A Population-Based Cross-Sectional Study of Visual Impairment in West Godavari and Krishna Districts in Andhra Pradesh: Akividu Visual Impairment Study (AVIS).

PURPOSE: To report the prevalence and causes of visual impairment (VI) among those aged ≥40 years in West Godavari and Krishna districts in Andhra Pradesh, India. METHODS: Trained teams visited the households in the selected clusters and conducted eye examinations. Presenting visual acuity (PVA) was assessed for distance and near. Torchlight examination was conducted to assess the anterior segment. Non-mydriatic retinal images were also obtained. VI was defined as PVA worse than 6/18 in the better eye. It included Moderate VI (PVA worse than 6/18 to 6/60), Severe VI (PVA worse than 6/60 to 3/60) and Blindness (PVA worse than 3/60). Multiple logistic regression analysis was conducted to assess the risk factors for VI. RESULTS: In total, 2587/3000 (86.2%) participants were examined. Of this, 1406 (54.4%) were women and 1224 (47.3%) had no education. The age- and gender-adjusted prevalence of VI was 12.8% (95% CI: 11.5-14.1). Compared to the 40-49-year age group, the odds of having VI among those aged 50-59 years, 60-69 years and ≥70 years were 2.93 (95% CI: 1.91-4.52), 6.53 (95% CI: 4.31-9.91) and 17.45 (95% CI: 11.50-26.46), respectively. Those respondents who had no education had a higher odds (OR: 1.73; 95% CI: 1.34-2.23) of VI compared to those who were educated. Cataract (62.4%) and uncorrected refractive errors (29.8%) were the leading causes of VI. Over 90% of the VI was due to avoidable causes. CONCLUSION: VI is a major public health challenge in Andhra Pradesh. Over 90% of this burden is avoidable and can be eliminated by low-cost interventions such as spectacles and cataract surgery.

Barriers to the Uptake of Cataract Surgery and Eye Care After Community Outreach Screening in Takeo Province, Cambodia.

PURPOSE: To assess the barriers influencing eye healthcare seeking behavior after community outreach screening. DESIGN: A concurrent mixed methods study. METHODS: A total of 469 patients screened during the previous 12 months were followed up, of which 354 (75%) from 5 districts were interviewed in person, using a semi-structured questionnaire, in-depth interviews (n = 11), and 16 focus groups (n = 71). SPSS and NVivo were used to analyze response frequency and identify themes. RESULTS: Of the respondents, 98% (350/354) reported they were told they had an eye problem, with 295 individuals (83%) told to attend CARITAS Takeo Eye Hospital (CTEH) and 55 to have their eyes checked at Kiri Vong Vision Centre. Of those 68.9% (244/354) who reported seeking treatment, only 7.4% (18/244) reported they attended CTEH, 54% (n = 132) attended a "local pharmacy," 31.6% (n = 77) "self-treated at home," 11% (n = 27) reported "using steam from boiling rice," and 10.7% (n = 26) attended a "traditional healer." Of those who reported reasons for "not attending," responses included "no time" (47.8%, 86/180), "no one to accompany" (21.7%, n = 39), "fear of losing sight" (17.8%, n = 32), "cannot afford to travel" (16.1%, n = 29), and "eye problem is not serious enough" (15.6%, n = 28). Follow-up of patient records identified that 128 individuals (79 females) attended eye care services. CONCLUSIONS: Socioeconomic factors, personal concerns, and the use of local cultural remedies were reasons for not seeking eye hospital treatment. An integrated community approach to improve awareness and uptake of appropriate treatment is recommended.

Depression screening among older adults attending low-vision rehabilitation and eye-care services: Characteristics of those who screen positive and client acceptability of screening.

AIM: To investigate characteristics associated with screening positive for depressive symptoms among older adults accessing low-vision rehabilitation and eye-care services and to determine client acceptability of depression screening using the Patient Health Questionnaire-2 (PHQ-2) in these settings. METHODS: One-hundred and twenty-four older adults (mean = 77.02 years, SD = 9.12) attending low-vision rehabilitation and eye-care services across Australia were screened for depression and invited to complete a telephone-administered questionnaire to determine characteristics associated with depressive symptoms and client acceptability of screening in these settings. RESULTS: Thirty-seven per cent (n = 46/124) of participants screened positive for depressive symptoms, and the majority considered the new depression screening method to be a 'good idea' in vision services (85%). Severe vision loss (<6/60 in the better eye) was associated with an increased odds of screening positive for depressive symptoms (odds ratio 2.37; 95% confidence interval 1.08-6.70) even after adjusting for potential confounders. Participants who screened positive had a preference for 'talking' therapy or a combination of medication and 'talking therapy' delivered within their own home (73%) or via telephone (67%). CONCLUSION: The PHQ-2 appears to be an acceptable method for depression screening in eye-care settings among older adults. Targeted interventions that incorporate home-based or telephone delivered therapy sessions may improve outcomes for depression in this group.

The impact of anti-vascular endothelial growth factor treatment on quality of life in neovascular age-related macular degeneration.

PURPOSE: To assess the impact of anti-vascular endothelial growth factor (VEGF) treatment in routine medical practice on vision-related quality of life (VRQoL) in neovascular age-related macular degeneration (AMD). DESIGN: Prospective case series. PARTICIPANTS: A total of 169 patients with neovascular AMD undergoing anti-VEGF treatment. METHODS: The VRQoL interviews at baseline (n = 169), 6 months (n = 138), and 12 months (n = 120), routine anti-VEGF treatment with up to monthly follow-ups, and re-treatment as indicated. The Impact of Vision Impairment (IVI) questionnaire was subjected to Rasch analysis to assess its measurement performance and generate interval-level estimates of VRQoL at all time points, anchoring the instrument to its baseline measurement characteristics. Factors associated with a change in reported VRQoL were assessed using generalized linear regression models. MAIN OUTCOME MEASURES: The VRQoL as measured by the IVI using its 3 subscales: Accessing Information, Mobility, and Emotional Well-being. FINDINGS: The mean age was 70 years (±6 years standard deviation [SD]); 56% were female. Visual acuity (VA) improved by a mean of 8 letters (±17 SD), and mean retinal thickness decreased by 87 (±89.7) µm with an average of 6.5 (±2.6) injections over 12 months. Those who lost >2 lines (n = 13, 11%) reported worse VRQoL at 12 months on the Accessing Information and Mobility subscales (P = 0.007 and P = 0.050, respectively). Conversely, those who gained >2 lines (n = 29, 24%) reported better VRQoL on the Accessing Information and Emotional Well-being subscales (P = 0.009 and P = 0.008, respectively). Patients who did not experience a change in VA reported no change in their VRQoL. In multivariate analyses, only a change in VA but not whether the better or worse eye was treated predicted a change in VRQoL on the Accessing Information (P = 0.004) and the Emotional Well-being (P = 0.008) subscales. CONCLUSIONS: We confirmed that anti-VEGF treatment for neovascular AMD improves patients' VRQoL in those who gain vision and maintains VRQoL in those who maintain VA in their treated eye, irrespective of whether the worse or better eye is treated. Against this background, the best possible outcomes should be aimed for even if the worse eye is treated because a loss of VA in the worse eye will adversely affect patients' VRQoL.

Shared care for chronic eye diseases: perspectives of ophthalmologists, optometrists and patients.

OBJECTIVE: To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases. DESIGN, SETTING AND PARTICIPANTS: Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable age-related macular degeneration, diabetic retinopathy and glaucoma, trialled by the Royal Victorian Eye and Ear Hospital in Melbourne during 2007­2009. Semi-structured interviews were conducted with optometrists, ophthalmologists and patients at completion of the project to obtain their perspectives on this model. RESULTS: Seventeen optometrists submitted expressions of interest to participate, and 12 completed web-based training modules and clinical observerships and adhered to specified examination and reporting protocols. All five participating ophthalmologists and 11 of the optometrists were interviewed. Ninety-eight patients participated and 37 were interviewed. Optometrists not only met ophthalmologists' expectations but exceeded them, appropriately detecting and referring patients with additional, previously undetected conditions. Patients reported savings in travel time and were satisfied with the quality of care they received. Optometrists, ophthalmologists and patients indicated a general acceptance of shared care arrangements, although there were some issues relating to interprofessional trust. CONCLUSIONS: Shared care between local optometrists and hospital-based ophthalmologists can help to reduce patient waiting time for review and offers an opportunity for these two groups of eye care professionals to collaborate in providing localised care for the benefit of patients. However, trust and relationship building need to be further developed.

Screening for depression: integrating training into the professional development programme for low vision rehabilitation staff.

BACKGROUND: To describe the integration of depression screening training into the professional development programme for low vision rehabilitation staff and report on staff evaluation of this training. DESIGN: Pre-post intervention study, in a single population of low vision rehabilitation staff. PARTICIPANTS: Three hundred and thirty-six staff from Australia's largest low vision rehabilitation organization, Vision Australia. METHODS: Staff completed the depression screening and referral training as part of a wider professional development programme. A pre-post-training questionnaire was administered to all staff. MAIN OUTCOME MEASURES: Descriptive and non-parametric statistics were used to determine differences in self-reported knowledge, confidence, barriers to recognition and management of depression between baseline and post training. RESULTS: One hundred and seventy-two participants completed both questionnaires. Following training, participants reported an increased knowledge of depression, were more likely to respond to depression in their clients and reported to be more confident in managing depression (P < 0.05). A range of barriers were identified including issues related to the client (e.g. acceptance of referrals); practitioners (e.g. skill, role); availability and accessibility of psychological services; time and contact constraints; and environmental barriers (e.g. lack of privacy). Additional training incorporating more active and 'hands-on' sessions are likely to be required. CONCLUSIONS: This training is a promising first step in integrating a depression screening tool into low vision rehabilitation practice. Further work is needed to determine the barriers and facilitators to implementation in practice and to assess clients' acceptability and outcomes.

The Impact of Knowledge and Attitudes on Access to Eye-Care Services in Cambodia.

PURPOSE: To investigate how knowledge and attitudes influence the access to eye-care services in Takeo Province, Cambodia. DESIGN: A cross-sectional survey (n=600). METHODS: 30 villages were randomly selected. Groups included: >50 years, 30-49 years, and parents with children <5 years. A newly developed Knowledge, Attitude and Practice in Eye Health (KAP-EH) questionnaire about knowledge and treatment of eye diseases, practices and attitudes to accessing services was used to interview respondents. Descriptive analysis, including Chi square and logistic regression tested for associations with sub-groups of gender, age group, education and self-reported type of disability. RESULTS: The proportion of respondents who reported having knowledge of specific eye conditions ranged from 97% for eye injury, to 8% for diabetic eye disease. While 509 (85%) people reported knowledge of cataract, 47% did not know how cataract was treated and only 19% listed surgery. The older group (66.5%) were least informed about cataract (p= 0.001) compared to other groups, and were least likely to believe that some blindness could be prevented (p < 0.001). Women (55%) were more likely than men (46%) (p=0 .003) to report that a child with blindness could attend school, as did people without a disability compared to those with a disability (58% vs 34%) (p < 0.001). CONCLUSIONS: The knowledge about cataract and refractive error and what to do to resolve the problems was low among this population and this study suggests that poor knowledge of eye diseases might contribute to the occurrence of un-operated cataract and uncorrected refractive error.

Economic impact of primary open-angle glaucoma in Australia.

BACKGROUND: Glaucoma is the World's leading cause of irreversible blindness, and poses serious public health and economic concerns. DESIGN: Review. SAMPLES: Published randomized trials and population-based studies since 1985. METHODS: We report the economic impact of primary open-angle glaucoma and model the effect of changes in detection rates and management strategies. MAIN OUTCOME MEASURES: The cost-effectiveness of different interventions to prevent vision loss from primary open-angle glaucoma was measured in terms of financial cost (Australian dollars) and disability-adjusted life years. RESULTS: The prevalence of glaucoma in Australia is expected to increase from 208 000 in 2005 to 379 000 in 2025 because of the aging population. Health system costs over the same time period are estimated to increase from $AU355 million to $AU784 million. Total costs (health system costs, indirect costs and costs of loss of well-being) will increase from $AU1.9 billion to $AU4.3 billion in Australia. CONCLUSION: Primary open-angle glaucoma poses a significant economic burden, which will increase substantially by 2025. This dynamic model provides a valuable tool for ongoing policy formulation and determining the economic impact of interventions to better prevent visual impairment and blindness from glaucoma.

Barriers to the implementation of the SAFE strategy to combat hyperendemic trachoma in Australia.

OBJECTIVE: Australia is the only developed country in the world that still has endemic levels of blinding trachoma. The SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy is an effective public health intervention that has been successfully used to eliminate blinding trachoma in some of the poorest countries of the world. Yet the SAFE strategy has not been systematically implemented in Australia. We undertook semi-structured interviews to identify some of barriers to the implementation of the SAFE strategy within remote indigenous communities of Australia. METHODS: Health care professionals who were responsible for delivering trachoma control programs throughout the Northern Territory were asked to participate in a semi-structured interview. Quantitative analysis was performed using an existing strategic management framework. RESULTS: Fourteen individuals were interviewed. Responses were grouped into 19 categories; 12 from the existing strategic management framework and 7 additional categories that were created for ideas unique to the trachoma control program in Australia. CONCLUSIONS: A number of key themes emerged from the interview and are presented in a literary style. From these key themes critical success factors for the implementation of a sustainable trachoma control program were identified. With the election of the Rudd government there has been a renewed interest in "closing the gap" between the health of indigenous and non-indigenous Australians. A federal government funding package of $58 million over four years has just been announced to tackle trachoma. It is hoped that the findings of this research can assist in making sure that money achieves its goal.

Detection of depression in patients with low vision.

PURPOSE: Depression is common in people with vision impairment and further reduces levels of functioning independent of vision loss. However, depression most often remains undetected and untreated this group. Eye health professionals (EHPs) (ophthalmic nurses, ophthalmologists, optometrists, and orthoptists) and rehabilitation workers (RWs) may be able to play a role in detecting depression. This study aimed to identify current practice and investigate factors associated with depression management strategies. METHODS: A self-administered cross-sectional survey of EHPs and RWs assessed current practice including confidence in working with depressed people with vision impairment; barriers to recognition, assessment, and management of depression; beliefs about the consequences, duration, and efficacy of treatment for depression in individuals with vision impairment. RESULTS: Ninety-four participants aged 23 to 69 years took part. Thirty-seven participants (39.8%) stated that they attempted to identify depression as part of patient management, with RWs significantly more likely to do so (n = 17, 60.7%) than EHPs (n = 20, 30.8%; p = 0.007). Intention to identify depression was not associated with sociodemographic factors, professional experience in eye care services, or the length and number of patient consultations, but a significant relationship was found for confidence, barriers, and beliefs about depression (p < 0.05). No consistent depression management strategy emerged and a range of barriers were highlighted. CONCLUSIONS: Training programs are needed to provide EHPs and RWs with the skills and resources to address depression in people with vision loss under their care and to support the development of procedures by which concerns about depression can be identified objectively, documented, and included as part of a referral to appropriate services.

Cataract surgery in high-risk age-related macular degeneration: a randomized controlled trial.

BACKGROUND: To investigate if cataract surgery causes progression, from high-risk early age-related macular degeneration (AMD) to choroidal neovascularization (CNV), in the postoperative period. METHODS: Randomized controlled trial. Patients, with visually significant cataract and fundus features of early AMD at high risk of progression to CNV, were randomized into two groups and were evaluated at baseline and 6 months. The study patients (n = 27) underwent immediate cataract surgery. The control group (n = 29) comprised patients who had cataract surgery deferred until after the 6-month visit. Assessment included visual acuity, quality of life (QoL) and fundus fluorescein angiography (FFA). RESULTS: Of 68 eligible eyes, 60 participated and 56 completed the study. Three referred eyes (3.2%) were ineligible on the basis of a pre-existing, unsuspected occult CNV that was detected by baseline FFA. All three cases had end-stage exudative AMD in the fellow eye. Of the study eyes in the immediate surgery arm (n = 27), one (3.7%) developed CNV compared with none (0/29) in the deferred arm (chi(2); P = 1.0) at 6 months. In the operated group, there was a 2.8-line improvement in logMAR visual acuity and 2.1-fold average gain in QoL at 6 months. CONCLUSIONS: No increased short-term risk of progression of AMD to CNV in high-risk fundi following uncomplicated phacoemulsification surgery was found. A low threshold for performing preoperative imaging in patients with AMD, especially in those with exudative AMD in the fellow eye, to exclude undetected CNV is recommended. Provided there is no CNV, there are distinct benefits of cataract surgery in people with early AMD.

Detection and management of depression in patients with vision impairment.

PURPOSE: Depression is common in people with vision impairment and has a number of debilitating effects. However, it is often not identified and therefore is left untreated. This study aimed to explore eye healthcare professionals' views of depression in patients with vision impairment and identify current management practices and barriers to effective care. METHODS: Six focus groups and two semistructured interviews were conducted with 26 staff members from a large tertiary eye care hospital. Participants included orthoptists, ophthalmic nurses, and support staff. The data were analyzed using an inductive analytical approach based on the constant comparative method. RESULTS: Participants reported relying mainly on observational cues of patients' behavior or using other indirect methods to identify depression. On the basis of these observations, they acknowledged that the prevalence of depression in visually impaired patients at the hospital was high and believed it impacts negatively on patients' practical and emotional functioning. Few reported overtly discussing depression with patients. Responses to suspected depression varied according to individual staff knowledge of resources or referral options. Various barriers to adequate management of depression were identified, including confusion over roles and responsibilities, and unclear communication pathways between staff. Participants were enthusiastic about resolving these obstacles and establishing clear pathways to care both within the hospital and in the wider community. They were also receptive to receiving training and education about depression, with specific reference to the visually impaired population. CONCLUSIONS: There is considerable scope and enthusiasm for improving depression management in this tertiary eye care facility. The results may not, however, be generalizable to all ophthalmic settings. New initiatives need to be tailored to suit implementation within such ophthalmic services.

Trachoma surveillance annual report, 2008. A report by the National Trachoma Surveillance and Reporting Unit.

The National Trachoma Surveillance and Reporting Unit has reported data for trachoma endemic regions and communities in the Northern Territory, South Australia and Western Australia for 2006 to 2008. Aboriginal children aged 1-9 years were examined using the World Health Organization grading criteria. Screening in the Northern Territory was conducted by the primary health care staff from the Healthy School Age Kids program, the Australian Government Emergency Intervention and Aboriginal Community Controlled Health Services. Forty-three of 92 communities in 6 regions were screened and reported data (2,462 children). In South Australia, the Eye Health and Chronic Disease Specialist Support Program and a team of eye specialists visited 11 of 72 communities in regions serviced by 6 Aboriginal Community Controlled Health Services (365 children). In Western Australia, population health unit and primary health care staff screened and reported data for 67 of 123 communities in 4 regions (1,823 children). Prevalence rates of active trachoma varied between the regions with reported prevalence ranging from 4%-67% in the Northern Territory, 0%-13% in South Australia and 8%-25% in Western Australia. Statistical comparisons must be viewed with caution due to the year-to-year variation in the coverage of children examined and the small numbers. Comparisons of 2006, 2007 and 2008 regional prevalence of active trachoma showed that many communities had no change in prevalence, though there were a few statistically significant increases and decreases (P<0.05). The number of communities screened and the number of children examined has improved but still remains low for some regions. The implementation of the World Health Organization Surgery (for trichiasis), Antibiotics (with azithromycin), Facial cleanliness and Environmental improvement (SAFE) strategy has been variable. Few data continue to be reported for the surgery and environmental improvement components. In general, the availability of the community programs for surgery, antibiotic treatment, and facial cleanliness has improved. Reporting of antibiotic treatment has improved from 2006 to 2008. No significant changes were noted in bacterial resistance reported by pathology services from 2007 to 2008; these rates are comparable to national data collected by the Advisory Group on Antibiotic Resistance in 2005.

An evaluation of the 10-item vision core measure 1 (VCM1) scale (the Core Module of the Vision-Related Quality of Life scale) using Rasch analysis.

PURPOSE: To assess and re-engineer the Vision Core Measure 1 (VCM1) questionnaire in low vision (LV) and cataract participants using Rasch analysis. METHODS: 295 participants drawn from a low vision clinic and 181 from a cataract surgery waiting list completed the 10-item VCM1. Unidimensionality, item fit to the model, response category performance, differential item functioning (DIF) and targeting of items to patients were assessed. Category collapsing and item removal were considered to improve the questionnaire. RESULTS: The initial fit of the VCM1 (combined populations) to the Rasch model showed lack of fit (chi2 = 83.3, df = 50, p = 0.002). There was evidence of DIF between the two populations which could not be resolved. Consequently, each population was assessed separately. Irrespective of the population, disordering of response category thresholds was evident. However, collapsing categories produced ordered thresholds and resulted in fit to the Rasch model for the LV (Total chi2 = 41.6, df = 30; p = 0.08) and cataract population (Total chi2 = 17.9, df = 20, p = 0.59). Overall, the VCM1 behaved as a unidimensional scale for each population and no item showed evidence of DIF. Item targeting to patients was however sub-optimal particularly for the cataract population. CONCLUSION: The VCM1 questionnaire could be improved by shortening the response scale, although different response categories are required for cataract and LV populations. Calibration of items also differed across populations. While the VCM1 performs well within the Rasch model, in line with its initial purpose, it requires the addition of items to satisfactorily target low vision and cataract populations.

Trachoma surveillance annual report, 2007. A report by the National Trachoma Surveillance and Reporting Unit.

Trachoma screening was conducted in 2007 in trachoma-endemic regions and communities in the Northern Territory, South Australia and Western Australia. Aboriginal children aged 1 to 9 years were examined using the World Health Organization grading criteria. Screening in the Northern Territory was conducted by the primary health staff from the Healthy School Age Kids program, the Australian Government Emergency Intervention and Aboriginal Community Controlled Health Services with 60 of the 117 communities screened in 5 regions (1,703 children). In South Australia, the Eye Health and Chronic Disease Specialist Support Program and a team of eye specialists screened eight out of 91 communities in areas serviced by 5 Aboriginal Controlled Health Services (128 children). In Western Australia, population health unit and primary health care staff screened 62 out of 167 communities in 4 regions (1,666 children). Active trachoma prevalence rates varied between the regions with reported prevalence ranging from 5%-26% in the Northern Territory, 0%-21% in South Australia and 4%-22% in Western Australia. Comparisons of 2006 and 2007 regional active trachoma prevalence showed no consistent pattern in changes. Only a small amount of data were reported for the surgery and environmental improvement components of the World Health Organization recommended trachoma control activities of surgery (for trichiasis), antibiotic treatment (with azithromycin), facial cleanliness and environmental improvement. Reporting forthe antibiotic treatment and facial cleanliness components has improved since 2006; however, many gaps still exist. A method to monitor bacterial resistance to azithromycin has been implemented. Baseline data collected by pathology services found similar results to national data collected by the Advisory Group on Antibiotic Resistance.

Vision-related quality of life comparison for emmetropes, myopes after refractive surgery, and myopes wearing spectacles or contact lenses.

PURPOSE: To compare the vision-related quality of life among emmetropes, myopes who had refractive surgery, and myopes who wore spectacles and/or contact lenses. METHODS: This cross-sectional study assessed vision-related quality of life using the Vision Quality of Life Index. Participants were age 18 years or older with a presenting visual acuity of 20/40 or better and no other ocular pathology. Responses were compared among three groups: emmetropes (spherical equivalent [SE] < 0.50 to > -0.50 diopters [D]), myopes (SE < or = -0.50 D) who wore spectacles and/or contact lenses, and myopes who had refractive surgery. RESULTS: The study population included 64 emmetropes, 66 myopes who wore spectacles and/or contact lenses, and 65 myopes who had refractive surgery. No significant differences were found between the refractive surgery and emmetropic groups. In contrast, the spectacle and/or contact lens group had significantly increased odds of having concerns about injuring themselves (odds ratio = 11.5, 95% confidence interval [CI] 2.3, 57.1), difficulties coping with demands in life (odds ratio = 23.6, 95% CI 23.8, 198.1), difficulties fulfilling roles (odds ratio = 5.6, 95% CI 1.4, 22.1), and less confidence joining in everyday activities (odds ratio = 30.6, 95% CI 3.2, 292.3) compared to emmetropes. CONCLUSIONS: Myopia corrected with spectacles or contact lenses had a negative impact on some areas of vision-related quality of life. However, individuals with myopia who had refractive surgery enjoyed the same vision-related quality of life as those with emmetropia. The potential improvement in vision-related quality of life should be considered when recommending treatment for myopia.

Impact of cataract surgery on quality of life in patients with early age-related macular degeneration.

PURPOSE: To investigate if cataract surgery improves overall and specific areas of quality of life (QoL) in patients with early age-related macular degeneration (AMD) using the impact of vision impairment (IVI) questionnaire. METHODS: Patients with visually significant cataract and early AMD, who were being considered for cataract surgery in the study eye, were recruited. Eligible patients were randomized to either "early surgery" or "standard surgery" (standard cataract surgery waiting time of 6 months) groups. The IVI, sociodemographic, and clinical data were collected. Rasch analysis was used to estimate QoL person measures at baseline and follow-up. The data were analyzed using repeated measures ANOVA. Effect sizes were calculated using Cohen's d coefficient. RESULTS: Fifty six patients (mean age = 78.5 years and visual acuity = 6/15) had one eye randomly allocated to either the early surgery (n = 29) or standard surgery (n = 27) groups. At follow-up, significant interaction effects were found for the overall IVI score [F(1,54) = 17.7; p < 0.001], the emotional well-being [F(1,54) = 13.4; p = 0.001], mobility and independence [F(1,54) = 13.4; p = 0.001], and reading and accessing information subscales [F(1,54) = 13.1; p = 0.001]. The standard surgery group systematically recorded worse scores at 6 months on all QoL measures whereas the early surgery group recorded significant gains (p < 0.001; Cohen's d = 0.66 to 0.91) on all of them. Visual acuity in the study eye significantly improved in the early surgery group only (Cohen's d = 1.1; p < 0.05) and improvement in log MAR lines read was identified as the single independent predictor of enhanced QoL explaining between 26 and 34% of the variance in the IVI scores. CONCLUSIONS: Cataract surgery is justified in patients with early AMD. It brings significant improvements in visual acuity, aspects of daily living, and overall QoL.

Changes in eye care utilization following an eye health promotion campaign.

BACKGROUND: The Vision Initiative is a public health campaign that promotes the early detection of the main causes of vision loss through regular eye examinations. Target groups are people over 50 years, with diabetes, a family history of glaucoma or age-related macular degeneration and those who have noted a change in vision. METHODS: In 2005, a range of initiatives promoted the main campaign messages using metropolitan and regional television, radio and newspapers. Campaign outcomes such as last visits to an eye specialist were evaluated comparing pre- and post-campaign data. Participation was volunteer based from randomly selected Melbourne suburbs. Recruitment was by mail. Participants were between 70 and 79 years of age. A questionnaire collected information about demographics, utilization of eye care services, general health and lifestyle. Key features of the five main eye diseases that cause vision loss in Australia were assessed. RESULTS: The percentage of people that reported to have visited an eye specialist within the last year increased significantly from 61% to 70% (P<0.001). Also the percentage of people with diabetes that reported to have a dilated fundus examination within the last 2 years increased significantly from 52% to 70% (P<0.001) and the percentage of people reporting to always wear sunglasses when going out in the sun increased significantly from 33% to 39% (P<0.001). CONCLUSIONS: Following the campaign, there was an improvement in the utilization of eye care services, especially by people with diabetes. However, other Australian public campaigns may contribute to the increased awareness of the effect of diabetes on eye health.

Costs of interventions for visual impairment.

PURPOSE: To quantify the economic costs of vision loss in Australia and assess the impact of a costed intervention package to prevent avoidable vision loss. DESIGN: Existing Australian population-based data on prevalence and causes of visual impairment were used, and costs were calculated from published data for the five main causes of visual impairment. METHODS: The cost of vision loss in Australia was determined from the weighted prevalence of visual impairment; unpublished data on the indirect costs of vision; and national databases on health care costs and other economic data. A costed intervention package was developed and its economic impact modeled. Outcome measures were total costs and savings from the interventions. RESULTS: The intervention package would cost AU$188.8 million to implement in its first year but would bring a net return of AU$163.1 million in direct costs in the first year and an overall savings to the country of AU$911.1 million, a 4.8-fold return on investment. CONCLUSIONS: Three-quarters of vision loss is avoidable, and many eye care interventions are cost effective. Even a developed economy cannot afford avoidable vision loss. Priority needs to be given to the prevention and treatment of avoidable vision loss.

Surveillance report for active trachoma, 2006: National Trachoma Surveillance and Reporting Unit.

The National Trachoma Surveillance and Reporting Unit (NTSRU) was established in November 2006 to improve the quality and consistency of data collection and reporting of active trachoma in Australia. Active trachoma data collected in 2006, prior to the commencement of the NTSRU, were reported by the Northern Territory, South Australia and Western Australia. In most regions, Aboriginal children aged 5-9 years were screened for signs of active trachoma, following the World Health Organization simplified trachoma grading system. In the Northern Territory the Healthy School Aged Kids program conducted school-based screening for active trachoma in 74 schools in five regions (n = 2,253). In South Australia Aboriginal school children presented for active trachoma screening when an eye team visited five Aboriginal Community Controlled Health Services (n = 275). In Western Australia population health units in collaboration with staff from population health care services, conducted school based screening for active trachoma in 53 schools in four regions (n = 1,719). Regional active trachoma prevalence for 2006 varied between the states and the Northern Territory with reported prevalences ranging from: Northern Territory = 2.5%-30%, South Australia = 0%-25%, and Western Australia = 18%-53%. Few data were reported on facial cleanliness or other aspects of the SAFE strategy, and no data were reported for trichiasis.