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Lieng MK, Emami-Naeini P, Lee SC, Alber S, Yiu G. Teleophthalmology provides earlier eye care access for patients with newly-diagnosed diabetes. Heliyon 2024; 10:e25845. [PMID: 38384560 PMCID: PMC10878910 DOI: 10.1016/j.heliyon.2024.e25845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
Purpose Timely diagnosis of diabetic retinopathy is important in preventing vision loss. This study aims to determine if remote retinal imaging enables earlier eye care access among newly-diagnosed diabetic patients. Design Retrospective cohort study. Methods Using the OptumLabs® Data Warehouse - a longitudinal, real-world dataset containing deidentified administrative claims and electronic health record (EHR) data, we included 968 846 adults with newly diagnosed type 2 diabetes and at least 1 year of continuous enrollment. We compared time from initial diabetes diagnosis to first eye exam by remote screening or in-person eye exam. Results We found that at year 1 after diagnosis, 5459 (0.56%) patients underwent remote imaging and 208 023 (21.5%) underwent in-person exam. The mean (95% CI) time to eye exam was 3.48 (3.38-3.58) months for remote imaging and 4.22 (4.20-4.23) months for in-person visits (p < 0.0001). Interestingly, 27.5% of remote screenings were performed on the same day of diabetes diagnosis. Excluding same-day encounters, mean time to eye exam was 4.80 (4.68-4.91) months for remote imaging and 4.85 (4.83-4.86) months for in-person eyecare (p = 0.4). Conclusions Thus, teleophthalmology may enable earlier eye care access among patients with newly-diagnosed diabetes, primarily with same-day screenings. Increased adoption of teleretinal screening may enable earlier detection of diabetic retinopathy and prevent vision loss.
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Affiliation(s)
- Monica K. Lieng
- Tschannen Eye Institute, University of California, Davis, Sacramento, CA, USA
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Parisa Emami-Naeini
- Tschannen Eye Institute, University of California, Davis, Sacramento, CA, USA
| | - Sophie C. Lee
- Tschannen Eye Institute, University of California, Davis, Sacramento, CA, USA
| | - Susan Alber
- Department of Public Health Sciences / Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento, CA, USA
| | - Glenn Yiu
- Tschannen Eye Institute, University of California, Davis, Sacramento, CA, USA
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Rooth V, van der Aa H, Wisse RPL, Maarsingh OR, Koopmanschap M, Keunen JEE, Vermeulen H, Klaver CCW, Janssen G, van Rens GHMB, van Nispen RMA. Health economic evaluation of a nurse-assisted online eye screening in home healthcare to reduce avoidable vision impairment (iScreen): study protocol for a cluster randomized controlled trial. Trials 2024; 25:102. [PMID: 38308377 PMCID: PMC10835833 DOI: 10.1186/s13063-023-07882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/15/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Among older people undiagnosed and untreated vision impairment and blindness are common. The leading causes are uncorrected refractive errors and cataracts. Vision problems are associated with a lower quality of life, several health problems, and a higher chance of falling accidents and fractures. To eliminate avoidable vision impairment and blindness, targeted eye screening programs are recommended. Older patients, receiving home healthcare, have not yet been considered as a population at risk who could benefit from eye screening. METHODS A cluster-randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of online nurse-assisted eye screening in home healthcare, compared to care as usual, in reducing avoidable vision impairment. A healthcare and societal perspective will be used. The study will be performed in collaboration with several home healthcare organizations in the Netherlands. The online eye screening consists of near and distance visual acuity, followed by an Amsler grading test. Measurements in both groups will take place at baseline and after 6 and 12 months of follow-up. A total of 240 participants will be recruited. Older men and women (65 +), who receive home-based nursing and are cognitively able to participate, will be included. The primary outcome will be the change of two lines or more on the Colenbrander-1 M visual acuity chart between baseline and 12-month follow-up. DISCUSSION An eye screening for populations at risk contributes to the detection of undiagnosed and untreated vision impairment. This may reduce the health-related consequences of vision loss and the high economic burden associated with vision impairment. TRIAL REGISTRATION ClinicalTrials.gov NCT06058637. Registered on 27 September 2023.
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Affiliation(s)
- Vera Rooth
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands.
| | - Hilde van der Aa
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Robert P L Wisse
- Department of Ophthalmology, UMC Utrecht, Utrecht, The Netherlands
| | - Otto R Maarsingh
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
- General Practice, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marc Koopmanschap
- Erasmus School of Health Policy & Management, Health Technology Assessment (HTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan E E Keunen
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
- Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | | | - Ger H M B van Rens
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
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Divya Parthasarathy Rao, Kalpa Negiloni, Sivasundaravadivel Gurunathan, Selvaraj Velkumar, Anand Sivaraman, Adeeb Ulla Baig, B. Kumari, Kaushik Murali. Validation of a simple-to-use, affordable, portable, wavefront aberrometry-based auto refractometer in the adult population: A prospective study. BMC Ophthalmol 2022; 22:498. [PMID: 36536321 DOI: 10.1186/s12886-022-02684-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Refraction is one of the key components of a comprehensive eye examination. Auto refractometers that are reliable and affordable can be beneficial, especially in a low-resource community setting. The study aimed to validate the accuracy of a novel wave-front aberrometry-based auto refractometer, Instaref R20 against the open-field system and subjective refraction in an adult population. METHODS All the participants underwent a comprehensive eye examination including objective refraction, subjective acceptance, anterior and posterior segment evaluation. Refraction was performed without cycloplegia using WAM5500 open-field auto refractometer (OFAR) and Instaref R20, the study device. Agreement between both methods was evaluated using Bland-Altman analysis. The repeatability of the device based on three measurements in a subgroup of 40 adults was assessed. RESULTS The refractive error was measured in 132 participants (mean age,30.53 ± 9.36 years, 58.3% female). The paired mean difference of the refraction values of the study device against OFAR was - 0.13D for M, - 0.0002D (J0) and - 0.13D (J45) and against subjective refraction (SR) was - 0.09D (M), 0.06 (J0) and 0.03D (J45). The device agreed within +/- 0.50D of OFAR in 78% of eyes for M, 79% for J0 and 78% for J45. The device agreed within +/- 0.5D of SR values for M (84%), J0 (86%) and J45 (89%). CONCLUSION This study found a good agreement between the measurements obtained with the portable autorefractor against open-field refractometer and SR values. It has a potential application in population-based community vision screening programs for refractive error correction without the need for highly trained personnel.
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Abstract
This study aimed to survey the factors influencing attendance to eye screening among Diabetes mellitus (DM) patients. This cross-sectional survey was carried out among 170 DM patients using self-administered questionnaires. Majority of participants, 45.9% (n=78) highlighted that lack of information regarding diabetes and not understanding the significance of eye screening are the barriers to eye screening. Whereas, 10.6% (n=18) reported lack of access to healthcare facilities, 6.5% (n=11) experienced time limitation and 2.9% (n=5) suffered financial issues. However, more than half of the participants (58.2%) have good knowledge related to diabetic eye complications. There was a significant difference between educational level with patients' attendance in yearly eye screening. Lack of information received by the patients on the importance of eye screening and communication issues seems to be prominent and becomes the reason for patients not attending eye screening.
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Affiliation(s)
- Rif'atunnailah Mat Isa
- Kulliyyah of Nursing, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Sanisah Saidi
- Kulliyyah of Nursing, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Adzura Salam
- Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Mohd Said Nurumal
- Kulliyyah of Nursing, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Teow Kheng Leong K, Abu Kassim SNA, Sidhu JK, Zohari Z, Sivalingam T, Ramasamy S, Mohd Khialdin S, Mohd Nordin N, Rahmat J. Neonatal eye screening for 203 healthy term new-borns using a wide-field digital retinal imaging system. BMC Ophthalmol 2021; 21:128. [PMID: 33750348 PMCID: PMC7941744 DOI: 10.1186/s12886-021-01882-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background The current practice for new-born eye examination by an Ophthalmologist in Malaysian hospitals is limited to only preterm new-borns, syndromic or ill infants. Healthy term new-borns are usually discharged without a thorough eye examination. This study is aimed at determining the proportion and types of ocular abnormalities detected in purportedly healthy term new-borns. Method This cross-sectional study is comprised of 203 participants, all purportedly healthy term new-born infants from the Obstetrics and Gynaecology ward at Hospital Kuala Lumpur over a 6 months period. The examination list includes external eye examination, red reflex test, and fundus imaging using a wide-field digital retinal imaging system (Phoenix Clinical ICON Paediatric Retinal Camera) by a trained Investigator. The pathologies detected were documented. The results were compared and correlated with similar studies published in the literature previously. Results Total ocular abnormalities were detected in 34% of the infants. The most common finding was retinal haemorrhage in 29.6% of the infants, of which 53.3% occurred bilaterally. Spontaneous vaginal delivery (SVD) remained the greatest risk factor which has nearly 3.5 times higher risk of new-borns developing retinal haemorrhage compared to Lower Segment Caesarean Section (LSCS). There was a 6% increased likelihood of developing retinal haemorrhage for every 1-min increment in the duration of 2nd stage of labour. Conclusion Universal eye screening for all new-borns using a wide-field digital imaging system is realistically possible, safe, and useful in detecting posterior segment disorders. The most common abnormality detected is retinal haemorrhage.
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Affiliation(s)
- Kenneth Teow Kheng Leong
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia. .,Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia.
| | | | - Jasvinjeet Kaur Sidhu
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Zayani Zohari
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Thivakar Sivalingam
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Sunder Ramasamy
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Safinaz Mohd Khialdin
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Noraihan Mohd Nordin
- Department of Obstetrics & Gynaecology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Jamalia Rahmat
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
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Metreş Ö, Yıldız S. Pain Management with ROP Position in Turkish Preterm Infants During Eye Examinations: A Randomized Controlled Trial. J Pediatr Nurs 2019; 49:e81-e89. [PMID: 31495577 DOI: 10.1016/j.pedn.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/22/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of infant positioning on pain, heart rate, oxygen saturation and crying time during examination. DESIGN & METHODS The randomized controlled experimental study was carried out on 70 preterm infants. ROP position + pacifier was used in the experimental group (n = 35) while only the pacifier was used in the control group. Heart rates, oxygen saturation, crying duration and pain score (Premature Infant Pain Profile-PIPP) were evaluated before, during and after the screening. RESULTS The preterm infants in the experimental group recorded lower pain scores at the beginning of the screening (p = 0.01), at the end of the screening (p = 0.01) and after screening (p = 0.01) than those in the control group. The heart rate was higher in the control group during screening (p = 0.010) and after screening (p = 0.008) than in the preterm infants in the experimental group. Oxygen saturation was not significantly different between the groups before, during or after screening. Crying duration was lower in the experimental group than in the control group (p = 0.010). CONCLUSIONS Positioning of the infant to support behavioral organization was found to be effective in reducing pain and shortening crying time during eye examination, and had favorable effects on physiological variables with ROP position during eye examinations. PRACTICE IMPLICATIONS ROP position is a practical and effective non-pharmacological method during eye examinations by neonatal nurses.
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Affiliation(s)
- Özlem Metreş
- The Turkısh Republıc of Demiroglu Bilim University, Faculty of Health Scıences, İstanbul, Turkey.
| | - Suzan Yıldız
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Department of Child Health and Diseases Nursing, İstanbul, Turkey.
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Rahim SS, Palade V, Shuttleworth J, Jayne C. Automatic screening and classification of diabetic retinopathy and maculopathy using fuzzy image processing. Brain Inform 2016; 3:249-267. [PMID: 27747815 PMCID: PMC5106407 DOI: 10.1007/s40708-016-0045-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/24/2016] [Indexed: 10/29/2022] Open
Abstract
Digital retinal imaging is a challenging screening method for which effective, robust and cost-effective approaches are still to be developed. Regular screening for diabetic retinopathy and diabetic maculopathy diseases is necessary in order to identify the group at risk of visual impairment. This paper presents a novel automatic detection of diabetic retinopathy and maculopathy in eye fundus images by employing fuzzy image processing techniques. The paper first introduces the existing systems for diabetic retinopathy screening, with an emphasis on the maculopathy detection methods. The proposed medical decision support system consists of four parts, namely: image acquisition, image preprocessing including four retinal structures localisation, feature extraction and the classification of diabetic retinopathy and maculopathy. A combination of fuzzy image processing techniques, the Circular Hough Transform and several feature extraction methods are implemented in the proposed system. The paper also presents a novel technique for the macula region localisation in order to detect the maculopathy. In addition to the proposed detection system, the paper highlights a novel online dataset and it presents the dataset collection, the expert diagnosis process and the advantages of our online database compared to other public eye fundus image databases for diabetic retinopathy purposes.
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Affiliation(s)
- Sarni Suhaila Rahim
- Faculty of Engineering, Environment and Computing, Coventry University, Priory Street, Coventry, CV1 5FB UK
- Faculty of Information and Communication Technology, Universiti Teknikal Malaysia Melaka, Hang Tuah Jaya, 76100 Durian Tunggal, Melaka Malaysia
| | - Vasile Palade
- Faculty of Engineering, Environment and Computing, Coventry University, Priory Street, Coventry, CV1 5FB UK
| | - James Shuttleworth
- Faculty of Engineering, Environment and Computing, Coventry University, Priory Street, Coventry, CV1 5FB UK
| | - Chrisina Jayne
- Faculty of Engineering, Environment and Computing, Coventry University, Priory Street, Coventry, CV1 5FB UK
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De-Gaulle VF, Dako-Gyeke P. Glaucoma awareness, knowledge, perception of risk and eye screening behaviour among residents of Abokobi, Ghana. BMC Ophthalmol 2016; 16:204. [PMID: 27855682 PMCID: PMC5114832 DOI: 10.1186/s12886-016-0376-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
Background Although glaucoma is the lead cause of irreversible blindness globally, the condition shows no signs or symptoms until later stages. Knowledge about the disease is known to influence utilization of eye screening services. This study aimed at understanding knowledge and perception of risk for glaucoma, as well as eye screening behaviour among residents of Abokobi, a peri-urban community. Methods This was a cross-sectional study that employed quantitative data collection methods, with the use of a questionnaire. Descriptive statistics were used to describe the socio-demographic characteristics, knowledge about glaucoma and eye screening behaviour. Also, associations between socio-demographic factors and awareness as well as perception of risk were analysed using Chi-square test or Univariate Fisher’s exact test. Results Out of a total of 300 respondents, 60.3 % were females and 39.3 % were aware of glaucoma. Majority (99.1 %) of respondents aware of glaucoma also agreed the disease can result in blindness with only (28 %) affirming that blindness from glaucoma is irreversible. Nearly half (49.7 %) of the respondents perceived themselves to be at risk of developing glaucoma. The results showed that age and education (p <0.0001) were statistically significant with glaucoma awareness. Approximately, 20.7 % of the respondents have had their eye screened with just a few (4.3 %) screening for glaucoma. Conclusion Although glaucoma awareness was high, the findings display inadequate knowledge about glaucoma. There is a need to effectively inform and educate people about the disease. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0376-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Virtue Fiawokome De-Gaulle
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana.
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
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Abokyi S, Ilechie A, Nsiah P, Darko-Takyi C, Abu EK, Osei-Akoto YJ, Youfegan-Baanam M. Visual impairment attributable to uncorrected refractive error and other causes in the Ghanaian youth: The University of Cape Coast Survey. J Optom 2016; 9:64-70. [PMID: 26025809 PMCID: PMC4705321 DOI: 10.1016/j.optom.2015.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To determine the prevalence of visual impairment attributable to refractive error and other causes in a youthful Ghanaian population. METHODS A prospective survey of all consecutive visits by first-year tertiary students to the Optometry clinic between August, 2013 and April, 2014. Of the 4378 first-year students aged 16-39 years enumerated, 3437 (78.5%) underwent the eye examination. The examination protocol included presenting visual acuity (PVA), ocular motility, and slit-lamp examination of the external eye, anterior segment and media, and non-dilated fundus examination. Pinhole acuity and fundus examination were performed when the PVA≤6/12 in one or both eyes to determine the principal cause of the vision loss. RESULTS The mean age of participants was 21.86 years (95% CI: 21.72-21.99). The prevalence of bilateral visual impairment (BVI; PVA in the better eye ≤6/12) and unilateral visual impairment UVI; PVA in the worse eye ≤6/12) were 3.08% (95% CI: 2.56-3.72) and 0.79% (95% CI: 0.54-1.14), respectively. Among 106 participants with BVI, refractive error (96.2%) and corneal opacity (3.8%) were the causes. Of the 27 participants with UVI, refractive error (44.4%), maculopathy (18.5%) and retinal disease (14.8%) were the major causes. There was unequal distribution of BVI in the different age groups, with those above 20 years having a lesser burden. CONCLUSION Eye screening and provision of affordable spectacle correction to the youth could be timely to eliminate visual impairment.
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Affiliation(s)
- Samuel Abokyi
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Central Region, Ghana.
| | - Alex Ilechie
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Central Region, Ghana
| | - Peter Nsiah
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Central Region, Ghana
| | - Charles Darko-Takyi
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Central Region, Ghana
| | - Emmanuel Kwasi Abu
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Central Region, Ghana
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