Population Based Assessment of Prevalence and Causes of Vision Impairment in the North-eastern State of Tripura, India - The Tripura Eye Survey.

PURPOSE: To report the prevalence and causes of vision impairment (VI) in a population aged ≥40 years from a state-wide survey conducted in the northeastern state of Tripura, India. METHODS: A population-based cross-sectional study was undertaken where a sample of 4500 people was selected using cluster random sampling methodology. A team comprising of an optometrist and field workers visited the households and conducted the eye examination that included visual acuity assessment, anterior segment examination including lens and fundus examination. VI was defined as presenting visual acuity <6/18 in the better eye and it included moderate VI (<6/18 to 6/60), severe VI (<6/60 to 3/60) and blindness (<3/60). RESULTS: In all, 4109/4500 (91.3%) subjects were examined from 90 clusters. Among those examined, 49.1% were men and 39.6% had no education. The age and gender-adjusted prevalence of VI was 8.7% (95% CI: 7.8-9.6). The prevalence of moderate VI was 6.2% (95% CI: 5.5-7.0), Severe VI was 1.0 (95% CI: 0.7-1.3) and blindness was 1.5% (95% CI: 1.1-1.9). On applying multiple regression analysis, the odds of having VI were higher in older age groups and among women. Overall, cataract was the leading cause of VI (54.5%) followed by uncorrected refractive errors (39.6%). CONCLUSIONS: VI is common affecting nine out of every hundred people aged ≥40 years in the state of Tripura. Over 90% of which is due to avoidable causes such as cataract and uncorrected refractive errors. Provision of cataract surgery and spectacles may result in a substantial reduction in VI in Tripura.

Hyderabad Ocular Morbidity in Elderly Study (HOMES) - Rationale, Study Design and Methodology.

Purpose: To describe the study design, interobserver variability of the questionnaires and clinical procedures of Hyderabad Ocular Morbidity in Elderly Study (HOMES) designed to, (a) to investigate the prevalence, causes and risk factors for visual impairment, and (b) to assess the impact of dispensing spectacles and cataract surgery on visual functions, fear of falls (FOF) and depression among the elderly in India.Methods: Individuals aged ≥60 years are considered elderly. The non-clinical protocol was administered by two trained investigators and included collection of personal, sociodemographic information, ocular and systemic history, Indian Visual Function Questionnaire (IND-VFQ33), Patient Health Questionnaire (PHQ9), Mini-Mental State Examination (MMSE) questionnaire, Hearing Handicap Inventory for the Elderly Screening (HHIE), Short Falls Efficacy Scale (SFES) questionnaire. The eye examination was conducted by a trained optometrist and vision technicians in clinics set-up in the homes and included visual acuity (VA) assessment for distance and near, anterior segment examination and fundus examination, and imaging. The reliability assessments were carried out among 138 participants.Result: The intraclass correlation (ICC) coefficients for MMSE, PHQ9, HHIE, SFES was 0.73 (95% CI: 0.62-0.81), 0.67 (95% CI: 0.54-0.77), 0.63 (95% CI: 0.48-0.74) and 0.70 (95% CI: 0.58-0.79) respectively. The ICC for INDVFQ domains ranged from 0.66 (95% CI: 0.55-0.74) for Psychosocial Impact to 0.88 (95% CI: 0.84-0.91) for activity limitation. The ICC for VA was 0.94 (95% CI: 0.92-0.96).Conclusion: All questionnaires demonstrated acceptable reliability and can be applied in the main study. HOMES is expected to provide data that will help plan strategies to contribute towards 'healthy aging' in India.