Cross-sectional study of prevalence, causes and trends in visual impairment in Nirmal District, Telangana, India: Nirmal Eye Evaluation for Trends study.

OBJECTIVE: To determine the prevalence, causes and risk factors associated with visual impairment (VI) in the Nirmal district of Telangana, India, using extended Rapid Assessment of Visual Impairment (RAVI) methodology. DESIGN: Cross-sectional study. SETTING: Community setting. PARTICIPANTS: Participants aged ≥16 years were enumerated from 90 randomly selected clusters and 4629/5400 (85.7%) participants were examined. Presenting visual acuity (VA) was assessed using a Snellen chart with E optotypes at a 6 m distance. Near vision was assessed binocularly using an N notation chart with tumbling E optotypes at a 40 cm distance. An anterior segment examination done followed by distance direct ophthalmoscopy at 50 cm. Non-mydriatic fundus images were obtained. VI was defined as presenting VA worse than 6/12 in the better eye. The prevalence of VI in the current study was compared with a RAVI study conducted in 2014 to assess the trends in VI among those aged ≥40 years. PRIMARY OUTCOME: Prevalence, causes and risk factors for VI. RESULTS: Among those examined, 55% were women, 53% had at least school-level education, 2.3% self-reported diabetes and 8.7% self-reported hypertension. The prevalence of VI was 8.81% (95% CI 8.01% to 9.67%). Overall, uncorrected refractive errors (49.5%) were the leading cause of VI, followed by cataracts (40.2%) and posterior segment diseases (4.9%). Among those aged ≥40 years, the prevalence of VI declined by 19.3% compared with the 2014 baseline study (from 20.2% to 16.3%; p<0.01). CONCLUSION: The extended RAVI study conducted in the Nirmal district showed a considerable decline in the prevalence of VI. Targeted interventions are needed to provide adequate eye care for the high-risk groups in this district.

Near vision impairment and effective refractive error coverage for near vision in Andhra Pradesh, India - The Akividu Visual Impairment Study (AVIS).

CLINICAL RELEVANCE: Near Vision Impairment (NVI) is common in developing countries. A substantial proportion of NVI can be addressed by providing spectacles. Innovative eye care programmes are needed to address NVI. Population-based epidemiological studies can provide vital data to plan such eye care service delivery models. BACKGROUND: To report the prevalence of NVI and effective Refractive Error Coverage (eREC) for near vision in West Godavari and Krishna districts in Andhra Pradesh, south India. METHODS: A population-based cross-sectional study was carried out using a Rapid Assessment of Visual Impairment methodology. Presenting and pinhole distance visual acuity were assessed followed by near vision assessment using a N notation chart at a fixed distance of 40 cm. If the presenting near vision was worse than N8, the best corrected near visual acuity was recorded with age appropriate near vision correction. NVI was defined as presenting near vision worse than N8 among those without distance vision impairment (6/18 or better in the better eye). Effective Refractive Error Coverage for near was calculated as the proportion of individuals with an adequate correction to the total participants, including those with inadequate, adequate, and no correction for near vision. RESULTS: Data of 2,228 participants aged ≥40 years were analysed. The mean age of these participants was 54.0 ± 10.4 years; 53.8% were women; 44.5% had no formal education. The prevalence of NVI was 27.1% (95% CI: 25.2-29.0%). NVI significantly associated with 70 and above age group (adjusted OR: 1.97; 95% CI: 1.45-3.70). Participants with formal education had lower odds for NVI (adjusted OR: 0.75; 95 % CI: 0.68-0.83). The eREC for near vision was 48.0%. CONCLUSION: NVI affects over a quarter of people aged ≥40 years in the West Godavari and Krishna districts of Andhra Pradesh. However, eREC is under 50% and there is scope for improving this by establishing eye care services to achieve universal eye health for all.

Analysing the effectiveness of Just-A-Minute Optometry Clinical Pearls: a micro-learning tool in continuing optometry education.

CLINICAL RELEVANCE: Just-A-Minute Clinical Pearls as a microlearning concept may be beneficial in enhancing optometry and ophthalmology practice globally. BACKGROUND: Medical education often witnesses a gap in effectively translating the learnings into clinical practice, pointing to the complex and traditional teaching methods as hindrances. The present work studied the usefulness and acceptability of Just-A-Minute Optometry Clinical Pearls, a micro-learning tool, among optometrists and ophthalmologists. METHODS: Just-A-Minute Optometry clinical pearls were developed by the optometry team of LV Prasad Eye Institute and shared (via email) among optometrists and ophthalmologists on a daily basis between June 2021 to May 2022. In the middle of the project, the recipients were invited to participate in an online survey. The variables studied included frequency of checking clinical pearls, simplicity of their content, grasping speed, most used subspeciality pearls, knowledge gain and retention, practice applicability, overall learning experience, and the likelihood of recommending it to a friend. RESULTS: Among 150 respondents, 103 (68.7%) were ophthalmologists, and 46 (30.7%) were optometrists. The majority were from private (n = 64, 42.7%) and institutional (n = 48, 32%) practices, with 102 (68.4%) having more than five years and 21 (14%) having 2-5 years of experience. About 115 (77%) respondents checked clinical pearls every day, 147 (99%) found the format easy, and 131 (88%) could grasp the content within one minute. They felt that JAM-OCP 'always' enhanced clinical knowledge (n = 108, 72%) and clinical applicability (n = 82, 55%) and helped in knowledge retention (n = 123, 84%). The responses to the clinical application significantly varied (Chi-square tests) among subgroups of education qualification (p < 0.001) and practice types (p < 0.03). CONCLUSIONS: The Just-A-Minute Optometry Clinical Pearls were beneficial to optometrists and ophthalmologists in their practices. This, as a tele-education tool, supports continuing optometry education across the globe.

Prevalence, pattern, and compliance with spectacles use among the elderly in homes for the aged in South India: The Hyderabad Ocular Morbidity in Elderly Study (HOMES).

Purpose: This study was conducted to report on the pattern of spectacles use and compliance among the elderly (aged ≥60 years) in homes for the aged in Hyderabad region in Telangana State, India. Methods: Participants were recruited from 41 homes for the aged centres for comprehensive eye health assessments. A questionnaire was used to collect information on current and past use of spectacles, type of spectacles, spectacles provider and amount paid for the spectacles. For those that reported using spectacles in the past, information was collected on the reasons for their discontinuation. Compliance with spectacles use was assessed after eight months of provision of the spectacles. Results: A total of 1182/1513 participants were examined from 41 homes for the aged in Hyderabad, India. The mean age of the participants examined was 75 years (standard deviation (SD): 8.8 years; range: 60-108 years); 764 (64.6%) of them were women and 240 participants (20.3%) had no formal education. The prevalence of spectacles use was 69.9% (95% confidence interval [CI]: 67.1-72.4; n = 825). Bifocals were the most commonly used type of spectacles (86.7%) followed by single vision glasses for distance vision (7.4%). Private eye clinics were the largest service provider (85.5%) followed by local optical outlets (6.9%) and other service providers (7.7%). The prevalence of spectacles compliance was 81.5% (211/259). Conclusion: Use of spectacles and compliance are high among the elderly living in residential care homes in the Hyderabad region. Spectacles use can be further improved by periodic eye assessments along the lines similar to school eye programs, which can immensely benefit this vulnerable, aged population.

Asymmetric Peripheral Refraction Profile in Myopes along the Horizontal Meridian.

SIGNIFICANCE: The investigation of peripheral refraction profiles in Indian myopes showed relative peripheral hyperopic refraction in temporal retina and possible dominant role of hyperopic defocus signals from temporal retina in the development of myopia. PURPOSE: Considering that the peripheral refraction profiles were extensively reported to be associated with the central refractive error and vary among different ethnicities, we investigated the peripheral refraction profiles in Indians. METHODS: A total of 161 participants aged between 18 and 33 years were included in the study. All of the eligible participants underwent a comprehensive eye examination. Central and peripheral refractions were determined using an open-field autorefractor in 10° intervals up to ±30° in the horizontal meridian, and in 5° intervals up to ±15° in the vertical meridian. Axial length and central corneal radius were measured using a non-contact optical biometer. Peripheral refraction was compared between the different refractive error groups and myopic subgroups. RESULTS: Myopes showed a significant asymmetrical peripheral refraction profile along horizontal meridian with relative peripheral myopia at nasal 30° and relative peripheral hyperopia at temporal 30° (mean ± standard error at N30°: -0.37 ± 0.13 D vs. T30°: +0.56 ± 0.11 D, P < .05). Emmetropes and hyperopes showed relative peripheral myopia both in nasal and temporal eccentricities. Relative peripheral refraction was significantly different between the refractive groups and myopic subgroups along the temporal retinal eccentricities only (P < .05). Along the vertical meridian, relative peripheral myopia was seen among the three refractive error groups (P < .05). J0 and J45 significantly changed with retinal eccentricity along both the meridians in all the refractive error groups (P < .05). CONCLUSIONS: Myopes showed an asymmetric type of peripheral refraction with relative hyperopic defocus in temporal retina and myopic defocus in the nasal retina. Possible role of retinal hyperopic defocus along temporal retina in myopiogenesis needs to be explored.

A Population-Based Cross-Sectional Study of Visual Impairment in West Godavari and Krishna Districts in Andhra Pradesh: Akividu Visual Impairment Study (AVIS).

PURPOSE: To report the prevalence and causes of visual impairment (VI) among those aged ≥40 years in West Godavari and Krishna districts in Andhra Pradesh, India. METHODS: Trained teams visited the households in the selected clusters and conducted eye examinations. Presenting visual acuity (PVA) was assessed for distance and near. Torchlight examination was conducted to assess the anterior segment. Non-mydriatic retinal images were also obtained. VI was defined as PVA worse than 6/18 in the better eye. It included Moderate VI (PVA worse than 6/18 to 6/60), Severe VI (PVA worse than 6/60 to 3/60) and Blindness (PVA worse than 3/60). Multiple logistic regression analysis was conducted to assess the risk factors for VI. RESULTS: In total, 2587/3000 (86.2%) participants were examined. Of this, 1406 (54.4%) were women and 1224 (47.3%) had no education. The age- and gender-adjusted prevalence of VI was 12.8% (95% CI: 11.5-14.1). Compared to the 40-49-year age group, the odds of having VI among those aged 50-59 years, 60-69 years and ≥70 years were 2.93 (95% CI: 1.91-4.52), 6.53 (95% CI: 4.31-9.91) and 17.45 (95% CI: 11.50-26.46), respectively. Those respondents who had no education had a higher odds (OR: 1.73; 95% CI: 1.34-2.23) of VI compared to those who were educated. Cataract (62.4%) and uncorrected refractive errors (29.8%) were the leading causes of VI. Over 90% of the VI was due to avoidable causes. CONCLUSION: VI is a major public health challenge in Andhra Pradesh. Over 90% of this burden is avoidable and can be eliminated by low-cost interventions such as spectacles and cataract surgery.

Population-based assessment of prevalence of spectacle use and effective spectacle coverage for distance vision in Andhra Pradesh, India - Akividu Visual Impairment Study.

CLINICAL RELEVANCE: Effective spectacle coverage is a useful indicator to assess the coverage of refraction services in a given region. We found a low coverage in the Akividu region suggesting a need to develop effective refraction services. BACKGROUND: To assess the prevalence of spectacle use and effective spectacle coverage for distance vision among people aged 40 years and older in the Indian state of Andhra Pradesh. METHODS: A population-based cross-sectional survey was carried out in the Akividu region in West Godavari and Krishna districts. The study teams visited selected households and conducted eye examinations in the selected clusters. A structured questionnaire was used to collect information on spectacle use. 'Met Need' was defined as unaided VA worse than 6/12 but improved to 6/12 or better with their current spectacles. 'Unmet Need' was defined as unaided VA worse than 6/12 but improved to 6/12 with pinhole, among those not using spectacles. The 'Under-met Need' was defined as aided VA worse than 6/12 but improving with pinhole to 6/12 or better. Based on these definitions, Effective Refractive Error Coverage (e-REC) is calculated as: e-REC (%) s = ((met need)/(met need + under-met need + unmet need)) X100. RESULTS: Of 3,000 enumerated from 60 clusters, 2,587 (86.2%) participants were examined. The prevalence of current spectacle use was 43.1% (95% CI:41.2-45.0). The e-REC was 37.4%. It was also lower in men compared to women and among those without any education. Participants who had cataract surgery in either eye had similar e-REC compared to those who were not operated. CONCLUSION: Though spectacle use was found to be high, there is a still large unmet need for refractive correction for distance. Effective service delivery models to provide refraction and spectacle dispensing services are needed to achieve universal eye health coverage in the region.