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We compared recruitment of participants at high risk for glaucoma and other eye diseases in three community-based studies designed to improve access to eye care in underserved populations in New York City, Alabama, and Michigan. We used (1) participant data collected at enrollment (e.g. demographic, medical conditions, healthcare access, and method of hearing about study) and (2) interviews with study staff to assess effective recruitment strategies in enrolling people at high risk for eye disease. We analyzed participant data using descriptive statistics and interview data using content analysis to categorize responses to questions. In these community-based studies, all sites recruited greater proportions of populations with increased risk of eye disease compared to their estimates in the US population. High-risk characteristics varied based on the setting (i.e. Federally Qualified Health Centers or affordable housing buildings). Older adults represented 35% to 57%; 43% to 56% identified as Black; 1% to 40% as Hispanic/Latino; 20% to 42% reported a family history of glaucoma; 32% to 61% reported diabetes; and 50% to 67% reported high blood pressure. Social risk factors for under-utilization of eye care due to poverty included that 43% to 70% of participants had high school or lower education; 16% to 40% were employed; and 7% and 31% had no health insurance. From a qualitative perspective, active, personalized, culturally sensitive methods were most effective in recruiting participants. Implementing eye disease detection interventions in community-based settings facilitated recruiting individuals at high risk for glaucoma and other eye diseases. [ABSTRACT FROM AUTHOR]

The key predictor variable for each model was whether the participant reported diagnosis of macular degeneration, diabetic retinopathy, glaucoma, or cataracts. In this study, we included adults (age>=40) who indicated having a previous diagnosis of ARMD, DR, glaucoma, or cataracts. [Extracted from the article]

Epidemiological information is expected to be used to develop key aspects of eye care such as to control and minimise the impact of diseases, to allocate resources, to monitor public health actions, to determine the best treatment options and to forecast the consequence of diseases in populations. Epidemiological studies are expected to provide information about the prevalence and/or incidence of eye diseases or conditions. To determine prevalence is necessary to perform a cross-sectional screening of the population at risk to ascertain the number of cases. The aim of this review is to describe and evaluate capture-recapture methods (or models) to ascertaining the number of individuals with a disease (e.g. diabetic retinopathy) or condition (e.g. vision impairment) in the population. The review covers the fundamental aspects of capture-recapture methods that would enable non-experts in epidemiology to use it in ophthalmic studies. The review provides information about theoretical aspects of the method with examples of studies in ophthalmology in which it has been used. We also provide a problem/solution approach for limitations arising from the lists obtained from registers or other reliable sources. We concluded that capture-recapture models can be considered reliable to estimate the total number of cases with eye conditions using incomplete information from registers. Accordingly, the method may be used to maintain updated epidemiological information about eye conditions helping to tackle the lack of surveillance information in many regions of the globe. [ABSTRACT FROM AUTHOR]

Purpose: To describe cataract services in Egypt and explore resources and practices in public and private sectors. Methods: The study was conducted between June and August 2015. All facilities in the country providing cataract services were contacted to obtain information on surgeries performed in 2014. Hospitals performing eye surgery in Quena, Sharkia, and Fayoum regions were visited and a questionnaire on resources for cataract surgery was completed. Results: Cataract surgery was offered in the public sector by 64 government and 16 university teaching hospitals and in the private sector by 101 hospitals. Over 90% of all facilities in the country contacted participated in the study. In 2014, the national cataract surgical rate (CSR) was 3674 varying in governorates from 7579 in Ismailia to 402 in Suez. The private sector performed 70% of cataract surgeries. Analysis of three regions showed an 11.7% increase in cataract output between 2010 and 2014. The average number of cataract surgeries per unit in 2014 was 2272 in private, 1633 in university, and 824 in government hospitals. Private hospitals had 60% of human resources for eye care. Phacoemulsification was the surgical technique in 85.6% of private, 72.1% of university, and 41% of government hospitals. Reasons explaining the differences in output between public and private sectors were the lack of trainers, supervisors, and incentives. Conclusion: The private sector provides most of the cataract services in Egypt, resulting in inadequate services for the poor. There is a 15-fold variation in CSR between the best and least served regions. The public sector could increase cataract output by improving training, supervision, and incentives. [ABSTRACT FROM AUTHOR]

Purpose: Gender and blindness initiatives continue to make eye care personnel aware of the service utilization inequity strongly favouring men, yet interventions to reduce that inequity, particularly for girls, are under developed. Methods: This descriptive study gathered quantitative data on the degree of gender equity at five Child Eye Health Tertiary Facilities (CEHTFs) in Asia and Africa and conducted in-depth interviews with eye care personnel to assess their strategies and capacity to reduce gender inequity. Cataract surgery was utilized to assess the degree of inequity and success of interventions to reduce inequity in case finding, service utilization, and follow-up. Results: CEHTF administrative data showed significant gender inequity in cataract surgical services favouring boys in all settings. CEHTFs actively seek children through community and school-based outreach, yet do not have initiatives to reduce gender inequity. Little gender inequity was found among children receiving surgical and follow-up care, although two out of three children were boys. CEHTF staff, despite being aware, offered no effective means to reduce gender inequity involving cataract surgical services. Interventions that successfully increased service utilization by girls came from individual cases, involving extraordinary effort by a single eye care programme person. Conclusion: Community-based case finders such as Anganwadi workers in India, Female Community Health Volunteers (FCHVs) in Nepal, and Key Informants (KIs) in Africa are necessary to identify children in need of cataract services, but insufficient to increase service utilization by girls. Secondary, often extra-ordinary community-based interventions by eye care personnel are needed in all settings. [ABSTRACT FROM AUTHOR]

Purpose: Myopia is a complex condition leading to visual impairment and blindness. This study assessed the prevalence of and risk factors for myopia among schoolchildren in urban and rural areas of Armenia. Methods: A cross-sectional interviewer-administered survey together with eye screenings was conducted among schoolchildren in the capital Yerevan and in Gegharkunik Province. The study used multi-stage random sampling to obtain the sample of 1260 schoolchildren. Study questionnaires were developed based on the Sydney Myopia Study questionnaire. Continuous reading was defined as the average number of hours spent reading or on near work without a break. Children underwent measurements of visual acuity using a Golovin-Sivtsev eye chart, cycloplegic retinoscopy, and dilated fundus examination. Results: The mean age of the children was 13 years, and myopia was present in 18.1%. The prevalence of myopia was higher among Yerevan children (23.3%) than those living in Gegharkunik Province (12.5%). In the adjusted model, myopia was significantly associated with age (odds ratio, OR, 1.11, 95% confidence interval, CI, 1.04–1.18), region (OR 2.40, 95% CI 1.62–3.57), school achievement (OR 1.62, 95% CI 1.05–2.51), parental myopia (OR 2.89, 95% CI 1.79–4.69), and continuous reading (OR 1.99, 95% CI 1.31–3.02), but not near work (OR 0.97, 95% CI 0.89–1.05). Conclusion: The study found that a positive family history of myopia and environmental factors had independent associations with myopia. The number of near work hours did not play a major role in the development of myopia, but length of time of focused continuous reading did. [ABSTRACT FROM AUTHOR]

Purpose: This paper describes the rationale, study design and procedures of the National Eye Survey of Trinidad and Tobago (NESTT). The main objective of this survey is to obtain prevalence estimates of vision impairment and blindness for planning and policy development. Methods: A population-based, cross-sectional survey was undertaken using random multistage cluster sampling, with probability-proportionate-to-size methods. Eligible participants aged 5 years and older were sampled from the non-institutional population in each of 120 cluster segments. Presenting distance and near visual acuity were screened in their communities. People aged 40 years and older, and selected younger people, were invited for comprehensive clinic assessment. The interview included information on potential risk factors for vision loss, associated costs and quality of life. The examination included measurement of anthropometrics, blood glucose, refraction, ocular biometry, corneal hysteresis, and detailed assessment of the anterior and posterior segments, with photography and optical coherence tomography imaging. Adult participants were invited to donate saliva samples for DNA extraction and storage. Results: The fieldwork was conducted over 13 months in 2013–2014. A representative sample of 10,651 individuals in 3410 households within 120 cluster segments identified 9913 people who were eligible for recruitment. Conclusion: The study methodology was robust and adequate to provide the first population-based estimates of the prevalence and causes of visual impairment and blindness in Trinidad and Tobago. Information was also gathered on risk factors, costs and quality of life associated with vision loss, and on normal ocular parameters for the population aged 40 years and older. [ABSTRACT FROM AUTHOR]

Purpose: To examine whether the local availabilities of ophthalmologists and optometrists were associated with outcomes related to the prevention and timely treatment of vision conditions. Methods: Data on adults from the 2008 National Health Interview Survey were linked to county-level information on the numbers of ophthalmologists and optometrists per capita from the Area Health Resources File. Multivariate logistic regression models were estimated for whether individuals likely to perceive themselves as being at lower risk of vision conditions had undergone a dilated eye exam in the previous 2 years, whether individuals with diabetes had a dilated eye exam in the previous year, and whether individuals with an age-related eye disease (ARED) had lost vision due to the condition. The models included measures of local eye care provider availability and additional explanatory variables. Results: The county-level availabilities of ophthalmologists and optometrists were positively and significantly related to the likelihood that perceived lower-risk individuals had undergone a dilated eye exam in the previous 2 years. Local eye care provider availability was not significantly related to whether individuals with diabetes had a dilated eye exam in the previous year. Greater county-level availability of ophthalmologists, but not optometrists, was associated with a significantly lower likelihood that individuals with an ARED had lost vision due to the condition. Conclusion: Public health interventions may be needed in order to increase access to preventive eye care in areas with limited overall eye care provider availability and to improve the treatment of vision conditions in areas with limited ophthalmologist availability. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of childhood blindness and ocular morbidity in a rural pediatric population in South India. Methods: A population-based, cross-sectional survey of children was conducted in three phases in Pavagada and Madhugiri taluks (subdivisions) of Tumkur district in the state of Karnataka, India. In the first phase, trained fieldworkers screened 23,100 children. In the second phase, children with eye diseases were referred to the peripheral hospital to be examined by a general ophthalmologist. In the third phase, children with major eye diseases were examined by a pediatric ophthalmologist. Results: The prevalence of ocular morbidity was 2.66% (95% confidence interval, CI, 2.46–2.87%). The most commonly observed ocular morbidity was Bitot spots (1%) followed by refractive error (0.6%). In total, 18 children were blind and the prevalence of childhood blindness (best-corrected visual acuity <3/60) was 0.08% (95% CI 0.04–0.11%); 8 (44.44%) had retinal blindness, 5 (27.76%) had lens-related blindness, 2 (11.11%) had bilateral microphthalmos, 1 (5.56%) was blind due to anterior staphyloma in the right eye and anophthalmos in the left eye, 1 (5.56%) had bilateral uveal coloboma and 1 (5.56%) had cortical visual impairment. Conclusions: Nearly half of the blindness in the population was due to unavoidable causes (retinal). In addition to providing eye care services, an appropriate service delivery model would include the provision of rehabilitative and low vision services and implementation of genetic studies to understand the causes and increase awareness of inherited eye diseases. [ABSTRACT FROM PUBLISHER]

Purpose: To describe the trend of Acanthamoeba keratitis case reports following an outbreak and the recall of a multipurpose contact lens disinfection solution. Acanthamoeba keratitis is a serious eye infection caused by the free-living amoeba Acanthamoeba that primarily affects contact lens users. Methods: A convenience sample of 13 ophthalmology centers and laboratories in the USA, provided annual numbers of Acanthamoeba keratitis cases diagnosed between 1999-2009 and monthly numbers of cases diagnosed between 2007-2009. Data on ophthalmic preparations of anti- Acanthamoeba therapies were collected from a national compounding pharmacy. Results: Data from sentinel site ophthalmology centers and laboratories revealed that the yearly number of cases gradually increased from 22 in 1999 to 43 in 2003, with a marked increase beginning in 2004 (93 cases) that continued through 2007 (170 cases; p < 0.0001). The outbreak identified from these sentinel sites resulted in the recall of a contact lens disinfecting solution. There was a statistically significant (p ≤ 0.0001) decrease in monthly cases reported from 28 cases in June 2007 (following the recall) to seven cases in June 2008, followed by an increase (p = 0.0004) in reported cases thereafter; cases have remained higher than pre-outbreak levels. A similar trend was seen in prescriptions for Acanthamoeba keratitis chemotherapy. Cases were significantly more likely to be reported during summer than during other seasons. Conclusion: The persistently elevated number of reported cases supports the need to understand the risk factors and environmental exposures associated with Acanthamoeba keratitis. Further prevention efforts are needed to reduce the number of cases occurring among contact lens wearers. [ABSTRACT FROM AUTHOR]

Purpose: Current knowledge of ethnic variability in the epidemiology of major eye diseases in Asia is limited. This report summarizes the rationale and study design of the Singapore Indian Chinese Cohort (SICC) Eye Study, a population-based study of ethnic South Asian (Indians) and East Asian (Chinese) older adults in Singapore. Methods: The SICC examined a population-based cross-sectional sample of 3,300 ethnic Indians and 3,300 ethnic Chinese aged 40–80+ years residing in the South-Western part of Singapore. Results: From two lists of 12,000 names of each ethnic group provided by the Ministry of Home Affairs, age-stratified random sampling was used to select 6,350 names in each group, with a target sample size of 3,300. Invitations were sent to attend a central clinic using letters, telephone calls and home visits. Examination procedures included interviews, measurement of blood pressure, anthropometry, presenting and best-corrected visual acuity, subjective refraction, ocular biometry, Goldmann applanation tonometry, slit-lamp biomicroscopy, optic disc imaging and digital photography of the lens and retina, using a standardized protocol. Selected participants underwent gonioscopic examination, visual field testing, and anterior and posterior segment optical coherence tomography. Blood, tear, and urine samples were collected for biochemical analyses, and stored for genetic and proteomic studies. Conclusions: In conjunction with the Singapore Malay Eye Study, the SICC study will permit an in-depth evaluation of the prevalence, risk factors, and impact of major eye diseases in Chinese, Indians and Malays, three distinct Asian ethnic groups, whose combined numbers represent half the world’s population. [ABSTRACT FROM AUTHOR]

Purpose: Evisceration is an alternative treatment modality to enucleation for many end-stage eye diseases. No study has addressed the indications for evisceration of eyes in Saudi Arabia. The aim of this study was to determine the current clinical indications for evisceration in patients at a tertiary eye care center and attempt clinicopathological correlation. Methods: Clinical records of patients who had undergone evisceration at a tertiary eye care center over a 4-year period were reviewed retrospectively. The patients' demographic data and clinical indications for evisceration were studied, and the results from histopathological findings were correlated with the clinical diagnosis. Results: Evisceration of the eyes was performed in 187 patients. Males outnumbered females in a ratio of 1.3:1 (105 males and 82 females). Blind painful eye was the primary presenting symptom in 117 (62.6%) patients and unsightly eye in 38 (20.3%) patients. Clinical indications for evisceration included endophthalmitis in 85 (45.5%), phthisis bulbi in 38 (20.3%), traumatic injury in 36 (19.2%), and glaucoma in 14 (7.5%) patients. Sixty-three patients (33.7%) had prior history of cataract surgery, penetrating keratoplasty, glaucoma surgery, or retina surgery. Clinicopathological correlation was 100% in cases with definite clinical diagnosis of endophthalmitis. Conclusion: Blind painful eye, endophthalmitis, phthisis bulbi, severe traumatic injury, and glaucoma were the major indications for eviscerations in a tertiary eye care center. [ABSTRACT FROM AUTHOR]

purpose To determine the prevalence of non-vision-impairing ocular conditions (NVIC) and estimate the number of primary eye care treatments per 1000 population per month. methods A cross-sectional study in a random sample of 1670 people was done to determine the load of NVIC in a village in Chakwal district. results The prevalence of NVIC was 30.6% (306 per 1000 population). NVIC with the exclusion of presbyopia accounted for 14.6%. The main NVIC were allergic conjunctivitis (3.7%), bacterial conjunctivitis (3.5%), pterygium/pinguicula (2.6%) and acute/chronic dacryocystitis (1%). The average Complaint Frequency (CF) per month/1000 population was 55, excluding complaints of near vision and watery eyes. conclusions The foundation of a comprehensive district eye care strategy in the light of VISION 2020 - the Right to Sight - remains an effective primary eye care service whose elements are treatment of NVIC, detection and referral of cataracts and refractive errors, and promotion of eye health. [ABSTRACT FROM AUTHOR]