Cause Of Avoidable Visual Impairment Research Articles

Ocular disorders in a tertiary Hospital in South East Nigeria

The object of this study was to determine the pattern of ocular disease patients that presented to the Enugu State University of Science and Technology Teaching Hospital, Park Lane, Enugu, Nigeria. A retrospective study was conducted, where the medical case notes of patients who had ocular examinations, other clinical examinations, and investigations from April 2022 through December 2022 were retrieved. There were a total of 1145 patients, with a male population of 476 (41.6%), while females were 669 (58.4%). The mean age of the study population was 40.8 years, with a Standard Deviation (SD) of 22.4. A total of 924 (80.7%) participants were adults while children (aged 16 years and below) were 221 in number and constituted 19.3% of the study population. The most common eye disease was refractive error, which occurred in 266 (23.2%) of the participants; it was followed by allergic eye diseases, 201 (17.6%), cataract, 170 (14.9%), glaucoma, 111 (9.7%), and trauma to the eye, 94 (8.2%). Among the children, the most common eye disease seen were allergic eye diseases, 78 (35.3%), followed by refractive error, 70 (31.7%), trauma, 21 (9.5%), cataract, 11 (5.0%), while infections of the eye were 10 (4.5%). The most common eye disease among the adult participants was refractive error, 196 (21.1%), and then cataract, 159 (17.2%), allergic eye diseases, 123 (13.3%), glaucoma, 105 (11.4%), and retinal pathologies, 82 (8.9%). The most common causes of eye diseases in this study were refractive error, allergic eye diseases, cataracts, glaucoma, and trauma. Health education at community and primary health care level could help to reduce the number of people with avoidable causes of visual impairment.

Prevalence of visual impairment among primary and secondary school children in Delta State, Nigeria

Purpose: Visual impairment (VI) being a state of physiological or pathological disorders of vision posesa burden on human activities globally. The purpose of this study was to determine the prevalence and risk factors of VI among school children in Delta State.
 Methods: A descriptive cross-sectional study of 201 respondents aged 6 to 19 years were randomly selected from primary and secondary schools in the three senatorial districts of Delta State. Participants were evaluated using a structured questionnaire, distance Snellen chart, ophthalmoscope, and torchlight. Vision status was defined using World Health Organization categories of visual impairment based on presenting visual acuity (PVA). Data were presented in frequency tables, charts and analysed with Chi-Square statistics. All p-values reported were two-tailed and statistical significance was defined as P < 0.05.
 Results: The mean age of participants was 12.30± 3.14 years, while 118 (58.7%) were females. The overall prevalence of VI (PVA of <6/18 in the better eye) was 58 (28.9%). The prevalence of mild, moderate, and severe VI was 40 (19.9%), 13 (6.5%), and 5 (2.5%) respectively. Refractive error 47 (23.4%) was the leading cause of VI. The prevalence of VI was higher in females, children 13-19 years, and respondents whose parents’ income per month was >100,000. These observed differences were not statistically significant (p>0.05)
 Conclusion: Untreated refractive error was the leading cause of VI among school children in Delta State. This is an avoidable cause of VI that can be treated with spectacle prescription to ease the burden of visual loss.

Prevalence and Factors Associated with Myopia Among High School Students in Hawassa City, South Ethiopia, 2019.

PurposeMyopia is one of the avoidable causes of visual impairment. Twenty-seven percent of the world population were myopic in 2010 and after 30 years it is expected half of the peoples in the planet will become myopic. The aim of this study was to determine the prevalence and factors associated with myopia among high school students.Materials and MethodsA cross-sectional school-based study design using stratified simple random sampling technique was used to select 349 high school students from 21 high schools in Hawassa city. The study was conducted from April 24 to May 7, 2019. Structured questionnaire, six meter Snellen visual acuity chart, trial frame, trial set, retinoscope and cyclopentolate 1% eye drops were used to collect data. Data were analyzed using Statistical Package for Social Science (SPSS) version 20 computer software. Variables having p-value <0.05 in multivariate logistic regression were considered as statistically significant.ResultsA total of 349 participants having a response rate of 97% were involved with the mean age of 16.90±1.32 years. Prevalence of myopia was 16.05% (95%CI: 12.6, 20.1). Early age of schooling (adjusted odds ratio, AOR=3.14; 95%CI: 1.16, 10.06), parents being myopic (AOR=8.46; 95%CI: 7.11, 12.08), prolonged near work (AOR=11.65; 95%CI: 2.11, 64.5), short working distance (AOR=10.90; 95%CI: 0.57, 20.55), lack of outdoor sport activities (AOR=7.37; 95%CI: 2.71, 20.03) and visual display unit (VDU) usage (AOR=8.36; 95%CI: 2.39, 29.33) were variables significantly associated with myopia.Conclusion and RecommendationsThe prevalence of myopia was high in the study area. Early age of schooling, parents being myopic, prolonged near work, short working distance, lack of outdoor sport activities, and visual display unit usage were variables significantly associated with myopia. There should be strategies to prevent visual impairments secondary to myopia with affordable optical corrections and appropriate use of visual display units.

Visual impairment among eye health workers in a tertiary eye centre in Ghana

To determine causes of visual impairment (VI) among staff of the Eye Centre at the Korle Bu Teaching Hospital. This was a cross-sectional study. The Eye Centre, Korle Bu Teaching Hospital (KBTH), from October 2016 to March 2017 on all consenting members of staff. Eighty-four (79.3%) of 106 consenting staff members participated in this study. A detailed history (demographic, ocular, medical co-morbid conditions), ocular examination and relevant diagnostic investigations were conducted. Interventions initiated included treatment for glaucoma, dry eye and allergic conjunctivitis and spectacles prescription for refractive errors. Prevalence of avoidable causes of VI (glaucoma, cataract, refractive errors). Secondary outcomes included prevalence of unavoidable causes of VI. Eighty-four (79.3%) members of staff participated in this study. Most of the participants were females, 54(64.3 %). Age ranged from 23 to 60 years with an average of 35.8±9.9 years (mean ± SD).Prevalence of VI was 9.5 % (8/84), all due to uncorrected refractive error. Other known causes of VI included open angle glaucoma in 12(14.3 %), macular scar of unknown cause, 1(1.2 %) and sutural cataract, 1(1.2 %) but were all visually insignificant. The prevalence of VI among the staff of the Eye Centre of the KBTH was 9.5 %, all due to refractive errors. Other known causes of avoidable visual impairment and blindness encountered were glaucoma (14.3 %), macular scar (1.2 %) and cataract (1.2 %), all asymptomatic. Routine eye screening should be part of periodic medical examination for employees. None declared.

A population-based study on the prevalence and causes of childhood blindness and visual impairment in North India.

Purpose:This was a population-based study to determine the prevalence and causes of visual impairment in children less than 16 years in Urban North India.Methods:This cross-sectional study was conducted in 40 clusters of urban Delhi. 20,955 children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. Unaided visual acuity of enumerated children aged over 2 years was assessed by using Lea symbols chart in 3-5 years age group and logMAR tumbling E charts for the 6-15 years age group. For children aged 0-2 years, fixation and following to torch light was assessed. All the children with unaided visual acuity of <6/12 in any eye in age group 3–15 years and inability to follow the light in age <3 years were referred for detailed ophthalmic examination.Results:Amongst 20,955 children examined for visual acuity a total of 789 children were referred to the central clinic for detailed ophthalmic examination. Of these referred children, a total of 124 had presenting visual acuity <6/18 in the better eye. The prevalence of visual impairment (VI) was 5.92 per thousand (95% CI: 4.96-7.05). The prevalence of moderate to severe visual impairment was maximum in the age group of 11 to 15 years. The main cause of avoidable VI in these children was a refractive error (75.7%). The prevalence of blindness was 0.42 per thousand.Conclusion:Optic nerve abnormalities were the most important cause of blindness in children. Refractive error is the most important cause of visual impairment amongst children and needs to be addressed.

Incidence of angle recession after blunt trauma- A longitudinal study

Introduction: Ocular injury is an important cause of avoidable visual impairment specially in young age group worldwide. Materials and Methods: 82 patients having blunt trauma to one eye attending ophthalmology department (outpatient, inpatient and emergency patients) are enrolled. Baseline investigation with fundus evaluation, intraocular tension assessment with applanation tonometry and anterior chamber angle evaluation done with gonioscopy on 1, 3 and 6 months. Statistical Analysis was performed with help of Epi Info.3.5.3. Results: The mean age (mean ± s.d.) of the patients was 32.53±11.86 years with range 4 - 55 years and the median age was 33.0 years. Male: Female 2.4:1 though there was no correlation of age and sex. Incidence of angle recession was 24.3% in 1st month of follow up. In patients with hyphema the incidence is 71%. 5% of patient with traumatic angle recession have increased intraocular pressure till last follow up but it is not related to degree of angle-recession. Conclusion: Recession of the anterior chamber angle is a common finding following concussive ocular trauma. This cohort of patients should be followed up for development of glaucomatous optic neuropathy and vision loss. Keywords: Angle recession, Blunt trauma, Post traumatic glaucoma.

A study on prevalence of refractive error and its associated factors among school children in Tamil Nadu

Background: Refractive error is an avoidable cause of visual impairment. Children do not complain of defective vision. This warrants early detection and treatment. The study was conducted with the objective of estimating the prevalence of refractive error in school children and its associated factors.Methods: This was a cross sectional study conducted in schools of selected district in Tamil Nadu from July 2017 to January 2018. Sample size of 422 covered. A semi structured questionnaire was used to collect the details and also screened for refractive errors. Data was analysed using SPSS.Results: Among the 422 students screened, 86 (20.4%) had refractive error. The prevalence of refractive error showed significant association with age, education and occupation of parents, socio economic status, parental history of refractive error, duration of watching television and body mass index.Conclusions: Refractive errors among school children can be easily identified by regular eye screening programmes, promptly treated can be protected from future complications. Periodic screening of school children is very essential to improve the quality of eye-sight.

Comprehensive diabetes care: The Goa model.

Diabetes mellitus continues to increase in epidemic proportions globally as well as in India. Poor glycemic control in long-standing diabetes mellitus eventually leads to chronic complications such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. Diabetic retinopathy is emerging as an important cause of avoidable visual impairment and blindness in India across all strata of society. Much of this vision loss can be prevented by improving control of known risk factors, annual fundus screening, with prompt treatment of individuals with sight-threatening retinopathy. The Queen Elizabeth Diamond Jubilee Trust has made a significant contribution by supporting such a program across India, including Goa. The newly established medical retina clinic at Goa Medical College now provides facilities for screening, a detailed evaluation of advanced retinopathy, and therapeutic modalities such as laser and intravitreal injections. The peripheral centers are equipped to screen all people with diabetes mellitus and refer those with sight-threatening retinopathy to the medical college. The provision of a foot scanner to evaluate the risk of foot ulcers and microalbuminuria assessment as part of the nephropathy screening would encompass the entire gamut of diabetic microvascular complications. The next decade would provide evidence if this initiative, with the enthusiastic partnership of the state government, results in reduction of blindness in the people of Goa and an overall reduction in diabetes-related morbidity and mortality.

SPECTACLE-WEAR

Background: Refractive errors are the most common cause of avoidable visual impairment in children worldwide. Importance of school screening of refractive errors is one of the most important initiatives outlined in WHO Vision 2025 targets. Corrected refractive errors visually rehabilitate the school going children. But the benefit depends on the compliance of the spectacle wear by children. Purpose: To study the compliance of spectacle wear and to highlight the reasons of non compliance in school going children of Multan. Study Design: Cross-sectional descriptive study. Setting: Ophthalmology Department, Nishtar Medical University Multan, Pakistan. Period: Jan 2009 to Oct 2012. Materials and Methods: 631 students. Among them 187 males and 175 female students were prescribed spectacles for constant wear during school screening program. Each student was given a pro forma indicating name, age, gender, prescription and column of reasons of non compliance. After six months, we conducted a follow-up visit where these students were accessed about spectacle compliance and reasons of non compliance on the given feedback pro forma from teachers. The data was collected and analyzed by SPSS version 20. Results: The overall non-compliance rate of spectacle wear in primary school children was 35.91%. A significantly higher proportion of boys 119 (57.14%) were not wearing their spectacles compared to girls 175 (54.86%). Themain reasons for non compliance in primary school boys and girls were casual in wearing their spectacles, does not like to wear spectacles, break their spectacles frequently and some children feel spectacles are not needed or cause headache. Conclusions: Poor compliance of using spectacles was noted in our study among children with refractive errors with main reason for not using these spectacles was that they did not like to wear them. So there is need to adopt aggressive awareness campaign among teachers and parents to enhance their knowledge for better outcomes and visual improvement of the children. Screening of primary school children with refractive error was difficult task in Multan. Limited information was available on the magnitude of the compliance for spectacle wear and their reasons of noncompliance. This information is crucial for establishing a program and will strengthen the efforts for a better eye care in school children.

Prevalence and associated factors of low vision and blindness among patients attending St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia

BackgroundLow vision and blindness are major public health problems. A vast burden of worlds visually impaired live in low-income settings especially in sub Saharan Africa. In such settings the blindness is associated with considerable disability and excess mortality, resulting in huge economic and social consequence. The main purpose of this study was to determine the prevalence and associated factors of low vision and blindness among patients at St. Paul’s hospital millenium medical college.MethodsInstitution based cross sectional design study was carried out from January to April, 2017 with sample size of 904. Systematic random sampling was used to recruit the study subjects. Retrospective medical chart review was done; data was entered into and analyzed by SPSS 23. Descriptive statistics such as frequency cross tabulation and chi-square test was carried out to translate data into information. P-value less than 0.05 was considered as statistically significant.ResultsA total of 881 subjects with a response rate of 97.4% selected. The mean age of the study subjects was 44.53(SD: ± 21.85) with a range of 1–100 years. The prevalence of low vision and blindness was 91 (10.3% (95% CI: 8.2, 12.3)), and 64 (7.3 95%CI: 5.7, 9.0)) respectively. Age (p-value < 0.001), cataract (p-value = 0.002), glaucoma (p-value = 0.002) and age related macular degeneration (p-value < 0.001) were significantly associated with low vision and blindness.ConclusionLow vision and blindness found in this study was high. Age, cataract, glaucoma and age related macular degeneration were significantly associated with low vision and blindness. This amount of magnitude will be reduced if prevention, early diagnosis and management will be targeted towards avoidable causes of visual impairment.

Population need for primary eye care in Rwanda: A national survey.

BackgroundUniversal access to Primary Eye Care (PEC) is a key global initiative to reduce and prevent avoidable causes of visual impairment (VI). PEC can address minor eye conditions, simple forms of uncorrected refractive error (URE) and create a referral pathway for specialist eye care, thus offering a potential solution to a lack of eye health specialists in low-income countries. However, there is little information on the population need for PEC, including prevalence of URE in all ages in Sub-Saharan Africa.MethodsA national survey was conducted of people aged 7 and over in Rwanda in September-December 2016. Participants were selected through two-stage probability proportional to size sampling and compact segment sampling. VI (visual acuity<6/12) was assessed using Portable Eye Examination Kit (PEEK); URE was detected using a pinhole and presbyopia using local near vision test. We also used validated questionnaires to collect socio-demographic and minor eye symptoms information. Prevalence estimates for VI, URE and need for PEC (URE, presbyopia with good distance vision, need for referrals and minor eye conditions) were age and sex standardized to the Rwandan population. Associations between age, sex, socio-economic status and the key outcomes were examined using logistic regression.Results4618 participants were examined and interviewed out of 5361 enumerated (86% response rate). The adjusted population prevalence of VI was 3.7% (95%CI = 3.0–4.5%), URE was 2.2% (95%CI = 1.7–2.8%) and overall need for PEC was 34.0% (95%CI = 31.8–36.4%). Women and older people were more likely to need PEC and require a referral.ConclusionsNearly a third of the population in Rwanda has the potential to benefit from PEC, with greater need identified in older people and women. Universal access to PEC can address unmet eye health needs and public health planning needs to ensure equitable access to older people and women.

Factors Associated With spectacle-wear compliance among hypermetropic pre-school children in Al-diwaniya Governorate, Iraq

Background: Uncorrected refractive error are community health problem among pre-school children. It's also considered as the most common cause of avoidable visual impairment in children worldwide. Objective: This study intended to measure the extent of compliance of hypermetropic preschool children with spectacle wear and the factors connected with non-compliance.Method: The study was carried out in my ophthalmology private clinic. One hundred and fourteen patients (114 patients) below 6 years old were enrolled this study. Each was interviewed by the author of correspondence. the possible factors associated with non-compliance with spectacle wear were identified.Results: The total number of patients enrolled in this study was 114 among them 36% were compliance with spectacle wear while 73% were non compliance. The results also revealed that children less than 2 years were 12 and 35 in compliant and non compliant respectively. For gender distribution, there were 15 male and 26 female in complaint children while there were 39 male and 34 female in those who non complaint. Urban children showed high compliant for spectacle wear than rural one.Conclusion: One of the risk factor for noncompliance with in the present study were region distribution and ignorance by family. More population based studies with larger sample should be conducted to assess the determinants of the spectacle use and the barriers to spectacle use should be addressed.

Prevalence and Visual Outcomes of Cataract Surgery in Rural South India: A Cross-Sectional Study

ABSTRACTPurpose: To determine the prevalence of cataract surgery and postoperative vision-related outcomes, especially with respect to sex, socioeconomic status (SES) and site of first contact with eye care, in a rural area of South India.Methods: In a population-based cross-sectional survey of 5530 individuals aged 50 years or older from 10 villages selected by cluster sampling, individuals who had undergone cataract surgery in one or both eyes were identified. Consenting participants were administered a questionnaire, underwent vision assessment and ophthalmic examination. Outcomes were classified as good if visual acuity of the operated eye was 6/18 or better, fair if worse than 6/18 but better than or equal to 6/60, and poor if worse than 6/60.Results: Prevalence of cataract surgery in this age group (771 persons) was 13.9% (95% confidence interval, CI, 13.0–14.9%). In the 1112 eyes of 749 persons studied, at presentation, 53.1% (95% CI 50.1–56.1%) of operated eyes had good, 38.1% (95% CI 35.2–41.0%) had fair, and 8.8% (95% CI 7.1–10.5%) had poor outcomes. With pinhole, 75.2% (95% CI 72.6–77.8%) had good, 17.2% (95% CI 14.9–19.5%) had fair, and 7.4% (95% CI 5.8–9.0%) had poor outcomes. In 76.3% of eyes with fair and poor presenting outcomes we detected an avoidable cause for the suboptimal visual acuity. Place of surgery and duration since surgery of 3 years or more were risk factors for blindness, while SES, sex and site of first eye care contact were not.Conclusion: The high prevalence of avoidable causes of visual impairment in this rural setting indicates the scope for preventive strategies.

Childhood eye care services in South Darfur State of Sudan: Learner and parent perspectives

Purpose: Most causes of childhood visual impairment are either treatable or preventable. Eye health education plays an important role in reducing avoidable causes of visual impairment as well as to help ensure a healthy and educated community. The main objective of this study was to assess the Knowledge, Attitudes and Practices of the students and their parents on childhood eye services and barriers for accessing child eye care.Methods: The study was conducted in South Darfur State of Sudan between January and February 2015. Both quantitative and qualitative methods were used to collect data from eight secondary schools. Four schools for boys and four schools for girls were randomly selected from a list of 21 districts of South Darfur State and the Knowledge, Attitudes and Practices surveys were conducted with the students to collect quantitative data. In addition, seven focus group discussions were conducted with the children’s parents to collect qualitative data.Results: The majority (57.5%) of the students reported that they knew about refractive error; however, 33.07% reported never hearing about refractive error. About 70.3% of the respondents believed that uncorrected refractive error leads to visual impairment, 21% believed refractive error did not cause visual impairment and 30.5% reported that wearing spectacles was not effective in the treatment of refractive error. With regard to the information about eye healthcare, 88.1% of the participants reported they did not have enough information about eye care. The reported need for more information about prevention, treatment and symptoms was 34.0%, 31.4% and 17.5%, respectively. With regard to barriers, 80.6% of the students reported never having had their eyes tested. The most cited barriers were cost, fear of wearing spectacles and fear of an eye examination. In addition, 72.6% of students reported that their health insurance did not cover eye care services. Most (53.6%) of the parents believed that the cause of refractive error in children was poor nutrition. Common themes arising from the focus group discussions included parents reporting that they looked for traditional treatment for their children and preferring to receive child eye information from an eye specialist and through the television and radio. The most frequently cited barriers by the parents were high cost of the treatment, lack of eye care specialists, lack of awareness about child eye diseases and mistrust in eye care providers.Conclusion: The level of knowledge and practices about eye care and refractive error is low and perceptions about spectacles as a method for treatment for refractive error were fraught with misconceptions amongst students. There is a need for structured educational programmes to raise awareness regarding the effect and treatment modalities for childhood eye disease and visual impairment in order to address the barriers for accessing childhood eye care.Keywords: Children; school; eye care; spectacles; refractive error; knowledge;barriers; optometrist

Global Vision Impairment and Blindness Due to Uncorrected Refractive Error, 1990-2010.

The purpose of this systematic review was to estimate worldwide the number of people with moderate and severe visual impairment (MSVI; presenting visual acuity <6/18, ≥3/60) or blindness (presenting visual acuity <3/60) due to uncorrected refractive error (URE), to estimate trends in prevalence from 1990 to 2010, and to analyze regional differences. The review focuses on uncorrected refractive error which is now the most common cause of avoidable visual impairment globally. : The systematic review of 14,908 relevant manuscripts from 1990 to 2010 using Medline, Embase, and WHOLIS yielded 243 high-quality, population-based cross-sectional studies which informed a meta-analysis of trends by region. The results showed that in 2010, 6.8 million (95% confidence interval [CI]: 4.7-8.8 million) people were blind (7.9% increase from 1990) and 101.2 million (95% CI: 87.88-125.5 million) vision impaired due to URE (15% increase since 1990), while the global population increased by 30% (1990-2010). The all-age age-standardized prevalence of URE blindness decreased 33% from 0.2% (95% CI: 0.1-0.2%) in 1990 to 0.1% (95% CI: 0.1-0.1%) in 2010, whereas the prevalence of URE MSVI decreased 25% from 2.1% (95% CI: 1.6-2.4%) in 1990 to 1.5% (95% CI: 1.3-1.9%) in 2010. In 2010, URE contributed 20.9% (95% CI: 15.2-25.9%) of all blindness and 52.9% (95% CI: 47.2-57.3%) of all MSVI worldwide. The contribution of URE to all MSVI ranged from 44.2 to 48.1% in all regions except in South Asia which was at 65.4% (95% CI: 62-72%). : We conclude that in 2010, uncorrected refractive error continues as the leading cause of vision impairment and the second leading cause of blindness worldwide, affecting a total of 108 million people or 1 in 90 persons.

A cross sectional study on refractive error among school children aged 6 to 17 years in Chennai, India

Background: Blindness due to refractive error is a substantial public health problem in many parts of the world. Refractive error would become the second largest cause of treatable blindness after cataract. Refractive error is the most common and avoidable causes of visual impairment. Screening programs need to be implemented to detect individuals suffering from refractive error. Early diagnosis and treatment is the simple and most effective measure to prevent refractive error blindness. The current study was designed to estimate the Prevalence of refractive error among school children. Methods: This cross sectional study was conducted among 1720 school children of 6- 17 years age group in Chennai. The sample size was estimated by the prevalence of refractive error as 20%, alpha error 5% and relative precision 10% of refractive error. School children were screened for defective vision with the help of Snellen’s chart. Results: Total of 1720 children was examined; 49.7% were boys and 50.3% were girls. The overall Prevalence of refractive error was 20.9% and the 95% Confidence interval was found to be 19.9% to 20.9%. The Prevalence of refractive error among boys was 10.8% and in girls was 10.1%. The difference in refractive error among male and female children was small and the difference was found to be statistically insignificant (p>0.05). Conclusions: Refractive error is the most common and avoidable causes of visual impairment. Uncorrected refractive error can affect their learning. So, early detection and intervention can improve child’s potential tremendously during the formative years.

A coalition partnership of vision health through a health-promoting school program for primary school students in Taiwan.

Myopia, the most common refractive error, is the most common cause of avoidable visual impairment among children and has reached epidemic proportions among children and young adults in urban areas of East and Southeast Asia that contain populations of Chinese ancestry. Moreover, vision health is an important theme of the health-promoting school program issued by the Ministry of Education in Taiwan. The aim of this study is to assess the impact of pre- and post-intervention proposed by the health-promoting school (HPS) model. The objectives are to understand whether the HPS model influenced the vision screening results and the attitude, knowledge level, and vision care behavior of the students involved. A prospective cohort study design was used to evaluate a vision health program. Four elementary schools, local education authorities, and one university in northern Taiwan established a coalition partnership to design a six-month program to combat myopia among students. The target population was 6668 school children from local elementary schools. For the purpose of this study, the outcome of visual acuity testing (in logMAR) was analyzed with a sampling of 373 school children (aged 11-12 years old) who were chosen from high prevalence of poor vision classes. After the HPS program, the attitudes, behaviors, and knowledge levels of the school children regarding vision health were significantly improved. The pre-intervention mean logMAR of all participating students ( N = 373) was -.10, which increased to -.19 after the intervention. Analysis using the Wilcoxon signed-rank test showed that the logMAR value was significantly improved after the intervention ( t = 2.13, p < 0.05). Our findings highlight the relevance and effectiveness of the coalition's efforts, which reinforces the usefulness of co-operatively implementing the HPS program.

Strategies for reducing visual impairment and blindness in rural and remote areas of Africa

The prevalence of visual impairment (VI) and blindness in Africa is one of the highest in the world; a large proportion of the causes are preventable. The prevalence is particularly high in rural and remote areas, where many of the continent’s inhabitants live. This is of great concern because of the low number and poor distribution of primary eye care practitioners, as well as poor eye care infrastructure services in those areas. Uncorrected refractive errors are a major cause of avoidable VI and blindness, and optometrists play a major role in refractive error correction on the continent. However, as with other healthcare providers in Africa, optometrists are few and tend to be mainly in major cities. This paper highlights possible strategies, in alignment with the Ottawa Charter for Health Promotion, that can reduce VI in rural and remote areas of the continent. The strategies include increasing the eye care workforce, attracting them to rural areas and retaining them there, improving the eye care infrastructure, service improvement such as equitable distribution of eye care practitioners, implementing preventive measures such as vision screening and affordable spectacles, and eye health education such as eye health promotions, school health programmes and eye care awareness campaigns. Such strategies could drastically reduce the prevalence of VI and blindness in rural and remote areas of Africa.

Self-adjustable glasses in the developing world

Uncorrected refractive errors are the single largest cause of visual impairment globally. Refractive errors are an avoidable cause of visual impairment that are easily correctable. Provision of spectacles is a cost-effective measure. Unfortunately, this simple solution becomes a public health challenge in low- and middle-income countries because of the paucity of human resources for refraction and optical services, lack of access to refraction services in rural areas, and the cost of spectacles. Low-cost approaches to provide affordable glasses in developing countries are critical. A number of approaches has been tried to surmount the challenge, including ready-made spectacles, the use of focometers and self-adjustable glasses, among other modalities. Recently, self-adjustable spectacles have been validated in studies in both children and adults in developed and developing countries. A high degree of agreement between self-adjustable spectacles and cycloplegic subjective refraction has been reported. Self-refraction has also been found to be less prone to accommodative inaccuracy compared with non-cycloplegic autorefraction. The benefits of self-adjusted spectacles include: the potential for correction of both distance and near vision, applicability for all ages, the empowerment of lay workers, the increased participation of clients, augmented awareness of the mechanism of refraction, reduced costs of optical and refraction units in low-resource settings, and a relative reduction in costs for refraction services. Concerns requiring attention include a need for the improved cosmetic appearance of the currently available self-adjustable spectacles, an increased range of correction (currently −6 to +6 diopters), compliance with international standards, quality and affordability, and the likely impact on health systems. Self-adjustable spectacles show poor agreement with conventional refraction methods for high myopia and are unable to correct astigmatism. A limitation of the fluid-filled adjustable spectacles (AdSpecs, Adaptive Eyecare Ltd, Oxford, UK) is that once the spectacles are self-adjusted and the power fixed, they become unalterable, just like conventional spectacles. Therefore, they will need to be changed as refractive power changes over time. Current costs of adjustable spectacles are high in developing countries and therefore not affordable to a large segment of the population. Self-adjustable spectacles have potential for “upscaling” if some of the concerns raised are addressed satisfactorily.

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.