Effects of a community-based health education intervention on eye health literacy of adults in Vietnam

Health education interventions are more commonly evaluated in hospitals or schools but rarely in the community. The purpose of this study was to assess the effects of a community-based eye health education intervention on the eye health literacy in an adult Vietnamese population. Four hundred households from two districts of Ba Ria-Vung Tau province were selected by multistage systematic random sampling. A pretested questionnaire was administered at baseline and re-administered, after an eye health education intervention in two of the four communes. The other two communes acted as controls. The intervention included eye health education through community presentation, brochures, posters and loudspeaker. Fisher’s exact test and logistic regression were used for statistical analysis. A total of 400 adults (mean age: 51.5 ± 14.5 years; range, 30–90 years) participated in the baseline survey and the repeat survey. Participants in the intervention group showed significantly greater awareness and knowledge of red eye preventive measures (Odds ratio range 2.1 to 4.1, p = 0.03 to 0.001) compared to control group. Participants in the intervention group were more than twice as likely to have heard of cataract (OR 2.3, p = 0.008), and more than three times as likely to be aware of cataract surgery (OR 3.1, p = 0.003) and know that the cataract blindness is reversible (OR 3.3, p = 0.002), than the control group. Multiple logistic regression showed that location, education, and eyeglasses ownership were the major factors associated with disease awareness. The eye health education intervention successfully increased awareness and knowledge of red eye and cataract in the intervention community

Barriers to availing refractive error services among an urban slum population in Mumbai, India

Barriers to availing refracti ve error services among an urban slum population in Mumbai, India. Background: A refractive error project for management of refractive errors in adults was undertaken in the urban slums of Mumbai, India. The project looked at the burden of refractive errors in the predominantly lower socio economic status groups as well as what common barriers prevent access to refractive services amongst this population. This presentation highlights the barriers that were elicited for availing and accessing refractive error services among the urban slum population in Mumbai, India. AIM: The study aimed to identify the common barriers to availing & accessing refractive error services among an urban slum population in Mumbai, India. Methods : A situation analysis of the community, with respect to availability of services was done as a part of the service delivery planning. The analysis revealed that services were available but the community was not accessing the same. Based on the situation analysis report a questionnaire with all perceived barriers was developed and the same was validated. Service delivery was done by establishing vision centers within the community. Trained health workers performed a door to door vision screening, identified and referred the needy population to the vision centre. Here the questionnaire was run by trained social workers on the people visiting the centers for eye examinations, who were referred by the social workers. Results : Data analysis was carried out to know the reasons for not availing the services within the community. Of the 4070 subjects who visited the vision centre, 4039 case records were complete and analyzed. The demographic associations of the use of spectacles and reasons for not availing services were assessed with age, gender, education, socioeconomic status. On further analyses it was revealed, that, 3373 (83.5%) were aware of their poor vision, of these 2000 people did not visit an eye doctor. When the questions were analyzed as economic reasons and lack of awareness, lack of awareness superseded economic reasons, as lack of awareness was 54.5% Vs economic was 53.70%. Conclusion: When refractive error service delivery was planned for this population, besides providing free spectacles, emphasis on generating awareness for need for refractive errors was also considered

Awareness regarding eye donation among stakeholders in Srikakulam district in South India

Background There is a huge need for the availability of transplantable donor corneas worldwide to reduce the burden of corneal blindness due to corneal opacity. Voluntary eye donation depends on the awareness levels of various stakeholders in the community. This study aimed to assess the awareness level regarding eye donation among various stakeholders in Srikakulam district in the state of Andhra Pradesh, India. Methods 355 subjects were selected from the district using multi stage random sampling. A pre tested semi structured questionnaire was used to collect information regarding each individual’s awareness, knowledge, and perception regarding eye donation. Each response was scored individually and a total score was calculated. Univariate and multivariate regression analysis was used to determine the factors associated with willingness towards eye donation and increased awareness levels. Results Of the 355 subjects interviewed, 192 (54%) were male and 163 (46%) were female. The mean age of the stakeholders was 35.9 years (SD ±16.1) and all the study subjects were literate. Ninety-three percent of subjects were aware of the concept of eye donation. Knowledge levels were similar among the teaching community and persons engaged in social service, but lower among students (p < 0.05). Among the stakeholders, there was considerable ambiguity regarding whether persons currently wearing spectacles or suffering from a chronic illnesses could donate their eyes. Older age group (p < 0.001), female gender (p < 0.001) and education (p < 0.001) were associated with increased knowledge levels. 82% of the subjects were willing to donate their eyes and this was unaffected by gender or geographical location (rural vs urban). Conclusions Awareness levels and willingness to donate eyes are high among the stakeholders in Srikakulam district in India. The services of stakeholders could be utilized, in conjunction with other community based eye donation counselors, to promote awareness regarding eye donation among the general population

Perceptions of Eye Health and Eye Health Services among Adults Attending Outreach Eye Care Clinics in Papua New Guinea

Purpose: To determine how people attending outreach eye care clinics in Papua New Guinea (PNG) perceive eye health and eye health services.Methods: An interview-based questionnaire was administrated to a convenience sample of 614 adult participants across four provinces and perceptions of eye health and eye health services were recorded. Presenting and near visual acuity were measured and cause of visual impairment (VI) determined.Results: In this sample, 113/614 participants (18.4%) presented with distance VI, 16 (2.6%) with distance blindness, and 221 (47.6%) with near VI. Older participants and those with near VI were more likely to indicate that it is hard to have an eye examination due to travel time, lack of transport and transport costs. Female participants and those from underserved areas were more likely to report shame and fear of jealousy from others when asked about their attitudes towards spectacles. Participants reporting that they were willing to pay higher amounts for testing and spectacles/treatment also reported higher education levels, higher household incomes and were more likely to be male. A quarter of participants (25.9%) indicated that they did not like having an eye examination because their reading and writing was poor.Conclusions: People attending outreach eye care clinics in PNG reported finding it difficult to attend eye health services due to transport difficulties and anticipated high costs. Negative attitudes towards spectacles were also prevalent, and negative perceptions appeared more frequently among older participants and those with less education

IMI impact of myopia

The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden

Poverty and Eye Health

Abstract Poverty and eye health, including vision disability from vision impairment and blindness, are believed to be interrelated. The relationship between poverty and eye health can be interpreted as being two-fold, in the sense that poverty may be a cause of poor eye health and poor eye health may lead to or deepen poverty. Evidence shows that the burden of vision impairment is high in poor people and vision impairment and poverty are linked to each other. However the empirical evidence to answer the questions-Does poverty perpetuate poor eye health? How and why? Does poor eye health deepen poverty?-is sparse globally; especially from low and middle income countries (LMICs). This article therefore aims to examine published information and other secondary data sources that provide insight on the relationship between poverty and eye health, including eye disability caused from vision impairment and blindness. The article provides a conceptual understanding of poverty related attributes that contribute to eye disability from vision impairment and blindness, using evidence sourced from poverty and eye health research studies. The article interrogates general theories and beliefs that have been conceptualised in relation to the impact that the vicious cycle of poverty has on eye health and the contribution of poor eye health on an individual&apos;s poverty status. The major outcomes of this article include: 1) identifying gaps in linking poverty and eye health, 2) establishing key issues that will assist in the development of a theoretical framework, and 3) preparing more appropriately for further investigation on the association between poverty and eye health

Clinical and Epidemiologic Research Population-Based Assessment of Prevalence and Risk Factors for Pterygium in the South Indian State of Andhra Pradesh: The Andhra Pradesh Eye Disease Study

PURPOSE. To describe the prevalence and risk factors for pterygium in a population-based sample of individuals aged 30 years and older in South Indian state of Andhra Pradesh. METHODS. A cross-sectional study was conducted in one urban and three rural locations in which 10,293 subjects were examined. All the subjects underwent comprehensive eye examination and a detailed interview by trained professionals. Pterygium was defined as fleshy fibro vascular growth, crossing the limbus, and typically seen on the nasal conjunctiva in either eye. RESULTS. Data were analyzed for 5586 subjects who were aged 30 years and older at the time of participation. The mean age of the participants was 47.5 years (SD 13 years; range 30-102 years). In total, 46.4% were male, 56.7% had no education, 52.2% of them were involved in outdoor occupations, and 25% belonged to urban area. The prevalence of pterygium was 11.7% (95% confidence interval [CI]: 10.9-12.6). The multiple logistic regression analysis revealed significantly higher odds of pterygium among older age groups, rural residents (odds ratio [OR]: 1.8; 95% CI: 1.4-2.4; P &gt; 0.01), and those involved in outdoor occupations (OR: 1.8; 95% CI: 1.5-2.2, P &lt; 0.001). Education had a protective effect (OR: 0.6; 95% CI: 0.5-0.7; P &lt; 0.001). CONCLUSIONS. Pterygium is common in the South Indian state of Andhra Pradesh. Exposure to sunlight is a significant modifiable risk factor. Protecting the eyes from sunlight may decrease the risk of pterygium. However, the important public health challenge is to encourage the use of this protection as a routine in developing countries such as India

Modeling the risks of age-related eye diseases in a population in South India

The objective of this research was to determine whether an artificial intelligence methodology such as artificial neural network (ANN), a new type of predictive model offers an increased performance over a conventional logistic regression model (LR) in predicting the ranking of risk factors for irreversible age-related chronic eye diseases age-related macular degeneration (AMD), diabetic retinopathy (DR), primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) in a South Indian population. The LR and ANN models were derived and validated for their respective models predictive accuracy based on a sample (n=3,723) aged >=40 years old by using a large scale population-based epidemiologic study. Sub-population data were drawn from this sample by appropriate standard techniques that used for modeling. The LR based risk score models (RS) were derived and the model fit was assessed in a standard manner including the bootstrap method for internal validity. The ANN model was built by using the multi-layer feed-forward back propagation network. The ANN models predictive ability was compared with that of traditional model with respect to the Area under the Receiver Operating Characteristic Curve (AUROC). The sensitivity and specificity of the fitted models with a threshold criterion ranged from 70% to nearly 99% overall for all models. The ANN model outperformed the traditional LR model in a sub-population analysis in predicting AMD and DR. The predictive accuracy of ANN and LR model in predicting AMD was statistically significant (AUROC=89% vs 79%; p=10 year (RS ranged from 29 to 42) was a highest priority predictor for DR. The modifiable risk factor intraocular pressure was in order of highest priority predictor for POAG and PACG. Population attributable risk percentage and population attributable fractions revealed that there is an urgent need of prioritizing modifying the modifiable factors as a public health approach. This was supported by a sensitivity analysis of the ANN model which indicated the relative importance of prioritizing modifiable risk factors on which to base preventive interventions to reduce the impact of onset or progression of these diseases

La parole donnée aux personnes âgées ayant une déficience visuelle et leurs perceptions psychosociales de la dépression

Le vieillissement démographique, dont la plus forte incidence se manifeste dans les pays industrialisés, produit de nouveaux phénomènes sociaux. Ceux-ci méritent qu'on s'y attarde pour mieux comprendre les enjeux qui y sont reliés. L'espérance de vie étant plus longue, cela entraîne indubitablement une succession de pertes pour les aînés. La déficience visuelle est une des pertes estimées comme la plus redoutable. Lorsqu'elle survient en âge avancé, elle entraîne des conséquences majeures dans toutes les sphères de vie et compromet l'autonomie. Certains aînés sombrent insidieusement dans la dépression; risque qui serait de deux à cinq fois plus élevé chez les personnes âgées ayant une déficience visuelle que chez d'autres personnes du même groupe d'âge. En référence à ce problème, ce mémoire de maîtrise s'intéresse à l'angle psychosocial de la dépression chez les personnes de 65 ans et plus ayant une déficience visuelle. Cette étude exploratoire s'inscrit dans le cadre d'une maîtrise en travail social dirigée par Madame Michèle Charpentier, dont l'expertise en gérontologie sociale permet l'évolution des connaissances en regard de la situation sociale des aînés au Québec. Pour ce faire, une méthodologie de recherche qualitative et d'approche inductive permet de traduire les perceptions de dix sujets de l'Institut Nazareth et Louis-Braille (INLB), lesquels constituent notre échantillon. Trois dimensions ont fait l'objet de l'analyse: la déficience visuelle, l'avancement en âge et la dépression. Un entretien semi-dirigé a permis de colliger un contenu riche d'expérience en fonction de ces trois angles d'analyse. Selon le modèle théorique utilisé en réadaptation visuelle (Processus de production du handicap [PPH]), cette étude contribue à faire progresser la compréhension du phénomène par la proposition d'un référentiel psychosocial pouvant consolider la compréhension de la réalité sociale des aînés du Québec. Les résultats de recherche démontrent qu'il existe des difficultés d'adaptation chez les aînés faisant face à une perte importante de vision parce qu'ils sont majoritairement conditionnés par des représentations et des préjugés négatifs liés à la déficience visuelle, à l'âgisme et à la dépression. Des points de convergence et de divergence émanent selon que certains aînés ont vécu ou non un état dépressif à la suite de la perte de leur vision. Bref, ce que la personne pense d'elle-même relativement à son handicap et l'image que la société lui renvoie auraient une influence majeure sur la capacité ou l'incapacité des aînés ayant une déficience visuelle à se résilier à celle-ci. L'apport d'un soutien de qualité demeure un incontournable pour s'adapter à une telle perte, pourvu que l'aide apportée réponde aux besoins précis de chaque aîné. \ud ______________________________________________________________________________ \ud MOTS-CLÉS DE L’AUTEUR : personnes âgées, déficience visuelle, dépression, approche psychosociale

Patient reported critical factors in community delivery of vision care: the vision centre model

The existing models of eye care in India have so far not adequately addressed the issues of access, affordability and community involvement, therefore making little impact on avoidable blindness.To this end, The LV Prasad Eye Institute, located in Hyderabad, India has developed a novel approach to reach underserved population in remote rural areas of Andhra Pradesh State in Southern India through a network of tertiary and Secondary Centres integrated with Primary Care facilities known as &#147;Vision Centres&#148;. The objective of the Vision Centre approach was to enhance the access of underserved communities to affordable basic eye care services through a permanent infrastructure and well-trained, community based Vision technician. While the Vision Centre model per se has been successful, it is also apparent that the individual centres vary in terms of success and impact. While many factors are no doubt responsible, the perceptions of the targeted communities in terms of benefit and ease of access may play an important role, little or no work has been carried out in developing countries to understand the underlying factors that determine patients&#146; satisfaction with health services at the primary level, and issues such as cost versus benefit, and how these might relate to uptake of services. A combination of qualitative and quantitative methods was used in this study. Participants included a randomly selected 136 patients (of the 136 selected, 4 patients of &#147;Better of Rural Locations&#148; (BRLs) were rejected and 5 patents of &#147;Poor Rural Locations&#148; (PRLs) were not available) who accessed the 4 selected Vision Centres (of the 8 Vision Centres initially selected, 4 were included in this study). Analyses applied included: a) factor analyses of patients&#146; satisfaction with two Vision Centres in BRLs and two in PRLs; b) regression analysis to determine the associations with patients&#146; characteristics and patient with patients&#146; satisfaction; c) chi-square to explore differences in satisfaction of patients with Vision Centre services; d) Paired sample t &#150; test to check if the costs to access Vision Centre and town based clinic were significantly different. A p-value of <0.05 was considered significant in each instance. Three factors were obtained from factor analysis: Vision Technician (Factor-1), Access to the location of Vision Centre (Factor-2) and Vision Centre services (Factor-3). These three factors of patients&#146; satisfaction can explain 50.0 % cumulative variance of patient satisfaction. Patients&#146; ease to travel to the Vision Centre facility (&#61538; = -0.47; P <0.001), perceived the severity of eye problem (&#61538; = -0.19, P <0.002), level of affordability (&#61538; = -0.27; P = 0.004), ease to identify the Vision Centre building (&#61538; = -0.24; P <0.001), and geographical setting of patients (&#61538; = 0.38; P = 0.001) were significant variables associated with patient satisfaction, which was higher among the patients of BRLs Vision Centres. The total costs were significantly lower for patients who accessed the Vision Centres compared to the patients&#146; costs of town - based facilities (mean INR 178.4 &#61617; 48.3, (SE mean: 4.2) and INR 366.2&#61617; 48.2, (SE mean: 4.2) respectively, t-test p- value <0.001). Conclusions: Three factors are accountable for patients&#146; satisfaction with the Vision Centre facility. Vision Centres, besides providing quality eye care services, offer substantial cost savings to rural population compared with town-based optical clinics. These findings call for greater attention to decentralized eye care services closer to the communities. However, effective service delivery through Vision Centres should also take into account patients&#146; perceptions in order to build a Primary Eye Care System which is truly sustainable and serves the needs of population optimally