Presbyopic spectacle coverage, willingness to pay for near correction, and the impact of correcting uncorrected presbyopia in adults in Zanzibar, East Africa.

PURPOSE: To assess presbyopic spectacle coverage, willingness to pay, and the impact of correcting uncorrected presbyopia in individuals 40 years of age and older in Zanzibar and whether assessment of presbyopia can be incorporated into Rapid Assessment of Blindness (RAAB) surveys. METHODS: A cross-sectional, population-based survey of presbyopia was incorporated into a RAAB survey. The sample size of 400 included individuals older than 50 years (from RAAB survey) and those 40 to 50 years old (from the same household) who had a corrected visual acuity (VA) of at least 6/18 in either eye. An Ophthalmic Clinical Officer (OCO) administered visual function (VF) and quality of life (QOL) questionnaires followed by clinical assessment by an optometrist. Participants requiring a simple near addition were dispensed free readymade spectacles. The same team traced participants 6 months later and readministered the questionnaires. Those requiring new spectacles had their near VA measured and were given spectacles. RESULTS: Three hundred eighty-one participants were examined. The prevalence of presbyopia was 89.2% (340/381) and spectacle coverage was only 17.6%. Barriers to accessing services included spectacles not being a priority and lack of money. At follow-up, 175 (93.6%) of 187 participants given spectacles still had them. Mean satisfaction was high at 89.5%. The mean amount participants were willing to pay for spectacles had increased from 2.17 USD at baseline to 3.14 USD at follow-up. The impact of correcting presbyopia on VF produced an effect size of 2.90 and effect sizes ranging from 1.15 to 3.90 for mean QoL scores. CONCLUSIONS: This study highlights the value of correcting presbyopia from the community perspective and the necessity of providing affordable, quality, and accessible near spectacles at the primary health level

Treatment of refractory diabetic macular edema with a fluocinolone acetonide implant in vitrectomized and non-vitrectomized eyes

AIM: To report real-life data on the use of an intravitreal fluocinolone acetonide implant in the treatment of refractory diabetic macular edema (DME) in pars plana vitrectomized (PPV) and non-PPV eyes. METHODS: This was a comparative retrospective observational study of 23 eyes with chronic DME. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded at baseline, 1, 4 and 12mo. Descriptive statistics and non-parametric tests were performed to analyze and compare PPV and non-PPV eyes. RESULTS: Seven PPV and 16 non-PPV eyes were included in the study. Median BCVA in the non-PPV group varied from 0.65 logMAR [Interquartile range (IQR): 0.40] at baseline to 0.42 logMAR (IQR: 0.40) at 12mo. Median CMT varied from 430 µm (IQR: 131.3) at baseline to 317 µm (IQR: 107.5) at 12mo. Median BCVA in the PPV group varied from 0.60 logMAR (IQR: 0.62) at baseline to 0.74 logMAR (IQR: 0.34) at 12mo. Median CMT varied from 483 µm (IQR: 146) at baseline to 397 µm (IQR: 132) at 12mo. Of 0/7 eyes and 1/16 eyes in the PPV and non-PPV eyes respectively had a baseline visual acuity of 6/12 or better (0.3 logMAR). At last follow up, 1/7 and 5/16 eyes in the PPV and non-PPV group respectively achieved a visual acuity of 6/12 or better. CONCLUSION: Visual outcomes are modest following the use of the fluocinolone acetonide implant for chronic DME. The steroid implant is a useful treatment option in the management of refractory DME in vitrectomized and non-vitrectmized eyes