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John D. Twelker, Marion Robine, Jane Mohler, Dawn K. DeCastro, Joseph M. Miller; Evaluating The Performance Of A Lay Visual Health Worker In Rural Honduras. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2510.
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© ARVO (1962-2015); The Authors (2016-present)
Visual screening is not widely available in many developing countries. Lay health workers, or promotoras, are often available in remote rural areas and could offer this screening care, however their abilities to effectively screen are unknown. Our objective was to compare the visual acuity (VA) outcomes and ocular disease referral pattern between a team of licensed providers and a lay visual health worker.
Two-hundred thirty-nine subjects presented to a community health clinic in rural Honduras and were provided an eye examination by a team of two doctors (a licensed optometrist, and a senior resident in ophthalmology) and a lay visual health worker who was masked to the results of the doctors.
The average age of the 239 subjects was 47.6 years (SD=17.6). The average entering distance VA in the better eye was 0.25 Logmar (SD=0.26), and for near was 0.57 Logmar (SD=0.34). After receiving correction from the visual health worker the improvement in VA was 0.10 logMAR (SD=0.20) and for the doctor it was 0.11 logMAR (SD=0.19), with no statistically significant difference (p=0.17, t-test). At near, the improvement was 0.40 logMAR (SD=0.31) and for the doctor it was 0.42 logMAR (SD=0.33). There was a statistically significant difference between near VA improvement (p=0.02, t-test), but this was not clinically significant. An inter-rater reliability analysis was performed to determine consistency between the visual health worker and the doctors for referring subjects for further evaluation, when needed (Kappa = 0.60 (p <.0.001), 95% CI (0.414, 0.790)). This indicates substantial agreement. The most common reason the visual health worker referred a subject, while the doctors did not, (n=10) was for borderline high intraocular pressure. The doctors referred one case of suspected normal tension glaucoma for further evaluation, while the visual health promoter did not.
The improvement in VA at distance and near was similar between the doctors and the lay visual health promoter. Thus, well-trained visual health workers might be useful in visual screening in remote areas of developing countries where licensed providers are not available. Limitations were that the visual health worker required more referrals for further evaluation, and might have missed one case of suspected normal tension glaucoma.
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