Methods for a population-based Comprehensive Eye care Workload Assessment (CEWA) study in Southern India

Eye care programs, in developing countries, are often planned using the prevalence of blindness and visual impairment, often estimated from Rapid Assessment of Avoidable Blindness (RAAB) surveys. A limitation of this planning approach is that it ignores the annual overall eye care requirements for a given population. Moreover, targets set are arbitrary, often influenced by capacity rather than need. To address this lacunae, we implemented a novel study design to estimate the annual need for comprehensive eye care in a 1.2 million populations. We conducted a population-based longitudinal study in Theni district, Tamil Nadu, India. All permanent residents of all ages were included. We conducted the study in three phases, (i) household-level enumeration and enrollment, (ii) basic eye examination (BEE) at household one-year post-enrollment, and (iii) assessment of eye care utilization and full eye examination (FEE) at central locations. All people aged 40 years and above were invited to the FEE. Those aged <40 years were invited to the FEE if indicated. In the main study, we enrolled 24,327 subjects (58% aged below 40 years and 42% aged 40 years and above). Of those less than 40 years, 72% completed the BEE, of whom 20% were referred for FEE at central location. Of the people aged ?40 years, 70% underwent FEE. Our study design provides insights for appropriate long-term public health intervention planning, resource allocation, effective service delivery, and designing of eye care services for resource-limited settings.

Regurgitation on pressure over the lacrimal sac versus lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries

Purpose: To determine the diagnostic accuracy of manual regurgitation on pressure over the lacrimal sac (ROPLAS) versus lacrimal irrigation for screening nasolacrimal duct obstruction (NLDO) in adults prior to intraocular surgeries. Methods: This cross-sectional study took place in a tertiary eye care hospital in South Tamil Nadu, India. From January to December 2017 and included consecutive patients who presented for routine cataract surgery. Prospective data collection occurred in 8369 eyes of patients who underwent cataract surgery. All patients underwent ROPLAS testing by an ophthalmologist followed by lacrimal irrigation by trained ophthalmic assistants, rechecked or confirmed in equivocal cases by ophthalmologists who were masked to the ROPLAS status. The primary outcome, the sensitivity, specificity, positive, and negative predictive values to detect lacrimal occlusion by ROPLAS compared with lacrimal irrigation with 95% confidence intervals was estimated. Results: A total of 8369 eyes underwent cataract surgery during the time periods of the study. ROPLAS and lacrimal irrigation were performed in all eyes. The sensitivity of ROPLAS to diagnose NLDO correctly was 54.5% (95% CI, 44.8%�.9%) and its specificity was 100% (95% CI, 100%�0%). The positive and negative predictive values were 75.3% (95% CI, 65.6%-83.0%) and 99.4% (95% CI, 99.2%�.5%), respectively. Conclusion: We found that ROPLAS when used alone had very low sensitivity and low positive predictive value in detecting NLDO prior to cataract surgery as compared with lacrimal irrigation. Hence, we recommend performing ROPLAS and lacrimal irrigation in every patient as part of the routine preoperative workup prior to cataract surgery

Quality of life after community-based rehabilitation for blind persons in a rural population of South India.

This study aimed to determine the impact of community-based rehabilitation on the quality of life of blind persons in a rural south Indian population. We performed a population-based survey followed by clinical examinations to identify blind persons in a rural south Indian population. Pre-and-post rehabilitation quality of life of 159 blind persons aged 15 years or above was ascertained through a questionnaire previously validated for use in this population. Post-rehabilitation quality-of-life scales showed some improvement for 151 (95.0%) subjects. The additional benefit from rehabilitation was greatest for the self-care and mobility subscales, ranging from 24.6% to 30.0% for the self care subscale and 37.6% to 44.3% for the mobility subscale with effect sizes of 21.5 and 2.38 respectively. Overall quality of life scores were not significantly different between those who did and did not receive economic rehabilitation (P = 0.1). Blind persons in this rural population benefited considerably from rehabilitation services even if economic rehabilitation is not provided. Initiatives against blindness need to consider rehabilitation of the blind as a priority.

Utilization of community-based rehabilitation services for incurably blind persons in a rural population of southern India.

PURPOSE: To identify barriers in utilisation of community based rehabilitation (CBR) services for incurably blind persons in rural South India. METHODS: A community-based rehabilitation programme for incurably blind persons was initiated in Theni district of southern Tamil Nadu in south India. After door-to-door enumeration and preliminary ocular screening by trained workers at the village, identified blind persons were categorised as either curable or incurable by an ophthalmologist. Trained workers provided rehabilitation, including mobility training (OM), training to perform activities of daily living (ADL), and economic rehabilitation for the incurably blind in their respective villages. RESULTS: Of the 460,984 persons surveyed, 400 (0.09%) were certified as incurably blind including 156 (39.00%) persons blind from birth. Social rehabilitation was provided for 268 (67.00%) incurably blind persons. Economic rehabilitation was provided to 96 persons, and integrated education to 22 children. Nearly one-fifth (n=68, 17.00%) of incurably blind persons refused the services provided. The major reasons for refusal included old age and other illnesses (41.18%), and multiple handicaps (19.12%). Twenty-seven (6.75%) persons had either migrated or died, and 29 (7.25%) persons were already able to function independently. CONCLUSION: Although CBR programmes provide useful services to the incurably blind, a better understanding of barriers is required to improve service utilisation. Developing a standardised data collection format for every CBR programme can result in the creation of a national database of ophthalmic diseases.