Eye Health Professionals Research Articles

A novel framework for Indigenous eye health care in New Zealand: Ngā Mata o te Ariki

ABSTRACT Clinical relevance Development of an Indigenous eye health framework could offer the opportunity for eye health professionals to enhance engagement with Indigenous populations. Background Indigenous populations globally experience disproportionately poorer eye health outcomes than non-Indigenous peoples. Incorporating Māori perspectives of eye care and pre-existing Indigenous models of health offers potential to enhance Māori experience and engagement with eye health services. This study seeks to develop and refine a practical framework for eye health care that incorporates nine established Indigenous health principles. Methods Qualitative methodology, guided by Indigenous Māori research principles, was used to evaluate interviews with five leading senior Māori academics surrounding the ongoing development and refinement of a Kaupapa Māori (Māori worldview centric) framework for eye care in Aotearoa New Zealand, created following Māori health consumer consultation. Interviews were semi-structured and analysed using reflexive thematic analysis. Results Seven key themes arose in relation to the development of a Kaupapa Māori framework for eye care in Aotearoa New Zealand: 1) vision is critical to Māori well-being, 2) cultural safety is important, 3) Māori health beliefs must be upheld, 4) achieving pae ora (healthy futures) is important, 5) key concepts and focus of the framework must be clear, 6) pūrākau (traditional Indigenous stories) are valuable resources in developing health frameworks and 7) embedding Matariki (fundamental Māori) principles is valuable. Conclusions Using Kaupapa Māori principles allowed development and refinement of a framework that encourages clinicians to consider Indigenous health principles when engaging with Māori patients who seek eye care. Application of this framework may contribute to enhancing cultural safety and responsiveness of eye care for Māori.

Testing the Hard to Test: A Pilot Study Examining the Role of Questionnaires in Eliciting Visual Behaviours in Children with Autistic Spectrum Disorder.

There is a higher prevalence of visual problems in children with Autistic Spectrum Disorder (ASD) compared with the neuro-typical population. Issues relating to visual perception can be evident as atypical visual behaviours (ViBes). The aim of the study was to compare findings of parents and eye health professionals using questionnaires to describe visual function in young children with ASD. Parents/Caregivers of patients diagnosed with ASD attending routine hospital eye clinics were invited to participate. A questionnaire to draw out presence of ViBes was completed by the parent prior to attending clinic. The clinician independently completed the same questionnaire and undertook a clinical ocular assessment. 32 children were recruited (mean age 7 years, range 4-11). Most caregivers indicated they had noted at least one atypical ViBe (97%, median 5, range 0-8). Parental-reported ViBe8 scores were higher than clinician-reported scores (p = 0.04). The most commonly reported ViBes by both groups related to use of vision at the same time as other senses, and atypical fixation (e.g. looking away during speech or side viewing). There was weak correlation between visual acuity and parental ViBe8 score (rho = 0.364) and no correlation between refractive error and parental ViBe8 score (rho = 0.047). Clinicians were likely to under-report atypical visual function compared with parent. Refraction and visual acuity alone do not detect all visual problems in children with ASD. A Visual Behaviour (ViBe) questionnaire offers a structured approach and shared language to allow documentation of functional visual assessment for both parents, carers, and educational professionals. Use of the ViBe questionnaire may promote understanding between caregiver and professional and provide a baseline for visual behaviours.

Critical appraisal of Australian and New Zealand paediatric vision screening clinical practice guidelines using the AGREE II tool

ABSTRACT Clinical Relevance Vision disorders in children impact health-related quality of life, with early detection and intervention improving outcomes and educational performance. Eye health professionals should be aware of paediatric vision screening guidelines and their development to understand the components of local programmes and the differences in sensitivity and specificity between protocols. Background High-quality clinical practice guidelines (CPGs) for vision screening enable the early detection of common vision disorders; however, they require rigorous development to ensure optimal accuracy in detecting vision disorders, enabling timely interventions. This study evaluated the quality of available vision screening CPGs on vision screening of children in Australia and New Zealand. Methods A systematic search of academic databases, guideline databases, professional associations and Google search engines was conducted to identify relevant paediatric vision screening CPGs. Four independent reviewers used the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument to assess the quality of individual guidelines and scores were aggregated and reported as the percentage of the total possible score across the six AGREE II domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. Results Initial 2,999 items were evaluated, with seven guidelines included. AGREE-II quality score agreement ranged from 43.3% to 95.8%. All guidelines scored >60.0% in the scope and purpose, however, most had poor scores of <26.5% in the rigour of development and <3.3% in editorial independence domains. All guidelines recommended screening using measures of habitual distance vision. Conclusion Of the guidelines developed for use in Australia and New Zealand, most guidelines scored poorly when assessed against the AGREE II tool, because of lack of editorial independence and rigour of development. Paediatric vision screening guidelines should prioritise systematic review of literature to inform practice and include statements regarding competing interests.

Trends in the Ophthalmic Workforce and Eye Care Infrastructure in South India: Cross-Sectional Questionnaire Study.

This study is part of broad-based research to determine the impact of blindness control activities in general and with special reference to the Andhra Pradesh Right to Sight Society (APRTSS) activities in the southern Indian states of Andhra Pradesh and Telangana. As part of the global "VISION 2020: The Right to Sight" initiative, the APRTSS was established in the undivided state of Andhra Pradesh in 2002. Since then, the APRTSS has been actively implementing the strategies of VISION 2020 to reduce visual impairment and blindness in the state. The availability and distribution of the eye care workforce are essential to reach the goals of VISION 2020: The Right to Sight, the global initiative to eliminate avoidable blindness. This study assessed the trends in the availability and distribution of eye health professionals and eye care infrastructure in 2 southern Indian states: Andhra Pradesh and Telangana. This cross-sectional study used a pretested questionnaire to gather data for the year from 2012 to 2013. Data for 2002 to 2003 were collected from available historical records. The questionnaires were pretested in a pilot study conducted before the main survey. Pretested questionnaires were administered to all eye care professionals-ophthalmologists (n=1712) and midlevel ophthalmic personnel (MLOP; n=1250)-eye care facilities with ≥10 inpatient beds or performing ≥100 cataract surgeries per annum (n=640), local nongovernmental eye care organizations (n=182), and international eye care organizations (n=10). Data were collected for 2 different time periods: the baseline year of 2002 to 2003 and the target year of 2012 to 2013. Data analysis was conducted using SPSS version 19.0. The response rates were 81.1% (519/640) for eye care facilities, 96.1% (1645/1712) for ophthalmologists, and 67.6% (845/1250) for MLOP. From 2002-2003 to 2012-2013, there has been an increase in eye care facilities, from 234 to 519 (121.8%); ophthalmologists, from 935 to 1712 (83.1%); and MLOP, from 767 to 1250 (63%). The ophthalmologist:population ratio improved from 1:88,260 in 2002-2003 to 1:51,468 in 2012-2013. The MLOP:population ratio improved from 1:168,283 in 2002-2003 to 1:138,117 in 2012-2013 but still falls short of the ideal number. Both southern Indian states are able to meet the requirements for ophthalmologists and eyecare infrastructure as per the goals of VISION 2020. However, the number of MLOP falls short of the ideal ratio for the population. This study has some limitations. For example, most of the data collected through questionnaires were based on self-report, which might introduce bias due to memory recall or over or under-reporting of certain information. However, this was addressed by cross-checking the collected data with information from supplementary sources.

Assessment of the distribution of human and material resources for eye health in the public sector in Nampula, Mozambique

BackgroundThe unavailability of human and material resources can affect access to eye health services, constituting an obstacle in the fight against avoidable visual impairment. This study aimed to assess the availability and distribution of human and material resources for eye health in the public sector in Nampula province.MethodsA mixed method approach was used, which included document reviews (to extract information regarding the number of professionals and inhabitants in each district) and application of a questionnaire to heads of the ophthalmology department in each health facility (to obtain the list of available equipment). The ratios of eye health professionals per population in Nampula province and each of its districts were calculated and evaluated taking into account the recommendations of the World Health Organization (WHO). Based on the level of care of each health facility, the availability of equipment was evaluated.ResultsNampula Province has not reached the recommended ratio of eye health professionals per population in the different categories (ophthalmic technicians with 0.8 per 100 thousand inhabitants; optometrists and ophthalmologists with 0.4 and 0.2 per 250 thousand inhabitants, respectively). Most districts of Nampula did not reach the recommended ratio in the three categories of professionals, except Nampula City (provincial capital). However, there was a greater concentration of professionals and facilities with eye health services in the provincial capital. Primary and secondary level health facilities lacked some equipment to provide eye health services within their scope.ConclusionsThere is an unequal distribution of the workforce in Nampula and the centralization of surgical services at the Central Hospital of Nampula level. Therefore, there is a need to review resource distribution strategies and decentralization policy of eye health services in Nampula.

Optical aberrations following implantation of multifocal intraocular lenses: a systematic review and meta-analysis protocol

IntroductionMultifocal intraocular lens (IOLs) are used to restore vision at different focal distances. The technology of multifocal IOLs is continually advancing. Optical aberrations a property of lenses that causes spreading...

Screening of Diabetic Retinopathy Using Teleophthalmology to Complement Human Resources for Eye Health: A Systematic Review and Meta-Analysis.

Diabetic retinopathy is a vascular disease of the retina that affects patients with uncontrolled diabetes. Untreated diabetic retinopathy (DR) can eventually lead to blindness. To date, diabetic retinopathy is the third leading cause of vision loss in the working class globally. Frequent retinal screening for all diabetic people is an effective method of preventing diabetic retinopathy blindness. This has relied on the use of ophthalmologists, but due to scarce resources, such as a shortage of human resources for eye health, this has denied many patients quality eye health care in a resource-limited setting. The recent advances on the use of teleophthalmology are promising to close this gap. This study aimed to map available evidence on the use of teleophthalmology in the screening of DR globally and to explore how this can be used to complement short-staffed eye clinics, especially in resource-constrained contexts. Studies were sourced from Google Scholar, PubMed, Science Direct, and EBSCO host. The final study selection was presented using a PRISMA chart. The mixed method appraisal tool was used to assess the quality of the nine studies included. The random effect model was used to estimate pooled prevalence estimates. Levels of heterogeneity were evaluated using Cochran’s Q statistic and I2. Of nine included studies, eight were from high-income countries. The screening was performed at the primary healthcare level in eight of nine included studies. Only one study used a mydriatic agent, and the commonly used fundus camera was the non-mydriatic fundus camera. The overall estimated pooled prevalence of DR was 29 (95%CI: 10–34). Teleophthalmology at the primary health care level showed that early intervention in diabetic retinopathy reduced avoidable blindness and ensured remote access to eye health professionals, thus alleviating the burden on them.

Safe Contact Lens Practices during Coronavirus (COVID-19) Pandemic

World is threatened by different variants of Coronavirus to an extent that life has been jeopardized in all services including eye care facility. Contact lenses which are one of the preferred modes of vision correction are not an exception to COVID-19 infection. Recently there is confusion among practitioners and patients regarding the safety of contact lens use during COVID-19. This review article summarizes the current recommendations and findings regarding contact lens use during COVID-19. Though eye health professionals and contact lens users are at risk to contract Coronavirus, with proper care, maintenance and disinfection techniques, it would be safe to continue wearing contact lenses. There is currently no strong evidence to suggest that contact lenses are not safe to wear during COVID 19 times. Eye care practitioners responsible for contact lens application must wear special surgical masks, protective glasses or visors and disposable waterproof gloves. Regarding soft contact lenses, preferably daily disposable lenses should be used from the sterile packages. Similarly for rigid gas permeable lenses, lenses made up of fluoropolymer contained in sealed packages must be motivated for the individuals. Since the infected hands can bring the virus to the eyes, contact lens users should avoid touching the nose, mouth and eye unnecessarily. Contact lens after each use must be disinfected with hydrogen peroxide solutions with a special catalyst container. In the case of eye redness and Flu like symptoms, contact lens trial and wearing practices should be suspended or postpone till the condition becomes normal. To minimize the contact time between the patient and examiner soft copy of the instruction sheet, teleconsultation should be motivated. Though the eye is an unlikely site for Coronavirus infection, eye doctors should warn the contact lens wearers to follow scrupulous contact lens hygiene rules.

Barriers to Cataract Surgery Utilization Among Cataract Patients Attending Surgical Outreach Sites in Ethiopia: A Dual Center Study.

BackgroundCataract is the leading cause of avoidable blindness globally and in Africa. Various barriers limit access of cataract blind individuals to cataract surgery. This study aimed to determine the barriers to cataract surgery utilization among cataract blind patients presenting to campaign sites in Ethiopia.MethodsAn institution-based cross-sectional design study was conducted to select 209 patients. The study was conducted from July to August 2020. A structured questionnaire was used to collect socio-demographic data and barriers for not having cataract surgery. Physical examination such as visual acuity, slit lamp bio microscopy and direct ophthalmoscopy was done for all participants. Epi Info 7 was used for data entry and Statistical Package for Social Science/SPSS version 23 was used for analysis after data were exported. Descriptive methods were employed for analysis.ResultsA total of 209 subjects were recruited in the study with a mean age of 64.2 (±14.6) years, with a range of 32–99 years. From the total study subjects, 53% were males and 40.2% were over 66 years old. Upon presentation to the campaign site, 33% of study subjects had visual acuity of operable eye under blindness category and half of the study subjects (50.2%) had mature cataract. The most reported barriers were waiting until cataract becomes mature (18.7%), fear of surgery complications (16.7%), far from eye health institution (16.4%) and lack of income/cost for surgery (11.5%).ConclusionRecognizing the severity and the blindness burden of cataract in Ethiopia, creating public awareness, establishing eye health institutions, increasing the number of eye health professionals, increasing the quantity and the quality of cataract campaigns to alleviate these barriers are of paramount importance at the country level.

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.

Referral thresholds for an integrated learning disability eye care pathway: a consensus approach

IntroductionLocal Optometric Support Unit (LOCSU) have published their refreshed clinical pathway for eye care for people with a learning disability. The document sets out the adjustments to practice that a community optometrist might make in order to provide optimal care for a person with learning disability attending a primary eye care assessment. The pathway specifically points to the need to retain patients in primary care where appropriate and ‘reduce the number of people with learning disability who are inappropriately referred into the Hospital Eye Service (HES).’ Pivotal to this refreshed pathway is the integration with secondary care, with local arrangements to facilitate referral and hospital management where appropriate. There are few ophthalmologists nationally who frequently encounter patients with a learning disability in their hospital practice and knowing where to start when creating referral criteria or KPIs may create a barrier to services becoming established. In order to address this gap in experience, we set about developing a set of consensus statements regarding referral thresholds for ocular conditions commonly encountered in adults with learning disability.MethodA series of video interviews were undertaken with eye health professionals with a range of experience in eye care for people with learning disability. Each contributor commented on the usability and clarity of each element of the referral criteria. In addition, each contributor was asked to express the overriding principles by which they make decisions regarding referral thresholds for patients with learning disability. These were collated into the final document which was circulated and agreed by all participants.ResultsA table setting out referral thresholds for commonly encountered eye conditions in adults with learning disabilities is presented.ConclusionWe have presented a succinct set of consensus statements relating referral thresholds for common presentations of visual problems in adults with learning disability in the UK distilled from the collective experience of a group of eye health professionals. The intention was not to present a comprehensive review of management of each condition. Rather, the consensus statements may form the starting point from which each area could develop locally agreed criteria, as is suggested by the LOCSU pathway guidance.

Emerging Technologies to Solve the Key Issues in Endothelial Keratoplasty

Endothelial keratoplasty (EK) is increasingly used to treat corneal endothelial disease. However, issues remain with EK including a non-zero rejection rate, shortage of donor tissue, and technical challenges for Descemet’s membrane endothelial keratoplasty. Technologies that might solve these issues include small-molecule drugs, surgical innovations, cell therapy, tissue engineering, and gene therapy. Our purpose is to inform ophthalmologists, eye bankers, and eye health professionals of technologies that could impact practice in the near future. Recent advances are targeted at solving known issues with EK. Although none is yet routine, some are in clinical trials. Technologies that are closest to an ideal solution are those facing the highest regulatory and commercial hurdles. In the future, there will multiple options for the treatment of corneal endothelial cell failure. Which of these differing treatments will be used will depend on their efficacy as well as commercial, regulatory, and patient factors.

The cost and quality of life impact of glaucoma in Tanzania: An observational study.

To determine the cost and quality of life impact imposed by glaucoma in Tanzania, East Africa. An expert panel of eye health professionals was convened to agree current glaucoma practice in Tanzania. In addition a structured patient survey was developed and administered. Supplemental cost and quality of life information was collected using cost questionnaires and validated quality of life measures, including the EQ5D and VFQ-25. Key findings include following. Non-adherence is a major issue, especially in rural settings where over 50% of the patients may fail to return for review. Whilst medical therapy is overwhelmingly the first line treatment, the cost of maintaining this represents up to 25% of a patient's income. There is an impact of glaucoma on patients general well-being as determined by the EQ-5D and more tellingly on visual function with particular impact on role limitations as determined by the VF25. Despite our sample being taken in a private clinic and thus containing a much larger proportion of professionals than the general population, one third of the population earned Tanzanian Shillings (TZS) 170,000 per month which is below the minimum wage. These findings are of great importance for health care planners seeking to determine cost-effective, acceptable methods of both identifying and treating this major cause of preventable blindness.

Mapping Evidence on the Management of Diabetic Retinopathy Using Teleophthalmology to Complement Human Resources for Eye Health: A Scoping Review Protocol

INTRODUCTION: Diabetic Retinopathy is the leading cause of blindness in working adults, and remains a serious public health concern, globally. Whilst extensive research has been done in this area, the prevention of diabetic retinopathy is still very poor. Attributing factors in previous studies have included shortage of Human Resources for Eye Health in primary health centres, and a shortage of technology and skill in most countries. In some countries, teleophthalmology has been introduced to assist in the management of diabetic retinopathy by capacitating Eye Health professionals in primary health care settings since diabetes is diagnosed at this level. Where implemented, management of diabetic retinopathy through teleophthalmology has further contributed to reduction in preventable blindness while minimizing turnaround times as patients no longer have to wait for an Ophthalmologist appointment. The main objective of this scoping review is to map evidence on the use of teleophthalmology in the management of diabetic retinopathy globally.&#x0D; &#x0D; METHODS &amp;amp; ANALYSIS: Methodology will be guided by Arksey and O&amp;rsquo;Malley scoping review framework. We will search for literature from the following EBSCO Host databases: MEDLINE, Health source: Nursing/Academic Edition, Health source &amp;ndash; Consumer, CINAHL and Academic Search Complete. PubMed, Google Scholar and Science Direct will also be searched for studies. Where articles are not accessible online, the author will be contacted for the article, failing which the University of KwaZulu-Natal library services will be asked for assistance. The literature search will be done for the period from January 2014 to October 2019 where all studies in English will be accepted. After the initial search, title, abstract and full text screening will be conducted by two independent reviewers. To assess the methodological rigour of included studies, the Mixed Method Appraisal tool (MMAT) 2018 will be used. Study results will be presented using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) chart.&#x0D; &#x0D; DISCUSSION: It is anticipated that this scoping review will identify suitable literature on diabetic retinopathy and its management through teleophthalmology. The findings of this review will be disseminated through peer-reviewed journals and information summarized will be used to guide future research.

Systematic Review on the Epidemiology and Management of the Dry Eye Disease in Sub-Saharan Francophone Africa

Introduction: Dry Eye Disease (DED) is a multifactorial affection of the tears and the ocular surface. Its prevalence in the world varies between 7% and 33%. To the best of our knowledge, the prevalence of DED in Subsaharan Francophone African countries is not yet known. The objectives of this systematic review were to determine the prevalence of DED, to identify the main risk factors for DED, and to determine the diagnostic and therapeutic management of DED in Subsaharan Francophone African countries. Methodology: This is a systematic review of articles, dealing with DED, published in English or French language from 2010 to 2020. The following key words (Prevalence OR Incidence OR Proportion OR Rate OR Frequency OR Epidemiology OR Distribution) AND (Risk Factors OR Influences) AND (Symptoms or Questionnaire) AND (Clinical Signs OR Clinical Tests) AND (Dry Eye Disease OR Dry Eye Syndrome) AND (Pharmacological Treatment OR Non-pharmacological Treatment OR Management) AND (Benin OR Burkina Faso OR Burundi OR Cameroon OR Cap-Green OR Central African Republic OR Congo OR Congo (Democratic Republic of) OR Ivory Coast OR Gabon OR Guinea OR Guinea-Bissau OR Equatorial Guinea OR Mali OR Madagascar OR Mauritius (island) OR Niger OR Rwanda OR Sao Tome and Principe OR Senegal OR Seychelles OR Chad OR Togo) in French and English were searched on Pubmed, Chocrane database, Google scholar and ICTRP. Articles in English and French were selected from 2010 to 2020. Results: We selected 05 articles on the epidemiology and management of DED in sub-Saharan francophone Africa. The prevalence of DED in sub-Saharan francophone Africa in the articles ranged from 7.5% to 90.4%. DED affects more women than men. The risk factors found were: age over 50 years, diabetes, meibomian gland dysfunction, prolonged use of computers, and glaucomatous anti-glaucoma drugs. The Test of Breack Up Time (TBUT) was commonly used for the clinical diagnosis of dry eye disease in Sub-Saharan Francophone Africa. The therapeutic strategy for DED was not mentioned in any article. Conclusion: DED, a multifactorial and blinding eye disease, is insufficiently explored by eye health professionals in sub-Saharan Francophone Africa. The implementation of a systematic screening program and strategies for the treatment of dry eye disease in at-risk individuals would be beneficial for sub-Saharan Francophone African countries.

Knowledge and practices of eye health professionals about the availability and accessibility of child eye care services in the public sector in Swaziland

Background: International and African rights instruments stipulate that children have the right to access quality general and eye health care. Lack of access to quality eye care can have a significant negative impact on the child, family and society in general.Aim: To determine the knowledge and practices of eye care professionals about the availability and accessibility of child eye care services in the public sector in Swaziland.Setting: The study was conducted in Swaziland.Methods: This was a quantitative study design, and 15 public eye health professionals completed and returned the Questionnaire for Eye Health Professionals (QEHP).Results: Thirteen (86.7%) eye health practitioners reported that both standard practice guidelines and paediatric national guidelines for ophthalmic services were unavailable. The majority (66.7%) identified cost and unawareness of available services by parents as the most common barrier to accessing eye care services. Nine (60%) felt that they were less informed about eye health problems and 6 (40%) reported being well informed. Eight (53.3%) respondents indicated that there were no outreach programmes and 7 (46.7%) reported that their clinics offered these services. Thirteen (86.7%) eye health practitioners indicated that they were not part of teachers’ training for supporting visually impaired children, while 2 (13%) reported that they were.Conclusion: Formulation of guidelines to support eye health care service delivery in Swaziland is essential in order to improve availability, accessibility, affordability and effectiveness in the public health system.

A situational analysis of eye care services in Swaziland.

Compared to other African countries, Swaziland performs the worst in terms of providing eye health care services. A priority goal of the World Health Organization (WHO) is to alleviate childhood blindness, particularly in low-income countries such as Swaziland, where many people live in poverty, which is a contributor to poor health outcomes. A mixed method approach that entailed a document review, key informant interviews and clinical facility assessment questionnaires was used. Hospitals and mission clinics offering ophthalmic services were identified through the website of the Ministry of Health and verified during key informant interviews. A saturated sampling procedure was applied due to the few facilities that offer eye care services. Six framework components from the WHO for analysing health systems were utilised in an eye health care service context: leadership and governance, eye health services, eye health workforce, eye health financing systems, eye health medical supplies and technologies, and eye health information systems. Poor management, lack of accountability, poor monitoring and evaluation mechanisms, weak coordination and ineffective private-public sector regulations were identified as factors that lead to poor eye care in the country. The optometrists indicated that refractive services are the most rendered ophthalmic services. The exodus of healthcare practitioners has contributed to the downfall of the public health sector in the country. Five government eye care facilities, 3 government hospitals, 1 non-governmental organization (NGO) and a church mission clinic were included in this analysis. The eye services distribution favors the more affluent areas, particularly the more urban Hhohho Region, which is also where most of the eye health professionals are located. No campaigns have been conducted to prevent childhood blinding diseases or create awareness about getting children’s eyes tested for refractive correction. The burden of eye diseases among children in Swaziland remains unknown. More eye health care personnel and equipped facilities are needed throughout the country, and the eye health care program needs to be adopted.

Patient perspectives of cataract surgery: protocol and baseline findings of a cohort study

BackgroundPatient‐reported outcome measures (PROMs) are becoming increasingly recognised as a key component in assessing the relative effectiveness of cataract surgery. This manuscript presents the protocol methodology and baseline characteristics of a prospective cohort study investigating patient‐centred predictors of cataract surgery outcomes.MethodsPatients with bilateral cataract (aged ≥ 50 years) scheduled for their first eye cataract surgery were recruited at four public hospitals and three private ophthalmology clinics in Sydney, Australia. Participants underwent a comprehensive assessment of clinical measures of vision (for example, visual acuity, contrast sensitivity) and PROMs prior to first eye surgery and three months after first and second eye surgery. The PROMs of interest included health‐related quality of life, visual disability and satisfaction with vision.ResultsThe characteristics of the baseline cohort of 359 participants are reported in this manuscript. Enrolment occurred over a two‐year period with the majority recruited from urban public hospitals (96 per cent, n = 345). Health‐related quality of life was scored highly (80 out of 100). Self‐reported visual disability was considered within normal ranges compared to cataract populations in other high‐income countries (−0.94 logits). Three‐quarters of participants (n = 263/351) were dissatisfied with their pre‐operative vision.ConclusionsThere is a complex and wide range of patient‐centred experiences prior to first eye cataract surgery in the public hospital setting. Gaining further insight into the patient perspective may allow eye health professionals to more appropriately time surgery, better manage patient expectations and provide direction for future prioritisation initiatives of cataract wait lists. Companion papers will follow, detailing results of surgery in terms of PROMs.

A qualitative study on gender barriers to eye care access in Cambodia

BackgroundThe Fred Hollows Foundation (FHF) Cambodia recently partnered with the Ministry of Women’s Affairs (MoWA) and National Program for Eye Health (NPEH, part of the Ministry of Health) to establish the Gender Equality in Eye Health Project. As part of this project, a qualitative study was carried out to identify barriers affecting women’s access to eye health in Cambodia.MethodsA cross-sectional qualitative study was conducted in four provinces in both urban and rural locations between May and June 2015. Purposive sampling was used to identify respondents from a range of age groups, geographical locations, and experiences to explore different perceptions regarding access barriers to eye health care. Thirteen women experiencing eye problems (age range 45–84 years; mean age 63 years) and 25 eye health professionals took part in in-depth interviews. Eleven focus groups discussions were held with 69 participants (50 women, 19 married men) to capture the views and experiences of both younger and older women, as well as household decision makers’ perspectives.ResultsGender-based differences in decision-making, access and control over resources and women’s social status all contributed to impeding women’s access to eye health services. Women relied predominantly on informal sources of information about health, and these channels might be utilised to address barriers to information and access. Disparities in perceived costs of eye health treatment were evident between eye healthcare providers and users: costs were not perceived as a barrier by service providers due to health financing support for poor patients, however, many users were not aware of the availability of the scheme.ConclusionDemand-side and supply-side elements interact to reduce women’s ability to seek eye treatment.

Study on Current State of Continuing Education for Optician in Chungcheongnam-do

Purpose: The purpose of this study was to examine and analyze the current state of continuing education for opticians in Chungcheongnam-do and thereby provide baseline data needed for quality improvement of continuing education. Method: Three hundred fifty three opticians among 403 who were participated in continuing education at the branch of Chungcheongnam-do in 2017 responded to a survey. A total of 330 questionnaires excluding 23 containing negligent responses were used for the final analysis. Results: The number of males was 273 and that of females was 57, and average age was 43. The number of optical shop founders was 189 and those of employees was 141. The number of those willing to keep working at the current optical shop was 210, which is the highest number. There were significant differences in the experience of continuing education depending on gender, age, type of employment, marital status, career, and income level. Most optometrists received information in the continuing education from Korean Optometric Association, and they mostly participated in continuing education to avoid legal sanctions. They claimed that continuing education should provide state-of-the-art technology and product information more than anything else. Conclusion: Systematic continuing education management can prevent opticians from becoming uneducated attendee for long term and help to secure eye health professionals. In the future, it is necessary to constantly study on satisfaction and demands of educated attendees and make an effort to improve and develop continuing education programs.