Utilization Of Eye Care Services Research Articles

Eye-care utilization among a Canadian diabetic refugee population: retrospective cohort study of an interdisciplinary care model

Introduction Vision health is an important and underutilized health service among newly arrived refugees in Canada, yet the body of literature on eye-care delivery in this population is limited. The study objective was to identify patterns of eye-care utilization among refugee patients with type 2 diabetes mellitus (T2DM) in Newfoundland and Labrador (NL) under an interdisciplinary clinic model comprised of family physicians, eye-care providers, and settlement services. Methods This was a retrospective cohort study at the Memorial University Family Medicine clinic. All patients with a new T2DM diagnosis between 2015–2020 were included. Data were described using basic statistics and unpaired t-tests. This study received full ethics approval. Results Seventy-three (18 refugee, 55 non-refugee) patients were included. Refugees had a higher rate of referral to an eye-care provider ( p = 0.0475) and were more likely to attend their eye-care provider appointment than non-refugees ( p = 0.016). The time from diagnosis to referral was longer for refugees than non-refugees ( p = 0.0498). A trend towards longer time from referral to appointment attendance for refugees than non-refugees was noted ( p = 0.9069). Discussion Refugee patients had higher rates of referral to eye-care providers and utilization of eye-care services. However, refugees also experienced a longer time to access vision screening services suggesting possible gaps in accessible care delivery. This suggests that the interdisciplinary model of care may be effective in referring refugee patients for vision screening and there may be a role for increased collaboration across family physicians, eye-care providers, and settlement services to improve accessibility of vision screening services.

Utilization and barriers of eye care services following pediatric vision screening within public schools

In August 2018, Ontario introduced the Child Visual Health and Vision Screening Protocol outlining school-based senior kindergarten vision screening. Screening implementation relies on individual public health units. (3) While there is a post-screening notification process, there is no obligation for families to comply. We evaluated the impact of screening in our region.

Use of Eye Care Service and Associated Factors Among Adult Diabetic Patients Attending at Diabetic Clinics in Two Referral Hospitals, Northeast Ethiopia.

PurposeThe objective of this study was to determine the proportion of use of eye care service and associated factors among adult diabetic patients attending diabetic clinics in two referral hospitals, Northeast Ethiopia, 2020.MethodsA hospital-based cross-sectional study was carried out with a sample size of 546 at Dessie and Debre-Birhan Comprehensive Specialized Hospitals from July 06 to August 14/2020. Systematic random sampling with a sampling fraction of 2 was employed to select study participants at outpatient departments in diabetic clinics. A pre-tested structured questionnaire, checklist, and visual acuity chart were used to collect the data. The collected data were entered into EPI-data version 4.4 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression was fitted to identify the possible factors associated with the outcome variable, and the strength of association was expressed using an adjusted odds ratio at a 95% confidence interval. Variables with p-values of less than 0.05 were considered statistically significant.ResultsA total of 531 adult patients with diabetes participated with a response rate of 97.3%. In this study, the proportion of use of eye care service within the past 1 year was 31.5% (95% CI: 27.5, 35.4). Age from 40 to 64 years (AOR=2.86, 95% CI; 1.43,5.70) and >65 years (AOR=3.15, 95% CI: 1.32,7.50), duration of diabetes 6–10 years (AOR=2.15, 95% CI: 1.26, 3.69) and >11 years (AOR=2.93, 95% CI: 1.51, 5.69), presence of visual symptoms (AOR=3.12, 95% CI: 1.56, 6.18), good attitude on the need of a regular eye checkup (AOR=2.87, 95% CI: 1.68, 4.94), and good knowledge about diabetic ocular complication (AOR=2.29, 95% CI: 1.33, 3.94) were positively associated with the use of eye care service.ConclusionThe proportion of use of eye care service among adult diabetic patients was low. The use of eye care service was significantly and independently associated with older age, longer duration of diabetes, presence of visual symptoms, good attitude on the need of a regular eye checkup, and good knowledge about diabetic ocular complication. We recommend that the patients with diabetes should be taught about diabetic ocular complications and the importance of regular eye check-ups by health professionals to increase utilization of eye care services by patients with diabetes.

Factors Influencing Utilization of Pediatric Eye Care Services in Bangladesh: A Qualitative Study

Factors Influencing Utilization of Pediatric Eye Care Services in Bangladesh: A Qualitative Study

Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology.

The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23 to 29 mm Hg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. Those with an abnormal image and/or IOP ≥30 mm Hg, are assigned as "fast-track" and referred to ophthalmology. Participants living in 7 developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in 3 developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. This study targets vulnerable populations where they live to ensure improved access to and utilization of eye care services in those who are least likely to seek eye care.

Prevalence and associated factors of vision loss in the South African National Health and Nutrition Examination Survey (SANHANES-1)

BackgroundVision loss is a major public health concern that significantly affects developing countries, including South Africa. Although existing literature have reported on the prevalence, causes, and impact of vision loss on the quality of life of affected individuals (children and adults) in parts of South Africa, there is no evidence of the prevalence and associated factors of vision loss in the general population. Hence, this study aimed to determine the prevalence of vision loss and its associated factors in South Africa using a population-based survey.MethodsSecondary analyses were conducted using data from the South African National Health and Nutrition Examination Survey (SANHANES-1), a population-based national health survey conducted from 2011 to 2012. Vision loss was defined as presenting visual acuity (PVA) worse than Snellen 6/12 in the better eye. Visual acuity was assessed by clinicians and participants’ subjective response to vision-related questions. Univariate and multiple logistic regression models were used to examine the association of the independent variables with vision loss.ResultsThe analytic sample comprised 4346 individuals with a mean age of 39.1 years. Female sex accounted for 55.6% of the participants. The prevalence of vision loss among participants was 9.2% (95% CI: 7.7–10.9). Older age (45–54 years, OR = 2.99, p < 0.001; 55–64 years, OR = 5.78, p < 0.001 and ≥ 65 years, OR = 5.12, p < 0.001), female sex (OR = 1.50, p = 0.016), and previous diabetes diagnosis (OR = 2.28, p = 0.001) were significantly associated with increased odds of vision loss. Further, secondary school education (OR = 0.71, p = 0.031), white ethnicity (OR = 0.11, p = 0.007), residing in Mpumalanga province (OR = 0.12, p < 0.001) and having never had an eye examination (OR = 0.56, p = 0.003) were significantly associated with reduced odds of vision loss.ConclusionAlmost one in ten participants had vision loss. Adopting strategies targeted at reducing barriers to the utilization of eye care services will promote early detection and management of blinding conditions, and thereby, decrease the burden of vision loss in South Africa.

Eye care utilization pattern in South Africa: results from SANHANES-1

BackgroundEye examinations are recommended for all persons throughout life. However, there is disparity in the uptake of eye care services in different populations. Using data from a nationally representative population-based cross-sectional study (the South African National Health and Nutrition Examination Survey, [SANHANES-1]), this paper investigates the utilization of eye care services and its associated factors in South Africa.MethodsParticipants aged 15 years and older who participated in interviews and clinical examination were enrolled in the SANHANES from 2011 to 2012. Eye care utilization was assessed from participants’ responses to whether they had their eyes examined by a medical professional and when they were last examined. Data were analysed using multiple logistic regression models employing a hierarchical approach to add predisposing (e.g. age, sex), enabling (e.g. health insurance) and need (e.g. hypertension) factors sequentially.ResultsThe study sampled 3320 participants, with 64.9% being females. 73.4% (95% CI [69.7–76.7]) of participants had never had an eye examination. After statistical adjustment, age groups (compared with 15–29 years: 30-44 years Odds Ratio [OR] = 1.76; 45-59 years OR = 2.13; 60-74 years OR = 2.74; ≥75 years OR = 3.22), ethnicity (compared with African descent: white OR = 4.71; mixed-race OR = 1.87; Indian OR = 7.67), high risk alcohol use (OR = 1.83), wealth index (compared with lowest quintile: third quintile OR = 1.75; fourth quintile OR = 2.23; fifth quintile OR = 2.49), health insurance (OR = 2.19), diabetes (OR = 1.75), high cholesterol (OR = 2.51), having assessed healthcare in the past 5 years (OR = 2.42), and self-reported vision problems (OR = 1.51) were significantly associated with eye care utilization.ConclusionAlmost three-quarters of South Africans sampled were not utilizing eye care services. It is imperative to strengthen current public health measures (including eye health promotion programs) to address the alarmingly low uptake of eye care services as well as the disparities in eye care utilization in South Africa.

Eye care service utilization and associated factors among older adults in Hawassa city, South Ethiopia.

PurposeThe study aimed to assess the proportion of eye care service utilization and associated factors among older adults age ≥ 40 years in Hawassa city, South Ethiopia, June 2019.MethodA community-based cross-sectional study was conducted among adults aged 40 years and above who permanently live in Hawassa city from April 25 to May 30, 2019. Multistage sampling technique was used to select 704 participants. An interviewer-administered questionnaire was used to collect the data. The collected data was entered to EPI info version 7 & was analyzed by SPSS version 20. Binary logistic regression model was used to identify actual predictors of eye care service utilization. All variables were entered to multivariable analysis and variables with p-value < 0.05 were considered as statistically significant.ResultA total of 668 adults participated with a response rate of 94.9%. The median (±IQR) age of study respondents was 48(±10) years and 52.7% were females. The proportion of eye care service utilization within the past 2 years was found to be 23.8% [95% CI: 20.5%-27.1%]. Having history of eye disease [AOR = 9.8, 95% CI: 6.1–15.6], having awareness of regular eye checkup importance [AOR = 7.3, 95% CI:4.4–12.2], older age (age ≥65 years) [AOR = 5.0, 95% CI:1.9–13.3] and higher family monthly income (income ≥6000 ETB) [AOR = 3.0, 95% CI:1.5–5.7] and income 4001–5999 ETB [AOR = 2.9, 95% CI: 1.4–5.9] were positively associated with eye care service utilization.Conclusion and recommendationThe proportion of eye care service utilization among older adults in Hawassa city was low. Having a history of eye disease, having awareness about regular eye checkup importance, older age and higher family monthly income were significantly associated with utilization of eye care service. Therefore, it is recommended to provide eye health education for the community to increase awareness about eye care service utilization which can improve eye care service utilization.

Uncorrected refractive errors for distance among the residents in 'homes for the aged' in South India-The Hyderabad Ocular Morbidity in Elderly Study (HOMES).

PurposeTo investigate the prevalence and risk factors of Uncorrected Refractive Errors (URE) for distance in elderly residents in ‘homes for the aged’ in Hyderabad, India.MethodsIndividuals aged ≥60 years and residing in ‘homes for the aged’ in Hyderabad, India for a minimum of 1 month and providing consent for participation were recruited. All participants underwent visual acuity assessment, refraction, slit lamp biomicroscopy, intraocular pressure measurement, fundus examination, and retinal imaging. Monocular presenting visual acuity was recorded using a logMAR chart. Objective and subjective refraction were performed, and best‐corrected visual acuity was recorded. URE was defined as presenting visual acuity worse than 6/12 but improving to 6/12 or better with refraction. Univariable and multivariable logistic regression analyses were used to assess the risk factors associated with URE.ResultsIn total, 1 513 elderly participants were enumerated from 41 homes of which 1 182 participants (78.1%) were examined. The mean age of participants was 75.0 years (standard deviation 8.8 years; range: 60–108 years). 35.4% of those examined were men and 20.3% had no formal education. The prevalence of URE was 13.5% (95% CI: 11.5–15.5; n = 159). On applying multiple logistic regression analysis, compared to those living in private homes, the odds of URE were significantly higher among the elderly living in the aided homes (OR: 1.65; 95% CI: 1.11–2.43) and free homes (OR: 1.67; 95% CI: 1.00–2.80). As compared to those who reported having an eye examination in the last 3 years, the odds of URE were higher among those who never had an eye examination in the last three years (OR: 1.51; 95% CI: 1.07–2.14). Similarly, those who had unilateral cataract surgery (OR: 1.80; 95% CI: 1.10–2.93) or bilateral cataract surgery (1.69; 95% CI: 1.10–2.56) had higher odds of URE compared to those elderly who were not operated for cataract. Gender, self‐report of diabetes, and education were not associated with URE.ConclusionsA large burden of URE was found among the residents in the ‘homes for the aged’ in Hyderabad, India which could be addressed with a pair of glasses. Over 40% of the residents never had an eye examination in the last three years, which indicates poor utilisation of eye care services by the elderly. Regular eye examinations and provision of spectacles are needed to address needless URE for distance among the elderly in residential care in India.

Female Gender Remains a Significant Barrier to Access Cataract Surgery in South Asia: A Systematic Review and Meta-Analysis.

Purpose To determine whether the female gender is a barrier for the access to cataract surgery services in South Asia in the last two decades. Methods Eligible cross-sectional studies were identified via computer searches and reviewing the reference lists of the obtained articles. The cataract surgical coverage (CSC) by sex based on person and eyes at visual acuity <3/60 and 6/18 is extracted. Pooled odds ratios (ORs) for males receiving cataract surgery in comparison with females were calculated by a random effect model. Results Sixteen studies with 135972 subjects were included in the final analysis. The pooled ORs of CSC by sex on a person basis at visual acuity <3/60 and at visual acuity <6/18 were 1.46 (95% CI: 1.23–1.75) and 1.14 (95% CI: 1.05–1.24), respectively. For CSC on a per-eye basis at visual acuity <3/60, the associations were statistically significant, with a pooled OR of 1.40 (95% CI: 1.16–1.70). The values of population attributable risk percentage at a per-person and per-eye basis at visual acuity <3/60 were 6.28% and 7.48%, respectively. Subgroup analyses by design and location types attained similar results as the primary analyses. There was no evidence of publication bias. Conclusions The female gender remains a significant barrier for the access to cataract surgery in South Asia. Visual impairment, including blindness, from unoperated cataract, could be reduced by approximately 6.28% with the elimination of gender disparities to access. More efforts are needed to increase eye care service utilization by female population.

Utilization of Outpatient Eye Care Services in Taiwan: A Nationwide Population Study

Introduction A study based on the Taiwanese National Health Insurance Research Database (NHIRD) to reveal the ocular diseases landscape. Materials and Methods This study comprised all ophthalmological outpatient patient visits (n = 6,341,266) in the Taiwanese longitudinal NHIRD 2000. Descriptive analytics based on 15 disease categories of ICD-9-CM and 10 tiers of age categories was performed with SAS for Windows 9.3 (SAS Institute, Inc., Cary, NC, U.S.A.). Results The average frequency of visits was 0.7 visits per year. The mean age was 36.2 years old. Bimodal peak of visits in the first, second, and eighth decade of life was revealed. Conjunctiva is the most dominant disease category throughout life while different categories play major roles in each decade of life. The most frequent disease code of each category was listed. Discussion The bimodal peak of visits revealed the age group of the most prominent ocular disease burden. Peak in school age population can be partially explained by the nationwide vision screening program, while aging accounts for the lens disorder and glaucoma of the senile peak. The disease category frequency variation among age categories reflects the development and aging of the eye. The most frequent disease codes of each category highlight disease of importance for primary practitioners and ophthalmologists. Conclusion Taiwanese longitudinal NHIRD was used to reveal the ophthalmological disease landscape. The epidemiological insight, while limited in clinical presentation and economic impact, enables physicians and policy makers to improve the overall vision health of the population.

Chronic Impediment in Utilization of Eye-Care Services

Abstract The visual impairment affects living in every aspect of life. Organizations (W.H.O. IAPB, NGOs) have initiated a campaign to eradicate preventable blindness under the program Vision 2020: “The Right to Sight”. There are three main considerations: qualities, reliability, and efficiency of eyecare facilities. Poor practitioner-to-patient ratio, shortage of eye-care staff, insufficient infrastructure, weak state support and lack of medical specialist, or training program are the hallmarks of obstacles to the usage of eyecare services in India. Significant obstacles to such programs for visually impaired people in rural areas are poor road infrastructure, transit facilities, and distance from remote communities influencing surgery and eyecare systems. Factors such as age, education, preferences, and psycho-social challenges influence the usage of healthy, affordable, and efficient eyecare facilities. To prevent avoidable blindness, the advancement of eye treatment and understanding of appropriate eye care resources must be intense and the consequences of inadequate eyecare must be acknowledged. Rural communities' beliefs and cultural traits need to be analysed to provide appropriate education thus reducing blindness. eyecare providers need to start educating people at an early stage about the role and use of health care resources.

Prevalence and determinants of self-reported ocular morbidity and utilization of eye services in Sri Lanka: results from a national population-based survey

Introduction Data on ocular morbidity is essential for planning primary and referral eye care services. Objectives Determine the prevalence and causes of self-reported ocular morbidity and eye care service utilization in Sri Lanka among adults ≥ 40 years of age. Methods Multistage, stratified, cluster random sampling was used to select a nationally representative sample aged ≥40 years. All participants were administered a questionnaire to assess ocular morbidity they had experienced in the previous month and the pattern of service utilization for reported eye problems. The interviews were conducted by a team of trained investigators at the clinical examination site before they underwent an eye examination. Results 5779 of those presenting for a clinical examination were interviewed among 6713 enumerated (86.1%). The prevalence of self-reported ocular morbidity was 89.9% [95% Confidence Interval (CI): 89.0–90.6%]. Near vision impairment was the commonest problem reported (72.1%; 95% CI: 70.8–73.3%) followed by distance vision impairment (36.2%; 95% CI: 34.9-37.5%). Among those reporting an eye problem, 31.4% sought treatment. 49.4% of those seeking care utilized private facilities. Financial constraints, perceptions that the condition was not serious or had insufficient impact on day-to-day tasks were the most important reasons for not accessing care. Conclusions Ocular morbidities are common in the Sri Lanka population; however utilization of services is relatively low, particularly for asymptomatic illnesses. It is important that the service planners take into account geographical and social inequalities and focus the services on underserviced areas and disadvantaged social groups.

Public Awareness regarding the Differences between Ophthalmologists and Optometrists among Saudi Adults Living in Riyadh: A Quantitative Study

Awareness of the patients to the differences between ophthalmologists and optometrists has been recognized as an important factor influencing patient utilization of available eye care services. This study aimed at assessing the public's knowledge of the differences between ophthalmologists and optometrists among the residents of Riyadh, Saudi Arabia. An online questionnaire was administered to adults in Riyadh, Saudi Arabia, from January to February in 2018. The number of the respondents was 1579. Results show that 50% (n=789) of the participants had fair knowledge of the differences between ophthalmologists and optometrists, while 32% (n=505) had poor knowledge. After multivariate logistic regression analysis, there was a significant association between satisfactory knowledge and visiting an optometrist (odds ratio (OR): 0.75, 95% CI: 0.57–0.98), age older than 26 (OR: 1.73, 95% CI: 1.17–1.19), higher level of education (OR: 1.92, 95% CI: 1.54–2.4), and wearing spectacles (OR: 0.57, 95% CI: 0.45–0.73). Given the low level of public knowledge regarding the differences in the duties between ophthalmologist and optometrists among a Saudi population, there is great potential for general population education through awareness campaign and social media regarding eye care provider's duties and practices.

Changes of eye care use among rural adults under the reform of New Rural Cooperative Medical Scheme: the Handan Eye Study

Objective: To assess the utilization of eye care services in the rural area of Handan, China under the New Rural Cooperative Medical Scheme, and to analyze the factors associated with the uptake of these services. Methods: In a cohort population-based study, subjects who joined both the baseline (2006-2007) and follow-up (2012-2013) were included. Information of demographic characteristics, participation in the New Rural Cooperative Medical Insurance and use of eye care services, comprehensive ophthalmic examinations, blood pressure and fasting was collected. The protocol got approved by the ethics committee of Beijing Tongren Hospital, and each subject signed the informed consent. Results: Of 5 193 eligible participants, 549 [10.6%; 95% confidence interval (CI), 9.8%-11.4%] had used eye care services, and the prevalence had no significant difference from baseline surveys (P=0.20). The municipal hospitals undertook 50.1% of eye care services. "No need" (4 422, 95.2%) was the most common reason cited for not using an eye care service; 2 875 (65.0%) of these participants had at least one type of eye diseases, 3 505 (79.3%) had at least one type of ocular complaints. In the multiple binary logistics regression model, participants who were elder [adjusted odds ratio (OR), 1.319; 95%CI, 1.177-1.478], were female (adjusted OR, 1.466; 95%CI, 1.085-1.981), had a diabetes history (adjusted OR, 1.930; 95%CI, 1.381-2.696), had a low income (adjusted OR, 0.826; 95%CI, 0.688-0.922), had ocular complaints (adjusted OR, 3.556; 95%CI, 2.484-5.091), had refractive errors (adjusted OR, 1.256; 95%CI, 1.007-1.567), had visual impairment (adjusted OR, 4.398; 95%CI, 2.667-7.253) or had cataract (adjusted OR, 1.278; 95%CI, 1.013-1.612) were more likely to take an eye care service. Conclusions: Under the New Rural Cooperative Medical Scheme, the prevalence of New Rural Cooperative Medical Insurance was increased significantly, but the rate of eye care use in the rural area was still low. Further efforts towards higher quality medical service in county hospitals and village clinics as well as better education about eye disease among the rural population may raise the eye care use in rural areas. (Chin J Ophthalmol, 2018, 54:570-579).

Policy implications of regional variations in eye disease detection and treatment on Prince Edward Island: a repeated cross-sectional analysis, 2010\u20132012

BackgroundIn Canada, government insurance covers eye care services provided by ophthalmologists and other physicians. However, government coverage for services provided by optometrists, non-medical school trained primary eye care providers, varies regionally. Little is known about the impact of a funding model in which ophthalmologist services are government-insured but services provided by optometrists are not, on eye care utilization and eye disease detection and treatment. We aimed to address this question by examining geographic variations in eye care service utilization on Prince Edward Island (PEI).MethodsPEI physician-billing data from 2010 to 2012 was analyzed across five distinct geographic regions (Charlottetown, Summerside, Prince, Queens & Kings and Stratford). The residential location of patients and practice locations of eye care providers were identified using the first three digits of their respective postal code. Age-standardized rates were computed for comparisons across different regions.ResultsThere were six ophthalmologists practicing on PEI, five with offices in Charlottetown. Twenty optometrists practiced on the island with offices across the province. Stratford is closest and Prince farthest from Charlottetown. Age-standardized utilization rates of ophthalmologists per 100 populations were 10.44 in Charlottetown and 10.90 in Stratford, which was significantly higher than in other regions (7.74–8.92; p < 0.05). The disparities were most pronounced amongst the elderly. The prevalence of glaucoma visits was higher in Charlottetown (6.10%) and Stratford (6.38%) and lower in other regions. A similar pattern was observed for the prevalence of cataract visits. While the prevalence of diabetes visits was higher in Prince and Summerside, the utilization of ophthalmologists by people with diabetes was almost twice as high in Charlottetown (6.49%) than in Prince (3.88%).ConclusionsThe observed discrepancies in vision care utilization across geographic regions were likely attributed to barriers in accessing government-insured, geographically concentrated ophthalmologists, as opposed to a reflection of the true differences in eye disease occurrence. The lower prevalence of glaucoma visits in regions farther away from ophthalmologist offices may result in delayed detection and blindness in this population. Encouraging ophthalmologists to work in other areas of the province and/or to publicly fund services provided by optometrists may mitigate the observed disparities.Trial registrationNot applicable.

A study of eye care service utilization among diabetic patients visiting a tertiary care hospital in Coastal Karnataka, southern India

The purpose of this study was to understand the eye care service utilization of diabetic patients visiting a tertiary care center. This was a cross-sectional study with a study period of 2 months conducted at a tertiary health care teaching hospital in South India. Diabetic patients visiting the hospital during the study period were subjected to a systematic questionnaire-based interview. The details of their ophthalmological evaluation were accessed from their records. A total of 230 diabetic patients were interviewed. Most of them (91%) were above the age group of 40 years, and 84% were literate. Around 73.2% were residing near the center with easy accessibility to health care. Although almost 90% of the patients were regularly visiting their physician for diabetes control, only 67% had undergone an ophthalmological evaluation and only 58% had been screened for retinopathy. Despite the availability of eye care facilities to a literate diabetic population with reasonable knowledge regarding ocular implications of the disease, the utilization of the services was inadequate. An integrated approach to diabetes and teleophthalmology services may help in making the comprehensive evaluation more convenient and thus begetting more compliance from the patient.

Barriers to Utilization of Eye Care Services in the Upper East Region, Ghana

Barriers to Utilization of Eye Care Services in the Upper East Region, Ghana

Magnitude and Determinants of the Ratio between Prevalence of Low Vision and Blindness in Rapid Assessment of Avoidable Blindness Surveys

ABSTRACTPurpose: To determine the magnitude and determinants of the ratio between prevalence of low vision and prevalence of blindness in rapid assessment of avoidable blindness (RAAB) surveys globally.Methods: Standard RAAB reports were downloaded from the repository or requested from principal investigators. Potential predictor variables included prevalence of uncorrected refractive error (URE) as well as gross domestic product (GDP) per capita, health expenditure per capita of the country across World Bank regions. Univariate and multivariate linear regression were used to investigate the correlation between potential predictor variables and the ratio.Results: The results of 94 surveys from 43 countries showed that the ratio ranged from 1.35 in Mozambique to 11.03 in India with a median value of 3.90 (Interquartile range 3.06;5.38). Univariate regression analysis showed that prevalence of URE (p = 0.04), logarithm of GDP per capita (p = 0.01) and logarithm of health expenditure per capita (p = 0.03) were significantly associated with the higher ratio. However, only prevalence of URE was found to be significant in multivariate regression analysis (p = 0.03).Conclusion: There is a wide variation in the ratio of the prevalence of low vision to the prevalence of blindness. Eye care service utilization indicators such as the prevalence of URE may explain some of the variation across the regions.

Utilization of eye care services among those with unilateral visual impairment in rural South India: Andhra Pradesh Eye Disease Study (APEDS).

To report on the utilization of eye care services and its associated factors among those with unilateral visual impairment (VI) in a rural South Indian population. A population based cross-sectional study was conducted in three districts (Adilabad, Mahbubnagar and West Godavari) in the state of Andhra Pradesh, India. A detailed interview and a comprehensive eye examination were conducted. Those with unilateral VI were asked questions about noticing any change in vision and on utilization of eye care services. The most important reason reported by the participant for not utilizing the services was used for the analysis. Multiple logistic regression models were used to examine the association between noticing a change in vision and socio-demographic variables such as age, gender, education and area of residence, severity and causes of VI. Among the 4456 participants aged ≥16y who were administered the questionnaire, 53.2% were women, and 54.7% had no education. Of the 489 (11%; 95% CI: 10.1-11.9) people with unilateral VI, 399 (81.6%) participants reported noticing a change in their vision over the last five years but only 136 (34.1%) participants had sought eye care consultation. Those who had any education (OR: 1.9; 95% CI: 1.1-3.2), had blindness (OR: 2.7; 95% CI: 1.4-5.2), and cataract (OR: 2.1; 95% CI: 1.0-4.3) as a cause of unilateral VI were more like to seek eye care consultations. The most commonly reported reasons for not seeking eye care services were "do not have money for eye checkup" in 30.7% of the participants followed by "do not have a serious problem" (30.0%). A large proportion of rural population though noticed a change in their vision did not seek eye care due to financial and person-related reasons. Eye care service providers need to address these barriers to enhance the uptake of eye care services among those with unilateral VI.