VISION RESEARCH FOR DEVELOPMENT
An Evaluation of Cataract Services in South Africa
In view of the VISION 2020 objectives to provide cataract surgical services to eliminate the backlog of cataract, it is essential that the number of service centers and the basket of services they provide be adequate; services be affordable for all people in rural and urban areas; and services be able to offer operated patients a satisfying visual outcome and an improvement in their quality of life (VISION 2020, 2008).
The aim of the evaluation of cataract services in South Africa is to undertake a situational analysis of cataract services and to determine cataract surgical performance, barriers and the impact of services in South Africa.
The study consists of two phases:
a) A Baseline Evaluation
b) An Impact Evaluation
The main objectives of the study are to:
• Estimate the prevalence of cataract in South Africa through a systematic review and a meta-analysis of cataract prevalence papers
• Determine the Human Resource challenges posed to cataract services and the availability of cataract service centres
• Determine the current cataract surgery rate
• Determine the needed cataract surgery rate
• Determine the impact of cataract on the quality of life of individuals pre and post cataract surgery
Mapping Human Resources for Eye Health in Sub-Saharan Africa
A study of the eye health workforce in sub-Saharan Africa was commissioned to inform programme strategies and policies for human resources for eye health (HREH) in the region. The results emanating from this study are expected to provide up to date and accurate data on the active eye health workforce and evidence regarding the relationship between human resources and eye health outcomes.
The overall aim of the study is to gain an in-depth understanding of the eye health human resource gaps and needs at a country level for the provision of an indicator eye health service, cataract surgery, in at least 15 countries of sub-Saharan Africa with more than 4 million population.
The objectives of the study are to:
1. Identify the training and education infrastructure for eye health available in each country and the numbers and types of eye health workers recently entering the active workforce.
2. Identify the number and geographical distribution of active eye care workers and at all levels of the health system currently working in selected countries.
3. Identify the numbers of eye health workers recently exiting the eye care workforce and the impact of emigration.
4. Estimate the workforce required to meet the needs of the selected country’s population for cataract surgery.
5. Make recommendations to inform policy makers concerned with human resources in eye health.
Mapping of Eye Health Research Capacity and Resources in Sub-Saharan Africa
The main aim of Mapping Eye Health Research Capacity and Resource in Sub-Saharan Africa is to map existing eye health and non-eye health research capacity (human resources and research centres) in Africa, including the availability of research support, resources, and education and training programs.
The Objectives of the study are to:
• Identify existing eye care research centres at academic institutions, NGOs and the private sector and their areas of specialisation.
• Determine the number of personnel available in research centres and their areas of specialisation.
• Map research capacity in non-eye health centres that can be supportive of the eye health agenda.
• Identify research capacity building courses and workshops available in Sub-Saharan Africa for researchers and postgraduate research students.
• Identify educational and training needs to support the eye health research agenda.
• Determine the capacity of current eye health faculty to provide postgraduate supervision and support.
• Establish the number of emerging researchers: postgraduate students currently registered in Sub-Saharan Africa.
The African Vision Research Institute in collaboration with Sightsavers has endeavored to undertake this research which is essential in developing appropriate global policies and strategies.
Near Vision Spectacle Correction and Work Productivity
The African Vision Research Institute in collaboration with the Brien Holden Vision Institute intends to investigate the increase in the productivity of textile factory workers following an eye assessment and near vision spectacle correction.
The aim of the study is to determine if spectacle correction of factory workers increases work productivity in textile factories that perform near visual tasks.
The main objectives of the Near Vision Spectacle Correction and Work Productivity study are to:
• Determine the patients socio-demographic and eye health profile.
• Conduct a baseline investigation of the patient’s feelings, concerns, and perceptions of their eye health and identify their limitations and complaints in relation to performing near vision tasks.
• Evaluate and examine the patient’s eyes and provide near vision spectacle correction.
• Track potential changes in work productivity after near vision spectacle correction.
• Disseminate the research findings to society.
All patients that have been identified as being near vision impaired or presbyopic will be given corrective spectacles of appropriate powers and will have their vision re-tested with the corrected device to determine if their vision is improved with the correction. Correction will include bifocal, multi-focal, and single vision spectacles.
Ergonomic factors will be noted and considered in the initial visit to the 2 textile factories before conducting the clinical eye examination and follow-up study. Near vision tasks requires both eyes to converge and focus on the near distance target. The visual demand of such tasks requires the consideration to the following ergonomic factors:
• Target size: The size of the task must be large enough that the worker can perform it comfortably and efficiently without having to strain his/her vision. In general, the work detail should be at least three times the minimum size required by the worker to resolve the detail.
• Contrast: Low contrast objects are difficult to see regardless of the size of an object.
• Viewing time: A longer viewing time is required to recognise details that are difficult to see at a glance. Colour coding and other strategies reduce search time for operations in which viewing time cannot be changed, such as in assembly line work, which will improve worker efficiency.
• Lighting: Good lighting is one of the most essential elements of visual comfort. Poor lighting creates an uncomfortable environment for any employee, irrespective of the work task or characteristic
The Poverty and Eye Health (PEH) Research
A research collaboration between the African Vision Research Institute (AVRI), ORBIS and the Brien Holden Vision Institute was formed to research the validity of the theory that; it is more likely for poor to become blind and for blind people to become poor. The research investigates poverty and eye health in South Africa.
As part of the National Poverty Eradication Strategy 2009–2014 this research collaboration brings together specialists in the field of poverty and eye health to investigate the prevalence of eye diseases in KwaZulu-Natal, South Africa. It also aims to identify, implement, and monitor eye health services that are desperately needed to improve sight.
The War on Poverty (WOP) initiative provided the researchers with direct access to people who were already identified as being poor with self-reported eye conditions. This database provided a sample of the poorest, which could be used to define the correlation between visual impairment and blindness and socio-economic status.
As part of the Poverty and Eye Health (PEH) study, the investigators place special emphasis on two core causes of visual impairment and blindness, namely refractive errors and cataract. The PEH study uses raw data from the WOP household surveys to:
• Determine the prevalence of self-rated eye care needs amongst people in the most under-resourced settings.
Determine if visual impairment and blindness amongst the poorest people contributes to their poverty – through analysis of the correlation between selected categories such as disability, access to health care and blindness.