Compared to other African countries, Swaziland performs the worst in terms of providing eye health care services. A priority goal of the World Health Organization (WHO) is to alleviate childhood blindness, particularly in low-income countries such as Swaziland, where many people live in poverty, which is a contributor to poor health outcomes. A mixed method approach that entailed a document review, key informant interviews and clinical facility assessment questionnaires was used. Hospitals and mission clinics offering ophthalmic services were identified through the website of the Ministry of Health and verified during key informant interviews. A saturated sampling procedure was applied due to the few facilities that offer eye care services. Six framework components from the WHO for analysing health systems were utilised in an eye health care service context: leadership and governance, eye health services, eye health workforce, eye health financing systems, eye health medical supplies and technologies, and eye health information systems. Poor management, lack of accountability, poor monitoring and evaluation mechanisms, weak coordination and ineffective private-public sector regulations were identified as factors that lead to poor eye care in the country. The optometrists indicated that refractive services are the most rendered ophthalmic services. The exodus of healthcare practitioners has contributed to the downfall of the public health sector in the country. Five government eye care facilities, 3 government hospitals, 1 non-governmental organization (NGO) and a church mission clinic were included in this analysis. The eye services distribution favors the more affluent areas, particularly the more urban Hhohho Region, which is also where most of the eye health professionals are located. No campaigns have been conducted to prevent childhood blinding diseases or create awareness about getting children’s eyes tested for refractive correction. The burden of eye diseases among children in Swaziland remains unknown. More eye health care personnel and equipped facilities are needed throughout the country, and the eye health care program needs to be adopted.

Methods:A cross-sectional, retrospective, descriptive study was undertaken. Stratified random selection was applied to select the study sites, and systematic sampling was used to select patients' files. A saturated sample of public sector optometrists employed in the selected districts completed study questionnaires. Data were analysed using the Statistical Package for Social Sciences, Version 21. Results:A total of 2968 records were reviewed, and gender distribution was 67.6% female and 32.4% male. Refraction (86.73%) was the most frequently conducted test, followed by ophthalmoscopy (74.73%), colour vision (0.07%) and gonioscopy (0.03%). The response rate for the questionnaires was 64.7%. Optometric outreach services were conducted by 54.5% of optometrists, and the majority (83.3%) reported that the farthest outreach facility was more than 50 km from their base hospital. The availability of equipment at outreach facilities was less as compared to base hospitals, while some reported not having the necessary equipment even at base hospitals. None of the optometrists did contact lens fitting at outreach facilities. A lack of equipment was cited as one of the reasons for not providing this service by 100% of optometrists. Most optometrists (63.6%) believed that more than 30% of their referrals might have been avoided if they had prescribed therapeutic agents to manage ocular conditions. Conclusion:Introducing optometrists within the public sector improves access to services for rural communities. However, the minimum standard of optometric care is not practised, allegedly because of a lack of equipment. Therefore, resources should be made available to enable optometrists to provide comprehensive optometric services. In addition, the study highlighted the need for more optometry posts in rural communities and for the implementation of career growth paths to attract and retain optometrists within the public sector.

BackgroundSwaziland, like many other developing countries, lacks appropriate eye health services, particularly for children.AimTo determine the knowledge and practices of parents about child eye health care in the public sector in Swaziland.SettingThe setting for this study was Swaziland.MethodsA descriptive study involving cross-sectional sampling methodology and quantitative analysis was employed with 173 randomly selected parents whose children attended public schools in Swaziland.ResultsOut of 173 participants, 104 (60.1%) parents reported that they have never taken their children for an eye test and 69 (31.7%) felt that their children’s vision was fine. Ninety-seven (53.1%) parents indicated having no knowledge about child eye conditions and no significant association was found between level of education and knowledge of eye conditions affecting children (p = 0.112). Having an immediate family member who wore spectacles increased the likelihood of a child being taken for eye testing (p = 0.001), but decreased the likelihood of being well informed about eye health (p = 0.218). Of those parents who reported taking their children for eye tests, 34 (49.3%) reported that they were given eye drops and 31 (44.9%) stated that their children were prescribed spectacles. Eighty-seven (50.3%) parents accepted the idea of their children wearing spectacles.ConclusionThe findings of the study suggest the need for parents to be informed about basic child eye health care and the importance of their children having regular eye examinations.

Background: There was a need to document population-expected normative data for parameters of non-strabismic binocular vision (NSBV) as the analysis and diagnosis of binocular vision disorders required comparison of patient’s clinical signs with expected data in their specific population.Aim: This article sought to review and map population-expected continental normative data for visual function parameters for evaluating the functional non-strabismic accommodative and vergence system, as these systems are very relevant to evaluate the comfort of visual system.Method: Search engines – namely, Google Scholar, Microsoft Academic, Web of Science database and Ovid MEDLINE database – were used to search studies published in English across different continents using keywords such as ‘normative or expected data’ and ‘specific NSBV parameter’. Results were summarised in tables for easy comparison; data were presented based on the geographical location, year of publication, demographics of the population studied and the techniques used for measuring the parameters. A summary of observed challenges with reviewed works and recommendations for the future studies are indicated. The article is delimited to studies published between 1910 and September 2019 only.Results: Most of the studies investigated specific parameters of either accommodation only or vergence only; few recent studies have comprehensively investigated both parameters. Most studies were conducted in North America followed by Asia and Europe, with a few in Africa. No studies were found with Oceania populations. There were discrepancies and differences in methodologies and techniques used by the studies reviewed and normative data varied among different continents and different populations within each continent.Conclusion: As the observed differences in reviewed studies could be attributed to differences in test techniques, the future studies should consider using identical, reliable, repeatable, objective and subjective techniques with good methodological designs to clarify these results. More studies should be conducted in African and Oceania populations.

Background Keratoconus (KC) is a corneal ectasia characterised by steepening corneal curvature, changes in refractive error and corneal thickness that result in visual impairment. Early signs of KC include displacement of the thinnest part of the cornea from the central position, changes in the corneal epithelial layer cell distribution, variations in the anterior corneal astigmatism/posterior corneal astigmatism relationship and a variation in corneal thickness. It is important that we review the corneal imaging methods for the diagnosis of preclinical KC. Method An online literature search was carried out on PubMed. Only publications detailing corneal assessment procedures were considered for this review and any publication on instruments that did not generate KC predictability indices were also excluded from the review. The 308 publications were reviewed. Discussion Corneal assessment techniques, with the ability to characterise both the anterior and posterior corneal surfaces, are invaluable in the diagnosis of pre-clinical KC. Reflection based and elevation based corneal imaging systems should be used in conjunction with other assessments such as higher order aberration measuring systems to improve sensitivity and reliability in the diagnosis of pre-clinical KC. Ultra high resolution ultrasound can detect pre-clinical KC. The ability to asses both the epithelium and endothelium makes anterior surface optical coherence tomography a superior technique for pre-clinical KC diagnosis. There is a positive correlation between central corneal thickness and corneal hysteresis. Corneal biomechanics should be considered in conjunction with other corneal assessments in the diagnosis of pre-clinical KC.