Vision Centres Research Articles

Transforming healthcare with integrated inter-professional education in a research-driven medical school

Singapore, located strategically at the meeting point of the Malacca Strait and the South China Sea, has established itself as a global financial and economic hub. Despite its small geographical size, Singapore is home to over 5 million people from diverse cultural backgrounds. The city-state’s medical education landscape has evolved significantly over the past century. Originally, Singapore had only one undergraduate medical school, the NUS Yong Loo Lin School of Medicine, established in 1905. Over time, this institution has grown into Singapore’s largest and oldest medical school. NUS Medicine’s vision centres on developing highly competent, values-driven, and inspired healthcare professionals to transform the practice of medicine and improve health worldwide. A curriculum overhaul in 2020 introduced new educational components to prepare future healthcare professionals for the challenges of Singapore’s resilient healthcare system. This includes proficiency in integrated care, collaboration across disciplines, and leveraging AI and data science in clinical decision-making. The introduction of a common curriculum in August 2023 for Medicine, Nursing, Dentistry, and Pharmacy undergraduates further aligns with Singapore’s 'Healthier SG' vision, ensuring that graduates are well-equipped to meet the evolving needs of the healthcare landscape. The common curriculum aims to address professional hierarchies and foster interprofessional collaboration among students from diverse academic backgrounds. By promoting frequent interaction and a team-oriented mindset, the curriculum seeks to instil a collective approach to healthcare, emphasising the importance of interprofessional practice in achieving the broader goals of healthcare delivery. This paper describes the reforms that took place and how the challenges were mitigated in a research-intensive top-ranked academic medical institution. This strategic alignment of medical education with national healthcare priorities underscores NUS Medicine’s commitment to transforming medical practice and improving health outcomes in Singapore and beyond.

Awareness, knowledge and challenges faced by beneficiaries and non-beneficiaries of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana with special reference to eyecare in three districts of Uttar Pradesh state: A cross-sectional study.

The aim was to analyse the knowledge and awareness regarding Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) within the operational districts of two high-volume non-profit eye organisations in Uttar Pradesh. Challenges faced by beneficiaries and non-beneficiaries are also examined. A prospective cross-sectional survey from November 2021 to April 2022 was conducted across operational districts of organisations A and B. Cluster sampling was used to select participants in randomly selected villages with 200 or more households, within 10-15 km of existing vision centres. A semi-structured interview schedule was used to collect data. The means of AB-PMJAY indicators were estimated. Awareness was estimated as a summed score. Multivariate logistic regression was applied to check the effects of the socio-economic and socio-demographic factors on the awareness of AB-PMJAY for both organisations separately and together. A total of 1151 participants were interviewed: 52.9% from the catchment area of organisation A and 47.1% from that of organisation B. From the catchment of organisations A and B, 82.6% and 22.9% participants, respectively, had heard of the scheme, mostly from family and friends. Whereas 43% interviewees from the catchment area of organisation A and 8.5% from that of organisation B had knowledge about at least one topic, only 8.5% and 2.8%, respectively, were knowledgeable about all topics. Village effect was found to be significant for most of the knowledge and awareness indicators in both catchments. Only 37.8% and 20.2% of the catchment from organisations A and B, respectively, were AB-PMJAY cardholders. Of the services availed, 50% were cataract surgery. Almost 40% of the applicants faced some challenges while securing the AB-PMJAY card and 9% while using the AB-PMJAY card. Family income was found to be the only common predictor of knowledge at both locations. Varied awareness and limited knowledge in catchment villages put the onus on community eyecare organisations to spread awareness in their catchment, which may increase the uptake and utilisation of the scheme.

Estimation of the lost productivity to the GDP and the national cost of correcting visual impairment from refractive error in Kenya.

In developing countries such as Kenya, minimal attention has been directed towards population based studies on uncorrected refractive error (URE). However, the absence of population based studies, warrants utilization of other avenues to showcase to the stakeholders in eye health the worth of addressing URE. Hence this study estimated the lost productivity to the Gross Domestic Product (GDP) as a result of URE and the national cost required to address visual impairment from URE in Kenya. The lost productivity to the GDP for the population aged 16-60 years was calculated. Thereafter the productivity loss of the caregivers of severe visual impaired individuals was computed as a product of the average annual productivity for each caregiver and a 5% productivity loss due to visual impairment. The productivity benefit of correcting refractive error was estimated based on the minimum wage for individuals aged between 16-60 years with URE. Estimation of the national cost of addressing URE was based on spectacle provision cost, cost of training functional clinical refractionists and the cost of establishing vision centres. A cost benefit analysis was undertaken based on the national cost estimates and a factor of 3.5 times. The estimated lost productivity to the GDP due to URE in in Kenya is approximately US$ 671,455,575 -US$ 1,044,486,450 annually for population aged between 16-60 years. The productivity loss of caregivers for the severe visually impaired is approximately US$ 13,882,899 annually. Approximately US$ 246,750,000 is required to provide corrective devices, US$ 413,280- US$ 108,262,300 to train clinical refractionists and US$ 39,800,000 to establish vision centres. The productivity benefit of correcting visual impairment is approximately US$ 41,126,400 annually. Finally, a cost benefit analysis showed a return of US$ 378,918,050 for human resources, US$ 863,625,000 for corrective devices and US$ 139,300,000 for establishment of vision centres. The magnitude of productivity loss due to URE in Kenya is significant warranting prioritization of refractive error services by the government and all stakeholders since any investment directed towards addressing URE has the potential to contribute a positive return.

Low Vision Practice and Service Provision Among Optometrists in Ghana: A Nationwide Survey

ABSTRACT Purpose To characterize practice patterns of low vision services among Optometrists in Ghana. Methods The nationwide cross-sectional survey identified entities through the Ghana Optometrists Association (GOA) registry and utilized a semi-structured questionnaire to consolidate survey information that comprises practitioners’ demographics, available services, diagnostic equipment, barriers to service provision and utilization, and interventions. Results 300 Optometrists were identified, with 213 surveyed (71% response rate). About fifty percent (52.6%) were in private practice, and more than two-thirds (77%) did not provide low vision services. Most (≥70%) reported lack of assistive devices, and basic eye care examination kits as the main barriers to low vision service provision. Similarly, practitioners reported unawareness of the presence of low vision centres (76.1%), and high cost of low vision aids (75.1%) as the prime perceived barriers for patients to utilize low vision services. Continuous professional development and public education (89–90%) were suggested as interventions to improve the uptake of low vision services. After statistical adjustment, private facility type (Adjusted odds ratio [AOR] = 0.35, p = 0.010) and lack of basic eye examination kits (AOR = 0.32, p = 0.002) were significantly associated with reduced odds of low vision service provision. Conversely, ≥15 years of work experience (AOR = 6.37, p = 0.011) was significantly associated with increased odds of low vision service provision. Conclusions Overall, the results indicate inadequate low vision coverage and service delivery. Government policies must be directed towards equipping practitioners with equipment and subsidize patient cost of treatment to optimize low vision care.

Eyesight to insight: evidence from urban eye health programme

India, with a population exceeding 1.486 billion, faces substantial challenges in urban eye health, particularly in densely populated states like Uttar Pradesh. This study delves into real-world impact of urban eye health programme, implemented in Kanpur and Prayagraj, Uttar Pradesh, aiming to identify success factors and examine the tangible effects of interventions through comprehensive endline study. Utilizing a hub-and-spoke model, the programme established base hospitals as hubs and vision centres as spokes, creating a network for affordable and accessible eye care. The project significantly improved accessibility, with over 85% in Kanpur and 97% in Prayagraj reporting easy access to vision centres. A shift in community behaviour was observed, with a preference for vision centres for eye examinations increasing from 5.6-64.6% in Kanpur and 10.6-57.1% in Prayagraj. The programme empowered women to prioritize their eye health, reaching 53% of women for eye screening. Community perception shifted positively, with over 82% in Prayagraj recognizing the programme's pivotal role. In Kanpur, 87.5% of women actively take charge of their eye health decisions, while 99.1% do so in Prayagraj. This empowerment underscores programme commitment to providing equal access to eye care and demonstrates a strong focus on inclusivity and gender equality.

Access to eye care during the COVID-19 pandemic, India.

ObjectiveTo study the impact of the coronavirus disease 2019 (COVID-19) pandemic on outpatient visits to eye care facilities in south India.MethodsWe used data on 7.69 million outpatient visits to primary (i.e. vision centres), secondary and tertiary Aravind Eye Care System’s centres between January 2019 and June 2021. We compared outpatient numbers and outpatients’ age and sex between the pandemic period and the pre-pandemic period in 2019 for all centres, whereas vision and ophthalmic assessments were compared for vision centres only.FindingsDuring the first wave, the number of outpatient visits at tertiary, secondary and vison centres was 39% (647 968/1 656 296), 60% (170 934/283 176) and 73% (180 502/246 282) respectively, of 2019 levels. During the second wave, outpatient visits at tertiary, secondary and vision centres were 54% (385 092/710 949), 73% (88 383/121 739) and 79% (121 993/154 007), respectively, of 2019 levels. The proportion of outpatients who were female or younger than 20 years or older than 60 years was significantly lower during the first and second waves than in 2019 (P < 0.0001 for all). The proportion of outpatients whose worse eye vision was poorer than 5/60 or who required referral was significantly higher (P < 0.0001 for both).ConclusionRestrictive measurements led to declines in outpatient visits, however the decline was less at secondary and vision centres than at tertiary centres. Easy access to specialized ophthalmic care via telemedicine and the relative proximity of these centres to communities helped reduce barriers to access.

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.

Factors influencing post-screening visits of students to local vision centres in rural northwest China

ABSTRACT Clinical relevance Children with uncorrected visual impairment have lower scores on a variety of motor and cognitive tests. Exploring the influencing factors of low-income groups seeking vision care services is helpful for identifying relevant barriers and necessary measures to improve the utilization rate of vision care services. Background The community-based vision center (VC) is a popular model for solving vision problem of students in rural China. Compliance is the key factor to the success of the VC model. Factors determining compliance with visitations to VC among primary school students after screening were explored. Methods A cross-sectional study was conducted with 15,763 students from 228 primary schools. Information was collected through questionnaires and vision examinations. The determinants that affect visits of students to the VC were analyzed using logistic regression. Results Among the 15,763 sample, 5,361 (34%) students had a visual impairment. At baseline, only 962 (18%) of students with visual impairment sought vision care services. After a local VC was established, among the 5,163 students who needed to be referred, only 2,237 (43.33%) students visited the VC. Multivariate logistic regression models for predicting students visit the VC revealed that the following characteristics were significant predictors: poor uncorrected visual acuity (P < 0.001), a higher grade level (P = 0.008; P = 0.010), ‘left-behind’ children (P < 0.001), short living distance between home and the VC (P < 0.001), and the fact that these students lived in Gansu province (P < 0.001). Conclusions Establishing a VC that provides students with vision screening and free vision care services can increase the rate of seeking vision health services for students in rural areas, but the compliance rate still needs to be improved. The influencing factors for student compliance have been identified.

Community Engagement as a Tool for Improving Efficiency of Primary Eye Care Delivery: Case Studies from Two Different Models

Background: Delivery of healthcare services needs to be rooted in frameworks supporting community engagement. Our organization delivers primary eyecare through two different models. These case studies quantitatively analyse the impact of community collaboration on the effectiveness of these models-camps and vision centres.Methods: Camp data from two rural blocks of north India comparing first year of operations in 2016 with that of 2017; April-September 2017 data from two underperforming vision centreswas compared to data from same period in 2018.Natural interventions in camps included visits of local leaders to surgical centre, health talks spreading awareness regarding eyecare plusour organization, and local partners helping counsel patients, while for vision centres,staff was trained to conduct regular health talks and meetings in nearby villages. For camps, before and after data on attendance, proportion of people over 50, proportion of people getting operated among those advised and acquisition cost were analysed,for vision centres referral from these centres wereanalysed.Results: Parameters for both models showed improvement inthe second year. Conclusion: Sustained presence in the community and collaboration with local stakeholders increases effectiveness of service delivery at primary level.

Temporal trends in the prevalence of spectacle use and spectacle coverage in India

BackgroundThis study aims to assess the temporal trends in the prevalence of spectacle use and spectacle coverage for refractive errors in population‐based studies conducted during 2011–2012 and 2017 among those aged ≥ 40-years in the state of Telangana, India. An intervention in the form of 10 vision centres and a secondary centre was established in one district (Khammam) after the 2011–2012 study and another district (Warangal) was left to secular trends.MethodsIn both the studies, multi‐stage cluster random sampling methodology was used to select the participants. In addition to a clinical examination, a questionnaire was used for collecting information on current and previous use of spectacles, type of spectacles and details of the spectacle providers. The same questionnaire was used in both the studies.ResultsIn total, 2,485 participants were examined in the 2011–2012 study and 2,711 participants were examined in the 2017 study in Khammam. Similarly, 2,438 and 2,646 participants were examined in Warangal in the two studies, respectively. In Khammam, the age and gender‐adjusted prevalence of current spectacle use increased from 30.0 per cent (95% CI 28.2–31.9) to 34.8 per cent (95% CI 33.0–36.6) in the 2011–2012 and 2017 studies, respectively (p < 0.01). However, in the Warangal district, the age and gender‐adjusted prevalence of current spectacle use declined from 32.8 per cent (95% CI 31.0–34.7) to 27.6 per cent (95% CI 25.9–29.3) during the 2011–2012 and 2017 studies, respectively (p < 0.01). In Khammam, the spectacle coverage increased from 26.9 per cent to 35.6 per cent, but it declined from 43.8 per cent to 35.7 per cent in Warangal between the studies in 2011–2012 and 2017.ConclusionsAn increase in spectacle use and coverage was observed in Khammam where the secondary centre and vision centres were established, compared to Warangal where there was no such intervention. The results suggest a positive impact of the intervention in the Khammam district and suggest replication of the model to address the burden of uncorrected refractive errors.

Evaluation of a training program on primary eye care for an Accredited Social Health Activist (ASHA) in an urban district.

Purpose:An Accredited Social Health Activist (ASHA) available in community could be a potential primary eye care (PEC) worker. Training programme for ASHAs on PEC was undertaken & evaluated in a district of a capital city.Methods:ASHAs selected randomly from a district were imparted one day training on PEC & expected to refer patients to nearby Vision Centres (VC). Their knowledge was assessed before & after training and re-evaluated 1 year later. ASHAs were asked to conduct vision screening of 40+ population in their areas and ASHA referrals were noted by Optometrist in VC. Focus Group Discussions (FGD) of ASHAs were held to find barriers & facilitating factors in engaging ASHAs in PEC. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results.Results:Mean knowledge score increased from 14.96 (±4.34) pre-training to 25.38 (±3.48) post- training and sustained at 21.75 (±4.16) at 1year. Monthly average OPD of vision centres increased by 23.6% after ASHA training. FGDs revealed that ASHAs were willing to work in eye care for awareness generation and patient facilitation but were hesitant in conducting vision screening.Conclusion:ASHAs can be trained as PEC workers provided they have adequate support.

Role of teleophthalmology to manage anterior segment conditions in vision centres of south India: EyeSmart study-I.

Purpose:To study the role of teleophthalmology (TO) in the diagnosis and treatment of anterior segment conditions (including adnexal conditions) in rural areas.Methods:This is a pilot study of 5,604 patients, who visited primary vision centres (VCs) for 1 week from 1-7 September 2018. The patients were examined by a vision technician (VT) to identify those who may need teleconsultation. The centres were located in 16 districts of four Indian states of Andhra Pradesh, Telangana, Odisha, and Karnataka. The demographic profile, along with the role of teleconsultation was reviewed.Results:Teleconsultation was advised in 6.9% of the patients, out of which 59.6% were referred to a higher level of care, and 40.4% were treated directly at the VC. Teleconsultations were higher among males (7.0% as compared to 6.6% in females), though not statistically significant (P = 0.55). Teleconsultation was higher in the older population, that is, 60 years and above (14.5%); those with severe visual impairment (VI) (21%) and blindness (31.1%); and in the states of Telangana (11%) and Andhra Pradesh (6.3%). It was noted that 45% of the patients who underwent teleconsultation had pathologies related to ocular surface, cornea and lid, and adnexa-related conditions.Conclusion:Teleconsultation has a significant role in the management of anterior segment conditions in bridging the gap between the patients and ophthalmologists in rural India. TO can also play an important role in the diagnosis and management of anterior segment, lid, and adnexa-related pathologies.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Economic Analysis of Primary Eye Care Services Provided through Vision Centers in Eastern India

ABSTRACTPurpose: Primary eye care services delivered through vision centres (VC) form an essential part of the national blindness control efforts, but systematic data on the outputs and cost of providing such services in India are not readily available for further planning and efficient use of resources.Methods: Detailed cost and output data were collected from written records for 2017–2018 fiscal year using standardized methods at nine VC in Kolkata city in West Bengal, India. The total economic cost for these VC was computed and the relation of unit cost of services per patient screened with VC scale was assessed using regression analysis. Break-even point was estimated from average and marginal cost functions.Results: 25,009 patients were screened at the 9 VC (range 709–5,717; median 2,826). The overall total economic cost was INR 7,304,172 (USD 113,306), ranging from INR. 509,618 (USD. 7,905) to INR. 1,390,855 (USD. 21,576). Personnel salaries made up 37.8% of the total cost. The unit economic cost of screening a patient was INR 292.1 (USD 4.4) and varied threefold between 9 VC. With a multiple regression model (p < .035, R2 = 0.797), apart from the fixed costs, the incremental cost for each patient screened was INR 81.33 (USD 1.26). Break-even analysis suggested that 44.4% of the VCs were functioning below optimal scale.Conclusion: A further reduction in the unit costs is possible if the optimal scale of services is achieved. These findings can inform resource requirement for the primary eye care services in India.

Development and validation of an instrument to assess job satisfaction in eye‐care personnel

PurposeThe aim was to develop and validate an instrument to measure job satisfaction in eye‐care personnel and assess the job satisfaction of one‐year trained vision technicians in India.MethodsA pilot instrument for assessing job satisfaction was developed, based on a literature review and input from a public health expert panel. Rasch analysis was used to assess psychometric properties and to undertake an iterative item reduction. The instrument was then administered to vision technicians in vision centres of Andhra Pradesh in India. Associations between vision technicians’ job satisfaction and factors such as age, gender and experience were analysed using t‐test and one‐way analysis of variance.ResultsRasch analysis confirmed that the 15‐item job satisfaction in eye‐care personnel (JSEP) was a unidimensional instrument with good fit statistics, measurement precisions and absence of differential item functioning. Overall, vision technicians reported high rates of job satisfaction (0.46 logits). Age, gender and experience were not associated with high job satisfaction score. Item score analysis showed non‐financial incentives, salary and workload were the most important determinants of job satisfaction.ConclusionsThe 15‐item JSEP instrument is a valid instrument for assessing job satisfaction among eye‐care personnel. Overall, vision technicians in India demonstrated high rates of job satisfaction.

Eliminating Avoidable Blindness Outreach Activities at Aravind Eye Care System

This case relates the genesis and evolution of vision centres (VCs) for primary eye care at Aravind Eye Care System (AECS). AECS, based in the south Indian state of Tamil Nadu, is the world's largest eye care provider. The case is based in 2014, exactly a decade after the first vision centre was opened, and evaluates the role of VCs in Aravind's outreach ecosystem. Community outreach programmes were an integral part of Aravind's model from the start and formed a central part of its vision of taking eye care to the community's doorstep. For many years, community outreach at Aravind was done through eye camps held in remote rural locations. Eye camps had worked extremely well for a long time. However, eye camps were not a perfect solution to Aravind's outreach goals for many reasons. Vision centres evolved as a way to address some of the shortcomings of eye camps, and both these outreach methods were employed in parallel. This case focuses on Aravind's vision centres and how they evolved over a decade, how they compare with the eye camps as a vehicle to attain Aravind's goals, and the opportunities and challenges ahead.

Accuracy of vision technicians in screening ocular pathology at rural vision centres of southern India

BackgroundThere is paucity of data on the inter‐observer agreement and diagnostic accuracy between a primary‐care technician (vision technician) and an ophthalmologist. Hence, the current study was conducted to assess the accuracy of vision technicians, to screen potentially sight‐threatening ocular conditions at rural vision centres of southern India and their agreement with an ophthalmologist.MethodsIn July to August 2010, patients presenting to seven vision centres in Adilabad district (Andhra Pradesh) were selected and screened in a masked manner by seven vision technicians followed by an examination by a consultant ophthalmologist. Agreement was assessed between vision technicians and the ophthalmologist for screening of potential sight‐threatening ocular conditions and decisions for referral. The ophthalmologist's findings were considered as the reference standard.ResultsTwo hundred and seventy‐nine patients were enrolled at seven vision centres with a mean age of 32.9 ± 21.8-years. Agreement for screening of ocular pathology was 0.82 (95 per cent CI, 0.8‐0.83). There was excellent agreement for cataract (0.97; 95 per cent CI, 0.93‐1), refractive error (0.98; 95 per cent CI, 0.96‐1), corneal pathology (1.0; 95 per cent CI, 1.0‐1.0) and other anterior segment pathology (0.95; 95 per cent CI, 0.9‐1); the agreement was moderate to fair for detection of glaucoma suspects (0.43; 95 per cent CI, 0.28‐0.60) and retinal pathology (0.39; 95 per cent CI, 0.14‐0.63). Sensitivity for screening of anterior segment pathology was 94.6‐100 per cent. There was a fair to moderate sensitivity for glaucoma suspect; 35.6 per cent (95 per cent CI, 21.9‐51.2) and retinal pathology 26.3 per cent (95 per cent CI, 9.2‐51.2). Specificity for screening of ocular pathology was 98.2 to 100 per cent. The kappa (κ) agreement for referral for any pathology was 0.82 (0.8‐0.83)ConclusionAs there is good agreement between the vision technicians and the ophthalmologist for screening and referral of anterior segment pathology but moderate to fair for glaucoma suspects and retinal pathology, vision technicians would be a good resource at the primary level to screen for anterior segment pathology; however, they may need further training to detect posterior segment pathology.

Aravind Eye Care System as Transformational Entrepreneurship: Spiritual Roots, Multi-Dimensional Impact

Initiated almost four decades ago in the form of an 11-bed clinic in Madurai, Aravind Eye Care System with its large network of hospitals, vision centres and community outreach programs is now recognized in India and beyond as a major actor of health care. This paper upholds the view that Aravind’s innovative characteristics call for the creation of a specific category: transformational entrepreneurship. It first clarifies what may be called the ‘Aravind paradox’: Aravind achieves compassion through Taylorism, providing free eye care to poor patients while expanding its robust entrepreneurial model. It then analyses the social, cultural and policy implications of Aravind’s success, notably from the perspective of its contribution to the common good. Finally, the paper identifies the definitional components of transformational entrepreneurship.

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.

PurposeTo evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India.MethodsThe Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1–3 weeks and 4–11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.ResultsMean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4–11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78).ConclusionsThis study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation.

Selection considerations when using a ‘standard optometrist’ to evaluate clinical performance of other eye‐care personnel

BackgroundSelection of a standard professional is crucial for assessing the clinical performance of other eye‐care personnel. This paper describes the selection considerations and the clinical competency assessment of two optometrists required to select a ‘standard optometrist’ (SO) for evaluating the clinical performance of vision technicians in India.MethodsTwo optometrists were short‐listed from 21 optometrists who responded to an advertisement to be selected as a SO for the assessment of the performance of 24 vision technicians in rural vision centres. Each candidate optometrist performed a routine eye examination on 40 randomly selected, newly registered subjects in a tertiary hospital clinic. Their non‐cycloplegic retinoscopic findings were compared with those of an experienced optometrist, while disease diagnoses were compared with the findings of an ophthalmologist.ResultsA comparison of retinoscopic findings showed that optometrist A produced retinoscopic values within ±0.50 D agreement for the spherical equivalent (SE) 100 per cent of the time, while optometrist B obtained agreement 91.3 per cent of the time. Similarly, optometrist A's limits of agreement (SE = ‐0.63 to +0.45 D) and reproducibility limits (SE = 0.78 D) were better than those of optometrist B (SE = ‐0.98 to +0.70 D and SE =1.18 D, respectively). Optometrist A demonstrated 89.2 per cent sensitivity in detecting ocular pathology compared to 76.3 per cent by optometrist B.ConclusionsOptometrist A achieved consistent and reproducible retinoscopic findings as well as higher sensitivity in detecting ocular pathology and was selected as the SO for a study to assess the clinical performance of one‐year trained vision technicians. The concept of a SO calibrated against an ophthalmologist for disease detection and diagnosis and an experienced optometrist for retinoscopy is a useful approach for the evaluation of eye‐care personnel.