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Prevalence and Causes of Blindness and Visual Impairment and Their Associated Risk Factors, in Three Tribal Areas of Andhra Pradesh, India
Objective: To assess the prevalence of blindness and visual impairment (VI), their associated causes and underlying risk factors in three tribal areas of Andhra Pradesh, India and compare this data in conjunction with data from other countries with low and middle income settings. Methods: Using a validated Rapid Assessment of Avoidable Blindness methodology, a two stage sampling survey was performed in these areas involving probability proportionate to size sampling and compact segment sampling methods. Blindness, VI and severe visual impairment (SVI) were defined as per the WHO guidelines and Indian definitions. Results: Based on a prior enumeration, 7281 (97.1%) subjects were enrolled (mean age = 61.0+/β7.9 years). Based on the presenting visual acuity (PVA), the prevalences of VI, SVI and blindness were 16.9% (95% CI: 15.7β18.1), 2.9% (95% CI: 2.5β3.4), and 2.3% (95% CI: 1.9β2.7), respectively. When based on the Pinhole corrected visual acuity (PCVA), the prevalences were lower in VI (6.2%, 95% CI: 5.4β6.9), SVI (1.5%, 95% CI: 1.2β1.9) and blindness (2.1%, 95% CI: 1.7β2.5). Refractive error was the major cause of VI (71.4%), whereas, cataract was the major cause of SVI and blindness (70.3%). Based on the PVA, the odds ratio (OR) of blindness increased in the age groups of 60β69 years (OR = 3.8, 95% CI: 2.8, 5.1), 70β79 years (OR = 10.6, 95% CI: 7.2, 15.5) and 80 years and above (OR = 30.7, 95% CI: 19.2, 49). The ORs were relatively higher in females (OR = 1.3, 95% CI: 1.0, 1.6) and illiterate subjects (OR = 4.3, 95% CI: 2.2, 8.5), but lower in those wearing glasses (OR = 0.2, 95% CI: 0.1, 0.4). Conclusions: This is perhaps the first study to assess the prevalence of blindness and VI in these tribal regions and the majority of the causes of blindness and SVI were avoidable (88.5%). These findings may be useful for planning eye care services in these underserved regions
Prevalence of Blindness, SVI and VI based on presenting and Pinhole-corrected visual acuity.
<p>VI: Visual Impairment; SVI: Severe Visual Impairment; CI: Confidence Interval.</p
Prevalence of blindness, SVI and VI in different studies in India and neighboring countries.
<p>*: Year of study not available; CI: Confidence Interval;</p><p>**: Confidence Interval calculated using binomial proportions; SVI: Severe Visual Impairment; VI: Visual Impairment; NA: Data not available.</p
Baseline characteristics of participants and non-participants.
<p>SD: Standard Deviation.</p
Presenting Visual Acuity: Risk factors for VI, SVI and blindness.
<p>VI: Visual Impairment; SVI: Severe Visual Impairment; CI: Confidence Interval; Ref: Reference group; OR: Odds Ratio.</p
Population Based Outcomes of Cataract Surgery in Three Tribal Areas of Andhra Pradesh, India: Risk Factors for Poor Outcomes
<div><h3>Purpose</h3><p>To report visual outcomes and risk factors for poor outcomes of cataract surgery in three Integrated Tribal Development Agency (ITDA) areas of Andhra Pradesh, India.</p> <h3>Methods and Results</h3><p>Using validated Rapid Assessment of Avoidable Blindness (RAAB) methodology, a population based cross-sectional study, was conducted in three ITDA areas. A two-stage sampling procedure was used to select 7281 participants aged 50 years and above. Vision assessment using a tumbling E chart and standard ocular examinations were completed. Visual outcomes and risk factors for poor outcomes were assessed among subjects undergoing cataract surgery (1548 eyes of 1124 subjects). Mean age at surgery was 67Β±8 years; Among the operated eyes, presenting visual acuity (PVA) and best corrected visual acuity (BCVA) worse than 6/18 was seen in 492 (31.8%; 95% CI, 29.5β34.2%) and 298 eyes (19.3%; 95% CI, 17.3β21.3%), respectively. Similarly, PVA and BCVA worse than 6/60 was seen in 219 (14.1%; 95% CI, 12.4β16%) and 147 eyes (9.5%; 95% CI, 8.1β11.1%), respectively. When either eye was taken into consideration, the PVA and BCVA worse than 6/18 was seen in 323 (20.1%; 95% CI, 18.9β23%) and 144 subjects (9.3%; 95% CI, 7.9β10.9%), respectively. PVA and BCVA worse than 6/60 was seen in 74 (4.8%; 95% CI, 3.8β6%) and 49 subjects (3.2%; 95% CI, 2.4β4.2%), respectively. Posterior capsular opacification was seen in 51 of 1316 pseudophakic eyes (3.9%; 95% CI, 2.9β5.1%). In multivariable analysis among pseudophakic subjects with PVA worse than 6/18, increasing age (pβ=β0.002) and undergoing free surgery (pβ=β0.05) were independent risk factors. Undergoing surgery before 2005 (pβ=β0.05) and being illiterate (pβ=β0.05) were independent risk factors for BCVA worse than 6/18.</p> <h3>Conclusions</h3><p>There are changing trends with improved outcomes in cataract surgery among these tribal populations of India. However, post-operative refractive error correction remains an issue, especially for those undergoing free surgeries.</p> </div
Causes of VI, SVI and blindness.
<p>VI: Visual Impairment; SVI: Severe Visual Impairment.</p
Pinhole Corrected Visual Acuity: Risk factors for VI, SVI and Blindness.
<p>VI: Visual Impairment; SVI: Severe Visual Impairment; CI: Confidence Interval; Ref: Reference group; OR: Odds Ratio.</p
Causes of blindness, SVI and VI in different studies in India and neighbouring countries.
<p>*: For both Blindness and Severe Visual Impairment; RE: Refractive error; SVI: Severe Visual Impairment; VI: Visual Impairment; NA: Data not available.</p
Cause of Visual impairment and blindness stratified by category of visual impairment and blindness.
*<p>Include one eye with phthisis.</p