Toward Universal Eye Health Coverage-Key Outcomes of the World Health Organization Package of Eye Care Interventions: A Systematic Review

Importance

Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed.

Objective

To describe the key outcomes of the PECI development.

Evidence Review

A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review.

Findings

Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI.

Conclusions and Relevance

This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.

What Do Patients Expect of Health Care Providers? Patient Perceptions and Expectations of Professionalism in Optometry Practice in KwaZulu-Natal, South Africa

BACKGROUND: Professionalism, which includes factors such as attire, hygiene, communication skills, compassion and empathy; has not been previously investigated in the discipline of Optometry and yet is known to be influential in building patient-practitioner relationships. METHODS: This study was conducted at public and private eye care facilities in KwaZulu-Natal (KZN), South Africa. Convenience sampling was used to select 600 participants and data collected with a self-administered questionnaire. Data was analyzed using SPSS version 25. RESULTS: Attire was considered a competency indicator by the majority of participants (70.1%). Practitioners who exercised good hygiene were regarded as being more competent (73.3%). More than half (57.4%) of the respondents perceived an optometrist who wears glasses as more professional and likely to better understand their condition. A practitioner who smelled of cigarette smoke was considered unprofessional (67.3%). The use of simple terms was preferred by 88.5%, while 75.6% respondents felt that an optometrist who introduces themselves and maintained eye contact is more reliable. Most respondents (65%) believed that an optometrist who considers their lifestyle and finance was more trustworthy. CONCLUSIONS: Overall, physical appearance and other factors such as hygienic practices, communication skills and empathy appear to be important contributors to patient perspectives of professionalism in optometrists. Health care practitioners would therefore do well to consider these factors and soft skills in advancing the public’s perception of them and apply them to routine practice to build trust with patients.