BACKGROUND Diabetic retinopathy (DR) is a leading cause of preventable blindness. However, Indonesia lacks a comprehensive screening program. Artificial intelligence (AI)-assisted screening in primary health care (PHC) is a promising solution. Patient satisfaction is crucial for ensuring the participation and sustainability of such programs. This study aimed to adapt Indonesian version of evaluate client satisfaction questionnaire-18 (CSQ-18) and evaluate its acceptability. METHODS This study was conducted from August 5–29, 2024 at 2 public PHCs in Jakarta. Patients with diabetes underwent DR screening, which included fundus photography and an AI-based grading system (RADR). Referable cases were graded secondarily by ophthalmologists. Satisfaction was assessed from November 10–20, 2024 using the Indonesian-translated CSQ-18, adapted through forward-backward translation, expert review, and pilot testing. Reliability was assessed using Cronbach’s alpha, validity was evaluated using Pearson’s correlation, and satisfaction scores were summarized as descriptive statistics. RESULTS Of 300 selected participants, 216 completed telephone or in-person interviews. The Indonesian CSQ-18 demonstrated a strong internal consistency (Cronbach’s alpha = 0.886). All items showed acceptable item-total correlations. The mean (SD) satisfaction score was 60.19 (5.50) of 72, with a median of 59, indicating high patient satisfaction. Most participants expressed positive perceptions of screening duration, accessibility, and provider competence, although awareness-related items scored slightly lower. Potential interviewer bias and nonresponse may have affected the findings. CONCLUSIONS The Indonesian CSQ-18 is a reliable tool for assessing patient satisfaction with DR screening. These findings confirm the feasibility and acceptability of AI-assisted DR screening at the PHC level, supporting its potential for broader implementation in Indonesia.

Purpose: Corneal transplantation is the definitive treatment for corneal blindness; however, Indonesia faces a critical shortage of donor tissue. The Hospital Corneal Retrieval Program (HCRP) has been proposed as a strategic initiative to increase corneal donations through hospital-based systems. This study aims to evaluate the influence of sociodemographic characteristics, knowledge, and attitudes on corneal donation practices among patients and their families at Dr. Cipto Mangunkusumo General Hospital (RSCM), in support of establishing the HCRP. Methods: A cross-sectional study was conducted at the outpatient clinics of RSCM. Participants, including patients and accompanying family members, completed a validated, researcher-developed questionnaire assessing sociodemographic factors, knowledge, attitudes, and donation-related practices. Associations were analyzed using univariate and multivariate models. Results: Significant sociodemographic correlates of donation practice included respondent type, gender, religion, ethnicity, education, and occupation (all P < 0.05). Both knowledge and attitudes were strongly associated with corneal donation practice. In multivariate analysis, gender, respondent type, religion, knowledge, and attitudes emerged as independent predictors, with knowledge exerting the strongest effect (odds ratio = 7.305). Conclusions: Knowledge and attitudes are key determinants of corneal donation practice, with knowledge emerging as the most powerful predictor. These findings highlight the importance of targeted educational interventions to enhance awareness and foster positive attitudes, thereby strengthening participation in corneal donation and supporting the successful implementation of the HCRP at RSCM.

To explore the state-of-the-art evidence on the effect of caffeine consumption on the development and progression of age-related macular degeneration (AMD), a significant cause of blindness worldwide. Eligible primary clinical studies published up to 15 June 2024 were included and appraised using the Joanna Briggs Institute critical appraisal tools for cohort and case–control studies. The available data were then analyzed using random-effects meta-analysis and effect direction-based vote-counting (PROSPERO CRD42023451237). Five studies (9318 patients) were included in this systematic review, three of which investigated the effect of caffeine intake on the development of AMD and two on AMD progression. Caffeine intake from coffee or other beverages showed no significant association with the occurrence of early (adjusted odds ratio 1.11 [95

Diabetic retinopathy (DR), a leading cause of blindness in working-age adults, disproportionately affects low- and middle-income countries (LMICs). While preventable through early intervention, DR screening programs are often lacking in these resource-constrained settings. This scoping review examines DR screening models implemented in LMICs, identifying evidence, research gaps, and potential improvement strategies. A literature search across multiple databases identified studies on DR screening in LMICs, limited to peer-reviewed articles from the past 20 years focusing on DR screening model effectiveness or implementation. Key data (study design, screening techniques, outcomes) were extracted and synthesized narratively. This review synthesized 30 studies on DR screening in LMICs, mainly from India, South Africa, Pakistan, and Bangladesh. These studies explored diverse screening methods, from traditional techniques (ophthalmoscopy, funduscopy, slit lamp exams) to telemedicine and AI. Non-mydriatic fundus photography, often with AI-assisted grading, was common, as were remote grading and store-and-forward systems. Given the resource constraints in these settings, non-mydriatic methods were often preferred. Many studies optimized resources by training non-physicians for image acquisition, followed by specialist grading. The reviewed studies highlighted the effectiveness of community-based screening programs in expanding coverage and improving patient adherence. Furthermore, they demonstrated the cost-effectiveness of smartphone-based imaging devices and AI-driven systems. However, challenges remained, including limited infrastructure, inconsistent training, and follow-up difficulties. LMIC DR screening utilizes traditional and innovative technologies, with community-based approaches, telemedicine, and AI enhancing reach and accuracy. Transitioning from case-finding to population-based screening requires stronger diabetes surveillance and integration within primary care.

Introduction: The school-based refractive error screening program is important in preventing visual impairment caused by uncorrected refractive errors and enhancing students' academic performance. This study aimed to identify key dimensions for establishing an effective school-based refractive error screening program from the perspective of elementary teachers. Methodology: The focus group discussion (FGD) using the qualitative-exploratory method among ten elementary teachers from one public school in Jakarta. The voice records of participants were transcribed verbatim, coded, and qualitatively analyzed to generate relevant dimensions. Several dimensions in the conceptual framework were concluded within the twelve categories. Results: Four key dimensions to establish an effective school-based refractive error screening program were identified ranging from resources, screening procedure, education and awareness, and spectacles. These dimensions emphasized the significance of having trained teachers as screeners, understanding the comprehensive screening and referral process, offering incentives and user-friendly tools, and ensuring accessible and affordable spectacles to enhance students' compliance. Conclusion: This study identified four dimensions for effective school-based refractive error screening programs, which are resources, screening procedures, education and awareness, and spectacles.

Introduction Diabetes is a serious public health problem, with low- and middle-income countries (LMICs) bearing over 80% of the burden. Diabetic retinopathy (DR) is one of the most prevalent diabetic microvascular problems, and early diagnosis through eye screening programs for people with diabetes is critical to prevent vision impairment and blindness. Community-based treatments, including non-physician cadres have been recommended to enhance DR care. Methods The review protocol was determined and scoping review was conducted.The population, concept, and context were “cadre”, “role of cadre in the management of DR”, and LMICs”. Data were collected from databases and searches, including grey literature. Results Cadre can motivate people to attend a diabetic eye screening event when the rate of eye examinations is about six times higher than before the start of the intervention. Health education is a possible area for task sharing, and the cadre reported could also perform the task of vision testing. The cadre could be a good supporter and a good reminder for society. However, several challenges have been faced in this study and inadequate infrastructure is the foremost challenge found in this study. Other challenges encountered in the studies include poverty, lack of community awareness, trust issues, and low education levels contributing to poor health. Conclusion The current study highlighted significant gaps in the literature, which focus on the role of cadre as a community-based intervention in managing DR in LMICs. Further research is needed to develop evidence to support cost-effective screening services and cadre-related policy development in LMICs.

Introduction: The COVID-19 pandemic has forced many conventional -face-to-face health promotion events to be conducted in an adaptive manner to keep healthcare in promotion, prevention, and even curative measures delivered to healthcare providers and patients. The same applies to leprosy, where Indonesia is still ranked as the third largest country with leprosy burden. This study aims to give rise to newer methods of health promotion on leprosy during this COVID-19 pandemic. Methods: Online training and case presentation workshop in the form of a KATAMATAKU webinar [MOU1] and live streaming via YouTube were held in August 2020. There were 120 general practitioners, 30 nurses, and 35 healthcare providers who registered and joined this event.[MOU2] Pre- and post-test [MOU3] were conducted to evaluate the participants' knowledge about the topics lectured during this training[MOU4] . Pre- and post-test were conducted using an online form, and all participants needed to answer several questions from each session. Participants were evaluated before the webinar began and after all sessions. We assessed the different scores from the pre- and post-test. Results: In the general practitioner group, median scores were 68 (27 – 95) and 82 (50 – 100) for pre- and post-test scores, respectively, with a mean difference between post and pre-test of 14.23+9.72. In nurses and other health care providers, the median for the pre-test score was 56 (22-89), and the post-test was 72 (39 – 100), with a mean difference between the post and pre-test of 18.93+10.27. Conclusion: In the pandemic situation, online seminars can be chosen as an effective method for health promotion to increase health care provider's knowledge. Pre- and post-test can be performed to evaluate participant's knowledge after the training. Regular training using online methods can be held in order to maintain participants' knowledge. We hope it can impact all health providers to continue their participation in the management of leprosy.

BackgroundInfectious keratitis (IK) is a sight-threatening condition requiring immediate definite treatment. The need for prompt treatment heavily depends on timely diagnosis. The diagnosis of IK, however, is challenged by the drawbacks of the current “gold standard.” The poorly differentiated clinical features, the possibility of low microbial culture yield, and the duration for culture are the culprits of delayed IK treatment. Deep learning (DL) is a recent artificial intelligence (AI) advancement that has been demonstrated to be highly promising in making automated diagnosis in IK with high accuracy. However, its exact accuracy is not yet elucidated. This article is the first systematic review and meta-analysis that aims to assess the accuracy of available DL models to correctly classify IK based on etiology compared to the current gold standards.MethodsA systematic search was carried out in PubMed, Google Scholars, Proquest, ScienceDirect, Cochrane and Scopus. The used keywords are: “Keratitis,” “Corneal ulcer,” “Corneal diseases,” “Corneal lesions,” “Artificial intelligence,” “Deep learning,” and “Machine learning.” Studies including slit lamp photography of the cornea and validity study on DL performance were considered. The primary outcomes reviewed were the accuracy and classification capability of the AI machine learning/DL algorithm. We analyzed the extracted data with the MetaXL 5.2 Software.ResultsA total of eleven articles from 2002 to 2022 were included with a total dataset of 34,070 images. All studies used convolutional neural networks (CNNs), with ResNet and DenseNet models being the most used models across studies. Most AI models outperform the human counterparts with a pooled area under the curve (AUC) of 0.851 and accuracy of 96.6% in differentiating IK vs. non-IK and pooled AUC 0.895 and accuracy of 64.38% for classifying bacterial keratitis (BK) vs. fungal keratitis (FK).ConclusionThis study demonstrated that DL algorithms have high potential in diagnosing and classifying IK with accuracy that, if not better, is comparable to trained corneal experts. However, various factors, such as the unique architecture of DL model, the problem with overfitting, image quality of the datasets, and the complex nature of IK itself, still hamper the universal applicability of DL in daily clinical practice.

Purpose:Uncorrected refractive errors after cataract surgery contribute to visual impairments. The aim of this study was to investigate the spectacle coverage rate (SCR) following cataract surgery and its relationship with socioeconomic factors in an urban city in Indonesia.Patients and Methods:This population-based cross-sectional study was conducted in 2015 in Jakarta. The former participants of the Rapid Assessment of Avoidable Blindness (RAAB) survey had a history of cataract surgery and met either of the following criteria: (1) wore spectacles with presenting visual acuity (PVA) 6/12 or (2) had PVA less than 6/12 regardless of spectacle use but achieved the best visual acuity (BVA) 6/12 with pinhole correction.Results:Of the 2998 participants of the RAAB survey, 173 (5.6%) (252 eyes) had a history of cataract surgery, among whom 53 (86 eyes) met our inclusion criteria. The SCR was 69.8% and was associated with age group, household income level, education level, and physicians' recommendation of spectacle wear. Participants who were of nonproductive age (80%), had the highest household income level (88.2%), the highest level of education (87.5%), and had been recommended for spectacle use by their physicians (80.9%) demonstrated higher SCR. Participants with the highest household income had the highest SCR. Patients who had received a physician's recommendation showed a higher SCR and were 26 times more likely to wear spectacles (odds ratio [OR] 25.99, 95% CI 2.59-260.10).Conclusion:There is an unmet need for refractive errors after cataract surgery. Factors such as household income levels and physician recommendations were predictive of spectacle wear.

Background People with leprosy who have been declared Release From Treatment (RFT) are often not aware of the leprosy sequelae possibility which can decrease their quality of life. This could be because they have been adapting for a long time hence they do not feel the need to see physicians. This study seeks to compare the results of Vision-Related Quality of Life (VR-QoL) among RFT persons based on the National Eye Institute Visual Functioning Questionnaire–25 (NEI-VFQ-25 ) and WHO grading disability based on physical examination. Methods A cross-sectional study of 325 RFT subjects from leprosy communities (Singkawang, West Kalimantan and Tangerang, Banten) was conducted between 2018 and 2019. We used the NEI-VFQ-25 questionnaire that had been validated and translated into Indonesian and distributed to the leprosy population. Relationships and comparisons among variables were evaluated using Kruskal–Wallis and Mann–Whitney tests. Results There were three main results: The median composite score of VR-QoL for WHO grade 0, 1, and 2 disabilities has decreased by 13%, 25.5%, and 30% of the maximum value, respectively. Of the total, eleven subscales were statistically significant between WHO grading disability and VR-QoL based on the NEI-VFQ-25 ( p < 0.05). The comparison between grade 0 and grade 2 disability in all subscales was statistically significant ( p < 0.05). Conclusions The grade of disability is related to their VR-QoL assessment using the NEI-VFQ-25 questionnaire. Thus, it can be used as an initial screening in primary healthcare settings to increase awareness of disability before a thorough physical examination.

Globaly, the prevalence of refractive errors, especially myopia in children, has increased significantly. The cause of myopia is multifactorial. Near-work activities and family history are some suggested factors associated with myopia. However, there has not been enough data on these factors and their association with myopia in Indonesia. This study aims to determine the prevalence and factors associated with myopia in primary and middle schoolaged children in Pamijahan Village, Bogor District, West Java, Indonesia. Data were taken in a cross-sectional design based on the visual acuity, anterior and posterior eye examination. A 14-item questionnaire regarding myopia-associated factors including family history, playing outdoors, and near-work activities, was distributed to the subjects. The data were taken from June to September 2018. Analysis was conducted using SPSS version 20. The prevalence of myopia in Pamijahan Village is 4,9% out of 474 subjects. Family history, including parental (p=0.001, OR 4.49) and sibling history (p=0.001, OR 5.58), was shown to be associated with the increasing risk of myopia in children while near-work activities and playing outdoors were not associated with myopia in children of Pamijahan Village.

Diabetes, especially T2DM, continues to be a significant health problem. One of the major concerns associated with diabetes is the development of its complications. Diabetic nephropathy, one of the chronic complication of diabetes, adversely affects the kidneys, leading to kidney damage. Diagnosing diabetic nephropathy involves considering various criteria, one of which is the presence of a pathologically significant quantity of albumin in urine, known as albuminuria. Thus, early prediction of albuminuria in diabetic patients holds the potential for timely preventive measures. This study aimed to develop a supervised learning model to predict the risk of developing albuminuria in T2DM patients. The selected supervised learning algorithms included Naive Bayes, Support Vector Machine (SVM), decision tree, random forest, AdaBoost, XGBoost, and Multi-Layer Perceptron (MLP). Our private dataset, comprising 184 entries of diabetes complications risk factors, was used to train the algorithms. It consisted of 10 attributes as features and 1 attribute as the target (albuminuria). Upon conducting the experiments, the MLP demonstrated superior performance compared to the other algorithms. It achieved accuracy and f1-score values as high as 0.74 and 0.75, respectively, making it suitable for screening purposes in predicting albuminuria in T2DM. Nonetheless, further studies are warranted to enhance the model's performance.

Background Diabetic retinopathy (DR) is an emerging cause of visual impairment and blindness and is often detected in the irreversible stage. General practitioners (GPs) play an essential role in the prevention of DR through diabetes control, early detection of retinal changes, and timely referral to ophthalmologists. This study aimed to determine the knowledge, attitude, and practice (KAP) towards DR screening among GPs in the district primary health centres (PHCs) in Jakarta, Indonesia. Methods A cross-sectional study was conducted between April 2021 and February 2022 in 17 randomly selected district PHCs. A validated online questionnaire was then distributed. Good knowledge was defined when the correct response rate was > 75%, positive attitude was indicated when desired attitudes were found in more than half of the items (> 50%), and good practice was defined when more than half of the practice items (> 50%) were performed. Results A total of 92 GPs, with a response rate of 60.1%, completed the questionnaire. Seventy-nine respondents (85.9%) were female with a median (range) age of 32 (24–58) years. Among the respondents, 82 (89.1%) had good knowledge and all showed positive attitude on DR screening. However, only four (4.3%) demonstrated good practices. We found a weak positive correlation (r s = 0.298, p = 0.004) between attitude and practices. Conclusion GPs in Jakarta showed good knowledge and positive attitude on DR screening. However, they did not show good practice. There was a positive correlation between attitude and practice.

Introduction COVID -19 pandemic has threatened the optimal achievement on type-2 diabetes mellitus (T2DM) target in primary health care (PHC), due to our priority in COVID-19 management, limited access of patients to PHC and their lifestyle changes as the impact of social restrictions. Therefore, the empowerment of capability of patients on diabetes self-care is required through optimal education and support. The use of telehealth in T2DM management has benefits on improving outcomes of patients. We aim to assess the role of telehealth diabetes self-management education (DSME) versus hybrid (telehealth and face-to-face method) diabetes self-management education and support (DSMES) to improve T2DM outcomes in PHC during COVID-19 pandemic. Methods and analysis This study is an open label randomized-controlled trial that will be conducted in 10 PHCs in Jakarta, Indonesia, involving patients with T2DM. Subjects are classified into 2 groups: DSME group and DSMES group. Intervention will be given every 2 weeks. DSME group will receive 1 educational video every 2 weeks discussing topics about diabetes self-management, while DSMES group will receive 1 educational video and undergo 1 coaching session every 2 weeks. All interventions will be conducted by trained health workers of PHC, who are physicians, nurses, and nutritionists. Our primary outcome is the change of HbA1C level and our secondary outcomes are the changes of nutritional intake, physical activity, quality of life, anthropometric parameter, fasting blood glucose, lipid profile, inflammatory markers, and progression of diabetes complications at 3 and 6 months after intervention compare to the baseline. Ethics and dissemination This study protocol has been approved by the Health Research Ethics Committee University of Indonesia. Subjects agree to participate will be given written informed consent prior to data collection. Findings from this study will be published in peer-reviewed journals and presented at conferences. Trial Registration with identifier number [NCT05090488][1]. Strengths and limitations of the study ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT05090488 ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Faculty of Medicine, University of Indonesia gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * T2DM : type-2 diabetes mellitus PHC : primary health care OAD : oral anti-diabetic DSMES : diabetes self-management education and support SMBG : self-monitoring of blood glucose [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05090488&atom=%2Fmedrxiv%2Fearly%2F2022%2F12%2F19%2F2022.12.18.22283494.atom

Leprosy has a high incidence of physical complications that will impact directly the physiological, economic, and social status of patients. Indonesia has a high burden of the disease, and several leprosy settlements are still spread in the country. Neglasari Village, Sitanala, Tangerang serves as one of the places of residence of people who have had leprosy. A health service initiative known as Identifikasi Tanda-Tanda Mata, Ekstremitas, dan Kulit pada Kusta (KATAMATAKU) was launched as a collaboration of health services among multi-departments (ophthalmology, dermatovenereology, and medical rehabilitation). Sitanala has a relatively high incidence of people who have had leprosy with disabilities of the hand, foot, and eye. As a continuation of this health service and combined with the efforts to improve the welfare of leprosy patients, in November 2019, a multidisciplinary program titled KATAMATAKU Universitas Indonesia, was conducted. This program aimed to determine the demographic data regarding the health, psychological, social, and economic status of the leprosy population at Sitanala The project consisted of a collaborative anti-stigma program by the Faculty of Psychology, Public Health, Social and Political Sciences, Cultural Sciences, Administrative Sciences, and Vocational Educational Program; thematic health program, which supports the improvement of physical abilities and empowerment of former leprosy patients, by the Faculty of Medicine, Dentistry, Nursing, and Pharmacy; thematic economics program, which aims to increase the economic capacity of the leprosy community, by the Faculty of Economics and Business, Mathematics and Natural Sciences, and Engineering. This program enabled the construction of a multidimensional management model, in which every aspect plays important roles to improve the patients’ quality of life.

Objective: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which has a high incidence of ocular involvement. Due to the need for good vision for leprosy patients, visual acuity becomes an essential early screening examination. The Snellen Chart has been commonly employed as the standard for measuring visual acuity. Nevertheless, it is immobile and time-consuming. A smartphone-based application, Portable Eye Examination Kit (Peek Acuity), is already known to be accessible, reliable and easy to use for measuring visual acuity. This study examines the reliability of Peek Acuity in performing visual acuity screening for leprosy patients. Methods: A population-based cross-sectional study was carried out at a leprosy settlement village near Sitanala Hospital, Tangerang and Alverno Hospital, Singkawang. Participants' uncorrected visual acuity was measured using both the Snellen Chart and Peek Acuity. The scores were converted into logMAR. Results: This study involved 347 subjects which included 692 eyes (2 eyes were anophthalmic). The mean difference between the Snellen chart and Peek Acuity was 0.11 logMAR (95% CI, 0.096 to 0.13). Linear regression analysis showed no statistically significant difference between the Snellen Chart and Peek Acuity measurements (P =0.98). Cohen's Kappa and concordance rate of visual acuity measured with Peek Acuity and Snellen Chart were 0.65 and 0.83. Conclusion: Peek Acuity is an accurate and repeatable visual acuity screening tool as effective as the Snellen Chart, which also can be used for leprosy patients to overcome barriers in accessing eye health services, especially in rural areas.

ABSTRACT Purpose: To report the latest data on blindness and visual impairment (VI) in Indonesia. Methods: Rapid Assessment of Avoidable Blindness (RAAB) surveys were done in 15 provinces in Indonesia between 2013 and 2017. The population of the study was people aged 50 +. In each province, the required number of clusters was selected with a probability proportionately to size. A weighted average analysis for prevalence, causes of visual impairment, and cataract surgical coverage (CSC) estimated the values of the country. Results: The prevalence of blindness in East Java was the highest at 4.4% (95% CI: 3.1–5.6%), followed by Nusa Tenggara Barat (NTB) at 4.0% (95% CI: 3.0–5.1%) and South Sumatra at 3.4% (95% CI: 2.4–4.4%). In number, blindness among people aged 50+ in East Java was the highest at 371,599, followed by West Java at 180,666 and Central Java at 176,977. Untreated cataract was the commonest cause of blindness in all provinces (range: 71.7% to 95.5%). CSCperson<3/60 and CSCperson<6/60 in Bali were the highest at 81.3% and 72.4%, respectively. Indonesia countrywide prevalence of blindness was 3.0%. The total number of people with VI (PVA less than 6/18 in the better eye) in Indonesia was 8,019,427, consisting of 1,654,595 of blindness and 6,364,832 of moderate and severe VI. Conclusion: The burden of blindness in Indonesia is high, and untreated cataract contributes the most. There is an urgent need to increase cataract surgical coverage by providing better access to cataract surgery services for all people in need.

Objective: Cataract is the leading cause of blindness worldwide and its only treatment is surgery, which is intended to restore the visual function; the expected outcomes are improved visual acuity (VA) and elimination of blindness. Therefore, evaluation of the outcomes of cataract surgery is needed to improve the quality of treatment programs. Materials and Methods: This was a cross-sectional study of 193 postcataract surgery eyes from August 2017 to March 2018 in six hospitals in Indonesia. Convenience sampling was used. Bivariate and multivariate analyses were performed on the medical records of pre- and postoperative VA, types of surgery, and complications.Results: Of the 193 eyes, 170 were analyzed. Phacoemulsification, manual small-incision cataract surgery, and extracapsular cataract extraction with intraocular lens (IOL) implantation were performed in 45.3%, 51.2%, and 3.5% of eyes, respectively. Preoperatively, 70% were blind, 8.8% had severe visual impairment (SVI), 17.1% had moderate visual impairment (MVI), and 4.1% were normal. Postoperatively, 78.2% were normal, 15.3% had MVI, 2.4% had SVI, and 4.1% were still blind. There were 93.5% of eyes with visual improvement; the blindness conversion rate was 95%. The overall complication rate was 15.3%, mostly from corneal edema (7.1%), followed by IOL dislocation (1.8%) and endophthalmitis (1.2%). There was no statistically significant difference in the postoperative visual outcome between groups treated with or without phacoemulsification (P = 0.870), but complications from corneal edema were statistically significantly higher with phacoemulsification (P = 0.003). Conclusion: All types of cataract surgery significantly improved VA, but the complication rate was higher with phacoemulsification, mostly from corneal edema.

PurposeTo estimate the total healthcare cost associated with diabetic retinopathy (DR) in type 2 diabetes in Indonesia and its projection for 2025.MethodsA prevalence-based cost-of-illness model was constructed from previous population-based DR study. Projection for 2025 was derived from estimated diabetes population in 2025. Direct treatment costs of DR were estimated from the perspective of healthcare. Patient perspective costs were obtained from thorough interview including only transportation cost and lost of working days related to treatment. We developed four cost-of-illness models according to DR severity level, DR without necessary treatment, needing laser treatment, laser +intravitreal (IVT) injection and laser + IVT +vitrectomy. All costs were estimated in 2017 US$.ResultsThe healthcare costs of DR in Indonesia were estimated to be $2.4 billion in 2017 and $8.9 billion in 2025. The total cost in 2017 consisted of the cost for no DR and mild–moderate non-proliferative DR (NPDR) requiring eye screening ($25.9 million), severe NPDR or proliferative DR (PDR) requiring laser treatment ($0.25 billion), severe NPDR or PDR requiring both laser and IVT injection ($1.75 billion) and advance level of PDR requiring vitrectomy ($0.44 billion).ConclusionsThe estimated healthcare cost of DR in Indonesia in 2017 was considerably high, nearly 2% of the 2017 national state budget, and projected to increase significantly to more than threefold in 2025. The highest cost may incur for DR requiring both laser and IVT injection. Therefore, public health intervention to delay or prevent severe DR may substantially reduce the healthcare cost of DR in Indonesia.

Based on WHO data, Indonesia has the third largest leprosy burden in the world, afterIndia and Brazil. Although leprosy was declared to be eliminated in severalprovinces, there are still several leprosy settlements spread in Indonesia. Oneof these settlements is Neglasari village in Tangerang City, West Java, whereleprosy patients have been living since 1981. There is a scarcity ofinformation regarding the features of leprosy in Indonesia, especially aboutthe description of the patients’ posttreatment condition in terms of bothclinical sequelae and health services provided. A collaboration betweenmultiple departments of Ophthalmology, Dermatovenereology, and MedicalRehabilitation from the Cipto Mangunkusumo Hospital/Universitas Indonesia,Jakarta, was established in the form of a health service program to determinethe number and features of disabilities of ex-leprosy patients. We providehealth services, including physical examinations, extend free medication andeye glasses, and impart knowledge about the chronic complications to patientsand local cadres. A nonroutine health service program for leprosy patients wasconducted in Neglasari village, which performed four primary activities ofpromotive, preventive, curative, and rehabilitative. The program included atotal of 260 patients, with a mean age of 50.45 ± 10.15 years and most of thembeing males (60.4%). A duration of >5 years of leprosy was found in 47% ofsubjects, and 96% of them have been released from treatment. Disabilitiescomprised 52.5% in the eye, 87.7% in the hand, and 92% in the foot. In total,65% of the patients had an uncorrected visual acuity of normal to mildimpairment, whereas 5.8% were blind. Eye abnormalities included madarosis(43.9%), entropion (41%), cataract (26%), corneal hypoesthesia (20.6%),trichiasis (17.8%), and lagophthalmos (15.1%), and examination of theextremities revealed that 16% of the subjects had an amputated foot. Spectacleswere successfully distributed to 100% of patients who were visually correctable.This proposed model for leprosy health care program involving multidisciplinaryexpertise is effective for screening numerous disabilities in leprosy patientsat one time. This enables caretakers to determine a holistic management that atthe end is intended to improve the quality of life of patients.