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Utilisation of eye care services in rural south India: the Aravind Comprehensive Eye Survey

P K Nirmalan^1,2, J Katz^3,4, A L Robin^3,5, R Krishnadas², R Ramakrishnan², R D Thulasiraj^1,2 and J Tielsch^3,4

Series editors: W V Good and S Ruit

¹ Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
² Aravind Medical Research Foundation, Aravind Eye Care System, Madurai, India
³ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
⁴ Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
⁵ Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence to:
Correspondence to:
A L Robin MD, PA
Lake Falls Professional Building, 6115, Falls Road, Third Floor, Baltimore, MD 21209-2226, USA; glaucomaexpert{at}cs.com

Aim: To determine utilisation of eye care services in a rural population of southern India aged 40 years or older.

Methods: 5150 subjects aged 40 years and older selected through a random cluster sampling technique from three districts in southern India underwent detailed ocular examinations for vision impairment, blindness, and ocular morbidity. Information regarding previous use of eye care services was collected from this population through a questionnaire administered by trained social workers before ocular examinations.

Results: 3476 (72.7%) of 5150 subjects examined required eye care examinations. 1827 (35.5%) people gave a history of previous eye examinations, primarily from a general hospital (n = 1073, 58.7%). Increasing age and education were associated with increased utilisation of eye care services. Among the 3323 people who had never sought eye care, 912 (27.4%) had felt the need to have an eye examination but did not do so. Only one third of individuals with vision impairment, cataracts, refractive errors, and glaucoma had previously utilised services.

Conclusions: A large proportion of people in a rural population of southern India who require eye care are currently not utilising existing eye care services. Improved strategies to improve uptake of services is required to reduce the huge burden of vision impairment in India.

Abbreviations: ACES, Aravind Comprehensive Eye Survey; ARM, age related maculopathy; CSMO, clinically significant macular oedema; DR, diabetic retinopathy; NPDR, non-proliferative diabetic retinopathy; PACG, primary angle closure glaucoma; POAG, primary open angle glaucoma; PDR, proliferative diabetic retinopathy; PPDR, pre-proliferative diabetic retinopathy; PSC, posterior subcapsular cataract; RPE, retinal pigment epithelium

Keywords: utilisation of eye care; older adults; rural population; India

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