Rapid survey for assessing effective cataract surgical coverage (eCSC) and effective refractive error coverage (eREC)-Novel indicators of universal eye health.

PURPOSE: As per the recent World Health Organization estimates, approximately 2.2 billion people have near and distance vision impairment (VI) globally, and out of this almost 50% is avoidable. METHODS: The Rapid Assessment of Avoidable Visual Impairment survey was a cross-sectional study conducted in September 2021, using cluster random sampling in 42 clusters with a cluster size of 140, giving a total of 6000 participants. Two teams comprising of trained optometrists and social workers conducted the ocular examination which included unaided, pinhole, and aided visual acuity assessments followed by examination of the anterior segment and lens. Distance visual acuity was measured using simplified tumbling "E" charts of different sizes for VA of 6/12, 6/18, and 6/60. The lens assessment was done in an un-dilated pupil with torch light by the optometrist. RESULTS: Overall, 6520 individuals aged 6 years and above were enumerated, of whom 5440 (83.4%) were examined. The response rate for examination was better among females (93.1%) than males (73.9%), and it decreased from 93.8% in the age group 6-15 years to 77.1% in the 45+ age group. The prevalence of blindness and VI were 0.18% (95% CI: 0.06-0.29) and 4.19% (95%CI: 3.65-4.72), respectively. The major causes of VI in all age groups were uncorrected refractive error (65.4%), cataract (23.7%), cataract surgical complications (2.6%), corneal opacity (0.4%), and other posterior segment diseases (7.5%). The effective cataract surgical coverage (eCSC) was 61.8%, effective refractive error coverage (eREC) for distance vision was 59.8%, and eREC for near vision was 47.0%. CONCLUSION: The RAAVI methodology is suitable to measure effective coverage in the general population, both for baseline measurement and periodic monitoring. The 2030 targets for the surveyed district are 90% eCSC and 100% eREC. Such exercises need to be conducted in each district of the country to determine the baseline and target values of effective coverage.

Assistive technology: The current perspective in India.

The world, today, recognizes the increasing importance of assistive technology (AT) that can reduce the functional limitations of persons with disabilities, individuals with chronic debilitating diseases, and elders. This indicates that at some point, everyone, either temporary or permanent, will require AT to improve their physical and functional abilities, thus contributing to independent living, social inclusion, and education. Besides this, the need for AT will be growing with a majority from low-middle-income countries. The same is true for India though we are not sure how many people have met a need, and unmet need for AT to date, but the requirement will continue to increase. There is a significant gap between needs and access to AT. Recently, the WHO has led many initiatives related to AT services after the 71st World Health Assembly's resolution in 2018, to improve access to AT for its member states. The UN Sustainable Development Goals (SDGs) have pledged that no one should be left behind irrespective of personal characteristics. India, a ratified member state, needs to align with various initiatives undertaken by the WHO and the UN. Despite many challenges, India needs to formulate evidence-based AT policy, planning within the purview of the healthcare delivery system in collaboration with various government and nongovernment sectors, including industries. This article explores the need, access, and potential challenges associated with AT services in India. Finally, we discussed various initiatives on AT in the country and possible recommendations to improve AT services across.

Prevalence and causes of low vision in a population-based study on childhood visual impairment in North India (CHVI 4).

Purpose: The present study was a population-based study to determine the prevalence and causes of low vision in children less than 16 years in North India. Methods: This cross-sectional study was conducted in 40 clusters of urban Delhi. Children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. All children with visual acuity of <6/12 in any eye in the age group between 3 and 15 years and inability to follow the light in age less than 3 years were referred for detailed ophthalmic examination in a centrally based clinic. Cycloplegic examination and best-corrected visual acuity (BCVA) were assessed. They were examined by an ophthalmologist to determine the prevalence and causes of functional low vision (FLV). The prevalence of FLV was compared with other population-based studies across India and other parts of the world. Results: Amongst 20,955 children examined for visual acuity, 789 children were referred to the central clinic for detailed ophthalmic examination. The overall prevalence of low vision was 0.62 per 1,000 children (95% confidence interval [CI] 0.12-1.90). The main anatomical cause of low vision was retinal abnormalities. Conclusion: Although the prevalence of children with low vision decreased as compared to previous population-based studies. There is an important need to create awareness among parents on appropriate and timely usage of low-vision devices (LVDs) at an affordable cost to improve the visual quality in children with low vision.

A study to assess the knowledge and skills of Accredited Social Health Activists and its retention after training in community-based primary eye care.

PURPOSE: Community volunteers like Accredited Social Health Activists (ASHAs) could be utilized for linking community and eye care services. Research is needed to effectively utilize them. This study was to assess whether ASHAs could imbibe new knowledge in eye care and conduct vision screening. METHODS: Settings and Design: A pre-post-intervention study in South Delhi Integrated Vision Centres. It was conducted from January 2016 to March 2017. One day of conceptual training followed by hands-on training in vision screening was imparted to ASHAs. The knowledge was assessed thrice: before, immediately after, and following 1 year after training. The vision screening skill was assessed twice. Descriptive analysis using percentages, mean and standard deviations. Paired t-test was used for assessing the change in scores. RESULTS: A total of 102 ASHAs were recruited. A significant increase in the knowledge score of ASHAs before (14.96) and after training (25.38) (P < 0.001) was noted. The knowledge score was sustained at 1 year (21.75). The satisfactory skill of vision screening was seen in 88 (86.3%) ASHAs after training, while 79 (77.5%) ASHAs still retained it after 1 year. CONCLUSION: The potential to involve ASHAs in community-based frontline eye care activities: awareness generation of eye diseases, identification of referrable conditions, and facilitating individuals to seek eye care facilities. This study informs about the duration, frequency, and content of the training. It also provides evidence on the improvement and sustainability of eye care knowledge and skills by ASHAs after conceptual and hands-on training.

Diabetic retinopathy screening in the public sector in India: What is needed?

India has been witnessing an epidemic of diabetes for several years now. A large proportion of patients with undiagnosed and poorly controlled diabetes are at great risk of developing diabetic retinopathy (DR) and irreversible blindness. The goal of DR screening is to identify people with sight-threatening DR early so that prompt treatment can be initiated, and blindness can be prevented. Systematic DR screening is essential to identify disease early, and a national effort for the same is required. We adopt a health system approach to outline the actions that need to take place for effective DR screening in the public sector in India. We discuss the role of national leadership, needs assessment, finalization of DR screening and referral pathway, trainings, strategies to improve the uptake, allocation of roles and responsibilities, public-private partnerships, quality control, and financing.

Current status of trachoma in India: Results from the National Trachoma Prevalence Survey.

Purpose: In the mid-twentieth century, trachoma was endemic in the northwestern states of India. We aimed to generate recent estimates of prevalence of trachomatous inflammation, follicular (TF) and trachomatous trichiasis (TT) in ten suspected-endemic districts across seven previously hyper-endemic states and union territories for trachoma in India including Delhi, Rajasthan, Haryana, Punjab, Gujarat, Uttarakhand and the Andaman and Nicobar Islands. Methods: Population-based prevalence surveys were undertaken in 10 districts. In each of those districts, two-stage cluster sampling was used to select a sample of 2000 children aged 1-9 years and all adults aged ≥15 years in the enumerated households from a total of 20 clusters per district. Consenting eligible participants were examined for trachoma by trained ophthalmologists using the World Health Organization's simplified grading system. Data were analyzed at the district level. Results: A total of 13,802 households were surveyed in which 19,662 children were examined for TF and 44,135 adults aged ≥15 years were examined for TT. District-level TF prevalence in 1-9-year-olds ranged from 0.1% in Bikaner (95% CI: 0.01-0.3) to 2.1% in Dholpur (95% CI: 1.6-2.8) and that of trichiasis ranged from 0.7 per 1000 in Pauri Garhwal (95% CI: 0.01-1.4) to 22.1 per 1000 (95% CI: 15.8-28.4) in Car Nicobar. In four districts (Car Nicobar, Dholpur, Hoshiarpur, Tonk), trichiasis prevalence in adults aged ≥15 years was ≥0.2%. Conclusion: TF was not a public health problem in any of the districts surveyed; thus, antibiotic mass drug administration is not needed. However, TT among adults was found to be above 0.2% in four districts; thus, further trichiasis surgery interventions at the public health level are warranted to achieve elimination. These findings will facilitate planning for elimination of trachoma as a public health problem in India.

Developing a disability inclusive model for low vision service.

The current practice for low vision management in India exclusively focuses on clinical aspects without much of the rehabilitation components. While making all efforts to improve independent living skills, daily living activities, and quality of life as a whole for people living visual disabilities, vision rehabilitation is an indispensable component. There is no single appropriate low vision and rehabilitation model implementable at health care institutions in the country to cover these fundamental aspects of a visually impaired individual. We did a literature review to know the existing practices of low vision and various disability models. The purpose of the review is to discern any pitfalls and shortcomings in managing visually disabled in India and to underpin the credibility and feasibility as well as suitability of the developed model. The review was done using search key terms low vision, current practices, visual disability, disability models, vision rehabilitation, and service delivery. Therefore, the article discusses the development of an inclusive low vision management model name as "Clinico-Social Model", which we consider the most appropriate for the best management of people with vision loss. The primary aim of this model is to provide both clinical and vision rehabilitation components of management for people with visual disabilities. Such an approach is likely to have the potential to improve the quality of life of people with vision loss and can provide practical guide to eye care managers across India. Given the specific context in the current practices of low vision in India, it is desirable to design a similar model to care for the visually disabled.

Prevalence of diabetic retinopahty in India: Results from the National Survey 2015-19.

PURPOSE: Diabetes mellitus (DM) and diabetic retinopathy (DR) contribute to ocular morbidity and are emerging as diseases with significant public health impact. Our aim was to assess the countrywide prevalence of DR and sight-threatening DR (STDR) among persons with diabetes and to evaluate the coverage of DR examinations among them. METHODS: The present survey was planned to estimate the burden of DR in the population aged ≥50 years for assisting in the planning and prioritization of diabetic eye services. For this survey, 21 districts with a high prevalence of DM were selected among the 31 districts where the national blindness and visual impairment survey was conducted. The total sample size was 63,000 people aged 50 years and above. DR was assessed by dilated fundus examination with indirect ophthalmoscope and was graded according to Scottish DR grading. STDR included severe nonproliferative DR, proliferative DR, and clinically significant macular edema. RESULTS: The prevalence of diabetes in the surveyed population was 11.8%. Among them, one-third were newly diagnosed DM, that is, diagnosed at the time of the survey. The study revealed that the prevalence of DR among persons with diabetes was 16.9%, the prevalence of STDR was 3.6%, and the prevalence of mild retinopathy was 11.8%. Risk factors for DR in the current study were duration of diabetes (>10 years, OR 4.8, 95% CI: 3.3-6.9), poor glycemic control (≥200 mg/dL, OR: 1.5, 95% CI: 1.2-1.7) and insulin treatment (OR: 2.6, 95% CI: 1.7-4.1). CONCLUSION: The current study highlights the substantial burden of DM and DR in India and the critical need to adopt a coordinated and multisectoral approach to reduce their prevalence. There is a need for early identification of persons with diabetes and their routine screening for DR along with availability of treatment facilities.

Impact of COVID-19 pandemic on people living with visual disability.

People living with visual disabilities/impairment are more likely vulnerable to get contracted from the severe acute respiratory syndrome coronavirus-2 (SARS-CoV 2) than people without visual impairment. This means more than 253 million people globally will be at higher risk of affecting by the COVID-19. The current pandemic, followed by a nationwide emergency lockdown to slow the unprecedented spread of the virus, will have a serious impact on people living with visual disabilities and even endangers their lives in the long run. Many restrictive and control measures, including the adoption of new behavioural changes (for example, social distance during outdoor movement, limiting touch or tactile contact) recommended by the government will pose immense challenges to individuals with a visual loss. This serious impact, including challenges in healthcare access, can be minimized through inclusive service approaches, involving persons with visual disabilities, caregivers, family members, and healthcare providers, along with the community to a large extent, and finally, support to improve the overall outcomes. The government, along with profit or non-profit private sectors, should consider initiating such inclusive approaches while planning responses to the pandemic. Indeed, the present COVID-19 pandemic provides an opportunity for health care planners and decision-makers of various organizations across India for a reformation of disabilities care. Impacts due to the pandemic and lockdown can be reduced substantially if planning and policy are in place before any emergency happened in the future.

Community eye-health and vision center guidelines during COVID-19 pandemic in India.

The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has disrupted our society on an unprecedented scale since its inception in December 2019. As the health-care system is finally re-organizing to mitigate the impact of the pandemic, it was necessary to re-structure primary eye care (PEC) activities as well on the same lines. A consensus meeting was held with leading eye-care experts on 2nd May 2020 to prepare a roadmap for PEC in the days to come. Guidelines are needed for PEC activities like vision testing, refraction, optical dispensing, counseling, etc., Some of the activities at vision centers (VCs) may be postponed or modified in light of the current pandemic situation. PEC workers need to strictly follow social distancing norms (minimum 3 feet) for minimizing risk of exposure and need access to appropriate personal protective equipment (PPE), like gloves, masks and shields while examining beneficiaries. For optometrists, sterilization of instruments and encouraging the people to remain silent during the examination is recommended. Because conjunctivitis may be an early sign which can present at VCs, extra precautions in the form of PPE has to be ensured while examining such patients. This is also an opportunity to start running telemedicine clinics for all emergent cases that cannot be managed at the primary level. The guidelines also need to be updated based on the context of the working environment and changes in government directives from time to time.