] Open
Abstract
Background The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people. Methods Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature. Results Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results. Conclusion In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.
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Affiliation(s)
- Yu Dong
- The First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Aiping Wang
- The First Hospital of China Medical University, Shenyang, People’s Republic of China
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McGuinness MB, Moo E, Varga B, Dodson S, Lansingh VC, Resnikoff S, Schmidt E, Ravilla T, Balu Subburaman GB, Khanna RC, Rathi VM, Arunga S, Limburg H, Congdon N. The Better Operative Outcomes Software Tool (BOOST) Prospective Study: Improving the Quality of Cataract Surgery Outcomes in Low-Resource Settings. Ophthalmic Epidemiol 2024:1-11. [PMID: 38635874 DOI: 10.1080/09286586.2024.2336518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Post-operative vision impairment is common among patients who have undergone cataract surgery in low-resource settings, impacting quality of clinical outcomes and patient experience. This prospective, multisite, single-armed, pragmatic validation study aimed to assess whether receiving tailored recommendations via the free Better Operative Outcomes Software Tool (BOOST) app improved surgical outcomes, as quantified by post-operative unaided distance visual acuity (UVA) measured 1-3 days after surgery. METHODS During the baseline data collection round, surgeons in low and middle-income countries recorded clinical characteristics of 60 consecutive cataract cases in BOOST. Additional data on the causes of poor outcomes from 20 consecutive cases with post-operative UVA of <6/60 (4-12 weeks post-surgery) were entered to automatically generate tailored recommendations for improvement, before 60 additional consecutive cases were recorded during the follow-up study round. Average UVA was compared between cases recorded in the baseline study round and those recorded during follow-up. RESULTS Among 4,233 cataract surgeries performed by 41 surgeons in 18 countries, only 2,002 (47.3%) had post-operative UVA 6/12 or better. Among the 14 surgeons (34.1%) who completed both rounds of the study (1,680 cases total), there was no clinically significant improvement in post-operative average UVA (logMAR units ±SD) between baseline (0.50 ± 0.37) and follow-up (0.47 ± 0.36) rounds (mean improvement 0.03, p = 0.486). CONCLUSIONS Receiving BOOST-generated recommendations did not result in improved UVA beyond what could be expected from prospective monitoring of surgical outcomes alone. Additional research is required to assess whether targeted support to implement changes could potentiate the uptake of app-generated recommendations and improve outcomes.
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Affiliation(s)
- Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Elise Moo
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Beatrice Varga
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Sarity Dodson
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Van Charles Lansingh
- Help Me See, Jersey City, New Jersey, USA
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Elena Schmidt
- Evidence Research and Innovations, Sightsavers, Chippenham, UK
| | | | | | - Rohit C Khanna
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Hyderabad, India
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Simon Arunga
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hans Limburg
- Health Information Services, Grootebroek, Netherlands
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Orbis International, New York, New York, USA
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Marmamula S, Saha R, Khanna RC. Effective Cataract Surgical Coverage in Four Large Districts in Telangana, India - Results from Rapid Assessment of Visual Impairment Study. Ophthalmic Epidemiol 2024:1-7. [PMID: 38569085 DOI: 10.1080/09286586.2024.2336498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To report cataract surgical coverage (CSC) and effective Cataract Surgical Coverage (eCSC) from four districts in Telangana, India. METHODS Individuals aged ≥40 years were recruited from Adilabad, Mahbubnagar, Warangal and Khammam districts using two stage cluster sampling methodology. All participants had detailed eye examinations including visual acuity assessment using a standard Snellen chart at a distance of six meters, anterior segment examination and fundus imaging by trained professionals. CSC and eCSC were calculated for persons using a 6/12 visual acuity cut-off. RESULTS Of 12,150 individuals enumerated from four districts 11,238 (92.5%) were examined. The mean (standard deviation) age of the participants was 54.1 (±11.2) years (range: 40 to 102 years) and 54.6% (n = 6137) were women. Overall, the CSC (%) was 54.2%. It ranged from a highest of 59% in Khammam followed by 57.5% in Adilabad, 51.7% in Warangal, and a least of 49.7% in Mahbubnagar district. Overall, the eCSC (%) was 39.9%. It ranged from a highest of 46.1% in Adilabad followed by 43.2% in Khammam, 36.2% in Warangal district and a least of 35.8% in the Mahbubnagar district. CONCLUSIONS CSC and eCSC varied across the districts. A significant gap between CSC and eCSC is noted suggestive of challenges with quality of services. District-wise planning of cataract surgical services with a focus on quality care is recommended to improve coverage and contribute towards achieving the goal of universal eye health coverage in the Telangana State in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Ranindita Saha
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Gupta S, Ravindran RD, Vardhan A, Ravilla TD. Evaluation and model to achieve sex parity in cataract surgical coverage in Theni district, India. Br J Ophthalmol 2024:bjo-2023-325098. [PMID: 38503478 DOI: 10.1136/bjo-2023-325098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND/AIMS To propose an approach to determine the target ratio of cataract surgical rates (CSRs) of female to male subpopulations to increase sex parity in cataract surgical coverage (CSC), based on the sex gap in cataract burden and incidence, and demonstrate its application to Theni district, India. METHODS A population-based longitudinal study between January 2016 and April 2018. We recruited 24 327 participants using random cluster sampling. We conducted detailed eye examinations of 7087 participants aged ≥40 years (4098 females, 2989 males). We fit exponential models to the age-specific and sex-specific cataract burden and estimated annual incidence rates. We developed a spreadsheet-based planning tool to compute the target CSR ratio of female to male subpopulations. RESULTS Among those aged ≥40 years, cataract burden was 21.4% for females and 17.5% for males (p<0.05). CSC was 73.9% for females versus 78.6% for males (p<0.05), with an effective CSC of 52.6% for females versus 57.6% for males (p<0.05). Treating only incident cataracts each year requires a target CSR ratio of female to male subpopulations of 1.30, while addressing in addition 10% of the coverage backlog for females and 5% for males requires a target CSR ratio of 1.48. CONCLUSIONS The female population in Theni district, as in many low-income and middle-income countries, bears a higher cataract burden and lower CSC. To enhance sex parity in coverage, both the higher number of annual incident cataracts and the larger backlog in females will need to be addressed.
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Affiliation(s)
- Sachin Gupta
- Cornell S C Johnson College of Business, Ithaca, New York, USA
| | | | - Ashok Vardhan
- Cataract Services, Aravind Eye Hospital, Tirupati, India
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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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Montero MJ, Marr H, Congdon N, Altun M, Calise A. Cybersight: improving remote access to surgical training and mentoring. COMMUNITY EYE HEALTH 2023; 36:18-19. [PMID: 38178822 PMCID: PMC10762707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
| | - Hannah Marr
- Pre-med student: New York University, New York, USA
| | - Nathan Congdon
- Ulverscroft Chair of Global Eye Health: Queens University Belfast & Orbis International, Royal Victoria Hospital, Belfast, Ireland, UK
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Gong X, Deng L, Yao Z, Xie L, Zhao X, Xiong K, Li W, Liu Y, Yuan M, Congdon N, He M, Liang X, Huang W. Six-Year Change in Cataract Surgical Coverage and Postoperative Visual Outcomes in Rural Southern China: The Yangxi Eye Study. Asia Pac J Ophthalmol (Phila) 2023; 12:565-573. [PMID: 37973047 DOI: 10.1097/apo.0000000000000643] [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: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate a 6-year change in cataract surgical coverage (CSC), effective cataract surgical coverage (eCSC), and visual outcomes in an elderly population in rural southern China. DESIGN This is a prospective population-based study with a 6-year follow-up. METHODS The study included rural residents aged 50 years and above in southern China with comprehensive eye examinations at baseline and follow-up in 2014 and 2020, respectively. RESULTS Five thousand six hundred thirty-eight participants underwent baseline examinations (mean age 66.1±10.2 y, 50.8% women); and 3141 (64.9%) of 4841 eligible survivors attended the 6-year follow-up. Cataract surgical coverage was 41.7% and 40.6% at baseline and follow-up, respectively, while eCSC were 32.6% and 26.6%. In multivariate models, the 6-year likelihood of cataract surgery decreased with older age [odds ratio (OR)=0.97 per year, 95% confidence interval (CI): 0.94, 0.99, P =0.012] and worse baseline presenting uncorrected visual acuity (PVA) in the worse-seeing eye (OR=0.35 per unit logarithm of the minimum angle of resolution (logMAR), 95% CI: 0.25, 0.48, P <0.001), and increased with prior cataract surgical history at baseline (OR=3.88, 95% CI: 1.91, 7.09, P <0.001). The likelihood of receiving effective cataract surgery decreased with worse baseline PVA in the worse eye (OR=0.49 per unit logMAR, 95% CI: 0.24, 0.97, P =0.042) and better-seeing eye (OR=0.68 per unit logMAR, 95% CI: 0.48, 0.95, P =0.026). Posterior capsular opacification was the main reason for PVA <6/18, reporting it in logMAR (0.5) in operated eyes (38.4% at baseline; 28.1% at follow-up). CONCLUSIONS World Health Organization has established a global target of increasing eCSC by 30% before 2030, but no increase was found in rural southern China between 2014 and 2020, let alone reaching the World Health Organization target of 56.3%. Strategies to improve surgery incidence should focus on older persons and those with worse preoperative PVA.
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Affiliation(s)
- Xia Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Liwen Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zeyu Yao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Liqiong Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xinyu Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Kun Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yuanping Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Meng Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Orbis International, New York, NY
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Cypel MC, Berezovsky A, Fernandes AG, Watanabe SS, Kimie Higashi Mitsuhiro MR, Ferraz NN, Sacai PY, Furtado JM, Morales PH, Muñoz S, Cohen JM, Belfort R, Salomão SR. Regional Disparities in Prevalence and Causes of Visual Impairment and Blindness, Cataract Surgical Coverage and Ocular Findings in Adults 50 Years and Older in Brazil: A Comparative Analysis between Two Population-Based Cross-Sectional Surveys Performed Within a 10-Year Interval. Semin Ophthalmol 2023; 38:656-664. [PMID: 37154578 DOI: 10.1080/08820538.2023.2209164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To investigate disparities in the prevalence and causes of visual impairment and blindness, cataract surgical coverage, and ocular findings in older adults from two Brazilian geo-socio-demographic areas, São Paulo and Parintins cities. METHODS Data from two population-based studies including participants 50 years and older from the cities of São Paulo (São Paulo Eye Study - SPES, 2004) and Parintins (Brazilian Amazon Region Eye Survey - BARES, 2014) were aggregated. RESULTS A total of 5318 participants (3677 from SPES;1641 from BARES) were included. The prevalence of severe visual impairment (SVI) and blindness were, respectively, 0.74% (0.46-1.02) and 0.77% (0.48-1.05) in SPES and 1.72% (1.09-2.35) and 3.44% (2.55-4.33) in BARES. SVI and blindness were associated with BARES study [OR = 2.27 (1.30-3.95); p = .004 - SVI] [OR:4.07 (2.51-6.60); p < .001- blindness]; and older age [OR = 10.93 (4.20-28.45); p < .001 - SPES; OR = 17.96 (8.75-36.83); p < .001 - BARES] while higher education level was a protective factor [OR = 0.21 (0.05-0.95) - SPES; p = .042; OR = 0.21 (0.05-0.91); p = .037 - BARES]. Cataract was the main cause of bilateral severe visual impairment (25.93% in SPES and 64.29% in BARES) and bilateral blindness (21.43% in SPES and 35.71% in BARES). Cataract surgical coverage was significantly lower in BARES (36.32%) compared to SPES (57.75%). CONCLUSION The prevalence of SVI and blindness was three times higher in older adults from the Brazilian Amazon compared to those living in São Paulo city, despite a 10-year interval between the two studies. These disparities should be mitigated by initiatives to promote access to eye care services targeting underprivileged and remote Brazilian areas.
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Affiliation(s)
- Marcela Colussi Cypel
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Adriana Berezovsky
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Arthur Gustavo Fernandes
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Sung Song Watanabe
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Marcia Regina Kimie Higashi Mitsuhiro
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Nivea Nunes Ferraz
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Paula Yuri Sacai
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - João Marcello Furtado
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
- Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, Brazil
| | - Paulo Henrique Morales
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Sergio Muñoz
- Department of Public Health-CIGES, Universidad de La Frontera, Temuco, Chile
| | - Jacob Moysés Cohen
- Divisão de Oftalmologia, Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Amazonas (UFAM), Manaus, Brazil
| | - Rubens Belfort
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
- Instituto da Visão, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), São Paulo, Brazil
| | - Solange Rios Salomão
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
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12
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Ramke J, Silva JC, Gichangi M, Ravilla T, Burn H, Buchan JC, Welch V, Gilbert CE, Burton MJ. Cataract services for all: Strategies for equitable access from a global modified Delphi process. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000631. [PMID: 36962938 PMCID: PMC10021896 DOI: 10.1371/journal.pgph.0000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 11/22/2022] [Indexed: 02/24/2023]
Abstract
Vision loss from cataract is unequally distributed, and there is very little evidence on how to overcome this inequity. This project aimed to engage multiple stakeholder groups to identify and prioritise (1) delivery strategies that improve access to cataract services for under-served groups and (2) population groups to target with these strategies across world regions. We recruited panellists knowledgeable about cataract services from eight world regions to complete a two-round online modified Delphi process. In Round 1, panellists answered open-ended questions about strategies to improve access to screening and surgery for cataract, and which population groups to target with these strategies. In Round 2, panellists ranked the strategies and groups to arrive at the final lists regionally and globally. 183 people completed both rounds (46% women). In total, 22 distinct population groups were identified. At the global level the priority groups for improving access to cataract services were people in rural/remote areas, with low socioeconomic status and low social support. South Asia and Sub-Saharan Africa were the only regions in which panellists ranked women in the top 5 priority groups. Panellists identified 16 and 19 discreet strategies to improve access to screening and surgical services, respectively. These mostly addressed health system/supply side factors, including policy, human resources, financing and service delivery. We believe these results can serve eye health decision-makers, researchers and funders as a starting point for coordinated action to improve access to cataract services, particularly among population groups who have historically been left behind.
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Affiliation(s)
- Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Juan Carlos Silva
- Pan American Health Organization, World Health Organization, Bogotá, Colombia
| | | | | | - Helen Burn
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John C. Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Clare E. Gilbert
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Moorfields Eye Hospital, London, United Kingdom
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13
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Furtado JM, Fernandes AG, Silva JC, Del Pino S, Hommes C. Indigenous Eye Health in the Americas: The Burden of Vision Impairment and Ocular Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3820. [PMID: 36900846 PMCID: PMC10000964 DOI: 10.3390/ijerph20053820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
Review of the burden of vision impairment and blindness and ocular disease occurrence in Indigenous Peoples of the Americas. We systematically reviewed findings of the frequency of vision impairment and blindness and/or frequency of ocular findings in Indigenous groups. The database search yielded 2829 citations, of which 2747 were excluded. We screened the full texts of 82 records for relevance and excluded 16. The remaining 66 articles were examined thoroughly, and 25 presented sufficient data to be included. Another 7 articles derived from references were included, summing a total of 32 studies selected. When considering adults over 40 years old, the highest frequencies of vision impairment and blindness in Indigenous Peoples varied from 11.1% in high-income North America to 28.5% in tropical Latin America, whose rates are considerably higher than those in the general population. Most of the ocular diseases reported were preventable and/or treatable, so blindness prevention programs should focus on accessibility to eye examinations, cataract surgeries, control of infectious diseases, and spectacles distribution. Finally, we recommend actions in six areas of attention towards improving the eye health in Indigenous Peoples: access and integration of eye services with primary care; telemedicine; customized propaedeutics; education on eye health; and quality of data.
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Affiliation(s)
- João Marcello Furtado
- Pan American Health Organization, Washington, DC 20037, USA
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14015-010, Brazil
| | - Arthur Gustavo Fernandes
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Sao Paulo 04023-062, Brazil
- Department of Anthropology and Archaeology, University of Calgary, Calgary, AB T2N 4N1, Canada
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Cicinelli MV, Buchan JC, Nicholson M, Varadaraj V, Khanna RC. Cataracts. Lancet 2023; 401:377-389. [PMID: 36565712 DOI: 10.1016/s0140-6736(22)01839-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/03/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022]
Abstract
94 million people are blind or visually impaired globally, and cataract is the most common cause of blindness worldwide. However, most cases of blindness are avoidable. Cataract is associated with decreased quality of life and reduced life expectancy. Most cases of cataract occur after birth and share ageing and oxidative stress as primary causes, although several non-modifiable and modifiable risk factors can accelerate cataract formation. In most patients, phacoemulsification with intraocular lens implantation is the preferred treatment and is highly cost-effective. There has been an increase in the use of comprehensive cataract surgical services, including diagnoses, treatment referrals, and rehabilitation. However, global inequity in surgical service quality is still a limitation. Implementation of preoperative risk assessment, risk reduction strategies, and new surgical technologies have made cataract surgery possible at an earlier stage of cataract severity with the expectation of good refractive outcomes. The main challenge is making the service that is currently available to some patients accessible to all by use of universal health coverage.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maneck Nicholson
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, Hyderabad, India; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
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15
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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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Abstract
BACKGROUND Eye health has widespread implications across many aspects of life, ranging from the individual to the societal level. Vision 2020: The Right to Sight is an initiative that was conceptualised in 1997 and launched in 1999. It was led by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) in response to the increasing prevalence of blindness. Approximately 80% of the causes of blindness were avoidable. Hence, the initiative set out to eliminate the major causes of avoidable blindness. These included cataract, uncorrected refractive error, trachoma, onchocerciasis, and childhood blindness. METHODS An electronic literature search was performed using PubMed, MEDLINE and Embase databases to assess the impacts of the Vision 2020 initiative. RESULTS AND CONCLUSION The Vision 2020 initiative was ambitious and was essential in catapulting the issue of avoidable blindness in the spotlight and putting it on the global health agenda. The causes of avoidable blindness remain and have not been eliminated. However, there have been noticeable changes in the distribution of the causes of avoidable blindness since the conception of Vision 2020, and this is mainly due to demographic shifts globally. We highlight some of the remaining challenges to acheiving avoidable blindness including, population size, gender disparities in access to eyecare services, and the professional workforce.
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Affiliation(s)
- Dalia Abdulhussein
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, NW1 5QH, UK
| | - Mina Abdul Hussein
- Faculty of Medicine, Imperial College London, Exhibition Road, London, UK
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17
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A Systematic Review of Clinical Practice Guidelines for Cataract: Evidence to Support the Development of the WHO Package of Eye Care Interventions. Vision (Basel) 2022; 6:vision6020036. [PMID: 35737423 PMCID: PMC9227019 DOI: 10.3390/vision6020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
The World Health Organization (WHO) is developing a Package of Eye Care Interventions (PECI) to facilitate the integration of eye care into Universal Health Coverage. This paper presents the results of a systematic review of clinical practice guidelines for cataract in adults, to help inform PECI development. We searched academic and guideline databases, and websites of professional associations, for guidelines published between January 2010 and April 2020. Guidelines were excluded if there was commercial funding or unmanaged conflicts of interest. Quality appraisal was conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. We identified 3778 reports, 35 related to cataract guidelines, four of which met the inclusion criteria (United Kingdom: 2, United States: 1, Iran: 1). The recommendations across the four guidelines covered pre-operative (43%), intra-operative (37%), and post-operative interventions (20%). Most ‘strong’ recommendations were supported by good quality evidence. Differences in recommendations across guidelines may be attributable to time of publication or regional differences in surgical practice. Few guidelines met the quality criteria, and only three countries were represented. The results of this step of the PECI development process will inform subsequent phases for development of the WHO’s package of evidence-based eye care interventions for cataract.
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18
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Hashemi H, Mehravar F, Asgari S, Emamian MH, Fotouhi A. Visual functions and disability in Iranian adults: a population-based study. BMC Ophthalmol 2022; 22:30. [PMID: 35057773 PMCID: PMC8781046 DOI: 10.1186/s12886-022-02262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Vision-related quality of life is related to severity of visual impairments and show the impact of eye diseases on daily activities. This study aims to assess visual functions and disability and its association with age, gender, education, marital status, and economic status in adults aged 45–69 years.
Methods
Data in this population-based study were from the second phase of the Shahroud eye cohort study and collected by using a Short-Form Visual Functioning Scale. The scores of visual function and disability were calculated based on Rasch-transformed scores of the National Eye Institute visual functioning questionnaire, where a more negative score indicates a better situation. Multiple linear regression was used to investigate the factors associated with visual functions.
Results
Among 4737 participants the visual function data for 4715 people were analyzed. The visual function of 75.3, 17.1 and 7.5% of participants were “ideal and good”, “moderate”, and “bad and very bad”, respectively, while 0.06% were unable for vision. The running mean of the visual function was calculated to be − 3.95 ± 0.02. The visual performance was worse in females than the males (β = 0.14, p = 0.005). Visual function improved with increasing levels of education (β = − 1.06, p < 0.001). It was worse in low-economic (β = 0.016, p = 0.005) and moderate-economic (β = 0.28, p < 0.001) participants than high-economic ones.
Conclusion
The visual function of Iranian adults aged 45–69 years was moderate. The male gender, higher education and the higher economic status had a better visual function.
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Gutierrez L, Lim JS, Foo LL, Ng WY, Yip M, Lim GYS, Wong MHY, Fong A, Rosman M, Mehta JS, Lin H, Ting DSJ, Ting DSW. Application of artificial intelligence in cataract management: current and future directions. EYE AND VISION (LONDON, ENGLAND) 2022; 9:3. [PMID: 34996524 PMCID: PMC8739505 DOI: 10.1186/s40662-021-00273-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/07/2021] [Indexed: 02/10/2023]
Abstract
The rise of artificial intelligence (AI) has brought breakthroughs in many areas of medicine. In ophthalmology, AI has delivered robust results in the screening and detection of diabetic retinopathy, age-related macular degeneration, glaucoma, and retinopathy of prematurity. Cataract management is another field that can benefit from greater AI application. Cataract is the leading cause of reversible visual impairment with a rising global clinical burden. Improved diagnosis, monitoring, and surgical management are necessary to address this challenge. In addition, patients in large developing countries often suffer from limited access to tertiary care, a problem further exacerbated by the ongoing COVID-19 pandemic. AI on the other hand, can help transform cataract management by improving automation, efficacy and overcoming geographical barriers. First, AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus photographs. This utilizes a deep-learning, convolutional neural network (CNN) to detect and classify referable cataracts appropriately. Second, some of the latest intraocular lens formulas have used AI to enhance prediction accuracy, achieving superior postoperative refractive results compared to traditional formulas. Third, AI can be used to augment cataract surgical skill training by identifying different phases of cataract surgery on video and to optimize operating theater workflows by accurately predicting the duration of surgical procedures. Fourth, some AI CNN models are able to effectively predict the progression of posterior capsule opacification and eventual need for YAG laser capsulotomy. These advances in AI could transform cataract management and enable delivery of efficient ophthalmic services. The key challenges include ethical management of data, ensuring data security and privacy, demonstrating clinically acceptable performance, improving the generalizability of AI models across heterogeneous populations, and improving the trust of end-users.
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Affiliation(s)
| | - Jane Sujuan Lim
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Li Lian Foo
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Wei Yan Ng
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Michelle Yip
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | | | - Melissa Hsing Yi Wong
- Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Allan Fong
- Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Mohamad Rosman
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Jodhbir Singth Mehta
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Haotian Lin
- Zhongshan Ophthalmic Center, Sun Yet Sen University, Guangzhou, China
| | - Darren Shu Jeng Ting
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore, Singapore. .,Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
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Ramke J, Evans JR, Habtamu E, Mwangi N, Silva JC, Swenor BK, Congdon N, Faal HB, Foster A, Friedman DS, Gichuhi S, Jonas JB, Khaw PT, Kyari F, Murthy GVS, Wang N, Wong TY, Wormald R, Yusufu M, Taylor H, Resnikoff S, West SK, Burton MJ. Grand Challenges in global eye health: a global prioritisation process using Delphi method. THE LANCET. HEALTHY LONGEVITY 2022; 3:e31-e41. [PMID: 35028632 PMCID: PMC8732284 DOI: 10.1016/s2666-7568(21)00302-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. METHODS Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. FINDINGS Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. INTERPRETATION This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. FUNDING The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. TRANSLATIONS For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- 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
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - 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
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Kenya Medical Training College, Nairobi, Kenya
| | | | - Bonnielin K Swenor
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Orbis International, New York, NY, USA
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria
- Africa Vision Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Peng T 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
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Indian Institute of Public Health, Hyderabad, India
| | - 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
| | - Tien Y 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
| | - Hugh Taylor
- Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute and School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | - 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
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Adediran O, Oluleye T, Ayorinde O, Ugalahi M, Mpyet C. Survey of blindness in Saki East, Oyo State, Nigeria. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:41-47. [PMID: 36203926 PMCID: PMC9531733 DOI: 10.4103/jwas.jwas_65_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022]
Abstract
Background: Aim and Objectives: Materials and Methods: Results: Conclusion:
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22
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TU Y, DENG J, FANG L, ZHANG Y, YING H, SUN Q. Effect of evidence-based nursing on the application of ultrasonic emulsification operation for cataract and the postoperative rehabilitation indicators. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.17921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yanqin TU
- The Second Affiliated Hospital of Nanchang University, China
| | - Jianmin DENG
- The Second Affiliated Hospital of Nanchang University, China
| | - Liang FANG
- The Second Affiliated Hospital of Nanchang University, China
| | - Yongmei ZHANG
- The Second Affiliated Hospital of Nanchang University, China
| | - Hongmei YING
- The Second Affiliated Hospital of Nanchang University, China
| | - Qiuzhen SUN
- The Second Affiliated Hospital of Nanchang University, China
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Fernandes AG, Ferraz AN, Lemos RDS, Watanabe SES, Berezovsky A, Salomão SR. Trends in cataract surgical treatment within the Brazilian national public health system over a 20-year period: Implications for Universal Eye Health as a global public health goal. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000328. [PMID: 36962381 PMCID: PMC10021674 DOI: 10.1371/journal.pgph.0000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
Cataract is a highly prevalent, treatable, and sight threatening condition considered one of the main focuses of public health policies addressing visual impairment and blindness towards Universal Eye Health. We aimed to investigate the trends on number of cataract surgical procedures performed through the Brazilian national health system (SUS) from 2000 to 2019 while also evaluating costs associated with it. The Brazilian Public Health System Information Database (DATASUS) was used as the primary data source for procedures including extracapsular cataract extraction (ECCE) and phacoemulsification. Trends along the years were evaluated through generalized linear models. A total of 8,424,521 cataract procedures were performed from 2000 to 2019, with a significant increase along the years from 228,145 in 2000 to 663,186 in 2019 (p<0.001), a cataract surgical procedure rate change from 13.15 to 32.28 procedures per 10,000 people. It was observed a significant increase on the number of phacoemulsification (p<0.001) and a significant decrease on the number of ECCE (p<0.001). A shift on the predominant technique has occurred between 2007 and 2008 with phacoemulsification increasing its percentual representativity from 34.3% to 69.7% of all procedures, reaching 96.1% in 2019. Phacoemulsification costs per procedure increased 30.5% from from USD$119.00 to USD$155.33 (p = 0.007) and the ECCE costs per procedure increased 29.1% from USD$78.57 to USD$101.43 (p = 0.001). There is an increasing trend of procedures related to cataract treatment performed through SUS along the 20-years period and a switch on the technique predominance from ECCE to phacoemulsification was observed after 2007. The costs associated with both techniques have increased but have not followed the country's overall inflation. Data derived from DATASUS is important to understand the overall panorama of ocular health offered by the national health system and to provide information to guide healthcare leaders on management and planning of public health policies within the system.
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Affiliation(s)
- Arthur Gustavo Fernandes
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
- Department of Anthropology and Archaeology, University of Calgary, Calgary, Alberta, Canada
| | - Aline Nunes Ferraz
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Rafael da Silva Lemos
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Sung Eun Song Watanabe
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Adriana Berezovsky
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Solange Rios Salomão
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
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Gupta V, Manna S, Vashist P, Senjam S, Shukla P, Gupta N, Bhardwaj A. Vision Delhi: A study of primary eye care model operational in urban slums and resettlement colonies of Delhi. J Family Med Prim Care 2022; 11:201-207. [PMID: 35309603 PMCID: PMC8930148 DOI: 10.4103/jfmpc.jfmpc_913_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Family physicians (FPs) encounter numerous patients who need eye care services. For providing eye care services at the primary level, they need to be abreast with the common disorders, their management and appropriate referral. Objectives: The aim of this study was to describe the socio-demographic and ocular morbidity profile of the beneficiaries, seasonal pattern of few ocular disorders and to find the proportion of blindness that is avoidable at the primary level. Methodology: Study was conducted in 25 vision centers across Delhi. Chart review was done in each center and retrospective data of previous 4 years was analyzed. Socio-demographic, ocular morbidity profile and trend of selected diseases was deducted and causes of blindness were determined. Results: Around 62.76% of patients were women and 78.26% were new patients. A seasonal peak of conjunctivitis was observed during the spring season. The common conditions detected by optometrists were refractive errors (34.68%), presbyopia (14.15%), cataract (14.02%), conjunctivitis (9.84%) and diseases of ocular adnexa (1.35%). In the age group ≥50 years, the proportion of patients who were blind was 2.5%, 39.0% had VI. The proportion of VI patients in all the categories was higher in women as compared to men. In patients ages ≥50 years, 81.4% of the blindness was avoidable. Conclusions: Women outnumbered men in availing services at the center and the proportion of visual impairment was also higher in them. The major causes of blindness in the older population were cataract and corneal-opacity, and it is avoidable by strengthening primary eye care services by FPs.
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Sapkota Y, Alizoi N, Siddiqi AM, Naseem M, Salaam AS, Rehman AU, D'Esposito F, Das T. Rapid assessment of prevalence of blindness and cataract surgery in Kabul province, Afghanistan. BMJ Open Ophthalmol 2021; 6:e000790. [PMID: 34557590 PMCID: PMC8413960 DOI: 10.1136/bmjophth-2021-000790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/18/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To estimate prevalence and causes of blindness and vision impairment and assess cataract surgical coverage and quality of cataract surgery in Kabul. Methods and analysis A total of 3751 adults aged 50 years and above were recruited from 77 randomly selected clusters. Each participant underwent presenting and pinhole visual acuity assessment and lens examination. Those with pinhole visual acuity <6/12 in either eye had a dilated fundus examination to determine the cause of reduced vision. Those with apparent lens opacity were interviewed on barriers to cataract surgery. Results The age-adjusted and sex-adjusted prevalence of blindness was 2.4% (95% CI: 1.8% to 3.0%). Prevalence of severe, moderate and mild vision impairment was 2.2% (95% CI: 1.7% to 2.7%), 6.9% (95% CI: 6.0% to 7.9%) and 8.7% (95% CI: 7.5% to 9.8%), respectively. Cataract was the main cause of blindness (36.8%), severe (54.4%) and moderate (46.1%) vision impairment. Uncorrected refractive error was the leading cause of mild vision impairment (20.3%). Age-related macular degeneration was the second leading cause of blindness (23.0%). In people with a presenting visual acuity of <3/60, cataract surgical coverage was 89.7%, and effective cataract surgical coverage was 67.8%. The major barriers to uptake of the available cataract surgical services were the need for surgery was not felt (23.7%) and cost (22.0%). Conclusion Kabul province has a high prevalence of blindness, largely due to cataract and age-related macular generation. The quality of cataract surgery is also lagging in terms of good visual outcomes. This calls for immediate efforts to improving the reach and quality of existing eye services and readiness to respond to the increasing burden of posterior eye disease.
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Affiliation(s)
- Yuddha Sapkota
- South East Asia, International Agency for the Prevention of Blindness, Kathmandu, Bagmati, Nepal
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Resnikoff S. Quality of eye care: Time to act. Clin Exp Ophthalmol 2021; 49:647-648. [PMID: 34505746 DOI: 10.1111/ceo.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bastani P, Hakimzadeh SM, Teymourzadeh E, Nouhi M. Universal health coverage under the Joint Comprehensive Plan of Action's sanctions: strategic purchasing approach in the Iranian health system. Health Promot Int 2021; 36:693-702. [PMID: 33006610 DOI: 10.1093/heapro/daaa070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Due to the sanctions imposed by the USA government upon the Iranian health system, achieving the UHC might face some financial problems. This study aimed to make the best solution for the Iran health care system to overcome not only the temporary sanctions but also a program to reach the UHC goals through the strategic purchasing approach. This was a qualitative study carried out from 2015 to 2017 containing two phases: a comparative analysis and a three-step Delphi technique. In the first phase, the Garden model was applied to select the countries. In the second phase, 20 experts who specialised in health management, health economics, and health insurance science were asked. Data were analyzed with SPSS (version 20.0) and STATA (version 15.0) In the threat of trade and economic sanctions imposed on the Iranian health care system, the experts identified and emphasized that the vulnerable groups to receive financial assistance can be the retired, fecund women, teenagers and people with lower wages. The experts thought that, in the context of resource constraints, different payment systems are proposed for cities and villages based on the different needs of local population. Considering the difficult situation, this study focused on how Iran can cope well in a dangerous situation and economies the health expenditure applying strategic purchasing as one of the key tools in controlling costs to achieve universal health coverage. Economic evaluation, payment system, and priority population are the linchpins of the UHC. Universal health coverage, if it is to be considered, not only is applicable, but it could also be a solution for future generations. Therefore, the proposed policy proposals can provide both a short-term and long-term basis for the health care system of countries that are facing budget constraints or are basically low-income.
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Affiliation(s)
- Peivand Bastani
- Department of Health Service Management and Health Economics, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Ghasrodasht Street, Shiraz , Iran
| | - Seyyed Mostafa Hakimzadeh
- Health Economics, Iran University of Medical Sciences, School of Public Health and Management, Kargar Street, Enqelab Square, Tehran 1541444456, Iran
| | - Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Sheikhbahaei Street, Tehran 1444445454, Iran
| | - Mojtaba Nouhi
- Health Economics, Health Equity Research Center, Tehran University of Medical Sciences, 2th floor. Sciences and Research Building, Kargar Street, Enqelab Square, Tehran 6446473199, Iran
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Marmamula S, Barrenakala NR, Challa R, Kumbham TR, Modepalli SB, Yellapragada R, Bhakki M, Reddy JC, Friedman DS, Khanna RC. Visual outcomes after cataract surgery among the elderly residents in the 'homes for the aged' in South India: the Hyderabad Ocular Morbidity in Elderly Study. Br J Ophthalmol 2021; 105:1087-1093. [PMID: 32855164 PMCID: PMC8311112 DOI: 10.1136/bjophthalmol-2020-317167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM To report visual outcomes and factors associated with good visual outcomes after cataract surgery among the elderly residents in 'homes for the aged' in Hyderabad, India. METHODS Individuals aged ≥60 years were recruited from 41 'homes for the aged'. All participants had a detailed eye examinations including visual acuity (VA) assessment , refraction, slit-lamp examination and fundus imaging by trained professionals. A detailed history of cataract surgery was recorded. Multivariate logistic regression was used to determine the factors associated with good visual outcomes after cataract surgery which was defined as presenting VA of 6/18 or better in the operated eye. Visual impairment (VI) is defined as presenting VA worse than 6/18 in the operated eye. RESULTS 1215 eyes of 703 individuals had cataract surgery. The mean age of these participants was 77.5 years (SD: 8.2 years; range: 60-108 years), 66.8% were women, 29.9% reported diabetes and 61% reported hypertension. 406/1215 (33.4%; 95% CI 30.8 to 36.1) eyes had VI after cataract surgery. Posterior capsular opacification (31.8%; n=129) was the leading cause of VI followed by uncorrected refractive error (24.1%; n=98). The prevalence of good outcomes was 66.6% (95% CI 63.8 to 69.2). On applying multivariable analysis, younger age, self-reported hypertension, independent mobility, surgery in a non-government (as opposed to private) hospital and undergoing paid surgery were associated with good outcomes. CONCLUSIONS One-third of the eyes of elderly individuals living in homes for the aged that had previously undergone cataract surgery had VI. Regular eye examinations with the provision of laser capsulotomy and appropriate refractive correction can substantially improve their vision.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- Department of Biotechnology / Wellcome Trust India Alliance, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology, Boston, United States of America
| | - Navya Rekha Barrenakala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Madhuri Bhakki
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Jagadesh C Reddy
- Cataract and Refractive Services, L V Prasad Eye Institute, Hyderabad, India
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology, Boston, United States of America
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Yoshizaki M, Ramke J, Zhang JH, Aghaji A, Furtado JM, Burn H, Gichuhi S, Dean WH, Congdon N, Burton MJ, Buchan J. How can we improve the quality of cataract services for all? A global scoping review. Clin Exp Ophthalmol 2021; 49:672-685. [PMID: 34291550 DOI: 10.1111/ceo.13976] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cataract is a leading cause of blindness and vision impairment globally. Cataract surgery is one of the most frequently performed operations worldwide, but good quality services are not universally available. This scoping review aims to summarise the nature and extent of published literature on interventions to improve the quality of services for age-related cataract globally. METHODS We used the dimensions of quality adopted by WHO-effectiveness, safety, people-centredness, timeliness, equity, integration and efficiency-to which we added planetary health. On 17 November 2019, we searched MEDLINE, Embase and Global Health for manuscripts published since 1990, without language or geographic restrictions. We included studies that reported quality-relevant interventions and excluded studies focused on technical aspects of surgery or that only involved children (younger than 18 years). Screening of titles/abstracts, full-text review and data extraction were performed by two reviewers independently. Studies were grouped thematically and results synthesised narratively. RESULTS Most of the 143 included studies were undertaken in high-income countries (n = 93, 65%); 29 intervention groups were identified, most commonly preoperative education (n = 17, 12%) and pain/anxiety management (n = 16, 11%). Efficiency was the quality element most often assessed (n = 58, 41%) followed by people-centredness (n = 40, 28%), while integration (n = 4) and timeliness (n = 3) were infrequently reported, and no study reported outcomes related to planetary health. CONCLUSION Evidence on interventions to improve quality of cataract services shows unequal regional distribution. There is an urgent need for more evidence relevant to low- and middle-income countries as well as across all quality elements, including planetary health.
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Affiliation(s)
- Miho Yoshizaki
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - 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
| | - Ada Aghaji
- Department of Ophthalmology, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, United Kingdom
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Nathan Congdon
- Centre for Public Health, Queens University Belfast, Belfast, United Kingdom.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Orbis International, New York, USA
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Moorfields Eye Hospital, London, United Kingdom
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Mathenge WC, Hillgrove T, Gisagara E, Uwaliraye P, Hess O, Byamukama E, Intili A, Nyemazi A, Nkurikiye J. The Rwanda National Blindness Survey: Trends and use of the evidence to change practice and policy. AFRICAN VISION AND EYE HEALTH 2021. [DOI: 10.4102/aveh.v80i1.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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31
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Keel S, Müller A, Block S, Bourne R, Burton MJ, Chatterji S, He M, Lansingh VC, Mathenge W, Mariotti S, Muirhead D, Rabiu MM, Ravilla TD, Resnikoff S, Silva JC, Tapply I, Vos T, Wang N, Cieza A. Keeping an eye on eye care: monitoring progress towards effective coverage. LANCET GLOBAL HEALTH 2021; 9:e1460-e1464. [PMID: 34237266 PMCID: PMC8440222 DOI: 10.1016/s2214-109x(21)00212-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 12/02/2022]
Abstract
The eye care sector is well positioned to contribute to the advancement of universal health coverage within countries. Given the large unmet need for care associated with cataract and refractive error, coupled with the fact that highly cost-effective interventions exist, we propose that effective cataract surgery coverage (eCSC) and effective refractive error coverage (eREC) serve as ideal indicators to track progress in the uptake and quality of eye care services at the global level, and to monitor progress towards universal health coverage in general. Global targets for 2030 for these two indicators were endorsed by WHO Member States at the 74th World Health Assembly in May, 2021. To develop consensus on the data requirements and methods of calculating eCSC and eREC, WHO convened a series of expert consultations to make recommendations for standardising the definitions and measurement approaches for eCSC and eREC and to identify areas in which future work is required.
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Affiliation(s)
- Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
| | - Andreas Müller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Rupert Bourne
- Cambridge University Hospitals, Cambridge, UK; Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Moorfields Eye Hospital, London, UK
| | - Somnath Chatterji
- Data and Analytics Department, World Health Organization, Geneva, Switzerland
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China; Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia
| | - Van C Lansingh
- Retina Department, Instituto Mexicano de Oftalmología IAP, Santiago De Querétaro, Querétaro, Mexico; HelpMeSee, New York, NY, USA
| | | | - Silvio Mariotti
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Debbie Muirhead
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; The Fred Hollows Foundation, Melbourne, VIC, Australia
| | - M Mansur Rabiu
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia; Brien Holden Vision Institute, Sydney, NSW, Australia; Organisation pour la Prévention de la Cécité, Paris, France
| | - Juan Carlos Silva
- Division of Blindness Prevention, Pan American Health Organization, Bogota, Colombia
| | - Ian Tapply
- Cambridge University Hospitals, Cambridge, UK
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Khandekar R, Senthil T, Nainappan M, Edward DP. Magnitude and Determinants of Diabetic Retinopathy Among Indian Diabetic Patients Undergoing Telescreening in India. Telemed J E Health 2021; 28:176-188. [PMID: 33999730 DOI: 10.1089/tmj.2021.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Methods: Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Results: Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, p < 0.001), older age (χ2 = 270, df = 3, p < 0.001), history of cataract surgery (OR = 2.0, p < 0.001), longer duration of diabetes (χ2 = 1084, p < 0.001), and type 1 diabetes (OR = 3.9, p = 0.01). There was a statistically significant variation of DR by geographic zones (χ2 = 310, p < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes (p < 0.001), cataract surgery in the past (p = 0.02), and females (p = 0.001) were predictors of STDR. Conclusion: This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.
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Affiliation(s)
- Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | - Deepak P Edward
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, Chicago, Illinois, USA
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Reis T, Lansingh V, Ramke J, Silva JC, Resnikoff S, Furtado JM. Cataract as a Cause of Blindness and Vision Impairment in Latin America: Progress Made and Challenges Beyond 2020. Am J Ophthalmol 2021; 225:1-10. [PMID: 33412124 DOI: 10.1016/j.ajo.2020.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To provide an update of cataract as a cause of vision loss in Latin America and to analyze sex inequalities in cataract surgical coverage (CSC) and effective CSC (eCSC) in the region. DESIGN Population-based systematic review with longitudinal comparisons. METHODS The Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databased were searched for population-based studies reporting cataract blindness, surgical coverage, and outcomes published between January 2014 and December 2019. Information on the number of surgeries performed from the 2014-2016 period was obtained from ministries of health and was used for calculation of the cataract surgical rate (CSR). Sources such as Rapid Assessment of Avoidable Blindness (RAAB) and Rapid Assessment of Cataract Surgical Services data were reanalyzed to calculate sex inequality in CSC and eCSC by subtracting the rate in women from the rate in men. RESULTS Cataract was the cause of 29.8%-77.6% of cases of blindness in the included studies; the CSR improved in 10 countries. The CSC pinhole visual acuity of 3/60 varied from 24.1% in Peru to 97.1% in Argentina, and the median absolute gender inequality CSC pinhole visual acuity 3/60 was -0.7%. The eCSC pinhole visual acuity 3/60 varied from 14.8% in Guatemala to 92.1% in Argentina, and the median absolute gender inequality eCSC pinhole visual acuity 3/60 was -0.8%. CONCLUSIONS Cataract remains a leading cause of blindness in Latin America. Coverage is suboptimal, and surgical results are also below target levels in many countries. Incentives for a better distribution of human resources, adequate training of ophthalmologists, and the inclusion of vision services in universal health care coverage could reduce the burden of cataract in Latin America.
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Affiliation(s)
- Tulio Reis
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Van Lansingh
- HelpMeSee, New York City, New York, USA; Instituto Mexicano de Oftalmología, Queretaro, Mexico
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Juan Carlos Silva
- Eye Care Program, Pan-American Health Organization, Bogotá, Colombia
| | - Serge Resnikoff
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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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: 478] [Impact Index Per Article: 159.3] [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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Jolley E, Cumaio M, Vilanculos A, Hassane I, Kimani K, Ogundimu K, Schmidt E. Changes in Eye Health and Service Coverage in Nampula, Mozambique between 2011 and 2018. Ophthalmic Epidemiol 2021; 29:91-99. [PMID: 33759697 DOI: 10.1080/09286586.2021.1900279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Globally, there are few examples of repeated eye health surveys to assess changes in prevalence and causes of visual impairment, and service coverage over time. Two separate, unlinked rapid assessments of avoidable blindness (RAAB) were conducted in Nampula province, Mozambique in 2011 and 2018. This paper reports the observed changes and examines how the trends differ for males and females.Methods: Standard RAAB methodology was used in both studies. Two-stage cluster sampling was used to generate random samples of adults aged over 50 years. Participants underwent a simplified visual acuity (VA) exam, a lens exam and posterior segment exam using a direct ophthalmoscope for all subjects with presenting VA<6/18. Data were analysed using Stata and logistic regression models were developed to assess changes.Results: The 2011 study enrolled 3,050 people and examined 96.9% (2,954 people). The 2018 survey enrolled 4,191 people and examined 95.8% (4,015 people). Age- and sex-adjusted estimates of blindness decreased from 6.2% in 2011 to 4.5% in 2018 (z = -2.21, p = .028). Cataract surgical coverage was higher among males in both surveys (13.4% among males vs 7.7% among females in 2011, and 40.0% among males vs 19.4% among females in 2018) and the gender disparity grew between surveys.Conclusion: Significant changes were observed in the eye health and service coverage between 2011 and 2018. Further improvements to services are required to improve access for women and people with moderate visual impairment.
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Affiliation(s)
- Emma Jolley
- Evidence, Research & Innovations, Sightsavers, Haywards Heath, UK
| | | | | | | | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Elena Schmidt
- Evidence, Research & Innovations, Sightsavers, Haywards Heath, UK
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McCormick I, Mactaggart I, Bastawrous A, Burton MJ, Ramke J. Effective refractive error coverage: an eye health indicator to measure progress towards universal health coverage. Ophthalmic Physiol Opt 2021; 40:1-5. [PMID: 31879992 PMCID: PMC7004023 DOI: 10.1111/opo.12662] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ian McCormick
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Islay Mactaggart
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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McCormick I, Mactaggart I, Resnikoff S, Muirhead D, Murthy GV, Silva JC, Bastawrous A, Stern J, Blanchet K, Wang N, Yusufu M, Cooper A, Gichangi M, Burton MJ, Ramke J. Eye health indicators for universal health coverage: results of a global expert prioritisation process. Br J Ophthalmol 2021; 106:893-901. [PMID: 33712481 PMCID: PMC9234411 DOI: 10.1136/bjophthalmol-2020-318481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 12/22/2022]
Abstract
IntroductionIn its recent World Report on Vision, the WHO called for an updated approach to monitor eye health as part of universal health coverage (UHC). This project sought to develop a consensus among eye health experts from all world regions to produce a menu of indicators for countries to monitor eye health within UHC.MethodsWe reviewed the literature to create a long-list of indicators aligned to the conceptual framework for monitoring outlined in WHO’s World Report on Vision. We recruited a panel of 72 global eye health experts (40% women) to participate in a two-round, online prioritisation exercise. Two-hundred indicators were presented in Round 1 and participants prioritised each on a 4-point Likert scale. The highest-ranked 95 were presented in Round 2 and were (1) scored against four criteria (feasible, actionable, reliable and internationally comparable) and (2) ranked according to their suitability as a ‘core’ indicator for collection by all countries. The top 30 indicators ranked by these two parameters were then used as the basis for the steering group to develop a final menu.ResultsThe menu consists of 22 indicators, including 7 core indicators, that represent important concepts in eye health for 2020 and beyond, and are considered feasible, actionable, reliable and internationally comparable.ConclusionWe believe this list can inform the development of new national eye health monitoring frameworks, monitor progress on key challenges to eye health and be considered in broader UHC monitoring indices at national and international levels.
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Affiliation(s)
- Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Debbie Muirhead
- The Fred Hollows Foundation Melbourne, Melbourne, Victoria, Australia
| | - G V Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Indian Institutes of Public Health, Hyderabad, India
| | | | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jude Stern
- International Agency for the Prevention of Blindness, London, UK
| | - Karl Blanchet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | | | - Michael Gichangi
- Ophthalmic Services Unit, Kenya Ministry of Health, Nairobi, Kenya
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Moorfields Eye Hospital, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
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Hydara A, Bastawrous A, Bell S, Boggs D, Bright T, Bobat H, Eaton J, Faal H, Jobe M, Kim MJ, Kirkpatrick B, McCormick I, Okoh JA, Olaniyan SI, Prentice AM, Ramke J, Taylor R, Burton M, Mactaggart I. The Gambia National Eye Health Survey 2019: survey protocol. Wellcome Open Res 2021; 6:10. [PMID: 34796273 PMCID: PMC8591516.2 DOI: 10.12688/wellcomeopenres.16531.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 01/12/2023] Open
Abstract
Two national surveys of vision impairment and blindness were undertaken in The Gambia in 1986 and 1996. These provided data for the inception of The Gambia's National Eye Health Programme (NEHP) within the Ministry of Health and Social Welfare. There have been important developments in the eye health services provided by the NEHP in the last 20 years. At the same time, the population has also undergone major demographic changes that may have led to substantial changes in the burden of eye disease. We conducted a National Eye Health Survey of vision impairment, blindness and its comorbidities in adults in The Gambia in 2019. We examined a nationally representative population-based sample of adults 35 years and above to permit direct comparison with the data available from the previous surveys. Alongside a comprehensive vision and eye examination, the survey provides nationally representative data on important comorbidities in this population: diabetes, hypertension, obesity, hearing impairment, disability and mental health. Secondly, it estimates access to assistive technologies and eye health services. Thirdly, it is powered to allow a five-year follow up cohort study to measure the incidence and progression of eye disease.
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Affiliation(s)
- Abba Hydara
- Sheikh Zayed Regional Eye Care Centre, Kanifing, The Gambia
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzannah Bell
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Dorothy Boggs
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
- CBM Global, Cambridge, UK
| | - Hannah Faal
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Modou Jobe
- Medical Research Unit The Gambia, London School of Hygiene & Tropical Medicine, Kanifing, The Gambia
| | - Min J. Kim
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - John Atta Okoh
- Sheikh Zayed Regional Eye Care Centre, Kanifing, The Gambia
| | | | - Andrew M. Prentice
- Medical Research Unit The Gambia, London School of Hygiene & Tropical Medicine, Kanifing, The Gambia
| | - 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
| | - Ruth Taylor
- East London NHS Foundation Trust, London, UK
| | - Matthew Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - 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
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Rif'Ati L, Halim A, Lestari YD, Moeloek NF, Limburg H. Blindness and Visual Impairment Situation in Indonesia Based on Rapid Assessment of Avoidable Blindness Surveys in 15 Provinces. Ophthalmic Epidemiol 2020; 28:408-419. [PMID: 33380229 DOI: 10.1080/09286586.2020.1853178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To report the latest data on blindness and visual impairment (VI) in Indonesia.Methods: Rapid Assessment of Avoidable Blindness (RAAB) surveys were done in 15 provinces in Indonesia between 2013 and 2017. The population of the study was people aged 50 +. In each province, the required number of clusters was selected with a probability proportionately to size. A weighted average analysis for prevalence, causes of visual impairment, and cataract surgical coverage (CSC) estimated the values of the country.Results: The prevalence of blindness in East Java was the highest at 4.4% (95% CI: 3.1-5.6%), followed by Nusa Tenggara Barat (NTB) at 4.0% (95% CI: 3.0-5.1%) and South Sumatra at 3.4% (95% CI: 2.4-4.4%). In number, blindness among people aged 50+ in East Java was the highest at 371,599, followed by West Java at 180,666 and Central Java at 176,977. Untreated cataract was the commonest cause of blindness in all provinces (range: 71.7% to 95.5%). CSCperson<3/60 and CSCperson<6/60 in Bali were the highest at 81.3% and 72.4%, respectively. Indonesia countrywide prevalence of blindness was 3.0%. The total number of people with VI (PVA less than 6/18 in the better eye) in Indonesia was 8,019,427, consisting of 1,654,595 of blindness and 6,364,832 of moderate and severe VI.Conclusion: The burden of blindness in Indonesia is high, and untreated cataract contributes the most. There is an urgent need to increase cataract surgical coverage by providing better access to cataract surgery services for all people in need.
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Affiliation(s)
- Lutfah Rif'Ati
- National Institute for Health Research and Development (NIHRD, Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Aldiana Halim
- Research Department, The Indonesian Eye Center, Cicendo Eye Hospital, Bandung, Indonesia
| | - Yeni Dwi Lestari
- Ophthalmology Department, Faculty of Medicine University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nila F Moeloek
- Ophthalmology Department, Faculty of Medicine University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hans Limburg
- Health Information Services, Grootebroek, Netherlands
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Rapid assessment of avoidable blindness and cataract surgery coverage among forcibly displaced Myanmar Nationals (Rohingya refugees) in Cox's Bazar, Bangladesh. PLoS One 2020; 15:e0243005. [PMID: 33259555 PMCID: PMC7707460 DOI: 10.1371/journal.pone.0243005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/12/2020] [Indexed: 11/26/2022] Open
Abstract
Aim To determine the prevalence and causes of blindness, vision impairment and cataract surgery coverage among Rohingya refugees aged ≥ 50 years residing in camps in Cox’s Bazar, Bangladesh. Methods We used the Rapid Assessment of Avoidable Blindness (RAAB) methodology to select 76 clusters of 50 participants aged ≥ 50 years with probability proportionate to size. Demographic and cataract surgery data were collected using questionnaires, visual acuity was assessed per World Health Organization criteria and examinations were conducted by torch, and with direct ophthalmoscopy in eyes with pinhole-corrected vision <6/12. RAAB software was used for data entry and analysis. Results We examined 3,629 of 3800 selected persons (95.5%). Age and sex adjusted prevalence of blindness (<3/60), severe visual impairment (SVI; >3/60 to ≤6/60), moderate visual impairment (MVI; >6/60 to ≤6/18), and early visual impairment (EVI; >6/18 to ≤6/12) were 2.14%, 2.35%, 9.68% and 14.7% respectively. Cataract was responsible for 75.0% of blindness and 75.8% of SVI, while refractive error caused 47.9% and 90.9% of MVI and EVI respectively. Most vision loss (95.9%) was avoidable. Cataract surgical coverage among the blind was 81.2%. Refractive error was detected in 17.1% (n = 622) of participants and 95.2% (n = 592) of these did not have spectacles. In the full Rohingya cohort of 76,692, approximately 10,000 surgeries are needed to correct all eyes impaired (<6/18) by cataract, 12,000 need distance glasses and 73,000 require presbyopic correction. Conclusion The prevalence of blindness was lower than expected for a displaced population, in part due to few Rohingya being ≥60 years and the camp’s good access to cataract surgery. We suggest the United Nations High Commissioner for Refugees include eye care among recommended health services for all refugees with long-term displacement.
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AlSawahli H, McCormick I, Mpyet CD, Ezzelarab G, Shalaby M. Population-based rapid assessment of avoidable blindness survey in Sohag governorate in Egypt. BMJ Open 2020; 10:e036337. [PMID: 33046461 PMCID: PMC7552864 DOI: 10.1136/bmjopen-2019-036337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To determine the prevalence and causes of blindness and vision impairment, and the coverage and quality of cataract surgical services, among population aged 50 years and older in Sohag governorate in Egypt. DESIGN A population-based cross-sectional survey using two-stage cluster random sampling following the rapid assessment of avoidable blindness methodology. SETTING A community-based survey conducted by six teams of ophthalmologists, assistants and local guides. Enrolment and examination were door-to-door in selected clusters. PARTICIPANTS Using 2016 census data, 68 population units were randomly selected as clusters (of 60 people) with probability proportionate to population size. Anyone aged 50 years and older, residing in a non-institutional setting in a cluster for at least 6 months, was eligible to participate. PRIMARY AND SECONDARY OUTCOME MEASURES The prevalence and causes of blindness and vision impairment. Secondary outcomes were CSC and effectiveness and participant-reported barriers to cataract surgery. RESULTS Of 4078 participants enrolled, 4033 (98.9%) were examined. The age-adjusted and sex-adjusted prevalence of blindness, severe vision impairment and moderate vision impairment were 5.9% (95% CI 4.8% to 6.9%), 4.7% (95% CI 3.8% to 5.7%) and 18.9% (95% CI 16.8% to 21.0%), respectively. Cataract caused most of blindness (41.6%), followed by non-trachomatous corneal opacity (15.7%) and posterior segment diseases (14.5%). Cataract surgical coverage (CSC) for persons for visual acuity <3/60 was 86.8%, the proportion of cataract surgeries with poor visual outcome was 29.5% and effective CSC (eCSC) was 44.9%. eCSC was lower in women than men. The most frequently reported barrier to surgery was cost (51.5%). CONCLUSIONS The prevalence of blindness in Sohag governorate is higher than districts in other middle-income countries in the region. CSC was high; however, women suffer worse quality-corrected CSC than men. The quality of cataract surgery needs to be addressed, while health system strengthening across government and private settings could alleviate financial barriers.
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Affiliation(s)
| | - Ian McCormick
- London School of Hygiene and Tropical Medicine International Centre for Eye Health, London, UK
| | - Caleb D Mpyet
- Ophthalmology, Jos University Teaching Hospital, Jos, Nigeria
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Yoshizaki M, Ramke J, Furtado JM, Burn H, Gichuhi S, Gordon I, Aghaji A, Marques AP, Dean WH, Congdon N, Buchan J, Burton MJ. Interventions to improve the quality of cataract services: protocol for a global scoping review. BMJ Open 2020; 10:e036413. [PMID: 32788187 PMCID: PMC7422650 DOI: 10.1136/bmjopen-2019-036413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Cataract is the leading cause of blindness globally and a major cause of vision impairment. Cataract surgery is an efficacious intervention that usually restores vision. Although it is one of the most commonly conducted surgical interventions worldwide, good quality services (from being detected with operable cataract to undergoing surgery and receiving postoperative care) are not universally accessible. Poor quality understandably reduces the willingness of people with operable cataract to undergo surgery. Therefore, it is critical to improve the quality of care to subsequently reduce vision loss from cataract. This scoping review aims to summarise the nature and extent of the published literature on interventions to improve the quality of services for primary age-related cataract globally. METHODS AND ANALYSIS We will search MEDLINE, Embase and Global Health for peer-reviewed manuscripts published since 1990, with no language, geographic or study design restrictions. To define quality, we have used the elements adopted by the WHO-effectiveness, safety, people-centredness, timeliness, equity, integration and efficiency-to which we have added the element of planetary health. We will exclude studies focused on the technical aspects of the surgical procedure and studies that only involve children (<18 years). Two reviewers will screen all titles/abstracts independently, followed by a full-text review of potentially relevant articles. For included articles, data regarding publication characteristics, study details and quality-related outcomes will be extracted by two reviewers independently. Results will be synthesised narratively and presented visually using a spider chart. ETHICS AND DISSEMINATION Ethical approval was not sought, as our review will only include published and publicly accessible information. We will publish our findings in an open-access peer-reviewed journal and develop an accessible summary of the results for website posting. A summary of the results will be included in the ongoing Lancet Global Health Commission on Global Eye Health. REGISTRATION DETAILS Open Science Framework (https://osf.io/8gktz).
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Affiliation(s)
- Miho Yoshizaki
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - João M Furtado
- Division of Ophthalmology, Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ada Aghaji
- Department of Ophthalmology, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ana P Marques
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - William H Dean
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Ophthalmology, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Moorfields Eye Hospital, London, UK
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Sobti S, Sahni B, Bala K. Surgical coverage of cataract in a rural area of north India: A cross-sectional study. J Family Med Prim Care 2020; 9:4112-4117. [PMID: 33110818 PMCID: PMC7586552 DOI: 10.4103/jfmpc.jfmpc_520_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/26/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background: India has the highest number of blind people globally, unoperated cataract being the most common cause of blindness and low vision. Although safe and effective cataract surgical techniques are available, the cataract burden continues to increase annually, due to the backlog of patients to be operated upon, and a growing number of cataract cases due to increased life expectancy. Aim: To assess cataract surgical coverage (CSC) in a rural area of north India. Methods: A population-based cross-sectional study of CSC among adults (40 years and above) was carried out in two villages of a block in north India using a predesigned questionnaire, visual acuity assessment, and distant direct ophthalmoscopy. Based on the data obtained, CSC (VA <6/60) for both “persons” as well as “eyes” was calculated. Results: Overall, CSC (persons) of 43.20% was observed, 29.31% coverage among persons with unilateral cataract and 50.45% among persons with bilateral cataract while CSC (eyes) was found to be 37.14%, being significantly higher (43.56%) among females compared to males (28.21%) (P = 0.012). Around 50% of cataract surgeries were performed in private facilities, 41.35% in government facilities, and rest 8.65% in eye camps. Nearly 90.38% were implanted intraocular lens and 9.62% were non-intraocular lens surgeries. Conclusions: Surgical needs for cataract are currently not being met effectively. Reasons for inadequate cataract surgical services need to be sought and addressed to improve the uptake of existing services. Further, reasons for underutilization of government hospitals for cataract surgeries need to be examined.
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Affiliation(s)
- Shalini Sobti
- Department of Community Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, J and K, India
| | - Bhavna Sahni
- Department of Community Medicine, Govt. Medical College, Jammu, J and K, India
| | - Kiran Bala
- Department of Community Medicine, Govt. Medical College, Jammu, J and K, India
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Factors associated with the uptake of cataract surgery and interventions to improve uptake in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0235699. [PMID: 32645065 PMCID: PMC7347115 DOI: 10.1371/journal.pone.0235699] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/21/2020] [Indexed: 11/19/2022] Open
Abstract
Despite significant evidence around barriers hindering timely access to cataract surgery in low- and middle-income countries (LMICs), little is known about the strategies necessary to overcome them and the factors associated with improved access. Despite significant evidence that certain groups, women for example, experience disproportionate difficulties in access, little is known about how to improve the situation for them. Two reviews were conducted recently: Ramke et al., 2018 reported experimental and quasi-experimental evaluations of interventions to improve access of cataract surgical services, and Mercer et al., 2019 investigated interventions to improve gender equity. The aim of this systematic review was to collate, appraise and synthesise evidence from studies on factors associated with uptake of cataract surgery and strategies to improve the uptake in LMICs. We performed a literature search of five electronic databases, google scholar and a detailed reference review. The review identified several strategies that have been suggested to improve uptake of cataract surgery including surgical awareness campaigns; use of successfully operated persons as champions; removal of patient direct and indirect costs; regular community outreach; and ensuring high quality surgeries. Our findings provide the basis for the development of a targeted combination of interventions to improve access and ensure interventions which address barriers are included in planning cataract surgical services. Future research should seek to examine the effectiveness of these strategies and identify other relevant factors associated with intervention effects.
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Lee CN, Ramke J, McCormick I, Zhang JH, Aghaji A, Mwangi N, Burn H, Gordon I, Yusufu M, He M, Silva JC, Burton MJ. Are we advancing universal health coverage through cataract services? Protocol for a scoping review. BMJ Open 2020; 10:e039458. [PMID: 32641342 PMCID: PMC7348466 DOI: 10.1136/bmjopen-2020-039458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Universal health coverage (UHC) includes the dimensions of equity in access, quality services that improve health and protection against financial hardship. Cataract continues to be the leading cause of blindness globally, despite cataract surgery being an efficacious intervention. The aim of this scoping review is to map the nature, extent and global distribution of data on cataract services for UHC in terms of equity, access, quality and financial protection. METHODS AND ANALYSIS The search will be constructed by an Information Specialist and undertaken in MEDLINE, Embase and Global Health databases. We will include all published non-interventional primary research studies and systematic reviews that report a quantitative assessment of access, equity, quality or financial protection of cataract surgical services for adults at the subnational, national, regional or global level from population-based surveys or routinely collected health service data since 1 January 2000 and published through to February 2020.Screening and data charting will be undertaken using Covidence systematic review software. Titles and abstracts of identified studies will be screened by two authors independently. Full-text articles of potentially relevant studies will be obtained and reviewed independently by two authors against the inclusion criteria. Any discrepancies between the authors will be resolved by discussion, and with a third author as necessary. A data charting form will be developed and piloted on three studies by three authors and amendments made as necessary. Data will be extracted by two reviewers independently and summarised narratively and using maps. ETHICS AND DISSEMINATION Ethical approval was not sought as the scoping review will only use published and publicly accessible data. The review will be published in an open access peer-reviewed journal. A summary of the results will be developed for website posting, stakeholder meetings and inclusion in the ongoing Lancet Global Health Commission on Global Eye Health.
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Affiliation(s)
- Chan Ning Lee
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Justine H Zhang
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Ada Aghaji
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Opthalmology, University of Nigeria, Enugu, Nigeria
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Clinical Medicine, Kenya Medical Training College, Nairobi, Kenya
| | - Helen Burn
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, United Kingdom
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Juan Carlos Silva
- Division of Blindness Prevention, Pan American Health Organization, Bogota, Colombia
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Moorfields Eye Hospital, London, United Kingdom
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Jolley E, Buttan S, Engels T, Gillani M, Jadoon MZ, Kabona G, Mohanty RN, Mohanty S, Trotignon G, Woldeyes A, Schmidt E. Prevalence of Visual Impairment and Coverage of Cataract Surgical Services: Associations with Sex, Disability, and Economic Status in Five Diverse Sites. Ophthalmic Epidemiol 2020; 27:429-437. [PMID: 32449411 DOI: 10.1080/09286586.2020.1768553] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Prevalence of visual impairment (VI) and access to services can vary significantly across and between different population groups. With renewed focus on universal health coverage and leaving no one behind, it is important to understand factors driving inequitable eye health. This paper presents results from five population-based surveys where prevalence of VI and cataract surgical coverage (CSC) were measured and examined for differences by sex, economic-status, and disability. METHODS Rapid assessments of avoidable blindness took place in four rural sites: Kalahandi, Jhabua and Sitapur in India; and Singida, Tanzania; and one urban site: Lahore, Pakistan. In addition, the Equity Tool was used to measure economic status and the Washington Group Short Set was used to measure disability. Prevalence of VI and CSC were calculated and associations with sex, disability, and relative wealth examined. RESULTS Prevalence of VI varied from 1.9% in Lahore to 15.0% in Kalahandi. CSC varied from 39.1% in Singida to 84.0% in Lahore. Additional disability was associated with greater levels of VI in all sites and lower CSC in Singida. Being female was associated with higher VI in Kalahandi, Lahore and Singida and lower CSC in Lahore and Singida. Being poorer was associated with higher VI in Singida and lower CSC in Singida and Sitapur. CONCLUSION Relationships between VI and relative wealth, sex, and disability are complex and variable. Although certain characteristics may be associated with lower coverage or worse outcomes, they cannot be generalized and local data are vital to tailor services to achieve good coverage.
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Affiliation(s)
| | | | | | | | - Muhammad Zahid Jadoon
- Department of Epidemiology and Biostatistics, Pakistan Institute of Community Ophthalmology , Peshawar, Pakistan
| | - George Kabona
- Eye Department, Iringa Regional Referral Hospital , Iringa, Tanzania
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Mohanty S, Jolley E, Mohanty RN, Buttan S, Schmidt E. Integrating Geospatial Data and Measures of Disability and Wealth to Assess Inequalities in an Eye Health Survey: An Example from the Indian Sunderbans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234869. [PMID: 31816932 PMCID: PMC6926603 DOI: 10.3390/ijerph16234869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 11/16/2022]
Abstract
The Sunderbans are a group of delta islands that straddle the border between India and Bangladesh. For people living on the Indian side, health services are scarce and the terrain makes access to what is available difficult. In 2018, the international non-governmental organisation Sightsavers and their partners conducted a population-based survey of visual impairment and coverage of cataract and spectacle services, supplemented with tools to measure equity in eye health by wealth, disability, and geographical location. Two-stage cluster sampling was undertaken to randomly select 3868 individuals aged 40+ years, of whom 3410 were examined. Results were calculated using standard statistical processes and geospatial approaches were used to visualise the data. The age-sex adjusted prevalence of blindness was 0.8%, with higher prevalence among women (1.1%). Cataract Surgical Coverage for eyes at visual acuity (VA) 3/60 was 86.3%. The study did not find any association between visual impairment and wealth, however there were significant differences by additional (non-visual) disabilities at all levels of visual impairment. Geospatial mapping highlighted blocks where higher prevalence of visual impairment was identified. Integrating additional tools in population-based surveys is critical for measuring eye health inequalities and identifying population groups and locations that are at risk of being left behind.
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Affiliation(s)
- Soumya Mohanty
- Monitoring Evaluation Research and Learning, Sightsavers India 110020, India;
| | - Emma Jolley
- Research, Sightsavers, Haywards Heath RH16 3BW, UK
- Correspondence: ; Tel.: +44-1444-446686
| | - RN Mohanty
- India Directorate Sightsavers India 110020, India;
| | - Sandeep Buttan
- Programme Development and Innovation Team, Sightsavers India 110020, India;
| | - Elena Schmidt
- Programme Development, Evidence and Research, Sightsavers, Haywards Heath RH16 3BW, UK;
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Taylor HR. Global Blindness: The Progress We Are Making and Still Need to Make. Asia Pac J Ophthalmol (Phila) 2019; 8:424-428. [PMID: 31789642 PMCID: PMC6903342 DOI: 10.1097/apo.0000000000000264] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/25/2019] [Indexed: 12/05/2022] Open
Abstract
The actual numbers of people blind or with poor vision continue to increase despite so excellent progress that is being made in reducing the prevalence or percentage of people affected. More attention is required to provide quality outcomes for cataract surgery, prevent and manage myopia, detect and treat diabetic retinopathy, glaucoma, and age-related macular degeneration (AMD). Although more ophthalmologists are needed to provide this eye care, it is important that ophthalmologists work in effective teams with allied eye health personal to be able to meet the community needs.
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Affiliation(s)
- Hugh R Taylor
- Melbourne Laureate Professor, Harold Mitchell Chair of Indigenous Eye Health, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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Ramke J, Kyari F, Mwangi N, Piyasena M, Murthy G, Gilbert CE. Cataract Services are Leaving Widows Behind: Examples from National Cross-Sectional Surveys in Nigeria and Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203854. [PMID: 31614715 PMCID: PMC6843674 DOI: 10.3390/ijerph16203854] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 11/25/2022]
Abstract
The Sustainable Development Goals aim to leave no one behind. We explored the hypothesis that women without a living spouse—including those who are widowed, divorced, separated, and never married—are a vulnerable group being left behind by cataract services. Using national cross-sectional blindness surveys from Nigeria (2005–2007; n = 13,591) and Sri Lanka (2012–2014; n = 5779) we categorized women and men by marital status (married/not-married) and place of residence (urban/rural) concurrently. For each of the eight subgroups we calculated cataract blindness, cataract surgical coverage (CSC), and effective cataract surgical coverage (eCSC). Not-married women, who were predominantly widows, experienced disproportionate cataract blindness—in Nigeria they were 19% of the population yet represented 56% of those with cataract blindness; in Sri Lanka they were 18% of the population and accounted for 54% of those with cataract blindness. Not-married rural women fared worst in access to services—in Nigeria their CSC of 25.2% (95% confidence interval, CI 17.8–33.8%) was far lower than the best-off subgroup (married urban men, CSC 80.0% 95% CI 56.3–94.3); in Sri Lanka they also lagged behind (CSC 68.5% 95% CI 56.6–78.9 compared to 100% in the best-off subgroup). Service quality was also comparably poor for rural not-married women—eCSC was 8.9% (95% CI 4.5–15.4) in Nigeria and 37.0% (95% CI 26.0–49.1) in Sri Lanka. Women who are not married are a vulnerable group who experience poor access to cataract services and high cataract blindness. To “leave no one behind”, multi-faceted strategies are needed to address their needs.
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Affiliation(s)
- Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
- School of Optometry and Vision Science, University of Auckland, Auckland 1010, New Zealand.
| | - Fatima Kyari
- College of Health Sciences, Baze University, Abuja 900108, Nigeria.
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
- Department of Clinical Medicine, Kenya Medical Training College, Nairobi 00100, Kenya.
| | - Mmpn Piyasena
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
- Ministry of Health, Indigenous Medicine and Nutrition, Policy Analysis and Development Unit, Colombo 10, Sri Lanka.
| | - Gvs Murthy
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
- Public Health Foundation of India, Hyderabad, Telangana 122002, India.
| | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Lepcha NT, Sharma IP, Sapkota YD, Das T, Phuntsho T, Tenzin N, Shamanna BR, Peldon S. Changing trends of blindness, visual impairment and cataract surgery in Bhutan: 2009-2018. PLoS One 2019; 14:e0216398. [PMID: 31071127 PMCID: PMC6508732 DOI: 10.1371/journal.pone.0216398] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/20/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose To obtain new rapid assessment of avoidable blindness (RAAB) data on the prevalence, causes and trends of blindness, visual impairment and cataract surgery; and compare the new 2018 data with the older RAAB 2009 data. Methodology The second nationwide RAAB used android based mRAAB technique and technology for data collection. Using the compact segment sampling probability proportionate to size, 5,050 participants from 101 clusters of 50 people aged 50 years and older were enrolled through house-to-house visits. Eligible participants received ophthalmic examination and interview by the ophthalmologist-led emuneration team as per the RAAB protocol. Results The age-sex adjusted magnitude of bilateral blindness in Bhutan was 1.0% (95% Confidence Interval, CI 0.5–1.4) with relatively higher prevalence in rural population (Odds Ratio, OR 1.5, p = 0.13) and women (OR 1.6, p = 0.06). Untreated cataract accounted for the most of blindness (53.8%), severe vision impairment (57.1%), and moderate visual impairment (65.3%); uncorrected refractive error was the main cause of early visual impairment (46.7%). Cataract Surgical Coverage was 86.1% with relatively better coverage in men (76.7% men; 73.1% female) and urban population (79.2% urban; 70.2% rural). Good cataract surgical outcome was achieved in 67.3% and leading cause of poor outcome was ocular comorbidity (43.6%). Accessibility was a significant barrier to the uptake of cataract surgical services. Conclusion There is a 33% reduction in blindness from 1.5% to 1.0%, since the first RAAB survey in 2009. In order to further reduce blindness and visual impairment, Bhutan should continue to implement long-term strategic action plan for eye health focused on strengthening primary eye care and comprehensive eye care service.
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Affiliation(s)
- Nor Tshering Lepcha
- Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan
- * E-mail:
| | - Indra Prasad Sharma
- Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan
| | - Yuddha Dhoj Sapkota
- International Agency for Prevention of Blindness, South East Asia Regional Office, Banjara Hills, Hyderabad, India
| | - Taraprasad Das
- International Agency for Prevention of Blindness, South East Asia Region, Kallam Anji Reddy Campus, L V Prasad Marg, Hyderabad, India
| | - Tshering Phuntsho
- Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan
| | - Ngawang Tenzin
- Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan
| | | | - Sonam Peldon
- Primary Eye Care Program, Ministry of Health, Thimphu, Bhutan
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