Impaired visual acuity caused by uncorrected refractive errors and amblyopia in a German paediatric cohort.

PURPOSE: This study describes the prevalence of visual impairment caused by uncorrected distance refractive error and the spectacle coverage in a large cohort of German children and adolescents. Furthermore, we determined the prevalence of amblyopia and amblyopia treatment. METHODS: Optometrists carried out visual acuity (VA) testing, non-cycloplegic autorefraction, VA retesting with the refractive correction obtained by autorefraction, and if necessary subjective refraction and cover-test in 1,874 subjects (901 girls/973 boys), aged 3 to 16 years. Additionally, a questionnaire on the history of previous eye care was completed. RESULTS: Distance visual impairment (VI) with VA worse than 6/18 Snellen in the better eye was present in 0.5% (95% confidence interval [95% CI]: 0.2% to 0.9%) of children. Logistic regression showed a significant positive association between VI and older age (OR = 1.21, P = 0.03). Gender differences were not found (P = 0.77). The spectacle coverage of all participants was 74.8% (95% CI: 65.2% to 82.8%). Amblyopia was found in 29 participants (1.5%; 95% CI: 1.0% to 2.2%) with no age or sex differences. The causes of unilateral amblyopia (27 cases, 93.1%) were anisometropia in 55.6% of children, strabismus in 25.9% and the combination of these factors in 18.5%. All children with bilateral amblyopia (2 cases, 6.9%) showed bilateral high ametropia. We observed 15 children with current amblyopia, who had been treated with occlusion therapy in the past (62.2%; 95% CI: 42.7% to 83.6%). CONCLUSIONS: The prevalence of impaired VA caused by uncorrected refractive error and amblyopia is comparable with previous studies conducted in urban areas worldwide. Adding the measurement of refractive error to existing medical check-ups, possibly using autorefraction, would be desirable.

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.

Incidence and correction of vision impairment among elderly population in southern urban China.

IMPORTANCE: Data on the incidence of presenting vision impairment (PVI) and spectacle coverage rate (SCR) in urban China is limited. BACKGROUND: To estimate the 6-year incidence and risk factors for PVI and the SCR in urban Southern China. DESIGN: Population-based cohort study. PARTICIPANTS: A total of 1817 participants aged ≥35 years were identified from Guangzhou in 2008 at baseline and 1427 attended follow-up examination in 2014. METHODS: Presenting visual acuity (PVA) was measured using the ETDRS chart with habitual spectacles. Participants with PVA ≤20/40 underwent subjective refraction at the follow-up visit. Incidence of PVI was calculated using the WHO and US criteria, respectively. The met-need SCR was defined as the percentage of participants with PVA <20/40 that had been improved to ≥20/40 after correction. MAIN OUTCOME MEASURES: Incidence of PVI and SCR. RESULTS: Incidence of PVI was 8.3% (95%CI, 6.9-9.8) and 12.2% (95%CI, 10.5-14.0) based on the WHO and US definition, respectively. Older age, female, lower education level, more myopic spherical equivalent and worse PVA at baseline were significantly related to a higher PVI incidence based on the WHO criteria, with similar associations identified using the US criteria except for gender. The overall met-need SCR was 42.5%, and was lower among the elderly, more hyperopic participants or participants with lower education level. CONCLUSIONS AND RELEVANCE: The incidence of PVI is high in urban Southern China and spectacle wearing is available in less than half of those in need. This highlights the needs to promote spectacle coverage even in the urban population.

Near visual impairment and spectacle coverage in Telangana, India.

IMPORTANCE: The study highlights the burden of near visual impairment (NVI) in India. BACKGROUND: NVI is a common condition that can be addressed through provision of spectacles. The study aims to assess the prevalence of NVI and spectacle coverage among those aged ≥40 years in south Indian state of Telangana. DESIGN: Population-based cross-sectional study using a rapid assessment methodology. PARTICIPANTS: Five thousand one hundred forty participants enumerated from 123 clusters in two districts and have presenting distance visual acuity of ≥6/18 in the better eye. METHODS: Presenting near vision was assessed binocularly at a fixed distance of 40 cm using a log MAR chart with tumbling E optotypes in ambient lighting conditions. If the presenting near vision was worse than 6/12 (log MAR 0.3), then it was re-assessed with addition lens appropriate to the age. NVI was defined as binocular presenting near vision worse than 6/12. MAIN OUTCOME MEASURES: Prevalence of NVI and spectacle coverage. RESULTS: The mean age of the participants was 51.1 years (standard deviation: 9.3 years), and 46.5% (n = 2392) were women. About 80% (n = 4142) of them had no education, and 21.9% (n = 1126) were using spectacles for near vision. Nearly half of the participants were from Adilabad district (n = 2665). The prevalence of NVI was 58.3% (95% confidence interval: 56.9-59.6). NVI was associated with older age groups, male gender and no education. The spectacle coverage was 26.5%. CONCLUSIONS AND RELEVANCE: NVI is common in rural Telangana with low spectacle coverage. Service delivery programs should use a multi-pronged approach to address the burden of NVI.

Prevalence of spectacles use in Andhra Pradesh, India: rapid assessment of visual impairment project.

BACKGROUND: To assess the prevalence and patterns of spectacles use in South India state of Andhra Pradesh. DESIGN: A population-based cross sectional study. PARTICIPANTS: Seven thousand eight hundred subjects aged ≥40 years, sampled from one urban and two locations. METHODS: Two-stage cluster random sampling method was used to enumerate 7800 subjects. Distance visual acuity and near vision were assessed. A questionnaire was used to collect information on current and previous use of spectacles, spectacles providers and type of spectacles. Among those who discontinued use of spectacles, the reasons were elicited. MAIN OUTCOME MEASURES: The prevalence of spectacles use and spectacle coverage. RESULTS: In total, 7378/7800 subjects (95.0%) were examined. Among those examined, 53.6% were female, 49.5% of them aged between 40 and 49 years, and 62% of them had no education. The overall prevalence of spectacles use was 29.5% (95% confidence interval 28.5-30.4), 30.3% (95% confidence interval 29.0-31.6) in rural area compared with 27.9% (95% confidence interval 26.1-29.7) (P < 0.05) in urban location. Bifocals (72.8%) were the most common type of spectacles. Private eye clinics were the leading spectacles provider in all three regions. On applying multiple logistic regression, the odds of spectacles use increased with increasing age and were significantly higher for rural residents and those with higher levels of education. The spectacle coverage was 38.0% and 27% for refractive errors and presbyopia, respectively. CONCLUSIONS: Although prevalence of spectacles use is moderate, the spectacle coverage for both refractive errors and presbyopia is low. The strategies are required to improve the spectacle coverage in the region.

Near vision impairment and effective refractive error coverage for near vision in Andhra Pradesh, India - The Akividu Visual Impairment Study (AVIS).

CLINICAL RELEVANCE: Near Vision Impairment (NVI) is common in developing countries. A substantial proportion of NVI can be addressed by providing spectacles. Innovative eye care programmes are needed to address NVI. Population-based epidemiological studies can provide vital data to plan such eye care service delivery models. BACKGROUND: To report the prevalence of NVI and effective Refractive Error Coverage (eREC) for near vision in West Godavari and Krishna districts in Andhra Pradesh, south India. METHODS: A population-based cross-sectional study was carried out using a Rapid Assessment of Visual Impairment methodology. Presenting and pinhole distance visual acuity were assessed followed by near vision assessment using a N notation chart at a fixed distance of 40 cm. If the presenting near vision was worse than N8, the best corrected near visual acuity was recorded with age appropriate near vision correction. NVI was defined as presenting near vision worse than N8 among those without distance vision impairment (6/18 or better in the better eye). Effective Refractive Error Coverage for near was calculated as the proportion of individuals with an adequate correction to the total participants, including those with inadequate, adequate, and no correction for near vision. RESULTS: Data of 2,228 participants aged ≥40 years were analysed. The mean age of these participants was 54.0 ± 10.4 years; 53.8% were women; 44.5% had no formal education. The prevalence of NVI was 27.1% (95% CI: 25.2-29.0%). NVI significantly associated with 70 and above age group (adjusted OR: 1.97; 95% CI: 1.45-3.70). Participants with formal education had lower odds for NVI (adjusted OR: 0.75; 95 % CI: 0.68-0.83). The eREC for near vision was 48.0%. CONCLUSION: NVI affects over a quarter of people aged ≥40 years in the West Godavari and Krishna districts of Andhra Pradesh. However, eREC is under 50% and there is scope for improving this by establishing eye care services to achieve universal eye health for all.

Presbyopia, spectacles use and spectacle correction coverage for near vision among cloth weaving communities in Prakasam district in South India.

PURPOSE: To assess the prevalence of presbyopia, spectacles use and spectacle correction coverage for near vision among weaving communities in Prakasam district in the South Indian state of Andhra Pradesh. METHODS: A population based cross sectional study was conducted among a population aged ≥40 years. Distance visual acuity was assessed at 6 m. Near vision was assessed using N notation charts at a fixed distance of 40 cm. Presbyopia was defined as binocular unaided near vision

Spectacle Coverage Rate After Cataract Surgery in an Urban Area in Indonesia.

Purpose: Uncorrected refractive errors after cataract surgery contribute to visual impairments. The aim of this study was to investigate the spectacle coverage rate (SCR) following cataract surgery and its relationship with socioeconomic factors in an urban city in Indonesia. Patients and Methods: This population-based cross-sectional study was conducted in 2015 in Jakarta. The former participants of the Rapid Assessment of Avoidable Blindness (RAAB) survey had a history of cataract surgery and met either of the following criteria: (1) wore spectacles with presenting visual acuity (PVA) 6/12 or (2) had PVA less than 6/12 regardless of spectacle use but achieved the best visual acuity (BVA) 6/12 with pinhole correction. Results: Of the 2998 participants of the RAAB survey, 173 (5.6%) (252 eyes) had a history of cataract surgery, among whom 53 (86 eyes) met our inclusion criteria. The SCR was 69.8% and was associated with age group, household income level, education level, and physicians' recommendation of spectacle wear. Participants who were of nonproductive age (80%), had the highest household income level (88.2%), the highest level of education (87.5%), and had been recommended for spectacle use by their physicians (80.9%) demonstrated higher SCR. Participants with the highest household income had the highest SCR. Patients who had received a physician's recommendation showed a higher SCR and were 26 times more likely to wear spectacles (odds ratio [OR] 25.99, 95% CI 2.59-260.10). Conclusion: There is an unmet need for refractive errors after cataract surgery. Factors such as household income levels and physician recommendations were predictive of spectacle wear.

Prevalence of Presbyopia, Near-spectacle Use and Near Vision Spectacle Coverage among Cosmetologists in Mushin Local Government Area of Lagos State, Nigeria.

Objective: To determine the prevalence of presbyopia, near vision spectacle use, and near vision spectacle coverage among cosmetologists in Mushin Local Government Area of Lagos State with the view of creating awareness, improving productivity and quality of life. Materials and Methods: This was a descriptive cross-sectional study, conducted among 251 cosmetologists aged ≥ 30 years. All participants had a standardized protocol including visual acuity assessment (distance and near), anterior and posterior segment examinations, and refraction. Spectacle usage, work, productivity impact, and near vision-related quality of life (NVQoL) information were obtained with the 12-item Near Vision-Related Quality of Life Questionnaire, the Spectacle Usage section of the World Health Organisation (WHO) Spectacle and Work Productivity Questionnaire. Data obtained was analysed using Statistical Package for Social Sciences version 23 (IBM Corp. Armonk, NY). Results: Two hundred and fifty-one cosmetologists were studied with a male to female ratio of 1:6.4 and overall mean age of 43.9 ± 6.5 years. The prevalence of presbyopia was 67.3% and the unmet need was 51.3%. Eighty-four percent of presbyopic participants reported severe difficulty with their NVQoL compared to 16% of non-presbyopes. There was a statistically significant association between uncorrected presbyopia and reduced NVQoL (P < 0.001). Conclusion: This study demonstrated a relatively high prevalence of presbyopia, high unmet need, and a significant reduction in the near vision-related quality of life. This indicates the need for improved access to refractive services and spectacles among this group of artisans in whom near vision plays an indispensable role.

Population-based assessment of prevalence of spectacle use and effective spectacle coverage for distance vision in Andhra Pradesh, India - Akividu Visual Impairment Study.

CLINICAL RELEVANCE: Effective spectacle coverage is a useful indicator to assess the coverage of refraction services in a given region. We found a low coverage in the Akividu region suggesting a need to develop effective refraction services. BACKGROUND: To assess the prevalence of spectacle use and effective spectacle coverage for distance vision among people aged 40 years and older in the Indian state of Andhra Pradesh. METHODS: A population-based cross-sectional survey was carried out in the Akividu region in West Godavari and Krishna districts. The study teams visited selected households and conducted eye examinations in the selected clusters. A structured questionnaire was used to collect information on spectacle use. 'Met Need' was defined as unaided VA worse than 6/12 but improved to 6/12 or better with their current spectacles. 'Unmet Need' was defined as unaided VA worse than 6/12 but improved to 6/12 with pinhole, among those not using spectacles. The 'Under-met Need' was defined as aided VA worse than 6/12 but improving with pinhole to 6/12 or better. Based on these definitions, Effective Refractive Error Coverage (e-REC) is calculated as: e-REC (%) s = ((met need)/(met need + under-met need + unmet need)) X100. RESULTS: Of 3,000 enumerated from 60 clusters, 2,587 (86.2%) participants were examined. The prevalence of current spectacle use was 43.1% (95% CI:41.2-45.0). The e-REC was 37.4%. It was also lower in men compared to women and among those without any education. Participants who had cataract surgery in either eye had similar e-REC compared to those who were not operated. CONCLUSION: Though spectacle use was found to be high, there is a still large unmet need for refractive correction for distance. Effective service delivery models to provide refraction and spectacle dispensing services are needed to achieve universal eye health coverage in the region.

Improving Access to Refractive Services in Adults: A Health Examination Center-Based Model.

Purpose: To assess the potential of a health examination center-based screening model in improving service for uncorrected refractive error. Methods: Individuals aged ≥18 years undergoing the routine physical examinations at a tertiary hospital in the northeast China were invited. Presenting visual acuity, noncycloplegic autorefraction, noncontact tonometry, fundus photography, and slit-lamp examination were performed. Refractive error was defined as having spherical equivalent ≤ -0.75 D or ≥ +1 D and uncorrected refractive error was considered as refractive error combined with presenting visual acuity < 6/12 in the better eye. Costs for the screening were assessed. Results: A total of 5,284 participants (61 ± 14 years) were included. The overall prevalence of myopia and hyperopia was 38.7% (95% CI, 37.4-40.0%) and 23.5% (95% CI, 22.3-24.6%), respectively. The prevalence of uncorrected refractive error was 7.85% (95% CI, 7.13-8.58%). Women (p < 0.001 and p = 0.003), those with age ≥ 70 years (p < 0.001 and p = 0.003), and myopia (p < 0.001 and p < 0.001) were at higher risk of uncorrected refractive error and uncorrected refractive error-related visual impairment. Spectacle coverage rate was 70.6% (95% CI, 68.2-73.0%). The cost to identify a single case of refractive error and uncorrected refractive error was US$3.2 and US$25.2, respectively. Conclusion: The prevalence of uncorrected refractive error is high in the urban Chinese adults. Health examination center-based refractive error screening is able to provide an efficient and low-cost model to improve the refractive services in China.

Temporal trends in the prevalence of spectacle use and spectacle coverage in India.

BACKGROUND: This study aims to assess the temporal trends in the prevalence of spectacle use and spectacle coverage for refractive errors in population-based studies conducted during 2011-2012 and 2017 among those aged ≥ 40 years in the state of Telangana, India. An intervention in the form of 10 vision centres and a secondary centre was established in one district (Khammam) after the 2011-2012 study and another district (Warangal) was left to secular trends. METHODS: In both the studies, multi-stage cluster random sampling methodology was used to select the participants. In addition to a clinical examination, a questionnaire was used for collecting information on current and previous use of spectacles, type of spectacles and details of the spectacle providers. The same questionnaire was used in both the studies. RESULTS: In total, 2,485 participants were examined in the 2011-2012 study and 2,711 participants were examined in the 2017 study in Khammam. Similarly, 2,438 and 2,646 participants were examined in Warangal in the two studies, respectively. In Khammam, the age and gender-adjusted prevalence of current spectacle use increased from 30.0 per cent (95% CI 28.2-31.9) to 34.8 per cent (95% CI 33.0-36.6) in the 2011-2012 and 2017 studies, respectively (p < 0.01). However, in the Warangal district, the age and gender-adjusted prevalence of current spectacle use declined from 32.8 per cent (95% CI 31.0-34.7) to 27.6 per cent (95% CI 25.9-29.3) during the 2011-2012 and 2017 studies, respectively (p < 0.01). In Khammam, the spectacle coverage increased from 26.9 per cent to 35.6 per cent, but it declined from 43.8 per cent to 35.7 per cent in Warangal between the studies in 2011-2012 and 2017. CONCLUSIONS: An increase in spectacle use and coverage was observed in Khammam where the secondary centre and vision centres were established, compared to Warangal where there was no such intervention. The results suggest a positive impact of the intervention in the Khammam district and suggest replication of the model to address the burden of uncorrected refractive errors.

Near Vision Spectacle Coverage and Associated Factors Among Adults Living in Finote Selam Town, Northwest Ethiopia: Community-Based Cross-Sectional Study.

BACKGROUND: Near visual impairment leads to difficulty with near tasks at a working distance (40 centimeters) when near visual acuity is 6/12 (N8) or worse. High cost is the main barrier reported for low near vision spectacle coverage. OBJECTIVE: This study aimed to determine near vision spectacle coverage and associated factors among adults living in Finote Selam town, Northwest Ethiopia. METHODS: A community-based, cross-sectional study was applied from June 3 to 25, 2019. A total of 565 study participants aged ≥35 years were recruited using a systematic random sampling technique. A pre-tested questionnaire with adequate physical examination was used for data collection. The data were entered into EPI INFO software and exported to a statistical package for science for analysis. Mean (standard), frequencies, tables, and figures were used to present descriptive statistics. A bi-variable and multivariable logistic regression was used to determine the association between independent variables and outcome variable with a P-value of less than 0.20 and a P-value of less than 0.05, respectively. Odds ratios and a 95% confidence interval were used to show strength of association. RESULTS: A total of 549 adults participated, with a response rate of 97.20% and a mean age of 46.4±8.7 years. The near vision spectacle coverage was 156 (28.42%; 95% CI=24.65-32.31). Higher education level (AOR=2.8; 95% CI=1.21-5.21), history of eye examination (AOR=2.40; 95% CI=1.51-3.81), awareness about near vision problems (AOR=2.12; 95% CI=1.41-3.24), and need of a high plus lens (AOR=4.21; 95% CI=2.41-7.39) were associated with near vision spectacle coverage. CONCLUSION: Near vision spectacle coverage was low among adults living in Finote Selam town. Higher educational level, history of eye examination, awareness about near vision problems, and need of a high plus lens were associated with near vision spectacle coverage.

Near vision spectacle coverage and barriers to near vision correction among adults in the Cape Coast Metropolis of Ghana.

PURPOSE: To determine the near vision spectacle coverage and barriers to obtaining near vision correction among adults aged 35 years and older in the Cape Coast Metropolis of Ghana. METHODS: A population-based cross-sectional study design was adopted and 500 out of 576 participants aged 35 years and older were examined from 12 randomly selected clusters in Cape Coast, Ghana. All participants underwent a comprehensive eye examination which included: distance and near visual acuities measurements and external and internal ocular health assessments. Distance and near refractions were performed using subjective refraction technique. Information on participants' demographics, near vision correction status, near visual needs and barriers to acquiring near vision correction were obtained through a questionnaire administered as part of the study. RESULTS: The mean age of participants was 52.3±10.3 years of whom 280 (56%) were females and 220 (44%) were males. The near vision spectacle coverage was 25%, 33% "met need" for near vision correction in the presbyopic population, and 64% unmet need in the entire study population. After controlling for other variables, age (5th and 6th decades) and educational level were associated with "met need" for near vision correction (OR=2.7 (1.55-4.68), p =0.00, and OR=2.36 (1.18-4.72), p=0.02 respectively). Among those who needed but did not have near vision correction, 64 (26%) did not feel the need for correction, 55 (22%) stated that they were unaware of available interventions, and 53 (21%) found the cost of near vision correction prohibitive. CONCLUSION: There was a low near vision spectacle coverage in this population which suggests the need for strategies on health education and promotion to address the lack of awareness of spectacle need and cost of services.

Rapid assessment of refractive error in the eThekwini Municipality of KwaZulu-Natal, Durban, South Africa.

BACKGROUND: Population-based studies involving refractive error in South Africa are few because they are expensive to conduct and require a high level of expertise. Rapid assessment of refractive error (RARE) is a relatively less resource-intensive method designed to assess the magnitude of uncorrected refractive error (URE), spectacle coverage and barriers to access of services. This information is useful for designing and implementing programs as well as for policy development. PURPOSE: The purpose of this study was to determine the prevalence of uncorrected refractive error and spectacle coverage and to explore the barriers to uptake of refractive services in persons 15 to 35 years old in the eThekwini municipality, Durban, South Africa. METHODS: A cross-sectional epidemiological study was conducted using the RARE protocol. A total of 1,543 participants were enumerated and 1,516 were examined. Uncorrected refractive error was defined as presenting visual acuity less than 6/12 that could be corrected to 6/12 or better using a pinhole. Spectacle coverage was defined as the proportion of need that was already met with spectacle correction. RESULTS: The prevalence of age and sex adjusted URE was 1.5% (95 per cent CI: 0.7 -2.3). Odds for uncorrected refractive error in women were 0.5 (95 per cent CI: 0.3-0.9) lower compared to men. There was a statistically significant association between uncorrected refractive error and respondents 15 to 24 years old (p < 0.001). The spectacle coverage (6/12 cut-off) was 51.4 per cent (95 per cent CI: 28.1-74.7). The prevalence of spectacle use among participants was 3.8 per cent. CONCLUSIONS: The low prevalence of uncorrected refractive error found in this study agrees with previous studies that indicate that despite uncorrected refractive error being the most common cause of visual impairment and the second most common cause of blindness worldwide, its prevalence is relatively low in South Africans.

Prevalence of presbyopia and spectacle correction coverage in a rural population of North West Nigeria.

PURPOSE: To determine the prevalence of presbyopia, and near vision spectacle coverage in a rural population of Northwestern Nigeria. STUDY DESIGN: Cross sectional prevalence study. SUBJECTS AND METHODS: Six hundred and fifty people of at least 40 years of age, in 13 clusters (50 per cluster) were examined using a multi-stage random sampling with probability proportional to size. The survey was conducted from April 7 to 28, 2012 at Bungudu Local Government Area of Zamfara State, Nigeria. Presbyopia was defined as the inability to read N8 at 40 cm. Presbyopic Spectacle Correction Coverage (PSCC) was calculated, and information on barriers to using near vision spectacles identified. RESULTS: The crude prevalence of presbyopia was 30.4%, 95% CI: (26.8%-34.1%). The prevalence was significantly higher in females (P=0.0005) and individuals with at least secondary education (P=0.022). The age specific prevalence of presbyopia was three times (63.5%) more among those aged 70 years and above, as compared to those within 40-49 years age group (19.3%). The met need was 0.2%, the unmet need 30.2%, and a PSCC of 0.7%. The major barriers reported as reasons for not obtaining near vision spectacles were unawareness and lack of felt need. CONCLUSION: The prevalence of presbyopia in Bungudu is relatively low compared to other reports with major risk factors being increasing age, female sex and attainment of higher education. The presbyopic spectacles correction coverage is very low with high unmet need thus there is a need to create awareness, and provide affordable and accessible optical services in the affected population.

Prevalence of refractive error, presbyopia and spectacle coverage in Kahama District, Tanzania: a rapid assessment of refractive error.

BACKGROUND: In Tanzania, the prevalence of refractive error and presbyopia have not been comprehensively assessed, limiting appropriate planning and implementation of delivery of vision care. This study sought to determine the prevalence of refractive error and presbyopia, spectacle coverage and the barriers to uptake of refractive services in people aged 15 years and older in the Kahama district of Tanzania. METHODS: A cross-sectional community-based survey was conducted using 54 randomly selected clusters. Respondents 15 years and older were interviewed and underwent standardised clinical eye examinations. Uncorrected refractive error (URE) was defined as presenting vision worse than 6/12 that could be corrected to better than 6/12 using a pinhole. Spectacle coverage was defined as the proportion of need that was met (those that improved from unaided vision with their own spectacle correction). RESULTS: A total of 3,230 subjects (99.75 per cent of 3,240 eligible) participated in the study with 57.2 per cent males and the median age of participants was 35 years (inter-quartile range, 24 to 49). The prevalence of visual impairment was 10.4 per cent (95% CI 9.4 to 11.4) and was lower in those who had completed their primary school education (odds ratio (OR) 0.54, 95% CI: 0.40 to 0.72) and highest in subjects 40 years and older (OR 3.17, 95% CI: 2.14 to 4.70) and farmers (OR 8.57 95% CI: 2.27 to 32.43). Refractive error prevalence was 7.5 per cent (95% CI: 6.65 to 8.54) and this was highest in participants over 40 years (OR 1.60, 95% CI: 1.14 to 2.25) and in students (OR 3.64, 95% CI: 1.35 to 9.86). Prevalence of presbyopia was 46.5 per cent (773/1,663, 95% CI: 44.34 to 48.75). Spectacle coverage for refractive error and presbyopia was 1.69% (95% CI: 0 to 3.29) and 0.42% (95% CI: 0 to 1.26), respectively. CONCLUSION: Uncorrected refractive error is a public health challenge in the Kahama district and sustainable service delivery and health promotion efforts are needed.