Poverty and Eye Health

Abstract Poverty and eye health, including vision disability from vision impairment and blindness, are believed to be interrelated. The relationship between poverty and eye health can be interpreted as being two-fold, in the sense that poverty may be a cause of poor eye health and poor eye health may lead to or deepen poverty. Evidence shows that the burden of vision impairment is high in poor people and vision impairment and poverty are linked to each other. However the empirical evidence to answer the questions-Does poverty perpetuate poor eye health? How and why? Does poor eye health deepen poverty?-is sparse globally; especially from low and middle income countries (LMICs). This article therefore aims to examine published information and other secondary data sources that provide insight on the relationship between poverty and eye health, including eye disability caused from vision impairment and blindness. The article provides a conceptual understanding of poverty related attributes that contribute to eye disability from vision impairment and blindness, using evidence sourced from poverty and eye health research studies. The article interrogates general theories and beliefs that have been conceptualised in relation to the impact that the vicious cycle of poverty has on eye health and the contribution of poor eye health on an individual's poverty status. The major outcomes of this article include: 1) identifying gaps in linking poverty and eye health, 2) establishing key issues that will assist in the development of a theoretical framework, and 3) preparing more appropriately for further investigation on the association between poverty and eye health

IMI impact of myopia

The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden

Associated factors for age-related maculopathy in the adult population in southern India: the Andhra Pradesh eye disease study

Background: To assess prevalence, potential risk factors and population attributable risk percentage (PAR) for age-related maculopathy (ARM) in the Indian state of Andhra Pradesh. Methods: A population-based study, cross-sectional epidemiological study was conducted in the state of Andhra Pradesh in India during 1996 and 2000. Participants from 94 clusters in one urban and three rural areas representative of the population of Andhra Pradesh underwent a detailed interview and a detailed dilated ocular evaluation by trained professionals. This report presents the prevalence estimates of ARM and examines the association of ARM with potential risk factors in persons aged 40-102 years (n=3723). ARM was defined as per the international classification and grading system. Results: ARM was present in 327 subjects, an age-gender-area-adjusted prevalence of 8.9% (95% confidence interval (CI), 8.1% to 9.9%). Multivariate analysis showed that, the adjusted prevalence of ARM was significantly higher in those 70 years of age or older (adjusted odds ratio (OR), 3.65; 95% CI 2.24 to 5.94) and in subjects with hypertension OR 1.30 (95% CI 1.02 to 1.65). The presence of any cataract and urban residence were significantly associated with increased prevalence of ARM (OR 1.67; 95% CI 1.27 to 2.21 and 2.30; 95% CI 1.79 to 2.96) respectively. Increased intraocular pressure (IOP) and increased cup-to-disc ratio (CDR) were also significantly associated with increased prevalence of ARM (OR 1.03; 95% CI 1.002 to 1.06 and 2.25; 95% CI 1.10 to 4.67) respectively. The PAR for hypertension and any cataract was 12% and 18% respectively in this population. Conclusion: The prevalence of ARM in this south Indian population is similar to those reported from other developed countries. Increased age, increased IOP and increased CDR were significantly associated with the increased risk of ARM

Visual impairment among weaving communities in Prakasam district in South India.

PURPOSE: To assess the prevalence and causes of visual impairment in weaving communities in Prakasam district in South India state of Andhra Pradesh. METHODS: Using Rapid Assessment of Visual Impairment (RAVI) methodology, a population based cross-sectional study was conducted. A two-stage sampling strategy was used to select 3000 participants aged ≥40 years. Visual Acuity (VA) was assessed using a tumbling E chart and ocular examinations were performed by trained Para medical ophthalmic personnel. A questionnaire was used to collect personal and demographic information. Blindness and moderate Visual Impairment (VI) was defined as presenting VA <6/60 and <6/18 to 6/60 respectively. VI included blindness and moderate VI. RESULTS: 2848 of 3000 enumerated subjects (94.0%) participated. 39% were in 40-49 years age group and 11.8% were aged ≥70 years, 55% were women and nearly half of them had no formal education. 400 (14%; 95% CI: 12.8-15.3) subjects had VI, including blindness in 131 (4.6%; 95% CI: 3.8-5.4) and moderate VI in 269 (9.4%; 95% CI: 8.3-10.5) individuals. On applying multiple logistic regression, VI was significantly associated with older age and no formal education. Though the odds of having VI were higher in females, it was of borderline statistical significance (p = 0.06). Refractive error was the leading cause of all VI followed by cataract (56%). However, refractive errors were the leading cause of moderate VI (73.2%) and cataract was the leading cause of blindness (62.6%). 'Cannot afford the cost of services' was the leading barrier for utilization of eye care services (47%). CONCLUSIONS: There is a significant burden of VI in weaving communities in Andhra Pradesh, India most of which is avoidable. With this information as baseline, services need to be streamlined to address this burden