Eye Health Care Research Articles

Critical Expansion of Care-Albany Area of Primary Health Care Opens Vision Care Centers.

Critical Expansion of Care—Albany Area of Primary Health Care Opens Vision Care Centers Shelley Spires, MSM (bio), Clifton Bush, MHA (bio), Brandy Church, BA (bio), and Sabrina Edgington, MSW (bio) Background According to a 2020 report entitled "Integrating Eye Health and Vision Care for Underserved Populations into Primary Care Settings" by the American Optometric Association and the Association of Clinicians for the Underserved, community health centers are uniquely positioned to improve access to eye health and vision care due to their reach in underserved communities and their emphasis in providing integrated, whole-person care to underserved populations.1 In a National Academies' Health and Medicine Division report, Making Eye Health a Population Health Imperative: Vision for Tomorrow, the authors state that "for many underserved and low-income communities, federally funded community and rural health centers may be the only source of eye and vision care services." Yet, most health centers are not equipped to provide comprehensive eye health and vision care.1 Despite the national need for vision care—one that is even greater for the underserved—a dearth of workforce negatively affects access to services. According to the organization Prevent Blindness, as of 2020, 721 out of 3006 counties in the United States had no ophthalmologist or optometrist. Furthermore, of the 29 million people who visited community health centers in 2019, only 2.76% received eye care services, far below service delivery for medical, oral health, and behavioral health services.2 These services affect the entire lifespan. Children from under-resourced urban areas, many of whom belong to ethnic minority groups, experience more than twice the normal incidence rate of vision problems but are also less likely to be referred to and receive an eye examination by an eye doctor.3 For the elderly population—a segment of the country that is expected to continue growing—data show that nearly half (46.7%) of adults aged 65 and older with severe vision impairment or blindness have experienced [End Page xi] a fall, compared with 27.7% of adults over age 65 without severe vision impairment or blindness who have experienced a fall.4 There are clear public and community health implications that accompany the need for vision care access. Intervention The need to expand to vision care services has long been a palpable reality for many health centers. One of these health centers, located in rural, southwest Georgia—Albany Area Primary Health Care (AAPHC)—started to address the need for expanded vision care in 2016. Shelley Spires, AAPCH Chief Executive Officer, met with Clifton Bush, AAPCH Chief Operating Officer, to plan what services should be added to their community health center. Even with a lot else on their wish list, they knew for certain that vision care needed to be added as quickly as possible. Albany Area Primary Health Care serves the uninsured and underinsured across nine counties in rural Georgia. As one of Georgia's largest community health centers, and one of southwest Georgia's largest medical groups, the organization cares for the most vulnerable in their communities. As a community health center, the organization can provide a sliding-scale fee program and a prescription saving plan to their patients to offset the costs of health care and prescriptions. Both Spires and Bush quickly realized they could expand the cost-savings to vision care too. "We knew that we could open this new service and ensure eye exams and glasses were affordable for our patients," says Spires. "We were closing a critical care gap in this area of rural Georgia." It didn't take long for expanded Vision Care Centers to become operational. On November 1, 2017, AAPHC opened their first Vision Care Center in Albany, Georgia. Albany Area Primary Health Care then opened their Vision Care Center at Alice Coachman Elementary School-Based Health Center on February 1, 2018. By adding vision Care Centers in Albany, Georgia, plus expanding Vision Care Centers into the local schools, AAPHC was adding a much-needed service to its community health center. "Our Vision Care Centers provide important eye exams and care for our patients," says Spires. "We follow up with our diabetic patients to ensure they are receiving their...

Severe Visual Impairment in Schools (A PEEK Study)

Childhood visual impairment is a major public health concern. The global financial burden of childhood-onset blindness is greater than that of adult-onset blindness due to the longer span of living. The importance of good vision for education and socialisation from an early age has prompted the adoption of vision screening in schools by many national eye care programmes in Zimbabwe. Therefore, the aim and purpose of this study were to determine the prevalence of visual impairment and the pattern of eye conditions affecting school children screened during the course of the “Portable Eye Examination Kit (PEEK) project.” The study was a retrospective review that utilized data that was collated and analysed from the PEEK project dashboard from June 2019 to December 2020 by well-trained eye health care providers. The sample size was 4591 school-going children aged between 5 to 20 years of age recruited from the Harare and Bulawayo schools. Results showed that 58% did not have any eye problems while 24% had a red watery and itchy eye, 10% had a red eye, 2% had lid and globe issues and 2% had strabismus. The visual acuity results showed that the majority of participants, 2/3, had a good vision as they recorded a Snellen acuity test score of 6/9 or better. In addition, 1/5 had mild visual impairment, and about 2% of the participants were legally blind. 15% of the participants recruited in this study had moderate to severe visual impairment.

Assessing Eye Health and Eye Care Needs Among North American Native Individuals

There are few population-level studies on ophthalmic conditions and services among North American Native individuals. To evaluate whether disparities in ophthalmic conditions and services exist between North American Native individuals and non-Hispanic White individuals in the US. This cross-sectional study used 100% Medicare fee-for-service (MFFS) enrollment data from the Vision and Eye Health Surveillance System (VEHSS) to examine ophthalmic conditions and service use in North American Native individuals and non-Hispanic White individuals in the US. In this study North American Native individuals included those who identified as American Indian, Native Alaskan, Native Hawaiian, and Pacific Islander. Data were analyzed from August 2020 to April 2021. Claims and sociodemographic characteristics were extracted and means computed for categories of ophthalmic conditions and select ophthalmic services. Ophthalmic conditions and services were defined in the VEHSS using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Logistic regression was used to model differences between age-adjusted mean ophthalmic condition and service claim rates among North American Native individuals and non-Hispanic White individuals for each age cohort. Matching ophthalmic condition claim rates and ophthalmic service claim rates was performed to examine disparities by racial group. Mean age-adjusted claim rates for ophthalmic conditions and services among North American Native individuals vs non-Hispanic White individuals per 100 persons. Claims were identified for 177 100 Native American Native individuals and 24 438 000 non-Hispanic White individuals. In 16 of 17 ophthalmic condition categories and 6 of 9 service categories, North American Native individuals had significantly different claim rates from non-Hispanic White individuals. There were higher ophthalmic condition claim rates but lower service claim rates for North American Native individuals (vs non-Hispanic White individuals) for refractive errors (ophthalmic condition, 17.2 vs 11.1; service, 48.3 vs 49.6, respectively; P < .001); blindness and low vision (ophthalmic condition, 1.48 vs 0.75: service, 19.2 vs 20.1, respectively; P < .001); injury, burns, and surgical complications (ophthalmic condition, 1.8 vs 1.7; service, 19.2 vs 20.1, respectively; P < .001); and orbital and external disease (ophthalmic condition, 15.7 vs 13.3; service, 48.3 vs 49.6, respectively; P < .001). For diabetic eye diseases, North American Native individuals had higher ophthalmic condition claim rates (5.22 vs 2.20) but no difference in service claim rates (14.4 vs 14.8; P = .26) compared with non-Hispanic White individuals. In this cross-sectional study, North American Native individuals had higher prevalence of ophthalmic conditions but no corresponding increase in services (treatment for most ophthalmic conditions) compared with non-Hispanic White individuals. These results suggest worse eye health and higher unmet eyecare needs for North American Native individuals with MFFS coverage compared with non-Hispanic White individuals with MFFS coverage.

Prevalence of Eye Conditions, Utilization of Eye Health Care Services, and Ophthalmic Medications After Entering Residential Aged Care in Australia.

PurposeThis study aims to evaluate the burden and trends of eye diseases, utilisation of eye health care services, and ophthalmic medications among older people living in residential aged care facilities in Australia.MethodsA cross-sectional study was conducted using data from the Registry of Senior Australians. Individuals aged ≥65 years who entered permanent residential aged care facilities between 2008 and 2015 were included. The prevalence (95% confidence interval [CI]) of eye diseases by year, eye health care services, and ophthalmic medication use within a year of entry into the service were evaluated. Poisson regression models estimated adjusted rate of change using prevalence ratio (PR) by age, sex, state, and frailty scores.ResultsOf the 409,186 people studied, 43.6% (N = 178,367) had an eye condition. Of the total cohort, 32.9% (N = 134,566) had chronic eye conditions and 19.7% (N = 80,661) had an acute eye condition. Common chronic eye conditions were glaucoma (13.6%, N = 55,830), cataract (8%, (N = 32,779), blindness (4.5%, N = 18,856), and poor vision (10.3%, N = 42,245). Prevalence of any eye condition (2008: 42.7%, 95% CI = 42.2%–43.2% and 2015: 41.2%, 95% CI = 40.8–41.6%, PR = 0.99, 95% CI = 0.99–0.99, P < 0.001), acute eye conditions (2008: 19.8%, 95% CI = 19.4%–20.2% and 2015: 17.4%, 95% CI = 17.1%–17.6%, PR = 0.97, 95% CI = 0.97–0.98, P < 0.001), and blindness (2008: 5.2%, 95% CI = 5.0%–5.4% and 2015: 3.7%, 95% CI = 3.5%–3.9%, PR = 0.93, 95% CI = 0.93–0.94, p < 0.001). decreased over the study period. The prevalence of glaucoma (2008: 13.5%, 95% CI = 13.2%–13.8% and 2015: 13.8%, 95% CI = 13.5%–13.7%; PR = 1.01, 95% CI = 0.99–1.10, P < 0.001) and cataract (2008: 7.4%, 95% CI = 7.2%–7.7% and 2015: 8.5%, 95% CI = 8.3%–8.7%, PR = 1.00, 95% CI = 1.00–1.01, P < 0.001) remained stable or slightly increased. Overall, 46.4% (N = 82,769) of individuals with eye conditions, accessed at least one eye health service within the first year of entering residential care and 70.5% (N = 125,673) used at least one ophthalmic medication. Optometric services (41.7%, N = 74,358) were the most used eye health care services and anti-infective eye drops (37.2%, N = 66,331) were the most commonly dispensed medications.ConclusionsThe prevalence of blindness among older Australian using residential aged care services decreased over the study period. However, the burden of eye diseases remained high between 2008 and 2015, whereas the use of eye health care services was disproportionately low. This study provides evidence of a significant need for eye health care services for older people with an eye disease in residential aged care facilities.Translational RelevanceFour in ten long term aged care residents in Australia had at least one eye condition over the study period, indicating potential for a high eye health care needs in aged care settings.

Human resource and governance challenges in the delivery of primary eye care: a mixed methods feasibility study in Nigeria

BackgroundTo increase access to eye care, the World Health Organization’s Africa Region recently launched a primary eye care (PEC) package for sub-Saharan Africa. To determine the technical feasibility of implementing this package, the capacity of health systems at primary level needs to be assessed, to identify capacity gaps that would need to be addressed to deliver effective and sustainable PEC. This study reports on the human resource and governance challenges for delivering PEC in Anambra State, Nigeria.MethodsDesign: This was a mixed methods feasibility study. A desk review of relevant Nigerian national health policy documents on both eye health and primary health care was conducted, and 48 primary health care facilities in Anambra state were surveyed. Data on human resource and governance in primary health facilities were collected using structured questionnaires and through observation with checklists. In-depth interviews were conducted with district supervisors and selected heads of facilities to explore the opportunities and challenges for the delivery of PEC in their facilities/districts. Data were analysed using the World Health Organization’s health system framework.ResultsA clear policy for PEC is lacking. Supervision was conducted at least quarterly in 54% of facilities and 56% of facilities did not use the standard clinical management guidelines. There were critical shortages of health workers with 82% of facilities working with less than 20% of the number recommended. Many facilities used volunteers and/or ad hoc workers to mitigate staff shortages.ConclusionOur study highlights the policy, governance and health workforce gaps that will need to be addressed to deliver PEC in Nigeria. Developing and implementing a specific policy for PEC is recommended. Implementation of existing national health policies may help address health workforce shortages at the primary health care level.

Eye health promotion-oriented policy statements in various national and provincial health policy documents in South Africa

Background: There are many fragmented public health policies that give directives towards various aspects of healthcare needs and implementation. However, none of these policies make specific reference to eye health promotion (EHP) as an enabler for individuals to take control of the determinants of their eye health (EH) needs. Aim: The current study sought to identify EHP messages in the various available policy documents at both national and provincial health department levels with a view to assessing awareness on the available gaps for the development of an integrated EHP policy in South Africa. Setting: The study used documents provided by the National Department of Health and those that were available online from various other provincial Departments of Health in the country. Methods: Content analysis of EH policies requested from the Directorate of Chronic Diseases, Disabilities and Geriatrics was conducted. Various other health policies that were enacted post-1994 and endorsed by the National and Provincial Departments of Health were also considered for analysis. Results: Twenty-four documents were considered for content analysis. The national guidelines on eye healthcare made reference to EH activities such as immunisation of children, vision screening of the elderly, vitamin A supplementation and maternal services to detect sexually transmitted diseases, amongst others. Of the 20 national and provincial health documents analysed, only four made reference to EH. None of these documents made any specific reference to EHP. Conclusion: Although four national guidelines contain content related to EHP, the fragmentation and lack of integration with other health policy documents may lead to eye healthcare messages not being prioritised for dissemination even where they are highly required. Also, public eye healthcare services in general will continue to lag behind as is the case in most provinces in South Africa.

Telemedicine and artificial intelligence related to vision screening

Purpose. This paper aims to evaluate whether telemedical models or examination and prevention models based on artificial intelligence offer German optometrists a chance to increase their status as vision care providers and to provide better eye care in Germany. Material and Methods. Both a systematic literature review and an expert survey were conducted. Study results of deep learning vision screening applications in the fields of glauco- ma, age-related macular degeneration, and diabetic retino- pathy as well results of expert interviews are discussed. Results. The study results and expert interviews demonstrate that cooperation between optometrists and ophthalmologists in a telemedical network is an essential tool for improving the eye health care of the population and relieves ophthalmo- logists of routine tasks. The first telemedical cooperative pro- gram between German optometrists and ophthalmologists demonstrates a successful cooperation. Conclusion. Artificial intelligence (AI) is increasingly finding its way into the field of vision screening. Telemedicine and the electronic patient medical record play a unique role. They en- able German optometrists to secure and expand high-quality service offerings in the field of optometry. Keywords telemedicine, artificial intelligence, vision screening, age- related macular degeneration diabetic retinopathy

Knowledge and practices of teachers about child eye healthcare in the public sector in Swaziland

Background: Vision-related problems have a negative impact on the learning abilities and school performance of a child. Adequate knowledge and practices of teachers enable the early identification and intervention of school children with visual deficits.Aim: This study aimed to investigate the knowledge and practices of teachers about child eye healthcare in the public education system in Swaziland.Setting: The setting for this study was Swaziland.Methods: This was a cross-sectional quantitative study using a survey instrument containing closed-ended questions to investigate the knowledge and practices of teachers about child eye health in the public sector.Results: Two hundred and forty-three (N = 243) teachers responded to the questionnaire. The majority (90.1%) of teachers indicated that they were able to detect signs and symptoms of eye diseases. Most teachers without a family member wearing spectacles were more likely to be informed about eye health (p = 0.001) than those who had family wearing spectacles. A significant proportion (44%) of teachers indicated that refractive errors were not serious among school children. Above one-third (38.7%) of the teachers indicated that they referred children with vision problems to public hospitals. One hundred and fifty-five (63.8%) reported that health officials have never visited their schools. One hundred and forty-nine (61.3%) teachers agreed that they did not monitor children wearing spectacles and 94 (38.7%) monitored them. Monitoring children wearing spectacles was significantly associated with teachers who indicated being well informed about eye health (p 0.001) and teachers who were more likely to advise parents to take their children for eye testing (p = 0.003).Conclusion: The lack of adequate knowledge by some teachers may contribute to the already existing barriers for children to access eye health. Addressing the broader issues of child eye health requires the participation of well-trained and knowledgeable teachers.

Eye care – 3 O perspective: obstacles and opportunities

Aim The aim of the present study is to determine the realization of different eye care practitioners as part of the 3 O perspective in eye health care and to analyze the methodologies for their development. Methods Retrospective documentary analysis of the trends for the specialty of medical opticians. Comparative analysis of the profession with other elements of the 3 O perspective, including optometrists and ophthalmologists. Results The number of medical opticians graduated from the Medical University of Varna since 2016 is 69, the largest in 2016 – 16, and the lowest in 2018 – 10. On average 20% of medical opticians are realized in practice without further qualification, while all others continue with a master‘s degree in optometry. Medical opticians most often work in an optical store, with 60% developing their own business. The number of opticians realized in medical establishments is small. The number of masters in optometry, realized in medical institutions is significantly higher and reaches 30%. Ophthalmologists are realized in medical institutions at 100% up to 3 years after graduation. Over 80% of ophthalmologists work in optical centers during their training. Conclusions As a result of an in-depth analysis of the market and the demand for qualified eye care practitioners, Medical University of Varna closes the cycle of the 3 O perspective with the following specialties: ophthalmologists, optometrists and opticians. The three categories of eye health professionals work in symbiosis to develop a comprehensive concept for prevention, prophylaxis, optical correction and treatment. Optical centers and medical institutions providing specialized care for eye diseases exchange staff, which is beneficial for the overall concept of the eye care.

Adjunctive effects of orthokeratology and atropine 0.01% eye drops on slowing the progression of myopia

ABSTRACT Clinical relevance All eye health care practitioners should know how to control myopia. Background Investigating the adjunctive effects of orthokeratology and 0.01% atropine eye drops on controlling the progression of myopia in Chinese children. Methods The prospective study included Chinese children aged 8 to 13 years having a spherical equivalent refractive error ranging from −2.00 to −5.00 D. Participants were categorised into two groups: combination group (orthokeratology and 0.01% atropine) or atropine group (0.01% atropine). The axial length and spherical equivalent refraction were measured at baseline and every three months post-treatment and compared over two years. Results The combinaion and atropine groups comprised 20 and 22 participants. Following two years of treatment, the average spherical equivalent refraction change was 0.88 ± 0.31 D and 1.14 ± 0.63 D in the combination group and atropine group, respectively (P = 0.026), with an average increment in axial length of 0.50 ± 0.17 mm and 0.61 ± 0.21 mm, respectively (P = 0.091). In the atropine group, increased axial length was positively correlated with baseline spherical equivalent refraction (P = 0.018) and negatively correlated with baseline age (P = 0.003). However, these correlations were not observed in the combination group. In the subgroup of subjects aged 8-10 years and another subgroup of subjects with shorter initial axial length (22.00 to 24.50 mm), the changes in axial length over two years were significantly smaller in the combination group than the atropine group. Conclusion Orthokeratology and 0.01% atropine eye drops combination therapy were found to be more effective in reducing progression of myopia, as measured through spherical equivalent refraction changes, than atropine monotherapy in children over two years. Combinatorial therapy was more effective in controlling the elongation of axial length in children with younger baseline age or shorter baseline axial length.

Utilization of eye health services and diabetic retinopathy: a cross-sectional study among persons living with diabetes visiting a tertiary eye care facility in Ghana

BackgroundThere have been a major advance made in screening, early diagnosis, and prompt treatment of Diabetic Retinopathy among Person living with diabetes (PLWD). However, screening services remain a challenge in Low-Middle-Income-Countries where access to eye care professionals is inadequate. This study assesses the utilization of Eye Health Service prevalence (UEHS) among PLWD and associated factors and further quantifies its association with Non-Proliferative Diabetic Retinopathy (NPDR).MethodsA cross-sectional study design with a random sample of 360 PLWD was conducted at Korle-Bu Teaching Hospital, a National Referral Centre in Ghana from May to July 2019. UEHS and DR were the study outcomes. We adopted Poisson and Probit regression analysis to assess factors associated with UEHS over the past year. We employed pairwise and phi correlation (fourfold correlational analysis) to assess the relationship between UEHS and DR (ordinal and binary respectively). Ordered Logistic and Poisson regression were applied to assess the association between the UEHS and DR. Stata 16.1 was used to perform the analyses and a p-value ≤ 0.05 was deemed significant.ResultsThe prevalence of UEHS over the past year and DR was 21.7 %(95 %CI = 17.7–26.2) and 65.0 %(95 %CI = 59.9–69.8 respectively. The prevalence of severe NPDR with Clinically Significant Macular Edema (CSME) was 23.9 %(19.8–28.6). Type of diabetes, increasing age, educational level, mode of payment for healthcare services, marital status, years since diagnosis, and current blood glucose significantly influenced UEHS. There was a negative relationship between DR and UEHS (Pairwise and φ correlation were − 20 and − 15 respectively; p < 0.001). Non-UEHS among PLWD doubles the likelihood of experiencing severe NPDR with CSME compared with UEHS among PLWD [aOR(95 %CI) = 2.05(1.03–4.08)]. Meanwhile, the prevalence of DR among patients per non-UEHS was insignificantly higher [12 %; aPR(95 %CI) = 0.89–1.41)] compared with patients who utilized eye care health service.ConclusionsMost of the PLWD did not utilize the eye health service even once in a year and that was highly influenced by type of diabetes and increasing age. Type 2 diabetes patients and middle age decreased the likelihood of UEHS. There was a negative relationship between DR and UEHS among PLWD and this doubled the likelihood of experiencing severe NPDR with CSME. Structured health education and screening interventions are key to improving UEHS.

Job satisfaction and its associated factors among opticians in Ghana: a cross-sectional study

BackgroundJob satisfaction refers to the feeling of contentment one experiences with their job. Job satisfaction among opticians is a crucial variable in determining their motivation and has consequential influence on the quality of eye health care, systems and services. Nevertheless, little has been done to assess job satisfaction levels among human resources for eye-health, such as opticians, in Ghana. This study assessed (for the first time) the job satisfaction level among opticians in Ghana, and the factors associated with their job satisfaction.MethodsThis was a cross-sectional survey involving all registered and licensed opticians working in Ghana. A validated, well-structured job satisfaction questionnaire was distributed to 195 opticians across all regions of the country. The questionnaire was composed of 15-item job satisfaction variables which were measured on a five-point Likert scale (‘1—strongly disagree’ to ‘5—strongly agree’). Logistic regression analyses were used to investigate the association between sociodemographic characteristics and factors of job satisfaction, and the overall job satisfaction level.ResultsA total of 101 opticians responded to the study. The mean presenting age of all participants was 25.3 ± 5.0 years (21 to 47 years), with majority being males (57.4%). The mean score of the overall job satisfaction level reported by participants was 2.65, with 12.9% (95% confidence interval [CI]: 7.0–21.0%) of them being satisfied with their jobs. There was no statistically significant association between overall job satisfaction and sociodemographic characteristics (p > 0.05; for all). Only salary was significantly associated with overall level of job satisfaction (odds ratio [OR]: 16.5; 95% CI: 2.06–132.86; p = 0.008).ConclusionMajority of opticians working in Ghana were not satisfied with their jobs. Enhancing salary/remuneration would improve the job satisfaction level among opticians in the country. There is the need for effective management of human resources for eye-health (particularly opticians) and policy revision on ophthalmic healthcare administration in Ghana.

Comparison of Stereopsis, Contrast Sensitivity and Near Points of Accommodation In Patients With Degree of Myopia

Background: Stereopsis is the ability to perceive depth in objects through binocular vision, where the brain interprets 2-dimensional retinal images as 3-dimensional shadows. It plays a crucial role in assessing and understanding the objects we see. Factors like sensory and motor fusion greatly influence the quality of stereoscopic vision. Myopia, a condition characterized by near- sightedness, can negatively impact stereopsis. Contrast sensitivity refers to the ability to discern sharp outlines and detect subtle differences in shading and patterns. It helps identify objects with unclear boundaries against their background. Purpose: This study aimed to compare Stereopsis, Contrast Sensitivity, and Near Point of Accommodation among individuals with different grades of Myopia and Emmetropia. Methods: A cross-sectional comparative study was conducted at Nandadeep Eye Hospital, Maharastra, involving staff and patients aged 15 to 30 years. Participants with strabismus, anisometropia, previous ocular surgery, ocular diseases, or systemic conditions were excluded. The assessments included objective and subjective refraction eye examinations, as well as measurements of stereopsis, contrast sensitivity, and near point of accommodation. Results: The results, based on 109 subjects, indicated no significant change in contrast sensitivity between emmetropes and myopes. However, there were significant differences in stereoacuity and NPA among different grades of myopes compared to emmetropes. Conclusions: the study suggests that optometrists and eye healthcare professionals should assess stereopsis and near point of accommodation in severely myopic patients even after optical correction, and consider vision therapy if necessary, as it is an effective treatment for accommodative and binocular vision anomalies.

Vision Screening of Learners by Teachers in Kafue District in Zambia as a Strategy to Address the Challenges of Childhood Blindness

Background: Early detection and treatment of eye diseases in children is critical in combating childhood blindness. Innovative community-based strategies such as training of teachers in vision screening need to be developed for effective utilisation of the available human resources as well as to counter the challenges of inequitable distribution of trained eye health human resourcesas well as the limited access of quality eye health care services to the majority of our population.&#x0D; Aim: To evaluate the effectiveness of using teachers as the first level of vision screeners.Materials and Methods: Teacher training programmes were conducted for schoolteachers to educate them about childhood eye diseases and the significance of their early detection. The teachers trained for the school vision screening were from all government, private and community schools located in Kafue District. The teachers then conducted vision screening of learners in their schools.Subsequently, the mobile eye health teams visited the schools for the re-evaluation of learners identified with poor vision. All learners identified with refractive errors had refraction performed on them and spectacles prescribed. The mobile eye health teams referred learners requiring a further ophthalmic evaluation to the University Teaching Hospitals – Eye Hospital which was the base hospital for the programme. The assessment included calculation of true positives, false positives, true negatives and false negatives.Results: One hundred and fifty-four (154) teachers from 73 primary and secondary schools underwent training in vision screening. The teachers screened 18,713 learners and reported eye diseases in 2,818 (15.1%) children. However, the mobile eye health teams examined 5,958 learners who included 2,818 referrals from teachers and 3,140 rescreened learners. The mobile eye health teams confirmed eye problems in 2,818 learners screened by the teachers and further diagnosed more eye problems in 999 learners giving a total of 3,817 learners with eye problems. Thus, the teachers were able to correctly identify eye problems (true positives) in 100.0% (2,818/2,818) of learners. The teachers could not identify eye problems in 999 learners giving false negatives were 26.2% (999/3,817).Conclusion: Considering the high true positive value and the comprehensive coverage provided by the survey, vision screening in schools by teachers is an effective method of identifying learners with eye problems and poor vision early. This strategy could be valuable in reducing the workload of the eye health care staff.

Vision Screening of Learners (School Children) by Teachers in Kafue District in Zambia as a Strategy to Address the Challenges of Childhood Blindness

Background: Early detection and treatment of eye diseases in children is critical in combating childhood blindness. Innovative community-based strategies such as training of teachers in vision screening need to be developed for effective utilisation of the available human resources as well as to counter the challenges of inequitable distribution of trained eye health human resources as well as the limited access of quality eye health care services to the majority of our population.&#x0D; Aim: To evaluate the effectiveness of using teachers as the first level of vision screeners.&#x0D; Materials and Methods: Teacher training programmes were conducted for schoolteachers to educate them about childhood eye diseases and the significance of their early detection. The teachers trained for the school vision screening were from all government, private and community schools located in Kafue District. The teachers then conducted vision screening of learners in their schools. Subsequently, the mobile eye health teams visited the schools for the re-evaluation of learners identified with poor vision. All learners identified with refractive errors had refraction performed on them and spectacles prescribed. The mobile eye health teams referred learners requiring a further ophthalmic evaluation to the University Teaching Hospitals – Eye Hospital which was the base hospital for the programme. The assessment included calculation of true positives, false positives, true negatives and false negatives.&#x0D; Results: One hundred and fifty-four (154) teachers from 73 primary and secondary schools underwent training in vision screening. The teachers screened 18,713 learners and reported eye diseases in 2,818 (15.1%) children. However, the mobile eye health teams examined 5,958 learners who included 2,818 referrals from teachers and 3,140 rescreened learners. The mobile eye health teams confirmed eye problems in 2,818 learners screened by the teachers and further diagnosed more eye problems in 999 learners giving a total of 3,817 learners with eye problems. Thus, the teachers were able to correctly identify eye problems (true positives) in 100.0% (2,818/2,818) of learners. The teachers could not identify eye problems in 999 learners giving false negatives were 26.2% (999/3,817).&#x0D; Conclusion: Considering the high true positive value and the comprehensive coverage provided by the survey, vision screening in schools by teachers is an effective method of identifying learners with eye problems and poor vision early. This strategy could be valuable in reducing the workload of the eye health care staff.

Fifteen-Year Incidence Rate of Primary Angle Closure Disease in the Andhra Pradesh Eye Disease Study

To report on the 15-year incidence of primary angle closure disease (PACD) among participants aged ≥40 years in rural southern India DESIGN: Population-based longitudinal incidence rate study METHODS: Setting: 3 rural study centres. Phakic participants aged ≥40 years who participated in both examination time points. All participants at the baseline and at the mean 15-year follow-up visit underwent a detailed interview, anthropometry, blood pressure measurement, and comprehensive eye examination. Automated perimetry was attempted based on predefined criteria. Main outcome measures included development of any form of PACD, as defined by the International Society for Geographical and Epidemiological Ophthalmology (ISGEO), during the follow-up period in phakic participants, who did not have the disease at baseline. We analyzed data obtained from 1,197 (81.4% out of available 1,470) participants to calculate the incidence of the disease. The mean age (standard deviation) of the study participants at the baseline was 50.2 (8.1) years, with 670 male (45.5%) and 800 female (54.4%) participants. The incidence rate per 100 person-years (95% confidence interval) for primary angle closure suspect, primary angle closure, and primary angle closure glaucoma was 8.8 (8.4, 9.2), 6.2 (5.9, 6.6), and 1.6 (1.4, 1.8), respectively. Thus, the incidence of all forms of PACD was 16.4 (15.9, 17) per 100 person-years. On logistic regression analysis, female gender was a significant risk factor whereas presence of myopia was protective. This study reports long-term incidence of PACD from rural India. It has implications for eye health care policies, strategies, and planning.

33149 Interventions and Education: What We Learned from the 'All Eyes on Us' Study

ABSTRACT IMPACT: This study identifies potential areas for community and clinical interventions to improve eye and vision health. OBJECTIVES/GOALS: The ‘All Eyes on Us’ study sought to understand perceptions of and barriers to eye and vision care, of residents over the age of 40 in the Broadway/Slavic Village neighborhood in Cleveland, Ohio. The goal of this study was to identify potential areas for community and clinical interventions to improve eye health. METHODS/STUDY POPULATION: Residents of the Broadway/Slavic Village neighborhood, an ethnically diverse, low socioeconomic status, neighborhood in Cleveland, Ohio were recruited from, and with the assistance of, University Settlement, a nonprofit that has been providing services to the neighborhood since 1926. The project’s Community Advisory Board assisted with the development of a semi-structured interview guide over the course of three meetings. Sixty interviews were completed, 30 with self-identified European Americans and 30 with self-identified African-Americans, all over the age of 40. Two research team members coded the interview transcripts and a thematic analysis was conducted. RESULTS/ANTICIPATED RESULTS: Participants identified barriers to obtaining eye and vision care for themselves as well as perceived barriers for others, including transportation, cost, insurance status, clinic locations, lack of education around eye and vision care, fear, forgetfulness, and priority management. To encourage people to go to the eye doctor more often, participants mentioned strategies related to access issues including lowering the cost of exams, operating on a sliding scale, improving insurance coverage, transportation services, and having mobile units that deployed to specific neighborhoods or senior centers. Additionally, participants suggested education and increasing awareness about the importance of eye and vision care. DISCUSSION/SIGNIFICANCE OF FINDINGS: Participants in this study identified that accessibility to and awareness about eye health and eye care is an issue. Interventions to address both access issues such as location, cost, and insurance as well as those that increase education could increase engagement with eye and vision care.

Critical Expansion of Care-Albany Area Primary Health Care Opens Vision Care Centers.

Critical Expansion of Care—Albany Area Primary Health Care Opens Vision Care Centers* Shelley Spires, Clifton Bush, Brandy Church, and Sabrina Edgington Background According to a 2020 report entitled "Integrating Eye Health and Vision Care for Underserved Populations into Primary Care Settings" by the American Optometric Association and the Association of Clinicians for the Underserved, community health centers are uniquely positioned to improve access to eye health and vision care due to their reach in underserved communities and their emphasis on providing integrated, whole-person care to underserved populations. In a National Academies Health and Medicine Division report, Making Eye Health a Population Health Imperative: Vision for Tomorrow, the authors state that "for many underserved and low-income communities, federally funded community and rural health centers may be the only source of eye and vision care services." Yet, most health centers are not equipped to provide comprehensive eye health and vision care.1 Despite this national need for vision care—one that is even greater for the underserved—a dearth of workforce negatively affects access to services. According to the organization Prevent Blindness, as of 2020, 721 out of 3,006 counties in the United States had no ophthalmologist or optometrist. Out of the 29 million people who visited community health centers in 2019, only 2.76% received eye care services, far below service delivery for medical, oral health, and behavioral health services.2 Vision care affects the entire lifespan. Children from under-resourced urban areas, many of whom are considered members of racial or ethnic minority groups, experience more than twice the normal incidence rate of vision problems but are also less likely to be referred to and receive examination by an eye doctor.3 Concerning the elderly population—a segment of the country that is expected to grow rapidly in the future—data show that nearly half (46.7%) of adults aged 65 and older with severe vision impairment or blindness have experienced a fall, compared with 27.7% of adults [End Page xi] over age 65 without severe vision impairment or blindness who have experienced a fall.4 There are clear public and community health implications that underlie the need for vision care access. Intervention The need to expand to vision care services has long been a palpable reality for many health centers. One of these health centers, located in rural Georgia—Albany Area Primary Health Care (AAPHC)—started to address the need for expanded vision care organizationally in 2016. Shelley Spires, AAPHC Chief Executive Officer, met with Clifton Bush, AAPHC Chief Operating Officer, to plan what services should be added to their community health center in southwest Georgia. With so much on their wish list, they knew for certain that one service needed to be added as quickly as possible—vision care. Albany Area Primary Health Care (AAPHC) serves the uninsured and underinsured across nine counties in rural Georgia. As one of Georgia's largest community health centers, and one of southwest Georgia's largest medical groups, the organization cares for the most vulnerable in their communities. As a community health center, the organization can provide a sliding fee scale program and prescription saving plan to their patients to offset the costs of health care and prescriptions. Both Spires and Bush quickly realized they could expand the costsavings to vision care, too. "We knew that we could open this new service and ensure eye exams and glasses were affordable for our patients," says Spires. "We were closing a critical care gap in this area of rural Georgia." It did not take long for expanded vision care centers to become operational. On November 1, 2017, AAPHC opened their first vision care center in Albany, Georgia. AAPHC then opened their vision care center at Alice Coachman Elementary School-Based Health Center on February 1, 2018. By adding vision care centers in Albany, Georgia, plus expanding vision care centers into the local schools, they were adding a much-needed service to their community health center. "Our vision care centers provide important eye exams and care for our patients," says Spires. "We follow-up with our diabetic patients to ensure they are receiving their annual diabetic eye exams, as well...

The Awareness of Keratoconus among General Population in Saudi Arabia

Introduction: Keratoconus (KCN) is one of the degenerative corneal disorders, which causes impairment in normal visual acuity with a higher prevalence in Saudi Arabia. The study aimed to assess the awareness and knowledge regarding KCN, its risk factors, and management among the Saudi population. Materials and Methods: A survey was conducted using a pre-tested and validated questionnaire distributed through online platforms. A mixture of convenience and snowball sampling techniques was adopted for sample collection. Our analysis included a final sample size of 837 participant responses. The questionnaire had items related to sociodemographic characteristics (5 items), knowledge (10 items), and source of information (1 item). The mean knowledge scores were calculated and categorized (good, fair, and poor) to assess each participant’s knowledge. Pearson’s chi-square test was used to determine the statistical association between categorical variables. Results: The mean knowledge score was found to be 4.12 ± 2.6, and 67.5% of the participants showed “poor” scores. There was no statistically significant association of knowledge scores observed with any of the sociodemographic details. It was agreed by 76% and 42.5% that genetic predisposition and chronic eye inflammation could predispose to KCN. Only 38.1% (n = 157) agreed that KCN could be treated with optical glasses or contact lenses in the initial stages. Conclusion: The knowledge regarding KCN was not satisfactory among our study population. There is a need to create an increased level of awareness for KCN. Health awareness programs and community campaigns should be organized to raise awareness regarding KCN and better eye health care utilization.

SARS-CoV-2 seroprevalence in healthcare workers in a high-volume ophthalmology centre in Guatemala

Purpose To determine the seroprevalence of SARS-CoV-2 antibodies in eye healthcare workers (EHCW) in the largest ophthalmology centre in Guatemala and factors associated with antibody positivity. Methods We conducted a cross sectional sero-survey in all the staff at the largest ophthalmology centre in Guatemala. Serum samples were collected and tested for total antibodies against SARS-CoV-2 employing Roche Elecsys Anti-SARS-CoV-2 Immunoassay. Results were reported as reactive or non-reactive. According to patient exposure the staff were divided into low risk (technicians, domestic and administrative staff) and high risk (nurses, ophthalmologists, anaesthesiologists, and optometrists). Among those with positive antibodies, they were given a survey that included demographic characteristics, COVID-19 exposure, and related symptomatology. Logistic regression was used to determine the factors associated with antibody positivity. Results On November 25th a total of 94 healthcare workers were sero-surveyed, mean age was 34.15 years (±8.41), most (57.44%) were females. Seroprevalence was 18%, the majority (77%) were in the low-risk group; while 64% at high-risk, tested negative. Those at low exposure, were five times more likely to have antibodies than those at high exposure (OR:5.69; 95% CI 1.69–19.13). Age and gender were not associated to seropositivity. Conclusions We found a similar seroprevalence of SARS-CoV-2 antibodies in EHCW to what has been reported in other healthcare groups. Seropositivity was higher among HCW with fewer patient exposure, hence the probability of community transmission. Key messages Even though eye healthcare workers are believed to be at higher risk of infection, the prevalence of antibodies against SARS-CoV-2 in this group is comparable to what has been reported previously in other healthcare groups.