Correction of refractive error and presbyopia in Timor-Leste

Area of Science:

• Ophthalmology
• Public Health
• Global Health

Background:

• Refractive error and presbyopia are leading causes of vision impairment globally.
• Access to affordable and appropriate spectacle correction remains a challenge in many low- and middle-income countries.
• Timor-Leste faces unique challenges in delivering eye care services due to its geographical and socioeconomic context.

Purpose of the Study:

• To investigate the prevalence of vision-impairing refractive error and presbyopia in adults aged 40 years and above in Timor-Leste.
• To assess the current spectacle correction coverage for refractive error and presbyopia in the study population.
• To explore factors associated with unmet refractive error and presbyopia needs, including willingness to wear and pay for spectacles.

Main Methods:

• A population-based cross-sectional survey was conducted using cluster random sampling in Timor-Leste.
• Participants aged 40 years and above were assessed for presenting visual acuity and near vision.
• Data on spectacle use, dispensing history, and willingness to wear and pay for spectacles were collected.

Main Results:

• The study found a "met refractive error need" of 2.2% and "unmet refractive error need" of 11.7%, with a "refractive error correction coverage" of 15.7%.
• For presbyopia, the "met need" was 11.5% and "unmet need" was 32.3%, resulting in "presbyopia correction coverage" of 26.2%.
• Lower correction coverage was associated with rural domicile, illiteracy, and farming. Willingness to pay for spectacles was low, especially among women and rural dwellers.

Conclusions:

• Spectacle correction coverage for both refractive error and presbyopia is significantly low in Timor-Leste.
• There is a substantial unmet need for spectacles, particularly among vulnerable groups like the elderly, illiterate, farmers, and rural inhabitants.
• The findings suggest the need for an equitable, cross-subsidized spectacle provision system to improve vision care accessibility in Timor-Leste.