Journal Article

Village-Integrated Eye Worker trial (VIEW): rationale and design of a cluster-randomised trial to prevent corneal ulcers in resource-limited settings

Gautam, Mariya, Keenan, Jeremy D, O’Brien, Kieran S, Srinivasan, Muthiah, Lietman, Thomas M, Whitcher, John P, Byanju, Raghunandan, Kandel, Ram Prasad, Gonzales, John A, Upadhyay, Madan, Poudyal, Bimal, Porco, Travis C

2018

Overview

IntroductionCorneal opacity is a leading cause of blindness worldwide. In resource-limited settings, untreated traumatic corneal abrasions may result in infection and ultimately, opacity. Although antimicrobial treatment of corneal ulcers may successfully cure infections, the scarring that accompanies the resolution of infection can still result in visual impairment. Prevention may be the optimal approach for reducing corneal blindness. Studies have employed community health workers to provide prompt administration of antimicrobials after corneal abrasions to prevent infections, but these studies were not designed to determine the effectiveness of such a programme.Methods and analysisThe Village-Integrated Eye Worker trial (VIEW) is a cluster-randomised trial designed to assess the effectiveness of a community health worker intervention to prevent corneal ulcers. Twenty-four Village Development Committees (VDCs) in Nepal were randomised to receive a corneal ulcer prevention programme or to no intervention. Female Community Health Volunteers (FCHVs) in intervention VDCs are trained to diagnose corneal abrasions, provide antimicrobials and to refer participants when needed. An annual census is conducted over 3 years in all study VDCs to assess the incidence of corneal ulceration via corneal photography (primary outcome). Masked outcome assessors grade corneal photographs to determine the presence or absence of incident corneal opacities. The primary analysis is negative binomial regression to compare the incidence of corneal ulceration by study arm.Ethics and disseminationThe University of California San Francisco Committee on Human Research, Nepal Netra Jyoti Sangh and the Nepal Health Research Council have given ethical approval for the trial. The results of this trial will be presented at local and international meetings and submitted to peer-reviewed journals for publication.Trial registration number NCT01969786; Pre-results.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Administration, Ophthalmic / Anti-Bacterial Agents - administration & dosage / Census of Population / Cluster Analysis / Community Health Workers - education / Cornea / Corneal Injuries - diagnosis / Corneal Injuries - drug therapy / Corneal Ulcer - diagnosis / Corneal Ulcer - prevention & control / Design / Evidence-based medicine / Female / Global Health / Humans / Intervention / Low income groups / Male / Multicenter Studies as Topic / Nepal / Photography / Poverty - statistics & numerical data / Prevention / Randomized Controlled Trials as Topic / Research Design / Systematic review / Ulcers / Visual impairment / Workers