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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. [ABSTRACT FROM AUTHOR]

Explore door-to-door eye screening in India as a model to reach school age children in need of eye care, especially during school closures due to the Covid-19 pandemic. Children between 5 and 18 years were screened in an urban-slum of Delhi from September 2020 to March 2021. Screening included capturing ocular complaints, visual acuity and conducting a torchlight examination. Children with any eye-related complaints, gross abnormality or a LogMAR acuity of more than 0.2 in either eye were referred to the nearby vision centre. Data were disaggregated by gender and age group. Reporting after referral and proportion of true positives referrals were used to assess the model. 32,857 children were screened. 55% were boys. Only 917 children (2.8%) had previous eye examinations. 1814 (5.5%) children were referred. Overall compliance rate amongst those referred was 59% (1070 of 1814) and compliance was significantly higher (72%) amongst those referred with poor vision as compared to those with only ocular morbidities (38%). Overall compliance was significantly higher amongst older age group (64% vs 50%) and amongst girls than boys (61% vs 56%). 3.9% children were detected with refractive error (RE) and 2.5% with uncorrected RE which was significantly higher in girls and in older age group. Of 1070 children reporting after referral, 85% had confirmed diagnosis for RE or other ocular pathology. Door-to-door screening had good referral compliance and positive predictive value. We recommend this model as a supplement to school screening especially in regions with low enrolment and high absenteeism in schools. [ABSTRACT FROM AUTHOR]

Purpose: India has the largest population of youth in the world, thereby making them important contributors to the "India of Tomorrow". Over 80% of knowledge gained is by the visual sense, thereby making school screening programs a necessity in our country. Data from the pre-COVID era, that is, 2017–18 was collected from close to 19,000 children in Gurugram, Haryana, a tier two city in National Capital Region, India. A similar prospective observational study is planned post COVID-19 (2022–23) for further analysis to depict the impact of COVID-19 in these areas. Methods: The program They See, They Learn was set at government schools in the area of operations (district of Gurgaon, Haryana), where the children and their families were unable to afford eye care services. All children who were screened underwent a comprehensive eye examination at the school premises itself. Results: A total of 18,939 students were screened over a period of 18 months, covering a total of 39 schools in the Gurugram belt, in the first phase of the program. Eleven point eight percent (n = 2254) of all school students had some form of refractive error. Girl students were found to have a higher refractive error rate (13.3%) compared to boy students (10.1%) across the schools screened. Myopia was the most common type of refractive error. Conclusion: School students require perfect vision or else they can be discouraged and may become a major burden to the economy of any developing nation. A school screening program aiming at populations that cannot afford such basic needs like spectacles is a must in all zones of the country. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to create vision standards for various tasks performed by hairdressers and to assess the spectacle compliance and its impact at work.Methods: The observational cross-sectional study enrolled hairdressers in and around Chennai, Tamil Nadu. It was done in three phases: (i) Job profiling from visual task analysis, creating vision standards for various hairdressing tasks and arriving at test protocols; (ii) Comprehensive eye examination, and (iii) Assessment of spectacle compliance and its impact on work. Descriptive analysis using Microsoft Excel and SPSS (IBM SPSS Statistics Version 21.0) was performed.Results: There were 305 participants with a mean age of 48 (SD ± 12) years. The visual acuity demand was found to be 6/18 and N15, for distance and near, respectively. Appropriate spectacles were prescribed for 203 (67%) hairdressers. Even with the best possible refractive correction, a few hairdressers did not meet the distance (13) and near (11) visual acuity standard. In all, 54 hairdressers were referred for further examination to a tertiary eye care center for lenticular changes, retinal abnormalities, and glaucoma screening. Among the subjects who were dispensed with spectacles, 181 (86%) were available for telephonic spectacle compliance assessment, and 164 (90%) were compliant with spectacle usage at work. Improved visual ability was reported by 133 (81%) hairdressers at work.Conclusion: This study provides vision standards for hairdressers. From the visual task analysis, hairdressing tasks were found to be visually demanding and hazardous. The study emphasizes that providing appropriate spectacle correction showed a clinically evident positive impact at work. [ABSTRACT FROM AUTHOR]

Background: Optometrists with different levels of optometric education in India provide eye care services under various capacities to the public. Aim: The study evaluated the status of optometrists in terms of their knowledge, skills and frequency of skill utilisation in public and private sectors. Setting: A quantitative study design was adopted using a survey questionnaire that was distributed to optometrists providing eye care services in public and private sectors. Methods: A structured and validated questionnaire with closed-ended questions was administered to 650 participants. Results: A total of 400 completed questionnaires were received (response rate = 62%) of which 207 respondents were males (52%) and 193 females (48%). Most (57%) of the respondents were bachelor's degree holders with 86% of the respondents in the private sector and 14% in the public sector. The knowledge level of ancillary and diagnostic tests (69%) was the least amongst public sector optometrists whilst it was binocular indirect ophthalmoscopy (66%) for private sector optometrists. The skill levels in indirect ophthalmoscopy was least amongst the public sector (56%) and private sector (44%) optometrists. Indirect ophthalmoscopy showed the least frequency of skill utilisation amongst public sector (13%) and private sector (34%) optometrists. Conclusion: The study highlighted the need for mandating best practice standards, and expanding the scope of defined practice, as optometrists are better suited for diagnostic roles and comprehensive eye examinations, and can contribute effectively towards averting preventable blindness. [ABSTRACT FROM AUTHOR]

Purpose. This study describes the development of an attachment for a smart tablet to stream live video information of an eye examination through the slit lamp. Methods. A tablet attachment was developed that enables the live streaming of video from the slit lamp from the rural vision centers of the LVPEI network. A video streaming solution like Skype Lite was used to transmit the same. The eyeSmart app was utilized for the documentation of the clinical information of the patients. Results. A tablet attachment of eyeSmart Cyclops was developed and piloted in 3 vision centers of the LVPEI network. Conclusion. The use of real-time video transmission illustrates a novel teleophthalmology solution in low resource settings to screen rural populations. The ability to transmit live video enables gathering more information than static images. [ABSTRACT FROM AUTHOR]

Purpose: To study the frequency and intraoperative difficulties associated with pseudoexfoliation (PXF) syndrome at a tertiary eye care center in a rural central India.Methods: This study included patients scheduled for cataract surgery who were diagnosed with PXF syndrome. All patients underwent a complete ophthalmologic evaluation, including slit-lamp examination, tonometry, gonioscopy, and ophthalmoscopy before the surgery. Cataract surgeries were performed by a single surgeon who reported the intraoperative difficulties.Results: In total, 1022 phakic eyes of 1823 patients were evaluated, 226 of whom (22.1%) were diagnosed with PXF syndrome. Most eyes (n = 81, 35.8%) with PXF syndrome were ≥81 years old. Eighty-six eyes (38.1%) had bilateral involvement, whereas 70 (30.9%) had right or left eye involvement. Further, PXF material was distributed on the iris, pupil, and lens in 70 eyes (30.9%) and on the pupillary margin in 36 eyes (15.9%). The mean pupillary dilation was 5.1 (±1.4) mm in patients with PXF syndrome compared with 7.2 (±1.6) mm in those without it (P = 0.03). Grade VI cataract was observed in 93 eyes (41.2%) and hypermature cataract was the most commonly observed cataract stage. Twenty-one eyes (9.3%) had increased intraocular pressure. Intraoperative difficulties were encountered in 62 eyes (27.4%) with poor pupillary dilation being the most common problem (32 eyes, 14.2%), followed by zonular dehiscence (18 eyes, 8%).Conclusion: This hospital-based study showed that PXF syndrome is common in Indian rural population and that the intraoperative complication rate in these patients is high. [ABSTRACT FROM AUTHOR]

India has done well in eye care delivery by recognizing visual impairment and blindness as a major medical challenge. Major contributions have come from ophthalmologists (mass cataract surgery in the early 1900s; major participation of non-government organizations), policy makers (National Program for Control of Blindness and Visual Impairment 1976; systematic development under the World Bank assisted India Cataract Project, 1995-2002), and the industry (manufacturing of affordable surgical instruments and medicines). Although the country could boast of higher cataract surgical coverage and near-total elimination of trachoma, there is increasing prevalence of diabetic retinopathy and undetected glaucoma. India is in the crossroad of adherence to old successful models of service delivery and adoption of new innovative methods of teaching and training, manpower development and skill-based training, relevant medical research and product development. In the absence of these new approaches, the initial gains in eye care could not be furthered in India. A new approach, that will combine the best of the "old" tradition of empathy and the "new" technology of analytics, is required to imagine the future of eye care in India. [ABSTRACT FROM AUTHOR]

Palash Eye Hospital was established with the aim of providing free eye care to the poor and affordable treatment to individuals with paying capacity in Calicut district of the State of Kerala in Southern India. Starting as the only specialty eye hospital of its kind in 1999, the hospital had grown over the last 10 years. It was operated on a cross-subsidy model where revenues from paid services were used for providing free treatment and funding expansion plans. The hospital was being managed by Palash Eye Care Trust while its community outreach activities were being handled by Palash Eye Care Society. With the entry of new commercial eye hospitals in the region, the hospital was facing competition for skilled resources and was falling behind on efficiency. The growth of the hospital was not accompanied with a corresponding development of structures and processes. The hospital was being run on the basis of informal relationships which could not be depended upon to manage a growing enterprise. Administrative control of the hospital lay in the hands of the Trust and Society members and was not shared with the medical staff. This had resulted in dissatisfaction on the part of doctors who wanted to be involved in the hospital administration in order to professionalize and increase hospital efficiency. Consequently, a conflict of interests emerged between the Trust and Society members on the one hand and the doctors on the other. Lack of established operating processes, career growth avenues, and reward and recognition systems was also creating discontent among the paramedical staff. At the same time, the failing health of the founder chairman was not allowing him to be actively involved in the hospital activities. Being a member of both the Trust and the Society, he was managing the interests of both groups in the hospital. In view of his decreased role, the problem of developing new interlocking mechanisms between the Trust and the Society was surfacing. [ABSTRACT FROM AUTHOR]

Aims To assess the willingness to utilise follow-up eye care services among participants of community vision screenings in rural villages surrounding Chennai. Methods Vision screening participants aged ⩾40 years were selected by systematic sampling and were invited to respond to a pretested verbal survey with close-ended questions before undergoing screening. Results Two hundred and ninety-two people responded. Among the respondents, 50.3% reported experiencing an eye problem, and 53% of these individuals had never had an eye examination. Acceptance rate for eye surgery, medications, and eyeglasses among the respondents was 59.2%, 52.7% and 90.8%, respectively. These acceptances were not associated with sex, age, or employment; medication acceptance was inversely associated with literacy. Surgery acceptance and medication acceptance were associated with area of residence. Presence of another chronic disease was a predictor for surgery acceptance among respondents experiencing eye problems. Conclusions Maintaining consistent quality of services delivered is crucial for increasing uptake of existing eye care services. Educational interventions may increase eye care service usage by targeting all demographic subgroups of rural populations equally. Additional interventions should be offered to patients without previous exposure to the healthcare system. [ABSTRACT FROM AUTHOR]

Introduction: Age-related macular degeneration (AMD) is among the fourth leading cause of blindness in India after cataract, refractive errors and glaucoma. Aim and Objective: To find out magnitude and determinants of blinding AMD among patients presenting at a tertiary level eye care centre in Dehradun with this condition. Material and methods: This was a study of eye patients above age 45 years seen from July 2010 to October 2013. After taking preliminary information, optometrist noted the best-corrected vision. Ophthalmologists examined eyes using a slit-lamp bio-microscope. AMD was confirmed by fluorescein angiography and optical coherence tomography. The age, sex, history of smoking, sun exposure, family history of AMD, diet, body mass index (BMI), history of hypertension, dyslipidemia and diabetes were noted. Results: Of the 14,698 patients seen, 221 had AMD (dry or wet) in at least one eye, the overall proportion of AMD being 1.50%. Of all AMD patients, 103 had blinding wet AMD (46.61%).Further analysis revealed that old age (71-80 years), male sex and history of hypertension, diabetes etc were significant risk factors of wet AMD. Of the 221 patients with AMD, nearly a third, that is 71 patients (32.13%) had visual acuity of better eye < 3/60, which was taken as criteria for blindness. Conclusions: AMD does not seem to be a problem of public health magnitude in the study area. Age, being male, history of hypertension, diabetes etc are significant risk factors for wet AMD. [ABSTRACT FROM AUTHOR]