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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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Joseph S, Rajendran VK, Khetwani D, Uduman MS, Ramasamy D, Gowth AM, Kowsalya A, Ehrlich JR, Ravilla TD. Evaluation of a telemedicine-enabled universal eye health delivery model in rural southern India. Eye (Lond) 2024; 38:1202-1207. [PMID: 38057562 PMCID: PMC11009233 DOI: 10.1038/s41433-023-02871-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES To evaluate the accuracy of tele-ophthalmic examination (TOE) for common ocular conditions in comparison with the gold-standard in-person examination (IPE) for diagnosis and treatment advice. METHODS In a prospective, diagnostic accuracy validation study, we recruited 339 consecutive new patients, aged ≥16 years, visiting a vision centre (VC) associated with Aravind Eye Hospital in south India during January and February, 2020. All participants underwent the TOE, followed by IPE on the same visit. The in-person ophthalmologist was masked to the TOE diagnosis and treatment advice. Data were analysed via the sensitivity specificity of TOE versus the gold-standard IPE. RESULTS TOE achieved high sensitivity and specificity for identifying normal eyes with 87.4% and 93.5%, respectively. TOE had high sensitivity for cataracts (91.7%), infective conjunctivitis (72.2%), and moderate sensitivity for pterygium (62.5%), DR (57.1%), non-serious injury (41.7%), but low sensitivity for glaucoma (12.5%). TOE had high specificity ranging from 93.5% to 99.8% for all diagnoses. The sensitivity for treatment advice ranged from 58.1% to 77.2% and specificity from 96.9% to 100%. CONCLUSIONS The TOE in VCs has acceptable accuracy to an IPE by an ophthalmologist for correctly identifying and treating major eye ailments. Through providing universal eye care to rural populations, this model may contribute to work toward achieving Universal Health Coverage, which is a linchpin of the health-related U.N. Sustainable Development Goals (SDG).
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Affiliation(s)
- Sanil Joseph
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Vinoth Kumar Rajendran
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Dhwanit Khetwani
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
| | | | - Dhivya Ramasamy
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | | | - Akkayasamy Kowsalya
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, USA
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Thulasiraj D Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India.
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Sandi F, Mercer G, Geneau R, Bassett K, Bintabara D, Kalolo A. Alternative community-led intervention to improve uptake of cataract surgery services in rural Tanzania-The Dodoma Community Cataract Acceptance Trial (DoCCAT): a protocol for intervention co-designing and implementation in a cluster-randomized controlled trial. Biol Methods Protoc 2024; 9:bpae016. [PMID: 38566775 PMCID: PMC10987207 DOI: 10.1093/biomethods/bpae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Age-related lens opacification (cataract) remains the leading cause of visual impairment and blindness worldwide. In low- and middle-income countries, utilization of cataract surgical services is often limited despite community-based outreach programmes. Community-led research, whereby researchers and community members collaboratively co-design intervention is an approach that ensures the interventions are locally relevant and that their implementation is feasible and socially accepted in the targeted contexts. Community-led interventions have the potential to increase cataract surgery uptake if done appropriately. In this study, once the intervention is co-designed it will be implemented through a cluster-randomized controlled trial (cRCT) with ward as a unit of randomization. This study will utilise both the qualitative methods for co-designing the intervention and the quantitative methods for effective assessment of the developed community-led intervention through a cRCT in 80 rural wards of Dodoma region, Tanzania (40 Intervention). The 'intervention package' will be developed through participatory community meetings and ongoing evaluation and modification of the intervention based on its impact on service utilization. Leask's four stages of intervention co-creation will guide the development within Rifkin's CHOICE framework. The primary outcomes are two: the number of patients attending eye disease screening camps, and the number of patients accepting cataract surgery. NVivo version 12 will be used for qualitative data analysis and Stata version 12 for quantitative data. Independent and paired t-tests will be performed to make comparisons between and within groups. P-values less than 0.05 will be considered statistically significant.
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Affiliation(s)
- Frank Sandi
- Department of Ophthalmology, The University of Dodoma Medical School, Dodoma, Tanzania
| | - Gareth Mercer
- Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada
| | - Robert Geneau
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Kenneth Bassett
- Department of Ophthalmology, The University of British Columbia, Vancouver, Canada
| | - Deogratius Bintabara
- Department of Community Medicine, The University of Dodoma Medical School, Dodoma, Tanzania
| | - Albino Kalolo
- Department of Public Health, St Francis University College of Health and Allied Sciences, Morogoro, Tanzania
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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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Lee L, Moo E, Angelopoulos T, Yashadhana A. Integrated people-centered eye care: A scoping review on engaging communities in eye care in low- and middle-income settings. PLoS One 2023; 18:e0278969. [PMID: 36656849 PMCID: PMC9851534 DOI: 10.1371/journal.pone.0278969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/24/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Community engagement has been endorsed as a key strategy to achieving integrated people-centered eye care that enables people and communities to receive a full spectrum of eye care across their life-course. Understanding the ways communities are engaged in eye care, to what degree participation is achieved, and the factors associated with intervention implementation is currently limited. OBJECTIVE The scoping review aimed to assess how community engagement is approached and implemented in eye care interventions in low- and middle-income countries, and to identify the barriers and facilitators associated with intervention implementation. METHODS Searches were conducted across five databases for peer-reviewed research on eye care interventions engaging communities published in the last ten years (January 2011 to September 2021). Studies were screened, reviewed and appraised according to Cochrane Rapid Reviews methodology. A hybrid deductive-inductive iterative analysis approach was used. RESULTS Of 4315 potential studies screened, 73 were included in the review. Studies were conducted across 28 countries and 55 targeted populations across more than one life-course stage. A variety of community actors were engaged in implementation, in four main domains of eye care: health promotion and education; drug and supplement distribution and immunization campaigns; surveillance, screening and detection activities; and referral and pathway navigation. With the approaches and level of participation, the majority of studies were community-based and at best, involved communities, respectively. Involving community actors alone does not guarantee community trust and therefore can impact eye care uptake. Community actors can be integrated into eye care programs, although with varying success. Using volunteers highlighted sustainability issues with maintaining motivation and involvement when resources are limited. CONCLUSION This scoping review provides researchers and policy makers contextual evidence on the breadth of eye care interventions and the factors to be considered when engaging and empowering communities in integrated people-centered eye care programs.
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Affiliation(s)
- Ling Lee
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
- School of Optometry and Vision Science, The University of New South Wales, Sydney Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Elise Moo
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
| | - Tiffany Angelopoulos
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
| | - Aryati Yashadhana
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
- Centre for Primary Health Care and Equity, The University of New South Wales, Sydney, Australia
- School of Population Health, The University of New South Wales, Sydney, Australia
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Flessa S. Cataract Surgery in Low-Income Countries: A Good Deal! Healthcare (Basel) 2022; 10:healthcare10122580. [PMID: 36554103 PMCID: PMC9778186 DOI: 10.3390/healthcare10122580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Cataract is a major cause of blindness worldwide. In particular, in low-income countries, the burden of disease as well as its direct and indirect economic cost are a major challenge for the population and economy. In many cases, it would be possible to prevent or cure blindness with a comparably simple cataract surgery, but many countries lack the resources to strengthen healthcare systems and implement broad cataract surgery programs reaching, in particular, the rural poor. In this paper, we analyse whether such an intervention could be cost-effective or even cost-saving for the respective health systems. We calculate the net value of the lifelong costs of cataract with and without surgery. This calculation includes direct costs (e.g., treatment, glasses, surgery) as well as indirect cost of the caregiver and the patient. We total all costs from the year of onset of cataract until death and discount the respective values to the year of onset. We define the surgery as cost-saving if the net-value of costs with surgery is lower than without surgery. If the cost per quality adjusted life year is lower than one gross national product per capita, we define the intervention as highly cost-effective. We find that the cost-effectiveness of cataract surgery depends on the age of onset of the disease and the age of surgery. If the surgery is performed with the beginning of severe impairment, even surgery of a 78-year-old patient is still cost-saving. Almost all possible constellations are highly cost-effective, only for the very old it is questionable whether the surgery should be performed. The simulations show that cataract surgery is one of the most cost-effective interventions. However, millions of people in low-income countries still have no chance to prevent or cure blindness due to limited resources. The findings of this paper clearly call for a stronger effort to reach poor and rural populations with this cost-effective service.
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Affiliation(s)
- Steffen Flessa
- Department of Health Care Management, Faculty of Law and Economics, University of Greifswald, 17487 Greifswald, Germany
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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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Hu EH, Buie T, Jensen RJ, Wu D, Pamnani RD. Comparative Study of Safety Outcomes Following Nucleus Disassembly with and without the miLOOP Lens Fragmentation Device During Cataract Surgery. Clin Ophthalmol 2022; 16:2391-2401. [PMID: 35942081 PMCID: PMC9356701 DOI: 10.2147/opth.s370290] [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: 04/11/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the effect of a microinterventional lens prefragmentation wire loop device (miLOOP®; Carl Zeiss Meditec AG, Oberkochen, Germany), on adverse events (AEs), cumulative dispersed energy (CDE), and vision outcomes when used before phacoemulsification of high-grade mature cataracts. Setting Three ambulatory surgical centers in the Peoria, IL region. Design Retrospective comparative consecutive case series; single-surgeon. Methods Patient outcomes were compared before and after introduction of miLOOP-assisted lens fragmentation prior to phacoemulsification during cataract surgeries performed 2016‒2020. The primary outcome was intraoperative AE rate/type. Secondary outcomes included ultrasound cumulative dispersed energy (CDE) administered during phacoemulsification, postoperative AEs, and best-corrected visual acuity (BCVA). Results Data from 765 subjects (mean age 72.9 years; 1025 eyes) comprised 524 conventional lens disassembly (Control) eyes and 501 Device eyes. One hundred percent of the cataracts in both groups were advanced WHO Grade 3+ nuclei. Significantly fewer intraoperative AEs occurred in the Device group versus Controls (2.2% and 6.3% of eyes, respectively; p=0.0011). Postoperative AE rates were comparable between groups (Controls=2.9%, Device=3.5%). Mean CDE from ultrasound was significantly reduced by 21% when the microfilament loop device was used for nuclear disassembly (9.6±5.2 CDE units) versus Controls (11.6±6.4 CDE units; p<0.0001). Median postoperative BCVA was 20/25 Snellen (0.091 logMAR) in both groups. More than 70% of both Control and Device eyes had postoperative BCVA better than 20/30 Snellen. Conclusion Microinterventional lens fragmentation was associated with lower ultrasound energy use and improved intraoperative safety than traditional unassisted surgery of advanced high-grade cataracts, while maintaining similarly acceptable postoperative complication rates and BCVA functional outcomes.
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Affiliation(s)
| | | | | | - David Wu
- University of Illinois at Chicago, Chicago, IL, USA
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Hambisa MT, Dolja-Gore X, Byles J. Application of Andersen-Newman model to assess cataract surgery uptake among older Australian women: findings from the Australian Longitudinal Study on Women's Health (ALSWH). Aging Clin Exp Res 2022; 34:1673-1685. [PMID: 35184260 PMCID: PMC9246771 DOI: 10.1007/s40520-022-02091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although Cataract Surgery Rate is increasing, the availability of surgery is outstripped by the increasing number of cataract cases as populations age. AIM The study aimed to identify factors associated with cataract surgery uptake in terms of predisposing, enabling, and need factors in very old Australian women. METHOD This study used ALSWH data included 6229 women aged 79-84 to 85-90 years. Women were asked whether they had undergone eye surgery (including cataracts) three years prior to each survey. Generalised estimating equation modelling was used to determine factors associated with these surgeries. RESULT At baseline (2005), more than half of the participants either had undergone surgery (43.5%) or had unoperated cataracts (7.6%). Increasing age (AOR = 1.11, 95% CI = 1.07, 1.15) and being current or ex-smokers (AOR = 1.15, 95% CI = 1.03, 1.29) were associated with higher odds of cataract surgery (predisposing factors). Women who had private health insurance had 27% higher odds of having surgery (AOR = 1.27, 95% CI = 1.16, 1.39) (enabling factor). Need factors of more General Practitioner visits (AOR = 1.16, 95% CI = 1.09, 1.25) and skin cancer (AOR = 1.09, 95% CI = 1.01, 1.17) also increased the odds of cataract surgery. Women who had no difficulty seeing newspaper print were more likely to have had cataract surgery (AOR = 1.35, 95% CI = 1.23, 1.48). CONCLUSION Need factors are the major drivers of cataract surgery; however, predisposing and enabling factors also play a role, including access to private health insurance. This finding indicates some inequity regarding access to cataract surgery in the Australian setting.
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Affiliation(s)
- Mitiku Teshome Hambisa
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, 2308, Australia.
- School of Public Health, Haramaya University College of Health and Medical Sciences, P. O. Box 235, Harar, Ethiopia.
| | - Xenia Dolja-Gore
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Julie Byles
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, 2308, Australia
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Keenan TDL, Chen Q, Agrón E, Tham YC, Lin Goh JH, Lei X, Ng YP, Liu Y, Xu X, Cheng CY, Bikbov MM, Jonas JB, Bhandari S, Broadhead GK, Colyer MH, Corsini J, Cousineau-Krieger C, Gensheimer W, Grasic D, Lamba T, Magone MT, Maiberger M, Oshinsky A, Purt B, Shin SY, Thavikulwat AT, Lu Z, Chew EY. Deep Learning Automated Diagnosis and Quantitative Classification of Cataract Type and Severity. Ophthalmology 2022; 129:571-584. [PMID: 34990643 PMCID: PMC9038670 DOI: 10.1016/j.ophtha.2021.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To develop and evaluate deep learning models to perform automated diagnosis and quantitative classification of age-related cataract, including all three anatomical types, from anterior segment photographs. DESIGN Application of deep learning models to Age-Related Eye Disease Study (AREDS) dataset. PARTICIPANTS 18,999 photographs (6,333 triplets) from longitudinal follow-up of 1,137 eyes (576 AREDS participants). METHODS Deep learning models were trained to detect and quantify nuclear cataract (NS; scale 0.9-7.1) from 45-degree slit-lamp photographs and cortical (CLO; scale 0-100%) and posterior subcapsular (PSC; scale 0-100%) cataract from retroillumination photographs. Model performance was compared with that of 14 ophthalmologists and 24 medical students. The ground truth labels were from reading center grading. MAIN OUTCOME MEASURES Mean squared error (MSE). RESULTS On the full test set, mean MSE values for the deep learning models were: 0.23 (SD 0.01) for NS, 13.1 (SD 1.6) for CLO, and 16.6 (SD 2.4) for PSC. On a subset of the test set (substantially enriched for positive cases of CLO and PSC), for NS, mean MSE for the models was 0.23 (SD 0.02), compared to 0.98 (SD 0.23; p=0.000001) for the ophthalmologists, and 1.24 (SD 0.33; p=0.000005) for the medical students. For CLO, mean MSE values were 53.5 (SD 14.8), compared to 134.9 (SD 89.9; p=0.003) and 422.0 (SD 944.4; p=0.0007), respectively. For PSC, mean MSE values were 171.9 (SD 38.9), compared to 176.8 (SD 98.0; p=0.67) and 395.2 (SD 632.5; p=0.18), respectively. In external validation on the Singapore Malay Eye Study (sampled to reflect the distribution of cataract severity in AREDS), MSE was 1.27 for NS and 25.5 for PSC. CONCLUSIONS A deep learning framework was able to perform automated and quantitative classification of cataract severity for all three types of age-related cataract. For the two most common types (NS and CLO), the accuracy was significantly superior to that of ophthalmologists; for the least common type (PSC), the accuracy was similar. The framework may have wide potential applications in both clinical and research domains. In the future, such approaches may increase the accessibility of cataract assessment globally. The code and models are publicly available at https://XXX.
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Affiliation(s)
- Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Qingyu Chen
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | | | - Xiaofeng Lei
- Institute of High Performance Computing, A*STAR, Singapore
| | - Yi Pin Ng
- Institute of High Performance Computing, A*STAR, Singapore
| | - Yong Liu
- Duke-NUS Medical School, Singapore; Institute of High Performance Computing, A*STAR, Singapore
| | - Xinxing Xu
- Duke-NUS Medical School, Singapore; Institute of High Performance Computing, A*STAR, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; Institute of High Performance Computing, A*STAR, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Switzerland; Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
| | - Sanjeeb Bhandari
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Geoffrey K Broadhead
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcus H Colyer
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jonathan Corsini
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD, USA
| | - Chantal Cousineau-Krieger
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - William Gensheimer
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA; Geisel School of Medicine, Dartmouth, NH, USA
| | - David Grasic
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tania Lamba
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | - M Teresa Magone
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Arnold Oshinsky
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | - Boonkit Purt
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Soo Y Shin
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | - Alisa T Thavikulwat
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
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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, Aghaji A, Adewole AT, Csutak A, Salam AS, Paduca A, Bron AM, Denniston AK, Lazo Legua A, Halim A, Tefera AW, Mwangi A, Jenkins AJ, Davis A, Meddeb-Ouertani A, Wali AH, Palis AG, Bastos de Carvalho A, Joshi A, Kreis AJ, Mueller A, Bastawrous A, Cooper A, Smith AF, Grzybowski A, Arvind A, Karanu AM, Orlina AO, Burnett A, Yashadhana A, Abeydeera AP, Abdurakhmanova A, Mohamed A, Bacchav A, Bernhisel A, Webson AW, Azuara-Blanco A, Hossain A, Ilhan B, Assumpta Lucienne B, Tousignant B, Shamanna BR, Wiafe B, Mueller B, Caglar C, Mpyet C, Abraham CH, Cheung CY, Thiel CL, Jan CL, Emedike C, Chuluunkhuu C, Chinyere C, Henein C, Gilbert CE, Bascaran C, Nitulescu CE, Patel D, Bachani D, Kiage D, Etya'ale D, Dahdal D, Woo Lawson D, Godin D, Nkanga DG, Ondeyo DM, O'Brien D, Mutie DM, Alalawi ESK, Mayorga E, Bin Hashim E, Ashrafi E, Kishiki EA, Kurian E, D'Esposito F, Masila F, Pena FY, Büsch F, Topouzis F, Bandello F, Oyediji FJ, Thumann G, Ezz Elarab G, Kitema GF, Schlenther G, Fefoame GO, Cochrane GM, Laganovska G, Awan HR, Ansari HM, Philippin H, Burn H, Dimaras H, Filipe HP, Monye HI, Kandel H, Randrianarisoa HL, Jones I, Murdoch IE, Fabian ID, Khan IA, Sharma IP, Elbeih I, Mactaggart I, Pastor JC, Keunen JEE, Ohuma JA, Pithuwa Nirwoth J, Hammou J, Vianna JR, Biao JE, Burr JM, Keenan JD, Blijkers J, Black JM, Barbosa Breda J, Furtado JM, Buchan JC, Lawrenson JG, Kempen JH, Ehrlich JR, Stern J, Zhang JH, Keskinbora KH, Knoll KM, Blanchet K, Schmid KL, Ono K, Ogundimu K, Balo K, Somda KP, Yeboah K, Amissah-Arthur KN, Nasehi L, Øverland L, Vijaya L, Keay L, Hamm LM, Mowatt L, Harrison-Williams LCM, Silva L, Bilotto L, Mörchen M, Rabiu M, Zondervan M, Chagunda M, Sandinha MT, Yee Melgar M, Salas Vargas M, Daniell MD, Katibeh M, Broom M, Collins ME, Alp MN, Kwarteng MA, Belkin M, Gichangi M, Sylvanowicz M, Wu M, Cano MR, Shalaby M, Duggal M, Khairallah M, Batur M, Bikbov MM, Ramappa M, Pamarathi N, Khachatryan N, Muhammad N, Kennedy N, Murray N, Beare NAV, Astbury N, Carnt NA, St Rose NA, Barker NH, Pehere NK, Uche NJ, Lois N, Awe OO, Mujica OJ, Okolo OE, Rani PK, Ruamviboonsuk P, Ndiaye PA, Dhakhwa P, Rozsival P, Mbulawa PK, Keane PA, Jones PR, Holland P, Nukella PB, Burgess PI, O'Dwyer PA, Piyasena P, Bastola P, Morjaria P, Nasimee Q, Rambacal RAT, Das R, Khandekar RB, Azad R, Bashshur R, Sousa RARC, Oenga R, Gurung R, Geneau R, Jacobs RJ, Finger RP, Guymer RH, Sevciuc R, Khanna RC, George R, Graham R, Kawasaki R, Ho SM, Mishra SK, Buttan S, Block SS, Talero S, Yoon S, Joseph S, Safi S, Dodson S, Munoz SR, Bakayoko S, Mohammadi SF, Muez SA, Pardhan S, Hopkins S, Sheu SJ, Coulibaly SM, Schellini SA, Arunga S, Bush SR, Sivaprasad S, Salomao SR, Marmamula S, Onwubiko SN, Misra SL, Kuyyadiyil S, Kulkarni S, khanal S, Yasmin S, Pavljasevic SN, Gilbert SS, Braithwaite T, Ghidirimschi T, Ravilla T, Fricke TR, Cogliati T, Kassa T, Peto T, Dibb U, Lansingh VC, Hu VH, Sheffield VM, Mathenge W, Dean WH, Nolan W, Hiratsuka Y, Mahsood YJ, Sapkota Y. 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,Correspondence to: Dr Jacqueline Ramke, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - 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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Bechange S, Virendramumar B, Schmidt E. Increasing demand for cataract surgery: lessons from a systematic review. COMMUNITY EYE HEALTH 2022; 35:18. [PMID: 36704528 PMCID: PMC9872211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Stevens Bechange
- Senior Research Advisor: Sightsavers Uganda Country Office, Kampala, Uganda
| | | | - Elena Schmidt
- Director of Evidence, Research and Innovations: Sightsavers United Kingdom, Haywards Heath, UK
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Bechange S, Roca A, Schmidt E, Gillani M, Ahmed L, Iqbal R, Nazir I, Ruddock A, Bilal M, Khan IK, Buttan S, Jolley E. Diabetic retinopathy service delivery and integration into the health system in Pakistan-Findings from a multicentre qualitative study. PLoS One 2021; 16:e0260936. [PMID: 34910755 PMCID: PMC8673653 DOI: 10.1371/journal.pone.0260936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 11/21/2021] [Indexed: 11/18/2022] Open
Abstract
This paper is based on qualitative research carried out in a diabetic retinopathy (DR) programme in three districts of Pakistan. It analyses the organisation and delivery of DR services and the extent to which the interventions resulted in a fully functioning integrated approach to DR care and treatment. Between January and April 2019, we conducted 14 focus group discussions and 37 in-depth interviews with 144 purposively selected participants: patients, lady health workers (LHWs) and health professionals. Findings suggest that integration of services was helpful in the prevention and management of DR. Through the efforts of LHWs and general practitioners, diabetic patients in the community became aware of the eye health issues related to uncontrolled diabetes. However, a number of systemic pressure points in the continuum of care seem to have limited the impact of the integration. Some components of the intervention, such as a patient tracking system and reinforced interdepartmental links, show great promise and need to be sustained. The results of this study point to the need for action to ensure inclusion of DR on the list of local health departments’ priority conditions, greater provision of closer-to-community services, such as mobile clinics. Future interventions will need to consider the complexity of adding diabetic retinopathy to an already heavy workload for the LHWs.
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Affiliation(s)
- Stevens Bechange
- Sightsavers Pakistan Country Office, Islamabad, Pakistan
- * E-mail:
| | - Anne Roca
- Department of Policy and Programme Strategy, Sightsavers, Haywards Heath, United Kingdom
| | - Elena Schmidt
- Department of Policy and Programme Strategy, Sightsavers, Haywards Heath, United Kingdom
| | | | - Leena Ahmed
- Sightsavers Pakistan Country Office, Islamabad, Pakistan
| | - Robina Iqbal
- Sightsavers Pakistan Country Office, Islamabad, Pakistan
| | - Imran Nazir
- Sightsavers Pakistan Country Office, Islamabad, Pakistan
| | - Anna Ruddock
- Department of Policy and Programme Strategy, Sightsavers, Haywards Heath, United Kingdom
| | - Muhammed Bilal
- Sightsavers Pakistan Country Office, Islamabad, Pakistan
| | | | | | - Emma Jolley
- Department of Policy and Programme Strategy, Sightsavers, Haywards Heath, United Kingdom
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Bechange S, Jolley E, Tobi P, Mailu E, Sentongo J, Chulu T, Abony M, Chege M, Mulenga G, Ngorok J, Adera T, Schmidt E. Understanding patient health-seeking behaviour to optimise the uptake of cataract surgery in rural Kenya, Zambia and Uganda: findings from a multisite qualitative study. Int Health 2021; 14:i57-i63. [PMID: 34581785 PMCID: PMC8986356 DOI: 10.1093/inthealth/ihab061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/14/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme. METHODS Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018-2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach. RESULTS Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system. CONCLUSIONS Cultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients' expectations and needs, as strategies for increasing cataract surgery uptake.
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Affiliation(s)
- Stevens Bechange
- Sightsavers Zambia Country Office, 10247 Great East Road, Cresta Golf View, Villa 6, PO Box 37535, Lusaka 10101, Zambia
| | - Emma Jolley
- Sightsavers United Kingdom, 35 Perrymount Road, Haywards Heath, West Sussex, RH16 3BW, UK
| | - Patrick Tobi
- Sightsavers United Kingdom, 35 Perrymount Road, Haywards Heath, West Sussex, RH16 3BW, UK.,Department of Natural Sciences, Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Eunice Mailu
- Sightsavers Kenya Country Office, Studio House, Ground Floor, Argwings Kodhek Road Hurlingham, PO Box 34690 00100 GPO, Nairobi, Kenya
| | - Juliet Sentongo
- Sightsavers Uganda Country Office, Second Floor, EADB Building, 4 Nile Avenue, PO Box 21249, Kampala, Uganda
| | - Titamenji Chulu
- Sightsavers Zambia Country Office, 10247 Great East Road, Cresta Golf View, Villa 6, PO Box 37535, Lusaka 10101, Zambia
| | - Maurice Abony
- Sightsavers Kenya Country Office, Studio House, Ground Floor, Argwings Kodhek Road Hurlingham, PO Box 34690 00100 GPO, Nairobi, Kenya
| | - Moses Chege
- Sightsavers Kenya Country Office, Studio House, Ground Floor, Argwings Kodhek Road Hurlingham, PO Box 34690 00100 GPO, Nairobi, Kenya
| | - Glenda Mulenga
- Sightsavers Zambia Country Office, 10247 Great East Road, Cresta Golf View, Villa 6, PO Box 37535, Lusaka 10101, Zambia
| | - Johnson Ngorok
- Sightsavers Uganda Country Office, Second Floor, EADB Building, 4 Nile Avenue, PO Box 21249, Kampala, Uganda
| | - Tesfaye Adera
- Sightsavers United Kingdom, 35 Perrymount Road, Haywards Heath, West Sussex, RH16 3BW, UK
| | - Elena Schmidt
- Sightsavers United Kingdom, 35 Perrymount Road, Haywards Heath, West Sussex, RH16 3BW, UK
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Sanders R, Gascoyne B, Appleby P, Rashida SA, Jolley E. Eye Health Service Uptake among People with Visual Impairment and Other Functional Difficulties in Bangladesh: A Cross-Sectional Study with Short-Term Follow Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9068. [PMID: 34501657 PMCID: PMC8431586 DOI: 10.3390/ijerph18179068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022]
Abstract
People with visual impairments are disproportionately likely to also have other impairments. However, little is known about whether these other impairments affect access to eye health services. This study among cataract and refractive error patients in four districts in Bangladesh explores the relationship between self-reported difficulties in hearing, mobility, self-care, communication and cognition domains, eye health service uptake, and location of initial eye health assessment. Cataract and refractive errors were diagnosed through ophthalmic clinical assessment, and the Washington Group Short Set (WG-SS) was used to ascertain difficulties in other functional domains. Univariate and multivariate analyses were used to examine the relationship between functional difficulties and uptake of cataract and refractive error services. We found that people with self-reported functional difficulties were less likely to take up refractive error services compared to people with same need but with no functional difficulties, and that they were more than twice as likely to access surgical services after attending an outreach camp compared with a hospital facility. Since a high proportion of people attending eye health assessment services have difficulties in a range of functional domains, strategies to improve the uptake of hospital-based health services are urgently required.
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Affiliation(s)
- Ruth Sanders
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
| | - Ben Gascoyne
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
| | - Paul Appleby
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
| | - Syeda Asma Rashida
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
- Bangladesh Office-Sightsavers, Banani, Dhaka 1213, Bangladesh
| | - Emma Jolley
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
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Pseudoexfoliation and Cataract Syndrome Associated with Genetic and Epidemiological Factors in a Mayan Cohort of Guatemala. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147231. [PMID: 34299682 PMCID: PMC8303577 DOI: 10.3390/ijerph18147231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023]
Abstract
The Mayan population of Guatemala is understudied within eye and vision research. Studying an observational homogenous, geographically isolated population of individuals seeking eye care may identify unique clinical, demographic, environmental and genetic risk factors for blinding eye disease that can inform targeted and effective screening strategies to achieve better and improved health care distribution. This study served to: (a) identify the ocular health needs within this population; and (b) identify any possible modifiable risk factors contributing to disease pathophysiology within this population. We conducted a cross-sectional study with 126 participants. Each participant completed a comprehensive eye examination, provided a blood sample for genetic analysis, and received a structured core baseline interview for a standardized epidemiological questionnaire at the Salama Lions Club Eye Hospital in Salama, Guatemala. Interpreters were available for translation to the patients’ native dialect, to assist participants during their visit. We performed a genome-wide association study for ocular disease association on the blood samples using Illumina’s HumanOmni2.5-8 chip to examine single nucleotide polymorphism SNPs in this population. After implementing quality control measures, we performed adjusted logistic regression analysis to determine which genetic and epidemiological factors were associated with eye disease. We found that the most prevalent eye conditions were cataracts (54.8%) followed by pseudoexfoliation syndrome (PXF) (24.6%). The population with both conditions was 22.2%. In our epidemiological analysis, we found that eye disease was significantly associated with advanced age. Cataracts were significantly more common among those living in the 10 districts with the least resources. Furthermore, having cataracts was associated with a greater likelihood of PXF after adjusting for both age and sex. In our genetic analysis, the SNP most nominally significantly associated with PXF lay within the gene KSR2 (p < 1 × 10−5). Several SNPs were associated with cataracts at genome-wide significance after adjusting for covariates (p < 5 × 10−8). About seventy five percent of the 33 cataract-associated SNPs lie within 13 genes, with the majority of genes having only one significant SNP (5 × 10−8). Using bioinformatic tools including PhenGenI, the Ensembl genome browser and literature review, these SNPs and genes have not previously been associated with PXF or cataracts, separately or in combination. This study can aid in understanding the prevalence of eye conditions in this population to better help inform public health planning and the delivery of quality, accessible, and relevant health and preventative care within Salama, Guatemala.
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Understanding the role of lady health workers in improving access to eye health services in rural Pakistan - findings from a qualitative study. Arch Public Health 2021; 79:20. [PMID: 33597017 PMCID: PMC7890803 DOI: 10.1186/s13690-021-00541-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background In 1994, the Lady Health Workers (LHWs) Programme was established in Pakistan to increase access to essential primary care services and support health systems at the household and community levels. In Khyber Pakhtunkhwa (KPK) province in northern Pakistan, eye care is among the many unmet needs that LHWs were trained to address, including screening and referral of people with eye conditions to health facilities. However, despite an increase in referrals by LHWs, compliance with referrals in KPK has been very low. We explored the role of LHWs in patient referral and the barriers to patient compliance with referrals. Methods Qualitative methodology was adopted. Between April and June 2019, we conducted eight focus group discussions and nine in-depth interviews with 73 participants including patients, LHWs and their supervisors, district managers and other stakeholders. Data were analysed thematically using NVivo software version 12. Results LHWs have a broad understanding of basic health care and are responsible for a wide range of activities at the community level. LHWs felt that the training in primary eye care had equipped them with the skills to identify and refer eye patients. However, they reported that access to care was hampered when referred patients reached hospitals, where disorganised services and poor quality of care discouraged uptake of referrals. LHWs felt that this had a negative impact on their credibility and on the trust and respect they received from the community, which, coupled with low eye health awareness, influenced patients’ decisions about whether to comply with a referral. There was a lack of trust in the health care services provided by public sector hospitals. Poverty, deep-rooted gender inequities and transportation were the other reported main drivers of non-adherence to referrals. Conclusions Results from this study have shown that the training of LHWs in eye care was well received. However, training alone is not enough and does not result in improved access for patients to specialist services if other parts of the health system are not strengthened. Pathways for referrals should be agreed and explicitly communicated to both the health care providers and the patients.
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