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    • The goals of Vision the global initiative to eliminate avoid

    2019-05-17

    The goals of Vision 2020—the global initiative to eliminate avoidable blindness by 2020—include increasing cataract surgical rate and cataract surgical coverage. However, quality must not be sacrificed for quantity. The final visual outcome matters, both to the individual patient and to the community. The quality of outcomes are important in maintaining and enhancing surgical uptake within programmes. Despite the strong evidence provided by Congdon and colleagues for the use of early postoperative visual outcome as a surrogate for the assessment of surgical quality, the work does not support complacency—the importance of mid-term and long-term postoperative care cannot be denied. Improvements in follow-up rates are needed for sound reasons. Careful monitoring at follow-up visits help clinicians to detect and treat postoperative complications in a timely manner. Follow-up examination at later stages after cataract surgery also allows for more accurate assessment and correction of refractive error, which has been shown to result in visual impairment in a substantial proportion of patients after cataract surgeries. Mid-term or long-term follow-up is also of importance for patients with intraoperative or immediate postoperative complications, which are not uncommon for junior surgeons in training programmes. The proportion of patients in the study who complied with optimum follow-up in different geographical areas ranged from 27% in China to 93% in Latin America, which is suggestive of the great variation in postoperative care in different developing countries. The postoperative follow-up rates in China, India, and Indonesia are especially worrying. Studies of barriers and challenges to postoperative care after cataract surgery suggest the potential for improvements with modest financial compensation, reminders after the surgery, and preoperative education about the importance of follow-up visits. Congdon and colleagues have also shown the effects of methods such as telephone calls and transportation subsidies in improving the follow-up rate. Another noteworthy result of the study was that A 779 postoperative refraction did not improve the correlation between early and late visual outcomes in patients who underwent small-incision cataract surgery or phacoemulsification, the two procedures that represent the mainstay of modern cataract surgery. This finding will be valuable for those who plan health-care expenditure in areas where neither qualified optometrists nor automated refraction devices are available.
    In the past few years, major efforts in malaria control, alongside a renewed emphasis on malaria elimination and eradication, have led to declines in disease incidence. Nowadays, malaria is just one of many causes of fever in most endemic contexts, and often a fairly rare one. Investigation of non-malarial causes of fever is therefore a priority, as was underlined at WHO\'s informal consultation meeting on fever management in January, 2013. In Mayfong Mayxay and colleagues discuss this crucial subject. The investigators provide invaluable information about causes of non-malarial febrile illness in the malaria-endemic country Laos and suggest some indications for evidence-based management of non-malarial and non-dengue fevers. Rapid diagnostic tests might be available for these illnesses at the primary level of care, whereas laboratory facilities are often scarce for other causes. Mayxay and colleagues had previously done a systematic review of the causes of non-malarial febrile illness in southeast Asia, in which Figure eight noted a substantial heterogeneity of study designs, diagnostic methods, and causes of fever. Moreover, previous studies in Laos were concentrated in the capital Vientiane. In their present study of 1938 patients, despite logistical constraints, the investigators did their study at two rural hospitals in northern and southern Laos to account for possible geographical heterogeneity of fever causes. The prospective study design and the high standard of the microbiological methods used are major strengths of this study. Although only a diagnosis that relied on almost 100% specific methods was considered confirmed (conservative approach), the proportion of patients with a confirmed diagnosis (799 [43%]) was not negligible. With exclusion of influenza, two of the most frequently diagnosed, treatable causes of fever were scrub typhus (caused by ) in 7% of patients, and leptospirosis in 6%.