Refractive Services Research Articles

Ocular Health of the Emerging Elderly Population in Ghana: Evidence From a Peri-urban Community

Purpose: As people age, the risk of visual impairment increases because the major eye diseases that cause visual disorders are age-related. By the age of 65, 1 in 3 people suffer from some degree of eye disease that contributes to impaired vision. This study assessed ocular disorders, visual impairment, and blindness among an elderly population at Yamoransa, Ghana. Method: A community based cross-sectional survey was conducted among 170 elderly (aged 60 years and over) persons. The research participants underwent a complete ophthalmic examination that involved visual acuity, external, and dilated internal examinations. Results: The mean age of the respondents was 70 years with 58.2% being females. Visual impairment and blindness were found among 58.7% and 5.9%, respectively, according to their presented visual acuity; these decreased to 45.3% and 5.2%, respectively, after optical correction. About 68.3% of the respondents had poor near vision with only 40% having near reading corrections. The major causes of visual impairment were cataract (42.5%), uncorrected refractive errors (21.8%), retinal disorders (11.4%), and glaucoma (9.8%). Among the elderly with bilateral blindness, cataract was the main cause. Multinomial logistic regression showed that sex had a higher likelihood of being associated with visual disorders compared with age and education (P = 0.001); similarly females, older patients, and the those with no education had higher odds ratios. Conclusion: The need for increased health education, regular eye examination, and the need to subsidize surgical and refractive eye care services for the elderly in Ghana cannot be over emphasized.

Visual outcomes of cataract surgery performed by supervised novice surgeons during training in rural China

To assess the outcomes of cataract surgery performed by novice surgeons during training in a rural programme. DESIGN : Retrospective study. Three hundred thirty-four patients operated by two trainees under supervision at rural Chinese county hospitals. Two trainees performed surgeries under supervision. Visual acuity, refraction and examinations were carried out 3 months postoperatively. Postoperative uncorrected visual acuity, pinhole visual acuity, causes of visual impairment (postoperative uncorrected visual acuity < 6/18) RESULTS: Among 518 operated patients, 426 (82.2%) could be contacted and 334 (64.4% of operated patients) completed the examinations. The mean age was 74.1 ± 8.8 years and 62.9% were women. Postoperative uncorrected visual acuity was available in 372 eyes. Among them, uncorrected visual acuity was ≥6/18 in 278 eyes (74.7%) and <6/60 in 60 eyes (16.1%), and 323 eyes (86.8%) had pinhole visual acuity ≥ 6/18 and 38 eyes (10.2%) had pinhole visual acuity < 6/60. Main causes of visual impairment were uncorrected refractive error (63.9%) and comorbid eye disease (24.5%). Comorbid eye diseases associated with pinhole visual acuity < 6/60 (n = 23, 6.2%) included glaucoma, other optic nerve atrophy, vitreous haemorrhage and retinal detachment. The findings suggest that hands-on training remains safe and effective even when not implemented in centralized training centres. Further refinement of the training protocol, providing postoperative refractive services and more accurate preoperative intraocular lens calculations, can help optimize outcomes.

Prevalence of Refractive Error and Spectacle Coverage in Zoba Ma’ekel Eritrea: A Rapid Assessment of Refractive Error

ABSTRACTPurpose: To determine the prevalence of refractive error and spectacle coverage in Zoba Ma’ekel, Eritrea in order to assist in planning for refractive services and blindness prevention strategies.Methods: A community-based cross-sectional study using multistage cluster sampling was conducted. A total of 3200 participants aged 15–50 years were enumerated and examined using the Rapid Assessment of Refractive Error (RARE) protocol.Results: The response rate was 99.1%. The prevalence of refractive error was 6.4% (95% confidence interval [CI], 5.6–7.2%). Spectacle coverage for refractive error was 22.2% (95% CI 16.7–28.5%). It was higher among males than females (Fisher’s exact test, p = 0.028), and highest in those who had completed secondary school (48.6%, 95% CI 31.9–65.6%) and those who resided in Asmara (Fisher’s exact test, p < 0.002). The prevalence of presbyopia was 32.9% (95% CI 30.3–35.7%) with 94.9% correctable. Spectacle use for presbyopia was 9.9% (95% CI 7.2–13.4%), which was lowest in those with no formal schooling but highest in those who had completed secondary school (χ2 test, p < 0.001) and those persons who resided in Asmara (Fisher’s exact test, p < 0.001). Respondents expressed different barriers to uptake of services. A total of 128 subjects were aware of the problem but did not feel the need for consultation while 83 subjects stated they could not afford the cost of examination and spectacles.Conclusion: The study provides helpful findings to assist with the development of appropriate refractive service planning in Zoba Ma’ekel. Uncorrected refractive error is of public health importance and prompt measures are needed to address the problem.

Visual impairment and spectacle coverage rate in Baoshan district, China: population-based study

BackgroundTo investigate the prevalence and risk factors of visual impairment associated with refractive error and the unmet need for spectacles in a special suburban senior population in Baoshan District of Shanghai, one of several rural areas undergoing a transition from rural to urban area, where data of visual impairment are limited.MethodsThe study was a population based survey of 4545 Chinese aged (age: >60 years or older ) at Baoshan, Shanghai, in 2009. One copy of questionnaire was completed for each subject. Examinations included a standardized refraction and measurement of presenting and best corrected visual acuity (BCVA) as well as tonometry, slit lamp biomicroscopy, and fundus photography.ResultsThe prevalence of mild (6/12 to 6/18), moderate (6/18 to 6/60) and severe visual impairment was 12.59%, 8.38% and 0.44%, respectively, and 5.26%, 3.06% and 0.09% with refractive correction. Visual impairment was associated with age, gender, education and career, but not insurance . The prevalence of correctable visual impairment was 5.81% (using 6/18 cutoff) and 13.18% (using 6/12 cutoff). Senior people and women were significantly at a higher risk of correctable visual impairment, while the well-educated on the contrary. The prevalence of undercorrected refractive error (improves by 2 or more lines with refraction) was 24.84%, and the proportion with undercorrected refractive error for mild, moderate , severe and no visual impairment was 61.54%, 67.98%, 60.00% and 14.10%, respectively. The spectacle coverage rate was 44.12%. Greater unmet need for spectacles was observed among elderly people, females, non-peasant, and subjects with less education and astigmatism only.ConclusionsHigh prevalence of visual impairment, visual impairment alleviated by refractive correction, and low spectacle coverage existed among the senior population in Baoshan District of Shanghai. Education for the public of the importance of regular examination and appropriate and accessible refraction service might be helpful to solve the problem.

How Much Eye Care Services Do Asian Populations Need? Projection from the Singapore Epidemiology of Eye Disease (SEED) Study

We quantified and measured the needs for specific eye care services, including refractive services (RS), annual eye examination services (AES), cataract surgery services (CSS), and low vision services (LVS) in urban adult populations in Asia. We conducted three population-based studies of Singapore-resident Chinese, Malays, and Indians aged ≥40 years to measure the proportion of people who needed specific eye care services. Our data included 3353 Chinese, 3280 Malays, and 3400 Indians (participation rate 73.6%). Overall, approximately 70% of the populations needed eye care services and more than 30% had more than one need. The age-standardized proportion of people who need RS, AES, CSS, and LVS were 65.3%, 22.4%, 12.5%, and 0.5%, respectively, in Chinese. These figures were 49.6%, 33.6%, 11.0%, and 0.7%, respectively, in Malays, and 55.6%, 40.0%, 13.4%, and 0.8%, respectively, in Indians. With demographic change, our projection showed that the number of adults needing eye care services in urban Asia will grow from 437 million in 2010 to 827 million in 2030. Diabetes was a major cause of AES and a significant predictor for CSS, whereas higher blood pressure was a predictor for AES. The needs for eye care services in an urban setting in Asia is high, particularly the needs for RS, AES, and CSS. The high prevalences of diabetes and hypertension are the driving factors underlying these needs. The burden of providing such eye care services highlights the need for new strategies for improvements in primary care and capacity building for eye care professionals other than ophthalmologists.

Prevalence and predictors of refractive error and spectacle coverage in Nakuru, Kenya: a cross-sectional, population-based study

A cross-sectional study was undertaken in Nakuru, Kenya to assess the prevalence of refractive error and the spectacle coverage in a population aged ≥50 years. Of the 5,010 subjects who were eligible, 4,414 underwent examination (response rate 88.1 %). LogMAR visual acuity was assessed in all participants and refractive error was measured in both eyes using a Topcon auto refractor RM8800. Detailed interviews were undertaken and ownership of spectacles was assessed. Refractive error was responsible for 51.7 % of overall visual impairment (VI), 85.3 % (n = 191) of subjects with mild VI, 42.7 % (n = 152) of subjects with moderate VI, 16.7 % (n = 3) of subjects with severe VI and no cases of blindness. Myopia was more common than hyperopia affecting 59.5 % of those with refractive error compared to 27.4 % for hyperopia. High myopia (<-5.0 DS) was also more common than extreme hyperopia (>+5.0 DS). Of those who needed distance spectacles (spectacle coverage), 25.5 % owned spectacles. In conclusion, the oldest, most poor and least educated are most likely to have no spectacles and they should be specifically targeted when refractive services are put in place.

A study on the prevalence of refractive errors among school childern of 7-15 years age group in the field practice areas of a medical college in bangalore

Background: Refractive Error is an avoidable cause of visual impairment. Diagnosis and Treatment of refractive errors is the simplest and most effective forms of eye care. Aims & Objective: To study the prevalence and determinants of uncorrected refractive errors, among school children of 7-15 years. Material and Methods: The study was a cross sectional study of 1378 government school children of 7- 15 years age group in both rural and urban field practice areas of Dr. BR Ambedkar Medical College, Bangalore. Students were screened for defective vision with the help of Snellen’s chart and refractionist confirmed the findings. Students with refractive error were provided with spectacles free of cost. Data was analysed to determine the prevalence of refractive errors among the school children. Results: 687 children of urban and 691 children of rural area were examined. 53.6% of the study population were boys and 46.4% were girls. The mean age of the study group was 12.4 years. The prevalence of uncorrected refractive error in urban and rural children was 7.03%. The prevalence of Myopia, Hypermetropia and Astigmatism in children was 4.4%, 1.03%, 1.6% respectively. Children 13 to years 15 attending urban schools were most likely to have uncorrected myopia. Hypermetropia was associated with younger age group and female children. Conclusion: The prevalence of uncorrected refractive error, especially myopia, was higher in older children. Causes of higher prevalence and barriers to refractive error correction services should be identified and addressed. Eye screening of school children is recommended.

Progress in blindness prevention in North Sudan (2003-2010)

Objectives: (1) To review progress in the prevention of blindness in Sudan compared to Vision 2020 targets. (2) To show gaps and shortfalls. Materials and Methods: Reports of national Vision 2020 program covering the period 2003-2010 are reviewed, including data generated from six RAAB surveys conducted in 2009-2010. Results: Prevalence of blindness is 1% compared to 1.5% in 2003. Cataract surgical out-put, cataract surgical rate (CSR), and IOL implantation rate increased steadily. It is estimated that 70% of the population are covered with refractive errors services. Low vision services are provided by four centers. Trachoma mapping completed for Northern Sudan except Darfur. SAFE strategy is implemented. Prevalence of childhood blindness is not known. Two centers provide specialized pediatric eye services. There is community-directed treatment with Ivermectin (CDTI) in 3 out the 4 onchocerciasis foci. Ophthalmologists tripled in number. Optometists exceeded 1000, compared to less than 500 in 2003. Secondary and tertiary level facilities increased in major cities. There is no primary eye-care program. Conclusion: Northern Sudan shows good progress in most of the components of Vision 2020, namely cataract, trachoma, onchocerciasis, refractive errors, and low vision. However, scaling up and attention to diabetic retinopathy and glaucoma are still needed to reach all the targets by the year 2020.

The impact of spectacle wear compliance on the visual function related quality of life of Omani students: A historical cohort study

Background:Eye screening and refractive services to students are part of a school health initiative in Oman. We evaluated the impact of the compliance of spectacle wear on the vision related quality of life (VFQ) among 12-13 years old and 15-16 years old Omani students with refractive error.Materials and Methods:This historical cohort study was conducted in 2012. Students using spectacles and those not using spectacles after 1 year of prescribing/providing spectacles were interviewed to assess their VFQ. The VQ 20 questionnaire with 5 graded close-ended responses was adopted for this purpose. The responses for the VFQ related to different visual functions of students who were/were not spectacle wear compliant, were compared.Results:Our cohort had 124 students in each group. The overall VFQ was significantly higher among the compliant spectacle wearers (compliant group) compared with the non-complaint wearers (non-compliant group) (relative risk [RR] =4.7% [95% of the confidence interval (CI): 2.8-6.6]). The association of gender and the grade level was not significant (P > 0.05). However, the variation of governorate was significantly associated to the difference of VFQ in both groups (χ2 = 16.6, degrees of freedom = 4, P = 0.0003). The VFQ related to the near work (RR = 1.3) and school related activities (RR = 1.3) was better in the compliant group.Conclusion:VFQ was better among those students who were spectacle wear compliant compared with those who were not. VFQ related to near work and school related activities seem to be the most influenced by spectacle wear compliance.

Global cost of correcting vision impairment from uncorrected refractive error

To estimate the global cost of establishing and operating the educational and refractive care facilities required to provide care to all individuals who currently have vision impairment resulting from uncorrected refractive error (URE). The global cost of correcting URE was estimated using data on the population, the prevalence of URE and the number of existing refractive care practitioners in individual countries, the cost of establishing and operating educational programmes for practitioners and the cost of establishing and operating refractive care facilities. The assumptions made ensured that costs were not underestimated and an upper limit to the costs was derived using the most expensive extreme for each assumption. There were an estimated 158 million cases of distance vision impairment and 544 million cases of near vision impairment caused by URE worldwide in 2007. Approximately 47 000 additional full-time functional clinical refractionists and 18 000 ophthalmic dispensers would be required to provide refractive care services for these individuals. The global cost of educating the additional personnel and of establishing, maintaining and operating the refractive care facilities needed was estimated to be around 20 000 million United States dollars (US$) and the upper-limit cost was US$28 000 million. The estimated loss in global gross domestic product due to distance vision impairment caused by URE was US$202 000 million annually. The cost of establishing and operating the educational and refractive care facilities required to deal with vision impairment resulting from URE was a small proportion of the global loss in productivity associated with that vision impairment.

Visual Function after Correction of Distance Refractive Error with Ready-made and Custom Spectacles: A Randomized Clinical Trial

To evaluate patient-reported outcome measures with the use of ready-made spectacles (RMS) and custom spectacles (CS) in an adult population in India with uncorrected refractive error (URE). Prospective, double-masked, randomized trial with 1-month follow-up. A total of 363 adults aged 18 to 45 years with ≥1 diopter (D) of URE (RMS, n = 183; CS, n = 180). All participants received complete refraction and were randomized to receive CS (full sphero-cylindrical correction) or RMS based on the spherical equivalent for the eye with lower refractive error but limited to the powers in the RMS inventory. Visual function and quality of life (VFQoL) instrument and participant satisfaction. Rasch scores for VFQoL increased from 1.14 to 4.37 logits in the RMS group and from 1.11 to 4.72 logits in the CS group: respective mean changes of 3.23 (95% confidence interval [CI], 2.90-3.56) vs. 3.61 (95% CI, 3.34-3.88), respectively. Mean patient satisfaction also increased by 1.83 points (95% CI, 1.60-2.06) on a 5-point Likert scale in the RMS group and by 2.04 points (95% CI, 1.83-2.24) in the CS group. In bivariate analyses, CS was not associated with increased VFQoL or patient satisfaction compared with the RMS group. In the full multivariable linear regression, the CS group had greater improvement when compared with those receiving RMS (+0.45 logits; 95% CI, 0.02-0.88), and subjects with astigmatism >2.00 D had significantly less improvement (-0.99 logits; 95% CI, -1.68 to -0.30) after controlling for demographic and vision-related characteristics. In multivariable analysis, increased change in patient satisfaction was related to demographic and optical characteristics, but not spectacle group. Ready-made spectacles produce large but slightly smaller improvements in VFQoL and similar satisfaction with vision at 1-month follow-up when compared with CS. Ready-made spectacles are suitable for the majority of individuals with URE in our study population, although those with high degrees of astigmatism may benefit from a trial of CS. This study provides further evidence for the use of RMS in settings where CS are unavailable or unaffordable, or refractive services are inaccessible to those in need.

Reduced Vision and Refractive Errors, Results from a School Vision Screening Program in Kanchanpur district of Far Western Nepal

At present there is no data available on reduced vision and refractive errors in school children of far western Nepal. So, school screening records were used to obtain data useful for planning of refractive services. Data are provided from school screening conducted by Geta Eye Hospital during February/March 2008. The cases with complete data sets on visual acuity, refractive error and age were included and analyzed using computer software. Of 1165 children (mean age 11.6 ± 2.5 years) examined, 98.8% (n = 1151) had uncorrected visual acuity of 6/9 and better in at least one eye whereas 1.2% (n = 14) had acuity 6/12 and worse in both eyes. Among them, either eye of 9 children improved to 6/9 and better with correction. However, visual acuity was 6/12 and worse in both eyes of 5 children even after correction. There were 24 children with refractive errors (myopia, 1.54%; n = 18 and hypermetropia, 0.51%; n = 6) in at least one eye. The spherical equivalent refraction was not significantly different with age and gender. The incidence of reduced vision and refractive errors among school children of this semi rural district were low.

School-based Approaches to the Correction of Refractive Error in Children

The World Health Organization estimates that 13 million children aged 5–15 years worldwide are visually impaired from uncorrected refractive error. School vision screening programs can identify and treat or refer children with refractive error. We concentrate on the findings of various screening studies and attempt to identify key factors in the success and sustainability of such programs in the developing world. We reviewed original and review articles describing children's vision and refractive error screening programs published in English and listed in PubMed, Medline OVID, Google Scholar, and Oxford University Electronic Resources databases. Data were abstracted on study objective, design, setting, participants, and outcomes, including accuracy of screening, quality of refractive services, barriers to uptake, impact on quality of life, and cost-effectiveness of programs. Inadequately corrected refractive error is an important global cause of visual impairment in childhood. School-based vision screening carried out by teachers and other ancillary personnel may be an effective means of detecting affected children and improving their visual function with spectacles. The need for services and potential impact of school-based programs varies widely between areas, depending on prevalence of refractive error and competing conditions and rates of school attendance. Barriers to acceptance of services include the cost and quality of available refractive care and mistaken beliefs that glasses will harm children's eyes. Further research is needed in areas such as the cost-effectiveness of different screening approaches and impact of education to promote acceptance of spectacle-wear. School vision programs should be integrated into comprehensive efforts to promote healthy children and their families.

Prevalence and causes of blindness and low vision among adults in Fiji

To estimate the prevalence and causes of blindness and low vision among adults aged ≥40 years in Fiji. Population-based cross-sectional study. Adults aged ≥40 years in Viti Levu, Fiji. A population-based cross-sectional survey used multistage cluster random sampling to identify 34 clusters of 40 people. A cause of vision loss was determined for each eye with presenting vision worse than 6/18. Blindness (better eye presenting vision worse than 6/60), low vision (better eye presenting vision worse than 6/18, but 6/60 or better). Of 1892 people enumerated, 1381 participated (73.0%). Adjusting sample data for ethnicity, gender, age and domicile, the prevalence of blindness was 2.6% (95% confidence interval 1.7, 3.4) and low vision was 7.2% (95% confidence interval 5.9, 8.6) among adults aged ≥40 years. On multivariate analysis, being ≥70 years was a risk factor for blindness, but ethnicity, gender and urban/rural domicile were not. Being Indo-Fijian, female and older were risk factors for vision impairment (better eye presenting vision worse than 6/18). Cataract was the most common cause of bilateral blindness (71.1%). Among participants with low vision, uncorrected refractive error caused 63.3% and cataract was responsible for 25.0%. Strategies that provide accessible cataract and refractive error services producing good quality outcomes will likely have the greatest impact on reducing vision impairment.

A new, pachymetry-based approach for diagnostic cutoffs for normal, suspect and keratoconic cornea

To analyze whether an association exists between keratometric and pachymetric changes in the cornea, and whether it can be used to create pachymetric cutoff criteria secondary to keratometric criteria. In this cross-sectional study, 1000 candidates presenting to the refractive surgery services of a tertiary care hospital underwent bilateral Orbscan IIz (Bausch and Lomb) assessment along with other ophthalmic evaluation. Stepwise regression analysis-based models showed that simulated keratometry (simK) astigmatism was significantly predicted by the minimum corneal thickness (MCT) and difference between central and MCT (δCT), mean SimK by the MCT and δCT, and maximum keratometry in the central 10-mm zone by the MCT and δCT (P<0.001). The mean MCT values were 542.5 ± 39.6, 539.9 ± 39.2, 524.2 ± 49.5, and 449.3 ± 73.7 μm for flatter normal (<44 D), steeper normal (≥ 44 D), keratoconus suspect and keratoconic eyes, respectively (P<0.001). The mean differences between central corneal thickness and MCT (δCT) were 12.2 ± 7.1 μm, 12.4 ± 7.4 μm, 14.4 ± 8.9 μm and 23.2 ± 10.1 μm for the flatter normal, steeper normal, keratoconus suspect, and keratoconic eyes, respectively (P<0.001). Mean and 2SD cutoff were used to suggest that a cornea having MCT< 461 μm or δCT>27 μm has only a 2.5% chance of being normal and not a keratoconus suspect or worse. Pachymetric diagnostic cutoffs can be used as adjuncts to the existing topographic criteria to screen keratoconus suspect and keratoconic eyes.

The KwaZulu-Natal Child Eye Care Programme: Delivering refractive error services to primary school learners

Globally, over 300 million people are estimated to be visually impaired. Uncorrected refractive error is the primary cause of almost half of all visual impairment, resulting in the global economy losing $269 billion in productivity annually. There is a definitive level of urgency in the treatment of refractive error in children as uncorrected refractive error results in the failure of normal visual maturation, termed amblyopia, which cannot be corrected in adult life. In South Africa, the lack of appropriatechild eye care strategies has posed a serious problem to the visual health of children. In 2006, the International Centre for Eye Care Education (ICEE) conducted a situational analysis of child eye care services in the province of KwaZulu-Natal (KZN). The findings of this analysis indicated a dire need for comprehensive services in the province. Stakeholders (the KwaZulu-Natal Department of Healthand the KwaZulu-Natal Department of Education) were advised on the value of a short-term strategy as the underpinning of a long-term sustainable approach. This resulted in the formation of a trialliance to implement the KZN Child Eye Care Programme. Eighty (80) individuals who were previously volunteers for the KZN Department of Health were trained in vision screening. These vi-sion screeners screened 239 606 primary school children from February 2007 to May 2008. Seven percent (15 944) of the children failed the vision screening and were referred for optometric assessments. Of the 15 944 children that failed the vision screening, 10 707 children were examined by optometrists and 1083 were found to have a refractive error and were therefore supplied with spectacles. The study indicates that a short-term programme to address a backlog of services can reach many underserved children. This programme identified many challenges of implementing a vision screening programme such as poor uptake of refractive services by learners in the absence of an appropriate referral system and high attrition of trained vision screeners. (S Afr Optom 2011 70(2) 61-68)

Refractive Error Status in Bayelsa State, Nigeria

Background: Refractive errors affect the whole spectrum of the population without regard to age, gender, race and ethnic group. Uncorrected refractive errors have severe consequences for the individual, family and society. This study , is the first of its kind, to document the distribution of refractive errors in Bayelsa State. Methods: Records of patients who presented between January 2004 and October 2005 in Okolobiri General Hospital&mdash;the government-subsidized eye clinic in Okolobiri, Bayelsa State&mdash;for treatment were examined. Myopia was defined as &amp;#8805;- 0.50DS; hyperopia as &amp;#8805;+ 1.00DS; while astigmatism was defined as &amp;#8805;- 0.25DC. Emmetropia was defined as spherical power of &ndash;0.25D to +0.75D. Results of the right eye were used for analysis. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 10. Results: A total of 654 patients were analyzed. There were 319 male and 335 female patients (48.8% and 51.2% respectively)with an age range of 5 &ndash; 86 years. Mean age was 42.18 years (SD 13.1, 95% CI = 41.17 &ndash; 43.19 years). Significant refractive errors were observed in 355 cases (54.3%), while 299 (45.7%) were emmetropic. Of the 355 with refractive error, 181 (51%) were men and 174 (49%) were woman. Astigmatism was the commonest refractive error (n=162, 45.7%) followed by myopia (n = 113, 31.8%) and hyperopia (n = 80, 22.5%). The range of refractive power was as follows: astigmatism, - 0.25DC to &ndash; 1.75DC. Myopia, - 0.50D to - 9.00D; hyperopia, + 1.00DS to + 11.00DS; More male patients have hyperopia and myopia while more female patients have astigmatism. Presbyopia as indicated by the use of near addition, was present in 490 (74.9%) of the subjects. Conclusion: Significant refractive error was present in over half of patients presenting in the period under analysis. The range of refractive errors recorded will assist in planning self-sustaining low-cost refractive error services in the state.Key words: refractive error, presbyopia, astigmatism, Bayelsa State, Nigeria.

Presbyopia and Near-Vision Impairment in Rural Northern China

Presbyopia limits activities of daily living, but population-based data from rural China are scarce. A population-based, cross-sectional study was conducted in 2009 among all persons aged 40+ years in a rural area near Shenyang, China. Distance and near VA were measured using logMAR E charts. Individuals with pinhole-corrected distance vision ≥20/63 underwent detailed eye examination and near refraction. A total of 1008 (91.5%) respondents were examined (mean age, 58.4 ± 10.7 years for men, 56.8 ± 9.89 years for women). Women and older subjects were more likely to participate. The prevalence of functional presbyopia (near vision <20/50 [N8] improved by ≥1 line with correction) was 67.3% (95% confidence interval [CI], 64.30%-70.09%), increasing from 27.6% at 40 to 49 years of age to 81.8% at 60 to 69 years. Multivariate analysis showed that older age (P < 0.001), but not gender or education, was significantly associated with a higher risk of presbyopia. Self-reported presbyopic spectacle correction coverage was 51.5%. In multivariate logistic regression models, worse presenting near vision (P = 0.013) and higher required spherical equivalent power (P < 0.001) were associated with having correction, while age, gender, education, and distance vision were unassociated. Major barriers reported by persons without near correction included poor quality of available glasses (33.1%) and lack of awareness of the condition and its treatment (28.8%). Presbyopia is highly prevalent in rural China, and nearly half of affected persons have no access to correction. Interventions should focus on education and improvement in the quality of refractive services.

Poor vision, refractive errors and barriers to treatment among commercial vehicle drivers in the Cape Coast municipality.

To determine the relationship between poor vision and occurrence of road traffic accidents (RTAs) and the barriers to uptake of refractive error services among commercial drivers in the Cape Coast Municipality of Ghana. A cross-sectional descriptive study was conducted involving commercial drivers in the municipality. Participants underwent an eye examination comprising visual acuity, colour vision test using Ishihara pseudo-isochromatic plates, confrontational visual fields, external and internal ocular eye health examinations. Structured questionnaire were also administered to the participants to collect demographic data, history of driving and RTAs and utilization of eye care services as well as identification of the colours of the traffic light. A total of 206 male drivers were interviewed and examined. Over 12% of the commercial drivers do not have the minimum visual acuity required for driving while 6.8% had visual impairment (VA < 6/18 in the better eye). There was no association between occurrence of RTAs and visual impairment (p = 0.050), visual field (p = 0.741) and colour vision defect (p = 0.343). A poor utilization of refractive error services was noted and the barriers to uptake of eye care services were largely due to unawareness of visual status. Refractive errors are the commonest ocular finding followed by cataracts. There are barriers to uptake of refractive error services among commercial drivers in the Cape Coast Municipality. These barriers could be addressed by health education targeting commercial vehicle drivers at their stations.

Refractive error blindness in Yenagoa, Bayelsa state, Nigeria: a hospital based study

Background: Despite the priority attention giving to refractive error in vision 2020 programme, blindness due to uncorrected refractive error is relatively unexplored. The aim of this study is to determine the prevalence and causes of refractive error blindness in Yenagoa. Method: All consecutive patients presenting to our eye clinic that were diagnosed to have refractive error over a one year period was studied. They underwent a full ocular examination including anterior and posterior segment examination, objective and subjective refraction. Objective refraction was done using a Carl Zeiss 599R autorefractometer. Information obtained included their age, sex, occupation, presenting visual acuity, history of couching and that of cataract surgery without an implant. Statistical analysis was done manually using a scientific calculator. Results: 1168 patients was seen during the study period and 135 persons had refractive error. Of the number with refractive error, 63 were males while 72 were females (M:F=1:1.4). Their age ranged from 6 to 83 years with a mean of 35.7 years (SD±4.102). The prevalence of refractive error blindness was 0.68 %. High myopia accounted for 75% of the blindness while high hyperopia and aphakia accounted for 12.5% each respectively. The prevalence of low vision due to refractive error was 2.5%. Myopia was responsible for half of the cases of low vision while hyperopia and astigmatism accounted for 30% and 16% respectively. Aphakia was responsible for 3.3% of low vision seen. Conclusion: Uncorrected refractive error is potentially blinding with a prevalence of 0.68% in this population, myopia being responsible for majority of cases. Health education is needed to create awareness on the availability of refractive error services in this population in order to stem the tide of needless blindness. Keywords: Blindness, refractive error, Yenagoa, myopia, aphakia, hyperopia.