Br J Ophthalmol 2000;84:22-27
( January )
Utilisation of eyecare services in an urban population in
southern India: the Andhra Pradesh eye disease study
Rakhi Dandonaa b, Lalit Dandonaa, Thomas J Naduvilatha, Catherine A McCartyb, Gullapalli N Raoa
a Public Health
Ophthalmology Service, LV Prasad Eye Institute, Hyderabad, India, b Centre for Eye Research Australia,
Department of Ophthalmology, University of Melbourne, Melbourne,
Australia
Correspondence to: Rakhi Dandona, LV Prasad Eye Institute, LV Prasad Marg, Banjara Hills,
Hyderabad - 500 034, India
Accepted for publication 11 August 1999
AIM To assess
utilisation of eyecare services by people with visual impairment <6/18
or equivalent visual field loss in the better eye in the urban
population of Hyderabad in southern India.
METHODS2522 subjects
of all ages, representative of the population of Hyderabad city,
underwent a detailed interview and dilated examination as part of the
population based Andhra Pradesh eye disease study. Subjects more than
15 years of age were interviewed regarding the use of eyecare services.
RESULTSOf 250 subjects with presenting distance visual acuity <6/18 or equivalent
visual field loss in the better eye, information on utilisation of
eyecare services was available for 229 (91.6%). Of these 229 subjects,
44 (19%) had visual acuity <6/60 or equivalent visual field loss in
the better eye, and 202 (88.2%) had noticed decrease in vision over
the past 5 years. Multivariate analysis showed that this decrease in
vision was noticed significantly less by subjects with refractive error
as the cause of visual impairment (odds ratio 0.34, 95% confidence
interval 0.12-0.93). Of the 229 subjects who were visually impaired,
108 (59%) did not seek treatment. Multivariate analysis revealed that
the odds for seeking treatment were significantly lower for Hindus than Muslims (odds ratio 0.53, 95% confidence interval 0.28-0.98). The
reasons for not seeking treatment could be classified as personal (49.5%), economic (30.8%), and social (19.6%).
CONCLUSIONA large
proportion of subjects with visual impairment in this urban population
in India did not seek treatment even after noticing decrease in vision.
Projecting these data to the 155 million urban population >15 years of
age in India, there may be 4.9 million (95% confidence interval
4.3-5.5 million) people in urban India who are not seeking treatment
for their visual impairment even after noticing decrease in vision.
These data suggest that efforts have to be made to better understand
the reasons for this phenomenon so that optimal utilisation of the available eyecare services in urban India can be planned.
© 2000 by British Journal of Ophthalmology
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