Strategies to address inequity of uncorrected refractive error in the Western Pacific: A modified Delphi process.

PURPOSE: Uncorrected refractive error is the leading cause of vision impairment globally; however, little attention has been given to equity and access to services. This study aimed to identify and prioritise: (1) strategies to address inequity of access to refractive error services and (2) population groups to target with these strategies in five sub-regions within the Western Pacific. METHODS: We invited eye care professionals to complete a two-round online prioritisation process. In round 1, panellists nominated population groups least able to access refractive error services, and strategies to improve access. Responses were summarised and presented in round 2, where panellists ranked the groups (by extent of difficulty and size) and strategies (in terms of reach, acceptability, sustainability, feasibility and equity). Groups and strategies were scored according to their rank within each sub-region. RESULTS: Seventy five people from 17 countries completed both rounds (55% women). Regional differences were evident. Indigenous peoples were a priority group for improving access in Australasia and Southeast Asia, while East Asia identified refugees and Oceania identified rural/remote people. Across the five sub-regions, reducing out-of-pocket costs was a commonly prioritised strategy for refraction and spectacles. Australasia prioritised improving cultural safety, East Asia prioritised strengthening school eye health programmes and Oceania and Southeast Asia prioritised outreach to rural areas. CONCLUSION: These results provide policy-makers, researchers and funders with a starting point for context-specific actions to improve access to refractive error services, particularly among underserved population groups who may be left behind in existing private sector-dominated models of care

The prevalence of diabetes among adults aged 40 years and over in Fiji

Aim To estimate the prevalence of diabetes among adults aged ≥40 years in Fiji, and determine the demographic characteristics associated with this diagnosis. Method During a population-based survey, participant glycosylated haemoglobin (HbA1c) was determined and physician diagnosis of diabetes self-reported. HbA1c ≥6.5% or claimed previous diagnosis, independent of HbA1c, defined presence of diabetes. Results were extrapolated to the whole population. Predictors of risk for diabetes were investigated using logistic regression models. Results Of those enumerated, 1381 participated (73.0%). For 1353 with either a history of diabetes or valid HbA1c, prevalence of diabetes was 44.8% (95%CI 42.2– 47.5). Adjusting for age and domicile, Indians had significantly higher risk of diabetes than Melanesians among males (OR 2.02, 95%CI 1.37–2.97, p<0.001) and females (OR 1.99, 95%CI 1.44–2.73, p<0.001). Females were at greater risk than males among Melanesians (OR 1.75, 95%CI 1.30–2.36, p<0.001) and Indians (OR 1.94, 95%CI 1.33–2.84, p<0.001). Risk increased with age for both genders and ethnicities, adjusting for ethnicity and domicile, then gender and domicile. The ethnicity-gender-age- domicile adjusted prevalence of diabetes among adults aged ≥40 years in Fiji was 41.0% (95%CI 38.4–43.6): 99,000 people. Conclusion As identified in 1970, diabetes continues to be a substantial population health problem in Fiji

Congenital orbital teratoma

We present a case of mature congenital orbital teratoma managed with lid-sparing exenteration and dermis fat graft. This is a case report on the management of congenital orbital teratoma. A full-term baby was born in Fiji with prolapsed right globe which was surrounded by a nonpulsatile, cystic mass. Clinical and imaging features were consistent with congenital orbital teratoma. Due to limited surgical expertise, the patient was transferred to Adelaide, Australia for further management. The patient underwent a lid-sparing exenteration with frozen section control of the apical margin. A dermis fat graft from the groin was placed beneath the lid skin to provide volume. Histopathology revealed mature tissues from each of the three germ cell layers which confirmed the diagnosis of mature teratoma. We describe the successful use of demis fat graft in socket reconstruction following lid-sparing exenteration for congenital orbital teratoma.Shereen Aiyub, Weng Onn Chan, John Szetu, Laurence J Sullivan, John Pater, Peter Cooper and Dinesh Selv

The association of diabetes and body mass index among Melanesian and Indian Fijians aged ≥40 years

The present study examines the association of diabetes with BMI (kg/m ) in Asian-Indian and Melanesian Fijian populations sharing a common environment. A population-based survey was used to investigate the risk of diabetes (defined by glycosylated Hb concentration 65% among participants who denied previous diagnosis of the disease by a medical practitioner) by sex, ethnicity and strata of BMI in a series of age-adjusted logistic regression models. Ethnicity and BMI interactions were compared using WHO and empirically derived BMI cut-off points. Indians had a greater risk (BMI and age adjusted) of undetected diabetes than Melanesians in both males (OR 299, 95% CI 173, 517;

Profile of ocular trauma in the Solomon Islands

Background The objective of this study was to characterize the causes of ocular trauma and determine the risk factors for infection and vision loss following ocular trauma in the Solomon Islands. Design A prospective clinic-based study. Participants A total of 507 patients with ocular trauma who were reviewed at the National Referral Hospital in Honiara or one of five provincial eye clinics were included. Methods An interview-based questionnaire to determine the circumstances of ocular trauma, and an ocular examination to elicit the trauma sustained, infectious sequelae and the visual outcome. Main Outcome Measure Visual acuity. Results Males were significantly more likely to have ocular trauma than females ( P = 0.01). The major cause of ocular trauma in young boys and girls was being poked by a stick, followed by lime burns in young boys. For both genders, physical violence resulted in most injuries across all adult age groups. Microbial keratitis complicated 4.4% of ocular trauma. Monocular vision impairment (&lt;6/18) occurred in 5.5% of participants and was more likely to occur if female ( P = 0.02). Conclusions Ocular trauma is a significant cause of visual morbidity in the Solomon Islands. The results from this prospective study provide a basis for planning blindness prevention programmes in the Western Pacific

Strategies to address inequity of uncorrected refractive error in the Western Pacific: A modified Delphi process

PurposeUncorrected refractive error is the leading cause of vision impairment globally; however, little attention has been given to equity and access to services. This study aimed to identify and prioritise: (1) strategies to address inequity of access to refractive error services and (2) population groups to target with these strategies in five sub-regions within the Western Pacific.MethodsWe invited eye care professionals to complete a two-round online prioritisation process. In round 1, panellists nominated population groups least able to access refractive error services, and strategies to improve access. Responses were summarised and presented in round 2, where panellists ranked the groups (by extent of difficulty and size) and strategies (in terms of reach, acceptability, sustainability, feasibility and equity). Groups and strategies were scored according to their rank within each sub-region.ResultsSeventy five people from 17 countries completed both rounds (55% women). Regional differences were evident. Indigenous peoples were a priority group for improving access in Australasia and Southeast Asia, while East Asia identified refugees and Oceania identified rural/remote people. Across the five sub-regions, reducing out-of-pocket costs was a commonly prioritised strategy for refraction and spectacles. Australasia prioritised improving cultural safety, East Asia prioritised strengthening school eye health programmes and Oceania and Southeast Asia prioritised outreach to rural areas.ConclusionThese results provide policy-makers, researchers and funders with a starting point for context-specific actions to improve access to refractive error services, particularly among underserved population groups who may be left behind in existing private sector-dominated models of care