Abstract Objective: To perform an updated meta-analysis of cataract surgical coverage (CSC) data in Latin American studies to confirm that gender equity exists in terms of receiving cataract surgery. Materials and methods: A literature search of Rapid Assessment of Avoidable Blindness (RAAB) studies in Latin American published since 2011 was done. Older studies from countries that did not have newer data published were also included. Using summary original study data of CSC rates on an individual basis, a random effects model of meta-analysis was performed to evaluate the differences in CSC between men and women. Results: Nineteen studies from 17 countries were included (Mexico data were pooled). The odds ratios at a visual acuity (VA) of <3/60 and <6/18 were 1.04 [95% confidence interval (CI): 0.82-1.32] and 1.04 (95% CI: 0.90-1.19), respectively, without heterogeneity. There were no significant gender differences for CSC at any VA level. Conclusions: This updated meta-analysis of CSC data from Latin American countries supports that gender inequity in terms of receiving cataract surgery is not an issue in the region. The results do not provide insight into gender inequity in terms of the quality of cataract surgery and other types of eye care services.

Resumen Objetivo: Realizar un metaanálisis actualizado de la cobertura de cirugía de catarata en estudios latinoamericanos para confirmar que existe equidad de género en términos del acceso a cirugía de catarata. Material y métodos: Se realizó una búsqueda de la literatura de “Rapid Assessments of Avoidable Blindness (Encuestas Rápida de Ceguera Evitable)” publicados en Latinoamérica desde el 2011. Se incluyeron también estudios anteriores de países que no tenían publicados datos más recientes. Utilizando el compendio de datos de los estudios originales de la cobertura de cirugía de catarata (Cataract Surgery Coverage, CSC por sus siglas en inglés) en base individual, se realizó un modelo de efectos aleatorios de metaanálisis para evaluar las diferencias en la CSC entre hombres y mujeres. Resultados: Se incluyeron 19 estudios de 17 países (los datos de México fueron agrupados). La oportunidad relativa (razón de probabilidades) para una agudeza visual (AV) de <3/60 y <6/18 fueron de 1.04 [95% Intervalo de confianza (IC): 0.82-1.32] y 1.04 (95% IC: 0.90-1.19), respectivamente, sin heterogeneidad. No hubo diferencias significativas para la CSC a ningún nivel de AV. Conclusiones: Este metaanálisis actualizado de la CSC de Latinoamérica, confirma que no existe inequidad de género en términos de acceso a cirugía de catarata en esta región.

Abstract: Background: This systematic review aims to report the current knowledge of retinoblastoma (Rb) and its implications in Mexico. We analyzed clinical and demographic data of patients with Rb at select hospitals with Rb programs or that treat and refer patients with Rb, and identified the gaps in practice. We propose solutions to improve diagnosis, provide adequate treatment, and improve patient uptake. Methods: A general review was conducted on PubMed of peer-reviewed literature on Rb in Mexico. Ophthalmology Department Heads or Directors of Rb programs at seven hospitals in Mexico were contacted for data available on their patients with Rb. Results: Five hospitals provided clinical data on 777 patients with Rb in a period spanning 2000-2015. Of the 122 patients with treatment, 83.4% underwent enucleation. From 33 to 45.3% of Rb tumors in Mexico reach an advanced intraocular stage of development. Knowledge of the disease is limited, despite the fact that the Mexican Retinoblastoma Group has elaborated Rb treatment guidelines and is developing a national Rb registry. Especially in the Southern states, prevalence and outcomes are comparable to African and Asian countries, and only few patients are referred to national treatment centers. Only three institutions have comprehensive Rb programs. Conclusions: There is an immediate need in Mexico to expand primary care providers’ knowledge of Rb and to expand and upgrade current Rb programs to meet the needs of the population adequately. Diagnosis and care of Rb patients in Mexico can also be improved by the establishment of a national Rb registry and a national early detection program, and by increased use of the national treatment protocol.

Resumen: Introducción: Esta es una revisión sistemática de los conocimientos actuales del retinoblastoma (Rb) y sus implicaciones en los centros de referencia más importantes del país. Se presenta un análisis situacional de los programas de Rb en México, se identificaron las brechas en la práctica, y se proponen soluciones para mejorar el diagnóstico, tratamiento y referencia oportuna de pacientes. Métodos: Se realizó una revisión general de la literatura publicada sobre Rb en México a través de PubMed. Los datos sociodemográficos de pacientes con Rb fueron obtenidos a través de los directores de programas de retinoblastoma en siete hospitales. Resultados: Casi una tercera parte de los casos Rb se diagnostican en estadios avanzados. A pesar de la existencia del Grupo Mexicano de Retinoblastoma, el conocimiento de esta patología entre los médicos es limitado. Las diferencias en el tratamiento son notorias en el sur del país, donde la prevalencia y los resultados son comparables con África y Asia. Solamente tres instituciones a nivel nacional tienen un programa establecido de Rb. Conclusiones: Existe la necesidad inmediata de consolidar los programas de Rb para cubrir las necesidades reales de la población. Se requiere mejorar la educación del médico de primer contacto, establecer el registro nacional de casos y el programa de detección temprana, establecer los programas de salvamento ocular nacional, y reforzar las instituciones que brindan tratamiento.

AbstractThis is the first of a two-part review that aims to report the current knowledge of retinoblastoma (Rb) and its implications in Mexico (including the authors' experience at the leading Rb centers), identify the gaps in practice, and propose solutions to improve diagnosis, treatment, and patient uptake. In this first part, general knowledge of Rb diagnosis and management is summarized with a focus on the latest advances in chemotherapy. A general review of peer-reviewed literature of Rb was conducted on PubMed. Key findings were summarized.Provided there is early detection and referral of patients followed by appropriate conservative management, Rb is curable. In developed countries, the primary treatment outcome is ocular salvage with sight preservation. Advanced chemotherapeutic options such as intra-arterial and intravitreal chemotherapy can now save even the most advanced tumors.Advances in Rb therapy are generally limited to developed countries. The implications in Mexico, of the findings from this review will be discussed in Part 2, which will be a comprehensive situational analysis of the state of Rb programming in Mexico, including a review of current demographic data available from hospitals that have Rb programs or treat Rb.

ResumenEsta es la primera parte de un trabajo de revisión donde se reportan los conocimientos actuales del retinoblastoma (Rb) y sus implicaciones en México (incluyendo la experiencia de los autores en los principales centros de referencia), así como las brechas en la práctica y las posibles soluciones para mejorar el diagnóstico, tratamiento y referencia de pacientes. En esta parte se resumen los conocimientos generales del Rb, su diagnóstico y tratamiento. Se realizó una revisión de los avances más recientes en esta enfermedad publicados en PubMed y se resumieron los hallazgos más importantes.La sospecha oportuna y la referencia adecuada de pacientes permiten que el tratamiento conservador del Rb sea curativo. En países en vías de desarrollo, el tratamiento primario es el salvamento ocular y la preservación de la visión. Las opciones de quimioterapia intraarterial o intravítrea permiten ofrecer opciones terapéuticas en estos pacientes.Los avances en el tratamiento del Rb están generalmente limitados a países industrializados. Las implicaciones de los hallazgos de esta revisión serán discutidas en la segunda parte, la cual será un análisis de la situación de los programas hospitalarios del Rb en México, incluyendo la revisión de los datos demográficos disponibles de los centros de referencia más importantes.

Objetivo: Comparar a taxa de cirurgia de catarata (TCC) em todas as províncias da Argentina entre 2001 e 2008, utilizando métodos de relatórios convencionais e verificar a precisão da TCC por meio do cruzamento desses métodos com o número de lentes intraoculares (LIOs) vendidas no país. Métodos: Estudo longitudinal realizado em clínicas públicas e privadas, com a participação de 40 oftalmologistas de 22 províncias, que forneceram dados sobre cirurgias de catarata para 2001 e 2008. Outros dados foram obtidos a partir do Ministério da Saúde. As observações foram cruzadas com os dados de mercado para LIOs no período de 2008 a 2010. Resultados: O número de cirurgias de catarata aumentaram 2,7 vezes, de 62.739 em 2001 para 169.762 em 2008, com aumentos em todas as províncias, exceto Mendoza. Embora a população também tenha aumentado 9,4 % durante o mesmo período de tempo, a aparente TCC saltou de 1.744 para 4.313 por milhão de população. O número de LIOs vendidas na Argentina em 2008 foi de 186.652, o que pode significar que tenham sido realizadas um pouco mais de cirurgias de catarata do que o estimado. Verificações cruzadas com outros países que utilizam dados de vendas de LIOs não apresentam discrepâncias quando comparado a TCC anteriormente relatadas. Conclusões: De 2001 a 2008, a TCC na Argentina aumentou consideravelmente por várias razões mas, principalmente, porque foi revelada, por meio do cruzamento de dados sobre cirurgias relatadas com o número de LIOs vendidas, que o número de cirurgias realizadas anualmente foi hipoestimado no passado, como resultado de relatórios incompletos feitos por médicos privados. Há também várias sociedades de oftalmologia no país, o que dificulta a obtenção de dados precisos.

Purpose: To compare the cataract surgical rate (CSR) in 2001 with that in 2008 in all Argentinean provinces using current reporting methods and verify the accuracy of CSRs by crosschecking these methods with the number of sold intraocular lenses (IOLs) within the country. Methods: A longitudinal study including public and private setups was conducted, and it included 40 ophthalmologists from 22 provinces who provided cataract surgery data for 2001 and 2008. Other data were obtained from the Ministry of Health. Estimates were crosschecked against the market data for sold intraocular lens (IOLs) in 2008 and 2010. Results: The number of cataract surgeries increased 2.7-fold, from 62,739 in 2001 to 169,762 in 2008, with increases in every province except Mendoza. Although the population also increased by 9.4% during the same time period, the apparent CSR jumped from 1,744 to 4,313 per million population. The number of IOLs sold in Argentina in 2008 was 186,652, suggesting that the number of cataract surgeries performed was slightly greater than anticipated. Crosschecks with other countries using IOL sales data did not show discrepancies when compared with previously reported CSRs. Conclusions: Although the CSR in Argentina increased considerably from 2001 to 2008 for several reasons, the main reason was that thorough crosschecking between the number of surgeries reported and the number of IOLs sold revealed that the number of surgeries performed annually were being underestimated as a result of incomplete reporting by private practitioners. Furthermore, the presence of multiple societies of ophthalmology in the country complicated the process of obtaining accurate data.