Pattern of optometry practice and range of services in India.

PURPOSE: This study was conducted to evaluate the range of services provided by optometrists in various modes of optometric practice in India. METHODS: An online questionnaire was administered to 1674 optometrists to collect information on the range of optometric services offered. Data were analyzed based on variables including sex, educational qualification, and modes of practice. Two-sample Wilcoxon rank sum tests, χ tests, and Fisher exact text were used to conduct inferential statistics. RESULTS: A total of 563 valid and completed survey questionnaires were received from graduates of 41 optometry institutes working across 23 states of India. Of these, 225 (40.0%) were female, 288 (51.2%) had completed postgraduate education, and 340 (60.5%) were involved in more than one mode of practice. The top three modes of practice were hospital-based practice (44.8%), academia (42.8%), and optical retail (33.0%). Of the 441, out of 563 (78.3%) respondents involved in patient care, the majority (98.4%) performed refraction and routine eye examination, 70.3% dispensed contact lenses, and 66.9% practiced optical dispensing. Lower involvement was seen in providing binocular-vision (45.1%) and low-vision services (30.2%). Higher education was associated with advanced level of practice (p < 0.05) except clinical investigative procedures. There was a significant association between postgraduate studies and involvement in academics and research (p < 0.01). CONCLUSIONS: Most optometrists are engaged in multiple modes of practice, with optical practice, hospital-based practice, and academia being the leading modes. Optometrists need to be more involved in providing the core optometric services of binocular vision and low vision. Higher education has an impact on the level of optometric practice.

The prevalence of self-reported vision difficulty in economically disadvantaged regions of South Africa.

BACKGROUND: Vision impairment, resulting in vision difficulties, is a leading cause of disability, and hence one of the key barriers for people to access education and employment, which may force them into poverty. OBJECTIVES: The objective of this study was to determine the prevalence of self-reported vision difficulties as an indicator of vision impairment in economically disadvantaged regions in South Africa, and to examine the relationship between self-reported vision difficulties and socio-economic markers of poverty, namely, income, education and health service needs. METHODS: A cross-sectional study was conducted in economically disadvantaged districts to collect data from households on poverty and health, including vision difficulty. As visual acuity measurements were not conducted, the researchers used the term vision difficulty as an indicator of vision impairment. Data were collected from 27 districts (74 901 respondents). Logistic regression analysis and chi-square tests were used to determine bivariate relationships between variables and self-reported vision difficulty. Kernel density estimators were used for age, categorised by self-reported and not reported vision difficulty. RESULTS: Prevalence of self-reported vision difficulty was 11.2% (95% CI, 8.7% - 13.7%). More women (12.7%) compared to men (9.5%) self-reported vision difficulty (p < 0.01). Self-reported vision difficulty was higher (14.2%) for respondents that do not spend any money. A statistically significant relationship was found between the highest level of education and self-reporting of vision difficulty; as completed highest level of education increased, self-reporting of vision difficulty became lower (p < 0.01). A significantly higher prevalence of self-reported vision difficulty was found in respondents who are employed (p < 0.01), 17% (95% CI: 12.8% - 21.1%). CONCLUSION: The evidence from this study suggests associations between socio-economic factors and vision difficulties that have a two-fold relationship (some factors such as education, and access to eye health services are associated with vision difficulty whilst vision difficulty may trap people in their current poverty or deepen their poverty status). The results are thus indicative of the need for further research in South Africa.

The prevalence of self-reported vision difficulty in economically disadvantaged regions of South Africa

Background: Vision impairment, resulting in vision difficulties, is a leading cause of disability, and hence one of the key barriers for people to access education and employment, which may force them into poverty. Objectives: The objective of this study was to determine the prevalence of self reported vision difficulties as an indicator of vision impairment in economically disadvantaged regions in South Africa, and to examine the relationship between self-reported vision difficulties and socio-economic markers of poverty, namely, income, education and health service needs. Methods: A cross-sectional study was conducted in economically disadvantaged districts to collect data from households on poverty and health, including vision difficulty. As visual acuity measurements were not conducted, the researchers used the term vision difficulty as an indicator of vision impairment. Data were collected from 27 districts (74 901 respondents). Logistic regression analysis and chi-square tests were used to determine bivariate relationships between variables and self-reported vision difficulty. Kernel density estimators were used for age, categorised by self-reported and not reported vision difficulty.Results: Prevalence of self-reported vision difficulty was 11.2% (95% CI; 8.7% - 13.7%). More women (12.7%) compared to men (9.5%) self-reported vision difficulty (p 0.01). Self-reported vision difficulty was higher (14.2%) for respondents that do not spend any money. A statistically significant relationship was found between the highest level of education and self-reporting of vision difficulty; as completed highest level of education increased, self-reporting of vision difficulty became lower (p 0.01). A significantly higher prevalence of self-reported vision difficulty was found in respondents who are employed (p 0.01), 17% (95% CI: 12.8% - 21.1%). Conclusion: The evidence from this study suggests associations between socio-economic factors and vision difficulties that have a two-fold relationship (some factors such as education; and access to eye health services are associated with vision difficulty whilst vision difficulty may trap people in their current poverty or deepen their poverty status). The results are thus indicative of the need for further research in South Africa

Mapping human resources for eye health in 21 countries of sub-Saharan Africa: current progress towards VISION 2020.

BACKGROUND: Development of human resources for eye health (HReH) is a major focus of the Global Action Plan 2014 to 2019 to reduce the prevalence of avoidable visual impairment by 25% by the year 2019. The eye health workforce is thought to be much smaller in sub-Saharan Africa than in other regions of the world but data to support this for policy-making is scarce. We collected HReH and cataract surgeries data from 21 countries in sub-Sahara to estimate progress towards key suggested population-based VISION 2020 HReH indicators and cataract surgery rates (CSR) in 2011. METHODS: Routinely collected data on practitioner and surgery numbers in 2011 was requested from national eye care coordinators via electronic questionnaires. Telephone and e-mail discussions were used to determine data collection strategies that fit the national context and to verify reported data quality. Information was collected on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and 'mid-level refractionists' and combined with publicly available population data to calculate practitioner to population ratios and CSRs. Associations with development characteristics were conducted using Wilcoxon rank sum tests and Spearman rank correlations. RESULTS: HReH data was not easily available. A minority of countries had achieved the suggested VISION 2020 targets in 2011; five countries for ophthalmologists/cataract surgeons, four for ophthalmic nurses/clinical officers and two for CSR. All countries were below target for optometrists, even when other cadres who perform refractions as a primary duty were considered. The regional (sample) ratio for surgeons (ophthalmologists and cataract surgeons) was 2.9 per million population, 5.5 for ophthalmic clinical officers and nurses, 3.7 for optometrists and other refractionists, and 515 for CSR. A positive correlation between GDP and CSR as well as many practitioner ratios was observed (CSR P = 0.0042, ophthalmologists P = 0.0034, cataract surgeons, ophthalmic nurses and optometrists 0.1 > P > 0.05). CONCLUSIONS: With only a minority of countries in our sample having reached suggested ophthalmic cadre targets and none having reached targets for refractionists in 2011, substantially more targeted investment in HReH may be needed for VISION 2020 aims to be achieved in sub-Saharan Africa.

Trends and implications for achieving VISION 2020 human resources for eye health targets in 16 countries of sub-Saharan Africa by the year 2020.

BACKGROUND: Development of human resources for eye health (HReH) is a major global eye health strategy to reduce the prevalence of avoidable visual impairment by the year 2020. Building on our previous analysis of current progress towards key HReH indicators and cataract surgery rates (CSRs), we predicted future indicator achievement among 16 countries of sub-Saharan Africa by 2020. METHODS: Surgical and HReH data were collected from national eye care programme coordinators on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and 'mid-level refractionists' and combined them with publicly available population data to calculate practitioner-to-population ratios and CSRs. Data on workforce entry and exit (2008 to 2010) was used to project practitioner population and CSR growth between 2011 and 2020 in relation to projected growth in the general population. Associations between indicator progress and the presence of a non-physician cataract surgeon cadre were also explored using Wilcoxon rank sum tests and Spearman rank correlations. RESULTS: In our 16-country sample, practitioner per million population ratios are predicted to increase slightly for surgeons (ophthalmologists/cataract surgeons, from 3.1 in 2011 to 3.4 in 2020) and ophthalmic nurses/clinical officers (5.8 to 6.8) but remain low for refractionists (including optometrists, at 3.6 in 2011 and 2020). Among countries that have not already achieved target indicators, however, practitioner growth will be insufficient for any additional countries to reach the surgeon and refractionist targets by year 2020. Without further strategy change and investment, even after 2020, surgeon growth is only expected to sufficiently outpace general population growth to reach the target in one country. For nurses, two additional countries will achieve the target while one will fall below it. In 2011, high surgeon practitioner ratios were associated with high CSR, regardless of the type of surgeon employed. The cataract surgeon workforce is growing proportionately faster than the ophthalmologist. CONCLUSIONS: The HReH workforce is not growing fast enough to achieve global eye health targets in most of the sub-Saharan countries we surveyed by 2020. Countries seeking to make rapid progress to improve CSR could prioritise investment in training new cataract surgeons over ophthalmologists and improving surgical output efficiency.

Comparison of cataract surgery techniques: safety, efficacy, and cost-effectiveness.

PURPOSE: To compare the safety, efficacy, and cost-effectiveness of manual sutureless small-incision cataract surgery (SICS) and phacoemulsification (Phaco) as treatment options for cataract surgery with focus on intumescent, mature, and hypermature lenses (white cataracts). METHODS: A systematic search of research articles was conducted to develop an internal database for the investigators' appraisal. Literature searches were conducted by using key words and MeSH terms including cataracts, phacoemulsification, small-incision cataract incision, visual acuity, costs, training, time, and barriers to cataract surgery. The final synthesis included 42 manuscripts. RESULTS: All studies show that both Phaco and SICS are safe and effective techniques to rehabilitate cataract patients, but Phaco is costlier, with its preoperative and postoperative medicines, anesthetic agents, viscoelastic materials, disposables, instrumentation, and intraocular lens (IOLs), and had a steeper learning curve. Small-incision cataract surgery, in comparison, has been shown to be faster and more cost-effective. It is useful in intumescent white, black, brown, and lens-induced glaucoma cataracts and could incorporate recent trends like topical and sub-Tenon anesthesia and temporal incisions. Both give equal best-corrected visual acuity but unaided vision has been shown to be slightly better in Phaco due to lesser astigmatism. CONCLUSIONS: The literature points to SICS being more useful for intumescent and hard cataracts and is the preferred technique for less-resourced settings. Small-incision cataract surgery is comparable to Phaco in almost all aspects except postoperative astigmatism.

Perception and trends of associated health risks with seasonal climate variation in Oke-Ogun region, Nigeria.

This paper investigates the perceived and observed trends of associated health risks with seasonal climate variability and identifies types of and preference for adaptation strategies that are available at households and community levels in Oke-Ogun region, Nigeria. The study made use of household survey and rapid appraisal through focus group discussion and key informant interviews. For a short term climate-health impacts analysis, cases of notable diseases were correlated with monthly mean temperature and rainfall for the period 2006 and 2008. The findings show similar trends in relation to local perception on climate-health risks and observed cases of some notable diseases during seasonal changes. Diarrhea, measles and malaria were prevalent during dry season, while flu cases increased at the onset of harmattan and monsoon of rainy season. Available adaptation strategies are autonomous, mostly in the form of treatment measures such as consultation with medical officers in hospitals (17.5%), self-medication (34%) and use of traditional therapy such as herbs (48.5%). Traditional therapy is mostly preferred and approved based on long-term experience of the study population.

Uncorrected refractive errors.

Global estimates indicate that more than 2.3 billion people in the world suffer from poor vision due to refractive error; of which 670 million people are considered visually impaired because they do not have access to corrective treatment. Refractive errors, if uncorrected, results in an impaired quality of life for millions of people worldwide, irrespective of their age, sex and ethnicity. Over the past decade, a series of studies using a survey methodology, referred to as Refractive Error Study in Children (RESC), were performed in populations with different ethnic origins and cultural settings. These studies confirmed that the prevalence of uncorrected refractive errors is considerably high for children in low-and-middle-income countries. Furthermore, uncorrected refractive error has been noted to have extensive social and economic impacts, such as limiting educational and employment opportunities of economically active persons, healthy individuals and communities. The key public health challenges presented by uncorrected refractive errors, the leading cause of vision impairment across the world, require urgent attention. To address these issues, it is critical to focus on the development of human resources and sustainable methods of service delivery. This paper discusses three core pillars to addressing the challenges posed by uncorrected refractive errors: Human Resource (HR) Development, Service Development and Social Entrepreneurship.