Most Latin American countries have national retinopathy of prematurity (ROP) screening guidelines, but how consistently these thresholds are applied and whether the metric used affects cross-country comparability is poorly documented. We analysed data from the SPROP (Sociedad Panamericana de Retinopatía del Prematuro) database (2021–2024), including 333 of 343 registrants from 17 countries who provided gestational age (GA) and/or birth weight (BW) screening cutoffs. We assessed between- and within-country variation, guideline concordance, and relative variability of GA and BW thresholds using the coefficient of variation (CV). Hospital-level alignment was classified as wider, at, or narrower than the national guideline. BW cutoffs were 3.6 to 5.1 times more variable than GA cutoffs across all countries. Mean GA cutoffs approximated national guidelines, but with marked country-level differences: Argentina applied broader cutoffs than recommended (Δ = +1.5 weeks; 50.5

CLINICAL RELEVANCE:Understanding the epidemiology and risk factors for the onset of myopia is essential to implementing its prevention and control strategies. BACKGROUND:Myopia is becoming a major public health condition affecting 30-35% of the global population and is expected to affect 50% by 2050. This study aimed to determine the 15-year cumulative incidence and risk factors of myopia among participants of the Andhra Pradesh Eye Disease Study. METHODS:A population-based longitudinal cohort study was conducted to follow-up participants at a mean of 15 years across three rural districts of two south Indian states. Participants underwent a comprehensive eye examination, including dry refraction. Incident myopia was defined as spherical equivalent of < -0.50D in the right eye at follow-up, excluding participants with baseline myopia or nuclear sclerosis (≥2.5 on LOCS III grading scale) or had undergone cataract surgery at follow-up. RESULTS:Of 7,771 baseline participants, 5,395 (69.4%) were examined at follow-up. A total of 2,071 participants <30 years and, 755 ≥30 years at baseline were analysed. The overall cumulative myopia incidence was 8.0% (95%CI: 7.0-9.0). It was 8.0% (95%CI: 6.9-9.3) and 7.8% (95%CI: 6.0-10.0) among the younger and older participants respectively. The incidence was higher in younger females (9.9%) than males (6.1%), but it was higher in older males (10.4%) than females (5.5%). In multivariable analysis, female gender and residence at Mahabubnagar and Adilabad districts were risk factors among those <30 years, whereas current alcohol consumption was a significant risk among ≥30 age group. CONCLUSION:Although the overall estimates were similar between younger and older participants, in the latter, the incidence may be linked to residual nuclear sclerosis. Future studies should consider including other modifiable risk factors associated with myopia, which could aid in developing suitable intervention strategies to address the rising global prevalence.

Global consensus has shifted to focus on how children can be supported to not only 'survive' but to 'thrive'. Blindness and visual loss in early childhood undermine a child's ability to thrive, affecting psychomotor, cognitive, and social development leading to life-long consequences for educational attainment, employment, economic and social status, and wellbeing. Despite this, eye health for children under the age of 5 years has been neglected, and not politically prioritized. In Tanzania, policy makers decided in 2019 to include eye conditions in the national Integrated Management of Newborn and Childhood Illness (IMNCI) programme, despite eye health not being part of the global World Health Organization/UNICEF IMNCI strategy. We conducted a qualitative policy analysis to explore enabling factors and barriers to this policy change. The interviews were semi-structured with key actors selected purposively and by snowball sampling, including those with a role in child and eye health at national and global levels. We used an adapted Shiffman and Smith framework (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet 2007;370:1370-9) to guide the interviews and analysis, and the Consolidated Criteria for Reporting Qualitative Research for planning and reporting. This study shows how rapidly one country altered its overall child health policy to include eye health, driven by good quality collaborative research and collective action (cohesive policy community) which importantly included co-design with the decision makers (Ministry of Health actors). These developments coincided with the shift in the international agenda moving from 'survive to thrive' in child health which was leveraged to include eye care in the national strategy.

To assess the rate of severe ROP and the burden of examining preterm infants requiring ROP screening. A prospective study of all inborn preterm infants eligible for ROP screening admitted to Lahore General Hospital (LGH) between 2015 and 2021 with a gestational age (GA) of ≤ 35 weeks or a birthweight (BW) of ≤ 2000 g. All infants had a dilated fundus exam, and the number of examinations and level of ROP were recorded. 3,521 infants met the screening criteria, 1,641 (46.7

Objective Retinopathy of prematurity (ROP) registers enable population-based studies to monitor ROP screening programmes to improve their effectiveness. The aim of this study was to determine the frequency of ROP and the coverage of screening in a South African cohort using a prospective ROP South African (ROPSA) register.Methods and analysis Infants born from 1 May 2022 to 31 January 2023 and screened prospectively for ROP at five neonatal intensive care units in Cape Town were included. The screening criteria were a gestational age (GA) <32 weeks or birth weight (BW) <1250 g. Data were extracted from the ROPSA register and analysed.Results 696 of 1154 (60.3%) eligible infants were screened, almost half of whom (45.7%) did not complete screening. ROP was detected in 220 infants (31.6%, 95% CI 28.3% to 35.3%), 7 (1.0%) of whom required treatment. Infants with incomplete screening had a lower mean GA than those who completed screening; 28.7 (SD 1.6, range 25–33) and 29.1 (SD 1.7, range 24–36) weeks, respectively (p=0.004) and a lower mean BW; 1048 (SD 203, range 650–1690) g and 1108.5 (SD 227, range 640–1840) g, respectively (p<0.001).Conclusions Data from the ROPSA register on the frequency of any ROP and treatment-requiring ROP may be biased due to low screening coverage and high incomplete screening. Reasons need to be explored and corrective interventions initiated. The ROPSA register will enable the impact of these interventions to be monitored. The findings of this study will contribute to the ongoing revision of South African national ROP screening guidelines.

To estimate the prevalence and determine predictors of lens opacities (LO) among South Asian Indians aged 41–44 years. This cross-sectional study included 1080 participants from the Vellore Birth Cohort, Vellore, South India. All underwent anthropometric measurements, detailed ophthalmic examination including assessment of LO by LOCS III classification and biochemical metabolic measurements. ‘Any cataract’ was defined as any opacity type with a score of >2 or evidence of cataract surgery in either eye. Data collected included information on ocular history, life-style factors, socio-economic and educational status, cooking fuel and sunlight exposure. Multivariable logistic regression analysis was used to examine the association between risk predictors and LO. The mean age (SD) of participants was 41.8 (1.0) years; 53.8% were male and 50% were rural residents. The overall prevalence of ‘any cataract’ was 13.8% (148/1075, 95% confidence interval (CI) 11.8,16.0). The types of cataract were nuclear 59.1%, cortical 16.9%, posterior subcapsular 4.1%, mixed cataracts 18.9% and pseudophakia 0.7%. Increased risk for LO was observed with a history of asthma (OR 4.51; 95% CI 2.1, 9.7), HbA1C of ≥6.5% (OR 2.29; 95% CI 1.4, 3.7), hypertension (OR 1.73; 95% CI 1.1, 2.7) and, in a subgroup (n = 372), lower 25(OH) vitamin D levels (≤20 ng/dL)(OR 5.56; 95% CI 2.3, 13.2). The high prevalence of LO at a relatively young age in South Asian Indians suggests earlier onset of ageing. History of asthma, higher HbA1C, hypertension and lower 25(OH) vitamin D levels were associated with LO.

BACKGROUND/AIMS:To determine whether retinopathy of prematurity (ROP) screening is initiated on time according to current South African (SA) guidelines, that is, before the onset of stage 3 and type 1 ROP. METHODS:A prospective study of preterm infants screened at five neonatal units between 1 May 2022 and 31 January 2023 in Cape Town, SA. Data on all infants screened with a birth weight <1250 g or gestational age (GA) <32 weeks were extracted from the ROP South African (ROPSA) register, including postnatal age (PNA) and postmenstrual age (PMA) at first screening. RESULTS:A total of 696 infants were included, 58.9% (n=410) of whom had an early ultrasound (EUS) for GA estimation. Overall, 220 (31.6%) infants developed ROP, 20 (2.9%) had stage 3 or type 1 and 7 (1.0%) required treatment. Screening was initiated on time according to SA criteria in 549 (78.9%) infants, none of whom had stage 3 or type 1 ROP at first screening. Stage 3 and type 1 ROP were first detected at PNA and PMA of 6.3 and 33.1 and 8.9 and 35.9 weeks, respectively. Most infants (319, 45.8%) were screened according to PNA only, and 78.9% of the 185 infants screened only once did not attend subsequent examinations. CONCLUSION:Screening started on time in most infants and prior to the development of severe ROP. Due to the limited availability of EUS in our region and to promote complete screening, we recommend that screening be initiated using PNA alone at 4-6 weeks or prior to discharge, whichever is earliest. The low proportion of infants with stage 3 and type 1 ROP is a limitation in our study. Therefore, recommendations may not be generalisable to South African regions where neonatal care results in a higher proportion of infants developing type 1 ROP.

Retinopathy of prematurity (ROP) is a leading cause of avoidable blindness in children, particularly in Latin America, where hyperoxia is a significant risk factor. This study evaluated resource availability and use for administering and monitoring supplemental oxygen in Mexico. In 2011, an observational study in which 32 government neonatal intensive care units (NICUs) across Mexico were visited. Data collected included occupancy, staffing levels, and equipment to deliver and monitor supplemental oxygen. Preterm infants receiving oxygen were observed. In 2023, 13 NICUs were revisited, and similar data collected. Staffing levels were benchmarked against Argentinian and US recommendations. In 2011, only 38

PURPOSE:To assess the impact of a retinopathy of prematurity (ROP) mentoring program in four rural regions with 31 neonatal units in Colombia between 2011 and 2019. METHODS:Indicators recommended by the national program were used for assessment: screening coverage of eligible preterm newborns, proportion screened with any stage of ROP, and proportion of screened infants treated. Data were also collected on the number of units with ROP services and birth weight (BW) and gestational age (GA) of babies treated. Data on the number of preterm births, BWs of infants screened, and their ROP status (any/none) were extracted from the national health information system. Ophthalmologists in each region provided data on the number screened and treated. A linear-by-linear statistic was used to assess trends in the indicators before and during mentoring. RESULTS:Of the 31 neonatal units, the number providing ROP services increased from 7 (23%) to 26 (84%). The number of eligible infants born in the four regions (total 33,521) was stable over the study period, the proportion screened increased from 14% to 41%, the proportion of those screened who were found to have any ROP tended to decrease over time, and the proportion of those screened who were treated declined from 9% to 3%, with some regional variation. By year 3 no infant with a BW ≥2000 g or GA of >36 weeks was treated. CONCLUSIONS:In our study, mentoring rural providers proved a valuable strategy for inducing new screening programs, increasing coverage, and improving local capacities in neonatal care and ROP services.

Objective This study aims to examine the reduction and subsequent recovery of routine digital screening (RDS) uptake in England from 2018 to 2022, exploring national, regional and individual Diabetic Eye Screening Programme (DESP) levels. The COVID-19 lockdown in most areas of England was from 26 March 2020 to 23 June 2020 (first national lockdown), 5 November 2020 to 2 December 2020 (second national lockdown) and 6 January 2021 to 8 March 2021 (third national lockdown).Design Retrospective data analysis.Setting DESPs of England.Participants Individuals with diabetes who were invited to take part in the DESP programmes.Methods Publicly available data from Public Health England (2018-2019) and National Health Service England (2019-2022) were examined to identify the rate of uptake (proportion of those who attended the DESPs to those who were invited) of RDS at national and regional levels and by each DESP in England.Primary outcome measures Rate of uptake of RDS.Results The national uptake of RDS decreased from 82% (2019-2020) to 68% (2020-2021) and then increased to 78% (2021-2022). At the regional level, the sharpest drop was in the Midlands which decreased from 79% (2019-2020) to 53% (2020-2021), increasing to 73% (2021-2022) but did not reach pre-COVID-19 levels. At individual DESP levels across England, the greatest drop in attendance (2020-2021) was recorded in Derbyshire (79% to 45%), Barnsley and Rotherham (78% to 45%) and Arden, Herefordshire and Worcestershire (78% to 46%). Although these DESPs showed an increase in 2021-2022 of 33%, 21% and 31%, they did not reach prepandemic (2018-2019) rates of 81%, 85% and 82%, respectively. Data suggest that West Sussex, East Sussex and East and North Hertfordshire DESPs maintained relatively higher uptake rates (86%-89%) in 2020-2021.Conclusion COVID-19 had an impact on England's diabetic eye screening attendance, with notable variations across regions and DESPs. Different regions and DESPs showed variable post-COVID-19 recovery. More importantly, what was not evident is the increased uptake that should have occurred after the COVID-19 lockdown to compensate for the low uptake during the lockdown. In some areas, addressing some of the barriers that affect retinal screening uptake may improve future attendance.

Background Retinopathy of prematurity (ROP) is a leading cause of preventable blindness, notably in Latin America, with hyperoxia as a significant risk factor. This study evaluates the resource availability and utilization for administering and monitoring supplemental oxygen in Mexico. Methods In 2011, an observational study examined 32 government neonatal intensive care units (NICUs) across Mexico, recording data on occupancy, staffing levels, and oxygen delivery and monitoring equipment. Preterm infants receiving supplemental oxygen were observed. In 2023, 13 NICUs were revisited, and similar data were gathered. Staffing levels were benchmarked against recommendations from Argentina and the US. Results In 2011, only 38% of NICUs had adequate medical and staffing levels to meet recommended cot-to-staff ratios for all shifts. Ratios were poorer on weekends and at night. Only 25.5% of cots had blenders, and 80.1% had saturation monitors. Of 153 observed infants, 87% were monitored, with 53% exhibiting high oxygen saturation (≥96%) and 8% low saturation (≤89%). Alarm settings were inadequate, with 38% and 32% of upper and lower alarms switched off and 16% and 53% incorrectly set, respectively. In the 13 NICUs with data from 2011 and 2023, cot-to-staff ratios deteriorated over time, with no unit achieving recommended ratios for all shifts in 2023. Equipment provision remained consistent, with similar rates of baby monitoring (79% in 2011; 75% in 2023). High oxygen saturation rates decreased slightly from 54% in 2011 to 49% in 2023. More upper alarms were set (46% in 2011; 75% in 2023), but a higher proportion were incorrectly set (52% in 2011; 68% in 2023). Conclusions Between 2011 and 2023, cot-to-staff ratios worsened, and equipment for safe oxygen delivery and monitoring remained insufficient. Despite available monitoring equipment, oxygen saturations often exceeded recommended levels, and alarms were frequently not set or incorrectly configured. Urgent improvements are needed in healthcare workforce numbers and practices, along with ensuring adequate equipment for safe oxygen delivery.

Background In 2020, almost 100 million people were blind or visually impaired from cataract. Cataract surgery is a cost-effective treatment for cataracts. In Nigeria, twice as many women are cataract blind as men. Cataract surgical rate (CSR, the number of cataract operations per million population per year in a defined geographical location) is an output indicator of cataract surgical services. The recommended target CSR for sub-Saharan Africa is 1000/year. The aim of this study was to assess the CSR in men and women in Imo state, Nigeria.Methods A retrospective review of cataract surgery undertaken in all eye health facilities in Imo State in 2019. Data collected included the type and location of facilities, patient demographics and the number and type of cataract operations performed in each facility. The CSR was calculated overall, in men and women, and in younger and older women.Results The CSR overall was 330/million and was slightly higher in women (347/million) than in men (315/million) (p<0.001). More elderly women (≥65 years) accessed cataract surgery through outreach than men and younger women (OR 1.5 (95% CI 1.03 to 2.22, p=0.03) and 1.6 (95% CI 1.07 to 2.44, p=0.02)), respectively.Conclusion The overall CSR in Imo state was approximately one-third of that recommended for sub-Saharan Africa. Although the CSR was higher in women than in men, considerably higher CSRs are needed in women to address their higher burden of cataract blindness. Operational and intervention science research are needed, to identify and evaluate interventions which address demand and supply barriers to accessing cataract surgery, particularly for elderly women.

PurposeControl 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 preventing infant blindness during the pandemic.MethodsData on the number of preemies recruited, screened and treated in the Karnataka Internet-assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program were collected in a retrospective (2019, interval 1) - prospective (2020, interval 2) manner. We summarize 10 key strategies that were developed as we faced logistic, operational and implementation challenges. These included pragmatic methods of enhancing enrolment, transporting for screening and ensuring timely treatment in the outreach.ResultsThe total number of ROP screening sessions was 20,598 (7,197 new) and 14,371 (5,773 new) during interval 1 and 2 respectively. Of these, 166 (2.3%) and 157 (2.7%) infants required treatment during interval 1 and 2 respectively. All infants needing treatment during the COVID period, were treated on time which was possible due to successful implementation of the 'on-the-go' strategies throughout the state of Karnataka. The fiscal equivalent of the blindness prevented during this period is USD 15.6 million.ConclusionThe greater decline in the number of ROP screening episodes in neonatal units in government hospitals was because several were converted to 'COVID only" hospitals. KIDROP's multi-zonal, decentralized strategy, which uses non-physician-based imaging in a telemedicine network, ensured that essential ROP services continued even during the lockdown.

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) were included. A comprehensive ophthalmic examination was performed on all participants. Mean intraocular pressure (IOP) was average of IOPs of right and left eyes. The definition of glaucoma was based on the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) classification. The main outcome measure was incidence of POAG during the follow-up period in participants without glaucoma or suspicion of glaucoma at baseline. Results Data from the available and eligible participants from the original cohort (1241/2790; 44.4%) were analysed. The mean age (standard deviation) of participants at baseline was 50.2 (8.1) years; 580 (46.7%) were men. Thirty-six participants developed POAG [bilateral in 17 (47.2%)] over 15 years. The incidence rate of POAG per 100-person years (95% confidence interval) was 2.83 (2.6, 3.08). Compared to baseline, the reduction in mean IOP [median (range) mm Hg] was −0.75 (−7.5, 9) in participants with incident POAG and −2.5 (−14.5, 14.5) in those without. The inter-visit difference in mean IOP was a significant risk factor on logistic regression analysis. Conclusion We report the long-term incidence of POAG in rural India. A longitudinal change in IOP, specifically a less pronounced reduction in IOP with increasing age, was a novel risk factor.

As the characteristics of preterm infants with retinopathy of prematurity (ROP) vary, depending on the quality of neonatal care they received, universal screening criteria for ROP are not possible. The purpose of this study was to compare ROP guidelines for those planning to develop guidelines, particularly in resource-poor settings. A systematic review was undertaken of PubMed, Embase and guidelines registers to identify national or international policy statements or guidelines in English, issued or operational in 2010–2021. Bibliographies of two publications were also reviewed. The searches identified 633, 1081 and 317 records, respectively, and 157 records were retrieved from other sources. 23 publications were included in the analysis. Most included documents defined cut-offs for screening as <32 weeks gestational age (GA) or ≤1500g birth weight (BW). The highest values were in the Philippines (<35 weeks GA; <2000g) and India (≤34 weeks GA; <2000g). The lowest were in high-income countries, i.e. the United States of America (≤32 weeks for GA) and New Zealand (<1250g for BW). Most guidelines included additional risk factors to consider. The most frequent indication for when screening should start was a combination of GA and chronological age. All but one document defined when screening could stop. There was general consensus on the indications, timing and methods of treatment. Indications for anti-VEGF therapy varied between countries. Guidelines were identified for a limited number of countries with none from low-income settings. Variation in the indications for screening reflects the varying exposure to risk factors in different settings.

Vision loss from cataract is unequally distributed, and there is very little evidence on how to overcome this inequity. This project aimed to engage multiple stakeholder groups to identify and prioritise (1) delivery strategies that improve access to cataract services for under-served groups and (2) population groups to target with these strategies across world regions. We recruited panellists knowledgeable about cataract services from eight world regions to complete a two-round online modified Delphi process. In Round 1, panellists answered open-ended questions about strategies to improve access to screening and surgery for cataract, and which population groups to target with these strategies. In Round 2, panellists ranked the strategies and groups to arrive at the final lists regionally and globally. 183 people completed both rounds (46% women). In total, 22 distinct population groups were identified. At the global level the priority groups for improving access to cataract services were people in rural/remote areas, with low socioeconomic status and low social support. South Asia and Sub-Saharan Africa were the only regions in which panellists ranked women in the top 5 priority groups. Panellists identified 16 and 19 discreet strategies to improve access to screening and surgical services, respectively. These mostly addressed health system/supply side factors, including policy, human resources, financing and service delivery. We believe these results can serve eye health decision-makers, researchers and funders as a starting point for coordinated action to improve access to cataract services, particularly among population groups who have historically been left behind.