Corneal pannus, Herbert's pits and conjunctival inflammation in older children in Papua New Guinea.

PURPOSE: The prevalence of trachomatous inflammation-follicular (TF) in Papua New Guinea (PNG) suggests antibiotic mass drug administration (MDA) is needed to eliminate trachoma as a public health problem but the burden of trichiasis is low. As a result, WHO issued bespoke recommendations for the region. If ≥ 20% of 10-14-year-olds have both any conjunctival scarring (C1 or C2 or C3) and corneal pannus and/or Herbert's pits, MDA should be continued. Equally, if ≥ 5% of that group have both moderate/severe conjunctival scarring (C2 or C3) and corneal pannus and/or Herbert's pits, MDA should be continued. METHODS: We identified 14 villages where > 20% of 1-9-year-olds had TF during baseline mapping undertaken 4 years and 1 month previously. Every child aged 10-14 years in those villages was eligible to be examined for clinical signs of corneal pannus, Herbert's pits and conjunctival scarring. A grading system that built on existing WHO grading systems was used. RESULTS: Of 1,293 resident children, 1,181 (91%) were examined. Of 1,178 with complete examination data, only one (0.08%) individual had concurrent scarring and limbal signs. CONCLUSIONS: The WHO-predefined criteria for continuation of MDA were not met. Ongoing behavioural and environmental improvement aspects of the SAFE strategy may contribute to integrated NTD control. Surveillance methods should be strengthened to enable PNG health authorities to identify future changes in disease prevalence.

Knowledge, attitudes and eye health-seeking behaviours in a population-based sample of people with diabetes in rural China.

AIMS: To assess knowledge of diabetes and acceptance of eye care among people with diabetes in rural China, to improve service uptake. METHODS: Population-based study of people in Guangdong, China, with glycosylated haemoglobin A1c≥6.5% and/or known history of diabetes. Between August and November 2014, participants answered a questionnaire (based on Delphi process/previous focus groups) on medical history, demographic characteristics, self-rated health and vision, knowledge about diabetes and diabetic retinopathy, quality of local healthcare, barriers to treatment, likely acceptance of eye exams and treatment, and interventions rated most likely to improve service uptake. Presenting visual acuity was assessed, fundus photography performed and images graded by trained graders. Potential predictors of accepting care were evaluated and confounders adjusted for using logistic regression. RESULTS: A total of 562 people (9.6% (256/5825), mean age 66.2±9.84 years, 207 (36.8%) men) had diabetes, 118 (22.3%) previously diagnosed. 'Very likely' or 'likely' acceptance of laser treatment (140/530=26.4%) was lower than for eye exams (317/530=59.8%, p<0.001). Predictors of accepting both exams and laser included younger age (p<.001) and prior awareness of diabetes diagnosis (p=0.004 and p=0.035, respectively). The leading barrier to receiving diabetes treatment was unawareness of diagnosis (409/454, 97.2%), while interventions rated most likely to improve acceptance of eye exams included reimbursement of travel costs (387/562, 73.0%), video or other health education (359/562, 67.7%) and phone call reminders (346/562, 65.3%). CONCLUSIONS: Improving diagnosis of diabetes, along with incentives, education and communication strategies, is most likely to enhance poor acceptance of diabetic eye care in this setting.

The Impact of Vision Impairment for Children (IVI_C): validation of a vision-specific pediatric quality-of-life questionnaire using Rasch analysis.

PURPOSE: To validate the Impact of Vision Impairment for Children (the IVI_C), a new vision-specific pediatric instrument designed to assess the affect of impaired vision on quality of life (QoL) in children. METHODS: The IVI_C was administered to vision-impaired and normally sighted students, 8 to 18 years of age. Reliability and validity were tested, and the IVI_C was subjected to Rasch analysis to assess the scale unidimensionality, measurement characteristics, response options, and targeting. RESULTS: The mean (SD) presenting bilateral distance visual acuity (VA) for the vision-impaired group (n = 122) was 1.10 (0.79) logMAR and 1.15 (0.80) logMAR for near VA. After the initial response categories were collapsed from five to three, content validity was further supported by good person and item fit parameters. The person separation index (PSI) was 0.85, which indicates that the IVI_C can assess QoL across children of several participation levels. The scale was shown to be unidimensional after principal components analysis (PCA) of the residuals (t-test; P = 0.48, P = 0.34). Significant differences in overall person measures between the vision-impaired and normally sighted groups substantiated the scale discriminant validity (ANOVA; F = 78.75; P < 0.0001). Guttman split-half correlations for temporal, mode (face-to-face and telephone), and interobserver administrations were 0.95, 0.90, and 0.86, respectively, supporting scale reliability. CONCLUSIONS: The modified IVI_C is a unidimensional, reliable, and valid scale for assessing QoL of children with vision impairment. It provides a valid means of assessing the outcomes of interventions and needs in children with vision impairment.