04896nas a2200997 4500000000100000008004100001260001600042653002100058100001700079700001300096700001400109700001400123700001600137700001300153700001600166700001700182700001500199700001500214700001400229700001700243700001300260700001400273700001200287700001300299700001100312700001500323700001600338700001200354700001300366700001300379700001500392700001500407700001300422700001700435700001400452700001500466700001200481700001500493700001200508700001400520700001500534700001300549700001600562700001600578700001600594700001700610700001400627700001200641700001300653700001800666700001200684700001100696700001500707700001500722700001500737700001600752700001400768700001400782700001500796700001100811700002200822700001600844700001500860700001400875700001000889700001000899700001500909700001300924700001300937700001200950700001300962700001400975700001400989700001201003700001401015700001601029700001301045700001601058700001301074245012901087856007501216300001401291490000701305520257201312022001403884 2022 d bElsevier BV10aGeneral Medicine1 aO’Brien KS1 aByanju R1 aKandel RP1 aPoudyal B1 aGonzales JA1 aPorco TC1 aWhitcher JP1 aSrinivasan M1 aUpadhyay M1 aLietman TM1 aKeenan JD1 aSrinivasan M1 aByanju R1 aKhadka KB1 aBista D1 aGautam M1 aGiri P1 aKayastha S1 aParajuli TP1 aShah RK1 aSharma N1 aSharma P1 aShrestha A1 aShrestha M1 aSubedi P1 aChaudhary DS1 aGhimire R1 aAdhikari M1 aHamal V1 aBhandari G1 aDahal G1 aPoudyal B1 aBhandari S1 aGurung J1 aBhattarai D1 aBhattarai R1 aChapagain D1 aChaudhary AK1 aGautam SK1 aGurau D1 aKandel D1 aLamichhane PC1 aRijal R1 aGiri G1 aUpadhyay M1 aLietman TM1 aAcharya NR1 aGonzales JA1 aKeenan JD1 aMcLeod SD1 aRamirez DA1 aRay KJ1 aRose-Nussbaumer J1 aWhitcher JP1 aO'Brien KS1 aCotter SY1 aKim J1 aLee S1 aMaamari RN1 aPorco TC1 aBasset K1 aChase H1 aEvans LJ1 aGilbert S1 aKandel RP1 aMoses D1 aTenzing C1 aChoudhary S1 aDhakwa P1 aFletcher DA1 aReber CD00aVillage-integrated eye workers for prevention of corneal ulcers in Nepal (VIEW study): a cluster-randomised controlled trial uhttps://www.thelancet.com/action/showPdf?pii=S2214-109X%2821%2900596-9 ae501-e5090 v103 a

Background

Corneal ulcers are a common cause of blindness in low-income and middle-income countries, usually resulting from traumatic corneal abrasions during agricultural work. Antimicrobial prophylaxis of corneal abrasions can help prevent corneal ulcers, but delays in the initiation of therapy are frequent. We aimed to assess whether a community-based programme for corneal ulcer prevention would reduce the incidence of corneal ulceration.

Methods

A cluster-randomised trial was performed in village development committees (VDCs) in Nepal. VDCs in the catchment area of Bharatpur Eye Hospital, Nepal with less than 15 000 people were eligible for inclusion. We randomly assigned (1:1) VDCs to either an intervention group or a control group. In the intervention VDCs, existing female community health volunteers (FCHVs) were trained to diagnose corneal abrasions and provide a 3-day course of ophthalmic antimicrobials to their patients. In the control VDCs, FCHVs did not provide this intervention. Participants were not masked given the nature of the intervention. Both groups were followed up for 3 years for photographic evidence of corneal ulceration. The primary outcome was the incidence of corneal ulceration, determined by masked assessment of corneal photographs. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT01969786.

Findings

We assessed 112 VDCs, of which 24 were enrolled. The study was performed between Feb 4, 2014, and Oct 20, 2017. 12 VDCs were randomly assigned to the intervention group and 12 to the control group. 252 539 individuals were included in the study (130 579 in the intervention group and 121 960 in the control group). FCHVs diagnosed and provided antimicrobials for 4777 corneal abrasions. The census identified 289 corneal ulcers among 246 893 person-years in the intervention group (incidence 1·21 cases [95% CI 0·85–1·74] per 1000 person-years) and 262 corneal ulcers among 239 170 person-years in the control group (incidence 1·18 cases [0·82–1·70] per 1000 person-years; incidence rate ratio 1·03 [95% CI 0·63–1·67]; p=0·93). Medication allergy was self-reported in 0·2% of participants.

Interpretation

We did not detect a reduction in the incidence of corneal ulceration during the first 3 years of a community-based corneal ulcer prevention programme. Further study might be warranted in more rural areas where basic eye care facilities are not available.

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