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Khan J, Shaw S. Risk of cataract and glaucoma among older persons with diabetes in India: a cross-sectional study based on LASI, Wave-1. Sci Rep 2023; 13:11973. [PMID: 37488196 PMCID: PMC10366202 DOI: 10.1038/s41598-023-38229-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/05/2023] [Indexed: 07/26/2023] Open
Abstract
According to the International Diabetes Federation-2019 estimates, India is home to 77 million diabetic individuals which is projected to grow up to 147.2 million by 2045. Diabetes being a progressive health disorder leads to multiple morbidities and complications including eye diseases and visual impairments. As the burden of diabetes mellitus is increasing, eye problems like cataracts and glaucoma are commonly cited problems among the older adults. In this context, this study aims to provide the public health evidences on diabetes associated burden and risk of developing cataracts and glaucoma among older adults aged 60 and above in India. The analytical sample of this cross-sectional study comprised of 31,464 individuals aged 60 and above. Bivariate cross-tabulation and chi-square test were performed to understand the differential in the prevalence of cataracts and glaucoma by diabetes mellitus including the socio-economic and demographic characteristics of the individuals. Binary logistic regression estimation was executed to estimate the adjusted odds ratio for each of the outcome variables within a multivariate framework. The cataract problem affects more than one-fifth of the older people, while glaucoma affects 2% of them. The prevalence of cataract and glaucoma is 29% among diabetic older adults compared to 22% among non-diabetic persons. In terms of gender, the cataract prevalence is comparatively higher among females (25%) than males (21%). It is important to note that while adjusting for socio-economic and demographic characteristics, the likelihood of cataract (AOR 1.495; p-value < 0.01) and glaucoma (AOR 1.554; p-value < 0.01) is significantly higher among older adults with diabetes than among their counterparts. Medical practitioners should conduct prognosis for diabetic eye problems among patients and raise awareness about the potential risks of developing vision loss, such as cataracts and glaucoma, which are more prevalent among individuals with diabetes.
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Affiliation(s)
- Junaid Khan
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India
| | - Subhojit Shaw
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India.
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Ehrlich JR, Agarwal A, Young C, Lee J, Bloom DE. The prevalence of vision impairment and blindness among older adults in India: findings from the Longitudinal Ageing Study in India. NATURE AGING 2022; 2:1000-1007. [PMID: 37118083 PMCID: PMC10148950 DOI: 10.1038/s43587-022-00298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/23/2022] [Indexed: 04/30/2023]
Abstract
Vision impairment and blindness are strongly associated with aging and late-life disability. While home to about 17% of the world's population, an estimated 25% of visually impaired people globally live in India. This proportion is expected to increase as India's population rapidly ages and continues to grow. There is a need for up-to-date epidemiologic data on the prevalence of vision impairment and blindness in India and on the socioeconomic determinants of poor vision, especially among older adults, to promote visual and overall health and well-being in later life. This paper uses newly available data from Wave 1 (2017-2019) of the population-based Longitudinal Ageing Study in India to estimate the overall and sex-specific prevalence of presenting visual acuity impairment and blindness among individuals aged 45 and older at the national level and for all constituent states and union territories. Overall, 33.8% (95% confidence interval: 33.31%, 34.26%) of the Indian population aged 45 and older had distance visual acuity impairment or was blind (visual acuity in the better-seeing eye < 20/40). The age-standardized prevalence varied considerably among states (22.3-54.6%), and women were more likely than men to be visually impaired or blind in all states. Near visual acuity impairment was also highly prevalent (43.0%, 95% confidence interval: 42.45%, 43.46%). Vision impairment and blindness were more common among marginalized groups and were associated with lower socioeconomic status. Findings from this study are relevant for surveillance of vision health, design of targeted eye care policies and programs and efforts to promote human and economic development.
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Affiliation(s)
- Joshua R Ehrlich
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Arunika Agarwal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Codi Young
- Center for Economic & Social Research, University of Southern California, Los Angeles, CA, USA
| | - Jinkook Lee
- Center for Economic & Social Research, University of Southern California, Los Angeles, CA, USA
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - David E Bloom
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Blindness and visual impairment and their causes in India: Results of a nationally representative survey. PLoS One 2022; 17:e0271736. [PMID: 35862402 PMCID: PMC9302795 DOI: 10.1371/journal.pone.0271736] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Avoidable blindness is a significant public health problem in India. Nationally representative RAAB surveys (Rapid Assessment of Avoidable Blindness) are being conducted periodically in the country to know the current status of blindness in the country. The current study describes the findings from the RAAB survey conducted during 2015–19 in India.
Methodology
A cross-sectional, population-based survey was conducted across the entire country among persons aged 50 years and above using RAAB version 6 methodology. Presenting and pinhole visual acuity was recorded followed by lens examination using a torchlight. In order to estimate the prevalence of blindness and visual impairment in overall population in India, district weights were assigned to each of the 31 surveyed districts and the prevalence was standardized using the RAAB software.
Results
The overall weighted, age-gender standardized, prevalence of blindness (presenting visual acuity <3/60 in better eye) in population aged ≥50 years was 1.99% (95% CI 1.94%, 2.13%) and of visual impairment (VI) (presenting visual acuity <6/12 in better eye) was 26.68% (95% CI 26.57–27.17%). On multivariate analysis, adjusted odds ratio showed that blindness was associated with age ≥ 80 years (OR = 20.3, 95% CI: 15.6–26.4) and being illiterate (OR = 5.6, 95% CI: 3.6–8.9). Blindness was not found to be significantly associated with either gender or locality.
Conclusion
The results of the survey demonstrate that currently more than one fourth of persons aged 50 years and above are visually impaired (PVA<6/12 in better eye) in India. The prevalence of blindness among them is 1.99%, and older age and illiteracy are significantly associated with blindness. Major causes of blindness included cataract (66.2%), corneal opacity (CO) (8.2%), cataract surgical complications (7.2%), posterior segment disorders (5.9%) and glaucoma (5.5%). The proportion of blindness and visual impairment that is due to avoidable causes include 92.9% and 97.4% respectively.
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Brar AS, Sahoo J, Behera UC, Jonas JB, Sivaprasad S, Das T. Prevalence of diabetic retinopathy in urban and rural India: A systematic review and meta-analysis. Indian J Ophthalmol 2022; 70:1945-1955. [PMID: 35647959 PMCID: PMC9359280 DOI: 10.4103/ijo.ijo_2206_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A systematic review and meta-analysis were conducted to estimate the prevalence of diabetic retinopathy (DR) in India’s urban and rural areas. Medline, Scopus, and ScienceDirect databases were searched for population-based studies published in English between January 1990 and April 2021, wherein the prevalence of DR among Indian residents with type 2 diabetes mellitus (DM) was reported. A random-effects model was used to estimate the overall, rural, and urban prevalence. Data from 10 eligible studies were aggregated for meta-analysis. The prevalence of DR was 17.44% (95% confidence interval [CI], 14.33–20.55) in urban and 14.00% (95% CI: 9.13–18.86) in rural population (P = 0.24). The overall DR prevalence was 16.10% (95% CI: 13.16–24.32), and the population prevalence was 1.63% [95% CI: 0.94–2.32]. Prevalence of DR in people with diabetes was lower in the age group of 40–49 years [13.57% (95% CI: 7.16–19.98)] than in the age group of 50–59 years [16.72% (95% CI: 12.80–20.64)] and the age group of 60 years and above [16.55% (95% CI: 12.09–21.00)]. Variability in studies was high: urban (I2 = 88.90%); rural (I2 = 92.14%). Pooled estimates indicate a narrow difference in DR prevalence among people with diabetes in rural and urban India. The fast urbanization and increasing diabetes prevalence in rural areas underscore the need for providing equitable eye care at the bottom of the health pyramid.
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Affiliation(s)
- Anand Singh Brar
- Department of Retina and Vitreous, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Jyotiranjan Sahoo
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Umesh Chandra Behera
- Department of Retina and Vitreous, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Jost B Jonas
- Department of Ophthalmology, Institute of Molecular and Clinical Ophthalmology Basel, Switzerland
| | - Sobha Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, L V Prasad Eye Institute (Kallam Anji Reddy Campus), Hyderabad, Telangana, India
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Sabherwal S, Kuyyadiyil S, Tomar VPS, Sood I, Singh KV, Jain EK, Majumdar A, Bassett K. A multicentric cross-sectional study measuring the equity of cataract surgical services in three high-volume eyecare organizations in North India: Equitable cataract surgical rate as a new indicator. Indian J Ophthalmol 2021; 69:3498-3502. [PMID: 34826983 PMCID: PMC8837367 DOI: 10.4103/ijo.ijo_134_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Cataract remains the leading cause of blindness and visual impairment in most low-and middle-income countries, with the greatest burden borne by women. To achieve Global Action Plan targets, cataract programs must target people, especially women, with maximum need. This study examines whether cataract surgical programs in three major north Indian eyecare institutions are equitable and describes a refined indicator for reporting equity. Methods: Retrospective one-year cross-sectional study of cataract surgery utilization using routine administrative data from three north Indian eyecare institutions. Patient data were categorized by paying category, sex, and preoperative visual acuity. Comparisons were made between payment categories and sexes. Results: Out of the total number of patients operated, 86,230 were in the non-paying category and 56,738 in the paying category. Overall, 8.2% were blind, 21.1% were severely visual impaired (SVI) or worse, and 86.1% were moderate visual impaired (MVI) or worse. Non-paying patients had a significantly higher proportion of poorer visual categories compared to paying patients [(blind, 9.7% vs. 5.8%; SVI or worse, 24.6% vs. 15.8%; and MVI or worse, 89.1% vs. 81.6%, respectively, (P < 0.001)]. Women had significantly higher proportion of poorer visual categories than men [(blind, 8.9% vs. 7.4%, SVI or worse, 21.9% vs. 20.3% and MVI or worse 87.6 vs. 84.7%) (P < 0.001)]. Conclusion: The institutions primarily provided surgery to patients with maximum need: too poor to pay, low visual acuity, and women. Similar data from all service providers of a region can help estimate the proposed “equitable cataract surgical rate”: the proportion of patients operated with maximum need among those operated in a year. This can be used for targeting people in need.
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Affiliation(s)
- Shalinder Sabherwal
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi; The Bodhya Eye Consortium a. Dr Shroff's Charity Eye Hospital, New Delhi, b. Sadguru Netra Chikitsalaya, Jankikund, Chitrakoot, Madhya Pradesh, c. Regional Institute of Ophthalmology and Sitapur Eye Hospital, Sitapur, Uttar Pradesh, d. MGM Eye Institute, Raipur, Chhattisgarh, e. CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India, f. LJ Eye Institute, Ambala City, Haryana, India
| | - Subeesh Kuyyadiyil
- Centre for Community Ophthalmology, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh; The Bodhya Eye Consortium a. Dr Shroff's Charity Eye Hospital, New Delhi, b. Sadguru Netra Chikitsalaya, Jankikund, Chitrakoot, Madhya Pradesh, c. Regional Institute of Ophthalmology and Sitapur Eye Hospital, Sitapur, Uttar Pradesh, d. MGM Eye Institute, Raipur, Chhattisgarh, e. CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India, f. LJ Eye Institute, Ambala City, Haryana, India
| | - Vijay P S Tomar
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh; The Bodhya Eye Consortium a. Dr Shroff's Charity Eye Hospital, New Delhi, b. Sadguru Netra Chikitsalaya, Jankikund, Chitrakoot, Madhya Pradesh, c. Regional Institute of Ophthalmology and Sitapur Eye Hospital, Sitapur, Uttar Pradesh, d. MGM Eye Institute, Raipur, Chhattisgarh, e. CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India, f. LJ Eye Institute, Ambala City, Haryana, India
| | - Ishaana Sood
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi; The Bodhya Eye Consortium a. Dr Shroff's Charity Eye Hospital, New Delhi, b. Sadguru Netra Chikitsalaya, Jankikund, Chitrakoot, Madhya Pradesh, c. Regional Institute of Ophthalmology and Sitapur Eye Hospital, Sitapur, Uttar Pradesh, d. MGM Eye Institute, Raipur, Chhattisgarh, e. CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India, f. LJ Eye Institute, Ambala City, Haryana, India
| | - Kunal V Singh
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh; The Bodhya Eye Consortium a. Dr Shroff's Charity Eye Hospital, New Delhi, b. Sadguru Netra Chikitsalaya, Jankikund, Chitrakoot, Madhya Pradesh, c. Regional Institute of Ophthalmology and Sitapur Eye Hospital, Sitapur, Uttar Pradesh, d. MGM Eye Institute, Raipur, Chhattisgarh, e. CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India, f. LJ Eye Institute, Ambala City, Haryana, India
| | - Elesh K Jain
- Centre for Community Ophthalmology, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh; The Bodhya Eye Consortium a. Dr Shroff's Charity Eye Hospital, New Delhi, b. Sadguru Netra Chikitsalaya, Jankikund, Chitrakoot, Madhya Pradesh, c. Regional Institute of Ophthalmology and Sitapur Eye Hospital, Sitapur, Uttar Pradesh, d. MGM Eye Institute, Raipur, Chhattisgarh, e. CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India, f. LJ Eye Institute, Ambala City, Haryana, India
| | - Atanu Majumdar
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Ken Bassett
- University of British Columbia; Seva Canada, Seva Canada Society, Vancouver, BC, Canada
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Sobti S, Sahni B, Bala K. Surgical coverage of cataract in a rural area of north India: A cross-sectional study. J Family Med Prim Care 2020; 9:4112-4117. [PMID: 33110818 PMCID: PMC7586552 DOI: 10.4103/jfmpc.jfmpc_520_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/26/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background: India has the highest number of blind people globally, unoperated cataract being the most common cause of blindness and low vision. Although safe and effective cataract surgical techniques are available, the cataract burden continues to increase annually, due to the backlog of patients to be operated upon, and a growing number of cataract cases due to increased life expectancy. Aim: To assess cataract surgical coverage (CSC) in a rural area of north India. Methods: A population-based cross-sectional study of CSC among adults (40 years and above) was carried out in two villages of a block in north India using a predesigned questionnaire, visual acuity assessment, and distant direct ophthalmoscopy. Based on the data obtained, CSC (VA <6/60) for both “persons” as well as “eyes” was calculated. Results: Overall, CSC (persons) of 43.20% was observed, 29.31% coverage among persons with unilateral cataract and 50.45% among persons with bilateral cataract while CSC (eyes) was found to be 37.14%, being significantly higher (43.56%) among females compared to males (28.21%) (P = 0.012). Around 50% of cataract surgeries were performed in private facilities, 41.35% in government facilities, and rest 8.65% in eye camps. Nearly 90.38% were implanted intraocular lens and 9.62% were non-intraocular lens surgeries. Conclusions: Surgical needs for cataract are currently not being met effectively. Reasons for inadequate cataract surgical services need to be sought and addressed to improve the uptake of existing services. Further, reasons for underutilization of government hospitals for cataract surgeries need to be examined.
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Affiliation(s)
- Shalini Sobti
- Department of Community Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, J and K, India
| | - Bhavna Sahni
- Department of Community Medicine, Govt. Medical College, Jammu, J and K, India
| | - Kiran Bala
- Department of Community Medicine, Govt. Medical College, Jammu, J and K, India
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