Determinantes sociales de la salud y la enfermedad visual en caficultores de Caldas, Colombia / Social Determinants of Health and Visual Disease in Coffee Harvesters from Colombia

Introducción: Aunque existen iniciativas globales que buscan mejorar la salud visual en las poblaciones y alcanzar una mayor inclusión social de las personas afectadas con pérdida de la visión, coexisten barreras importantes como la poca accesibilidad y equidad de los servicios de salud y las diferencias económicas y de género que impiden obtener mejores indicadores. Objetivo: Establecer la asociación entre los determinantes sociales de la salud y la enfermedad visual en una comunidad de caficultores en el Departamento de Caldas, Colombia. Métodos: Estudio descriptivo correlacional en el que participaron 1387 caficultores. La información se recolectó en el momento de la valoración por optometría. Se aplicó un cuestionario para explorar los determinantes sociales de la salud estructurales e intermedios y datos relacionados con salud visual. La asociación entre las variables fue establecida a través de la prueba de chi cuadrado. Resultados: La edad promedio fue de 57 años ± 10,7 años, 77,3 por ciento hombres, el 97,2 por ciento pertenecía al estrato socioeconómico bajo y un 73 por ciento habían realizado estudios primarios. Las enfermedades visuales más frecuentes fueron los trastornos de refracción en un 85,7 por ciento, el principal diagnóstico fue la presbicia con una prevalencia de 75,8 por ciento (IC 95 por ciento: 73,5 por ciento; 78,03 por ciento). En el análisis bivariado se encontró asociación estadísticamente significativa (p < 0,05) entre el diagnóstico de optometría y los determinantes sociales de la salud estructurales e intermedios: sexo, estado civil, grupo de edad, nivel educativo, estrato socioeconómico y ocupación. Conclusiones: La enfermedad visual en caficultores se encuentra influenciada por determinantes sociales de la salud estructurales e intermedios, modificables con acciones intersectoriales y transectoriales como el nivel educativo, estrato socioeconómico y la ocupación, los que deben ser incorporados a las políticas públicas para mejorar su calidad de vida y reducir la ceguera prevenible(AU)

Introduction: Although there are global initiatives aimed at improving visual health in populations and at achieving greater social inclusion of people affected with vision loss, important barriers coexist such as poor accessibility and equity of healthcare services and economic and gender-related differences that prevent obtaining better indicators. Objective: To establish the association between the social determinants of health and visual disease in a community of coffee harvesters in the department of Caldas, Colombia. Methods: Descriptive and correlational study with the participation of 1,387 coffee harvesters. The information was collected at the time of optometric assessment. A questionnaire was applied to explore the structural and intermediate social determinants of health and data related to visual health. The association between the variables was established through the chi-square test. Results: The average age was 57 years ± 10.7 years, 77.3 percent were men, 97.2 percent belonged to the low socioeconomic stratum and 73 percent had completed elementary school. The most frequent visual diseases were refractive disorders, account ting for 85.7 percent; and the main diagnosis was presbyopia, with a prevalence of 75.8 percent (95 percent CI: 73.5 percent; 78.03 percent). The bivariate analysis showed a statistically significant association (p<0.05) between the diagnosis of optometry and the structural and intermediate social determinants of health: sex, marital status, age group, educational level, socioeconomic status, and occupation. Conclusions: Visual disease in coffee harvesters is influenced by structural and intermediate social determinants of health, modifiable with intersector and cross-sector actions such as educational level, socioeconomic stratum, and occupation, which must be incorporated into public policies to improve their quality of life and to reduce preventable blindness(AU)

The role of optometrists in India: An integral part of an eye health team.

India has a proud tradition of blindness prevention, being the first country in the world to implement a blindness control programme which focused on a model to address blinding eye disease. However, with 133 million people blind or vision impaired due to the lack of an eye examination and provision of an appropriate pair of spectacles, it is imperative to establish a cadre of eye care professionals to work in conjunction with ophthalmologists to deliver comprehensive eye care. The integration of highly educated four year trained optometrists into primary health services is a practical means of correcting refractive error and detecting ocular disease, enabling co-managed care between ophthalmologists and optometrists. At present, the training of optometrists varies from two year trained ophthalmic assistants/optometrists or refractionists to four year degree trained optometrists. The profession of optometry in India is not regulated, integrated into the health care system or recognised by the majority of people in India as provider of comprehensive eye care services. In the last two years, the profession of optometry in India is beginning to take the necessary steps to gain recognition and regulation to become an independent primary health care profession. The formation of the Indian Optometry Federation as the single peak body of optometry in India and the soon to be established Optometry Council of India are key organisations working towards the development and regulation of optometry.

Advocacy for eye care.

The effectiveness of eye care service delivery is often dependant on how the different stakeholders are aligned. These stakeholders range from the ministries of health who have the capacity to grant government subsidies for eye care, down to the primary healthcare workers who can be enrolled to screen for basic eye diseases. Advocacy is a tool that can help service providers draw the attention of key stakeholders to a particular area of concern. By enlisting the support, endorsement and participation of a wider circle of players, advocacy can help to improve the penetration and effectiveness of the services provided. There are several factors in the external environmental that influence the eye care services – such as the availability of trained manpower, supply of eye care consumables, government rules and regulations. There are several instances where successful advocacy has helped to create an enabling environment for eye care service delivery. Providing eye care services in developing countries requires the support – either for direct patient care or for support services such as producing trained manpower or for research and dissemination. Such support, in the form of financial or other resources, can be garnered through advocacy.

Óculos oclusor: teste de um modelo para uso com crianças / The eyeglass-shaped ocluder: test of a model to be used with children

Oclusor é um instrumento utilizado durante o teste com escala optométrica. Esta tem por função a determinação da acuidade visual. Objetivou-se testar o oclusor com formato de óculos. Pesquisa experimental, realizada em março de 2005, em Fortaleza- CE, com amostra de 64 crianças estudantes da 1ª série do Ensino Fundamental de uma escola pública. Coleta de dados desenvolvida em grupo controle que utilizou oclusor do Conselho Brasileiro de Oftalmologia e o experimental com o ÓculOs. As variáveis sexo e tempo de realização do exame demonstraram-se insignificantes. A pesquisa apresentou valores estatisticamente dependentes quanto à eficiência e ao ajustamento. Como observado, a disposição da criança para o exame independe do oclusor. Em virtude desses fatores, o ÓculOs demonstra-se uma boa opção, independente do tempo de realização do teste, sexo e idade das crianças, em relação à eficiência e ao ajustamento.

Guidelines for prescribing optical correction in children.

As the eye grows, the axial length increases while the cornea and lens flatten. High refractive errors which are common in the neonatal period, reduce rapidly during the first year of life through the process called emmetropization. The possibility that long-term full- time glasses wear may impede emmetropization must be considered. Hyperopia greater than 5.00 diopters (D) in young children is associated with an increased risk of amblyopia and strabismus, therefore optical correction should be prescribed. When hyperopia is associated with esotropia, full correction of the cycloplegic refractive error should be prescribed. Myopia greater than 8.00 D and astigmatism greater than 2.50 D are common causes of isometropic amblyopia. Patients with hyperopic anisometropia with as little as l D difference between the eyes may develop amblyopia while the difference should reach 3-4 D for myopic anisometropia to develop amblyopia. Full cycloplegic refractive difference between two eyes should be given to the anisometropic child in spite of age, strabismus and degree of anisometropia. Myopia control is the attempt to slow the rate of progression of myopia such as cycloplegic agents, plus lenses at near, and rigid contact lenses.