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Eye disease and care at hospital clinics in Cook Islands, Fiji, Samoa and Tonga

Authors

  • Jacqueline Ramke BAppSc(Optom) MPH MHSM,

    1. The International Centre for Eyecare Education, Sydney, Australia; and
    2. The Fred Hollows Foundation New Zealand, Auckland, New Zealand
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  • Garry Brian FRANZCO,

    Corresponding author
    1. The International Centre for Eyecare Education, Sydney, Australia; and
    2. The Fred Hollows Foundation New Zealand, Auckland, New Zealand
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  • Renee Du Toit MPhil(Optom) MPH

    1. The International Centre for Eyecare Education, Sydney, Australia; and
    2. The Fred Hollows Foundation New Zealand, Auckland, New Zealand
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  • The International Centre for Eyecare Education distributes and receives financial benefit from the sale of readymade spectacles in developing countries. However, the authors, who are no longer employees of this organization, have no personal pecuniary interest in the manufacture, distribution or sale of spectacles. None of the authors has any pecuniary interest in any other product mentioned or in the outcome of this study.

Dr Garry Brian, 5 Hazelmere Parade, Sherwood, 4075, Australia. Email: grbrian@tpg.com.au

Abstract

Purpose:  To obtain eye disease and care data to assist with service planning in Cook Islands, Fiji, Samoa and Tonga.

Methods:  A hospital-based rapid assessment including interviews and examination of clinical records.

Results:  An overview of equipment, staff and services was attained. Visual impairment was associated with increasing age but not gender of clinic attendees. Cataract was the most common cause of low vision and blindness. A substantial proportion of visually significant cataract, particularly that causing low vision but not blindness, was not offered treatment. The vision outcome of cataract surgery in Fiji was less successful than elsewhere. Only Samoa achieved the World Health Organization suggested outcomes. Refractive error was a significant cause of low vision, but poorly treated. Diabetic retinopathy was a substantial contributor to visual impairment at all locations except the Cook Islands, but not all was treated with laser. Trauma/corneal opacity was an important cause of blindness in Cook Islands and Tonga. Pterygium-induced low vision and glaucoma blindness were diagnosed most frequently in Samoa.

Discussion:  This methodology enabled quick and cost-efficient collection of data about hospital eye services, the conditions diagnosed and treated, and the outcome of treatment. It could easily be repeated by local clinicians to measure the impact of service planning and implementation. In the four countries audited, the management of, and intervention outcomes for, cataract, refractive error, diabetic retinopathy and trauma need attention.

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