Anna Palagyi

Correction of refractive error and presbyopia in Timor-Leste

Aim: To investigate the aspects of spectacle correction of vision-impairing refractive error and presbyopia in those aged ⩾40 years in Timor-Leste. Method: A population-based cross-sectional survey with cluster random sampling was used to select 50 clusters of 30 people. Those who had uncorrected or undercorrected refractive error (presenting acuity worse than 6/18, but at least 6/18 with pinhole), uncorrected or undercorrected presbyopia (near vision worse than N8), and/or who were using or had used spectacles were identified. Dispensing history, willingness to wear and willingness to pay for spectacles were elicited. Results: Of 1470 people enumerated, 1414 were examined (96.2%). The “met refractive error need” in the sample was 2.2%, and the “unmet refractive error need” was 11.7%. The “refractive error correction coverage” was 15.7%. The “met presbyopic need” was 11.5%, and the “unmet presbyopic need” was 32.3%. The “presbyopia correction coverage” was 26.2%. Lower correction coverage was associated with rural domicile, illiteracy and farming. Of the sample, 96.0% were willing to wear spectacles correcting impaired vision. Of these, 17.0% were willing to pay US

Prevalence and causes of blindness and low vision in Timor-Leste

3 (£1.52, €2.24) for spectacles, whereas 50.2% were unwilling to pay US

Eye care in Timor-Leste: a population-based study of utilization and barriers

1 (£0.51, €0.75). Women and rural dwellers were less likely to be willing to pay at least US

The Impact of Reduced Distance and Near Vision on the Quality of Life of Adults in Timor-Leste

1 for spectacles. Conclusion: Refractive error and presbyopia correction coverage rates are low in Timor-Leste. There is a large need for spectacles, especially for elderly and illiterate people, farmers and rural dwellers: those least able to pay for them. An equitable cross-subsidisation spectacle system should be possible.

Barricades and brickwalls - a qualitative study exploring perceptions of medication use and deprescribing in long-term care

Aim: To estimate the prevalence and causes of blindness and low vision in people aged ⩾40 years in Timor-Leste. Method: A population-based cross-sectional survey using multistage cluster random sampling to identify 50 clusters of 30 people. A cause of vision loss was determined for each eye presenting with visual acuity worse than 6/18. Results: Of 1470 people enumerated, 1414 (96.2%) were examined. The age, gender and domicile-adjusted prevalence of functional blindness (presenting vision worse than 6/60 in the better eye) was 7.4% (95% CI 6.1 to 8.8), and for blindness at 3/60 was 4.1% (95% CI 3.1 to 5.1). The adjusted prevalence for low vision (better eye presenting vision of 6/60 or better, but worse than 6/18) was 17.7% (95% CI 15.7 to 19.7). Gender was not a risk factor for blindness or low vision, but increasing age, illiteracy, subsistence farming, unemployment and rural domicile were risk factors for both. Cataract was the commonest cause of blindness (72.9%) and an important cause of low vision (17.8%). Uncorrected refractive error caused 81.3% of low vision. Conclusion: Strategies that make good-quality cataract and refractive error services available, affordable and accessible, especially in rural areas, will have the greatest impact on vision impairment.

Cataract and its surgery in Timor-Leste

Background:  To determine utilization of Western‐style conventional health services for eye problems in Timor‐Leste, and barriers to seeking that care.

Equity and Blindness: Closing Evidence Gaps to Support Universal Eye Health.

PURPOSE To determine the independent, relative, and combined impact of reduced distance and near vision on the vision-specific quality of life (VS QOL) of adults in Timor-Leste. DESIGN A population-based cross-sectional eye health survey was conducted in urban and rural areas in Timor-Leste. PARTICIPANTS Participants were 40 years or older. Those with better eye presenting distance vision worse than 6/18, and every third participant with 6/18 or better vision, completed the VS QOL questionnaire: in total 704 of the 1414 participants. METHODS Distance and near visual acuities were measured and eye health was assessed. The VS QOL questionnaire administered by interview was analyzed using Rasch analysis, univariate analysis, and linear regression to determine associations between VS QOL, demographic factors, and levels of visual impairment. MAIN OUTCOME MEASURES The Timor-Leste VS QOL questionnaire results. RESULTS Rasch analysis confirmed that for participants both with and without visual impairment, the Timor-Leste VS QOL questionnaire provided a valid and reliable measure, was unidimensional, and had appropriate response categories. There was a consistent pattern of deterioration in VS QOL as vision worsened: for each category of distance- and near-vision impairment, there was an independent and significant change in Timor-Leste VS QOL scores between no visual impairment and either mild, moderate, or severe impairment (P < 0.05). Combined distance- and near-vision impairment was associated with a greater impact on VS QOL than categories separately, the impact of severe distance- and near-vision impairment being the greatest and clinically significant: -3.05 (95% confidence interval [CI], -3.60 to -2.49; P<0.05; and 95% CI, <-1.0). Distance vision (37.2%) contributed relatively more than near vision (4.7%) to the total variance in VS QOL (41.9%). Older people, those not married, not literate, and rural dwellers had significantly worse Timor-Leste VS QOL scores (P < 0.05). CONCLUSIONS This study provides evidence of independent dose-response relationships between distance- and near-vision impairment and poorer VS QOL. Distance-vision impairment had a relatively larger impact on VS QOL than near-vision impairment. Combined distance- and near-vision impairment was associated with a greater impact on VS QOL compared with the independent impact of distance- or near-vision impairment at similar levels.

Applying standards to readymade spectacles used in low-resource countries.

BackgroundThe co-administration of multiple drugs (polypharmacy) is the single most common cause of adverse drug events in the older population, and residents of long-term care facilities (LTCFs) are at particularly high risk of medication harm. ‘Deprescribing’ – the withdrawal of an inappropriate medication with goal of managing polypharmacy and improving outcomes – may improve the quality of life of LTCF residents. The RELEASE study sought to explore perceptions of medication use and the concept of deprescribing in LTCFs.MethodsFocus groups and interviews were conducted with General Practitioners (GPs), pharmacists, nursing staff, residents and their relatives within three LTCFs in the Illawarra-Shoalhaven region of NSW, Australia. Audiotapes were transcribed verbatim and, using the Integrative Model of Behaviour Prediction as a framework, thematic analysis of transcripts was conducted using QSR NVivo 10.ResultsParticipants acknowledged the burden of too many medications (time to administer, physical discomfort, cost), yet displayed passivity towards medication reduction. Residents and relatives lacked understanding of medicine indications or potential harms. Willingness to initiate and accept medication change was dependent on the GP, who emerged as a central trusted figure. GPs preferred ‘the path of least resistance’, signalling systems barriers (poor uniformity of LTCF medical records, limited trained LTCF personnel); time constraints (resident consultations, follow-up with specialists and family); and the organisation of care (collaborating with LTCF staff, pharmacists and prescribing specialists) as obstacles to deprescribing.ConclusionsTargeted engagement is required to raise awareness of the risks of polypharmacy in LTCFs and encourage acceptance of deprescribing amongst residents and their relatives. GPs are integral to the success of deprescribing initiatives within this sector.

Spectacles in Fiji: need, acquisition, use and willingness to pay

Purpose:  To determine the prevalence of visually significant and unoperated blinding cataract, and the coverage, characteristics and outcome of cataract surgery in Timor‐Leste.

Using assessment of willingness to pay to improve a Cambodian spectacle service

Abstract Purpose: The World Health Organization Program for the Prevention of Blindness adopted the principles of universal health coverage (UHC) in its latest plan, Universal Eye Health: A Global Action Plan, 2014–2019. This plan builds on the achievements of Vision 2020, which aimed to reduce the global prevalence of avoidable blindness, and its unequal distribution, by the year 2020. Methods: We reviewed the literature on health equity and the generation and use of evidence to promote equity, particularly in eye health. We describe the nature and extent of the equity-focused evidence to support and inform eye health programs on the path to universal eye health, and propose ways to improve the collection and reporting of this evidence. Results: Blindness prevalence decreased in all regions of the world between 1990 and 2010, albeit not at the same rate or to the same extent. In 2010, the prevalence of blindness in West Africa (6.0%) remained 15 times higher than in high-income regions (0.4%); within all regions, women had a higher prevalence of blindness than men. Beyond inter-regional and sex differences, there is little comparable data on the distribution of blindness across social groups within regions and countries, or on whether this distribution has changed over time. Similarly, interventions known to address inequity in blindness are few, and equity-relevant goals, targets and indicators for eye health programs are scarce. Conclusion: Equity aims of eye health programs can benefit from the global momentum towards achieving UHC, and the progress being made on collecting, communicating and using equity-focused evidence.