Preventing blindness and visual impairment in Europe: What do we have to do?

Németh, János; Tóth, Gábor; Resnikoff, Serge; Faber, Jan Tjeerd de

doi:10.1177/1120672118819397

Cited by 11 publications

(11 citation statements)

References 17 publications

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“…macular degeneration). In an aging population, the demand for eye care is increasing rapidly, which imposes a challenge for providers of eye care in both developed and less-developed countries [ 1 , 3 ]. The acutely reduced access to healthcare during the COVID-19 outbreak underlined the need for a paradigm shift in the delivery of eye care [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The evaluation of a web-based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: A method comparison study

Muijzer

Claessens

Cassano³

et al. 2021

PLoS ONE

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Purpose To evaluate the outcome of a web-based digital assessment of visual acuity and refractive error, compared to a conventional supervised assessment, in keratoconus patients with complex refractive errors. Material and methods Keratoconus patients, aged 18 to 40, with a refractive error between -6 and +4 diopters were considered eligible. An uncorrected visual acuity and an assessment of refractive error was taken web-based (index test) and by manifest refraction (reference test) by an optometrist. Corrected visual acuity was assessed with the prescription derived from both the web-based tool and the manifest refraction. Non-inferiority was defined as the 95% limits-of-agreement (95%LoA) of the differences in spherical equivalent between the index and reference test not exceeding +/- 0.5 diopters. Agreement was assessed by a Bland-Altman analyses. Results A total of 100 eyes of 50 patients were examined. The overall mean difference of the uncorrected visual acuity measured -0.01 LogMAR (95%LoA:-0.63–0.60). The variability of the differences decreased in the better uncorrected visual acuity subgroup (95%LoA:-0.25–0.55). The overall mean difference in spherical equivalent between the index and reference test exceeded the non-inferiority margin: -0.58D (95%LoA:-4.49–3.33, P = 0.008). The mean differences for myopic and hyperopic subjects were 0.09 diopters (P = 0.675) and -2.06 diopters (P<0.001), respectively. The corrected visual acuities attained with the web-based derived prescription underachieved significantly (0.22±0.32 logMAR vs. -0.01±0.13 LogMAR, P <0.001). Conclusions Regarding visual acuity, the web-based tool shows promising results for remotely assessing visual acuity in keratoconus patients, particularly for subjects within a better visual acuity range. This could provide physicians with a quantifiable outcome to enhance teleconsultations, especially relevant when access to health care is limited. Regarding the assessment of the refractive error, the web-based tool was found to be inferior to the manifest refraction in keratoconus patients. This study underlines the importance of validating digital tools and could serve to increase overall safety of the web-based assessments by better identification of outlier cases.

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Section: Introductionmentioning

confidence: 99%

The evaluation of a web-based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: A method comparison study

Muijzer

Claessens

Cassano³

et al. 2021

PLoS ONE

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show abstract

“…In an aging population, the demand for eye care is increasing rapidly, which imposes a challenge for providers of eye care in both developed and less-developed countries. (1,3) The acutely reduced access to healthcare during the COVID-19 outbreak underlined the need for a paradigm shift in the delivery of eye care. (4) To become less reliant on hospital facilities and trained professionals for monitoring eye conditions, there is a growing interest in telemedicine and digital tools.…”

Section: Introductionmentioning

confidence: 99%

The evaluation of a web‐based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: a prospective open‐label method comparison study

Muijzer

Claessens

Cassano

et al. 2021

Preprint

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Purpose: To evaluate the outcome of a web-based digital assessment of visual acuity and refractive error, compared to a manifest refraction assessment, in keratoconus patients with complex refractive errors. Material and methods: Keratoconus patients, aged 18 to 40, with a refractive error between -6 and +4 diopters were eligible. Each participant subsequently underwent a uncorrected visual acuity and a refractive assessment. Refractive error was assessed with the web based tool (index test), autorefractor, and a manifest refraction (reference test) by an optometrist. Corrected visual acuity was assessed with the web based and manifest refractive prescription. Noninferiority was defined as the 95% limits of agreement (95%LoA) of the differences in spherical equivalent between the index and reference test not exceeding plus/minus 0.5 diopters. Agreement was assessed by an intraclass correlation coefficient and Bland Altman analyses. Results: A total of 100 eyes of 50 patients were examined. The overall mean difference of the uncorrected visual acuity measured minus0.01 LogMAR (95%LoA: minus 0.63 to 0.60). The variability decreased in the high uncorrected visual acuity subgroup (mean difference: 0.15 LogMAR, 95%LoA: minus 0.25 to 0.55). The intraclass correlation coefficient of the three refractive assessments was 0.32. The overall mean difference in spherical equivalent between the index and reference test measured minus 0.58 diopters (95%LoA: minus 4.49 to 3.33, P=0.008). The mean differences for myopic and hyperopic subjects were 0.09 diopters (P=0.675) and minus 2.06 diopters (P<0.001), respectively. Conclusions: Our results show promising results in the ability of the web based tool to remotely assess visual acuity in keratoconus patients. The agreement is better in higher visual acuity ranges and could provide physicians with an objective measurement to enhance teleconsultations, especially relevant when access to health care is limited. The assessment of the refractive error using the web based tool was found to be inferior to the manifest refraction and deserves further training of the tools algorithm.

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“…Second, as this approach is not currently widespread in the epidemiology community, its use would have rendered our results less accessible. There are only a few published European population‐based studies on prevalence of vision impairment and blindness (measuring visual acuity of participants rather than self‐reporting) by cause, some of them focusing on specific European countries (Munier et al 1998 ; Cruciani et al 2011 ; Finger et al 2012 ; Havstam Johansson et al 2020 ) and others having a more global focus (Flaxman et al 2017 ; Bourne et al 2018 ; Németh et al 2019 ). According to the Vision Loss Expert Group, uncorrected refractive errors, cataract, AMD and glaucoma, that are entirely or partly curable pathologies, were still the main causes of both blindness and moderately to severely impaired vision in Western, Central and Eastern European countries (Bourne et al 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…In that respect, the EHIS 2 developed and funded by the European Union represents an excellent opportunity to gather data on the health status, healthcare use and health determinants in every member state. These data, in turn, should be useful for European and local public health policies in their efforts to improve access to health services for all and to decrease inequalities (Németh et al 2019 ). A strength of our study is the large size of the representative population sample, which allowed the analyses to be carried out at the level of participating countries, namely member states of Europe.…”

Section: Discussionmentioning

confidence: 99%

Self‐reported visual difficulties in Europe and related factors: a European population‐based cross‐sectional survey

Leveziel

Marillet

Braithwaite

et al. 2020

Acta Ophthalmologica

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Purpose There is a relative paucity of self‐reported vision problems data in European countries. Methods In this context, we investigated self‐reported vision problems through European Health Interview Survey 2, a cross‐sectional European population survey based on a standardized questionnaire including 147 medical, demographic and socioeconomic variables applied to non‐institutionalized individuals aged 15 years or more in 28 European countries, in addition to Iceland and Norway. Results The survey included 311 386 individuals (54.18% women), with overall crude prevalence of self‐reported vision problems of 2.07% [95% CI; 2.01–2.14]. Among them, 1.70 % [1.61–1.78] of men, 2.41% [2.31–2.51] of women and 4.71% [4.53–4.89] of individuals aged 60 or more reported to have a lot of vision problems or to be not able to see. The frequency of self‐reported vision problems was the highest in Eastern European countries with values of 2.43% [2.30–2.56]. In multivariate analyses, limiting long‐standing illness, depression, daily smoking, lack of physical activity, lower educational level and social isolation were associated with self‐reported vision problems with ORs of 2.66 [2.42–2.92], 2.16 [2.01–2.32], 1.11 [1.01–1.23], 1.31 [1.21–1.42], 1.29 [1.19–1.40] and 1.45 [1.26–1.67], respectively, while higher income was associated with less self‐reported vision problems with OR of 0.80 [0.73–0.86]. Conclusions This study demonstrated inequalities in terms of prevalence of self‐reported vision problems in Europe, with higher prevalence in Eastern European countries and among women and older individuals.

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Preventing blindness and visual impairment in Europe: What do we have to do?

Cited by 11 publications

References 17 publications

The evaluation of a web-based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: A method comparison study

The evaluation of a web-based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: A method comparison study

The evaluation of a web‐based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: a prospective open‐label method comparison study

Self‐reported visual difficulties in Europe and related factors: a European population‐based cross‐sectional survey

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