Correction of refractive error and presbyopia in Timor-Leste

Aim: To investigate the aspects of spectacle correction of vision- impairing refractive error and presbyopia in those aged >= 40 years in Timor- Leste. Method: A population- based cross- sectional survey with cluster random sampling was used to select 50 clusters of 30 people. Those who had uncorrected or undercorrected refractive error ( presenting acuity worse than 6/ 18, but at least 6/ 18 with pinhole), uncorrected or undercorrected presbyopia ( near vision worse than N8), and/ or who were using or had used spectacles were identified. Dispensing history, willingness to wear and willingness to pay for spectacles were elicited. Results: Of 1470 people enumerated, 1414 were examined ( 96.2%). The "met refractive error need'' in the sample was 2.2%, and the "unmet refractive error need'' was 11.7%. The "refractive error correction coverage'' was 15.7%. The "met presbyopic need'' was 11.5%, and the "unmet presbyopic need'' was 32.3%. The "presbyopia correction coverage'' was 26.2%. Lower correction coverage was associated with rural domicile, illiteracy and farming. Of the sample, 96.0% were willing to wear spectacles correcting impaired vision. Of these, 17.0% were willing to pay US$3 (1.52 pound, EURO2.24) for spectacles, whereas 50.2% were unwilling to pay US$1 (0.51 pound, EURO0.75). Women and rural dwellers were less likely to be willing to pay at least US$ 1 for spectacles. Conclusion: Refractive error and presbyopia correction coverage rates are low in Timor- Leste. There is a large need for spectacles, especially for elderly and illiterate people, farmers and rural dwellers: those least able to pay for them. An equitable cross- subsidisation spectacle system should be possible.