Refractive Error and Presbyopia Among Adults in Fiji

Abstract

Purpose: To characterize refractive error, presbyopia and their correction among adults aged ≥ 40 years in Fiji, and contribute to a regional overview of these conditions.

Methods: A population-based cross-sectional survey using multistage cluster random sampling. Presenting distance and near vision were measured and dilated slitlamp examination performed.

Results: The survey achieved 73.0% participation (n = 1381). Presenting binocular distance vision ≥ 6/18 was achieved by 1223 participants. Another 79 had vision impaired by refractive error. Three of these were blind. At threshold 6/18, 204 participants had refractive error. Among these, 125 had spectacle-corrected presenting vision ≥ 6/18 (“met refractive error need”); 79 presented wearing no (n = 74) or under-correcting (n = 5) distance spectacles (“unmet refractive error need”). Presenting binocular near vision ≥ N8 was achieved by 833 participants. At threshold N8, 811 participants had presbyopia. Among these, 336 attained N8 with presenting near spectacles (“met presbyopia need”); 475 presented with no (n = 402) or under-correcting (n = 73) near spectacles (“unmet presbyopia need”). Rural residence was predictive of unmet refractive error (p = 0.040) and presbyopia (p = 0.016) need. Gender and household income source were not. Ethnicity-gender-age-domicile-adjusted to the Fiji population aged ≥ 40 years, “met refractive error need” was 10.3% (95% confidence interval [CI] 8.7–11.9%), “unmet refractive error need” was 4.8% (95%CI 3.6–5.9%), “refractive error correction coverage” was 68.3% (95%CI 54.4–82.2%),”met presbyopia need” was 24.6% (95%CI 22.4–26.9%), “unmet presbyopia need” was 33.8% (95%CI 31.3–36.3%), and “presbyopia correction coverage” was 42.2% (95%CI 37.6–46.8%).

Conclusion: Fiji refraction and dispensing services should encourage uptake by rural dwellers and promote presbyopia correction. Lack of comparable data from neighbouring countries prevents a regional overview.

Keywords::

• Developing country
• Fiji
• Melanesia
• Oceania
• Presbyopia
• Refractive error
• Spectacles

ACKNOWLEDGMENTS

The authors acknowledge the help of Sanya Baker, Louisa Semmons, Tom Schaefer, Carmel Williams, Andrew Page, John Szetu, Losalini Tavaga, Nicole Pearce, Louise Maher and the FEHS2009 survey team.

The design, implementation and analysis of the Fiji Eye Health Survey 2009 were financially supported by the New Zealand Agency for International Development (NZAID), the Australian Agency for International Development (AusAID), and The Fred Hollows Foundation New Zealand.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.