Evaluating eye health care services progress towards VISION 2020 goals in Gurage Zone, Ethiopia.

BACKGROUND: Ethiopia signed the VISION 2020 Global Declaration and launched its eye health program in 2002. Since then, there has been limited systematic and comprehensive evaluation of the progress towards VISION 2020 goals in Ethiopia. OBJECTIVE: To evaluate Gurage Zone progress towards VISION 2020 targets and process indicators. METHOD: An institutional-based cross-sectional study was conducted among all public and private eye health care facilities in the Gurage Zone within the Southern Nations, Nationalities, and People Region of Ethiopia. The evaluation protocol was adopted from the VISION 2020 situational analysis data collection tool. We used this structure to evaluate progress in terms of human resources for eye health, infrastructure, and service delivery at the zonal health office and health facilities. At the time of the study, Gurage Zone had a 1.7 million catchment area population. There were a total of five eye care centers, one of which was established by a non-governmental organization. Three of these facilities were secondary eye care centers with an operating theatre and two facilities were primary eye care centers. At the zonal level, there was no survey data available on the prevalence of blindness. RESULT: There was no systemic evaluation of VISION 2020 process indicators. The budget allocation specific to eye health care was less than 0.7% of the total budget of the zonal health office. The human resources for eye health (HReH) in the catchment area were: one ophthalmologist, two cataract surgeons, five optometrists, and 12 ophthalmic nurses, which is below the VISION 2020 targets for HReH. In terms of equipment, neither primary eye care center had a slit lamp biomicroscope, and two of the three secondary eye care centers did not have intraocular pressure measuring equipment. Only one secondary eye care center was providing glaucoma surgical services, and no center provided emergency and elective pediatric surgery. The cataract surgical rate determined by the study was 1967. CONCLUSION: Gurage Zone showed significant improvement in terms of cataract surgical rate. But it had not achieved VISION 2020 goals in terms of critical HReH and service delivery. We recommend that the zonal health office carries out a focused and baseline evaluation of eye health care service achievements.

Efficacy and Safety of Selective Laser Trabeculoplasty among Ethiopian Glaucoma Patients.

BACKGROUND: Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering intraocular pressure (IOP). PURPOSE: To determine the efficacy and safety of SLT among Ethiopian patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), and ocular hypertension (OHT). METHOD: A prospective, nonrandomized interventional study was conducted at Menelik II Hospital, Ethiopia. Patients on antiglaucoma medication with uncontrolled IOP and those patients treated for the first time with 360 degrees of SLT were included. Success was defined as an IOP lowering of > 20% from baseline without repeat treatment. RESULT: A total of 95 eyes of 61 patients with a diagnosis of OAG and OHT were enrolled. The diagnosis was POAG in 55 (57.9%) eyes, PXG in 22 (23.2%) eyes, and OHT in 18 (18.9%) eyes. Seventy (73.7%) eyes were on medications, and 25 (26.3%) eyes were treated with laser as primary therapy. The mean (SD) baseline IOP and medication were 24.3 ± 2.5 mmHg and 1.29 ± 1.01, respectively. The one-year mean (SD) IOP reduction was 6.7 ± 4.2 mmHg and medication reduction was 0.26 ± 1.34. The overall IOP reduction at 12 months was 27.6%, and the success rate was 60%. The mean IOP (SD) reduction for patients who were treated for the first time with laser and on antiglaucoma medication was 6.5 ± 3.1 mmHg and 6.8 ± 2.8 mmHg, respectively. Post-SLT, patients experienced transient ocular pain, brow ache, headache, and/or blurring of vision in 31.6%, anterior chamber reaction in 36.8%, and IOP spike ≥ 6 mmHg in 11.6%. CONCLUSION: SLT is an effective and safe treatment modality for OHT, POAG, and PXG among Ethiopian patients either as a first-line treatment or as an adjunct to topical glaucoma treatment.