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Objectives: To report ocular manifestations in patients with Fabry disease (FD) from a tertiary eye care center in Türkiye. Materials and Methods: This prospective, cross-sectional study included 30 eyes of 15 patients with FD. The diagnosis of FD was made based on a combination of clinical findings, genetic analysis, and biochemical evaluation. All participants underwent a detailed ophthalmic examination with special focus on the typical ocular features of FD (cornea verticillata, conjunctival aneurysms, cataract, retinal vessel tortuosity). Results: The mean age was 45±17 years (range: 22-75 years), with a female/male ratio of 2:3. All patients had tortuous conjunctival vessels and 12 patients (80%) had conjunctival aneurysms. Cornea verticillata was present in 10 patients (66.6%), lens opacification in 4 patients (26.6%), and retinal vascular tortuosity in 8 patients (53.3%). All patients had at least two different ocular findings; most (3 heterozygotes/7 hemizygotes) had a combination of corneal verticillata and conjunctival vessel abnormality. The conjunctiva, cornea, and retina were affected together in 5 hemizygous patients (33.3%). One hemizygous patient had all FD-related ocular manifestations in both eyes. Conclusion: To our knowledge, this study is the first to describe the ocular manifestations of FD in the Turkish population. Although cornea verticillata is considered a hallmark of FD, it was absent in approximately one-third of patients. Moreover, cataract, another well-known feature of FD, was present in only 26.6% of the patients. Conjunctival vascular abnormality alone seems to be quite rare in FD, although it often accompanies other ocular manifestations. Therefore, recognition of other mild findings and special consideration of their associations may increase the diagnostic value of ocular findings in FD. [ABSTRACT FROM AUTHOR]

Aim: To investigate the barriers to the uptake of referral services from secondary care centers (SC) to a higher-level tertiary care center (TC) in Southern India. Methods: A cross-sectional study was conducted in the Mahabubnagar district of Telangana, India, between February 1, 2018 to January 31, 2019 and all those referred from SC to TC between January 1, 2013 to December 30, 2016 were identified for interview. Based on inclusion criteria, of the 960 participants identified, 681 (70.9%) participated in the study. A validated study questionnaire was administered to all participants. Information collected were the demographic details, details related to their referral and barriers to referral. The participants that presented at TC were considered compliant and who did not, were non-compliant. Reasons for non-compliance was also collected. Results: The mean age those interviewed was 46.1 years (SD: 17.3 years) and 429 (63%) were males and 252 (37%) were females. Overall, 516 (75.8%) were compliant, and 165 (24.2%) were non-compliant. The major factors for non-compliance were economic (16.4%) and attitudinal (44.2%) barriers. Within the attitudinal barrier category, the most prevalent individual attitudinal barriers were 'too busy to go to the eye center for treatment (16.4%)'and 'able to manage routine daily activities with current vision (12.1%)'. The multivariable analysis showed that the non-compliant participants had only visited the SC once prior to the referral (odds ratio: 2.82; 95% CI: 1.43–5.57) (p = 0.003). Conclusions: Participants with only one SC visit, were less likely to comply with referrals and the major barriers to compliance were economical and attitudinal. It is important to address these specific barriers to provide proper counseling to participants during referrals. [ABSTRACT FROM AUTHOR]

Background: The majority of childhood blindness causes in low-income countries are treatable or avoidable. Parents or guardians are responsible for making decisions regarding a child's eye care. Understanding parents' awareness and perception of eye problems in crucial in helping to know parents' eye care-seeking behavior. Objective: To determine parental knowledge, attitudes and practice regarding child eye health. Methods: Seven focus groups were carried out in Northwest Ethiopia on knowledge, attitude and practice of parents towards child eye health. Their responses were tape-recorded and later transcribed. A thematic phenomenological approach was used for the analysis. Result: Seventy-one parents participated in the focus groups. Participants were aware of common eye problems like trachoma, trauma, and glaucoma. However, they were unaware of the causes and etiologies of childhood blindness. Participants perceived that eye problems could be treated with hygiene and food, and often held misconceptions about the cause of strabismus and utilization of wearing spectacles. Conclusion: The study revealed that parents are often unaware of the causes and etiologies of common childhood eye diseases, which has downstream effects on health-seeking behavior. Health promotion efforts, potentially through mass and social media, could be helpful to raise awareness, coupled with training of health professionals at primary and secondary health facility levels. [ABSTRACT FROM AUTHOR]

Purpose: Early detection of sight-threatening disorders by technological applications like teleophthalmology and prompt treatment can help decrease visual impairment. This study evaluated the role of teleophthalmology in underserved rural areas along with cost-saving estimates for the end user. Methods: A prospective, observational, cross-sectional hospital-based study was conducted over 3 months. First 1000 teleconsultations were included. None of the patients denied providing informed consent. The patients were consulted at the eight vision centers and three satellite centers of the hospital in the nearby rural and tribal regions closer to their residential places. These vision and satellite centers were connected to the base hospital like a hub and spoke model with a teleophthalmology network. Results: Cataract (n = 301, 30.1%) and refractive error (n = 290, 29%) were the most common diagnosis. 42.1% of patients were referred to base hospital for further evaluation. Thus, a total of 57.9% of patients were not required to visit the base hospital for initial consultation, saving time and money. Furthermore, 15.1% of patients were provided medical treatment at the vision center and satellite center, which helped in making teleophthalmology cost-saving for the patients. An average of Rs. 621/- were saved per patient for the community in our study. Conclusion: Networked teleophthalmology model can be an affordable and feasible tool for providing eye care delivery services in rural and tribal regions of Gujarat and the whole country, especially for the end user. Thus, it may be a workable model in ophthalmology practice with substantial cost saving to the community. [ABSTRACT FROM AUTHOR]

Technological advancement has brought commendable changes in medicine, advancing diagnosis, treatment, and interventions. Telemedicine has been adopted by various subspecialties including ophthalmology. Over the years, teleophthalmology has been implemented in various countries, and continuous progress is being made in this area. In underserved populations, due to socioeconomic factors, there is little or no access to healthcare facilities, and people are at higher risk of eye diseases and vision impairment. Transportation is the major hurdle for these people in obtaining access to eye care in the main hospitals. There is a dire need for accessible eye care for such populations, and teleophthalmology is the ray of hope for providing eye care facilities to underserved people. Numerous studies have reported the advantages of teleophthalmology for rural populations such as being cost-effective, timesaving, reliable, efficient, and satisfactory for patients. Although it is being practiced in urban populations, for rural populations, its benefits amplify. However, there are certain obstacles as well, such as the cost of equipment, lack of steady electricity and internet supply in rural areas, and the attitude of people in certain regions toward acceptance of teleophthalmology. In this review, we have discussed in detail eye health in rural populations, teleophthalmology, and its effectiveness in rural populations of different countries. [ABSTRACT FROM AUTHOR]

Background: Public eye care services in South Africa are relatively underdeveloped. This is, in part, due to optometry services historically being private sector-focussed, as well as a lack of ophthalmologists in the country. Optometry students who engage in service learning at public health facilities are well placed to share their perceptions of this service. Aim: To investigate the perceptions and experiences of optometry students regarding public eye care services in South Africa. Setting: Data were collected on the Phelophepa Health Care Train while it was stationed at Musina and Polokwane in 2019. Methods: A qualitative study was conducted using focus group interviews to collect data from South African optometry students. Two focus group sessions were held, with a total sample of 18 representing two different higher education institutions. Interview recordings were transcribed, and data were thematically analysed using interpretive content analysis. Results: Three main themes emerged, namely 'inability to deliver quality services', 'negative perceptions about public eye care services' and 'potential to improve public eye care services'. Strengthening infrastructure and human resource capacity were seen as fundamental steps to improving public eye care services in South Africa. Conclusion: Strengthening public eye care services in South Africa is necessary in order to improve the experience-based perceptions of optometry students towards this sector. Addressing eye health system weaknesses through appropriate resourcing will likely contribute to attracting this potential future human resource to the sector, and assist in alleviating the shortage of human resources for eye health within South Africa's public health service. Contribution: Optometry education and professional practice in South Africa is increasingly adopting a more public health approach. This shift towards strengthening public eye care services and improving human resources capacity for the same is both important and necessary to address unmet eye health needs in the country. However, current gaps and challenges within the public health system may deter new graduates in South Africa from choosing this practice path if the overall challenges of resourcing and capacity to deliver quality services are not addressed. [ABSTRACT FROM AUTHOR]

Objectives: To observe patterns of Pediatric eye diseases over five years 2015-19, to improve management of ophthalmic pediatric units in the developing countries. Methods: It was an observational, cross-sectional study carried out in a tertiary eye care Hospital, Karachi. Records of the children under 16 years of age from 2015 to 2019 were retrieved. Inclusion criteria included complete records with age, gender of the children, symptoms, examination, investigation if necessary, and diagnosis. All incomplete records were excluded. Results: A total of 35348 records with 55.17% boys and 44.82% girls were analyzed. Similar gender difference was reflected in disease frequency. Seven percent of the children did not have detectable ocular pathology. Conjunctivitis, refractive errors and squint were the three most common ocular morbidities observed in decreasing order of frequency as 32.67%, 20.08% and 14.7% respectively. Cataract was present in 4.51%, Corneal disease in 4.11%, Retinal pathology in 1.04%, Glaucoma in 0.49% cases; but Retinoblastoma was present in 55 cases and ROP in 4 cases only. Almost 60% of the children had simple ocular problems like conjunctivitis, refractive error and absence of any pathology. Conclusion: Majority of the children attending pediatric ophthalmology had simple problems manageable at primary health facility level. Strengthening of the primary health care facility will reduce considerable burden of pediatric unit at the tertiary level. Optometrists and orthoptists are important members of the team for refraction and squint management. [ABSTRACT FROM AUTHOR]

Background: Over two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for primary eye care. However, there are limited data on the capacities needed for delivery, to guide policymakers and implementers on the feasibility of integration. The overall purpose of this study was to assess the technical capacity of the health system at primary level to deliver the WHO primary eye care package. Findings with respect to service delivery, equipment and health management information systems (HMIS) are presented in this paper.Methods: This was a mixed-methods, cross sectional feasibility study in Anambra State, Nigeria. Methods included a desk review of relevant Nigerian policies; a survey of 48 primary health facilities in six districts randomly selected using two stage sampling, and semi-structured interviews with six supervisors and nine purposively selected facility heads. Quantitative study tools included observational checklists and questionnaires. Survey data were analysed descriptively using STATA V.15.1 (Statcorp, Texas). Differences between health centres and health posts were analysed using the z-test statistic. Interview data were analysed using thematic analysis assisted by Open Code Software V.4.02.Results: There are enabling national health policies for eye care, but no policy specifically for primary eye care. 85% of facilities had no medication for eye conditions and one in eight had no vitamin A in stock. Eyecare was available in < 10% of the facilities. The services delivered focussed on maternal and child health, with low attendance by adults aged over 50 years with over 50% of facilities reporting ≤10 attendances per year per 1000 catchment population. No facility reported data on patients with eye conditions in their patient registers.Conclusion: A policy for primary eye care is needed which aligns with existing eye health policies. There are currently substantial capacity gaps in service delivery, equipment and data management which will need to be addressed if eye care is to be successfully integrated into primary care in Nigeria. [ABSTRACT FROM AUTHOR]

Background: To increase access to eye care, the World Health Organization's Africa Region recently launched a primary eye care (PEC) package for sub-Saharan Africa. To determine the technical feasibility of implementing this package, the capacity of health systems at primary level needs to be assessed, to identify capacity gaps that would need to be addressed to deliver effective and sustainable PEC. This study reports on the human resource and governance challenges for delivering PEC in Anambra State, Nigeria.Methods: Design: This was a mixed methods feasibility study. A desk review of relevant Nigerian national health policy documents on both eye health and primary health care was conducted, and 48 primary health care facilities in Anambra state were surveyed. Data on human resource and governance in primary health facilities were collected using structured questionnaires and through observation with checklists. In-depth interviews were conducted with district supervisors and selected heads of facilities to explore the opportunities and challenges for the delivery of PEC in their facilities/districts. Data were analysed using the World Health Organization's health system framework.Results: A clear policy for PEC is lacking. Supervision was conducted at least quarterly in 54% of facilities and 56% of facilities did not use the standard clinical management guidelines. There were critical shortages of health workers with 82% of facilities working with less than 20% of the number recommended. Many facilities used volunteers and/or ad hoc workers to mitigate staff shortages.Conclusion: Our study highlights the policy, governance and health workforce gaps that will need to be addressed to deliver PEC in Nigeria. Developing and implementing a specific policy for PEC is recommended. Implementation of existing national health policies may help address health workforce shortages at the primary health care level. [ABSTRACT FROM AUTHOR]

Background: Trachoma is the most common infectious cause of blindness in the globe. Trichiasis surgery is the best treatment option for this disease. Despite efforts done to eliminate blinding trachoma, there is limited evidence on the surgical uptake of trachoma trichiasis in Ethiopia. This study was aimed to assess the uptake of trachoma trichiasis surgery in Southern Tigray, Ethiopia. Methods: Mixed cross-sectional study was employed among 409 participants. Study participants were selected using a consecutive sampling technique. Pretested and interviewer-administered data were collected using a structured questionnaire. Binary and multivariable logistic regression was done to identify associated factors. Adjusted odds ratios 95% CI was estimated to show the strength and direction. Variables with p-values < 0.05 were considered statistically significant. For qualitative data, 4 focus group discussions were conducted with 40 participants and described by thematic analysis then triangulated with quantitative findings. Results: About 234 (57.9%, 95% CI: (53.2, 62.9)) participants utilized trachoma trichiasis surgery (TT). History of trachoma trichiasis (TT) for > 2 years [AOR: 0.4, 95% CI: (0.22, 0.72)], informed about surgery program by health workers [AOR: 0.3, 95% CI: (0.13, 0.71)], history of TT surgery [AOR: 0.18, 95% CI: (0.05, 0.6)], absence of someone to care the family [AOR: 14, 95% CI: (6.9, 28.6)], companion [AOR: 8.9, 95% CI: (4.3, 18.3)], nearby health facility [AOR: 2.4, 95% CI: (1.1, 5.4)], work load [AOR: 8.8, 95% CI: (4.6, 17)], fear [AOR: 4.3, 95% CI: (1.8, 10)], and believing eye drop can treat TT [AOR: 3.9, 95% CI: (1.4, 11)] were significantly associated factors. Conclusion: More than half of the participants accepted the TT surgical uptake. Strengthening community awareness on proper eye care, and effective treatment options, and addressing the negative attitude towards surgical treatment in the community are important measures to achieve the elimination target of trachoma. [ABSTRACT FROM AUTHOR]

Purpose: To assess awareness regarding Primary Eye Care among (primary healthcare workers) PHCWs and also intended to identify its determinants. Study Design: Descriptive cross-sectional study. Place and Duration of Study: All primary healthcare facilities of Tehsil Kallar Syedan, from October 2019 to December 2019. Methods: The calculated sample size was 115. Data was collected from primary health care workers (PHCWs). Data was collected through a structured questionnaire with both open-ended and close-ended questions. Questions were made using simple language and were also translated in Urdu. Questionnaire was adapted from two articles and some questions were made after reading the components of National Programme for Prevention and Control of Blindness (Punjab, Pakistan).Chi-square test of independence was used for finding associations. Results: Fifty-four percent PHCWs had poor awareness regarding primary eye care. Majority of the PHCWs, N = 64 (55.7%) identified just the names of common eye diseases. Cataract was identified with correct treatment by 88% primary healthcare workers. Age, education, designation were significantly associated with awareness of PHCWs. Conclusion: The study concluded that more than half of PHCWs had low awareness regarding PEC. All of them mentioned that there was a need of improving and refreshing their knowledge related to primary eye care. This will definitely help to reduce pressure on secondary and tertiary healthcare workers. [ABSTRACT FROM AUTHOR]

Background: In 1994, the Lady Health Workers (LHWs) Programme was established in Pakistan to increase access to essential primary care services and support health systems at the household and community levels. In Khyber Pakhtunkhwa (KPK) province in northern Pakistan, eye care is among the many unmet needs that LHWs were trained to address, including screening and referral of people with eye conditions to health facilities. However, despite an increase in referrals by LHWs, compliance with referrals in KPK has been very low. We explored the role of LHWs in patient referral and the barriers to patient compliance with referrals.Methods: Qualitative methodology was adopted. Between April and June 2019, we conducted eight focus group discussions and nine in-depth interviews with 73 participants including patients, LHWs and their supervisors, district managers and other stakeholders. Data were analysed thematically using NVivo software version 12.Results: LHWs have a broad understanding of basic health care and are responsible for a wide range of activities at the community level. LHWs felt that the training in primary eye care had equipped them with the skills to identify and refer eye patients. However, they reported that access to care was hampered when referred patients reached hospitals, where disorganised services and poor quality of care discouraged uptake of referrals. LHWs felt that this had a negative impact on their credibility and on the trust and respect they received from the community, which, coupled with low eye health awareness, influenced patients' decisions about whether to comply with a referral. There was a lack of trust in the health care services provided by public sector hospitals. Poverty, deep-rooted gender inequities and transportation were the other reported main drivers of non-adherence to referrals.Conclusions: Results from this study have shown that the training of LHWs in eye care was well received. However, training alone is not enough and does not result in improved access for patients to specialist services if other parts of the health system are not strengthened. Pathways for referrals should be agreed and explicitly communicated to both the health care providers and the patients. [ABSTRACT FROM AUTHOR]

Background: Globally, at least 1 billion people have a vision impairment that could have been easily prevented or easily treated. Cataract is the leading preventable and most treatable causes of blindness and bilateral low vision among adults. Despite being the leading cause of preventable and most treatable blindness, the lack of knowledge about the disease and its option of treatment is still a major barrier in reducing the blindness owing to cataract in the developing countries particularly in Ethiopia. Hence, the aim of this study is to determine the level of knowledge about cataract and associated factors among adults in Yirgalem Town, Sidama National Regional State, Southern Ethiopia, 2020.Methods: A community-based cross-sectional study design was conducted among randomly selected 599 adult's age 18 years and above from May 10-30, 2020. A multi-stage sampling technique was used to select the study participants. Data were collected using pre-tested and structured face-to-face interview questionnaires. The collected data were entered to Epi data version 3.1 and then exported to SPSS version 21 for analysis. Bi-variable and multivariable logistic regression was used to identify associated factors of knowledge about cataract. Adjusted Odds Ratio (AOR) together with 95% Confidence Interval (CI) was used to declare the statistical association between dependent and independent variables.Results: Of the total study participants, 379 (64.7%), [(95% CI: 60.7-68.6%)] of them had good knowledge about cataract. Age (≥40 years) [AOR = 2.29(95% CI 1.18-4.44)], Elementary school completed [AOR = 2.31(95% CI 1.30-4.10)], High school & above [AOR = 5.55(95% CI 2.81-10.89)], governmental and non-governmental employed [AOR = 5.62 (95% CI 2.78-11.38)], Merchant [AOR = 1.72(95% CI 1.03-2.88)], Positive Attitude [AOR = 3.85(95% CI 2.94-6.47)] were positively significantly associated with knowledge about cataract. Whereas, rural residence [AOR = 0.19 (95% CI: 0.12-0.31)] was negatively associated with knowledge about cataract.Conclusions: More than one third of the participants still had poor knowledge about cataract. This implies that health facilities should be engaged and raises the awareness of the community and empowers people about eye care needs. [ABSTRACT FROM AUTHOR]

Background: The development of human resources for eye health (HReH), aimed at achieving a 25% reduction in visual impairment by the year 2020, was one of the VISION 2020 objectives. Aim: To assess HReH in the public sector of KwaZulu-Natal (KZN), and its effect on the accessibility of eye care in the province. Setting: All public eye facilities in KZN. Methods: A quantitative cross-sectional study using a close-ended questionnaire to assess distribution and outputs of HReH. At the end of the questionnaire, respondents gave general comments on their ability to provide services. Results: Human resource rates were 0.89 for ophthalmologists, 2.44 for cataract surgeons, 4.8 for optometrists and 4.7 for ophthalmic nurses per 1 million population. Most health facilities had some HReH working in them, albeit none had dispensing opticians. Regression analysis showed that 67.1% of variation in cataract surgery was because of the number of surgeons available. Cataract surgical rates were low with a waiting period of up to 18 months. In addition to the refractive error regression analysis of 33.7%, spectacle supply was low, with a backlog of up to 9 months in some facilities. Conclusion: Overall, HReH targets as per VISION 2020 and the National Prevention of Blindness have not been met in this region. Dispensing opticians are not employed in any of the province's health districts. An increase in the eye health workforce is necessary to improve the eye health outcomes for people dependent on public eye facilities. [ABSTRACT FROM AUTHOR]

Retinopathy of prematurity has emerged and continues to be one of the leading causes of avoidable childhood blindness in low- and middle-income countries over the past few years. A major reason is the lack of adoption of effective and efficient screening for retinopathy of prematurity in various neonatal or newborn units across the countries. At the same time, there is an improvement in the survival rate of high-risk newborn babies which causes a further rise in retinopathy of prematurity. Most of the associated risk factors for retinopathy of prematurity are avoidable, therefore, various preventive strategies can be developed at various levels of healthcare facilities ranging from primary to tertiary level. The integration of appropriate retinopathy of prematurity intervention programs between healthcare departments and partnerships with other non-governmental eye care institutions would be an important as well as critical step to prevent blindness and visual impairment due to retinopathy of prematurity in India and other developing nations. [ABSTRACT FROM AUTHOR]

Pediatric cataract is a treatable leading cause of childhood blindness. The incidence ranges from 1.8 to 3.6 per 10,000 per year.[[4]] The prevalence of childhood cataract is higher in low-income economies (0.63-13.6/10,000) compared to that of high-income economies (0.42-2.05/10,000).[[5]] Rubella or Cytomegalovirus infections are mostly responsible for higher incidence in lower socioeconomic group. REFERENCES 1 Sen P, Gupta N, Mohan A, Shah C, Sen A, Jain E. Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care center in central rural India. [Extracted from the article]

Background: Visual impairment disproportionately affects people in the low-income countries. A high proportion of visual impairment can be prevented or cured. Yet, care seeking for eye health is restricted for women and older adults. This article uses the intersectionality approach to understand how eye care seeking behaviour changes in men and women with increase in age and visual impairment in a poor and underserved region of India. It brings forth the commonalities and differences between the various groups.Methods: The article is based on qualitative data. Persons aged 50 years and more are categorized into young-old, middle-old and old-old. Men and women with low vision/ high visual impairment have been selected from each of the three age groups. In-depth interviews have been carried out with 24 study participants. Data saturation has been attained. The JHPIEGO Gender Analysis Framework underpins the study. The narrative data has been coded in NVivo 10 software.Results: Various symptoms are associated with visual impairment. The young-old with low vision do not report much difficulty due to visual impairment. Study participants with high visual impairment, and in the older age groups do. Difficulty in the discharge of regular chores due to visual impairment is rarely reported. Impaired vision is considered to be inevitable with advancing age. Care seeking is delayed for eye health. Typically, outpatient care from nearby health care facilities has been sought by men and women in every group. Inpatient care is limitedly sought, and mostly restricted to men. Eye care seeking behaviour changes among men with increase in age and visual impairment. Women consistently seek less care than men for both outpatient and inpatient eye care. Study participants of both genders become dependent with increasing age and visual impairment. Traditional patriarchal privileges enjoyed by men (such as mobility and economic independence) decrease with age. The vulnerability of women gets compounded with time.Conclusions: The article presents a granulated understanding of eye care seeking behaviour among older adults in India. Such differentials need to be taken cognizance of in programmes promoting universal access to health care. Existing conceptualizations on access to health care need to be revisited. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to analyse eye health delivery in Ghana and examine the progress towards achieving VISION 2020 indicator targets.Methods: This descriptive cross-sectional study was conducted between October 2017 and May 2018. It used a mixed method approach including desk-based reviews, a questionnaire-based survey of eye facilities in Ghana, and interviews with eye health system stakeholders to collect information on eye health delivery in facilities owned by the Ghana Health Service (GHS), quasigovernmental bodies (security agencies), and Christian Association of Ghana (CHAG). The information was benchmarked against the World Health Organization (WHO) targets for achieving the goals of VISION 2020.Results: The magnitude of blindness and moderate to severe visual impairment (without pinhole) was 0.9% and 3.0%, respectively. The number of ophthalmologists available at the country level was 80.6% of the VISION 2020 target with optometrists and ophthalmic nurses exceeding targets for VISION 2020. The distribution of human resources was heavily skewed towards two out of the 10 regions in Ghana. Cataract surgical rate was low and met 25% of the WHO target. Basic equipment for refraction was available in the majority of facilities; however, there was a general lack of specialised eye care equipment across the country. Comparatively, CHAG facilities were better equipped than GHS facilities at the same level.Conclusion: The Government of Ghana should revitalize the goals of VISION 2020 beyond the year 2020 and spearhead a concerted effort to ensure equitable distribution of human and infrastructural resources across the country. [ABSTRACT FROM AUTHOR]

Introduction: At the time of independence, eye care services were provided by a few Christian missionary hospitals, Government hospitals and a few family owned Cottage hospitals. In 1950s and 60s, new eye departments were established in Karachi, Multan & Peshawar and also at Armed Forces' hospitals. In spite of this, no organized eye care services were available to 80% of the population. Prof Hugh Taylor, a WHO Consultant, conducted a survey in 1980 only to find out that there was a gross human resource mismatch in Pakistan. Another survey and situational analysis carried out in 1998 showed a lack of trained manpower at all levels with poorly organized services and infrastructure at district level and a total lack of eye care services at THQ hospitals, Rural Health Centres and Basic Health Units. There was no referral pathway from primary level onwards. Methodology: The results of the situational analysis led to development of a new National Plan. The guiding document in this regard was Vision 2020 - "The Right to Sight" initiative. The main objectives were provision of latest technology for eye care, development of infrastructure, training and deployment of Human Resource (HR) at different levels of health careto provide eye care services to poor, at their door step. Provision of equipment and up gradation of infrastructure was planned for 7 centers of excellence, 20 tertiary teaching eye departments, 63 DHQ Hospitals and 147 THQ Hospitals across the country with creation of posts of ophthalmologists, subspecialists and allied vision sciences personnel at different levels of health care. Results: The results of these interventions show that 37 medical institutions for eye care have produced more than 2300 ophthalmologists with 46 vitreo-retina (VR) specialists, 30 paediatric ophthalmologists and 92 community ophthalmologists. There are also 20 institutions training allied vision personnel that have trained 1568 optometrists, 50 orthoptists, 84 investigative oculists, 56 refractionists, 150 ophthalmic nurses & 1568 ophthalmic technicians. Eye units at 33 out of 47 tertiary hospitals and 94 out of 131 DHQ Hospitals have been upgraded while 96 out of 147 THQ Hospitals have new eye departments. Posts of ophthalmologists, and allied vision personnel have been created at different tiers of eye care. The impact has been 97% increase in OPD attendance, 94% more access by females, 82 % increase in surgeries and 78% increase in intraocular lens implants. At the present time, cataract surgeries are being done with no or minimal cost to the patients, trachoma is near eradication, blindness due to glaucoma and diabetes is being prevented due to early screening and low vision devices are being provided to people with vision impairment. Similarly, people with complicated vitreo-retinal disorders and children with eye disorders are being treated at sub specialty centres. In the next 5 years, it is planned to establish eye screening and service delivery centres at rural health centres (RHCs) with creation of posts and provision of equipment, training of nutrition supervisors and school teachers in vision screening & provision of portable eye examination kit (PEEK) to LHWs with referral to RHCs/THQs. [ABSTRACT FROM AUTHOR]

Objective: Control of visual loss from retinopathy of prematurity requires high quality neonatal care, and timely screening and treatment of sight-threatening disease. We assessed services for retinopathy of prematurity provided by ophthalmic training institutions in major Indian cities. Methods: Eleven cities were purposefully selected and eye-care facilities were evaluated using predefined criteria. Field teams visited these facilities to collect data by interview and observation using structured questionnaires. Results: 30 training institutions were visited (18 public; 12 notfor- profit); 24 (24/30, 80%) provided a service for retinopathy of prematurity in 58 neonatal units (30 public, 28 private). 15/24 (63%) screened in one unit; six (25%) in 2-3 units and three (12%) in >3 units. Not-for-profit facilities (n=9) screened in more units than public facilities (n=15)(mean (range) 4.5 [1-12] vs 1.1 [1-2] units). Indirect ophthalmoscopy by ophthalmologists was the commonest screening modality but only half of these visited the units weekly. Laser was the commonest treatment, but only half treated babies in the neonatal unit. Annual treatments ranged from 1-200 (mean 39). Conclusion: Eye-care services for retinopathy of prematurity need to expand, particularly in the government sector. [ABSTRACT FROM AUTHOR]

Aim: To estimate the prevalence of visual impairment (VI) due to uncorrected refractive error (URE) and to assess the barriers to utilization of services in the adult urban population of Delhi.Materials and Methods: A population-based rapid assessment of VI was conducted among people aged 40 years and above in 24 randomly selected clusters of East Delhi district. Presenting visual acuity (PVA) was assessed in each eye using Snellen's "E" chart. Pinhole examination was done if PVA was <20/60 in either eye and ocular examination to ascertain the cause of VI. Barriers to utilization of services for refractive error were recorded with questionnaires.Results: Of 2421 individuals enumerated, 2331 (96%) individuals were examined. Females were 50.7% among them. The mean age of all examined subjects was 51.32 ± 10.5 years (standard deviation). VI in either eye due to URE was present in 275 individuals (11.8%, 95% confidence interval [CI]: 10.5-13.1). URE was identified as the most common cause (53.4%) of VI. The overall prevalence of VI due to URE in the study population was 6.1% (95% CI: 5.1-7.0). The elder population as well as females were more likely to have VI due to URE (odds ratio [OR] = 12.3; P < 0.001 and OR = 1.5; P < 0.02). Lack of felt need was the most common reported barrier (31.5%).Conclusions: The prevalence of VI due to URE among the urban adult population of Delhi is still high despite the availability of abundant eye care facilities. The majority of reported barriers are related to human behavior and attitude toward the refractive error. Understanding these aspects will help in planning appropriate strategies to eliminate VI due to URE. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of information on the availability of services for diagnosis and management of diabetic retinopathy (DR) in India. Objectives: The study was undertaken to document existing healthcare infrastructure and practice patterns for managing DR. Methods: This cross-sectional study was conducted in 11 cities and included public and private eye care providers. Both multispecialty and stand-alone eye care facilities were included. Information was collected on the processes used in all steps of the program, from how diabetics were identified for screening through to policies about follow-up after treatment by administering a semistructured questionnaire and by using observational checklists. Results: A total of 86 eye units were included (31.4% multispecialty hospitals; 68.6% stand-alone clinics). The availability of a dedicated retina unit was reported by 68.6% (59) facilities. The mean number of outpatient consultations per year was 45,909 per responding facility, with nearly half being new registrations. A mean of 631 persons with sight-threatening-DR (ST-DR) were registered per year per facility. The commonest treatment for ST-DR was laser photocoagulation. Only 58% of the facilities reported having a full-time retina specialist on their rolls. More than half the eye care facilities (47; 54.6%) reported that their ophthalmologists would like further training in retina. Half (51.6%) of the facilities stated that they needed laser or surgical equipment. About 46.5% of the hospitals had a system to track patients needing treatment or for follow-up. Conclusions: The study highlighted existing gaps in service provision at eye care facilities in India. [ABSTRACT FROM AUTHOR]

Objective To estimate the cost-effectiveness of cataract surgery and refractive error/presbyopia correction in Zambia. Methods Primary data on costs and health related quality of life were collected in a prospective cohort study of 170 cataract and 113 refractive error/presbyopia patients recruited from three health facilities. Six months later, follow-up data were available from 77 and 41 patients who had received cataract surgery and spectacles, respectively. Costs were determined from patient interviews and micro-costing at the three health facilities. Utility values were gathered by administering the EQ-5D quality of life instrument immediately before and six months after cataract surgery or acquiring spectacles. A probabilistic state-transition model was used to generate cost-effectiveness estimates with uncertainty ranges. Results Utility values significantly improved across the patient sample after cataract surgery and acquiring spectacles. Incremental costs per Quality Adjusted Life Years gained were US$ 259 for cataract surgery and US$ 375 for refractive error correction. The probabilities of the incremental cost-effectiveness ratios being below the Zambian gross national income per capita were 95% for both cataract surgery and refractive error correction. Conclusion In spite of proven cost-effectiveness, severe health system constraints are likely to hamper scaling up of the interventions. [ABSTRACT FROM AUTHOR]

The aim of this study is to compare accessibility of vision-impaired (VI) patients to other eyecare centres before attending the mobile and stationary hospitals. Under a cross-sectional study design, VI patients were consecutively enrolled if they visited one of the three Impact Foundation Hospitals—one mobile and two stationary hospitals. The cost and service output of all hospitals were also reviewed; 27.7% of patients at the mobile and 36.8% at the two stationary hospitals had sought eyecare at other health facilities in the past. Mobile hospital patients lived closer to the hospital but spent more time in travelling, bore less direct cost, needed less extra support, and had a higher level of satisfaction on the service. They also identified more barriers to access eyecare in the past. The mobile hospital had a higher percentage of patients with accessibility problems and should continue to help the remote population in overcoming these problems. [ABSTRACT FROM AUTHOR]

Background: Patient safety is one of the major issues concerning the medical community and the World Health Organization (WHO) in most countries. This study aimed to evaluate the patient safety status in an Eye Hospital in Tehran, using the WHO model for Patient Safety Friendly Hospital Initiatives (PSFHI) in 2012. Methods: This Cross-Sectional study was done in an Eye Hospital in Tehran. Measurement tool was a checklist related to the PSFHI, including 140 standards in three groups of critical, core and developmental. It was covering five domains of: a) Leadership and management, b) Patient and public involvement, c) Safe evidence-based clinical practices, d) Safe environment, and e) Lifelong learning. Results: Compliance with critical, core and developmental standards were 77.78%, 75.29%, and 21.42% respectively. The Rates of Meeting Standards in the leadership and management, patient and public involvement, safe evidence-based clinical practices, secure environment and for lifelong learning were 66.89%, 42.85%, 75.68%, 73.68%, and 63.63% respectively. Conclusions: The PSFHI standards play important role in improving patient safety using leadership, safety practices and creating good working conditions and environment for the staff. So focus on these standards is essential in improving the patient safety in hospitals in Iran. [ABSTRACT FROM AUTHOR]

The article discusses on how eye care services should be provided to the community by finding out why and what do the patients think of the services and by understanding the community and understanding the patients. It mentions that to gain a more in-depth understanding of patient's experiences, a individual semi-structured interview can be conducted or hold patient focus group. It opines that World Health Organization (WHO) offices and staff members can also offer support and advice. INSETS: A need for change at Kilimanjaro Christian Medical Centre (KCMC);Patient shadowing;Making changes - and managing change.

The article discusses some of the advantages offered through an eye clinic for patients including appropriate referral, a correct diagnosis, the right information and advice, the right treatment. Eye clinics also offer benefits for managers in terms of reduced waste, more efficient use of theatre time and human resources, and reduced costs. Some of the ways to improve patient flow through an eye clinic including better systems and better use of space and staff are highlighted. INSETS: Doing a baseline assessment;AN INTEGRATED INFORMATION AND COMMUNICATION SYSTEM;Improvements on the ward and in theatre.

Background: Globally, eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services; in addition, specialist services are over-utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smartphone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteers (CV) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualising service delivery. We hypothesise that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches.Study Design: A single masked, cluster randomised controlled trial design will be used. The unit of randomisation will be the 'community unit', defined as a dispensary or health centre with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitisation, where attendance will be ascertained. During triage, participants will be assessed and treated and, if necessary, referred onwards to Kitale Eye Unit.Discussion: We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level.Trial Registration: The Pan African Clinical Trials Registry (PACTR), 201807329096632 . Registered on 8 June 2018. [ABSTRACT FROM AUTHOR]

The article presents a case report of a 55 year old man suffering with obscured vision in both eyes and he reported to a health facility in second stage of Vogt-Koyangi-Harada disease. Fundus autofluorescence (FAF) imaging was conducted on the patients which revealed swollen pigmented epithelium (RPE) and informs that after the treatment choroidal inflammation may persist.

The article instructs about the necessary parts and services of an eye clinic. Further, it describes the difficulties that patients usually encounter in a clinic. In addition, it highlights the important points those are required to make a patient- friendly environment in a clinic. In this regard, it introduces- reception to give full information about clinic services, triage to quickly assess emergency patients and physical environment which makes access easy for eye patients and etc. INSET: The case for a walk-in clinic.