Improving Access to Refractive Services in Adults: A Health Examination Center-Based Model

Haishuang Lin,Shaodan Zhang,Meiping Xu,Shanshan Liu,Hailin Wang,Jing Sun,Yuanbo Liang,Nathan Congdon

doi:10.3389/fmed.2021.753257

Abstract

Purpose: To assess the potential of a health examination center-based screening model in improving service for uncorrected refractive error.Methods: Individuals aged ≥18 years undergoing the routine physical examinations at a tertiary hospital in the northeast China were invited. Presenting visual acuity, noncycloplegic autorefraction, noncontact tonometry, fundus photography, and slit-lamp examination were performed. Refractive error was defined as having spherical equivalent ≤ -0.75 D or ≥ +1 D and uncorrected refractive error was considered as refractive error combined with presenting visual acuity < 6/12 in the better eye. Costs for the screening were assessed.Results: A total of 5,284 participants (61 ± 14 years) were included. The overall prevalence of myopia and hyperopia was 38.7% (95% CI, 37.4–40.0%) and 23.5% (95% CI, 22.3–24.6%), respectively. The prevalence of uncorrected refractive error was 7.85% (95% CI, 7.13–8.58%). Women (p < 0.001 and p = 0.003), those with age ≥ 70 years (p < 0.001 and p = 0.003), and myopia (p < 0.001 and p < 0.001) were at higher risk of uncorrected refractive error and uncorrected refractive error-related visual impairment. Spectacle coverage rate was 70.6% (95% CI, 68.2–73.0%). The cost to identify a single case of refractive error and uncorrected refractive error was US$3.2 and US$25.2, respectively.Conclusion: The prevalence of uncorrected refractive error is high in the urban Chinese adults. Health examination center-based refractive error screening is able to provide an efficient and low-cost model to improve the refractive services in China.

Highlights

Uncorrected refractive error (URE), predominantly myopia, is the most common cause of moderate and severe visual impairment and the second leading cause of blindness globally, imposing a significant public health burden to the society [1, 2]
We report the efficacy of health examination center-based RE screening and referral among adults aged ≥18 years
A total of 5,522 eligible adults were initially enrolled with 5,284 adults (95.7%; 95% CI, 95.2–96.2%) completing all the examinations and fulfill the criteria for analysis

Summary

Introduction

Uncorrected refractive error (URE), predominantly myopia, is the most common cause of moderate and severe visual impairment and the second leading cause of blindness globally, imposing a significant public health burden to the society [1, 2]. Despite the relatively low cost of refractive correction, such as spectacles, the prevalence of URE remains high [3, 4]. The main barrier keeping the affected adults from seeking refractive services is the absence of convenient and low-cost access to the healthcare delivery system [5]. China is one of the countries facing the greatest burden of refractive error (RE) [6]. Refractive service is not well established and even absent in some underserved regions in China. Reorganizing eye care to the coexist established health services may be a way forward

Methods

Results

Conclusion