Summary Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.

Purpose: To evaluate the awareness, knowledge and the perception of risks of glaucoma among rural and urban dwellers in Ghana, a high prevalent country, in order to provide information for health promotion planning. Method: In a population-based descriptive cross-sectional survey, 1200 adults were selected from household settings, using a two-stage cluster and simple systematic random sampling. Quantitative data collection, using interviewer-administered questionnaire, was employed. Descriptive statistics were performed using chi-square, ordinal univariate, multinomial and multivariate logistic regression models used to calculate odds ratio with 95% confidence interval (CI) to identify predictive factors. Results: Overall, only 326 (27.2%, 95% CI = 24.6–29.7) indicated they were aware of glaucoma, whereas 331 (27.6%, 95% CI = 24.6–29.7) had ever undergone an eye screening. Low knowledge was demonstrated in 152 (46.6%, 95% CI = 41.2–52.0) and high knowledge in 99 (30.4%, 95% CI = 25.4–35.4) glaucoma-aware participants. Only 238 (19.8%, 95% CI = 17.6–22.1) of respondents presumed themselves to be at risk of developing glaucoma. Having eye examination (within the last 6 months) was positively associated with knowledge (adjusted odds ratio (AOR) = 1.413; 95% CI = 0.9–1.896) and awareness (AOR = 1.13; 95% CI = 0.938–2.449). Three levels of education (no education (AOR = 0.041; 95% CI = 0.016–0.11), primary (AOR = 0.057; 95% CI = 0.018–0.179), and middle school (AOR = 0.254; 95% CI = 0.127–0.51)) were associated with low knowledge while all levels of education were inversely associated with awareness. Perceived risk of glaucoma was also influenced by area of residence (rural (AOR = 0.344; 95% CI = 0.21–0.57)), being young (18–24 years (AOR = 4.308; 95% CI = 2.36–7.88)) and having previously undergone screening for glaucoma (AOR = 13.200; 95% CI = 5.318–32.764). Conclusion: The main modifiers of glaucoma awareness and knowledge were education and previous eye examination, but awareness had additional factor of area of residence. Perceived risk of glaucoma was influenced by being young and living in urban areas.

ObjectiveSelf-refracting spectacles (SRSs) have different optical and mechanical designs, which may affect the refractive outcome, depending on the experience of the end user. This study compared the performance of two SRS among children in Ghana.Methods and analysisA cross-sectional study of two Alvarez variable-focus SRS designs was conducted. A total of 167 children (mean age 13.6±1.6 years) identified as having refractive error were recruited from 2465 students who underwent screening. Subjects completed self-refraction using FocusSpecs, and Adlens, autorefraction and cycloplegic subjective refraction (CSR) (gold standard). Wilcoxon signed-rank test was used to compare visual outcomes and accuracy of refraction and graphically illustrated using Bland-Altman plots.ResultsEighty (47.9%) urban and 87 (52.1%) rural children were analysed and only about one-quarter 40 (24.0%) wore spectacles. The proportion who achieved visual acuity of ≥6/7.5 with FocusSpec, Adlens, autorefraction and CSR among urban schools were 92.6%, 92.4%, 60% and 92.6%, while those in rural schools were 81.6%, 86.2%, 54.0% and 95.4%, respectively. The mean±SD spherical equivalent errors for urban and rural schools using FocusSpec, Adlens and CSR were −1.05±0.61 D, –0.97±0.58 D and −0.78±0.53 D; and −0.47±0.51 D, –0.55±0.43 D and −0.27±0.11 D, respectively. The mean differences between the two self-refraction spectacles for urban and rural schools were not statistically different (p>0.00) but differed significantly when both were compared with the gold standard (CSR) (p<0.05).ConclusionBackground and refraction experience of school children did not significantly affect self-refraction.

Purpose: There is poor adherence to medication among patients with glaucoma especially in people of African ancestry. The present study assessed the influence of personality traits on adherence to glaucoma medication among patients living with primary open angle glaucoma (POAG) from an African population. Methods: A clinic-based cross sectional study was conducted among patients with POAG attending a specialist eye care facility. Adapted and validated personality trait and medication adherence measures questionnaires were used.Results: Self-reported adherence to glaucoma medication was 60.8% but the overall mean adherence score was 18.58±3.40, indicating slight non-adherence. The personality traits conscientiousness and agreeableness significantly predicted medication adherence but accounted for only 30.3% and 13.3% of the variance respectively. Non-adherence to medication was significantly predicted by the personality profiles neuroticism, extraversion and openness which respectively accounted for 61.7%, 20.3% and 13.3% of the variance in the personality trait assessment. Old age and longer use of glaucoma medications were also significantly associated with non-adherence to glaucoma medication.Conclusions: Glaucoma patients’ personality profiles significantly predicted their adherence to glaucoma medications. Assessment of the personality profiles and appropriate psychotherapeutic approaches should be included in glaucoma diagnosis and management protocols in order to enhance medication adherence in patients living with glaucoma.

SIGNIFICANCEInappropriate ophthalmic self-medication continues to plague Sub-Saharan Africa because of lack of public health education and inaccessibility to eye care services. This case series describes three cases of blindness (two monocular, one binocular) in Ghana, because of self-treatment of ocular conditions using improper drugs or homemade herbal mixtures. The article highlights the consequences of misinterpretation of symptoms and use of traditional home remedies, leading to delayed professional eye care and avoidable blindness.PURPOSEThis case series aims to report three separate cases of avoidable blindness after inappropriate ophthalmic self-medication to draw attention to the need for intense public health education in Ghana.CASE REPORTSThree men aged 25, 79, and 35 years, respectively, reported severe reduction in visual acuity in one eye for two cases and both eyes for one case. All patients reported ophthalmic self-medication either with an inappropriate drug bought from the drug store or a homemade herbal mixture made from leaves assumed to treat eye infections. Professional care did not yield any improvement in visual acuity because their corneas were already decompensated at the onset of management. The eye of one patient had to be enucleated.CONCLUSIONSThese cases highlight the importance of eye health promotion and education. It is recommended that intense sensitization is carried out at all levels.