The role of cadre in the community on diabetic retinopathy management and its challenges in low-middle income countries: a scoping review.

INTRODUCTION: Diabetes is a serious public health problem, with low- and middle-income countries (LMICs) bearing over 80% of the burden. Diabetic retinopathy (DR) is one of the most prevalent diabetic microvascular problems, and early diagnosis through eye screening programs for people with diabetes is critical to prevent vision impairment and blindness. Community-based treatments, including non-physician cadres have been recommended to enhance DR care. METHODS: The review protocol was determined and scoping review was conducted.The population, concept, and context were "cadre", "role of cadre in the management of DR", and LMICs". Data were collected from databases and searches, including grey literature. RESULTS: Cadre can motivate people to attend a diabetic eye screening event when the rate of eye examinations is about six times higher than before the start of the intervention. Health education is a possible area for task sharing, and the cadre reported could also perform the task of vision testing. The cadre could be a good supporter and a good reminder for society. However, several challenges have been faced in this study and inadequate infrastructure is the foremost challenge found in this study. Other challenges encountered in the studies include poverty, lack of community awareness, trust issues, and low education levels contributing to poor health. CONCLUSION: The current study highlighted significant gaps in the literature, which focus on the role of cadre as a community-based intervention in managing DR in LMICs. Further research is needed to develop evidence to support cost-effective screening services and cadre-related policy development in LMICs.

Accuracy of artificial intelligence model for infectious keratitis classification: a systematic review and meta-analysis.

Background: Infectious keratitis (IK) is a sight-threatening condition requiring immediate definite treatment. The need for prompt treatment heavily depends on timely diagnosis. The diagnosis of IK, however, is challenged by the drawbacks of the current "gold standard." The poorly differentiated clinical features, the possibility of low microbial culture yield, and the duration for culture are the culprits of delayed IK treatment. Deep learning (DL) is a recent artificial intelligence (AI) advancement that has been demonstrated to be highly promising in making automated diagnosis in IK with high accuracy. However, its exact accuracy is not yet elucidated. This article is the first systematic review and meta-analysis that aims to assess the accuracy of available DL models to correctly classify IK based on etiology compared to the current gold standards. Methods: A systematic search was carried out in PubMed, Google Scholars, Proquest, ScienceDirect, Cochrane and Scopus. The used keywords are: "Keratitis," "Corneal ulcer," "Corneal diseases," "Corneal lesions," "Artificial intelligence," "Deep learning," and "Machine learning." Studies including slit lamp photography of the cornea and validity study on DL performance were considered. The primary outcomes reviewed were the accuracy and classification capability of the AI machine learning/DL algorithm. We analyzed the extracted data with the MetaXL 5.2 Software. Results: A total of eleven articles from 2002 to 2022 were included with a total dataset of 34,070 images. All studies used convolutional neural networks (CNNs), with ResNet and DenseNet models being the most used models across studies. Most AI models outperform the human counterparts with a pooled area under the curve (AUC) of 0.851 and accuracy of 96.6% in differentiating IK vs. non-IK and pooled AUC 0.895 and accuracy of 64.38% for classifying bacterial keratitis (BK) vs. fungal keratitis (FK). Conclusion: This study demonstrated that DL algorithms have high potential in diagnosing and classifying IK with accuracy that, if not better, is comparable to trained corneal experts. However, various factors, such as the unique architecture of DL model, the problem with overfitting, image quality of the datasets, and the complex nature of IK itself, still hamper the universal applicability of DL in daily clinical practice.

Vision-related quality of life among released from treatment cases of leprosy evaluated with NEI-VFQ-25: a cross-sectional study.

BACKGROUND: People with leprosy who have been declared Release From Treatment (RFT) are often not aware of the leprosy sequelae possibility which can decrease their quality of life. This could be because they have been adapting for a long time hence they do not feel the need to see physicians. This study seeks to compare the results of Vision-Related Quality of Life (VR-QoL) among RFT persons based on the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and WHO grading disability based on physical examination. METHODS: A cross-sectional study of 325 RFT subjects from leprosy communities (Singkawang, West Kalimantan and Tangerang, Banten) was conducted between 2018 and 2019. We used the NEI-VFQ-25 questionnaire that had been validated and translated into Indonesian and distributed to the leprosy population. Relationships and comparisons among variables were evaluated using Kruskal-Wallis and Mann-Whitney tests. RESULTS: There were three main results: The median composite score of VR-QoL for WHO grade 0, 1, and 2 disabilities has decreased by 13%, 25.5%, and 30% of the maximum value, respectively. Of the total, eleven subscales were statistically significant between WHO grading disability and VR-QoL based on the NEI-VFQ-25 (p < 0.05). The comparison between grade 0 and grade 2 disability in all subscales was statistically significant (p < 0.05). CONCLUSIONS: The grade of disability is related to their VR-QoL assessment using the NEI-VFQ-25 questionnaire. Thus, it can be used as an initial screening in primary healthcare settings to increase awareness of disability before a thorough physical examination.

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.

Knowledge, attitude, and practice pattern towards diabetic retinopathy screening among general practitioners in primary health centres in Jakarta, the capital of Indonesia.

BACKGROUND: Diabetic retinopathy (DR) is an emerging cause of visual impairment and blindness and is often detected in the irreversible stage. General practitioners (GPs) play an essential role in the prevention of DR through diabetes control, early detection of retinal changes, and timely referral to ophthalmologists. This study aimed to determine the knowledge, attitude, and practice (KAP) towards DR screening among GPs in the district primary health centres (PHCs) in Jakarta, Indonesia. METHODS: A cross-sectional study was conducted between April 2021 and February 2022 in 17 randomly selected district PHCs. A validated online questionnaire was then distributed. Good knowledge was defined when the correct response rate was > 75%, positive attitude was indicated when desired attitudes were found in more than half of the items (> 50%), and good practice was defined when more than half of the practice items (> 50%) were performed. RESULTS: A total of 92 GPs, with a response rate of 60.1%, completed the questionnaire. Seventy-nine respondents (85.9%) were female with a median (range) age of 32 (24-58) years. Among the respondents, 82 (89.1%) had good knowledge and all showed positive attitude on DR screening. However, only four (4.3%) demonstrated good practices. We found a weak positive correlation (rs = 0.298, p = 0.004) between attitude and practices. CONCLUSION: GPs in Jakarta showed good knowledge and positive attitude on DR screening. However, they did not show good practice. There was a positive correlation between attitude and practice.

Blindness and Visual Impairment Situation in Indonesia Based on Rapid Assessment of Avoidable Blindness Surveys in 15 Provinces.

Purpose: To report the latest data on blindness and visual impairment (VI) in Indonesia.Methods: Rapid Assessment of Avoidable Blindness (RAAB) surveys were done in 15 provinces in Indonesia between 2013 and 2017. The population of the study was people aged 50 +. In each province, the required number of clusters was selected with a probability proportionately to size. A weighted average analysis for prevalence, causes of visual impairment, and cataract surgical coverage (CSC) estimated the values of the country.Results: The prevalence of blindness in East Java was the highest at 4.4% (95% CI: 3.1-5.6%), followed by Nusa Tenggara Barat (NTB) at 4.0% (95% CI: 3.0-5.1%) and South Sumatra at 3.4% (95% CI: 2.4-4.4%). In number, blindness among people aged 50+ in East Java was the highest at 371,599, followed by West Java at 180,666 and Central Java at 176,977. Untreated cataract was the commonest cause of blindness in all provinces (range: 71.7% to 95.5%). CSCperson<3/60 and CSCperson<6/60 in Bali were the highest at 81.3% and 72.4%, respectively. Indonesia countrywide prevalence of blindness was 3.0%. The total number of people with VI (PVA less than 6/18 in the better eye) in Indonesia was 8,019,427, consisting of 1,654,595 of blindness and 6,364,832 of moderate and severe VI.Conclusion: The burden of blindness in Indonesia is high, and untreated cataract contributes the most. There is an urgent need to increase cataract surgical coverage by providing better access to cataract surgery services for all people in need.

The estimated healthcare cost of diabetic retinopathy in Indonesia and its projection for 2025.

PURPOSE: To estimate the total healthcare cost associated with diabetic retinopathy (DR) in type 2 diabetes in Indonesia and its projection for 2025. METHODS: A prevalence-based cost-of-illness model was constructed from previous population-based DR study. Projection for 2025 was derived from estimated diabetes population in 2025. Direct treatment costs of DR were estimated from the perspective of healthcare. Patient perspective costs were obtained from thorough interview including only transportation cost and lost of working days related to treatment. We developed four cost-of-illness models according to DR severity level, DR without necessary treatment, needing laser treatment, laser +intravitreal (IVT) injection and laser + IVT +vitrectomy. All costs were estimated in 2017 US$. RESULTS: The healthcare costs of DR in Indonesia were estimated to be $2.4 billion in 2017 and $8.9 billion in 2025. The total cost in 2017 consisted of the cost for no DR and mild-moderate non-proliferative DR (NPDR) requiring eye screening ($25.9 million), severe NPDR or proliferative DR (PDR) requiring laser treatment ($0.25 billion), severe NPDR or PDR requiring both laser and IVT injection ($1.75 billion) and advance level of PDR requiring vitrectomy ($0.44 billion). CONCLUSIONS: The estimated healthcare cost of DR in Indonesia in 2017 was considerably high, nearly 2% of the 2017 national state budget, and projected to increase significantly to more than threefold in 2025. The highest cost may incur for DR requiring both laser and IVT injection. Therefore, public health intervention to delay or prevent severe DR may substantially reduce the healthcare cost of DR in Indonesia.

Ocular diseases among HIV/AIDS patients in Jakarta, Indonesia.

We conducted a survey of ocular diseases among HIV/AIDS outpatients in Jakarta, Indonesia. This cross sectional study was conducted among 311 HIV/ AIDS patients presenting to three referral hospitals in Jakarta, Indonesia from September 2008 to May 2009. All subjects underwent ophthalmological examination, including visual acuity, intraocular pressure, eye movement, Schirmer's test and anterior and posterior segment evaluation. Most subjects (86%) were aged 20-40 years; and 77% were male. Intravenous drug use was the most common risk factor (48.9%) for HIV infection. At the time of enrollment, 85% of subjects were receiving anti-retroviral therapy (ART); the median CD4+ T cell count prior to ART was 56 (0-757) cells/microl. The most common ocular manifestations were dry eye syndrome (54%), followed by toxoplasma retinochoroiditis (8.4%) and cytomegalovirus (CMV) retinitis (5.8%). Risk factors associated with ocular diseases were late HIV clinical stage (OR = 4.35 for clinical stage 4 vs 1; p = 0.001), co-infection (OR = 2.67 for 2 co-infections vs no co-infection; p = 0.009) and low CD4+ T cell count prior to ART (< 50 cells/microl vs > or = 200 cells/microl; p = 0.003). The CD4+ count at the first visit (p = 0.041) and clinical stage (p = 0.049) were associated with dry eyes. This study shows dry eyes were the most prevalent ocular disease among HIV/ AIDS patients in Jakarta. HIV clinical stage 3 or 4, co-infection with tuberculosis and hepatitis C infection and a CD4+ T cell count of <50 cells/microl were risk factors for ocular disease in HIV/AIDS patients.