Assessment of a high-fidelity, virtual reality-based, manual small-incision cataract surgery simulator: A face and content validity study.

Purpose: To establish the face and content validity of the HelpMeSee Eye Surgery Simulator - a virtual reality-based cataract surgery simulator for manual small-incision cataract surgery (MSICS). Methods: The face and content validity were assessed on the sclero-corneal tunnel construction course. A questionnaire with 11 questions focused on the visual realism, with resemblance to real life surgery, and the training value of the simulator was developed. Thirty-five experienced MSICS surgeons participated in the study. Responses were recorded using a seven-point scoring system. Results: Overall, 74.3% (26/35) of the respondents agreed that the overall visual representation of the eye and the instruments in the simulator were realistic. The task of injecting a visco-elastic through the paracentesis was reported to be the most visually realistic task with a mean score of 5.78 (SD: 1.09; range: 2-7). With regard to content validity, 77.1% (27/35) of the subjects felt agreed that the errors and complications represented throughout the entire tunnel construction module were similar to those encountered in real life; the task of entering the anterior chamber with the keratome had a mean score of 5.54 (SD: 0.98; range 1-7), being rated the highest in that aspect. Overall, 94.3% (33/35) of the subjects agreed that the simulator would be useful in developing hand-eye co-ordination. A similar number of 94.3% (33/35) agreed that based on their experience, they would recommend cataract surgical training on this simulator. Conclusion: The results suggest that the HelpMeSee Eye Surgery Simulator appears to have sufficient face and content validity for cataract surgical training.

Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs?

BACKGROUND/AIMS: To estimate 2015 global ophthalmologist data and analyse their relationship to income groups, prevalence rates of blindness and visual impairment and gross domestic product (GDP) per capita. METHODS: Online surveys were emailed to presidents/chairpersons of national societies of ophthalmology and Ministry of Health representatives from all 194 countries to capture the number and density (per million population) of ophthalmologists, the number/density performing cataract surgery and refraction, and annual ophthalmologist population growth trends. Correlations between these data and income group, GDP per capita and prevalence rates of blindness and visual impairment were analysed. RESULTS: In 2015, there were an estimated 232 866 ophthalmologists in 194 countries. Income was positively associated with ophthalmologist density (a mean 3.7 per million population in low-income countries vs a mean 76.2 in high-income countries). Most countries reported positive growth (94/156; 60.3%). There was a weak, inverse correlation between the prevalence of blindness and the ophthalmologist density. There were weak, positive correlations between the density of ophthalmologists performing cataract surgery and GDP per capita and the prevalence of blindness, as well as between GDP per capita and the density of ophthalmologists doing refractions. CONCLUSIONS: Although the estimated global ophthalmologist workforce appears to be growing, the appropriate distribution of the eye care workforce and the development of comprehensive eye care delivery systems are needed to ensure that eye care needs are universally met.

Rapid assessment of avoidable blindness: Prevalence of blindness, visual impairment and diabetes in nuevo leon, Mexico 2014.

PURPOSE: To estimate the prevalence of blindness, visual impairment, diabetes mellitus, and diabetic retinopathy in patients aged 50 years and older in the State of Nuevo León, Mexico. METHODS: Ninety-one clusters of 60 people aged 50+ were selected randomly and a rapid assessment of avoidable blindness (RAAB) was conducted. Participants had their visual acuity and cause of visual impairment assessed, underwent a random glucose test and fundoscopy under mydriasis if they had diabetes. The diabetic retinopathy (DR) degree was classified according to the Scottish diabetic retinopathy grading scheme. RESULTS: From the sample 5,055 (92.6%) people were examined. The blindness prevalence was 1.7% (95% Confidence Interval: 1.3-2.1%). Cataract (32.6%), DR (29.1%) and glaucoma (16.3%) were the leading causes of blindness. The prevalence of severe, moderate, and early visual impairment was 1.0%, 5.1%, and 7.7%, respectively. Among respondents, 31% had diabetes and 8.1% of them was not diagnosed prior to the study. Of all participants with diabetes, 50% had glucose levels of 200 mg/dl or higher and 15.7% had sight-threatening diabetic retinopathy. CONCLUSIONS: Besides strengthening of cataract intervention activities, more ophthalmic services for diabetic retinopathy and glaucoma control are needed in Nuevo León to provide timely intervention to prevent blindness.

Cataract Surgical Rate and Socioeconomics: A Global Study.

PURPOSE: Cataract is the leading cause of blindness and cataract surgical rate (CSR) is used as a proxy indicator of access to cataract services in a country. The aim of this study was to explore the associations between the CSR and the economic development of countries in terms of gross domestic product per capital (GDP/P) and gross national income per capita (GNI/P). METHODS: We systematically searched OVID (Medline and Embase), Pubmed, Embase.com, ISI Web of Science, and Cochrane Library databases, and retrieved additional data from unpublished reports. Cataract surgical rates and economic indicators (GDP/P, GNI/P) were collected for each country from 2005 to 2014. Complete data were used for the 50 largest countries according to World Health Organization (WHO) population estimates. Linear correlations between GDP/P and CSR were calculated. Cataract surgical rate data over two periods were used for analysis: 2005 to 2009 and 2010 to 2014 (CSR in 2009 or nearest year, CSR in 2014 or nearest year). RESULTS: Over the study period, CSR data were available for 152 countries across both time periods. Most of the CSR data were obtained from nongovernment organization (NGO) reports, including WHO reports. A good linear correlation between CSR and GDP/P was found overall, nearest to 2009 (ß = 0.162, Linear: y = 0.162x + 282.242; R2 = 0.665, P < 0.001). Regression analysis of CSR nearest to 2014 produced similar findings, with significant correlations between CSR and GDP/P (Linear: y = 0.208x + 94.008; R2 = 0.785, P < 0.001). When using GNI/P as an economic indicator, similarly excellent lines of fit were obtained. After adjusting for time and country, CSR was significantly associated with GDP/P (Coefficient = 0.147, R2 = 0.759, P < 0.001), and GNI/P (Coefficient = 0.152, R2 = 0.757, P < 0.001). Most countries had an increase in CSRs over time, with the greatest increases observed for Iran and Argentina. CONCLUSION: Cataract surgical rate and economic indicators are closely associated, indicating the strong influence of resource availability on healthcare delivery. Considering this relationship, it is important to be innovative in delivery of low-cost services and invest strategically in capacity development to meet cataract surgical need in low-resource settings.