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Background: People with a learning disability experience challenges accessing primary health care services, including eye care services. Methods: Eye care needs of people with a learning disability, and how well they are met by existing services in England, were explored. Barriers and enablers to accessing these services were investigated. This was informed by a scoping review of the literature and a historic literature library. Findings: Adults with a learning disability are 10 times more likely than other adults to have a serious sight problem and children with learning disabilities are 28 times more likely. There is good evidence of high levels of unmet eye care need special schools in England with over 4 in 10 children attending having no history of any eye care. Conclusion: The authors discuss possible systemic changes to address these inequalities in England. These include automatic entitlement to an NHS sight test annually, specialist pathways in community opticians, eye care services in special schools, and peer to peer and peer to professional promotion of services by people with lived experience. Dedicated care pathways have improved uptake of services in other areas of primary care. Research into the effectiveness of lived experience eye health advocacy is needed. Accessible summaries: People with learning disabilities are much more likely to have sight problems but much less likely to get the eye care they need.Everyone should be able to access good eye care.Not getting good eye care puts eyesight at risk and existing problems might not be discovered.We look at what helps people get better eye care and what stops people from getting it.We found that improving awareness, better staff training and good communication are important.Special eye care services for people with learning disabilities have been designed but are not available in much of the UK. Having these specialist services across nations would help more people get the eye care they need. [ABSTRACT FROM AUTHOR]

Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. The 2023–2024 budget allocated AU$445 million to further enable general practice-led, multidisciplinary teams, with integrated care located within practices, including employment of allied health professionals. Such team care models are recognised by The Royal Australian College of General Practitioners as vital to delivery of high-quality care for older adults. They are especially relevant for over 250,000 Australians who live with dementia in the community. However, not all allied health professionals are currently based within general practices. Future, sustainable general practice-led models of multidisciplinary care that connect patients with external allied health providers could be considered for a comprehensive and collaborative approach to care. Our focus is on people living with dementia, who are at greater risk of preventable vision impairment. Poor vision and/or ocular health can be detected and managed through regular eye examinations, which are predominantly delivered by community-based optometrists in Australia, in a primary care capacity. However, people living with dementia are also less likely to have regular eye examinations. In this paper, we highlight the value of ensuring access to primary eye care services as part of post-diagnosis dementia care. We illustrate the important role of primary care practitioners in building and sustaining connections with allied health professions, like optometry, through effective referral and interprofessional communication systems. This can help break down access barriers to dementia-friendly eye care, through promoting the importance of regular eye tests for people living with dementia. Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. People living with dementia are at greater risk of experiencing vision impairment, preventable through regular eye examinations usually provided by community-based optometrists in a primary care capacity. We encourage all primary care practitioners to 'think vision' when consulting with people living with dementia, and advocate for a schedule of regular eye tests post-diagnosis. This article belongs to the Collection Access to Primary Health Care. [ABSTRACT FROM AUTHOR]

The lack of formal eye screening is the main reason for insufficient eye care utilization in rural China. Cataract, in particular, is increasingly prevalent with the aging population, but the treatment rate is relatively low. Village doctors are the most accessible health care resource for rural residents, receiving few empirical investigations into their role in eye care. This study aims to assess the role of village doctors in residents' uptake of eye screening (vision and cataract screening), the first step of cataract treatment. Data come from a community-based, cross-sectional survey conducted in 35 villages of a county of the Gansu Province, Northwestern China, in 2020. Among 1010 residents aged ≥ 50 and 35 village doctors, the multivariate logistic regression shows that village doctors' age, time spent on public health service, and service population were positively associated with residents' uptake of vision and cataract screening. Village doctors were capable of playing an active role in primary eye health services due to their richer knowledge about cataracts than residents (accuracy rate 86.75% vs. 63.50%, p < 0.001), but less than half of them were willing to undertake eye screening. This study highlights the positive role of village doctors in aging residents' eye screening and the potential role in improving the uptake of eye screening by offering health education. [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]

PURPOSE: The purpose of the study was to determine knowledge, practice, and resources available to primary care physicians to diagnose and manage corneal abrasion in Saudi Arabia. METHODS: This cross-sectional survey was held in 2017. Family physicians and emergency physicians attending an international conference were surveyed. The questions related to demography, invagination, and tools available in their institute were collected. The questionnaire on how to diagnose and how they manage case of corneal abrasion was also collected using tablet-based software. RESULTS: Two hundred and twenty-five participants participated in the survey. Exposure to eye patients in two-third of participants was too low (93; 39.6%). Resources for diagnosing corneal abrasion were available in limited centers (51; 21.7%). The rate of good practice to manage corneal abrasion was 21.2% (95% confidence interval 16.0; 26.5). Certified emergency physicians (P < 0.001) and western and central regions (P < 0.001) were positively associated with good practice. Availability of slit lamp (P = 0.2) was not significantly associated with the level of practice to manage corneal abrasion. Fluorescein staining and use of cobalt blue light are essential for diagnosing corneal abrasion as per 40% of participants. About 44.7% of participants replied that antibiotics and lubricants should be used to treat. Nearly one-fourth of participants suggested urgent reference to the ophthalmologist. Use of specific antibiotic varied widely; however, ofloxacin was the main choice of antibiotic in treating corneal abrasion. CONCLUSION: The knowledge and practice among physicians about corneal abrasion were low. Integrating primary eye care into emergency services through provision of required resources and training physicians is recommended. [ABSTRACT FROM AUTHOR]

Aims: To improve diabetes management in Indigenous Australians using an integrated nurse‐led model of diabetes education and eye screening in indigenous primary care and specialist diabetes clinics. Design: A pre–post study. Methods: This study will be implemented in indigenous primary care and specialist diabetes clinics in Victoria, Australia. Participants recruited to the study will be existing adult patient with diagnosed diabetes attending study sites. A nurse‐credentialled diabetes educator and certified retinal imager will deliver three study components: (a) retinal photography as a diabetic retinopathy screening and patient engagement tool; (b) lifestyle and behaviour surveys, administered at baseline and at the final visit, in 12 months. Findings from the surveys and participants' retinal images will be used to guide; and (c) personalized diabetes education. The primary outcomes are participant adherence to diabetic eye screening recommendations and health service diabetic retinopathy screening coverage. Secondary outcomes are baseline DR prevalence and changes in clinical and lifestyle risk factor levels, diabetes knowledge and satisfaction with diabetes care. Discussion: Compared with non‐indigenous Australians, Indigenous Australians have a high prevalence of diabetic retinopathy and blindness, low adherence to eye screening recommendations and suboptimal health literacy. Nurse‐credentialled diabetes educators can be trained to incorporate retinal imaging and eye screening into their clinical practice to give image‐based diabetes education to facilitate diabetic retinopathy management. Impact: Credentialled nurse diabetes educators who integrate eye screening and diabetes education can facilitate timelier diabetic retinopathy screening, referral pathways and treatment of sight‐threatening retinopathy. We believe that this model of integrated diabetes education and eye screening will also improve adherence to eye screening recommendations, population screening coverage, health literacy, risk factor levels and diabetes self‐care. Clinical Trial Registration: ANZCTRN1261800120435. [ABSTRACT FROM AUTHOR]

Background: Migraine is underdiagnosed and undertreated. Optometrists are primary eye care providers, who regularly encounter people with migraine as an incidental finding during routine eye examinations, or when patients present to rule out whether visual or ocular problems are contributing to headache symptoms. Knowledge and use of a migraine screening tool in optometric practice is, therefore, important to be able to identify and refer people with migraine for appropriate management. Objective: We sought to investigate optometrists' current behaviors regarding screening for migraine, and to assess the effectiveness of an educational resource in promoting the use of a 3‐item validated migraine screening questionnaire, the ID‐Migraine. Methods: We first conducted a cross‐sectional study using a survey to assess optometrists' current knowledge and behaviors about migraine screening and willingness to participate in a pilot implementation program. Participants who provided their contact details were invited to watch an online educational resource about a validated migraine screening tool. After 6 weeks, these participants were invited to participate in a follow‐up cohort study involving a survey to assess the effectiveness of the educational resource. Results: Ninety‐eight optometrists completed the initial survey as part of the cross‐sectional study. We found that most optometrists actively asked patients about migraine (79/98 respondents, 81%) as part of routine eye examinations and self‐rated themselves as confident in identifying migraine (71/98 respondents, 72%). However, the majority (90/98 respondents, 92%) were not aware of any validated migraine screening tools. Seventy‐eight respondents provided their contact details to receive information about the subsequent cohort study. In response to the follow‐up study survey (31/78 participants, 40%), 45% (14/31 respondents) of participants self‐reported using the ID‐Migraine tool after watching our educational video, and most of these participants (12/14 respondents, 86%) were likely or extremely likely to continue to use the tool in their practice. Conclusions: From our initial cross‐sectional survey, we conclude that optometrists do not currently use validated screening tools for migraine and as such, there is an opportunity for continuing professional development in this area. Our follow‐up cohort study demonstrates that educating optometrists on the importance and utility of a validated migraine screening tool is achievable with a relatively simple, low‐time investment intervention (an online educational video). Such education may result in improved identification of migraine, which may lead to improved management. [ABSTRACT FROM AUTHOR]

Aim: Provision of vision care to patients in areas of under-developed infrastructure. Subjects: Provision of vision care should include determining the prescription and the immediate supply of spectacles. There should be a repair facility. The examination and provision of the glasses should be possible in unfavorable conditions and at a reasonable price. The labour needed, and the related education required, plus the production of materials should encourage a home-grown service. This will lead to the establishment of a professional service. Results: Although some NGOs are setting up self-sustaining services, in many cases help provided from the outside fails to create an immediate and continuing solution for the patient's needs. This article shows the need for treatment, as described in the literature, a brief discussion of services being provided and a proposal for improvement in facilitating the examination, production and the development of optometric care. Conclusion: The proposed system will require field research to verify the claims made and the viability of implementing it in the specific environment. If the proposed system is proven to be reliable, and financially viable, an industry can be created for the indigenous supply of vision care at a suitable cost to the patient. [ABSTRACT FROM AUTHOR]

Background: This research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision services.Methods: Optometrist locations were gathered from provincial regulatory bodies. Optometrist-to-population ratios (i.e. the number of providers per 10,000 people at the health region level) were then calculated. Utilization of vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013-2014 question regarding self-reported contacts with optometrists or ophthalmologists. Data from the 2016 Statistics Canada census were used to create three population 'need' subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Cross-classification mapping compared optometrist distribution to self-reported use of vision care services in relation to need. Each variable was converted into three classes (i.e., low, moderate, and high) using a standard deviation (SD) classification scheme where ±0.5SD from the mean was considered as a cut-off. Three classes: low (< - 0.5SD), moderate (- 0.5 to 0.5SD), and high (> 0.5SD) were used for demonstrating distribution of each variable across health regions.Results: A total of 5959 optometrists across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada; they are predominantly concentrated in urban areas. The national mean ratio of optometrists was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services.Conclusion: This research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availability relative to "supply" and "need" factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies. [ABSTRACT FROM AUTHOR]

Recently, several professional groups have recommended a change from chart-based to instrument-based screening for preschool-age children, but the effect of this change on health care utilization is unknown. We performed a secondary analysis of a site-randomized quality improvement project on transitioning from chart-based to instrument-based vision screening for 3- to 5-year-old children in primary care. We analyzed visit rates to ophthalmologists and optometrists and costs of such care before and after implementation of instrument-based vision screening with comparison to nonparticipating practices. The implementation of instrument-based vision screening resulted in a decrease in visits to eye care specialists from 83.1 visits per 1000 children per year to 55.0, a reduction of 33.8%; no comparable reduction was seen in nonparticipating practices. The cost of services by eye care specialists fell from $65 715 per 1000 children per year prior to $55 740, a decline of 15.2%; similar costs among control practices rose 13.4%. [ABSTRACT FROM AUTHOR]

Background: The integration of eye care services into the primary health-care (PHC) system and the accessibility and quality of eye health in the community is hugely dependent on available resources. Objective: The aim was to assess the resources available for eye care delivery in public PHC facilities in Obokun Local Government Area (LGA), Osun State, Nigeria. Methodology: This was a descriptive cross-sectional study of public PHC facilities and workers in Obokun LGA, Nigeria. A PHC facility checklist was used to obtain data on available infrastructure, material resources, primary eye care (PEC) services, and human resources during a tour and inspection of each facility. Further data on human resources were obtained with a semi-structured questionnaire administered to PHC workers. Data included information on the age, sex, cadre, duration of service, PEC practices, and training of PHC workers. Results: There were 4 (10.0%) primary health (PH) centres, 19 (47.5%) PH clinics and 17 (42.5%) health posts. The number and distribution of PHC facilities, material resources, and PEC services were below-recommended guidelines. There were 12 (11.2%) nurses, 4 (3.7%) community health officers, 19 (17.8%) community health extension workers (CHEWs), 7 (6.5%) health technicians, 8 (7.5%) junior CHEWs, and 57 (53.3%) health assistants. There was a sufficient number of PHC workers and community services to build capacity for PEC delivery. Conclusions: Resources were available for PEC in Obokun LGA; however, some were insufficient or unevenly distributed. Further training of PHC workers in PEC and the provision of the minimum required infrastructure and material resources are recommended. [ABSTRACT FROM AUTHOR]

Background: The eye-care seeking behaviour of parents for their children has a role to play in increasing or reducing the prevalence of childhood blindness. In Nigeria, little or no work has been done in this area. Hence, this study was carried out with a view to assisting eye-care professionals plan better program regimens and also to help them identify various elements that either facilitate or hinder eye-care seeking behaviour of parents for their school age children.Methods: This was a qualitative narrative study. Data were collected using in-depth interviews (IDIs) and focus group discussions (FGDs). Thirty-five parents and 10 eye-care practitioners were selected by random sampling and homogenous sampling methods, respectively. Parents were selected, based on those who sought care and those who did not seek care for their children after a school screening exercise. Collected data were analysed qualitatively by transcribing the voice recordings of interview sessions into textual data and themes were raised.Results: Four FGDs and 13 IDIs were conducted. Parents were more likely to seek care for manifest conditions than for conditions they could not perceive. A family history of ocular disease and repetitiveness of complaints facilitated parents to seek eye care for their children. The cost of eye-care services was a major barrier. Logistics such as fixing a doctor's appointment, getting time off work and long waiting periods at the clinic were also reported as barriers. Fear of treatment options and family interferences were also mentioned.Conclusion: Parents have some concerns and challenges in seeking eye care for their children. This study recommends that more work be done through planned awareness programs to educate parents and help them overcome the concerns and barriers that hinder them from seeking eye care for their children. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study was to determine whether adults across the life span differ in responses to quick vision screening and how those responses relate to adults' use of specialized eye care.Methods: Subjects were 363 community-dwelling ambulatory adults, 21 to 95 years old, who were tested while they wore their corrective lenses during routine visits to a tertiary care facility. No subjects had known neurological impairments, age-related macular degeneration, or other significant eye disease. A wall-mounted Early Treatment in Diabetic Retinopathy Study chart was used.Results: Older adults 58 years old or older had significantly worse scores than younger adults. Scores did not differ between subjects who had been tested within or prior to the last 10 months. Older subjects had their vision tested significantly more recently than younger subjects.Conclusions: Vision screening is quick, inexpensive, and easily performed by ancillary staff, and it may provide the physician with useful additional information for treatment planning. [ABSTRACT FROM AUTHOR]

Background: Visual impairment is a public health problem in sub-Saharan Africa, affecting nearly 5% of the population. Efforts to combat avoidable causes have been hampered by weak health systems and little evidence exists to suggest what interventions may be effective to improve the situation. Despite this, there are calls to promote some specific interventions, one of which being the closer integration of eye health services into health systems, often focusing on training primary health workers to deliver basic eye health services. This study seeks to understand how eye health services are delivered by primary health workers who have received training and what constraints remain to effective service provision.Methods: This was a qualitative investigation into the experiences of 20 primary health workers trained in primary eye care and eight key informants working within specialist eye health services or regional and district health management positions in two districts in Tanzania.Results: Despite feeling confident in their own eye care skills, most primary health workers felt constrained in the services they could provide to their communities by insufficient resources needed for diagnosis and treatment, and by lack of systematic supportive supervision to their work. Specialist ophthalmic staff were aware of this issue, although for the most part they felt it was not within their capacity to remedy and that it fell within the remit of general health managers. Many participants discussed the low support to eye health from the national government, evidenced through the lack of dedicated funding to the area and traditional reliance on outside funds including international charities.Conclusions: Although training of primary health workers is useful, it is recognised that is not sufficient to address the burden of eye health disease present in rural communities in Tanzania. It is likely that broader engagement with the general health system, and most likely with the private sector, will be necessary to improve the coverage of eye health care to remote and poor communities such as those in Morogoro. Further investment is needed to develop innovative approaches to delivering eye health services, including preventative, curative and rehabilitative services. [ABSTRACT FROM AUTHOR]

Background. The provision of population-wide, accessible, affordable, acceptable and evenly distributed qualitative eye care services remains a recurrent challenge to eye care organizations worldwide. Objectives. To report the challenges encountered in setting up eye care service in a pre-existing primary health care facility in rural Nigeria and also audit the common causes of eye disorders in rural setting southeast of Nigeria. Material and methods. The study was an operations research study conducted at Akpuoga-Nike between February and April 2011. Demographic and ophthalmic clinical data were collected. Health system-, community- and patient-determined challenges were catalogued and analyzed using Epi Info Statistical software for Windows, version 6. Univariate analysis was performed for data distribution testing. Analytical statistics were performed, with p < 0.05 considered statistically significant. Results. A total of 481 (males, 144 (29.9%); females, 377(70.1%)) patients aged 42.3 ± 20.2 SD years (range 4-80 years) were seen. The leading eye disorders were refractive error - 28.9%, and cataract - 16.4%. The operations challenges encountered included difficulties with community sensitization/advocacies, inadequate infrastructure and mobile equipment, as well as lack of eye care manpower, consumables and funding deficits. Conclusions. Health system-related issues were the main challenges encountered. Recruitment of an adequate number of rural eye care workforce, provision of needed material resources, adequate funding and engendering community participation in rural eye care delivery through grass roots advocacy and health service public education would overcome the challenges. [ABSTRACT FROM AUTHOR]

Background: There are 285 million people with visual impairment (VI) worldwide including 39 million who are blind; 15 % of those with VI live in Africa, and around 80 % of VI is preventable or treatable with the right equipment, information and skills. The scarcity of human resources for eye health, particularly in Sub-Saharan Africa, is a key challenge towards achieving this goal. Therefore training primary health workers (PHW) in providing eye-care services has been seen by some authors as a way to improve access to eye-care services in remote communities. However, the package of interventions which could be effectively delivered for eye-care at the primary-care level or the set of skills and competencies that PHWs need has not yet been delineated. The aim of the study was to evaluate the effectiveness of a four day training programme of PHWs in primary eye-care conducted in Morogoro, Tanzania in 2010/2011. Methods: A mixed methods study using pre- and immediate post-training knowledge assessment of 60 trainees, and in-depth face to face interviews with 20 PHWs and 8 service managers 2 to 3 years after the training. Results: Pre-and immediate post-training assessments indicated improvement in health worker knowledge about eye-care in the short term. Qualitative investigations 2 to 3 years after the training showed that although staff could make the correct management decisions when presented with eye-health problems, they often could not make a correct diagnosis. PHWs and managers reported satisfaction with the content of the training but some of the less well qualified staff found it overwhelming. Theoretical teaching was appreciated by most participants but almost all suggested increasing the time spent on acquiring skills. The training manual was accepted by many and some improvements were recommended. All interviewed PHWs were keen to improve their skills and knowledge. Acquired skills and knowledge were used for identification, referral of patients and for eye-health promotion. Conclusion: The training program in Morogoro was considered by PHWs as broadly successful and satisfying in terms of content, methods and duration of training. However, any future programme needs to be considered within the context of strengthening wider health systems. [ABSTRACT FROM AUTHOR]

Eye problems constitute 2% to 3% of all primary care and emergency department visits. Common eye conditions that can cause eye pain are conjunctivitis, corneal abrasion, and hordeolum, and some of the most serious eye conditions include acute angle-closure glaucoma, orbital cellulitis, and herpetic keratitis. The history should focus on vision changes, foreign body sensation, photophobia, and associated symptoms, such as headache. The physical examination includes an assessment of visual acuity and systematic evaluation of the conjunctiva, eyelids, sclera, cornea, pupil, anterior chamber, and anterior uvea. Further examination with fluorescein staining and tonometry is often necessary. Because eye pain can be the first sign of an ophthalmologic emergency, the physician should determine if referral is warranted. Specific conditions that require ophthalmology consultation include acute angle-closure glaucoma, optic neuritis, orbital cellulitis, scleritis, anterior uveitis, and infectious keratitis. [ABSTRACT FROM AUTHOR]

With a global target set at reducing vision loss by 25% by the year 2019, sub-Saharan Africa with an estimated 4.8 million blind persons will require human resources for eye health (HReH) that need to be available, appropriately skilled, supported, and productive. Targets for HReH are useful for planning, monitoring, and resource mobilization, but they need to be updated and informed by evidence of effectiveness and efficiency. Supporting evidence should take into consideration (1) ever-changing disease-specific issues including the epidemiology, the complexity of diagnosis and treatment, and the technology needed for diagnosis and treatment of each condition; (2) the changing demands for vision-related services of an increasingly urbanized population; and (3) interconnected health system issues that affect productivity and quality. The existing targets for HReH and some of the existing strategies such as task shifting of cataract surgery and trichiasis surgery, as well as the scope of eye care interventions for primary eye care workers, will need to be re-evaluated and re-defined against such evidence or supported by new evidence. [ABSTRACT FROM AUTHOR]

Background: Primary open angle glaucoma is a chronic, progressive eye disease that is the leading cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about 10 years earlier in African Americans as compared to whites. African Americans are also less likely to receive comprehensive eye care when glaucoma could be detected before irreversible blindness. Screening and follow-up protocols for managing glaucoma recommended by eye-care professional organizations are often not followed by primary eye-care providers, both ophthalmologists and optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care for African Americans. Telemedicine may be an effective solution for improving management and diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically transmitted to remote reading centers where tertiary care specialists can examine the results. We describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY), set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving communities with a large percentage of African Americans. Methods/Design: We conducted an observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations and diagnostic testing for glaucoma, followed by the optometrist's diagnosis and a preliminary management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who completed fellowship training in glaucoma review results and provide feedback to the optometrist, who manages the care of the patient. Patients also receive eye health education about glaucoma and comprehensive eye care. Research questions include diagnostic and management agreement between providers, the impact of eye health education on patients' knowledge and adherence to follow-up and medication, patient satisfaction, program cost-effectiveness, and EQUALITY's impact on Walmart pharmacy prescription rates. Discussion: As eye-care delivery systems in the US strive to improve quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-risk for chronic blinding diseases. [ABSTRACT FROM AUTHOR]

Purpose To investigate the agreement in dry eye care management between general practitioners (GPs) and optometrists in the Netherlands. Methods A web-based survey was used to investigate the agreement in symptoms associated with dry eye, causes of developing dry eye, and investigative techniques used in practice, between GPs and optometrists. Additional questions surveyed knowledge of the latest research, and co-management of dry eye disease in primary healthcare. The anonymised questionnaire contained 16 forced-choice questions with Likert scales, and was sent to 1471 general medical practitioners and 870 registered optometrists. The response data was stored on an online database, and was converted directly to text format for analysis using SPSS 21 statistical analysis software. Results 138 optometrists and 93 GPs responded to the survey (Cronbach α = 0.885, optometrists, and 0.833, GPs). Almost no agreement was found for all the questions: a statistically significant difference (Chi-square p < 0.0001) was found between the optometrists and GPs in the use of investigative techniques, associating symptoms, causes of dry eye ( p > 0.0001), and dry eye symptoms, except for ‘burning sensation of the eye’ and ‘irritation of the eye’ as agreed symptoms, and agreement that dry eye is an age-related disease. Conclusions As the optometrist and the GP are the gatekeepers for secondary healthcare, the fundamental differences in the methods of investigation and interpretation of dry eye-related symptoms, the possible cause of developing dry eye disease, and the therapy given by GPs and optometrists in the Netherlands, may have a significant impact on consistency of patient care. [ABSTRACT FROM AUTHOR]

Objective To assess knowledge and practice of primary eye care among primary healthcare workers known as community health extension workers in Funtua district of Nigeria. Methods Cross-sectional mixed method study among health workers employed in government-owned primary healthcare facilities. Quantitative data were obtained using self-administered questionnaires and checklists, while qualitative data by modified Delphi technique, role plays and observation. A score of 1 was given for each correct answer, while a total score of ≥60% was considered 'good'. Results Eighty three of 88 health workers participated (94%) in the questionnaire survey; while 16 of them were selected for the qualitative survey. Good scores regarding the knowledge of common eye diseases were obtained by 68.7%, but only 26.4% of them could identify their most important features. Participants could undertake 3 of 5 steps in visual acuity testing. Skills in recognising common eye diseases and their management were weak; while practice was often not according to the guidelines. Conclusion Community health extension workers displayed good knowledge of common eye diseases. Areas of weakness are recognition and interpretation of eye signs, and practice rarely follows the guidelines. Preventive medicine was neglected; community health extension workers require practical retraining and supervision to achieve integration of primary eye care into primary healthcare services. [ABSTRACT FROM AUTHOR]

The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter 'Aboriginal') Australians is three times greater than non-Aboriginal Australians, contributing to a greater risk of blindness from treatable and preventable ocular conditions, most prominently cataract and diabetic retinopathy. In rural and remote Aboriginal communities, blindness prevalence is higher, and ocular treatment coverage and uptake are lower. In collaboration with Aboriginal Community Based Researchers (CBRs), this study explored complex contingent factors that shape access to eye health services among rural and remote Aboriginal Australians living with diabetes. Interviews (n = 126) and focus groups (n = 12) were conducted with patients, primary care clinicians, and CBRs, in four rural communities in the Northern Territory and New South Wales. Factors internal and external to health systems were examined, drawing on Bourdieu's concepts of habitus, and doxa to understand agency and decision-making among patients and clinicians. The study used the ontology of critical realism, categorising contingent factors as underlying structures (generative mechanisms), and applying a decolonising approach that centred causal relationships and tensions between dominant (Western biomedical neoliberalism) and non-dominant (Aboriginal) value systems. Three forms of marginalisation; linguistic, economic, and cultural, were identified as the generative mechanisms that inhibit equitable eye health outcomes. Marginality is linked to structural factors that position Aboriginal culture as a barrier, and is reinforced through biomedical health systems, and the agents who operate in and influence them. In order to address eye health inequity, a shift in how Aboriginal cultural sovereignty is understood within health systems is needed, to position it as a strength that can facilitate eye care accessibility, and to support enhanced cultural responsivity among clinicians and service providers. • Sociocultural contingencies shape eye health outcomes among Aboriginal Australians. • Linguistic, economic, and cultural marginalisation underpin eye health inequity. • Differences between Western biomedical and Aboriginal cultural norms form tensions. • Supporting linguistic and cultural sovereignty in clinical spaces is needed. • Cultural responsivity training and an expanded Aboriginal health workforce are key. [ABSTRACT FROM AUTHOR]

There is a rampant increase in diabetes prevalence globally. Sub-Saharan Africa (SSA) is projected to carry the largest burden of diabetes (34.2 million) by 2030. This will inevitably cause a parallel increase in diabetes-associated complications; with the predominant complications being blindness due to diabetic retinopathy and diabetic cataracts. Eye programs in developing countries remain inadequate, existing as stand-alone programs, focused on the provision of acute symptomatic care at secondary and tertiary health levels. Over 60% of people with undiagnosed diabetes report to eye care facilities with already advanced retinopathy. While vision loss due to cataracts is reversible, loss of vision from diabetic retinopathy is irreversible. Developing countries have in the last two decades been significantly impacted by infectious pandemics; with SSA countries committing over 80% of their health budgets towards infectious diseases. Consequently, non-communicable diseases and eye health have been neglected. This paper aimed to highlight the importance of strengthening primary health care services to prevent diabetes-related blindness. In SSA, where economies are strained by infectious disease, the projected rise in diabetes prevalence calls for an urgent need to reorganize health systems to focus on life-long preventative and integrated measures. However, research is critical in determining how best to integrate these without further weakening health systems. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to medical care model for management of eye health conditions associated with community. Topics discussed include initiation of eye health education approaches in Brazil by analysis of training program in Ophthalmology (TPO); improvement in eye care approaches under primary health care (PHC) system for eye diseases treatment; and observation of decrement in referrals through TPO system.