Measuring the outcome of cataract surgery: the importance of the patient perspective.

Most eye care staff have had the pleasure of removing the pad from a patient’s eye after cataract surgery and seeing their joy at having their sight restored. However, when the outcome of cataract surgery is discussed prior to surgery, the first thing most people think about is visual acuity or complications. Whilst these are critically important, they are only part of the story

Improving the quality of cataract surgery.

Quality is a difficult concept to describe and there is no clear definition. People have different views of what quality means and describe it in different ways

The cost-utility of telemedicine to screen for diabetic retinopathy in India.

PURPOSE: To assess the cost-effectiveness of a telemedicine diabetic retinopathy (DR) screening program in rural Southern India that conducts 1-off screening camps (i.e., screening offered once) in villages and to assess the incremental cost-effectiveness ratios of different screening intervals. DESIGN: A cost-utility analysis using a Markov model. PARTICIPANTS: A hypothetical cohort of 1000 rural diabetic patients aged 40 years who had not been previously screened for DR and who were followed over a 25-year period in Chennai, India. METHODS: We interviewed 249 people with diabetes using the time trade-off method to estimate utility values associated with DR. Patient and provider costs of telemedicine screening and hospital-based DR treatment were estimated through interviews with 100 diabetic patients, sampled when attending screening in rural camps (n = 50) or treatment at the base hospital in Chennai (n = 50), and with program and hospital managers. The sensitivity and specificity of the DR screening test were assessed in comparison with diagnosis using a gold standard method for 346 diabetic patients. Other model parameters were derived from the literature. A Markov model was developed in TreeAge Pro 2009 (TreeAge Software Inc, Williamstown, MA) using these data. MAIN OUTCOME MEASURES: Cost per quality-adjusted life-year (QALY) gained from the current teleophthalmology program of 1-off screening in comparison with no screening program and the cost-utility of this program at different screening intervals. RESULTS: By using the World Health Organization threshold of cost-effectiveness, the current rural teleophthalmology program was cost-effective ($1320 per QALY) compared with no screening from a health provider perspective. Screening intervals of up to a frequency of screening every 2 years also were cost-effective, but annual screening was not (>$3183 per QALY). From a societal perspective, telescreening up to a frequency of once every 5 years was cost-effective, but not more frequently. CONCLUSIONS: From a health provider perspective, a 1-off DR telescreening program is cost-effective compared with no screening in this rural Indian setting. Increasing the frequency of screening up to 2 years also is cost-effective. The results are dependent on the administrative costs of establishing and maintaining screening at regular intervals and on achieving sufficient coverage

Barriers to hand hygiene in ophthalmic outpatients in Uganda: a mixed methods approach.

BACKGROUND: Healthcare-associated infection rates are high in low-income countries and are associated with significant morbidity. There is a paucity of published data on infection control practice, attitudes or resources in these settings, particularly in ophthalmology. The aim of this study is to understand current hand washing practices, barriers to hand washing and facilities available in two Ugandan specialist eye hospitals. This study was undertaken through non-participant observations of healthcare worker hand washing practices, documentation of hand hygiene facilities and semi-strucutured interviews with clinical staff. RESULTS: Eighty percent of the WHO opportunities for hand washing were missed through lack of attempted hand hygiene measures. Facilities for hand hygiene were inadequate with some key clinical areas having no provisions for hand hygiene. Training on effective hand hygiene varied widely with some staff reporting no training at all. The staff did not perceive the lack of facilities to be a barrier to hand washing but reported forgetfulness, lack of time and a belief that they could predict when transmission might occur and therefore did not wash hands as often as recommended. CONCLUSIONS: Hand hygiene at the two observed sites did not comply with WHO-recommended standards. The lack of facilities, variable training and staff perceptions were observable barriers to effective hand hygiene. Simple, low-cost interventions to improve hand hygiene could include increased provision of hand towels and running water and improved staff education to challenge their views and perceived barriers to hand hygiene

Ocular morbidity and health seeking behaviour in Kwara state, Nigeria: implications for delivery of eye care services.

BACKGROUND: There is currently limited information as to which conditions are most prevalent in communities in developing countries. This makes effective planning of eye services difficult. METHODS: 3,899 eligible individuals were recruited and examined in a cross-sectional survey in Asa Local Government Area, Nigeria. Those who self-reported an ocular morbidity were also asked about their health-seeking behaviour. Health records of local facilities were reviewed to collect information on those presenting with ocular morbidities. RESULTS: 25.2% (95% CI: 22.0-28.6) had an ocular morbidity in at least one eye. Leading causes were presbyopia and conditions affecting the lens and conjunctiva. The odds of having an ocular morbidity increased with age and lower educational attainment. 10.1% (7.7-13.0) self-reported ocular morbidity; 48.6% (40.4-56.8) of them reported seeking treatment. At the facility level, 344 patients presented with an ocular morbidity over one month, the most common conditions were red (26.3%) or itchy (20.8%) eyes. CONCLUSION: Ocular morbidities, including many non vision impairing conditions, were prevalent with a quarter of the population affected. The delivery of eye care services needs to be tailored in order to address this need and ensure delivery in a cost-effective and sustainable manner

A Rapid Assessment of Avoidable Blindness in Southern Zambia

INTRODUCTION: A rapid assessment of avoidable blindness (RAAB) was conducted in Southern Zambia to establish the prevalence and causes of blindness in order to plan effective services and advocate for support for eye care to achieve the goals of VISION 2020: the right to sight. METHODS: Cluster randomisation was used to select villages in the survey area. These were further subdivided into segments. One segment was selected randomly and a survey team moved from house to house examining everyone over the age of 50 years. Each individual received a visual acuity assessment and simple ocular examination. Data was recorded on a standard proforma and entered into an established software programme for analysis. RESULTS: 2.29% of people over the age of 50 were found to be blind (VA <3/60 in the better eye with available correction). The major cause of blindness was cataract (47.2%) with posterior segment disease being the next main cause (18.8%). 113 eyes had received cataract surgery with 30.1% having a poor outcome (VA <6/60) following surgery. Cataract surgical coverage showed that men (72%) received more surgery than women (65%). DISCUSSION: The results from the RAAB survey in Zambia were very similar to the results from a similar survey in Malawi, where the main cause of blindness was cataract but posterior segment disease was also a significant contributor. Blindness in this part of Zambia is mainly avoidable and there is a need for comprehensive eye care services that can address both cataract and posterior segment disease in the population if the aim of VISION 2020 is to be achieved. Services should focus on quality and gender equity of cataract surgery

A global review of marine recreational spearfishing

24 pages, 5 figures, 2 tables, supplementary information https://doi.org/10.1007/s11160-023-09790-7.-- Data availability: The full list of papers used for the systematic review is available as a supplementary tableRecreational spearfishing is a fishing method that occurs globally, yet receives considerably less attention in the scientific literature relative to other recreational fishing methods, such as angling. Lack of scientific information on spearfishing may negatively affect the development and management of marine recreational fisheries. We conducted a systematic review of 102 peer-reviewed papers published between 1967 and 2022 pertaining to marine recreational spearfishing. Based on this literature review, we provide an overview of key insights across social, economic, and ecological dimensions of marine recreational spearfishing. While spearfishers represent less than 5% of marine recreational fishers, the participants are younger and may differ from recreational anglers in their motivations, with suggestions of increased well-being generated from a close connection with the sea during underwater fishing. Recreational spearfishers mostly target species of moderate to high levels of vulnerability that are mid to high trophic level carnivores. Though spearfishers can deliberately target larger individuals of exploited populations, this is not a generalizable pattern. Despite a growing body of research on the ecological impacts of marine recreational spearfishing, there is limited knowledge of these effects and their mechanisms across biological levels of organization (e.g., individual, population, community and ecosystem) compared with those of other fishing methods. Recreational spearfishers can contribute to advances in marine ecological knowledge, and inclusive participatory management could represent a key step towards transformative sustainable development of marine recreational spearfishing. Throughout the review, we identify gaps in the research and areas where future research is needed to better inform the socio-economic importance, ecosystem impacts and future management of marine recreational spearfishingVS was supported by a “Juan de la Cierva Incorporación” (IJC2018-035389-I), and he is now supported by a “Ramón y Cajal” research fellowships (RYC2021-033065-I) granted by the Spanish Ministry of Science and Innovation. SV and PP are supported by the Xunta de Galicia (RECREGES I and II projects under Grants ED481B2014/034-0 and ED481B2018/017), Grupo de Referencia Competitiva GI-2060 AEMI, under Grant ED431C2019/11), and Fundación Biodiversidad, Ministerio para la Transición Ecológica y el Reto Demográfico, Gobierno de España (SICORE and GT PMR projects). VJG received a postdoctoral grant (#2017/22273-0) from São Paulo Research Foundation (FAPESP). MR would like to acknowledge Portuguese national funds from FCT—Foundation for Science and Technology through projects UIDB/04326/2020, UIDP/04326/2020 and LA/P/0101/2020. MR would also like to acknowledge FCT funding through a postdoctoral grant (SFRH/BPD/116307/2016). JACCN thanks to Meros do Brasil Project sponsored by Petrobras. FJH is supported by a Sȇr Cymru European Regional Development Fund Fellowship (80761-SU-135). RA was supported by the German Federal Ministry of Education and Research (Grants 01LC1826E and 033W046A). ML is supported by the Agencia Nacional de Investigación e Innovación (ANII, POS_EXT_2020_1_165362). This work acknowledges the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S). [...] Open Access funding provided thanks to the CRUE-CSIC agreement with Springer NaturePeer reviewe

Findings from a Rapid Assessment of Avoidable Blindness (RAAB) in Southern Malawi

BACKGROUND: Data on prevalence and causes of avoidable blindness in Malawi are not readily available. The purpose of this study was to determine the prevalence and causes of blindness in persons aged 50 and above in southern Malawi to plan eye care services for the community. METHODOLOGY: A population-based survey was conducted in 7 districts in southern Malawi. Villages were selected by probability proportionate to size within each district. Clusters were further subdivided into segments. A predetermined number of segments were selected randomly in each cluster. The survey team moved from house to house in each segment until they had examined 50 people over the age of 50. Examination consisted of visual acuity measurement with tumbling "E" chart and ocular examination by an ophthalmologist. Participants were categorized by visual acuity. Those who were visually impaired (VA<6/18 in the better eye with available correction) were assigned a main cause of visual loss. Further information was sought from anyone who had received cataract surgery. RESULTS: A total number of 3,583 persons aged 50 and above were sampled; among these 3,430 (95.7%) were examined. The prevalence of blindness (presenting visual acuity <3/60 in the better eye) among persons aged 50 and above was 3.3% (95% CI 2.5-4.1). Cataract was the most common cause of blindness contributing to 48.2% of all cases, followed by glaucoma (15.8%) and cornea scarring (12.3%). The cataract surgical coverage in blind persons was 44.6%. CONCLUSION: The prevalence of blindness and visual impairment in persons aged 50 and above was lower than the WHO estimate for Malawi. The majority of the causes were avoidable, with cataract accounting for approximately half of all cases of blindness. The data suggests that expansion of eye care programs to address avoidable causes of blindness is necessary in this area of southern Malawi