Refractive Error and Presbyopia in Timor-Leste: The Impact of 5 Years of a National Spectacle Program

Abstract

To characterize refractive error, presbyopia, and spectacle correction among adults aged ≥40 years in Timor-Leste in 2010 and examine the impact of the National Spectacle Program by comparing results to those obtained 5 years earlier. A population-based, cross-sectional survey sampled 50 clusters of 45 people each. Participants with uncorrected and undercorrected refractive error (presenting visual acuity <6/18, but ≥6/18 in the better eye with pinhole), uncorrected and undercorrected presbyopia (<N8 binocular), corrected refractive error (≥6/18 in the better eye with presenting spectacles), and corrected presbyopia (binocular ≥N8 with presenting spectacles) were identified. Willingness to wear and to pay for spectacles was elicited. Data were adjusted for sex, age, and urban/rural domicile, to compare results from 2005 and 2010. A participation rate of 89.5% (n = 2014) was achieved. The 2010 sex-age-domicile-adjusted parameters were as follows: 3.7% (95% confidence interval [CI], 2.8%-4.5%) met refractive error need; 9.6% (95% CI, 8.3%-10.9%) unmet refractive error need; 27.6% (95% CI, 22.2%-32.9%) refractive error correction coverage; 8.6% (95% CI, 7.4%-9.8%) met presbyopia need; 41.8% (95% CI, 39.7%-44.0%) unmet presbyopia need; and, 17.0% (95% CI, 14.7%-19.3%) presbyopia correction coverage. Refractive error correction coverage was significantly higher in 2010 than in 2005 (8.0%; 95% CI, 4.5%-11.6%), but presbyopia correction coverage was unchanged. Almost all the 2010 sample (99.5%) were willing to wear spectacles if needed. Sex-age-domicile-adjusted willingness to pay at least US$1.00 for spectacles was 56.9% (95% CI, 54.7%-59.1%) in 2010, significantly greater than in 2005 (47.2%; 95% CI, 44.5%-49.9%). The National Spectacle Program has not produced uniform improvement across all service indicators. Evidence-based enhancements may now be initiated.