Reported wearing compliance of ready-made spectacles at 6 and 12 months.

PURPOSE: Ready-made spectacles are often used in low-resource environments, but to date, there has been little evaluation of the continued use of these spectacles over time. The aim of this study was to assess wearing compliance of those who received ready-made spectacles. METHODS: The International Rescue Committee trains refugee health workers to provide simple refractive services and dispense ready-made spherical lenses to residents of refugee camps on the Thailand-Burma border. We conducted follow-up interviews in five camps among all eligible and available spectacle recipients who had been examined either 6 (n = 230) or 12 months earlier (n = 187). Interviewers asked about continued use of spectacles and, among those who had discontinued spectacle use, asked the reason for discontinuing. RESULTS: Reported spectacle wear was significantly higher at 6 months compared with 12 months (73.9 vs. 55.6%, p < 0.001). At 6 months, wearing compliance was significantly higher for females than males (79.2 vs. 67.6%, p = 0.033), but gender differences in wearing compliance were not seen at 12 months, and no differences were found between 10-year age groups at 6 or 12 months. Wearing compliance rates among recipients seen at different camps were significantly different at both 6 months (range, 58.1 to 87.5%, p = 0.005) and 12 months (range, 32 to 85.7%, p = 0.002). The top reason given for discontinued spectacle wear was broken frames, followed by vision-related complaints, scratched lenses, lost spectacles, and appearance. CONCLUSIONS: Our findings suggest that spectacle wearing compliance studies will not be comparable unless a standard time frame is used to assess compliance. We found assessing self-reported compliance to be a useful tool in guiding our program. Understanding the reasons for non-compliance will help guide corrective action and planning of interventions designed to increase wearing rates.

Rapid assessment of avoidable blindness and cataract surgery coverage among forcibly displaced Myanmar Nationals (Rohingya refugees) in Cox's Bazar, Bangladesh.

AIM: To determine the prevalence and causes of blindness, vision impairment and cataract surgery coverage among Rohingya refugees aged ≥ 50 years residing in camps in Cox's Bazar, Bangladesh. METHODS: We used the Rapid Assessment of Avoidable Blindness (RAAB) methodology to select 76 clusters of 50 participants aged ≥ 50 years with probability proportionate to size. Demographic and cataract surgery data were collected using questionnaires, visual acuity was assessed per World Health Organization criteria and examinations were conducted by torch, and with direct ophthalmoscopy in eyes with pinhole-corrected vision <6/12. RAAB software was used for data entry and analysis. RESULTS: We examined 3,629 of 3800 selected persons (95.5%). Age and sex adjusted prevalence of blindness (<3/60), severe visual impairment (SVI; >3/60 to ≤6/60), moderate visual impairment (MVI; >6/60 to ≤6/18), and early visual impairment (EVI; >6/18 to ≤6/12) were 2.14%, 2.35%, 9.68% and 14.7% respectively. Cataract was responsible for 75.0% of blindness and 75.8% of SVI, while refractive error caused 47.9% and 90.9% of MVI and EVI respectively. Most vision loss (95.9%) was avoidable. Cataract surgical coverage among the blind was 81.2%. Refractive error was detected in 17.1% (n = 622) of participants and 95.2% (n = 592) of these did not have spectacles. In the full Rohingya cohort of 76,692, approximately 10,000 surgeries are needed to correct all eyes impaired (<6/18) by cataract, 12,000 need distance glasses and 73,000 require presbyopic correction. CONCLUSION: The prevalence of blindness was lower than expected for a displaced population, in part due to few Rohingya being ≥60 years and the camp's good access to cataract surgery. We suggest the United Nations High Commissioner for Refugees include eye care among recommended health services for all refugees with long-term displacement.

The rationale for shifting from a voluntary clinical approach to a public health approach in addressing refractive errors.

Millions of people need eyeglasses and do not have them. Assuming that the average pair of eyeglasses has an effective life span of two to five years, an additional 60 to 150 million spectacles would be needed each year for the estimated 303 million individuals who currently need correction. Optometrists are engaged in a variety of capacities in an attempt to address the significant public health problem of uncorrected refractive error. One popular method used by many voluntary optometry-led organisations is to provide direct clinical services to individual patients in developing countries. Considerable manpower, materials, money and logistical resources are used in conducting these short-term missions, yet scarce evidence exists regarding their cost effectiveness or the efficacy and long-term impact of these interventions. The provision of direct clinical services by most foreign volunteers does not directly build local capacity and may hinder development of sustainable local services. Adopting public health approaches will enable volunteer provider organisations to dramatically increase their program effectiveness and output, while developing local capacities in a sustainable way. These approaches should include: 1. Following the national strategy for blindness prevention as determined by the Ministry of Health and forming partnerships with relevant local, national and international organisations. 2. Using need-based criteria to target programs more efficiently. 3. Developing sustainable services via local capacity building. 4. Monitoring, evaluating and using evidence to guide programs. By using these approaches, a larger contribution will be made by the volunteer organisations in addressing the unmet need for refractive correction.

Simple spectacles for adult refugees on the Thailand-Burma border.

PURPOSE: This article describes the development of, and outputs from, a program in which trained refugee health workers provided spherical lenses to adult refugees along the Thailand-Burma border. METHODS: Between 1998 and 2001, the International Rescue Committee trained 48 refugee health workers in basic refraction courses. Once trained, these health workers conduct weekly eye clinics in several refugee camps and one migrant community covering a total population of 142,000. We supplied spherical lenses in 11 powers from +1.00 to +4.00 in 0.50-D steps and from -1.00 to -2.50 in 0.50-D steps. We collected output data from these clinics for the year 2001. RESULTS: In 2001, these clinics provided a total of 7219 eyeglasses. Approximately 84% of all lenses given were for presbyopia, approximately 10% for myopia, and approximately 6% for hyperopia. Our spectacle provision rates per 100,000 persons were 4284 for presbyopia, 482 for myopia, and 317 for hyperopia. Our target provision rates, which would allow the average wearer to get a new pair every 3 to 4 years, was met for presbyopia, but not met for myopia or hyperopia. Few corrections for high errors were needed and only 92 people were found to need powers higher than we provided. In 2001, the cost per eyeglass recipient was approximately $7.00. CONCLUSIONS: Training refugee health workers has allowed for sustainable, low-cost spectacle provision to a large population over an extensive geographic area in a challenging environment.