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.
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.
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.
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.
ABSTRACT
Purpose: To estimate the prevalence, causes, and risk factors for visual impairment (VI) among children of school for hearing-impaired (HI) in Guntur district of Andhra Pradesh, India. Methods: Children between 6 and 16 years of age available in all the 12 special schools for HI were examined. Visual acuity (VA) testing, ocular motility, and examination of anterior and posterior segment for all children were done. Those having VA of less than 6/12 in better eye underwent cycloplegic refraction. For definition of VI, as per World Health Organization (WHO), VA of better eye was considered. HI was also classified as mild, moderate, severe, and profound as per WHO definitions. Examination for systemic diseases and other associated disabilities was also done. Results: In all, 402 children underwent examination. Ophthalmic abnormality was seen in 64 children with a prevalence of 15.9% [95% confidence interval (CI) 14.9%–16.8%], and VI was seen in 29 children with a prevalence of 7.2% (95% CI 4.9%–10.2%). Refractive errors [29 (7.2%)], retinitis pigmentosa (RP) [16 (4%)], and squint [8 (2%)] were the major ophthalmic abnormalities. Thirty-five (54.7%) of the abnormalities were either preventable or treatable. The major cause of VI was refractive error (18) followed by RP (5). Twenty of them (69%) with VI in this study group were treatable. Twenty-two (75.9%) children with eye problem were newly diagnosed. The only risk factor for VI was being mentally challenged (odds ratio: 5.63; 95% CI: 1.89–16.8). Conclusion: The prevalence of ophthalmic abnormalities and VI in school for HI was high, and the majority of them were not detected so far. As most of them are easily treatable, it is highly recommended to conduct regular eye examinations in these schools.
ABSTRACT
Diabetic retinopathy (DR) and glaucoma are emerging causes of blindness and visual impairment in India and the world. Both diseases do not have any early warning symptoms, and once the symptoms appear, the diseases are reasonably advanced. Because of the long-standing nature of the diseases, one cannot adopt the cataract detection and treatment model so successfully developed in India. It requires an altogether different approach for screening and related infrastructure including human capital development. The solutions developed to reduce the burden of DR/glaucoma should be customized to urban, semi-urban, and rural areas. Greater advocacy, improving the health-seeking behavior, development of infrastructure and skilled personnel appropriate for the points of care, and an emphasis in comprehensive eye care are some of the solutions.
ABSTRACT
We report a patient who presented with endocapsular capsule tension ring (CTR) in iridocorneal angle leading to secondary angle closure glaucoma (ACG) and subsequent removal of the CTR from trabeculectomy ostium. Secondary ACG was diagnosed 2 years and 6 months after cataract surgery in which a CTR was used for zonular instability. CTR removal with trabeculectomy was performed, after which there was the resolution of symptoms. To the best of our knowledge, this is the first case report in which CTR was removed from trabeculectomy ostium. We describe a surgical technique to explant CTR and combining with trabeculectomy.