National Eye Survey of Trinidad and Tobago (NESTT): prevalence, causes and risk factors for presenting vision impairment in adults over 40 years

Braithwaite, Tasanee; Verlander, N Q; Bartholomew, Debra; Deomansingh, Frank; Bridgemohan, Petra; Saei, Ayoub; Sharma, Subash; Singh, Delezia; Ramsewak, Samuel; Bourne, Rupert

doi:10.1136/bjophthalmol-2018-313428

Cited by 21 publications

(24 citation statements)

References 24 publications

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“…Moreover, through comparing the two regression results of the used and unused instrumental variables method, the adverse selection problem of Chinese rural residents in deciding whether to participate in health insurance was confirmed. Our findings reinforce past studies demonstrating that participating in health insurance is associated with lower VI [ 14 – 18 ]. However, a study based on a US sample found that the frequency of eye care utilization by people with health insurance was positively associated with VI severity, which reflects the adverse selection of insurance participants [ 19 ].…”

Section: Discussionsupporting

confidence: 92%

“…High blood pressure can cause substantial vision damage [ 43 , 44 ]. VI is also commonly found in patients with diabetes [ 18 , 37 , 45 ]. Vision problems often coexist with hypertension and dyslipidemia, which may increase the risk of CI; moreover, people with longer histories of diabetes and hypertension usually have a higher level of VI [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…For example, not participating in vision insurance was demonstrated to induce higher risk of VI, reduce eye care utilization and cause irreversible vision damage in samples of US [ 14 , 15 ], and Low- and Middle-Income Countries [ 16 ]. VI was also found to be associated with a lack of health insurance in samples of Korea, Trinidad, and Tobago [ 17 , 18 ]. However, some people, especially the rural people, believe that the preventive care of health insurance is unnecessary, and they habitually obtain health services only when symptoms become severe [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Health insurance enrollment and vision health in rural China: an epidemiological survey

Yan

Yao

Chen

et al. 2021

BMC Health Serv Res

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Background Vision health is an important aspect of health worldwide. Visual impairment (VI) is associated with poor quality of life and is usually more prevalent in rural areas. To help rural populations obtain vision care, health insurance policies have emerged throughout the world. However, some existing literatures show that health insurance enrollment’s impact on the overall physical health of rural population has been minimal. Focusing on vision health among adults in rural China, our study aims to investigates the impact of health insurance on vision health, heterogeneity of the effect, and the moderating effect of health insurance enrollment on the impact of chronic physical diseases and basic eye diseases on vision health. Methods Primary data were collected through a nation-wide epidemiological survey of vision health conducted in rural China in 2018, with a sample size of 28,787 used in our statistical analysis. Instrumental variables regression and Heckman selection models were conducted to examine the impact of health insurance enrollment and reimbursement ratio adults’ vision health outcomes. Subsample regressions by sex, age, education level, and whether with eye diseases were further conducted to explore the heterogeneity in our results. We then examined whether health insurance enrollment moderates the impact of chronic physical diseases and basic eye diseases on vision health through the method of introducing interaction terms. Results Participating in health insurance reduced the probability of VI by 2.15 %. The reimbursement rate increasing by 1 % point may reduce the probability of worsening VI by 6.12 %. Men (-0.0235, P = 0.0002) benefit more from insurance enrollment than women (-0.0201, P = 0.0082) with respect to vision health. From the young adult group to the oldest group, the marginal effect of health insurance increased from − 0.0068 (P = 0.0394) to -0.0753 (P < 0.0001). The marginal effect on VI was most significant in people with lower education levels and weakened with increased education levels. People with basic eye diseases (-0.0496, P = 0.0033) benefit more from participating insurance than the people without basic eye diseases (-0.0196, P = 0.0001) with respect to vision health. The moderating effects of health insurance enrollment on the impacts of cerebral infarction (-0.1225, P < 0.0001), diabetes (-0.0398, P = 0.0245), hyperlipidemia (-0.1364, P = 0.0271), mental illness (-0.1873, P = 0.0010), glaucoma (-0.1369, P = 0.0073), diabetic retinopathy (-0.1560, P = 0.0043), and retinal vein obstruction (-0.2018, P = 0.0155) on vision health were significantly negative. Conclusions The results suggest that participation in health insurance and higher health insurance reimbursement ratios reduced the risk of VI in the sampled adults. Health insurance has the most significant effect in in vulnerable groups. Heath insurance enrollment moderates the impacts of several chronic physical and basic eye conditions on vision health. Our findings have potential implications for reforming health insurance policies to improve vision health conditions in rural areas of developing countries.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health insurance enrollment and vision health in rural China: an epidemiological survey

Yan

Yao

Chen

et al. 2021

BMC Health Serv Res

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“…3 Further, visual impairment has been found to be associated with unemployment. 8,9 Importantly, screening for visual problems and providing free eyeglasses have been shown to improve the quality of life and earning potential of homeless individuals. 4 The free ophthalmology clinic was created to bridge some of these gaps.…”

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confidence: 99%

Follow-Up Rates at a Free Ophthalmology Clinic at a Homeless Shelter

Hennein

Spaulding

Karlegan

et al. 2021

Journal of Academic Ophthalmology

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Objective Eye health among the homeless community is important, as poor vision makes this population vulnerable and adds significantly to the social and health burden. There is limited knowledge on patient follow-up rates for their eye conditions and barriers to accessing care in this population. The purpose of this retrospective chart review study is to examine follow-up rates and barriers to care for patients referred from a free, medical-student run ophthalmology clinic at a homeless shelter. Methods All patients evaluated at a free ophthalmology clinic from September 2017 to September 2018 were included; no patients were excluded. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a nonprofit organization. Primary outcomes were follow-up rates at the county hospital and nonprofit organization. Secondary outcomes included prespecified baseline variables hypothesized to be associated with follow-up rates. These categorical variables were compared with Chi-square testing to determine their association with follow-up rates. The hypothesis being tested was formulated before data collection. Results Of the 68 patients, 84% were males with a mean age of 50 years. Overall, 40 patients were referred for free eyeglasses and 17 to the county hospital. Of those referred, 14 patients presented for free eyeglasses and 7 presented to the county hospital. About 79% of patients with a pre-established primary care provider presented to their appointment compared with 20% of those without one (p = 0.03). The 44% of patients with a high school diploma presented while all patients without a high school diploma failed to present (p = 0.04). Vision-threatening conditions identified at the shelter clinic did not affect follow-up rates (p = 0.79). Conclusion Less than half of referred patients in our study presented to their appointments. Barriers to presentation included no primary care provider and lower educational status, with no improvement in follow-up rates among those referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be warranted, particularly for those not looped into the health care system and those of lower educational attainment.

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“…7,8 Visual impairment has also been associated with unemployment. 9,10 Further, it has been suggested that screening for visual problems and providing free spectacles may improve the quality of life and earning potential of homeless individuals. 5 Despite this, there is a paucity of literature on the eye care needs of the homeless population; little is known about how homeless patients access eye care 4 or if/how their eye care needs are met.…”

mentioning

confidence: 99%