Presbyopic Spectacle Coverage, Willingness to Pay for Near Correction, and the Impact of Correcting Uncorrected Presbyopia in Adults in Zanzibar, East Africa

Abstract

To assess presbyopic spectacle coverage, willingness to pay, and the impact of correcting uncorrected presbyopia in individuals 40 years of age and older in Zanzibar and whether assessment of presbyopia can be incorporated into Rapid Assessment of Blindness (RAAB) surveys. A cross-sectional, population-based survey of presbyopia was incorporated into a RAAB survey. The sample size of 400 included individuals older than 50 years (from RAAB survey) and those 40 to 50 years old (from the same household) who had a corrected visual acuity (VA) of at least 6/18 in either eye. An Ophthalmic Clinical Officer (OCO) administered visual function (VF) and quality of life (QOL) questionnaires followed by clinical assessment by an optometrist. Participants requiring a simple near addition were dispensed free readymade spectacles. The same team traced participants 6 months later and readministered the questionnaires. Those requiring new spectacles had their near VA measured and were given spectacles. Three hundred eighty-one participants were examined. The prevalence of presbyopia was 89.2% (340/381) and spectacle coverage was only 17.6%. Barriers to accessing services included spectacles not being a priority and lack of money. At follow-up, 175 (93.6%) of 187 participants given spectacles still had them. Mean satisfaction was high at 89.5%. The mean amount participants were willing to pay for spectacles had increased from 2.17 USD at baseline to 3.14 USD at follow-up. The impact of correcting presbyopia on VF produced an effect size of 2.90 and effect sizes ranging from 1.15 to 3.90 for mean QoL scores. This study highlights the value of correcting presbyopia from the community perspective and the necessity of providing affordable, quality, and accessible near spectacles at the primary health level.