Development of an assessment instrument to measure disability related distress in primary school learners with vision impairment due to uncorrected refractive error in rural areas of KwaZulu-Natal Province, South Africa.

Doctoral Degree. University of KwaZulu-Natal, Durban.With the increasing global emphasis on improving eye health in children, numerous efforts are being implemented to meet the eye care needs of the children. There is no instrument which can be used to measure the impact of the Disability Related Distress (DRD) on children with vision impairment (VI) due to uncorrected refractive error (URE). Aim The aim of the study was to develop an assessment instrument to measure DRD in Grade 1 to Grade 5 learners with VI due to URE in a rural and semi-rural setting. Methods This mixed-method study was conducted in 4 primary schools in Pinetown, KwaZulu Natal, Durban in 3 phases. Phase 1 involved twelve focus group discussions using semi-structured interviews to identify themes that formed the DRD items in the Instrument. A topic was qualified as an item if at least two participants made substantive comments on the topic in a single focus group and the topic was discussed by at least one child in two different groups. In Phase 2, we consulted ten experts to construct an instrument for pre-testing by considering relevance, relative importance, upsetting issues and wording of the items. Issues that had a mean score < 2 for relevance or importance were excluded. In Phase 3, we pre-tested the instrument to identify missing or redundant issues. An item was included in the final instrument if the mean score of relevance was > 1.5; prevalence ratio >30% or prevalence of scores 3 or 4 >50%; range of rate of occurrence was > 2 points; no significant concerns expressed by Primary Subjects, Secondary Subjects and Tertiary Subjects, and compliance of less than 5% of the responses to the item in the debriefing session suggested that the issues were not related to VI due to URE. Results In Phase 1, thirteen children with normal vision and 63 children with VI due to URE consented to participate in the focus group discussions. Eleven themes were generated from the focus group discussions and included as items in the draft provisional list. In Phase 2, one item was excluded and the experts pointed out the need to give explanations to the children. The items included were from the domains of Loss of Self Confidence (n=3), Loss of self-worth (n=3), Loss of interconnection/ interaction with community (n=2), Suspicion, humiliation and fight (n=1) and Discrimination (n=2). In Phase 3, pre-testing was conducted on 120 children (Normal vision, NV: Mild vision impairment, MVI: Severe vision impairment, SVI: 60:30:30). The rate of occurrence of the items showed an increasing trend, from NV to MVI and SVI. The average time needed for completing the questionnaire showed an increasing trend, from NV to MVI and SVI. All eleven items in the provisional list fulfilled the retention parameters. Conclusion The developed instrument is valid, appropriate and culturally sensitive to the rural population. Its administration is resource-friendly and efficient with straightforward analysis and interpretation of data. This makes it easy to communicate the finding to a wide range of stakeholders and decision makers

Improving the practice of cataract surgical outcome measurement

A successful cataract outcome monitoring and continuous quality improvement system will assist practitioners and centres to identify and implement ongoing improvements in eye care delivery

Assessment of cataract surgical outcomes in settings where follow-up is poor: PRECOG, a multicentre observational study

Background Poor follow-up after cataract surgery in developing countries makes assessment of operative quality uncertain. We aimed to assess two strategies to measure visual outcome: recording the visual acuity of all patients 3 or fewer days postoperatively (early postoperative assessment), and recording that of only those patients who returned for the fi nal follow-up examination after 40 or more days without additional prompting. Methods Each of 40 centres in ten countries in Asia, Africa, and Latin America recruited 40–120 consecutive surgical cataract patients. Operative-eye best-corrected visual acuity and uncorrected visual acuity were recorded before surgery, 3 or fewer days postoperatively, and 40 or more days postoperatively. Clinics logged whether each patient had returned for the fi nal follow-up examination without additional prompting, had to be actively encouraged to return, or had to be examined at home. Visual outcome for each centre was defi ned as the proportion of patients with uncorrected visual acuity of 6/18 or better minus the proportion with uncorrected visual acuity of 6/60 or worse, and was calculated for each participating hospital with results from the early assessment of all patients and the late assessment of only those returning unprompted, with results from the fi nal follow-up assessment for all patients used as the standard. Findings Of 3708 participants, 3441 (93%) had fi nal follow-up vision data recorded 40 or more days after surgery, 1831 of whom (51% of the 3581 total participants for whom mode of follow-up was recorded) had returned to the clinic without additional prompting. Visual outcome by hospital from early postoperative and fi nal follow-up assessment for all patients were highly correlated (Spearman’s rs=0·74, p<0·0001). Visual outcome from fi nal followup assessment for all patients and for only those who returned without additional prompting were also highly correlated (rs=0·86, p<0·0001), even for the 17 hospitals with unprompted return rates of less than 50% (rs=0·71, p=0·002). When we divided hospitals into top 25%, middle 50%, and bottom 25% by visual outcome, classifi cation based on fi nal follow-up assessment for all patients was the same as that based on early postoperative assessment for 27 (68%) of 40 centres, and the same as that based on data from patients who returned without additional prompting in 31 (84%) of 37 centres. Use of glasses to optimise vision at the time of the early and late examinations did not further improve the correlations. Interpretation Early vision assessment for all patients and follow-up assessment only for patients who return to the clinic without prompting are valid measures of operative quality in settings where follow-up is poor

Depression, anxiety, stress symptoms and their determinants among secondary students with vision impairment in rural Northwestern China during the COVID-19 pandemic

ObjectiveThe measures implemented to control the spread of Coronavirus disease 2019 (COVID-19) could affect children’s mental and vision health. Youth particularly from minority and socioeconomically disadvantaged backgrounds were more likely to be impacted by these measures. This study aimed to examine the mental health of children with vision impairment and associated factors in North-western China during the COVID-19 pandemic.MethodsA cross-sectional study was conducted among 2,036 secondary school children living in Ningxia Hui Autonomous Region. Participants completed a survey on sociodemographic and lifestyle information and answered the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21) questionnaire. Presenting visual acuity was measured by a trained enumerator. Multivariate logistic regression analysis was used to identify potential risk factors for mental health problems.ResultsResponses from 1,992 (97.8%) children were included in the analysis after excluding those with incomplete mental health outcome data. The prevalence of depression, anxiety and stress symptoms within the dataset were 28.9, 46.4, and 22.3%, respectively. The distribution of children with different stress levels differed significantly between those with and without vision impairment (p = 0.03). Multivariable logistic regression analyses revealed that depression symptoms decreased with higher parental education (OR, 0.76, 95% confidence intervals (CI):0.63–0.96), longer sleep duration (OR, 0.90, 95% CI: 0.81–0.97) and longer study time (OR, 0.82, 95% CI: 0.74–0.91), whereas they increased with higher recreational screen time (OR, 1.19, 95% CI: 1.08–1.32). Anxiety symptoms decreased with higher parental education (OR, 0.80, 95% CI: 0.66–0.96) and increased with higher recreational screen time (OR, 1.15, 95% CI: 1.04–1.27) and being a left-behind child (OR, 1.26, 95% CI: 1.04–1.54). In addition, stress symptoms decreased with longer sleep duration (OR, 0.92, 95%CI: 0.85–0.99) and increased with higher number of siblings (OR, 1.10, 95% CI: 1.01–1.19), higher recreational screen time (OR, 1.15, 95% CI: 1.04–1.28) and older age (OR,1.12, 95% CI: 1.004–1.24).ConclusionA considerable proportion of our sample experienced mental health problems during the pandemic. Healthcare planners in China should consider interventions such as reducing recreational screen time, ensuring sufficient sleep, and timely detection of mental health symptoms among socioeconomically disadvantaged groups

School eye health- going beyond refractive error.

Health, including visual health, is inextricably linked to school achievement, quality of life, and economic productivity. Introducing health education in schools is essential as knowledge and good habits acquired at an early age are likely to persist

Near vision correction and quality of life among textile workers.

Background: Uncorrected near vision impairment affects the performance of near vision tasks and activities for an estimated 410 million people worldwide. Once normal vision becomes blurred or impaired, the ordinary and simple daily routines of individuals become difficult; often resulting in frustration and irritation, which is consequently reflected in their quality of life. Aim: We investigated the change of vision-related quality of life (VRQoL) following near correction among textile factory workers in South Africa. Methods: Presbyopic subjects who were 40 years and older with no other eye conditions were provided near spectacle correction. We interviewed subjects to ascertain their VRQoL scores using the National Eye Institute Visual Function Questionnaire, pre-treatment and 6 months after the provision of near corrections. Setting: The study was conducted among the textile factory workers in KwaZulu-Natal, South Africa. Results: A total of 423 textile factory workers were followed up from seven textile factories in Durban. The overall increase in VRQoL scores of 21.9 (95% CI 16.7–27) was significant (p < 0.01). This translates to a 36.5% (95% CI 30.6–42.4) change in VRQoL. The increase was highest among participants of African origin 25.1 (95% CI 21.14–29.1), males 18.8 (95% CI 12.6–27.2), among those who had completed primary school 35.8 (95% CI 21.7–49.9) and among participants with other responsibilities (ironing and quality assurance) 21.9 (95% CI 16.7–27). Conclusion: Correcting near vision impairment improved the VRQoL scores of textile factory workers. The results showed that VRQoL scores increased significantly across levels of education and categories of responsibilit