Rapid Assessment Of Avoidable Blindness Research Articles

Assessment of eye health programme reach by comparison with rapid assessment of avoidable blindness (RAAB) survey data, Talagang, Pakistan

BackgroundThe purpose of this study was to quantify how much of the burden of visual impairment (VI) and unmet need in Talagang, identified by Rapid Assessment of Avoidable Blindness (RAAB) survey data, has been addressed by Community Eye Health (CEH) programme efforts.MethodsA RAAB survey was carried out in November 2018, with 2,824 participants in Talagang Tehsil, Punjab, Pakistan, aged 50 and over. Census data were used to extrapolate survey data to the population. Alongside this, a CEH programme was launched, consisting of community eye screening, and onward referral to rural health centres, secondary or tertiary ophthalmological services, as required. This health intervention aimed to address the eye care needs surfaced by the initial survey. From 2018 to 2022, 30,383 people aged 50 or over were screened; 14,054 needed referral to further steps of the treatment pathway and more detailed data collection. Programme data were compared to estimates of population unmet needs. Main outcome measures were prevalence of VI, and proportion of need met by CEH Programme, by cause and level of VI.ResultsAmong those aged 50 and over, 51.0% had VI in at least one eye. The leading causes were cataract (46.2%) and uncorrected refractive error (URE) (25.0%). In its first four years, the programme reached an estimated 18.3% of the unmet need from cataract, and 21.1% of URE, equally in both men and women.ConclusionsRobustly collected survey and programme data can improve eye health planning, monitoring and evaluation, address inequities, and quantify the resources required for improving eye health. This study quantifies the time required to reach eye health needs at the community level.

Rapid assessment of avoidable blindness (RAAB): A 15-year follow-up in Gegharkunik province of Armenia

PurposeThis study assessed the changes in the prevalence of visual impairment (VI)/blindness, cataract surgical coverage (CSC), visual outcome after cataract surgery, and main barriers to cataract surgery among the population aged 50 years and older in Gegharkunik province of Armenia from 2003 - 4 to 2019. DesignA cross-sectional study. MethodsA multi-stage cluster sampling technique was used to conduct Rapid Assessment of Cataract Surgical Services (RACSS) and Rapid Assessment of Avoidable Blindness (RAAB) surveys in 2003–4 and 2019, respectively. Overall, 56 clusters (40 people in each cluster) were selected for RACSS, and 24 clusters (50 people in each cluster) for RAAB. Both surveys collected data on participants’ demographics, presenting/pinhole visual acuity (PVA/PinVA), the principal cause of VI, CSC, and barriers to cataract surgery. ResultsOverall, 1,787 people participated in RACSS and 1,099 people in RAAB. Between 2003–4 and 2019, age- and sex-adjusted prevalence of bilateral blindness decreased from 2.0 % to 1.4 % while severe VI decreased from 5.2 % to 2.2 % and moderate VI from 16.0 % to 7.3 %. Untreated cataract contributed to 71.9 % and 40.9 % of all blindness cases in 2003–4 and 2019, respectively. The CSC at the threshold <6/18 improved from 23.7 % in 2003–4 to 64.8 % in 2019. Both surveys mentioned the cost as the most common barrier to cataract surgery. ConclusionDespite substantial improvements, cataract remained the main cause of blindness in the province. Increasing financial coverage of cataract surgeries and improving the quality of surgeries could increase their utilization of services and help improve visual outcomes in the population.

The Rapid Assessment of Avoidable Blindness survey: Review of the methodology and protocol for the seventh version (RAAB7).

The Rapid Assessment of Avoidable Blindness (RAAB) is a population-based cross-sectional survey methodology used to collect data on the prevalence of vision impairment and its causes and eye care service indicators among the population 50 years and older. RAAB has been used for over 20 years with modifications to the protocol over time reflected in changing version numbers; this paper describes the latest version of the methodology-RAAB7. RAAB7 is a collaborative project between the International Centre for Eye Health and Peek Vision with guidance from a steering group of global eye health stakeholders. We have fully digitised RAAB, allowing for fast, accurate and secure data collection. A bespoke Android mobile application automatically synchronises data to a secure Amazon Web Services virtual private cloud when devices are online so users can monitor data collection in real-time. Vision is screened using Peek Vision's digital visual acuity test for mobile devices and uncorrected, corrected and pinhole visual acuity are collected. An optional module on Disability is available. We have rebuilt the RAAB data repository as the end point of RAAB7's digital data workflow, including a front-end website to access the past 20 years of RAAB surveys worldwide. This website ( https://www.raab.world) hosts open access RAAB data to support the advocacy and research efforts of the global eye health community. Active research sub-projects are finalising three new components in 2024-2025: 1) Near vision screening to address data gaps on near vision impairment and effective refractive error coverage; 2) an optional Health Economics module to assess the affordability of eye care services and productivity losses associated with vision impairment; 3) an optional Health Systems data collection module to support RAAB's primary aim to inform eye health service planning by supporting users to integrate eye care facility data with population data.

SICS as a procedure for cataract with severe corneal scar: a case report

Introduction : Cataracts are the most common cause of visual impairment and blindness in Indonesia, according to the Rapid Assessment of Avoidable Blindness (RAAB) survey, which is around 70-80% of patients. Meanwhile, corneal disorders are the second cause of blindness after cataract in the world. Incidence of corneal scar in patients with cataracts can exacerbate visual disturbances to cause blindness and require special treatment.&#x0D; Case Illustration : A 75 years old woman with blurry eyes since 1 year ago. Acuity of the right eye (OD) was 1/300 and the left eye (OS) was 1/300. Extensive and severe scars were found on the corneas of both eyes. Lens opacities were found in the anterior eye segment. Patient was diagnosed with ODS mature senile cataract and ODS corneal scar. Surgical treatment was carried out using the small-incision cataract surgery (SICS) method, IOL inserted and iridectomy.&#x0D; Discussion : Mature cataract patients with advanced age tend to have a denser and harder lens. Cataract extraction performed by phacoemulsification procedure in very dense and hard cataracts requires higher ultrasound energy settings thereby increasing the risk of corneal endothelial trauma and burns which will exacerbate corneal scarring in patients. SICS is a better treatment compared to phacoemulsification in patients with complex situations such as corneal scarring in dense and hard cataracts with minimal surgical complications and optimal results. Iridectomy in cataract surgery can be performed if iris prolapse occurs due to high pressure from the posterior segment of the eye.&#x0D; Conclusion : The SICS procedure shows good results for cataract patients with severe corneal scars

SCREENING ON CATARACT APPLICATION (SERIOC)

Introduction &amp; Objectives : West Nusa Tenggara is a province that has the second highest prevalence of blindness at the national level according to the results of the 2014 Rapid Assessment of Avoidable Blindness (RAAB) survey. During the covid-19 period the offline cataract screening is not permitted, as a result it’s difficult to reach underprivileged and isolated areas, also people with disabilities. In 2021 West Nusa Tenggara Eye Hospital launched a smartphone-based eye health examination application Screening On Cataract namely SERIOC, while still paying attention to service standards clinically and in management. SERIOC can be used by public health as the nearest public health facility.&#x0D; Methods : The waterfall method is used in the development of this application, The waterfall methodology is a project management approach that emphasizes a linear progression from beginning to end of a project. This methodology, is front-loaded to rely on careful planning, detailed documentation, and consecutive execution.&#x0D; Results : SERIOC has successfully screened 2,713 patients from 2021 with 2117 patients diagnosed cataract and 593 patients diagnosed non-cataract whose data is centralized and directly connected to an ophthalmologist at the West Nusa Tenggara Eye Hospital. Patients diagnosed with cataracts will be referred to the hospital for further action.&#x0D; Conclusion : Based on the information above, it can be concluded that SERIOC application in eye health screening is very effective and efficient method to avoid blindness on West Nusa Tenggara.

Prevalence and causes of blindness and visual impairment in Kogi state, Nigeria-Findings from a Rapid assessment of avoidable blindness survey.

To determine the prevalence and causes of blindness and visual impairment among adults in Kogi, Nigeria. A Rapid assessment of avoidable blindness (RAAB) protocol was used with additional tools measuring disability and household wealth to measure the prevalence of blindness and visual impairment (VI) and associations with sex, disability, wealth, cataract surgical coverage and its effectiveness. Age- and sex-adjusted all-cause prevalence of bilateral blindness was 3.6% (95%CI 3.0-4.2%), prevalence of blindness among people living with additional, non-visual disabilities was 38.3% (95% CI 29.0-48.6%) compared to 1.6% (95%CI 1.2-2.1%; [Formula: see text] = 771.9, p<0.001) among people without additional disabilities. Cataract was the principal cause of bilateral blindness (55.3%). Cataract surgical coverage (CSC) at visual acuity (VA) 3/60 was 48.0%, higher among men than women (53.7% vs 40.3%); 12.0% among people with non-visual disabilities; 66.9% among people without non-visual disabilities, being higher among people in the wealthiest two quintiles (41.1%) compared to the lowest three (24.3%). Effective Cataract Surgical Coverage at Visual Acuity 6/60 was 31.0%, higher among males (34.9%) than females (25.5%), low among people with additional, non-visual disabilities (1.9%) compared to people with no additional disabilities (46.2%). Effective CDC was higher among people in the wealthiest two quintiles (411%) compared to the poorest three (24.3%). Good surgical outcome (VA>6/18) was seen in 61 eyes (52.6%) increasing to 71 (61.2%) eyes with best correction. Cost was identified as the main barrier to surgery. Findings suggest there exists inequalities in eye care with women, poorer people and people with disabilities having a lower Cataract Surgical Coverage, thereby, underscoring the importance of eye care programs to address these inequalities.

The second rapid assessment of avoidable blindness survey in Palestine: A national cross‐sectional study

Aim: To assess prevalence and main causes of blindness, vision impairment and cataract surgical coverage in Palestinians aged 50 years and older.Methods: The survey was part of a larger population‐based survey using the rapid assessment of avoidable blindness (RAAB) methodology to estimate prevalence of vision impairment, blindness and disability in individuals aged 50 years and older in Palestine. It was a nationally representative, cross‐sectional, population‐based survey in Gaza Strip and West Bank. A sample size of 4224 participants aged 50 years and older was determined in 69 clusters in the West Bank and 52 clusters in the Gaza Strip. Within each cluster, 35 people aged 50 years or older were examined in their homes.Results: The total examined was 3848. Adjusted prevalence of blindness was 2.6%. This is a non‐significant decrease from 3.4% in 2008. The prevalence of blindness in Gaza (4.0%) was higher than the prevalence of blindness in the West Bank (1.8%). The prevalence was higher among females than males.Adjusted prevalence of severe vision impairment, moderate vision impairment and mild vision impairment was 1.4%, 10.2% and 11.6%, respectively. Principal cause of blindness, severe and moderate vision impairment was untreated cataract followed by diabetic retinopathy. Refractive error was the principal cause of mild vision impairment. More than 80% of vision impairment was avoidable.Unmet need for cataract surgery varied from 0.9% among blind participants to 6.5% among participants with mild vision impairment. Effective cataract surgical coverage was low in general and varied from 42.4% among blind operated participants to 25.9% among participants with mild vision impairment.Conclusions: Around 80% of vision impairment was avoidable. Untreated cataract and diabetic retinopathy were the main causes of blindness, severe and moderate vision impairment. Refractive error was the principal cause of mild vision impairment. Effective cataract surgical coverage was low.

Posterior capsule opacification assessment of need and outcome of Nd-YAG laser capsulotomy: a follow up of rapid assessment of avoidable blindness in a district in central India

Background: Current study highlights the burden of PCO related blindness, need of Nd YAG laser in rural set up and positive and negative outcomes of Nd-YAG laser capulotomy in treating PCO. Methods: This study was conducted in 2020 at the department of ophthalmology at a medical college in central india. A total 53 such eyes were studied. Results: A 408 individuals were included with pseudophakia in one or both eyes. Mean age of pseudophakic study population was 67.9±7.6 years (range 50-92 years). Nearly 50% of the eyes had a visual acuity of less than 6/18. 40% of the pseudophakic eyes had visually significant PCO. There were 53 eyes where the visual impairment was solely due to PCO and Nd-YAG Laser capsulotomy was done for these eyes. Post Laser Treatment 79.2% of treated eyes achieved a visual acuity of ≥6/18. Most commonly encountered complications after YAG Laser Capsulotomy was IOP spike which was seen in 29.5% of eyes undergoing the procedure which was followed by IOL pitting seen in 29.7%. Conclusions: The reach of Nd-YAG laser capsulotomy is limited to these masses. A step to prevent blindness in this category of population would be to ensure vailibility of Nd-YAG laser capsulotomy. This procedure is relatively safe with few complications.

Methods for a population-based Comprehensive Eye care Workload Assessment (CEWA) study in Southern India.

Eye care programs, in developing countries, are often planned using the prevalence of blindness and visual impairment, often estimated from Rapid Assessment of Avoidable Blindness (RAAB) surveys. A limitation of this planning approach is that it ignores the annual overall eye care requirements for a given population. Moreover, targets set are arbitrary, often influenced by capacity rather than need. To address this lacunae, we implemented a novel study design to estimate the annual need for comprehensive eye care in a 1.2 million populations. We conducted a population-based longitudinal study in Theni district, Tamil Nadu, India. All permanent residents of all ages were included. We conducted the study in three phases, (i) household-level enumeration and enrollment, (ii) basic eye examination (BEE) at household one-year post-enrollment, and (iii) assessment of eye care utilization and full eye examination (FEE) at central locations. All people aged 40 years and above were invited to the FEE. Those aged <40 years were invited to the FEE if indicated. In the main study, we enrolled 24,327 subjects (58% aged below 40 years and 42% aged 40 years and above). Of those less than 40 years, 72% completed the BEE, of whom 20% were referred for FEE at central location. Of the people aged ≥40 years, 70% underwent FEE. Our study design provides insights for appropriate long-term public health intervention planning, resource allocation, effective service delivery, and designing of eye care services for resource-limited settings.

Cataract Blindness in Armenia: The Results of Nationwide Rapid Assessment of Avoidable Blindness (RAAB)

ABSTRACT Purpose This study assessed the prevalence of cataract blindness, cataract surgical coverage (CSC), effective CSC, visual outcome after cataract surgery, and barriers to cataract surgery in a population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. Methods The study sample included 2258 individuals aged 50 years and older who were randomly selected from 11 provinces of Armenia in 2019 following the RAAB methodology. The study team randomly selected 50 clusters, 50 people in each. The RAAB survey form was used to collect information on cataract blindness, visual outcome after cataract surgery, and barriers to cataract surgery. Results The mean age of the participants was 65.3 (SD = 9.9) ranging from 50 to 99. The majority of participants were women (65.6%). Age- and sex-adjusted prevalence of blindness due to all causes was 1.5%; of which 36.4% was bilaterally blind due to cataract. The CSC and effective CSC at a cataract surgical threshold of <6/12 were 55.1% and 24.4%, respectively. Good outcome was reported in 43.7% of eyes after cataract surgery, borderline in 37.2% of eyes, and poor outcome in 19.1%. The main barriers to cataract surgery included “cost,” “need not felt,” or “fear.” Conclusion The prevalence of cataract blindness in our study was higher compared to high-income regions and lower than estimates from South/Southeast Asia. This study suggests the urgent need to update the National Strategic Plan to prevent blindness in Armenia with a focus on improving the quality and coverage of cataract surgery.

Spectacle Coverage Rate After Cataract Surgery in an Urban Area in Indonesia.

Uncorrected refractive errors after cataract surgery contribute to visual impairments. The aim of this study was to investigate the spectacle coverage rate (SCR) following cataract surgery and its relationship with socioeconomic factors in an urban city in Indonesia. This population-based cross-sectional study was conducted in 2015 in Jakarta. The former participants of the Rapid Assessment of Avoidable Blindness (RAAB) survey had a history of cataract surgery and met either of the following criteria: (1) wore spectacles with presenting visual acuity (PVA) 6/12 or (2) had PVA less than 6/12 regardless of spectacle use but achieved the best visual acuity (BVA) 6/12 with pinhole correction. Of the 2998 participants of the RAAB survey, 173 (5.6%) (252 eyes) had a history of cataract surgery, among whom 53 (86 eyes) met our inclusion criteria. The SCR was 69.8% and was associated with age group, household income level, education level, and physicians' recommendation of spectacle wear. Participants who were of nonproductive age (80%), had the highest household income level (88.2%), the highest level of education (87.5%), and had been recommended for spectacle use by their physicians (80.9%) demonstrated higher SCR. Participants with the highest household income had the highest SCR. Patients who had received a physician's recommendation showed a higher SCR and were 26 times more likely to wear spectacles (odds ratio [OR] 25.99, 95% CI 2.59-260.10). There is an unmet need for refractive errors after cataract surgery. Factors such as household income levels and physician recommendations were predictive of spectacle wear.

Nationwide Rapid Assessment of Avoidable Blindness (RAAB) in Armenia

ABSTRACT Purpose This study aimed to estimate the prevalence and main causes of blindness and visual impairment in population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. Methods The study team randomly selected 50 clusters (each consisting of 50 people) from all 11 regions of Armenia. Data on participants’ demographics, presenting visual acuity, pinhole visual acuity, principal cause of presenting visual acuity, spectacle coverage, uncorrected refractive error (URE), and presbyopia were collected using the RAAB survey form. Four teams of trained eye care professionals completed data collection in 2019. Results Overall, 2,258 people of 50 years and older participated in the study. The age- and gender- adjusted prevalence of bilateral blindness, severe and moderate visual impairment were 1.5% (95% CI: 1.0–2.1), 1.6% (95% CI: 1.0–2.2) and 6.6% (95% CI: 5.5–7.7), respectively. The main causes of blindness were cataract (43.9%) and glaucoma (17.1%). About 54.6% and 35.3% of participants had URE and uncorrected presbyopia, respectively. The prevalence of bilateral blindness and functional low vision increased with age and was the highest in participants 80 years and older. Conclusion The rate of bilateral blindness was comparable with findings from countries that share similar background and confirmed that untreated cataract was the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed aiming to further increase the volume and quality of cataract care in Armenia.

Diagnostic accuracy of direct ophthalmoscopy in the rapid assessment of avoidable blindness protocol: A cross-sectional study

Background: Rapid Assessment of Avoidable Blindness (RAAB) relies mainly on direct ophthalmoscopy (DO) for the diagnosis of posterior segment eye diseases (PSEDs). There is, however, a growing concern that DO may not be sufficiently sensitive to detect PSED owing to inherent diagnostic limitations. Aim of the Study: The aim of the study was to determine the sensitivity and specificity of DO for the detection of PSEDs in RAAB, using indirect ophthalmoscopy (IO) as a reference standard. Materials and Methods: Participants were patients 50 years and older, presenting to the eye clinic of a tertiary hospital in Jos, between April and September 2016 who gave consent. Their visual acuity was assessed as is done in RAAB6. Those found to be unilaterally or bilaterally visually impaired underwent anterior and posterior segment eye examinations to identify the cause. Dilated fundoscopy was first performed by a senior ophthalmology resident with DO (index test), followed by IO (reference standard test) by a consultant ophthalmologist. Results: A total of 250 patients were recruited into the study, of which 188 took the index and reference standard tests. PSEDs were detected in 65 (34.6%) persons and glaucoma accounted for 87.7% of these. The sensitivity of DO for the detection of glaucoma was 95.3%, while the specificity was 91.0%. Sensitivity and specificity for the detection of diabetic retinopathy and central retinal vein occlusion were both 100%. Specificity for the detection of other PSEDs was good even though sensitivity was below acceptable limits. Conclusion: The performance of DO against IO in this study, suggests that it is a satisfactory modality for the detection of the most common PSEDs in RAAB.

Effective cataract surgical coverage in adults aged 50 years and older: estimates from population-based surveys in 55 countries

Cataract is the leading cause of blindness globally. Effective cataract surgical coverage (eCSC) measures the number of people in a population who have been operated on for cataract, and had a good outcome, as a proportion of all people operated on or requiring surgery. Therefore, eCSC describes service access (ie, cataract surgical coverage, [CSC]) adjusted for quality. The 74th World Health Assembly endorsed a global target for eCSC of a 30-percentage point increase by 2030. To enable monitoring of progress towards this target, we analysed Rapid Assessment of Avoidable Blindness (RAAB) survey data to establish baseline estimates of eCSC and CSC. In this secondary analysis, we used data from 148 RAAB surveys undertaken in 55 countries (2003-21) to calculate eCSC, CSC, and the relative quality gap (% difference between eCSC and CSC). Eligible studies were any version of the RAAB survey conducted since 2000 with individual participant survey data and census population data for people aged 50 years or older in the sampling area and permission from the study's principal investigator for use of data. We compared median eCSC between WHO regions and World Bank income strata and calculated the pooled risk difference and risk ratio comparing eCSC in men and women. Country eCSC estimates ranged from 3·8% (95% CI 2·1-5·5) in Guinea Bissau, 2010, to 70·3% (95% CI 65·8-74·9) in Hungary, 2015, and the relative quality gap from 10·8% (CSC: 65·7%, eCSC: 58·6%) in Argentina, 2013, to 73·4% (CSC: 14·3%, eCSC: 3·8%) in Guinea Bissau, 2010. Median eCSC was highest among high-income countries (60·5% [IQR 55·6-65·4]; n=2 surveys; 2011-15) and lowest among low-income countries (14·8%; [IQR 8·3-20·7]; n=14 surveys; 2005-21). eCSC was higher in men than women (148 studies pooled risk difference 3·2% [95% CI 2·3-4·1] and pooled risk ratio of 1·20 [95% CI 1·15-1·25]). eCSC varies widely between countries, increases with greater income level, and is higher in men. In pursuit of 2030 targets, many countries, particularly in lower-resource settings, should emphasise quality improvement before increasing access to surgery. Equity must be embedded in efforts to improve access to surgery, with a focus on underserved groups. Indigo Trust, Peek Vision, and Wellcome Trust.

Blindness and visual impairment and their causes in India: Results of a nationally representative survey.

IntroductionAvoidable blindness is a significant public health problem in India. Nationally representative RAAB surveys (Rapid Assessment of Avoidable Blindness) are being conducted periodically in the country to know the current status of blindness in the country. The current study describes the findings from the RAAB survey conducted during 2015–19 in India.MethodologyA cross-sectional, population-based survey was conducted across the entire country among persons aged 50 years and above using RAAB version 6 methodology. Presenting and pinhole visual acuity was recorded followed by lens examination using a torchlight. In order to estimate the prevalence of blindness and visual impairment in overall population in India, district weights were assigned to each of the 31 surveyed districts and the prevalence was standardized using the RAAB software.ResultsThe overall weighted, age-gender standardized, prevalence of blindness (presenting visual acuity <3/60 in better eye) in population aged ≥50 years was 1.99% (95% CI 1.94%, 2.13%) and of visual impairment (VI) (presenting visual acuity <6/12 in better eye) was 26.68% (95% CI 26.57–27.17%). On multivariate analysis, adjusted odds ratio showed that blindness was associated with age ≥ 80 years (OR = 20.3, 95% CI: 15.6–26.4) and being illiterate (OR = 5.6, 95% CI: 3.6–8.9). Blindness was not found to be significantly associated with either gender or locality.ConclusionThe results of the survey demonstrate that currently more than one fourth of persons aged 50 years and above are visually impaired (PVA<6/12 in better eye) in India. The prevalence of blindness among them is 1.99%, and older age and illiteracy are significantly associated with blindness. Major causes of blindness included cataract (66.2%), corneal opacity (CO) (8.2%), cataract surgical complications (7.2%), posterior segment disorders (5.9%) and glaucoma (5.5%). The proportion of blindness and visual impairment that is due to avoidable causes include 92.9% and 97.4% respectively.

Karakteristik Pasien Penyakit Mata Di RSUD Masohi Maluku Tengah; Studi Deskriptif

Maluku is one of the provinces with a fairly high blindness rate in Indonesia. The prevalence of blindness in Maluku was 2.6%, according to the Rapid Assessment of Avoidable Blindness (RAAB) between 2013 and 2017. Some of the causes are cases of uncorrected refraction, cataracts, pterygium, glaucoma, and diseases of the posterior segment of the eye. This study aims to determine the characteristics of eye diseases recorded in Masohi Hospital, Central Maluku. This study uses a quantitative method through a retrospective approach. Data collection was conducted through patient medical records at Masohi Hospital, Central Maluku, from January 2019 to December 2020. The results of data analysis showed that there were 852 new patient visits throughout 2019 and 465 people in 2020. The prevalence of cases was mostly found in women in 2019 and 2020. Masohi City District is the sub-district with the highest number of eye patients, followed by Amahai District. The most cases in 2019 included refraction, cataract, pterygium and asthenopia. While in 2020, refraction was the most cases, followed cataract, pterygium and asthenopia.Keywords: Blindness; characteristics of eye diseases; visual disturbances

The prevalence of diabetic retinopathy in the occupied Palestinian territories: a national cross-sectional study

BackgroundDiabetic retinopathy is a complication of diabetes that affects the eyes and can lead to blindness if not adequately managed. No national or population-based estimates of diabetic retinopathy in Palestine exist. High-quality ophthalmic services are not available at the primary health care level for patients with diabetes in all sectors. Specialised eye centres are lacking. St John of Jerusalem Eye Hospital Group, which consists of five facilities in the West Bank and Gaza Strip, is the only provider of expert eye care in Palestine. The aim of this study was to determine the population prevalence of diabetic retinopathy among people with diabetes aged 50 years and older in Palestine. MethodsThis survey was part of a larger population-based survey using the rapid assessment of avoidable blindness (RAAB) methodology to estimate prevalence of vision impairment, blindness, and disability in individuals aged 50 years and older in Palestine. It was a nationally representative, cross-sectional, population-based survey in Gaza Strip and West Bank. Based on an expected prevalence of blindness of 3·4% in individuals aged 50 years and older, 20% precision level, 95% confidence level, 10% non-response rate, and a design effect of 1·4 to account for clustering, a sample size of 4224 participants aged 50 years and older was determined. 69 clusters in the West Bank and 52 clusters in the Gaza Strip were selected with probability proportionate to size from a list of areas from the Palestinian Central Bureau of Statistics population and housing census of 2017. Within each cluster, 35 people aged 50 years or older were randomly selected for examination in their homes. Three teams collected data; each consisted of a nurse and an ophthalmologist. Dilated fundus examination and Scottish diabetic retinopathy grading were done by the ophthalmologist in each team. Participants were classified as having diabetes if they had been diagnosed by a health professional, or if their random blood glucose (RBG) was 200 mg/dL or above on the day of data collection, as measured by a portable glucometer. Ethical approval was obtained from the St John of Jerusalem Eye Hospital Group and the London School of Hygiene & Tropical Medicine ethics committees. Informed oral witnessed consent was obtained from all participants. FindingsThe survey was conducted between July, 2018, and April, 2019. 4224 individuals were asked to participate, of whom 376 did not, leaving 3848 participants. The number of previously diagnosed and newly diagnosed patients with diabetes was 1176 (486 male, 690 female) and 103 (55 male, 48 female), respectively. The overall prevalence of diabetes across West Bank and Gaza was 33·2% (95% CI 31·5–34·9; 1279 of 3848 participants). The prevalence was higher in women (738 of 2047 [36·1%, 95% CI 33·6–38·5]) than in men (541 of 1801 [30·0%, 27·9–32·2), and in Gaza Strip (639 [35·8%] of 1783) than in West Bank (640 [31·0%] of 2065; p=0·002). Only 539 (46·3%) of 1164 patients with diagnosed diabetes who consented to blood blucose measurement had controlled blood glucose (RBG <200 mg/dL). 483 (41·1%) of 1176 patients with previously diagnosed diabetes had never had an eye check-up or had not been checked in the 2 years before the survey. 327 (25·6%) of 1279 patients with diabetes refused dilated fundus examination; 952 patients did undergo this examination, and 457 (48·0%, 95% CI 43·5–52·6) had diabetic retinopathy or maculopathy. Vision impairment was more common in those with diabetes (428 [33·5%] of 1279) than in those without (652 [25·4%] of 2569). 43 (3·4%) of 1279 participants with diabetes had blindness, compared with 65 (2·5%) of 2569 patients without diabetes. The principal cause of blindness in Gaza Strip was diabetic retinopathy (23 [32·4%] of 71) and in West Bank was untreated cataract (19 [51·4%] of 37). Diabetic retinopathy was the main cause of blindness, severe visual impairment, and moderate visual impairment among patients with diabetes. InterpretationDiabetes and diabetic retinopathy are substantial health problems in Palestine. Earlier detection and proper management at primary health care clinics and by outreach clinics for marginalised populations could be key. Referral networks between health-care sectors and specialised eye centres might provide the necessary infrastructure. FundingFred Hollows Foundation, Australia, German Federal Ministry for Economic Cooperation and Development.

Visual impairment and blindness caused by posterior segment diseases in Hungary in people aged 50 years and older

Introduction: Posterior segment diseases are the most common causes of blindness and visual impairment in devel-oped countries among people aged 50 years and older in Hungary. Objective: The purpose of this study was to estimate the prevalence of visual impairment and blindness caused by posterior segment diseases in the population aged 50 years and older in Hungary. Method: 105 census enumeration units were randomly selected with a probability proportional to size by the Hungar-ian Central Statistical Office. The standardised Rapid Assessment of Avoidable Blindness (RAAB) method was used. Participants underwent eye examination with a direct ophthalmoscope. Participants underwent visual acuity testing with a Snellen tumbling E-chart with or without a pinhole. Dilated fundus examination was performed in diabetic participants using an indirect binocular ophthalmoscope. Results: In total, 3523 (95.9%) out of 3675 eligible people were examined, of whom the prevalence of bilateral blind-ness and severe visual impairment was 0.7% and 0.2%, respectively. The most common causes of visual impairment caused by posterior segment diseases were age-related macular degeneration (1.419%), glaucoma (0.397%), diabetic retinopathy (0.341%) and rhegmatogenous retinal detachment (0.198%). The most common causes of blindness caused by posterior segment diseases were age-related macular degeneration (37.5%), glaucoma (16.7%), diabetic retinopathy (8.3%), high myopia (8.3%), rhegmatogenous retinal detachment (8.3%) and retinitis pigmentosa (8.3%). Conclusion: Prevalence of severe visual impairment and blindness caused by posterior segment diseases was lower compared to results of RAAB surveys in other countries. The frequency order of different posterior segment diseases was in line with developed countries. Availability of eye care should be improved and financing should be modernized due to the continuously increasing number of patients with age-related macular degeneration, glaucoma, diabetes and pathologic myopia.

Non-mydriatic fundus photography as an alternative to indirect ophthalmoscopy for screening of diabetic retinopathy in community settings: a comparative pilot study in rural and tribal India

ObjectivesThe impending and increasing prevalence of diabetic retinopathy (DR) in India has necessitated a need for affordable and valid community outreach screening programme for DR, especially in rural and far...

Meta-analysis of gender inequities in cataract surgical coverage in Latin America.

To perform an updated meta-analysis of cataract surgical coverage (CSC) data in Latin American studies to confirm that gender equity exists in terms of receiving cataract surgery. A literature search of Rapid Assessment of Avoidable Blindness (RAAB) studies in Latin American published since 2011 was done. Older studies from countries that did not have newer data published were also included. Using summary original study data of CSC rates on an individual basis, a random effects model of meta-analysis was performed to evaluate the differences in CSC between men and women. Nineteen studies from 17 countries were included (Mexico data were pooled). The odds ratios at a visual acuity (VA) of <3/60 and <6/18 were 1.04 [95% confidence interval (CI): 0.82-1.32] and 1.04 (95% CI: 0.90-1.19), respectively, without heterogeneity. There were no significant gender differences for CSC at any VA level. This updated meta-analysis of CSC data from Latin American countries supports that gender inequity in terms of receiving cataract surgery is not an issue in the region. The results do not provide insight into gender inequity in terms of the quality of cataract surgery and other types of eye care services.