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The series, 'Mastering your Fellowship', provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars (and their supervisors) in preparing for this examination. [ABSTRACT FROM AUTHOR]

Background: Private healthcare in South Africa is largely financed by medical schemes. Optometrists reluctantly contract with administrators and networks to service these patients, despite them feeling networks are undesirable and exploitative. Networks contend that various mechanisms employed are necessary to ensure sustainability and prevent fraud, wastage and abuse. A working relationship between practitioners and networks should ideally be cordial and appreciated by each party as being mutually beneficial to the success of their respective businesses. Aim: To assess practitioners' knowledge and perceptions regarding optometric networks. Setting: The study was conducted amongst optometric professionals in the private sector in South Africa. Methods: A descriptive, mixed-method study was conducted using a semi-structured questionnaire. Interviews with senior personnel from the networks were conducted. Results: Approximately 77% of respondents belonged to networks with 91% being knowledgeable about networks and their role within optometry. Opticlear had 72% members, while Iso Leso and preferred provider negotiators (PPN) had 67% and 41%, respectively. Most optometrists (69%) neither believed in the need for networks nor that they provide value to the profession, while 94.7% joined networks merely to receive direct payment and access patients, with no other benefits noted. Conclusion: Practitioners reluctantly contract to networks for direct payment and to access patients. Furthermore, practitioners feel that networks bully and victimise them while networks highlight their responsibility to reduce healthcare costs and negative practices of fraud, waste and abuse. Contribution: Providing sustainable, cost-effective and quality eye care services requires collaboration between networks and practitioners and appreciating each other's roles in the delivery of eye care services. [ABSTRACT FROM AUTHOR]

Background: Vision impairment (VI) affects people worldwide, and demographic factors like age are significantly linked to VI. Routine eye exams and other eye care treatments can detect and prevent common eye illnesses. However, many lack access to these services. Aim: This study's major objective was to analyse the distribution and funding of eye care services by medical schemes in South Africa. Setting: The study was conducted in the private sector in South Africa for benefits paid by medical schemes to optometrists, ophthalmologists and orthoptists. Methods: A retrospective, longitudinal study of eye care services claim data from the Council for Medical Schemes (CMS) annual reports. The review period was 2020, and scheme-level data were gathered and analysed at the aggregated rather than benefit option level. Results: In 2020, eye care benefits comprised 3.1% of total benefits paid; this proportion remained at the same levels throughout the review period. Closed schemes spent more per beneficiary per year than open schemes for optometrists, orthoptists and ophthalmologists. Self-administered schemes had 11% copayment for ophthalmology services, whereas outsourced schemes had less than 10%. Conclusion: Optometrists had higher copayments than ophthalmologists and orthoptists. Medical schemes with capitated models had a lower average expenditure than other types of models, and the operating model affected expenditure; self-administered schemes spent less on optometry benefits when adjusted for beneficiaries. The study suggests reviewing eye care benefit funding models (risk vs savings), administration activities and managed care models for cost savings and health quality. Contribution: This research contributes to the discussion and implementation of universal health insurance coverage through national health insurance in South Africa. The research shows that there are not enough eye care services in the public sector and that there are different funding gaps in the private sector. [ABSTRACT FROM AUTHOR]

Background: Globally, contact lenses are an important part of the management process for refractive errors. Contact lenses are accepted widely in developed countries, but they are currently less used in developing countries like Kenya. Aim: To assess the knowledge, attitudes and perceptions (KAP) (both pre- and post-education) to contact lens uptake specifically for correction of refractive errors by patients attending a Kenyan University Eye Clinic. Setting: Academic Vision Centre, Masinde Muliro University of Science and Technology, Kakamega, Kenya. Methods: A quasi-experimental cross-sectional study was performed by reviewing all records from February 2014 to March 2020; 360 records were purposively selected. Thereafter, a structured questionnaire with educative content on contact lenses was administered by phone and online to determine KAP. Responses were collected over a period of one month. Knowledge, attitudes and perceptions were categorised and scored, and descriptive statistics and paired t-tests were used for data analysis. Results: More women (58.3%) and mostly students (59.2%) participated, with ages from 16 to 38 years (mean age and standard deviation of 22.85 ± 4.32). Overall, there was poor knowledge of contact lenses for refractive errors (96.7%). Attitudes to contact lenses were unfavourable, both pre- and post-education (94.7% and 92.8%). Perceptions of contact lens uptake were negative pre-education (92.5%) but positive post-education (95.3%). Conclusion: Education changed perceptions of contact lens usage for refractive errors correction, but even with some focused education, negative attitudes and poor knowledge regarding contact lenses persisted in the sample. Practitioners should inform patients about contact lenses as a possibility for refractive error management, and institutions training eye care providers should consolidate their clinical teaching regarding contact lenses. Contribution: This study showed that the more people with refractive errors are knowledgeable about contact lenses, the more uptake of contact lenses will happen, optometrists and ophthalmologists should educate people more on contact lenses. [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]

Background: Keratoconus (KC) is a progressive condition that usually affects young persons between their first and fourth decades. Myopia and irregular astigmatism are the common presentations which are proceeded by corneal steepening and thinning. Keratoconus is a progressive ectasia of the cornea that presents bilaterally, although often asymmetrical. Aim: To explore the experiences of KC patients attending public eye care facilities in Capricorn District of Limpopo province. Setting: Capricorn District, Limpopo province, South Africa. Methods: Descriptive qualitative phenomenology approach was used in the study to explore the lived experiences of patients diagnosed with KC, attending public eye care facilities. Purposive sampling was used to select 16 patients who were diagnosed with KC and referred for contact lens fitting. Data were collected through face-to-face, one-on-one interviews. Results: Patients reported to have developed gradual vision loss which worsened when they grew older. There was lack of knowledge of KC amongst patients and this was exacerbated by limited health literacy and vocabulary barriers. Patients had difficulty performing daily activities where some had dropped out of school while others worked at a slower pace and reduced working distances. Conclusion: Patients with KC received inadequate information on their condition due to limited health literacy and vocabulary barriers. Programmes to promote practitioner and patient education are required to improve the perceived service level provided to KC patients. Contribution: The findings of this study will assist to improve the experiences of KC patients on perceived service quality received from public facilities. [ABSTRACT FROM AUTHOR]

Background: In Ghana and other developing countries, people resort to other means of eye care apart from the orthodox treatment given by eye care practitioners. Aim: This study aimed to examine the determinants of traditional eye practices amongst a sample in the Central Region of Ghana. Setting: The study employed a mixed-method convergent parallel study design and adapted the Expanded Programme on Immunization Survey Technique to enrol 191 residents. Methods: A questionnaire and an interview were used to obtain data from the participants. Descriptive statistics were computed along with univariate and multivariable logistic regression analysis to determine associated factors for the use of traditional eye medication (TEM), ophthalmic self-medication and its combination. Results: The study included 191 participants with an age range of 18–79 years. The odds of TEM use were 2.3 times higher in male than female participants (adjusted odds ratio [AOR]: 2.307, 95% confidence interval [CI]: 1.219, 4.364, p = 0.01). Other socio-demographic characteristics (age, marital status, occupation and educational status) were not associated with traditional eye practices. The p -value in all these was p > 0.05 during the univariant analysis, but age was independently significant during the multivariant statistic (p = 0.041). Conclusion: Gender and age were significantly associated with TEM use. Public education on TEM and ophthalmic self-medication and its consequences should be organised, targeting the natives in the rural communities, by the Ghana Health Service. Keywords: determinants; self-medication; traditional eye medication; traditional medical practitioners; traditional therapies; eye care. [ABSTRACT FROM AUTHOR]

Regarding the education and clinical training of eye care professionals in Africa, positive changes are occurring locally and across the continent to improve and expand the quality of the courses and programmes on offer and as the number of institutions and academics and professionals improve we can also anticipate that the quality of undergraduate and postgraduate education and clinical preparation and overall abilities of eye care practitioners will similarly grow and thereby increase diversity of opportunities and activities in eye and vision care across Africa. Prof. Alan Rubin, Editor I African Vision Eye Health i Footnotes 1 How to cite this article: Rubin A. Ocular Therapeutics for Optometry in Africa. Although the process is slow and there remain many hurdles and some opposition, expansion of the scope of optometric practice to include ocular therapeutics is increasingly happening in South Africa and other parts of Africa. [Extracted from the article]