Prevalence of Visual Impairment and Coverage of Cataract Surgical Services: Associations with Sex, Disability, and Economic Status in Five Diverse Sites.

PURPOSE: Prevalence of visual impairment (VI) and access to services can vary significantly across and between different population groups. With renewed focus on universal health coverage and leaving no one behind, it is important to understand factors driving inequitable eye health. This paper presents results from five population-based surveys where prevalence of VI and cataract surgical coverage (CSC) were measured and examined for differences by sex, economic-status, and disability. METHODS: Rapid assessments of avoidable blindness took place in four rural sites: Kalahandi, Jhabua and Sitapur in India; and Singida, Tanzania; and one urban site: Lahore, Pakistan. In addition, the Equity Tool was used to measure economic status and the Washington Group Short Set was used to measure disability. Prevalence of VI and CSC were calculated and associations with sex, disability, and relative wealth examined. RESULTS: Prevalence of VI varied from 1.9% in Lahore to 15.0% in Kalahandi. CSC varied from 39.1% in Singida to 84.0% in Lahore. Additional disability was associated with greater levels of VI in all sites and lower CSC in Singida. Being female was associated with higher VI in Kalahandi, Lahore and Singida and lower CSC in Lahore and Singida. Being poorer was associated with higher VI in Singida and lower CSC in Singida and Sitapur. CONCLUSION: Relationships between VI and relative wealth, sex, and disability are complex and variable. Although certain characteristics may be associated with lower coverage or worse outcomes, they cannot be generalized and local data are vital to tailor services to achieve good coverage.

Results From the First Teleglaucoma Pilot Project in Addis Ababa, Ethiopia.

PRECIS: A teleglaucoma case-finding model was utilized in Ethiopia using a high-risk case identification approach. An overall 7.9% of patients had definite glaucoma, and 13.8% were glaucoma suspects. Most cases could be managed medically. BACKGROUND: This study was carried out to analyze disease prevalence and clinical referral pathways for high-risk patients assessed through a hospital-based teleglaucoma case-finding program. METHODS: Patients over the age of 35 years were referred from outpatient diabetic and hypertensive clinics. Through a teleglaucoma consultation, a glaucoma specialist provided remote diagnosis and management recommendations. Patient referral pathways were analyzed. Part way through the program, frontline ophthalmic nurses and optometrists were empowered to refer patients to be seen by general ophthalmologists within a week if patients met high-risk criteria. Qualitative stakeholder feedback was also obtained. RESULTS: A total of 1002 patients (53% female) were assessed with a mean age of 51.0±11.7 years. The prevalence of glaucoma and glaucoma suspects was 7.9% (79 cases) and 13.8% (138 cases), respectively. Retinopathy was found in 9.1%, with hypertensive retinopathy (2.7%) and diabetic retinopathy (2.5%) representing the majority of cases. Age-related macular degeneration was present in 1.5% and cataract in 16%. An overall 63% of cases were without organic eye disease. 35% of patients were referred to a general ophthalmologist, 0.7% to a glaucoma specialist (for surgery), 1.5% to a retina specialist, and 17.7% to an optometrist for further care. Qualitative analysis revealed that stakeholders felt the value of teleglaucoma would be in triaging patients requiring more urgent management and in identifying disease at an earlier stage. CONCLUSIONS: There is a high prevalence of glaucoma in Ethiopian patients assessed through this teleglaucoma program. This model and study have also demonstrated various principles behind telemedicine, such as the development of an intelligent triage system, case-finding for a variety of diseases, and consideration of optimal patient flow/referral pathways.

Prevalence of Cataract Blindness in Rural Ethiopia

Background: Over three-quarter of all blindness worldwide are preventable and usually caused by cataract and trachoma. Objective: To assess the prevalence of cataract blindness in rural Ethiopia in order to facilitate further health care planning. Methods: A Cross-sectional; community-based study of inhabitants over 40 years of age from villages in the Abeshge and Kebena Districts; south of Addis Ababa. A total of 1100 eligible participants were identified in the study. Visual acuity (VA) was measured using a Snellen's E chart at 6 metres and eye examinations were performed using torch light; 2.5 X magnifying glasses and an ophthalmoscope. Cataract was defined as lens opacity identified as the cause of blindness and low vision after ruling out other causes. Unfortunately; there was no access to a refraction set and slit lamp to conduct thorough examinations. Results: The adjusted prevalence of bilateral cataract blindness (VA3/60) was 2.4; 95confidence interval [CI]; 1.8-3.0. Cataract is the major cause of bilateral blindness (66.7) among the participants. The cataract surgical coverage was 28.9for men and 18.1for women. The adjusted prevalence of bilateral cataract and VA6/60 was 3.6(95CI; 1.4-5.8). In this last group; the surgical coverage was 41.2(persons) and 38.5(eyes). Of all operated eyes; 30could not see at 6/60. Inability to afford the procedure (64.5) and poor knowledge of cataract (29.8) were the reasons why surgery had not been performed. Conclusions: Cataract blindness is a major health problem in the study area with low surgical uptake. There is backlog of cataract blindness in the study area that will increase with ageing. This backlog was also reflected in other developing countries. Awareness campaigns; reducing cost; and expansion of surgical services may help to increase the cataract surgical rate; and women should be offered more cataract surgery. These results will enable health managers to plan effective interventions in line with Vision 2020

Gender differences in adult blindness and low vision, Central Ethiopia.

BACKGROUND: Blindness is a major global public health concern. Approximately 50 million people are blind, three times that number is visually impaired; 90% of whom live in poor countries. Women account for 65% of blind people in the world. OBJECTIVE: To assess gender differences in prevalence rates and causes of low vision and blindness. DESIGN: Population-based cross-sectional survey. PARTICIPANTS: Gurage Zone; Ethiopian adults 40 years old and above. (n = 1100). METHODS: Equal number of women and men 40 years-old and above in the Gurage Zone, Ethiopia, were selected using a multistage sampling method. MAIN OUTCOME MEASURES: Bilateral low vision was defined as presenting Visual Acuity (VA) worse than 6/18 and better than 3/60, and bilateral blindness as presenting VA worse than 3/60 in the better eye. RESULTS: The prevalence rates were 10.9% for bilateral low vision and 3.5% for bilateral blindness. Women comprised 59.0% of blindness, and 70.0% of low vision. The difference in gender distribution and low vision was statistically significant in all age groups. Women had 1.46 excess risk of bilateral blindness. The rates of bilateral low vision and blindness increased with age. Cataract is a leading cause of bilateral low vision (66.7%) and blindness (59.0%). Glaucoma is the second cause of blindness. Uncorrected refractive errors are the second cause of low vision (23.3%). Trachoma is the third cause of low vision and blindness. CONCLUSION: The age- and gender-adjusted rates of low vision and blindness is very high in general and in women in particular. Cataract is a leading cause of blindness and low vision in Ethiopian adults. It is recommended that gender sensitive prevention and intervention program of avoidable blindness needs to be an ongoing focus in the study area.