Prevalence of Ocular Anomalies among Schoolchildren in Ashaiman, Ghana.

PURPOSE: Information on ocular anomalies can help in developing specific interventions to prevent visual impairment especially among children. The aim of this study was therefore to determine the prevalence, the causes of ocular anomalies, and their impact on vision of schoolchildren in Ghana. METHODS: A cluster random sampling technique was used to select four government primary schools in Ashaiman Municipal for this study. Each pupil underwent ocular examination involving visual acuity, external examination, anterior and posterior segment examination, and objective and subjective refraction. They also answered questions relating to ocular problems affecting them. RESULTS: A total of 811 pupils were sampled, with ages ranging from 6 to 16 years. The mean age of the sampled population was 10.6 years (95% confidence interval, 10.4 to 10.8). Prevalence of ocular anomalies was 27.3% (95% confidence interval, 24.2 to 30.5). Allergic conjunctivitis (17.3%) and refractive errors (6.8%) were the main causes of ocular anomalies. Others include pinguecula (1.2%), pterygia (0.9%), infectious conjunctivitis (0.3%), corneal opacity (0.1%), lens opacity (0.1%), and retinal degeneration (0.1%). Ocular anomalies and refractive errors were significantly associated with sex (p = 0.04 and p = 0.01, respectively). Presenting visual acuity in the better eye 20/40 or worse was identified in 5.3% of schoolchildren, and 0.5% had moderate visual impairment. Only 11.8% of schoolchildren with ocular anomalies had been treated for their ocular problems before the study. CONCLUSIONS: The prevalence and causes of ocular anomalies found in this study suggest a need for more targeted eye health interventions such as school eye screening for early diagnosis and treatment of any presenting conditions among schoolchildren.

Barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa within a global context.

Low vision is an uncorrectable form of visual impairment that affect millions of people worldwide. Low vision care and rehabilitation are essential to improving the independence of affected individuals. Even though sub-Saharan Africa has one of the highest burdens of low vision globally, there are inadequate care and rehabilitation services in most countries and in some cases they are non-existent This scoping review aimed to identify the barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa and assess these within the global context. The review was conducted using the five-step Arksey and O'Malley framework. Search terms were formulated based on the research questions and a search strategy was designed to search for eligible research articles from electronic databases; Pubmed, Ovid, Medline, and Embase. The data was screened by two members of the research team in accordance with set inclusion and exclusion criteria. Twenty-five out of 260 articles satisfied the inclusion criteria for the study. Inadequate low vision care infrastructure and supplies, non-standardised training of low vision care providers, health system failure and poor awareness of low vision care were the main barriers noted by eye care practitioners. Patients living with low vision cited the cost and availability of low vision aids, societal stigma, and poor awareness of services as the main barriers. No direct enablers were identified in sub-Saharan Africa; however, practitioners suggested improved training in low vision as a potential enabler. The barriers to low vision care and rehabilitation services identified were not unique to sub-Saharan Africa when viewed within a global context. Adopting and adapting solutions from other countries may therefore assist in improving low vision care and rehabilitation in sub-Saharan Africa.

Accessibility of and barriers to the use of eye health services in Kumasi Metropolis, Ghana.

BACKGROUND:  There is a high prevalence of vision impairment and blindness in Africa. The poor access to eye health services, among other barriers, has been found to have a considerable effect on the burden of avoidable vision loss and blindness, particularly in low- and middle-income countries. AIM:  To determine the accessibility of and barriers to the utilisation of eye health services in the Kumasi Metropolis of Ghana. SETTING:  A descriptive cross-sectional survey was conducted in the Kumasi Metropolis of the Ashanti Region in Ghana to identify barriers affecting the utilisation of eye health services. METHODS:  Convenience sampling was used to recruit participants visiting the eye clinics at five selected District Municipal Hospitals for the first time. Data were collected by means of questionnaires and analysed using Statistical Package for Social Sciences (SPSS). RESULTS:  Barriers faced by participants when accessing eye health services included distance to the clinic, cost of services, time spent away from work and/or school, self-medication and long waiting periods. CONCLUSION:  The study found that eye care services in the Kumasi Metropolis, Ghana are largely accessible, but underutilised. Improvement of public health education initiatives through engagement with community groups will also enhance uptake at health care facilities.Contribution: Underutilisation of health services in the Metropolis has been identified in the study and must be addressed by health managers in various sectors. Accessibility is relatively good but can further be improved especially for the elderly to be able to utilise health care services with ease.

Global burden of fall and associated factors among individual with low vision: A systematic-review and meta-analysis.

INTRODUCTION: Low vision has a significant global health problem that impacts the personal, economical, psychological, and social life of an individual. Each year around 684 000 individuals die from falls, 80% of these deaths occur are in low- and middle-income countries. The risk of falling significantly increases with visual impairment. This review aimed to determine the global pooled prevalence of fall and associated factors among individuals with low vision. METHODS AND MATERIALS: Systematic search of published studies done on PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science CINAHL and, Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to report the findings. Quality of studies was assessed using the modified Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using a random-effects method using the STATA™ Version 14 software. RESULT: Thirty-five (35) studies from different regions involving 175,297 participants included in this meta-analysis. The overall pooled global prevalence fall among individual with low vision was17.7% (95% CI: 16.4-18.9) whereas the highest prevalence was 35.5%; (95% CI: 28.4-42.5) in Australia and the lowest was 19.7%; (95% CI: 7.6-31.8) seen in South America. Fear of falling (OR: 0.16(95%CI 0.09-0.30), and severity of visual impairment (OR: 0.27(95%CI (0.18-0.39) increases the odds of falling. CONCLUSION: As one cause of accidental death, the prevalence of falls among individuals with low vision is high. Fear of falling and severity of falling increases the odds of falling. Different stakeholders should give due attention and plan effective strategies to reduce the fall among this population.

A protocol for a scoping review to map the assessment approaches in optometry education programmes globally.

BACKGROUND: The training of optometrists aims to prepare practitioners with critical thinking skills who utilise their education and experience to solve clinical problems in real-life practice. Professional competencies should inform assessment, and as such, assessment methods for learning should encompass a wide range of approaches. The objective of this scoping review is therefore to map assessment approaches utilised within optometry education programmes globally. METHODS: This study is a scoping review based on the PRISMA methodology. The review will be guided by the following research question, "What are the assessment approaches that inform optometry training globally?". This was validated by the Population-Concept-Context framework according to the methodology for Joanna Briggs Institution Scoping Reviews. Relevant peer-reviewed studies and grey literature conducted during the last 10 years will be identified from electronic databases including CINAHL, PubMed, PROquest and ERIC. The search strings using keywords such as "Optometry students and staff", "Assessments" and "Optometry education" will be conducted using Boolean logic. An independent reviewer will conduct all title screening, two independent reviewers will conduct abstract and full article screening, followed by data extraction. Thereafter, a thematic analysis will be conducted. The Mixed Method Appraisal Tool version 2018 will be used for quality appraisal of mapped studies. DISCUSSION: The review will document evidence of assessment approaches utilised in optometry training globally. Considering the exit level competencies required in the basic job function of an optometrist, a coherence in assessment approaches and relevant rationale for these would be expected, if the accredited (regulated) training programmes follow a competency-based model.

Online e-learning during the COVID-19 lockdown in Trinidad and Tobago: prevalence and associated factors with ocular complaints among schoolchildren aged 11-19 years.

Background: The increase in online learning during the pandemic has been linked to various ocular complaints. This study determined the prevalence and factors associated with ocular complaints among schoolchildren aged 12-19 years during the COVID-19 lockdown in Trinidad and Tobago (T&T). Methods: A cross-sectional study was conducted between January and May 2021, during the COVID-19 lockdown in T&T among secondary school students studying remotely. A two-stage cluster sampling method was employed. A modified web-based Computer Vision Syndrome questionnaire was administered to students. Data on demography, duration of digital device use, and ocular complaints were collected, and multilevel logistic regression was used to determine factors associated with ocular complaints among school children, 12-19 years of age in T&T. Results: A total of 435 schoolchildren (mean age, standard deviation, 15.2 ± 1.9 years range 12-19 years) responded to the questionnaire. The prevalence of self-reported symptoms of headache, blurred vision, dry eyes, itchy eyes, and double vision were 75.0%, 65.1%; 56.8%; 46.4%; and 33.5%, respectively. Schoolchildren aged 18-19 years, those that used spectacles for correction of their refractive errors, and spent more than 6 h on average on digital devices, reported a high prevalence of any ocular complaints. Analysis also revealed that age (14-15 years) was associated with dry eyes, blurred vision, and headaches, while gender (more prevalently females) was associated with blurred vision and headache. Those that had an eye examination in the last year and schoolchildren that took action to resolve ocular complaints were more likely to experience nearly all ocular complaints. Conclusions: During the COVID-19 lockdown, over three in four students in T&T reported ocular complaints from digital devices for online learning. Tailored interventional messages to reduce all forms of ocular complaints should target older students, particularly females, those who laid down when learning online via their devices and people who regularly examine their eyes.

The Rising Burden of Diabetes-Related Blindness: A Case for Integration of Primary Eye Care into Primary Health Care in Eswatini.

There is a rampant increase in diabetes prevalence globally. Sub-Saharan Africa (SSA) is projected to carry the largest burden of diabetes (34.2 million) by 2030. This will inevitably cause a parallel increase in diabetes-associated complications; with the predominant complications being blindness due to diabetic retinopathy and diabetic cataracts. Eye programs in developing countries remain inadequate, existing as stand-alone programs, focused on the provision of acute symptomatic care at secondary and tertiary health levels. Over 60% of people with undiagnosed diabetes report to eye care facilities with already advanced retinopathy. While vision loss due to cataracts is reversible, loss of vision from diabetic retinopathy is irreversible. Developing countries have in the last two decades been significantly impacted by infectious pandemics; with SSA countries committing over 80% of their health budgets towards infectious diseases. Consequently, non-communicable diseases and eye health have been neglected. This paper aimed to highlight the importance of strengthening primary health care services to prevent diabetes-related blindness. In SSA, where economies are strained by infectious disease, the projected rise in diabetes prevalence calls for an urgent need to reorganize health systems to focus on life-long preventative and integrated measures. However, research is critical in determining how best to integrate these without further weakening health systems.

Characterization of Retinal Thickness in Individuals with Albinism: Baseline Data for a Black South African Population.

INTRODUCTION: The central retina is responsible for several visual functions and continues to develop postnatally. In albinism, which is a genetic disorder characterized by impaired melanin biosynthesis, the development of the central retina is prematurely arrested and results in foveal hypoplasia. Retinal thickness measurements can be determined non-invasively using optical coherence tomography systems. This article reports on the retinal thickness measurements of individuals with albinism in South Africa to aid in the assessment and management of affected individuals. METHODS: The study used a comparative research design and included 60 individuals (30 albinism and 30 controls) aged from 10 to 30 years who accessed the eye clinic at a tertiary institution in KwaZulu-Natal, South Africa. The Optovue iVue100 optical coherence tomographer was used to measure retinal thickness in the nine Early Treatment Diabetic Retinopathy Study (ETDRS) sectors including the central foveal, parafoveal and perifoveal regions. Study data were analysed using descriptive and inferential statistics. RESULTS: The mean central foveal thickness was significantly higher in individuals with albinism compared with controls (289 µm versus 239 µm, p < 0.001). In contrast, control participants showed thicker retinal thickness measurements in the other ETDRS sectors (p < 0.001). The nasal and temporal quadrants were thickest and thinnest, respectively, in the parafoveal and perifoveal regions for the albinism and control groups. CONCLUSION: Individuals with albinism, aged from 10 to 30 years, have higher central foveal thickness but thinner retinal thickness measurements in the parafoveal and perifoveal regions. Optometric personnel should consider these measurements when assessing individuals with albinism with foveal retinal diseases.

The universal eye health imperative for Canada: an inescapable reality of unmet need.

Universal eye health is a component of universal health care, which member states of the World Health Organization have supported in principle through their endorsement of the Global Action Plan for the Prevention of Avoidable Blindness and Visual Impairment (2014-2019). While much of the world's attention has been on addressing the needs of developing countries which suffer significant shortcomings in terms of effective and accessible eye care services, similar access inequities exist in developed nations such as Canada. The Canadian health system is based on the principle of universal health coverage; yet, for the majority of the population, access to primary eye care services such as an eye examination and spectacles is an out-of-pocket expense. Therefore, despite the global call for universal eye health, Canada has still not made relevant policy shifts in terms of addressing the structural barriers to all its citizens accessing primary eye care services within its health system, despite active advocacy efforts of key stakeholder groups in eye health. There is, therefore, an inescapable reality of unmet eye care needs, which Canada must address if it is to meet the World Health Organization's goals of universal eye health.

Knowledge, attitudes and practices of contact lens use in a South African adolescent population.

BACKGROUND: Contact lens usage is becoming increasingly popular amongst young people. Assessing their knowledge, attitudes and practices in relation to contact lens wear is therefore important, so that gaps in understanding or incorrect practices can be rectified to promote continued safety and success of contact lens wear. OBJECTIVES: This study aimed to assess and describe the knowledge, attitudes and practices of contact lens wearers aged 18 to 30 years, in the greater Durban area of South Africa. METHODS: A semi-structured questionnaire was used to assess the knowledge, attitudes and practice of the participants. Results: Two hundred and forty six participants completed the survey. Young contact lens wearers in this sample generally had poor knowledge with regards to appropriate hygiene and contact lens wear complications. Despite wearers exhibiting a positive attitude with satisfactory hand hygiene and lens cleaning practices, important aspects such as lens case hygiene, storage and lens removal practices were found to be unsatisfactory. Compliance with after-care visits was also unsatisfactory. CONCLUSION: There is a need for contact lens practitioners to educate young contact lens wearers regarding appropriate contact lens-related care, to promote long term ocular health and contact lens-related safety.

Prevalence of congenital colour vision deficiency among Black school children in Durban, South Africa.

OBJECTIVES: Congenital colour vision deficiency (CCVD) is an x-linked chromosome disorder that results from abnormalities in one or all three-cone type's photoreceptors. Early assessment and diagnosis of CCVD is necessary to minimise the disability associated with the condition. Multistage sampling was used to determine the prevalence of CCVD among Black South African school children in Durban, South Africa. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy, auto-refraction, and examination of the anterior segment, media and fundus. Colour vision testing was performed using Colour Vision Testing Made Easy colour plates (Home Vision Care, Gulf Breeze, FL). RESULTS: 1305 (704 boys and 601 girls) Black school children participated in the study. The overall prevalence of colour vision deficiency was 29 (2.2%), which was higher in boys (25, 4.2%) than girls (4, 0.6%), with prevalence of protanopia and deuteranopia found to be 10 (0.7%) and 19 (1.5%), respectively. The prevalence of protanopia and deuteranopia among males was nine (1.5%) and 16 (2.7%) respectively, which was significantly higher than the 1 (0.1%) protanopia and 3 (0.4%) deuteranopia in females (p < 0.05). Policies and guidelines for comprehensive school eye health programmes which screen children for CCVD are required in South Africa.

Decentralised clinical training in optometry: a developmental strategy for eye health in KwaZulu Natal?

BACKGROUND: Decentralised clinical training (DCT) in optometry is an emerging concept in South Africa. In 2016, the University of KwaZulu Natal (UKZN) implemented this adaptive model of clinical training for undergraduate health professions. The initiative, which emanated through an agreement between UKZN's College of Health Sciences and the KwaZulu Natal Department of Health, centres on the placement of undergraduate optometry students within public health facilities for clinical training purposes. Optometry services in South Africa have, however, had a historical bias towards a private sector model of training and a curative practice approach resulting in access barriers for the rural poor and high levels of unmet need. It has further contributed to a general state of underdevelopment of eye health services within the public sector. DISCUSSION: DCT challenges historical undergraduate programme structures and modes of teaching and learning in optometry. It is largely underpinned by a need to strengthen health service delivery through a primary health care-centred, community-based training approach and produce 'fit-for-purpose' graduates who have contextually appropriate competencies for effective, local health service delivery. The historical absence of optometry services within the public sector has, however, contributed to limited planning for, and development of eye health services in this sector. This has inadvertently contributed to the burden of avoidable vision impairment in the country. The public health system in South Africa, therefore, faces various developmental challenges which impact eye health services and student clinical training. CONCLUSION: While the model is still in a developmental state and resourcing challenges potentially affecting DCT are noted, early experiences of the Discipline of Optometry at the UKZN are that DCT shows promise in terms of its potential contribution towards the development of eye health services within the public health sector from graduate readiness, resource strengthening, access improvement and health service development perspectives.