National Eye Care Research Articles

Implementing teleophthalmology services to improve cost-effectiveness of the national eye care system

Background and purposeOptometrist-assisted and teleophthalmology-enabled referral pathway (OTRP) for community optometry referrals has the potential to improve the capacity and efficiency of eye care delivery systems through risk stratification and limiting the number of improved referrals. This study investigates the expected future costs and benefits of implementing OTRP under various possible organizational set-ups relevant to a Danish context.MethodsA decision-analytic model (decision tree) with a one-year time horizon was constructed to portray alternative future patient referral pathways for people examined in optometry stores for suspected ocular posterior segment eye disease. The main outcomes were total healthcare costs per patient, average waiting time from eye examination in store until the start of treatment or end of referral pathway, and quality-adjusted life-years (QALY) gained. The economic evaluation compares the general ophthalmologist referral pathway (GO-RP) with a potential reimbursement model for the optometrist-assisted teleophthalmology referral pathways (R-OTRP) and a procurement model for the optometrist-assisted teleophthalmology referral pathways (P-OTRP).ResultsThe cost per individual with suspected ocular posterior segment eye disease was estimated to be £116 for GO-RP and £75 and £94 for P-OTRP and R-OTRP respectively. The average waiting time for diagnosis or end of referral pathway was 25 weeks for GO-RP and 5.8 and 5.7 for P-OTPR and R-OTPR respectively. QALY gain was 0.15 for P-OTRP/R-OTRP compared to 0.06 for GO-RP.ConclusionOTRP is effective in reducing unnecessary referrals and waiting times, increasing patients’ HRQoL, and decreasing the costs of diagnosing individuals with suspected ocular posterior segment eye disease.

Barriers of High Cataract Surgery Rate in Rural Area of Barisal Division

Background: Cataract is the leading cause of preventable blindness in the world. the most important component of vision 2020 to eliminate the cataract related blindness as a signatory of vision 2020 programme the government of Bangladesh takes many effective steps to increase cataract surgery rate CSR through national eye care operation plan but still there are some obstacles that desisted the rural people to undergo surgery for cataract Aim of the study: To find out the reasons for the low cataract surgery rate among the cataract patients in rural area of Barisal division. Methodology: This cross-sectional study was conducted on the District Sadar Hospital, Jhalkathi from January 2016 to December 2016 over 200 patients out of 500 cataract patients who are selected for cataract surgery but did not under one the procedures finally not the medical ground. The causes of unwilling to undergo surgery was asked about by personal discussion through a structured questionnaire. All the relevant information was recorded in the data collection sheet and were analyzed and displayed for dissemination. Result: Out of 200 patients 91 patients did not undergo surgery due to fear about the surgical procedure, which followed by 43 patients who abstained from surgery due to fear of become total blind after surgery, 41 patients did not undergo surgery for not to bear the relevant expenditure the other reasons are no care giver for post-operative care and fear of complications (as experienced by persons, previously underwent surgery) which refrained 14 and 11 patients respectively from surgery. Conclusion: To increase the cataract surgery rate (CSR) in rural area among the under privileged people to achieve the goal of VISION 2020, it is necessary to conduct awareness program as well base hospitals should be equipped with effective instruments and skilled manpower. J.Natl.Inst.Ophthalmol.2023;6(1): 32-36

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.

Utilising the Orthoptic Skill Set to Improve Access to Eye Care for Adults with Severe/Profound Learning Disabilities-A Service Evaluation.

Intro:There is a wealth of research evidencing the high incidence of visual impairment (VI) and poor uptake of eye care services by adults with learning disabilities (LD). Despite this, very few authorities within England currently provide the additional support required by those with severe/profound LD (S/PLD).Method:By means of an initial funded pilot study, an unmet need was evidenced locally and a small service established to improve access to eye care for adults with S/PLD. Operational since 2007, this service has provided evidence to support the campaign for a nationally funded eye care pathway.This service evaluation outlines the initial service set up, aims and objectives, and provides an analysis of the current service by means of a detailed breakdown of service-user outcomes during a sample 5-year period.Results:Orthoptic home visits (OHV) revealed high levels of strabismus (54.4%), refractive error (43.3%), cataracts (23.3%), and many other ophthalmic conditions (29%). Over a quarter of the adults with LD (26.6%) were certified as VI and 61% of people were provided with tailored strategies, the majority of which were for visual processing difficulties.Conclusion:The prospect of a nationally funded eye care pathway for adults with LD in England is now a real possibility. This service model has identified a clearly defined unmet need and illustrates the unique skill set orthoptists can offer to address this health inequality. Requiring minimal financial outlay and flexible enough to be integrated into any future national eye care framework, this service has ensured that access to eye care is truly equitable for all people with LD.

Danish teleophthalmology platform reduces optometry referrals into the national eye care system

ObjectiveThe purpose of this study was to evaluate the stratification of follow-up and referral pathways after implementation of a systematic cloud-based electronic-referral teleophthalmological service for optometry-initiated ocular posterior segment disease...

Prevalence of undiagnosed, preventable visual impairment in children with intellectual disability in special needs schools in Western Saudi Arab

Background: Visual disorders have been reported to be higher among children with intellectual disability (ID) than among their peers without special needs; however, prevalence data on visual problems in children in Saudi Arabia are scarce. Aims: The aim of this study is to report the prevalence and causes of undiagnosed, correctable visual impairment in children with ID. Materials and Methods: A cross-sectional study of students enrolled in special educational needs schools in the western region of Saudi Arabia in April 2018. Teller visual acuity (VA) assessment and refractive errors were noted. Participants with mild to profound ID underwent detailed ophthalmologic examinations, including cycloplegic refraction, full orthoptic workup, biomicroscopy, and funduscopy. Results: A total of 61 students participated in this study. Ocular findings in decreasing prevalence were as follows: Subnormal VA (n = 41, 67.2%), refractive errors (n = 31, 51.7%), fundus anomalies (n = 13, 22%), significant strabismus (n = 9, 14.8%), abnormal head posture (n = 8, 13.3%), nystagmus (n = 3, 4.9%), anterior segment abnormality (n = 3, 4.9%), and extraocular motility abnormality (n = 2, 3.3%). Astigmatism was found in 22 cases (36.7%), followed by hyperopia (n = 13, 21.7%), myopia (n = 10, 16.7%), and anisometropia (n = 5, 8.3%). Students with syndromic ID had significantly more moderate-to-severe subnormal VA (P < 0.001) and myopic shift on cycloplegic refraction (P = 0.014 right eyes and P = 0.004 left eyes) than those with nonsyndromic ID. Conclusions: A considerable proportion of ID children have significant visual disorders. This emphasizes the need for adequate diagnostic and therapeutic national eye care services for children with ID.

Risk factors for self-reported cataract symptoms, diagnosis, and surgery uptake among older adults in India: Findings from the WHO SAGE data

ABSTRACT Visual impairments have a substantial impact on the well-being of older people, but their impact among older adults in low- and middle-income countries is under-researched. We examined risk factors for self-reported cataract symptoms, diagnosis, and surgery uptake in India. Cross-sectional data from the nationally representative WHO SAGE data (2007–2008) for India were analysed. We focused on a sub-sample of 6558 adults aged 50+, applying descriptive statistics and logistic regression. Nearly 1-in-5 respondents self-reported diagnosed cataracts, more than three-fifths (62%; n = 3879) reported cataract symptoms, and over half (51.8%) underwent surgery. Increasing age, self-reported diabetes, arthritis, low visual acuity, and moderate or severe vision problems were factors associated with self-reported diagnosed cataracts. Odds of cataract symptoms were higher with increasing age and among those with self-reported arthritis, depressive symptoms, low visual acuity, and with moderate or severe vision problems. Odds of cataract surgery were also higher with increasing age, self-reported diabetes, depressive symptoms, and among those with low visual acuity. A public health approach of behavioural modification, well-structured national outreach eye care services, and inclusion of local basic eye care services are recommended.

Towards The Reduction of The National Impact of Blindness Due to Glaucoma- A National Glaucoma Summit

Glaucoma is a serious condition that involves elevation in pressure inside the eye caused by build-up of excess fluid. Though there are several varieties of the disease that do not show elevation of pressure inside the eyes, generally, glaucoma in whatever form, if left untreated would lead to impairment in vision by causing irreversible damage to the optic nerve and eventually blindness. Between 2005 and 2007 the National Programme for the Prevention of Blindness (NPPB), now known as National Eye Care Programme, in collaboration with states, local government and FCT embarked on National Blindness and low vision survey. The survey revealed that glaucoma, an unavoidable cause of blindness constitutes 16% of all blindness in the country. There are global initiatives that work to eradicate blindness in National communities in the developed and developing world. The major one being the Vision 2020 - the right to sight. Nigeria endorsed the initiative. This initiative is complacent on glaucoma as it is unavoidable, incurable and not within the targeted disease conditions of vision 2020. Elimination of blindness due to glaucoma in our communities, therefore calls for a National action. This paper is an advocacy for a National Summit on Glaucoma that would produce a National Glaucoma Eradication document; implementation of which would lead to reduction and elimination of the National impact of blindness due to glaucoma.

A comparative analysis on human resources among the specialized ophthalmic medical institutions in China

BackgroundThis study compares perspectives on specialized ophthalmic medical institutions, identifies the gaps in property and geographic offerings, and explores the ways that ophthalmic medical institutions can better allocate resources. The results of this research will increase patient’s access to equitable and high-quality ophthalmic care in China.MethodsThe data for this research was gathered from the Survey of China National Eye Care Capacity and Resource for the year 2015. The paper specified the number, professional level of expertise, and educational background of ophthalmic health personnel. The authors of the paper analyzed and compared the differences in ophthalmic care in public vs. private and urban vs. rural regions in China. Descriptive statistics were used.ResultsOf the 395 specialized ophthalmic hospitals surveyed, 332 were private medical institutions (84%), and 63 were public (16%). Of the 26 607 ophthalmic personnel surveyed, working in specialized ophthalmic hospitals, 17 561 were in private hospitals (66%) and 9 046 were in public ones (34%). Furthermore, 22 578 of those personnel worked in urban ophthalmic institutions (85%) and 4 029 worked in rural ones (15%). As for regional differences, 14 090 personnel were located in eastern China (53%), 8 828 in central regions (33%), and 3 689 in the western regions (14%).ConclusionsPublic ophthalmic medical institutions still face challenges in providing equitable and widespread care. The availability of well-staffed health centers varies significantly by region. These variations impact resource allocation and directly lead to inequalities and inaccessibility of health services in certain regions of China.

Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph–Based Diabetic Retinopathy Screening Program in Bangladesh

Diabetic retinopathy (DR) is the leading cause of low vision among working-age adults. An estimated 6.9 million people in Bangladesh were living with diabetes in 2017, which is projected to increase to more than 10 million people in 2025. Currently, no standardized and/or large-scale DR screening program exists in Bangladesh. To develop a novel fundus photograph-based eye screening model for early detection of DR to prevent vision loss in Bangladeshi individuals with diabetes. In this cross-sectional study, 49 264 patients with diabetes underwent opportunistic eye screening at 2 eye hospitals and 1 diabetic hospital in Bangladesh between June 1, 2010, and September 30, 2017. The data set was analyzed from April 8 to December 30, 2018. Technicians were trained to obtain 2-field digital fundus photographs and to grade each according to a standardized DR severity scale. Each patient was counseled and triaged for treatment using defined DR referral criteria. Primary DR grading outcomes, visual acuity, and treatment outcomes. A total of 49 264 patients (54.3% male; mean [SD] age, 50.8 [12.3] years) underwent DR screening during a 7-year period. The DR prevalence rate across all 3 sites was 33% (95% CI, 33%-33%). Prevalence rates varied by center (Chittagong, 64.6% [95% CI, 64.0%-65.0%]; Dhaka, 39.8% [95% CI, 39.0%-41.0%]; and Feni, 13.0% [95% CI, 13.0%-14.0%]). Across all age groups, male patients were at higher risk of prevalent DR than female patients (odds ratio, 1.99; 95% CI, 1.90-2.07). The prevalence was 3.9% for preproliferative DR, 7.8% for proliferative DR, and 19.2% for maculopathy. Individuals with DR had significantly worse visual acuity than those with no DR (best-corrected visual acuity, 0.35 vs 0.21 logMAR; P < .001). The rate of moderate visual impairment was 12.2%, and the rate of blindness was 2.5%. Primary treatments included laser photocoagulation (n = 1637), intravitreal injection (n = 1440), and vitrectomy (n = 309). Screening Bangladeshi individuals known to have diabetes using fundus photography identified large numbers of patients with sight-threatening proliferative DR, maculopathy, and visual impairment or blindness. Expansion of eye screening services in Bangladesh is warranted as part of a national government eye care and diabetes health policy.

Inequity in Access: Cataract Surgery Throughput of Chinese Ophthalmologists from the China National Eye Care Capacity and Resource Survey

ABSTRACTPurpose: To investigate the distribution of cataract surgery performed by ophthalmologists in China.Methods: A cross-sectional study was designed to investigate nationwide ophthalmological resources and capacity for cataract surgery in China⁠—The 2014 China National Eye Care Capacity and Resource Survey. Data analyzed in this report included regional distribution, urban-rural comparison, levels and types of medical institutions, and cataract surgery types and volume per surgeon. In China, only ophthalmologists at or above the level of attending are eligible to perform cataract surgery independently, so the ability of cataract surgery for ophthalmologists at or above the level of attending is analyzed in the current study. Descriptive statistics were used.Results: 36,333 ophthalmologists were included in this survey, which is an average of 1.33 ophthalmologists to every 50,000 population. Of the surgeons in this survey, 23,412 (50.22%) were attending or more senior ophthalmologists and were mainly distributed in eastern urban areas. Annual average cataract surgeries per ophthalmologist in China were 259 in 2017, less than 300 cases.Conclusion: The average number of ophthalmologists per population in China has achieved the goal of WHO’s Vision 2020; however, these surgeons are concentrated in urban areas. Further, the ability of cataract surgery among ophthalmologists is unbalanced. The annual average cataract surgeries performed by ophthalmologists are insufficient, which is an important factor resulting in the current situation in China that ophthalmic service capacity has not met the requirements for eliminating cataract blindness.

Process evaluation of a National Primary Eye Care Programme in Rwanda

BackgroundVisual impairment is a global public health problem, with an estimated 285 million affected globally, of which 43% are due to refractive error. A lack of specialist eye care in low and middle-income countries indicates a new model of care would support a task-shifting model and address this urgent need. We describe the features and results of the process evaluation of a national primary eye care (PEC) programme in Rwanda.MethodsWe used the Medical Research Council process evaluation framework to examine the implementation of the PEC programme, and to determine enablers and challenges to implementation. The process evaluation uses a mixed methods approach, drawing on results from several sources including a survey of 574 attendees at 50 PEC clinics, structured clinical observations of 30 PEC nurses, in-depth interviews with 19 key stakeholders, documentary review and a participatory process evaluation workshop with key stakeholders to review collated evidence and contextualize the results.ResultsStructured clinical assessment indicated that the PEC provided is consistent with the PEC curriculum, with over 90% of the clinical examination processes conducted correctly. In 4 years, programme monitoring data showed that nearly a million PEC eye examinations had been conducted in every health centre in Rwanda, with 2707 nurses trained. The development of the eye health system was an important enabler in the implementation of PEC, where political support allowed key developments such as inclusion of eye-drops on the essential medicines list, the inclusion of PEC on insurance benefits, the integration of PEC indicators on the health management information systems and integration of the PEC curriculum into the general nursing school curriculum. Challenges included high turnover of primary care nurses, lack of clarity and communication on the future funding of the programme, competing priorities for the health sector and sustained supervision to assure quality of care.ConclusionsA model of a national primary eye care programme is presented, with service delivery to all areas in Rwanda. Key learning from this evaluation is the importance of strengthening the eye health care system, together with a strong focus on training primary care nurses using a PEC curriculum.

Population-based prevalence survey of follicular trachoma and trachomatous trichiasis in the Casamance region of Senegal

BackgroundTrachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. We conducted the first population-based trachoma prevalence survey in the Casamance region of Senegal to enable the Senegalese National Eye Care Programme (NECP) to plan its trachoma control activities. The World Health Organization (WHO) guidelines state that any individual with trachomatous trichiasis (TT) should be offered surgery, but that surgery should be prioritised where the prevalence is >0.1%, and that districts and communities with a trachomatous inflammation, follicular (TF) prevalence of ≥10% in 1–9 year-olds should receive mass antibiotic treatment annually for a minimum of three years, along with hygiene promotion and environmental improvement, before re-assessing the prevalence to determine whether treatment can be discontinued (when TF prevalence in 1–9 year-olds falls <5%).MethodsLocal healthcare workers conducted a population-based household survey in four districts of the Bignona Department of Casamance region to estimate the prevalence of TF in 1–9 year-olds, and TT in ≥15 year-olds. Children’s facial cleanliness (ocular and/or nasal discharge, dirt on the face, flies on the face) was measured at time of examination. Risk factor questionnaires were completed at the household level.ResultsSixty communities participated with a total censused population of 5580 individuals. The cluster-, age- and sex-adjusted estimated prevalence of TF in 1–9 year-olds was 2.5% (95% Confidence Interval (CI) 1.8–3.6) (38/1425) at the regional level and <5% in all districts, although the upper 95%CI exceeded 5% in all but one district. The prevalence of TT in those aged ≥15 years was estimated to be 1.4% (95%CI 1.0–1.9) (40/2744) at the regional level and >1% in all districts.ConclusionWith a prevalence <5%, TF does not appear to be a significant public health problem in this region. However, TF monitoring and surveillance at sub-district level will be required to ensure that elimination targets are sustained and that TF does not re-emerge as a public health problem. TT surgery remains the priority for trachoma elimination efforts in the region, with an estimated 1819 TT surgeries to conduct.

Cataract Surgical Uptake Among Older Adults in Ghana.

In sub-Saharan Africa, cataract surgical services are highly inadequate and surgical uptake for cataract is low. This paper describes cataract surgical uptake among older adults in Ghana. This work was based on World Health Organization's multi-country Study on global Ageing and adult health (SAGE), conducted in six countries including Ghana. Wave one of SAGE in Ghana was conducted in 2007-2008 as collaboration between WHO and Department of Community Health, University of Ghana Medical School. A nationally representative sample of 5571 older adults (≥50 years) and a small sample of persons 18-49 years were interviewed. Data was obtained on uptake of cataract surgery in older adults and analyzed using descriptive measures and chi square for associations in categorical outcome measures. Overall surgical uptake was 48.9% among older adults and was slightly higher among older men (49.1%) than women (48%). Cataract surgical uptake was relatively higher in the 60-69 years group (55%), urban residents (52.6%) and those living without partners (50%). Educational and income levels of older persons did not affect cataract surgical uptake. Regional differences in cataract surgical uptake existed; was less than 60% in all ten regions (except one), and the two regions with most self-reported cataracts (Ashanti and Greater Accra) had less than 50% uptake. Intensive public education, engagement of community groups and increased access to cataract surgery at health facilities and outreach services need consideration at national/sub-national levels. Further investigations to garner equity in national eye care efforts are recommended.

Self-reported cataracts in older adults in Ghana: sociodemographic and health related factors.

BackgroundChanges in function of sensory organs with increasing age have significant impact on health and wellbeing of older persons. This paper describes cataract, a chronic eye condition, self-reported among older adults in Ghana and the need for improving access to eye care services.MethodsThis work was based on the World Health Organization’s multi-country Study on global AGEing and adult health (SAGE), conducted in six countries including Ghana. SAGE Wave 1 in Ghana was conducted in 2007–2008 in a nationally representative sample of 4278 older adults, ≥ 50 years. Data were obtained on sociodemographic and health factors related to self-reported cataracts in older persons in Ghana. Data were analysed using descriptive measures (frequencies and proportions), chi-square test for associations in categorical outcome measures, and logistic regression for predictors of cataracts with SPSS version 21.ResultsOverall prevalence of self-reported cataracts among 4278 older adults in Ghana was 5.4%. Prevalence was proportionately higher for women (5.9%) than men (4.7%). Reported cataracts increased with age, among urban residents, in older adults living without partners and among those with the worse life satisfaction index. Older adults in lower income groups, poorly educated or living alone had difficulty seeking vision care services. Prevalence was 8.4% among persons with diabetes, 10.4% among hypertensives and 11.4% in persons with previous history of stroke. Among older persons who had ever used alcohol or tobacco, prevalence rates of reported cataracts were 5.7% and 4.9%, respectively. Logistic regression analysis indicated that increasing age, lower income status and self-reported hypertension were significantly associated with cataract among older adults in Ghana.ConclusionsCataract is prevalent in older people in Ghana with approximately 1 in 20 people aged 50 years or older reporting a previous diagnosis of cataract. As cataract surgery is restorative, a public health approach on behavioural modification, well structured national outreach eye care services (for rural residents), inclusion of basic eye health services at sub-district levels, increased family support and national health insurance for older persons is indicated.

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

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

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

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

Evaluation of the National Eye Care Coordination Programme in Zambia

In 2008, an evaluation of the National Eye Care Coordination programme in Zambia was undertaken, after just over 1 year of its existence. The evaluation was undertaken to assess the performance of the programme since it was created as a stand-alone project from its previous operation in the integrated system. Integrating health services has become a common term especially in developing countries where it is believed that bundling together of resources (financial and human resources) is more effective and resource conserving. The evaluation, of the Eye Care Programme in Zambia after turning it into a stand-alone programme shows results that can be compared to the time it was in an integrated system.

Perspective on ophthalmic support in countries of the developing world

There are over 300 million people living in the world today who are visually impaired and a further 45 million who are blind. The large majority (90%) of these people live in developing countries, and up to 75% of blindness are avoidable. With cataracts being the major cause of blindness and visual impairment, many ophthalmic aid programmes are aimed at alleviating the enormous burden caused by this readily treatable disease. Having said that, caution should be exercised that short surgical visits to remote rural areas that are not coordinated with local national eye care managers should be discouraged because they do little for the development of sustainable eye care programmes. With this in view, it has become imperative to design blindness prevention and ophthalmic support programmes that are workable, comprehensive, economical and sustainable.

Refractive Errors in the Adult Pakistani Population: The National Blindness and Visual Impairment Survey

Purpose: To determine the prevalence of refractive error (RE) and spectacle wear and to explore the need for spectacle correction in adults (30 years or older) in Pakistan. Methods: Multi-stage, cluster random sampling national survey. Each subject had their medical history taken, visual acuity measured, and underwent autorefraction, biometry and fundus examination. Those that presented with visual acuity of less than 6/12 in either eye underwent more detailed examination, including corrected distance visual acuity measurement (autorefraction results placed in a trial lens frame). Myopia was defined as a spherical equivalent of worse than –0.5D, hypermetropia as greater than +0.5D, and astigmatism as greater than 0.75D. Spectacle need (i.e., those that improved from unaided VA with spectacle correction) was determined along with the spectacle coverage, defined as the proportion of need that was met (by the participant's own spectacles). Results: The crude prevalence of myopia, hypermetropia and astigmatism was 36.5%, 27.1%, and 37%, respectively. The prevalence of spectacle wear in phakic participants was 4.0%, significantly lower than for those who were pseudo/aphakic (41.7%). Just over a quarter (25.8%) of spectacle wearers presenting with visual impairment (< 6/12) were able to improve their vision when retested with their autorefraction prescription. The overall spectacle coverage (6/12 cutoff) was 15.1%. Conclusions: This survey provides the first reliable national estimates. RE services are not covering the majority of the population in need and the provision of spectacle correction, as a highly cost effective treatment for visual impairment, needs addressing within the country's national eye care program.