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Vashist P, Grover S, Manna S, Senjam SS, Gupta V, Gupta N, Bhardwaj A. Rapid survey for assessing effective cataract surgical coverage (eCSC) and effective refractive error coverage (eREC)-Novel indicators of universal eye health. Indian J Ophthalmol 2024; 72:1321-1328. [PMID: 38767538 DOI: 10.4103/ijo.ijo_1668_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE As per the recent World Health Organization estimates, approximately 2.2 billion people have near and distance vision impairment (VI) globally, and out of this almost 50% is avoidable. METHODS The Rapid Assessment of Avoidable Visual Impairment survey was a cross-sectional study conducted in September 2021, using cluster random sampling in 42 clusters with a cluster size of 140, giving a total of 6000 participants. Two teams comprising of trained optometrists and social workers conducted the ocular examination which included unaided, pinhole, and aided visual acuity assessments followed by examination of the anterior segment and lens. Distance visual acuity was measured using simplified tumbling "E" charts of different sizes for VA of 6/12, 6/18, and 6/60. The lens assessment was done in an un-dilated pupil with torch light by the optometrist. RESULTS Overall, 6520 individuals aged 6 years and above were enumerated, of whom 5440 (83.4%) were examined. The response rate for examination was better among females (93.1%) than males (73.9%), and it decreased from 93.8% in the age group 6-15 years to 77.1% in the 45+ age group. The prevalence of blindness and VI were 0.18% (95% CI: 0.06-0.29) and 4.19% (95%CI: 3.65-4.72), respectively. The major causes of VI in all age groups were uncorrected refractive error (65.4%), cataract (23.7%), cataract surgical complications (2.6%), corneal opacity (0.4%), and other posterior segment diseases (7.5%). The effective cataract surgical coverage (eCSC) was 61.8%, effective refractive error coverage (eREC) for distance vision was 59.8%, and eREC for near vision was 47.0%. CONCLUSION The RAAVI methodology is suitable to measure effective coverage in the general population, both for baseline measurement and periodic monitoring. The 2030 targets for the surveyed district are 90% eCSC and 100% eREC. Such exercises need to be conducted in each district of the country to determine the baseline and target values of effective coverage.
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Affiliation(s)
- Praveen Vashist
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Sumit Grover
- Department of Ophthalmology, National Cancer Institute, AIIMS, New Delhi, India
| | | | - Suraj S Senjam
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Vivek Gupta
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Noopur Gupta
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Amit Bhardwaj
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Onyia O, Aghaji AE, Ubaka C, Achigbu EO, Ejiakor IL, Mbatuegwu AI, Okeke CJP, Okoli BC, Ogborogu EU, Dike KC, Nkwogu FU, Gilbert C. Assessing the cataract surgical rate and gender equity in cataract services in south-east Nigeria. BMJ Open Ophthalmol 2024; 9:e001326. [PMID: 39089733 PMCID: PMC11293407 DOI: 10.1136/bmjophth-2023-001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND In 2020, almost 100 million people were blind or visually impaired from cataract. Cataract surgery is a cost-effective treatment for cataracts. In Nigeria, twice as many women are cataract blind as men. Cataract surgical rate (CSR, the number of cataract operations per million population per year in a defined geographical location) is an output indicator of cataract surgical services. The recommended target CSR for sub-Saharan Africa is 1000/year. The aim of this study was to assess the CSR in men and women in Imo state, Nigeria. METHODS A retrospective review of cataract surgery undertaken in all eye health facilities in Imo State in 2019. Data collected included the type and location of facilities, patient demographics and the number and type of cataract operations performed in each facility. The CSR was calculated overall, in men and women, and in younger and older women. RESULTS The CSR overall was 330/million and was slightly higher in women (347/million) than in men (315/million) (p<0.001). More elderly women (≥65 years) accessed cataract surgery through outreach than men and younger women (OR 1.5 (95% CI 1.03 to 2.22, p=0.03) and 1.6 (95% CI 1.07 to 2.44, p=0.02)), respectively. CONCLUSION The overall CSR in Imo state was approximately one-third of that recommended for sub-Saharan Africa. Although the CSR was higher in women than in men, considerably higher CSRs are needed in women to address their higher burden of cataract blindness. Operational and intervention science research are needed, to identify and evaluate interventions which address demand and supply barriers to accessing cataract surgery, particularly for elderly women.
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Affiliation(s)
- Onyinye Onyia
- Ophthalmology, Federal Teaching Hospital, Owerri, Imo, Nigeria
| | - Ada Ejealor Aghaji
- Ophthalmology, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Christiana Ubaka
- Ophthalmology, DMMM St Joseph's Eye Hospital, Mgbirichi, Imo, Nigeria
| | | | | | | | | | | | - Emmanuel U Ogborogu
- Ophthalmology, Federal Teaching Hospital, Owerri, Imo, Nigeria
- Ophthalmology, Imo state General Hospital, Umuguma, Imo, Nigeria
| | - Kenneth C Dike
- Ophthalmology, Federal Teaching Hospital, Owerri, Imo, Nigeria
| | - Florence U Nkwogu
- Ophthalmology, Uche Chukwu Hospital and Specialist Eye Centre, Ogbaku, Imo, Nigeria
- Ophthalmology, Imo State University Faculty of Clinical Sciences, Owerri, Imo State, Nigeria
| | - Clare Gilbert
- Clinical Research Unit, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Joseph S, Rajendran VK, Khetwani D, Uduman MS, Ramasamy D, Gowth AM, Kowsalya A, Ehrlich JR, Ravilla TD. Evaluation of a telemedicine-enabled universal eye health delivery model in rural southern India. Eye (Lond) 2024; 38:1202-1207. [PMID: 38057562 PMCID: PMC11009233 DOI: 10.1038/s41433-023-02871-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES To evaluate the accuracy of tele-ophthalmic examination (TOE) for common ocular conditions in comparison with the gold-standard in-person examination (IPE) for diagnosis and treatment advice. METHODS In a prospective, diagnostic accuracy validation study, we recruited 339 consecutive new patients, aged ≥16 years, visiting a vision centre (VC) associated with Aravind Eye Hospital in south India during January and February, 2020. All participants underwent the TOE, followed by IPE on the same visit. The in-person ophthalmologist was masked to the TOE diagnosis and treatment advice. Data were analysed via the sensitivity specificity of TOE versus the gold-standard IPE. RESULTS TOE achieved high sensitivity and specificity for identifying normal eyes with 87.4% and 93.5%, respectively. TOE had high sensitivity for cataracts (91.7%), infective conjunctivitis (72.2%), and moderate sensitivity for pterygium (62.5%), DR (57.1%), non-serious injury (41.7%), but low sensitivity for glaucoma (12.5%). TOE had high specificity ranging from 93.5% to 99.8% for all diagnoses. The sensitivity for treatment advice ranged from 58.1% to 77.2% and specificity from 96.9% to 100%. CONCLUSIONS The TOE in VCs has acceptable accuracy to an IPE by an ophthalmologist for correctly identifying and treating major eye ailments. Through providing universal eye care to rural populations, this model may contribute to work toward achieving Universal Health Coverage, which is a linchpin of the health-related U.N. Sustainable Development Goals (SDG).
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Affiliation(s)
- Sanil Joseph
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Vinoth Kumar Rajendran
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Dhwanit Khetwani
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
| | | | - Dhivya Ramasamy
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | | | - Akkayasamy Kowsalya
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, USA
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Thulasiraj D Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India.
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Vishwakarma P, Sundararaj L, Chavan S, Mondal A, Ranpise D, Sudhir RR, Kumar SGP, Kurian E. Spectacle compliance postcataract surgery significantly improved vision function-related quality of life of adult patients in India: Evidence from a multicenter longitudinal cohort study. Oman J Ophthalmol 2023; 16:500-508. [PMID: 38059111 PMCID: PMC10697246 DOI: 10.4103/ojo.ojo_234_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Cataract is the leading cause of avoidable blindness globally. This study aims to measure the changes in Vision function-related quality of life (VFQoL) before and after cataract surgery and identify the predictors of an improvement in these outcomes. METHODS A multicenter, longitudinal cohort study was conducted. Patients with first eye cataracts were interviewed before and 6 months after cataract surgery. Multiple classification analysis (MCA) was performed to assess variation in the intensities of mean change scores for general function, psychosocial impact, and visual function with select factors. RESULTS A total of 747 participated in the baseline assessment. The 6-month follow-up rate was 86.5%. The mean general function, psychosocial impact, and visual function scores were 35.3 (±8.6), 12.5 (±3.4), and 8.3 (±3) in the baseline and 17 (±5.3), 6 (±2.2) and 3.8 (±1.3) in the follow-up assessments, respectively. In MCA, patients using spectacles postsurgery (β 0.111) and those having a very good postoperative visual acuity (β 0.098) had the most impact on general function. Patients reporting no ocular complaints postsurgery had a relatively higher effect on the psychosocial impact, (β 0.168) and similarly, patients using spectacles postsurgery and those aged 70 and older had the most impact on the visual function scores (β 0.146 and 0.126), respectively. CONCLUSION Cataract surgery is associated with meaningful improvements in vision and VFQoL in general. The determinants of better VFQoL include the usage of spectacles postsurgery. Strategies to further improve patient participation in postoperative review visits are needed for spectacle provision and patient education regarding spectacle use and compliance is imparted during such visits.
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Affiliation(s)
| | | | | | | | | | - Rachapalle Reddi Sudhir
- Department of Preventive Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Xiang Y, Wang X, Cao X, Wei F, Chen Y, Ran J, Long Z, Tan Q, Lai Z, Liu L, Zhao D, Xiong L, Tang B, Wan W, Hu K. Efficacy of cataract surgeries performed during blindness prevention programs in Chongqing, China: a multicenter prospective study. BMC Ophthalmol 2023; 23:353. [PMID: 37563617 PMCID: PMC10413487 DOI: 10.1186/s12886-023-03082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE To determine the efficacy of cataract surgeries in blindness prevention programs in Chongqing. METHODS During February-December 2019, we prospectively enrolled 487 patients (592 eyes) undergoing cataract surgery during blindness prevention programs in 6 Chongqing district/county hospitals (experimental group) and 481 patients (609 eyes) undergoing cataract surgery in the First Affiliated Hospital of Chongqing Medical University (controls). Uncorrected visual acuity (UCVA), refractive status, best corrected visual acuity (BCVA), slit lamp examination, and visual function/quality of life (VF-QOL) questionnaire scores were evaluated preoperatively, and at 1 and 6 months postoperatively. RESULTS In the experimental group, UCVA, BCVA, and VF-QOL scores at 1 and 6 months were better than the preoperative values (P < 0.05), but lower than the control-group values (P < 0.05). Rates of good UCVA and BCVA outcomes (≤ 0.5 logMAR) in the experimental group were 76.2% and 87.6%, respectively, at 1 month and 68.9% and 83.1%, respectively, at 6 months. Most eyes in the experimental (82.1%) and control (89.5%) groups had refractive errors within ± 1 D at 1 month. At 6 months, posterior capsule opacification (PCO) was more common in the experimental group (20.9% vs. 15.0%, P < 0.05). At 6 months, the main causes of visual impairment (UCVA > 0.5 logMAR) in the experimental group were uncorrected refractive errors (33.0%), PCO (29.5%), and fundus diseases (33.9%). CONCLUSION Cataract surgeries in blindness prevention programs in Chongqing significantly improved visual acuity, VF, and QOL, but underperformed compared to surgeries in the tertiary teaching hospital.
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Affiliation(s)
- Yongguo Xiang
- Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaoqin Wang
- People's Hospital of Tongliang District, Tongliang District, Chongqing, People's Republic of China
| | - Xiaochuan Cao
- People's Hospital of Tongliang District, Tongliang District, Chongqing, People's Republic of China
| | - Fang Wei
- Youyang County People's Hospital, Youyang County, Chongqing, People's Republic of China
| | - Yu Chen
- Youyang County People's Hospital, Youyang County, Chongqing, People's Republic of China
| | - Jianchuan Ran
- Qianjiang Central Hospital, Qianjiang District, Chongqing, People's Republic of China
| | - Zhengqin Long
- Qianjiang Central Hospital, Qianjiang District, Chongqing, People's Republic of China
| | - Qunwu Tan
- Wushan County People's Hospital, Wushan County, Chongqing, People's Republic of China
| | - Zhenying Lai
- Wushan County People's Hospital, Wushan County, Chongqing, People's Republic of China
| | - Li Liu
- People's Hospital of Dazu District, Dazu District, Chongqing, People's Republic of China
| | - Desheng Zhao
- People's Hospital of Dazu District, Dazu District, Chongqing, People's Republic of China
| | - Liang Xiong
- People's Hospital of Jiangbei District, Jiangbei District, Chongqing, People's Republic of China
| | - Bin Tang
- People's Hospital of Jiangbei District, Jiangbei District, Chongqing, People's Republic of China
| | - Wenjuan Wan
- Chongqing Medical University, Chongqing, People's Republic of China.
- Chongqing Key Laboratory of Ophthalmology, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, People's Republic of China.
| | - Ke Hu
- Chongqing Medical University, Chongqing, People's Republic of China.
- Chongqing Key Laboratory of Ophthalmology, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, People's Republic of China.
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Han X, Zhang J, Liu Z, Tan X, Jin G, He M, Luo L, Liu Y. Real-world visual outcomes of cataract surgery based on population-based studies: a systematic review. Br J Ophthalmol 2023; 107:1056-1065. [PMID: 35410876 PMCID: PMC10359559 DOI: 10.1136/bjophthalmol-2021-320997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/24/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIMS Quantity of cataract surgery has long been an important public health indicator to assess health accessibility, however the quality of care has been less investigated. We aimed to summarise the up-to-date evidences to assess the real-world visual outcomes after cataract surgery in different settings. METHODS A systematic review was undertaken in October 2021. Population-based cross-sectional and longitudinal studies reporting vision-related outcomes after cataract surgery published from 2006 onward were included. A meta-analysis was not planned. RESULTS Twenty-six cross-sectional studies from low-income and middle-income countries (LMICs) and five cross-sectional studies from high-income countries (HICs) were included. The proportions of participants with postoperative presenting visual acuity (VA) ≥0.32 (20/60) were all over 70% in all HICS studies, but mostly below 70% in LMICS studies, ranging from 29.9% to 80.5%. Significant difference in postoperative VA was also observed within countries. The leading causes for postoperative visual impairment (defined mostly as presenting VA <20/60) mainly included refractive error, ocular comorbidities and surgical complications including posterior capsule opacification, except for one study in Nigeria wherein the leading cause was aphakia. Only four population-based cohort studies were included with 5-20 years of follow-up time, generally demonstrating no significant changes in postoperative visual outcomes during the follow-up. CONCLUSIONS We observed large inequality in the visual outcomes and principal causes of visual impairment after cataract surgery among different countries and regions. Structured quality control and enhancement programmes are needed to improve the outcomes of cataract surgery and reduce inequality.
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Affiliation(s)
- Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Jiaqing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Xuhua Tan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
- Opthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
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Warad C, Tenagi A, Satarasi P, Goyal D, Mendpara R, Harakuni U, Bubanale SC, K S S, B K B, Wani V. Visual Outcome Following Manual Small Incision Cataract Surgery at a Tertiary Center in South India. Cureus 2021; 13:e20687. [PMID: 35106227 PMCID: PMC8786263 DOI: 10.7759/cureus.20687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Cataract being one of the leading causes of avertible blindness has been found to be quite prevalent in developing countries like India. The National Programme for Control of Blindness (NPCB) aims at reducing blindness due to cataract via cataract control programs. The most commonly performed surgery is the manual small incision cataract surgery (MSICS). Aim The aim of this study was to determine the visual acuity and outcome in patients who underwent MSICS in a tertiary hospital in south India. Methodology A prospective longitudinal interventional study was conducted in a tertiary hospital in Karnataka, India, over a period of nine months. A total of 105 eyes underwent MSICS and were followed up for one month to assess their postoperative visual outcome and complications, if any. During this period, they were started on antibiotic + steroid combination eyedrops, which were tapered over four weeks. Results Results were assessed based on visual grading categorized by the World Health Organization (WHO). A total of 103 (98.1%) patients had good vision, i.e., visual acuity of 6/6 - 6/18, followed by two (1.9%) who had moderate vision i.e., visual acuity of <6/18 - 3/60, and none were blind or with visual acuity of <3/60. Complications seen intraoperatively in two patients (1.9%) were iris prolapse and posterior capsular rent, respectively, and postoperatively one (0.95%) patient showed hyphema with inferior haptic in the anterior chamber. Conclusion This study proves that a good visual outcome with a low complication rate can be achieved after MSICS with posterior chamber intraocular lens implantation.
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Marmamula S, Barrenakala NR, Challa R, Kumbham TR, Modepalli SB, Yellapragada R, Bhakki M, Reddy JC, Friedman DS, Khanna RC. Visual outcomes after cataract surgery among the elderly residents in the 'homes for the aged' in South India: the Hyderabad Ocular Morbidity in Elderly Study. Br J Ophthalmol 2021; 105:1087-1093. [PMID: 32855164 PMCID: PMC8311112 DOI: 10.1136/bjophthalmol-2020-317167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM To report visual outcomes and factors associated with good visual outcomes after cataract surgery among the elderly residents in 'homes for the aged' in Hyderabad, India. METHODS Individuals aged ≥60 years were recruited from 41 'homes for the aged'. All participants had a detailed eye examinations including visual acuity (VA) assessment , refraction, slit-lamp examination and fundus imaging by trained professionals. A detailed history of cataract surgery was recorded. Multivariate logistic regression was used to determine the factors associated with good visual outcomes after cataract surgery which was defined as presenting VA of 6/18 or better in the operated eye. Visual impairment (VI) is defined as presenting VA worse than 6/18 in the operated eye. RESULTS 1215 eyes of 703 individuals had cataract surgery. The mean age of these participants was 77.5 years (SD: 8.2 years; range: 60-108 years), 66.8% were women, 29.9% reported diabetes and 61% reported hypertension. 406/1215 (33.4%; 95% CI 30.8 to 36.1) eyes had VI after cataract surgery. Posterior capsular opacification (31.8%; n=129) was the leading cause of VI followed by uncorrected refractive error (24.1%; n=98). The prevalence of good outcomes was 66.6% (95% CI 63.8 to 69.2). On applying multivariable analysis, younger age, self-reported hypertension, independent mobility, surgery in a non-government (as opposed to private) hospital and undergoing paid surgery were associated with good outcomes. CONCLUSIONS One-third of the eyes of elderly individuals living in homes for the aged that had previously undergone cataract surgery had VI. Regular eye examinations with the provision of laser capsulotomy and appropriate refractive correction can substantially improve their vision.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- Department of Biotechnology / Wellcome Trust India Alliance, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology, Boston, United States of America
| | - Navya Rekha Barrenakala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Madhuri Bhakki
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Jagadesh C Reddy
- Cataract and Refractive Services, L V Prasad Eye Institute, Hyderabad, India
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology, Boston, United States of America
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Rathi VM, Sharma S, Das T, Khanna RC. Endophthalmitis prophylaxis study. Report 1: Intracameral cefuroxime and moxifloxacin prophylaxis for the prevention of postcataract endophthalmitis in rural India. Indian J Ophthalmol 2021; 68:819-824. [PMID: 32317453 PMCID: PMC7350447 DOI: 10.4103/ijo.ijo_1400_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: Intracameral antibiotics are known to reduce the incidence of acute endophthalmitis. Various drugs are available for intracameral use. This prospective study was carried out to compare the efficacies of intracameral cefuroxime and moxifloxacin prophylaxis in reducing the incidence of acute endophthalmitis after cataract surgery in rural India. Methods: This was a prospective, nonrandomized, comparative, interventional study. Between October 2016 and March 2018, 15 eye care facilities spread over four Indian states were preselected to use either of the intracameral antibiotics, cefuroxime or moxifloxacin, following cataract surgery (phacoemulsification or manual small incision cataract surgery, SICS). The main outcome measure was the occurrence of acute clinical endophthalmitis within six weeks of the surgery. This was compared with the earlier rate of endophthalmitis in the same locations. Results: The study was done in 42,466 eyes. Of the total, 42.2% received intracameral cefuroxime and 57.8% received intracameral moxifloxacin. SICS was performed more often. Clinical acute endophthalmitis occurred in 15 eyes. This accounted to a 72.22% reduction, from the earlier 0.126% to 0.035%, of postcataract surgery acute endophthalmitis. The reduction in the incidence of endophthalmitis after intracameral cefuroxime was 0.017% and that after intracameral moxifloxacin was 0.049%. With either intracameral antibiotics, the reduction in incidence was statistically significant (P < 0.001), but not between the molecules. Intracameral cefuroxime showed 66.67% reduction and intracameral moxifloxacin showed 74.74% reduction. Conclusion: A 3.6-fold decrease in postcataract surgery endophthalmitis was observed upon the use of intracameral antibiotics in rural India. Both intracameral cefuroxime and moxifloxacin proved efficacious.
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Affiliation(s)
- Varsha M Rathi
- Allen Foster Research Centre for Community Eye Health, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute (LVPEI), Banjara Hills, Hyderabad, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, LVPEI, Hyderabad, India
| | - Taraprasad Das
- Kanuri Santhamma Center for Vitreoretinal Diseases, LVPEI, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Research Centre for Community Eye Health, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute (LVPEI), Banjara Hills, Hyderabad, India
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10
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Marmamula S, Challa R, Khanna RC, Kunkunu E, Rao GN. Population-based Assessment of Vision Impairment in the Elderly Population in Telangana State in India - Policy Implications for Eye Health Programmes. Ophthalmic Epidemiol 2020; 28:144-151. [PMID: 32746673 DOI: 10.1080/09286586.2020.1797122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the prevalence, causes and risk factors for vision impairment (VI) among the elderly population in Telangana State, India. METHODS A population-based cross-sectional study were conducted in four districts. All participants had eye examinations including visual acuity assessment for distance and near, anterior segment examination and non-mydriatic fundus imaging by trained personnel. VI was defined as presenting visual acuity worse than 6/18 in the better eye. Individuals aged ≥60 years were considered as elderly. RESULTS In total, 11,238/12,150 (92.5%) individuals aged ≥40 years were examined. Of this, the dataset of 3,640 individuals (32.4%) elderly participants was used for analysis. Among the 3,640 participants, 53.1% were women and 78.1% had no education. The mean age of the participants was 67.8 years (standard deviation: 7 years; range: 60 to 102 years). The age and gender-adjusted prevalence of VI was 32.1% (95% CI: 29.5-34.8). On multivariable analysis, the odds of VI was significantly higher in older age groups, and among those with no education. Gender and district of residence were not associated with the prevalence of VI. Cataract (54.8%) was the leading cause of VI followed by uncorrected refractive errors (37.6%). CONCLUSIONS AND RELEVANCE VI was common and largely avoidable in the elderly population in Telangana state in India. Elderly centric eye care including screening for vision loss, provision of cataract surgery and spectacles can be used as strategies to address VI in the elderly.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.,Department of Biotechnology/Wellcome Trust India Alliance, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Eswararao Kunkunu
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Gullapalli N Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
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11
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Marmamula S, Barrenkala NR, Challa R, Kumbam TR, Modepalli SB, Yellapragada R, Bhakki M, Khanna RC, Friedman DS. Uncorrected refractive errors for distance among the residents in 'homes for the aged' in South India-The Hyderabad Ocular Morbidity in Elderly Study (HOMES). Ophthalmic Physiol Opt 2020; 40:343-349. [PMID: 32207179 PMCID: PMC7277039 DOI: 10.1111/opo.12684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the prevalence and risk factors of Uncorrected Refractive Errors (URE) for distance in elderly residents in 'homes for the aged' in Hyderabad, India. METHODS Individuals aged ≥60 years and residing in 'homes for the aged' in Hyderabad, India for a minimum of 1 month and providing consent for participation were recruited. All participants underwent visual acuity assessment, refraction, slit lamp biomicroscopy, intraocular pressure measurement, fundus examination, and retinal imaging. Monocular presenting visual acuity was recorded using a logMAR chart. Objective and subjective refraction were performed, and best-corrected visual acuity was recorded. URE was defined as presenting visual acuity worse than 6/12 but improving to 6/12 or better with refraction. Univariable and multivariable logistic regression analyses were used to assess the risk factors associated with URE. RESULTS In total, 1 513 elderly participants were enumerated from 41 homes of which 1 182 participants (78.1%) were examined. The mean age of participants was 75.0 years (standard deviation 8.8 years; range: 60-108 years). 35.4% of those examined were men and 20.3% had no formal education. The prevalence of URE was 13.5% (95% CI: 11.5-15.5; n = 159). On applying multiple logistic regression analysis, compared to those living in private homes, the odds of URE were significantly higher among the elderly living in the aided homes (OR: 1.65; 95% CI: 1.11-2.43) and free homes (OR: 1.67; 95% CI: 1.00-2.80). As compared to those who reported having an eye examination in the last 3 years, the odds of URE were higher among those who never had an eye examination in the last three years (OR: 1.51; 95% CI: 1.07-2.14). Similarly, those who had unilateral cataract surgery (OR: 1.80; 95% CI: 1.10-2.93) or bilateral cataract surgery (1.69; 95% CI: 1.10-2.56) had higher odds of URE compared to those elderly who were not operated for cataract. Gender, self-report of diabetes, and education were not associated with URE. CONCLUSIONS A large burden of URE was found among the residents in the 'homes for the aged' in Hyderabad, India which could be addressed with a pair of glasses. Over 40% of the residents never had an eye examination in the last three years, which indicates poor utilisation of eye care services by the elderly. Regular eye examinations and provision of spectacles are needed to address needless URE for distance among the elderly in residential care in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
- Wellcome Trust/Department of Biotechnology India AllianceL V Prasad Eye InstituteHyderabadIndia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
- Department of OphthalmologyMassachusetts Eye and EarHarvard Medical SchoolBostonUSA
| | - Navya Rekha Barrenkala
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Rajesh Challa
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Thirupathi Reddy Kumbam
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Madhuri Bhakki
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
| | - David S Friedman
- Department of OphthalmologyMassachusetts Eye and EarHarvard Medical SchoolBostonUSA
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12
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Bhatia R, Singhal D. Managing media during ophthalmic crisis. Indian J Ophthalmol 2020; 68:541. [PMID: 32057030 PMCID: PMC7043181 DOI: 10.4103/ijo.ijo_1781_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Marmamula S, Khanna RC, Yellapragada S, Challa R, Mohd J, Rao GN. Temporal trends in the prevalence and causes of visual impairment in the South Indian state of Telangana: a population-based cross-sectional study. BMJ Open 2019; 9:e029114. [PMID: 31345976 PMCID: PMC6661589 DOI: 10.1136/bmjopen-2019-029114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the temporal trends in the prevalence and causes of visual impairment (VI) in South India. DESIGN Population-based cross-sectional studies conducted during the years 2011-2012 and 2017 using identical study methods and in geographical locations are compared. The L V Prasad Eye Institute established services in Khammam and not in Warangal district after the 2011-2012 study. SETTING Khammam and Warangal districts in Telangana, India. PARTICIPANTS In total, 5357 participants aged ≥40 years were examined from two districts in the 2011-2012 study and 4923 participants were examined in the 2017 study. MAIN OUTCOME MEASURES Age-adjusted and gender-adjusted temporal trends in the prevalence and causes of VI.Blindness and moderate VI (MVI) were defined as presenting visual acuity worse than 6/60 and 6/18-6/60 in the better eye, respectively. VI included MVI and blindness. RESULTS Nearly 2500 participants were examined in each location in both the 2011-2012 and 2017 studies. In Khammam district, overall VI declined by 2.5% from 15.5% to 13.0% (p<0.001). While there was no significant change in MVI (p=0.566), blindness declined by 3.0% from 5.4% to 2.4% (p<0.001). In Warangal district, the overall VI remained unchanged (p=0.60). While MVI increased by 3% from 9.3% to 12.3% (p=0.001), blindness declined by 3.5% from 6.5% to 3.0% (p<0.001). While MVI due to cataract increased in both districts, there was a significant decline in MVI due to refractive errors in Khammam. CONCLUSION There was a significant decline in VI in Khammam district but not in Warangal district. The differential trends in prevalence and causes of VI can be explained by the availability and uptake of eye care services in these two districts.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
- WellcomeTrust / Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, Telangana, India
- School of Optometry and Vision Science, University of South Wales, Sydney, NSW, Australia
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- School of Optometry and Vision Science, University of South Wales, Sydney, NSW, Australia
| | - Shashank Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Javed Mohd
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gullapalli Nageswara Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
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