by Lucy Goodman | 29 Aug, 2024 | Diabetes, News, Student
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 | 12 Aug, 2024 | Pacific Islands, Resources
Key messages
Delivering eye health services in the Pacific Islands is challenging due to the remote location, susceptibility to the impacts of climate change, and economic instability. To direct future eye health research, we have reviewed all available evidence describing eye health in the Pacific Islands since 1980. The report illustrates that not enough research is available describing the prevalence of common eye conditions or service coverage in the Pacific islands, which makes it difficult to plan new eye care services.
Read the published report here.
Below is a Q&A with co-authors Dr Lisa Hamm, Dr Iris Wainiqolo, and A/Prof Jacqueline Ramke on their recently published report.
What was the question you were hoping to answer?
Our aim was to summarise all the research about eye health in the Pacific Islands since 1980. We wanted to know what research topics have been investigated, where they were conducted, and who was involved in funding. We were also interested in whether any of these variables have changed over time. Fundamentally, we hoped that this review would highlight the gaps and guide the future direction of the research.
What is the most important finding from this research?
Our review speaks to the wider issues faced by eye care providers and policy makers who are attempting to strengthen research capacity in the Pacific Islands. We observed that previous research about eye health in this region is influenced by external funders and researchers and does not correlate well with the eye conditions that are most important for people living in the Pacific Islands.
Why was it important to do this research?
Good eye health has many benefits for the well-being of individuals and society and underlies many of the United Nation’s Sustainable Development Goals. To support these goals, individual countries need as much information as possible describing the eye health needs of their population so that they can plan and deliver better eye care services.
Unfortunately, delivering eye health services in the Pacific Islands is challenging due to the remote location, susceptibility to the impacts of climate change, and economic instability. Without the infrastructure in place, the direction of future eye health research remains unclear. By identifying the gaps in our knowledge, we see this review as the first step towards improving eye health in the Pacific islands.
What research did you find describing eye health in the Pacific Islands?
Unfortunately, there is limited up-to-date research describing the prevalence of common eye conditions or service coverage in the Pacific islands, which makes it difficult to plan new eye care services. The lack of high-quality data (e.g. population-based prevalence studies) was notable.
The research we identified was mainly concentrated on Papua New Guinea, Fiji, and Vanuatu, although reported funding sources were most often from New Zealand, Australia, or the United States, illustrating the need to expand research infrastructure in the Pacific Islands.
What does this research say about the future of eye health in the Pacific?
Research in the Pacific Islands has evolved over the past ~40 years from small prevalence studies to larger externally funded research on specific eye conditions (that may not reflect local research priorities). Considering the economic challenges that limit financial investment into research, future research should be chosen strategically to fill the knowledge gaps identified from this report. Importantly, improving eye health in the Pacific islands will rely on first strengthening research leadership in the region so that Pacific Peoples can set their own research priorities.
Citation: Hamm LM, Wainiqolo I, Pant N, et al. Research about eye health and eye health services in Pacific Island Countries and Territories: a scoping review. The Lancet Regional Health – Western Pacific. 2024; 50:101152. doi: 10.1016/j.lanwpc.2024.101152
by Lucy Goodman | 10 Jul, 2024 | Children
New Zealand children are offered publicly funded vision screening services when they begin school (via the nationwide
B4 School Check service) and again in Year 7 (ages 11-12, as part of the Well Child Tamariki Ora Programme). While these screening services are good at identifying children with certain types of eye problems, we know that many children pass these screening tests and go attend school with undiagnosed vision problems. Some children also do not receive vision screening. We are addressing this problem within our teaching and research, by
providing additional screening services to schools, and
conducting research to identify how the current school screening services could be improved
Our school screening services
The School of Optometry and Vision Science provides an ongoing vision screening service for primary school children at participating schools in the Auckland region. The service provides a valuable training opportunity for Bachelor of Optometry students, who visit schools and conduct vision screening assessments on children aged 5-19. Approximately
4,000 children are screened via this service every year. One of the most common vision problems detected is refractive error, which can be corrected with spectacles or contact lenses. The School of Optometry and Vision Science’s school screening service operates alongside the
Vision Bus Aotearoa and the
Community Spectacles Scheme, so that children who are identified with a vision problem can receive the follow-up eye care that they need, through donation.
by Lucy Goodman | 24 Jun, 2024 | Community engagement, 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 | Pacific Islands, 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.
