Non-compliance for wearing spectacles: Prevalence and determinants in school-going children in South India.

Purpose: To study the prevalence and determinants of compliance with spectacle wear among school-age children in South India who were given spectacles free of charge under a school vision screening program. Methods: A cross-sectional, descriptive study was performed. The participants were recruited from the school from Tirunelveli and Tuticorin districts of Tamil Nadu, where a school vision screening camp was conducted between January 2012 and October 2012. The school screening was performed under. "Lavelle Pediatric Eye Care Project": . Of the 129,720 children examined of 249 schools, 4253 of children had refractive error and 3333 were prescribed and dispensed spectacles. A total of 683 children were interviewed, who were not wearing glasses on follow-up. Results: About 20% of the participants (683/3333) were not wearing their spectacles at examination. The most common reasons given for non-wear were lost (44.9%) or broken (35.3%) spectacles. There was no gender preference on compliance to spectacles. Conclusion: Compliance with spectacle wear is less even when spectacles are provided free of cost, particularly in children among the age group of 5-15 years. Because factors such as type of school, area (urban or rural), parent's income, occupation, and their education were not significantly affecting the compliance of spectacle wear, proper encouragement and counseling of the parents and the child become extremely important.

Visual function, spectacle independence, and patients' satisfaction after cataract surgery- a study in the Central Region of Ghana.

BACKGROUND: Reduced visual function is associated with diminished quality of life as well as decreased physical and mental health. Poor visual function related to cataracts is also a risk factor for falls and traffic accidents, which may lead to hospital admissions and limit independence. OBJECTIVE: To evaluate patients' satisfaction, visual functions and spectacle independence among patients in the Central Region of Ghana who had cataract surgery in one eye. METHODS: A hospital-based prospective cohort study was carried out on 146 patients booked for cataract surgery: 16 were lost through follow-ups whilst 130 completed the study. Visual functions including visual acuity, contrast sensitivity, stereopsis and colour vision were assessed before and after a month of cataract surgery. Objective and subjective refractions were performed to determine the post-surgery refractive status of the participants. Participants completed the NEI-VFQ 25 questionnaire and the scores obtained were used as a construct of their satisfaction. RESULTS: The NEI-VFQ 25 questionnaire scores indicated patients' satisfaction was high with an average quality of life score of 77.46. Patients satisfaction was strongly correlated with contrast sensitivity (r=0.653, p<0.001) but moderately correlated with visual acuity (r=-0.554, p<0.001), stereopsis (r=0.490, p<0.001) and colour vision (r=0.466, p<0.001). Contrast sensitivity was a better predictor of patients' satisfaction than visual acuity and stereopsis. Spectacle independence at distance was achieved in only 44.6% of the participants and 5.4% at near. There was a significant (p>0.001) association between spectacle independence and the two types of cataract surgery performed which included Small Incision Cataract Surgery (SICS) and Extracapsular Cataract Extraction (ECCE). Among those who were spectacle independent, 53.4% of them were low vision patients. CONCLUSION: Satisfaction of patients after cataract surgery was high but was greatly influenced by visual functions with contrast sensitivity being a better predictor of satisfaction than visual acuity and stereopsis. Spectacle independence after cataract surgery was low at distance and extremely low at near. The type of cataract surgery performed influenced thespectacle independence.

Visual and Ocular Conditions among a Homeless Adult Population of Boston.

SIGNIFICANCE: The eye care needs of the homeless population in the United States are not well known. This study elucidates those needs for health care for the homeless programs and eye care practitioners. This information could result in an increase in the provision of necessary eye care services. PURPOSE: The purpose of this study was to assess the extent of visual and ocular conditions, the frequency of eyeglass orders and receipt of eyeglasses, and the frequency of ophthalmology referrals and receipt of ophthalmological care in an adult homeless population in Boston. METHODS: A cross-sectional retrospective chart review was conducted for patients of the Boston Health Care for the Homeless Program's Pine Street Inn eye clinic from September 26, 2016, to December 31, 2017. Data on sociodemographics, medical history, comprehensive eye examination findings, glasses orders and receipt, and ophthalmology referrals and receipt of care were collected and analyzed. RESULTS: A total of 424 patients were included in the study. The mean age of the study population was 52.7 (interquartile range, 46 to 60), and the majority were male (74%). The most common systemic conditions were hypertension (40.6%) and diabetes (23.8%). The most common refractive error was presbyopia (67.7%), followed by astigmatism (38.9%), hyperopia (34.0%), and myopia (30.7%). The most common ocular conditions were dry eye (28.6%), visually or clinically significant cataract (20%), and glaucoma/glaucoma suspicion (13.9%). Refractive correction was indicated for 356 patients (84%), but 82 (29%) did not receive ordered eyeglasses. Ophthalmology referrals were placed for 61 patients (14.4%), yet only 20 (32.8%) of those referrals were completed. CONCLUSIONS: A significant need for refractive correction and a large gap for ophthalmological care were found among the study population. Health care for the homeless programs and eye care practitioners should be aware of the visual and ocular needs of this patient population so as to better meet their needs.

Barriers and Facilitators to Obtaining Eyeglasses for Vulnerable Patients in a Michigan Free Clinic.

SIGNIFICANCE: Uncorrected refractive error is the main cause of visual impairment globally. Understanding barriers and facilitators underserved individuals face in obtaining eyeglasses will help address high rates of uncorrected refractive error. PURPOSE: The purpose of this study was to understand the barriers and facilitators to obtaining eyeglasses among low-income patients in Michigan. METHODS: Participants older than 18 years with hyperopia, myopia, or presbyopia and without active eye disease, severe mental illness, or cognitive impairment at Hope Clinic, Ypsilanti, Michigan, were included in this study. The participants answered a sociodemographic survey and underwent autorefraction and an interview. Interviews were audiorecorded, transcribed, and analyzed by two investigators. RESULTS: Interviews were completed by 43 participants, and 30 participants' interviews were analyzed. The mean ± standard deviation age of 30 participants was 55 ± 12 years, 70% were female, 57% were African American, 40% had high school diploma or less, 57% earned less than U.S. $25,000 per year, 93% had worn glasses previously, and 87% had some medical insurance. Uncorrected visual acuity was logMAR 0.73 ± 0.61; best-corrected visual acuity was logMAR 0.16 ± 0.21. Thematic saturation was reached after 25 transcripts. Top barriers to using eyeglasses were cost (312 mentions, 29 participants), negative experiences with eyeglasses (263, 29), and limited access to eye care (175, 27). Top facilitators were positive experiences with glasses (230, 29), easy access to eyeglasses (143, 27), and availability of transportation (65, 27). Most participants (97%, 29) reported being negatively impacted by uncorrected refractive error. Most (97%, 29) were skeptical about obtaining eyeglasses online because of possible prescription problems. CONCLUSIONS: Key barriers to correcting uncorrected refractive error in our community span across multiple health domains but are predominately rooted in external factors such as cost and access to vision care. Online eyeglasses may address access issues, but many participants were uncomfortable or unable to obtain glasses online.

High Rates of Uncorrected Vision Conditions among Schoolchildren in Rural Queensland, Australia.

SIGNIFICANCE: This study is the first to report high rates of uncorrected vision conditions among Australian secondary schoolchildren living in a rural area and to comment on the rate of eye examinations undertaken on Australian Indigenous children. Uncorrected vision problems that continue throughout the school years have significant implications for children's quality of life and education. PURPOSE: This study aimed to investigate the prevalence of uncorrected vision conditions among Australian schoolchildren. METHODS: Participants included 280 students from rural primary and secondary schools (aged 4 to 18 years), of whom 40% identified as being of Aboriginal and/or Torres Strait Islander descent (Indigenous). All participants underwent an eye examination including measurements of monocular distance and near visual acuity, assessment of accommodative and vergence function, stereoacuity, color vision, and cycloplegic autorefraction. A parental questionnaire was used to determine whether the child had previously had his/her eyes examined. RESULTS: The overall prevalence of uncorrected vision conditions in this population was 35%. The odds of previously having had an eye examination were 2.3× higher for non-Indigenous compared with Indigenous children despite both groups exhibiting high rates of uncorrected vision conditions (Indigenous, 31 [29%]; non-Indigenous, 66 [40%]; χ21 = 3.24, P = .07). Of the children who had significant refractive error (Indigenous, 23 [21%]; non-Indigenous, 49 [30%]; χ21 = 2.70, P = .10), 82% were uncorrected, and only 39% of Indigenous children and 54% of non-Indigenous children had previously had an eye examination. CONCLUSIONS: These findings suggest that high rates of uncorrected vision conditions are present among Australian primary and secondary schoolchildren from a rural area and highlight that Indigenous children are much less likely to have had an eye examination. Understanding factors that affect the rate of eye examinations and compliance with spectacle correction must be addressed given the potential impact of these vision conditions.

Impact of spectacles wear on uncorrected visual acuity among urban migrant primary school children in China: a cluster-randomised clinical trial.

OBJECTIVE: To estimate the effect of providing free spectacles on uncorrected visual acuity (VA) among urban migrant Chinese school children. DESIGN: Exploratory analysis from a parallel cluster-randomised clinical trial. METHODS: After baseline survey and VA screening, eligible children were randomised by school to receive one of the two interventions: free glasses and a teacher incentive (tablet computer if ≥80% of children given glasses were wearing them on un-announced examination) (treatment group) or glasses prescription and letter to parents (control group). The primary outcome was uncorrected logarithm of the minimal angle of resolution (LogMAR) VA at study closeout, adjusted for baseline uncorrected VA. RESULTS: Among 4376 randomly selected children, 728 (16.6%, mean age 10.9 years, 51.0% boys) at 94 schools failed VA screening and met eligibility criteria. Of these, 358 children (49.2%) at 47 schools were randomised to treatment and 370 children (50.8%) at 47 schools to control. Among these, 679 children (93.3%) completed follow-up and underwent analysis. Spectacle wear in the treatment and control groups was 68.3% and 29.3% (p<0.001), respectively. Uncorrected final VA for eyes of treatment children was significantly better than control children, adjusting only for baseline VA (difference of 0.039 LogMAR units, 95% CI: 0.008, 0.070, equivalent to 0.39 lines, p=0.014) or baseline VA and other baseline factors (0.040 LogMAR units, 95% CI 0.007 to 0.074, equivalent to 0.40 lines, p=0.020). CONCLUSION: We found no evidence that spectacles wear worsens children's uncorrected VA among urban migrant Chinese school children.

Visual and Patient-Reported Outcomes of a Diffractive Trifocal Intraocular Lens Compared with Those of a Monofocal Intraocular Lens.

PURPOSE: To evaluate the effectiveness and safety of a trifocal intraocular lens (IOL), the TFNT00 (Alcon, Fort Worth, TX), versus a monofocal IOL, the SN60AT (Alcon). DESIGN: Food and Drug Administration-approved, prospective, multicenter, nonrandomized, parallel-group, assessor-masked, confirmatory trial. PARTICIPANTS: Patients enrolled were 22 years of age or older with a diagnosis of bilateral cataract with planned removal by phacoemulsification with a clear corneal incision. METHODS: Consented participants selected their preferred IOL, which was implanted sequentially into each eye of patients meeting eligibility criteria. MAIN OUTCOME MEASURES: The coprimary effectiveness outcomes were mean photopic monocular best-corrected distance visual acuity (BCDVA; 4 m) and distance-corrected near visual acuity (DCNVA; 40 cm) at 6 months after surgery. Secondary effectiveness outcomes included mean monocular distance-corrected intermediate visual acuity (DCIVA; 66 cm) and proportion of participants responding "never" to question 1 of the Intraocular Lens Satisfaction questionnaire (regarding frequency of spectacle use in the past 7 days). Safety outcomes included frequency of "severe" and "most bothersome" visual disturbances. RESULTS: Two hundred forty-three patients underwent cataract surgery with bilateral implantation of the TFNT00 (n = 129) or SN60AT (n = 114) and were followed up for 6 months. Noninferiority of TFNT00 to SN60AT in mean photopic monocular BCDVA (95% upper confidence limit of the difference was <0.1 logarithm of the minimum angle of resolution [logMAR] margin), and superiority in mean photopic monocular DCNVA (difference of 0.42 logMAR; P < 0.001) and DCIVA (difference of 0.26 logMAR; P < 0.001) were demonstrated. The proportion of patients never requiring glasses overall was superior for TFNT00 versus SN60AT (80.5% and 8.2%, respectively). Starbursts, halos, and glare were the most frequently rated severe symptoms with TFNT00; however, less than 5% of patients were very bothered at month 6. CONCLUSIONS: The TFNT00 exhibited superior monocular DCNVA and DCIVA to a spherical monofocal IOL, with comparable monocular BCDVA. Binocular visual acuity was 20/25 or better for distance to near (+0.5 D to -2.5 D), resulting in high levels of spectacle independence. Less than 5% of patients were very bothered by the photic visual disturbances associated with the TFNT00 at 6 months after surgery.

Prevalence and determinants of uncorrected refractive error among a socially vulnerable older adult population living in Armenia.

OBJECTIVE: This study estimated the prevalence of uncorrected refractive error (URE) and its determinants in a socially vulnerable older population living in Armenia. STUDY DESIGN: The study design used in the stidy is a cross-sectional study. METHODS: A total of 485 people responded to a survey on sociodemographic characteristics, spectacle use, and ophthalmic services' use. All participants underwent a comprehensive ophthalmic examination including assessment of presenting and best-corrected visual acuity, measuring intraocular pressure and dilated eye fundus examination. Patients who had presenting visual acuity (<6/12) but improved ≥ one line with/without available spectacles after refraction in the better eye were considered to have URE. Descriptive statistics described the sample and estimated the prevalence of the URE in the population. Logistic regression models were used to evaluate its determinants. RESULTS: The mean age of participants was 74.5 (7.27) years, ranging from 51 to 94 years. Women constituted the majority of participants (86%). The prevalence of URE in the better eye was 26%. In bivariate analysis, those who were older and who had less than 10 years of education had higher odds of URE than younger and more educated respondents. In multivariable analysis, only education remained associated with URE (OR = 3.71; 95% CI: 1.10-12.5). The rate of normal vision (≥6/12) improved from 58.9% to 81.5%, whereas the rate of visual impairment (<6/12) decreased from 41.1% to 18.5% after best correction in the better eye. CONCLUSION: The prevalence of URE was high in this study population. The findings warrant the need for eye screening and provision of affordable spectacle correction to the target population in Armenia.

Estimating assistive product need in Cameroon and India: results of population-based surveys and comparison of self-report and clinical impairment assessment approaches.

OBJECTIVES: To estimate population need and coverage for distance glasses, hearing aids and wheelchairs in India and Cameroon, and to explore the relationship between assistive product (AP) need measured through self-report and clinical impairment assessment. METHODS: Population-based surveys of approximately 4000 people each were conducted in Mahabubnagar district, India and Fundong district, Cameroon. Participants underwent standardised vision, hearing and musculoskeletal impairment assessment to assess need for distance glasses, hearing aids, wheelchairs. Participants with moderate or worse impairment and/or self-reported difficulties in functioning were also asked about their self-reported AP need. RESULTS: 6.5% (95% CI 5.4-7.9) in India and 1.9% (95% CI 1.5-2.4) in Cameroon of the population needed at least one of the three APs based on moderate or worse impairments. Total need was highest for distance glasses [3.7% (95% CI 2.8-4.7) India; 0.8% (95% CI 0.5-1.1), Cameroon] and lowest for wheelchairs (0.1% both settings; 95% CI 0.03-0.3 India, 95% CI 0.04-0.3 Cameroon). Coverage for each AP was below 40%, except for distance glasses in India, where it was 87% (95% CI 77.1-93.0). The agreement between self-report and clinical impairment assessment of AP need was poor. For instance, in India, 60% of people identified through clinical assessment as needing distance glasses did not self-report a need. Conversely, in India, 75% of people who self-reported needing distance glasses did not require one based on clinical impairment assessment. CONCLUSIONS: There is high need and low coverage of three APs in two low-and middle-income settings. Methodological shortcomings highlight the need for improved survey methods compatible with the international classification of functioning, disability and health to estimate population-level need for AP and related services to inform advocacy and planning.

OBJECTIFS: Estimer les besoins et la couverture de la population en lunettes de distance, appareils auditifs et chaises roulantes en Inde et au Cameroun; et explorer la relation entre les besoins en produits d'assistance (PA) mesurés par l'auto-déclaration et l'évaluation clinique de la déficience. MÉTHODES: Enquêtes de population sur environ 4.000 personnes, chacune menées dans le district de Mahabubnagar, en Inde et dans le district de Fundong, au Cameroun. Les participants ont subi une évaluation standardisée de la vision, de l'audition et des troubles musculosquelettiques pour évaluer les besoins en lunettes de distance, en appareils auditifs et en chaises roulantes. Les participants ayant une déficience modérée ou sévère et/ou des difficultés fonctionnelles autodéclarées ont également été interrogés sur leurs besoins autodéclarés en PA. RÉSULTATS: 6,5% (IC95%: 5,4-7,9) de la population en Inde et 1,9% (IC95%: 1,5-2,4) au Cameroun avait besoin d'au moins l'un des trois PA sur la base de déficiences modérées ou sévères. Le besoin total était le plus élevé pour les lunettes de distance [3,7% (IC95%: 2,8-4,7) Inde; 0,8% (IC95%: 0,5-1,1), Cameroun] et le plus faible pour les chaises roulantes (0,1% dans les deux paramètres; IC95%: 0,03-0,3 Inde, IC95%: 0,04-0,3 Cameroun). La couverture pour chaque PA était inférieure à 40%, sauf pour les lunettes de distance en Inde, où elle était de 87% (IC95%: 77,1-93,0). La concordance entre l'auto-déclaration et l'évaluation clinique de la déficience du besoin en PA était faible. Par exemple, en Inde, 60% des personnes identifiées lors de l'évaluation clinique comme ayant besoin de lunettes de distance n'ont pas autodéclaré un besoin. A l'inverse, en Inde, 75% des personnes qui ont déclaré avoir besoin de lunettes de distance n'en avaient pas besoin sur la base d'une évaluation clinique de la déficience. CONCLUSIONS: Il y a un besoin élevé et une faible offre de trois PA dans deux milieux à revenu faible et intermédiaire. Les lacunes méthodologiques soulignent le besoin de méthodes d'enquête améliorées compatibles avec la classification internationale du fonctionnement, du handicap et de la santé pour estimer les besoins au niveau de la population en PA et en services connexes pour éclairer le plaidoyer et la planification.

Cataract surgery in Kinshasa-Is there a place for "Monovision"?

OBJECTIVES: Monovision is a method of correcting presbyopia where one eye is focused for far and the other for near vision. It is a simple, cost-effective approach to overcome the loss of accommodation with age and to become spectacles independent. METHODOLOGY: About 50 patients, where bilateral cataract extraction was indicated, were included in this study performed at the St. Joseph's Eye Hospital in Kinshasa (DR Congo). Small incision cataract surgery technique (SICS) was applied with the implantation of 6 mm PMMA lenses in the capsular bag. IOL refractive power choice was made to achieve a post-operative refraction of -0.5 dpt for the eye selected for far vision. The second eye received an implant heading for a post-operative myopia of -1.5 dpt suitable for intermediated and near vision. According to the literature, monovision criteria have been regarded as fulfilled when (a) far vision was 0.5 (logMAR) or better and (b) near vision was P3 (0.40, Decimal 32 cm) or better. Spectacle dependence after bilateral cataract surgery heading for monovision was analysed using a dedicated questionnaire. RESULTS: Out of all 50 patients 22 (44%) fulfilled the above defined criteria of monovision in terms of post-operative refraction and visual acuity. About 19 out of these 22 (86.3%) patients were happy without glasses. Two of them used bifocal spectacles, whereas the remaining patient refused spectacles. About 28 patients did not fulfill monovision criteria. Out of these 28 patients, however, 9 (32.1%) of them are happy without glasses. CONCLUSION: In view of the described local circumstances aiming for monovision after bilateral cataract surgery is a suitable approach to optimise cataract surgical outcomes with no extra costs for surgery but considerable improvement of patient's visual performance in daily life.

Prevalence of myopia among secondary school students in Welkite town: South-Western Ethiopia.

BACKGROUND: Refractive error, especially myopia, is the most common eye disorder in the world and a significant cause of correctable visual impairment. The aim of this study was to assess the prevalence of myopia among secondary school students in Welkite town, South-Western Ethiopia. METHODS: A school based cross sectional study was carried out among secondary school students of 13 to 26 years of age. The students were selected using a multi stage-stratified cluster sampling technique from four secondary schools. The students' socioeconomic background, usage of eyeglasses and parental myopia was assessed by a questionnaire before visual acuity assessment. Students with visual acuity of less than or equal to 6/12 in the worse eye, who showed vision improvement with pinhole, underwent non-cycloplegic retinoscopy and subjective refraction. Myopia was defined as a spherical equivalent of less than or equal to - 0.50 diopters. Logistic regression was used to see the association of myopia with age, sex, grade level, ethnicity, parental history of myopia and severity. RESULTS: A total of 1271 students with a response rate of 89.4% were evaluated. The mean age was 16.56+ 1.51 years. Eighty three students were identified to have myopic refractive error making the prevalence of 6.5% (95% CI: 5.30, 8.02). Of 648 females, 50 (7.7%) had myopia while 33 (5.3%) of 623 males had myopia making females relative risk to be 1.5 times that of males. From the total students diagnosed to have refractive error (n = 92), myopia constituted 83/92 (90.2%) of the students indicating that it is the commonest type of refractive error found amongst secondary school students. Only 36.1% of students with myopia wore eyeglasses when they attended the survey. Myopia was more common among older age group 17-21 years (OR: 1.54 95% CI 0.986-2.415) and higher grade level 11-12 (OR: 1.14 95% CI 0.706-1.847). CONCLUSIONS: The prevalence of myopia is high in our study. Attention to the correction of myopia in secondary schools students of Welkite town using eyeglasses can prevent a major proportion of visual impairment.

Eye Care Among US Adults at High Risk for Vision Loss in the United States in 2002 and 2017.

Importance: Timely eye care can prevent unnecessary vision loss. Objectives: To estimate the number of US adults 18 years or older at high risk for vision loss in 2017 and to evaluate use of eye care services in 2017 compared with 2002. Design, Setting, and Participants: This survey study used data from the 2002 (n = 30 920) and 2017 (n = 32 886) National Health Interview Survey, an annual, cross-sectional, nationally representative sample of US noninstitutionalized civilians. Analysis excluded respondents younger than 18 years and those who were blind or unable to see. Covariates included age, sex, race/ethnicity, marital status, educational level, income-to-poverty ratio, health insurance status, diabetes diagnosis, vision or eye problems, and US region of residence. Main Outcomes and Measures: Three self-reported measures were visiting an eye care professional in the past 12 months, receiving a dilated eye examination in the past 12 months, and needing but being unable to afford eyeglasses in the past 12 months. Adults at high risk for vision loss included those who were 65 years or older, self-reported a diabetes diagnosis, or had vision or eye problems. Multivariable logistic regression models incorporating sampling weights were used to investigate associations between measures and covariates. Temporal comparisons between 2002 and 2017 were derived from estimates standardized to the US 2010 census population. Results: Among 30 920 individuals in 2002, 16.0% were 65 years or older, and 52.0% were female; among 32 886 individuals in 2017, 20.0% were 65 years or older, and 51.8% were female. In 2017, more than 93 million US adults (37.9%; 95% CI, 37.0%-38.7%) were at high risk for vision loss compared with almost 65 million (31.5%; 95% CI, 30.7%-32.3%) in 2002, a difference of 6.4 (95% CI, 5.2-7.6) percentage points. Use of eye care services improved (56.9% [95% CI, 55.7%-58.7%] reported visiting an eye care professional annually, and 59.8% [95% CI, 58.6%-61.0%] reported receiving a dilated eye examination), but 8.7% (95% CI, 8.0%-9.5%) said they could not afford eyeglasses (compared with 51.1% [95% CI, 49.9%-52.3%], 52.4% [95% CI, 51.2%-53.6%], and 8.3% [95% CI, 7.7%-8.9%], respectively, in 2002). In 2017, individuals with lower income compared with high income were more likely to report eyeglasses as unaffordable (13.6% [95% CI, 11.6%-15.9%] compared with 5.7% [95% CI, 4.9%-6.6%]). Conclusions and Relevance: Compared with data from 2002, more US adults were at high risk for vision loss in 2017. Although more adults used eye care, a larger proportion reported eyeglasses as unaffordable. Focusing resources on populations at high risk for vision loss, increasing awareness of the importance of eye care, and making eyeglasses more affordable could promote eye health, preserve vision, and reduce disparities.

Compliance to spectacle use in children with refractive errors- a systematic review and meta-analysis.

BACKGROUND: Primary objective of this review was to measure compliance with spectacle use in children with refractive errors. Secondary objective was to understand the reasons for non-compliance. METHODS: The databases searched were Ovid, EMBASE, CINAHL and Pubmed. All studies up to March, 2018 were included. The search terms were- ((((((Compliance [Title/Abstract]) OR Adherence [Title/Abstract]) OR Compliant [Title/Abstract]) OR Adherent [Title/Abstract])) AND (((Spectacle [Title/Abstract]) OR Spectacles [Title/Abstract]) OR Eye Glasses [Title/Abstract])) AND ((((Child [Title/Abstract]) OR Children [Title/Abstract]) OR Adolescent [Title/Abstract]) OR Adolescents [Title/Abstract]). Two researchers independently searched the databases and initial screening obtained 33 articles. The PRISMA guidelines were followed for conducting and writing the systematic review. Two reviewers assessed data quality independently using the Quality Assessment tool for systematic reviews of observational studies (QATSO). Poor quality studies were those, which had a score of less than 33% on the QATSO tool. Sensitivity analysis was done to determine if poor quality studies effected compliance. Galbraith plot was used to investigate statistical heterogeneity amongst studies. A random effects model was used to pool compliance. RESULTS: Twenty-three studies were included in the review, of which 20 were included in the quantitative analysis. All the studies were cross sectional. The overall compliance with spectacle use was 40.14% (95% CI- 32.78-47.50). The compliance varied from 9.84% (95% CI = 2.36-17.31) to 78.57% (95% CI = 68.96-88.18). The compliance derived in sensitivity analysis was 40.09%. Reasons for non-compliance were broken/lost spectacles, forgetfulness, and parental disapproval. CONCLUSION: Appropriate remedial measures such as health education and strengthening vision care services will be required to address poor compliance with spectacle use among children.

Visual impairment and spectacles ownership among upper secondary school students in northwestern China.

PURPOSE: To assess the prevalence of visual impairment and spectacles ownership among academic and vocational upper secondary school students in rural China. METHODS: This cross-sectional study included 5583 students from four academic upper secondary schools (AUSSs) and two vocational upper secondary schools (VUSSs) in Mei and Qianyang counties, Baoji Prefecture, Shaanxi Province. In March and April 2016, students underwent assessment of visual acuity (VA) and completed a questionnaire regarding spectacles use and family characteristics. Students with visual impairment (presenting VA ≤6/12 in the better eye) and students needing spectacles (uncorrected VA ≤6/12 in the better eye, which could be improved to >6/12 with refraction) were identified. RESULTS: Among 5583 students (54% boys, mean age 16.4±1.0 years) in grades 10 and grade 11 attending AUSSs (n=4549) and VUSSs (n=1034), visual impairment was detected in 4026 students. Among the AUSS students, 3425 (75%) needed spectacles; 2551 (75%) had them. Among the VUSS students, 601 (58%) needed spectacles; this proportion was significantly smaller (P=0.004), as was the proportion who had spectacles (n=212, 35%, P<0.001), compared with the AUSS students. Multivariate analysis showed that ownership of spectacles among children who needed them was associated with worse uncorrected VA (P<0.001), male sex (P<0.001), and residence in an urban area (P<0.034). Spectacles ownership was also strongly associated with AUSS education (P<0.001). CONCLUSION: There is a high rate of unmet need in visual care among upper secondary school students. Lack of spectacles ownership among children who needed them was significantly associated with VUSS education.

Myopia and its progression in children in London, UK: a retrospective evaluation.

PURPOSE: Worldwide, the prevalence of myopia is increasing. Myopia begins at younger ages and progresses faster, leading to more adults with high myopia and risk of sight-threatening complications. No data are available about myopia trends in children in urban areas in the UK. We present a 10-year review of children attending a secondary and tertiary eye care facility in London, focussing on the proportion of glasses prescriptions for myopia and progression rates. METHODS: We collated refraction and demographic data from children under the age of 17 years seen at Moorfields Eye Hospital, London, UK, between 2008 and 2017. RESULTS: We included 63,854 datasets from 23,593 children (51.2% boys, median age 5.4 years, interquartile range IQR 3.8-7.1). The proportion of myopic prescriptions increased from 24 to 32%. In n = 3355 with initial mild/moderate myopia, median progression rate was -0.16 (-0.5 to 0.04) D/year. In those with progression (n = 2095), the rate was -0.40 (-0.19 to -0.74) D/year, slightly higher in girls than in boys (-0.42 vs -0.38 D/year; p = 0.02). Progression was faster in initial moderate than initial mild myopia (-0.54 vs -0.37 D/year; p < 0.001), and before than after average age of onset of puberty (-0.41 vs -0.35 D/year; p = 0.013). There was no statistically significant difference between children of different ethnic backgrounds. CONCLUSIONS: In this cohort, the proportion of glasses prescriptions for myopia and the rate of progression are higher than previously reported for European countries. Living in an urban environment may result in similar progression rates despite different genetic backgrounds.

Use of spectacles for distance vision: coverage, unmet needs and barriers in a rural area of North India.

BACKGROUND: Uncorrected refractive errors contribute enormously to the burden of avoidable visual impairment worldwide. There is a huge disparity in different parts of the globe in context to spectacle coverage for distance vision. This study was undertaken with objectives of determining prevalence of spectacle coverage, unmet needs and associated factors among adults in a rural community of north India. METHODS: A community-based cross-sectional study was carried out within selected clusters of Jhajjar district of Haryana. All participants aged > 15 years underwent visual acuity assessment by LogMAR "E" screening chart. Participants with presenting visual acuity < 6/12 in any eye and all current spectacle users underwent detailed ophthalmic examination and refraction. Additional details about spectacles, barriers for their use and willingness to pay for them were collected. Participants with met and unmet need for spectacle use at visual acuity > 6/12 was computed. These are reported as proportions with 95% confidence intervals. Associated factors with unmet need were determined using bivariable and multivariable logistic regression analysis. RESULTS: A total of 6910 participants were examined. The current spectacle use was 7.5% (95% Confidence Interval CI: 6.5, 8.7). The spectacle coverage was found in 33.3% (95% CI: 30.0, 36.7) participants among those in need. The unmet need was found in 10.8% of participants (95% CI: 10.1, 11.6). On multivariable analysis, odds of unmet need was associated with age, gender, level of education and marriage status. The most common barrier for refractive correction was lack of perceived need for refraction and its correction. CONCLUSION: There is substantial unmet need for distance vision spectacles in this population. It is imperative that multi-component intervention be implemented to improve spectacle coverage in this rural north Indian setting.

Reliability Testing of Augmented Reality Glasses Technology: Establishing the Evidence Base for Telewound Care.

PURPOSE: To test the fidelity and feasibility of using augmented reality glass (ARG) telehealth technology for comprehensive wound, ostomy, and continence (WOC) service delivery to underserved rural practice settings. DESIGN: Intrarater reliability design focusing on treatment integrity. SAMPLE AND SETTING: Adult patients in a tertiary care hospital and a rural long-term care setting who were scheduled for routine wound care consults. METHODS: Intra- and interrater reliability were assessed using a documentation-based wound assessment tool comprising 6 discrete assessment points. The wound teleassessment was first conducted by the telehealth "hub" WOC nurse remotely in collaboration with a bedside nurse wearing the ARG. The same hub WOC nurse then conducted an assessment at the bedside. Initial assessment points and treatment plans were compared to establish assessment and treatment intrarater reliability. A different WOC nurse, blinded to the first assessment, also conducted a bedside assessment and provided treatment recommendations, which were then compared to the hub WOC nurse's initial remotely ARG-generated treatment plan to establish treatment interrater reliability. RESULTS: Sixteen patients with 21 wounds were assessed. Six wound assessment components were included, yielding a total of 126 total observation points. Intrarater assessment reliability was 98%. Treatment plan interrater reliability was 100%. CONCLUSIONS: Results support further evaluation of ARG technology as a tool to enhance the delivery of wound care services in remote underserved settings. Implementation and evaluation of this technology on clinical and financial outcomes in multiple wound care delivery environments should be determined moving forward. Successful implementation should serve as a template to expand evidence-based WOC nursing care across the globe.

Prevalence of Refractive Error, Presbyopia, and Spectacle Coverage in Bogotá, Colombia: A Rapid Assessment of Refractive Error.

SIGNIFICANCE: Uncorrected refractive error is the leading cause of visual impairment; therefore, reducing its prevalence is important worldwide. For two decades, there has not been a comprehensive assessment of refractive error in Latin America. PURPOSE: The purpose of this study was to determine the current prevalence of refractive error, presbyopia, spectacle coverage, barriers to uptake refractive services, and spectacle correction in people 15 years and older in Bogotá, Colombia. METHODS: A cross-sectional community-based survey was conducted using 50 randomly selected clusters from 10 districts of Bogotá reflecting the socioeconomic status of the city. Respondents 15 years and older were interviewed and underwent standardized clinical eye examinations. Prevalence of uncorrected refractive error, spectacle coverage, and visual impairment were standardized to 2015 age-sex population distribution of Bogotá and further analyzed. RESULTS: A total of 2886 subjects (90% of 3206 eligible subjects) participated in the study; 39.1% were male and 60.9% were female in the age range of 15 to 96 years, with a median age of 46 years (interquartile range, 45 to 54 years). Age- and sex-standardized prevalence of visual impairment was 19.3% (95% confidence interval [CI], 17.8 to 20.8%). Prevalence of uncorrected refractive error was 12.5% (95% CI, 11.3 to 13.7%). Prevalence of presbyopia among participants 35 years and older was 55.2% (95% CI, 52.9 to 57.4%). Spectacle coverage was 50.9% for distance vision, and it was 33.9% for presbyopia. Main barrier to spectacle uptake was a limitation in affording spectacles because of economic factors (29.5%). CONCLUSIONS: This study provides a current estimate of refractive error using the Rapid Assessment of Refractive Error for Colombia and the Latin American region. The prevalence of uncorrected refractive error and presbyopia was high, and the barriers to spectacle uptake were higher in the lowest socioeconomic strata. The results obtained in the present study will help in making evidence-based decisions related to eye care service delivery in Colombia.

Self-adjustable Spectacle Wearing Compliance and Associated Factors among Rural School Children in Ghana.

SIGNIFICANCE: Self-adjustable spectacles are increasingly being used in refractive service delivery programs in developing countries. Despite the success of self-refraction as a refraction technique, compliance with actual wear of adjustable spectacles has not been evaluated. Findings in this study have significant programmatic implications for the effectiveness and sustainability of this mode of correction in developing countries. PURPOSE: The purpose of this study was to assess compliance with wearing of adjustable spectacles and factors associated with compliance in pre-teen schoolchildren at 6 months after spectacles were dispensed. METHODS: A cohort of 86 children aged 6 to 12 years with presenting vision worse than or equal to 6/12 in the better eye that could be improved to better than or equal to 6/7.5 by subjective refraction and who were identified from a randomized sample of 18 primary schools in the coastal areas of Cape Coast in Ghana received free FocusSpecs adjustable spectacles after successfully completing self-refraction and cycloplegic subjective refraction. Follow-up examination to assess compliance and to determine reasons for noncompliance was conducted at 6 months after spectacle provision. Logistic regression models assessed factors associated with spectacle wear compliance (95% confidence intervals [CIs]). RESULTS: Spectacle wear compliance was 33.7% (95% CI, 31.3 to 36.1%); an additional 29% had their spectacles with them but were not wearing them. The major reasons given by the children for noncompliance were "loss" (32%; 18/57) and "breakage" (23%; 13/57). Modest compliance (49%) was observed among the poorer children who attend public schools. Attending public school was the only predictor of compliance to spectacle wear (odds ratio, 3.096; 95% CI, 1.228 to 7.805; P = .02). CONCLUSIONS: Despite accurate self-refraction by most children, only a small proportion was compliant with actual wear of the spectacles. Loss and breakage were the major reasons for noncompliance. The poorer children who attend public schools, who stand to benefit most from the technology, were the ones more likely to be compliant with wear.

Influence of presbyopia on smartphone usage among Chinese adults: A population study.

IMPORTANCE: Presbyopia, an essentially universal, age-related loss of the ability to focus un-aided on near objects, is the world's leading cause of visual impairment. BACKGROUND: Smartphone use is widespread in China, but little is known about the prevalence, determinants and correction of difficulties with smartphone use in the setting of presbyopia. DESIGN: Cross-sectional data from a population-based longitudinal cohort study. PARTICIPANTS: A total of 1817 persons aged ≥35 years in Guangzhou, Southern China. METHODS: Participants underwent near visual acuity (NVA) testing and completed questionnaires on smartphone usage detailing knowledge of their own presbyopia status, frequency (hours/day) and subjective difficulties with use of mobile and smartphones. Presbyopia was defined as uncorrected bilateral NVA ≤6/12 with best-corrected bilateral NVA >6/12. MAIN OUTCOME MEASURES: Difficulty in smartphone use associated with uncorrected presbyopia. RESULTS: Among 1427 respondents (78.5%) undergoing examination, 1191 (83.5%) completed questionnaires (mean age 52.3 ± 11.6 years; 54.9% women). Among 451 persons (37.8%) with presbyopia owning smartphones, 290 (64.3%) reported difficulty using them. Multiple ordinal logistic regression modelling showed difficulty in smartphone use due to presbyopia was associated with higher educational level (P = .013), worse NVA (P < .001) and more time spent using smartphones (P = .002 for 1-3 hours/day). Among persons with presbyopia owning smartphones, 353 (78.0%) said they would pay >US$15 (median US$45) for innovations making smartphone use easier. CONCLUSIONS AND RELEVANCE: Difficulty in using smartphones in the presence of presbyopia is common and affected persons are willing to pay for useful solutions to the problem.