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Objective: To assess whether there was an improvement in the knowledge, attitudes and practices of students after the Healthy Eyes in Schools Project intervention and to complete a process evaluation to inform future implementation of health promotion interventions. Design: A descriptive, mixed-methods design was used, including questionnaires and interviews. Setting: Four primary schools in Aileu District, Timor-Leste. Local teachers received training and resources to implement nine lessons about eye health. The intervention was supported in two schools by the concurrent creation of school gardens and improvements to the water and sanitation, where required. Method: Students from classes 5 and 6 participated: 384 students aged 10-17 years (median = 12 years, inter-quartile range = 12-13 years) completed the baseline knowledge, attitudes and practices survey and 237 students participated in a follow-up survey. Interviews with teachers, students and parents informed the process evaluation. Results: The intervention was associated with an improvement in eye health knowledge and some attitudes and practices of students. Attitudes about the capabilities of blind children and adults did not change. The teachers' attitude and support from principals and an international non-governmental organisation appeared to be key factors in the successful implementation of the Healthy Eyes in Schools Project. The limited eye health in the existing curriculum, limited parent participation and access to healthy food may have influenced the effectiveness of the Healthy Eyes in Schools Project intervention. Conclusion: A number of benefits appeared to be associated with the inclusion of eye health topics in school health and hygiene education in Timor-Leste. Concurrent development of a supportive environment appeared to enable this initiative. The results of this evaluation can be used to advocate to the Ministries of Education and Health and other education stakeholders for the inclusion of eye health in the health and hygiene curriculum.

Background: Formative assessment can assist students in acquiring clinical and professional competencies. Many tools exist in medical education literature, assessing various components of learning. However, using multiple processes is administratively complex. Methods: Using best practice in medical education, we integrated multiple processes into a portfolio for the Postgraduate Diploma in Eye Care. Results: The portfolio contains objective structured clinical examination guidelines, mini-clinical evaluations, learning journals, performance appraisals and patient feedback to assess development of competencies, assist learning and provide feedback to staff and students. Evaluation by supervisors and students showed good portfolio face validity and acceptability. Conclusion: Similar clinical portfolios could be applied to competency-based optometry programs. [ABSTRACT FROM AUTHOR]

Purpose. To measure the limbal vascular response after 8 hours of eye closure while wearing high and low permeability lenses compared to control eyes without lenses. Method. Twenty neophyte participants wore lotrafilcon A silicone hydrogel lenses (HDk; Dk = 140) or etafilcon A hydrogel lenses (LDk; Dk = 18). On two different nights the lenses were randomly worn for 8 hours during sleep in the right eyes only. Left eyes were non-lens wearing controls. Biomicroscopic images of the temporal limbal area were videotaped at baseline, on eye opening and every 20 minutes for 3 hours. A masked observer graded digitized images of the limbal area. Results. On waking and after lens removal there were no differences in hyperemia between the HDk and LDk lens wearing eyes. There were also no differences at any time between the HDk lens wearing eyes and their control eyes (p > 0.05). On waking the eyes wearing the LDk lens were more hyperemic compared to baseline (p < 0.001) and compared to their control eyes at 20 (p < 0.001) and 180 minutes (p = 0.01), indicating slower recovery from hyperemia. The HDk lens wearing eyes recovered to their baseline levels by 180 minutes (p = 0.99), compared to the LDk lens wearing eyes, which had not recovered to baseline levels by 180 minutes (p = 0.04). Conclusion. The reduction in hyperemia over time of the HDk lens wearing eyes was the same as the controls. The LDk lens wearing eyes were more hyperemic than the controls on waking and the reduction in hyperemia over time was slower. This suggests that the slower recovery from hyperemia may be affected by the lower oxygen transmissibility of the LDk lens. [ABSTRACT FROM AUTHOR]

Background: Little information is available regarding the perceived need, previous acquisition, use and willingness to pay for spectacles in Fiji, on which to base spectacle provision services., Methods: Using a rapid appraisal technique, semi-structured interviews were conducted with 174 urban and rural households in Fiji's Central Province to assist in planning eye-care services., Results: Problems with distance and/or near vision comprised 85.8 per cent of reported eye problems and started between the ages of 40 and 64 years for 54.8 per cent of people surveyed. Of these vision problems, no treatment was sought for 24.2 per cent and of the remainder, spectacles were the treatment for 65.5 per cent. At least one person in 51.7 per cent of households previously or currently used spectacles, and 90 per cent of these reported using them for near tasks. Spectacle usage occurred in more urban (61.8 per cent) than rural (47.1 per cent) households. The majority (54.0 per cent) were willing to pay over FJD10 for spectacles in the future, although more rural (21.8 per cent) than urban (7.3 per cent) households were willing to pay less than FJD10 (USD 4.70). Where spectacles had been received at no cost in the past, 89.5 per cent were prepared to pay FJD10 or more for these in the future., Conclusions: Given the high number of reported visual problems, it should be a priority to construct a sustainable spectacle system for Fiji. This will require further consultation with the community and government but it should be possible to design a system responsive to the financial and other needs of urban and rural Fijians.

Purpose: To develop and determine the reliability and validity of a vision-specific quality-of-life instrument (TL-VSQOL) designed to assess the impact of distance and near vision impairment in adults living in Timor-Leste., Methods: A vision-specific quality-of-life questionnaire was developed, piloted, and administered to 704 Timorese aged >or=40 years during a population-based eye health rapid assessment. Rasch analysis was performed on the data of 457 participants with presenting near vision worse than N8 (78.5%) and/or distance vision worse than 6/18 (69.8%). Unidimensionality, item fit to the model, response category performance, differential item functioning, and targeting of items to participants were assessed., Results: Initially, the questionnaire lacked fit to the Rasch model. Removal of two items concerning emotional well-being resulted in a fit of the data (overall item-trait interaction: chi(2) (df) = 81 (51); mean (SD) person and item fit residual values: -0.30 (1.02) and -0.32 (1.46), and good targeting of person ability and item difficulty was evident. Poorer distance and near visual acuities were significantly associated with worse quality-of-life scores (P < 0.001). Person separation reliability was substantial (0.93), indicating that the instrument can discriminate between groups with normal and impaired vision. All 17 items were free of differential item functioning, and there was no evidence of multidimensionality., Conclusions: This 17-item TL-VSQOL has high reliability, construct, and criterion validity and effective targeting. It can effectively assess the impact on quality of life of adult Timorese with distance and near vision impairment. The TL-VSQOL could be adapted for use in other low-resource settings.

Purpose: To determine first how much induced horizontal and vertical prism could be comfortably tolerated with readymade spectacle wear. Ultimately, the purpose is to develop a guide for dispensing decisions for blindness prevention programs in low-resource countries., Methods: Nine participants each wore plano spectacles with differing prism power for 8 h (plano control). If visual discomfort could not be tolerated, participants removed the spectacles, noting duration of wear and reason for discontinuation. Distance and near visual comfort were rated, and participants asked if they would be able to adapt to wearing the spectacles., Results: On average, half of the wearing time was spent on concentrated near viewing tasks. The highest prism powers (1 Delta BU, 2 Delta BO, 2 Delta BI) could not be worn for 8 h by the majority of participants. Comfort ratings at near (similar to those at distance) were statistically significantly different when the highest prism power was compared with each of the lower powers (vertical prism: both the control and 0.5 Delta differed from 1 Delta; horizontal prism: the control, 0.5 Delta and 1 Delta all differed from 2 Delta)., Conclusions: Most spectacle wearers would likely comfortably tolerate

Purpose: The advantages of a focometer (FOCOMETER) over other methods of refraction for use in developing countries are that it is lightweight, compact, relatively inexpensive, fairly quick, and easy to use with minimal training. This clinical trial compared the repeatability, validity, and ease of use of the focometer with an autorefractor., Methods: The refractive status of the right eye of 80 participants was determined with an autorefractor (Canon RK3). Three measurements were also taken with the focometer., Results: The spherical equivalent (M) of the focometer was 0.25 D more positive than the autorefractor (p < 0.001) and 84% of measurements were within 0.75 D of the autorefractor. The autorefractor detected astigmatism in 91% (73) of the eyes, whereas the focometer identified only 32% (26). The design of the clock target restricts cylinder axis accuracy to the nearest 15 degrees . There was evidence of a learning effect for the focometer: the second and third measurements were more repeatable in the untrained group. There were no differences between the mean (1.03 +/- 2.28) and third focometer (-1.05 +/- 2.32) measurements (p = 0.34). However, using the third focometer measurement, 94% of participants had visual acuities of at least 6/12(-2)., Conclusions: This study highlighted the focometer's restricted power range, inaccuracy of astigmatism and axis determination, and dependence on subject understanding and compliance. Therefore, in most clinical settings, the focometer would not be adequate for quantifying refractive error, but the focometer spherical equivalent was within acceptable limits of the autorefractor, and the visual acuity with lenses determined by the focometer indicates its potential usefulness in public health settings, especially where only spherical ready-made spectacles are dispensed. There may be more cost-effective ways to determine refractive error in these circumstances. A potentially important enhancement in focometer methodology that improves its ease of use was identified: use only the third measurement for each eye.