Search

Background: This study was undertaken to ascertain the current magnitude and causes of blindness and visual impairment in persons aged 50 years and over and to assess the impact of a 10-year eye care program in Sokoto State, Nigeria., Methods: A rapid assessment of avoidable blindness (RAAB) survey (in persons 50 years and over) was conducted in 2016. Participants were selected in Wurno health zone using a two-stage cluster randomized sampling with probability proportional to size. Operational definitions were based on RAAB and World Health Organization eye examination record definitions. Eye care program documents were reviewed and data from a baseline survey undertaken in 2005 were reanalyzed., Results: A response of 89.1% (2405 of 2700 participants) was obtained in the 2016 survey. With available correction, the unadjusted prevalence of blindness was 7.7% (95% confidence interval [CI]: 6.4, 8.9). The odds of blindness were 1.8 times higher in females than males (95% CI: 1.3, 2.4; P < 0.001). Major causes of blindness were cataract (48.9%) corneal disease (20.1%), glaucoma (10.3%), and uncorrected refractive error/aphakia (8.7%). The age- and sex-adjusted prevalence of blindness has declined from 11.6% (95% CI: 7.4, 17.0) in 2005 to 6.8% (95% CI: 5.6, 8.0%) in 2016., Conclusion: The blindness prevalence is high, and the major causes are avoidable in the health zone. The findings suggest that investments in the program over the last 10 years might have led to almost a halving in the prevalence of blindness in th e population. However, the small sample size of persons 50+ years from Wurno zone in the 2005 survey necessitate caution when comparing the 2005 and the 2016 surveys., Competing Interests: There are no conflicts of interest.

Most industrialized countries and many emerging economies have chosen to define 'blindness' at a visual acuity above that which WHO uses. This reflects the increasing visual demands of modern society for tasks such as driving or using cell phones. Meeting these demands will require more highly skilled health workers using more sophisticated equipment than has generally been considered sufficient for primary eye care., (© The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The purpose of this study was to quantify how much of the burden of visual impairment (VI) and unmet need in Talagang, identified by Rapid Assessment of Avoidable Blindness (RAAB) survey data, has been addressed by Community Eye Health (CEH) programme efforts. Methods: A RAAB survey was carried out in November 2018, with 2,824 participants in Talagang Tehsil, Punjab, Pakistan, aged 50 and over. Census data were used to extrapolate survey data to the population. Alongside this, a CEH programme was launched, consisting of community eye screening, and onward referral to rural health centres, secondary or tertiary ophthalmological services, as required. This health intervention aimed to address the eye care needs surfaced by the initial survey. From 2018 to 2022, 30,383 people aged 50 or over were screened; 14,054 needed referral to further steps of the treatment pathway and more detailed data collection. Programme data were compared to estimates of population unmet needs. Main outcome measures were prevalence of VI, and proportion of need met by CEH Programme, by cause and level of VI. Results: Among those aged 50 and over, 51.0% had VI in at least one eye. The leading causes were cataract (46.2%) and uncorrected refractive error (URE) (25.0%). In its first four years, the programme reached an estimated 18.3% of the unmet need from cataract, and 21.1% of URE, equally in both men and women. Conclusions: Robustly collected survey and programme data can improve eye health planning, monitoring and evaluation, address inequities, and quantify the resources required for improving eye health. This study quantifies the time required to reach eye health needs at the community level. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence and causes of blindness and visual impairment among adults in Kogi, Nigeria. Methods: A Rapid assessment of avoidable blindness (RAAB) protocol was used with additional tools measuring disability and household wealth to measure the prevalence of blindness and visual impairment (VI) and associations with sex, disability, wealth, cataract surgical coverage and its effectiveness. Results: Age- and sex-adjusted all-cause prevalence of bilateral blindness was 3.6% (95%CI 3.0–4.2%), prevalence of blindness among people living with additional, non-visual disabilities was 38.3% (95% CI 29.0–48.6%) compared to 1.6% (95%CI 1.2–2.1%; χ2 = 771.9, p<0.001) among people without additional disabilities. Cataract was the principal cause of bilateral blindness (55.3%). Cataract surgical coverage (CSC) at visual acuity (VA) 3/60 was 48.0%, higher among men than women (53.7% vs 40.3%); 12.0% among people with non-visual disabilities; 66.9% among people without non-visual disabilities, being higher among people in the wealthiest two quintiles (41.1%) compared to the lowest three (24.3%). Effective Cataract Surgical Coverage at Visual Acuity 6/60 was 31.0%, higher among males (34.9%) than females (25.5%), low among people with additional, non-visual disabilities (1.9%) compared to people with no additional disabilities (46.2%). Effective CDC was higher among people in the wealthiest two quintiles (411%) compared to the poorest three (24.3%). Good surgical outcome (VA>6/18) was seen in 61 eyes (52.6%) increasing to 71 (61.2%) eyes with best correction. Cost was identified as the main barrier to surgery. Conclusion: Findings suggest there exists inequalities in eye care with women, poorer people and people with disabilities having a lower Cataract Surgical Coverage, thereby, underscoring the importance of eye care programs to address these inequalities. [ABSTRACT FROM AUTHOR]

Introduction: Preservation of life, preservation of limb, and preservation of eyesight are the priorities for military medical personnel when attending to casualties. The incidences of eye injuries in modern warfare have increased significantly, despite personal eye equipment for service members. Serious eye injuries are often overlooked or discovered in a delayed fashion because they accompany other life- and limb-threatening injuries, which are assigned a higher priority. Prehospital military ocular trauma care is to shield the eye and evacuate the casualty to definitive ophthalmic care as soon as possible, with exceptions for treatment of ocular chemical injury and orbital compartment syndrome. Retrospective analysis of eye injuries in recent conflicts identified gaps in clinical capabilities with up to 96% of ocular injuries being suboptimally managed. Ocular compartment syndrome (OCS) is a complication associated with orbital hemorrhage, where significant morbidity occurs as a result of increasing intracompartment pressure. The ischemic tolerance of the retina and optic nerve is approximately 90 minutes, so OCS must be rapidly diagnosed and aggressively treated through lateral canthotomy/cantholysis (LC/C) to prevent permanent vision loss. LC/C procedures consist of using hemostats to crush the lateral canthal fold and cutting the lateral canthal tendon from the inferior crus to relieve increasing intracompartment pressure. The purpose of this study was to examine the baseline capabilities of military physicians and surgeons to accurately and independently perform the LC/C procedures and identify performance gaps that could be closed through focused professional development activities.Materials and Methods: This study received institutional review board approval at our institution. A total of 60 subjects voluntarily participated in the study from emergency medicine (15), general surgery (28), and ophthalmology (17). All procedural assessments were performed 1:1 by expert faculty ocular trauma specialists using a high-reliability eye trauma simulator (Sonalysts, Inc.). The competency standard was set at independent and accurate completion of all procedural components and all critical procedural components. Analyses were performed using descriptive statistics and analysis of variance to examine between-group differences (P < 0.05).Results: There was a significant difference between the total score performance and the critical score performance for the three groups (P < 0.001). Outcomes indicate a significant linear relationship between the expertise level of the clinical provider and the procedural performance of LC/C. Outcomes demonstrate the baseline surgical capabilities of the general surgeons transferred to LC/C performance; however, they were unfamiliar with the anatomy and the procedural techniques and requirements. The group of emergency medicine participants demonstrated performance gaps not only in the same areas as the general surgeons but also in their baseline surgical abilities. This suggests that different professional development activities are necessary for surgeons and physicians tasked with performing LC/V procedures.Conclusions: We identified significant performance gaps among emergency medicine physicians, general surgeons, and ophthalmologists in their abilities to recognize and treat OCS through LC/C procedures. These sight-saving procedures are a critical competency for forward-situated clinicians in expeditionary contexts. We identified the need for targeted approaches to professional development for closing the performance gaps for both emergency medicine physicians and general surgeons. [ABSTRACT FROM AUTHOR]

Heather Machin,1,2 Mark Daniell,1,2 Lauren Entwistle,3 Clare Hafner,4 Anna MK Huigen,5 Harsimrat Kaur,2 Joanna McCulloch,4,6,7 Marina Osadchiy2 1Corneal Research Unit, Centre for Eye Research Australia, Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Australia; 2Royal Victorian Eye and Ear Hospital, Melbourne, Australia; 3Independent Researcher, Perth, Australia; 4Ophthalmology Outpatients Department, Sydney Hospital and Sydney Eye Hospital, South East Sydney Local Health District, Sydney, Australia; 5Primary and Public Health Care, Community Primary Care, NT Health – Central Australia, Alice Springs, Australia; 6Nursing Education, Research and Leadership Unit, Sydney Hospital and Sydney Eye Hospital, South East Sydney Local Health District, Sydney, Australia; 7School of Nursing and Midwifery, Notre Dame University, Sydney Campus University of Notre Dame, Sydney, AustraliaCorrespondence: Heather Machin, Corneal Research Unit, Centre for Eye Research Australia, University of Melbourne, Level 7 Smorgan Family Wing, 32 Gisborne Street, East Melbourne, Victoria, 3004, Australia, Email heather.machin@unimelb.edu.auPurpose: An estimated 13 million Australians live with one or more chronic eye conditions, with prevalence increasing. Eye care services today and in the future rely on effective workforces, in which nurses play a pivotal role. Despite nurse involvement in eye care, there is no information describing their engagement, deployment, training, and opinion. This paper offers the first review of nurse engagement in eye care in Australia.Methods: We conducted an e-survey on Australian nurse engagement in eye care. Quantitative questions were analysed by descriptive, chi-square and bivariate correlation coefficients with assumed power of 0.80, and significance of p=0.05. Grounded theory, sentiment and saturation analysis extracted key themes, meaning and opinion from the qualitative questions.Results: There were n=238 Australian nurse participants. Results indicated they were satisfied with their role, engaged in a wide range of healthcare and eye care setting and organisations, and adapted to their employer. Task-shifting “to” and “from” nurses was not universally supported but recognised by participants as necessary. Of concern, the results suggested that 68.6% of our participants would exit eye care over the next ten years, with insufficient entry pathways into the field for graduate and early-career nurses.Conclusion: For Australia to meet and sustain eye care services for its population, steps must be taken to improve exposure and entry to the field for students, graduates, and early-career nurses. Strategies to train and prepare nurses for task-shifting are urgently required and the eye care nursing sector must professionalise to achieve positive change.Keywords: Australia, nurse, eye care, ophthalmology, blindness, workforce

This study aimed to estimate the prevalence and main causes of blindness and visual impairment in population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. The study team randomly selected 50 clusters (each consisting of 50 people) from all 11 regions of Armenia. Data on participants' demographics, presenting visual acuity, pinhole visual acuity, principal cause of presenting visual acuity, spectacle coverage, uncorrected refractive error (URE), and presbyopia were collected using the RAAB survey form. Four teams of trained eye care professionals completed data collection in 2019. Overall, 2,258 people of 50 years and older participated in the study. The age- and gender- adjusted prevalence of bilateral blindness, severe and moderate visual impairment were 1.5% (95% CI: 1.0–2.1), 1.6% (95% CI: 1.0–2.2) and 6.6% (95% CI: 5.5–7.7), respectively. The main causes of blindness were cataract (43.9%) and glaucoma (17.1%). About 54.6% and 35.3% of participants had URE and uncorrected presbyopia, respectively. The prevalence of bilateral blindness and functional low vision increased with age and was the highest in participants 80 years and older. The rate of bilateral blindness was comparable with findings from countries that share similar background and confirmed that untreated cataract was the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed aiming to further increase the volume and quality of cataract care in Armenia. [ABSTRACT FROM AUTHOR]

Copyright of Revista Sociedad Colombiana de Oftalmología is the property of Sociedad Colombiana de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Vision loss is a public health challenge adversely affecting over a billion people worldwide. Low and middle income countries (LMICs) have a disproportionately higher prevalence of vision loss compared to high-income countries. Over 80% of vision loss can be addressed with either spectacles or cataract surgery. Both of these interventions are low cost and cost effective. Despite this, several barriers prevent individuals from accessing eye care. This paper covers various elements of access (approachability, acceptability, affordability, availability and appropriateness) and presents barriers that prevent access to eye care services in LMICs. Disease-specific barriers and various models and strategies that address the accessibility challenges are presented with a special reference to the use of technology to improve access. Strategies such as providing free eye care, lowering direct and indirect costs, improve access to cataract surgery. While access-related challenges related to cataract surgery are well studied, there is inadequate information on access to refraction services for refractive errors and other conditions. Future research can focus on addressing this information gap. This can then help develop strategies to address the burden of uncorrected refractive errors and other causes of vision loss and contribute towards achieving universal eye health coverage. A literature search was carried out to identify the relevant articles reporting barriers to seeking eye care in the Medline, CINHAL and PsycINFO databases between 20 and 27 May 2023. From this search, the relevant articles were shortlisted for data extraction. [ABSTRACT FROM AUTHOR]

Purpose: Clinical research brings the potential of improved diagnostics, sight-saving treatments, and more accessible services to those suffering with severe sight impairment (SSI). This report investigates whether registered ophthalmology clinical studies address the leading causes of SSI in the general and working populations of the United Kingdom (UK).Methods: The latest statistics on the leading causes of SSI in the UK general and working populations were identified by searching PubMed, Cochrane Library, and TRIP databases. Clinical study registries were searched to identify registered clinical studies (on or prior to 1st December 2022) on the leading causes of SSI. The relationship between the number of clinical studies on leading causes of SSI and the percentage of SSI certifications they account for was analyzed.Results: In the UK general population, the number of registered clinical studies on the leading causes of SSI is statistically significantly correlated (Spearman's rho = 0.86, p < 0.01) with the percentage of SSI certifications they account for. However, there is no correlation between the two in the UK working population (aged 16– 64) (Spearman's rho = 0.15, p = 0.70). Eye conditions accounting for the most SSI certifications in individuals of working age have significantly less clinical research activity than those that cause the most SSI certifications in the general population. Out of the leading causes of SSI certifications studied, disorders of the visual cortex and congenital anomalies of the eye have the least clinical research activity.Conclusion: Clinical research into the leading causes of SSI in the general population is essential. However, it is important to consider eye conditions that cause the most severe visual impairment in individuals of working age due to the significant health and socioeconomic implications of sight loss in this population. [ABSTRACT FROM AUTHOR]

(1) To identify if adults with uncorrectable sight loss would increase their physical activity (PA) following advice from general healthcare, eyecare or sight loss service professionals. (2) To identify what resources could be provided alongside advice from a professional to facilitate PA. Survey data from 100 UK adults with uncorrectable sight loss were analysed. Adjusted logistic regression models were used to examine the association between participant characteristics, and the likelihood that participants would increase PA if advised to by different professionals. Most of our sample would increase their PA if advised to by a general practitioner (GP) (n = 78), ophthalmologist or optometrist (n = 70) or a low vision rehabilitation officer (n = 75). Thirty-one participants would increase their PA if advised to by a dispensing optician. Participants with a history of anxiety and depression were less likely to report they would increase their PA based on advice from a GP (p = 0.002). Sight loss specific and community-based PA groups, exercise specialist support, a sighted guide, and a travel plan, were considered by most participants to be useful facilitators of PA. The results suggest eyecare and sight loss service professionals could facilitate increases in PA among adults with sight loss. Physical activity levels among populations with sight loss are critically low, and inactivity increases the risk of chronic conditions and premature mortality within these populations. GPs, optometrists, ophthalmologists, or low vision rehabilitation officers could play a pivotal role in increasing physical activity levels among people with sight loss, by providing physical activity advice during consultations. Professionals advising people about physical activity should have the knowledge, and opportunity, to refer people with sight loss to accessible physical activity groups or services. [ABSTRACT FROM AUTHOR]

To develop a simple but more precise model to calculate potential annual productivity losses due to blindness and moderate and severe vision impairment (MSVI) at the national, regional, and global level. Productivity loss was defined as the loss of minimum wage/Gross National Income per capita (GNI) incurred by people aged 50–64 years with blindness or MSVI, who were not able to work or worked with reduced earnings in 2020. We developed a global list of minimum wage data from on-line sources. All other model data were sourced from international, standardised, and open-access databases. For blindness, the total productivity loss (not working) incurred by 64%–90% of the affected population was summed up with partial productivity loss, defined as 10%–36% of the affected population earning one-third of that of the sighted population. For MSVI, the total productivity loss for 30%–55% of the affected population was summed with the partial productivity loss, defined as 45%–70% of the affected population having 35% reduced earnings. The costs of blindness and MSVI were summed to obtain the cost of combined vision loss. The global cost of vision loss based on minimum wage was US$160-US$216.32 billion for 2020. The global cost of vision loss using GNI was US$449.36-US$584.66 billion. A parsimonious model that considers minimum wage and GNI potentially lost due to blindness and MSVI can be used for eye care programming planning and advocacy at the national, regional, and global level. [ABSTRACT FROM AUTHOR]

Background: Diabetes is increasingly prevalent in Indigenous women and increases their risk of developing diabetic retinopathy, an eye complication of diabetes and a common cause of vision loss in Canada, especially among adults. Early detection is the most effective approach to prevent vision loss and reduce the impact of diabetic retinopathy. Objective: This study examined enablers and barriers that influence the diabetes eye care behaviour of First Nations and Métis women with diabetes and at risk of diabetes. Methods: We conducted a descriptive qualitative study with 35 First Nations and Métis women with diabetes or at risk of diabetes in Saskatoon, Canada. Data were collected via four sharing circle discussions and were analysed using thematic analysis. Results: The study findings showed that understanding of diabetes eye care access and cost, and unsupportive interactions with health care practitioners, were barriers to diabetic retinopathy care behaviour. Conversely, the presence of eye complications, participants' resolve to manage diabetes, self‐efficacy and fear due to experiences of family members with diabetes enabled diabetes eye care. Conclusions: Our study advances knowledge in socio‐cultural factors influencing diabetic retinopathy care behaviour among First Nations and Métis women living with and at risk of diabetes. The study shows the need for further public health and health system interventions to address barriers and support Indigenous peoples with or at risk of diabetes to make informed health decisions. [ABSTRACT FROM AUTHOR]

Purpose: To determine the associations of blindness within rural and urban counties using a registry of blind persons and geospatial analytics. Methods: We used the Oregon Commission for the Blind registry to determine the number of persons who are legally blind, as well as licensure data to determine the density of eye care providers (optometrists and ophthalmologists) within each county of the State of Oregon. We used geospatial statistics, analysis of variance, and logistic regression to determine the explanatory variables associated with blindness within counties. Results: We included 8350 individuals who are legally blind within the state of Oregon in the calendar year 2015. The mean observed prevalence of registered blindness was 0.21% and ranged almost 9-fold from 0.04% to 0.58% among counties (p <.001). In univariate models, higher blindness was associated with increasing median age (p =.027), minority race (p <.001), decreased median household income (p <.001), increased poverty within a county (p <.001), and higher density of ophthalmologists (p =.003). Density of optometrists was not associated with prevalence of blindness (p =.89). The final multivariable model showed higher blindness to be associated with lower median household income, higher proportion of black race, and lower proportion of Hispanic race (p <.001 for all). Conclusion: Geospatial analytics identified counties with higher and lower than expected proportions of blindness even when adjusted for sociodemographic factors. Clinicians and researchers may use the methods and results of this study to better understand the distribution of individuals with blindness and the associated factors to help design public health interventions. [ABSTRACT FROM AUTHOR]

Keywords: Blindness; COVID-19; equity; eye health; Indigenous Australians; inequality; telehealth; vision impairment; vision loss EN Blindness COVID-19 equity eye health Indigenous Australians inequality telehealth vision impairment vision loss 215 217 3 03/08/23 20230301 NES 230301 COVID-19 and Aboriginal and Torres Strait Islander eye health Over recent years there have been notable improvements in Aboriginal and Torres Strait Islander eye health outcomes, such as an increase in overall screening and treatment coverage rates of common eye diseases and decreasing rates of blindness.[[1], [3]] However, vision loss remains at least three times more prevalent amongst Aboriginal and Torres Strait Islander peoples than among other Australians. Similarly, in rural South Australia, where travel was restricted for approximately four months in 2020, and again from December 2021 to March 2022, the regional health service initiated a tele-optometry program that utilised an ophthalmic nurse and an off-site optometrist to collaborate in providing refractive and eye health assessments approaching that which is available with traditional face-to-face care. Examples of successful models include a health service in the Northern Territory, where an ACCHS-employed Aboriginal eye health coordinator acted as a central point of contact for both the optometrist and the primary health care staff of the region, facilitating effective patient triage and support. [Extracted from the article]

Purpose: To find out visual outcome of cataract surgery at secondary eye care hospital in Karachi, Pakistan. Study Design: Surgical audit. Place and Duration of study: Al-Baseer Eye Hospital, Karachi from January 2019 to January 2021. Methods: A total of 1540 cataract surgeries were performed. Patients referred from distant eye camps (outside of city limits) were not included. Data collection was done using hospital medical records on patient's age, sex, pre-operative best-corrected visual acuity (BCVA), surgical complications, visual acuity(VA) at 1st post-operative day, 1, 3 and 4 - 16 post-operative weeks, BCVA at 4 --16 post-operative weeks and causes of poor visual outcome (BCVA worse than 6/60) at 4 - 16 post--operative weeks. For data analysis, IBM SPSS Statistics 23 was used. Results: Out of 1540 cataract surgeries, 81% (1248) cases underwent phacoemulsification with intraocular lens implantation. Mean age at the time of surgery was 56.24 ± 11.45 years. Males were 54.9% (845) while 45.1% (695) were females. Rate of intraoperative complications was 0.9% (14 cases). Posterior capsule rupture occurred in 0.8% (13 cases), and zonular disinsertion in 0.1% (1 case). At 4 - 16 weeks post-operatively, follow-- up rate was 53.8% (828 patients); and the percentages of patients with good, borderline and poor BCVA were 94.7% (784 cases), 2.3% (19 cases), and 3.0% (25 cases) respectively. Conclusion: Good visual outcome can be obtained after cataract surgery at a secondary eye hospital, provided the surgeons and operating room team are trained, well equipped and follow aseptic measures. [ABSTRACT FROM AUTHOR]

Introduction: Pterygium represents a significant cause of visual impairment and blindness in the Amazon and surgery is the only definitive treatment available. The cost of surgery and the need for prolonged postoperative follow-up have proved to be an obstacle to its management. The aim of this prospective study carried out in the southern region of the Amazon was to evaluate telemedicine in the pterygium surgery follow-up to help make pterygium surgery postoperative care feasible in places without ophthalmologic assistance. Materials and Methods: Postoperative follow-up care was done through teleconsultation. It involved capturing photographs from the corneal and conjunctiva by trained technicians and sending them to a reading center for an ophthalmologist's assessment based on an asynchronous (store-and-forward) model. Patients and ophthalmologists were inquired about their satisfaction regarding the postoperative follow-up. Results: All pictures were classified as adequate, allowing proper assessments of results and complications. It was possible to manage the postoperative and conclude there were no postoperative surgical complications during the 6-month follow-up. All patients reported satisfaction with the remote performed evaluation and considered that all their doubts and expectations were met. Conclusion: Teleophthalmology allows remote access and can significantly improve eye care quality, access, and affordability. It may represent an alternative to providing pterygium surgery postoperative monitoring in areas without the availability of an ophthalmologist, making it possible to combat one of the leading causes of reversible blindness in the equatorial region. [ABSTRACT FROM AUTHOR]

Background. Childhood cataract is an important cause of blindness in children and imposes a huge socio economic burden on society. Purpose. Aim of the study is to identify the visual outcome after cataract surgery in paediatric age group and to study the various factors which influence visual outcome and surgical complications in paediatric cataract surgery. Material and Methods. This prospective study conducted at a tertiary Eye care Hospital for the period of September 2016 to February 2017. 30 children who presented with developmental cataract or congenital cataract in the age group of 2months - 16 years included in this study. Visual acuity in children less than 5 years was assessed using picture chart, E charts and Cardiff acuity cards and by snellen's chart for >5 years age children. Biomicroscopy, Fundus examination, and A scan were done. Children were reviewed every day for the first day and then every weekfor the first month and every 3 months for the first year after cataract surgery. Results. There was males (56.67%) dominance. Visual Inattentiveness/ defective vision was observed in 29(64.4%) of eyes. 13(33%) children had consanguity. Most of them were bilateral 26 (87%). Nystagmus was found to be the most common (20%) associated ocular anomaly. Vision at the time of presentation was less than 6/60 in better eye in 30 eyes (66.66%). The commonest type of cataract was total cataract 20(44.44%), followed by lamellar cataract 10 (22.22%). 45 eyes were operated, and IOL was implanted 73.33% of the eyes. Posterior capsulotomy with or without anterior vitrectomy was done in children less than 8 years of age. Following retinoscopic refraction, children were prescribed bifocal spectacles. Aphakic spectacles were prescribed in needed cases. Visual outcome at the end of 6 weeks was found to be greater than 6/24 in 66.66%. At the end of 12 months, vision greater than 6/24 was 48.88%. Posterior Capsule Opacification (PCO) was thick enough to require capsulotomy in 4 eyes. 3 Children underwent YAG capsulotomy. 1 eye needed surgical membranectomy. Complications other than PCO that was noted in this study were amblyopia which was seen in 5 eyes and optic capture in 2 eyes, anterior synaechiae in 1 eye and vitreous haemorrhage in 1 eye. Conclusion. Children less than 8 years who underwent primary posterior capsulotomy with or without anterior vitrectomy showed good visual outcome. PCO is the commonest complication and a major cause for visual obscuration following surgery, though the incidence of PCO has been brought down with modified surgical techniques and newer IOL designs. Children who underwent YAG/surgical capsulotomy had significant visual gain. Children with amblyopia who had strict adherence to occlusion therapy had significant improvement in visual acuity. [ABSTRACT FROM AUTHOR]

Purpose: To identify the profile of a pediatric low-vision population and investigate the differences between low-vision services in urban and rural areas. Methods: A retrospective study was conducted of the records of 286 consecutive children presenting at the Low Vision Clinic of the Eye and ENT Hospital of Fudan University from January 2009 to December 2018. The data retrieved included age, sex, education, family history, rural vs. urban residence, cause of visual impairment, and low-vision aids dispensed. Results: Of the 286 children (65.0% boys and 35.0% girls), over half (178, 62.2%) were from urban areas. The age range of the patients was 3–15 years (mean 9.54 ± 4.11). The four major causes of visual impairment were congenital cataract (70, 24.5%), optic atrophy (37, 12.9%), congenital glaucoma (34, 11.9%), and macular dystrophy (31, 10.8%). Low-vision aids were prescribed for 203 children (71.0%), with binocular telescopes (69, 25.0%) and stand magnifiers (66, 23.9%) being the most common. The urban children enjoyed higher rates of low-vision services than the rural children, with more low-vision aids (192, 94.6%) prescribed for the former. Conclusions: Congenital and hereditary diseases constituted the major causes of low vision in the study population. In contrast to their urban counterparts, the rural children experienced inadequate low-vision rehabilitation. Our findings suggest that policymakers need to better address gender inequalities and urban–rural disparities in low-vision services and that the coverage of low-vision services, especially in rural areas, should be enhanced in China. [ABSTRACT FROM AUTHOR]

Background: Glaucoma, the silent thief of sight, is a major cause of blindness worldwide. It is a burden for people in low-income countries, specifically countries where glaucoma-induced blindness accounts for 15% of the total incidence of blindness. More than half the people living with glaucoma in low-income countries are unaware of the disease until it progresses to an advanced stage, resulting in permanent visual impairment. Objective: This study aims to evaluate the acceptability of the Glaucoma Easy Screener (GES), a low-cost and portable visual field screening platform comprising a smartphone, a stereoscopic virtual reality headset, and a gaming joystick. Methods: A mixed methods study that included 24 eye care professionals from 4 hospitals in Southwest Ethiopia was conducted to evaluate the acceptability of GES. A pre-post design was used to collect perspectives before and after using the GES by using questionnaires and semistructured interviews. A Wilcoxon signed-rank test was used to determine the significance of any change in the scores of the questionnaire items (two-tailed, 95% CI; α=.05). The questionnaire and interview questions were guided by the Unified Theory of Acceptance and Use of Technology. Results: Positive results were obtained both before and after use, suggesting the acceptance of mobile health solutions for conducting glaucoma screening by using a low-cost headset with a smartphone and a game controller. There was a significant increase (two-tailed, 95% CI; α=.05) in the average scores of 86% (19/22) of postuse questionnaire items compared with those of preuse questionnaire items. Ophthalmic professionals perceived GES as easy to use and as a tool that enabled the conduct of glaucoma screening tests, especially during outreach to rural areas. However, positive evaluations are contingent on the accuracy of the tool. Moreover, ophthalmologists voiced the need to limit the tool to screening only (ie, not for making diagnoses). Conclusions: This study supports the feasibility of using a mobile device in combination with a low-cost virtual reality headset and classic controller for glaucoma screening in rural areas. GES has the potential to reduce the burden of irreversible blindness caused by glaucoma. However, further assessment of its sensitivity and specificity is required. [ABSTRACT FROM AUTHOR]

To explore the laymen knowledge of low vision and blindness concepts, and to assess the readability of some on-topic information available online. A cross-sectional study was performed in March 2019. Knowledge was evaluated by means of an ad hoc questionnaire-survey with two dichotomous questions about concepts related to low vision and blindness, followed with a list of 10 true-or-false statements. Readability of two on-topic online texts of different complexity was evaluated asking participants to rate the difficulty they experienced on a Likert scale and, objectively, by means of the freeware INFLESZ Readability Scale for Spanish language. Data analysis included descriptive statistics, t-tests, and ANOVA test (statistical significance: p < 0.05). Fifty-two percent of 103 participants declared never having heard of low vision. Ninety-four percent participants were aware about the word blindness, although most of them misinterpreted it. Neither academic level nor age influenced knowledge (p > 0,05). Higher academic level was related to better readability scores of the complex online text (p < 0.05). Overall, the general public has a limited awareness of low vision and a large misconception of blindness. Therefore, visual health education actions should aim at fostering knowledge and literacy on the issue. This strategy may encourage individuals to seek the advice of eye care providers in order to prevent and treat visual impairment, with relevant consequences in time, both in terms of quality of life and costs. [ABSTRACT FROM AUTHOR]

To estimate prevalence and causes of avoidable blindness among people ≥50 years and to assess willingness to pay (WTP) for cataract surgery in tribal region of south Gujarat, India. A cross-sectional population based survey was conducted with 44 randomly selected clusters each having 50 people aged ≥50 years selected by probability proportional to size of sampling. Adults identified with cataract causing visual loss (<6/18) in any eye were interviewed to assess their WTP for surgery. Total of 2137 examined out of 2200 people enumerated (response rate 97.1%). The prevalence of blindness (Presenting Visual Acuity (PVA)<3/60 in better eye) was 2.23% (95% CI: 2.95%–1.51%). Cataract was main cause of blindness (67.3%) followed by corneal scarring (8.2%). Major barrier to cataract surgery cited by bilaterally blind people was lack of escort to the surgical facility (34.3%). Cataract surgical coverage (CSC) was 84.9% (eyes) and 92% (persons). Of the 492 people interviewed to assess WTP for their surgery, only 36.4% people were willing to pay. The tribal population has a high poverty profile in India. Within this group, cataract remains the main treatable cause of blindness despite a high CSC. Assessment of barriers suggested that a well-coordinated outreach programme with free transport facilities to the surgical facility is required along with strategies to improve accessibility and prioritising cataract blind in the community. One-third of people were willing to pay for their surgeries implying that cross subsidization or tier system could be feasible for eye care programme sustainability. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to characterize the epidemiological and clinical profile of patients with lagophthalmos associated with leprosy, seen at the ophthalmology outpatient clinic of Fundação Alfredo da Matta, Manaus, Amazonas. Methods: This is a retrospective study carried out by analyzing the medical records of the patients included in the study. Sex, age, clinical form, degree of disability in diagnosis and outcome were obtained from medical records. Onset, type of impairment (unilateral or bilateral), degree of intensity of lagophthalmos and associated eye changes were also compiled. Results: 65 patients were included; 66.1% were male and 53.8% were older than 60 years. Regarding the operational classification of leprosy, most patients (81.5%) were multibacillary: 33.8% in the form of borderline leprosy and 47% virchowian. 36.9% of cases had ocular sequelae associated with lagophthalmos: corneal opacity, epiphora, band keratopathy, and corneal neovascularization.41.6% progressed to blindness. Lagophthalmos was performed clinically in 23 patients and the surgical approach was indicated in 42. Regarding surgical treatment, it consisted mainly of gold weight implantation and Tessier's canthoplasty. Discussion: Lagophthalmos in this sample affected more elderly men, was related to the multibacillary form, with leprosy-like leprosy as reported in the literature. The diagnosis of lagophthalmos was delayed in most cases, explaining the large number of sequelae including blindness. Conclusion: The present study reinforces the need for early eye care so that the potential and serious sequelae associated with this condition are avoided. [ABSTRACT FROM AUTHOR]

Background: Low vision and blindness have significant implications, resulting in a generally reduced quality of life amongst the sufferers. Aim: To determine the prevalence and causes of low vision and blindness amongst learners at the Akropong School for the Blind. Setting: The study was conducted in Akropong School for the Blind, Ghana. Methods: A cross-sectional study design was used. Eye examinations included measurements of presenting distance visual acuity (PDVA) with the Tumbling 'E' distance LogMAR chart. Anterior and posterior segments were examined with an ophthalmoscope and a slit lamp. Results: Two hundred and sixty-eight (N = 268) learners comprising 157 (58.6%) males and 111 (41.4%) females took part in this study and their ages ranged from 4 to 43 years (mean and standard deviation [SD] = 15.79 ± 6.15 years). The results indicated that 76.1% were classified as blind and 23.9% of the learners had low vision. The leading cause of low vision was glaucoma (39.1%) followed by pseudophakia (21.9%) and retinopathy (18.8%). The most common causes of low vision and blindness based on pathology found on ocular anatomical structures were corneal opacity/phthisis bulbi (35.5%), followed by glaucoma (25%), cataract (13.4%) and retinopathy (10.8%). Conclusion: The leading causes of low vision and blindness identified in this study were because of avoidable diseases such as corneal opacity/phthisis bulbi and glaucoma. This highlighted the need for adequate primary eye care services, equitable eye health workforce distribution and eye health awareness in Ghana to help prevent low vision and blindness. [ABSTRACT FROM AUTHOR]

Background: In order to gather evidence to guide eye care policy changes in Rwanda, a national population-based blindness and visual impairment survey was undertaken in 2015. Aim: To influence and direct policy changes using blindness survey findings. Setting: Nationwide sampling. Methods: Standard Rapid Assessment of Avoidable Blindness (RAAB) survey methodology was used across to examine 5065 (97.5% response rate) people aged 50 years and older. This is a case report of how the government used the evidence from the survey. Results: The age- and sex-adjusted prevalence of blindness was 1.1% (0.7–1.4) of which 83.9% was avoidable, with cataract being the major cause. The age- and sex-adjusted prevalence of visual impairment at the 6/18 level is 4.4% (3.7–5.1), with refractive errors and cataract being the major causes. The prevalence of all refractive errors was 4.3%, the majority of which was uncorrected. The cataract surgical coverage (CSC) was 68.4%, with 45.4% of surgeries performed at the secondary level. Difficulty in reaching surgical facilities (33.3%) was the main barrier to surgery. These results informed policy changes aimed towards an increase in the number of cataract surgeons, the volume of cataract surgery performed and broader spectacle provision. Conclusion: The prevalence of blindness in Rwanda is low compared to the previous estimates, although a considerable proportion is avoidable and the majority of refractive errors were uncorrected. The CSC and surgical outcomes are improving. The government, informed by this evidence, has introduced targeted initiatives to improve eye-care delivery in Rwanda. [ABSTRACT FROM AUTHOR]

To evaluate the effect of a mobile-based screening programme on eye care utilization in Iran. In this cluster randomized community trial, a representative sample of residents aged≥50 years from urban and rural areas in four districts in Tehran province were enrolled. The clusters were randomly assigned to one of the three parallel arms; the mHealth arm with digital data collection, vision screening test and retina evaluation using an integrated mobile application, the conventional arm with manual data collection and screening tests using Snellen chart and Fundus photography at the local primary healthcare facility, and the control arm with manual data collection without screening tests. The main outcome measure was eye care utilization which was defined as at least one visit to an optometrist or ophthalmologist. Of 3312 eligible individuals, 2520 (76.1%) participated. In the first 3 months after the screening programme, eye care utilization was higher among those who were referred by the mHealth method (35.6% 95%CI: 31.1–40.4%) compared to those referred by the conventional method (32.7%, 95%CI: 27.5–38.2%) and to those observed in the control arm (4.5%, 95%CI: 3.2–6.0). Eye care utilization improved (OR = 1.5, 95%CI: 1.2–1.9) among the referred people after the screening programme compared to the utilization before this programme; however, this improvement was significantly higher in the mHealth method (OR: 1.7, 95%CI: 1.2–2.4) compared to the conventional method (OR: 1.2, 95%CI: 0.8–1.8). The mobile-based screening programme can significantly improve eye care utilization at the community level. [ABSTRACT FROM AUTHOR]

Navigating access to eye care requires that patients recognize the need for screening and care, employ limited financial and social resources, manage complex health insurance policies, and access specialty clinical care. We investigated the experience of patients through the progression of vision loss to blindness, utilizing qualitative methods. We conducted structured telephone interviews with 28 persons with blindness throughout Oregon. Utilizing closed and open-ended questions, we explored patient experience on the events preceding avoidable blindness. Coding for emergent themes was conducted independently by two researchers using a constant comparative method. Participants described important barriers to accessing eye care: at the systems level, lack of access to providers and treatment; at the community level, available social support and services; and at the individual level, readiness to act and trust in providers. These findings suggest that important barriers to accessing preventive eye care, early diagnosis and treatment, vocational rehabilitation, and social services often occur at multiple levels. Access to eye care should be prioritized in efforts to reduce preventable visual impairment. [ABSTRACT FROM AUTHOR]

Purpose: Reliable data on eye care needs in Kyrgyzstan are not readily available. The purpose of this study was to determine the prevalence and causes of blindness and visual impairment in persons aged 50 and above in the southwest of Kyrgyzstan and to support the Ministry of Health (MoH) in the planning of eye care in the region. Methods: A population-based survey was conducted in three states (Oblast) in the southwest region of Kyrgyzstan. Sixty clusters of 50 people aged 50 years and older were selected by probability proportionate to size sampling. Ethical approval was obtained from the MoH, consent was obtained from each participant. Results: A total number of 3,000 persons aged 50 and older were sampled. Among these 2,897 (95.9%) were examined. The prevalence of bilateral blindness was 1.7% [95%CI: 1.1–2.4]. Cataract (43.3%) was the main cause of blindness, followed by glaucoma (30%), age-related macular degeneration (ARMD) (8.3%), other posterior segment diseases (6.7%) and non-trachomatous corneal opacities (5%). The prevalence of blindness and visual impairment increased strongly with age. The cataract surgical coverage in blind persons was 59%. Conclusion: Cataract and glaucoma were the major causes of blindness and visual impairment in persons 50 and above. The majority of the causes (85%) were avoidable, with 45% (cataract and uncorrected aphakia) treatable, 6.7% (corneal opacity and phthisis) preventable by primary health care/eye care services and 33.3% (cataract surgical complications, glaucoma) preventable by specialized ophthalmic services. The data suggest that an expansion of eye care services to reduce avoidable blindness is needed, as ageing will lead to an increase in older people at risk and a higher demand for eye care in the future. [ABSTRACT FROM AUTHOR]

Background. For so long, corneal diseases have been known as one of the leading causes to blindness in the global. This blindness might be due to failure to accept the corneal transplantation. Therefore, this study aimed to determine the prevalence and the root challenges for corneal transplantation acceptance at the University of Gondar tertiary eye care and training center, Ethiopia. Methods. An institution-based cross-sectional study was conducted among patients who had an indication for corneal transplantation at the University of Gondar tertiary eye care and training center since January 1, 2017, up to October 30, 2018. A structured questionnaire was used to collect the data and entered into Epi-Info 7 software and analyzed using SPSS version 20. Simple logistic regression was used to identify the associated factors of corneal transplantation acceptance. Associations between outcome and exposure variables were expressed by the adjusted odds ratio with a 95% confidence interval and p value <0.05. Result. A total of 116 patients with a mean age of 51 (±21) years participated in the study. The overall acceptance level of corneal transplantation was only 38.8% (95% CI: 29.93, 47.66). Patients with poor knowledge [AOR = 2.41; 95% CI: 1.90, 6.48] and an unfavorable attitude [AOR = 6.33; 95% CI: 2.42, 16.54] were significantly associated with the acceptance of corneal transplantation. Conclusion. The study revealed that the corneal transplantation acceptance level was very low. Hence, the government and other concerned stakeholders should give due emphasis to the awareness creation and behavior change communication strategies to increase the acceptance level of corneal transplantation. [ABSTRACT FROM AUTHOR]

Low vision and blindness are two grave health concerns in India. Besides poor socioeconomic background and low education, lack of awareness, the choice to use eye care devices and non-availability of eye care experts are major factors to magnify the issue. Right time care and proper communication between the patient and caregiver can be a solution to handle the crucial situation. The aim of this study is to understand the status of low vision and visually handicapped services in India. The major findings suggest that there is an ultimate need to have attention in fulfilling the demand-supply gap. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To obtain new rapid assessment of avoidable blindness (RAAB) data on the prevalence, causes and trends of blindness, visual impairment and cataract surgery; and compare the new 2018 data with the older RAAB 2009 data. Methodology: The second nationwide RAAB used android based mRAAB technique and technology for data collection. Using the compact segment sampling probability proportionate to size, 5,050 participants from 101 clusters of 50 people aged 50 years and older were enrolled through house-to-house visits. Eligible participants received ophthalmic examination and interview by the ophthalmologist-led emuneration team as per the RAAB protocol. Results: The age-sex adjusted magnitude of bilateral blindness in Bhutan was 1.0% (95% Confidence Interval, CI 0.5–1.4) with relatively higher prevalence in rural population (Odds Ratio, OR 1.5, p = 0.13) and women (OR 1.6, p = 0.06). Untreated cataract accounted for the most of blindness (53.8%), severe vision impairment (57.1%), and moderate visual impairment (65.3%); uncorrected refractive error was the main cause of early visual impairment (46.7%). Cataract Surgical Coverage was 86.1% with relatively better coverage in men (76.7% men; 73.1% female) and urban population (79.2% urban; 70.2% rural). Good cataract surgical outcome was achieved in 67.3% and leading cause of poor outcome was ocular comorbidity (43.6%). Accessibility was a significant barrier to the uptake of cataract surgical services. Conclusion: There is a 33% reduction in blindness from 1.5% to 1.0%, since the first RAAB survey in 2009. In order to further reduce blindness and visual impairment, Bhutan should continue to implement long-term strategic action plan for eye health focused on strengthening primary eye care and comprehensive eye care service. [ABSTRACT FROM AUTHOR]

To test a model of integrated pediatric eye care delivery and examine the prevalence and factors associated with childhood ocular morbidity in a peri-urban setting in Bangladesh. Cross-sectional, population-based study. The study was conducted in three phases among children aged ≤15 years. Trained community health workers (CHWs) conducted awareness intervention and identified children with ocular problems. These children were then referred to the base hospital for examination and treatment by ophthalmologists. A pediatric ophthalmologist further examined the children with complicated eye diseases and ensured treatment at a tertiary public eye hospital. Awareness, referral patterns, and health-seeking behavior were also examined. All data were analyzed statistically using Statistical Package for Social Sciences. CHWs screened 33,549 eligible children and identified 1887 cases with ocular morbidity. The prevalence of ocular morbidity and childhood blindness were 5.63% (95% confidence interval [CI] = 5.27–6.16) and 0.060% (95% CI = 0.03–0.11), respectively. The most commonly observed ocular morbidities were refractive error (3.24%; 95% CI = 3.11–3.45), allergic eye conditions (1.2%; 95% = CI 0.74–1.27), and nasolacrimal duct obstruction (0.52%; 95% CI = 0.25–0.74). Blindness was more frequently seen in children aged <5 years than in those aged 5–15 years (χ2 = 7.25; P = 0.007). The causes of blindness were corneal opacity, congenital eye anomaly, cataract, retinopathy of prematurity, and retinoblastoma. The prevalence of ocular morbidity was higher among older children, boys, children with low parental education and income, and children from households dwelling in slums. This study demonstrated that in a setting where screening and treatment for vision problems remain low, ocular morbidity among children could be easily identified through well-designed community-based screening programs involving appropriately trained CHWs. Community mobilization, awareness, and early detection of childhood eye diseases, with effective referral mechanisms for accessing appropriate care, are crucially important to improve service delivery. • Trained community health workers conducted awareness interventions, identified and referred children with ocular problems. • Refractive error was the most common ocular morbidity. • Ocular morbidity was associated with older children and slum dwellers. • Gender inequalities existed in care seeking; fewer girls sought care from the referral hospital. • Community mobilization, early detection and effective referral are important for improving eye care service delivery. [ABSTRACT FROM AUTHOR]

Caring Vision Hospital (pseudo-name) started as a small charitable organization in Bangladesh which later turned to be a renowned eye care institute. This eye care service model is dedicated towards providing proper eye care to both the affluent and underprivileged patients through cross-subsidization measures. A key to the success of this concept is due to the good relationship between foreign non-governmental organizations, philanthropists and renowned ophthalmologists who act as key stakeholders. The present case study highlights the growth of Caring Vision. Moreover, the problems and future scopes shed light into the practical business world which can be implemented across any organization. [ABSTRACT FROM AUTHOR]

Background: China used to be among the countries with a high prevalence of trachoma. At the launch of The Global Elimination of Trachoma (GET) 2020 campaign by the World Health Organization (WHO) in 1996, China was placed on the list of countries endemic for trachoma based on historical data. However, empirical observation and routinely collected eye care data were suggesting that trachoma was no longer a public health problem. To determine whether the GET 2020 goals had been met in P. R. China, we conducted a targeted assessment with national scope. Methodology/principal finding: Province assessment teams, trained in WHO Trachoma Rapid Assessment (TRA) methodology and in WHO simplified trachoma grading system, carried out assessments in 16 provinces (among them, 2 provinces conducted pilot assessment). Based on the published literature, including national and international reports, suspected trachoma-endemic areas within each province were identified. Within these areas, trachomatous inflammation- follicular (TF) assessments were carried out in at least 50 grade-one children in primary schools serving villages with the lowest socio-economic development. Trachomatous trichiasis (TT) and corneal opacity (CO) assessments were conducted among persons aged 15 and over in villages within the catchment area of the selected schools. Of 8,259 children examined in 128 primary schools in 97 suspected trachoma endemic areas, only 16 cases of conjunctivitis were graded as TF. 38 cases with TT were found among the 339,013 examined residents in villages surrounding the schools. Among these 97 suspected trachoma endemic areas in only three was the prevalence of TT more than 0.2%. Conclusions/significance: This large study suggested that trachoma was not a public health problem in 16 provinces that had been previously suspected to be endemic. These findings will facilitate planning for elimination of trachoma from PR China. [ABSTRACT FROM AUTHOR]

Introduction: Cataracts remain the leading cause of blindness worldwide. Despite this, there is a lack of information surrounding cataracts in Ecuador. We sought to assess the rate and barriers to cataract-related care in two Ecuadorian communities to identify points of intervention for local and international organizations. Methods: This was a cross-sectional assessment using a convenience sample of patients seen in clinics run by Fundacion Internacional Buen Samaritano Paul Martel, a local nonprofit providing affordable eye care in Ecuador. Two populations were assessed. Week 1 patients were from the Andean region of Chimborazo (W1) and week 2 patients from Santa Cruz Island, Galapagos (W2). All patients seen were assessed for cataracts. Patients identified as having cataracts completed a six-question survey related to barriers to care. The primary outcomes were the rate of cataracts and the leading barriers to care. Results: Forty-four total patients during W1 and 1,002 during W2 were seen and screened for cataracts. Mean age (years) was W1 - 44 years and W2 - 42 years. The overall rate of cataracts was 4 (9%) in W1 and 50 (5%) in W2. When stratified by age, the rate of cataracts in individuals aged 50 and over was 21% (W1) and 6% (W2). Forty-six participants with cataracts completed the survey. The major barriers to cataract-related care were cost (n = 26), followed by access (n = 7), and fear of surgery (n = 4). Conclusions: Our results confirm the high overall rate of cataracts in patients presenting to eye clinics in two distinct communities. We found that cost and access are the main barriers to care. These communities would benefit greatly from care delivery models that bring services close to where individuals live, through partnerships between local and global organizations. [ABSTRACT FROM AUTHOR]

Introduction: Cataract is a leading cause of avoidable blindness in children in sub-Saharan Africa (SSA). We provide an overview of the epidemiological evidence about childhood cataract in SSA, we look at the resources in place to address the needs of affected children and families, the remaining challenges, and bring a perspective about the way forward for the next five years. Areas covered: The paper covers the following areas: epidemiology of the disease; barriers of access and mitigation strategies; management of childhood cataract, and the human resources that should be in place across the whole continuum of care - from case finding to the achievement of optical outcomes and educational placement after the delivery of low vision and rehabilitation services. Expert commentary: Despite the creation of new Child Eye Health Tertiary Facilities (CEHTF) in recent years, there is still a shortage of pediatric ophthalmologists and other staff members in SSA. Accessing training opportunities is challenging, especially in Francophone Africa, and a more systematic, multidisciplinary, and strategic approach to training for CEHTF as well as supporting CEHTF is needed to strengthen the delivery of comprehensive long-term care. The links between the eye care and the education sectors need to be strengthened throughout SSA. [ABSTRACT FROM AUTHOR]

India has done well in eye care delivery by recognizing visual impairment and blindness as a major medical challenge. Major contributions have come from ophthalmologists (mass cataract surgery in the early 1900s; major participation of non-government organizations), policy makers (National Program for Control of Blindness and Visual Impairment 1976; systematic development under the World Bank assisted India Cataract Project, 1995-2002), and the industry (manufacturing of affordable surgical instruments and medicines). Although the country could boast of higher cataract surgical coverage and near-total elimination of trachoma, there is increasing prevalence of diabetic retinopathy and undetected glaucoma. India is in the crossroad of adherence to old successful models of service delivery and adoption of new innovative methods of teaching and training, manpower development and skill-based training, relevant medical research and product development. In the absence of these new approaches, the initial gains in eye care could not be furthered in India. A new approach, that will combine the best of the "old" tradition of empathy and the "new" technology of analytics, is required to imagine the future of eye care in India. [ABSTRACT FROM AUTHOR]

Purpose: To describe the program planning of Sunetra (Healthy Eyes), the universal eye health coverage in the Indian state Odisha. Methods: The Indian state of Odisha launched the universal eye health coverage in October 2017. This is the first Indian state to officially respond to the World Health Organization's Global Action Plan. Results: The Government of Odisha pledged INR 6,820 million (US$ 100 million approximately) spread over 5 years. Each third of the pledged money is allocated for immediate direct benefit, building the infrastructure and human resources, and creating a digital eye health platform for uniform documentation and policy planning. Conclusion: It is hoped that at the end of 5 years, by 2022, the state will attain the goals prescribed in the Global Action Plan in eye care. [ABSTRACT FROM AUTHOR]

Many low- and middle-income countries use national eye-care plans to guide efforts to strengthen eye-care services. The World Health Organization recognizes that evidence is essential to inform these plans. We assessed how evidence was incorporated in a sample of 28 national eye-care plans generated since the Universal eye health: a global action plan 2014-2019 was endorsed by the World Health Assembly in 2013. Most countries (26, 93%) cited estimates of the prevalence of blindness and 18 countries (64%) had set targets for the cataract surgical rate in their plan. Other evidence was rarely cited or used to set measurable targets. No country cited evidence from systematic reviews or solution-based research. This limited use of evidence reflects its low availability, but also highlights incomplete use of existing evidence. For example, despite sex-disaggregated data and cataract surgical coverage being available from surveys in 20 countries (71%), these data were reported in the eye health plans of only nine countries (32%). Only three countries established sex-disaggregated indicators and only one country had set a target for cataract surgical coverage for future monitoring. Countries almost universally recognized the need to strengthen health information systems and almost one-third planned to undertake operational or intervention research. Realistic strategies need to be identified and supported to translate these intentions into action. To gain insights into how a country can strengthen its evidence-informed approach to eye-care planning, we reflect on the process underway to develop Kenya's seventh national plan (2019-2023). [ABSTRACT FROM AUTHOR]

Objective To review interventions improving eye-care services for schoolchildren in low- and middle-income countries. Methods We searched online databases (CINAHL, Embase®, ERIC, MEDLINE®, ProQuest, PubMed® and Web of ScienceTM) for articles published between January 2000 and May 2018. Eligible studies evaluated the delivery of school-based eye-care programmes, reporting results in terms of spectacle compliance rates, quality of screening or attitude changes. We considered studies to be ineligible if no follow-up data were reported. Two authors screened titles, abstracts and full-text articles, and we extracted data from eligible full-text articles using the availability, accessibility, acceptability and quality rights-based conceptual framework. Findings Of 24 559 publications screened, 48 articles from 13 countries met the inclusion criteria. Factors involved in the successful provision of school-based eye-care interventions included communication between health services and schools, the willingness of schools to schedule sufficient time, and the support of principals, staff and parents. Several studies found that where the numbers of eye-care specialists are insufficient, training teachers in vision screening enables the provision of a good-quality and cost--effective service. As well as the cost of spectacles, barriers to seeking eye-care included poor literacy, misconceptions and lack of eye health knowledge among parents. Conclusion The provision of school-based eye-care programmes has great potential to reduce ocular morbidity and developmental delays caused by childhood vision impairment and blindness. Policy-based support, while also attempting to reduce misconceptions and stigma among children and their parents, is crucial for continued access. [ABSTRACT FROM AUTHOR]

Classification is a defining characteristic of para-sports whereby eligible athletes are allocated a sport class to compete against others with similar activity limitations. To account for the unique characteristics of each sport, para-sports should develop their own classification system using evidence that demonstrates the impact of impairment on performance in that sport. Although the move towards sport-specific classification has progressed in sports for athletes with physical and intellectual impairments, sports for athletes with vision impairment (VI) continue to use the same three classes irrespective of the sport, with classes delineated by legal definitions of low vision and blindness. The aim of this joint International Paralympic Committee/International Blind Sports Federation (IPC/IBSA) Position Stand is to provide guidance for how evidence-based sport-specific classification should be achieved in VI sports. It does so by outlining three conceptual research models (correlation, simulation, and component analysis) that can be used to establish both the minimum impairment required to compete plus the appropriate number of sport classes and their inclusion criteria. The present evaluation of vision relies on measures of visual acuity and field, but new criteria may require a sport-specific combination of additional measures of visual function (e.g. contrast, motion, and light sensitivity) to better account for the impact of VI on sport performance. Moreover, the test procedures used during athlete evaluation (e.g. whether to evaluate both eyes individually or together) should be chosen to better represent the habitual viewing situation experienced in that sport. The development of sport-specific criteria should enhance the legitimacy of competition and encourage increased grassroots participation in VI sports. [ABSTRACT FROM AUTHOR]