# Unmasking the Hidden Morbidity of Ocular Diseases in Primary Care Through a Collaboration with Specialists in Remote Areas: A Cross-Sectional Study from Rural Crete, Greece

## TL;DR

This study found that many eye diseases go undiagnosed in rural primary care settings, highlighting the need for better access to specialists in remote areas.

## Contribution

The study reveals a high rate of previously undiagnosed eye disorders in a remote rural population, suggesting hidden morbidity in primary care.

## Key findings

- 34.3% of participants had previously undiagnosed eye disorders.
- Quality of life scores were significantly lower for known eye disease cases compared to newly diagnosed or undiagnosed individuals.
- Common eye conditions included refractory errors, cataracts, glaucoma, and maculopathy.

## Abstract

Background: Ocular disorders are not frequently addressed in primary care, which is more visible in remote rural settings. The aim of the study was to assess the prevalence and pattern of eye diseases in a remote rural population of Crete and to explore whether they represent a hidden morbidity. Materials and Methods: A community-based, cross-sectional study based on data collected through a comprehensive clinical investigation conducted by a mobile ophthalmological unit. Permanent inhabitants, aged over 40 years, living in one remote rural community located on the highest mountain of Crete, were invited to participate. The prevalence of eye diseases was measured during the comprehensive ophthalmological examination. Patients’ medical records were used to assess hidden morbidity. The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) was applied to measure self-reported vision-targeted health status. Results: A total of 239 individuals agreed to participate; 54.9% were females (n = 151), with a mean ageof 66.13 years (±14.56). The most common diagnoses were refractory errors (59%), cataract (21.7%), glaucoma (11.7%), maculopathy (8.8%), and dry eyes (8.8%). A previously undiagnosed eye disorder was detected in 34.3% (n = 82). Total scores of NEI VFQ-25 measured quality of life were highand significantly lower in Known Cases of eye diseases compared to patients with New or Without diagnosis (76.6 vs. 84.1 and 84.6, respectively, p = 0.009). Conclusions: Our study highlighted the need for increased awareness of primary care in rural areas concerning eye disorders. Local policies should focus on implementing public health interventions and encouraging close cooperation with specialists to overcome accessibility issues.