1
|
Liu R, Sule AA, Shannon CS, Ravilla T, Taylor H, Rojas-Carabali W, Khanna RC, Mishra C, Sen A, Khatri A, Tan ACS, Sobrin L, Agrawal R. A practical model for effective eye care delivery in Southeast Asian rural communities: A proposal built based on experts' recommendations. Indian J Ophthalmol 2024; 72:S473-S481. [PMID: 38648455 DOI: 10.4103/ijo.ijo_2196_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/03/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To evaluate rural community-based eye care models from the perspective of community ophthalmology experts and suggest sustainable technological solutions for enhancing rural eye care delivery. METHODS A semi-structured descriptive survey, using close-ended and open-ended questions, was administered to the experts in community ophthalmology sourced through purposive sampling. The survey was self-administered and was facilitated through online platforms or in-person meetings. Uniform questions were presented to all participants, irrespective of their roles. RESULTS Surveyed participants (n = 22 with 15 from India and 7 from Nepal) in high-volume tertiary eye hospitals faced challenges with resources and rural outreach. Participants had mixed satisfaction with pre-operative screening and theatre resources. Delayed presentations and inexperienced surgeons contributed to the surgery complications. Barriers to rural eye care included resource scarcity, funding disparities, and limited infrastructure. In rural/peri-urban areas 87% of participants agreed with providing primary eye care services, with more than 60% of the experts not in agreement with the makeshift center model of eye care delivery. Key components for an effective eye care model are sustainability, accessibility, affordability, and quality. These can be bolstered through a healthcare management platform and a human-chain supply distribution system. CONCLUSION Tailored interventions are crucial for rural eye care, emphasizing the need for stronger human resources, optimized funding, and community awareness. Addressing challenges pertinent to delayed presentation and surgical training is vital to minimizing complications, especially with advanced cataracts. Enhancements in rural eye care demand a comprehensive approach prioritizing accessibility, affordability, and consistent quality.
Collapse
Affiliation(s)
- Renee Liu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Ashita A Sule
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Choo Sheriel Shannon
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | - Hugh Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - William Rojas-Carabali
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Singapore
| | - 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, Telangana, India
| | | | - Alok Sen
- Sadguru Netra Chikatsalaya, Sri Sadguru Seva Sangh Trust, Chitrakoot, Madhya Pradesh, India
| | | | - Anna C S Tan
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
McGuinness MB, Moo E, Varga B, Dodson S, Lansingh VC, Resnikoff S, Schmidt E, Ravilla T, Balu Subburaman GB, Khanna RC, Rathi VM, Arunga S, Limburg H, Congdon N. The Better Operative Outcomes Software Tool (BOOST) Prospective Study: Improving the Quality of Cataract Surgery Outcomes in Low-Resource Settings. Ophthalmic Epidemiol 2024:1-11. [PMID: 38635874 DOI: 10.1080/09286586.2024.2336518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Post-operative vision impairment is common among patients who have undergone cataract surgery in low-resource settings, impacting quality of clinical outcomes and patient experience. This prospective, multisite, single-armed, pragmatic validation study aimed to assess whether receiving tailored recommendations via the free Better Operative Outcomes Software Tool (BOOST) app improved surgical outcomes, as quantified by post-operative unaided distance visual acuity (UVA) measured 1-3 days after surgery. METHODS During the baseline data collection round, surgeons in low and middle-income countries recorded clinical characteristics of 60 consecutive cataract cases in BOOST. Additional data on the causes of poor outcomes from 20 consecutive cases with post-operative UVA of <6/60 (4-12 weeks post-surgery) were entered to automatically generate tailored recommendations for improvement, before 60 additional consecutive cases were recorded during the follow-up study round. Average UVA was compared between cases recorded in the baseline study round and those recorded during follow-up. RESULTS Among 4,233 cataract surgeries performed by 41 surgeons in 18 countries, only 2,002 (47.3%) had post-operative UVA 6/12 or better. Among the 14 surgeons (34.1%) who completed both rounds of the study (1,680 cases total), there was no clinically significant improvement in post-operative average UVA (logMAR units ±SD) between baseline (0.50 ± 0.37) and follow-up (0.47 ± 0.36) rounds (mean improvement 0.03, p = 0.486). CONCLUSIONS Receiving BOOST-generated recommendations did not result in improved UVA beyond what could be expected from prospective monitoring of surgical outcomes alone. Additional research is required to assess whether targeted support to implement changes could potentiate the uptake of app-generated recommendations and improve outcomes.
Collapse
Affiliation(s)
- Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Elise Moo
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Beatrice Varga
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Sarity Dodson
- Global Programs, The Fred Hollows Foundation, Melbourne, Australia
| | - Van Charles Lansingh
- Help Me See, Jersey City, New Jersey, USA
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Elena Schmidt
- Evidence Research and Innovations, Sightsavers, Chippenham, UK
| | | | | | - Rohit C Khanna
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, Australia
- 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 Eye Research Centre, L.V. Prasad Eye Institute, Hyderabad, India
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Varsha M Rathi
- 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
| | - Simon Arunga
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hans Limburg
- Health Information Services, Grootebroek, Netherlands
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Orbis International, New York, New York, USA
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
3
|
Yelagondula VK, Marmamula S, Banerjee S, Khanna RC. Near vision impairment and effective refractive error coverage for near vision in Andhra Pradesh, India - The Akividu Visual Impairment Study (AVIS). Clin Exp Optom 2024:1-6. [PMID: 38616051 DOI: 10.1080/08164622.2024.2333769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/17/2024] [Indexed: 04/16/2024] Open
Abstract
CLINICAL RELEVANCE Near Vision Impairment (NVI) is common in developing countries. A substantial proportion of NVI can be addressed by providing spectacles. Innovative eye care programmes are needed to address NVI. Population-based epidemiological studies can provide vital data to plan such eye care service delivery models. BACKGROUND To report the prevalence of NVI and effective Refractive Error Coverage (eREC) for near vision in West Godavari and Krishna districts in Andhra Pradesh, south India. METHODS A population-based cross-sectional study was carried out using a Rapid Assessment of Visual Impairment methodology. Presenting and pinhole distance visual acuity were assessed followed by near vision assessment using a N notation chart at a fixed distance of 40 cm. If the presenting near vision was worse than N8, the best corrected near visual acuity was recorded with age appropriate near vision correction. NVI was defined as presenting near vision worse than N8 among those without distance vision impairment (6/18 or better in the better eye). Effective Refractive Error Coverage for near was calculated as the proportion of individuals with an adequate correction to the total participants, including those with inadequate, adequate, and no correction for near vision. RESULTS Data of 2,228 participants aged ≥40 years were analysed. The mean age of these participants was 54.0 ± 10.4 years; 53.8% were women; 44.5% had no formal education. The prevalence of NVI was 27.1% (95% CI: 25.2-29.0%). NVI significantly associated with 70 and above age group (adjusted OR: 1.97; 95% CI: 1.45-3.70). Participants with formal education had lower odds for NVI (adjusted OR: 0.75; 95 % CI: 0.68-0.83). The eREC for near vision was 48.0%. CONCLUSION NVI affects over a quarter of people aged ≥40 years in the West Godavari and Krishna districts of Andhra Pradesh. However, eREC is under 50% and there is scope for improving this by establishing eye care services to achieve universal eye health for all.
Collapse
Affiliation(s)
- Vijay Kumar Yelagondula
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
| | - Srinivas Marmamula
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
- Allen Foster Community Eye Health Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Saptak Banerjee
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
4
|
Marmamula S, Saha R, Khanna RC. Effective Cataract Surgical Coverage in Four Large Districts in Telangana, India - Results from Rapid Assessment of Visual Impairment Study. Ophthalmic Epidemiol 2024:1-7. [PMID: 38569085 DOI: 10.1080/09286586.2024.2336498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To report cataract surgical coverage (CSC) and effective Cataract Surgical Coverage (eCSC) from four districts in Telangana, India. METHODS Individuals aged ≥40 years were recruited from Adilabad, Mahbubnagar, Warangal and Khammam districts using two stage cluster sampling methodology. All participants had detailed eye examinations including visual acuity assessment using a standard Snellen chart at a distance of six meters, anterior segment examination and fundus imaging by trained professionals. CSC and eCSC were calculated for persons using a 6/12 visual acuity cut-off. RESULTS Of 12,150 individuals enumerated from four districts 11,238 (92.5%) were examined. The mean (standard deviation) age of the participants was 54.1 (±11.2) years (range: 40 to 102 years) and 54.6% (n = 6137) were women. Overall, the CSC (%) was 54.2%. It ranged from a highest of 59% in Khammam followed by 57.5% in Adilabad, 51.7% in Warangal, and a least of 49.7% in Mahbubnagar district. Overall, the eCSC (%) was 39.9%. It ranged from a highest of 46.1% in Adilabad followed by 43.2% in Khammam, 36.2% in Warangal district and a least of 35.8% in the Mahbubnagar district. CONCLUSIONS CSC and eCSC varied across the districts. A significant gap between CSC and eCSC is noted suggestive of challenges with quality of services. District-wise planning of cataract surgical services with a focus on quality care is recommended to improve coverage and contribute towards achieving the goal of universal eye health coverage in the Telangana State in India.
Collapse
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
- Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Ranindita Saha
- 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
| | - 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
| |
Collapse
|
5
|
Bourne RRA, Jonas JB, Friedman D, Nangia V, Bron A, Tapply I, Fernandes AG, Cicinelli MV, Arrigo A, Leveziel N, Resnikoff S, Taylor HR, Sedighi T, Bikbov MM, Braithwaite T, Cheng CY, Congdon N, Del Monte MA, Ehrlich JR, Fricke T, Furtado JM, Gazzard G, George R, Hartnett ME, Kahloun R, Kempen JH, Khairallah M, Khanna RC, Kim JE, Lansingh VC, Leasher J, Naidoo KS, Nowak M, Pesudovs K, Peto T, Ramulu P, Topouzis F, Tsilimbaris M, Wang YX, Wang N, Flaxman S, Bourne RRA, Jonas JB, Casson RJ, Friedman DS, Nangia V, Bron AM, Tapply I, Fernandes AG, Cicinelli MV, Leveziel N, Briant PS, Vos T, Resnikoff S, Abate YH, Abate MD, Dolatabadi ZA, Abdollahi M, Aboagye RG, Abu-Gharbieh E, Aburuz S, Adnani QES, Aghamiri S, Ahinkorah BO, Ahmad D, Ahmadieh H, Ahmadzadeh H, Ahmed A, Alfaar AS, Alinia C, Almidani L, Amu H, Androudi S, Anil A, Arabloo J, Areda D, Ashraf T, Bagherieh S, Baltatu OC, Baran MF, Barrow A, Bashiri A, Bayileyegn NS, Bazvand F, Berhie AY, Bhatti JS, Bikbov M, Birck MG, Bitra VR, Bozic MM, Braithwaite T, Burkart K, Bustanji Y, Butt ZA, Cenderadewi M, Chattu VK, Coberly K, Dadras O, Dai X, Dascalu AM, Dastiridou A, Devanbu VGC, Dhimal M, Diaz D, Do THP, Do TC, Dziedzic AM, Ehrlich JR, Ekholuenetale M, Elhadi M, Emamian MH, Emamverdi M, Farrokhpour H, Fetensa G, Fischer F, Forouhari A, Fowobaje KR, Furtado JM, Gandhi AP, Gebregergis MWW, Goulart BNG, Gudeta MD, Gupta S, Gupta VK, Gupta VB, Heidari G, Hong SH, Huynh HH, Ibitoye SE, Ilic IM, Immurana M, Jayapal SK, Joseph N, Joshua CE, Kahloun R, Kandel H, Karaye IM, Kasraei H, Kebebew GM, Kempen JH, KhalafAlla MT, Khanal S, Khatib MN, Krishan K, Lahariya C, Leasher JL, Lim SS, Marzo RR, Maugeri A, Meng Y, Mestrovic T, Mishra M, Mohamed NS, Mojiri-forushani H, Mokdad AH, Momeni-Moghaddam H, Montazeri F, Mulita A, Murray CJL, Foodani MN, Naik GR, Natto ZS, Nayak BP, Negaresh M, Negash H, Nguyen DH, Oancea B, Olagunju AT, Olatubi MI, Osman WMS, Osuagwu UL, Padubidri JR, Panda-Jonas S, Pardhan S, Park S, Patel J, Perianayagam A, Pesudovs K, Pham HT, Prates EJS, Qattea I, Rahim F, Rahman M, Rapaka D, Rawaf S, Rezaei N, Roy P, Saddik B, Saeed U, Safi SZ, Safi S, Sakshaug JW, Saleh MA, Samuel VP, Samy AM, Saravanan A, Seylani A, Shaikh MA, Shamim MA, Shannawaz M, Shashamo BB, Shayan M, Shittu A, Siddig EE, Singh JA, Solomon Y, Sousa RARC, Tabatabaei SM, Tabish M, Ticoalu JHV, Toma TM, Tsatsakis A, Tsegay GM, Valizadeh R, Viskadourou M, Wassie GT, Wickramasinghe ND, Yon DK, You Y, Flaxman S, Steinmetz JD. Global estimates on the number of people blind or visually impaired by glaucoma: A meta-analysis from 2000 to 2020. Eye (Lond) 2024:10.1038/s41433-024-02995-5. [PMID: 38565601 DOI: 10.1038/s41433-024-02995-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/20/2023] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by glaucoma and their proportion of the total number of vision-impaired individuals. METHODS A systematic review and meta-analysis of published population studies and grey literature from 2000 to 2020 was carried out to estimate global and regional trends in number of people with vision loss due to glaucoma. Moderate or severe vision loss (MSVI) was defined as visual acuity of 6/60 or better but <6/18 (moderate) and visual acuity of 3/60 or better but <6/60 (severe vision loss). Blindness was defined as presenting visual acuity <3/60. RESULTS Globally, in 2020, 3.61 million people were blind and nearly 4.14 million were visually impaired by glaucoma. Glaucoma accounted for 8.39% (95% uncertainty intervals [UIs]: 6.54, 10.29) of all blindness and 1.41% (95% UI: 1.10, 1.75) of all MSVI. Regionally, the highest proportion of blindness relating to glaucoma was found in high-income countries (26.12% [95% UI: 20.72, 32.09]), while the region with the highest age-standardized prevalence of glaucoma-related blindness and MSVI was Sub-Saharan Africa. Between 2000 and 2020, global age-standardized prevalence of glaucoma-related blindness among adults ≥50 years decreased by 26.06% among males (95% UI: 25.87, 26.24), and by 21.75% among females (95% UI: 21.54, 21.96), while MSVI due to glaucoma increased by 3.7% among males (95% UI: 3.42, 3.98), and by 7.3% in females (95% UI: 7.01, 7.59). CONCLUSIONS Within the last two decades, glaucoma has remained a major cause of blindness globally and regionally.
Collapse
|
6
|
Prakash WD, Marmamula S, Keeffe J, Khanna RC. Effective refractive error coverage and spectacle coverage among school children in Telangana, South India. Eye (Lond) 2024:10.1038/s41433-024-02986-6. [PMID: 38438796 DOI: 10.1038/s41433-024-02986-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/08/2024] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Uncorrected refractive error (URE) is one of the leading causes of childhood vision impairment. Increasing effective refractive error coverage (e-REC) is one of the main indicators of WHO's 2030 global eye health targets. The aim of this study is to estimate the e-REC and spectacle coverage among school children in Telangana, South India. METHODS School children aged 4-15 years in the study locations underwent vision screening using 6/12 tumbling E optotype by trained community eye health workers in the schools. Those failing the initial vision screening and/or found to be having eye conditions were referred to a nearby referral centre appropriately, where they underwent detailed eye examination. RESULTS A total of 774,184 children were screened in schools of which 51.49% were boys. The mean age was 9.40 ± 3.27 years. The prevalence of URE was 1.44% (95%CI:1.41-1.46) of which myopia was 1.38% (95%CI: 1.35-1.41). In multivariate analysis, the risk of myopia was higher among older children (Adj.OR: 17.04; 95%CI: 14.64-19.85), those residing in urban areas (Adj.OR:3.05, 95%CI:2.60-3.57), those with disabilities (Adj.OR:2.61, 95%CI:2.00-3.39) and among girls (Adj.OR:1.30, 95%CI:1.25-1.35) (P < 0.001). The overall e-REC was 56.97% and the spectacle coverage was 62.83%. CONCLUSION The need for interventions to improve e-REC to achieve 2030 global eye health target is eminent among children in this region. Improving refractive services through school eye health programs could aid in accelerating this process to achieve the target. Myopia being the most common type of RE, the risk factors included increasing age, urban location, and presence of disability.
Collapse
Affiliation(s)
- Winston D Prakash
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
- J V Ramanamma Children Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - 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, Telangana, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Jill Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, 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, Telangana, India.
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India.
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
| |
Collapse
|
7
|
Chadalavada HP, Marmamula S, Khanna RC. Vision impairment and access to eye care in an integrated network of eye care system in Southern and Eastern India. Indian J Ophthalmol 2024; 72:264-269. [PMID: 38099374 PMCID: PMC10941943 DOI: 10.4103/ijo.ijo_1043_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE The World Report on Vision highlights that health information systems (HIS) should collect information on the determinants of eye conditions and vision impairment (VI) as a step toward integrated people-centered eye care (IPEC). Thus, this retrospective study aims to elucidate VI trends across age and gender of the patients who visited our centres in southern and eastern India. METHODS Electronic medical records of all new patients who visited the network were included. VI was defined as visual acuity less than 6/12; unilateral VI was based on the worse presenting eye (the other eye being normal), and bilateral VI was based on the better eye. "Total VI" includes both unilateral and bilateral VI. RESULTS The records of 7,31,307 patients from January to December 2019 were extracted. Males were 54%. The mean age was 40 years (SD: 19.16 years). The majority of patients (46.54%) visited a primary care centre. Centres in Andhra Pradesh saw the largest number of patients (46%). Approximately 65% of all patients presented had no VI in either eye. Total VI was 23.5% at the primary-centre level and approximately 45% at other levels, the highest being in Odisha. More females accessed care at primary and secondary centres (46.6%) than at higher levels of care (44%). Odisha had the lowest number of females accessing care (43.01%). CONCLUSION Non-visually impairing conditions form an important reason for patients visiting our eye care facilities. Strategies focusing on improving access to eye care for females should be planned at all levels, especially in Odisha.
Collapse
Affiliation(s)
- Harithaa P Chadalavada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- DBT Wellcome India Alliance, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
8
|
Rani PK, Khanna RC, Ravindrane R, Yeleswarapu SC, Panaganti AK, Thakur VS, Sharadi V, Iype V, Rathi VM, Vaddavalli PK. Teleophthalmology at a primary and tertiary eye care network from India: environmental and economic impact. Eye (Lond) 2024:10.1038/s41433-024-02934-4. [PMID: 38253864 DOI: 10.1038/s41433-024-02934-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To evaluate the environmental and economic impact of teleophthalmological services provided by a primary (rural) and tertiary (urban) eyecare network in India. METHODS This prospective study utilised a random sampling method, and administered an environmental and economic impact assessment questionnaire. The study included 324 (primary: 173; tertiary: 151) patients who received teleconsultations from July to September 2022. The primary network (rural) used a colour-coded triage system (Green: eye conditions managed by teleconsult alone; yellow: semi-urgent referral within 1 week to a month, red: urgent referral within a day to a week). The tertiary network (urban) included new and follow-up patients. The environmental impact was assessed by estimating the potential CO2 emissions saved by avoiding travel for various transport modes. Economic impact measured by the potential cost savings from direct (travel) and indirect (food and wages lost) expenses spent by yellow and red referrals (primary) and the first-visit expenses of follow-up (tertiary) patients. RESULTS The primary rural network saved 2.89 kg CO2/person and 80 km/person. The tertiary urban network saved 176.6 kg CO2/person and 1666 km/person. The potential cost savings on travel expenses were INR 19,970 (USD 250) for the primary (average: INR 370 (USD 4.6) per patient) and INR 758,870 (USD 9486) for the tertiary network (average: INR 8339 (USD 104) per patient). Indirect cost savings (food and wages) were of INR 29,100 (USD 364) for the primary and INR 347,800 (USD 4347) for the tertiary network. CONCLUSION Teleophthalmology offers substantial environmental and economic benefits in rural and urban eyecare systems.
Collapse
Affiliation(s)
- Padmaja Kumari Rani
- Department of Teleophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India.
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India.
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
| | - Rohit C Khanna
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
- 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 Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | | | - Sarath Chandra Yeleswarapu
- 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
| | - Anand Kumar Panaganti
- 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
| | - Vishal Singh Thakur
- Department of Teleophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Viresh Sharadi
- Department of Teleophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Varghese Iype
- Department of Teleophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Varsha M Rathi
- 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
| | - Pravin Krishna Vaddavalli
- Department of Teleophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
9
|
Wong B, Singh K, Everett B, O’Brien KS, Ravilla T, Khanna RC, Chase H, Frick KD. The case for investment in eye health: systematic review and economic modelling analysis. Bull World Health Organ 2023; 101:786-799. [PMID: 38024247 PMCID: PMC10680113 DOI: 10.2471/blt.23.289863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To assess how the returns on investment from correcting refractive errors and cataracts in low- and middle-income countries compare with the returns from other global development interventions. Methods We adopted two complementary approaches to estimate benefit-cost ratios from eye health investment. First, we systematically searched PubMed® and Web of Science™ on 14 August 2023 for studies conducted in low-and-middle-income countries, which have measured welfare impacts associated with correcting refractive errors and cataracts. Using benefit-cost analysis, we compared these impacts to costs. Second, we employed an economic modelling analysis to estimate benefit-cost ratios from eye health investments in India. We compared the returns from eye health to returns in other domains across global health and development. Findings We identified 21 studies from 10 countries. Thirteen outcomes highlighted impacts from refractive error correction for school students. From the systematic review, we used 17 out of 33 outcomes for benefit-cost analyses, with the median benefit-cost ratio being 36. The economic modelling approach for India generated benefit-cost ratios ranging from 28 for vision centres to 42 for school eye screening, with an aggregate ratio of 31. Comparing our findings to the typical investment in global development shows that eye health investment returns six times more benefits (median benefit-cost ratio: 36 vs 6). Conclusion Eye health investments provide economic benefits with varying degrees based on the intervention type and location. Our findings underline the importance of incorporating eye health initiatives into broader development strategies for substantial societal returns.
Collapse
Affiliation(s)
- Brad Wong
- Mettalytics, 23 Philip St, South Golden Beach 2483, New South Wales, Australia
| | | | - Bryce Everett
- Department of Economics, College of Arts and Sciences, University of San Francisco, San Francisco, United States of America (USA)
| | - Kieran S O’Brien
- Department of Ophthalmology, Institute for Global Health Sciences, University of California San Francisco, San Francisco, USA
| | - Thulasiraj Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Rohit C Khanna
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | | | - Kevin D Frick
- Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, USA
| |
Collapse
|
10
|
Choudhari NS, Khanna RC, Marmamula S, Mettla AL, Giridhar P, Banerjee S, Shekhar K, Chakrabarti S, Murthy GVS, Gilbert C, Rao GN. Incidence of primary open angle glaucoma in the Andhra Pradesh Eye Disease Study (APEDS). Eye (Lond) 2023:10.1038/s41433-023-02799-z. [PMID: 37968514 DOI: 10.1038/s41433-023-02799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND To report 15-year incidence rate of primary open angle glaucoma (POAG) in the Andhra Pradesh Eye Disease Study (APEDS). METHODS A population-based longitudinal study was carried out at three rural study sites. Phakic participants aged ≥40 years who participated at baseline (APEDS I) and the mean 15-year follow-up visit (APEDS III) were included. A comprehensive ophthalmic examination was performed on all participants. Mean intraocular pressure (IOP) was average of IOPs of right and left eyes. The definition of glaucoma was based on the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) classification. The main outcome measure was incidence of POAG during the follow-up period in participants without glaucoma or suspicion of glaucoma at baseline. RESULTS Data from the available and eligible participants from the original cohort (1241/2790; 44.4%) were analysed. The mean age (standard deviation) of participants at baseline was 50.2 (8.1) years; 580 (46.7%) were men. Thirty-six participants developed POAG [bilateral in 17 (47.2%)] over 15 years. The incidence rate of POAG per 100-person years (95% confidence interval) was 2.83 (2.6, 3.08). Compared to baseline, the reduction in mean IOP [median (range) mm Hg] was -0.75 (-7.5, 9) in participants with incident POAG and -2.5 (-14.5, 14.5) in those without. The inter-visit difference in mean IOP was a significant risk factor on logistic regression analysis. CONCLUSION We report the long-term incidence of POAG in rural India. A longitudinal change in IOP, specifically a less pronounced reduction in IOP with increasing age, was a novel risk factor.
Collapse
Affiliation(s)
- Nikhil S Choudhari
- VST Glaucoma Centre, Dr. Kallam Anji Reddy Campus, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Telangana State, 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, Kismatpur Road, Himayathsagar, Telangana State, India.
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India.
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
| | - 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, Kismatpur Road, Himayathsagar, Telangana State, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
- Department of Biotechnology/ Wellcome Trust India Alliance, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Telangana State, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Pyda Giridhar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Telangana State, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Seema Banerjee
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Telangana State, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Konegari Shekhar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Telangana State, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Subhabrata Chakrabarti
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Gudlavalleti V S Murthy
- Indian Institute of Public Health, Madhapur, Hyderabad, India
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - 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, Kismatpur Road, Himayathsagar, Telangana State, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| |
Collapse
|
11
|
Prakash WD, Marmamula S, Mettla AL, Keeffe J, Khanna RC. Variations in the prevalence of vision impairment across regions among school children in Telangana State, South India. Indian J Ophthalmol 2023; 71:3322-3327. [PMID: 37787229 PMCID: PMC10683682 DOI: 10.4103/ijo.ijo_215_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose Undetected vision impairment (VI) could negatively affect the overall development in children. School vision screening program is a viable and cost-effective approach for the early identification and management of VI. Aim This study aims to estimate the prevalence of VI, its risk factors, and ocular morbidity among school children in Telangana, South India. Methods Children aged 4-15 years attending schools in the study area were screened in this study. The vision screenings were performed in schools by trained community eye health workers using 6/12 tumbling E optotypes. Children who failed the test and/or presented with other eye conditions were referred to vision centers or secondary and tertiary eye care centers. A comprehensive eye examination was conducted in these centers, including cycloplegic refraction and fundus examination. Results A total of 774,184 children, with a mean age of 9.4 ± 3.27 years, were screened. Overall, 51.49% (N = 398,596) were male. In total, 4.33% [N = 33,528; 95% confidence interval (CI): 4.29-4.38] required referral services, while 1.16% (N = 9,002) had a presenting visual acuity of < 6/12. Multivariate analysis showed a high risk of VI among older children [Adj. odds ratio (OR): 5.75; 95% CI: 5.18-6.38], those with disabilities (Adj. OR: 5.12; 95% CI: 4.14-6.33), female gender (Adj. OR: 1.29; 95% CI: 1.24 - 1.35), and those residing in the urban areas (Adj. OR: 2.87; 95% CI: 2.42-3.39). The main cause of VI was uncorrected refractive errors (74.14%). Conclusion The prevalence of VI among school children was 1.16% in Telangana, South India, and refractive error was the leading cause of VI among this population. Increasing age, urban location, female gender and other disabilities increase the risk of VI among children.
Collapse
Affiliation(s)
- Winston D Prakash
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - 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, Telangana, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jill Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, 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, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| |
Collapse
|
12
|
Khanna RC, Padhy D, Mettla AL, Bhargava A, Sharma S, Jalali S. Vaccination and COVID-19 positivity rates in a network of eye hospitals in Southern and Eastern India during the second wave of COVID-19. Indian J Ophthalmol 2023; 71:2920-2922. [PMID: 37417152 PMCID: PMC10491059 DOI: 10.4103/ijo.ijo_414_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Affiliation(s)
- 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, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
- Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Debananda Padhy
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Archana Bhargava
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Savitri Sharma
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Subhadra Jalali
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
13
|
Majhi D, Das T, Padhy D, Marmamula S, Khanna RC, Ota AB, Rout PP, Avhad K, Rath S. Prevalence and causes of visual impairment in Dongaria indigenous (tribal) community. Tribal Odisha eye disease study # 12. Indian J Ophthalmol 2023; 71:2850-2855. [PMID: 37417133 PMCID: PMC10491089 DOI: 10.4103/ijo.ijo_2788_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To document the spectrum and magnitude of eye disorders and visual impairment in the Dongaria-a Particularly Vulnerable Tribal Group in the Rayagada district of Odisha, India. Methods A door-to-door screening protocol included a record of basic health parameters, visual acuity for distance, and near and flashlight examination of the eyes. Spectacles were dispensed to those who improved; those who failed the screening were referred to fixed (primary and secondary) eye care centers. Results We examined 89% (n = 9872/11,085) of people who consented for screening. The mean age was 25.5 ± 18.8 years; 55% (n = 5391) were female; 13.8% (n = 1361) were under-five children, and 39% (n = 3884) were 6 to 16 years. 86% (n = 8515) were illiterate. 12.4% (n = 1224) were visually impaired, of which 9.9% had early moderate VI, and 2.5% had severe VI and blindness. Uncorrected refractive error was detected in 7.5% (n = 744) and cataracts in 7.6% (n = 754); among the adults, 41.5% (n = 924/2227) had presbyopia. In children, 20% (n = 790) had vitamin A deficiency, 17% (n = 234) had global acute malnutrition, and 18% (n = 244) were stunted for their age. Almost two-thirds (62%, n = 6144) confirmed habitual intake of alcohol, and 4% (n = 389) of adults had essential hypertension. Following the screening, 43.5% (n = 837) of referred patients reported to the fixed centers, and 55% (134/243) of people advised underwent cataract surgery. Spectacles were dispensed to 1496 individuals. Conclusion Visual impairment and malnutrition are high in Dongaria indigenous community. Permanent health facilities and advocacy would improve this community's health and health-seeking behavior.
Collapse
Affiliation(s)
- Debasmita Majhi
- Indian Oil Centre for Rural EyeHealth, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Pediatric Ophthalmology, Strabismus, and Neuro-Ophthalmology, Child Sight Institute, Miriam Hyman Children's Eye Care Centre, MithuTulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Taraprasad Das
- Indian Oil Centre for Rural EyeHealth, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Debananda Padhy
- Indian Oil Centre for Rural EyeHealth, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - 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
- 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
- Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Akhila Bihari Ota
- Scheduled Castes and Scheduled Tribes Research and Training Institute, Government of Odisha, India
| | - Prachi Parimita Rout
- Scheduled Castes and Scheduled Tribes Research and Training Institute, Government of Odisha, India
| | - Komal Avhad
- Indian Oil Centre for Rural EyeHealth, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Suryasnata Rath
- Indian Oil Centre for Rural EyeHealth, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
- Ophthalmic Plastics, Orbit, and Ocular Oncology Services, Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, India
| |
Collapse
|
14
|
Marmamula S, Barrenkala NR, Kumbham TR, Modepalli SB, Yellapragada R, Khanna RC, Friedman DS. Impact of an intervention for avoidable vision loss on visual function in the elderly-The Hyderabad Ocular Morbidity in Elderly Study (HOMES). Eye (Lond) 2023; 37:1725-1731. [PMID: 36104520 PMCID: PMC10220055 DOI: 10.1038/s41433-022-02229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To report the impact of interventions for avoidable vision impairment (VI) on the visual function of elderly residents in 'homes for the aged' in India. METHODS Participants aged ≥60 years were recruited. A comprehensive eye examination was conducted by trained examiners and interventions were provided. Trained social investigators administered the Indian Vision Function questionnaire (INDVFQ) to assess visual function before and after the intervention (spectacles, cataract surgery or laser capsulotomy). Lower scores on IVFQ imply better visual function. VI was defined as presenting visual acuity worse than 6/18 in the better eye. VI due to cataract, uncorrected refractive errors, and posterior capsular opacification after cataract surgery were considered avoidable VI. RESULTS The mean age of the participants (n = 613) was 73.8 years (standard deviation: 8.1 years) and 378 (62.2%) were women. 64/103 (62.1%) participants who had avoidable VI at baseline were evaluated after the intervention. Significant gains were observed in all four domains of visual function. There was a 14.9% improvement in mobility scores (33.8 versus 28.8; p = 0.03), a 19.9% improvement in the activity limitations score (36.8 versus 29.5; p < 0.01), a 10.9% improvement in the psychosocial impact score (41.1 versus 36.6; p < 0.01) and a 13.6% improvement in the visual symptoms score (49.2 versus 42.5 p < 0.01). Overall, the mean IVFQ score improved by 16.4% (47.6 versus 39.8; p < 0.01). CONCLUSION Elderly individuals in residential care with avoidable VI had a significant improvement in visual function after relatively low-cost interventions such as spectacles and cataract surgery. Strategies are needed to provide these interventions for the elderly in 'homes for the aged' in India.
Collapse
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, NSW, Australia.
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Harvard Medical School, Boston, MA, USA.
| | - Navya Rekha Barrenkala
- 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
| | - 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
- Brien Holden Institute of Optometry and Vision Science, 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, NSW, Australia
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Choudhari NS, Khanna RC, Marmamula S, Mettla AL, Giridhar P, Banerjee S, Shekhar K, Chakrabarti S, Murthy GVS, Gilbert C, Rao GN. Regional variation in the incidence of pseudo-exfoliation in the Andhra Pradesh Eye Disease Study (APEDS). Eye (Lond) 2023; 37:1704-1710. [PMID: 36085361 PMCID: PMC10220056 DOI: 10.1038/s41433-022-02226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To report the 15-year incidence rate of pseudo-exfoliation (PXF), PXF glaucoma and regional variation among rural participants in the Andhra Pradesh Eye Disease Study (APEDS) III. METHODS This population-based longitudinal study was carried out at three rural study sites. Individuals of all ages who participated at baseline with a mean 15-year follow-up visit were included. Detailed Comprehensive ophthalmic examination was performed on all participants. The main outcome measure was development of PXF during the follow-up period in participants who were phakic in one or both eyes without PXF at baseline. RESULTS Among 5395 participants, 5108 (94.6%) met the inclusion criteria. There were 93 (1.82%; 95% confidence interval (CI), 1.47-2.22) cases of incident PXF. Their median baseline age (1st, 3rd quartiles) was 51 (44, 59) years and the male: female ratio was 1.3:1. There was no case of incident PXF in participants aged <30 years at baseline. The incidence rate per 100 person years (95% CI) among all ages and those aged ≥30 years at baseline was 1.73 (1.64-1.82) and 3.73 (3.53-3.93), respectively. PXF material was located on iris as well as anterior surface of lens and it was often bilateral. Participants living in two study sites and increasing age were associated with the incidence of PXF. The 15-year incidence of PXF glaucoma (95% CI) in participants ≥30 years of age at baseline was 0.33% (0.14-0.66). CONCLUSION There is significant regional variation in incidence of PXF in south India which warrants further investigation.
Collapse
Affiliation(s)
- Nikhil S Choudhari
- VST Glaucoma Centre, Dr. Kallam Anji Reddy Campus, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Hyderabad, Telangana, 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, Kismatpur Road, Himayathsagar, Hyderabad, Telangana, India.
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
| | - 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, Kismatpur Road, Himayathsagar, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
- Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Pyda Giridhar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Seema Banerjee
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Konegari Shekhar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Kismatpur Road, Himayathsagar, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Subhabrata Chakrabarti
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Gudlavalleti V S Murthy
- Indian Institute of Public Health, Madhapur, Hyderabad, India
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - 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, Kismatpur Road, Himayathsagar, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| |
Collapse
|
16
|
Parameswarappa DC, Jalali S, Marmamula S, Natarajan R, Mettla AL, Giridhar P, Banerjee S, Shekhar K, Chakrabarti S, Khanna RC. Visual impairment and blindness due to retinitis pigmentosa in India: 15-year follow-up of the Andhra Pradesh Eye Disease Study cohort. Indian J Ophthalmol 2023; 71:902-908. [PMID: 36872706 DOI: 10.4103/ijo.ijo_1610_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Purpose To assess the incidence, visual impairment, and blindness due to retinitis pigmentosa (RP) in a rural southern Indian cohort. Methods This is a population-based longitudinal cohort study of participants with RP from the Andhra Pradesh Eye Disease Study (APEDS) cohorts I and III, respectively. The study included participants with RP of APEDS I who were followed until APEDS III. Their demographic data along with ocular features, fundus photographs, and visual fields (Humphrey) were collected. Descriptive statistics using mean ± standard deviation with interquartile range (IQR) were calculated. The main outcome measures were RP incidence, visual impairment, and blindness as per the World Health Organization (WHO) definitions. Results At baseline (APEDS I), 7771 participants residing in three rural areas were examined. There were nine participants with RP with a mean age at baseline of 47.33 ± 10.89 years (IQR: 39-55). There was a male preponderance (6:3), and the mean best-corrected visual acuity (BCVA) of 18 eyes from nine participants with RP was 1.2 ± 0.72 logarithm of minimum angle of resolution (logMAR; IQR: 0.7-1.6). Over a mean follow-up duration of 15 years, 5395/7771 (69.4%) were re-examined, which included seven RP participants from APEDS 1. Additionally, two new participants with RP were identified; so, the overall incidence was 370/ million in 15 years (24.7/million per year). The mean BCVA of 14 eyes of seven participants with RP who were re-examined in APEDS III was 2.17 ± 0.56 logMAR (IQR: 1.8-2.6), and five of these seven participants with RP developed incident blindness during the follow-up period. Conclusion RP is a prevalent disease in southern India that warrants appropriate strategies to prevent this condition.
Collapse
Affiliation(s)
- Deepika C Parameswarappa
- Srimati Kanuri Santhamma Center for Vitreo - Retinal Diseases, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreo - Retinal Diseases, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - 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; Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Ramya Natarajan
- Ophthalmic Biophysics lab, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Asha L Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Pyda Giridhar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Seema Banerjee
- Department of Ophthalmology, The Wilmer eye institute, Johns Hopkins University, School of medicine, Baltimore, Maryland, USA
| | - Konegari Shekhar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Subhabrata Chakrabarti
- Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, 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; Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| |
Collapse
|
17
|
Abstract
94 million people are blind or visually impaired globally, and cataract is the most common cause of blindness worldwide. However, most cases of blindness are avoidable. Cataract is associated with decreased quality of life and reduced life expectancy. Most cases of cataract occur after birth and share ageing and oxidative stress as primary causes, although several non-modifiable and modifiable risk factors can accelerate cataract formation. In most patients, phacoemulsification with intraocular lens implantation is the preferred treatment and is highly cost-effective. There has been an increase in the use of comprehensive cataract surgical services, including diagnoses, treatment referrals, and rehabilitation. However, global inequity in surgical service quality is still a limitation. Implementation of preoperative risk assessment, risk reduction strategies, and new surgical technologies have made cataract surgery possible at an earlier stage of cataract severity with the expectation of good refractive outcomes. The main challenge is making the service that is currently available to some patients accessible to all by use of universal health coverage.
Collapse
Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maneck Nicholson
- Brien Holden Eye Research Centre, 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, Hyderabad, India; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
| |
Collapse
|
18
|
Chadalavada HP, Marmamula S, Yanamala NK, Khanna RC. "Eyecare on-call" - Home-based eye care delivery model - Reflections on one year of experience. Indian J Ophthalmol 2023; 71:306-307. [PMID: 36588260 PMCID: PMC10155573 DOI: 10.4103/ijo.ijo_1745_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Harithaa P Chadalavada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Niranjan K Yanamala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| |
Collapse
|
19
|
Padhy D, Das T, Majhi D, Khanna RC, Avhad K, Ota AB, Rout PP, Rath S. Prevalence of refractive error among Dongarias and use of Folding Phoropter (FoFo) as a field device enabling implementation research in this indigenous community. Tribal Odisha Eye Disease Study (TOES) Report # 13. PLoS One 2023; 18:e0284790. [PMID: 37167346 PMCID: PMC10174504 DOI: 10.1371/journal.pone.0284790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/07/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE To evaluate the prevalence of uncorrected refractive error (URE) among Dongarias-a particularly vulnerable tribal group in Rayagada, Odisha, India and evaluate if folding phoropter (FoFo) can help achieve on-site correction of URE. METHODS This was a cross-sectional study. FoFo was used for people with URE. Spherical equivalent (SE) spectacles based on the FoFo refraction were dispensed when distance visual acuity improved to > 6/12. Others were referred to fixed eye centres. Multivariable logistic regression evaluated the relationship of URE with sociodemographic characters and factors predicting acceptance of FoFo. RESULTS In the study, 7.5% (95% confidence interval [CI]:7-8) people had URE, and included 4% with severe vision impairment and 36% with moderate visual impairment. URE was less common in children. Simple hyperopia was more common in females (25.3% vs 19.3%); compound myopic astigmatism was more common in males (27.4% vs 20.2%). People older than 50 years (p <0.0001) and females (p <0.0001) were more likely to have URE. Ninety-four people accepted FoFo on-site refraction and received SE spectacles; the acceptance was better in the younger (15-29 years old) and literate people (p <0.0001). CONCLUSIONS URE was the second most common cause of visual impairment in older adults and was higher in females. Within its technological limit, FoFo could be used in the field for correcting URE and obviating the need for travel, thus bridging the know-do gap for the marginalised Dongaria community.
Collapse
Affiliation(s)
- Debananda Padhy
- Indian Oil Centre for Rural Eye Health, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute, Hyderabad, India
| | - Taraprasad Das
- Indian Oil Centre for Rural Eye Health, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
- Anant Bajaj Retina Institute- Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Debasmita Majhi
- Indian Oil Centre for Rural Eye Health, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
- Pediatric Ophthalmology, Strabismus, and Neuro-Ophthalmology, Child Sight Institute, Miriam Hyman Children's Eye Care Centre, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, 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
- Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Komal Avhad
- Indian Oil Centre for Rural Eye Health, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Akhila Bihari Ota
- Scheduled Castes and Scheduled Tribes Research and Training Institute, Government of Odisha, Bhubaneswar, India
| | - Prachi Parimita Rout
- Scheduled Castes and Scheduled Tribes Research and Training Institute, Government of Odisha, Bhubaneswar, India
| | - Suryasnata Rath
- Indian Oil Centre for Rural Eye Health, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
- Ophthalmic Plastics, Orbit, and Ocular Oncology Services, Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, India
| |
Collapse
|
20
|
Wong B, Singh K, Khanna RC, Ravilla T, Kuyyadiyil S, Sabherwal S, Sil A, Dole K, Chase H, Frick KD. Strategies for cataract and uncorrected refractive error case finding in India: Costs and cost-effectiveness at scale. Lancet Reg Health Southeast Asia 2022; 7:100089. [PMID: 37383934 PMCID: PMC10305965 DOI: 10.1016/j.lansea.2022.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background India has the largest number of individuals suffering from visual impairment and blindness in the world. Recent surveys indicate that demand-based factors prevent more than 80% of people from seeking appropriate eye services, suggesting the need to scale up cost-effective case finding strategies. We assessed total costs and cost-effectiveness of multiple strategies to identify and encourage people to initiate corrective eye services. Methods Using administrative and financial data from six Indian eye health providers, we conduct a retrospective micro-costing analysis of five case finding interventions that covered 1·4 million people served at primary eye care facilities (vision centers), 330,000 children screened at school, 310,000 people screened at eye camps and 290,000 people screened via door-to-door campaigns over one year. For four interventions, we estimate total provider costs, provider costs attributable to case finding and treatment initiation for uncorrected refractive error (URE) and cataracts, and the societal cost per DALY averted. We also estimate provider costs of deploying teleophthalmology capability within vision centers. Point estimates were calculated from provided data with confidence intervals determined by varying parameters probabilistically across 10,000 Monte Carlo simulations. Findings Case finding and treatment initiation costs are lowest for eye camps (URE: $8·0 per case, 95% CI: 3·4-14·4; cataracts: $13·7 per case, 95% CI: 5·6-27·0) and vision centers (URE: $10·8 per case, 95% CI: 8·0-14·4; cataracts: $11·9 per case, 95% CI: 8·8-15·9). Door-to-door screening is as cost-effective for identifying and encouraging surgery for cataracts albeit with large uncertainty ($11·3 per case, 95% CI: 2·2 to 56·2), and more costly for initiating spectacles for URE ($25·8 per case, 95% CI: 24·1 to 30·7). School screening has the highest case finding and treatment initiation costs for URE ($29·3 per case, 95% CI: 15·5 to 49·6) due to the lower prevalence of eye problems in school aged children. The annualized cost of operating a vision center, excluding procurement of spectacles, is estimated at $11,707 (95% CI: 8,722-15,492). Adding teleophthalmology capability increases annualized costs by $1,271 per facility (95% CI: 181 to 3,340). Compared to baseline care, eye camps have an incremental cost-effectiveness ratio (ICER) of $143 per DALY (95% CI: 93-251). Vision centers have an ICER of $262 per DALY (95% CI: 175-431) and were able to reach substantially more patients than any other strategy. Interpretation Policy makers are expected to consider cost-effective case finding strategies when budgeting for eye health in India. Screening camps and vision centers are the most cost-effective strategies for identifying and encouraging individuals to undertake corrective eye services, with vision centers likely to be most cost-effective at greater scale. Investment in eye health continues to be very cost-effective in India. Funding The study was funded by the Seva Foundation.
Collapse
Affiliation(s)
- Brad Wong
- Mettalytics, New South Wales, 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, India
| | - Thulasiraj Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Subeesh Kuyyadiyil
- Sadguru Netra Chikitsalaya, Shri Sadguru Seva Sangh Trust Chitrakoot, India
| | | | - Asim Sil
- Vivekananda Mission Asram Netra Niramay Niketan, West Bengal, India
| | - Kuldeep Dole
- Poona Blind Men's Association, HV Desai Eye Hospital, Pune, Maharashtra, India
| | | | - Kevin D. Frick
- Johns Hopkins Carey Business School, Baltimore, USA
- Johns Hopkins Bloomberg School of Public Health, Departments of Health Policy and Management and International Health; Johns Hopkins University, School of Medicine Department of Ophthalmology, USA
| |
Collapse
|
21
|
Marmamula S, Varada R, Williams JD, Khanna RC. Vision guardians for community eye health: the LV Prasad Eye Institute model in India. Community Eye Health 2022; 35:24-26. [PMID: 36425853 PMCID: PMC9680605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Srinivas Marmamula
- Associate Director, Public Health Research and Training: GPR ICARE, LV Prasad Eye Institute, Hyderabad, India
| | - Rajashekar Varada
- Network Associate Director: GPR ICARE, LV Prasad Eye Institute, Hyderabad, India
| | - Jachin D Williams
- Associate Public Health Specialist: GPR ICARE, LV Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Network Director: GPR ICARE, LV Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
22
|
Rathi VM, Thokala P, MacNeil S, Khanna RC, Monk PN, Garg P. Early treatment of corneal abrasions and ulcers-estimating clinical and economic outcomes. Lancet Reg Health Southeast Asia 2022; 4:None. [PMID: 36092742 PMCID: PMC9439957 DOI: 10.1016/j.lansea.2022.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background In low-and-middle income countries, corneal abrasions and ulcers are common and not always well managed. Previous studies showed better clinical outcomes with early presentation and treatment of minor abrasions, however, there have been no formal studies estimating the financial impact of early treatment of abrasions and ulcers compared to delayed treatment. Methods We used the LV Prasad Eye Institute's (LVPEI's) electronic health record system (eyeSmart) to estimate the impact of early presentation on clinical outcomes associated with abrasions and ulcers. 861 patients with corneal abrasion and 1821 patients with corneal ulcers were studied retrospectively, and 134 patients with corneal abrasion prospectively. A health economic model was constructed based on LVPEI cost data for a range of patient scenarios (from early presentation with abrasion to late presentation with ulcer). Findings Our findings suggest that delayed presentation of corneal abrasion results in poor clinical and economic outcomes due to increased risk of ulceration requiring more extensive surgical management, increasing associated costs to patients and the healthcare system. However, excellent results at low cost can be achieved by treatment of patients with early presentation of abrasions at village level health care centres. Interpretation Treatment of early minor corneal abrasions, particularly using local delivery of treatment, is effective clinically and economically. Future investment in making patients aware of the need to react promptly to corneal abrasions by accessing local healthcare resources (coupled with a campaign to prevent ulcerations occurring) will continue to improve clinical outcomes for patients at low cost and avoid complex and more expensive treatment to preserve sight. Funding This research was funded by the Medical Research Council, grant MR/S004688/1.
Collapse
Affiliation(s)
- Varsha M. Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care (GPR-ICARE), L V Prasad Eye Institute (LVPEI), Hyderabad, Telangana, India
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sheila MacNeil
- Department of Materials Science Engineering, University of Sheffield, Broad Lane, Sheffield, S3 7HQ, UK
- Corresponding author at: Professor of Biomaterials and Tissue Engineering, Department of Materials Science Engineering, University of Sheffield, North Campus, Broad Lane, Sheffield S3 7HQ, UK.
| | - Rohit C. Khanna
- Allen Foster Community Eye Health Research Centre, GPR-ICARE, LVPEI, Hyderabad, Telangana, India
| | - Peter N. Monk
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Prashant Garg
- The Cornea Institute, LVPEI, Hyderabad, Telangana, India
| |
Collapse
|
23
|
Abstract
Purpose Addressing childhood vision impairment (VI) is one of the main goals of the World Health Organization's (WHO) combating blindness strategies. The primary aim of this study was to estimate the prevalence of VI, causes, and its risk factors in school children in Krishna district, Andhra Pradesh, India. Methods Children aged 4-15 years were screened in schools using the 6/12 Snellen optotype by trained community eye health workers, and those who failed the test and those reported or found to have obvious eye conditions were referred to primary (VC), secondary (SC), or tertiary (TC) care centre appropriately, where they underwent a complete eye examination including cycloplegic refraction and fundus examination. Results A total of 56,988 children were screened, of whom 51.18% were boys. The mean age was 9.69 ± 3.26 years (4-15 years). Overall, 2,802/56,988 (4.92%) children were referred to a VC, of which 632/56,988 (1.11%) required referral to SC/TC. PVA of <6/12 was found in 1.72% (95% confidence interval [CI]: 1.61-1.83). The prevalence of refractive error (corrected and uncorrected) was 2.38% (95% CI: 2.26-2.51) and myopia was 2.17% (95% CI: 2.05-2.29). In multivariable analysis, older children, those in urban schools, private schools, and children with a disability had an increased risk of VI and myopia. Additionally, the risk of myopia was higher among girls than boys. Of those referred and reached SC/TC, 73.64% were due to avoidable causes. Conclusion Childhood VI prevalence was 1.72% in this region. Uncorrected refractive error (URE) was the major cause of VI in children. Older age, schools in urban locations, private schools, and the presence of disability were associated with the risk of VI among children.
Collapse
Affiliation(s)
- Winston D Prakash
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute Hyderabad, Telangana, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute Hyderabad, Telangana, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jill Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| |
Collapse
|
24
|
Rathi VM, Williams JD, Rajshekar V, Khanna RC, Das T. Tribal Odisha Eye Disease Study (TOES). Report # 10. Disability inclusive eye health survey in a tribal district (Rayagada) in Odisha, India. Indian J Ophthalmol 2022; 70:976-981. [PMID: 35225555 PMCID: PMC9114597 DOI: 10.4103/ijo.ijo_1887_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To estimate seeing and other disabilities in a population cohort in a tribal district, Rayagada, in the Indian state of Orissa. Methods: A door-to-door survey was conducted to identify the disabilities. The vision was measured at the residence of the subject, and other disabilities were documented from the history obtained from the subject/household/neighbor. All people with seeing disabilities were reexamined in the community eye center (primary or secondary), and required treatment was given at no cost to the patients. People with other disabilities were transported to the public health facility for appropriate care and disability certification. The results were compared with the 2011 national census data. Results: A total of 147,699 people were enumerated, and 106,339 (72%) were examined over one year period, 2016–17. In this cohort, 47.3% (n = 50,320) were male and 27.5% (n = 29,215) were 40 years or older. We recorded systemic disease in 0.6% (n = 689) people; hypertension was two times higher than diabetes mellitus. Disability was identified in 2.8% (n = 3022). Common disabilities were seeing (46.7%; n = 1411), hearing (36.8%; n = 1112), mobility (10.4%; n = 315), and mental retardation (3.2%; n = 98). Dual sensory disability (seeing and hearing) was seen in 6.4% (n = 251), and it was higher in the older age group. Seeing and hearing disabilities were higher than the 2011 state (P =< 0.001) and national (P =< 0.001) disability census. Conclusion: The first population-based survey in Rayagada, Odisha (India) in 2017 showed a higher proportion of people with seeing and hearing disabilities. It calls for an appropriate service strategy.
Collapse
Affiliation(s)
- Varsha M Rathi
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jachin D Williams
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Varda Rajshekar
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Srimati Kanuri Shanthamma Centre for Vitreoretinal diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana; Indian Oil Centre for Rural Eye Health, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| |
Collapse
|
25
|
Rathi VM, Murthy SI, Vaddavalli PK, Khanna RC. Feasibility and Outcomes of Corneal Transplantation Performed at Rural Centers: An Extension of the Pyramidal Model of Enhanced Eye Care at Rural Outreach. Cornea 2022; 41:211-218. [PMID: 34320597 DOI: 10.1097/ico.0000000000002839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to report on the feasibility of setting up a system of corneal transplants at rural outreach centers and report the outcomes of the first 111 cases. METHODS Retrospective analysis of the outcomes of corneal transplantation performed on patients with optical indications between March 2016 and September 2019 at 4 secondary (rural) centers. The centers are a part of a network in the pyramidal model developed by L V Prasad Eye Institute. The graft clarity and best-corrected visual acuity (BCVA) at 1-year follow-up were analyzed. RESULTS Of the 111 patients, 34.23% underwent penetrating keratoplasty and 65.77% endothelial keratoplasty. The mean age was 59.4 ± 15.0 (range-17-86 years); 47.75% were men and 52.25% were women. The indications for surgery were bullous keratopathy (54.05%), corneal scar/adherent leukoma (23.42%), and repeat grafts (13.51%). At the end of 1 year, 69.37% grafts remained clear. Factors associated with graft failure included poor socioeconomic status and graft infiltrate in both univariate and multivariate analyses. Surgical technique of endothelial keratoplasty was associated with failure on multivariate analysis only. Of the 77 eyes with clear corneal grafts at 1 year, the preoperative mean logMAR BCVA was 1.91 ± 0.06, which improved to 0.90 ± 0.08 postoperatively. Overall, 84.4% had preoperative BCVA of <3/60. Postoperatively, 40% had BCVA of 6/18 or better. CONCLUSIONS Our study showed that close to 70% grafts remained clear at 1 year. Graft failure was associated with poor socioeconomic status and graft infiltrates. This study established a viable model for delivery of corneal transplant surgery and care in a rural setup.
Collapse
Affiliation(s)
- Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics (IHOPE) Research Centre, LVPEI, Hyderabad, Telangana, India
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pravin K Vaddavalli
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics (IHOPE) Research Centre, LVPEI, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India ; and
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
26
|
Sahoo NK, Mehta MC, Rani PK, Khanna RC, Raman R, Bhattacharya J, Das AV, Murthy GVS, Narayanan R. Impact of age-related macular degeneration on diabetic retinopathy: An electronic health record based big data analysis from a tertiary eye centre in South India. Indian J Ophthalmol 2021; 69:3184-3188. [PMID: 34708768 PMCID: PMC8725103 DOI: 10.4103/ijo.ijo_1175_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To determine whether the presence of age-related macular degeneration (AMD) decreases the risk of diabetic retinopathy. Methods: This was a retrospective, case-cohort study performed in patients with a systemic diagnosis of diabetes at a tertiary health care center from May 2011 to April 2020. A total of 43,153 patients (1,024 AMD patients and 42,129 non-AMD patients) were included in the analysis. A total of 1,024 age and diabetes mellitus (DM) duration-matched controls were chosen from the non-AMD group for risk factor analysis. The severity of diabetic retinopathy was compared between the patients with AMD and the patients without AMD. Results: Out of the enrolled 43,153 diabetic patients, 26,906 were males and 16,247 were females. A total of 1,024 patients had AMD and 42,129 had no AMD. The mean age of the cohort was 58.60 ± 0.09 years. The overall prevalence of DR was noted to be 22.8% (9,825 out of 43,153 eyes). A significantly lower prevalence of diabetic retinopathy (DR) (23% in non-AMD, 11.4% in AMD, OR = −0.43, P < 0.001), non-proliferative diabetic retinopathy (NPDR) (12% in non-AMD, 8.2% in AMD, OR = −0.66, P < 0.001), and proliferative diabetic retinopathy (PDR) (11% in non-AMD, 3.2% in AMD, OR = −0.27, P < 0.001) was seen in the AMD patients. No significant difference was seen between the dry and wet AMD. On multivariate logistic regression analysis, the lower age, absence of AMD, and male gender were associated with a higher risk of PDR. Conclusion: The presence of AMD was noted to statistically reduce the risk of DR. Our results may be useful in the field of resource allocation and awareness of DR.
Collapse
Affiliation(s)
- Niroj K Sahoo
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma, Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Mehul C Mehta
- Department of Vitreo-retina, L VPrasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Padmaja K Rani
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajiv Raman
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jayanta Bhattacharya
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Department of Medicine, Center for Primary Care and Outcomes Research, Stanford University, USA
| | - Anthony V Das
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gudlavalleti V S Murthy
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Indian Institute of Public Health Hyderabad, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Raja Narayanan
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
27
|
Choudhari NS, Khanna RC, Marmamula S, Mettla AL, Giridhar P, Banerjee S, Shekhar K, Chakrabarti S, Murthy GVS, Gilbert C, Rao GN. Fifteen-Year Incidence Rate of Primary Angle Closure Disease in the Andhra Pradesh Eye Disease Study. Am J Ophthalmol 2021; 229:34-44. [PMID: 33667399 DOI: 10.1016/j.ajo.2021.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To report on the 15-year incidence of primary angle closure disease (PACD) among participants aged ≥40 years in rural southern India DESIGN: Population-based longitudinal incidence rate study METHODS: Setting: 3 rural study centres. STUDY POPULATION Phakic participants aged ≥40 years who participated in both examination time points. OBSERVATION PROCEDURES All participants at the baseline and at the mean 15-year follow-up visit underwent a detailed interview, anthropometry, blood pressure measurement, and comprehensive eye examination. Automated perimetry was attempted based on predefined criteria. Main outcome measures included development of any form of PACD, as defined by the International Society for Geographical and Epidemiological Ophthalmology (ISGEO), during the follow-up period in phakic participants, who did not have the disease at baseline. RESULTS We analyzed data obtained from 1,197 (81.4% out of available 1,470) participants to calculate the incidence of the disease. The mean age (standard deviation) of the study participants at the baseline was 50.2 (8.1) years, with 670 male (45.5%) and 800 female (54.4%) participants. The incidence rate per 100 person-years (95% confidence interval) for primary angle closure suspect, primary angle closure, and primary angle closure glaucoma was 8.8 (8.4, 9.2), 6.2 (5.9, 6.6), and 1.6 (1.4, 1.8), respectively. Thus, the incidence of all forms of PACD was 16.4 (15.9, 17) per 100 person-years. On logistic regression analysis, female gender was a significant risk factor whereas presence of myopia was protective. CONCLUSIONS This study reports long-term incidence of PACD from rural India. It has implications for eye health care policies, strategies, and planning.
Collapse
Affiliation(s)
- Nikhil S Choudhari
- VST Glaucoma Centre, Dr. Kallam Anji Reddy Campus (N.S.C., R.C.K.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (N.S.C., R.C.K., S.M., A.L.M., P.G., S.B., K.S., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Rohit C Khanna
- VST Glaucoma Centre, Dr. Kallam Anji Reddy Campus (N.S.C., R.C.K.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (N.S.C., R.C.K., S.M., A.L.M., P.G., S.B., K.S., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Brien Holden Eye Research Centre (R.C.K., S.M., A.L.M., P.G., S.B., K.S., S.C., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales (R.C.K.), Sydney, Australia; School of Medicine and Dentistry, University of Rochester (R.C.K.), Rochester, NY, USA.
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (N.S.C., R.C.K., S.M., A.L.M., P.G., S.B., K.S., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Brien Holden Eye Research Centre (R.C.K., S.M., A.L.M., P.G., S.B., K.S., S.C., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Wellcome Trust / Department of Biotechnology India Alliance (S.M.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (N.S.C., R.C.K., S.M., A.L.M., P.G., S.B., K.S., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Brien Holden Eye Research Centre (R.C.K., S.M., A.L.M., P.G., S.B., K.S., S.C., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Pyda Giridhar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (N.S.C., R.C.K., S.M., A.L.M., P.G., S.B., K.S., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Brien Holden Eye Research Centre (R.C.K., S.M., A.L.M., P.G., S.B., K.S., S.C., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Seema Banerjee
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (N.S.C., R.C.K., S.M., A.L.M., P.G., S.B., K.S., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Brien Holden Eye Research Centre (R.C.K., S.M., A.L.M., P.G., S.B., K.S., S.C., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Konegari Shekhar
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (N.S.C., R.C.K., S.M., A.L.M., P.G., S.B., K.S., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Brien Holden Eye Research Centre (R.C.K., S.M., A.L.M., P.G., S.B., K.S., S.C., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Subhabrata Chakrabarti
- Brien Holden Eye Research Centre (R.C.K., S.M., A.L.M., P.G., S.B., K.S., S.C., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Gudlavalleti V S Murthy
- Indian Institute of Public Health (G.V.S.M.), Madhapur, Hyderabad, India; International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, (G.V.S.M., C.G.), London, United Kingdom
| | - Clare Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, (G.V.S.M., C.G.), London, United Kingdom
| | - Gullapalli N Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (N.S.C., R.C.K., S.M., A.L.M., P.G., S.B., K.S., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India; Brien Holden Eye Research Centre (R.C.K., S.M., A.L.M., P.G., S.B., K.S., S.C., G.N.R.), L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| |
Collapse
|
28
|
Abstract
Purpose: To describe the clinical profile of patients with ocular Calotropis poisoning presenting to a multitier ophthalmology hospital network in India. Methods: This cross-sectional hospital-based study included 2,047,360 new patients presenting between August 2010 and March 2020. Patients with a clinical diagnosis of Calotropis poisoning in at least one eye were included. The data were collected using an electronic medical record system. Descriptive statistics using mean ± standard deviation and median with inter-quartile range (IQR) were used to elucidate the demographic data. Chi-square test was done for univariate analysis. Results: Overall, 362 (0.018%) new patients were diagnosed with ocular Calotropis poisoning during the study period. The mean age of the patients was 44.10 ± 18.61 years. The incidence rates were 0.013% in children and 0.018% in adults. Males were 57.46% and 87.29% had unilateral affliction. A significant number of patients presented from the rural geography (59.67%) and were from the higher socioeconomic class (72.65%). About a fourth of the patients were homemakers (23.48%) followed by agriculture workers (18.23%). Of the 408 affected eyes, 49.26% had mild visual impairment (<20/70) followed by moderate visual impairment (>20/70 to ≤ 20/200) in 23.28%. The most common clinical signs were conjunctival congestion (61.03%), descemet membrane folds (57.35%), stromal edema (30.39%), and corneal epithelial defect (24.51%). Conclusion: Calotropis poisoning in individuals seeking eye care in India is very rare. It is commonly unilateral and occurs more in the rural geography. It is common in middle-aged males and may affect vision due to involvement of the cornea.
Collapse
Affiliation(s)
- Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (GPRICARE), L V Prasad Eye Institute (LVPEI), Hyderabad, India
| | - Anthony Vipin Das
- Department of EyeSmart EMR & AEye; Indian Health Outcomes, Public Health and Economics Research Center, LVPEI, Hyderabad, Telangana, India
| | | | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (GPRICARE); Indian Health Outcomes, Public Health and Economics Research Center; Brien Holden Eye Research Centre, LVPEI, Banjara Hills, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
29
|
Abstract
COVID-19 pandemic has significantly impacted every sphere of life. Health care workers, including eye care professionals, are at a higher risk of contracting infection directly or indirectly. To mitigate the risk of cross-infection among these front-line workers, it is vital to follow appropriate safety protocols. On the other hand, childhood eye conditions lead to permanent vision loss unless these are identified and treated early. School eye health programs are the best option to reach a large childhood population for early detection and treatment of vision-threatening eye conditions. While several clinical safety guidelines have been developed for ophthalmic practice, no such guidelines are available for carrying out school eye health programs. This article aims to set out COVID-19 safety guidelines for conducting school eye health programs in India.
Collapse
Affiliation(s)
- Winston D Prakash
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| |
Collapse
|
30
|
Marmamula S, Barrenkala NR, Khanna RC, Challa R, Bhakki M, Kumbham TR, Modepalli SB, Yellapragada R, Friedman DS. Near vision impairment among the elderly in residential care-the Hyderabad Ocular Morbidity in Elderly Study (HOMES). Eye (Lond) 2021; 35:2310-2315. [PMID: 33159176 PMCID: PMC8302663 DOI: 10.1038/s41433-020-01243-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/10/2020] [Accepted: 10/16/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVE To report on the prevalence and risk factors for near vision impairment (NVI) among the elderly in residential care in Telangana State in India. METHODS Individuals aged ≥60 years were recruited from 41 'home for the aged' centres in Hyderabad, India. All participants had complete eye examinations including presenting and best-corrected visual acuity assessment for distance and near. NVI was defined as binocular presenting near vision worse than N8 (6/15) among those who had a normal presenting distance visual acuity of 6/18 in the better eye. RESULTS Of the 826 participants, the mean age was 74.4 years (standard deviation-8.4 years), 525 (63.6%) were women, 715 (86.6%) had at least school education. The prevalence of NVI was 51.2% (95% CI: 47.7-54.7) based on presenting vision. On applying multiple logistic regression analysis, the odds of NVI were higher in 80 years and older age (OR: 2.17; 95% CI: 3.44-13.6). Those with school education (OR: 0.58: 95% CI: 0.36-0.94) and higher education (OR: 0.38; 95% CI: 0.21-0.69) had lower odds for NVI. Similarly, those with self-reported diabetes (OR: 0.69; 95% CI: 0.49-0.97), those using spectacles (OR: 0.09; 95% CI: 0.05-0.16), and those who had undergone cataract surgery (OR: 0.51; 95% CI: 0.36-0.74) had lower odds for NVI. CONCLUSIONS NVI was common among the elderly in residential care in homes for the aged in Hyderabad, India. As most of this NVI is correctable, a routine screening programme and dispensing of spectacles can be undertaken to address this vision loss.
Collapse
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.
- Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India.
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
| | - Navya Rekha Barrenkala
- 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, NSW, 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
| | - 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
| | - 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
| | - David S Friedman
- Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
31
|
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: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
32
|
Marmamula S, Yelagondula VK, Khanna RC, Banerjee S, Challa R, Yellapragada R, Keeffe JE. A Population-Based Cross-Sectional Study of Visual Impairment in West Godavari and Krishna Districts in Andhra Pradesh: Akividu Visual Impairment Study (AVIS). Ophthalmic Epidemiol 2021; 29:411-416. [PMID: 34294023 DOI: 10.1080/09286586.2021.1946829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the prevalence and causes of visual impairment (VI) among those aged ≥40 years in West Godavari and Krishna districts in Andhra Pradesh, India. METHODS Trained teams visited the households in the selected clusters and conducted eye examinations. Presenting visual acuity (PVA) was assessed for distance and near. Torchlight examination was conducted to assess the anterior segment. Non-mydriatic retinal images were also obtained. VI was defined as PVA worse than 6/18 in the better eye. It included Moderate VI (PVA worse than 6/18 to 6/60), Severe VI (PVA worse than 6/60 to 3/60) and Blindness (PVA worse than 3/60). Multiple logistic regression analysis was conducted to assess the risk factors for VI. RESULTS In total, 2587/3000 (86.2%) participants were examined. Of this, 1406 (54.4%) were women and 1224 (47.3%) had no education. The age- and gender-adjusted prevalence of VI was 12.8% (95% CI: 11.5-14.1). Compared to the 40-49-year age group, the odds of having VI among those aged 50-59 years, 60-69 years and ≥70 years were 2.93 (95% CI: 1.91-4.52), 6.53 (95% CI: 4.31-9.91) and 17.45 (95% CI: 11.50-26.46), respectively. Those respondents who had no education had a higher odds (OR: 1.73; 95% CI: 1.34-2.23) of VI compared to those who were educated. Cataract (62.4%) and uncorrected refractive errors (29.8%) were the leading causes of VI. Over 90% of the VI was due to avoidable causes. CONCLUSION VI is a major public health challenge in Andhra Pradesh. Over 90% of this burden is avoidable and can be eliminated by low-cost interventions such as spectacles and cataract surgery.
Collapse
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.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Vijay Kumar Yelagondula
- Brien Holden Institute of Optometry and Vision Science, 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.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Saptak Banerjee
- 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
| | - 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
| | - Jill E Keeffe
- 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
| |
Collapse
|
33
|
Marmamula S, Banerjee S, Yelagondula VK, Khanna RC, Challa R, Yellapragada R, Keeffe J. Population-based assessment of prevalence of spectacle use and effective spectacle coverage for distance vision in Andhra Pradesh, India - Akividu Visual Impairment Study. Clin Exp Optom 2021; 105:320-325. [PMID: 34132172 DOI: 10.1080/08164622.2021.1916386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CLINICAL RELEVANCE Effective spectacle coverage is a useful indicator to assess the coverage of refraction services in a given region. We found a low coverage in the Akividu region suggesting a need to develop effective refraction services. BACKGROUND To assess the prevalence of spectacle use and effective spectacle coverage for distance vision among people aged 40 years and older in the Indian state of Andhra Pradesh. METHODS A population-based cross-sectional survey was carried out in the Akividu region in West Godavari and Krishna districts. The study teams visited selected households and conducted eye examinations in the selected clusters. A structured questionnaire was used to collect information on spectacle use. 'Met Need' was defined as unaided VA worse than 6/12 but improved to 6/12 or better with their current spectacles. 'Unmet Need' was defined as unaided VA worse than 6/12 but improved to 6/12 with pinhole, among those not using spectacles. The 'Under-met Need' was defined as aided VA worse than 6/12 but improving with pinhole to 6/12 or better. Based on these definitions, Effective Refractive Error Coverage (e-REC) is calculated as: e-REC (%) s = ((met need)/(met need + under-met need + unmet need)) X100. RESULTS Of 3,000 enumerated from 60 clusters, 2,587 (86.2%) participants were examined. The prevalence of current spectacle use was 43.1% (95% CI:41.2-45.0). The e-REC was 37.4%. It was also lower in men compared to women and among those without any education. Participants who had cataract surgery in either eye had similar e-REC compared to those who were not operated. CONCLUSION Though spectacle use was found to be high, there is a still large unmet need for refractive correction for distance. Effective service delivery models to provide refraction and spectacle dispensing services are needed to achieve universal eye health coverage in the region.
Collapse
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
| | - Saptak Banerjee
- 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
| | - Vijay Kumar Yelagondula
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Prof. Brien Holden Eye Research Centre, 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
| | - 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
| | - Jill Keeffe
- 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
| |
Collapse
|
34
|
Misra N, Khanna RC, Mettla AL, Marmamula S, Keeffe JE. Agreement and diagnostic accuracy of vision screening in preschool children between vision technicians and spot vision screener. Indian J Ophthalmol 2021; 69:117-121. [PMID: 33323593 PMCID: PMC7926156 DOI: 10.4103/ijo.ijo_1740_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Screening preschool children for vision-related disorders poses a challenge. This study is designed to determine the agreement and diagnostic accuracy of the spot vision screener (SVS) in screening preschool children compared to screening procedure by vision technicians (VT). Methods This study was conducted as a part of the ongoing study titled "Initiative for Screening Children for Refractive Errors and other Eye Health Needs (I-SCREEN)." Children from 33 Anganwadis (preschools) in two districts, Adilabad district of Telangana and Krishna district of Andhra Pradesh, in South India, underwent eye health screening by a VT and by a trained community eye health workers (CEHW) using the SVS. Findings were compared for agreement and diagnostic accuracy of assessment. Results A total of 976 preschool children were screened by the VT and separately by the CEHW using the SVS in Adilabad (15 schools) and Krishna (18 schools) districts. The overall mean age of these children was 2.5 years (SD ± 1.3 years). There were 48 (4.9%) referrals by VT compared to 105 (10.8%) referrals by CEHW using SVS. The overall sensitivity of SVS was 91.7% (95% CI: 80%-97.7%) and the specificity was 93.4% (95% CI: 91.6%-94.9%). Positive predictive value was 41.9% (95% CI: 32.3%-51.9%) and negative predictive value was 99.5% (95% CI: 98.8%-99.9%) with a moderate agreement (0.54; 95% CI 0.49-0.64) between VT screening and screening with SVS. Conclusion The SVS showed good diagnostic accuracy and agreement in screening for possible vision-related disorders in preschool children.
Collapse
Affiliation(s)
- Neha Misra
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana; Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute; Department of Biotechnology / Wellcome Trust India Alliance Research Fellow, L V Prasad Eye Institute, Hyderabad, India
| | - Jill E Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
35
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
36
|
Marmamula S, Keeffe J, Challa R, Mohd J, Khanna RC. Near-vision impairment and effective near-vision spectacle coverage in two districts in Telangana, India: a population-based cross-sectional study. BMJ Open 2021; 11:e047131. [PMID: 33820793 PMCID: PMC8030469 DOI: 10.1136/bmjopen-2020-047131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of near-vision impairment (NVI) and effective spectacle coverage for near vision in those aged ≥40 years in Khammam and Warangal district in Telangana, India. DESIGN A population-based cross-sectional study. SETTING Khammam and Warangal district in Telangana, India. PARTICIPANTS Of 6000 people enumerated, 5357 were examined (89%). 4526 participants without distance vision impairment were included in the analysis. MAIN OUTCOME MEASURES The study teams visited selected households and conducted eye examinations. NVI was defined as binocular presenting near vision worse than N6. 'Unmet need' was deemed to be present if the unaided near vision was worse than N6 and improved to N6 with near correction among the participants who did not have spectacles for near vision. 'Met need' was deemed to be present when unaided near vision was worse than N6 but improving to N6 with their spectacles. The 'undermet need' was deemed to be present when aided near vision was worse than N6 but improved to N6 with correction. Based on these definitions, e-near-vision coverage (%) is calculated as follows: e-NVC (%)=met need/(met need+undermet need+unmet need) × 100. RESULTS The mean age was 53.5 years (SD: 10.8 years), 2534/4526 (55.8%) were women, 1819/4526 (41.8%) had at least primary school education and 2368/4526 (52.3%) were from the Khammam district. The prevalence of NVI was 55.8% (95% CI 72.5 to 75.1; n=3343). Overall, the e-NVC (%) was 31.8%. It was 40.0% in Khammam and 23.2% in Warangal. CONCLUSION NVI is common in Khammam and Warangal districts in Telangana with inadequate effective near-vision coverage. Effective service delivery models are needed to reach out and provide services to address NVI to achieve universal eye health coverage in the region.
Collapse
Affiliation(s)
- Srinivas Marmamula
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- Wellcome Trust, Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- 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
| | - Jill Keeffe
- 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
| | - 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, India
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- 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
| |
Collapse
|
37
|
Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021; 9:e489-e551. [PMID: 33607016 PMCID: PMC7966694 DOI: 10.1016/s2214-109x(20)30488-5] [Citation(s) in RCA: 438] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Damodar Bachani
- John Snow India, New Delhi, India; Ministry of Health and Family Welfare, New Delhi, India
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Tasanee Braithwaite
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; The Medical Eye Unit, St Thomas' Hospital, London, UK
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chimgee Chuluunkhuu
- Orbis International, Ulaanbaatar, Mongolia; Mongolian Ophthalmology Society, Ulaanbaatar, Mongolia
| | | | | | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alastair K Denniston
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Emerson
- International Trachoma Initiative and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - João M Furtado
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Eyu-Ethiopia Eye Health Research, Training, and Service Centre, Bahirdar, Ethiopia
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Peng Tee Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Van C Lansingh
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico; Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico; Help Me See, New York, NY, USA
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Milka M Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lizette Mowatt
- University Hospital of the West Indies, Kingston, Jamaica
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Indian Institute of Public Health, Hyderabad, India
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kenya Medical Training College, Nairobi, Kenya
| | - Daksha B Patel
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Solange R Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Bernadetha R Shilio
- Department of Curative Services, Ministry of Health Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nation, New York, NY, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Vision Institute, University of New South of Wales, Sydney, Australia
| | | | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria; Africa Vision Research Institute, Durban, South Africa
| |
Collapse
|
38
|
Tripathy D, Roy AK, Khanna RC, Jalali S, Panigrahy B, Parija DC, Rath S. Point-of-care rapid antigen testing for COVID-19 at a tertiary eye care facility: Role in commencement of elective surgeries, contact tracing and implementation of back-to-work policy. Indian J Ophthalmol 2021; 69:964-970. [PMID: 33727467 PMCID: PMC8012960 DOI: 10.4103/ijo.ijo_3119_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to report the use and the impact of a point-of-care rapid antigen test (PoC-RAT) at a tertiary eye care facility in facilitating commencement of elective surgeries, contact tracing of exposed health care professionals (HCPs) and ancillary hospital staff, and implementation of back-to-work (BTW) policy for them. Methods Retrospective analysis of subjects undergoing PoC-RAT for COVID-19 infection at a tertiary level dedicated eye care facility. Decision making with regard to commencement of elective surgeries post COVID-19 related discontinuation of services, contact tracing of HCPs and ancillary hospital staff exposed to known COVID-19 cases and implementation of back-to-work policy for all staff based upon the results of PoC-RAT were studied. Results A total of 311 subjects (224 patients and 87 hospital staff) were tested. Overall positivity rate was around 7%. Asymptomatic patients who were screened preoperatively had a lower positivity rate at around 3% compared to the staff (who were either known contacts or were symptomatic) at around 17%. Contact tracing found three-quarters of the staff at low risk and only one quarter at medium or high risk. Among patients, 97% of those followed up for at least 2 weeks after the test remained healthy. For staff, this was around 65%. Conclusion Based on our preliminary results, we suggest that PoC-RAT may be considered routinely for indication-based preoperative screening of asymptomatic patients, and for on-campus screening, contact tracing and implementation of BTW policies for HCPs and ancillary hospital staff at a tertiary level eye care facility.
Collapse
Affiliation(s)
- Devjyoti Tripathy
- Faculty, Ophthalmic Plastics, Orbit & Ocular Oncology Service, MTC Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Avik Kumar Roy
- Faculty, Glaucoma Service, MTC Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Rohit C Khanna
- Director, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care (GPR ICARE), LV Prasad Eye Institute, Hyderabad, Telengana, India
| | - Subhadra Jalali
- Director, Retina Institute, Newborn Eye Health Alliance, (NEHA) and Director- Quality, L V Prasad Eye Institute Network, KAR Campus, LV Prasad Eye Institute, Hyderabad, Telengana, India
| | - Bharat Panigrahy
- Consultant Physician In-House, MTC Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Deepthi Chandran Parija
- Communications and Patient Care Administrator, MTC Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Suryasnata Rath
- Faculty, Ophthalmic Plastics, Orbit & Ocular Oncology Service; Director and Taraprasad Das Chair of Ophthalmology, MTC Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| |
Collapse
|
39
|
Rathi VM, Reddy RP, Fernandes M, Rath S, Nayak S, Vemuri JPS, Yanamala NK, Varda R, Marmamula S, Das AV, Khanna RC. The impact of COVID-19 "Unlock-I" on L V Prasad Eye Institute Network in Southern India. Indian J Ophthalmol 2021; 69:695-700. [PMID: 33595503 PMCID: PMC7942085 DOI: 10.4103/ijo.ijo_3143_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: The aim of this study was to report on the impact of COVID-19 “Unlock-I” on Network of Eye Centers in Southern India. Methods: Our eye health pyramid model has a network of eye care centers in four Indian states. The network constitutes a center of excellence (CoE) at the apex followed by tertiary care centers (TC) located in urban areas, secondary care centers (SC), and primary care vision centers (VC) at the base located in rural areas. We collected data on patients seen between June 2019 and June 2020, which included age, gender, total patients seen (new or follow-up), and socioeconomic status (paying and nonpaying). A comparative study was done between the data for outpatients and surgeries performed pre-COVID-19 and during Unlock-I in COVID-19 period. Results: There was a 36.71% reduction in the overall outpatients seen in June 2020 (n = 83,161) compared to June 2019 (n = 131,395). The reduction was variable across different levels of the pyramid with the highest reduction in CoE (54.18%), followed by TCs (40.37%), SCs (30.49%) and VCs (18.85%). Similar pattern was seen for new paying patients with the highest reduction in CoE (54.22%), followed by TCs (25.86%) and SCs (4.9%). A 43.67% reduction was noted in the surgeries performed in June 2020 (n = 6,168), compared to June 2019 (n = 10,950). Reduction in paying services was highest in CoE (47.52%), followed by TCs (15.17%) and SCs (4.87%). There was no significant change in the uptake of services by gender in the network. Conclusion: Highest reduction in patient footfalls during “Unlock-1” was noted in urban centers. Going forward, there is a need to develop strategies to provide eye care closer to the doorsteps.
Collapse
Affiliation(s)
- Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Rajeev Pappuru Reddy
- Brien Holden Eye Research Centre; Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Merle Fernandes
- Grandhi Mallikarjun Rao Varalakshmi Campus, L V Prasad Eye Institute, Vishakhapatnam, Andhra Pradesh, India
| | - Suryasnata Rath
- Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswara, Odisha, India
| | - Sameera Nayak
- Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, India
| | - Joji Prasad Satya Vemuri
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Niranjan Kumar Yanamala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Rajashekar Varda
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Wellcome Trust/Department of Biotechnology India Alliance Research Fellow, LV Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Brien Holden Eye Research Centre, L V Prasad Eye Institute; Department of eyeSmart EMR & AEye, 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 Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
40
|
Khanna RC, Garg P, Vaddavalli PK, Fernandes M, Rath S, Nayak S, Narayanan R, Pappuru RR, Kaliki S, Das AV, Sharma S, Jalali S. Response of L V Prasad Eye Institute to COVID-19 outbreak in India: experience at its tertiary eye care centre and adoption to its Eye Health Pyramid. Int J Ophthalmol 2021; 14:1-9. [PMID: 33469477 DOI: 10.18240/ijo.2021.01.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023] Open
Abstract
AIM To summarize the experience of response to COVID-19 outbreak at a tertiary eye care institute and its network of health facilities in India. METHODS Our responses are based on the principles of social distancing, hand hygiene, respiratory etiquettes, surface disinfection protocol, and rational use of appropriate personal protective equipment (PPE). We describe our response in terms of administrative controls, clinical protocols, staff protection, environmental controls, and social distancing measures. We also discuss our communication strategies and monitoring systems, to ensure compliance to protocols. RESULTS Administrative control is mainly related to formation of task force and its functions. Clinical protocols are related to patient triaging methods and clinical examination guidelines in Outpatient, Inpatient and Operating Room. Staff protection is focused on training staff on the protocols to be followed in hospital as well as at home, and use of PPE. Environmental protocol is focused on cleaning and disinfectant methods to be used in the hospital. In addition, there are systems for communication as well as monitoring compliance to protocols. CONCLUSION We hope that these protocols and our experience would help the ophthalmic community globally and serve as a guide to protect ophthalmologists and ophthalmic care personnel, and their patients across the world.
Collapse
Affiliation(s)
- 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 500030, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,School of Optometry and Vision Science, University of New South Wales, Sydney 2033, Australia.,University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Prashant Garg
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Pravin K Vaddavalli
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Merle Fernandes
- Grandhi Mallikarjun Rao Varalakshmi Campus, L V Prasad Eye Institute, Vishakhapatnam, Andhra Pradesh 530040, India
| | - Suryasnata Rath
- Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswara, Odisha 751024, India
| | - Sameera Nayak
- Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada 521134, India
| | - Raja Narayanan
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Rajeev Reddy Pappuru
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Swathi Kaliki
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Anthony Vipin Das
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India.,Department of eyeSmart EMR & AEye, L V Prasad Eye Institute 500034, India
| | - Savitri Sharma
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Subhadra Jalali
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India.,Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| |
Collapse
|
41
|
Kyari F, Khanna RC. Minimum requirements for a glaucoma programme. Community Eye Health 2021; 34:57-58. [PMID: 35210708 PMCID: PMC8862630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Fatima Kyari
- Associate Professor: International Centre for Eye Health, London School of Hygiene & Tropical Medicine, UK. Consultant Ophthalmologist: College of Health Sciences, University of Abuja, Nigeria
| | - Rohit C Khanna
- Network Director: Allen Foster Eye Health Research Centre & Brien Holden Eye Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
42
|
Marmamula S, Mitchell W, Zebardast N, Locascio J, Barrenkala NR, Kumbham TR, Modepalli SB, Khanna RC, Friedman DS. Impact of Vision Loss on Visual Function Among Elderly Residents in the "Home for the Aged" in India: The Hyderabad Ocular Morbidity in Elderly Study. Transl Vis Sci Technol 2020; 9:11. [PMID: 33344055 PMCID: PMC7726582 DOI: 10.1167/tvst.9.13.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/18/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to report the association between visual impairment (VI) and self-reported visual difficulty among the elderly in residential care using the Indian Vision Functioning Questionnaire (IND-VFQ-33) psychometrically validated questionnaire. Methods Participants aged ≥ 60 years were recruited from 41 homes in Hyderabad in South India. All participants underwent detailed eye examination and interviews. Self-reported visual function was assessed using the IND-VFQ-33 questionnaire. Factor Analysis and Item Response Theory (IRT) models were used for analysis. Multivariable regression models were used to investigate associations between derived global difficulty scores versus severity and causes of VI. Presenting visual acuity worse than 6/18 in the better eye was considered as VI. Results In total, 867 elderly participants completed the INDVFQ-33. Two latent traits ("daily activities" and "visual symptoms") were identified on factor analysis, each with uniquely loading questions. Participants with VI reported significantly higher daily activities difficulty (6 points higher) and visual symptoms difficulty (1.7 points higher) than those without VI (P < 0.05). Those with cataract reported the highest daily activities and visual symptoms difficulty (7.6 points and 2.2 points higher, respectively, P < 0.05). Greater severity of VI was associated with increased self-reported difficulty for both factors, and for all causes of VI. Conclusions We present a psychometrically validated visual questionnaire particularly suited to older adults in residential homes. We show a significant association between cause/severity of VI and difficulty with daily activities and visual symptoms after adjusting for sociodemographic and medical factors. Translational Relevance Understanding the impact of vision loss on visual functions in the elderly will help in planning and resource allocation for developing early intervention programs for the elderly.
Collapse
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
- Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - William Mitchell
- Massachusetts Eye and Ear, Harvard Medical School, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | - Nazlee Zebardast
- Massachusetts Eye and Ear, Harvard Medical School, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | | | - Navya Rekha Barrenkala
- 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
| | - 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
| | - 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
| | - David S. Friedman
- Massachusetts Eye and Ear, Harvard Medical School, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| |
Collapse
|
43
|
Abstract
The World Health Organization (WHO) Global Action Plan (GAP) 2014-19 emphasize providing Comprehensive Eye Care (CEC) using the health system approach to achieve Universal Eye Health Coverage (UEHC). An important aspect of CEC is Primary Eye Care (PEC). The scope of PEC varies significantly with primary health workers providing PEC in most parts of the developing world, whereas in developed nations PEC is provided by specialized personnel such as optometrists. This article focuses on delivery of PEC models in India, specifically through the vision center (VC) approach. VCs are part of a larger eye care network and provide PEC in remote rural areas of the country. The authors describe the how PEC is delivered in more than 300 VCs operated by six mentor hospitals in India under the Global Sight Initiative (GSI). Key factors compared include: The role of leadership; human resource planning, including recruitment and retention; service delivery; leveraging technology for planning and reaching key populations; financial sustainability; supply chain management; and quality and monitoring. It also discusses issues to be considered to strengthen VCs as we move ahead towards our collective goal of achieving UEHC and eliminating avoidable blindness.
Collapse
Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care; Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Shalinder Sabherwal
- Community Ophthalmology and Public Health Research, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Asim Sil
- Vivekananda Mission Asram Netra Niramay Niketan, West Bengal, India
| | - Mohammed Gowth
- Lions, Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Kuldeep Dole
- Pune Blind Men's Association, HV Desai Eye Hospital, Pune, Maharashtra, India
| | | | - Heidi Chase
- Director of Programs, Seva Foundation, Berkley, CA, USA
| |
Collapse
|
44
|
Misra N, Khanna RC, Mettla AL, Marmamula S, Rathi VM, Das AV. Role of teleophthalmology to manage anterior segment conditions in vision centres of south India: EyeSmart study-I. Indian J Ophthalmol 2020; 68:362-367. [PMID: 31957728 PMCID: PMC7003575 DOI: 10.4103/ijo.ijo_991_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: To study the role of teleophthalmology (TO) in the diagnosis and treatment of anterior segment conditions (including adnexal conditions) in rural areas. Methods: This is a pilot study of 5,604 patients, who visited primary vision centres (VCs) for 1 week from 1-7 September 2018. The patients were examined by a vision technician (VT) to identify those who may need teleconsultation. The centres were located in 16 districts of four Indian states of Andhra Pradesh, Telangana, Odisha, and Karnataka. The demographic profile, along with the role of teleconsultation was reviewed. Results: Teleconsultation was advised in 6.9% of the patients, out of which 59.6% were referred to a higher level of care, and 40.4% were treated directly at the VC. Teleconsultations were higher among males (7.0% as compared to 6.6% in females), though not statistically significant (P = 0.55). Teleconsultation was higher in the older population, that is, 60 years and above (14.5%); those with severe visual impairment (VI) (21%) and blindness (31.1%); and in the states of Telangana (11%) and Andhra Pradesh (6.3%). It was noted that 45% of the patients who underwent teleconsultation had pathologies related to ocular surface, cornea and lid, and adnexa-related conditions. Conclusion: Teleconsultation has a significant role in the management of anterior segment conditions in bridging the gap between the patients and ophthalmologists in rural India. TO can also play an important role in the diagnosis and management of anterior segment, lid, and adnexa-related pathologies.
Collapse
Affiliation(s)
- Neha Misra
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Asha L Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, Hyderabad, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute; Brien Holden Institute of Optometry and Vision Science; Wellcome Trust/ Department of Biotechnology India Alliance Research Fellow, Hyderabad, Telangana, India
| | - Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, Hyderabad, India
| | - Anthony V Das
- Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
45
|
Abstract
As we move from a disease-specific care model toward comprehensive eye care (CEC), there is a need for a more holistic and integrated approach involving the health system. It should encompass not only treatment, but also prevention, promotion, and rehabilitation of incurable blindness. Although a few models already exist, the majority of health systems still face the challenges in the implementation of CEC, mainly due to political, economic, and logistic barriers. Shortage of eye care human resources, lack of educational skills, paucity of funds, limited access to instrumentation and treatment modalities, poor outreach, lack of transportation, and fear of surgery represent the major barriers to its large-scale diffusion. In most low- and middle-income countries, primary eye care services are defective and are inadequately integrated into primary health care and national health systems. Social, economic, and demographic factors such as age, gender, place of residence, personal incomes, ethnicity, political status, and health status also reduce the potential of success of any intervention. This article highlights these issues and demonstrates the way forward to address them by strengthening the health system as well as leveraging technological innovations to facilitate further care.
Collapse
Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Srinivas Marmamula
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Senior Visiting Fellow - School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Wellcome Trust / Department of Bio-technology India Alliance fellow, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Senior Visiting Fellow - School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
46
|
Panda L, Khanna RC, Metla AL, Marmamula S, Pehere NK, Keeffe JE. Causes of vision impairment and blindness among children in schools for the blind in South Indian States of Andhra Pradesh and Telangana. Indian J Ophthalmol 2020; 68:345-350. [PMID: 31957724 PMCID: PMC7003598 DOI: 10.4103/ijo.ijo_923_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To study the causes of severe vision impairment (SVI) and blindness among children in Andhra Pradesh (AP) and Telangana State (TS) in South India. Methods: A total of 299 children from 10 schools for the blind were examined between January and December 2017. The schools were chosen from 3 districts of AP (Guntur, Krishna and West Godavari) and 2 districts of TS (Adilabad and Mahabubnagar). The World Health Organization Prevention of Blindness' eye examination protocol for children with blindness or visual impairment (VI) was followed. Results: Based on presenting visual acuity (PVA), 248 children (82.9%) were blind, 16 children (5.3%) had SVI, 18 (6%) had moderate VI, and 17 (5.7%) were normal. The most common anatomical cause of blindness or SVI was whole globe anomaly (32%), followed by an abnormality in the retina and vitreous (26.6%). While whole globe anomalies were high both in AP (33.8%) and TS (21.6%), lens-related pathologies were higher in TS (29.7%) and retina-related abnormalities were higher in AP (29.3%). The most common cause was related to heredity (40.5%). Etiology was unknown in 33.5% of cases. Overall, 37.1% of the causes were avoidable. In AP, 33.4% were avoidable whereas in TS nearly 60% were avoidable. Conclusion: Whole globe anomaly constitutes a major cause of SVI and blindness, especially in AP. Lens-related pathologies were higher in TS. Nearly 40% of the causes were avoidable. Hence, robust screening methods and strategies must be established for timely intervention to reduce the burden on VI in children.
Collapse
Affiliation(s)
- Lapam Panda
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Asha Latha Metla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Institute of Optometry and Vision Science; Wellcome Trust/Department of Biotechnology India Alliance Research Fellow, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Niranjan K Pehere
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana; The David Brown Children's Eye Care Centre, L V Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Tadigadapa, Vijayawada, Andhra Pradesh, India
| | - Jill E Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
47
|
Abstract
Purpose: With the outbreak of coronavirus disease 2019 (COVID-19), India went for lockdown-I on March 23, 2020. In this article, we report on the demographic profile and ocular disorders from our 20 rural eye centres during lockdown-I and its comparison with the pre-lockdown period. Methods: A retrospective analysis was conducted for all patients who visited or had teleconsultations at the 20 rural centres in our network between March 23 and April 19, 2020. Demographic and clinical details were collected from electronic medical records (EMR). Subspecialty was decided based on the diagnosis. Patients who needed advanced care were referred to the higher tertiary centres. We report the profile of patients seen and managed at the rural centres and the reasons for referrals. We also compare the data with the pre-lockdown period. Results: During the lockdown-I period, a total of 263 patients were treated including 48 teleconsultations (18.25%). The mean age was 48.16 years (SD: 19.53 years). There were 118 females (44.87%). As compared to pre-lockdown, during the lockdown, the patient visits were highest in the cornea and anterior segment specialty with 114 patients (43.35%), including conjunctivitis (n = 25; 22.32%). Of the 263 patients, 24 patients (9.12%) were referred to tertiary centres. This includes 6/27 (22.22%) patients of microbial keratitis. As compared to this, during pre-lockdown, 28,545 patients were seen. The mean age was 49.03 years (SD: 19.24 years). There were 14,927 (52.29%) females. The referral was 1525 (5.34%), including 34/249 (13.65%) of those with keratitis. Conclusion: Lockdown-I had significantly impacted patient care in rural areas. As compared to the pre-lockdown period, during the lockdown, there was an issue with access to services by females. Despite a higher number of specialty patients (including emergencies) visiting during the lockdown, 91% of the patients who visited rural centres could be managed locally, avoiding long-distance travel.
Collapse
Affiliation(s)
- Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural, Eyecare L V Prasad Eye Institute; Brien Holden Eye Research Centre, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Brien Holden Eye Research Centre; Department of eyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural, Eyecare L V Prasad Eye Institute; Brien Holden Eye Research Centre; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| |
Collapse
|
48
|
Marmamula S, Yanamala NK, Khanna RC. "Eyecare on call" - Extending the frontiers of care through home-based eye care - Concept and the protocol. Indian J Ophthalmol 2020; 68:2625-2627. [PMID: 33120718 PMCID: PMC7774164 DOI: 10.4103/ijo.ijo_2352_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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, Sydney, Australia,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Sydney, Australia,Wellcome Trust/ Department of Biotechnology India Alliance Research Fellow, L V Prasad Eye Institute, Hyderabad, Telangana, India,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Niranjan K Yanamala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Sydney, Australia,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Sydney, 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, Sydney, Australia,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Sydney, Australia,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia,School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA,
Correspondence to: Dr. Rohit C Khanna, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad - 500 034, Telangana, India. E-mail:
| |
Collapse
|
49
|
Rathi VM, Sharma S, Das T, Khanna RC. Endophthalmitis Prophylaxis Study, Report 2: Intracameral antibiotic prophylaxis with or without postoperative topical antibiotic in cataract surgery. Indian J Ophthalmol 2020; 68:2451-2455. [PMID: 33120637 PMCID: PMC7774195 DOI: 10.4103/ijo.ijo_1738_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: Intracameral antibiotic in cataract surgery has shown level I evidence as prophylaxis for postoperative endophthalmitis. Not much is known if one should also use topical antibiotics after intracameral injection. The purpose of the study was to determine efficacy of intracameral antibiotic with and without postoperative topical antibiotic in reducing the incidence of acute endophthalmitis after cataract surgery in rural India. Methods: A prospective comparative, non-randomized interventional study was designed in 15 rural centres in India. The study recruited 40,006 patients (n = 42,466 eyes), who underwent cataract surgery (phacoemulsification/small incision cataract surgery), and received intracameral antibiotic (cefuroxime/moxifloxacin). Postoperative topical antibiotic prescription was left to the choice of the treating physician, but they were encouraged not to use it in uneventful surgeries. Primary outcome measure was occurrence of acute clinical endophthalmitis within 6 weeks of surgery. Statistical analysis was done using STATA software v13.1 (StataCorp, Texas); P value of <0.05 was considered statistically significant. Results: In the study, 17,932 (42%) eyes received intracameral cefuroxime (ICC) and 24,534 (58%) eyes received intracameral moxifloxacin (ICM). Topical antibiotic was not prescribed to 17,855 (42%) eyes - 5723 (32%) eyes in ICC group and 12,132 (68%) eyes in ICM group. Acute clinical endophthalmitis occurred in 15 (0.035%) eyes - 1 / 3515 (0.028%) eyes and 1 / 2231 (0.045%) eyes that received and did not receive topical antibiotic, respectively. The difference in occurrence of endophthalmitis with/without topical antibiotics in each group (ICC: 0.016% and 0.017%; P = 0.958; ICM: 0.040% and 0.058%; P = 0.538) was not significant (P = 0.376). Conclusion: Supplementing intracameral antibiotic with topical antibiotic postoperatively did not impact the occurrence of acute post cataract surgery endophthalmitis in rural India
Collapse
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
| |
Collapse
|
50
|
Khanna RC, Thulasiraj RD. Obituary - Dr Ramachandra Pararajasegaram. Ophthalmic Epidemiol 2020. [PMID: 33108938 DOI: 10.1080/09286586.2020.1839915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- 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.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Ravilla D Thulasiraj
- Lions Aravind Centre for Community Ophthalmology, Aravind Eye Care System, Madurai, India
| |
Collapse
|