Eye Health

Background: Although a leading cause of visual impairment and a treatable cause of blindness globally, the pattern of refractive errors in many populations is unknown. This study determined the pattern of refractive ocular conditions, reasons for spectacles renewal and the effect of correction on refractive errors in a resource-limited community.

Objectives: The aims of this study were to developed snakes-and-ladder game as an eye health promotion. Method: A research and development (RnD) method was conducted in this study, adapting ADDIE development model which consist of analysis stage, design stage, development stage, implementation stage, dan evaluation stage. Result and Discussion: The content that integrated into the game were healthy eye tips, eye exercise, refractive disorder, proper way of reading, eyestrain, and eye-care health officers. The aptness of the game was carried out by three expert. The result were 91% valid by media expert, 82% valid by health promotion expert, and 46% by eye health-content expert. Conclusion: The eye health snake-and-ladder games had revised and ready to be tested in limited and field trial as an eye health promotion media.

Introduction
Uncorrected refractive error is the leading cause of visual impairment worldwide and leads to an impaired quality of life. This study was designed to determine the prevalence of uncorrected refractive error and presbyopia, to assess spectacle coverage, and to evaluate visual health-related quality of life among persons aged 15–50 years old in Nampula, Mozambique.
Methods
Participants were assessed using a validated rapid assessment of refractive error protocol, comprised of a demographic questionnaire, a standardized ophthalmic assessment to determine refractive status and spectacle coverage, and a modified vision-related quality of life questionnaire to assess the impact of uncorrected refractive error on participants’ visual health status.
Results
Among the 3,453 respondents, visual impairment prevalence was 3.5%

Rapid Assessment of Refractive Error, Presbyopia, and Visual Impairment and Associated Quality of Life in Nampula, Mozambique

James Loughman, Technological University DublinFollow
Lindelwa Nxele, Brian Holden Vision Institute, Durban, South AfricaFollow
Cesar Faria, Lúrio University, Nampula, MozambiqueFollow
Stephen Thompson, Technological University DublinFollow
Prasidh Ramson, Brian Holden Vision Institute, Durban, SouthFollow
Farai Chinanyi, Brian Holden Vision Instiute, Durban, South AfricaFollow
Kovin S. Naidoo, Brian Holden Vision Institute, Durban, South AftricFollow
Document Type
Article

Rights
This item is available under a Creative Commons License for non-commercial use only

Disciplines
1.7 OTHER NATURAL SCIENCES

Abstract
Introduction: Uncorrected refractive error is the leading cause of visual impairment worldwide and leads to an impaired quality of life. This study was designed to determine the prevalence of uncorrected refractive error and presbyopia, to assess spectacle coverage, and to evaluate visual health-related quality of life among persons aged 15–50 years old in Nampula, Mozambique.

Methods: Participants were assessed using a validated rapid assessment of refractive error protocol, comprised of a demographic questionnaire, a standardized ophthalmic assessment to determine refractive status and spectacle coverage, and a modified vision-related quality of life questionnaire to assess the impact of uncorrected refractive error on participants’ visual health status.

Results: Among the 3,453 respondents, visual impairment prevalence was 3.5% (95%, CI 2.7%–4.2%), with 65.8% of those visually impaired being 35 years of age and older. Uncorrected refractive error prevalence was 2.6% (95%, CI 2.1–3.2%), and was the primary cause of visual impairment among 64.5% of cases. The spectacle coverage for uncorrected refractive error was 0%. Presbyopia prevalence was higher, at 25.8% (95%, CI 12.0–30.5%), with only 2.2% spectacle coverage. Respondents with visual impairment demonstrated statistically significantly lower quality of life scores compared to those without visual problems (p < 0.01).

Implications for practitioners: The uncorrected refractive error problem and a distinct lack of spectacle coverage for refractive error and presbyopia indicate an urgent need for the development and delivery of a comprehensive refractive error service in the Nampula region of Mozambique.

Access to open water is considered good for the welfare of Pekin ducks. These studies investigated the effect water resource type provided over either straw bedding or a plastic mesh, on measures of duck health. Pekin strain ducklings (n=2600) were managed in pens of 100 on straw over a solid concrete floor. In study 1, one of 2 water resources, nipple (NIP; n = 5 pens) or wide lip bell drinker (WIDE; n= 5 pens) were located directly over the straw. In study 2 one of 3 water resources (Narrow lip bell drinker; n = 6 pens, TROUGH; n = 5 pens, and BATH; n = 5 pens) were located over a rubber mesh. On d16, d24, d29, d35 and d43 (study1) or d21, d29, d35 and d43 post-hatch (study 2), ten birds were selected from each pen, weighed, then feather hygiene, foot pad dermatitis (FPD), eye health, gait score and nostril condition scores taken. There was no effect of treatment on live weight in either study, but in study 2 ducks in the open water treatments overtook NARROW (P < 0.001) by d43. In study 1 there was no effect of treatment on hygiene scores, but scores increased over time (P<0.001). In study 2 ducks in the NARROW treatment were dirtier than BATH (P=0.01) with TROUGH intermediate. In both studies, ducks with bell drinkers had worse gait scores than the other treatments (Study1; P < 0.01: Study 2; P < 0.05). There was no effect of treatment on eye health score. However, ducks were less likely to have dirty nostrils with more open water resources in both studies (P < 0.01), or to have blocked nostrils in TROUGH and BATH than in NARROW in study 2 (P=0.01). Provision of open water, in particular over a properly constructed drainage area, improved some aspects of duck health (improved feather hygiene, and live weight, and fewer dirty and blocked nostrils). However, further work is needed to investigate these treatments at a commercial scale.

Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges.

Prioritas kerja pemerintah pada bidang kesehatan lebih ditekankan pada upaya promotif dan preventif. Salah satu bentuk partisipasi terhadap hal tersebut serta dalam rangka peringatan World Sight Day 2019, dilakukan kegiatan pengabdian masyarakat dalam bentuk pendidikan dan pemeriksaan kesehatan mata. Pendidikan kesehatan yang dilakukan dengan menggunakan media permainan ular tangga. Pemeriksaan kesehatan yang dilakukan adalah pemeriksaan tajam penglihatan dan koreksi dengan menggunakan Snellen Chart dan Lensa Coba. Pengabdian masyarakat dilakukan pada kegiatan Car Free Day Cilembang dengan subjek masyarakat Kota Tasikmalaya yang berpartisipasi dalam kegiatan tersebut. Masyarakat antusias dengan kegiatan ini. Kegiatan pendidikan kesehatan lebih banyak diikuti oleh anak-anak, dan kegiatan pemeriksaan kesehatan lebih banyak diikuti oleh orang dewasa. Dari hasil pemeriksaan kesehatan mata diperoleh sebanyak 53% klien memiliki penglihatan normal, 35% klien mengalami kelainan refraksi miopia (termasuk astigmatism), dan 12% mengalami kelainan refraksi hipermetropia (termasuk astigmatism). Kegiatan ini diharapkan dapat menumbuhkan pengetahuan masyarakat tentang kesehatan mata serta kesadaran masyarakat tentang pentingnya menjaga kesehatan mata.

ABSTRACT The burden of vision impairment due to uncorrected refractive error (needing spectacles) in Mozambique is known to be significant. To improve the planning and provision of eye health services, a better understanding of how vision is valued by patients is needed. The willingness to pay (WTP) for improved vision through correcting refractive error was investigated in Nampula, Mozambique, using stated choice and bidding game methodologies. The mean WTP values were found to be 388.92 Meticals (US$13) for stated choice and 469.89 Meticals (US$16) for the bidding game. The mean WTP values for rural dwellers were found to be lower than responses from those living in urban areas. If avoidable vision impairment is to be addressed in Mozambique, the cost of services must not be a barrier and the construction of a sustainable spectacle system that delivers for both rural and urban patients must be a priority.

Many low- and middle-income countries use national eye-care plans to guide efforts to strengthen eye-care services. The World Health Organization recognizes that evidence is essential to inform these plans. We assessed how evidence was incorporated in a sample of 28 national eye-care plans generated since the was endorsed by the World Health Assembly in 2013. Most countries (26, 93%) cited estimates of the prevalence of blindness and 18 countries (64%) had set targets for the cataract surgical rate in their plan. Other evidence was rarely cited or used to set measurable targets. No country cited evidence from systematic reviews or solution-based research. This limited use of evidence reflects its low availability, but also highlights incomplete use of existing evidence. For example, despite sex-disaggregated data and cataract surgical coverage being available from surveys in 20 countries (71%), these data were reported in the eye health plans of only nine countries (32%). Only three...

Introduction:
There are 161 million people living with vision impairment, due to uncorrected refractive errors. A further 510 million people are living with near-vision impairment. There is a need for clearly defined indicators that capture the quality of refractive error service outputs and outcomes and provide insights to shape, change and stimulate action. This study aims to evaluate the quality of refractive error care (Q.REC) in Cambodia, Malaysia and Pakistan, by using unannounced standardised patients (USPs) to identify the proportion of prescribed and dispensed spectacles appropriate for people’s refractive error needs and pinpoint/detail opportunities for quality improvement.

Method and analysis:
A cross-sectional Q.REC study will be conducted in randomly selected optical services in Cambodia (180 services, 900 USP visits), the Klang Valley in Malaysia (66 services, 198 USP visits) and in Jhang, Sahiwal and Khanewal districts of Punjab region/state in Pakistan (64 services, 256 USP visits). USPs will receive baseline refractions by three skilled study optometrists/refractionists trained in the Q.REC protocol. USPs will then visit individual optical services, undergo a refraction, purchase spectacles or lenses (if recommended) and record observations about which elements of a refraction and dispensing were conducted. The study optometrist/refractionist will assess each pair of dispensed spectacles by examining the USP’s aided visual acuity and visual comfort at distance and/or near and compare the lens prescription to the averaged baseline refraction.

Ethics and dissemination This study has been approved by the University of New South Wales Human Research Ethics Committee (HC210102), the National Ethics Committee for Health Research in Cambodia (043 NECHR), National Medical Research Registry and the Medical Research and Ethics Committee (NMRR-21-689-59279) in Malaysia and the College of Ophthalmology & Allied Vision Sciences Ethical Review Board (COAVS 545/2021) in Pakistan. Written informed consent will be obtained from USPs. Service owners will have the opportunity to opt-out verbally or in writing. Results will be disseminated locally through workshops including the relevant local ministry of health personnel and stakeholders, published in peer-reviewed publications and presented at national and international conferences.

Although recent advancements in technology have led to major transformations in healthcare services, the use of tele-monitoring in patient care is yet an emerging occurrence. This study examines factors that affect the adoption of video based remote treatment of senior patients in a tele-glaucoma project in a large hospital in Greece. Several themes emerge from the study encapsulating technical, usability, process, institutional, ethics and privacy, clinicians’ behaviour and patients’ demography related factors. The findings of the study showed that while the benefits of tele-monitoring service adoption were of foremost importance for doctors, usability and connectivity for enabling remote services was critical for its success.

What is already known? ► Vision and impairment and blindness among Indigenous Australians is largely preventable and treatable, yet uptake of primary and tertiary eye care remains fragmented. What are the new findings? ► Our study presents a novel analysis of Indigenous patient perspectives specifically related to diabetic eye health. ► Culture, communication and trust are key determinants of access to and uptake of eye care, and prevention of diabetic eye diseases. What do the new findings imply? ► Our findings highlight the need for increased health promotion activity to be undertaken in Indigenous language speaking communities: through access to Indigenous interpreter services, and translation of key health promotion messages targeting diabetic retinopathy. ► Shared health knowledge can help bridge the communication gap, support Indigenous patients to make informed health decisions and enable culturally safe access to eye care services.

Purpose
There is no plan for a national child eye care programme or existing human resource infrastructure to address the immediate challenge of child eye health in Mozambique. Furthermore, the prevalence and incidence of refractive error, visual impairment (VI) and child blindness (CB) in Mozambique is unknown. VI and CB have devastating personal, developmental, economic and other implications for the child, the family, the community and indeed, the nation. This study aims to design, implement and evaluate a school based paediatric vision screening service, to identify those in need of eye health services, among Mozambique’s 11,561,000 children.

Methods
Primary School Screening took place in three schools in Nampula, Mozambique in September 2010 and March 2011. The children’s vision was screened by an optometry student, optometrist or teacher with a Log MAR 0.3 line at 4 Meters. Ophthalmoscopy was performed on all children. Children who failed to read all 5 letters monocularly had their visual acuity examined on a standard Log Mar chart. If they failed to see the 0.3 line on the standard chart they had a full refraction on site. Children who required refraction were refracted on site. Those needing ophthalmological assessment were referred to Nampula Central Hospital, Ophthalmology Unit.

Results
These studies found that there is a cohort of students attending school in Nampula who are in need of eyecare service provision. Refractive Error was present among this population tested in these studies but none of the children observed wore spectacles.The training received by these teachers was very brief but teachers appear to have an adequate level of education and interest to undertake vision screening in children. The ideal teacher profile for Vision Officers within schools is trainee teachers who can be taught the basics of vision screening and eye health through their existing studies.

The results of this study will inform a regional pilot teacher screening project for Nampula, which will include the addition of “Vision Screening” to teacher training modules at Pedagogical Universities in Nampula, Mozambique, as part of a plan to develop a national child eye care programme for Mozambique.

Objective: To document the clinical features of chronic blepahritis in our patients.
Study Design: Descriptive study
Place and Duration of Study: Pakistan Field Hospital 3 Level III (United Nations-African Union Mission in Darfur), Nyala Sudan from Feb 2011 to Jan 2012.
Patients and Methods: All the diagnosed chronic blepharitis patients attending our ophthalmology clinic werefurther evaluated and included. History focused especially on burning, itching, grittiness, discomfort and redness of eye lids. Slit lamp examination was done to classify disease as seborrhoeic anterior, staphylococcal anterior and posterior blepharitis. Uncomplicated disease was graded as mild;blepharitis associated with dry eyes was moderate whereas presence of trichiasis, papillary conjunctivitis or inferior punctate corneal erosions was severe disease.
Results: Out of 399 patients seen, 52 (13.03%) had chronic blepharitis. The mean age of these patients was 35.87 ± 8.16 years. Of them, 40 (76.92%) were males and 12 (23.08%) were females. 28 (53.85%) cases were symptomatic. 36 (69.23%) had anterior blepharitis, 8 (15.38%) had posterior blepharitis whereas 8 (15.38%) had mixed blepharitis. 30 (57.69%) had mild disease, 18 (34.62%) had moderate disease whereas 4 (7.69%) had severe disease.
Conclusion: Chronic blepharitis is usually symptomatic, mostly mild in severity and anterior in location.

Background: The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the burden of URE in Lusophone Africa. The nature of the MEP programme provides the opportunity to determine, using Cost Benefit Analysis (CBA), whether investing in the establishment and delivery of a comprehensive system for optometry human resource development and public sector deployment is economically justifiable for Lusophone Africa. Methods: A CBA methodology was applied across the period 2009-2049. Costs associated with establishing and operating a school of optometry, and a programme to address uncorrected refractive error, were included. Benefits were calculated using a human capital approach to valuing sight. Disability weightings from the Global Burden of Disease study were applied. Costs were subtracted from benefits to provide the net societal benefit, which was discounted to provide the net present value using a 3% discount rate. Results: Using the most recently published disability weightings, the potential exists, through the correction of URE in 24.3 million potentially economically productive persons, to achieve a net present value societal benefit of up to $1.1 billion by 2049, at a Benefit-Cost ratio of 14:1. When CBA assumptions are varied as part of the sensitivity analysis, the results suggest the societal benefit could lie in the range of $649 million to $9.6 billion by 2049. Conclusion: This study demonstrates that a programme designed to address the burden of refractive error in Mozambique is economically justifiable in terms of the increased productivity that would result due to its implementation.

Background: The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the burden of URE in Lusophone Africa. The nature of the MEP programme provides the opportunity to determine, using Cost Benefit Analysis (CBA), whether investing in the establishment and delivery of a comprehensive system for optometry human resource development and public sector deployment is economically justifiable for Lusophone Africa. Methods: A CBA methodology was applied across the period 2009-2049. Costs associated with establishing and operating a school of optometry, and a programme to address uncorrected refractive error, were included. Benefits were calculated using a human capital approach to valuing sight. Disability weightings from the Global Burden of Disease study were applied. Costs were subtracted from benefits to provide the net societal benefit, which was discounted to provide the net present value using a 3% discount rate. Results: Using the most recently published disability weightings, the potential exists, through the correction of URE in 24.3 million potentially economically productive persons, to achieve a net present value societal benefit of up to $1.1 billion by 2049, at a Benefit-Cost ratio of 14:1. When CBA assumptions are varied as part of the sensitivity analysis, the results suggest the societal benefit could lie in the range of $649 million to $9.6 billion by 2049. Conclusion: This study demonstrates that a programme designed to address the burden of refractive error in Mozambique is economically justifiable in terms of the increased productivity that would result due to its implementation.

The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter &#39;Aboriginal&#39;) Australians is three times greater than non-Aboriginal Australians, contributing to a greater risk of blindness from treatable and preventable ocular conditions, most prominently cataract and diabetic retinopathy. In rural and remote Aboriginal communities, blindness prevalence is higher, and ocular treatment coverage and uptake are lower. In collaboration with Aboriginal Community Based Researchers (CBRs), this study explored complex contingent factors that shape access to eye health services among rural and remote Aboriginal Australians living with diabetes. Interviews (n = 126) and focus groups (n = 12) were conducted with patients, primary care clinicians, and CBRs, in four rural communities in the Northern Territory and New South Wales. Factors internal and external to health systems were examined, drawing on Bourdieu&#39;s concepts of habitus, and doxa to understand agency and decision-making among patients and clinicians. The study used the ontology of critical realism, categorising contingent factors as underlying structures (generative mechanisms), and applying a decolonising approach that centred causal relationships and tensions between dominant (Western biomedical neoliberalism) and non-dominant (Aboriginal) value systems. Three forms of marginalisation; linguistic, economic, and cultural, were identified as the generative mechanisms that inhibit equitable eye health outcomes. Marginality is linked to structural factors that position Aboriginal culture as a barrier, and is reinforced through biomedical health systems, and the agents who operate in and influence them. In order to address eye health inequity, a shift in how Aboriginal cultural sovereignty is understood within health systems is needed, to position it as a strength that can facilitate eye care accessibility, and to support enhanced cultural responsivity among clinicians and service providers.

A situational analysis indicates a lack of eye health personnel who can and do refract. The logical course of action would be to train more eye health personnel. A conservative estimated annual burden of URE in lost productivity in Mozambique is $14,486,692. To achieve the V2020 target ratio, an extra 184 workers are needed in six provinces analysed. The analysis assumes the existing personnel are well trained and dedicate time to offering a refraction service. It also assumes that the patient receives the care they require. Other aspects of the situational analysis suggest this is currently not always the case. A more comprehensive analysis would look at the number of work hours each person dedicates to refraction and the outcome.

The Mozambique Eyecare Project was an international partnership to implement and research eye health education in Mozambique and the Africa region. An optometry degree was developed at Universidade Lúrio, Mozambique. In addition, existing eye health workers were upskilled with training. Researchers from various disciplines evaluated the project and its potential for impact on eye health in the region. The body of evidence generated from the research provides useful lessons for development programmes in general, as well as specific lessons for delivering eye health education and service delivery models for low-income settings.

Preventable eye diseases cause 94% of vision loss in Aboriginal and Torres Strait Islander (herein Aboriginal) adults (Taylor et al, 2012). Despite this, blindness rates in Aboriginal adults continue to sit at 6 times the rate of the mainstream population (Taylor et al, 2012). Recent studies have identified structural and systemic factors that inhibit access to eye care for Aboriginal people. However there is little evidence of the phenomenological factors that affect Aboriginal people’s access to eye care, and the influence this has on decisions around eye health and care.
This study investigates why some Aboriginal people complete or do not complete their clinical eye care pathways, and why some do not access eye care at all. With a focus on cataract and diabetes eye diseases, we present the barriers and enablers around prevention practices, and primary, secondary and tertiary pathways of care, that have been identified through the perspectives of Aboriginal people in 2 remote Top End communities in the Northern Territory.
Three of the authors are Aboriginal community based researchers, who played an integral role in the conduct of interviews, and the thematic analysis of data. Engaging community researchers facilitated cultural and contextual appropriateness, knowledge exchange and capacity building. This presentation outlines (a) the research process (b) barriers and enablers to eye care through the voices of Aboriginal patients and (c) community driven recommendations to strengthen eye care systems in rural and remote communities. 
Using a qualitative, Participatory Action Research (PAR) design, and in collaboration with Aboriginal Community Controlled Health Services (ACCHS), we aim to privilege the voices, experiences and lives of Aboriginal people, through understanding how human experiences and the social determinants that shape them, impact equity in eye health.

Background: Blindness, which is potentially avoidable, is a serious public health problem globally. Thi s study was carried out to determine prevalence of bilateral blindness and the utilization of existing eye care facilities by the bilaterally blind. Methods: A randomi ze d cross sectional community-based study. Participants were community members aged 5years and above who were selected from 30 enumeration areas determined with EPI INFO V6 statistical software in line with standard practice. They had detailed ocular examinations and data were analyzed with SPSS. Results: Eligible participants were 1,236 (Male: Female = 1:2). Age ranged 5-103 years (median age, 55years). Prevalence of blindness was 4% (49/1236) for which Cataract (42.9%); Glaucoma (24.5%), Couching (10.2%) and Cornea opacity (8.2%) were the common causes. Most of those that were blind (57.1%) had never utilized eye care services available in the study area and lack of awareness was the reason in majority of them.

Despite the widespread acceptance of the principles of the Alma Ata Declaration of 1978 and the subsequent amendments, health for all has remained a distant dream in many parts of the developing world. Concerns such as the economic efficiency of health systems and their reach and coverage have dominated discussions of public health, with ethics remaining at best a shadowy set of assumptions or at worst completely ignored. Similarly, questions of ethics have been incidental or assumed in the design of public health models across sectors and are rarely explicitly addressed. This paper uses the experience of the L V Prasad Eye Institute’s (LVPEI) pyramidal model of eye health delivery to explore ethical issues in the design and implementation of public health interventions. The LVPEI model evolved over time from its beginnings as a tertiary care centre to a network that spans all levels of eye care service delivery from the community through primary and secondary levels. A previously published analytical framework is applied to this model, and in doing so, the utility of this framework as well as the ethics of the LVPEI model, are interrogated. The authors then evolve an analytical and prescriptive framework that could be used to build in and evaluate ethics in other public health delivery models.