Millennium development goals and eye health

Management Of Glaucoma In Developing Countries: Challenges And Opportunities For Improvement

Glaucoma is the leading cause of blindness in the developed and developing world. Not only is the clinical impact of this disease considerable, but associated economic and humanistic burdens - affecting patients, caregivers, and society - are substantial. Since glaucoma is an age-related disorder and populations in many developing countries are aging at a faster pace than in the developed world, increasing attention is being focused on ways to ameliorate the burdens of illness. In this paper, we examine the burdens of glaucoma with particular focus on developing countries, discuss some of the challenges that exist in delivering optimal glaucoma management within budget constraints, and bring into perspective how we could improve current healthcare systems, leverage technology, and strike an appropriate balance between cost and quality of care, thereby offering considerations to payors and policymakers in these countries that may result in longer-term cost savings, while concurrently striving to achieve the WHO Vision on the prevention of blindness and visual impairment.

A Randomized Noninferiority Trial of Wearing Adjustable Glasses versus Standard and Ready-made Spectacles among Chinese Schoolchildren: Wearability and Evaluation of Adjustable Refraction III

PURPOSE

To compare wear of standard, adjustable, and ready-made glasses among children.

DESIGN

Randomized, controlled, open-label, noninferiority trial.

PARTICIPANTS

Students aged 11 to 16 years with presenting visual acuity (VA) ≤6/12 in both eyes, correctable to ≥6/7.5, subjective spherical equivalent refractive error (SER) ≤-1.0 diopters (D), astigmatism and anisometropia both <2.00 D, and no other ocular abnormalities.

METHODS

Participants were randomly allocated (1:1:1) to standard glasses, ready-made glasses, or adjustable glasses based on self-refraction. We recorded glasses wear on twice-weekly covert evaluation by head teachers (primary outcome), self-reported and investigator-observed wear, best-corrected visual acuity (BCVA) (not prespecified), children's satisfaction, and value attributed to glasses.

MAIN OUTCOME MEASURE

Proportion of glasses wear on twice-weekly covert evaluation by head teachers over 2 months.

RESULTS

Among 379 eligible participants, 127 were allocated to standard glasses (mean age, 13.7 years; standard deviation [SD], 1.0 years; 54.3% were male), 125 to ready-made (mean age, 13.6; SD, 0.83; 45.6%), and 127 to adjustable (mean age, 13.4 years; SD, 0.85; 54.3%). Mean wear proportion of adjustable glasses was significantly lower than for standard glasses (45% vs. 58%; P = 0.01), although the adjusted difference (90% confidence interval [CI], -19.0% to -3.0%) did not meet the prespecified inferiority threshold of 20%. Self-reported (90.2% vs. 84.8%, P = 0.64) and investigator-observed (44.1% vs. 33.9%, P = 0.89) wear did not differ between standard and adjustable glasses, nor did satisfaction with (P = 0.97) or value attributed to study glasses (P = 0.55) or increase in quality of life (5.53 [SD, 4.47] vs. 5.68 [SD, 4.34] on a 100-point scale, P > 0.30). Best-corrected visual acuity with adjustable glasses was better (P < 0.001) than with standard glasses. Change in power of study lenses at the end of the study (adjustable: 0.65 D, 95% CI, 0.52-0.79; standard, 0.01 D; 95% CI, -0.006 to 0.03, P < 0.001) was greater for adjustable glasses, although interobserver variation in power measurements may explain this. Lens scratches and frame damage were more common with adjustable glasses, whereas lens breakage was less common than for standard glasses.

CONCLUSIONS

Proportion of wear was lower with adjustable glasses, although VA was better and measures of satisfaction and quality of life were not inferior to standard glasses.

Leaving No One Behind: Strengthening Access to Eye Health Programs for People With Disabilities in 6 Low- and Middle-Income Countries

PURPOSE

To assess the impact of inclusive eye health programs for people with disabilities.

DESIGN

A synthesis evaluation study.

METHODS

A cross-disciplinary team of ophthalmologists, evaluation, and disability-inclusive development advisors purposively selected evaluation reports of CBM-supported inclusive eye health programs in low- and middle-income countries. Employing a change-promoting paradigm, salient achievements and challenges were narratively analyzed and recommendations suggested based on a previously developed framework for strengthening disability inclusion in eye health programs.

RESULTS

Evaluations from 10 programs implemented in 6 countries (Cambodia, Egypt, Ethiopia, Indonesia, Pakistan, Vietnam) from 2011 to 2016 were identified. Training of medical staff and government officials resulted in increased awareness about disability rights and improved physical accessibility of eye health facilities. Relevant information about inclusion in eye health was incorporated in national eye health training curricula in some countries. Information, education, and communication material about eye health neglected patients with hearing and learning impairments. An overly narrow focus on disability inclusion confounded intersectoral barriers to eye health services. Collaboration of eye health staff with disability peoples organizations improved significantly but evidence of its impact was elusive. Collection of disability-disaggregated data posed significant challenges and made it difficult to demonstrate increased access to eye health programs by people with disabilities.

CONCLUSIONS

Introduction of disability inclusion in eye health systems of countries with limited resources poses significant challenges. Future programs striving to improve access to eye health services for marginalized populations including people with disabilities might consider more flexible and contextualized approaches.

Towards Universal Eye Health: Hospital-based disability-disaggregated data collection in Takeo province, Cambodia

BACKGROUND

Universal access and equity are salient principles of the World Health Organization global action plan 'Towards Universal Eye Health'. However, collection of disability-disaggregated data to measure access to eye hospitals in low- and middle income countries, including referral to rehabilitative services, are not routinely integrated into Health Management Information Systems.

OBJECTIVE

This report presents secondary-data analysis of disability-disaggregated data collection that was introduced at a tertiary eye hospital in a rural province in Cambodia.

METHODS

A modified version of the Washington Group Short Set of Questions was used to count the number of eye patients with self-reported difficulties. The number of referrals of patients with unavoidable visual impairment to low vision services as well as referral to rehabilitative services was also counted.

RESULTS

From 2011 to 2016, out of 182,327 patients overall 4981 (2.7%; 95% CI 2.66-2.81) reported difficulties with hearing, moving or communicating in addition to visual or other eye-related problems. Most of the difficulties were reported in the age group of patients aged 50 years and older (89.8% [95% CI 88.9-90.6]). All together 901 (0.5%; 95% CI 0.46-0.53) patients were treated at the low vision unit and 652 (0.36%; 95% CI 0.33-0.39) patients were referred to rehabilitation services. The number of referrals to rehabilitation declined annually from the year 2013-2016.

CONCLUSIONS

Patients with self-reported impairments constitute a significant proportion of the eye hospital's population. A modified version of the Washington Group Short Set of Questions enabled routine disability-disaggregated data collection but resulted also in possible under-reporting of difficulties.