Prevalence, pattern, and compliance with spectacles use among the elderly in homes for the aged in South India: The Hyderabad Ocular Morbidity in Elderly Study (HOMES)

Purpose: This study was conducted to report on the pattern of spectacles use and compliance among the elderly (aged ?60 years) in homes for the aged in Hyderabad region in Telangana State, India. Methods: Participants were recruited from 41 homes for the aged centres for comprehensive eye health assessments. A questionnaire was used to collect information on current and past use of spectacles, type of spectacles, spectacles provider and amount paid for the spectacles. For those that reported using spectacles in the past, information was collected on the reasons for their discontinuation. Compliance with spectacles use was assessed after eight months of provision of the spectacles. Results: A total of 1182/1513 participants were examined from 41 homes for the aged in Hyderabad, India. The mean age of the participants examined was 75 years (standard deviation (SD): 8.8 years; range: 60–108 years); 764 (64.6%) of them were women and 240 participants (20.3%) had no formal education. The prevalence of spectacles use was 69.9% (95% confidence interval [CI]: 67.1–72.4; n = 825). Bifocals were the most commonly used type of spectacles (86.7%) followed by single vision glasses for distance vision (7.4%). Private eye clinics were the largest service provider (85.5%) followed by local optical outlets (6.9%) and other service providers (7.7%). The prevalence of spectacles compliance was 81.5% (211/259). Conclusion: Use of spectacles and compliance are high among the elderly living in residential care homes in the Hyderabad region. Spectacles use can be further improved by periodic eye assessments along the lines similar to school eye programs, which can immensely benefit this vulnerable, aged population

Visual impairment and refractive errors in school children in Andhra Pradesh, India

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

Population-based assessment of barriers for uptake of eye care services among elderly people: Findings from rapid assessment of visual impairment studies from Telangana, India

Purpose: To report the barriers for seeking eye care among the elderly population aged ?60 years with avoidable vision impairment (VI) in the South Indian state of Telangana. Methods: A total of 3640 participants aged ?60 years were recruited using cluster?random sampling. Demographic information, including presenting visual acuity, was measured using the standard Rapid Assessment of Visual Impairment (RAVI) protocol. “Avoidable VI” was considered if the VI was due to cataract or uncorrected refractive error (URE). A detailed interview was conducted using a validated questionnaire to report the barriers for not seeking eye care. Data were analyzed using the Stata statistical software version 14. Results: Prevalence of avoidable VI was 30.2% (95% CI: 28.02–31.06; n = 1102). Among those who noticed decreased vision (n = 1074), only 392 participants (36.4%) reported that they felt the need for seeking eye care. The major barriers for not seeking eye care were: cannot afford the consultation fee and services (42.0%) and no escort (25.7%). Overall, the personal barriers (57.9%) were the major reason for not seeking care, followed by economic barriers (42.0%). No significant difference was reported in barriers between the participants with unilateral and bilateral VI (>0.05). Conclusion: Overall, among the elderly people, personal and economic barriers were the major reason for not seeking eye care. Health care providers and policymakers should focus on newer models of eye care delivery to ensure better accessibility and uptake of care by the elderly people

Awareness of cataract and glaucoma in two rural districts of Telangana, India

Purpose: To determine the level of awareness of cataract and glaucoma and identify the determinants of awareness in two rural districts of Telangana, India. Methods: A population?based cross?sectional study was conducted using the rapid assessment of visual impairment (RAVI) methodology in Khammam and Warangal districts. A validated questionnaire was administered to participants aged 40 years and above to assess the level of awareness of cataract and glaucoma. Results: The awareness questionnaire was administered to 3273 participants of whom 1433 (43.8%) were men, 1985 (60.6%) of them had no education, and 1645 (50.3%) were from Khammam district. In total, 2539/3273 (77.6%; 95% confidence intervals (CI): 76.1– 79.0%) participants reported awareness of cataract. Awareness of cataract was higher in Khammam compared to that in Warangal (84.4% versus 70.6%; P < 0.01). Only 41/3273 (1.25%, 95% CI: 0.90–1.69%) participants were aware of glaucoma. Awareness of glaucoma was also higher in Khammam (1.88% versus 0.61%; P < 0.01). Younger age groups, men, any level of education, and residing in Khammam were factors associated with awareness of cataract. Only having any level of education and residing in Khammam were associated with awareness of glaucoma. Conclusion: Awareness of cataract was high, but awareness of glaucoma was very poor. There is a need to spread awareness about these potentially blinding conditions. Moving forward, this can be a critical step in developing a preventive eye care strategy to achieve universal eye health in India.

Modeling the risk of age-related macular degeneration and its predictive comparisons in a population in South India.

Background: Objective of current study was to develop and cross-validate the prediction models for Age-related Macular Degeneration (AMD) by using Logistic Regression (LR) and Artificial Neural Networks (ANN). Methods: A population based cross-sectional epidemiologic study. The data (n=3723) were analyzed on participants aged ≥40 years in Andhra Pradesh, South India. Sub-population data from this sample was drawn by using random under sampling and random over sampling techniques to derive a risk score from the LR model. The models were compared for their predictive abilities by an Area under the Receiver Operating Characteristic Curve (AUROC). Results: The LR risk score was built with a score ranging from 0 to 60 for a sub-population dataset (n=213). A cut-off score of ≥30 had a sensitivity of 79% and a specificity of 69%. The predictive performance of ANN and LR was statistically equivalent (76% vs. 78%; P = 0.624). Both the models were stable and consistently obtained the same predictive accuracies in a 30-fold split-sample cross validation. Conclusions: The sensitivity analysis of the ANN model indicated the relative importance of prioritizing modifiable risk factors for AMD in order to base preventive interventions to reduce the impact of the modifiable factors on AMD.

Changing trends in the prevalence of visual impairment, uncorrected refractive errors and use of spectacles in Mahbubnagar district in South India.

Background/Aim: The Andhra Pradesh Eye disease Study (APEDS) was a conventional cross‑sectional study conducted in four locations during 1996‑2000. Ten years later, a Rapid Assessment of Refractive Errors (RARE) survey was conducted in one of the geographical regions. The prevalence of visual impairment (VI), uncorrected refractive error (URE), spectacles use obtained from both the surveys was compared. Settings and Design: Rural settings; cross‑sectional studies. Materials and Methods: In both the surveys, distance visual acuity (VA) was assessed using a logMAR chart. Pinhole VA was assessed if presenting VA was <20/20 in APEDS and <20/40 in RARE. VI was defined as presenting VA <20/40 in the better eye. URE was defined as presenting VA <20/40 and improving to ≥20/40 with a pinhole. Statistical Analysis Used: Performed using Statistical Package for Social Sciences (SPSS). Chi square tests and t‑test were used. Results and Conclusions: The results from a RARE survey with 3,095 subjects were compared with an APEDS dataset that had 1,232 subjects in the same age group of 15-49 years. The prevalence of VI has decreased from 9.5% (95% CI, 7.7-11.1) in APEDS to 2.7% (95% CI, 2.1-3.3) in RARE. Similarly, the prevalence of URE in the better eye decreased from 5.8% (95% CI, 4.5-7.1) to 2.3% (95% CI, 1.8- 2.8). The usage of spectacles increased from 6.6% (95% CI, 5.2-8.0) to 9.7% (95% CI, 8.7-10.7). There is a decreasing trend in the prevalence of VI and URE in Mahbubnagar district in Andhra Pradesh over a decade.

Critical issues in implementing low vision care in the Asia-Pacific region.

Two-thirds of the world's population with low vision resides in the Asia-Pacific region. Provision of comprehensive low vision services is important to improve vision-related quality of life (QoL) for people with this condition. This review outlines the critical issues and challenges facing the provision of low vision services in the Asia-Pacific region. The review offers possible strategies to tackle these issues and challenges facing service providers and policy makers in lieu of Vision 2020 strategies in this area. Pertinent findings from the global survey of low vision services and extensive ground work conducted in the region are used; in addition, a discussion on the availability of services, human resources and training, and funding and the future sustainability of low vision care will be covered. In summary, current issues and challenges facing the region are the lack of specific evidence-based data, access, appropriate equipment and facilities, human resources, funding, and sustainability. These issues are inextricably interlinked and thus cannot be addressed in isolation. The solutions proposed cover all areas of the VISION 2020 strategy that include service delivery, human resources, infrastructure and equipment, advocacy and partnership; and include provision of comprehensive care via vertical and horizontal integration; strengthening primary level care in the community; providing formal and informal training to enable task shifting and capacity building; and promoting strong government and private sector partnership to achieve long-term service financial sustainability.

Rapid assessment methods in eye care: An overview.

Reliable information is required for the planning and management of eye care services. While classical research methods provide reliable estimates, they are prohibitively expensive and resource intensive. Rapid assessment (RA) methods are indispensable tools in situations where data are needed quickly and where time- or cost-related factors prohibit the use of classical epidemiological surveys. These methods have been developed and field tested, and can be applied across almost the entire gamut of health care. The 1990s witnessed the emergence of RA methods in eye care for cataract, onchocerciasis, and trachoma and, more recently, the main causes of avoidable blindness and visual impairment. The important features of RA methods include the use of local resources, simplified sampling methodology, and a simple examination protocol/data collection method that can be performed by locally available personnel. The analysis is quick and easy to interpret. The entire process is inexpensive, so the survey may be repeated once every 5–10 years to assess the changing trends in disease burden. RA survey methods are typically linked with an intervention. This article provides an overview of the RA methods commonly used in eye care, and emphasizes the selection of appropriate methods based on the local need and context.