Abstract
Purpose Healthcare access is one of the determinants of visual impairment (VI), as a public health problem. The objective of this study was to estimate VI prevalence, related causes, and its correlation with access to physicians in Iran. Methods: This systematic review and meta-analysis include observational studies published in Iran. PubMed, Web of Science, Scopus, Google Scholar, and local databases were systematically searched by using the MeSH headings. Data on the provincial distribution of physicians, as an index of access to healthcare, was retrieved. A random-effect meta-analysis was performed to assess. Results Eight articles were included. The pooled prevalence of blindness, low vision, and VI was 0.80% (95% CI: 0.61–0.99%), 2.92% (95% CI: 2.40–3.44%), and 5.57% (95% CI: 4.71–6.43%). Refractive errors were the most common causes of VI based on PVA with the pooled prevalence of 54.6% (95% CI: 43.4–65.8%). Based on BCVA, we found that the pooled prevalence of cataracts was 37.4% (95% CI: 29.5–45.3%) as the most common cause of VI. The results of metaregression showed that the greater number of general practitioners (GPs) (P value = 0.01) and pharmacists (P value = 0.024) per population were associated with a lower prevalence of blindness. Conclusion Some of the main causes of visual impairment in Iran are preventable. Access to healthcare services may lead to early diagnosis of preventable causes of VI. Further well-designed studies and national surveys should be conducted to provide accurate data from different regions of Iran.
Highlights
Visual impairment (VI) is one of the most common public health issues with substantial personal, financial, and social burdens on both patients and healthcare systems [1,2,3]
Five studies were entered in the analysis based on bestcorrected visual acuity (BCVA) and we found that the pooled prevalence of cataracts was 37.4% as the
Refractive errors were the most common causes of VI based on presenting visual acuity (PVA) with the pooled prevalence of 54.6%. e pooled prevalence of cataract, amblyopia, macular degeneration, corneal opacity, and glaucoma based on PVA was 23.5%, 4%, 5.1%, 1.3%, and 1.8%, respectively. e I2 in the heterogeneity test for the most common causes of VI based on PVA were as follows: refractive errors 89.4%, cataracts 48.6%, amblyopia 60.8%, macular degeneration 75.2%, corneal opacity 0.4%, and glaucoma 0.0%
Summary
Visual impairment (VI) is one of the most common public health issues with substantial personal, financial, and social burdens on both patients and healthcare systems [1,2,3]. Cases of low vision and blindness comprise VI as the main category. Most of the known causes of VI are preventable and manageable by medical treatments, interventions, or access to primary healthcare services. Primary healthcare as the main mechanism of the healthcare service delivery is the first level of relationship between the Journal of Ophthalmology individual, family, and community with the health system of countries. Primary healthcare services are located in the community and refer patients to other levels of healthcare services. The number and distribution of physicians are one of the indices of access to healthcare services. Improving the quality of healthcare services and increasing access to health services for community members especially for people with lower socioeconomic status are the most important goals of healthcare in Iran [9]
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