Prevalence and surgical status of cataract in adults aged 50 years and older in Kandze Tibetan areas of Sichuan, China / 中华实验眼科杂志

Objective:To investigate the prevalence of cataract, cataract surgical coverage and surgical outcomes in people aged 50 years and older in Kandze Tibetan areas of Sichuan Province, and to evaluate the effectiveness of the prevention and treatment of blindness in the region.Methods:A cross-sectional study was conducted to study the population aged 50 years and above in Ganzi Tibetan Autonomous Prefecture, Sichuan Province, from October 2017 to April 2018 using the Rapid Assessment of Avoidable Blindness (RAAB) method.A total of 5 000 permanent residents aged 50 years and older were selected using a stratified, cluster sampling method with reference to the data from the 2010 China Population Census with the RAAB software, and each cluster consisted of 50 people, for a total of 100 clusters.The survey was conducted by two survey teams, and all subjects underwent visual acuity and ophthalmic examinations at home to investigate relevant cataract prevalence, surgical coverage, surgical barriers, and postoperative outcomes according to WHO Standards.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Kandze Prefecture People's Hospital (No.GZZYY-2016-11). Written informed consent was obtained from each subject.Results:Of 5 000 eligible participants, 4 763 were examined, with a response rate of 95.3%.Referred to the visual impairment standard of WHO and the pinhole visual acuity, the prevalence of bilateral blindness, severe, moderate and mild visual impairment was 0.6%(95% [confidence interval, CI]: 0.4%-0.9%), 0.9%(95% CI: 0.6%-1.2%), 2.4%(95% CI: 2.0%-2.9%) and 5.2%(95% CI: 4.6%-5.9%), respectively.The prevalence of cataract blindness was 0.7%(95% CI: 0.4%-1.0%) in females, significantly higher than 0.2%(95% CI: 0.1%-0.5%) in males( P<0.05). The prevalence of cataract blindness was 2.3% among Tibetan, higher than 1.0% among Han Chinese, showing a statistically significant difference ( P<0.05). By the number of eyes, the cataract surgical coverage was 60.8%(95% CI: 55.5%-65.8%) in females, which was lower than 70.1%(95% CI: 63.7%-75.7%) in males, with a statistically significant difference ( P<0.05). By the number of cases, the surgical coverage for cataract blindness in both eyes was 82.0%(95% CI: 75.2%-87.6%), with blindness defined as the pinhole visual acuity <0.05 in the dominant eye.A total of 171 people with untreated cataract received a questionnaire about barriers to cataract surgery.The most important barrier was unaware that treatment was available at 77.8%, followed by inconvenient transportation or being unaccompanied to the hospital at 11.7%.A total of 364 eyes underwent cataract surgery, of which 336 eyes underwent intraocular lens implantation, and the intraocular lens implantation rate was 92.3%.There were 216 eyes with a postoperative cataract visual acuity ≥0.3, accounting for 59.3%(216/364). Conclusions:In the Kandze Tibetan area of Sichuan Province, cataract is still the main cause of blindness among people aged 50 and above, and surgery for cataract remains the focus of blindness prevention work.The cataract surgical coverage in this area is high, but the postoperative outcomes are still poor compared with the WHO reference index for post-cataract surgery (1998), and corresponding measures must be taken to improve the quality of surgery.

Prevalence and causes of avoidable blindness and visual impairment, including the prevalence of diabetic retinopathy in Siwan district of Bihar, India: A population-based survey

Purpose: The aim of this study was to estimate the prevalence and causes of visual impairment (VI) and blindness and diabetic retinopathy (DR) in Siwan district, Bihar. Methods: A population-based cross-sectional study was done from January to March 2016 using the Rapid Assessment of Avoidable Blindness 6 (RAAB 6, incorporating DR module) methodology. All individuals aged ?50 years were examined in 57 randomly selected clusters within the district. Results: A total of 3476 individuals were enumerated and 3189 (92%) completed examination. The overall prevalence of blindness and severe VI was 2.2% (95% confidence interval (CI): 1.6–2.8) and 3.4% (95% CI: 2.6–4.3), respectively. Untreated cataract was the leading cause of blindness (73%) and severe VI (93%). The cataract surgical coverage (CSC) at <3/60 was 71.5% for eyes and 89.3% for persons in this sample and the CSC was similar between the genders. Refractive error (71%) was the primary cause of early VI. The overall prevalence of known and newly diagnosed diabetes was 6.3% (95% CI, 5.4–7.2%). Prevalence of any DR, maculopathy, and sight-threatening DR was 15, 12.4, and 6%, respectively. Conclusion: To conclude, as compared to previous reports, the prevalence of blindness and DR in Siwan district of Bihar was found to be lower and the CSC was higher. However, the problem of avoidable blindness remains a major problem in this region.

SMEC eye care system: Profile and its role in eliminating avoidable blindness in Indonesia

Untreated cataract remains the leading cause of avoidable blindness in Indonesia, as it pointed out 1.9% prevalence of the total population, with incidence of 0.1% and the backlog between 320,000 and 350,000 cases per year. It is reported that 51.6% of people do not know if they suffer from cataracts, 11.6% because they cannot afford it, and 8.1% due to fear of surgery. SMEC eye care system was established with a model similar to Aravind’s to increase the number of cataract surgeries with high volume, high quality, affordable, and accessible cataract surgery, combined with well-designed outreach programs to increase demand. The results are that there are 29 branches of eye hospitals and eye clinics from west to east region of Indonesia, with a total of 58,000 cataract surgeries per year. SMEC also collaborates with private and public hospitals to develop their eye clinics to reach out to more people with blindness. Although with a high volume of cataract surgeries, SMEC only contributed cataract surgical rate of 225, as compared to the national target of 2000, which means that only 11% of total untreated cataract were cured by SMEC. At this rate, SMEC, along with the government and ophthalmologists in Indonesia, still has a lot of homework to do to give more hope to people with blindness.

Factors limiting the Northeast Indian elderly population from seeking cataract surgical treatment: Evidence from Kolasib district, Mizoram, India

Purpose: Reliable data on the barriers to the uptake of cataract surgical services in the Northeast Indian states are scanty. The purpose of this study was to assess the barriers to uptake of cataract surgical services among elderly patients and suggest appropriate strategies to reduce these. Methods: A cross-sectional study was conducted among patients who failed to avail cataract surgical services, 6–12 months' postinitial diagnosis at a community eye health camp. Validated questionnaire was used to collect information through face-to-face interviews at the residence of the participants. Descriptive statistics and Chi-square tests were conducted to assess the association between the barriers quoted and sociodemographic variables. Results: A total of 140 (89.2%) individuals participated in the study, of whom 56 (40%) were aged between 71 and 80 years. The median age for men and women was 73.5 and 72.5 years, respectively. About 57% of participants were female patients. A total of 66 (47.1%) participants had borderline visual acuity followed by those with poor vision (41.4%, n = 58). “Bad roads/difficult terrain” (P = 0.009), “witnessed bad surgical outcomes in others” and “did not feel important” (P < 0.024), “poor overall health status” (P < 0.001), “lack of information” (P = 0.025) and “no escort” (P = 0.025) were significant barriers reported by this population. Conclusion: Most of the barriers reported in this study seem to be endogenous in nature and appear to be within the purview of the local eye care service provider to remedy. Counseling and targeted awareness and information, education, and communication strategies could nullify many of the barriers reported in this study.

Prevalence and causes of the avoidable blindness and low vision in Mongolia / Монголын Анагаах Ухаан

The Rapid Assessment of Avoidable Blindness (RAAB) has been developed as a simple and rapidsurvey methodology that can provide data on the prevalence and main causes of blindness.AimTo assess the prevalence and main causes of avoidable blindness and visual impairment in peopleaged 50 and above in Mongolia.MethodsThe RAAB uses a standard methodology which is documented in the RAAB Instruction Manual (HansLimburg, International Centre for Eye Health, London School of Hygiene and Tropical Medicine).Assuming an estimated prevalence of blindness in persons aged 50+ of 2.14% and a non-complianceof 5%, with a variation to 25% around the estimate of 2.14% at 95% probability, the required samplesize was calculated at 4,040: 101 clusters of size 40. Visual acuity (VA) was measured with a Snellentumbling E chart, using optotype size 18 (60) on one side and size 60 (200) on the other side. Thelens status of all participants was assessed by both torch and distant direct ophthalmoscopy, by anophthalmologist in a shaded or dark environment. The data were analyzed using RAAB Version 4.02(ICEH, London) for pre-defined reports relating to both crude and age and gender adjusted results.ResultsThe survey included 4,040 people aged 50 years and older, of whom 4,029 were actually examined.The coverage was 99.7%. 7 persons (0.2%) were absent and 4 (0.1%) refused to participate in thestudy. The prevalence of bilateral blindness with available correction in the better eye is 2.2 % (95% CI,1.7 - 2.7%); 2.4% in males and 2.2% in females. The prevalence of bilateral severe visual impairment(SVI) is 2.1% and bilateral moderate visual impairment (MVI) is 10.8%. The prevalence of functionallow vision, requiring low vision services, is 4.5%. In people aged 50+, untreated cataract is the mostcommon cause of bilateral blindness with 38.9%, followed by glaucoma (20.0%), non-trachomatouscorneal opacity (13.3%), and other posterior segment disease (7.8%).Conclusion: Untreated cataract and uncorrected refractive errors are the major causes of avoidableblindness and low vision in Mongolia, respectively. Priority should be given to cataract surgery,followed by the development of optical services and PHC and PEC services, as these are the mostcost-effective interventions. These three interventions will address about three thirds (67.8%) of thecauses of blindness and have most impact.

The global cost of eliminating avoidable blindness.

Aims: To complete an initial estimate of the global cost of eliminating avoidable blindness, including the investment required to build ongoing primary and secondary health care systems, as well as to eliminate the ‘backlog’ of avoidable blindness. This analysis also seeks to understand and articulate where key data limitations lie. Materials and Methods: Data were collected in line with a global estimation approach, including separate costing frameworks for the primary and secondary care sectors, and the treatment of backlog. Results: The global direct health cost to eliminate avoidable blindness over a 10-year period from 2011 to 2020 is estimated at $632 billion per year (2009 US$). As countries already spend $592 billion per annum on eye health, this represents additional investment of $397.8 billion over 10 years, which is $40 billion per year or $5.80 per person for each year between 2010 and 2020. This is concentrated in high-income nations, which require 68% of the investment but comprise 16% of the world's inhabitants. For all other regions, the additional investment required is $127 billion. Conclusions: This costing estimate has identified that low- and middle-income countries require less than half the additional investment compared with high-income nations. Low- and middle-income countries comprise the greater investment proportion in secondary care whereas high-income countries require the majority of investment into the primary sector. However, there is a need to improve sector data. Investment in better data will have positive flow-on effects for the eye health sector.

Turning the tide of corneal blindness.

Corneal diseases represent the second leading cause of blindness in most developing world countries. Worldwide, major investments in public health infrastructure and primary eye care services have built a strong foundation for preventing future corneal blindness. However, there are an estimated 4.9 million bilaterally corneal blind persons worldwide who could potentially have their sight restored through corneal transplantation. Traditionally, barriers to increased corneal transplantation have been daunting, with limited tissue availability and lack of trained corneal surgeons making widespread keratoplasty services cost prohibitive and logistically unfeasible. The ascendancy of cataract surgical rates and more robust eye care infrastructure of several Asian and African countries now provide a solid base from which to dramatically expand corneal transplantation rates. India emerges as a clear global priority as it has the world's largest corneal blind population and strong infrastructural readiness to rapidly scale its keratoplasty numbers. Technological modernization of the eye bank infrastructure must follow suit. Two key factors are the development of professional eye bank managers and the establishment of Hospital Cornea Recovery Programs. Recent adaptation of these modern eye banking models in India have led to corresponding high growth rates in the procurement of transplantable tissues, improved utilization rates, operating efficiency realization, and increased financial sustainability. The widespread adaptation of lamellar keratoplasty techniques also holds promise to improve corneal transplant success rates. The global ophthalmic community is now poised to scale up widespread access to corneal transplantation to meet the needs of the millions who are currently blind.

The accomplishments of the global initiative VISION 2020: The Right to Sight and the focus for the next 8 years of the campaign.

In the first 12 years of VISION 2020 sound programmatic approaches have been developed that are capable of delivering equitable eye health services to even the most remote and impoverished communities. A body of evidence around the economic arguments for investment in eye health has been developed that has fuelled successful advocacy work resulting in supportive high level policy statements. More than a 100 national plans to achieve the elimination of avoidable blindness have been developed and some notable contributions made from the corporate and government sectors to resource eye health programs. Good progress has been made to control infectious blinding diseases and at the very least there is anecdotal evidence to suggest that the global increase in the prevalence of blindness and visual impairment has been reversed in recent years, despite the ever increasing and more elderly global population. However if we are to achieve the goal of VISION 2020 we require a considerable scaling up of current efforts–this will depend on our future success in two key areas: i) Successful advocacy and engagement at individual country level to secure significantly enhanced national government commitment to financing their own VISION 2020 plans.ii) A new approach to VISION 2020 thinking that integrates eye health into health system development and develops new partnerships with wider health development initiatives.

Best practice eye care models.

Since the launching of Global Initiative, VISION 2020 “the Right to Sight” many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.

Prevalencia de ceguera en el Departamento de Santander - Colombia / Blindness prevalence in Santander, Colombia

Objetivo: Medir la prevalencia de ceguera y déficit visual severo en población mayor de 50 años en el Departamento de Santander; igualmente medir la prevalencia de catarata relacionada con ceguera y déficit visual; la cobertura y resultados de los servicios de cirugía de catarata y las principales barreras que tienen las personas para acceder a dicho servicio. Materiales y métodos: estudio de prevalencia de base poblacional con muestreo aleatorio sistemático por conglomerados, tamaño de la muestra de 4.082 individuos. Se siguió la metodología de evaluación rápida de servicios de cirugía de catarata de la Organización Mundial de la Salud - OMS. Resultados: la prevalencia de ceguera fue de 1,79%, el problema afecta prioritariamente a la población pobre y rural. Las principales causas de ceguera son la catarata (67.61%), alteraciones del segmento posterior (14.08%), otras opacidades cornéales (8.45%), glaucoma (2.82%) y errores refractivos, retinopatía diabética y complicaciones quirúrgicas (cada una con 1.41%). El 82,5% de las personas no se han operado por desconocimiento de la enfermedad o dificultades económicas. Discusión: la ceguera es un problema de salud pública de la región y su distribución es inequitativa, afectando prioritariamente a la población pobre ubicada en zonas rurales. Las principales causas de déficit visual son la catarata y los errores refractivos, causas totalmente corregibles de manera sencilla y económica. Se recomienda a las autoridades de salud, formular e implementar un plan de salud visual que incluya la movilización de actores del sistema de seguridad social en salud del Departamento. [Galvis V, Rey JJ, Rodríguez LA, Serrano C, Tello A. Prevalencia de ceguera en el Departamento de Santander - Colombia. MedUNAB 2009; 12:66-73].

Objective: to measure the prevalence of blindness and severe visual deficit in population greater of 50 years in the Department of Santander, Colombia; also to measure the cataract prevalence related to blindness and visual deficit, the cover and results of the cataract's surgery services, and the main barriers that people have to access to this service. Materials and methods: cross-sectional study with population base and systematic conglomerates random sampling; sample size of 4.082 individuals. The methodology followed was the WHO Fast Evaluation of Cataract's Surgery Services survey. Results: the prevalence of blindness was of 1,79%; this problem affects primarily poor and rural population. The main causes of blindness are the cataract (67.61%) back segment alteration (14.08%), another corneal opacities (8.45%), glaucoma (2.82%) y refractive errors, diabetic retinopathy and surgical complications (each with 1.41%). 82,5% of the people have not been operated by ignorance of their disease or economic difficulties. Discussion: blindness is a public health problem in Santander, and its distribution is inequitable, affecting primarily poor population located in rural zones. The main causes of visual deficit are cataract and refracting errors, totally correctable causes by simple and economic way. It is recommended to the health authorities, to formulate and to implement a plan of visual health that includes mobilization all social security system actors in health in Santander. [Galvis V, Rey JJ, Rodríguez LA, Serrano C, Tello A. Blindness prevalence in Santander, Colombia. MedUNAB 2009; 12:66-73].