Toward Universal Eye Health Coverage—Key Outcomes of the World Health Organization Package of Eye Care Interventions
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Published:2022-12-01
Issue:12
Volume:140
Page:1229
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ISSN:2168-6165
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Container-title:JAMA Ophthalmology
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language:en
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Short-container-title:JAMA Ophthalmol
Author:
Keel Stuart1, Lingham Gareth23, Misra Neha1, Block Sandra4, Bourne Rupert56, Calonge Margarita78, Cheng Ching-Yu910, Friedman David S.11, Furtado João M.12, Khanna Rohit13, Mariotti Silvio1, Mathenge Wanjiku14, Matoto Elenoa15, Müeller Andreas1, Rabiu Mansur16, Rasengane Tuwani1718, Resnikoff Serge192021, Wormald Richard22232425, Yasmin Sumrana26, Zhao Jialiang27, Evans Jennifer R.2225, Cieza Alarcos1, Azuara-Blanco Augusto28, Chan Ving Fai28, Chen Yanxian28, Chinnery Holly28, Dodson Sarity28, Downie Laura28, Gordon Iris 28, Ghadiri Nima28, Govender Poonsamy Pirindhavellie28, Han Xiaotong28, Hui Flora28, Jackson Mary Lou28, Lawrenson John28, Ning Lee Chan28, McGuinness Myra28, Murray Craig28, Newsham David28, van Nispen Ruth28, Prictor Megan28, Puri Lila28, Ramke Jacqueline28, Reekie Ian28, Safi Sare28, Scheetz Jane28, Shen Sunny28, Silveira Sue28, Thakur Sahil28, Virgili Gianni28, Yong Ai Chee28, Zhang Justine28, Ziaei Mohammed28, Ali Mustafa Abdu28, AlObaida Ibrahim Abdulkarim28, AlShamlan Fatemah T28, Alsulaiman Sulaiman M28, Amissah-Arthur Kwesi N28, Ang Marcus28, Azad Rajvardhan 28, Bell Kristin28, Bharadwaj Shrikant R28, Booysen Dirk J28, Branchevski Sergey 28, Bosch Vanessa28, Brossard-Barbosa Natalie28, Chen Yi28, Craig Jennifer P28, Dada Tanuj28, Dichoso Carmen A28, Duerksen Rainald28, Ebri Anne 28, Erdmann Irmela28, Freddo Thomas28, Flanagan John 28, Gammoh Yazan28, Gupta Neeru28, Hendicott Peter28, Husni Mohd Aziz28, Jonathan Jackson Andrew28, Jadoon Muhammad Zahid28, Januleviciene Ingrida28, Jeeva Irfan28, Jimenez Maria Sheila S28, Kocur Ivo28, Kreis Andreas28, Kyei Samuel28, Lan Weizhong 28, Loy Marie Joan V28, Marmamula Srinivas28, Minto Late Hasan 28, Muhit Mohammad28, Nsubuga Naomi H28, Ogundipe Ayobade28, Okonkwo Ogugua N28, Olawoye Olusola O28, Ouertani Amel Meddeb28, Ovenseri-Ogbomo Godwin28, Özkan Seyhan B28, Patel Bina28, Paula Jayter S28, Rahi Jugnoo S28, Ravilla Ravindran D28, Senanayake Nandana Saman28, Sil Asim Kumar28, Solebo Ameenat L28, Sousa Raúl ARC28, Tennant Matthew TS28, van Staden Diane B28, Wazir Junaid Faisal28, Webber Ann L28, Yorston David28, Zin Andrea28, Faal Hannah B28, Keeffe Jill28, McGrath Colleen E28,
Affiliation:
1. Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland 2. Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland 3. Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Australia 4. Illinois College of Optometry, Chicago 5. Cambridge University Hospitals, Cambridge, United Kingdom 6. Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom 7. Institute of Applied OphthalmoBiology, Universidad de Valladolid, Valladolid, Spain 8. CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain 9. Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 10. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 11. Massachusetts Eye and Ear, Harvard University, Boston 12. Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil 13. Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India 14. Rwanda International Institute of Ophthalmology, Kigali, Rwanda 15. Colonial War Memorial Hospital, Suva, Fiji 16. Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates 17. Department of Optometry, University of the Free State, Bloemfontein, South Africa 18. Universitas Hospital, Bloemfontein, South Africa 19. School of Optometry and Vision Science, University of New South Wales, Sydney, Australia 20. Brien Holden Vision Institute, Sydney, Australia 21. Organisation pour la Prévention de la Cécité, Paris, France 22. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom 23. NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom 24. UCL Institute of Ophthalmology, London, United Kingdom 25. Cochrane Eyes and Vision, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland 26. Sightsavers, Islamabad, Pakistan 27. Department of Ophthalmology, Peking Union Medical College Hospital, Eye Research Center Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China 28. for the Package of Eye Care Interventions Development Group
Abstract
ImportanceDespite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed.ObjectiveTo describe the key outcomes of the PECI development.Evidence ReviewA standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review.FindingsFifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI.Conclusions and RelevanceThis systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.
Publisher
American Medical Association (AMA)
Cited by
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