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Dear Readers,
Sitenews is 2 years young this April. We would like to acknowledge the support of all our readers and well wishers in helping us grow to having readership in over 120 countries. We look forward to your continued patronage and we would encourage you at this point to register as a member if you have already not done so.

In this second year anniversary issue we focus the spotlight back on cataract which contributes to 46 percent of the global blindness. The theme EVIDENCE FOR ACTION CATARACT CONTROL provides you with research based evidence products which you can convert to action for cataract control.

Cataract is an eye problem which can affect anyone irrespective of age, gender, or social status. Even though the treatment, surgical know, trained personnel is there still the magnitude of blindness due to cataract is high. This is highlighted when one examines the prevalence and incidence of cataract. When we have the basics of epidemiology it will help us to understand in detail how to conduct a cataract survey. Software and protocols are readily available which to day can make this job so much easier. In order to tackle this cataract problem we as service providers need to understand the various issues related to utilization, barriers, patients willingness to pay. There are currently various treatment interventions to choose from, which must be selected based on the context of the provider setting. Yet several research is underway in cataract to unearth new breakthroughs which can help in tackling this problem. There are several training programmes which can develop your skill in epidemiology including epidemiology in cataract. There are also weblinks provided of other websites related to this particular area. The organization we are featuring this issue is the prestigious Dept of Epidemiology and Population Health.

Happy Reading!

Regards,

Vision 2020 e-resource team
The Issue Features...
Evidence for Action - Cataract Control
Vol. 3 No. 4 April 2006
•   Cataract as a Problem
•   Prevalence and Incidence of Cataract
•   Measuring the Cataract Problem
•   Dealing with Problem
•   Which Intervention to Choose
•   Research Areas
•   Training Programs
•   Websites
•   Collaborating Partner
Cataract as a Problem
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Worldwide it is estimated that 180 million people are visually disabled. Of these, 37 million people are blind and this number increases by 1 to 2 million every year. Cataract contributes to 46% of blindness world wide. This is a very serious issue as cataract is easily curable through a simple surgery which is today available the world over. Yet cataract remains a public health problem in many developing countries. Traditionally, the cataract intervention programme is evaluated by the number of cataract operations performed per million population per year. In most of the countries the numbers has increased considerably, however impressive this increase may be, the figure does not indicate the extent to which the problem of cataract blindness has been reduced.
Prevalence and Incidence of Cataract
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Two indicators are used to measure impact of cataract blindness. First, it can be measured by a change in prevalence of cataract blindness, obtained through community based surveys. The second indicator to measure impact is Cataract Surgical Coverage (CSC). This community based parameter compares the proportion who have received surgery (aphakic) to the total, who still need or have had surgery (aphakic + operable cataract) in a certain area. It indicates to what extent the services have covered the needs. It measures the effectiveness of the cataract intervention programme in providing surgical services and, as such, it is an output indicator and does not measure the quality of cataract intervention.
  • VISION 2020 DATA UPDATE
    Abstract:
    This tools consists of CSR, no of Ophthalmologist, Refractionist, Optometrist, Surgeries etc of Different countries in the world.

  • CHILDHOOD CATARACT: MAGNITUDE, MANAGEMENT, ECONOMICS AND IMPACT
    Abstract:
    This article focuses the magnitude of childhood cataract and the management of childhood cataract to reduce it.

  • BLINDNESS PREVENTION PROGRAMMES - PAST, PRESENT, AND FUTURE
    Abstract:
    This article tells in detail about various blindness prevention programme carried out , how it got into effect in the present by having the partnerships with international nongovernmental organizations. Moreover it describes the action of National programmes for the prevention of blindness .It also tell about the development of Global database on blindness and visual impairment , to study and step into VISION 2020 at national level. It also describes the Health Systems Research carried out to analyze and prevent the needful blindness.
Measuring the Cataract Problem
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  1. Basics about Epidemiology
    Epidemiology helps to develop and conduct clinical research on eye disease by practicing ophthalmologist, specialist, managers and epidemiologist. Epidemiology is the study of the occurrence, frequency and causes of disease in humans. By knowing the disease level we can develop the strategies and Action plans to control them. This scientific discipline investigates what factors increase or decrease the risk of developing eye diseases, so they can be prevented or decreased for future generations.

    • EPIDEMIOLOGY FOR OPHTHALMOLOGISTS-AN INTRODUCTION TO CONCEPTS, STUDY DESIGNS, AND INTERPRETING FINDINGS
      Abstract:
      This review provides an overview of the types of information epidemiological research can provide and how these data can be used. All examples in the review are drawn from the ophthalmic literature. The first part of the review is relatively conceptual and focuses on epidemiological theory, including case definition, measures of the burden of disease, sampling and the interpretation of results. In the second part different study designs are describedspecifically, cross sectional surveys, cohort studies, case-control studies, and randomized controlled trials, and the strengths and limitations of each highlighted.

    • EPIDEMIOLOGY BASED ETIOLOGICAL STUDY OF PEDIATRIC CATARACTS IN WESTERN INDIA
      Abstract:
      This article gives the etiological study of Pediatric cataracts. This article provides the materials and the methods followed to conduct the cataract study on Traumatic Cataract, Non-traumatic cataracts and the discussion paper about the study.

    • A SHORT INTRODUCTION TO EPIDEMIOLOGY
      Abstract:
      This article gives a brief introduction to Epidemiology process. It inturn gives a brief sketch of Study design options such as Incidence Studies, Prevalence studies and More complex study designs, Study design issues such as Precision, Validity and Effect Modification, the process of conducting a study such as Measurement of Exposure and Health status,Cohort studies and case control studies. Moreover it describes howto Analyse and Interpret a study by following the process of Data Analysis and Interpretation.

    • INTRODUCTION TO BASIC EPIDEMIOLOGY AND PRINCIPLES OF STATISTICS FOR TROPICAL DISEASES CONTROL
      Abstract:
      This article describes the problem-solving approach to facilitate the learning of some basic epidemiological concepts and practices and simple statistics. It is designed for health workers responsible for tropical diseases control. It is considered to be fundamental to the learning of the epidemiological approach to malaria control and for a situation analysis.

    • A NATIONAL RESEARCH STRATEGY FOR CATARACT
      Abstract:
      This article describes the epidemiology of eye disease in the older population, retinal disorders, vitreoretinal disease, vision impairment and rehabilitation, the magnitude of the problem and the population need, research priorities, sources of data and the study references and retinal disorders.


  2. Software's used for Epidemiology Research
    • RAPID ASSESSMENT OF CATARACT SURGICAL SERVICES (RACSS)
      Abstract
      The Rapid Assessment of Cataract Surgical Services (RACSS) is a sound epidemiological method using systematic random cluster sampling to collect data on cataract surgical services in the age group most affected by cataract. RACSS can be repeated by local ophthalmic staff at 5-years interval. This will enable eye care planners to assess the impact of their intervention programmes. Rapid assessment of cataract is a simple, quick, inexpensive and practical method to determine the cataract load in a target area where the intervention is planned.

    • RAPID ASSESSMENT OF AVOIDABLE BLINDNESS
      Abstract:
      Rapid assessment of Avoidable Blindness is a similar to RACSS, targeting people over 50 years of age, and surveys all preventable and/or treatable causes of blindness. It is called RAAB, and is currently under development. RAAB will be available for use by the end of 2006.


  3. Survey Protocols
    We have provided you with the link some of the survey protocols like Cataract survey protocol, Pakistan survey, Sydney myopia study, Utilization of eye care services in rural south India: The Aravind comprehensive eye survey and Evidence based eye care - Evidence for the effectiveness of interventions for congenital, Infantile and childhood cataract for your references.

Dealing with Problem
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Although cataracts can be surgically removed, in many countries surgical services are inadequate, and cataract remains the leading cause of blindness. As people in the world live longer, the number of people with cataract is growing. Cataract is also an important cause of low vision in both developed and developing countries. Even where surgical services are available, low vision associated with cataract may still be prevalent, as a result of the long period spent waiting for operations and barriers to surgical uptake, such as cost, lack of information, and transportation problems.

  1. Utilization
    There is always shortage of ophthalmic resources in developing countries, efforts must be taken to ensure that optimum utilization of the minimum resources is been done.

    • HIGH VOLUME, HIGH QUALITY CATARACT SURGERY
      Abstract:
      This article explore the factors that contribute to doing high volume, high quality cataract surgery and details the processes, systems and procedures involved.


  2. Barrier
    Despite improvements in the availability of cataract blindness preventing and restoring treatment in the developing world, massive barriers remain to increasing the use of services. The reasons for barriers changes from country to country. Few receiver barriers identified are cost of surgery, Distance to the Hospital, Cultural and Social Barriers, Knowledge of Services.



  3. Willingness to pay
    In developing and underdeveloped countries awareness of the availability of treatment and services provided are within the reach, people are not willing to pay for the surgery and use the facility primarily because of poverty. Hence, to change patients attitudes, an holistic approach is needed keeping in view the cultural, social, and economic background of the society, Trust in Outcome of Surgery and Visual needs differ.



  4. Gender
    Women bear approximately two-thirds of the global burden of blindness, with cataract being the major cause in developing countries, and it is likely that much of the excess female blindness in these countries is due to cataract. This variance may be due to various reasons like cultural, social, literacy, and economic background of the society. Achieving equal surgical coverage between genders will have resulted in an additional 25.3% reduction of cataract blindness.

Which Intervention to Choose
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Equipments and instruments available for performing cataract surgery are advancing at a rapid phase. This has led to surgical advancements also evolving. Today cataract surgery has evolved from ICCE to ECCE with various types of lenses to PHACO and SICS surgery. There are several studies which has investigated the outcomes and efficacy of each. In a developing country with limited resources SICS surgery is advocated whereas Phaco continues to be the surgery of choice at the other end of the spectrum.
Research Areas
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A list of epidemiological studies being conducted on the prevalence and causes of visual impairment world wide. Clicking on a study link will bring you to a page that describes the study in greater detail.
Training Programs
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The following are the courses related to Epidemiology and Epidemiology in eye care. We have provided you with the course name, Objective, duration and contact persons of these courses for your information.
Websites
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Collaborating Partner
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The London School of Hygiene & Tropical Medicine is Britain's national school of public health and a leading postgraduate institution in Europe for public health and tropical medicine. Part of the University of London, the London School is an internationally recognized centre of excellence in public health, international health and tropical medicine with a remarkable depth and breadth of expertise. It is one of the highest-rated research institutions in the UK.

Its mission is to contribute to the improvement of health worldwide through the pursuit of excellence in research, postgraduate teaching and advanced training in national and international public health and tropical medicine, and through informing policy and practice in these areas.

Contact them at http://www.lshtm.ac.uk/eph/

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