Benefits of an Android Based Tablet Application in Primary Screening for Eye Diseases in a Rural Population, India.

To investigate the effectiveness, efficiency and cost gains in collecting patient eye health information from remote rural villages of India by trained field investigators through an Android Based Tablet Application namely 'Sankara Electronic Remote Vision Information System (SERVIS)". During January and March 2016, a population based cross-sectional study was conducted in three Indian states employing SERVIS and manual method. The SERVIS application has a 48-items survey instrument programed into the application. Data on 281 individuals were collected for each of these methods as part of screening. The demographic details of individuals between both screening methods were comparable (P>0.05). The mean time (in minutes) to screen an individual by SERVIS was significantly less when compared to manual method (6.57±1.46 versus 11.93±1.53) (P<0.0001). The efficiency of SERVIS in screening was significantly evident as 26% (n = 73) of the patients screened have been referred to campsite and 69.8% (n = 51) of those referred were visited the campsite for a detailed eye examination by an ophthalmologist. The cost of screening through SERVIS is significantly less when compared to manual method; INR 7,633 (USD 113.9) Versus INR 24,780 (USD 370). SERVIS is an effective and efficient tool in terms of patients' referral conversion to the camp site leading to timely detection of potential blinding eye conditions and their appropriate treatment. This ensures timely prevention of avoidable blindness and visual impairment. In addition, the storage and access of eye health epidemiological quality data is helpful to plan appropriate blindness prevention initiatives in rural India.

The impact of successful cataract surgery on quality of life, household income and social status in South India.

BACKGROUND: To explore the hypothesis that sight restoring cataract surgery provided to impoverished rural communities will improve not only visual acuity and vision-related quality of life (VRQoL) but also poverty and social status. METHODS: Participants were recruited at outreach camps in Tamil Nadu, South India, and underwent free routine manual small incision cataract surgery (SICS) with intra-ocular lens (IOL) implantation, and were followed up one year later. Poverty was measured as monthly household income, being engaged in income generating activities and number of working household members. Social status was measured as rates of re-marriage amongst widowed participants. VRQoL was measured using the IND-VFQ-33. Associations were explored using logistic regression (SPSS 19). RESULTS: Of the 294 participants, mean age ± standard deviation (SD) 60 ± 8 years, 54% men, only 11% remained vision impaired at follow up (67% at baseline; p<0.001). At one year, more participants were engaged in income generating activities (44.7% to 77.7%; p<0.001) and the proportion of households with a monthly income <1000 Rps. decreased from 50.5% to 20.5% (p<0.05). Overall VRQoL improved (p<0.001). Participants who had successful cataract surgery were less likely to remain in the lower categories of monthly household income (OR 0.05-0.22; p<0.02) and more likely to be engaged in income earning activities one year after surgery (OR 3.28; p = 0.006). Participants widowed at baseline who had successful cataract surgery were less likely to remain widowed at one year (OR 0.02; p = 0.008). CONCLUSION: These findings indicate the broad positive impact of sight restoring cataract surgery on the recipients' as well as their families' lives. Providing free high quality cataract surgery to marginalized rural communities will not only alleviate avoidable blindness but also - to some extent - poverty in the long run.

Regular provision of outreach increases acceptance of cataract surgery in South India.

OBJECTIVES: The prevalence of visual loss and blindness from cataract remains high in India. Marginalized communities are frequently reached through outreach clinics. The aim of this study was to explore the hypothesis that regular outreach, held in the same location by the same provider, leads to greater acceptance of cataract surgery than outreach clinics that are irregular in terms of timing and location. METHODS: The study was integrated into outreach clinics run in two districts by Sankara Eye Centre, Coimbatore, Southern India. A semi-structured questionnaire was administered to patients who had attended outreach eye clinics and either accepted or not accepted the offer of cataract surgery. RESULTS: Overall acceptance of surgery was high (91.7%), being higher in the district with regular outreach (94.6%vs. 82.3%, P < 0.001). A total of 398 participants (240, 60% acceptors) were interviewed. Acceptors were more likely to live in smaller households and in supportive families than non-acceptors who lived in larger families which could not provide support and where transport and distance were also barriers (P .001). Attending regular outreach and having had first eye cataract surgery were independent predictors of acceptance in a logistic regression model. CONCLUSION: The findings indicate the importance of providers building trust by organizing regular outreach in the same location. Previous eye surgery was also a strong predictor of accepting cataract surgery. To promote universal access to health care, marginalized rural communities will continue to need outreach for some time to come.

The impact of the severity of vision loss on vision-related quality of life in India: an evaluation of the IND-VFQ-33.

PURPOSE: To validate the 33-item Indian Vision Functioning Questionnaire (IND-VFQ-33), a vision-specific scale, and determine the relationship between the severity of vision impairment (VI) and vision-related quality of life (VRQoL). METHODS: In this cross-sectional, observational study 273 participants with VI from cataract were recruited from a South Indian eye hospital. Participants underwent a clinical examination and completed the IND-VFQ-33 scale. The psychometric properties of the IND-VFQ-33 and its subscales were assessed using Rasch analysis, exploring key indices such as instrument unidimensionality, discriminant ability, and targeting of item difficulty to patient ability. RESULTS: Rasch analysis demonstrated the validity of the IND-VFQ-33 to assess VRQoL through four subscales (i.e., vision-specific mobility, activity limitation, psychosocial impact, and visual symptoms), but not as an overall measure. In adjusted multivariate analysis models, those with severe VI and blindness reported significantly poorer vision-specific mobility and activity limitation (mean change, -18.82, P = 0.007 and -29.48, P < 0.001, respectively) compared with those with no VI. These decrements in vision-specific functioning were both clinically significant. Lack of schooling and schooling up to completion of primary school were associated with poorer vision-specific mobility and visual symptoms, respectively. CONCLUSIONS: Using a psychometrically valid IND-VFQ, only severe VI and blindness led to a clinically meaningful decline in vision-specific mobility and activity limitation. This finding reflects the current protocol for cataract surgery referral in developing or transitional countries, where priority is given to patients with at least moderate to severe VI.