Aim: To assess the prevalence and demographic associations of moderate visual impairment in the population of the southern Indian state of Andhra Pradesh. Methods: From 94 clusters in one urban and three rural areas of Andhra Pradesh, 11 786 people of all ages were sampled using a stratified, random, cluster, systematic sampling strategy. The eligible people were invited for interview and detailed dilated eye examination by trained professionals. Moderate visual impairment was defined as presenting distance visual acuity less than 6/18 to 6/60 or equivalent visual field loss in the better eye. Results: Of those sampled, 10 293 (87.3%) people participated in the study. In addition to the previously reported 1.84% prevalence of blindness (presenting distance visual acuity less than 6/60 or central visual field less than 20°in the better eye) in this sample, 1237 people had moderate visual impairment, an adjusted prevalence of 8.09% (95% CI 6.89 to 9.30%). The majority of this moderate visual impairment was caused by refractive error (45.8%) and cataract (39.9%). Increasing age, female sex, decreasing socioeconomic status, and rural area of residence had significantly higher odds of being associated with moderate visual impairment. Conclusions: These data suggest that there is a significant burden of moderate visual impairment in this population in addition to blindness. Extrapolation of these data to the population of India suggests that there were 82 million people with moderate visual impairment in the year 2000, and this number is likely to be 139 million by the year 2020 if the current trend continues. This impending large burden of moderate visual impairment, the majority of which is due to the relatively easily treatable refractive error and cataract, would have to be taken into account while estimating the eye care needs in India, in addition to dealing with blindness. Specific strategies targeting the elderly population, people with low socioeconomic status, those living in the rural areas, and females would have to be implemented in the long term to reduce moderate visual impairment. W e conducted the population based Andhra Pradesh Eye Disease Study (APEDS) in one urban and three rural populations of the southern Indian state of Andhra Pradesh. The objectives of APEDS were to assess the prevalence and causes of blindness and other levels of visual impairment, prevalence and risk factors for eye diseases, effect of visual impairment on quality of life, and barriers to eye care services.1 Andhra Pradesh is one of the larger states of India accounting for 8.4% of the country's area with a population of 75.7 million in early 2001, which was 7.4% of total population of India.2 The age distribution of the population of the state is pyramidal like the rest of India with an estimated 35.6% of the total population below 16 years of age, 25.7% between 16-29 years, and 38.7% 30 years of age or more.3 The rural population comprises a little less than three fourths of the total population of the state, and the male t...
There is significant refractive error in this population. These data on the distribution and associations of refractive error can be useful for the planning of refractive eye-care services.
BackgroundA large-scale prevalence survey of blindness and visual impairment (The Andhra Pradesh Eye Diseases Study [APEDS1]) was conducted between 1996-2000 on 10,293 individuals of all ages in three rural and one urban clusters in Andhra Pradesh, Southern India. More than a decade later (June 2009-March 2010), APEDS1 participants in rural clusters were traced (termed APEDS2) to determine ocular risk factors for mortality in this longitudinal cohort.Methods and FindingsMortality hazard ratio (HR) analysis was performed for those aged >30 years at APEDS1, using Cox proportional hazard regression models to identify associations between ocular exposures and risk of mortality. Blindness and visual impairment (VI) were defined using Indian definitions. 799/4,188 (19.1%) participants had died and 308 (7.3%) had migrated. Mortality was higher in males than females (p<0.001). In multivariable analysis, after adjusting for age, gender, diabetes, hypertension, body mass index, smoking and education status the mortality HR was 1.9 (95% CI: 1.5-2.5) for blindness; 1.4 (95% CI: 1.2-1.7) for VI; 1.8 (95% CI: 1.4-2.3) for pure nuclear cataract, 1.5 (95% CI: 1.1-2.1) for pure cortical cataract; 1.96 (95% CI: 1.6-2.4) for mixed cataract, 2.0 (95% CI: 1.4-2.9) for history of cataract surgery, and 1.58 (95% CI: 1.3-1.9) for any cataract. When all these factors were included in the model, the HRs were attenuated, being 1.5 (95% CI: 1.1-2.0) for blindness and 1.2 (95% CI: 0.9-1.5) for VI. For lens type, the HRs were as follows: pure nuclear cataract, 1.6 (95% CI: 1.3-2.1); pure cortical cataract, 1.5 (95% CI: 1.1-2.1); mixed cataract, 1.8 (95% CI: 1.4-2.2), and history of previous cataract surgery, 1.8 (95% CI: 1.3-2.6).ConclusionsAll types of cataract, history of cataract surgery and VI had an increased risk of mortality that further suggests that these could be potential markers of ageing.
A large proportion of rural population though noticed a change in their vision did not seek eye care due to financial and person-related reasons. Eye care service providers need to address these barriers to enhance the uptake of eye care services among those with unilateral VI.
Andhra Pradesh Eye Disease Study 3 will provide data on the incidence and progression of visual impairment and major eye diseases and their associated risk factors in India. The study will provide further evidence to aid planning eye care services.
Context:Globally, limited data are available on changing trends of blindness from a single region.Aims:To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade.Settings and Design:Rural setting; cross-sectional study.Materials and Methods:Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district.Statistical Analysis:Done using 11th version of Stata.Results:Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9–9.1%) and 11% (95% CI, 8.3–13.7%), while that of VI was 13.6% (95% CI, 12.2–15.1%) and 40.3% (95% CI, 36.1–44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5–21.8%) compared with APEDS (34%; 95% CI, 20.9–49.3%).Conclusion:There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade.
Purpose: To report 15 year(range:13-17 years) incidence rate of visual loss(blindness and visual impairment (VI)), causes and risk factors for all ages, and for those 40 years or above at baseline for participants in Andhra Pradesh Eye Disease Study(APEDS). Design: Population based cohort studyMethods: All rural participants were interviewed and underwent a comprehensive eye examination. Presenting visual acuity(PVA) was measured using a standard logarithm of minimum angle of resolution chart at 3 meters. Unaided, presenting, pinhole and best-corrected visual acuity(BCVA) were also recorded. World Health Organization(WHO) and United States of America(USA) categories of VI and blindness were used for analysis. Incident visual loss was defined as the development of, or worsening of visual loss of one or more categories.Results: At baseline, 7,771 participants were examined and in APEDS III, 5,395(69.4%) were re-examined. Using WHO categories, the crude incidence rate of any visual loss based on PVA and BCVA were 14.6 and 6.3 per 100 person-years, respectively. Using US criteria, the values were 22.6 and 10.6 per 100 person-years, respectively. More than 90% of visual loss was due to cataract and uncorrected refractive error. Using WHO categories, significant independent risk factors for the incident visual loss were increasing age, female, illiterate, past or current smoker and current use of alcohol. Using the USA definition, additional risk factor was lower level of education. Conclusions:The high incidence likely reflects poor access to eye care in this population which needs to be taken into account when planning eye care programs.
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