Garry Brian

Cataract blindness--challenges for the 21st century.

Cataract prevalence increases with age. As the worlds population ages, cataract-induced visual dysfunction and blindness is on the increase. This is a significant global problem. The challenges are to prevent or delay cataract formation, and treat that which does occur. Genetic and environmental factors contribute to cataract formation. However, reducing ocular exposure to UV-B radiation and stopping smoking are the only interventions that can reduce factors that affect the risk of cataract. The cure for cataract is surgery, but this is not equally available to all, and the surgery which is available does not produce equal outcomes. Readily available surgical services capable of delivering good vision rehabilitation must be acceptable and accessible to all in need, no matter what their circumstances. To establish and sustain these services requires comprehensive strategies that go beyond a narrow focus on surgical technique. There must be changes in government priorities, population education, and an integrated approach to surgical and management training. This approach must include supply of start-up capital equipment, establishment of surgical audit, resupply of consumables, and cost-recovery mechanisms. Considerable innovation is required. Nowhere is this more evident than in the pursuit of secure funding for ongoing services.

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries. DOI: http://dx.doi.org/10.7554/eLife.13410.001

Risk factors for moderate and severe microbial keratitis in daily wear contact lens users

OBJECTIVE To establish risk factors for moderate and severe microbial keratitis among daily contact lens (CL) wearers in Australia. DESIGN A prospective, 12-month, population-based, case-control study. PARTICIPANTS New cases of moderate and severe microbial keratitis in daily wear CL users presenting in Australia over a 12-month period were identified through surveillance of all ophthalmic practitioners. Case detection was augmented by record audits at major ophthalmic centers. Controls were users of daily wear CLs in the community identified using a national telephone survey. TESTING Cases and controls were interviewed by telephone to determine subject demographics and CL wear history. Multiple binary logistic regression was used to determine independent risk factors and univariate population attributable risk percentage (PAR%) was estimated for each risk factor. MAIN OUTCOME MEASURES Independent risk factors, relative risk (with 95% confidence intervals [CIs]), and PAR%. RESULTS There were 90 eligible moderate and severe cases related to daily wear of CLs reported during the study period. We identified 1090 community controls using daily wear CLs. Independent risk factors for moderate and severe keratitis while adjusting for age, gender, and lens material type included poor storage case hygiene 6.4× (95% CI, 1.9-21.8; PAR, 49%), infrequent storage case replacement 5.4× (95% CI, 1.5-18.9; PAR, 27%), solution type 7.2× (95% CI, 2.3-22.5; PAR, 35%), occasional overnight lens use (<1 night per week) 6.5× (95% CI, 1.3-31.7; PAR, 23%), high socioeconomic status 4.1× (95% CI, 1.2-14.4; PAR, 31%), and smoking 3.7× (95% CI, 1.1-12.8; PAR, 31%). CONCLUSIONS Moderate and severe microbial keratitis associated with daily use of CLs was independently associated with factors likely to cause contamination of CL storage cases (frequency of storage case replacement, hygiene, and solution type). Other factors included occasional overnight use of CLs, smoking, and socioeconomic class. Disease load may be considerably reduced by attention to modifiable risk factors related to CL storage case practice.

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

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.

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

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

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.

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

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.

Awareness and Use of Eye Care Services in Fiji

Purpose: To determine the awareness, use, and barriers to use of eye services in Fijis Central Province. Methods: A cross-sectional survey study design with random clusters of households was used. Semi-structured interviews were conducted (152 females and 22 males). For 267 household members, presenting distance and near visual acuities were measured, and the perception of and satisfaction with their vision were recorded. Results: Most (86%; 150/174) respondents were aware of at least one conventional eye care service. However, only 66% (121/183) of household members with previous eye problems had consulted one of these; the proportion was even lower for those in the older age groups (p < 0.01). Rural dwellers expressed satisfaction with their vision, despite being more likely to regard it as limiting their activities and being less likely to seek conventional care. A higher proportion of females were reported to have (or have had) eye problems (60:40) and were found to have bilateral visual impairment (60:40). Despite this, females and males attended the hospital eye clinic (47:53) or sought treatment from conventional services (51:49) nearly equally. The reasons given for not seeking conventional care were “fatalistic attitude” (“did not bother”, “could manage”, or accepted the condition: 57%), expense (12%), and fear (8%). Conclusion: Central Province Fijians, particularly the old, rural, and female, under-utilise conventional eye care services. As in developing countries elsewhere, fatalistic attitudes to visual impairment are a significant contributor to this. To improve eye health, planning and implementation of eye care services must overcome under-utilisation by addressing local barriers to uptake through community participation in education and affirmative action.

Tolerance to prism induced by readymade spectacles: setting and using a standard.

Purpose. To determine first how much induced horizontal and vertical prism could be comfortably tolerated with readymade spectacle wear. Ultimately, the purpose is to develop a guide for dispensing decisions for blindness prevention programs in low-resource countries. Methods. Nine participants each wore plano spectacles with differing prism power for 8 h (plano control). If visual discomfort could not be tolerated, participants removed the spectacles, noting duration of wear and reason for discontinuation. Distance and near visual comfort were rated, and participants asked if they would be able to adapt to wearing the spectacles. Results. On average, half of the wearing time was spent on concentrated near viewing tasks. The highest prism powers (1&Dgr; BU, 2&Dgr; BO, 2&Dgr; BI) could not be worn for 8 h by the majority of participants. Comfort ratings at near (similar to those at distance) were statistically significantly different when the highest prism power was compared with each of the lower powers (vertical prism: both the control and 0.5 &Dgr; differed from 1 &Dgr;; horizontal prism: the control, 0.5 &Dgr; and 1 &Dgr; all differed from 2 &Dgr;). Conclusions. Most spectacle wearers would likely comfortably tolerate ≤0.5 &Dgr; vertical, ≤1.0 &Dgr; base out, or ≤1.0 &Dgr; base in induced prism. A guide to the maximum interpupillary distance/optical center distance disparities likely to be comfortably tolerated with varying spectacle powers was formulated. Powers up to ±1.50 DS are unlikely to have sufficient lens decentration to cause discomfort. This small study supports the feasibility of using readymade spectacles in low-resource settings even though optical center distance may be different to the interpupillary distance of the wearer. It would seem that fear of visual discomfort because of induced prism need not preclude the use of readymade spectacles, potentially correcting about 75% of refractive error and presbyopia, mostly with powers +3.00 to −3.00 DS. Further study is needed to more fully address these issues.

Cataract and its surgery in Timor-Leste

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