Rapid and cost-effective method to assess vision disorders in a population

PURPOSE: The aim was to develop a means of rapidly assessing eye health in a cost- and time-effective way to monitor changes over time. METHODS: Key features of the five main eye diseases that cause vision loss in Australia were assessed. Participation was volunteer-based from randomly selected Melbourne suburbs. Recruitment was by mail. Anterior segments and fundi were photographed with a digital non-mydriatic fundus camera. Visual fields were tested with Frequency Doubling Technology. A questionnaire collected information about demographics, general health and lifestyle. Findings from this rapid assessment were compared with those from a population-based study. RESULTS: A total of 1695 people, aged between 70 and 79 years (mean 74), were recruited. The rates and causes of visual impairment were similar between the rapid assessment method and the population-based study. Among the 134 people (8%) with visual impairment at presentation, 98 (73%) had undercorrected refractive error, 17 (13%) had age-related macular degeneration, 11 (8%) had cataract, 2 (2%) had diabetic retinopathy and 2 (2%) had glaucoma. Screening costs per participant were only about AU$145, compared with AU$433 in the Melbourne Visual Impairment Project (VIP). The application of Frequency Doubling Technology as well as the use of a non-mydriatic digital camera for fundus and lens photography resulted in an average examination time of less than half the time needed in the VIP. Data collection took 3 months rather than 4 years in the VIP. CONCLUSION: The rapid assessment method was efficient in time and cost and produced results comparable to a normal population-based survey. Repeating the study design for a similarly sampled group every 2 years would allow the assessment of changes in the prevalence of undiagnosed eye disease.     

Applying principles of health system strengthening to eye care

Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries) often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.     

我国防盲与眼健康事业的发展历程

防盲和眼健康是涉及民生的重大公共卫生问题和社会问题。新中国建立七十年来，特别是实施“视觉2020”行动的二十年来，我国防盲和眼健康取得重要进展。本文简要地回顾了我国防盲和眼健康的历程，分为新中国建国之前（1949年前）、新中国建立初期至改革开放初期（1970年代）、改革开放初期至21世纪初期、21世纪初期至现在等几个部分，以期进一步促进我国普遍眼健康的发展，以适应建立社会主义强国的需要。（眼科， 2020， 29： 321-325）     

我国防盲与眼健康事业的主要成就

防盲和眼健康是涉及民生的重大公共卫生问题和社会问题。新中国建立七十年来,特别是实施“视觉2020”行动的二十年来,我国防盲和眼健康取得重要进展。本文简要回顾了我国防盲和眼健康事业取得的主要成就,包括盲和视力损伤的患病率、眼病防治（沙眼、白内障、其他眼病）、建立眼科医疗服务体系和防盲体系等几个部分,以期进一步促进我国普遍眼健康的发展,以及适应建设有中国特色社会主义强国的需要。     

Mobilizing slit lamp to the field: A new affordable solution

We are describing a simple and affordable design to pack and carry the slit lamp to the field. Orbis staff working on the Flying Eye Hospital (FEH) developed this design to facilitate mobilization of the slit lamp to the field during various FEH programs. The solution involves using a big toolbox, a central plywood apparatus, and foam. These supplies were cut to measure and used to support the slit lamp after being fitted snuggly in the box. This design allows easy and safe mobilization of the slit lamp to remote places. It was developed with the efficient use of space in mind and it can be easily reproduced in developing countries using same or similar supplies. Mobilizing slit lamp will be of great help for staff and institutes doing regular outreach clinical work.     

The role of optometrists in India: An integral part of an eye health team

India has a proud tradition of blindness prevention, being the first country in the world to implement a blindness control programme which focused on a model to address blinding eye disease. However, with 133 million people blind or vision impaired due to the lack of an eye examination and provision of an appropriate pair of spectacles, it is imperative to establish a cadre of eye care professionals to work in conjunction with ophthalmologists to deliver comprehensive eye care. The integration of highly educated four year trained optometrists into primary health services is a practical means of correcting refractive error and detecting ocular disease, enabling co-managed care between ophthalmologists and optometrists. At present, the training of optometrists varies from two year trained ophthalmic assistants/optometrists or refractionists to four year degree trained optometrists. The profession of optometry in India is not regulated, integrated into the health care system or recognised by the majority of people in India as provider of comprehensive eye care services. In the last two years, the profession of optometry in India is beginning to take the necessary steps to gain recognition and regulation to become an independent primary health care profession. The formation of the Indian Optometry Federation as the single peak body of optometry in India and the soon to be established Optometry Council of India are key organisations working towards the development and regulation of optometry.     

Primary eye care needs and services to Aboriginal and Torres Strait Islander populations across Queensland: a ‘users' perspective

The ocular health status of the Aboriginal and Torres Strait Islander (A&TSI) population is significantly poorer than that of the wider community. This study examined the primary eye care needs of, and services to, A&TSI people from an indigenous perspective. The findings reported here are based on questionnaire-based interviews of 292 A&TSI people from three urban and three rural communities in Queensland. The level of eye care services to A&TSI people failed to meet the perceived needs of most communities, this deficiency being greater in rural than urban communities. Limited physical accessibility of optometric services, cultural barriers and education were identified as the three main issues contributing to the low utilisation rate of currently available services by A&TSI people. These findings indicate unmet needs within A&TSI communities in Queensland, both for culturally appropriate and accessible primary eye care services and for education about eye health issues.     

Eye health is everyone’s responsibility: China’s first Western-style eye hospital improves in the prevention of blindness

AIM: To investigate the relationship between China’s first Western-style eye hospital development and the prevention of blindness in China and determine the main factor influencing eye health today.METHODS: Data about eye health, blindness and cataract surgery rate of China from public website of World Health Organization (WHO), ORBIS International, Ministry of Health (MOH) of China, Pubmed center and Historical Archives of Zhongshan Ophthalmic Center (ZOC) were reviewed and analyzed.RESULTS: ZOC is China’s first Western-style eye hospital. In 2012, the ORBIS Flying Eye Hospital has chosen ZOC once again as one of its destinations, 30 years after ORBIS expanded internationally to train eye care professionals and treat underserved patients in developing countries in 1982. During the past 30 years, cataract surgery rate and public awareness of blindness prevention were improved greatly in China, in which ZOC plays a very important role.CONCLUSION: ZOC, as China’s first Western-style eye hospital,has improved in the prevention of blindness. Eye health has become everyone’s responsibility.     

注视视频终端对眼健康的影响

目的:了解长时间注视视频终端(video display terminal,VDT)对眼健康的影响,并提出预防对策。方法:对长时间连续注视VDT者视功能、屈光状态及眼进行检查,测定调节幅度、集合近点,并与很少或不操作VDT者的同样检查或测定情况进行对比。结果:长时间连续注视VDT者,其眼的健康比非注视VDT者更容易出现眼痛、眼胀、视物模糊、视力下降等视疲劳现象,并且随注视时间的延长,视疲劳的倾向更明显,调节幅度降低,集合近点远离。两组比较差异有统计学意义(P<0.05)。结论:长时间连续注视视频终端较阅读书本等界面更易对眼产生负面影响,应加强预防VDT性眼健康损害。     

Eye conditions and blindness in children: Priorities for research, programs, and policy with a focus on childhood cataract

The major causes of blindness in children encompass intrauterine and acquired infectious diseases, teratogens and developmental and molecular genetics, nutritional factors, the consequences of preterm birth, and tumors. A multidisciplinary approach is therefore needed. In terms of the major avoidable causes (i.e., those that can be prevented or treated) the available evidence shows that these vary in importance from country to country, as well as over time. This is because the underlying causes closely reflect socioeconomic development and the social determinants of health, as well as the provision of preventive and therapeutic programs and services from the community through to tertiary levels of care. The control of blindness in children therefore requires not only strategies that reflect the local epidemiology and the needs and priorities of communities, but also a well functioning, accessible health system which operates within an enabling and conducive policy environment. In this article we use cataract in children as an example and make the case for health financing systems that do not lead to 'catastrophic health expenditure' for affected families, and the integration of eye health for children into those elements of the health system that work closely with mothers and their children.     

Primary eye care in rural sub-Saharan Africa

Primary eye care in rural sub-Saharan Africa is reviewed. In the context of eye care delivered by village health workers (VHW's) living in and supported by the community, such a system of health care does not exist in Africa today. There are no VHW's, and primary health care is currently a matter of experimentation and conjecture only. However, most basic eye care is rendered by non-ophthalmologists; such care consists of screening, treatment of infections and inflammations, and in some cases, cataract surgery. Lower levels of non-ophthalmic general health workers are being tasked to promote measures to prevent trachoma and xerophthalmia/nutritional blindness by intervention at the village level. Preliminary results of such programs are encouraging, and warrant further evaluation and expansion.     

眼科门诊干眼患病率的初步调查和健康指导

目的:了解我院眼科门诊患者中干眼患者的患病情况,分析其影响因素,制定有针对性的健康指导措施。方法:对我院眼科门诊就诊的部分20岁以上患者392例(男性180例,女性212例)进行询问式调查、干眼检查[包括裂隙灯检查、泪液分泌试验I(SchirmerI)、泪膜破裂时间(BUT)测定]以确定诊断并分析其影响因素。结果:选取患者392例,其中干眼患者52例(13.3%),男性17例(4.3%),女性35例(8.9%)。其中20～39岁2例(0.5%),40～59岁27例(6.9%),≥60岁23例(5.9%)。环境因素影响者为34例(65.4%),全身疾病及用药患者18例(34.6%),眼部疾病及用药患者20例(38.5%),无明显诱因者6例(11.5%),同时存在2种及以上上述因素患者22例(42.3%)。结论:干眼发病年龄有下降趋势,发病因素有年龄、性别、全身疾病及用药、眼部疾病及用药、工作及生活环境等方面。应根据导致干眼的不同因素给予相应的健康指导,以减少干眼的发生及控制干眼症状。     

9月龄婴儿屈光状态及其胎婴儿期影响因素

目的：研究9月龄婴儿屈光状态及其胎婴儿期的影响因素,为屈光异常的早期预防提供科学依据。 方法：基于监测数据的回顾性研究。根据上海市闵行区妇幼保健院2012年至2019年积累的屈光筛查 记录,纳入16 746名9月龄婴儿作为研究对象,通过儿保体检记录和问卷调查资料采集9月龄前的影 响因素,对屈光状态进行描述。采用卡方检验和多因素回归模型分析胎婴儿期因素与各类可能屈光 异常的关联。结果：9月龄婴儿球镜度P5~P95为+0.50~+3.00 D,柱镜度P5为-2.50 D。屈光可能偏近视、 屈光可能偏远视、可能散光及可能屈光参差的检出率分别为13.46%、11.13%、25.58%和8.29%。在 控制性别和遗传因素后,冬季出生、经常看电子产品与较高的屈光可能偏近视发生风险有关（调整 OR=1.35、1.55）;夏季及秋季出生、早产、9月龄体格百分位数≥P80与较高的屈光可能偏远视发生风 险有关（调整OR=1.67、1.62、1.80、1.22）;夏季出生、9月龄体格百分位数≥P80、9月龄采用人工喂 养与较高的可能散光发生风险有关（调整OR=1.92、1.42、1.19）。每日户外活动时长>0.5 h与较低的 各类可能屈光异常发生风险有关（调整OR=0.71~0.80）。结论：9月龄婴儿各种可能屈光问题的检出 率为8%～25%,散光比较突出。具有早产、父母屈光异常、较大体格等高危因素的婴幼儿应作为屈 光筛查和随访的重点。     

Use of Protective Eyewear During Recreational Activities in Adults of the United States: Analysis from the 2016 National Health Interview Survey

Purpose: Eye injuries occur frequently in the United States resulting in vision loss. Protective eyewear (PE) is a simple, effective way to prevent these injuries. The study aims to evaluate characteristics associated with no PE usage in hopes to better understand factors that may be targeted to alleviate future injuries.

Methods: Individuals from the 2016 National Health Interview Survey (NHIS) who performed recreational activities that could cause eye injury were divided into two groups – those with and without PE usage during these activities – and compared on several variables consisting of age group, gender, race, family income, ability to afford eyeglasses, employment, wearing of corrective lenses, and visitation with general and eye care providers. Statistical analyses were performed with SAS controlling for the complex same design via chi-square tests and logistic regression.

Results: From a total of 8,199 subjects, those who are female, Asian, black, Hispanic, ages 18–24 years old, have a family income <$35,000, unemployed, not wearers of corrective lenses, and have not seen a general or eye care provider showed increased no PE usage according to chi-square analysis. With multivariate analysis, only race, gender, age, and wearing of corrective lenses correlated to PE usage.

Conclusions: Comparing 2002 and 2016 NHIS, PE usage had increased from 34.7% to 65.1%. Individuals who were younger, female, of a minority race, or who did not wear corrective lenses had increased odds of not using PE during recreational activities. Prevention should target these associated groups in efforts to reduce recreational eye injuries.     

体育活动促进背景下"眼保健操"政策及其实施效果的回顾与展望

作为一项长期实施的教育政策,眼保健操在我国已历经50余年的发展过程。现有的实证研究显示,没有证据表明包括眼保健操在内的视觉训练能够有效预防或减缓近视进展;体育活动在对儿童青少年视力健康发挥作用过程中,"户外"是关键因素。在体育活动促进背景下回顾和展望眼保健操政策,我们不但应该组织力量进行实证研究,检验并公布眼保健操对儿童青少年视力保护的作用效果;探索将10min的室内眼保健操时间,转化为中高强度户外体育活动时间的可行性;同时还要紧紧依托体育活动促进综合施策,避免对眼保健操护眼功效的过度依赖。     

Lack of Awareness of Common Eye Conditions in the Community

ABSTRACT

Purpose: Awareness of eye conditions aids health promotion activities and leads to better outcomes. We examined factors influencing the lack of awareness of common eye conditions in a population.

Methods: The Singapore Malay Eye Study examined 3280 (78.7% response) Malays aged 40–80 years. We included 2112 (64.4%) participants with at least one of five eye conditions: 1504 (71.2%) with cataract, 1013 (47.8%) with myopia, 270 (12.8%) with diabetic retinopathy, 181 (8.6%) with age-related macular degeneration and 150 (7.1%) with glaucoma. Lack of awareness was defined in the questionnaire as not answering “yes” to previously being told by a doctor of having the eye condition.

Results: Among 2112 participants, 83.2% were unaware of at least one of their eye conditions. After controlling for age, sex and socioeconomic factors, participants unaware of their eye condition were older (odds ratio, OR, 1.03, per 1 year, p?<?0.001), had better visual acuity (OR 1.32, p?=?0.04), lower education (OR 1.89, p?<?0.001), poorer literacy (OR 1.44, p?=?0.02), lower income (OR 1.73, p?=?0.009), higher blood glucose (OR 1.08, per 1?mmol/L, p?<?0.001), higher serum cholesterol (OR 1.20, per 1?mmol/L, p?=?0.003), lower annual eye examination attendance (OR 2.08, p?<?0.001) and were less likely to wear glasses (OR 2.90, p?<?0.001) than those who were aware of their condition.

Conclusions: In this community-based population, 80% of those with common eye conditions were unaware of their condition.