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To assess the prevalence of near and correctable distance visual impairment among screened participants in the garment industry and to explore associations with income, age, and urban versus rural residence. Methods: Vision screenings were conducted at 4 garment factories, 2 urban and 2 rural locations during September and October 2019. Distance vision impairment was the presence of uncorrected vision of <6/12 in either eye, correctable to !6/7.5 with distance refraction. Near vision impairment was defined as 1 or more of the following: 1) either eye with presenting near vision 6/12 in the same eye; 2) having been prescribed near add spectacle power in examination records; and/or 3) clinical diagnosis of presbyopia at the time of screening. Demographic information and monthly income were selfreported by questionnaire completion. Results: Among 915 participating workers (100% female, 18 to 70 years), 29.2% (n ¼ 267) and 26.8% (n ¼ 245) had correctable distance and near vision impairment respectively. Prevalence of near vision impairment was significantly higher among rural residents (34.2%, n ¼ 160), compared to urban (19.0%, n ¼ 85, P < 0.0001) with the largest differences in the 35 to 39 (68.2% vs 44.2%, P ¼ 0.0019) and 40þ (85.9 vs 48.9%, P < 0.0001) year age ranges. Prevalence of near vision impairment was already high among urban (20.4%, n ¼ 20) and rural (23.0%, n ¼ 17) workers aged 30 to 34 years. In simple linear regression models, participants with near vision impairment earned $13.3 [standard error (SE) 2.44, P < 0.0001] less per month than those without, while urban residents earned $40.6 (SE 1.74, P < 0.0001) more than rural dwellers. In the final multivariate linear model, both near vision impairment ($6.51 lower monthly earnings, SE 1.84, P ¼ 0.0004) and urban residence ($43.2 higher monthly earnings, SE 2.39, P < 0.0001) remained significantly associated with income.Conclusions: This study found high rates of near vision impairment among female garment workers, particularly rural dwellers, and at a younger age than expected. The high prevalence and association between near vision impairment and lower income suggest that focusing on industries with a high proportion of female workers, such as readymade garments, may be effective in addressing gender disparities in vision impairment and its economic impact.

This study assesses the prevalence and the causes of visual impairment among bus drivers undergoing screening in Bangladesh and associations with self-reported crashes. Methods: Eye health screenings including refraction and questionnaires were conducted at 10 bus terminals in 7 districts of Bangladesh from June through August 2019. Presenting near and distance visual impairment and self-reported road traffic crashes were recorded. Results: Among 700 participants, nearly 1 in 5 (n ¼ 126, 18.0%) had presented visual acuity (VA) in the better-seeing eye 6/9, not meeting the vision standard of Bangladesh for bus drivers. A majority of drivers (n ¼ 492, 70.3%) had near or distance refractive error, and most who failed to reach the driving standard (88.1%, n ¼ 111) could be improved with readily available treatment, either glasses or cataract surgery. A history of 1 or more road traffic crashes while driving a bus or minibus was reported by 62 (8.97%) participants. In multivariable models, factors significantly associated with near or distance visual impairment included older age [odds ratio (OR) per year 1.15, 95% confidence interval (CI): 1.12-1.18, P < 0.0001] and having no driver's license (OR 1.80, 95% CI: 1.04-3.13, P ¼ 0.037). Self-reported history of a motor vehicle crash was associated with near or distance visual impairment (OR 2.45, 95% CI: 1.09-5.49, P ¼ 0.030), even when adjusting for other factors such as age and weekly miles are driven. Conclusions: Ensuring that bus drivers are screened to meet the required visual standards for driving while referring those who do not for treatment, can contribute to safer roads in this high-risk setting.

Background There is a growing awareness that addressing chronic as well as acute health conditions may contribute importantly to the well-being of displaced populations, but eye care service has generally not been prioritized in crisis situations. We describe a replicable model of eye care provision as delivered by Orbis International and local partners to the Rohingya and host population in Cox's Bazar, Bangladesh, and characterize the burden of vision impairment and demand for sight-restoring services in this setting. Methods and findings Orbis International and local secondary facility Cox's Bazar Baitush Sharaf Hospital (CBBSH) provide eye care support to the Rohingya population and the host community of all ages in Cox's Bazar, Bangladesh, with fixed vision screening locations established in Camps 4 and 11 of the Kutupalong refugee settlement. Structured outreach targets these camps and four surrounding local subdistricts, with referrals made as needed for refraction (glasses measurement) and cataract surgery to CBBSH. Between February 2018 and March 2019, 48,105 displaced Rohingya (70.3%, among whom 71.6% were children and 46.5% women) and 20,357 local residents (29.7%, 88.5% children, 54.4% women) underwent vision screening. Displaced Rohingya sought services from a total of 12 surrounding camps, within which coverage was 17.3%, including 43.3% (27,027/62,424) of children aged 5-11 years and 60.0% (5,315/8,857) of adults � 60 years old. The prevalence of blindness (presenting acuity < 3/60) among Rohingya patients exceeded that among local residents by 3-to 6-fold in each 10-year age group between 18 and 59 years (P < 0.001 comparing vision between the two groups in this age range), and the prevalence of cataract requiring surgery was also higher in Rohingya patients (18-29 years: 4.67% versus 1.80%,