Purpose: To assess the impact of uncorrected hyperopia and hyperopic spectacle correction on children's academic performance. Design: Systematic review and meta-analysis Methods: We searched 9 electronic databases from inception to July 26, 2021, for studies assessing associations between hyperopia and academic performance. There were no restrictions on language, publication date, or geographic location. A quality checklist was applied. Random-effects models estimated pooled effect size as a standardized mean difference (SMD) in 4 outcome domains: cognitive skills, educational performance, reading skills, and reading speed. (PROSPERO registration: CRD-42021268972). Results: Twenty-five studies (21 observational and 4 interventional) out of 3415 met the inclusion criteria. No full-scale randomized trials were identified. Meta-analyses of the 5 studies revealed a small but significant adverse effect on educational performance in uncorrected hyperopic compared to emmetropic children {SMD À0.18 [95% confidence interval (CI), À0.27 to À0.09]; P < 0.001, 4 studies} and a moderate negative effect on reading skills in uncorrected hyperopic compared to emmetropic children [SMD À0.46 (95% CI, À0.90 to À0.03); P ¼ 0.036, 3 studies]. Reading skills were significantly worse in hyperopic than myopic children [SMD À0.29 (95% CI, À0.43 to À0.15); P < 0.001, 1 study]. Qualitative analysis on 10 (52.6%) of 19 studies excluded from metaanalysis found a significant (P < 0.05) association between uncorrected hyperopia and impaired academic performance. Two interventional studies found hyperopic spectacle correction significantly improved reading speed (P < 0.05). Conclusions: Evidence indicates that uncorrected hyperopia is associated with poor academic performance. Given the limitations of current methodologies, further research is needed to evaluate the impact on academic performance of providing hyperopic correction.
BACKGROUND:The growing global burden of vision impairment makes it imperative that there are appropriately trained human resources. Optometrists play a critical role in alleviating this burden, but the low number of optometrists available or the numbers in different countries has always been a challenge for eye care planning. Despite this, there have been limited studies conducted to quantify the deficits in the number of optometrists globally. Methods:A standardised English language questionnaire was used in this cross-sectional study to determine the number and distribution of optometrists globally between February 2017 and May 2020. The survey was translated where necessary and completed by key informants. Using the World Council of Optometry’s scope of practice guidelines, optometrists were defined at levels 2 to 4. Optometrist-to-population ratios were calculated for all countries and regions and compared to targets of 1:50 000 (in developing contexts) or 1:10 000 (in developed contexts).Results:An overall response rate of 80.9% was achieved with responses from 123 of the 152 countries invited. Most (40.7%) key informants were academics. The total number of optometrists across 21 Global Burden of Disease (GBD) regions was 331,781 as of 2019. Sixty-six (53.7%) of 123 countries met the 1:50,000 Optometrist-to-population ratio. A strong (r=0.7) direct positive relationship existed between age-standardised prevalences of blindness and mild- and severe-vision impairment and optometrist-to-population ratios. Strong inverse relationships were observed between country GDP and optometrist-to-population ratio.Conclusion:High-income countries met the target for optometrist-to-patient ratios, while low-to-, middle-income countries and low-income countries did not meet the targets. Low optometrist-to-patient ratios were strongly associated with a higher magnitude of blindness and vision impairment.
Purpose: To systematically review and critically appraise clinical practice guidelines (CPGs) and summarise the recommendations for non-infectious and infectious conjunctivitis Methods: CPGs published on non-infectious and infectious conjunctivitis between 2010 and March 2020 were reviewed, evaluated, and selected using nine items from the Appraisal of Guidelines for Research and Evaluation II tool (4, 7, 8, 10, 12, 13, 15, 22 and 23). CPGs with an average score for items 4, 7, 8, 12, or 22 below 3 and/or a sum of the two researchers' average score for all nine items less than 45 were excluded. Two authors independently extracted and validated the data using standardised forms. Results: Fifteen CPGs from five sources remained for data extraction. CPGs consistently recommended non-pharmacological interventions (artificial tears, cold compress, avoidance or removal of allergens) for non-infectious conjunctivitis and pharmacological interventions (topical antihistamine, mast-cell stabiliser and dual-acting agent) for allergy types. Observation without treatment was strongly recommended for non-herpetic viral and bacterial infections. Systemic and topical anti-viral was consistently recommended for herpetic viral conjunctivitis, while systemic and topical antibiotics were recommended for chlamydial and gonorrhoeal conjunctivitis. The methods used to assess the level of evidence and the strength of recommendation varied among CPGs. Conclusions: There are a number of high-quality CPGs for non-infectious and infectious conjunctivitis. While there were a number of consistencies in the recommendations provided within these CPGs, several inconsistencies were also identified. Many of which related to the scope of practise of the targeted end-user of the particular guideline.
ObjectivesTo describe the demographic characteristics and ocular needs of children attending four child eye clinics in Cross River State, Nigeria, to inform the development of a sustainable spectacle cross-subsidisation scheme.DesignRetrospective analysis of clinic records.SettingFour child eye clinics in Calabar, Ogoja, Ikom and Ugep, Cross River State, Nigeria, from 1 May 2017 to 30 June 2019.ParticipantsChildren who failed the vision screening in schools and visited assigned child eye clinics, and self-referred children from the community.Main outcome measuresChildren’s age, sex, residence, diagnosis, disease management, presenting and corrected visual acuity, history of spectacle wear and magnitude of refractive errors in spherical equivalent in the worse eye.ResultsOf all the 3799 records reviewed, data were available for 3774 children (mean age 10.6±4.35 years; 61.6% girls; 69.1% from urban settings); 30.8% (n=1162) of them had vision impairment. Of those children, 71.2% (n=827) were diagnosed with refractive error. For management, 48.6% (n=1833) were prescribed spectacles and 40.5% (n=1527) were prescribed ocular medications. Children prescribed spectacles were significantly more likely to be girls (68.0%, p<0.001), and older than 13 years of age (53.6%, p<0.001). The most common range of spherical equivalent (in the worse eye) was <−0.50 DS to +1.75 DS (51.6%, n=945), followed by >−0.25 DS to −3.00DS (39.7%, n=727). Non-refractive eye conditions such as cataract (33.3%) and corneal disorders (14.1%) contributed to almost half of the total blindness.ConclusionThe findings show that spectacles provisions and ocular medications are the primary and secondary needs for children who attended child eye clinics seeking eye care services. Further research is needed to understand parents’ willingness to pay for spectacles to set strategic multitier pricing for a sustainable cross-subsidisation scheme.
Background This study aims to understand the key factors influencing guardians’ decisions when purchasing spectacles for their children in semi-urban and urban areas of Cross River State, Nigeria, where a spectacle cross-subsidisation scheme will be implemented. Methods This cross-sectional study was conducted among all consecutive guardians visiting the Calabar (urban), Ugep, Ikom and Ogoja (semi-urban) public eye clinics in Cross River State, southern Nigeria, from August 1 to October 31 2019, and whose children had significant refractive errors (myopia ≤-0.50D, hyperopia ≥1.50D, astigmatism >0.75D) and received spectacles. Guardians were interviewed using a questionnaire which included i) close-ended questions on reasons guardians choose to purchase spectacles for their children in eye clinics, ii) guardians’ perceptions of the quality and design of children’s current spectacle, iii) factors most heavily influencing their choice of spectacles for children, and iv) open-ended questions to seek guardians’ suggestions on how to improve the current spectacle range. Results All 137 eligible guardians (67.2% women [n = 92]) who visited the selected eye clinics participated in the study (response rate = 100%), with 109 (79.6%) from semi-urban and 28 (20.4%) attending urban clinics. Guardians from both urban and semi-urban clinics prioritised frame design, quality, and material as the main factors affecting their decision when purchasing spectacles for their children. Female guardians and those with higher incomes were both 1.5 times more likely to emphasise frame quality when describing selection criteria for purchasing spectacles for their children than male guardians (p = 0.01) or guardians earning less (p = 0.03). Conclusion Design, material, and frame quality are key factors influencing guardians when purchasing spectacles for their children in these setting and female guardians or those with higher income prioritise frame quality. This study could guide the planning and implementation of a novel cross-subsidisation scheme in Cross River State.
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