Modelling ready-made spectacle coverage for children and adults using a large global database.

BACKGROUND/AIMS: To model the suitability of conventional ready-made spectacles (RMS) and interchangeable-lens ready-made spectacles (IRMS) with reference to prescribing guidelines among children and adults using a large, global database and to introduce a web-based application for exploring the database with user-defined eligibility criteria. METHODS: Using refractive power and interpupillary distance data for near and distance spectacles prescribed to children and adults during OneSight clinics in 27 countries, from 2 January 2016 to 19 November 2019, we modelled the expected suitability of RMS and IRMS spectacle designs, compared with custom-made spectacles, according to published prescribing guidelines. RESULTS: Records of 18 782 presbyopic adult prescriptions, 70 619 distance adult prescriptions and 40 862 paediatric prescriptions were included. Globally, 58.7%-63.9% of adults could be corrected at distance with RMS, depending on the prescribing cut-off. For presbyopic adult prescriptions, coverage was 44.1%-60.9%. Among children, 51.8% were eligible for conventional RMS. Coverage for all groups was similar to the above for IRMS. The most common reason for ineligibility for RMS in all service groups was astigmatism, responsible for 27.2% of all ineligible adult distance prescriptions using the strictest cut-off, 31.4% of children's prescriptions and 28.0% of all adults near prescriptions globally. CONCLUSION: Despite their advantages in cost and convenience, coverage delivered by RMS is limited under current prescribing guidelines, particularly for children and presbyopic adults. Interchangeable designs do little to remediate this, despite extending coverage for anisometropia. Our free application allows users to estimate RMS coverage in specific target populations.

Health system strengthening for vision care in The Gambia.

INTRODUCTION: According to global estimates, 39 million people are blind and 285 million are at risk of severe vision loss, with a significant portion of this burden in Sub-Saharan Africa. Some African nations like The Gambia are beginning to tackle vision impairment by addressing the problem through a health system lens. METHODS: A health system framework, focusing on system areas of leadership and governance, resources for vision care, and vision care access, was used to understand and analyze how The Gambia has increased access to vision care using a public-private pilot partnership. A desk review of relevant literature, key informant interviews with stakeholders, and a cross-sectional analysis of several databases were used to understand the following aspects of the pilot vision care model in The Gambia: leadership and governance, financial and human resources, and vision care access. RESULTS: The results show that a coordinated public-private pilot partnership between the government of The Gambia and the non-profit organization OneSight has led to improved leadership and governance for vision care, increased workforce and training, and sustainable financing for vision centers producing net revenue resulting in an increase in both the supply and demand for eyeglasses. The results also show that there is considerable variation in the prevalence of refractive errors and access to eyecare services across The Gambia, which can be influenced by accessibility, awareness, and affordability. CONCLUSION: Using a health system framework enables a systematic examination of vision care services. Results from The Gambia provide an example of a public-private pilot partnership that can improve vision care for all.

Scaling up the delivery of refractive error services within a district health system: the KwaZulu-Natal, South Africa experience.

BACKGROUND: In South Africa, the health service is based on a Primary Health Care (PHC) philosophy with the District Health System (DHS) as the locus of delivery. However eye care services, particularly primary eye care, refractive error and low vision, have not been prioritised accordingly. Hence the aim of the Giving Sight to KwaZulu-Natal (GSKZN) project was to integrate the delivery of eye care services into the district health system, with emphasis on addressing the need for uncorrected refractive error and low vision services.The project was implemented in the KwaZulu-Natal province, South Africa, to scale up the delivery of refractive error services utilising a four pronged approach; including advocacy, human resource development, equipment provision and research. METHODS: This paper is a description of the project and a retrospective analysis of data received through the course of the project from July 2007 to June 2011. Data were collected from training registers, equipment schedules and service delivery reports from institutions. Reports from the data base were then analysed and achievements in training and trends in service delivery were determined. RESULTS: Over a four year period (July 2007 and July 2011) 1004 persons received training in rendering eye health services appropriate to their level of deployment within the DHS. During the course of the project, these 1004 persons examined 1,064,087 patients. Furthermore, the total number of clinics offering primary eye care, refractive error and low vision services increased from 96 (10%) to 748 (76%). With increased numbers of PHC Nurses trained in primary eye care, a subsequent decrease of 51.08 percent was also observed in the number of patients seeking services at higher levels of care, thus streamlining eye health service delivery. CONCLUSION: This project has shown that scaling up can occur in delivering eye health services within a health district, through a multi-faceted approach that encompasses focused training, advocacy, development of appropriate infrastructure and the development of referral criteria with clear guidelines for the management of patients.