Strategies to address inequity of uncorrected refractive error in the Western Pacific: A modified Delphi process.

PURPOSE: Uncorrected refractive error is the leading cause of vision impairment globally; however, little attention has been given to equity and access to services. This study aimed to identify and prioritise: (1) strategies to address inequity of access to refractive error services and (2) population groups to target with these strategies in five sub-regions within the Western Pacific. METHODS: We invited eye care professionals to complete a two-round online prioritisation process. In round 1, panellists nominated population groups least able to access refractive error services, and strategies to improve access. Responses were summarised and presented in round 2, where panellists ranked the groups (by extent of difficulty and size) and strategies (in terms of reach, acceptability, sustainability, feasibility and equity). Groups and strategies were scored according to their rank within each sub-region. RESULTS: Seventy five people from 17 countries completed both rounds (55% women). Regional differences were evident. Indigenous peoples were a priority group for improving access in Australasia and Southeast Asia, while East Asia identified refugees and Oceania identified rural/remote people. Across the five sub-regions, reducing out-of-pocket costs was a commonly prioritised strategy for refraction and spectacles. Australasia prioritised improving cultural safety, East Asia prioritised strengthening school eye health programmes and Oceania and Southeast Asia prioritised outreach to rural areas. CONCLUSION: These results provide policy-makers, researchers and funders with a starting point for context-specific actions to improve access to refractive error services, particularly among underserved population groups who may be left behind in existing private sector-dominated models of care.

Epidemiology of eye diseases: outcomes from a free provincial eye clinic in Papua New Guinea.

Aim: To ascertain the prevalence and pattern of eye problems in Madang Province, Papua New Guinea. Materials and methods: A six-month retrospective study was performed at Madang Provincial Hospital Eye Clinic. Convenience sampling was used in this study and all patient records from January to June 2020 were included. Data was extracted using Microsoft Excel and the data included gender, age, occupation, district where the patient lived, presenting visual acuity, and diagnosis. It was then analyzed using International Business Machines Corporation's Statistical Package for the Social Sciences version 26. A p-value of ≤0.05 was considered statistically significant. Results: A total of 1,715 patients received services at the eye clinic between January and June 2020, and 1,664 were included in this study. The mean age of the patients was 39.3 ± 20.3 years. There were slightly more males (50.4%) than females. The overall leading ocular morbidities were corneal ulcers and keratitis (20.7%), refractive errors (17.4%), and cataracts (16.8%). More than half of the patients (56.2%) were either visually impaired or blind. Nearly half of the patients (41.8%) traveled long distances to seek services at the eye clinic. There was a significant association between demographic characteristics, diagnosis, and level of visual impairment. Conclusion: There is a high prevalence of potential causes of visual impairment and blindness in Madang Province and these conditions affect all age groups and genders. It is essential to increase accessibility to eye care services in the country.

Prevalence of Risk Factors of Retinal Diseases among Patients in Madang Province, Papua New Guinea.

Purpose: To explore the prevalence of risk factors of retinal diseases among patients seeking services from Madang Provincial Hospital Eye Clinic in Papua New Guinea. Materials and Methods: A hospital-based retrospective study was conducted at the only eye clinic serving the entire Madang province of Papua New Guinea. Purposive sampling was used to obtain data from patients' record cards at the eye clinic from January to June 2021. The data collected included gender, age, presenting visual acuity, blood pressure, blood sugar level, body mass index, smoking habits, and history of cataract surgery. The data was analyzed using the International Business Machines Corporation's Statistical Package for Social Sciences version 21. A p-value of <0.05 was considered statistically significant. Results: Two hundred and fifty-five (255) patients went through diabetes and hypertension screening during the period of the study (January to June 2021). The mean age of the patients was 53.14 ± 11.20 years and there were more males (56.86%) than females. Nearly half of the patients (43.6%) were either visually impaired or blind. More than half (52.6%) had diabetes mellitus. Majority of the patients (73.3%) were hypertensive and more than half (57.0%) of the patients had unhealthy body mass index (BMI <18.525 kg/m2 or > 25 kg/m2). Overweight was significantly associated with hypertension (p < 0.001) and diabetes mellitus (p < 0.001). A few of them were smokers or had a history of cataract surgery (13.7% and 2.0%, respectively). Conclusion: There is a high prevalence of diabetes, hypertension, and overweight among ophthalmic patients in Madang. It is important that measures are put in place to eliminate barriers to health care and to strengthen eye care services in Papua New Guinea.

Prevalence and Distribution of Refractive Errors among Ophthalmic Patients in Madang Province, Papua New Guinea.

Purpose: To assess the prevalence and distribution of refractive errors in Madang Province, Papua New Guinea (PNG). Methods: A retrospective hospital-based study was conducted at Madang Provincial Hospital Eye Clinic. It is a free eye clinic and spectacle costs are further subsidized by a nongovernmental organization. Nonprobability purposive sampling was used to retrieve patients' records at the eye clinic from January to December 2016. Only demographic and clinic data on the patients' first visit to the eye clinic were recorded and these included their age, gender, location, presenting visual acuity (VA), and refractive correction. Results: One thousand and one hundred eighty-four patients' records were retrieved, of which 622 (52.53%) had refractive error. The mean age of refractive error presentation was 49.68 ± 16.29 years with a range of 9-86 years. There were more males (55%) than females. About a quarter of the patients (21.2%) presented with moderate visual impairment. There was a statistically significant relationship between visual impairment and age group (P < 0.001). Myopia (53.1%) was the most common type of refractive error followed by hyperopia (32.5%) and astigmatism (14.4%). The uptake of spectacle correction was very high (95.3%) among the patients. More than one-tenth of the patients (12.5%) reported from other provinces. Almost one-third of the patients (31.4%) could not obtain a VA of 6/6 after refraction. About one-fifth (17.0%) of the patients were suspected of functional amblyopia. Conclusions: Uncorrected refractive error (URE) is a significant cause of visual impairment in PNG. There is a need for the integration of eye care services into primary health care for early detection, treatment, and prevention of visual impairment caused by UREs.

Knowledge and Awareness of Diabetes and Diabetic Retinopathy among Patients Seeking Eye Care Services in Madang Province, Papua New Guinea.

Purpose: To assess the knowledge and awareness of diabetes and diabetic retinopathy among ophthalmic patients in Madang. Materials and Methods: This was a hospital-based study conducted at Madang Provincial Hospital Eye Clinic in Papua New Guinea. The study included all patients who visited the facility during the period of the study. A structured questionnaire was used to collect data on the patients' demographics and their knowledge and awareness about diabetes and diabetic retinopathy. Results: A total of 203 (97.6%) patients consented and participated in the study out of 208 patients who were approached. The age of participants ranged from 19 to 78 years with a median (IQR) of 41 (53-29) years. 107 (52.7%) were female participants. A majority of the participants (62.6%) had at least secondary education. A few of the participants (3.9%) had known diabetes, and 134 (66%) had no relatives or friends with diabetes. A total of 145 (71.4%) participants knew that diabetes can affect the eye. Most of the participants (93.6%) checked their eyes only when their vision was affected, 161 (79.3%) agreed that regular eye checks are necessary, and more than half (54.2%) knew that diabetes can lead to blindness. Age, gender, level of education, and whether a participant or participant's friends and relatives had been diagnosed with diabetes were significantly associated with the knowledge and awareness of participants about diabetes and diabetic retinopathy. Conclusion: A majority of the participants had good knowledge of diabetes and diabetic retinopathy. Health education and promotion will also help increase the awareness of diabetes and diabetic retinopathy in the country.