Making the decision to donate eyes: Perspectives from the families of the deceased in Madurai, India.

PURPOSE: To identify factors affecting family members' decision whether to donate eye organs. METHODS: A community-based case-control study based on in-home interviews with families of deceased individuals who had or had not donated eye organs, in Madurai district, Tamil Nadu, India. Data collected were knowledge and awareness of eye donations, whether the deceased individual had expressed or pledged willingness to donate, and family members' attitudes and willingness to donate their own eye organs. RESULTS: Seventy-six families of donors and 256 families of non-donors completed the survey. Multivariable analysis showed that the following variables were significantly associated with a donation: age, whether the deceased had registered for eye donation, pre-expressed willingness of deceased to donate, whether family members personally know beneficiaries of eye donations, and higher score on a scale evaluating knowledge and awareness about eye donation. The majority of donors' families (71%) had been encouraged by someone to donate. Among non-donor families, a substantially larger fraction (52.8%) indicated they would have donated had someone reminded or encouraged them to do so, in comparison with those who indicated lack of awareness or knowledge (14.5%). CONCLUSION: Community programs are likely to be effective if they encourage individuals to pledge their eyes or express their willingness to donate their eyes to family members in advance of death; they increase public awareness of the value of eye donation. A friend, family member, neighbor or counselor approaching bereaved families and having a dialogue about eye donation would substantially increase the probability of a decision to donate.

The key informant strategy to determine the prevalence and causes of functional low vision among children in South India.

PURPOSE: To report the prevalence and causes of functional low vision (FLV) in school-age children in Coimbatore District, Tamil Nadu, India and to report our experience using the key informant (KI) method in this setting. METHODS: Children suspected of having low vision were identified by KIs or Aravind Eye Hospital personnel in Coimbatore District. All identified children underwent a cycloplegic refraction and full eye exam. A primary cause of decreased vision was determined for each child. The prevalence of FLV was calculated for children 6-14 years old. Spectacles and low vision devices were provided free of charge. RESULTS: 345 children aged 6-14 years were referred and 231 had FLV. The positive-predictive value of KI referrals was 64.5%. The prevalence of FLV was 0.071% (7.1 per 10,000; 95% CI 0.062-0.080%) and ranged from 0.026% to 0.141% across the district's blocks. Older children (age 11-14 years; OR 1.41; 95% CI 1.09-1.82) and males (OR 1.52; 95% CI 1.16-1.98) had greater odds of being diagnosed with FLV. The most common causes of FLV were retinal disorders (30.0%) and amblyopia (25.5%). Low vision devices were provided to 169 children who had a mean near and distance visual acuity improvement of 0.31 and 0.63 logMAR, respectively (p < 0.001). CONCLUSIONS: This study reports a moderate prevalence of FLV and demonstrates the ability of KIs to identify school-age children with FLV in South India. The provision of basic low vision services can improve visual outcomes in this population.

Economic and social factors that influence households not willing to undergo cataract surgery.

PURPOSE: Literature investigating barriers to cataract surgery is mostly done from the patient's point of view. However, many medical decisions are jointly taken by household members, especially in developing countries such as India. We investigated from the household head's (or representative's) perspective, households' view on those not willing to undergo cataract surgery along with the economic and social factors associated with it. MATERIALS AND METHODS: A cross-sectional survey of four randomly selected village clusters in rural areas of Theni district, Tamil Nadu, India, was conducted to elicit the willingness to pay for cataract surgery by presenting "scenarios" that included having or not having free surgery available. The presentation of scenarios allowed the identification of respondents who were unwilling to undergo surgery. Logistic regression was used to estimate relationships between economic and social factors and unwillingness to undergo cataract surgery. RESULTS: Of the 1271 respondents, 49 (3.85%) were not willing to undergo surgery if they or their family members have cataract even if free surgery were available. In the regression results, those with good understanding of cataract and its treatment were less likely to be unwilling to undergo cataract surgery. Those not reporting household income were more likely to be unwilling to undergo cataract surgery. CONCLUSIONS: As a good understanding of cataract was an important predictor of willingness to undergo cataract surgery, health education on cataract and its intervention can improve uptake.

Household preferences for cataract surgery in rural India: a population-based stated preference survey.

PURPOSE: Cataract surgery is provided both by the private and public sector in India. Free cataract surgery (with minimal amenities) funded through subsidies/reimbursements by government and non-governmental organizations is provided for underprivileged and poor patients, especially in rural areas. However, no evidence exists whether this free surgery is used by those who could afford to pay and are willing to pay for cataract surgery. So, understanding willingness to pay and preferences for cataract surgery in the population can have important policy implications. METHODS: A cross-sectional survey of 1272 households from four randomly drawn rural household clusters in Theni district, Tamilnadu state, India was conducted. Respondents from households were presented with scenarios (with and without free surgery availability) to elicit their willingness to pay and preferences for cataract surgery. RESULTS: Of those willing to undergo surgery; 696 (57%) were willing to undergo paid surgery, 148 (12%) only free surgery, and 378 (31%) paid surgery if no free surgery was available. In a multinomial logit model, household wealth measures, income variables and family history of cataract surgery largely distinguished the preferences. Good understanding of cataract and its intervention only marginally influenced preference for paid surgery. CONCLUSION: A larger number of people were willing to pay when free surgery was not available. Free surgery may be crowding out surgery for which costs can be recovered. With non-cataract causes of blindness in the Indian population also requiring attention, this has implications for allocation of scarce resources.

Cluster randomized trial to compare spectacle delivery systems at outreach eye camps in South India.

PURPOSE: To study the optimal method for delivery of spectacles at eye camps to maximize procurement and use. METHODS: A cluster randomized controlled trial, undertaken in the catchment districts of Aravind Eye Hospital - Theni, in the state of Tamil Nadu, India. Community eye camps (n = 21) were allocated to offer one of three types of service for purchase of spectacles to correct refractive error: (1) Issuance of a prescription only; (2) booking orders for spectacles with subsequent delivery; (3) on-the-spot fitting and dispensing of spectacles. Follow-up questionnaires were administered 6 weeks after interventions to assess patient outcomes. The primary outcome measured was spectacle procurement at follow-up 6 weeks post-screening. Secondary outcomes included use of and satisfaction with spectacles. Reasons for purchase/non-purchase were also assessed. RESULTS: Compared to those who were issued only a prescription and adjusting for distance from base hospital, spectacle procurement was significantly higher for those allowed to book spectacles for subsequent delivery (odds ratio, OR, 8.79, 95% confidence interval, CI, 4.61-16.78) and for those receiving spectacles on the spot (OR 13.97, 95% CI 8.12-24.05). Among those with spectacles at 6 weeks, spectacle use was nearly universal and satisfaction with spectacles varied between 92 and 94% among the three different dispensing modalities. CONCLUSION: Making spectacles available on the spot is important to ensure procurement in a context where availability and access to dispensing opticians is poor.