Volunteer-based vision nongovernmental organizations and VISION 2020

BACKGROUND: The World Health Organization and the International Agency for the Prevention of Blindness developed the global initiative, VISION 2020, with the goal of eliminating avoidable blindness by 2020. An unknown number of volunteer-based organizations conduct short-term vision camps as a means of eliminating blindness in developing countries. METHODS: VISION 2020 strategies are reviewed and volunteer organizations' understanding of VISION 2020 and methods of service delivery are considered through survey results. RESULTS: From the surveys it is apparent that volunteer organizations are not aware of the VISION 2020 initiative and do not conduct their projects and programs in a way that is supported by VISION 2020. CONCLUSION: Volunteer organizations have the skills, resources, and enthusiasm to make an impact on the burden of visual impairment. They do not, however, follow strategies accepted as most appropriate by the larger global eye health care community. Volunteer organizations are encouraged to reprioritize the work they do and change the methods they use.     

Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study

Background

To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks.

Methods

Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care.

Results

One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders.

Conclusions

This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.     

2007年云南省医疗机构眼科现状调查

目的了解截至2007年云南省的眼科医疗现状和服务能力。设计横断面问卷调查。研究对象云南省内165家医疗机构。方法采用卫生部统一设计的眼科机构现状调查表,于2007年10-12月对云南省内医疗机构的眼科现状进行问卷调查。收集整理并分析问卷结果。主要指标医护人员数量、年手术量、门诊量、可独立完成白内障手术的医生数量。结果参与调查的的165家医疗机构共有眼科医生735名,能独立完成白内障手术者392名,眼科护理人员771人。全省16个地州市中,昭通地区每百万人口拥有的眼科医生资源仅为7人,而昆明市为32人。2006年所有医疗机构共完成眼科各类手术58346例,包括白内障23833例。尚未开展白内障手术的医疗机构有27家。各级医疗机构仅29家（17．6％）拥有较好的眼科设备,6家（3．6％）没有任何眼科设备。结论云南省不同等级和不同地区之问的医疗机构眼科水平差异很大,人力资源分布不均,工作效率较低,需要进一步进行资源整合和优化利用,以满足群众对眼科医疗服务的需求。（跟科,2010,19：142—144）     

Glaucoma in oman: a review

PURPOSE: Glaucoma is one of the priority eye diseases in Oman in its VISION 2020 Plan. A review of available data is presented on the basis of situation analysis carried out in 2002. METHODS: The General demography, morbidity and management of eye diseases reported by different eye institutions. Predefined parameters and definitions were used to calculate incidence and coverage of glaucoma. RESULTS: The rate of glaucoma cases reported by ophthalmologists was 1.14/1000. 11.5% of estimated blindness in Oman in 1997 was due to glaucoma. Primary Open angle glaucoma constituted 63.5% of the total glaucoma cases. In spite of free and easy access to the eye treatment, coverage of glaucoma surgery was 25% of the reported cases. Evidence based information on glaucoma in the community is needed in Oman. The health facilities for eye care of glaucoma cases are available in different health regions of Oman. CONCLUSIONS: Glaucoma should be addressed through a program approach both to reduce/delay visual disabilities and improve quality of life of glaucoma patients.     

Globale Blindheit

Worldwide there are 37 million people who are completely blind and another 112 million whose sight is severely restricted. Of all blind people throughout the world, 85% live in developing countries. In three quarters of cases, blindness could be prevented or treated. The VISION 2020 campaign is dedicated to halving the number of people suffering from the diseases leading to blindness by means of disease control, training of specialist ophthalmic staff and development of appropriate infrastructures. More effort is needed if these goals are to be met. German ophthalmologists engaged in conservative and surgical treatments who join in and support VISION 2020 will be welcomed.     

The challenge of uncorrected refractive error: driving the agenda of the Durban Declaration on refractive error and service development

The purpose of this article is to highlight the challenge of uncorrected refractive error globally, as well as to discuss recent advocacy successes and innovative programs designed to address the need for broader refractive error service development, particularly in developing countries. The World Health Organization's VISION 2020: The Right to Sight program first posed the challenge to national governments to give priority to strategies and resources targeted towards avoidable causes of blindness and visual impairment, so that these unnecessary forms of blindness or visual impairment can be eliminated globally by the year 2020. The blindness prevention community is challenged to increase in scale its initiatives, which support the attainment of VISION 2020: The Right to Sight goals primarily and the United Nation's Millennium Development Goals indirectly. The Durban Declaration on Refractive Error and Service Development was the outcome of a meeting of eye‐care professionals, researchers, governments, civil society and industry in March 2007 and still stands as a guiding document to the blindness prevention community for the elimination of avoidable blindness due to uncorrected refractive error.     

The accomplishments of the global initiative VISION 2020: The Right to Sight and the focus for the next 8 years of the campaign

In the first 12 years of VISION 2020 sound programmatic approaches have been developed that are capable of delivering equitable eye health services to even the most remote and impoverished communities. A body of evidence around the economic arguments for investment in eye health has been developed that has fuelled successful advocacy work resulting in supportive high level policy statements. More than a 100 national plans to achieve the elimination of avoidable blindness have been developed and some notable contributions made from the corporate and government sectors to resource eye health programs. Good progress has been made to control infectious blinding diseases and at the very least there is anecdotal evidence to suggest that the global increase in the prevalence of blindness and visual impairment has been reversed in recent years, despite the ever increasing and more elderly global population. However if we are to achieve the goal of VISION 2020 we require a considerable scaling up of current efforts-this will depend on our future success in two key areas: i) Successful advocacy and engagement at individual country level to secure significantly enhanced national government commitment to financing their own VISION 2020 plans.ii) A new approach to VISION 2020 thinking that integrates eye health into health system development and develops new partnerships with wider health development initiatives.     

Coming Out of the Office: The Need for Local Involvement

Practicing ophthalmologists represent a potent broad-based resource group uniquely capable of educating the public about the excellence of ophthalmologic care. Leaders of American ophthalmology have recognized the importance of involvement by individual ophthalmologists in public education. It is essential that each ophthalmologist learn to work closely with news media representatives in order to publicize the activities, actions, and policy decisions of the Academy and the Association. It is time for all ophthalmologists to “come out of the office” and become advocates for their patients, informing the public about the advantages of medical eye care.     

超声乳化联合IOL植入术治疗急性原发性闭角型青光眼

0引言随着晶状体超声乳化及人工晶状体(IOL)植入术的成熟和完善,其应用范围也得到了扩大,许多眼科医生将这一手术引入了原发性闭角型青光眼的治疗中。此手术能解除瞳孔阻滞,加深前房,改善房水循环,降低眼压,同时此手术切口小,损伤少,并发症少,减少了抗青光眼术的     

Rationalizing the delivery of eye care--part II.

The provision of eye care within the previously described regional model requires that resources be distributed in a rational manner. In a levels of care approach those eye care services that would meet most of the people's needs most of the time would be provided at the primary level, on an ambulatory basis. At the secondary level those more specialized services such as glaucoma surgery would be provided, usually at the community hospital setting. At the tertiary level those superspecialized services requiring the resources of a major medical center would be provided. Such a system of eye care would require changes in the role and responsibility of both optometrists and ophthalmologists.     

Perceived barriers to the provision of low vision services among ophthalmologists in India

PURPOSE: To identify and report the perceived barriers to the provision of low vision services among ophthalmologists in India. METHODS: Seventy nine ophthalmologists responded to a structured self-administered questionnaire. Information was collected to understand the level of awareness and barriers/constraints to provision of low vision services. Significant factors associated with each barrier/constraint and perceptions on providing low vision care were investigated. RESULTS: Lack of training/knowledge [65 (82.3%)], lack of awareness [59 (74.7%)] and non-availability of low vision devices [57 (72.2%)] were perceived as the major constraints / barriers to providing low vision care. At least one significant factor was found for each of the above constraints/barriers in providing low vision care. The perception of lack of awareness as being one of the constraints/barriers was significantly higher [OR 3.97 (95% CI, 1.02 - 7.8)] among ophthalmologists from organisations providing low vision services. The perception of lack of motivation as constraint/barrier was significantly higher [OR 3.62 (95% CI, 1.3 - 10.3)] among ophthalmologists from organisations providing low vision services and/or those involved in VISION 2020: The Right to Sight programmes [OR 3.83 (95% CI, 1.4 - 10.4)]. The likelihood of responding that low vision care is time consuming was greater for those belonging to a teaching institute [OR 7.19 (95% CI, 2.0 - 26.1)], those involved in low vision services [OR 5.45 (95% CI, 1.8 - 16.5)] and those who knew that low vision is a priority in VISION 2020 [OR 15.1, 95% CI, 1.5 -155.4]. CONCLUSION: Ophthalmologists need more education about the benefits of low vision care in order to increase their level of awareness and knowledge.     

临床视觉电生理学教学模式改革经验

 视觉电生理检查作为客观的视功能检查方法在眼科临床工作中具有重要意义，但大部分眼科医师对此技术一知半解。这与当前眼科继续教育和研究生教育等精英教育现况相关。本文总结多年临床视觉电生理学教学实践经验，分享该课程设计、教学实施和课程考核等多个环节的改革经验，对医学精英教育的探索有一定参考价值。（眼科，2020，29： 315-317）     

【In Press】Smartphones, Tele-Ophthalmology, and VISION 2020

Telemedicine is an emerging field in recent medical achievements with rapid development. The smartphone availability has increased in both developed and developing countries even among people in rural and remotes areas. Tele-based services can be used for screening ophthalmic diseases and also monitoring patients with known diseases. Electronic ophthalmologic records of the patients including captured images by smartphones from anterior and posterior segments of the eye will be evaluated by ophthalmologists, and if Patients require further evaluations, they will be referred to experts in the relevant field. Eye diseases such as cataract, glaucoma, age-related macular degeneration, diabetic retinopathy, and retinopathy of prematurity are the most common causes of blindness in many countries and beneficial use of teleophthalmology with smartphones will be a good way to achieve the aim of VISION 2020 all over the world. Numerous studies have shown that teleophthalmology is similar to the conventional eye care system in clinical outcomes and even provides more patient satisfaction as it saves time and cost. This review explains how teleophthalmology helps to improve patient outcomes through smartphones.     

Optometry/Ophthalmology: the Future

• 1 The most serious problem for the future of optometry and ophthalmology is surplus manpower. It is imperative that the two groups immediately join in future eye-manpower studies before we face an insoluble problem.
• 2 It is important that moderate leadership of optometry and ophthalmology put more time and effort into reducing the conflict between our two professions. The present actions by optometry and ophthalmology in legislative hearings are producing nothing but harm and a lack of credibility for optometry and ophthalmology. In general we are looked upon as ‘money grabbers’.
• 3 It is important that greater efforts be made in the area of joint education between optometry and ophthalmology in order to obtain not only better patient care but also to develop a better understanding of our roles in the eye-healthcare field. To obtain this, ophthalmology should provide leadership in developing programmes for optometrists. However, it is equally important that optometry ask ophthalmology to assist in formulating joint programmes.
• 4 It is important that we expand MD-OD or OD-MD committees that meet on a regular basis in order to discuss inter professional problems and to present a joint front in areas of common interests where unified action will be of benefit to the public, optometrists and ophthalmologists.
• 5 It is desirable to form more group practices of optometrists and ophthalmologists in order to provide better services at lower costs. The increasing costs of instruments, salaries, rent, etc., are making solo practice in metropolitan areas too expensive to provide services at a reasonable cost.
• 6 If optometry and ophthalmology fail to form closer relationships, the future is not good for either group, because the third party who pays the bills and the public will take advantage of our inability to respond rapidly to social problems and health-care costs.
• 7 It is important that optometry and ophthalmology review their individual attempts to obtain consumer attention, because the present actions result in consumer confusion. Despite both optometry's and ophthalmology's efforts to ‘educate the public’, a majority of consumers think of eye doctors and not the difference between the skills and practices of optometrists and ophthalmologists. Many consumers interpret these educational efforts of the public by both optometry and ophthalmology as serving the self-interest of each group and increasing eye-health-care costs.

(The Carel C. Koch Award Lecture, 1977 reprinted by kind permission of the American Journal of Optometry and Physiological Optics 55, 1 .)     

An international strategic plan to preserve and restore vision: four curricula of ophthalmic education

PURPOSE: To highlight the four International Curricula of Ophthalmic Education developed by the Task Forces of the International Council of Ophthalmology, published in Klinische Monatsbl?tter für Augenheilkunde in November 2006. DESIGN: A global perspective of developing educational curricula as tools to improve eye care. METHODS: Review of the experience and conclusions of the four international panels. RESULTS: The Task Force on Resident and Specialist Education developed a curriculum consisting of 15 topics in basic, standard, and advanced levels to provide flexibility of educational programs of the ophthalmic specialist in different locations across the world. The curricula were designed to be an educational tool to stimulate multiple levels of training of the ophthalmic specialist. The Task Force on Ophthalmic Education of Medical Students designed a curriculum covering 11 topics and provides illustrative materials for teachers and students. The Task Force strongly advocates the ophthalmology curriculum to be part of the core program of general medical schools education. The Task Force on Para-ophthalmic Vision Specialist Education developed a curriculum to highlight the importance of a team approach to eye care, consisting of ophthalmic specialists and paraophthalmic personnel to produce maximum efficiency. The Task Force on Continuing Medical Education (CME) designed a curriculum exploring the principles, elements, categories, and administration of CME activities in a variety of topics. CONCLUSIONS: These curricula shifted the traditional apprentice system of education to a curriculum-based training program in which goals, expectations, competencies, and technical training are defined to improve eye care worldwide.     

Benefits and risks of immediately sequential bilateral cataract surgery: a literature review

Immediately sequential bilateral cataract surgery (ISBCS) is a highly contended issue in ophthalmology, mainly due to the risk of bilateral endophthalmitis and financial penalties that many ophthalmologists face when performing simultaneous cataract surgeries. The purpose of this review is to understand the current status of the knowledge of ISBCS, mainly its benefits and risks and how they compare with the standard of care, delayed sequential bilateral cataract surgery. Evidence, although limited, increasingly supports ISBCS for providing faster rehabilitation, improved visual outcomes, and cost and time savings. Evidence does not support the fear of bilateral endophthalmitis resulting from the simultaneous procedure. However, stronger and greater evidence is needed before ISBCSs can be considered the standard of care. Where ISBCS can potentially create the most beneficial impact is in public eye health programmes in developing countries, but this has not yet been explored.     

Prevalence of non-vision-impairing conditions in a village in Chakwal district, Punjab, Pakistan

PURPOSE: To determine the prevalence of non-vision-impairing ocular conditions (NVIC) and estimate the number of primary eye care treatments per 1000 population per month. METHODS: A cross-sectional study in a random sample of 1670 people was done to determine the load of NVIC in a village in Chakwal district. RESULTS: The prevalence of NVIC was 30.6% (306 per 1000 population). NVIC with the exclusion of presbyopia accounted for 14.6%. The main NVIC were allergic conjunctivitis (3.7%), bacterial conjunctivitis (3.5%), pterygium/pinguicula (2.6%) and acute/chronic dacryocystitis (1%). The average Complaint Frequency (CF) per month/1000 population was 55, excluding complaints of near vision and watery eyes. CONCLUSIONS: The foundation of a comprehensive district eye care strategy in the light of VISION 2020 - the Right to Sight - remains an effective primary eye care service whose elements are treatment of NVIC, detection and referral of cataracts and refractive errors, and promotion of eye health.     

Prevalence of non-vision-impairing conditions in a village in Chakwal district,Punjab, Pakistan

purpose To determine the prevalence of non-vision-impairing ocular conditions (NVIC) and estimate the number of primary eye care treatments per 1000 population per month. methods A cross-sectional study in a random sample of 1670 people was done to determine the load of NVIC in a village in Chakwal district. results The prevalence of NVIC was 30.6% (306 per 1000 population). NVIC with the exclusion of presbyopia accounted for 14.6%. The main NVIC were allergic conjunctivitis (3.7%), bacterial conjunctivitis (3.5%), pterygium/pinguicula (2.6%) and acute/chronic dacryocystitis (1%). The average Complaint Frequency (CF) per month/1000 population was 55, excluding complaints of near vision and watery eyes. conclusions The foundation of a comprehensive district eye care strategy in the light of VISION 2020 - the Right to Sight - remains an effective primary eye care service whose elements are treatment of NVIC, detection and referral of cataracts and refractive errors, and promotion of eye health.     

Patient expectations for medical and surgical care: a review of the literature and applications to ophthalmology

Over the past several decades, emphasis on patient-centered care, the dramatic growth of refractive surgery in the United States, and increasing competition in the eye care marketplace have made patient expectations increasingly important in the field of ophthalmology. Patient-centered care recognizes the obligation to understand and meet patient's expectations. Despite increasing patient expectations for refractive surgery and eye care in general, however, there has been limited research on patient expectations within the field of ophthalmology. The vast majority of existing research on patients' expectations has focused on expectations of primary care physicians. Because ophthalmologists are involved in both surgical and medical care, it is important to expand the consideration of patient expectations beyond the traditional primary care setting. Using elements of the taxonomy developed by Kravitz (Kravitz RL: Patients' expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev 53:3-27, 1996), this article reviews the existing literature on patient expectations and draws attention to the limited research in specialty and surgical fields. This article has the following objectives: 1) provide a context for understanding what patient expectations are, 2) review the different ways that patient expectations are measured, 3) illustrate the content of patient expectations from empirical research, 4) outline potential determinants of patient expectations, and 5) discuss the role of patient expectations in ophthalmology.     

山东省三级甲等医疗机构眼科现状调查

 目的 了解山东省三级甲等医疗机构眼科资源和服务能力,为全省防盲治盲工作的有效开展提供依据。设计 横断面问卷调查。研究对象 山东省28家三级甲等医院眼科。方法 以信函方式由山东省卫生厅发放中华医学会设计的《眼科基本情况调查表》,调查表由眼科负责人填写,收集后对相关数据进行分析。主要指标 医护人员数量、医护人员职称与学历、医疗设备数量、门诊量等。结果 2011年山东省28所三甲医院眼科开放床位数875张,病区47个,均为有科主任或者负责人的独立科室。眼科共统计各类设备468件。眼科医务人员总数844人,其中眼科医师、护理人员分别占51.3％和48.7%,平均每所医院的眼科医师15.5人,医师高级、中级和初级及以下职称所占比重分别为47.1%、34.9%和18.0%;省部属医疗机构眼科执业医师数量［（23.7±12.3）人］明显多于市级［（12.1±7.2）人］医疗机构（t=2.364,P=0.00）。从2008年到2010年山东省眼科平均年门诊人次从25 289人次增长为27 528人次,科室平均年出院人次从1203人次增长为1423人次,科室平均年手术人次从914人次增长为1133人次,均呈递增趋势;平均住院日从7.49日缩减为7.01日,呈递减趋势;山东省开展的眼科手术每年均以白内障手术居多,从2008年开展8155例到2010年开展10595例,每年均占总手术量的50%以上。结论 山东省眼科医疗服务水平有所提高,但是眼科资源配置不均衡,需要进一步资源整合和优化,为患者提供更高质量的眼保健服务。