Visual impairment (low vision and blindness) is a major health concern all over the world. Three main reasons for the high prevalence of visual impairment are non-availability, non-accessibility andnon-affordability of eye care services. However, there are several factors that may act as barriers to the use of available, accessible and affordable eye care services. These include the lack of knowledge of the services, lack of knowledge of the possible impact of an eye disease and lack of knowledge of who to consult for management of eye diseases. Also, demographic, personal, social and cultural factors may influence or act as barriers to eye care utilization. These various factors are reviewed in this article. Where there is poor utilization of available services, educational campaigns would lead to better understanding and promote greater utilization of eye care services. Early detection and management of eye diseases would reduce the burden of visual impairment and disability. Therefore, eye care providers and health care managers must have good knowledge of the various factors that would negatively influence utilization of eye care services and be responsive to them. (S Afr Optom 2010 69(4) 182-193)

BackgroundVisual impairment and blindness are major health problems worldwide, especially in the rural and remote areas of developing countries. Utilisation of eye care services is essential to reduce the burden of visual impairment and blindness, and it is therefore important that it is monitored.ObjectivesThe objectives of this study were to determine the level of utilisation of public eye care services and factors that might have influenced their usage in rural communities, Capricorn district, Limpopo Province, South Africa.MethodA population-based cross-sectional study design was used. Participants were residents in selected rural villages located within approximately 5 km of six Government hospitals. Following ethical approval and receipt of informed consent, a questionnaire with closed and open-ended questions was used to collect information on the utilisation of eye care services and factors that might influence utilisation. Descriptive statistics and Pearson's Chi-square test were used to analyse and compare the data.ResultsMany (62.7%) of the respondents had used the government eye care services in the past. Over fifty-nine per cent (59.3%) of them were satisfied with the services. Factors reported to influence utilisation (such as monthly income, knowledge of available services and the need for regular eye tests) were positively associated with utilisation of eye care services in this study (p < 0.05).ConclusionUtilisation of eye care services was relatively good, but varied significantly between sites. An awareness campaign by government and non-governmental organisations about eye care services may increase utilisation amongst rural communities.

Background: Historically, two clinical methods have been used for measuring the amplitude of accommodation, which are the push-up and minus lens methods. However, it has been documented that the push-up method overestimates amplitude of accommodation, while the minus lens method underestimates it.Aim: The purpose of this study was to compare subjective and objective procedures for determining the monocular amplitude of accommodation in young optometry students.Setting: The study was conducted in the optometry clinic at the university.Methods: Amplitude of accommodation was measured on 45 optometry students (17 males and 28 females, whose ages ranged from 21 to 27 years) using the push-up, push-down, minus lens, modified dynamic retinoscopy and Pascal dynamic retinoscopy methods. Data were collected by three different examiners in this study. One examiner measured all the subjective tests, while another examiner measured the modified dynamic retinoscopy. The third examiner measured the Pascal heterodynamic retinoscopy.Results: The highest amplitude of accommodation was obtained using the push-up method (10.23 ± 1.67 D), while the minus lens method gave the lowest subjective finding (8.43 ± 1.68 D). However, the subjective methods generally produced comparable results. Both retinoscopic methods showed the lowest mean amplitude of accommodation of approximately 6.50 ± 1.40 D. However, there was a high correlation between the various methods.Conclusion: The push-up and push-down methods overestimate the true amplitude of accommodation because of the relative magnification, while the minus lens method creates an abnormal viewing environment in which the target is stationary but the stimulus becomes increasingly minified. Subjective amplitude of accommodation is an inadequate measure to assess any true accommodation because it fails to differentiate between passive depth of focus and an active accommodative power change in the eye. Therefore, subjective measurement of the amplitude of accommodation may suggest that accommodation is present when it is not. Further research is needed to further validate dynamic retinoscopy as the optimal or best possible routine clinical method to assess the true amplitude of accommodation.