Research about eye health and eye health services in Pacific Island Countries and Territories

Research about eye health and eye health services in Pacific Island Countries and Territories

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

 

Through the looking glass: ideas to improve access to spectacles in the Western Pacific: a closer look at Australasia

Through the looking glass: ideas to improve access to spectacles in the Western Pacific: a closer look at Australasia

spectacle dispensing

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.

Eye care: what’s the situation in Aotearoa New Zealand?

Eye care: what’s the situation in Aotearoa New Zealand?

ecsat coverIn 2022, researchers from the Community Eye Health team (Pushkar Silwal, Renata Watene, Jacqueline Ramke) were commissioned to prepare a detailed report that summarises the state of eye care services in Aotearoa New Zealand. The report highlights that while New Zealand has a solid foundation for good quality eye care services, there is room for improvement in the way we plan and deliver eye care services to ensure all New Zealanders can access the services they need. Eye Care in Aotearoa New Zealand (2022) uses the World Health Organization’s Eye Care Situation Analysis Tool (ECSAT) to summarise the performance of our eye care services. The tool consists of 31 items (grouped into six ‘building blocks’) that each assess a different component of New Zealand’s eye care services.

Read the published report and download the plain language summary of the findings. 

Why did we undertake an ECSAT?

Globally, more than a billion people live with vision impairment and the negative effects this can have on their lives. To reduce this problem, in its inaugural World report on vision, the World Health Organization called for eye health to be part of efforts to achieve universal health coverage (UHC) through implementing Integrated People-centred Eye Care across the spectrum of promotive, preventative, curative and rehabilitative services. In 2020, this call was adopted by 194 countries at the 73rd World Health Assembly (including Aotearoa). To improve our eye care services, we must first understand the strengths and weaknesses of current services. This understanding is enabled by ECSAT, which is the first of four tools in the Guide for Action developed by WHO to support countries to strengthen integration of eye care into the health system.

The ECSAT report was commissioned by Eye Health Aotearoa to support New Zealand’s policy makers to develop integrated people-centred eye care, and ensure that all New Zealanders can access quality care.

How did we prepare the report?

To prepare the report, we established a Technical Working Group that included members with experience in optometry, ophthalmology, primary care/general practice, rehabilitation and Māori health. We used information gathered from published documents, which we augmented by interviewing with people with detailed knowledge of eye care services. The report can be downloaded from the Open Science Framework.

The report was launched by Eye Health Aotearoa at Parliament on 27 July 2023.

What are the major findings of the report?

The report identified that components of our eye care services in Aotearoa that are generally “strong” or only “need minor strengthening”, include:

  • Service delivery: The quality of eye care services.
  • Workforce & infrastructure: Ensuring that workers are trained and available to provide eye care services.

In contrast, the components of our eye care services that had aspects that “need major strengthening” include:

  • Leadership & governance: Planning, integrating and coordinating services, with appropriate policies in place.
  • Financing: How services are funded, including reducing out-of-pocket costs for population groups who are less able to afford services.
  • Access to services: Availability of the range of services throughout the country, as well as whether all population groups can access them.
  • Information: How service performance is monitored, and whether evidence is used to inform how services operate.

The report provides a detailed list of 81 recommended actions that may help strengthen eye care services in New Zealand.

Citation: Silwal P, Watene R, Cowan C, Cunningham W, Harwood M, Korau J, Sue W, Wilson G, Ramke J. Eye care in Aotearoa New Zealand 2022: Eye care situation analysis tool (ECSAT). Auckland: University of Auckland, 2022. Available at: https://osf.io/r75zs/

Funding: The report was prepared for Eye Health Aotearoa, with funding from Blind Low Vision New Zealand.