by Lucy Goodman | 30 Aug, 2024 | Resources
Key messages:
Eye health surveys generate essential information for planning new services. Some surveys specifically target underserved groups (e.g. people living in rural areas), while many exclude some groups (e.g. those without housing). In future, researchers can consider ways they can better consider underserved groups when planning their survey.
Read the published paper and download the plain language summary of the findings.
Why do a population-based eye health survey?
Eye health surveys are used to gather information about the number of people in a population who have eye health conditions and to identify any groups of people who have unmet need for eye health services. This evidence can be used to develop more equitable eye care services.
Why did we do this research?
Our aim was to summarise the different ways that previous eye health surveys have included underserved groups. This information can be used in future eye health surveys that wish to better include these groups.
What did we do?
We identified all eye health surveys published globally since the year 2000 that estimated the number of people with impaired vision. Underserved groups were defined according to pre-determined criteria (examples included women, people living in rural areas, and unemployed people). We summarised the different ways that underserved groups were considered in the way the survey was designed, conducted, or how the results were reported.
What did we find?
Almost all surveys considered underserved groups in some way, and the number of groups considered within each survey has increased over this time. Most surveys considered groups retrospectively, such as by comparing prevalence estimates between different groups. Very few surveys prospectively considered underserved groups when designing the survey (e.g. by using recruitment strategies that enabled underserved groups to participate). Some underserved groups were actively excluded from surveys, particularly those without stable housing.
What are the implications of this research?
Some population groups with large unmet eye health needs are rendered invisible by commonly used survey methods. Small surveys of specific underserved groups are needed to supplement large national-level surveys, so that policy makers have information about the eye health needs of everyone in the population.
Citation: Goodman L, Reis T, Zhang JH, et al. Underserved groups could be better considered within population-based eye health surveys: A methodological study. J. Clin. Epidemiol. 27 June 2024. doi: 10.1016/J.JCLINEPI.2024.111444. Available here.
Funding: This work was not funded by a specific grant from the public, commercial, or not-for-profit sectors.
by Lucy Goodman | 29 Aug, 2024 | Evidence base, News
PhD candidate Nimisha Chabba presenting her work at the IAPB conference in June 2024.
PhD candidate Nimisha Chabba from the Community Eye Health team is supporting global efforts to improve eye care by refining the way that diabetic retinopathy services are monitored and reported worldwide.
Diabetes is a public health concern, as the number of people living with the disease is expected to reach 643 million by 2030. Diabetes can cause bleeding from vessels on the retina at the back of the eye (known as diabetic retinopathy), and this is the leading cause of vision loss in people of working age. Fortunately, regular eye screening and treatment can help people with diabetes to maintain good vision.
For policymakers and clinicians working to reduce vision loss from diabetes, a key priority is to gain a better understanding of access to diabetes eye care services, and how effective these services are at preserving vision. Guided by her PhD supervisors A/Prof Jacqueline Ramke and Dr Pushkar Silwal who offer their experience in eye health and health systems research, Nimisha hopes to improve the tools available to monitor diabetic eye services globally.
“We first need to understand what types of diabetic eye services are available and how many people they are reaching,” says Nimisha. “Only then can individual countries develop new and better services for people with diabetes.”
In 2022, the World Health Organization (WHO) released an Eye Care Indicator Menu (ECIM)—as the name suggests, a series of measures (known as “indicators”) that individual countries can use to monitor their own eye care services in a consistent way. Included in the Menu was an indicator to monitor retinal screening coverage—that is, the proportion of people with diabetes who have accessed these services.
Importantly, the amount of data reporting this indicator is unknown, and the first stage of Nimisha’s PhD is to address this knowledge gap by summarising all the existing literature worldwide that reports diabetic retinopathy screening coverage.
Nimisha presented the preliminary findings of her research and the plan for her PhD at the IAPB’s 2030 IN SIGHT Live meeting in Mexico City in June 2024. Of note, Nimisha described significant variability in the way that services worldwide report retinal screening coverage, which means that access to diabetic retinopathy screening cannot be easily compared between settings.
“It’s important that we have the right measures available to help countries monitor whether diabetic retinopathy services are effectively reaching the people who need them,” says eye health researcher A/Prof Jacqueline Ramke.
Looking towards the next phases of her PhD research, Nimisha hopes to expand WHO’s existing diabetic retinopathy indicator by developing a way to measure and assess service access concurrently with quality (known as an “effective coverage” indicator for diabetic retinopathy). To do this, she plans to collect feedback from international experts and reach a consensus about how effective coverage should be defined, and then test out the new indicator using local data from Aotearoa New Zealand. This work will have global impact by supporting the efforts of WHO and IAPB to improve monitoring and reporting of eye care services worldwide, and Nimisha is well on the way towards achieving her goals.
“Strengthening the monitoring of diabetic retinopathy services can help reduce vision loss, and I’m excited to be a part of this,” she says.
Sources:
Chabba, N. et al. What is the coverage of retina screening services for people with diabetes? Protocol for a systematic review and meta-analysis. BMJ Open 14, e081123 (2024). Read the published protocol here.
by Lucy Goodman | 24 Jun, 2024 | Community engagement, General, News
Members of the Community Eye Health Team on the first day of the Whakaaturanga Rangahau Wiki Hauora (Health Week Research Expo) at Kia Aroha Campus: Left to right: Joanna Black, Jaymie Rodgers, Sachi Rathod, Jacqui Ramke, Telusila Vea
In May 2024, the Community Eye Health team took part in the Whakaaturanga Rangahau Wiki Hauora (Health Week Research Expo) at Kia Aroha Campus in South Auckland.
Kia Aroha school offers a learning approach that encourages Year 1 to 13 students’ Māori and Pacific cultural identify. As an initiative of Iwi United Engaged—an organisation committed to advancing Maori health and wellbeing—the Health Research Expo aims to bring together health research with tamariki and their whanau within the wider community.
The event was engaging for both students and the visiting kairangahau (researchers), with over twenty different interactive displays on offer. Over the three-day event, the Vision Bus Aotearoa staff and students provided free vision screening services and follow-up care to Year 9 children, alongside other wellness checks. Meanwhile, other Community Eye Health team members were busy engaging with tamariki about eyes and vision, and the students were excited to take home their own pair of 3D glasses and some information packs about “eye health”.
We thank Kia Aroha school for inviting us to participate in this event, and we hope to see you again next year.
ngā mihi nui | fa’afelai lava | malo ‘aupito
by Lucy Goodman | 16 Jun, 2024 | Resources
Key messages:
Countries concerned with eye health should consider strategies to improve access to spectacles. In Australia and New Zealand, eye health experts identified Indigenous people as the population group to be prioritized in efforts to improve access to refractive error services. Reducing out-of-pocket costs via public funding for refractive error correction was the most promising strategy identified by these experts to improve access.
Read the published paper and download the plain language summary of the findings.
About refractive error:
Throughout the world, the most common cause of impaired vision is uncorrected refractive error—a condition where the eye cannot focus light correctly, leading to blurry eyesight. Refractive error can (usually) be corrected with spectacles or contact lenses. However, even in countries where spectacles are readily available, they are often unaffordable for some people. Improving access to spectacles is one of the most effective ways that a country can reduce the number of people experiencing impaired vision.
Why did we do this research?
We conducted this research to identify different ways that countries in the Western Pacific could improve access to spectacles.
What did we do?
This study gathered opinions from eye care experts in 17 countries within the Western Pacific region. Experts provided their opinions on the population groups that faced the most barriers to refractive error services, and the strategies they believed would be more effective to provide these services. The experts provided multiple rounds of feedback to prioritise the important strategies in each region.
What did we find in Australasia?
Of the 75 experts, 15 were from Australia or New Zealand. Many of the population groups and strategies identified by these experts were unique to this region. Australasian experts identified Indigenous people as the population group to whom services were least accessible.
Reducing out-of-pocket costs by providing publicly funded services to certain population groups (e.g. elderly, low-income groups, and children) was the most promising strategy to improve access to eye examinations or spectacles.
Other strategies to improve access to eye examinations included:
- Improving cultural safety of the services so that people feel comfortable using the service.
- Establishing refractive services in regions where they are most needed, and incentivising optometrist to work there.
Other strategies to improve access to spectacles included:
- Health promotion to raise awareness and acceptance of spectacle wear.
- Using readymade spectacles where suitable (alongside messaging of the importance of regular eye checks).
- Regular screening of adults who are likely to need near vision correction (~>40 years), e.g. during medical examinations in the workplace
Citation: McCormick I, Tong K, Abdullah N, et al. Strategies to address inequity of uncorrected refractive error in the Western Pacific: A modified Delphi process. Ophthalmic and Physiological Optics. Published Online First: 16 June 2024. doi: 10.1111/opo.13348
Funding: This work was not funded by a specific grant from the public, commercial, or not-for-profit sectors.
by Lucy Goodman | 26 Mar, 2024 | Resources
Key messages
New Zealand has very little evidence describing vision impairment or access to eye care services. Reassuringly, recent studies often compare their findings between Māori and Pacific People and other ethnic groups. The evidence we do have consistently reports that eye care services are less accessible to Māori and Pacific People compared to other ethnic groups.
Read the published paper and download the plain language summary of the findings.
Inequities in eye health
Health inequities are common in Aotearoa New Zealand. In particular, Māori experience poorer access to services and subsequently poorer health compared to other population groups in New Zealand. However, we don’t know if this is the case for eye health services, and eye health has received little attention by policy makers. To improve eye health, policy makers need to know the number of people and the population groups who are most in need of eye health services. While further research may be needed to answer these questions, some of the information could be identified from existing evidence.
Why did we do this research?
We wanted to identify and summarise all the existing evidence of inequities in eye health between different population groups—particularly between Māori and other ethnic groups. This will help us identify what types of research is still needed.
What did we do?
We looked for all published studies about eye health in New Zealand. Studies were eligible if they reported the number of people with impaired vision, or access to an eye care service (such as the number of people attending a vision screening service). We did this in a systematic way, by searching databases for published evidence and carefully screening the results using pre-defined criteria.
What did we find?
New Zealand has very little published evidence describing the prevalence of vision impairment or access to eye health services. We found 47 relevant studies published since 1960. Almost all this evidence comes from data collected from health facilities (e.g. hospitals), which means the information is not relevant to everyone in the population. Many studies were about diabetic retinopathy (an eye condition resulting from diabetes), or cataract. Since the year 2000, studies have consistently compared their findings between Māori or Pacific People and one or more other ethnic groups. These studies reported that Māori and Pacific People experienced worse access to services compared to other groups.
What’s next?
Future eye health services need to address barriers and enablers to eye care services experienced by Māori and Pacific People. In addition, we need more evidence describing the number of people with vision impairment in the general population, and access to services for all major eye conditions.
Citation: Rogers JT, Black J, Harwood M, et al. Vision impairment and differential access to eye health services in Aotearoa New Zealand: a scoping review. BMJ Public Health. 2024;2:e000313. doi: 10.1136/BMJPH-2023-000313.
Funding: This work was not funded by a specific grant from the public, commercial, or not-for-profit sectors.
