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Harvey AA, Morjaria P, Tousignant B. Priorities in school eye health in low and middle-income countries a scoping review. Eye (Lond) 2024:10.1038/s41433-024-03032-1. [PMID: 38565599 DOI: 10.1038/s41433-024-03032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/02/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
School eye health (SEH) has been on the global agenda for many years, and there is mounting evidence available to support that school-based visual screenings are one of the most effective and cost-efficient interventions to reach children over five years old. A scoping review was conducted in MEDLINE, Web of Science, PubMed, and CINHAL between February and June 2023 to identify current priorities in recent literature on school eye health in low- and middle-income countries (LMICs). Selection of relevant publications was performed with Covidence, and the main findings were classified according to the WHO Health Promoting Schools framework (HPS). A total of 95 articles were included: cross-sectional studies (n = 55), randomised controlled trials (n = 7), qualitative research (n = 7) and others. Results demonstrate that multi-level action is required to implement sustainable and integrated school eye health programmes in low and middle-income countries. The main priorities identified in this review are: standardised and rigorous protocols; cost-effective workforce; provision of suitable spectacles; compliance to spectacle wear; efficient health promotion interventions; parents and community engagement; integration of programmes in school health; inter-sectoral, government-owned programmes with long-term financing schemes. Even though many challenges remain, the continuous production of quality data such as the ones presented in this review will help governments and other stakeholders to build evidence-based, comprehensive, integrated, and context-adapted programmes and deliver quality eye care services to children all over the world.
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Affiliation(s)
- Alex-Anne Harvey
- Department of Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Peek Vision, Berkhamsted, UK
| | - Benoit Tousignant
- Department of Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada.
- School of Optometry, Université de Montréal, Montreal, QC, Canada.
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Wong B, Singh K, Everett B, O’Brien KS, Ravilla T, Khanna RC, Chase H, Frick KD. The case for investment in eye health: systematic review and economic modelling analysis. Bull World Health Organ 2023; 101:786-799. [PMID: 38024247 PMCID: PMC10680113 DOI: 10.2471/blt.23.289863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To assess how the returns on investment from correcting refractive errors and cataracts in low- and middle-income countries compare with the returns from other global development interventions. Methods We adopted two complementary approaches to estimate benefit-cost ratios from eye health investment. First, we systematically searched PubMed® and Web of Science™ on 14 August 2023 for studies conducted in low-and-middle-income countries, which have measured welfare impacts associated with correcting refractive errors and cataracts. Using benefit-cost analysis, we compared these impacts to costs. Second, we employed an economic modelling analysis to estimate benefit-cost ratios from eye health investments in India. We compared the returns from eye health to returns in other domains across global health and development. Findings We identified 21 studies from 10 countries. Thirteen outcomes highlighted impacts from refractive error correction for school students. From the systematic review, we used 17 out of 33 outcomes for benefit-cost analyses, with the median benefit-cost ratio being 36. The economic modelling approach for India generated benefit-cost ratios ranging from 28 for vision centres to 42 for school eye screening, with an aggregate ratio of 31. Comparing our findings to the typical investment in global development shows that eye health investment returns six times more benefits (median benefit-cost ratio: 36 vs 6). Conclusion Eye health investments provide economic benefits with varying degrees based on the intervention type and location. Our findings underline the importance of incorporating eye health initiatives into broader development strategies for substantial societal returns.
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Affiliation(s)
- Brad Wong
- Mettalytics, 23 Philip St, South Golden Beach 2483, New South Wales, Australia
| | | | - Bryce Everett
- Department of Economics, College of Arts and Sciences, University of San Francisco, San Francisco, United States of America (USA)
| | - Kieran S O’Brien
- Department of Ophthalmology, Institute for Global Health Sciences, University of California San Francisco, San Francisco, USA
| | - Thulasiraj Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Rohit C Khanna
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | | | - Kevin D Frick
- Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, USA
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Sil A, Aggarwal P, Sil S, Mitra A, Jain E, Sheeladevi S, Murthy G. Design and delivery of the Refractive Errors Among Children (REACH) school-based eye health programme in India. Clin Exp Optom 2023; 106:859-868. [PMID: 37914536 DOI: 10.1080/08164622.2022.2125793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
CLINICAL RELEVANCE Optimisation of vision screening programmes can result the detection of refractive anomalies in a high proportion of school children. BACKGROUND The Refractive Errors Among Children (REACH) programme aims to optimise outcomes of school-based vision screening in India by collaborating with hospitals and monitoring eye care throughout school attendance. METHODS REACH delivers school vision screening using pocket vision screeners (cards presenting rows of seven 0.2 logMAR Sloan letters at a 3 m viewing distance) in five states across India. Children who fail screening are referred for detailed evaluation including refraction, those requiring cycloplegic refraction are referred to partner hospitals. Spectacles are dispensed as needed and compliance is assessed. All data are recorded electronically. RESULTS Out of 2,240,805 children aged 5 to 18 (mean 11.5; SD ±3.3) years, 2,024,053 have undergone REACH screening in 10,309 schools predominantly in rural locations (78.7%) and government-funded (76%). Of those screened, 174,706 (8.6%) underwent detailed evaluation. A higher proportion of children in private or urban schools (11.8% and 10.4% respectively) were referred for detailed evaluation than those in government-funded or rural schools (5.9% and 7.2%, respectively; p < 0.001). The proportion referred for detailed evaluation differed by state (p < 0.001), from 4.0% in West Bengal to 14.4% in Kerala. CONCLUSION The REACH programme screened a high proportion of school children, providing further care and follow-up to optimise visual outcomes.
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Affiliation(s)
- Asim Sil
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | | | - Subhra Sil
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | - Ankita Mitra
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | - Elesh Jain
- Department of Community Ophthalmology, Sadguru Netra Chikitsalaya, Madhya Pradesh, India
| | | | - Gvs Murthy
- Department of Public Health, Indian Institute of Public Health, Telangana, India
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Wu L, Feng J, Zhang M. Implementing interventions to promote spectacle wearing among children with refractive errors: A systematic review and meta-analysis. Front Public Health 2023; 11:1053206. [PMID: 36969641 PMCID: PMC10036364 DOI: 10.3389/fpubh.2023.1053206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/16/2023] [Indexed: 03/12/2023] Open
Abstract
PurposeTo investigate the level of compliance of children with refractive errors who are provided free spectacles, and to identify the reasons for non-compliance.MethodsWe systematically searched the PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library databases from the time these databases were established to April 2022, including studies published in English. The search terms were “randomized controlled trial” [Publication Type] OR “randomized” [Title/Abstract], OR “placebo” [Title/Abstract]) AND ((“Refractive Errors”[MeSH Terms] OR (“error refractive” [Title/Abstract] OR “errors refractive” [Title/Abstract] OR “refractive error” [Title/Abstract] OR “refractive disorders” [Title/Abstract] OR “disorder refractive” [Title/Abstract] OR “disorders refractive” [Title/Abstract] OR “refractive disorder” [Title/Abstract] OR “Ametropia” [Title/Abstract] OR “Ametropias” [Title/Abstract])) AND (“Eyeglasses” [MeSH Terms] OR (“Spectacles” [Title/Abstract] OR “Glasses”[Title/Abstract]) AND (“Adolescent” [MeSH Terms] OR (“Adolescents” [Title/Abstract] OR “Adolescence”[Title/Abstract]) OR “Child”[MeSH Terms] OR “Children”[Title/Abstract])). We only selected studies that were randomized controlled trials. Two researchers independently searched the databases, and 64 articles were retrieved after the initial screening. Two reviewers independently assessed the quality of the collected data.ResultsFourteen articles were eligible for inclusion, and 11 studies were included in the meta-analysis. The overall compliance with spectacle use was 53.11%. There was a statistically significant effect of free spectacles on compliance among children (OR = 2.45; 95% CI = 1.39–4.30). In the subgroup analysis, longer follow-up time was associated with significantly lower reported ORs (6–12 vs. <6 months, OR = 2.30 vs. 3.18). Most studies concluded that sociomorphic factors, RE severity, and other factors contributed to children not wearing glasses at the end of the follow-up.ConclusionThe combination of providing free spectacles along with educational interventions can lead to high levels of compliance among the study participants. Based on this study's findings, we recommend implementing policies that integrate the provision of free spectacles with educational interventions and other measures. In addition, a combination of additional health promotion strategies may be needed to improve the acceptability of refractive services and to encourage the consistent use of eyewear.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=338507, identifier: CRD42022338507.
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Affiliation(s)
- Linrong Wu
- Joint Shantou International Eye Center (JSIEC) of Shantou University & The Chinese University of Hong Kong, Shantou, China
- School of Public Health, Shantou University, Shantou, China
| | - Jiayi Feng
- Joint Shantou International Eye Center (JSIEC) of Shantou University & The Chinese University of Hong Kong, Shantou, China
- School of Public Health, Shantou University, Shantou, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center (JSIEC) of Shantou University & The Chinese University of Hong Kong, Shantou, China
- *Correspondence: Mingzhi Zhang
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Marmamula S, Bhoopalan D, Kumbham TR, Yelagondula VK, Keeffe J. Prevalence, pattern, and compliance with spectacles use among the elderly in homes for the aged in South India: The Hyderabad Ocular Morbidity in Elderly Study (HOMES). Indian J Ophthalmol 2023; 71:263-267. [PMID: 36588247 PMCID: PMC10155529 DOI: 10.4103/ijo.ijo_884_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 01/03/2023] Open
Abstract
Purpose This study was conducted to report on the pattern of spectacles use and compliance among the elderly (aged ≥60 years) in homes for the aged in Hyderabad region in Telangana State, India. Methods Participants were recruited from 41 homes for the aged centres for comprehensive eye health assessments. A questionnaire was used to collect information on current and past use of spectacles, type of spectacles, spectacles provider and amount paid for the spectacles. For those that reported using spectacles in the past, information was collected on the reasons for their discontinuation. Compliance with spectacles use was assessed after eight months of provision of the spectacles. Results A total of 1182/1513 participants were examined from 41 homes for the aged in Hyderabad, India. The mean age of the participants examined was 75 years (standard deviation (SD): 8.8 years; range: 60-108 years); 764 (64.6%) of them were women and 240 participants (20.3%) had no formal education. The prevalence of spectacles use was 69.9% (95% confidence interval [CI]: 67.1-72.4; n = 825). Bifocals were the most commonly used type of spectacles (86.7%) followed by single vision glasses for distance vision (7.4%). Private eye clinics were the largest service provider (85.5%) followed by local optical outlets (6.9%) and other service providers (7.7%). The prevalence of spectacles compliance was 81.5% (211/259). Conclusion Use of spectacles and compliance are high among the elderly living in residential care homes in the Hyderabad region. Spectacles use can be further improved by periodic eye assessments along the lines similar to school eye programs, which can immensely benefit this vulnerable, aged population.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
- DBT/Wellcome Trust India Alliance, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Dharani Bhoopalan
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Thirupathi R Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vijay Kumar Yelagondula
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jill Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Sabherwal S, Sood I, Siddiqui Z, Majumdar A, Singh BP, DasGupta S, Ganesh S. Door-to-door Screening as a New Model Augmenting School Eye Screening: Reaching Out to School Age Children in the Midst of a Pandemic. Ophthalmic Epidemiol 2022:1-9. [PMID: 36121011 DOI: 10.1080/09286586.2022.2123003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE Explore door-to-door eye screening in India as a model to reach school age children in need of eye care, especially during school closures due to the Covid-19 pandemic. METHODS Children between 5 and 18 years were screened in an urban-slum of Delhi from September 2020 to March 2021. Screening included capturing ocular complaints, visual acuity and conducting a torchlight examination. Children with any eye-related complaints, gross abnormality or a LogMAR acuity of more than 0.2 in either eye were referred to the nearby vision centre. Data were disaggregated by gender and age group. Reporting after referral and proportion of true positives referrals were used to assess the model. RESULTS 32,857 children were screened. 55% were boys. Only 917 children (2.8%) had previous eye examinations. 1814 (5.5%) children were referred. Overall compliance rate amongst those referred was 59% (1070 of 1814) and compliance was significantly higher (72%) amongst those referred with poor vision as compared to those with only ocular morbidities (38%). Overall compliance was significantly higher amongst older age group (64% vs 50%) and amongst girls than boys (61% vs 56%). 3.9% children were detected with refractive error (RE) and 2.5% with uncorrected RE which was significantly higher in girls and in older age group. Of 1070 children reporting after referral, 85% had confirmed diagnosis for RE or other ocular pathology. CONCLUSION Door-to-door screening had good referral compliance and positive predictive value. We recommend this model as a supplement to school screening especially in regions with low enrolment and high absenteeism in schools.
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Affiliation(s)
- Shalinder Sabherwal
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Ishaana Sood
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Zeeshan Siddiqui
- Department of Community Outreach, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Atanu Majumdar
- Biostatistician, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Birendra Pratap Singh
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Shantanu DasGupta
- Department of Community Operations and Strategic Planning, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Suma Ganesh
- Department of Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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