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Clinical relevance: In all countries, there are population groups that are underserved by eye health services. By exploring access to eye care for these communities, optometrists and other eye care providers can promote equitable access to quality eye care, including strengthening patient relationships, and championing inclusive, people-centred services. Background: New Zealand has very few policies to enable access to primary eye health services. The aim of this study was to explore the barriers and facilitators to accessing eye health services among adults from an underserved community in Auckland. Methods: A qualitative study was conducted using in-depth interviews, drawing on the domains of a widely accepted patient-centred framework for health care access. Twenty-five adults with vision impairment were recruited from a community-based eye clinic in a suburb with high area-level deprivation. Interviews were audio-recorded, transcribed verbatim, coded, and analysed using thematic analysis. Results: Twenty-five participants were interviewed, aged between 47 and 71 years, of whom 13 were female. The participants included 13 Pacific people, 6 Māori, 4 New Zealand Europeans and 2 people of other ethnicities. Thematic analysis revealed five themes describing accessing eye care from a community perspective. Two major themes related to barriers were identified, financial barriers and barriers due to location of services and transport. The facilitators of access were, the ability of individuals to identify available eye health services, the provision of appropriate eye health services, and the crucial role played by whānau (family) in supporting participants to seek eye health services. Conclusion: Cost is a major barrier to accessing eye health services in New Zealand. The barriers and facilitators expressed by this underserved community can inform efforts to improve eye health access in New Zealand through people-centred service designs. [ABSTRACT FROM AUTHOR]

Background: There is a high prevalence of vision impairment and blindness in Africa. The poor access to eye health services, among other barriers, has been found to have a considerable effect on the burden of avoidable vision loss and blindness, particularly in low- and middle-income countries. Aim: To determine the accessibility of and barriers to the utilisation of eye health services in the Kumasi Metropolis of Ghana. Setting: A descriptive cross-sectional survey was conducted in the Kumasi Metropolis of the Ashanti Region in Ghana to identify barriers affecting the utilisation of eye health services. Methods: Convenience sampling was used to recruit participants visiting the eye clinics at five selected District Municipal Hospitals for the first time. Data were collected by means of questionnaires and analysed using Statistical Package for Social Sciences (SPSS). Results: Barriers faced by participants when accessing eye health services included distance to the clinic, cost of services, time spent away from work and/or school, self-medication and long waiting periods. Conclusion: The study found that eye care services in the Kumasi Metropolis, Ghana are largely accessible, but underutilised. Improvement of public health education initiatives through engagement with community groups will also enhance uptake at health care facilities. Contribution: Underutilisation of health services in the Metropolis has been identified in the study and must be addressed by health managers in various sectors. Accessibility is relatively good but can further be improved especially for the elderly to be able to utilise health care services with ease.

Abstract Purpose: To find out the level of eye care service utilization and its determinants among the elderly visually impaired populations while visiting ophthalmic outreach locations in North-Western Ethiopia, 2021. Methods: An ophthalmic outreach-based cross-sectional study was conducted on 852 visually impaired older people. Participants were selected by using a systematic random sampling method from January to July 2021. Data were collected by using an interviewer-administered questionnaire and an ocular examination. The collected data were entered into the Epi Info 7, and analyzed using SPSS 20. A binary logistic regression was fitted. Results: A total of 821 participants, with a response rate of 96.5%, were included in the study. The utilization of eye care services within the past two years prior to the study was 21.1% (95 % CI: 18.2–23.9). Having systemic disease (AOR = 3.2, 95% CI: 1.5–7.0), being a spectacle wearer (AOR = 4.5, 95% CI: 2.0–9.4), having visual impairment at distance (AOR = 2.9; 95% CI: 1.5–5.6), being blind (AOR = 2.9; 95% CI: 1.5–5.6), duration of visual impairment ≤ 1 year (AOR = 2.5; 95% CI: 1.3–4.9) were all significantly associated. Conclusion: In this study, utilization of eye care services was low. Being visually impaired at distance, being blind, recent onset of visual impairment, being a spectacle wearer, and having systemic disease were all related to the use of eye care services. The commonest barriers to utilization of eye care services were financial scarcity and long distances between eye care facilities.

Background: Best practice in optometry and ophthalmology recommends regular visits to eye care professionals, as routine eye examinations support early detection of ocular defects and associated systemic, sometimes potentially life-threatening, conditions. Aim: The study sought to determine the utilisation of ophthalmic services and its associated factors in the Ashanti region of Ghana. Setting: Fifty electoral areas in 10 of the 43 districts in the Ashanti region of Ghana. Methods: A total of 1615 participants, aged 18 years and above, were randomly selected in the Ashanti region of Ghana for this population-based, cross-sectional survey. The factors associated with having had an eye examination were guided by Andersen’s Behavioural Model. The data were analysed using multiple logistic regression, employing the IBM SPSS software, version 25. Results: After statistical adjustments, compared with the 18–29-year-old age group, older participants were found to be more likely to utilise eye care services: In addition, participants with higher formal education had higher odds for eye care utilisation compared with no former education: Being hypertensive, self-reported vision problems and feeling that regular eye examinations are important, were statistically associated with eye care utilisation. Conclusion: There is alarmingly poor utilisation of ophthalmic services in the Ashanti region of Ghana. Effective programmes to promote public health by addressing the socio-economic and individual barriers hindering the uptake of ophthalmic services in the Ashanti region of Ghana are thus necessary. Contribution: The study addresses a gap in the knowledge of factors associated with ophthalmic services utilisation in the Ashanti region of Ghana.

The aim of this study was to systematically review and meta-analyse epidemiological data of refractive error prevalence in Portugal. A structured search strategy and systematic literature review was applied to multiple databases, such as MEDLINE/PubMed, Web of Science, Scopus, Google Scholar, official organizations and academic repositorium's, to identify all relevant epidemiological studies in Portugal until February 2021. The outcome measure was the prevalence of refractive error among the Portuguese population. The events and sample size were entered as raw data and the effect size parameters were computed by Comprehensive Meta-Analysis Software. A total of 9 studies were pooled for the meta-analysis. The fixed effects model points to an estimated effect size of 43% (95% CI: 41.9–44.1%). However, the statistics of heterogeneity (Q-value p < 0.001; I-squared =99.344) showed very high heterogeneity among studies and recommends using a random-effects model. The random effects model points to an estimated effect size of 31.9% (95% CI: 19.8–47.0%) prevalence of refractive error in the Portuguese population. A prevalence of refractive error in Portugal of 31.9% (95% CI: 20.0–47.0%) can be considered as a conservative approach to the real burden of this condition. However, it translates into at least 2 to 4.5 million Portuguese individuals with a refractive error. The high heterogeneity between studies, the wide estimate and the random effects involved demonstrate the need for more studies and consistent sources to obtain narrower estimates. [ABSTRACT FROM AUTHOR]

Purpose: To find out the level of eye care service utilization and its determinants among the elderly visually impaired populations while visiting ophthalmic outreach locations in North- Western Ethiopia, 2021. Methods: An ophthalmic outreach-based cross-sectional study was conducted on 852 visually impaired older people. Participants were selected by using a systematic random sampling method from January to July 2021. Data were collected by using an interviewer-administered questionnaire and an ocular examination. The collected data were entered into the Epi Info 7, and analyzed using SPSS 20. A binary logistic regression was fitted. Results: A total of 821 participants, with a response rate of 96.5%, were included in the study. The utilization of eye care services within the past two years prior to the study was 21.1% (95 % CI: 18.2-23.9). Having systemic disease (AOR = 3.2, 95% CI: 1.5-7.0), being a spectacle wearer (AOR = 4.5, 95% CI: 2.0-9.4), having visual impairment at distance (AOR = 2.9; 95% CI: 1.5-5.6), being blind (AOR = 2.9; 95% CI: 1.5-5.6), duration of visual impairment ≤1 year (AOR = 2.5; 95% CI: 1.3-4.9) were all significantly associated. Conclusion: In this study, utilization of eye care services was low. Being visually impaired at distance, being blind, recent onset of visual impairment, being a spectacle wearer, and having systemic disease were all related to the use of eye care services. The commonest barriers to utilization of eye care services were financial scarcity and long distances between eye care facilities. [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.

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: Evidence shows that poor utilization of available eye care services by potential beneficiaries is a major barrier to reducing the burden of visual impairment (VI) and blindness. Aim: We sought to determine the extent of utilization and barriers to uptake of orthodox eye care services among adults with VI in Jos, the capital of Plateau state, Nigeria. Materials and Methods: A population-based cross-sectional study using cluster sampling technique was conducted. Twenty-two clusters were chosen: from each cluster, 39 persons recruited for participation were interviewed to obtain demographic data and then examined to determine the visual acuity. Individuals with visual acuity of

Purpose: As the prevalence of eye diseases increases, demand for effective, accessible and equitable eye care grows worldwide. This is especially true in lower and middle‐income countries, which have variable levels of infrastructure and economic resources to meet this increased demand. In the present study we aimed to review the literature on eye care in Pakistan comprehensively, with a particular focus on eye care pathways, patient priorities and economics. Methods: A systematic scoping review was performed to identify literature relating to eye care in Pakistan. Searches of relevant electronic databases and grey literature were carried out. The results were analysed through a mixed methods approach encompassing descriptive numerical summary and thematic analysis. To consolidate results and define priority areas for future study, expert consultation exercises with key stakeholders were conducted using qualitative semi‐structured interviews. Results: One hundred and thirty‐two papers (published and unpublished) were included in the final review. The majority (n = 93) of studies utilised a quantitative design. Seven interlinked themes were identified: eye care pathways, burden of eye disease, public views on eye‐related issues, workforce, barriers to uptake of eye care services, quality of eye care services and economic impact of blindness. Research priorities included investigating the eye care workforce, the quality and efficiency of current eye care services, eye care services available in rural Pakistan and the costs and benefits related to eye care provision and sustaining eye care programmes. Conclusions: To the best of our knowledge, this is the first review to synthesise evidence from papers across the field relating to eye care in Pakistan. As such, this work provides new insights into the achievements of the national eye health programme, challenges in eye care in Pakistan and priority areas for future research. [ABSTRACT FROM AUTHOR]

Background: Access to and utilization of eye care services may improve vision-related quality of life (VRQoL) of older people. This study aimed to evaluate the VRQoL of older adults and its associations with access to and utilization of eye care services. Methods: This is a community-based cross-sectional survey conducted in Tehran, Iran, on 566 older people in 2018. The NEI-25 VFQ was used to measure the VRQoL. Multilevel Linear Regression analysis used to test the study hypotheses. Results: The average score of the VRQoL was 80 out of 100. About 61% of the participants did not utilize the annual routine eye examination and the mean score of overall access to eye care was 85 out of 115. Having a higher physical, socio-cultural and overall access were significantly associated with higher VRQoL, but those with regular utilization had no better VRQoL status compared to non-users. Conclusion: Access to eye care services showed to be very important in improvement of the VRQoL, whereas higher utilization was not found to be associated with better VRQoL statue of older people, as there might have a reverse causality with using more eye services with higher Visual impairment.

Background: Identifying common eye diseases in childhood is a Step towards the prevention of visual impairment and preservation of vision in children who still have many productive years ahead. Aim: The aim is to determine the spectrum of eye disorders in children attending a tertiary health institution to plan preventive and curative strategies. Methodology: This was a 4-year retrospective study of children 0–16 years who presented to a tertiary institution. Through retrieval and study of case notes, information on age, sex, duration before the presentation, month of presentation, and diagnosis were obtained and analyzed using descriptive statistics. Results: Of 1120 case notes, studied, (53.8%) were male and (46.2%) female in a ratio of 1.6:1. The mean age was 8.54 years ± 5.03 and the modal age group was 11–16 years ± 0.85. About 51% (51.2%) had normal vision while (13.4%) were blind. The commonest eye disorders were conjunctivitis 488 (43.3%), refractive errors 292 (26.1%), and cornea-related problems 94 (8.4%). The less frequent disorders found were trauma 65 (5.8%), cataract 63 (5.6%), glaucoma 14 (4.3%), uveitis 7 (0.6%), and strabismus/others 67 (6.0%). Cataract 36/150 (24.0%) and refractive error 107/198 (54.0%) were the most common causes of blindness and visual impairment. Most children presented after 2–3 weeks of the onset of symptoms. Refractive error was more prevalent in females 176/518 (34.0%), while trauma was more prevalent in males 42/602 (7.0%). Conclusion: The common causes of ocular diseases in children in this study are avoidable. There should be an unrelenting effort toward the prevention of visual impairment or amblyopia by the provision of adequate treatment through subsidized eye care services. A follow-up study to ascertain the causes of delay in presentation would be helpful.

Abstract Background Eye examinations are recommended for all persons throughout life. However, there is disparity in the uptake of eye care services in different populations. Using data from a nationally representative population-based cross-sectional study (the South African National Health and Nutrition Examination Survey, [SANHANES-1]), this paper investigates the utilization of eye care services and its associated factors in South Africa. Methods Participants aged 15 years and older who participated in interviews and clinical examination were enrolled in the SANHANES from 2011 to 2012. Eye care utilization was assessed from participants’ responses to whether they had their eyes examined by a medical professional and when they were last examined. Data were analysed using multiple logistic regression models employing a hierarchical approach to add predisposing (e.g. age, sex), enabling (e.g. health insurance) and need (e.g. hypertension) factors sequentially. Results The study sampled 3320 participants, with 64.9% being females. 73.4% (95% CI [69.7–76.7]) of participants had never had an eye examination. After statistical adjustment, age groups (compared with 15–29 years: 30-44 years Odds Ratio [OR] = 1.76; 45-59 years OR = 2.13; 60-74 years OR = 2.74; ≥75 years OR = 3.22), ethnicity (compared with African descent: white OR = 4.71; mixed-race OR = 1.87; Indian OR = 7.67), high risk alcohol use (OR = 1.83), wealth index (compared with lowest quintile: third quintile OR = 1.75; fourth quintile OR = 2.23; fifth quintile OR = 2.49), health insurance (OR = 2.19), diabetes (OR = 1.75), high cholesterol (OR = 2.51), having assessed healthcare in the past 5 years (OR = 2.42), and self-reported vision problems (OR = 1.51) were significantly associated with eye care utilization. Conclusion Almost three-quarters of South Africans sampled were not utilizing eye care services. It is imperative to strengthen current public health measures (including eye health promotion programs) to address the alarmingly low uptake of eye care services as well as the disparities in eye care utilization in South Africa.

Background:The costs of the eye care services are considered as one of the most important obstacles to timely diagnosis and treatment of eye disorders, but there is little evidence about patients’ cost for receiving these services. Objective: This paper aimed to investigate the costs paid by patients for eye care services in Tehran hospitals. Methods: 346 patients referring to ophthalmology wards of Tehran's educational hospitals were selected throughconvenient sampling method. The data were extracted through researcher-made checklist and investigating the hospital bills in 2017. Then, they were analyzed using descriptive statistics methods, as well as Mann-Whitney and Kruskal Wallis tests in SPSS 21. Results: The share ofhospital bills, informal payments like bought & brought goods, and non-medical costs were 32.8%, 1.85%, and 66.06%, from the total cost paid by patients, respectively. Further, 10.24%, 83.1%, and 6.85% of medical costs were paid by patients, insurance organizations, and government, respectively. Age (p=0.008), type of basic insurance (p=0.000), and the type of the treated disorder (p=0.000) affected the patients' medical costs. On the other hand, the level of income (p=0.001) and place of residence (p=0.001) variables caused significant differences in the total costs paid by patients. Conclusions: The patients’ out-of-pocket payments for ophthalmology services are evaluated as reasonable. Nevertheless, a large share of the total costs paid by patients was non-medical ones. Improving equity in geographical access to ophthalmology services across regions of the country can reduce non-medical costs and increase the possibility of benefiting from the needed ophthalmology services for all population.

Abstract Background In sub-Saharan Africa (SSA), the delivery of eye care services continues to be undermined by health systems performance bottlenecks. There is a growing focus by partners in the sector on the analysis of the different components of eye care within the wider health system context to diagnose and manage interactions in ways that achieve more effective improvements. However, there has been no attempt to date to systematically synthesize these studies. In this study, we conducted a meta-synthesis of eye health system assessments to gain a more comprehensive understanding of the current systems and how they can be strengthened across different SSA contexts. Methods We conducted a comprehensive search for eye health system assessment reports using global and regional websites of the WHO and other organizations supporting eye care in sub-Saharan Africa. A range of online databases with no language restrictions (PubMed, EMBASE, MEDLINE, PsycINFO and CINAHL) were searched for peer-reviewed publications referring to eye health system assessment (EHSA) or eye care service assessment tool (ECSAT). Assessments were included if they used the ECSAT or EHSA tool; were conducted in sub-Saharan Africa; and had been completed with full reports available in the public domain by January 15, 2019. A combination of framework and thematic syntheses was used. Results Our search strategies yielded a total of 12 assessments conducted in nine countries using the ECSAT/EHSA tool in Sub-Saharan Africa. Eight assessments met our inclusion criteria: four were from West Africa, two from East Africa and two from Southern Africa. Across the eight countries, findings show considerable progress and improvements in the areas of governance, organisation, financing, provision, and coverage of eye care. However, several systemwide weaknesses were found to continue to impede quality eye health service planning and delivery across the countries included in this review. Conclusions These findings highlight the need for national governments and iNGOs to invest in conducting and wider use of these assessments. Such analyses are particularly useful in building links between different system elements and in finding innovative, more flexible solutions and partnerships – needed to address avoidable vision loss in resource poor settings.

Introduction: Careful consideration of what is necessary for the workspace is inevitable to curb the spreading of COVID-19. Work from home is a logistic challenge for the health, retail, and manufacturing sectors. Hence, a workspace probe is imperative to obtain elementary evidence to fine-tune implementation strategy in pandemic crisis management. Sparse information concerning the workspace of the eye examination rooms inducted this investigation to gather the footing data towards impending preparation of post-COVID-19 new norms for optical outlets in Malaysia. Methods: Nine optical outlets with a combination of commercial chains, individual practices, suburban and urban areas were selected to represent assorted types of retail settings. The on-site workspaces' data were measured and recorded in a logbook with a laser meter and measurement tape. Self-assessments of workspaces were gathered through structured interviews. Results: The on-site data revealed that all-optical outlets did not comply with the minimum requirement for an optimal eye examination in terms of space area and illuminance. None of the eye examination rooms had a built-in air filtering system and handwash infrastructure. Paradoxically, the functionality of the workspace was self-graded as 'above average'. Conclusion: Variation in the eye examination room designs and deviance from the standard requirement may just be a noticeable part of a larger problem about the service quality of optical outlets. Lack of basic hygiene facilities requires action for preventive measures. The incongruity between the self-assessment and the on-site data might indicate a conjectural challenge to efficiently self-implement the post- COVID-19 workspace new norm in optical outlets. [ABSTRACT FROM AUTHOR]

Background:  There is a high prevalence of vision impairment and blindness in Africa. The poor access to eye health services, among other barriers, has been found to have a considerable effect on the burden of avoidable vision loss and blindness, particularly in low- and middle-income countries., Aim:  To determine the accessibility of and barriers to the utilisation of eye health services in the Kumasi Metropolis of Ghana., Setting:  A descriptive cross-sectional survey was conducted in the Kumasi Metropolis of the Ashanti Region in Ghana to identify barriers affecting the utilisation of eye health services., Methods:  Convenience sampling was used to recruit participants visiting the eye clinics at five selected District Municipal Hospitals for the first time. Data were collected by means of questionnaires and analysed using Statistical Package for Social Sciences (SPSS)., Results:  Barriers faced by participants when accessing eye health services included distance to the clinic, cost of services, time spent away from work and/or school, self-medication and long waiting periods., Conclusion:  The study found that eye care services in the Kumasi Metropolis, Ghana are largely accessible, but underutilised. Improvement of public health education initiatives through engagement with community groups will also enhance uptake at health care facilities.Contribution: Underutilisation of health services in the Metropolis has been identified in the study and must be addressed by health managers in various sectors. Accessibility is relatively good but can further be improved especially for the elderly to be able to utilise health care services with ease.

Vision loss and blindness is a significant public health concern that has had a profound impact on various communities in the United States. Both anticipated and unforeseen barriers have been linked to the rising rates of vision loss and blindness in the country. Extensive research has identified numerous barriers that put many Americans at a disadvantage when trying to seek high-quality eye care services. Not only do the barriers to eye care services create problems for eye health, but also create a poor quality of life. Therefore, understanding and identifying barriers to eye healthcare services is incredibly important. In addition to understanding and identifying barriers, it is also important to identify solutions to the problems created by these barriers. A systematic review of articles characterizing the barriers to eye care was completed which resulted in the identification of the major barriers that affect Americans. The review of previous research was also used to identify available solutions for problems associated with the barriers to eye care services. The major barriers identified were cost, insurance, transport and accessibility, eye health care literacy, and communication. Because of the identification of the major barriers, solutions were also identified. Health education and increased vision screenings were found to be the most used forms of solutions by healthcare professionals promoting good eye health. Telemedicine has also been cited as a possible solution to the growing problem of visual impairment and blindness within the American population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Green et al.)

Background: Cataract has been reported to be the leading single cause of visual impairment and blindness. However, uptake of cataract services is very low in rural areas though these services are available for free. This study, therefore, sought to explore barriers related to the low uptake of these services through engaging health service providers. Methods: This study used a qualitative design to explore barriers related to the uptake of cataract surgery and care from professional nurses’ perspective in Vhembe District of Limpopo province, South Africa. The target population comprised of 20 ophthalmic service providers. Of these 20 in Limpopo Province, 15 were general nurses involved in eye health service provision, 3 registered ophthalmic nurses and 2 registered eye specialists. Three Focus Group Discussions were held with 8, 6 and 6 participants respectively. Data was collected through the use of a digital tape recorder, transcribed and then thematically analyzed. Results: The majority of the respondents were aged between 56 and 60 years and females constituted 80% of the respondents. In terms of experience in working in the field of ophthalmology, most of the respondents had between 1 and 10 years of experience. Reported barriers related to the provision of cataract services by patients were: Lack of provision of comprehensive awareness programs; Failure to tailor-make cataract programs that overcome cultural myths; Unavailability of cataract services at the grass-root level; Shortage of ophthalmologist and supportive ophthalmic health professionals; and inadequate cataract facilities and resources. Conclusion: There is a need for the development of comprehensive awareness campaigns and the integration of traditional health systems and the modern system to overcome myths associated with cataracts. There is a need for investment in the ophthalmic services and ensure that the service is decentralized to health facilities in the communities so as to increase coverage. More health service providers are to be trained to ensure that they are able to provide this service at the grass-root level. This would, in turn, reduce the waiting times and ensure efficient and effective ophthalmic services.

Background: In sub-Saharan Africa (SSA), the delivery of eye care services continues to be undermined by health systems performance bottlenecks. There is a growing focus by partners in the sector on the analysis of the different components of eye care within the wider health system context to diagnose and manage interactions in ways that achieve more effective improvements. However, there has been no attempt to date to systematically synthesize these studies. In this study, we conducted a meta-synthesis of eye health system assessments to gain a more comprehensive understanding of the current systems and how they can be strengthened across different SSA contexts.Methods: We conducted a comprehensive search for eye health system assessment reports using global and regional websites of the WHO and other organizations supporting eye care in sub-Saharan Africa. A range of online databases with no language restrictions (PubMed, EMBASE, MEDLINE, PsycINFO and CINAHL) were searched for peer-reviewed publications referring to eye health system assessment (EHSA) or eye care service assessment tool (ECSAT). Assessments were included if they used the ECSAT or EHSA tool; were conducted in sub-Saharan Africa; and had been completed with full reports available in the public domain by January 15, 2019. A combination of framework and thematic syntheses was used.Results: Our search strategies yielded a total of 12 assessments conducted in nine countries using the ECSAT/EHSA tool in Sub-Saharan Africa. Eight assessments met our inclusion criteria: four were from West Africa, two from East Africa and two from Southern Africa. Across the eight countries, findings show considerable progress and improvements in the areas of governance, organisation, financing, provision, and coverage of eye care. However, several systemwide weaknesses were found to continue to impede quality eye health service planning and delivery across the countries included in this review.Conclusions: These findings highlight the need for national governments and iNGOs to invest in conducting and wider use of these assessments. Such analyses are particularly useful in building links between different system elements and in finding innovative, more flexible solutions and partnerships - needed to address avoidable vision loss in resource poor settings. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the utilisation of eye and skin care, and social services among persons with albinism is essential for planning intervention strategies for this group. Aim: The aim of this study was to determine the utilisation of eye and skin care, and social services among persons with albinism in the Ulundi Municipality of KwaZulu-Natal Province, South Africa. Setting: The Ulundi Municipality of KwaZulu-Natal, South Africa. Methods: The cross-sectional survey used a questionnaire to collect data from 21 participants living with albinism. Semi-structured face-to-face interviews were conducted in small peer groups. Results: The participants (n = 21; males 8 and females 13) were aged 4 to 60 years (mean = 24.5 ± 17.9 years). All participants reported that they had their eyes tested within the last two years by an optometrist and none by an ophthalmologist. Almost half (42.9%) had never used a low vision device, this being because of their non-availability (44.4%), financial constraints (33.3%) and lack of or poor awareness (22.2%). Participants reported wearing a wide-brimmed hat (47.6%), a combination of wide-brimmed-hats and sunglasses (33.3%) for eye protection and 19% reported using neither. All the participants reported that they used sunscreen with sun protection factor and 90.5% reported using long-sleeved shirts for skin protection. The majority (81%) of participants reported receiving the South African Social Security Agency (SASSA) social (visual disability) grant, with 85.7% knowing where the SASSA offices were located. Conclusion: Despite the poor use of low vision aids, the level of utilisation of eye and skin care, and other social services among participants was good.

Background:  Best practice in optometry and ophthalmology recommends regular visits to eye care professionals, as routine eye examinations support early detection of ocular defects and associated systemic, sometimes potentially life-threatening, conditions., Aim:  The study sought to determine the utilisation of ophthalmic services and its associated factors in the Ashanti region of Ghana., Setting:  Fifty electoral areas in 10 of the 43 districts in the Ashanti region of Ghana., Methods:  A total of 1615 participants, aged 18 years and above, were randomly selected in the Ashanti region of Ghana for this population-based, cross-sectional survey. The factors associated with having had an eye examination were guided by Andersen's Behavioural Model. The data were analysed using multiple logistic regression, employing the IBM SPSS software, version 25., Results:  After statistical adjustments, compared with the 18-29-year-old age group, older participants were found to be more likely to utilise eye care services: In addition, participants with higher formal education had higher odds for eye care utilisation compared with no former education: Being hypertensive, self-reported vision problems and feeling that regular eye examinations are important, were statistically associated with eye care utilisation., Conclusion:  There is alarmingly poor utilisation of ophthalmic services in the Ashanti region of Ghana. Effective programmes to promote public health by addressing the socio-economic and individual barriers hindering the uptake of ophthalmic services in the Ashanti region of Ghana are thus necessary.Contribution: The study addresses a gap in the knowledge of factors associated with ophthalmic services utilisation in the Ashanti region of Ghana.

Background: Knowledge of the utilisation of eye and skin care, and social services among persons with albinism is essential for planning intervention strategies for this group. Aim: The aim of this study was to determine the utilisation of eye and skin care, and social services among persons with albinism in the Ulundi Municipality of KwaZulu-Natal Province, South Africa. Setting: The Ulundi Municipality of KwaZulu-Natal, South Africa. Methods: The cross-sectional survey used a questionnaire to collect data from 21 participants living with albinism. Semi-structured face-to-face interviews were conducted in small peer groups. Results: The participants (n = 21; males 8 and females 13) were aged 4 to 60 years (mean = 24.5 ± 17.9 years). All participants reported that they had their eyes tested within the last two years by an optometrist and none by an ophthalmologist. Almost half (42.9%) had never used a low vision device, this being because of their non-availability (44.4%), financial constraints (33.3%) and lack of or poor awareness (22.2%). Participants reported wearing a wide-brimmed hat (47.6%), a combination of wide-brimmed-hats and sunglasses (33.3%) for eye protection and 19% reported using neither. All the participants reported that they used sunscreen with sun protection factor and 90.5% reported using long-sleeved shirts for skin protection. The majority (81%) of participants reported receiving the South African Social Security Agency (SASSA) social (visual disability) grant, with 85.7% knowing where the SASSA offices were located. Conclusion: Despite the poor use of low vision aids, the level of utilisation of eye and skin care, and other social services among participants was good. [ABSTRACT FROM AUTHOR]

Background: In South Africa, optometry has been traditionally positioned within the private sector. The situation has gradually changed over the past two decades, with optometry being introduced into the public sector in many parts of the country. Despite the growing numbers, optometrists are still new within the public health sector, motivating this study to evaluate the eye care services they provide. Methods: A cross-sectional, retrospective, descriptive study was undertaken. Stratified random selection was applied to select the study sites, and systematic sampling was used to select patients’ files. A saturated sample of public sector optometrists employed in the selected districts completed study questionnaires. Data were analysed using the Statistical Package for Social Sciences, Version 21. Results: A total of 2968 records were reviewed, and gender distribution was 67.6% female and 32.4% male. Refraction (86.73%) was the most frequently conducted test, followed by ophthalmoscopy (74.73%), colour vision (0.07%) and gonioscopy (0.03%). The response rate for the questionnaires was 64.7%. Optometric outreach services were conducted by 54.5% of optometrists, and the majority (83.3%) reported that the farthest outreach facility was more than 50 km from their base hospital. The availability of equipment at outreach facilities was less as compared to base hospitals, while some reported not having the necessary equipment even at base hospitals. None of the optometrists did contact lens fitting at outreach facilities. A lack of equipment was cited as one of the reasons for not providing this service by 100% of optometrists. Most optometrists (63.6%) believed that more than 30% of their referrals might have been avoided if they had prescribed therapeutic agents to manage ocular conditions. Conclusion: Introducing optometrists within the public sector improves access to services for rural communities. However, the minimum standard of optometric care is not practised, allegedly because of a lack of equipment. Therefore, resources should be made available to enable optometrists to provide comprehensive optometric services. In addition, the study highlighted the need for more optometry posts in rural communities and for the implementation of career growth paths to attract and retain optometrists within the public sector.

Background: Monitoring of patients' experiences and satisfaction provide the health institution one of several parameters to measure quality of services and determine areas where improvement and or additional services are needed. Aim: To determine patients' satisfaction regarding the services in the ophthalmic out-patient clinic in University of Calabar Teaching Hospital. Materials and methods: A descriptive cross sectional study was conducted among patients attending the eye clinic of the department of ophthalmology, University of Calabar Teaching hospital, Calabar from 1st October to 31st December 2016. All consecutive registered adult patients who gave consent, along with consenting guardians of patients who were younger than 18 years were included in the study and interviewed. An Interviewer-administered pretested and validated questionnaire was used for data collection. Data obtained were analyzed using SPSS (Statistical Package for Social Sciences version 20 software). Frequencies and percentages were used. Parametric analyses included bivariate analysis and multiple logistic regressions and Pearson coefficient of correlation with p 0·05 being considered statistically significant. Results: The level of satisfaction with accessibility to the hospital and medical care in the eye clinic was very high 95.4%. On time spent in clinic, majority of respondents (50.8%) felt that the waiting time for emergency treatment was good. However, only 39.9% of the respondents felt that the waiting time to be attended to by a doctor in the routine clinic was short. Waiting time for performing an investigation and subsequently getting the result was reported as poor by 62.5% and very poor by 69% respectively. Conclusion: This study demonstrated that only 35.2% of respondents were satisfied with the overall quality of the medical care service received from the eye clinic of the UCTH, Calabar. [ABSTRACT FROM AUTHOR]

Purpose: To find out the level of eye care service utilization and its determinants among the elderly visually impaired populations while visiting ophthalmic outreach locations in North-Western Ethiopia, 2021., Methods: An ophthalmic outreach-based cross-sectional study was conducted on 852 visually impaired older people. Participants were selected by using a systematic random sampling method from January to July 2021. Data were collected by using an interviewer-administered questionnaire and an ocular examination. The collected data were entered into the Epi Info 7, and analyzed using SPSS 20. A binary logistic regression was fitted., Results: A total of 821 participants, with a response rate of 96.5%, were included in the study. The utilization of eye care services within the past two years prior to the study was 21.1% (95 % CI: 18.2-23.9). Having systemic disease (AOR = 3.2, 95% CI: 1.5-7.0), being a spectacle wearer (AOR = 4.5, 95% CI: 2.0-9.4), having visual impairment at distance (AOR = 2.9; 95% CI: 1.5-5.6), being blind (AOR = 2.9; 95% CI: 1.5-5.6), duration of visual impairment ≤ 1 year (AOR = 2.5; 95% CI: 1.3-4.9) were all significantly associated., Conclusion: In this study, utilization of eye care services was low. Being visually impaired at distance, being blind, recent onset of visual impairment, being a spectacle wearer, and having systemic disease were all related to the use of eye care services. The commonest barriers to utilization of eye care services were financial scarcity and long distances between eye care facilities., Competing Interests: None., (Copyright © 2023 Assaye et al.)

Background: Visual impairment and blindness are major health problems worldwide, especially in the rural and remote areas of developing countries. Utilisation of eye care services is essential to reduce the burden of visual impairment and blindness, and it is thereforeimportant that it is monitored. Objectives: The objectives of this study were to determine the level of utilisation of public eye care services and factors that might have influenced their usage in rural communities, Capricorn district, Limpopo Province, South Africa.Method: A population-based cross-sectional study design was used. Participants were residents in selected rural villages located within approximately 5 km of six Government hospitals. Following ethical approval and receipt of informed consent, a questionnaire withclosed and open-ended questions was used to collect information on the utilisation of eye care services and factors that might influence utilisation. Descriptive statistics and Pearson’s Chisquare test were used to analyse and compare the data. Results: Many (62.7%) of the respondents had used the government eye care services in the past. Over fifty-nine per cent (59.3%) of them were satisfied with the services. Factors reported to influence utilisation (such as monthly income, knowledge of available services and the need for regular eye tests) were positively associated with utilisation of eye care services in this study (p < 0.05).Conclusion: Utilisation of eye care services was relatively good, but varied significantly between sites. An awareness campaign by government and non-governmental organisations about eye care services may increase utilisation amongst rural communities.

Two-thirds of the world′s population with low vision resides in the Asia-Pacific region. Provision of comprehensive low vision services is important to improve vision-related quality of life (QoL) for people with this condition. This review outlines the critical issues and challenges facing the provision of low vision services in the Asia-Pacific region. The review offers possible strategies to tackle these issues and challenges facing service providers and policy makers in lieu of Vision 2020 strategies in this area. Pertinent findings from the global survey of low vision services and extensive ground work conducted in the region are used; in addition, a discussion on the availability of services, human resources and training, and funding and the future sustainability of low vision care will be covered. In summary, current issues and challenges facing the region are the lack of specific evidence-based data, access, appropriate equipment and facilities, human resources, funding, and sustainability. These issues are inextricably interlinked and thus cannot be addressed in isolation. The solutions proposed cover all areas of the VISION 2020 strategy that include service delivery, human resources, infrastructure and equipment, advocacy and partnership; and include provision of comprehensive care via vertical and horizontal integration; strengthening primary level care in the community; providing formal and informal training to enable task shifting and capacity building; and promoting strong government and private sector partnership to achieve long-term service financial sustainability.

Objective: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries. Materials and Methods: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations. Results: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available. Conclusions: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.

Corneal diseases represent the second leading cause of blindness in most developing world countries. Worldwide, major investments in public health infrastructure and primary eye care services have built a strong foundation for preventing future corneal blindness. However, there are an estimated 4.9 million bilaterally corneal blind persons worldwide who could potentially have their sight restored through corneal transplantation. Traditionally, barriers to increased corneal transplantation have been daunting, with limited tissue availability and lack of trained corneal surgeons making widespread keratoplasty services cost prohibitive and logistically unfeasible. The ascendancy of cataract surgical rates and more robust eye care infrastructure of several Asian and African countries now provide a solid base from which to dramatically expand corneal transplantation rates. India emerges as a clear global priority as it has the world′s largest corneal blind population and strong infrastructural readiness to rapidly scale its keratoplasty numbers. Technological modernization of the eye bank infrastructure must follow suit. Two key factors are the development of professional eye bank managers and the establishment of Hospital Cornea Recovery Programs. Recent adaptation of these modern eye banking models in India have led to corresponding high growth rates in the procurement of transplantable tissues, improved utilization rates, operating efficiency realization, and increased financial sustainability. The widespread adaptation of lamellar keratoplasty techniques also holds promise to improve corneal transplant success rates. The global ophthalmic community is now poised to scale up widespread access to corneal transplantation to meet the needs of the millions who are currently blind.

Global estimates indicate that more than 2.3 billion people in the world suffer from poor vision due to refractive error; of which 670 million people are considered visually impaired because they do not have access to corrective treatment. Refractive errors, if uncorrected, results in an impaired quality of life for millions of people worldwide, irrespective of their age, sex and ethnicity. Over the past decade, a series of studies using a survey methodology, referred to as Refractive Error Study in Children (RESC), were performed in populations with different ethnic origins and cultural settings. These studies confirmed that the prevalence of uncorrected refractive errors is considerably high for children in low-and-middle-income countries. Furthermore, uncorrected refractive error has been noted to have extensive social and economic impacts, such as limiting educational and employment opportunities of economically active persons, healthy individuals and communities. The key public health challenges presented by uncorrected refractive errors, the leading cause of vision impairment across the world, require urgent attention. To address these issues, it is critical to focus on the development of human resources and sustainable methods of service delivery. This paper discusses three core pillars to addressing the challenges posed by uncorrected refractive errors: Human Resource (HR) Development, Service Development and Social Entrepreneurship.

Background: In the final push toward the elimination of avoidable blindness, cataract occupies a position of eminence for the success of the Right to Sight initiative. Aims: Review existing situation and assess what monitoring indicators may be useful to chart progress towards attaining the goals of Vision 2020. Settings and Design: Review of published papers from low and middle income countries since 2000. Materials and Methods: Published population-based data on prevalence of cataract blindness/visual impairment were accessed and prevalence of cataract blindness/visual impairment computed, where not reported. Data on prevalence of cataract blindness, cataract surgical coverage at different visual acuity cut offs, surgical outcomes, and prevalence of cataract surgery were analyzed. Scatter plots were used to look at relationships of some variables, with Human Development Index (HDI) rank. Available data on Cataract Surgical Rate (CSR) was plotted against prevalence of cataract surgery reported from surveys. Results: Worse HDI Ranks were associated with higher prevalence of cataract blindness. Most studies showed that a significant proportion of the blind were covered by surgery, while a fifth showed that a significant proportion, were operated before they went blind. A good visual outcome after surgery was positively correlated with higher surgical coverage. CSR was positively correlated with cataract surgical coverage. Conclusions: Cataract surgical coverage is increasing in most countries at vision

Reliable information is required for the planning and management of eye care services. While classical research methods provide reliable estimates, they are prohibitively expensive and resource intensive. Rapid assessment (RA) methods are indispensable tools in situations where data are needed quickly and where time- or cost-related factors prohibit the use of classical epidemiological surveys. These methods have been developed and field tested, and can be applied across almost the entire gamut of health care. The 1990s witnessed the emergence of RA methods in eye care for cataract, onchocerciasis, and trachoma and, more recently, the main causes of avoidable blindness and visual impairment. The important features of RA methods include the use of local resources, simplified sampling methodology, and a simple examination protocol/data collection method that can be performed by locally available personnel. The analysis is quick and easy to interpret. The entire process is inexpensive, so the survey may be repeated once every 5-10 years to assess the changing trends in disease burden. RA survey methods are typically linked with an intervention. This article provides an overview of the RA methods commonly used in eye care, and emphasizes the selection of appropriate methods based on the local need and context.

Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world′s health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.

The major causes of blindness in children encompass intrauterine and acquired infectious diseases, teratogens and developmental and molecular genetics, nutritional factors, the consequences of preterm birth, and tumors. A multidisciplinary approach is therefore needed. In terms of the major avoidable causes (i.e., those that can be prevented or treated) the available evidence shows that these vary in importance from country to country, as well as over time. This is because the underlying causes closely reflect socioeconomic development and the social determinants of health, as well as the provision of preventive and therapeutic programs and services from the community through to tertiary levels of care. The control of blindness in children therefore requires not only strategies that reflect the local epidemiology and the needs and priorities of communities, but also a well functioning, accessible health system which operates within an enabling and conducive policy environment. In this article we use cataract in children as an example and make the case for health financing systems that do not lead to ′catastrophic health expenditure′ for affected families, and the integration of eye health for children into those elements of the health system that work closely with mothers and their children.

Aim : This paper intends to discuss the patients′ perspective on the determinants of primary eye care services from vision centers (VC) in rural India. Materials and Methods : A retrospective study design and interview method was used on 127 randomly selected patients who accessed the 4 VCs in 2007. Factor analyses and linear regression models were used to predict the associations with patient satisfaction. Results : The three factors derived from factor analyses were: (1)-vision technician (VT), (2)-location of VC, and (3)-access to VC; explaining 60% of the variance in total patients′ satisfaction with VC. The first model (R2 : 0.61; F 1,124=144.36, P

Cataract is the leading cause of blindness globally and surgery is the only known measure to deal with it effectively. Providing high quality cataract surgical services is critical if patients with cataract are to have their sight restored. A key focus of surgery is the outcome of the procedure. In cataract surgery this is measured predominantly, using visual acuity. Population- and hospital-based studies have revealed that the visual outcome of cataract surgery in many low and middle income settings is frequently sub-optimal, often failing to reach the recommended standards set by the World Health Organization (WHO). Another way of measuring outcome of cataract surgery is to ask patients for their views on whether surgery has changed the functioning of their eyes and their quality of life. There are different tools available to capture patient views and now, these patient-reported outcomes are becoming more widely used. This paper discusses the visual outcome of cataract surgery and frames the outcome of surgery within the context of the surgical service, suggesting that the process and outcome of care cannot be separated. It also discusses the components of patient-reported outcome tools and describes some available tools in more detail. Finally, it describes a hierarchy of challenges that need to be addressed before a high quality cataract surgical service can be achieved.

Context : Globally, limited data are available on changing trends of blindness from a single region. Aims : To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade. Settings and Design : Rural setting; cross-sectional study. Materials and Methods : Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district. Statistical Analysis : Done using 11 th version of Stata. Results : Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9-9.1%) and 11% (95% CI, 8.3-13.7%), while that of VI was 13.6% (95% CI, 12.2-15.1%) and 40.3% (95% CI, 36.1-44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5-21.8%) compared with APEDS (34%; 95% CI, 20.9-49.3%). Conclusion : There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade.

Purpose : To describe preoperative factors, long-term (>3 years) postoperative outcome and cost of traumatic cataracts in children in predominantly rural districts of western India. Subjects : Eighty-two traumatic cataracts in 81 children in a pediatric ophthalmology department of a tertiary eye-care center. Materials and Methods : Traumatic cataracts operated in 2004-2008 were reexamined prospectively in 2010-2011 using standardized technique. Cause and type of trauma, demographic factors, surgical intervention, complications, and visual acuity was recorded. Statistical Analysis : Data analysis done by using SPSS (Statistical package for social sciences) version 17.0 We have used Chi-square test, Fisher′s exact test, paired t-test to find the association between the final vision and various parameters at 5% level of significance; binary logistic regression was performed for visual outcome ≥6/18 and ≥6/60. Results : The children were examined in a 3-7 year follow-up (4.35 ± 1.54). Average age at time of surgery was 10.4 ± 4.43 years (1.03 to 18). Fifty (61.7%) were boys. Forty (48.8%) were blunt and 32 (39%) were sharp trauma. The most common cause was wooden stick 23 (28.0%) and sharp thorn 14 (17.1%). Delay between trauma and presentation to hospital ranged from same day to 12 years after the injury with median of 4 days. The mean preoperative visual acuity by decimal notation was 0.059 ± 0.073 and mean postoperative visual acuity was 0.483 ± 0.417 (P < 0.001). Thirty-eight (46.3%) had best corrected visual acuity (BCVA) ≥6/18 and 51 (62.2%) had BCVA ≥ 6/60. In univariable analysis, visual outcome (≥6/18) depended on type of surgery (P = 0.002), gender (P = 0.028), and type of injury (P = 0.07)-sharp trauma and open globe injury had poorer outcomes; but not on age of child, preoperative vision, and type of surgeon. On multivariable binary logistic regression, only gender was significant variable. Of the 82 eyes, 18 (22%) needed more than one surgery. The parents spent an average of Rs. 2250 ($45) for the surgery and 55 (66.4%) were from lower socio-economic class. Conclusion : The postoperative visual outcomes varied and less than half achieved ≥ 6/18.

Aims : To complete an initial estimate of the global cost of eliminating avoidable blindness, including the investment required to build ongoing primary and secondary health care systems, as well as to eliminate the ′backlog′ of avoidable blindness. This analysis also seeks to understand and articulate where key data limitations lie. Materials and Methods : Data were collected in line with a global estimation approach, including separate costing frameworks for the primary and secondary care sectors, and the treatment of backlog. Results : The global direct health cost to eliminate avoidable blindness over a 10-year period from 2011 to 2020 is estimated at $632 billion per year (2009 US$). As countries already spend $592 billion per annum on eye health, this represents additional investment of $397.8 billion over 10 years, which is $40 billion per year or $5.80 per person for each year between 2010 and 2020. This is concentrated in high-income nations, which require 68% of the investment but comprise 16% of the world′s inhabitants. For all other regions, the additional investment required is $127 billion. Conclusions : This costing estimate has identified that low- and middle-income countries require less than half the additional investment compared with high-income nations. Low- and middle-income countries comprise the greater investment proportion in secondary care whereas high-income countries require the majority of investment into the primary sector. However, there is a need to improve sector data. Investment in better data will have positive flow-on effects for the eye health sector.

Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries) often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.

A number of organizations have employed a consultative process with the vision community to engage relevant parties in identifying needs and opportunities for vision research. The National Eye Institute in the US and the European Commission are currently undergoing consultation to develop priorities for vision research. Once these priorities have been established, the challenge will be to identify the resources to advance these research agendas. Success rates for Federal funding for research have decreased recently in the USA, UK, and Australia. Researchers should consider various potential funding sources for their research. The universal consideration for funding is that the reason for funding should align with the mission of the funding organization. In addition to Federal research organizations that fund investigator-initiated research, other potential funding sources include nongovernmental organizations, for-profit companies, individual philanthropy, and service organizations. In addition to aligning with organizational funding priorities, researchers need to consider turn-around time and total funds available including whether an organization will cover institutional indirect costs. Websites are useful tools to find information about organizations that fund research, including grant deadlines. Collaboration is encouraged.

Visual impairment (low vision and blindness) is a major health concern all over the world. Three main reasons for the high prevalence of visual impairment are non-availability, non-accessibility andnon-affordability of eye care services. However, there are several factors that may act as barriers to the use of available, accessible and affordable eye care services. These include the lack of knowledge of the services, lack of knowledge of the possible impact of an eye disease and lack of knowledge of who to consult for management of eye diseases. Also, demographic, personal, social and cultural factors may influence or act as barriers to eye care utilization. These various factors are reviewed in this article. Where there is poor utilization of available services, educational campaigns would lead to better understanding and promote greater utilization of eye care services. Early detection and management of eye diseases would reduce the burden of visual impairment and disability. Therefore, eye care providers and health care managers must have good knowledge of the various factors that would negatively influence utilization of eye care services and be responsive to them. (S Afr Optom 2010 69(4) 182-193)

Introduction: Objective of the study was to assess the knowledge of blinding eye diseases and the satisfaction for the eye services at government hospitals among community. Methods: This was a descriptive study 200 people of more than 18 years of age were given a close ended questionnaire. Their self re- ported responses were collected. Questions were related to their knowledge of eye disorders and their attitude toward eye related issues. Results: The knowledge about cataract was found to be good in more than 75% of respondents. 46% of the respondents were satis- fied with type of eye services provided in government hospitals. Difference of awareness between younger (40 years) was found significant (P

Trachoma is responsible for the visual impairment of about two million people worldwide, out of which a majority are irreversibly blind. The study aimed to assess the level of knowledge, attitudes and eye care seeking practices of the community regarding the available trachoma eye care services. Community members aged eighteen and over participated. Descriptive cross-sectional study design was adapted. Data analysis was performed using Stata. The level of awareness of trachoma disease in the study area was high (95%). About three quarters (71%) of the respondents were knowledgeable of the available trachoma eye care services. A majority had a positive attitude towards the available services and expressed need for the services. Public health facilities were mostly preferred. The study concluded that the community was knowledgeable of the available trachoma eye care services and had a positive attitude towards the services. Concerned stakeholders should reinforce the positive attitudes through community based educational programs and improve eye care seeking practices through community participation in education and outreach services.

Purpose UK demographic and legislative changes combined with increasing burdens on National Health Service manpower and budgets have led to extended roles for community optometrists providing locally-commissioned enhanced optometric services ( EOS). This realist review's objectives were to develop programme theories that implicitly or explicitly explain quality outcomes for eye care provided by optometrists via EOS and to test these theories by investigating the effectiveness of services for cataract, glaucoma, and primary eye care. Methods The review protocol was published on PROSPERO, and RAMESES publication standards were followed. Programme theories were formulated via scoping literature searches and expert consultation. The searching process involved all relevant electronic databases and grey literature, without restrictions on study design. Data synthesis focussed on questioning the integrity of each theory by considering supportive and refuting evidence from the source literature. Results Good evidence exists for cataract, glaucoma and primary eye care EOS that: with appropriate training, accredited optometrists manage patients commensurate with usual care standards; genuine partnerships can exist between community and hospital providers for cataract and glaucoma EOS; patient satisfaction with all three types of service is high; cost-effectiveness of services is unproven for cataract and primary eye care, while glaucoma EOS cost-effectiveness depends on service type; contextual factors may influence service success. Conclusions The EOS reviewed are clinically effective and provide patient satisfaction but limited data is available on cost-effectiveness. [ABSTRACT FROM AUTHOR]

Purpose: To describe the factors that determine the utilization of eye care services in a rural community in South‑Western Nigeria. Methods: A descriptive cross‑sectional survey using a multistage sampling technique was conducted. The main outcome measure was self‑reported previous consultation of an orthodox medical facility for eye care. Results: The study sample included 643 participants. Only 122 (19%) respondents had previously visited orthodox facilities in search of eye care and 24% of those with presenting visual acuity <6/18 had sought eye care. Characteristics associated with previous utilization of eye care services were age of ≥70 years (odds ratio [OR] = 1.7, P = 0.02); male gender (OR = 1.5, P = 0.04); literacy (OR = 1.7, P = 0.007); and residing close to an eye care facility (OR = 2.8, P < 0.001). Blind respondents were three times more likely to seek eye care (P < 0.001). Regression analysis revealed that factors associated with increased likelihood of utilization of eye care services included age ≥70 years; literacy; residence close to an eye facility; being diabetic or hypertensive; history of ocular symptoms, and blindness. Conclusions: These findings suggest that a significant proportion (75%) of adults in the study area are not utilizing eye care services and that blindness is an important determinant of utilization of eye care services. Health education and awareness campaigns about the importance and benefits of seeking eye care early, and the provision of community‑based eye care programs are essential to boost the uptake of eye care services in this community as well as other rural areas of West Africa. [ABSTRACT FROM AUTHOR]