Eye care utilization by older adults in low, middle, and high income countries

Vela, Claudia; Samson, Elodie; Zunzunegui, Marı́a Victoria; Haddad, Slim; Aubin, Marie-Josée; Freeman, Ellen E.

doi:10.1186/1471-2415-12-5

Cited by 67 publications

(74 citation statements)

References 33 publications

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“…In surveys in Australia, Canada and the USA, a similar proportion (60-70%) of older adults had visited an eye-care provider, although not necessarily an optometrist, in the previous year. 142 Data from the Optical Confederation survey for 2011/12 give an average interval between eye examinations of 27 months overall and 30 months for those of working age, 52 which is broadly consistent with findings in PrOVIDe (see Figures 9 and 10).…”

Section: Intervals Between Eye Examinations and Spectacle Dispensingsupporting

confidence: 74%

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

Bowen

Edgar

Hancock

et al. 2016

Health Serv Deliv Res

121

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BackgroundThe prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia.ObjectivesTo measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons for underdetection or inappropriate management.DesignStage 1 – cross-sectional prevalence study. Stage 2 – qualitative research exploring participant, carer and professional perspectives of eye care.SettingStage 1 – 20 NHS sites in six English regions. Stage 2 – six English regions.ParticipantsStage 1 – 708 participants with dementia (aged 60–89 years): 389 lived in the community (group 1) and 319 lived in care homes (group 2). Stage 2 – 119 participants.InterventionsStage 1 gathered eye examination data following domiciliary sight tests complying with General Ophthalmic Services requirements and professional guidelines. Cognitive impairment was assessed using the Standardised Mini-Mental State Examination (sMMSE) test, and functional ability and behaviour were assessed using the Bristol Activities of Daily Living Scale and Cambridge Behavioural Inventory – Revised. Stage 2 involved individual interviews (36 people with dementia and 11 care workers); and separate focus groups (34 optometrists; 38 family and professional carers).Main outcome measures.VI defined by visual acuity (VA) worse than 6/12 or worse than 6/18 measured before and after refraction.ResultsStage 1 – when participants wore their current spectacles, VI prevalence was 32.5% [95% confidence interval (CI) 28.7% to 36.5%] and 16.3% (95% CI 13.5% to 19.6%) for commonly used criteria for VI of VA worse than 6/12 and 6/18, respectively. Of those with VI, 44% (VA < 6/12) and 47% (VA < 6/18) were correctable with new spectacles. Almost 50% of remaining uncorrectable VI (VA < 6/12) was associated with cataract, and was, therefore, potentially remediable, and one-third was associated with macular degeneration. Uncorrected/undercorrected VI prevalence (VA < 6/12) was significantly higher in participants in care homes (odds ratio 2.19, 95% CI 1.30 to 3.73;p < 0.01) when adjusted for age, sex and sMMSE score. VA could not be measured in 2.6% of group 1 and 34.2% of group 2 participants (p < 0.01). The main eye examination elements (excluding visual fields) could be performed in > 80% of participants. There was no evidence that the management of VI in people with dementia differed from that in older people in general. Exploratory analysis suggested significant deficits in some vision-related aspects of function and behaviour in participants with VI. Stage 2 key messages – carers and care workers underestimated how much can be achieved in an eye examination. People with dementia and carers were unaware of domiciliary sight test availability. Improved communication is needed between optometrists and carers; optometrists should be informed of the person’s dementia. Tailoring eye examinations to individual needs includes allowing extra time. Optometrists wanted training and guidance about dementia. Correcting VI may improve the quality of life of people with dementia but should be weighed against the risks and burdens of undergoing examinations and cataract surgery on an individual basis.LimitationsSampling bias is possible owing to quota-sampling and response bias.ConclusionsThe prevalence of VI is disproportionately higher in people with dementia living in care homes. Almost 50% of presenting VI is correctable with spectacles, and more with cataract surgery. Areas for future research are the development of an eye-care pathway for people with dementia; assessment of the benefits of early cataract surgery; and research into the feasibility of specialist optometrists for older people.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Intervals Between Eye Examinations and Spectacle Dispensingsupporting

confidence: 74%

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

Bowen

Edgar

Hancock

et al. 2016

Health Serv Deliv Res

121

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“…This is in agreement with reports from other countries (2,3,5,7,9,11,12,23-25,33). Nevertheless, in contrast to other studies, (5,7,9,24,25) gender inequality was more serious in our study, where women were seen to be more deprived of eye care services than men. This difference was significant in simple as well as multiple logistic regression models.…”

Section: Discussioncontrasting

confidence: 54%

“…Several studies on inequality have indicated that blindness is more prevalent in poor communities (17)(18)(19); gender disparity in eye diseases and access to eye care services has also been reported (20)(21)(22). Although reports of disparity in the frequency of utilization of eye care services (23)(24)(25) are available, we found no report on the role of economic inequality in utilization of eye care services. The goals of vision 2020 will undoubtedly be made easier by understanding the extent of this disparity and its determinants.…”

Section: Introductioncontrasting

confidence: 54%

“…The findings presented above show that striving to equalize the utilization of men and women to eye care services will be more effective in battling economic inequality than would efforts to equalize level of education among different economic groups of the population. Numerous studies have used regression models to investigate the role of income in utilization of eye care services (23)(24)(25). To the best of our knowledge, no study has been done regarding the economic gap in eye care utilization and its determinant.…”

Section: Discussionmentioning

confidence: 99%

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Economic inequality in eye care utilization and its determinants: a Blinder–Oaxaca decomposition

Emamian

Zeraati

Majdzadeh

et al. 2014

Int J Health Policy Manag

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Background: The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran. Methods: Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low-and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method. Results: Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31-17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69-32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51-2.14], the low-economic group (OR= 2.33, 95% CI= 1.90-2.87), the visually impaired (OR= 1.41, 95% CI= 1.05-1.90), and the uninsured (OR= 1.93, 95% CI= 1.45-2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93-0.96) and education (OR= 0.94, 95% CI= 0.92-0.96). In this study, 24.72% (95% CI= 22.30-27.14) of the low-economic group and 9.94% (95% CI= 8.75-11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality. Conclusion: A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause.

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“…Similar absence of ophthalmological care were described recently only in low income countries from South Asia and Africa [24], and particularly in very isolated locations or in critical conditions. [25,26] When marginalized groups located in urban areas from developed countries are studied, access to eye care is substantially higher.…”

Section: Discussionmentioning

confidence: 78%

Ocular Findings in a Brazilian Rural Slave-Descendant Community: Eye Health in Quilombos

Oliveira¹,

Leitão²,

Carvalho³

et al. 2016

Int Arch Med

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Purpose: To report ophthalmological findings from one quilombo remnant population, a Brazilian marginalized rural and slave-descendant community.Methods: Descriptive study of eye health from one of the largest quilombo communities in Brazil, located in Conceição das Crioulas, Pernambuco. Ophthalmic exam including visual acuity, refractive examination, biomicroscopy, fundus examination, tonometry and pachymetry was performed in a convenience sample of 255 residents over 40 years-old, representing approximately one third of the population in this age range.Results: Half of the subjects had never been examined by an ophthalmologist in their lives. Blindness was identified in 6.7% of participants and low vision in 8.6%. Visual impairment was caused mainly by cataract and uncorrected refractive errors. Cataract was found in 27.3% of subjects. Ametropia was documented in 71% of participants and the most prevalent refraction error was hyperopia. Prevalence of glaucoma and age-related macular degeneration were respectively 5.4% and 1.9%. Pterygium was detected in 26.7% of participants. Correcting lenses were prescribed to 57.4% of individuals, 5.5% were referred for surgery, 2.7% to specialized clinics and 1.2% to additional tests. Conclusions:Blindness, cataract and pterygium were highly frequent in quilombo residents, and distribution of other ocular diseases were close to average published rates. Data collected may help planning preventive and promotive actions for eye health of socioeconomic disadvantaged quilombo populations.

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Eye care utilization by older adults in low, middle, and high income countries

Cited by 67 publications

References 33 publications

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

Economic inequality in eye care utilization and its determinants: a Blinder–Oaxaca decomposition

Ocular Findings in a Brazilian Rural Slave-Descendant Community: Eye Health in Quilombos

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