Community-based Vision Research Articles

Predictors of Clinic Attendance After Community-Based Vision Screening.

The purpose of this study was to analyze appointment attendance rates and patient characteristics associated with follow-up adherence after referral from a community vision screening event. A retrospective chart review of patients who attended a 2021 or 2022 community vision screening event and were referred to the university clinic for further care. Appointments were offered without charge and scheduled at the event. Associations between patients' clinical and demographic characteristics and appointment attendance were assessed by binary logistical regression. A total of 935 patients attended the annual community vision screening events held in 2021 and 2022. Of these patients, 117 (13%) were referred to the clinic for follow-up, of whom 56 (48%) attended their scheduled follow-up appointment. The most common reasons for clinic referral included cataract (12, 10%), diabetic retinopathy (11, 9%), glaucoma (9, 8%), and challenging refractive error (9, 8%). Health insurance and male gender were predictors of follow-up (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.19-7.99, P = 0.021 and OR = 2.72, 95% CI = 1.10-6.61, P = 0.035, respectively). Half of the referred patients followed up after vision screening. Providing appointment scheduling at the point of care and offering follow-up care at no cost may help to promote clinic follow-up, but further assessment of barriers to regular eye care is warranted. Health insurance most strongly predicted successful clinic attendance. This study emphasizes the enduring impact of health insurance status as a barrier to accessing comprehensive vision care.

Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

Screening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown. To evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government's perspective. An economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors. For each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained. School screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, -0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively. In this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.

An Analysis of Visual Outcomes in the Community-Based Vision Screening Programs

Introduction: A community vision screening is a quick eye examination that searches for potential vision problems. Screening helps to detect visual disorders early. This study intended to determine the outcomes of the vision screening. The association between demographic variables, vision testing, and vision screening outcomes was also investigated. Methods: Vision screening data conducted from 2017 to 2020 were obtained. Demographic data (age, gender, and location) and optometric findings (distance visual acuity (DVA), near visual acuity (NVA), refractive errors, intraocular pressure (IOP), and retina abnormalities) were extracted and analyzed. The pass or fail vision screening and causes were determined. Results: Thirty-five percent (35%) were failed the vision screening. The elderly was the most likely to fail (17%). The females and males showed an equal proportion of failure rate. Those who failed screening in urban areas (27%) were greater than in rural areas (8%). Reduced DVA was the most common reason for failed vision screening, followed by reduced NVA. Age (p<0.001) and location (p<0.001) was significantly linked with the outcome of vision screening. DVA (p<0.001), NVA (p<0.001), IOP measurement (p=0.006) and ophthalmoscopy findings (p<0.001) demonstrated significant association with vision screening results. Conclusion: The failure rate in community vision screening was high. Age, location, DVA, NVA, IOP measurement, and fundus evaluation were associated with vision screening outcomes. Outreach initiatives help identify potential vision problems in the community. This evidence is vital for determining the need for treatment and management of optometry services and planning for targeted vision screening programs, thereby preventing vision loss.

An evaluation of a community-based vision care programme for the elderly

BackgroundThis study evaluated the real-world effectiveness and potential cost-effectiveness of a community-based vision care programme for the elderly population aged 60 years or above.MethodsData from a total of 8899 subjects participating in a community-based comprehensive vision care programme from 2015 to 2019 were analysed to evaluate the effectiveness of the programme in terms of the prevalence of distance visual impairment (VI), the change in the prevalence of distance VI after refractive error correction, and the types of ocular disorders suspected. Distance VI was defined as a) visual acuity (VA) worse than 6/18 in any eye (worse eye) and b) VA worse than 6/18 in the better eye. The cost-effectiveness from the funder’s perspective was also estimated in terms of cost per distance VI avoided.ResultsBased on the presenting vision of the worse eye, the prevalence of distance VI was 39.1% (3482/8899, 95% CI: 38.1%-40.1%) and reduced to 13.8% (1227/8899, 95% CI: 13.1%-14.5%) based on best-corrected VA. Referenced to the presenting vision of the better eye, the prevalence of distance VI was 17.3% (1539/8899, 95% CI: 16.5%-18.1%) and decreased to 4.2% (373/8899, 95% CI: 3.8%-4.6%) with best optical correction. Uncorrected refractive error was the major cause of presenting distance VI. From the funder’s perspective, the cost per distance VI case prevented was HK$1921 based on VA in the worse eye and HK$3715 based on the better eye.ConclusionThis community-based programme identified distance VI in the best eye of 17 out of every 100 subjects. With appropriate new or updated distance optical corrections, distance VI was reduced to about 4 in 100 subjects. Visual impairment in the elderly is common even in a relatively affluent city. A model of care which could minimise avoidable distance VI would bring benefits at individual and societal levels.

Outcomes and Revenue Generation of a Community-based Screening at a Center in the United States: The SToP Glaucoma Program.

Of 611 individuals seen at referral clinic visits following community screenings, 76% were diagnosed with ≤1 eye condition needing treatment, generating a total of $213,110 in collections for the institution over 2.5 years. The purpose of this study was to examine the outcomes and revenue generation of community-based eye screenings. Individuals aged 50 years and above screened at community sites in Baltimore, MD, with abnormal ophthalmic findings were referred for one free-of-charge definitive eye examination at the Wilmer Eye Institute. Diagnoses, treatment, and billing information were abstracted from electronic medical records of patients subsequently seen at Wilmer from January 1, 2016, to July 31, 2018. A total of 611 individuals attended 3696 encounters at Wilmer during this time period. Most patients were female (60.3%) and African American (83.7%). At the screening event, 82.9% reported difficulty seeing when not wearing corrective eyewear, although only 49.8% reported having visited an eye doctor within the last 2 years. The majority (60.2%) reported having Medicare/Medicaid coverage, and 8.1% reported being uninsured. At the definitive eye examination after the screening, 75.5% of patients were diagnosed with ≥1 eye condition, most commonly cataract (30.3%), suspicion of glaucoma (24.9%), manifest glaucoma (11.9%), diabetic retinopathy (5.4%), and ocular hypertension (2.6%). Overall, 430 (70.4%) individuals required treatment including surgery (n=106), intravitreal injections (n=14), laser procedures (n=9), and medications (n=48). A total of $213,110 was collected for visits and procedures after the initial referral visit during the study period. A large community-based vision screening program in Baltimore was able to identify ocular conditions requiring treatment in underserved older adults and connect them to eyecare. Our findings also highlight that this model simultaneously generates new revenue streams for the institution organizing the community screenings.

Review of vision screening referrals in children

Background: Childhood vision screening is aimed at the detection of reduced vision due to amblyopia, thus enabling early diagnosis and timely intervention. The purpose of the study was to review the demographics and visual parameters of children referred to the ophthalmologist at Community Health Centre Ljubljana from Slovenian community-based vision screening program and define the visual outcome after treatment in children with amblyopia.
 Methods: Retrospective medical records review of children referred from community-based vision screening program for further assessment. Medical records were reviewed to determine findings from ophthalmic assessments, treatment received, and visual acuity at the final visit. The main outcome measures were the cause of visual impairment and the visual acuity at the final follow-up visit.
 Results: From 439 children (mean age 7.3 +/- 3.7 years) referred from community-based vision screening program, 75 children (17%; mean age 5.3 +/- 2.6 years) had amblyopia and received treatment. They had amblyogenic refractive error (3.67 +/- 2.44 diopters of sphere and 1.86 +/- 1.23 diopters of astigmatism) with uncorrected visual acuity on average 0.32 +/- 0.28 logMAR in the worse eye. Visual outcomes after treatment were good with a visual acuity of 0.04 +/- 0.07 logMAR in the worse eye, 60% of them had a visual acuity of 0.00 logMAR (40/40).
 Conclusion: Children with amblyopia in the presented clinical sample were mostly diagnosed and treated before the school-age. These children showed significant improvement in visual acuity in the amblyopic eye.

Prevalence and characteristics of hearing and vision loss in preschool children from low income South African communities: results of a screening program of 10,390 children

BackgroundThe majority of children with sensory impairments live in low- and middle-income countries. More studies of hearing and vision impairment prevalence are needed, in order to generate more accurate estimates of trends in sensory impairments. This study aimed to estimate the prevalence and describe the characteristics of hearing and vision loss among preschool children (4–7 years) in an underserved South African community following community-based mobile health (mHealth) supported hearing and vision services.MethodsA screening program of sensory impairments was undertaken of children attending preschools in the communities of Khayelitsha and Mitchell’s Plain, Cape Town, from September 2017 until June 2019. Hearing and vision screening were done by trained community health workers using mHealth technology. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were conducted using smartphones that host point-of-care validated and calibrated hearing and vision testing applications (hearTest app, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). Descriptive statistical analysis and logistic regression analysis were conducted after extracting data from a secure cloud-based server (mHealth Studio, hearX Group) to Microsoft Excel (2016).ResultsA total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6 and 4.4% of children failed hearing and vision screening respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of children of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was done on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.05), but not for hearing loss (p = 0.06). Gender was not a significant predictor of hearing (p = 0.22) or vision loss (p = 0.20).ConclusionsHearing loss is prevalent in at least 22 per 1000 and vision loss in at least 23 per 1000 preschool children in an underserved South African community. Timely identification of sensory losses can be facilitated through community-based hearing and vision services supported by mHealth technology.

Factors influencing post-screening visits of students to local vision centres in rural northwest China

ABSTRACT Clinical relevance Children with uncorrected visual impairment have lower scores on a variety of motor and cognitive tests. Exploring the influencing factors of low-income groups seeking vision care services is helpful for identifying relevant barriers and necessary measures to improve the utilization rate of vision care services. Background The community-based vision center (VC) is a popular model for solving vision problem of students in rural China. Compliance is the key factor to the success of the VC model. Factors determining compliance with visitations to VC among primary school students after screening were explored. Methods A cross-sectional study was conducted with 15,763 students from 228 primary schools. Information was collected through questionnaires and vision examinations. The determinants that affect visits of students to the VC were analyzed using logistic regression. Results Among the 15,763 sample, 5,361 (34%) students had a visual impairment. At baseline, only 962 (18%) of students with visual impairment sought vision care services. After a local VC was established, among the 5,163 students who needed to be referred, only 2,237 (43.33%) students visited the VC. Multivariate logistic regression models for predicting students visit the VC revealed that the following characteristics were significant predictors: poor uncorrected visual acuity (P < 0.001), a higher grade level (P = 0.008; P = 0.010), ‘left-behind’ children (P < 0.001), short living distance between home and the VC (P < 0.001), and the fact that these students lived in Gansu province (P < 0.001). Conclusions Establishing a VC that provides students with vision screening and free vision care services can increase the rate of seeking vision health services for students in rural areas, but the compliance rate still needs to be improved. The influencing factors for student compliance have been identified.

Reducing the Costs of an Eye Care Adherence Program for Underserved Children Referred Through Inner-City Vision Screenings

We previously reported costs and outcomes of the Children's Eye Care Adherence Program (CECAP1), a social worker intervention designed to improve adherence to eye care for underserved children in urban Philadelphia. Using cost findings from CECAP1, we revised the intervention to reduce costs. The aim of this study was to evaluate costs and effectiveness of the revised intervention (CECAP2). Retrospective cohort study. Records of children needing ophthalmic follow-up after 2 community-based vision screening programs were reviewed. We modified CECAP1 to prioritize children more likely to visit, decreased phone calls and scheduling attempts, better documented children already followed by other doctors, and constricted our geographic catchment area for better accessibility. Cost was calculated using time spent executing CECAP2 by our salaried social worker. Effectiveness was defined as the percentage of patients completing at least 1 follow-up visit within the recommended time frame. Of 462 children referred to CECAP2 from our in-school and on-campus screening programs, 242 (52.4%) completed subsequent recommended eye examinations, a proportion identical to our prior report (52.3%). Social worker time per patient was 0.8 hours; a significant reduction from the previous 2.6 hours (P < .01). Cost per patient was $32.73; a significant reduction compared to the previous $77.20 (P < .01). Programmatic changes to reduce social worker intervention time and target potential patients by likelihood to attend along with constriction of the catchment area led to reduced costs by more than 50%, without impairing CECAP effectiveness.

Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology.

The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23 to 29 mm Hg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. Those with an abnormal image and/or IOP ≥30 mm Hg, are assigned as "fast-track" and referred to ophthalmology. Participants living in 7 developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in 3 developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. This study targets vulnerable populations where they live to ensure improved access to and utilization of eye care services in those who are least likely to seek eye care.

Community participation in Intangible Cultural Heritage safeguarding

According to the Convention for the Safeguarding of Intangible Cultural Heritage (ICH), social actors are at the core of the ICH. Article 2 proposes a subjective, creative and dynamic definition of heritage based on community, groups and individuals (CGIs), highlighting a spiritual connection: ICH safeguarding must respect the “sense of identity and continuity” of CGIs — the main actors in the process of heritage transmission. This community-based vision of heritage is developed in the text of the Convention, the Operational Directives, and reinforced since 2016 by the Twelve Ethical principles introduced in the Basic Texts. A Convention is much more than a text: it determines political, social and cultural contexts, as well as processes of change. A normative tool conceived as guidelines for governments, permeates social life, becoming a framework for the actions and evolution of civil society. This article reflects on the following case study: the “Tocatì Programme for the Safeguarding of Traditional Games and Sports” (TGS). The programme started in Verona, Italy in 2003, connecting a network of communities and building relationships through the organization of an international event: The “Tocatì Festival of Games in the Streets”. From the beginning, this social movement has strengthened the support of institutions at different levels, connecting people, communities and living traditions with representatives of institutions, researchers, artists and policymakers. The cultural association coordinating Tocatì, Associazione Giochi Antichi (AGA) met the UNESCO ICH Convention in 2007. The author examines what has changed in the framework of the Convention in regard to the history of a community-based process and how the Tocatì experience contributes to the effective implementation of the Convention today. An attempt is made to identify the key factors, actors and steps of the Tocatì cultural, social and political process. This is a story that improves our understanding of the role of civil society in the complex, often conflictual and powerful dynamic of heritage-making.

Community-based vision health screening with on-site definitive exams: Design and outcomes

In the U.S., the prevalence of blindness is expected to double by 2050 and as many half of those with blinding eye disease are unaware of their diagnosis. Screening for vision health in the community setting may offer a key strategy to address the rising trend avoidable vision loss. However, problems with excessive referrals and low compliance with these referrals (often <50%) undermine the effectiveness of vision screening programs. We investigated the outcomes of a modified vision screening program design. Key modifications were 1) incorporating an on-site ophthalmologist during screening events; and 2) leveraging community partner resources to maximizing benefit to participants. A review of screening outcomes of 4349 particpant examinations from the Casey Eye Institute Outreach Program (CEIO program) from 01/04/2012 to 10/3½016 were analyzed for demographics and disease findings. The burden on participants to comply with referrals was lessened as 97% of participants completed definitive exams. Clinical care was recommended for 924 (21.2%) participants. Nearly four out of five participants (78.8%) were provided care for all of their immediate vision health needs (full exams, refractions, and spectacle ordering). Modifications to vision screening program design may improve their effectiveness.

Improving access to vision screening in urban Philadelphia elementary schools

The Wills Eye Vision Screening Program for Children is a community-based vision screening program for children in urban Philadelphia elementary schools that aims to provide vision screening, remedy refractive error by providing glasses, and refer children with suspected nonrefractive eye disease for eye care. Children in grades K-5 from 45 Philadelphia elementary schools were screened for distance and near visual acuity, stereopsis, and color vision from January 2014 to June 2015. Children who failed were assessed by an on-site optometrist. Two pairs of eyeglasses were provided at no cost. Children with suspected, nonrefractive disease were referred to Wills Eye Hospital Pediatric Ophthalmology and contacted by a social worker to schedule an appointment. Over 84days, 10,726 children were screened for vision problems at 45 schools. A total of 1,321 children (12%) had refractive error and 1,015 children (77%) returned the consent form and received two pairs of glasses. Of the 509 children (5%) referred to Wills Eye, 177 returned consent forms and were not being followed by an ophthalmologist. Of these, 127 children (72%) completed an eye examination at Wills. The program described herein can provide comprehensive vision screening, with eyeglasses and/or referrals, to children within an underserved community.

Community-based vision rehabilitation provision in England

Sight loss is more common among older than younger people. With an ageing population and increasing pressure on health and social care services, preventive and rehabilitation services are being prioritised. However, evidence around community-based vision rehabilitation services is underdeveloped. The focus of this article is on the prevalence, organisational models and capacity of community-based vision rehabilitation services in England that are wholly or partly funded by local authorities (LAs). In all, 89 of the 152 (57%) LAs responded to an online survey about vision rehabilitation services. Services vary widely in the type of provider, type of support offered, structure and skills of the team delivering interventions, caseloads and waiting times. Voluntary organisations appear to experience more pressure on budgets and staffing ratios than LA in-house services. The article discusses implications for practice.

A population study of correlates of social participation in older adults with age-related vision loss

Objective: To examine personal characteristics, disease-related impairment variables, activity limitations, and environmental factors as correlates of social participation in older adults with vision loss guided by the World Health Organization’s International Classification of Functioning, Disability and Health Model. Design: Baseline data of a larger longitudinal study. Setting: Community-based vision rehabilitation agency. Subjects: A total of 364 older adults with significant vision impairment due to age-related macular degeneration. Main Measures: In-person interviews assessing social participation (i.e. frequency of social support contacts, social/leisure challenges faced due to vision loss, and of social support provided to others) and hypothesized correlates (e.g. visual acuity test, Functional Vision Screening Questionnaire, ratings of attachment to house and neighborhood, environmental modifications in home). Results: Regression analyses showed that indicators of physical, social, and mental functioning (e.g. better visual function, fewer difficulties with instrumental activities of daily living, fewer depressive symptoms) were positively related to social participation indicators (greater social contacts, less challenges in social/leisure domains, and providing more support to others). Environmental factors also emerged as independent correlates of social participation indicators when functional variables were controlled. That is, participants reporting higher attachment to their neighborhood and better income adequacy reported having more social contacts; and those implementing more environmental strategies were more likely to report greater challenges in social and leisure domains. Better income adequacy and living with more people were related to providing more social support to others. Conclusion: Environmental variables may play a role in the social participation of older adults with age-related macular degeneration.

Design Strategies for Reorganizing the Public Realm of a Neighbourhood Unit: The Case of the Modern Housing Complex, Manimajra, Chandigarh

The Public Realm, an interface between the public and the private, is a vital aspect of the built environment that helps to give a city its identity. Despite being a highly significant contributor towards shaping the urban life and the quality of urban spaces, the fact remains that the concept and idea of meaningful public realm remains largely ignored, especially within neighbourhoods with their series of unmaintained and misused public spaces. Such is the case of the Modern Housing Complex at Manimajra, Chandigarh, where the planned open spaces and parks have been increasingly converted into parking lots, garbage yards with uncontrolled vegetation, or spaces that promote antisocial activities, all of which together affect the livability and attractiveness of the ‘model’ colony.’ This paper is based on a study of Manimajra’s Modern Housing Complex, that was undertaken in 2012-13. The objective was to focus on the public realm and to devise design strategies for a livable neighbourhood through a community-based vision for an improved, high quality Public Realm making the neighbourhood more vibrant, safe and a truly liveable place. The study was based on an understanding of how the physical pattern and organization of a neighborhood influences perception and understanding of public places, multiple forms in which public places are manifested, different ways in which public places are understood, and various manners in which public places are used. The study reinforced the notion that the design, condition and quality of the neighbourhood streets and spaces have a major impact on the quality of its inhabitants’ life, and their careful designing and quality development can help to create successful public places.

THE IMPACT OF HERITAGE-BASED DEVELOPMENT PROJECTS IN CITY CENTERS ON LOCAL COMMUNITIES THE CASE OF UQBA BIN NAFI AREA DEVELOPMENT PROJECT, AS-SALT

The Hashemite Kingdom of Jordan signed agreements with the World Bank, Japan and other donor countries to conduct development projects in historic city centers, including As-Salt Historic City Center Development Project, which included the demolition of modern buildings constructed in the sixties and the seventies of the last century. This incorporated the demolition of Uqba Bin Nafi school, an international style hybrid built in 1960, in addition to the demolition of surrounding modern commercial buildings, known as Uqba Triangle, in order to create open urban spaces and some services. This project has attracted criticism from local residents and shopkeepers.Consequently, this paper raises several questions<1. What is the impact of this project on the local community, functionally, economically and culturally?2. Is the project responsive to the needs and priorities of the local community?3. To what extent did the local community participate in the demolition decision and other aspects of the project? Are they satisfied with the project?4. Did Oqba Bin Nafi' school hold significance and value to the local community thus warranting its conservation rather than demolition?This paper uses a multi-method approach, utilizing statistical analysis, ethnography, and historical methods. The enquiry bases its critique on conservation charters and modern heritage theories, and tackles the status quo through questionnaires, interviews and field observations.The results emphasize the need to have an urban development strategy for the city so that urban heritage conservation projects are part of such a development strategy that is rooted in a community-based vision. This current project-by-project approach leads to projects that are not responsive to the needs of the city and its people. Consequently, the recommendations emphasize the importance of public participation in order to meet people’s needs and achieve better satisfaction.This paper brings to attention the negative urban consequences of the demolition of modern heritage buildings. Often considered nonessential within the historic fabric, the results caution against the undermining of the values modern buildings hold or their role in the urban structure.Finally, the study emphasizes the significance of having a multi-disciplinary team, including economists, social workers, planners and architects. It is important not to overlook the economic and social feasibility of the interventions, and avoid the fixation on the aesthetics of the urban setting to prevent similar negative impacts on the local community

Change in community-based preschool vision screening from visual charts to Retinomax

To determine the difference in referral rate and positive predictive values between a community-based vision screening program using eye charts against one using autorefraction. 5,186 preschool children were screened in the 2010-2011 using vision charts, motility, and cover-uncover testing. Follow-up on referred children was determined through provider surveys. 1,773 preschool children were screened in 2011-2012 using autorefraction with Retinomax (manufactured by Nikon, Tokyo, Japan), Hirschberg and cover-uncover testing. Follow-up on referred children was provided on a mobile eye-van. Populations were compared for referral rates and positive predictive value. Positive cases were defined as: refractive error treated with glasses, strabismus, cataracts, or amblyopia. The visual charts screening program referred 4.3% of screened children. The autorefraction screening program referred 16.5% of screened children. The difference (12.2%) was significant (P < 0.0001). The probability of a referred child meeting case definition at follow-up was 69.3% and 56.2% for vision charts and autorefraction, respectively (P = 0.07). A significantly larger number of preschool children were referred for follow-up in a community-based screening program using autorefraction rather than vision charts. There is a non-significant trend towards decreased positive-predictive value in children referred based on Retinomax compared with visual eye chart. Screening programs based on Retinomax are likely to refer a greater number of children that require glasses compared with vision charts. This will increase the number of children appropriately treated with glasses as well as overall screening costs.

Comparison Between the plusoptiX and MTI Photoscreeners

Both the Medical Technology and Innovations (MTI) and plusoptiX photoscreeners are used to objectively screen for amblyogenic risk factors in children. The MTI has been extensively studied, but the limited availability of film may render it obsolete. We compared the MTI with the plusoptiX, a newer digital photoscreener, for the ability to detect amblyogenic factors when compared with a comprehensive pediatric ophthalmic examination. We believe our results will help to guide community-based vision screening programs. One hundred fifty-one children were examined consecutively in our office. Each patient was screened with the MTI and plusoptiX devices on the same day as part of a comprehensive pediatric ophthalmic examination. Results via MTI were evaluated by an expert masked examiner (R.W.A.), and the plusoptiX results were interpreted by the incorporated software. Sixty-five percent of patients were found to have amblyopia or amblyogenic risk factors during the pediatric ophthalmic examination conducted via the American Association of Pediatric Ophthalmology and Strabismus referral criteria. We found the MTI photoscreener to have a sensitivity of 83.6%, specificity of 90.5%, false- positive rate of 9.4%, false-negative rate of 16.3%, and positive predictive value of 94.2%. The plusoptiX demonstrated a sensitivity of 98.9%, specificity of 96.1%, false- positive rate of 3.7%, false-negative rate of 1.0%, and positive predictive value of 97.9%. The MTI and plusoptiX photoscreeners proved to be effective when compared with a comprehensive cycloplegic pediatric ophthalmic examination. The plusoptiX, however, was found to have a higher sensitivity and specificity than the MTI.

Vision screening of older people

A recent systematic review found that between 20% and 50% of older people in the UK have undetected reduced vision and in most cases this is caused by refractive error or cataracts, and is correctable. Two approaches to improve the detection of these problems are to better publicise optometric services and to carry out community-based vision screening of older people. Screening programmes should pass the Wilson criteria and a consideration of these highlights three inter-related questions: 'Is vision screening effective at detecting correctable low vision in older people?'; 'Which tests should be included?' and 'Which venues are most appropriate?' We carried out a systematic review to investigate these questions. For the first question, only one study was found which met our selection criteria. The 'gold standard' eye examination in this study lacked several important components, and the vision screening method that was used was not found to be very effective. The review revealed other studies, which, although not meeting our selection criteria, included relevant information. The screening studies highlight the lack of agreement on the content of a gold standard eye examination and of the test(s) that should be used to screen vision. Visual function in older people is not adequately described by high contrast visual acuity (VA), nor by self-reports of visual difficulties. Other tests that may be relevant include visual field testing, low contrast VA, contrast sensitivity and stereo-acuity. The pinhole test has often been used in attempts to detect uncorrected refractive errors, but results from this test can be problematic and possible reasons for this are discussed. Appropriate venues for vision screening are contingent upon the format of the vision screening programme. There is still uncertainty over the battery of vision tests that are most appropriate. This, and optimum venues for screening, require further research before it can be fully determined whether vision screening of older people meets the Wilson criteria. If a vision screening programme using a battery of vision tests, perhaps computerised, can be established, then this should be tested to determine the sensitivity and specificity for detecting the target conditions. Ultimately, longitudinal studies are necessary to determine whether such a screening programme will lead to improved visual performance and quality of life in older people.