The Economics of Sight and Vision Loss

No Abstract - Faculty Lectur

Grand Challenges in global eye health: a global prioritisation process using Delphi method

Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings: Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation: This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding: The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations: For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section

Grand Challenges in global eye health: a global prioritisation process using Delphi method

Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings: Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation: This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding: The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations: For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section

Uniocular blindness among children in the Gambia

Background: Uniocular blindness in children though not uncommon has not been given prominence, as emphasis is placed on binocular blindness. Aim: To determine the common causes of uniocular blindness in children, and to suggest strategies for prevention. Methods: A prospective study involving children seen at the Eye Clinic of the Royal Victoria Hospital, The Gambia was undertaken; from the 1st December 1999 to 30th June 2000. All newly diagnosed cases of children who attended the clinic and were blind in one eye during the period of the study were included. A history was taken, visual acuity using age specific methods and ocular examinations were carried out. When necessary an examination under anaesthesia was performed. Results: Out of 470 children, 45(10%) had uniocular blindness, 39(86%) were aged 6-15years. The male - female ratio was 4:1. Common causes were trauma 28(62%), uveitis 4(9%), and corneal ulcer 3(7%) . Others included congenital cataract, glaucoma and retinoblastoma. Conclusion: The commonest cause of uniocular blindness was ocular trauma. Focus should be directed towards the prevention, early referral and appropriate treatment of ocular trauma in children. Strategies for the prevention of childhood blindness would also be applicable to uniocular blindness in The Gambia. Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 167-17

A Critical Analysis Of The Management Of Acute Postcataract Surgery Endophthalmitis In The Gambia

Objectives: To report the pattern of presentation and the outcome of management of postcataract surgery endophthalmitis at the Royal Victoria Hospital (RVH), Banjul, The Gambia, and to critically analyse the methods employed. Methods: The records of four consecutive cases of acute endophthalmitis following cataract surgery, seen over a one-year period (October 2000 to September 2001) at the eye unit of RVH, Banjul, were analysed. Results: Early diagnosis of endophthalmitis, based on clinical signs only, was made within the first 14 post-operative days in all 4 patients (3 females and l male aged between 50 and 60 years.) Prompt treatment with a variety of broad spectrum systemic, topical and subconjunctival antibiotics was administered to each patient. Despite this treatment, vision was eventually lost in all the eyes. Conclusion: Because of the poor outcome of the treatment of these patients, one may conclude that the current management of acute postcataract surgery endophthalmitis in the Gambia does not seem to be effective. A new evidence-based management protocol is proposed using the results of the Endophthalmitis Vitrectomy Study (EVS) as a guide. Nigerian Jnl Ophthalmology Vol.11(2) 2003: 80-8

Prevalence and causes of blindness in the South Australian population aged 50 and over

Purpose to conduct a population based study examining the prevalence and causes of blindness and visual impairment in the South Australian population aged 50 and over. METHODS A random stratified cluster sample of 2115 persons was recruited from geographically exhaustive local government areas within South Australia. All participants underwent distance visual acuity measurements. In those participants with corrected visual acuity < 6/18 in the better eye a cause was determined. RESULTS Cataract and macular degeneration were the most common causes of monocular and binocular blindness. The prevalence of monocular and binocular blindness in South Australia in the population aged 50 and over is calculated to be approximately 3.7% and 1.3%, respectively. These rates increase significantly in the elderly (70 years of age and over) subgroups. CONCLUSIONS Degenerative conditions are the principal causes of visual impairment in South Australia. The number of visually impaired persons in South Australia is likely to increase over the coming decades. Accurate data are essential in order to optimise the use of limited resources.H. S. Newland, J. E. Hiller, R. J. Casson, S. Obermede

Genetic studies of African populations: an overview on disease susceptibility and response to vaccines and therapeutics.

Africa is the ultimate source of modern humans and as such harbors more genetic variation than any other continent. For this reason, studies of the patterns of genetic variation in African populations are crucial to understanding how genes affect phenotypic variation, including disease predisposition. In addition, the patterns of extant genetic variation in Africa are important for understanding how genetic variation affects infectious diseases that are a major problem in Africa, such as malaria, tuberculosis, schistosomiasis, and HIV/AIDS. Therefore, elucidating the role that genetic susceptibility to infectious diseases plays is critical to improving the health of people in Africa. It is also of note that recent and ongoing social and cultural changes in sub-Saharan Africa have increased the prevalence of non-communicable diseases that will also require genetic analyses to improve disease prevention and treatment. In this review we give special attention to many of the past and ongoing studies, emphasizing those in Sub-Saharan Africans that address the role of genetic variation in human disease