Response of L V Prasad Eye Institute to COVID-19 outbreak in India: experience at its tertiary eye care centre and adoption to its Eye Health Pyramid

AIM:To summarize the experience of response to COVID-19 outbreak at a tertiary eye care institute and its network of health facilities in India.METHODS:Our responses are based on the principles of social distancing,hand hygiene,respiratory etiquettes,surface disinfection protocol,and rational use of appropriate personal protective equipment(PPE).We describe our response in terms of administrative controls,clinical protocols,staff protection,environmental controls,and social distancing measures.We also discuss our communication strategies and monitoring systems,to ensure compliance to protocols.RESULTS:Administrative control is mainly related to formation of task force and its functions.Clinical protocols are related to patient triaging methods and clinical examination guidelines in Outpatient,Inpatient and Operating Room.Staff protection is focused on training staff on the protocols to be followed in hospital as well as at home,and use of PPE.Environmental protocol is focused on cleaning and disinfectant methods to be used in the hospital.In addition,there are systems for communication as well as monitoring compliance to protocols.CONCLUSION:We hope that these protocols and our experience would help the ophthalmic community globally and serve as a guide to protect ophthalmologists and ophthalmic care personnel,and their patients across the world.     

One-year Profile of Eye Diseases in Infants (PEDI) in secondary (rural) eye care centers in South India

Purpose:The aim of this study was to report the proportion and patterns of eye diseases observed among infants seen at two rural eye care centers in South India.Methods:A retrospective review of case records of infants seen between January 1, 2017 and December 31, 2017 at two rural secondary eye care centers attached to L V Prasad Eye Institute, Hyderabad. Data were collected regarding their demographic profile, the pattern of eye problems observed, management at the facility itself, and need for referrals.Results:During this period, a total of 3092 children were seen. Among them, 141 were infants (4.56%, 71 boys: 70 girls, median age: 8 months). Twenty-five percent of infants were less than 6 months of age. The most common eye problem was congenital nasolacrimal duct obstruction (n = 76, 53.90%), followed by conjunctivitis (n = 33, 23.40%), retinopathy of prematurity (n = 4, 2.84%) and strabismus (n = 3, 2.13%). One case each of congenital cataract and suspected retinoblastoma were identified. Majority of the cases (58.8%) belonged to the oculoplastic and orbital surgery sub-specialty. Sixteen percent of the infants (n = 23) had sight-threatening eye problems. Twenty percent (n = 28) were referred to tertiary care hospital for further management.Conclusion:Profile of eye disease in infants in secondary or rural eye care centers ranged from simple to complex, including sight-threatening diseases. While our study concluded that nearly 4/5^th of these eye problems were simple and could be managed by a well-trained comprehensive ophthalmologist, 20% of these cases required a referral to a tertiary care center.     

Key factors determining success of primary eye care through vision centres in rural India: Patients' perspectives

Aim : This paper intends to discuss the patients' perspective on the determinants of primary eye care services from vision centers (VC) in rural India. Materials and Methods : A retrospective study design and interview method was used on 127 randomly selected patients who accessed the 4 VCs in 2007. Factor analyses and linear regression models were used to predict the associations with patient satisfaction. Results : The three factors derived from factor analyses were: (1)-vision technician (VT), (2)-location of VC, and (3)-access to VC; explaining 60% of the variance in total patients' satisfaction with VC. The first model (R2 : 0.61; F 1,124=144.36, P <0.001), indicated that respondents who had 'difficulty to travel to the place of VC' and those who can afford to pay had less satisfaction with VT services. The second model (R2 =0.18; F 1,124=29.5, P <0.001) explained that respondents' difficulty to identify the building of VC had decreased patients' satisfaction and the third model (R2 =0.36; F 1,124=45.6, P <0.001) indicated that those who had to travel<5 km to the VC and had 0.38 units of increased satisfaction level with the services of VC. Conclusion : A good VT can enhance patient satisfaction. However, patient expectations are not only confined to the provider but also other factors such as ability to pay and convenient transportation that helps patients reach the location of the VC with ease.     

The Duke Elder lecture: the challenge of equitable eye care in Pakistan

Purpose

Pakistan, like many other developing countries, is caught in the vicious cycle of poverty, illiteracy, violence, and disease. Right from its inception, it has been facing serious challenges of fast growing population, longevity, unemployment, wars, floods, double burden of diseases including blindness, as well as earthquakes, insurgencies, and political instability. Despite such challenges, the country has managed to reduce the burden of blindness from 1.78% in 1987-88 to 0.9% in 2003.This paper will highlight the methods used to achieve such a difficult goal.

Methods

The country used the report of the World Health Organization (WHO) temporary consultant as the initial tool for advocacy to obtain political and professional commitment. Results from the first National Blindness Survey 1987–1990 were used as baseline for development of the programme. Under the Ministry of Health, national and provincial committees with respective coordinators were constituted. To ensure access and equity, the national programme was developed on the basis of district comprehensive eye care services. The concept was carefully tested in a laboratory and then piloted in a real district before it was rolled over to the country. Strong national institutes for human resource development, research and development, and service delivery were established. A strong network of high-quality national institutes was set up and run by powerful national non-governmental organizations. The second National Blindness Survey evaluated the achievements of the programme in 2001–2003.

Conclusion

National prevalence of blindness was reduced by 100% by improving the uptake of services at the district level, especially by females.     

The role of optometrists in India: An integral part of an eye health team

India has a proud tradition of blindness prevention, being the first country in the world to implement a blindness control programme which focused on a model to address blinding eye disease. However, with 133 million people blind or vision impaired due to the lack of an eye examination and provision of an appropriate pair of spectacles, it is imperative to establish a cadre of eye care professionals to work in conjunction with ophthalmologists to deliver comprehensive eye care. The integration of highly educated four year trained optometrists into primary health services is a practical means of correcting refractive error and detecting ocular disease, enabling co-managed care between ophthalmologists and optometrists. At present, the training of optometrists varies from two year trained ophthalmic assistants/optometrists or refractionists to four year degree trained optometrists. The profession of optometry in India is not regulated, integrated into the health care system or recognised by the majority of people in India as provider of comprehensive eye care services. In the last two years, the profession of optometry in India is beginning to take the necessary steps to gain recognition and regulation to become an independent primary health care profession. The formation of the Indian Optometry Federation as the single peak body of optometry in India and the soon to be established Optometry Council of India are key organisations working towards the development and regulation of optometry.     

江苏省初级眼保健与防盲的调查研究

目的了解江苏省农村基层的眼保健与防盲工作状况。设计横断面调查研究。研究对象江苏省13个全国防盲先进县的34个乡76个村。方法对上述乡、村的防盲治盲人员、职责、业务、设备进行检查、评估,并作统计分析。主要指标按卫生部标准所规定的乡村初级眼保健与防盲的各项指标。结果所有乡、村达到或超过了卫生部颁布标准中有关组织网络、职责、设备指标。约50％的乡、村达到或超过了卫生部颁布标准规定的常见眼病的诊疗技术要求。部分乡、村存在统计报表不准确、白内障手术方法落后等不足。结论江苏省防盲先进地区的农村基层眼保健与防盲工作基本达到了卫生部颁布标准,但业务水平有待提高。(眼科,2006,15：355-358)     

Breaking down barriers to eye care for Indigenous people: a new scheme for delivery of eye care in Victoria

This report describes the implementation of and outcomes from a new spectacle subsidy scheme and de‐centralised care options for Aboriginal and Torres Strait Islander peoples in Victoria, Australia. The Victorian Aboriginal Spectacle Subsidy Scheme (VASSS) commenced in 2010, as an additional subsidy to the long‐established Victorian Eyecare Service (VES). The Victorian Aboriginal Spectacle Subsidy Scheme aimed to improve access to and uptake of affordable spectacles and eye examinations by Indigenous Victorians. The scheme is overseen by a committee convened by the Victorian Government's Department of Health and Human Services and includes eye‐health stakeholders from the Aboriginal community and government, not‐for‐profit, university and Aboriginal communities. Key features of the Victorian Aboriginal Spectacle Subsidy Scheme include reduced and certain patient co‐payments of $10, expanded spectacle frame range, broadened eligibility and community participation in service design and implementation. We describe the services implemented by the Australian College of Optometry (ACO) in Victoria and their impact on access to eye‐care services. In 2014, optometric services were available at 36 service sites across Victoria, including 21 Aboriginal Health Services (AHS) sites. Patient services have increased from 400 services per year in 2009, to 1,800 services provided in 2014. During the first three years of the Victorian Aboriginal Spectacle Subsidy Scheme program (2010 to 2013), 4,200 pairs of glasses (1,400 pairs per year) were provided. Further funding to 2016/17 will lift the number of glasses to be delivered to 6,600 pairs (1,650 per year). This compares to population projected needs of 2,400 pairs per year. Overcoming the barriers to using eye‐care services by Indigenous people can be difficult and resource intensive; however the Victorian Aboriginal Spectacle Subsidy Scheme provides an example of positive outcomes achieved through carefully designed and targeted approaches that engender sector and stakeholder support. Sustained support for the Victorian Aboriginal Spectacle Subsidy Scheme at a level that meets population needs is an ongoing challenge.     

The impact of COVID-19 “Unlock-I” on L V Prasad Eye Institute Network in Southern India

Purpose:The aim of this study was to report on the impact of COVID-19 “Unlock-I” on Network of Eye Centers in Southern India.Methods:Our eye health pyramid model has a network of eye care centers in four Indian states. The network constitutes a center of excellence (CoE) at the apex followed by tertiary care centers (TC) located in urban areas, secondary care centers (SC), and primary care vision centers (VC) at the base located in rural areas. We collected data on patients seen between June 2019 and June 2020, which included age, gender, total patients seen (new or follow-up), and socioeconomic status (paying and nonpaying). A comparative study was done between the data for outpatients and surgeries performed pre-COVID-19 and during Unlock-I in COVID-19 period.Results:There was a 36.71% reduction in the overall outpatients seen in June 2020 (n = 83,161) compared to June 2019 (n = 131,395). The reduction was variable across different levels of the pyramid with the highest reduction in CoE (54.18%), followed by TCs (40.37%), SCs (30.49%) and VCs (18.85%). Similar pattern was seen for new paying patients with the highest reduction in CoE (54.22%), followed by TCs (25.86%) and SCs (4.9%). A 43.67% reduction was noted in the surgeries performed in June 2020 (n = 6,168), compared to June 2019 (n = 10,950). Reduction in paying services was highest in CoE (47.52%), followed by TCs (15.17%) and SCs (4.87%). There was no significant change in the uptake of services by gender in the network.Conclusion:Highest reduction in patient footfalls during “Unlock-1” was noted in urban centers. Going forward, there is a need to develop strategies to provide eye care closer to the doorsteps.     

Eye care in Timor-Leste: a population-based study of utilization and barriers

Background: To determine utilization of Western‐style conventional health services for eye problems in Timor‐Leste, and barriers to seeking that care. Methods: An interview‐based questionnaire was administered as part of a population‐based cross‐sectional survey of 50 clusters (urban and rural) of 30 people aged ≥40 years. Results: Of 1470 people enumerated, 1414 were examined (96.2%). A total of 1293 (91.4%) reported at least one previous or present eye problem, mostly (88.6%) blurred/poor vision, for near and/or distance. Men (OR 1.6, 95% CI 1.1–2.3), literates (OR 2.1, 95% CI 1.4–3.5), urban dwellers (OR 4.1, 95% CI 2.6–6.4) and those in paid employment compared with being a farmer (OR 3.0, 95% CI 1.5–5.9) were more likely to have reported a problem. A total of 858 (66.4%) sought Western‐style care for its remedy. Non‐utilization was associated with being illiterate (OR 3.7, 95% CI 2.9–4.8), a rural dweller (OR 3.8, 95% CI 3.0–4.9), unemployed (OR 1.6, 95% CI 1.1–2.2) or a farmer (OR 5.2, 95% CI 3.5–7.6) compared with being in paid employment, having moderately impaired compared with non‐impaired near vision (OR 1.4, 95% CI 1.1–1.8), and red/itchy/painful eyes compared with blurred vision (OR 2.3, 95% CI 1.6–3.2), but not age, gender or poor distance vision. Lack of awareness of service availability was the most frequent reason for not seeking treatment (32.9%), especially for rural respondents. Attitudinal reasons were also prevalent (32.5%), with social (11.8%), economic (11.5%) and service‐related (9.0%) issues less so. Conclusions: If eye health is to improve in Timor‐Leste, there must be better appreciation of it, and increased availability, accessibilty and awareness of services.     

A survey of the availability of state-funded primary eye care in the UK for the very young and very old

BACKGROUND: The National Health Service (NHS) provides General Ophthalmic Services (GOS) to eligible patients in the UK. Nearly all community optical practices have a contract with the NHS via local primary care organisations (primary care trusts in England) allowing the practices to provide NHS sight tests to eligible patients. OBJECTIVE: To determine the accessibility of GOS sight tests for certain groups of patient in the UK. METHOD: A telephone survey was carried out to investigate the availability of GOS sight tests for two categories of eligible patient. A total of 200 primary eye care practices were randomly selected, of which 100 were telephoned to establish the availability of a sight test for a child aged 1 year whose mother is concerned due to the presence of a family history (parental) of strabismus. The other 100 practices were telephoned to investigate the availability of a sight test for a person aged 90 years who was described as having dementia. RESULTS: A total of 199 of the 200 practices provided GOS sight tests. The mean age at which practices declared that they start examining children was 3.1 years. Most (76%) practices recommended an eye examination for the 1-year-old child, but only 46% said that they would carry this out themselves. Of the other 100 practices telephoned across the country, 93% said that they could arrange an eye examination for the patient with dementia. DISCUSSION: Of the UK optical practices that participated in this study, 99.5% provide GOS sight tests. About half of these would not offer a GOS sight test to a 1-year-old child. It has been suggested that the GOS Terms of Service do not permit practitioners to exclude categories of patients from GOS services, although we argue that this interpretation is equivocal. Indeed, it is suggested that clinical and ethical reasons may sometimes require practitioners to decline to examine certain categories of patient. It is worrying that one quarter of practices did not recommend an eye examination for a young child with a family history of strabismus. It is hoped that a continuing education and training project will increase interest in paediatric optometry.     

Eye care seeking behavior among rural adults in South India: Tamil Nadu Rural Eye Examination (TREE) Study Report 1

Purpose:To present the eye care seeking behavior among rural adults in South India.Methods:This cross-sectional study was conducted between 2019 and 2020 covering three blocks of the Thiruvannamalai district, Tamil Nadu, India. Door-to-door survey was performed to collect demographic information, status of literacy, occupation, and details of previous eye examination. Distance visual acuity was tested for individuals available in the house using a log MAR (logarithm of minimum angle of resonance) chart. Association between demographic details, details of previous eye examination, and status of vision was analyzed using logistic regression.Results:A data of 12,913 individuals were included for the analysis, of which 6460 (50.03%) were females. Of the total individuals, 2007 (15.54%) had undergone an eye examination previously. There were 1639 (28.50%) people who had a vision less than 0.2 log MAR in at least one eye. The odds of reported ‘previous eye examination’ were more among females [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.32–1.66, P < 0.001]; individuals aged above 60 years [OR: 11.46, 95% CI: 9.44–13.91, P < 0.001], between 40 and 60 years [OR: 10.43, 95% CI: 8.85–12.30, P < 0.001], and between 18 and 40 years [OR: 2.48, 95% CI: 2.16–2.84, P < 0.001]; illiterates (OR: 1.76, 95% CI: 1.45–2.15, P < 0.001); and farmers (OR: 1.32 95% CI: 1.12–1.55, P = 0.001).Conclusion:The study presents the utilization of eye care among rural South Indian adults. Almost 84.46% of individuals had not undergone any eye examination. Robust measures to promote eye care management would help in effective utilization of eye care services among rural adults.     

眼部注射的安全问题与护理防范

目的:探讨眼部注射中存在的安全问题,降低护理操作风险。方法:眼部注射部位的准确。结果:在569只患眼眼部注射中,有161眼出现不同情况的不良反应。结论:提高护士眼部注射的风险责任性和安全操作,可保证患者得到有效的治疗,最大限度地减少不良反应的发生。     

Prevalence of Primary Glaucoma as Diagnosed by Study Optometrists of L. V. Prasad eye Institute – Glaucoma Epidemiology and Molecular Genetics Study

Purpose: To report the prevalence of primary glaucoma as identified by study optometrists of the L. V. Prasad Eye Institute – Glaucoma Epidemiology and Molecular Genetics Study (LVPEI-GLEAMS).

Methods: Two study optometrists and a total number of 3833 individuals participated in the LVPEI-GLEAMS. All subjects underwent a complete medical history and comprehensive eye examination including slit lamp photography, imaging of anterior and posterior segment, frequency doubling technology and standard automated perimetry including gonioscopy with a Sussman 4 mirror goniolens, post dilated evaluation of the optic disc and fundus was done with a 90 D lens by the study optometrist. A diagnosis of primary open angle glaucoma (POAG), primary angle closure suspect (PACS), primary angle closure (PAC), primary angle closure glaucoma (PACG), normal tension glaucoma (NTG), glaucoma/disc suspect or no glaucoma was made based on the clinical examination.

Results: Estimated prevalence of OAG (POAG and NTG) was 1.07% (0.74–1.39), PACS 2.03% (1.58–2.48), PAC 1.77% (1.35–2.19), PACG 0.21% (0.06–0.35) as identified by the study optometrists on site.

Conclusions: Prevalence of all the categories of primary glaucoma, as reported by the study optometrists of LVPEI-GLEAMS was comparable to previous findings of other regions in South India.     

人眼屈光状态的泛化理论及有效眼模式

目的：人眼的屈光状态可由一新理论来分析，此理论基于几种不同眼生长部位的比值与实验值比较的结果。方法：由光学成像理论可知，眼系统屈光状态可由眼轴长(L)，主平面(L2)及角膜及晶状体有效焦距(f1，f2)、曲率(r1，r2，R1，R2)及两者有效距离(S)来表示。比值Cl=X／f1，X／f2，L／r1，L／R1的理论值符合实验值。本研究同时介绍一种有效眼模式(EEM)，其由X，C1及C2来描述。结果：在正视态时，(Cl，C2)=(0．59，0．29)，(L／r1，L／R1)=(3．08，2．3)，(E1，E2)=(0．7l，0．29)。在标准范围内，各值为(单位：mm)，n=(29—34)，f2=(60-64)，S=(5．0-6．5)。本理论求得L*=(22—25)，而比值C1=(0．56—0．6)，C2=(0．27—0．31)；L／r1=(2．8—3．3)，L／R1=(2．1—2．5)；E1=S／(f1-S)=(0．65—0．75)，E2=S/f2=(0．27—0．32)。本研究理论值L／r1符合Hong等人所测的实验值(2．75—3．28)。结论：人眼的发展可由本研究理论统一描述，EEM含C1，C2，E1，E2四个比值，可用来预测人眼最有可能的生长趋势(正视及非正视态).