Susan H. Forster

Identifying barriers to follow-up eye care for children after failed vision screening in a primary care setting

PURPOSE To identify barriers to follow-up eye care in children who failed a visual acuity screening conducted by their primary care provider. METHODS Children aged 3-14 years who failed a visual acuity screening were identified. A phone survey with the parent of every child was conducted 4 months after the screening. Family demographics, parental awareness of childhood eye diseases and eye care for children, and barriers to follow-up eye care were assessed. RESULTS Of 971 children sampled, 199 (20.5%) failed a visual acuity screening. The survey was completed by the parents of 58 children (29.1%), of whom 27 (46.6%) presented for follow-up examination. The most common reason for failure to follow-up was parental unawareness of screening results (29.3%). Follow-up rates were higher in children with previous eye examinations than in those without (81% versus 17%; P = 0.005) and in children who waited <2 months for a follow-up appointment than in those who had to wait longer (100% versus 63%; P = 0.024). Childs sex, ethnicity, and health insurance status, parents marital, education and employment status, household income, and transportation access were not associated with statistically significant different follow-up rates. CONCLUSIONS Parental unawareness of a failed visual acuity screening is an important barrier to obtaining follow-up. Strategies to improve follow-up rates after a failed visual acuity screening may include communicating the results clearly and consistently, providing education about the importance of timely follow-up, and offering logistic support for accessing eye appointments to families.

Willingness to use follow-up eye care services after vision screening in rural areas surrounding Chennai, India

Aims To assess the willingness to utilise follow-up eye care services among participants of community vision screenings in rural villages surrounding Chennai. Methods Vision screening participants aged ≥40 years were selected by systematic sampling and were invited to respond to a pretested verbal survey with close-ended questions before undergoing screening. Results Two hundred and ninety-two people responded. Among the respondents, 50.3% reported experiencing an eye problem, and 53% of these individuals had never had an eye examination. Acceptance rate for eye surgery, medications, and eyeglasses among the respondents was 59.2%, 52.7% and 90.8%, respectively. These acceptances were not associated with sex, age, or employment; medication acceptance was inversely associated with literacy. Surgery acceptance and medication acceptance were associated with area of residence. Presence of another chronic disease was a predictor for surgery acceptance among respondents experiencing eye problems. Conclusions Maintaining consistent quality of services delivered is crucial for increasing uptake of existing eye care services. Educational interventions may increase eye care service usage by targeting all demographic subgroups of rural populations equally. Additional interventions should be offered to patients without previous exposure to the healthcare system.

Assessing Impact of Community Health Nurses on Improving Primary Care Use by Homeless/Marginally Housed Persons

This study invited a cross-sectional sample of 112 homeless/marginally housed adults in New Haven, CT to respond to a structured survey questionnaire. Seventy-six individuals responded. Among them, 39 (51%) had utilized primary care services during the preceding 2 years. Multivariate logistic regression analysis adjusting for age, sex, ethnicity, housing status, health insurance status, and self-reported health status found that having utilized primary care services was significantly associated with having regular contact with a community health nurse. This finding indicates that community health nurses may have a significant influence in increasing primary care service utilization by homeless and marginally housed individuals.

Prevalence of Ocular Manifestations of HIV/AIDS in the Highly Active Antiretroviral Therapy (HAART) Era: A Different Spectrum in Central South China

Abstract Purpose: To investigate ocular manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in a population in central south China during a time of highly active antiretroviral therapy (HAART). Methods: A cross-sectional study in central south China was performed between June 2009 and April 2010. Ocular examinations were performed on recruited patients with HIV/AIDS. Systemic information (including CD4+ T cell count) was also collected where possible. Results: Among 1041 patients (2082 eyes) with HIV/AIDS enrolled in our study, we found a broad spectrum of ocular manifestations related to HIV/AIDS. The prevalence of HIV-associated ocular disease was 23.73% (247 patients). Of those with ocular complications, 87.85% had CD4 counts <200 cells/µL. HIV retinopathy (12.68%) was the most common HIV-associated ocular finding, followed by cytomegalovirus retinitis (6.72%). Prevalences of visual impairment and blindness were 7.59% and 0.77%, respectively. Conclusions: This epidemiologic study shows the spectrum of ocular lesions associated with HIV/AIDS in central south China. Our findings highlight the need for routine ophthalmic examinations in this population, even in patients who are asymptomatic, especially those at high risk, in the era of HAART.

Effect of education sessions of a structured school eye screening programme on Indian schoolteachers’ knowledge and responsibility for children’s eye health

Objective: To evaluate the effect of education sessions on Indian schoolteacher awareness of childhood eye health issues, responsibility for children’s eye health, and successful participation in a teacher-led eye screening health intervention programme in primary schools aimed at addressing avoidable childhood blindness in India. Design: Quantitative study, pre-intervention and post-intervention surveys and questionnaires. Setting: One hundred and four government-employed schoolteachers in primary schools of Hyderabad, India. Method: Prior to the screening intervention programme, questionnaires were administered to evaluate baseline teacher knowledge and observed responsibility for management of children’s eye health. The intervention consisted of three one-hour educational training sessions at central community locations about children’s eye health and proper screening practices, followed by on-site monitoring of teacher screenings after a period of 10 school days. Post-programme questionnaires and surveys were administered to evaluate changes in knowledge and attitudes. Results: Despite low levels of pre-programme knowledge and felt responsibility, teachers demonstrated significant improvements in overall knowledge of eye parts and functions, common childhood diseases, and local myths (39.3% to 63.7%, p < 0.01) and significant increases in felt responsibility for children’s eye health (45.5% to 77.8%, p < 0.01) through the course of the programme. Conclusion: Apart from technical training, educational sessions may play an important role in promoting sustained teacher interest in school-based health intervention programmes and overall impact on community health. Urban schoolteachers have therefore been identified as promising candidates in the continued effort to eliminate avoidable childhood blindness in India and other parts of the developing world.