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 jram843 | 12 Oct, 2022 | Evidence base, News
Centre for Ageing Better Images – Pictures Peter Kindersley
Estimates for eREC and eCSC contribute to WHO 2030 targets
Two papers published today (12 October 2022) in The Lancet Global Health mark an important milestone in the inclusion of two indicators of eye care coverage into the monitoring framework for Universal Health Coverage and ultimately the global indicator framework for the United Nations Sustainable Development Goals.
Using data from population-based eye health surveys around the World, investigators (including School Of Optometry and Vision Science Associate Professor Jacqui Ramke) have published baseline estimates for effective Cataract Surgical Coverage (eCSC) and effective Refractive Error Coverage (eREC) .
What is eCSC and eREC?
Effective cataract surgical coverage (eCSC) measures the number of people in a population that have been operated for cataract, and had a good outcome, as a proportion of all the people requiring or having received surgery in that population.
Similarly, effective refractive error coverage (eREC) is defined as the proportion of people in need of services for poor eyesightrefractive error such as spectacles or contact lenses who have received these interventions and have a resultant good-quality outcome.
Cataract surgery and correction of refractive error remain two of the most cost-effective healthcare interventions ever. These two indicators serve as ideal proxy indicators not only to track changes in the uptake and quality of eye care services at the global level, but also contribute to monitoring progress towards UHC in general. In 2021, the World Health Assembly set ambitious global eyecare targets for 2030 of a 30% increase in eCSC and a 40% increase in eREC.
The paper on Effective Cataract Surgical Coverage shows the indicator varies widely between countries, with higher coverage in countries with greater income-level, with the highest at 70.3% and the lowest only 3.8%. Higher coverage was also seen among men, highlighting the need to embed equity in efforts to improve access to surgery.
The paper on Effective Refractive Error Coverage estimated that less than half (43%) of people who need glasses for distance vision have had this need met. The paper’s authors note that despite coverage increasing by 19% in the last 20 years, the WHO target will require substantial improvements in quantity and quality of refractive services, particularly for women and among older people.
Speaking on behalf of the WHO at the launch of the “Report of the 2030 targets on effective coverage of eye care”, at the United Nations in New York on 12 October, the eve of World Sight Day, Dr Stuart Keel said: “These two papers set the baseline for what we want to achieve by 2030 and the international collaborative effort demonstrates how well-positioned the eye care sector is to contribute to the advancement of Universal Health Coverage within countries”.
The work for the eCSC study was funded by the Indigo Trust, Peek Vision, and the Wellcome Trust, while the eREC study was funded by WHO, Sightsavers, The Fred Hollows Foundation, Fondation Thea, Brien Holden Vision Institute and Lions Clubs International Foundation.
Publications
by Lucy Goodman | 29 Jul, 2022 | ECSAT, Evidence base, News
Attendees at the Eye Health Aotearoa launch in July 2022: Hon Peeni Henare, Associate Minister of Health (Māori Health) ; Dr Liz Craig MP and Dr Elizabeth Kerekere, Co-chairs of the Parliamentary Friends of Eye Health; Renata Watene, Joint author of the “Eye care in Aotearoa New Zealand 2022” Report; Judy Small, Chair of the RNZFB Board, and Drew Keys from the IAPB; with Eye Health Aotearoa Trustees. Source: Eye Health Aotearoa
In July 2022, Eye Health Aotearoa held an event in parliament to promote the importance of eye health. The event launched a report prepared by Community Eye Health researchers describing the state of eye care services in Aotearoa New Zealand, commissioned by Eye Health Aotearoa and funded by Blind Low Vision New Zealand. Read the full story here.
For a plain language summary of this work, please visit our resources page.
by Lucy Goodman | 9 Sep, 2021 | Evidence base, Indigenous service delivery, News
International Agency for the Prevention of Blindness, September 2021
By Jacqueline Ramke and Hugh Bassett, International Centre for Eye Health
Globally, there are an estimated 370 million Indigenous people, living in 90 countries. Marginalisation, displacement and institutional racism has left Indigenous people across the world with poorer health and social outcomes compared with non-Indigenous people, including dying younger, having higher rates of infant mortality and poverty, and lower educational attainment…
Inequity in eye health is also evident with high income countries failing to ensure Indigenous populations have equitable access to eye care service. A recent scoping review from a team at the University of Auckland and the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine also shows limited evidence that high-income countries are actively tackling this lack of access.
Read the full blog post on the IAPB website.
by Lucy Goodman | 15 Mar, 2021 | Diversity in eye care providers, Evidence base, News
The International Agency for the Prevention of Blindness, March 2021
By Jacqueline Ramke (Associate Professor of Global Eye Health, London School of Hygiene and Tropical Medicine), Anthea Burnett (Knowledge Consultant, IAPB), Jude Stern (Head of Knowledge Management, IAPB)
A challenged world is an alert world and from challenge comes change.
When leaders reflect the populations that they serve, there can be substantial benefits. These benefits extend across health, democracy, economic growth and human development, governance, justice, and peace and security.(1) Currently, women are a minority in health leadership positions globally, which inhibits health gains among women, children and minorities worldwide.(2)
“Women belong in all places where decisions are being made” — Ruth Bader Ginsberg, 2009
The theme of International Women’s Day this year provides the opportunity to reflect on how far we have to go in eye health to ensure enough women are in the room when decisions are being made. This is essential to address the pervasive gender inequity in eye health—in 2020, there were an estimated 112 women living with vision loss for every 100 men, even after adjusting for the longer life expectancy of women.
Read the full blog post on the IAPB website.
