RESUMO
BACKGROUND: Uncorrected presbyopia can greatly impact a person's quality of life and employment prospects. Nicaragua is the poorest country in Latin America and there are no population-based reports of prevalence of presbyopia in Nicaragua. METHODS: A cross-sectional population-based household survey was conducted. The sample was selected through random cluster sampling. Adults 35 years and older were enlisted through a door-to-door method using aged-based sampling. All enumerated household members 35 years and older were asked to attend a free visual acuity screening. Autorefraction was done and then uncorrected distance vision and near visual acuity were measured for all subjects. All those who had distance or near vision that was 6/12 or worse underwent a clinical examination, which included refraction at distance and near. Free spectacles were provided. RESULTS: Of the 3,390 subjects surveyed, 37.1 per cent reported that they wore spectacles on a regular basis. A total of 1,871 (55.2 per cent) of those enumerated were examined. The prevalence of near visual impairment (6/12 [N 6] or worse) was 79.6 per cent for the 35 to 49-year-old group, 97.3 per cent for the 50 to 64-year-old group and 96.7 per cent for the 65 and over group. Of those reporting for the examination, 82.2 per cent did not have glasses. Of those examined, 10 per cent did not need spectacles, four per cent were given spectacles for distance only, 38 per cent spectacles for distance and near, 42 per cent spectacles for near only and seven per cent were referred for medical evaluation due to ocular pathology. During the refractions, 91.5 per cent were corrected to 6/12 or better at distance and 89.4 per cent were corrected to 6/12 or better at near. CONCLUSION: The majority of the participants who were examined did not have the spectacles that they needed. Over one-third of those participants who presented without spectacles had distance vision better than 6/12 and could be improved to good near vision with ready-made near-only spectacles.
Assuntos
Presbiopia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Óculos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Presbiopia/terapia , Encaminhamento e Consulta , Acuidade VisualRESUMO
PURPOSE: In affluent societies, distance and near vision problems are typically corrected with custom-made eyeglasses. Many persons in less affluent areas do not have the resources for such. The purpose of this study was to assess the use of less expensive ready-made (RM) bifocals and readers to correct distance and near refractive error and presbyopia in an outreach clinic in Nicaragua. METHODS: This is a retrospective review of records of all patients older than 34 years who presented for an eye examination in an outreach clinic in Granada, Nicaragua, in 2010. A visual satisfaction questionnaire had been administered to patients before they were examined and after RM plus sphere bifocals or plus sphere reading spectacles were dispensed. The main outcome measures included pre- and post-distance and near visual acuities, vision satisfaction and difficulty ratings, and perceived cost and willingness to pay for replacement rating. RESULTS: Ready-made plus sphere spectacles (bifocals or single-vision readers) were dispensed to 95.4% of those examined. The remaining 4.6% required custom prescriptions because of astigmatism, myopia, or anisometropia. The RM bifocals were very well accepted, with high visual satisfaction ratings with the bifocals improving from a presenting value of 11 to 89.4% at distance and from 6.6 to 89.4% at near. Percentage of patients achieving visual acuity of 20/40 or better improved from 60 to 84.5% at distance and from 44 to 97% at near. Percentage achieving functionally good near vision (20/40 or better) improved from 38 to 97% with RM readers. Patients reporting highest satisfaction with near vision improved from 6.3 to 86.6%. Patients indicated that, on average, they would be willing to pay US$18.39 to replace the bifocals and US$16.67 to replace the readers. CONCLUSIONS: Ready-made bifocals and RM single-vision readers may be an acceptable and affordable alternative for many patients with hyperopia and/or presbyopia where access to custom-made eyeglasses is difficult.