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Rajagopal RN, Murthy SI, Rathi VM. Microbial keratitis and its management at a rural centre: achieving success with limited resources. Int Ophthalmol 2024; 44:205. [PMID: 38676784 DOI: 10.1007/s10792-024-03125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Microbial keratitis is a sight-threatening condition with a higher incidence in agrarian populations. In countries with a high indigent population, due to financial and other constraints, patients prefer to seek therapy locally rather than travel to advanced centres. The aim of this study is to describe the epidemiology, clinical characteristics, and outcomes of 60 consecutive patients with microbial keratitis managed at a rural centre. METHODS Descriptive case series. All patients clinically diagnosed with infectious keratitis were included. Corneal scrapings were obtained and microbiological identification was done by Gram stain. Anti-microbial therapy was commenced based on smear findings and the patients were followed up till disease resolution. RESULTS Sixty eyes of 60 patients were diagnosed with microbial keratitis in the study period. The mean age was 47.43 ± 18.69 years. Male:female ratio was 47:53. Risk factors included ocular trauma in the majority of patients (46/60; 76.7%). Microorganisms were identified on 75.6% of smears, with fungal filaments (65.4%) being the most common. Ulcers were central in over half (32/60; 53.3%), and > 3 mm in diameter in over three-fourths (81.6%) of patients. Forty-four patients (73.3%) achieved treatment success whereas 16/60 (26.6%) required referral to our tertiary-eye care facility for management. The median time to resolution was 14 days (IQR 10-26 days). CONCLUSION Our series demonstrates the feasibility of microbiology-guided therapy in microbial keratitis by ophthalmologists at the secondary rural eye-care level. Two-thirds of the patients could be successfully managed at the rural centre and only severe cases needed a referral to tertiary centres.
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Affiliation(s)
- Raksheeth Nathan Rajagopal
- Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, India
- The Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute (LVPEI), Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500034, India
| | - Somasheila I Murthy
- The Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute (LVPEI), Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500034, India.
| | - Varsha M Rathi
- The Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute (LVPEI), Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500034, India
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute (LVPEI), LV Prasad Marg, Hyderabad, India
- Indian Health Outcomes, Public Health Outcomes and Health Economics (IHOPE), L V Prasad Eye Institute, Hyderabad, India
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Ugalahi MO, Onebunne EO, Olusanya BA, Baiyeroju AM. Familial Cataracts: Profile of Patients and Their Families at a Child Eye Care Tertiary Facility in a Developing Country. Korean J Ophthalmol 2023; 37:314-321. [PMID: 37400084 PMCID: PMC10427905 DOI: 10.3341/kjo.2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/27/2023] [Accepted: 07/02/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE The aim of this study is to describe the clinical profile, pedigree charting, and management of children with familial cataracts at a child eye health tertiary facility in southwest Nigeria. METHODS The clinical records of children ≤16 years diagnosed with familial cataracts at the Pediatric Ophthalmology Clinic, University College Hospital Ibadan (Ibadan, Nigeria) from January 1, 2015, to December 31, 2019, were retrospectively reviewed. Information on demographic data, family history, visual acuity, mean refractive error (spherical equivalent), and surgical management was retrieved. RESULTS The study included 38 participants with familial cataract. The mean age at presentation was 6.30 ± 3.68 years, with a range of 7 months to 13 years. Twenty-five patients (65.8%) were male. All patients had bilateral involvement. The mean duration from onset of symptoms to presentation at the hospital was 3.71 ± 3.20 years, with a range of 3 months to 13 years. In 16 of the 17 pedigree charts obtained, at least one individual was affected in each generation. The most common cataract morphology was cerulean cataract, observed in 21 eyes (27.6%). The most common ocular comorbidity was nystagmus which was observed in seven patients (18.4%). Sixty-seven eyes of 35 children underwent surgery within the period of the study. The proportion of eyes that had best-corrected visual acuity ≥6 / 18 before surgery was 9.1%; this proportion had increased to 52.7% at the last postoperative visit. CONCLUSIONS Autosomal dominant inheritance appears to be the major pattern among our patients with familial cataract. The most common morphological type found in this cohort was cerulean cataract. Genetic testing and counseling services are vital for the management of families with childhood cataract.
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Affiliation(s)
- Mary Ogbenyi Ugalahi
- Department of Ophthalmology, College of Medicine, University of Ibadan, University College Hospital, Ibadan,
Nigeria
| | | | - Bolutife Ayokunnu Olusanya
- Department of Ophthalmology, College of Medicine, University of Ibadan, University College Hospital, Ibadan,
Nigeria
| | - Aderonke Mojisola Baiyeroju
- Department of Ophthalmology, College of Medicine, University of Ibadan, University College Hospital, Ibadan,
Nigeria
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Kabylbekova A, Meirmanov S, Aringazina A, Orazbekov L, Auyezova A. Age at recognition and age at presentation for surgery for congenital and developmental cataract in Kazakhstan. Ann Med 2022; 54:1988-1993. [PMID: 35833752 PMCID: PMC9291700 DOI: 10.1080/07853890.2022.2091156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the age at recognition and presentation for surgery for congenital and developmental cataract at Kazakh Eye Research Institute in Kazakhstan. METHODS A retrospective review of children aged 0-18 years, who presented with congenital and developmental cataract between January 1, 2010 and December 31, 2020. All medical records were reviewed. Gender, age at recognition, age at surgery, laterality, residential location (rural/urban) were recorded. RESULTS The study population included 897 patients of children presented with congenital and developmental cataract over a 10-year study period, 58% of them were boys and 44.6% were from rural areas. Cataract was bilateral in 621 (69.2%) and unilateral in 276 (30.8%) of patients. Median age at recognition for patients with congenital/developmental cataract was 12 months. Median age at surgery for congenital/developmental cataract was 51 months. Only 14.7% of children underwent surgery within first year of life. The urban citizens underwent surgery earlier than patients from rural areas. The median delay in presentation for surgery was 15 months. CONCLUSION The average age at cataract surgery in the population of Kazakhstan is much older than in developed countries. It is essential to study barriers that associated with delayed presentation to build strategies to overcome them.Key messagesIt is known that cataract surgery in children early in life provides favourable visual outcome.Children with congenital and developmental cataract in Kazakhstan experience delay in surgical treatment.Children from rural areas undergo cataract surgery later than urban citizens.
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Affiliation(s)
- Aliya Kabylbekova
- Department of Population Health and Social Science, Kazakhstan's Medical University "KSPH", Almaty, Kazakhstan
| | - Serik Meirmanov
- College of Asia Pacific Studies, Ritsumeikan Asia Pacific University, Beppu City, Japan
| | - Altyn Aringazina
- Caspian International School of Medicine, Caspian University, Almaty, Kazakhstan
| | - Lukpan Orazbekov
- Department of Pediatric Ophthalmology, Kazakh Eye Research Institute, Almaty, Kazakhstan
| | - Ardak Auyezova
- Department of Population Health and Social Science, Kazakhstan's Medical University "KSPH", Almaty, Kazakhstan
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Fang R, Yu YF, Li EJ, Lv NX, Liu ZC, Zhou HG, Song XD. Global, regional, national burden and gender disparity of cataract: findings from the global burden of disease study 2019. BMC Public Health 2022; 22:2068. [DOI: 10.1186/s12889-022-14491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To evaluate the global burden of cataracts by year, age, region, gender, and socioeconomic status using disability-adjusted life years (DALYs) and prevalence from the Global Burden of Disease (GBD) study 2019.
Methods
Global, regional, or national DALY numbers, crude DALY rates, and age-standardized DALY rates caused by cataracts, by year, age, and gender, were obtained from the Global Burden of Disease Study 2019. Socio-demographic Index (SDI) as a comprehensive indicator of the national or regional development status of GBD countries in 2019 was obtained from the GBD official website. Kruskal-Wallis test, linear regression, and Pearson correlation analysis were performed to explore the associations between the health burden with socioeconomic levels, Wilcoxon Signed-Rank Test was used to investigate the gender disparity.
Results
From 1990 to 2019, global DALY numbers caused by cataracts rose by 91.2%, crude rates increased by 32.2%, while age-standardized rates fell by 11.0%. Globally, age-standardized prevalence and DALYs rates of cataracts peaked in 2017 and 2000, with the prevalence rate of 1283.53 [95% uncertainty interval (UI) 1134.46–1442.93] and DALYs rate of 94.52 (95% UI 67.09–127.24) per 100,000 population, respectively. The burden was expected to decrease to 1232.33 (95% UI 942.33–1522.33) and 91.52 (95% UI 87.11–95.94) by 2050. Southeast Asia had the highest blindness rate caused by cataracts in terms of age-standardized DALY rates (99.87, 95% UI: 67.18–144.25) in 2019. Gender disparity has existed since 1990, with the female being more heavily impacted. This pattern remained with aging among different stages of vision impairments and varied through GBD super regions. Gender difference (females minus males) of age-standardized DALYs (equation: Y = -53.2*X + 50.0, P < 0.001) and prevalence rates (equation: Y = − 492.8*X + 521.6, P < 0.001) was negatively correlated with SDI in linear regression.
Conclusion
The global health of cataracts is improving but the steady growth in crude DALY rates suggested that health progress does not mean fewer demands for cataracts. Globally, older age, females, and lower socioeconomic status are associated with higher cataract burden. The findings of this study highlight the importance to make gender-sensitive health policies to manage global vision loss caused by cataracts, especially in low SDI regions.
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May E, Arach P, Kishiki E, Geneau R, Maehara G, Sukhai M, Hamm LM. Learning to see after early and extended blindness: A scoping review. Front Psychol 2022; 13:954328. [PMID: 36389599 PMCID: PMC9648338 DOI: 10.3389/fpsyg.2022.954328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/26/2022] [Indexed: 10/03/2023] Open
Abstract
PURPOSE If an individual has been blind since birth due to a treatable eye condition, ocular treatment is urgent. Even a brief period of visual deprivation can alter the development of the visual system. The goal of our structured scoping review was to understand how we might better support children with delayed access to ocular treatment for blinding conditions. METHOD We searched MEDLINE, Embase and Global Health for peer-reviewed publications that described the impact of early (within the first year) and extended (lasting at least 2 years) bilateral visual deprivation. RESULTS Of 551 reports independently screened by two authors, 42 studies met our inclusion criteria. Synthesizing extracted data revealed several trends. The data suggests persistent deficits in visual acuity, contrast sensitivity, global motion, and visual-motor integration, and suspected concerns for understanding complex objects and faces. There is evidence for resilience in color perception, understanding of simple shapes, discriminating between a face and non-face, and the perception of biological motion. There is currently insufficient data about specific (re)habilitation strategies to update low vision services, but there are several insights to guide future research in this domain. CONCLUSION This summary will help guide the research and services provision to help children learn to see after early and extended blindness.
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Affiliation(s)
- Eloise May
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | | | - Robert Geneau
- Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Goro Maehara
- Department of Human Sciences, Kanagawa University, Yokohama, Japan
| | - Mahadeo Sukhai
- Accessibility, Research and International Affairs, Canadian National Institute for the Blind, Toronto, ON, Canada
- Department of Ophthalmology, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Lisa M. Hamm
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
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Trotignon G, Engels T, Saeed Ali S, Mugwang’a Z, Jones I, Bechange S, Kaminyoghe E, Adera TH, Schmidt E. Measuring equity of access to eye health outreach camps in rural Malawi. PLoS One 2022; 17:e0268116. [PMID: 35594293 PMCID: PMC9122225 DOI: 10.1371/journal.pone.0268116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Equity in the access and use of health services is critical if countries are to make progress towards universal health coverage and address the systematic exclusion of the most vulnerable groups. The purpose of this study was to assess if the Co-ordinated Approach To Community Health programme implemented by Sightsavers was successful in reaching the poorest population, women, and people living with disabilities in Kasungu district, Malawi. Methods Between April and September 2017, data on socio-economic status, household characteristics and functional disability were collected from patients attending at eye camps in Kasungu district, Malawi. Using asset-based tools to measure household wealth (EquityTool© and Simple Poverty Scorecard©) and the Washington Group Short Set of Questions, individuals were categorised by wealth quintiles, poverty status, and functional disability status and then compared to relevant representative national household surveys. In addition, a follow-up household survey was conducted to check the validity of self-reported household characteristics at eye camps. Results A total of 1,358 individuals participated in the study. The study shows that self-reported data on household characteristics and assets are reliable and can be collected in clinical settings (instead of relying on direct observations of assets). Individuals attending outreach camps were poorer in terms of relative wealth and absolute poverty rates compared to the rest of the population in Kasungu. It was estimated that 9% of the participants belonged to the poorest quintile compared to 4% for the population in Kasungu (DHS 2015–2016). The ultra-poverty rate was also lower among respondents (13%) compared to 15% for Kasungu district (IHS 2017). The functional disability rate was 27.5% for study participants, and statistically higher than the general population (5.6%, SENTIF 2017). Even though women are more at risks than men, 54% of the participants were men. Conclusions Our study shows that existing tools can be reliably used, and combined, if based on recent population data, to assess equity of access to health services for vulnerable groups of the population. The findings suggest that the programme was successful in reaching the poorest people of the Kasungu district population as well as those with disabilities through outreach camps but that more men than women were reach through the programme. Subsequently, our study showed that self-reported household characteristics are a reliable method to measure asset-based wealth of camps’ attendee. However, it is essential to use sub-national data (district or regional level) from recent surveys for the purpose of benchmarking in order to produce accurate results.
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Affiliation(s)
| | - Thomas Engels
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
| | | | | | - Iain Jones
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
| | | | | | | | - Elena Schmidt
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
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Jolley E, Virendrakumar B, Pente V, Baldwin M, Mailu E, Schmidt E. Evidence on cataract in low- and middle-income countries: an updated review of reviews using the evidence gap maps approach. Int Health 2022; 14:i68-i83. [PMID: 35385873 PMCID: PMC8986350 DOI: 10.1093/inthealth/ihab072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
In 2014, Sightsavers developed the first evidence gap map (EGM) to assess the extent and quality of review-level evidence on cataract relevant to low-and middle-income countries. The EGM identified 52 studies across five broad themes. This paper reports the update of the EGM conducted in 2021 and changes to the extent and quality of the evidence base. We updated the EGM using the exact process conducted to develop the original. Searches were run to 14 September 2021, and two independent reviewers selected eligible studies, critically appraised them and extracted data using the Supporting the Use of Research Evidence checklist. A summary quality assessment was shared with the authors for comments. Forty-six new reviews were identified, and the EGM now includes 98 reviews. The new reviews predominantly focus on treatment and risk factors. The overall methodological quality was found to be improved, with 13/46 reporting high confidence in findings. EGMs remain a useful tool for policy-makers to make informed decisions and periodic updates are important to assess changes and to refine the focus for future research. The EGM highlights significant disparity in the topics addressed by reviews, with health system interventions particularly neglected.
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Affiliation(s)
- Emma Jolley
- Sightsavers UK, Haywards Heath, RH16 3BW, UK
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Kulkarni S, Gilbert C, Giri N, Hankare P, Dole K, Deshpande M. Visual impairment and blindness among children from schools for the blind in Maharashtra state, India: Changing trends over the last decade. Indian J Ophthalmol 2022; 70:597-603. [PMID: 35086244 PMCID: PMC9023984 DOI: 10.4103/ijo.ijo_1930_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India. Methods: Children aged <16 years, enrolled in the schools for the blind in Maharashtra state, India were examined between October 2018 and December 2019. The anatomical sites and etiology for blindness were recorded using the World Health Organization’s standard reporting form. Causes of blindness were compared among different regions of the state and also by different age groups. Results: Of the 1,969 students examined from 39 schools for the blind, 188 children (9.5%) had severe visual impairment and 1,666 children (84.6%) were blind. Whole globe anomalies (794, 42.8%) were the most common anatomical site of vision loss in children, followed by corneal (289, 15.6%) and retinal abnormalities (280, 15.2%). Corneal causes were second most common in the poorer districts of Vidarbha (15.3%) and Marathwada (14.6%), whereas retinal causes were second most common in the wealthier regions of western Maharashtra (18.3%) and Khandesh (24.1%). Nearly one-third (593, 32%) of children were blind from potentially avoidable causes. Preventable blindness consisting of corneal causes and retinopathy of prematurity was seen in 281 (15.2%) cases, whereas treatable causes comprising of lens-related causes, glaucomas, refractive errors, amblyopia, and uveitis accounted for another 311 (16.8%). Among the younger children (≤10 years), the proportion of corneal blindness was lower (83/623, 13.3% vs. 206/1232, 16.7%) and that of retinal blindness was higher (119/623, 19% vs. 163/1232, 13.2%) than the older children. Conclusion: Whole globe anomalies constitute a major cause of SVI and blindness in Maharashtra. There seems to be an increase in the proportion of retinal blindness, especially retinopathy of prematurity, suggesting a need for increased screening coverage.
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Affiliation(s)
- Sucheta Kulkarni
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Nilesh Giri
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Pravin Hankare
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Kuldeep Dole
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - M Deshpande
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
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Ezeh E, Nkanga E, Okonkwo S, Agweye C, Ibanga A, Nkanga D. Paediatric cataracts in a tertiary eye centre in South-South Nigeria: An initial audit of surgical outcome. Niger J Med 2022. [DOI: 10.4103/njm.njm_40_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kulkarni S, Lawande DD, Dharmadhikari S, Deshpande CM. Exploring the barriers for eye care among transgenders and commercial sex workers in Pune, Maharashtra. Indian J Ophthalmol 2021; 69:2277-2281. [PMID: 34427198 PMCID: PMC8544039 DOI: 10.4103/ijo.ijo_3480_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To explore all possible barriers faced by transgenders (TG) and commercial sex workers (CSW) in accessing eye care in Pune city in western India. Methods This qualitative study was conducted at a tertiary eye care center in Pune. Interview topic guides for face-to-face interviews and focused group discussions were developed. Comprehensive eye check-up was organized in the residential localities of TG and CSW communities in Pune. Those with severe visual impairment or blindness were identified. A sample of TGs and CSWs from this group was purposively selected and invited to participate in this study. Face-to-face interviews were conducted with each TG and CSW. A group of health care providers and NGO workers serving these communities were invited to participate in focused group discussions. All interviews/discussions were audio recorded, transcribed, and translated into English. A qualitative software (N vivo 12, QRS International, Australia) was used to identify various themes and subthemes under each domain of barriers. Results A total of 24 people (6 each from TGs, CSWs, health care provider, and NGO worker groups) participated in this study. The most common barriers reported were social stigma, discrimination, poverty, financial exclusion, and mental health factors. Non availability of gender-neutral facilities in clinics was a unique barrier reported by TGs. Conclusion Marginalized communities of TGs and CSWs in Pune face several previously unexplored and unique barriers for access to eye care despite the availability of services in the vicinity.
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Affiliation(s)
- Sucheta Kulkarni
- Department of Community Ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Devika D Lawande
- Department of Community Ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Sheetal Dharmadhikari
- Department of Community Ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Col Madan Deshpande
- Department of Community Ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
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Fabian ID, Khetan V, Stacey AW, Allen Foster, Ademola-Popoola DS, Berry JL, Cassoux N, Chantada GL, Hessissen L, Kaliki S, Kivelä TT, Luna-Fineman S, Munier FL, Reddy MA, Rojanaporn D, Blum S, Sherief ST, Staffieri SE, Theophile T, Waddell K, Ji X, Astbury NJ, Bascaran C, Burton M, Zondervan M, Bowman R. Sex, gender, and retinoblastoma: analysis of 4351 patients from 153 countries. Eye (Lond) 2021; 36:1571-1577. [PMID: 34272514 PMCID: PMC9307655 DOI: 10.1038/s41433-021-01675-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 01/26/2023] Open
Abstract
Objective To investigate in a large global sample of patients with retinoblastoma whether sex predilection exists for this childhood eye cancer. Methods A cross-sectional analysis including 4351 treatment-naive retinoblastoma patients from 153 countries who presented to 278 treatment centers across the world in 2017. The sex ratio (male/female) in the sample was compared to the sex ratio at birth by means of a two-sided proportions test at global level, country economic grouping, continent, and for selected countries. Results For the entire sample, the mean retinoblastoma sex ratio, 1.20, was higher than the weighted global sex ratio at birth, 1.07 (p < 0.001). Analysis at economic grouping, continent, and country-level demonstrated differences in the sex ratio in the sample compared to the ratio at birth in lower-middle-income countries (n = 1940), 1.23 vs. 1.07 (p = 0.019); Asia (n = 2276), 1.28 vs. 1.06 (p < 0.001); and India (n = 558), 1.52 vs. 1.11 (p = 0.008). Sensitivity analysis, excluding data from India, showed that differences remained significant for the remaining sample (χ2 = 6.925, corrected p = 0.025) and for Asia (χ2 = 5.084, corrected p = 0.036). Excluding data from Asia, differences for the remaining sample were nonsignificant (χ2 = 2.205, p = 0.14). Conclusions No proof of sex predilection in retinoblastoma was found in the present study, which is estimated to include over half of new retinoblastoma patients worldwide in 2017. A high male to female ratio in Asian countries, India in specific, which may have had an impact on global-level analysis, is likely due to gender discrimination in access to care in these countries, rather than a biological difference between sexes.
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Affiliation(s)
- Ido Didi Fabian
- International Centre for Eye Helath, London School of Hygiene & Tropical Medicine, London, UK. .,The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel.
| | | | - Andrew W Stacey
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Allen Foster
- International Centre for Eye Helath, London School of Hygiene & Tropical Medicine, London, UK
| | - Dupe S Ademola-Popoola
- University of Ilorin Teaching Hospital, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Jesse L Berry
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nathalie Cassoux
- Institut Curie, Université de Paris Medicine Paris V Descartes, Paris, France
| | | | - Laila Hessissen
- Pediatric Hematology and Oncology Department of Rabat, Mohammed V University, Rabat, Morocco
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Tero T Kivelä
- Ocular Oncology Service, Department of Ophthalmology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Sandra Luna-Fineman
- Hematology/Oncology/SCT, Center for Global Health, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile de Aveugles, University of Lausanne, Lausanne, Switzerland
| | - M Ashwin Reddy
- The Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Duangnate Rojanaporn
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sharon Blum
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Sadik T Sherief
- Department of Ophthalmology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sandra E Staffieri
- Department of Ophthalmology, Royal Children's Hospital, Parkville, VIC, Australia
| | | | | | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nicholas J Astbury
- International Centre for Eye Helath, London School of Hygiene & Tropical Medicine, London, UK
| | - Covadonga Bascaran
- International Centre for Eye Helath, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Burton
- International Centre for Eye Helath, London School of Hygiene & Tropical Medicine, London, UK
| | - Marcia Zondervan
- International Centre for Eye Helath, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Bowman
- International Centre for Eye Helath, London School of Hygiene & Tropical Medicine, London, UK.,Ophthalmology Department, Great Ormond Street Children's Hospital, London, UK
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Kulkarni S, Ramachandran R, Sivaprasad S, Rani PK, Behera UC, Vignesh TP, Chawla G, Agarwal M, Mani SL, Ramasamy K, Raman R. Impact of treatment of diabetic macular edema on visual impairment in people with diabetes mellitus in India. Indian J Ophthalmol 2021; 69:671-676. [PMID: 33595499 PMCID: PMC7942112 DOI: 10.4103/ijo.ijo_2614_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The aim of this study was to report visual and anatomical outcomes following treatment for diabetic macular edema (DME) in clinical practice in India. Methods: Retrospective chart review of patients with DME who were initiated on treatment and followed up for at least 1 year at 9 tertiary eye care centers during 2016–2017 was performed. Data on demographics, systemic illnesses, visual acuity and anatomical characteristics of DME, treatment history were collated and analyzed for change in visual acuity level and central macular thickness at 1 year. Results: A total 1853 patients were diagnosed with treatable DME during study period, 1315 patients were treated and 556 patients (1019 eyes) followed up at one year. Although patients achieved significantly better anatomical outcome (central macular thickness of <300μ in 32.3% at baseline compared to 60.7% at 1 year, P < 0.001), visual impairment due to DME did not differ from baseline (mild visual impairment in 53.2% at baseline compared to 56% at 1 year, P = 0.7). Cystoid type of DME was the most common phenotype (432/1019, 42.4%) followed by spongy type (325, 31.9%) and cystoid plus spongy type (138, 13.5%). Bevacizumab monotherapy was the most common (388/1019, 38.1%) treatment followed by combination therapy (359, 35.2%). Mean number of anti-VEGF injections received per eye in a year was 2.1 (SD ± 0.9). Conclusion: Only about a third of treated DME patients complete one year follow up in India. Most patients receive suboptimal number of treatments. Treated DME cases largely show better anatomical outcome but not a better functional outcome.
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Affiliation(s)
- Sucheta Kulkarni
- Department of Retina, PBMA's H.V. Desai Eye Hospital, Pune, India
| | - Rajalakshmi Ramachandran
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London and University College London, London, UK
| | - Padmaja Kumari Rani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Umesh C Behera
- Department of Vitreo-Retina, L V Prasad Eye Institute, Bhubaneswar, India
| | - T P Vignesh
- Department of Retina-Vitreous, Aravind Eye Hospital, Madurai, India
| | - Gajendra Chawla
- Department of Retina, Vision Care & Research Centre, Bhopal, India
| | - Manisha Agarwal
- Department of Vitreoretina, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Sheena Liz Mani
- Department of Retina, Dr. Tony Fernandez Eye Hospital, Aluva, India
| | - Kim Ramasamy
- Department of Retina-Vitreous, Aravind Eye Hospital, Madurai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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Jolley E, Buttan S, Engels T, Gillani M, Jadoon MZ, Kabona G, Mohanty RN, Mohanty S, Trotignon G, Woldeyes A, Schmidt E. Prevalence of Visual Impairment and Coverage of Cataract Surgical Services: Associations with Sex, Disability, and Economic Status in Five Diverse Sites. Ophthalmic Epidemiol 2020; 27:429-437. [PMID: 32449411 DOI: 10.1080/09286586.2020.1768553] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Prevalence of visual impairment (VI) and access to services can vary significantly across and between different population groups. With renewed focus on universal health coverage and leaving no one behind, it is important to understand factors driving inequitable eye health. This paper presents results from five population-based surveys where prevalence of VI and cataract surgical coverage (CSC) were measured and examined for differences by sex, economic-status, and disability. METHODS Rapid assessments of avoidable blindness took place in four rural sites: Kalahandi, Jhabua and Sitapur in India; and Singida, Tanzania; and one urban site: Lahore, Pakistan. In addition, the Equity Tool was used to measure economic status and the Washington Group Short Set was used to measure disability. Prevalence of VI and CSC were calculated and associations with sex, disability, and relative wealth examined. RESULTS Prevalence of VI varied from 1.9% in Lahore to 15.0% in Kalahandi. CSC varied from 39.1% in Singida to 84.0% in Lahore. Additional disability was associated with greater levels of VI in all sites and lower CSC in Singida. Being female was associated with higher VI in Kalahandi, Lahore and Singida and lower CSC in Lahore and Singida. Being poorer was associated with higher VI in Singida and lower CSC in Singida and Sitapur. CONCLUSION Relationships between VI and relative wealth, sex, and disability are complex and variable. Although certain characteristics may be associated with lower coverage or worse outcomes, they cannot be generalized and local data are vital to tailor services to achieve good coverage.
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Affiliation(s)
| | | | | | | | - Muhammad Zahid Jadoon
- Department of Epidemiology and Biostatistics, Pakistan Institute of Community Ophthalmology , Peshawar, Pakistan
| | - George Kabona
- Eye Department, Iringa Regional Referral Hospital , Iringa, Tanzania
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Evans J, Mwangi N, Burn H, Ramke J. Equity was rarely considered in Cochrane Eyes and Vision systematic reviews and primary studies on cataract. J Clin Epidemiol 2020; 125:57-63. [PMID: 32389807 DOI: 10.1016/j.jclinepi.2020.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/18/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to understand the extent to which Cochrane Eyes and Vision systematic reviews of interventions for cataract, and primary studies, consider equity. STUDY DESIGN AND SETTING This is a review of Cochrane Eyes and Vision systematic reviews (CSRs) on cataract published on the Cochrane Library (end of March 2019) (n = 23), and recently published primary studies included in those reviews (n = 62), using the PROGRESSPlus framework. RESULTS One CSR considered equity as a topic. Four (17%) CSRs included a low- and middle-income country (LMIC) author; one of them was a first author. The CSR with equity as a main topic restricted primary studies to those conducted in LMICs; otherwise none of the systematic reviews used PROGRESS factors as inclusion or exclusion criteria. None of the CSRs reported subgroup analyses by any PROGRESS factor, although these were planned in two. Two of the primary studies were led by an LMIC author; 42% involved LMIC authors; 37% were conducted in LMICs; 73% of studies reported on gender/sex of participants, but other PROGRESS factors were less frequently reported. Three studies reported subgroup analyses by sex; one reported subgroup analyses by race/ethnicity. CONCLUSION PROGRESS factors and equity are rarely considered in studies of interventions for cataract, and this is reflected in the associated Cochrane reviews.
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Affiliation(s)
- Jennifer Evans
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| | - Nyawira Mwangi
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; Department of Clinical Medicine, Kenya Medical Training College, Nairobi, Kenya
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Bell SJ, Singh T, Bunce C, Singh SK, Bascaran C, Gilbert C, Foster A. Factors influencing the decision-making of carers of children with bilateral cataract in Nepal. BMJ Open Ophthalmol 2020; 5:e000422. [PMID: 32518835 PMCID: PMC7254144 DOI: 10.1136/bmjophth-2019-000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/24/2020] [Accepted: 03/03/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives Two hundred thousand children worldwide are blind from cataract. Late presentation for surgery resulting in poor visual outcomes is a problem globally. We aimed to explore the reasons why children are not brought earlier for surgery in Nepal. Methods and analysis Mixed-method study of carers of children with bilateral cataract attending a large non-government eye hospital were administered a proforma. A random sample took part in semistructured interviews and focus group discussions. Results Carers of 102 children completed proformas; 10 interviews and 2 focus group discussions were held. 80.4% were Indian, 35.3% of children were female, and their mean age was 58 months (range 4 months to 10 years). Median delay in time between the carer first noticing a problem to presentation was 182 days IQR (60.8–364.8). This was significantly longer for girls (median 304 IQR (91.2–1094.4)) than boys (median 121.6 IQR (30.4–364.8); p=0.02). Cost to access care was a problem for 42 (41.2%) carers. 13 (12.8%) participants were not aware of treatment and 12 (11.8%) were aware but did not seek treatment. The community influenced carer’s health-seeking behaviour. Cataract was sometimes described as ‘phula’, meaning something white seen on the eye. Conclusion Fewer girls presented for surgery, and they also had a significantly longer delay to presentation than boys. Carers are influenced by factors at family, community and socio-organisational levels. Approaches to increase timely access, particularly by girls, are required, such as health education using the term phula, which is widely understood.
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Affiliation(s)
- Suzannah J Bell
- Research and Development, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Tirtha Singh
- Paediatric Ophthalmology, Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
| | - Catey Bunce
- Primary Care and Public Health Sciences, Kings College London, London, UK
| | - Sanjay Kumar Singh
- Paediatric Ophthalmology, Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
| | - Cova Bascaran
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
| | - Clare Gilbert
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
| | - Allen Foster
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
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Langawi MA, Byrnes C, Davies JC, Hamouda S, Kabra M, Rached SZ, Sands D, Shteinberg M, Taylor-Cousar J, Tullis E, Wainwright C. 'Go for it, dream big, work hard and persist': A message to the next generation of CF leaders in recognition of International Women's Day 2020. J Cyst Fibros 2020; 19:184-193. [PMID: 32156627 DOI: 10.1016/j.jcf.2020.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Abstract
The focus for International Women's Day 2020 is gender equity:'We can actively choose to challenge stereotypes, fight bias, broaden perceptions, improve situations and celebrate women's achievements. Collectively, each one of us can help create a gender equal world.' We have come together as an international group of women holding senior positions within CF to raise awareness. There is growing recognition of gender imbalance within our sector in senior leadership, grant and publication success. Several institutions, such as National Institutes of Health, have missions to tackle this. The issues raised by our panellists were wide-ranging: decisions around starting a family, impact on career progression; experiences of bias in appointments or promotions; selfbelief. We hope that raising these issues will encourage future leaders in CF to step up, to build teams based on fairness, equity and diversity, and to catalyse steps towards this goal in their institutions and society more widely.
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Affiliation(s)
- Mona Al Langawi
- Internal Medicine, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Cass Byrnes
- Starship Children's Health and Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Jane C Davies
- NHLI, Imperial College London and Royal Brompton Hospital, Cystic Fibrosis and Chronic Lung Disease Research Group, National Heart & Lung Institute, Imperial College London, Manresa Rd SW3 6LR, London, UK.
| | - Samia Hamouda
- Pediatrics Department B, Bechir Hamza Children's Hospital of Tunis, Tunisia
| | - Madhulika Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Samia Z Rached
- Pulmonary Division, Heart Institute, Hospital das Clínicas da Universidade de São Paulo, SP, Brazil
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
| | - Michal Shteinberg
- Pulmonary Division, Lady Davis-Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Elizabeth Tullis
- Internal Medicine, Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Claire Wainwright
- Respiratory and Sleep Medicine, Queensland Children's Hospital and Faculty of Medicine, University of Queensland, Brisbane, Australia
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Olusanya BA, Ugalahi MO, Adeyemo AO, Baiyeroju AM. Age at detection and age at presentation of childhood cataract at a tertiary facility in Ibadan, Southwest Nigeria. BMC Ophthalmol 2020; 20:38. [PMID: 32000728 DOI: 10.1186/s12886-020-1323-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe factors which influence the age at detection and age at presentation of patients with childhood cataract at a tertiary eye care facility in Southwest Nigeria. METHODS A retrospective review of children who presented with cataract between 2011 and 2015. Case notes were reviewed and data on age at detection and presentation as well as other clinical information was collected and analyzed using Stata 12 statistical software. RESULTS A total of 164 cases were reviewed, 52.4% of them were boys. Median age at presentation was 48 months while the median age at detection was 13.5 months. Seventy-four (45.1%) children had congenital cataract, 31.1% had developmental cataract, and 21.3% had traumatic cataract. The child's mother detected the cataract in 116 (70.7%) of the patients. Median age at presentation for patients with congenital cataract was 18 months and 84 months for developmental cataract. The median age at presentation for congenital cataracts that were noticed by the mother was 17 months compared with 72 months for those noticed by other caregivers (p = 0.0085). The median age at presentation for developmental cataracts that were noticed by the mother was 72 months compared with 114 months for those noticed by other caregivers (p = 0.0065). Gender of the child did not significantly influence the age at detection or presentation. The source of referral and the location of domicile did not significantly affect the time interval between detection of the cataract and presentation to hospital. CONCLUSION The average age of children presenting with cataracts in our setting is older than in high income countries. Detection of the cataract by the mother increases the likelihood of early presentation; thus, focused maternal education may promote earlier detection and presentation.
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Byanju RN, Kandel RP, Sharma P, Thapa HB, Shrestha M, Bassett K. Childhood blindness and visual impairment in the Narayani Zone of Nepal: a population-based survey. Ophthalmic Epidemiol 2019; 26:257-263. [PMID: 31030589 DOI: 10.1080/09286586.2019.1604976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To estimate the prevalence and causes of blindness (BL), severe visual impairment (SVI), moderate visual impairment (ModVI) and mild visual impairment (MildVI) in children in Narayani Zone, Nepal. Methods: In 2017, 100 population clusters within the Narayani Zone of Nepal were selected using RAAB software. Children (aged 0-15 years) suspected of having visual problems were identified using Key Informants (KIs) and school teachers and were referred for ophthalmologic examination. Eye care staff actively sought children who failed to present for examination. Causes of BL/SVI/ModVI/MildVI were categorized using standard World Health Organization definitions. Results: Of 76,588 children selected, 72,900 (95%) were screened. Of 2,158 children referred for examination, 1,322 were referred by teachers and 836 by KIs. A total of 1,617 (75%) children received a detailed examination, of whom 128 children [65 girls (51%)] mean age of 9.4 (± 4.1 years) were confirmed to have BL 7 (5.5%), SVI 16 (12.5%), ModVI 19 (15%) or MildVI 86 (67%). The combined prevalence of BL/SVI/ModVI/MildVI was 175/100,000 (95% CI 172-178/100,000); BL/SVI/ModVI was 55/100,000 (95% CI 53-57/100,000) and the combined BL/SVI estimate was 30/100,000 (95% CI 29-31/100,000). The leading causes of BL/SVI/MVI were refractive error 23 (55%) and whole globe disorders 5 (12%). Total avoidable causes were 31 (74%). Conclusion: The prevalence of BL/SVI/ModVI among children in Narayani Zone was moderate and included a high proportion of avoidable and treatable cases. Pediatric ophthalmic services need improvement, mainly refractive error correction in rural areas of Nepal.
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Affiliation(s)
- R N Byanju
- a Ophthalmology , Bharatpur Eye Hospital , Bharatpur , Nepal
| | | | | | | | | | - Ken Bassett
- d Department of Ophthalmology and Visual Sciences , University of British Columbia , Vancouver , Canada
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Wang D, Jiang Y, He M, Scheetz J, Wang W. Disparities in the Global Burden of Age-Related Macular Degeneration: An Analysis of Trends from 1990 to 2015. Curr Eye Res 2019; 44:657-663. [DOI: 10.1080/02713683.2019.1576907] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Decai Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Yu Jiang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Miao He
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Jane Scheetz
- Centre for Eye Research Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People’s Republic of China
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Mercer GD, Lyons P, Bassett K. Interventions to improve gender equity in eye care in low-middle income countries: A systematic review. Ophthalmic Epidemiol 2019; 26:189-199. [DOI: 10.1080/09286586.2019.1574839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gareth D. Mercer
- Department of Ophthalmology, Faculty of Medicine, McGill University, Montréal, Canada
- Seva Canada Society, Vancouver, Canada
| | | | - Ken Bassett
- Seva Canada Society, Vancouver, Canada
- British Columbia Centre for Epidemiologic and International Ophthalmology, Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Wang J, Jin L, Lu Q, Borah RR, Ali R, Li J, Chakraborti C, Kumar M, Pan J, Gilbert C, Congdon N. Barriers, Costs, and Attitudes Toward Pediatric Cataract Surgery at Two Large Facilities in China and India. Ophthalmic Epidemiol 2018; 26:47-54. [PMID: 30142020 DOI: 10.1080/09286586.2018.1513043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To better understand barriers of costs and attitudes toward pediatric cataract surgery in China and India. METHODS From January 2014 to June 2015, families of children ≤ 10 years old about to undergo or having completed surgery for bilateral, non-traumatic cataract at two tertiary centers in China and India completed questionnaires regarding their demographic characteristics, financial status, living environment, health seeking behaviors, and medical burden. RESULTS In China, 38 children (23 boys [60.5%], mean age 3.11 ± 2.88 years) were un-operated, and 44 (26 boys [59.1%], mean age 5.09 +/- 2.17 years) had undergone surgery, while in India there were 60 (44 boys [73.3%], mean age 4.61 +/- 3.32 years) and 39 (29 boys [74.4%], mean age 6.45 +/- 2.74 years) children respectively, 181 in total. Chinese children were younger at presentation (p ≤ 0.03 for both operated and un-operated) and also when cataract was detected (median [inter quartile range] 10 [3-34] versus 24 [6-60] months [p = 0.06] for un-operated, 5 [2-12] versus 36 [8-72] months [p < 0.001] for operated). Maternal education levels were lower in India (48.3% and 51.3% with elementary education only among un-operated [p = 0.11] and operated [p = 0.006] families in India versus 27.0% and 20.5% in China), as were rates of consulting medical practitioners for illness (44.7% and 36.4% for un-operated [p < 0.001] and operated [p = 0.001] in China versus 10% and 5.13% in India). CONCLUSIONS Socioeconomic challenges to securing cataract surgery may be greater, and delays in obtaining surgery longer, in India compared to China, if these facilities are representative.
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Affiliation(s)
- Jun Wang
- a Division of Preventive Ophthalmology, State Key Laboratory of Ophthalmology , Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , Guangdong , China
| | - Ling Jin
- a Division of Preventive Ophthalmology, State Key Laboratory of Ophthalmology , Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , Guangdong , China
| | - Qing Lu
- b Orbis International , New York , NY , USA
| | | | - Rahul Ali
- b Orbis International , New York , NY , USA
| | - Junhong Li
- c Translational Research for Equitable Eyecare , Shanxi Eye Hospital , Taiyuan , Shanxi , China
| | - Chandni Chakraborti
- d Department of Epidemiology , Vivekananda Mission Asram Netra Niramay Niketan , Purba Medinipur , West Bengal , India
| | - Manish Kumar
- d Department of Epidemiology , Vivekananda Mission Asram Netra Niramay Niketan , Purba Medinipur , West Bengal , India
| | - Jessica Pan
- e Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Clare Gilbert
- f Department of Clinical Research, International Centre for Eye Health (ICEH) , London School of Hygiene & Tropical Medicine , London , UK
| | - Nathan Congdon
- a Division of Preventive Ophthalmology, State Key Laboratory of Ophthalmology , Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , Guangdong , China.,b Orbis International , New York , NY , USA.,g Translational Research for Equitable Eyecare, Center for Public Health , Queen's University Belfast, Royal Victoria Hospital , Belfast N , Ireland
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Kulkarni S, Gilbert C, Zuurmond M, Agashe S, Deshpande M. Blinding Retinopathy of Prematurity in Western India: Characteristics of Children, Reasons for Late Presentation and Impact on Families. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1355-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sheeladevi S, Lawrenson JG, Fielder A, Kekunnaya R, Ali R, Borah RR, Suttle C. Delay in presentation to hospital for childhood cataract surgery in India. Eye (Lond) 2018; 32:1811-1818. [PMID: 30061651 PMCID: PMC6292888 DOI: 10.1038/s41433-018-0176-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 04/03/2018] [Accepted: 05/30/2018] [Indexed: 11/10/2022] Open
Abstract
Purpose Cataract is one of the major causes of avoidable visual disability in children and the aim of this study was to investigate the age at which children with cataract present for surgery at tertiary hospitals across India. Methods A prospective multicenter study collected data from 9 eye hospitals in 8 states in India. All children admitted for cataract surgery between Nov 2015 and March 2016 were considered eligible. Parents were interviewed at the hospital by trained personnel and socio demographic information, age at diagnosis and at surgery and the relevant clinical data were obtained from the medical records. Mean age, age range at surgery were used and performed logistic regression analyses. Results Parents of 751 consecutive cases were interviewed, of which 469(63%) were boys and 548 (73%) were from rural areas. Cataract was bilateral in 493 (66%) and unilateral in 258 (34%); of the unilateral cases, 179 (69%) were due to trauma. The mean age at surgery for ‘congenital’ and ‘developmental’ cataract was 48.2 ± 50.9 and 99.7 ± 46.42 months, respectively and the mean age was lower in the southern region compared to other regions. Children with 2 or more siblings at home were five times more likely to undergo surgery within 12 months (OR, 4.69; 95% CI: 2.04–10.79; p = < 0.001). Conclusions Late surgery for childhood cataract remains a major challenge and the factors determining this issue in India are pertinent also to several other countries and need to be addressed for every child with cataract to achieve full visual potential.
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Affiliation(s)
- Sethu Sheeladevi
- Division of Optometry and Visual Science, City, University of London, London, UK.
| | - John G Lawrenson
- Division of Optometry and Visual Science, City, University of London, London, UK
| | - Alistair Fielder
- Division of Optometry and Visual Science, City, University of London, London, UK
| | - Ramesh Kekunnaya
- Child Sight Institute & Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | | | - Catherine Suttle
- Division of Optometry and Visual Science, City, University of London, London, UK
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Asferaw M, Mekonen SY, Woodruff G, Gilbert CE, Tesfaye S. Outcome of paediatric cataract surgery in Northwest Ethiopia: a retrospective case series. Br J Ophthalmol 2018; 103:112-118. [PMID: 29669781 DOI: 10.1136/bjophthalmol-2017-311513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 11/04/2022]
Abstract
AIM To assess visual acuity outcomes, and factors associated with the outcome, of paediatric cataract surgery at the Child Eye Health Tertiary Facility, Gondar, Northwest Ethiopia. METHODS The medical records of children aged below 16 years who underwent cataract surgery between September 2010 and August 2014 were reviewed for preoperative, surgical and postoperative data. RESULTS One hundred and seventy-six eyes of 142 children (mean age 7.9 years±4.2 SD, 66% male) who had cataract surgery were included. Twenty-five per cent (35/142) of children had bilateral cataract, 18 (13%) had unilateral non-traumatic cataracts and 89 (63%) had unilateral traumatic cataracts. An intraocular lens was implanted in 93% of eyes. Visual acuities at last follow-up: bilateral cases in the better eye: good (≥6/18 or fix and follow) in 21/34 eyes (62%), borderline (<6/18-6/60) in 4 eyes (12%) and poor (<6/60) in 9 eyes (26%). In unilateral non-traumatic cases: good in 6 eyes (33%), borderline in 3 eyes (17%) and poor in 9 eyes (50%). In unilateral traumatic cases: good in 36 eyes (40%), borderline in 20 eyes (23%) and poor in 33 eyes (37%). In bilateral cataract, worse outcomes were associated with preoperative nystagmus/strabismus. In traumatic cases, worse outcomes were associated with the preoperative trauma-related complications. CONCLUSIONS Visual acuity improved significantly after surgery, with better outcomes in bilateral cases. Early detection and surgery by a trained surgeon with good follow-up and postoperative rehabilitation can lead to better visual outcomes.
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Affiliation(s)
- Mulusew Asferaw
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | | | | | - Clare E Gilbert
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
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Adhisesha Reddy P, Kishiki EA, Thapa HB, Demers L, Geneau R, Bassett K. Interventions to improve utilization of cataract surgical services by girls: Case studies from Asia and Africa. Ophthalmic Epidemiol 2017; 25:199-206. [PMID: 29125374 DOI: 10.1080/09286586.2017.1398340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Gender and blindness initiatives continue to make eye care personnel aware of the service utilization inequity strongly favouring men, yet interventions to reduce that inequity, particularly for girls, are under developed. METHODS This descriptive study gathered quantitative data on the degree of gender equity at five Child Eye Health Tertiary Facilities (CEHTFs) in Asia and Africa and conducted in-depth interviews with eye care personnel to assess their strategies and capacity to reduce gender inequity. Cataract surgery was utilized to assess the degree of inequity and success of interventions to reduce inequity in case finding, service utilization, and follow-up. RESULTS CEHTF administrative data showed significant gender inequity in cataract surgical services favouring boys in all settings. CEHTFs actively seek children through community and school-based outreach, yet do not have initiatives to reduce gender inequity. Little gender inequity was found among children receiving surgical and follow-up care, although two out of three children were boys. CEHTF staff, despite being aware, offered no effective means to reduce gender inequity involving cataract surgical services. Interventions that successfully increased service utilization by girls came from individual cases, involving extraordinary effort by a single eye care programme person. CONCLUSION Community-based case finders such as Anganwadi workers in India, Female Community Health Volunteers (FCHVs) in Nepal, and Key Informants (KIs) in Africa are necessary to identify children in need of cataract services, but insufficient to increase service utilization by girls. Secondary, often extra-ordinary community-based interventions by eye care personnel are needed in all settings.
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Affiliation(s)
- Priya Adhisesha Reddy
- a Aravind Eye Hospital and Post graduate Institute of Ophthalmology , Pondicherry , India.,b Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | | | | | | | - Robert Geneau
- f Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Ken Bassett
- e Seva Canada , Vancouver , BC , Canada.,g Department of Ophthalmology , University of British Columbia , Vancouver , BC , Canada
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White MC, Hamer M, Biddell J, Claus N, Randall K, Alcorn D, Parker G, Shrime MG. Facilitating access to surgical care through a decentralised case-finding strategy: experience in Madagascar. BMJ Glob Health 2017; 2:e000427. [PMID: 29071129 PMCID: PMC5640035 DOI: 10.1136/bmjgh-2017-000427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 11/18/2022] Open
Abstract
Over two-thirds of the world’s population lack access to surgical care. Non-governmental organisation’s providing free surgeries may overcome financial barriers, but other barriers to care still exist. This analysis paper discusses two different case-finding strategies in Madagascar that aimed to increase the proportion of poor patients, women and those for whom multiple barriers to care exist. From October 2014 to June 2015, we used a centralised selection strategy, aiming to find 70% of patients from the port city, Toamasina, and 30% from the national capital and two remote cities. From August 2015 to June 2016, a decentralised strategy was used, aiming to find 30% of patients from Toamasina and 70% from 11 remote locations, including the capital. Demographic information and self-reported barriers to care were collected. Wealth quintile was calculated for each patient using a combination of participant responses to asset-related and demographic questions, and publicly available data. A total of 2971 patients were assessed. The change from centralised to decentralised selection resulted in significantly poorer patients undergoing surgery. All reported barriers to prior care, except for lack of transportation, were significantly more likely to be identified in the decentralised group. Patients who identified multiple barriers to prior surgical care were less likely to be from the richest quintile (p=0.037) and more likely to be in the decentralised group (p=0.046). Our country-specific analysis shows that decentralised patient selection strategies may be used to overcome barriers to care and allow patients in greatest need to access surgical care.
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Affiliation(s)
- Michelle C White
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK.,Hospital Department, Mercy Ships, Cotonou, Benin.,Hospital Department, Mercy Ships, Toamasina, Madagascar
| | - Mirjam Hamer
- Hospital Department, Mercy Ships, Toamasina, Madagascar.,Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jasmin Biddell
- Hospital Department, Mercy Ships, Toamasina, Madagascar.,Department of Emergency Care, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Nathan Claus
- Hospital Department, Mercy Ships, Cotonou, Benin.,Hospital Department, Mercy Ships, Toamasina, Madagascar
| | - Kirsten Randall
- Hospital Department, Mercy Ships, Cotonou, Benin.,Hospital Department, Mercy Ships, Toamasina, Madagascar
| | | | - Gary Parker
- Hospital Department, Mercy Ships, Cotonou, Benin.,Hospital Department, Mercy Ships, Toamasina, Madagascar
| | - Mark G Shrime
- Department of Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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