The Mobile Teleophthalmology Unit in Rural and Underserved Areas of South India

Objective: Our objective was to provide an eye care service to rural and underserved areas in Chennai, Kanchipuram, and Thiruvallur districts of Tamil Nadu, South India. Design: We conducted eye camps to provide ophthalmic services to the underserved and rural areas, where people cannot afford to go to a hospital due to lack of accessibility, lack of awareness, or financial constraints. Setting: The study was conducted in rural and underserved areas of Thiruvallur, Chennai, and Kanchipuram districts from January 2015 to December 2019. Participants: Patients (N = 1,05,827) underwent comprehensive eye examination in eye camps with the state-of-art ophthalmic equipment. Main outcome measures: To report on the number of patients examined, number of eye disorders screened, and different types of ocular pathology screened, all clinical findings were recorded and all ocular images were uploaded in the electronic medical records. All patients with ocular diseases underwent teleconsultation with an ophthalmologist at the base hospital with internet connectivity. Video conferencing and teleconsultation were feasible only in areas with good internet connectivity. Results: Over the 5-year study period, 1,05,827 patients underwent eye evaluation at 1,061 eye camps. Among these, 48,354 (45.7%) patients were males, 57,473 (54.3%) patients were females, 15,515 patients were emmetropes. The most common cause of avoidable blindness was uncorrected refractive error detected in 66,137 eyes, referable cataract was seen in 13,536 eyes, 2,491 eyes were identified to have retinal diseases, and there were 789 patients with only diabetic retinopathy, thus totaling to 3,280 comprising of all retinal disease. 2424 patients received teleconsultations. For further investigations and treatment, which were provided free of cost, patients were referred to the base hospital in Chennai. There were 6,309 patients who received free spectacles and an additional 31,192 patients received spectacles at a low cost; 13,536 patients had referable cataract and were referred to the base hospital for further evaluation and surgery. Conclusions: Teleophthalmology holds great potential to overcome barriers, improve quality, access, and affordability to eye care, and has proven to be an innovative means of taking comprehensive eye care facilities to the doorsteps of rural India.

Measuring equity of access to health services in practice: test and application of existing measuring tools in eye health outreach camps in rural Malawi

Introduction: Equity in the access and use of health services is critical if countries are to make progress towards universal health coverage and address the systematic exclusion of the most vulnerable groups. The purpose of this study was to test the feasibility of existing wealth measurement tools and functional disability questions to assess if the Co-ordinated Approach To Community Health programme implemented by Sightsavers was successful in reaching the poorest population and people living with disabilities in Kasungu district, Malawi. Methods: Between April and September 2017, data on socio-economic status, household characteristics and functional disability were collected from patients attending at eye camps in Kasungu district, Malawi. Using asset-based tools to measure household wealth (EquityTool© and Simple Poverty Scorecard©) and the Washington Group Short Set of Questions, individuals were categorised by wealth quintiles, poverty status, and functional disability status and then compared to relevant representative national household surveys. A follow-up household survey was conducted to check the validity of self-reported household characteristics at eye camps. Results: A total of 1,358 individuals participated in the study. The study shows that self-reported data on household characteristics and assets are reliable and can be collected in clinical settings (instead of relying on direct observations of assets). Individuals attending outreach camps were poorer in terms of relative wealth and absolute poverty rates compared to the rest of the population in Kasungu. It was estimated that 9% of the participants belonged to the poorest quintile compared to 4% for the population in Kasungu (DHS 2015-2016). The ultra-poverty rate was also lower among respondents (13%) compared to 15% for Kasungu district (IHS 2017). The functional disability rate was 27.5% for study participants, and statistically higher than the general population (5.6%, SENTIF 2017). Conclusions: Our study shows that existing tools can be reliably used, and combined, if based on recent population data, to assess equity of access to health services for vulnerable groups of the population. The findings suggest that the programme was successful in reaching the poorest people of the Kasungu district population as well as those with disabilities through outreach camps. However, it is essential to use sub-national data (district or regional level) from recent surveys for the purpose of benchmarking in order to produce accurate results.

Efficiency of mobile eye camps for providing combined eye and vision care in underserved areas in Uttarakhand

To report eye examinations findings and cost-efficiency of mobile eye and vision care screening in underserved areas in north India. The Aloka Vision Program combines optometrical and ophthalmological screening as mobile eye camps with organized referrals to local eye hospitals. 402 people from urban (N = 191) and rural (N = 211) areas in the district of Uttarakhand, India, were screened for refractive error (RE), visual acuity (VA) and eye health. Statistical analysis was performed using ANOVA model and odd ratios. Costs were estimated based on the expenses of the camps. 44 % of the participants were male and 56 % were female and the age ranged from 7 to 72 years (urban) and 7 to 80 years (rural). Lack of accessibility of eye care was mentioned by 10% of the urban and 47% of the rural participants, why not attending regular vision test. Mild and severe visual impairment VA < 0.5 logMAR affected every fifth person, independent from the living environment. RE showed a myopic trend for the urban environment (Δ M = 0.67 D, p = 0.11). The risk for blindness was three times higher in rural compared to the urban area, mainly caused by cataract. The major costs are given by the treatments (58 %), followed by mobilization and organization (∼30 %), whereas personal costs are low (∼11%). Combined eye and vision care models reduce costs for separated screening’s organization and thus can increase the effectiveness of eye screening programs significantly.

CATARACT & OTHER CO MORBIDITIES – STUDY FROM NORTH INDIA.

Background: Rural areas are away from medical facilities & these areas catters more than 3/4th of Indian populations. Thus, eye care services need to be planned & executed in these areas. Aim: To determine the prevalence of other ocular and systemic co-morbidities among the camp selected cataract patients in rural areas. Methodology: The present observational study was conducted at postgraduate department of Ophthalmology of GMC Jammu & involved patients from various eye camps selected for ECCE (SICS with PC-IOL implantation surgery). Total of 84 patients were participated in the study. Detailed history was taken from the patient & relevant ocular & systemic examination was done.Routine investigations were also done. Results: The most frequently occuring systemic co-morbidities was hypertension i.e.36.9% followed by back pain in 32.1% in the present study. The ocular co-morbities other than cataract were diabetic retinopathy in 4.8%, glaucoma in 3.6% etc. Among other ocular co morbidity, optic atrophy, amblyopia, chorioretinal atrophy, macular scar etc were noted. Conclusion: From present study it has been concluded that large number of patients who came to seek ocular treatment in eye camps has systemic co morbidities also. Thus, other specialities should also be part of team of eye camp so that along with eye other comorbidities should also be treated. Key words: Cataract, Ocular co-morbidities, Systemic co-morbidities.

Ophthalmic services during ongoing conflict: the eye health system in Yemen

There is little information on the provision of ophthalmic services and the eye health system in Yemen. Using the WHO framework for analysing health systems, we aim to assess what is known about the current eye health system in Yemen with ongoing conflict. Financial constraints, transportation difficulties and security instability are barriers for many of Yemen’s people in need of healthcare. The most recent cataract surgical rate reported in 2012 is 2473 operations per million population, with an increase in operations performed in charity eye camps and the private sector. We identify many governorates of Yemen have inadequate ophthalmic resources. We describe the need for short-term solutions to reduce the backlog prevalence of blindness while local infrastructure is rebuilt, and the importance of long-term reconstruction and transition to local ownership with a sustainable workforce and health service as peace is restored.