Clare E Gilbert

• London School of Hygiene and Tropical Medicine

Background: To report 15-year incidence rate of primary open angle glaucoma (POAG) in the Andhra Pradesh Eye Disease Study (APEDS). Methods: A population-based longitudinal study was carried out at three rural study sites. Phakic participants aged ≥40 years who participated at baseline (APEDS I) and the mean 15-year follow-up visit (APEDS III) w...

Purpose: Control of blindness due to retinopathy of prematurity (ROP) requires timely screening and treatment within 48-72 h. Anticipating that the coronavirus disease 2019 (COVID-19) pandemic would disrupt ROP services, we devised strategies ''on-the''-go"" to ameliorate this possiblity. We describe the successful outcomes of this approach in pre...

Purpose: To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India. Methods: Children aged <16 years, enrolled in the schools for the blind in Maharashtra state, India were examined between October 2018 and December 2019. The anatomical sites and etiology for blindness were recor...

Purpose: To study the zonal variations in diabetic retinopathy (DR) and associated factors in people with known type 2 diabetes mellitus (T2DM) attending large eye care facilities in different regions of India. Methods: In this cross-sectional eye-care facility-based study, India was divided into five zones; large eye care facilities with a good...

Purpose: Uncorrected refractive error is the leading cause of visual impairment in children. Many countries, including India, implement school eye health programmes involving vision screening and provision of free spectacles. This is costly for governments/organisations involved. This analysis estimates potential cost-savings if ready-made spectacl...

Background Uncorrected refractive errors can be corrected by spectacles which improve visual functioning, academic performance and quality of life. However, spectacle wear can be low due to teasing/bullying, parental disapproval and no perceived benefit. Hypothesis: higher proportion of children with uncorrected refractive errors in the schools all...

Purpose: To report 15 year incidence rate of visual loss(blindness and visual impairment (VI)), causes and risk factors for participants in Andhra Pradesh Eye Disease Study III(APEDS III). Design: Population based cohort study METHODS: From 2012-16, all rural participants were interviewed and underwent a comprehensive eye examination, including,...

Diabetes mellitus now affects 65 million adults in India, which is likely to increase to over 130 million by 2045. Vision impairment and blindness from diabetic retinopathy (DR) and diabetic macular edema (DME) will increase unless systems and services are put in place to reduce the incidence of DR and DME, and to increase access to diagnosis and e...

This report describes the goal, activities, and outcomes of the Queen Elizabeth Diamond Jubilee Trust funded retinopathy of prematurity (ROP) program in the state of Maharashtra in collaboration with the Public Health Foundation of India, Hyderabad. The project was initiated in July 2016 with the goal of establishing a sustainable ROP program in th...

Background Blindness and visual impairment from diabetic retinopathy (DR) are avoidable through early detection and timely treatment. The Western Province of Sri Lanka has the highest prevalence of diabetes mellitus (DM) (18.6%) in the country. A situational analysis identified a significant gap in DR screening services (DRSS) uptake in this region...

To assess the change in attitudes of ophthalmologists to transscleral diode laser cyclophotocoagulation treatment for glaucoma before and after training.

Purpose : Uncorrected refractive errors are the leading cause of visual impairment in children, affecting children in all settings. The majority of refractive errors can be corrected with spectacles. High compliance with spectacle wear is required for children to realize the benefit, such as higher academic achievement. This review collates evidenc...

Purpose: To explore the knowledge of retinopathy of prematurity (ROP) and habilitation services for children with visual loss from ROP, among health care professionals (HCPs) involved in care of preterm children and to explore their attitudes and practices in relation to referral for habilitation. Methods: A modified knowledge, attitude and prac...

Following publication of the original article [1], the authors reported an error in Fig. 4 in the PDF version. Figure 4 is the duplicate image of Fig. 3 and the correct figure is missing. The authors would like to apologize for this error. The correct figure is shown below.

Background Diabetic retinopathy (DR) can lead to visual impairment and blindness if not detected and treated in time. Knowing the barriers/enablers in advance in contrasting different country income settings may accelerate development of a successful DR screening (DRS) program. This would be especially applicable in the low-income settings with the...

Quantitative Data Synthesis—Factors associated with DR screening uptake and regular follow up. (DOCX)

Themes tables by country income setting. (DOCX)

Participants’ characteristics of included articles. (DOCX)

Search strategy of barriers to access systematic review. (DOCX)

Methodological quality and applicability assessment of the included studies. (DOCX)

Importance: Visual impairment from uncorrected refractive errors affects 12.8 million children globally. Spectacle correction is simple and cost-effective; however, low adherence to spectacle wear, which can occur in all income settings, limits visual potential. Objective: To investigate predictors of spectacle wear and reasons for nonwear in st...

BACKGROUND:Visual impairment and blindness from diabetic retinopathy (DR), which can be reduced by early screening and treatment, is an emerging public health concern in low-income and middle-income countries (LMICs) owing to the increasing prevalence of diabetes mellitus (DM). However, no systematic screening exists in most LMIC settings. The West...

Importance: To investigate the safety, effectiveness and follow up rates after transscleral diode laser cyclophotocoagulation as primary treatment for seeing eyes with primary open angle glaucoma in Bauchi, Nigeria. Background: There is a high prevalence of primary open angle glaucoma in Africa where adherence to medical treatment and acceptance o...

Background: Cataract is the leading cause of blindness in low- and middle-income countries (LMICs), and the prevalence is inequitably distributed between and within countries. Interventions have been undertaken to improve cataract surgical services, however, the effectiveness of these interventions on promoting equity is not known. Objectives: T...

Purpose: To assess whether adapted motivational interviewing (MI) has any impact on the proportion of participants who subsequently underwent surgery or laser treatment for glaucoma. Materials and methods: A single site randomized controlled trial in Bauchi, Nigeria. Participants were new patients with a confirmed diagnosis of primary open-angle...

Purpose The purpose of this study is to estimate the unknown burden of retinopathy of prematurity (ROP) blindness from nine states of India using demographic, incidence and treatment data from an ongoing statewide ROP program in Karnataka called the Karnataka Internet Assisted Diagnosis of ROP (KIDROP) and to calculate the fiscal quantum of prevent...

Importance: Uncorrected refractive errors are the most common cause of visual impairment in children despite correction being highly cost-effective. Objective: To determine whether less expensive ready-made spectacles produce rates of spectacle wear at 3 to 4 months comparable to those of more expensive custom-made spectacles among eligible scho...

Glaucoma in Africa is sometimes referred to as the silent thief of sight. In Nigeria, glaucoma is common, it is serious, ophthalmologists face many constraints in managing it, people do not even know they have it until it is advanced, patients do not understand or comply with treatment after they are diagnosed and the poor are more likely to be gla...

Purpose: To determine agreement in estimations of vertical cup-to-disc ratio (VCDR) between clinical stereo-biomicroscopic funduscopy and digital fundus image analysis. Methods: Systematic sampling of 1-in-7 from a sample of 13,591 participants aged ≥40 years gave a subsample who were examined in detail. VCDR was estimated clinically by 60 diopter...

Purpose of the study Glaucoma, a chronic non-communicable disease, and leading cause of irreversible blindness worldwide is a public health problem in Nigeria, with a prevalence of 5.02% in people aged ≥40 years. The purpose of this nationwide survey was to assess Nigerian ophthalmologists’ practice patterns and their constraints in managing glauco...

Background: Couching is a traditional treatment for cataracts but often has poor visual outcomes, as identified during the Nigerian National Blindness Survey. Objectives: To investigate why couching is accessed by individuals with cataracts in northern Nigeria. Methods: The ten rural clusters in Jigawa State included in the National BlindnessSurv...

Background In Nigeria, glaucoma has a high prevalence and is the second cause of blindness among adults after cataract. People with glaucoma frequently present very late with advanced disease, and acceptance of and adherence to treatment is low. The purpose of the study was to explore how patients’ understand and respond to glaucoma in order develo...

To assess the extent to which climate may affect the abundance of Musca sorbens, a putative vector of trachoma. Studies were identified by systematically searching online databases including CAB abstracts, Embase, Global Health, Medline, Web of Science and BIOS Online, references from key articles, and the websites of relevant international agenc...

Uncorrected refractive errors are the commonest cause of visual impairment in children, with myopia being the most frequent type. Myopia usually starts around 9 years of age and progresses throughout adolescence. Hyperopia usually affects younger children, and astigmatism affects all age groups. Many children have a combination of myopia and astigm...

Background: To determine the stage of primary open angle glaucoma at presentation at a tertiary eye unit, to assess patient's knowledge of glaucoma and acceptance and subsequent adherence to treatment. Method: Information collected prospectively on new glaucoma patients aged 30 or more years included distance from residence and what they knew ab...

PurposeTo describe the rationale, objectives, study design and procedures for the longitudinal Andhra Pradesh Eye Disease Study (APEDS).DesignLongitudinal cohort studyParticipantsSurviving cohort from the rural component of APEDSMethods During 1996–2000, Andhra Pradesh Eye Disease Survey (APEDS) was conducted in three rural (n = 7771) and one urban...

Retinopathy of prematurity (ROP) is a major cause of potentially avoidable blindness in children in the middle-income countries of Latin America and Eastern Europe, and is becoming a public health problem in Asia.1 Indeed, the earlier estimate that there were 50 000–60 000 children worldwide who were blind from ROP2 is a marked underestimate, as a...

The distribution of trachoma in Nigeria is spatially heterogeneous, with large-scale trends observed across the country and more local variation within areas. Relative contributions of individual and cluster-level risk factors to the geographic distribution of disease remain largely unknown. The primary aim of this analysis is to assess the relatio...

Unlabelled: Retinopathy of prematurity (ROP) is the main cause of avoidable blindness in children in Mexico despite National ROP Guidelines and examination of preterm infants being a legal requirement. Objective: To assess coverage of ROP programs and their compliance with national guidelines. Study design: Thirty-two neonatal intensive care u...

Cost is frequently reported as a barrier to cataract surgery, but few studies have reported costs of accessing surgery in Africa. The purpose of this prospective, facility based study was to compare direct non-medical cost with total direct cost of cataract surgery to patients, and to assess how money was found to cover costs. Participants were tho...

To investigate the postmenstrual (PMA) age at treatment of severe retinopathy of prematurity (i.e. Type 1 prethreshold or threshold) in infants in a tertiary referral center in China. 76.6% (359/469) of infants were treated for threshold disease. 67.5% (317/469) of infants had a birth weight (BW) of 1250g or above and almost 30% (126) had a gestati...

The preterm baby may develop ophthalmic sequelae which can be due to prematurity per se, due to retinopathy of prematurity (ROP) or due to neurological damage. Focusing on the former two, we discuss how in high-income countries the risk of sight-threatening ROP is largely confined to babies <1000 g birth weight (BW), whereas in low-income or middle...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects on equity of interventions to improve access to cataract services for populations with cataract blindness (and visual impairment) in LMICs.

Background: Glaucoma is the leading cause of irreversible blindness in Nigeria. Patients present with advanced disease. Acceptance of surgery is very poor as there is no visual improvement. Diode laser has often been used as treatment for refractory glaucoma in non-seeing eyes. Recent evidence shows that it can be safely used in patients with good...

Background: An estimated 12.8 million being children aged 5-15 years are visually impaired and uncorrected refractive error uRE is the commonest cause. This is despite the fact that correcting RE is highly cost effective. There is evidence that correcting uRE is beneficial to a child’s academic and behavioural development and quality of life. Howev...

Background: Preterm birth contributes significantly to infant mortality and morbidity, including blindness from retinopathy of prematurity (ROP). Access to intensive neonatal care is expanding in many countries, but care is not always optimal, one factor being that nursing is often by inadequately trained nurse assistants. Objective: The aim of...

Achieving universal coverage in eye care remains a tremendous challenge as 226 million people in the world remain visually impaired, the majority from avoidable causes. The impact of eye care interventions has been constrained by the limited capacities of health systems in low-income and middle-income countries to deliver effective eye care service...

Objective: To assess the additional cost of incorporating the detection and treatment of retinopathy of prematurity (ROP) into neonatal care services of Brazil's Unified Health System (SUS). Methods: A deterministic decision-tree simulation model was built to estimate the direct costs of screening for and treating ROP in neonatal intensive-care...

Glaucoma is a chronic eye disease associated with irreversible visual loss. In Africa, glaucoma patients often present late, with very advanced disease. One-off procedures, such as laser or surgery, are recommended in Africa because of lack of or poor adherence to medical treatment. However, acceptance of surgery is usually extremely low. To preven...

To estimate the cost-effectiveness of cataract surgery and refractive error/presbyopia correction in Zambia. Primary data on costs and health related quality of life were collected in a prospective cohort study of 170 cataract and 113 refractive error/presbyopia patients recruited from three health facilities. Six months later, follow-up data were...

Aim: To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program for retinopathy of prematurity (ROP) screening in underserved rural areas using an indigenously developed tele-ROP model. Materials and Methods: KIDROP currently provides ROP screening and treatment services in three zones and 81 neonatal units...

In 2010 there were estimated to be 1.26 million blind children in the world, 10% fewer than the 1999 estimate. The prevalence and major causes reflect socioeconomic development and both can change rapidly over time. For example, corneal scarring from vitamin A deficiency and measles infection has declined in the poorest countries but retinopathy of...

Background: Retinopathy of prematurity (ROP) is a leading cause of potentially avoidable childhood blindness worldwide. We estimated ROP burden at the global and regional levels to inform screening and treatment programs, research, and data priorities. Methods: Systematic reviews and meta-analyses were undertaken to estimate the risk of ROP and su...

Objective: To obtain information on Refractive Error (RE) services in Kenya in terms of human resources and equipment, their distribution and levels of provision. Methods: All eye health facilities in Kenya were identified (77), through the Division of Ophthalmic Services. The following information was collected by postal questionnaire and telephon...

Trachoma is the most common cause of infectious blindness. Hot, dry climates, dust and water scarcity are thought to be associated with the distribution of trachoma but the evidence is unclear. The aim of this study was to evaluate the epidemiological evidence regarding the extent to which climatic factors explain the current prevalence, distributi...

A large-scale prevalence survey of blindness and visual impairment (The Andhra Pradesh Eye Diseases Study [APEDS1]) was conducted between 1996-2000 on 10,293 individuals of all ages in three rural and one urban clusters in Andhra Pradesh, Southern India. More than a decade later (June 2009-March 2010), APEDS1 participants in rural clusters were tra...

Antiretroviral treatment (ART) has altered the spectrum of HIV-related eye disease, resulting in a lower prevalence of retinal opportunistic infections (OIs). However, abnormalities in visual function have been reported in HIV-infected individuals despite effective viral suppression and the absence of retinal OIs. These changes may be mediated by a...

Background Non-communicable diseases are now a global priority. We report on the prevalence of hypertension and its risk factors, including ethnicity, in a nationally representative sample of Nigerian adults recruited to a survey of visual impairment. Methods A multi-stage, stratified, cluster random sample with probability proportional to size pr...

HIV-infected individuals have an increased risk of age-related morbidity despite antiretroviral treatment (ART). Several anatomic and functional ophthalmological parameters are associated with increasing chronological age. These may, therefore, potentially serve as biomarkers of ageing. We investigated associations between ocular parameters (lens d...

Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practised TT procedures in endemic settings...

Supplementation with carotenoids is proposed to protect against age-related macular degeneration. There is, however, considerable variability in retinal macular pigment response, which may be due to underlying genetic variation. The purpose of this study was to determine whether genetic factors, which have been previously associated with cross-sect...

Objectives: Little is known about the impact of HIV infection on biological ageing in sub-Saharan Africa. The study aimed to assess biological ageing in South African HIV-infected adults and HIV-seronegative individuals using two validated biomarkers, telomere length and CDKN2A expression (a mediator of cellular senescence). Design: A case-contr...

Retinopathy of prematurity (ROP) programs require collaboration between neonatologists, ophthalmologists, nurses, and allied health personnel, together with parents. The concept of a ROP program will vary according to the setting. However, in every situation there should be 2 main aspects: primary prevention of ROP through better overall care, and...

Certain anatomic and functional parameters of the eye change with increasing chronological age. They may, therefore, serve as potential biomarkers of ageing. We investigated associations between four such ocular parameters (lens density, retinal vessel calibre, corneal endothelial cells and retinal nerve fibre layer thickness) and two 'cellular' bi...

Introduction/Purpose: To obtain key informant perspectives on the current level of refractive service provision against the targets in the ‘National Strategic Plan for Eye Care (NSPEC) in Kenya 2005-2010’ by the Ministry of Health-Division of Ophthalmic Services. When investigating barriers to delivery of health care services, frequently only pat...

Purpose: To report the outcomes of bilateral pediatric cataract surgery from eastern Nepal and northern India. Methods: Preoperative, intraoperative, and postoperative data of 390 children who underwent surgery bilaterally between 2007 and 2009 were analyzed. Results: Forty-two (10.8%) children came from Nepal and 348 (89.2%) from India (mainl...

The purpose of this study is to review the epidemiology of different types of glaucoma relevant to Sub-Saharan Africa (SSA) and to discuss the evidence regarding the risk factors for onset and progression of glaucoma, including risk factors for glaucoma blindness. Electronic databases (PubMed, MedLine, African Journals Online- AJOL) were searched u...

Cellular senescence may be a key factor in HIV-related premature biological aging. We assessed features of the corneal endothelium that are known to be associated with biological aging, and cellular senescence markers in HIV-infected adults. Case-control study of 242 HIV-infected adults and 249 matched controls. Using specular microscopy, the corne...

Background: HIV infection is thought to be associated with an increased risk of age-related morbidity and premature aging. Lens density increases with age and may function as a biomarker of aging. The relationship of lens density measurements with clinical and demographic characteristics in HIV-infected individuals in comparison with a matched pop...

The eye and visual system are valuable in many areas of translational research such as stem cell therapy, transplantation research and gene therapy. Changes in many ocular tissues can be measured directly, easily and objectively in vivo (e.g. lens transparency; retinal blood vessel calibre; corneal endothelial cell counts) and so the eye may also b...

HIV infection is associated with an increased risk of age-related morbidity mediated by immune dysfunction, atherosclerosis and inflammation. Changes in retinal vessel calibre may reflect cumulative structural damage arising from these mechanisms. The relationship of retinal vessel calibre with clinical and demographic characteristics was investiga...