Ocular disorders among schoolchildren in Khartoum State, Sudan

From December 2005 to June 2007, a total screening of all 1418 government primary schools in Khartoum State, Sudan, was performed to estimate ocular problems among children aged 6-15 years. We screened 671,119 children (56.7% males) for significant refractive error and other eye ailments. Ocular problems were found in 20,321 (3.03%) children. The 3 localities with highest ocular pathology were Karary (26.2%), Ummbada (21.0%) and Jabal Awlia (15.7%). The overall prevalence of refractive error was 2.19%. Myopia was found in 10,064 (1.50%) children while 4661 (0.70%) were hyperopic. Other ocular problems included vernal keratoconjunctivitis, vitamin A deficiency, microbial conjunctivitis, strabismus and corneal opacity. Only 288 (0.04%) children were diagnosed with active trachoma: 86.5% of these were from Ummbada locality, on the periphery ofthe State, where transportation facilities are poor and poverty is widespread. Overall, 99% of the eye ailments identified are either treatable or preventable. To reduce these and to achieve the goals of Vision 2020, an effective and efficient school health programme is needed.

An assessment of recycled spectacles donated to a developing country

BACKGROUND

A rapid assessment methodology was used to determine the suitability of donated recycled spectacles for the Pacific nation of Tuvalu.

METHODS

Spectacles (102) from a donated cache were examined. Those with astigmatism of > 1.00 D, anisometropia of > 0.50 D, significant central lens scratches, broken frame, poor cosmetic fit and comfort, or unsuitable frame appearance were excluded. The refractive errors (> or = +/-0.50 D distance or near) of 320 Tuvaluans were determined.

RESULTS

Of the spectacles, 62.7% had > 1.00 DC and/or > 0.50 D anisometropia, 30% were broken and/or scratched and 50% were uncomfortable or cosmetically unacceptable. Only 13% were optically satisfactory, physically intact, and cosmetically appropriate. Of the people, 8.8% had > 1.00 DC and/or > 0.50 D anisometropia, requiring custom-made spectacles. A further 8.1% needed a -0.50 to -2.00 DS correction, for which there were no spectacles in this cache. For the other 83.1% (266), if the cache contained at least 5538 spectacles, each would eventually find a suitable pair.

CONCLUSION

If the scheme to Tuvalu is typical, refractive error will remain largely uncorrected if only donated recycled spectacles are available. No amount of efficiency and effectiveness in the delivery chain can justify the output and outcome of this recycling scheme.

Uncorrected refractive errors and spectacle utilisation rate in Tehran: the unmet need

AIM

To determine the prevalence of the met and unmet need for spectacles and their associated factors in the population of Tehran.

METHODS

6497 Tehran citizens were enrolled through random cluster sampling and were invited to a clinic for an interview and ophthalmic examination. 4354 (70.3%) participated in the survey, and refraction measurement results of 4353 people aged 5 years and over are presented. The unmet need for spectacles was defined as the proportion of people who did not use spectacles despite a correctable visual acuity of worse than 20/40 in the better eye.

RESULTS

The need for spectacles in the studied population, standardised for age and sex, was 14.1% (95% confidence interval (CI), 12.8% to 15.4%). This need was met with appropriate spectacles in 416 people (9.3% of the total sample), while it was unmet in 230 people, representing 4.8% of the total sample population (95% CI, 4.1% to 5.4%). The spectacle coverage rate (met need/(met need + unmet need)) was 66.0%. Multivariate logistic regression showed that variables of age, education, and type of refractive error were associated with lack of spectacle correction. There was an increase in the unmet need with older age, lesser education, and myopia.

CONCLUSION

This survey determined the met and unmet need for spectacles in a Tehran population. It also identified high risk groups with uncorrected refractive errors to guide intervention programmes for the society. While the study showed the unmet need for spectacles and its determinants, more extensive studies towards the causes of unmet need are recommended.

Correction of refractive error in the Victorian population: the feasibility of "off the shelf" spectacles

AIMS

To assess the feasibility of providing a stock of ready made spectacles for correction of refractive error in the general population.

METHODS

Data were collected in the Visual Impairment Project, a population based survey of Victorian residents aged 40 years or older in randomly selected urban and rural sample areas. This included a refractive eye examination and the proportion of subjects with hypermetropia, emmetropia (defined as -1.0 to +1.0D spherical equivalent), and myopia documented in the 40-60 year age group.

RESULTS

2595 (54.8%) participants were aged between 40 and 60 years. Those with a best corrected visual acuity of less than 6/12, astigmatism of more than 1.25D, and anisometropia of more than 0.5D were excluded. 516 participants had refractive error which was deemed suitable for correction by "off the shelf" spectacles. This represents 19.9% of all participants between 40 and 60 years of age. Provision of spectacles in 0.5D increments would provide suitable stock spectacles for 85.5% of a -3.0 to +3.0D range or 89.2% of a -3.50 to +3.50D range.

CONCLUSIONS

Ready made "off the shelf" spectacles could significantly alleviate visual morbidity due to refractive error in up to 20% of an urban population in Australia. This approach may also be useful in developing countries with poor access to optometric services.

Unmet need for eyeglasses: results from the 1994 Robert Wood Johnson Access to Care Survey

BACKGROUND

Although poor access to general medical care services has been documented widely, the unmet need for supplemental health care services--such as eyeglasses--has been largely ignored. This article documents the inability to obtain eyeglasses on the national level and for various subpopulations using the 1994 Robert Wood Johnson Foundation National Access to Care Survey.

METHODS

The Survey, a followup to the 1993 National Health Interview Survey, collected data on respondents' inability to obtain health care services due to access barriers. The sample comprised 3,480 observations, weighted to represent the U.S. civilian non-institutionalized population.

RESULTS

More than 5% of the U.S. population reported an unmet need for eyeglasses, and of these, more than 80% cited financial reasons as the primary barrier. Persons in poor health and blacks were most likely to face barriers to obtaining eyeglasses.

CONCLUSION

Understanding this under-served population and their unmet needs can help policymakers formulate new initiatives. The focus on preventive care within managed care organizations may ease some barriers for the insured population. Policy should focus on uninsured and underinsured working individuals who cannot afford and do not receive public assistance for needed eye care.

Sociodemographic differences in access to vision care among adults in the United States, 1974-1975

Access to refractive care is examined by comparing uncorrected and corrected (with eyeglasses or contact lenses) distance visual acuity across eight race-sex-economic status groups. Of those with less than 20/20 uncorrected distance visual acuity, the age-adjusted proportion using corrective lenses is examined across these sociodemographic groups to assess unmet need in vision care. Measurements of distance visual acuity were obtained for 2,828 adults aged 25-74 years from the national probability sample selected for the 1974-1975 National Health and Nutrition Examination Augmentation Survey. Questionnaire responses were collected on usual correction. Individuals were classified by race, sex, and economic status. Weighted least squares categoric data analysis showed that blacks, males, and nonpoor persons have a higher proportion with 20/20 uncorrected distance vision than whites, females, and poor persons. Individuals who are white, male, and nonpoor are more likely to have 20/20 corrected distance vision than their counterparts.

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