Moderate visual impairment in India: the Andhra Pradesh Eye Disease Study

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 degrees 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.

Blindness in the Indian state of Andhra Pradesh

PURPOSE

To determine the current prevalence and causes of blindness in the Indian state of Andhra Pradesh to assess if blindness has decreased since the last survey of 1986-1989.

METHODS

A population-based epidemiology study, using a stratified, random, cluster, systematic sampling strategy, was conducted in the state of Andhra Pradesh in India. Participants of all ages (n = 10,293), 87.3% of the 11,786 eligible, from 94 clusters in one urban and three rural areas representative of the population of Andhra Pradesh, underwent interview and a detailed dilated ocular evaluation by trained professionals. Blindness was defined as presenting distance visual acuity < 6/60 or central visual field < 20(o) in the better eye.

RESULTS

Two hundred seventy-five participants were blind, a prevalence of 1.84% (95% confidence interval, 1.49%-2.19%) when adjusted for the age, sex, and urban-rural distribution of the population in 2000. The causes of this blindness were easily treatable in 60.3% (cataract, 44%; refractive error, 16.3%). Preventable corneal disease, glaucoma, complications of cataract surgery, and amblyopia caused another 19% of the blindness. Blindness was more likely with increasing age and decreasing socioeconomic status, and in female subjects and in rural areas. Among the 76 million population of Andhra Pradesh, 714,400 are estimated to have cataract-related blindness (615,600 cataract, 53,200 cataract surgery-related complications, 45,600 aphakia), and 228,000 refractive error-related blindness (159,600 myopia, 22,800 hyperopia, 45,600 refractive error-related amblyopia). If 95% of the cataract and refractive error blindness in Andhra Pradesh had been treated effectively, 3.4 and 7.4 million blind-person-years, respectively, could have been prevented. If 90% of the blindness due to preventable corneal disease and glaucoma had been prevented, another 2.7 million blind-person-years could have been prevented.

CONCLUSIONS

The prevalence of blindness in this Indian state has increased from 1.5% in the late 1980s to 1.84% currently, as against the target of the National Program for Control of Blindness to reduce the prevalence to 0.3% by 2000. The number of people with cataract-related blindness has not reduced even with the eye care policy focus on cataract. Reduction of blindness in India will require strategies that are more effective than those that have been pursued so far.

Removal of toxic metals from solution by leaf, stem and root phytomass of Quercus ilex L. (holly oak)

Increased consciousness for safeguarding the aqueous environment has prompted a search for alternative technologies for the removal of toxic metal ions from aqueous solutions. In this regard, a wide variety of biomass is being considered as adsorbents of heavy metals for treatment of industrial and domestic wastewaters as well as natural waters, including drinking water. In the present investigation, the potential of Quercus ilex phytomass from stem, leaf and root as an adsorbent of chromium (Cr), nickel (Ni), copper (Cu), cadmium (Cd) and lead (Pb) at ambient temperature was investigated. The metal uptake capacity of the root for different metals was found to be in the order: Ni>Cd>Pb>Cu>Cr; stem Ni>Pb>Cu>Cd>Cr; and leaf Ni>Cd>Cu>Pb>Cr. The highest amount adsorbed was Ni (root>leaf>stem). Data from this laboratory demonstrated that Ni is sequestered mostly in the roots, where concentrations can be as high as 428.4 ng/g dry wt., when 1-year-old seedlings were treated with Ni (2000 mg/l) in pot culture experiments, compared to 7.63 ng/g dry wt., control (garden and greenhouse soil) topsoil where Ni was present in trace amounts. This proves that the root biomass of Q. ilex has the capacity for complexing Ni. Cr exhibited the least adsorption values for all the three types of phytomass compared to other metals. The trend of adsorption of the phytomass was similar for Ni and Cd, i.e. root>leaf>stem. Desorption with 10 mM Na(4) EDTA was effective (55-90%) and, hence, there exists the possibility of recycling the phytomass. The biosorption results of recycled phytomass suggest that the selected adsorbents are re-usable. The advantages and potential of the Q. ilex phytomass as a biofilter of toxic trace metals, the scope and need for enhancing the efficiency of the Q. ilex phytomass as an adsorbent of metals are presented.

Purification and partial characterization of a lectin from Euphorbia neriifolia latex

A lectin was purified from Euphorbia neriifolia latex to homogeneity by affinity chromatography on Sepharose 4B. The protein appears to be a dimer with approximate M(r) of 60,000 on gel filtration and showing a single band at M(r) 32,000 in SDS-PAGE, and contains 12.3% carbohydrate. It agglutinated trypsinized human and rabbit erythrocytes, but not sheep erythrocytes. However, sialidase-treated sheep erythrocytes were agglutinated. The galactose and galactose containing sugars inhibited the heamagglutination with increased beta-anomeric specificity. The Euphorbia lectin possesses mitogenic activity with murine spleen lymphocytes but it does not inhibit protein synthesis in rabbit reticulocyte lysate.