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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. Purpose: This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. Methods: A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. Results: Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33–2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28–1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67–2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74–3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. Conclusion: The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population.

Vision loss and blindness are among the top ten disabilities in the United States, yet access and utilization of eye care remains low. Vision Detroit aimed to address eye-care disparities via community-based screenings. By investigating burden of eye disease and barriers to eye-care utilization in an underserved urban community, we may direct efforts to improve access.Twenty-three screenings were conducted from March 2015-November 2017. Patient information gathered at screenings were demographics, medical and social history, eye exam/referral history, insurance status, primary care physician (PCP) status, and patient-perceived eye-care barriers.Three-hundred-eighty patients were screened, 42% African American and 51% Hispanic. Average age was 53 ± 16.4 years, 70% reported vision problems, 50% reported over two years of vision problems, and average habitual visual acuity in best-seeing eye was 20/37. Eye-care underutilization was reported in 61% of type-2 diabetics. Older age and PCP recommendations/referrals were associated with increased utilization in all patients. Insurance was the most common barrier (53%); of the 55% insured, 31% reported financial barriers. Employed patients were more likely than unemployed to report a time barrier (odds ratio = 1.76, 95% confidence interval 1.03-3.01). Those with high school or less education reported "unaware of need", "unsure where to go", "transportation", and "insurance" as barriers more often.Visual burden was pervasive, yet access was suboptimal. Financial, logistical, and awareness barriers were common. PCP referral and older age were associated with increased utilization. Those less educated reported more barriers, highlighting the need to address fiscal concerns and eye-health education.

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., This study was supported by FCT (COMPETE/QREN) grant reference [PTDC/DPT-EPI/0412/2012] in the context of the Prevalence and Costs of Visual Impairment in Portugal: a hospital-based study (PCVIP-study) and FCT Strategic Funding UID/FIS/04650/2013. PLR is funded by FCT (COMPETE/QREN) grant reference [SFRH/BD/119420/2016].

To estimate the number of patients accessing eye care with low vision (LV) at a large multi-site ophthalmology institute who utilize low vision rehabilitation (LVR) services and compare their characteristics to individuals who do not utilize LVR services.This is an electronic health record-based retrospective chart analysis. Patients with LV were identified as having at least one encounter in 2014 where the best visual acuity (VA) in the better-seeing eye was worse than 20/40. Utilization of LVR services across 9 clinic locations was evaluated. Logistic regression analyses were used to examine patient characteristics associated with service utilization.Of the 7,752 LV patients, 1,585 (20%) utilized LVR services over the 17-month period. Those utilizing LVR were more likely to have VA between 20/60 and 20/200 or between 20/200 and 20/500 than non-users (Patients are more likely to utilize services when VA is moderately to severely impaired, VA fluctuations are present, or when LVR services are provided at the same location where other ophthalmic services are obtained. These estimates are important for developing interventions aimed at improving LVR utilization.

Purpose To explore stakeholders' perceptions of a school-based vision programme (SBVP). Methods We conducted 20 focus groups with 105 parents and teachers at schools in Baltimore, MD, that participated in a SBVP. Facilitators used a semi-structured interview guide to discuss participants' perceptions of the SBVP. Focus groups were audio-recorded, transcribed, and coded using inductive thematic analysis. Results Participant perceptions fell into three categories: benefits of school-based eye care, limitations of school-based eye care, and observation of impact. The majority of participants had positive comments about the programme; benefits included convenience (location, time, and cost), the comprehensive nature of the programme, the quality of the eyeglasses and ability to receive replacements, and a positive screening/exam experience. Limitations of programme impact were related to communication and organisation, the time to receive the glasses, missed instructional time, and uncertainty about screenings. Observations of impact included academic and classroom improvements, as well as visual and other health improvements. Conclusion Parents and teachers reported mostly positive perceptions regarding the SBVP. Their appreciation for the convenience underscores that location, cost, time, and comprehensive services are crucial aspects for implementing a successful programme. To maximize impact, programs must also implement robust communication campaigns that integrate into the schools' workflow to help parents and teachers stay engaged in the process from start to finish.

Purpose: To modify the Western Canada Waiting List Project (WCWLP) cataract prioritization criteria into measurement instruments for assessing appropriateness and prioritization emphasizing health-...

Purpose: L. V. Prasad Eye Institute has adopted horizontal approach of eye care delivery for the past 22 years at one of its rural secondary centers. The recent implementation of a diagonal model for enhancing glaucoma care at this center and its outcomes are reported.Methods: This was a retrospective case-control study. We included newly and consecutively diagnosed adult glaucoma patients. A comprehensive ophthalmologist provided glaucoma care. During the study period, an experienced glaucoma specialist supported the care for 2 days every month in a structured format that consisted of triaging glaucoma patients for defined protocols of therapy along with hands-on and remote online guidance to the comprehensive ophthalmologist. The data from the worst or single eye were analyzed.Results: We have included 231 patients (151 study and 80 historical controls). Sixty (75%) control patients were managed at the study center and 20 (25%) were referred. The comprehensive ophthalmologist managed 70 (48.2%) study patients and co-managed 75 (51.7%) with the glaucoma specialist. The latter changed the diagnosis in 15 eyes and altered the treatment plan in 44 eyes. Six were excluded. Successful outcome was achieved in 52 (65%) eyes in the control group and 120 (84.5%) eyes in the study group (P < .01). Additionally, study group did better in terms of case detection rate, compliance to treatment and saving on expenses for patients.Conclusion: The new model has shown better clinical outcomes of glaucoma care in an under-served geographic area. The model has the potential for wider applicability.

Purpose: To estimate the prevalence and causes of blindness (BL), severe visual impairment (SVI), moderate visual impairment (ModVI) and mild visual impairment (MildVI) in children in Narayani Zone, Nepal. Methods: In 2017, 100 population clusters within the Narayani Zone of Nepal were selected using RAAB software. Children (aged 0-15 years) suspected of having visual problems were identified using Key Informants (KIs) and school teachers and were referred for ophthalmologic examination. Eye care staff actively sought children who failed to present for examination. Causes of BL/SVI/ModVI/MildVI were categorized using standard World Health Organization definitions. Results: Of 76,588 children selected, 72,900 (95%) were screened. Of 2,158 children referred for examination, 1,322 were referred by teachers and 836 by KIs. A total of 1,617 (75%) children received a detailed examination, of whom 128 children [65 girls (51%)] mean age of 9.4 (± 4.1 years) were confirmed to have BL 7 (5.5%), SVI 16 (12.5%), ModVI 19 (15%) or MildVI 86 (67%). The combined prevalence of BL/SVI/ModVI/MildVI was 175/100,000 (95% CI 172-178/100,000); BL/SVI/ModVI was 55/100,000 (95% CI 53-57/100,000) and the combined BL/SVI estimate was 30/100,000 (95% CI 29-31/100,000). The leading causes of BL/SVI/MVI were refractive error 23 (55%) and whole globe disorders 5 (12%). Total avoidable causes were 31 (74%). Conclusion: The prevalence of BL/SVI/ModVI among children in Narayani Zone was moderate and included a high proportion of avoidable and treatable cases. Pediatric ophthalmic services need improvement, mainly refractive error correction in rural areas of Nepal.

Cataract surgery is the most common surgery performed in the European Union (EU) annually. Analysis of Google Trends (GT) data could give European eye care providers useful information regarding interest in cataract surgery and potential barriers making patients unwilling to undergo surgery.Data were collected using GT for cataract surgery and the two most related queries, for each of 14 included countries from January 2004 to December 2018. Case volumes were extracted from the Eurostat report for the calendar years 2004-2018.The most related queries analysis demonstrated surgery outcomes, founding issues and understanding of the disease as potential factors for patients considering cataract surgery. Trend analysis showed that the total search volumes for "cataract surgery" gradually increased over the study period. Also, for "cataract", "after cataract surgery", "cataract surgery NHF" rising trends were revealed. Trends found for "cataract surgery price" and "cataract surgery complications" were inconclusive. Univariate linear regression analysis demonstrated statistically significant correlations between average annual search volumes of "cataract surgery" and the annual volume of cataract surgeries performed in included countries, according to Eurostat data (To the knowledge of the authors, this is the first and the only analysis of GT data in the ophthalmology literature to date. This study highlights this potentially powerful data set for European eye care providers.

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.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.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.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.

To outline and detail the importance of conditional probability in clinical decision making and discuss the various diagnostic measures eye care practitioners should be aware of in order to improve the scope of their clinical practice.We conducted a review of the importance of conditional probability in diagnostic testing for the eye care practitioner.Eye care practitioners use diagnostic tests on a daily basis to assist in clinical decision making and optimizing patient care and management. These tests provide probabilistic information that can enable the clinician to increase (or decrease) their level of certainty about the presence of a particular condition. While an understanding of the characteristics of diagnostic tests are essential to facilitate proper interpretation of test results and disease risk, many practitioners either confuse or misinterpret these measures.In the interests of their patients, practitioners should be aware of the basic concepts associated with diagnostic testing and the simple mathematical rule that underpins them. Importantly, the practitioner needs to recognize that the prevalence of a disease in the population greatly determines the clinical value of a diagnostic test.

Purpose: To investigate the distribution of cataract surgery performed by ophthalmologists in China.Methods: A cross-sectional study was designed to investigate nationwide ophthalmological resources and capacity for cataract surgery in China⁠-The 2014 China National Eye Care Capacity and Resource Survey. Data analyzed in this report included regional distribution, urban-rural comparison, levels and types of medical institutions, and cataract surgery types and volume per surgeon. In China, only ophthalmologists at or above the level of attending are eligible to perform cataract surgery independently, so the ability of cataract surgery for ophthalmologists at or above the level of attending is analyzed in the current study. Descriptive statistics were used.Results: 36,333 ophthalmologists were included in this survey, which is an average of 1.33 ophthalmologists to every 50,000 population. Of the surgeons in this survey, 23,412 (50.22%) were attending or more senior ophthalmologists and were mainly distributed in eastern urban areas. Annual average cataract surgeries per ophthalmologist in China were 259 in 2017, less than 300 cases.Conclusion: The average number of ophthalmologists per population in China has achieved the goal of WHO's Vision 2020; however, these surgeons are concentrated in urban areas. Further, the ability of cataract surgery among ophthalmologists is unbalanced. The annual average cataract surgeries performed by ophthalmologists are insufficient, which is an important factor resulting in the current situation in China that ophthalmic service capacity has not met the requirements for eliminating cataract blindness.

To estimate the mean costs of cataract surgery and refractive error correction at a faith-based eye hospital in Zambia.Out-of-pocket expenses for user fees, drugs and transport were collected from 90 patient interviews; 47 received cataract surgery and 43 refractive error correction. Overhead and diagnosis-specific costs were determined from micro-costing of the hospital. Costs per patient were calculated as the sum of out-of-pocket expenses and hospital costs, excluding user fees to avoid double counting.From the perspective of the hospital, overhead costs amounted to US$31 per consultation and diagnosis-specific costs were US$57 for cataract surgery and US$36 for refractive error correction. When including out-of-pocket expenses, mean total costs amounted to US$128 (95% confidence interval [CI] US$96--168) per cataract surgery and US$86 (95% CI US$67--118) per refractive error correction. Costs of providing services corresponded well with the user fee levels established by the hospital.This is the first paper to report on the costs of eye care services in an African setting. The methods used could be replicated in other countries and for other types of visual impairments. These estimates are crucial for determining resources needed to meet global goals for elimination of avoidable blindness.

To assess the use of eye care services in a rural population in North China and to analyze the factors associated with underuse of these services.In a cross-sectional population-based study, demographic, health and vision-related information including use of eye care services were determined during a face-to-face interview. A single visit to an eye care provider qualified as "use" of eye care services.Of 6612 participants, 754 (11.4%, 95% confidence interval, CI, 8.7-14.1%) had used eye care services. The most common reason cited for not seeing an eye care provider was "no need" (n = 5754). Of the 5754 who thought that there was no need to see an ophthalmologist, 3458 (60.1%) were found to have one or more type of eye disease, including glaucoma (56, 1.0%), cataract (1056, 18.4%), age-related macular degeneration (AMD; 164, 2.9%) and refractive error (3048, 53.0%). Also, 74 (1.3%) and 409 (7.1%) of the 5754 participants had visual impairment (20/60) according to best-corrected visual acuity and presenting visual acuity, respectively. In a multiple regression model, participants who had glaucoma (adjusted odds ratio, OR, 4.0, 95% CI 3.0-5.4), AMD (adjusted OR 1.6, 95% CI 1.2-2.3) or refractive error (adjusted OR 1.4, 95% CI 1.1-1.8), were more likely to visit an eye care provider.A high proportion of the Chinese rural population had never used eye care services although three fifths had eye diseases. Further efforts towards better education of the general population about common eye problems as well as increasing the number of ocular health providers would be necessary in future.

To evaluate the association between sociodemographic factors and eye care expenditure and to assess the burden of ocular expenditure compared to total health care expenditure.A retrospective analysis of ocular expenditure in participants of the 2007 Medical Expenditure Panel Survey. Data from 20,620 unique participants aged ≥18 years were evaluated for eye care expenditure by demographic characteristics.A total of 22% of the studied population had eye care expenditures in 2007. Demographic factors significantly associated with higher probability of having eye care expenditures included older age (65+ years 35%, 45-64 years 23%,45 years 17%), female sex (female 26%, male 19%), higher educational attainment (greater than high school education 25%, less than high school education 17%), having insurance (private 24%, uninsured 13%), and visual impairment (mild 31%, none 22%). Older age, female sex, higher educational attainment, having insurance, and presence of visual impairment were also significantly associated with higher mean eye care expenditure. In those with eye care expenditure, the mean ratio between eye care and total medical expenditure was 24%, with uninsured patients spending 42% of their medical care expenditure on eye care.Demographic factors are associated with both the probability of having ocular expenditure and the amount of expenditure. Of all factors examined, insurance status has the most potential for modification. Policy makers should consider these numbers when devising the terms by which eye care coverage will be provided under the Patient Protection and Affordable Care Act.

To investigate patterns and factors associated with subsequent eye care for Taiwan's children.We conducted a population-based historical cohort study of 2464 children aged between 3 and 12 years old from the 2005 National Health Interview Survey (NHIS). Participants' ocular conditions were identified based on 2005 NHIS questionnaire answers given by caregivers. Subsequent eye care data was obtained from 2006 and 2007 National Health Insurance claim data. Eye care related to these children's ocular conditions was defined by physician's diagnosis using the International Classification of Diseases version 9 clinical modification codes. Poisson regression with robust variance estimation was used to determine factors associated with eye care use.Of the 2464 children, 712 (28.9%) had ocular conditions in 2005, and 56.5% and 44.7% of them didn't receive eye care during the subsequent 1- and 2-year periods, respectively. Among those with ocular conditions, the 3-4-year-olds were least likely to receive eye care in the subsequent 1 and 2 years. Children with highly educated fathers were more likely to receive eye care in the subsequent 1-year period. Sex, family income, level of mother's education, residential area and eye care resources were not significant factors for children with ocular conditions receiving subsequent eye care within either 1 or 2 years.Despite the fact that Taiwan has a National Health Insurance Program, lack of subsequent eye care remains high, even when a child's ocular condition is known by the caregiver. Determinants associated with follow-up eye care must be considered when designing eye care enhancing programs for children.

To examine whether the local availabilities of ophthalmologists and optometrists were associated with outcomes related to the prevention and timely treatment of vision conditions.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.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.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.

To test whether general nurses, trained in screening for glaucoma, can increase the number of glaucoma cases seen by eye-care professionals in a rural setting in Africa.In two districts in Malawi, 87 clinic nurses and two ophthalmic clinical officers were trained in case detection and referral of patients with suspect glaucoma. Data were collected on the number of patients screened and referred over a 12-month period. The clinic nurses and ophthalmic clinical officers received supportive supervision four times during the period and interviews were used to elicit their perspectives on the training and referral procedures.The 87 nurses screened 294 people (mean 3.4 per nurse) and referred 147 (50%) of them. Of the 147 referred, 56 (38%) were seen by the ophthalmic clinical officers who referred 15 (27%) to the ophthalmologist. Only two people were seen by the ophthalmologist. Testing visual acuity in people over 40 years of age was not seen as a priority by primary level clinic nurses. Nurses reported that cost and distance were barriers precluding attendance by patients at the next level. Women were two times less likely to be referred. About one quarter of patients who were offered surgery refused. Fewer than half the patients who had surgery attend for follow-up.Training general nurses to screen for and refer suspect glaucoma cases did not lead to increased glaucoma service delivery. Other strategies to identify high risk patients need to be tested.

To determine the use of medical services for eye problems in Fiji, and barriers to seeking that care.An interview-based questionnaire was administered as part of a population-based cross-sectional survey of adults selected by multistage random sampling from those aged ≥40 years living on Fiji's main island.Participation rate was 73.0% (n = 1381). A current vision or eye problem was reported by 931 participants, and a further 235 recalled a previous difficulty. Urban dwellers (P = 0.002) and those aged ≥50 years (P = 0.017) were more likely to report a problem. Gender was not predictive (P = 0.215). "Blurred/poor vision" was the most common complaint (78.5%). Over half (53.3%) had not sought care for the problem most important to them. For current problems, being younger (P 0.001) and from a household without paid income (P = 0.007) were predictive of being less likely to seek treatment. Gender was not (P = 0.416). The most frequently cited principal reason for not seeking care was "able to manage/accept the problem" (66.5%; of whom 84.7% claimed vision problems). Direct and indirect costs were mentioned as deterrents. "Thought nothing could be done" (P = 0.032) and "lack of awareness of service availability" (P = 0.026) were more common among rural dwellers. Of participants who sought care, 75.6% used government services. Most participants requiring spectacles or medication incurred costs for these. Satisfaction with overall care was independent of provider (P = 0.062) and user gender (P = 0.851).With expanding service delivery, increased eye health promotion, and attention to the financing of treatments, improved service use ought to be possible in Fiji.

To determine how people attending outreach eye care clinics in Papua New Guinea (PNG) perceive eye health and eye health services.An interview-based questionnaire was administrated to a convenience sample of 614 adult participants across four provinces and perceptions of eye health and eye health services were recorded. Presenting and near visual acuity were measured and cause of visual impairment (VI) determined.In this sample, 113/614 participants (18.4%) presented with distance VI, 16 (2.6%) with distance blindness, and 221 (47.6%) with near VI. Older participants and those with near VI were more likely to indicate that it is hard to have an eye examination due to travel time, lack of transport and transport costs. Female participants and those from underserved areas were more likely to report shame and fear of jealousy from others when asked about their attitudes towards spectacles. Participants reporting that they were willing to pay higher amounts for testing and spectacles/treatment also reported higher education levels, higher household incomes and were more likely to be male. A quarter of participants (25.9%) indicated that they did not like having an eye examination because their reading and writing was poor.People attending outreach eye care clinics in PNG reported finding it difficult to attend eye health services due to transport difficulties and anticipated high costs. Negative attitudes towards spectacles were also prevalent, and negative perceptions appeared more frequently among older participants and those with less education.

Purpose To describe the methods and innovations used in constructing the VisQoL, a vision-related utility instrument for the health economic evaluation of eye care and rehabilitation programs. Methods The VisQoL disaggregates vision into six items. Utilities were estimated for item worst responses (the worst level for each item, with all other items at their best level) and VisQoL all-worst responses (all items at their worst level) using the time trade-off procedure. Time trade-off questions require people to imagine living a fixed number of years with a particular health condition and then indicate how many of those years of life they would be willing to trade to have perfect health. Where respondents indicated a health state was “worse than death” negative utilities were estimated. Time trade-off questions minimized the “focusing effect,” which occurs if respondents discount the fact that all other aspects of health are at their best when answering questions, by using pictorial and verbal aids. Results Item utilities were combined using a multiplicative model, and VisQoL model utilities placed on a scale where 0.00 and 1.00 represent full health and death, respectively. The VisQoL allows utilities to be calculated for a wide range of vision-related conditions. Conclusion The 6-item VisQoL has excellent psychometric properties and is specifically designed to be sensitive to vision-related quality of life. It is the first instrument to permit the rapid estimation of utility values for use in economic evaluations of vision-related programs.

1. To estimate the prevalence and identify the determinants of Trachomatous Trichiasis (TT) among the40 years old Omani population. 2. To compare the results of the present study to those of the survey conducted in 1996 and propose public health policies for eye care in Oman.Ophthalmologists randomly selected 75 houses in 24 clusters. The visual status per eye was noted. The anterior segment of the eye was examined to detect TT, using the WHO simplified grading. Frequencies, the age sex standardized prevalence and their 95% Confidence Intervals (unadjusted for clustering) were calculated and the numbers of people with TT in the population were estimated.Persons examined numbered 2,339. The prevalence of TT among the40 years old Omani population was 4.14% (CI 95% 3.3 to 4.9). The gender variation [OR = 1.51 (CI 95% 1.01 to 2.37)] and regional variation of TT was significant (p0.001). The standardized prevalence of TT in the40 years old Omani population had declined from 7.25% in 1996 to 3.96% in 2005. Predictors of TT were female gender, and age60 years.Trichiasis is still a public health problem in Oman. The prevalence is higher than the "1 TT case per 1000" target set for the "Ultimate Intervention Goals" for the "Elimination of Blinding Trachoma." The TT surgery rate in Oman should be increased to reach this goal. The underlying causes of low coverage should be identified and addressed through a program approach.

To evaluate the quality and efficacy of the Ban Phaeo Mobile Eye Clinic (BPMEC) model in providing cataract surgery to rural Thailand.Retrospective review of 4-week postoperative visual acuity (VA) of 7040 patients receiving unilateral cataract surgery at 75 sites from October 2008 to March 2011. BPMEC conducted screening, surgery, and follow-up at partnering local hospitals that otherwise do not offer eye care. The primary outcome was achievement of VA ≥20/70, which was secondarily analyzed by cataract extraction method (phacoemulsification, phaco, or extracapsular cataract extraction, ECCE) and intraocular lens (IOL) type (foldable acrylic or rigid polymethylmethacrylate).Preoperatively, 249 eyes (4%) had uncorrected VA ≥20/70. Four weeks postoperatively, 5957 (85%) had VA ≥20/70, 3288 (47%) had VA ≥20/40, and 69 (1%) were lost to follow-up. Phaco was performed in 6324 eyes (90%), 1581 (25%) receiving foldable IOLs. A total of 1403 eyes (89%) undergoing phaco with a foldable IOL had postoperative VA ≥20/70, compared to 4058 (85%) and 496 (69%) of those undergoing phaco with a rigid IOL (p 0.05) and ECCE with a rigid IOL (p 0.001), respectively. Overall, 37 eyes were left aphakic. Reported intraocular complications included zonular dehiscence (37 eyes), retained lens fragment (2 eyes), wound leakage (1 eye), and posterior capsule tear (1 eye).The 4-week uncorrected postoperative VAs met the World Health Organization's quality target of VA ≥20/70 for eyes undergoing phaco and were comparable to those published by an urban hospital in Bangkok.

Glaucoma is a priority eye disease in Oman. In order to revise the existing policies for eye care, a study was conducted to review the noncompliance rates among glaucoma patients.Using the random method, we selected 105 glaucoma patients from among those visiting glaucoma clinics during 2003. They were interviewed by trained health professionals. A closed-ended questionnaire with 42 questions was used to note their responses. The questions dealt with their personal characteristics along with the patients' glaucoma treatment and their knowledge of and attitudes towards different components of noncompliance with medical treatment. The field staffs also observed the 'practice' of instilling placebo eyedrops. The responses were analyzed to grade the compliance, knowledge, attitude and practice of each patient.Excellent compliance was found in 26 patients. Discontinuation of medication in the past was reported by 87 patients. Missing instillation of eyedrops and irregular visits to the ophthalmologist were noted in 10 and 14 patients, respectively. Adequate knowledge about glaucoma and its complications was negatively associated with noncompliance [RR 2.05 (95% CI 1.07-3.93)].The high rates of noncompliance among glaucoma patients in Oman demand a systematic programmed approach. Longitudinal studies are needed to confirm the causal association between noncompliance and Knowledge, Attitude and Practice. Health education, communication while dispensing medication, reducing the frequency of medication and using devices for the easy administration of eyedrops could further improve compliance.

The aim of the study was to develop a new questionnaire to assess visual symptoms/dysfunction and impact on vision-specific quality of life for those undergoing second eye cataract extraction. Items for the VSQ questionnaire were devised with reference to existing literature and following consultation with eye care experts (n = 18) and interviews with cataract patients (n = 40). Piloting work conducted with 53 patients indicated that the questionnaire was promising, with a high level of internal consistency, low levels of missing data and indications that it was responsive to surgery. A modified version of the questionnaire was completed by 105 patients having received 'early' surgery and 103 scheduled for routine surgery within a randomised controlled trial evaluating the effectiveness of second eye cataract surgery. Analyses showed that the internal consistency of both the visual symptoms/dysfunction and quality of life areas was high (Cronbach's alpha 0.82 and 0.83, respectively). Highly significant improvements were found for early surgery patients (p < 0.0001), with little change among routine surgery patients. Two final versions of the VSQ questionnaire have been produced for future use in assessing visual symptoms/dysfunction and impact on vision-specific quality of life: a scoreable short form and more detailed and sensitive long form.

Purpose: To describe the methodology of Aditya Jyot-Diabetic Retinopathy in Urban Mumbai Slums Study (AJ-DRUMSS), which was designed (i) to estimate the prevalence of diabetic retinopathy (DR) in a general population, (ii) to study the risk factors associated with DR in those with type 2 diabetes mellitus (DM), and (iii) to create awareness for early detection and develop timely interventional management for DR. Methods: AJ-DRUMSS is an ongoing population-based cross sectional study conducted in seven wards of slums in Mumbai, India, wherein eligible subjects from the general population were screened for DR and profiled for their demographic, social and biochemical parameters to study the associations of these factors. Results: To date, nearly 54,000 households have been enumerated for both awareness and DR prevalence in five study areas (out of seven) during 17 awareness campaigns and 78 DR screening camps. Of these, 4295 households were included in AJ-DRUMSS. Nearly 15,000 camp subjects (including subjects from awarenessfocused areas who also turned up for the screening camps) were screened from the total enumerated households, of which 16.1% were diagnosed with type 2 DM. A total of 14.5% of these had evidence of DR and 3.5% had sight-threatening DR. Conclusions: A detailed study design of AJ-DRUMSS is described. In the screening camps nearly 3.5% of the diabetic population had sight-threatening DR, which needed an active interventional strategy. This study will help in formulating efficient eye care policies, making optimum use of available resources, reorienting healthcare providers and the ignorant within the population regarding the need for periodic ophthalmic surveillance and timely intervention.

To report the prevalence and causes of blindness in people aged 50 years and older in Paraguay, and to compare these with the previous national survey in 1999, focusing on planning of future eye care activities.A rapid assessment of avoidable blindness (RAAB) was conducted in 2011. A total of 60 clusters of 50 residents aged 50 years and older were randomly selected and visited, and 2862 people were examined (95.4%). Survey data were analyzed with the RAAB software and compared with findings of a similar survey from 1999.The prevalence of bilateral blindness in Paraguay was 1.0% (95% confidence interval, CI, 0.6-1.6) in 2011, significantly less than the 3.1% (95% CI 2.2-4.4) in 1999. Prevalence of bilateral cataract and cataract eyes had also reduced significantly for visual acuity, VA,3/60, VA6/60 and VA6/18. Cataract surgical coverage in persons doubled to 90% for VA3/60, 78% for VA6/60 and 63% for VA6/18. Visual outcome after cataract surgery also improved to nearly the World Health Organization norm. Cataract was the main cause of blindness (43.8%), followed by severe visual impairment (40.5%). Uncorrected refractive errors were the main cause of moderate (78.0%) and the second cause of severe (18.9%) visual impairment.The reduction in blindness and visual impairment due to cataract in Paraguay between 1999 and 2011 was highly significant. Results and coverage of cataract surgical services improved substantially. The reported numbers of cataract operations may not have been complete as these do not seem to match the dramatic improvement in the cataract situation in Paraguay.

Purpose Family practice (FP), General Practice (GP) and obstetrics-gynecology (OB/GYN) physicians were surveyed to determine whether they routinely referred pregnant patients with diabetes to an ophthalmologist, looked into the patient's eyes to screen for retinopathy, and dilated the eyes for fundi examination.Methods Hospitals providing obstetrical services were contacted to identify primary-care physicians. Physicians identified as having obstetrical privileges were surveyed by mail to determine if they were actively providing obstetrical care. Physicians who provided both obstetrical and diabetes care were mailed a survey.Results Of 668 physicians surveyed, 429 responded: 224 FPS, 184 OB/GYNS and 21 GPS. A relatively small percentage (27%) of physicians in both groups routinely refer all of their pregnant patients with pre-existing diabetes to an ophthalmologist. Family practice physicians were more likely to perform an eye exam to screen for retinopathy in patients with both pre-existing and gestatio...

In order to improve the sustainability of eye care programs including provision of surgical services, an understanding of a patient's capacity to contribute towards the costs relating to sight-restoring surgery is essential. Therefore, we investigated willingness to pay for cataract surgery in a hospital-based cross-sectional study in rural Malawi.We interviewed consecutive patients following surgery for senile cataract at Nkhoma Eye Hospital, Malawi. Patients were asked about their willingness to pay for surgery (in local currency, Kwacha, as well as surrogates for money). We also collected data on socio-demographic variables and pre- and post-operative visual acuity (VA).A total of 212 participants were included (99.5% acceptance), of whom 82.0% were farmers. Mean age of participants was 68.2 years, and 89 (42.0%) were female. There were 136 (64.2%) who were willing to pay something. Median willingness to pay was 500 Kwacha (interquartile range 0-2,000; ~US$3.00, August 2011). Following adjustment for age, sex, family size and occupation, patients who were blind pre-operatively (pinhole-corrected VA3/60) were less likely to pay something for surgery (odds ratio 0.44, 95% confidence interval 0.20-0.96, P = 0.038) compared to those with VA6/60.In this setting where people are used to free services, the median monetary amount elderly patients were willing to pay for surgery is well below the actual cost of screening, transport, accommodation and surgery. Substantial cost recovery will require pre-operative involvement of family members, but might slow down current screening practices and also lower acceptance rates.

To explore the effect of demographic characteristics on the outcomes of cataract surgery in terms of visual acuity and patient satisfaction, and gender role in the uptake of postoperative care.Comprehensive ocular examinations were performed on 478 subjects (558 eyes) over the age of 50 years who underwent surgery for age-related cataract at the largest eye hospital in Iran. Demographic characteristics were obtained and surgical records were reviewed.Male subjects had significantly better outcomes in terms of uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) (mean difference 0.12 and 0.13 logMAR; p = 0.004 and p0.001, respectively). Women were significantly less satisfied than men (73.2% vs. 83.6%; p = 0.011). Postoperative UCVA and BSCVA were better in patients with higher levels of education (both p0.001). Age had an inverse association with UCVA (p = 0.004) and BSCVA (p0.001). Women were twice as likely to need capsulotomy (p = 0.002). Men's uptake of postoperative refractive care was 4-fold that of women's (31% vs. 7%). In multivariable analyses, age, sex, education, presence of ocular comorbidity and need for capsulotomy, spectacle prescription and other care were associated with postoperative UCVA (all p0.05; adjusted R(2) = 0.256).Female patients were shown to be at a clear disadvantage in cataract surgery; outcomes of the procedure and postoperative care were both poorer. Older age, lower level of education, ocular comorbidity and unmet postoperative need were also associated with a poorer outcome.

To determine the extent and reasons for delay in accessing specialist eye care following a significant eye injury.Mixed methods study involving 93 consecutive admissions to Kilimanjaro Christian Medical Center, Tanzania (KCMC). Semi-structured interviews were conducted and supplemented by a review of medical notes. A statistical analysis of delay and predictor variables was conducted. Framework analysis of interviews was conducted.Ninety of 93 patients took part. Significant visual loss was determined in 95.5% of affected eyes on arrival. The mean delay for treatment was 6.8 days. Of participants, 61.1% visited some health facility within 24 hours, and 82.2% within 48 hours. Injury on a weekend, using topical drops and visiting other health facilities before KCMC were independently associated with delay greater than 24 hours and greater than 48 hours, female gender with was associated with delay greater than 24 hours. Patient journeys involved key milestones and processes. Journeys were frequently "circular," involving delays caused by repeated visits to health units unable to treat the injury, often on a health worker's advice. Systems problems included unclear referral systems and opening times, frequent staff absence and unqualified staff deputizing. Individual health workers had an important influence on delay but their performance appeared variable. They influenced patient journeys positively when they made an accurate diagnosis, referred directly to KCMC, discussed practicalities and communicated the seriousness of the injury, the need for urgent treatment and the adverse consequences of delay.There is significant delay in accessing appropriate specialist care following eye injury in Tanzania, much of which occurs after first visiting a health facility. We present a new model of delay that may help guide interventions to reduce this delay.

To examine the different dimensions of access to eye care from a public health perspective.We substantively review the theoretical and empirical literature on access to eye care and summarize the major considerations in measuring access to eye care using a modified behavioral framework.We found that progress has been made, but some gaps still remain in measuring access to eye care. Most studies have focused on individual characteristics and use of eye care services. Only a very few studies have touched on contextual characteristics, such as demographic make-up of the area in which the patient lives, and their impact on the use of eye care services. Few studies have explored the linkage between the use of eye care services and outcomes or between the use of such services and patient satisfaction.To address a variety of demands from patients, providers, and policy makers, it is necessary to account for potential access and realized access measures. We need to adopt new methods in assessing the relationship between contextual characteristics and use of eye care services. Moreover, we need to better understand patients' satisfaction and their relationship with utilization and health outcomes.

Screening school students for refractive errors is a component of many primary eye care programs. In 2004 a trial of two approaches of spectacle-delivery to Tanzanian secondary school students found that only one third of students were using their spectacles at three months. Barriers to spectacle use were investigated using questionnaires and focus group discussions.At the three months follow-up survey a questionnaire explored satisfaction with spectacles and the attitudes of trial participants (median age 15 years). Attitudes and reactions of friends, teachers and families were also explored. Students also discussed their experience with spectacle use and reasons for non-use in 8 focus groups divided by intervention, sex and spectacle use.In general, students seemed happy with the appearance of their spectacles and the beneficial impact on their vision. Peer pressure and parental concerns about safety of spectacle use, cost of purchasing spectacles and difficulties in accessing good local optical services were identified as the main barriers. Students criticized prescribing practices of local opticians and favored alternative and traditional treatments for visual impairment.To increase the effectiveness of school vision screening in Tanzania, barriers such as peer pressure or concerns about safety need to be addressed, in addition to provision of affordable, good quality spectacles. Barriers to spectacle use in children are likely to exist in all populations, but may vary in their nature and importance and therefore should be investigated in existing and new screening programs.

To evaluate ophthalmic manifestations in patients with Human Immunodeficiency Virus (HIV) infection in the era of highly active antiretroviral therapy (HAART) at the apex institute for eye healthcare in India.This prospective study was undertaken between October 2004 and December 2005. A complete ophthalmological and systemic examination was performed on each patient. Relevant investigations were carried out in selected patients.One hundred consecutive HIV infected patients (199 eyes) were examined for ophthalmic manifestations. Of these 17% (17/100) had Category A HIV infection (asymptomatic or acute HIV or persistent generalized lymphadenopathy), 23%(23/100) had Category B HIV infection (symptomatic, not A or C), 60%(60/100) had Category C HIV infection (AIDS indicator condition).76%(70/100) were male and 24%(24/100) were female. The median age of patients was 34 years and 52%(52/100) were in the fourth decade. 68%(68/100) patients were on HAART. 45% (45/100) patients had ophthalmic manifestations, the most common being cytomegalovirus (CMV) retinitis (20%) (20/100). Retinal detachment was seen in 70% (14/20) of CMV retinitis patients. HIV vasculopathy was seen in 11% (11/100) of patients. Other lesions included immune recovery uveitis (IRU) (5%)(5/100), acute retinal necrosis (ARN) (3%)(3/100), choroiditis (2%)(2/100), neuro-ophthalmic manifestations (12%)(12/100), complicated cataract (6%)(6/100), keratouveitis (1%)(1/100) and corneal ulcer (1%)(1/100). 7%(7/100) patients presented to us with ophthalmic manifestation as the only presenting sign of HIV infection. Amongst those who had ophthalmic involvement, about 50% (19/40) patients had CD4 count below 100 cells/micro liter and 70% (28/40) patients had CD4 count below 200 cells/micro liter.CMV Retinitis (20%) (20/100) is still the most common manifestation of HIV infection in this series, even in the era of HAART, and is more common than HIV vasculopathy. Immune recovery uveitis is appears to be more common with the introduction of HAART in absence of affordable anti CMV therapy in India. 7% (7/100) of patients present with ophthalmological features as the initial manifestation of HIV. As before, most (70%) (28/40) of the ophthalmic manifestations of HIV infection are present when CD4 count is less than 200 cells/micro liter.