|ORIGINAL RESEARCH REPORT
|Year : 2017 | Volume
| Issue : 4 | Page : 188-192
Presbyopic spectacle coverage and barriers to near vision correction among adult population in ido local government area, Southwest Nigeria
Mukaila Alaba Seidu, Charles O Bekibele, Ayobade O Ayorinde
Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
|Date of Web Publication||8-Nov-2017|
Mukaila Alaba Seidu
Department of Ophthalmology, Ring Road State Hospital, Ibadan
Source of Support: None, Conflict of Interest: None
Background: The magnitude of presbyopes with appropriate near vision correction is low globally and spectacles' correction remains cost-effective option for low- and middle-income countries. Objectives: The objective of this study was to determine presbyopia correction coverage (PCC), presbyopic met need and unmet need, willingness to pay for a pair of near vision spectacles, and barriers to usage of near vision spectacles among adults aged 40 years and above in a semiurban population of Southwest Nigeria. Materials and Methods: A cross-sectional, population-based study was carried out on 440 participants who were 40 years and above. Participants were selected using multistage sampling technique. Participants had refraction for both distance and near vision. Information on the use, barriers, and source of near vision spectacle was collected using interviewer-administered questionnaire. Data analysis was done using Statistical Package for Social Sciences software version 22 (IBM Corp., New York, USA). Results: A total of 440 participants were examined. Male to female ratio was 1:1.2 and the mean age of the participants was 51 ± 8 years. The PCC in the study was 27.3% with met need of 20.5% and unmet need of 54.5%. The major barriers to usage of near spectacles in this study were “not a priority” at 38.4% (95% confidence interval [CI] 32.3–44.5) and “not aware of the problem” at 34.7% (95% CI 28.7–40.7). Most of the participants (75.7%) were willing to pay at least 1000 naira (US$6) for a pair of near spectacles; hence, cost was not a significant barrier. Conclusion: The PCC in the area was low. Basic eye screening and refractive services should be incorporated into primary eye care for easy accessibility by the adult population in this area.
Keywords: Barriers, correction coverage, near spectacle, Nigeria, presbyopia
|How to cite this article:|
Seidu MA, Bekibele CO, Ayorinde AO. Presbyopic spectacle coverage and barriers to near vision correction among adult population in ido local government area, Southwest Nigeria. J Clin Sci 2017;14:188-92
|How to cite this URL:|
Seidu MA, Bekibele CO, Ayorinde AO. Presbyopic spectacle coverage and barriers to near vision correction among adult population in ido local government area, Southwest Nigeria. J Clin Sci [serial online] 2017 [cited 2020 Jul 5];14:188-92. Available from: http://www.jcsjournal.org/text.asp?2017/14/4/188/217813
| Introduction|| |
Global estimate of the number of people with presbyopia is above one billion and almost half of them are without adequate correction. The need for near vision correction will increase as the world's aging population increases and also with the widespread use of devices such as mobile phones in rural areas of the developing countries. Several studies , have shown that there is need for correction of presbyopia even among the illiterate in rural community because of its impact on their vision-related quality of life. Near vision is needed for sorting grains, threading needle, sewing, cooking food, dressing children, lighting, and adjusting lamps. Recently, the impact of uncorrected presbyopia on visual impairment was appreciated by the World Health Organization (WHO) and presbyopia service was then included in the 2006–2011 WHO action plans as part of refractive error program. The magnitude of presbyopes with appropriate near vision correction is low in developing countries.,,, Lack of knowledge about refractive services, poor accessibility to available facilities in the community, and financial constraints are some of the hindrances to uptake of spectacles in developing countries.,,,,
The study aimed to determine the presbyopia correction coverage (PCC), presbyopic met and unmet need, willingness to pay for a pair of near vision spectacles, and barriers to uptake of near vision spectacles among the people who were 40 years and above in the studied local government area.
| Materials and Methods|| |
The population-based, cross-sectional study was carried out between April and May 2014. The study was conducted among participants aged 40 years and above who have been living in a suburban population of Ido Local Government Area in Oyo State, Southwest of Nigeria, for at least 6 months before the survey. The total population of the area based on the 2006 national census figures  was 104,087 and about 22% of population in the area were 40 years and above. The people in this local government are mainly farmers, artisans, traders, and civil servants. Minimal sample size was determined using Kish  statistical formula,
Zα=1.96, P = 53.4% (prevalence in a previous study ), Q = 1 − p, d = 5%
After accounting for 10% nonresponse rate, sample size was 424.87; however, minimal sample size of 430 was used for the study. Description of sampling technique and visual acuity assessments was explained in earlier publication. Salient and additional information are mentioned here. Multistage sampling method with probability proportional to size procedure was used to select the population studied. The study was done in 5 political wards which were selected out of 10 wards using simple random sampling. Three settlements were then chosen in each of the 5 wards selected by balloting. The first house in each settlement selected was determined by spinning a bottle at the center of the settlement. Eligible respondents were recruited from the subsequent houses along the same direction until the required population sample size was obtained using probability proportional to size procedure. The next house with eligible individuals was chosen in case there was no eligible individual in a selected house.
All respondents who were aged 40 years and above, with best-corrected distance visual acuity of ≥6/18 and had been residing in the community for at least 6 months were included in the survey after consent was obtained.
All participants had distance visual acuity assessment done and participants with visual acuity of <6/6 were refracted. Near vision was then assessed at 40 cm with distance correction in place if required. Subjects who could not read N8 optotypes were asked if they had reading glasses and where they obtained it. Subjects who did not have a pair of glasses were asked on the reason for not having one and how much they could willingly pay for a pair of reading glasses. Cost of a pair of readymade reading glasses, which was 500 naira (US$3) at University College Hospital (UCH) Ibadan optical shop, during the survey, was used as reference. Information on near vision spectacle use was collected using interviewer-administered questionnaires and the data were analyzed using Statistical Package for Social Sciences software version 22 (IBM Corp., New York, USA). Chi-square test was used to test for association between qualitative variables and level of statistical significance was set at P < 5%. The study protocol was approved by the Institutional Review Board of UCH, Ibadan.
PCC (%) was the percentage of met presbyopic need divided by sum of met need and unmet need (met need/met need + unmet need) ×100.
The met need was defined as number of individuals with presbyopia who had spectacles that allowed near vision to improve to ≥N8.
Unmet need was defined as number of those with near vision <N8 due to presbyopia who did not have near vision corrective spectacles or whose spectacles did not improve their vision. For the purpose of analysis, occupational status was reclassified into skilled and unskilled. Skilled were civil servants, professional, retiree, priest, and clergy while unskilled were traders, artisans, laborers, hunters, and peasant farmers.
| Results|| |
A total of 440 individuals participated in the study; age range of the participants was between 40 and 80 years with a mean of 51 (±8) years. Male participants were 204 (46.4%). Majority (71.6%) of the participants had at least secondary school education and skilled workers accounted for 47.5% of the participants as shown in [Table 1].
[Table 2] showed that 90 (20.5%) out of 440 participants had spectacles corrected near vision of at least N8 at presentation; the met presbyopic need was thus 20.5%. Two hundred and forty participants (54.5%) could not read N8 line because of uncorrected presbyopia, thus unmet presbyopic need was 54.5%. PCC was 27.3%. It was higher for males (30.0%) than females (25.0%) and for those older than 60 years; however, the difference was not statistically significant (P > 0.05). The PCC was significantly higher among the skilled workers and participants who had at least secondary school education (P< 0.05). Two hundred and forty-five participants who did not have reading glasses were interviewed regarding the barriers to the use of near vision spectacles. The most common barrier as presented in [Table 3] was “not a priority” at 38.4% (95% confidence interval [CI] 32.3–44.5) followed by “not aware of the problem” at 34.7% (95% CI 28.7–40.7) while 0.8% felt that it was not fashionable. The study showed that most of the respondents (75.7%) were willing to pay at least N1000 (US$6) for a pair of reading spectacles as presented in [Table 4]. Among these were people <60 years, women, and individuals with at least secondary school education. [Table 5] showed that 109 (55.9%) of 195 subjects who were currently using reading glasses were not satisfied with their glasses and only 28 (14.4%) of them obtained theirs from an eye clinic.
|Table 3: Barriers to the use of near vision spectacles among participants in the survey|
Click here to view
|Table 4: Maximum price participants were willing to pay for reading glasses|
Click here to view
| Discussion|| |
Uncorrected refractive error was reported to be an important cause of visual impairment among Nigeria adults who were above 40 years in Nigeria National Blindness Survey  and more than 90% of participants in the survey who needed spectacles to correct their visual impairment either did not have spectacle or were using incorrect prescriptions. Holden et al. also reported that half of a billion people with presbyopia did not have adequate near correction.
The PCC in this study was 27.3% with met need of 20.5% and unmet need of 54.5%. The correction coverage and the met need in this study were low and similar findings were reported in other studies ,, from developing countries. PCC was 26.2% in Timor-Leste, 21.0% in rural Abuja, 17.6% in Zanzibar, and 6.3% in Kenya. The low coverage in these areas might be attributed to poor accessibility to affordable and qualitative eye care services in developing countries.,, The population-based survey conducted in Timor-Leste  and rural Abuja, Nigeria, also showed lower presbyopic met need of 11.5% and 11.2%, respectively, unlike 20.5% that was found in this study. This difference could be attributed to higher literacy level among the participants in this study compared to the studies done in Timor-Leste  and rural Abuja  where more than two-third of their participants had less than secondary school education.
Unskilled workers and individuals below secondary school education had the lowest correction coverage in this study, similar to the findings in Timor-Leste. This significant association between correction coverage and higher level of education was also reported by other population-based studies., Skilled workers and those with higher education would likely be able to afford near vision spectacle for their regular visual need such as reading because they would probably be engaged in paying job. In the present study, PCC was slightly higher among male (30% vs. 25%) similar to findings reported by Ramke et al. with higher PCC of 31.2% for males compared to 21% for females. This disparity could be due to gender imbalance in usage of eye care services. Several sociocultural factors such as limited financial authority and freedom of movement often affect women, especially in Africa., There was no significant association between PCC and age groups and this is consistent with what Muhammad and Jamda  found in rural Abuja, Nigeria.
The most common barrier to utilization of reading spectacles in this study was “not a priority” at 38.4% (95% CI 32.3–44.5). This is similar to the findings of Laviers et al. in Zanzibar which showed that the major barrier was “not consider it a priority” (33%). Similar to the finding in rural China by Lu et al., the second major barrier in this study was “not aware of the problem” at 34.7% (95% CI 28.7–40.7). The study in rural China  identified that low quality of available spectacles (33.1%) and lack of awareness about presbyopia (28.8%) were major barriers in not having near vision spectacles. More than 75% of the respondents in this study were willing to pay at least 1000 naira (US$6) for a pair of glasses. This could be attributed to the fact that majority of the subjects had at least secondary school education and they were likely to be engaged in a paying employment. The average price of a pair of readymade reading glasses at UCH during this study was 500 naira (3USD); hence, cost (9.4%) was not a major barrier among the respondents. Unlike the studies from Kenya  and rural Abuja, Nigeria, which showed that costs were the major barrier for not having near vision correction.
Consistent with the finding in rural China, more than 80% of participants with reading glasses in this study obtained their spectacle outside eye clinics such as markets where they were unlikely to receive appropriate visual assessment. Presbyopia correction services can play an important role in the development of an integrated eye care system because the need for reading spectacles is a health issue that encourages people to seek eye care, especially in developing countries. Thereby, consulting an eye care practitioner enables examination and detection of potentially blinding diseases such as cataract, diabetes eye diseases, and glaucoma. Periodic public education on where people can seek for eye care should be emphasized in the local government. Provision of good and affordable near vision spectacles by trained health personnel in the area will not only encourage more people to seek for eye care but will also give opportunity for appropriate examination of the patients and detections of other diseases.
| Conclusion|| |
PCC and met need in the area were low. Most of the respondents either did not consider obtaining a pair of reading glasses a priority or were not even aware of the problem; hence, local government authority should incorporate eye screening and basic refractive services to primary health care for easy accessibility by inhabitants of the area. Primary health-care workers in the area should be trained on basic eye care services. Health education and awareness campaign on the importance of obtaining near vision correction spectacle from appropriate health-care facilities should be periodically carried out in the local government. Good and affordable reading glasses should then be made available at the primary health center because most respondents obtained their glasses from outside eye clinic where their qualities might not be guaranteed. Study limitations involved getting precise age of few respondents despite using historic events and measurement of N8 at 40 cm that was used often fails to account for individual habitual reading distance.
Future study would be needed to assess the feasibility and impact of presbyopia service delivery after its incorporation into the primary health-care system.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Holden BA, Fricke TR, Ho SM, Wong R, Schlenther G, Cronjé S, et al
. Global vision impairment due to uncorrected presbyopia. Arch Ophthalmol 2008;126:1731-9.
Patel I, Munoz B, Burke AG, Kayongoya A, McHiwa W, Schwarzwalder AW, et al
. Impact of presbyopia on quality of life in a rural African setting. Ophthalmology 2006;113:728-34.
McDonnell PJ, Lee P, Spritzer K, Lindblad AS, Hays RD. Associations of presbyopia with vision-targeted health-related quality of life. Arch Ophthalmol 2003;121:1577-81.
Ramke J, du Toit R, Palagyi A, Brian G, Naduvilath T. Correction of refractive error and presbyopia in Timor-Leste. Br J Ophthalmol 2007;91:860-6.
Laviers HR, Omar F, Jecha H, Kassim G, Gilbert C. Presbyopic spectacle coverage, willingness to pay for near correction, and the impact of correcting uncorrected presbyopia in adults in Zanzibar, East Africa. Invest Ophthalmol Vis Sci 2010;51:1234-41.
Ezelum C, Razavi H, Sivasubramaniam S, Gilbert CE, Murthy GV, Entekume G, et al
. Refractive error in Nigerian adults: Prevalence, type, and spectacle coverage. Invest Ophthalmol Vis Sci 2011;52:5449-56.
Sherwin JC, Keeffe JE, Kuper H, Islam FM, Muller A, Mathenge W. Functional presbyopia in a rural Kenyan population: The unmet presbyopic need. Clin Exp Ophthalmol 2008;36:245-51.
Muhammad RC, Jamda MA. Presbyopic correction coverage and barriers to the use of near vision spectacles in rural Abuja, Nigeria. Sub Saharan Afr J Med 2016;3:20-4.
Nirmalan PK, Krishnaiah S, Shamanna BR, Rao GN, Thomas R. A population-based assessment of presbyopia in the state of Andhra Pradesh, South India: The Andhra Pradesh eye disease study. Invest Ophthalmol Vis Sci 2006;47:2324-8.
Kish L. Survey Sampling. New York: John Wiley and Sons; 1965.
Seidu MA, Bekibele CO, Ayorinde OO. Prevalence of presbyopia in a semi-urban population of Southwest, Nigeria: A community-based survey. Int Ophthalmol 2016;36:767-73.
Sommer A, Taylor HR, Ravilla TD, West S, Lietman TM, Keenan JD, et al
. Challenges of ophthalmic care in the developing world. JAMA Ophthalmol 2014;132:640-4.
Jaggernath J, Overland L, Ramson P, Kovai V, Chan V, Naidoo KS. Poverty and Eye Health. Health 2014;6:1849-60.
Marmamula S, Keeffe JE, Raman U, Rao GN. Population-based cross-sectional study of barriers to utilisation of refraction services in South India: Rapid Assessment of Refractive Errors (RARE) Study. BMJ Open 2011;1:e000172.
Maseko S. Prevalence of Presbyopia, Near Spectacle Correction Coverage and Patients' Acceptance of Readymade Spectacles in Swaziland. [Msc Dissertation Submitted to London School of Hygiene and Tropical Medicine]; 2011.
Olusanya BA, Ashaye AO, Owoaje ET, Baiyeroju AM, Ajayi BG. Determinants of utilization of eye care services in a rural adult population of a developing country. Middle East Afr J Ophthalmol 2016;23:96-103.
] [Full text]
Mganga H, Lewallen S, Courtright P. Overcoming gender inequity in prevention of blindness and visual impairment in Africa. Middle East Afr J Ophthalmol 2011;18:98-101.
] [Full text]
Lu Q, He W, Murthy GV, He X, Congdon N, Zhang L, et al
. Presbyopia and near-vision impairment in rural Northern China. Invest Ophthalmol Vis Sci 2011;52:2300-5.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]