90 The Epidemiology of Eye Disease
for blindness which could result in bias. Many of
the recent eye surveys in developing countries
have managed to minimize the non-response, hav-
ing examined more than 90% of all those who
were selected. By contrast, some eye surveys in
urban settings, particularly in large metropolitan
areas, have examined only about 60% of the
selected sample. Surveys that involve house-to-
house visits by the seam tend to achieve a better
response rate. When persons arc invited to attend
examination in a remote centre, or when postal
questionnaires are used, the response generally
tends to be poorer. The well-designed rye survey
in the west of Ireland managed to examine 99.5%
of all those invited to attend clinics at 18 exami-
nation sites throughout the county. (see Section
4.3 for more detail). The 4,709 participants in
the Barbados Eyc Study tt represented about
84% of the eligible members in the sample. The
Melbourne Visual Impairment Project achieved a
response rate of 83%.'s The response rate in the
North London Eyc Study' was 84%. These studies
have relied on media publicity and public relations
to help provide information to the community and
to secure the co-operation of community leaders
and other key officials.
3.5.4 Other sources of bias
Other sources of information bias include system-
atic mistakes in measurement, diagnosis and the
classification of individuals, mistakes in recording
data, and mistakes in data analysis and reporting.
These errors could mean that the estimates of
prevalence and causes of blindness from the survey
do not reflect the true values in the total popula-
tion. Procedures that may help to eliminate these
sources of bias include:
O Preparation of a detailed protocol (manual of
operations) for training and reference.
O Training of the members of the survey team in
standardized methods of examination, grading
and classification, and assessing the level of
agreement between the examiners (observers),
before and during the survey, using observer
agreement studies.
> Making the examinations and assessments as
objective and as automated as possible. This may
include (when possible) the use of image-capture
systems (such as a fundus camera) and
subsequent 'reading' of the images by an expert
group, or a computerized image-analysis systcm.
Data entry (manual or by scanning of the
record shcct) using software with range-checks
and validity-checks, and double data entry or
formal checking of entered data against original
rccords.
3.6 SAMPLE SIZE FOR ESTIMATING
PREVALENCE
The sample size will depend upon the desired level
of precision for estimating prevalence, the sampling
scheme, she population size, and cost and logistic
issues. Having devised an efficient sampling
scheme (one that would result in minimal sampling
error for any given sample size and cost), an
approximate minimum sample sizc, required to
give the desired precision, may be calculated using
standard statistical tools which are widely available.
The equations require the following criteria to be
specified:
O The expected prevalence of the condition in the
population. This is usually based on the results
of stu-veys conducted in similar settings. O
The desired precision (the maximum sampling
error that is acceptable) for estimating the
prevalence of the disorder(s) deemed as 'most
important' in die objectives of the study. Calculations
are also made for the secondary objectives. The
desired precision will strongly depend upon she
'expected' prevalence in the population: for
example, when the prevalence is expected to be in
the region of 0.1 (i.e. 10%) a sampling error of ±
0.02 may be acceptable, whereas a much
smaller sampling error (e.g. ± 0.005) is
required for an expected prevalence of, for
example, 0.025. Calculations are usually made
for several different assumed values of the
prevalence and the corresponding levels of
precision.