Barriers and enablers to low vision care services in a tertiary eye care hospital: A mixed method study.

PURPOSE: Visual impairment is a major health concern all over the world. Globally, it has been studied that utilization of low vision care (LVC) services varies from 3% to 15%. This study describes barriers to access the LVC services and suggest enablers to improve the uptake of services in a tertiary eye care hospital. METHODS: A snapshot qualitative research design with purposive sampling was adopted. Qualitative part of the study involved 13 eye care practitioners (ECPs) and 7 patients with low vision participated in one to one in-depth interviews. The interviews were audio recorded, transcribed, inductively coded, and analyzed. The barriers to access LVC services were identified and enablers to improve the uptake of services were implemented. The referral rate and utilization of LVC services were analyzed in the quantitative part. RESULTS: Themes emerged out of qualitative part of the study were barriers, perceived benefits, and enablers to improve the uptake of LVC services. Barriers among ECPs included lack of awareness on referral criteria and available LVC. Barriers among patients were lack of knowledge and understanding about the need for services. The enablers included development of referral criteria and referral pathway to LVC services, creating awareness of LVC services to patients and ECPs, stratification levels of LVC services, and implementation of LVC counseling chamber. Referral rate improved from 25.6% to 51.2% and the utilization of services increased from 67.9% to 81.7% after implementation of the recommended enablers. CONCLUSION: Execution of stratified enablers increased the uptake of LVC services benefiting more number of people with low vision in this study.

Photosystem II acclimation to limiting growth light in fully developed leaves of Amaranthus hypochondriacus L., an NAD-ME C4 plant.

A remarkable acclimation strategy was exhibited by Photosystem II when fully mature Amaranthus hypochondriacus L. plants grown at light sufficient (2000 µE m(-2) s(-1)) conditions were transferred to light limited environment (650 µE m(-2) s(-1)). There was a two pronged response of PS II to low growth light both by way of modulating the size of LHC II to offset the decrease in excitation energy capture and by decreased synthesis of reaction centre protein, D1 the later through depressed level of transcription of psbA gene. The molecular regulation of PS II under low light stress is discussed.