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      Near-vision impairment and effective near-vision spectacle coverage in two districts in Telangana, India: a population-based cross-sectional study

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          Abstract

          Objectives

          To investigate the prevalence of near-vision impairment (NVI) and effective spectacle coverage for near vision in those aged ≥40 years in Khammam and Warangal district in Telangana, India.

          Design

          A population-based cross-sectional study.

          Setting

          Khammam and Warangal district in Telangana, India.

          Participants

          Of 6000 people enumerated, 5357 were examined (89%). 4526 participants without distance vision impairment were included in the analysis.

          Main outcome measures

          The study teams visited selected households and conducted eye examinations. NVI was defined as binocular presenting near vision worse than N6. ‘Unmet need’ was deemed to be present if the unaided near vision was worse than N6 and improved to N6 with near correction among the participants who did not have spectacles for near vision. ‘Met need’ was deemed to be present when unaided near vision was worse than N6 but improving to N6 with their spectacles. The ‘undermet need’ was deemed to be present when aided near vision was worse than N6 but improved to N6 with correction. Based on these definitions, e-near-vision coverage (%) is calculated as follows: e-NVC (%)=met need/(met need+undermet need+unmet need) × 100.

          Results

          The mean age was 53.5 years (SD: 10.8 years), 2534/4526 (55.8%) were women, 1819/4526 (41.8%) had at least primary school education and 2368/4526 (52.3%) were from the Khammam district. The prevalence of NVI was 55.8% (95% CI 72.5 to 75.1; n=3343). Overall, the e-NVC (%) was 31.8%. It was 40.0% in Khammam and 23.2% in Warangal.

          Conclusion

          NVI is common in Khammam and Warangal districts in Telangana with inadequate effective near-vision coverage. Effective service delivery models are needed to reach out and provide services to address NVI to achieve universal eye health coverage in the region.

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          Most cited references39

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          Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis.

          Contemporary data for causes of vision impairment and blindness form an important basis of recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modelling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020.
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            Global vision impairment due to uncorrected presbyopia.

            To evaluate the personal and community burdens of uncorrected presbyopia. We used multiple population-based surveys to estimate the global presbyopia prevalence, the spectacle coverage rate for presbyopia, and the community perception of vision impairment caused by uncorrected presbyopia. For planning purposes, the data were extrapolated for the future using population projections extracted from the International Data Base of the US Census Bureau. It is estimated that there were 1.04 billion people globally with presbyopia in 2005, 517 million of whom had no spectacles or inadequate spectacles. Of these, 410 million were prevented from performing near tasks in the way they required. Vision impairment from uncorrected presbyopia predominantly exists (94%) in the developing world. Uncorrected presbyopia causes widespread, avoidable vision impairment throughout the world. Alleviation of this problem requires a substantial increase in the number of personnel trained to deliver appropriate eye care together with the establishment of sustainable, affordable spectacle delivery systems in developing countries. In addition, given that people with presbyopia are at higher risk for permanently sight-threatening conditions such as glaucoma and diabetic eye disease, primary eye care should include refraction services as well as detection and appropriate referral for these and other such conditions.
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              Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience

              Blindness is a major global public health problem and recent estimates from World Health Organization (WHO) showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS) provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP). It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI) developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion) in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2021
                5 April 2021
                : 11
                : 4
                : e047131
                Affiliations
                [1 ]departmentBrien Holden Institute of Optometry and Vision Science , L V Prasad Eye Institute , Hyderabad, India
                [2 ]departmentWellcome Trust, Department of Biotechnology India Alliance , L V Prasad Eye Institute , Hyderabad, India
                [3 ]departmentSchool of Optometry and Vision Science , University of New South Wales , Sydney, New South Wales, Australia
                [4 ]departmentAllen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care , L V Prasad Eye Institute , Hyderabad, India
                Author notes
                [Correspondence to ] Dr Srinivas Marmamula; sri.marmamula@ 123456lvpei.org
                Author information
                http://orcid.org/0000-0003-1716-9809
                http://orcid.org/0000-0002-8698-5562
                Article
                bmjopen-2020-047131
                10.1136/bmjopen-2020-047131
                8030469
                33820793
                e7efecdc-c393-4cf0-af89-7b750878b7f5
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 20 November 2020
                : 27 February 2021
                : 16 March 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100011238, Lions Clubs International Foundation;
                Award ID: SF 1943/UND
                Funded by: FundRef http://dx.doi.org/10.13039/501100005809, Hyderabad Eye Research Foundation;
                Award ID: NA
                Categories
                Ophthalmology
                1506
                1718
                Original research
                Custom metadata
                unlocked

                Medicine
                epidemiology,public health,ophthalmology
                Medicine
                epidemiology, public health, ophthalmology

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