Quality of refractive error care in Pakistan: an unannounced standardised patient study.

OBJECTIVE: Undercorrected refractive errors are the primary cause of vision impairment worldwide, including in Pakistan. However, limited data exist on the quality of refractive error care. Our study assessed the quality of refractive error care in Punjab, Pakistan by estimating the proportion of spectacles that were optimally prescribed. METHODS AND ANALYSIS: In this cross-sectional study, 12 unannounced standardised patients (USPs) from Jhang, Khanewal and Sahiwal districts were recruited. USPs underwent baseline subjective refraction and were trained to attend optical services, observe consultations, request spectacles and obtain prescriptions. The spectacles received were compared with baseline refraction to determine quality. We also examined the associations between spectacle quality, service and patient characteristics. RESULTS: Out of 276 attempted visits to 69 optical services, 241 pairs of spectacles were dispensed. A population size-weighted percentage of 42.7% (95% CI 36.4% to 49.3%) of spectacles were optimal quality, with the range varying from 13.8% in Jhang to 67.0% in Khanewal. Half the suboptimal quality spectacles had horizontal prism deviations outside of tolerance limits. Optimal spectacles were associated with performing focimetry (unadjusted OR=7.15, 95% CI (3.02 to 16.94), p<0.001) and good communication (OR=2.23, 95% CI (1.06 to 4.67), p=0.03). Hyperopic USPs were less likely to receive optimal spectacles (OR=0.01 95% CI (0.00 to 0.11), p<0.001). CONCLUSION: The quality of refractive error care in Pakistan requires improvement, particularly in the Jhang district. Key areas for enhancing refractive error care in Pakistan include refining dispensing and refraction skills for hyperopic prescriptions, providing training on the risks of using previous spectacles, and emphasising the importance of effective communication skills.

Results of a community-based screening programme for diabetic retinopathy and childhood blindness in district Hyderabad, Pakistan.

PURPOSE: To present the results of a community-based screening programme for diabetes, diabetic retinopathy (DR) and childhood blindness (CB) in District Hyderabad, Pakistan. METHODS: Prospective cross-sectional data collection from January 2014 to December 2015 of screening for diabetes, DR and CB in Hyderabad District. Female health workers were trained to identify high-risk (potential) patients for diabetes and childhood eye disorders to undertake preliminary screening and refer patients to basic health units. The patients were further assessed by medical officers with the support of qualified optometrist, after which they were referred to Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad, Pakistan for management. RESULTS: A total of 995 244 population was covered in this screening programme during which 2622 children (0-≤15 years) were screened for CB while 16 760 adult patients (>15 years) were screened for diabetes. Random blood glucose level of 3075 patients was >140 mg/dL. Out of these patients, 17% were diagnosed with DR. Refractive error (42%) was the most common cause of childhood visual impairment. CONCLUSION: The diabetic screening programme detected a high prevalence (17%) of retinopathy in patients with diabetes living in Hyderabad District. The most common cause of childhood visual impairment was refractive error (42%), which was successfully managed due to timely diagnosis. A large number of patients benefited from this community-based screening programme.

A simple integrated primary health care based model for detection of diabetic retinopathy in resource-limited settings in Pakistani population.

OBJECTIVE: To find out prevalence of Diabetic Retinopathy in general population of three districts in Pakistan. METHODS: A community based cross-sectional survey was conducted in three large districts of Pakistan namely Rawalpindi in Punjab, Peshawar in Khyber Pakhtoonkhwa and Hyderabad in Sindh between January 2013 and August 2015. Lady Health Workers identified individuals at high risk for diabetes based on pre-defined criteria. High risk population was tested for dysglycemia. Fundoscopic evaluation for evidence of DR was performed in all individuals with a random blood glucose >190mg/dl. Individuals with the evidence of DR were referred to affiliated tertiary care ophthalmology departments. RESULTS: A total of 42,629 individuals reported at the project sites and 63% (n=26,859) were female. Fifty one percent (n=21,989) individuals met high risk criteria. Out of these 21,989 individuals, dysglycemia was found in 3,869 (17.6%). Fundoscopy showed evidence of DR in 1,042 (27%) individuals. Amongst high risk population, dysglycemia was significantly more common in females as compared to males. The frequency of DR in dysglycemic patients was comparable across both gender groups. CONCLUSION: The prevalence of DR in Pakistani population is alarmingly high. This preventable cause of blindness is largely undiagnosed in our population and a simple integrated model based on primary health care facilities can help identify and treat a large population of DR patients.