Avoidable Visual Impairment Research Articles

Mapping human resources for eye health in 21 countries of sub-Saharan Africa: current progress towards VISION 2020.

BackgroundDevelopment of human resources for eye health (HReH) is a major focus of the Global Action Plan 2014 to 2019 to reduce the prevalence of avoidable visual impairment by 25% by the year 2019. The eye health workforce is thought to be much smaller in sub-Saharan Africa than in other regions of the world but data to support this for policy-making is scarce. We collected HReH and cataract surgeries data from 21 countries in sub-Sahara to estimate progress towards key suggested population-based VISION 2020 HReH indicators and cataract surgery rates (CSR) in 2011.MethodsRoutinely collected data on practitioner and surgery numbers in 2011 was requested from national eye care coordinators via electronic questionnaires. Telephone and e-mail discussions were used to determine data collection strategies that fit the national context and to verify reported data quality. Information was collected on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and ‘mid-level refractionists’ and combined with publicly available population data to calculate practitioner to population ratios and CSRs. Associations with development characteristics were conducted using Wilcoxon rank sum tests and Spearman rank correlations.ResultsHReH data was not easily available. A minority of countries had achieved the suggested VISION 2020 targets in 2011; five countries for ophthalmologists/cataract surgeons, four for ophthalmic nurses/clinical officers and two for CSR. All countries were below target for optometrists, even when other cadres who perform refractions as a primary duty were considered. The regional (sample) ratio for surgeons (ophthalmologists and cataract surgeons) was 2.9 per million population, 5.5 for ophthalmic clinical officers and nurses, 3.7 for optometrists and other refractionists, and 515 for CSR. A positive correlation between GDP and CSR as well as many practitioner ratios was observed (CSR P = 0.0042, ophthalmologists P = 0.0034, cataract surgeons, ophthalmic nurses and optometrists 0.1 > P > 0.05).ConclusionsWith only a minority of countries in our sample having reached suggested ophthalmic cadre targets and none having reached targets for refractionists in 2011, substantially more targeted investment in HReH may be needed for VISION 2020 aims to be achieved in sub-Saharan Africa.

Trends and implications for achieving VISION 2020 human resources for eye health targets in 16 countries of sub-Saharan Africa by the year 2020.

BackgroundDevelopment of human resources for eye health (HReH) is a major global eye health strategy to reduce the prevalence of avoidable visual impairment by the year 2020. Building on our previous analysis of current progress towards key HReH indicators and cataract surgery rates (CSRs), we predicted future indicator achievement among 16 countries of sub-Saharan Africa by 2020.MethodsSurgical and HReH data were collected from national eye care programme coordinators on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and ‘mid-level refractionists’ and combined them with publicly available population data to calculate practitioner-to-population ratios and CSRs. Data on workforce entry and exit (2008 to 2010) was used to project practitioner population and CSR growth between 2011 and 2020 in relation to projected growth in the general population. Associations between indicator progress and the presence of a non-physician cataract surgeon cadre were also explored using Wilcoxon rank sum tests and Spearman rank correlations.ResultsIn our 16-country sample, practitioner per million population ratios are predicted to increase slightly for surgeons (ophthalmologists/cataract surgeons, from 3.1 in 2011 to 3.4 in 2020) and ophthalmic nurses/clinical officers (5.8 to 6.8) but remain low for refractionists (including optometrists, at 3.6 in 2011 and 2020). Among countries that have not already achieved target indicators, however, practitioner growth will be insufficient for any additional countries to reach the surgeon and refractionist targets by year 2020. Without further strategy change and investment, even after 2020, surgeon growth is only expected to sufficiently outpace general population growth to reach the target in one country. For nurses, two additional countries will achieve the target while one will fall below it. In 2011, high surgeon practitioner ratios were associated with high CSR, regardless of the type of surgeon employed. The cataract surgeon workforce is growing proportionately faster than the ophthalmologist.ConclusionsThe HReH workforce is not growing fast enough to achieve global eye health targets in most of the sub-Saharan countries we surveyed by 2020. Countries seeking to make rapid progress to improve CSR could prioritise investment in training new cataract surgeons over ophthalmologists and improving surgical output efficiency.

A population-based cross-sectional study of barriers to uptake of eye care services in South India: the Rapid Assessment of Visual Impairment (RAVI) project

ObjectiveTo assess the barriers to uptake of eye care services among those with avoidable impairment in the population aged ≥40 years in the South Indian state of Andhra Pradesh.DesignCross-sectional study.SettingCommunity...

Pattern of gun pellet ocular injuries in Kashmir, India

Objective: The objective was to study the type and severity of ocular injuries in gun pellet victims. Materials and Methods: The study is a retrospective case series conducted in the Department of Ophthalmology, SKIMS Medical College, Bemina, Srinagar. The study included gun pellet victims admitted in our department between January 2010 and September 2013. Results: The study included 20 patients with 19 males and 1 female. Mean age of the subjects was 21.45 years. Ocular injury was unilateral in 17 cases and bilateral in 3 cases. The most common type of injuries encountered were hyphema in 82.60% of eyes, followed by corneo-scleral tear in 78.26% and vitreous hemorrhage in 47.82% of eyes. Of the 23 eyes, 18 eyes (78.26%) had an open globe injury, while only 3 eyes (13.04%) had closed globe injury at presentation in our hospital. The most commonly performed surgery was corneo-scleral repair in 18 eyes. Final corrected visual acuity (VA) remained unchanged in 34.78% and improved in 65.22% of eyes. About 47.83% of eyes had final VA < 6/60. Conclusion: Gun pellet related ocular injuries are becoming increasingly common in Kashmir Valley. In severely injured eyes, the visual prognosis remained poor despite adequate treatment. Measures toward reducing violence in our society so as to reduce avoidable visual impairment are strongly advocated.

Making a difference with Vision 2020: The Right to Sight? Lessons from two states of North Western Nigeria.

Settings and Aim: The World Health Organization launched in 1999 an initiative to eliminate the global avoidable blindness and prevent the projected doubling of avoidable visual impairment between 1990 and 2020 (Vision 2020: The Right to Sight). The World Health Assembly (WHA) adopted resolutions WHA 59.25, WHA 56.26 urging member states to adopt the Vision 2020 principles. More than 90 nongovernmental development organizations, agencies, and institutions, together with a number of major corporations, are now working together in this global partnership. Two neighboring states in North Western Nigeria provide eye care services using different approaches; one state uses the principles of Vision 2020, the other uses a different strategy. The aim of the study was to assess awareness and utilization of eye care services in two Nigerian states. A population-based cross-sectional interview of households was conducted in two neighboring states using a structured questionnaire. Data analysis was performed using SPSS version 21 and a P < 0.05 was considered as significant. Participation rate was 97% in the two states. The population in the Vision 2020-compliant state were significantly more aware about general eye care services (80% vs. 44%, P < 0.0005); had less proportion of households unaware of any eye care service (55% vs. 69%, P < 0.0005); and have a significantly higher felt the need to utilize eye care services (47% vs. 5.9%, P < 0.0005). The service utilization rate was however low in the two states. The principles of Vision 2020: The Right to Sight is adaptable to different cultures/societies and has demonstrated a potential to increase awareness and a felt need for eye care in poor resource settings.

A Descriptive Study on Compliance of Spectacle , Wear in Children of Primary Schools at Qassim Province , Saudi Arabia

Uncorrected Refractive errors are the most common cause of avoidable visual impairment in children worldwide. Importance of school screening of refractive errors are one of the most important initiatives outlined in WHO Vision 2020 targets for control of avoidable visual impairment in children. But the benefit depends on the compliance of the spectacle wear by children. To study the prevalence and determinants of compliance of spectacle wear among children and to investigate the reasons of non compliance associated with the spectacle wear in primary school children. This was a cross-sectional descriptive study of 631 students who had been prescribed spectacles for constant wear during school screening programme done by our Department of Optometry, College of Applied Medical Sciences, Qassim University during 2010-2011. After six months, experienced Optometrists conducted a follow-up visit where these students were assessed about spectacle compliance. Information on age, gender, type of refractive error, reasons for non compliance were collected and analyzed. The non-compliance rate of spectacle wear in primary school children is 66.80%. A significantly higher proportion of boys 244(69.13%) were not wearing their spectacles compared to girls 178 (64.03%) (P<0.05). Non-compliance was not related to age of the students (P<0.05), but older and myopic children were slightly more non-compliant. The main reasons for non-compliance in primary school boys and girls for using spectacles were disapproving spectacle wear by parents, not like to wear spectacles, broken spectacles and many children feel spectacles are not needed or causes head ache. Comprehensive eye care for primary school children with refractive error is practised in Qassim Province, but limited information is available on the magnitude of the compliance for spectacle wear and their reasons. School children were not compliant because of many issues that could and should be addressed. This information is crucial for establishing a program and will strengthen its efforts for a better eye care in primary school children with refractive errors.

Ocular features and management challenges of Marfan′s Syndrome in Benin City, Nigeria

The objective of this study is to describe the ocular features of Marfan's Syndrome in Benin City, Nigeria and highlight problems associated with their management A study of all consecutive patients with a diagnosis of Marfan's syndrome at the eye clinic of the University of Benin Teaching Hospital, Benin City, Nigeria was done between June 1st 2009 and December 31st 2010. There were 13 patients (8 males and 5 females). The age range was 10 to 50 years with a mean age of 23+10.1 years. The duration of symptoms was 1 year to 22 years with a mean of 7.9 years. The ocular features were ectopia lentis in 92.3% of the patients, cataract in 69.2%, glaucoma and myopia in 30.8% each. Others were strabismus (7.7%), unilateral corneal opacities from the use of traditional eye medication (15.4%), phthisis bulbi and retinal detachment in 7.7% each. Three (23%) patients were bilaterally blind while 7(53.8%) had unilateral blindness. The best corrected visual acuity in 4 out of 5 patients who had cataract extraction at 8 weeks post op. was 6/60 to 6/12. There was no improvement in 1 patient. Patients with Marfan's syndrome in Benin City, Nigeria have visual impairment and blindness due to delay in presentation and the use of traditional eye medications. Health education and early presentation to hospital is recommended. This will help in reducing avoidable visual impairment and blindness and thus improve survival and quality of life in these patients.

Spectacle compliance amongst rural secondary school children in Pune district, India

Background:Refractive errors (RE) are the most common cause of avoidable visual impairment in children. But benefits of visual aids, which are means for correcting RE, depend on the compliance of visual aids by end users.Aim:To study the compliance of spectacle wear among rural school children in Pune district as part of the sarva siksha abhiyan (education for all scheme) after 6 - 12 months of providing free spectacles.Settings and Design:Cross-sectional follow-up study of rural secondary school children in western India.Materials and Methods:The students were examined by a team of optometrists who collected the demographic details, observed if the child was wearing the spectacles, and performed an ocular examination. The students were asked to give reasons for non-wear in a closed-ended questionnaire.Statistical Analysis:Chi-square test and multiple logistic regression used for data analysis.Results:Of the 2312 students who were dispensed spectacles in 2009, 1018 were re-examined in 2010. 523 students (51.4%) were female, the mean age was 12.1 years 300 (29.5%) were wearing their spectacles, 492 (68.5%) students claimed to have them at home while 211 (29.4%) reported not having them at all. Compliance of spectacle wear was positively associated to the magnitude of refractive error (P < 0.001), father's education (P = 0.016), female sex (P = 0.029) and negatively associated to the visual acuity of the better eye (P < 0.001) and area of residence (P < 0.0001). Of those that were examined and found to be myopic (N = 499), 220 (44%) wore their spectacles to examination. Factors associated with compliance to spectacle usage in the myopic population included increasing refractive error (P < 0.001), worsening visual acuity (P < 0.001), and higher academic performance (P < 0.001). The causes for not wearing spectacles were ‘lost spectacles’ 67(9.3%), ‘broken spectacles’ 125 (17.4%), ‘forgot spectacles at home’ 117 (16.3%), ‘uses spectacles sometimes’ 109 (15.2%), ‘teased about spectacles’ 142 (19.8%) and ‘do not like the spectacles’ 86 (12%).Conclusion:Spectacle compliance was poor amongst school children in rural Pune; many having significant vision loss as a result.

Rapid assessment methods in eye care: An overview

Reliable information is required for the planning and management of eye care services. While classical research methods provide reliable estimates, they are prohibitively expensive and resource intensive. Rapid assessment (RA) methods are indispensable tools in situations where data are needed quickly and where time- or cost-related factors prohibit the use of classical epidemiological surveys. These methods have been developed and field tested, and can be applied across almost the entire gamut of health care. The 1990s witnessed the emergence of RA methods in eye care for cataract, onchocerciasis, and trachoma and, more recently, the main causes of avoidable blindness and visual impairment. The important features of RA methods include the use of local resources, simplified sampling methodology, and a simple examination protocol/data collection method that can be performed by locally available personnel. The analysis is quick and easy to interpret. The entire process is inexpensive, so the survey may be repeated once every 5–10 years to assess the changing trends in disease burden. RA survey methods are typically linked with an intervention. This article provides an overview of the RA methods commonly used in eye care, and emphasizes the selection of appropriate methods based on the local need and context.

P68 The prevalence of eye disease in Norfolk and Waveney

IntroductionVisual impairment is an important preventable cause of disability in the UK. Cataract, glaucoma, diabetic retinopathy and age related macular degeneration are the common causes of visual impairment in the...

Rapid Assessment of Avoidable Blindness and Cataract Surgical Services in Kilimanjaro Region, Tanzania

Purpose: To estimate the prevalence and causes of avoidable blindness and visual impairment in persons 50 years of age and older, and to assess the impact of cataract surgical services.Methods: In this cross-sectional population-based survey, 72 clusters of 50 people 50 years and older were selected by probability proportionate to size sampling. Households within clusters were selected through compact segment sampling. Participants underwent an ophthalmic examination in their homes, including measurement of visual acuity (VA) with a tumbling-E chart and diagnosis of the principal cause of visual impairment. Patients who had been operated on were questioned about details of their cataract surgery.Results: Three thousand six hundred eligible subjects were selected, of whom 3,436 (95.5%) were examined. The prevalence of bilateral blindness (presenting VA < 3/60) was 2.4% (95% confidence interval [CI], 1.9%–2.9%); prevalence of severe visual impairment was 0.99% (95% CI, 0.98%–0.99%); and prevalence of visual impairment (VA of < 6/18 and ≥ 6/60) was 5.4% (95% CI, 4.6%–6.2%) in the sample. Unoperated cataract accounted for 52.4% of blindness and 70.6% of severe visual impairment. Cataract surgical coverage among people at 3/60 was 68.9%. Overall, 58.6% and 69.6% of the 191 eyes that had undergone cataract surgery had VA greater than or equal to 6/18 with available correction and best correction respectively.Conclusions: The prevalence of blindness in this population in Kilimanjaro Region was low, reflecting high cataract surgical coverage from an outreach program. Even with high cataract surgical coverage, cataract remains the leading cause of vision loss and an emphasis on quality is needed.

Blindness and low vision in The Netherlands from 2000 to 2020—modeling as a tool for focused intervention

Purpose: To estimate the magnitude and causes of blindness and low vision in The Netherlands from 2000 to 2020.Methods: Recent population-based blindness surveys in established market economies were reviewed. Age and gender specific prevalence and causes of blindness and low vision were extracted and calculated for six population subgroups in The Netherlands. A mathematical model was developed to relate the epidemiologic data with demographic data for each subgroup for each year between 2000 and 2020.Results: In 2008 an estimated 311,000 people are visually impaired in The Netherlands: 77,000 are blind and 234,000 have low vision. With the current intervention the number may increase by 18% to 367,000 in 2020. Visual impairment is most prevalent among residents of nursing homes and care institutions for the elderly, intellectually disabled persons and people aged 50+ living independently. Of all people with visual impairment 31% is male (97,000) and 69% female (214,000). More than half of all visual impairment (56%; 174,000 persons) is avoidable. A variation of around 20% might be applied to the numbers in these estimates.Conclusions: The aim of VISION 2020: The Right to Sight to reduce avoidable visual impairment is also relevant for developed countries like The Netherlands. Vision screening and awareness campaigns focusing on the identified risk groups can reduce avoidable blindness considerably. Regular updates of the model will ensure that the prognoses remain valid and relevant. With appropriate demographic data, the model can also be used in other established market economies.

Global Vision Impairment Due to Uncorrected Presbyopia

To evaluate the personal and community burdens of uncorrected presbyopia. We used multiple population-based surveys to estimate the global presbyopia prevalence, the spectacle coverage rate for presbyopia, and the community perception of vision impairment caused by uncorrected presbyopia. For planning purposes, the data were extrapolated for the future using population projections extracted from the International Data Base of the US Census Bureau. It is estimated that there were 1.04 billion people globally with presbyopia in 2005, 517 million of whom had no spectacles or inadequate spectacles. Of these, 410 million were prevented from performing near tasks in the way they required. Vision impairment from uncorrected presbyopia predominantly exists (94%) in the developing world. Uncorrected presbyopia causes widespread, avoidable vision impairment throughout the world. Alleviation of this problem requires a substantial increase in the number of personnel trained to deliver appropriate eye care together with the establishment of sustainable, affordable spectacle delivery systems in developing countries. In addition, given that people with presbyopia are at higher risk for permanently sight-threatening conditions such as glaucoma and diabetic eye disease, primary eye care should include refraction services as well as detection and appropriate referral for these and other such conditions.

Pediatric ophthalmology in the developing world

It is estimated that of the 45 million people who are blind worldwide in 2000, 1.4 million are children from middle-income and low-income countries, the majority of whom live in the poorest regions of Africa and Asia. The focus of this paper is to discuss the status of pediatric ophthalmology in developing countries and the progress that has been made in the areas of avoidable childhood blindness and visual impairment, particularly corneal scarring as a result of vitamin A deficiency, congenital cataract and retinopathy of prematurity. In addition, we will review the prevalence of uncorrected refractive error and discuss the access to pediatric ophthalmologists in developing countries. Some developing countries have begun incorporating vitamin A supplementation and measles immunizations and have seen a decrease in xerophthtalmia. With improvement in vitamin A status, cataract is becoming a more apparent cause of treatable childhood blindness. Amblyopia and uncorrected refractive errors are important and inexpensively treatable causes of visual impairment, with myopia being most common. As neonatal intensive care services in middle-income developing countries improve the survival of premature infants, retinopathy of prematurity is emerging as a significant cause of childhood blindness. Childhood blindness and visual impairment in developing countries remains a significant public health issue, but recent initiatives have shown promise of future improvements.

Retinopathy of prematurity: incidence and risk factors

Retinopathy of prematurity (ROP) remains a leading cause of avoidable childhood visual impairment and blindness worldwide. The incidence of ROP varies among countries, being influenced both by levels of neonatal care and developmental stage of populations. Incidence of ROP has been decreasing in developed countries over the past 10 years and ROP has become potentially confined to immature neonates with birth weights almost always less than 1000 g, that is, extreme low birth-weight infants in these countries. By contrast, the incidence of ROP has been increasing in developing or poorly developed countries, and more mature neonates may develop severe ROP in these countries. Various risk factors correlate with the occurrence of ROP but gestational age and birth weight in particular are the most important and well-documented risk factors. To decrease the risk of ROP in very low birth-weight infants, efforts should be taken to prevent preterm delivery and premature birth. Further research is necessary to fully understand and determine the incidence and prevent the disease; however, appropriate screening programs, standard neonatal care and treatment strategies will be important in reducing visual impairment due to ROP.

Sehbehinderung - gesundheitliche Auswirkungen, Kosten und Prognosen

Vision impairment in the elderly is significantly related to increased morbidity as well as mortality rates. Recent studies suggest the true costs associated with visual impairment and blindness to be much higher than reported previously. Without successful interventions the number of visually impaired or blind people world-wide will double within the next 20 years. The lack of a significant world-wide reduction in avoidable visual impairment and blindness would have substantial social as well as economical consequences. In contrast, three-quarters of all visual impairments are avoidable and therefore unnecessary. In summary, vision Impairment deserves a higher degree of attention by the public as well as from governments.

Avoidable visual impairment among elderly people in a Slum of Addis Ababa

Background: In developing countries major causes of visual impairment are known to be preventable, however there is no information about the situation in Ethiopia. Objective: To identify the major avoidable causes of visual impairment in elderly people. Methods: A survey was conducted between November and December 1997, in the slum of central Addis Ababa. Five hundred seventy one people above the age of 50 years underwent detailed eye examinations including visual acuity test and intra-ocular pressure measurements. Results: About 9% were blind [visual acuity 3/60 but