Purpose: To describe the study design, interobserver variability of the questionnaires and clinical procedures of Hyderabad Ocular Morbidity in Elderly Study (HOMES) designed to, (a) to investigate the prevalence, causes and risk factors for visual impairment, and (b) to assess the impact of dispensing spectacles and cataract surgery on visual functions, fear of falls (FOF) and depression among the elderly in India. Methods: Individuals aged ≥60 years are considered elderly. The non-clinical protocol was administered by two trained investigators and included collection of personal, sociodemographic information, ocular and systemic history, Indian Visual Function Questionnaire (IND-VFQ33), Patient Health Questionnaire (PHQ9), Mini-Mental State Examination (MMSE) questionnaire, Hearing Handicap Inventory for the Elderly Screening (HHIE), Short Falls Efficacy Scale (SFES) questionnaire. The eye examination was conducted by a trained optometrist and vision technicians in clinics setup in the homes and included visual acuity (VA) assessment for distance and near, anterior segment examination and fundus examination, and imaging. The reliability assessments were carried out among 138 participants. Result: The intraclass correlation (ICC) coefficients for MMSE, PHQ9, HHIE, SFES was 0.73 (95% CI: 0.62-0.81), 0.67 (95% CI: 0.54-0.77), 0.63 (95% CI: 0.48-0.74) and 0.70 (95% CI: 0.58-0.79) respectively. The ICC for INDVFQ domains ranged from 0.66 (95% CI: 0.55-0.74) for Psychosocial Impact to 0.88 (95% CI: 0.84-0.91) for activity limitation. The ICC for VA was 0.94 (95% CI: 0.92-0.96). Conclusion: All questionnaires demonstrated acceptable reliability and can be applied in the main study. HOMES is expected to provide data that will help plan strategies to contribute towards 'healthy aging' in India.

ObjectivesTo investigate the temporal trends in the prevalence and causes of visual impairment (VI) in South India.DesignPopulation-based cross-sectional studies conducted during the years 2011–2012 and 2017 using identical study methods and in geographical locations are compared. The L V Prasad Eye Institute established services in Khammam and not in Warangal district after the 2011–2012 study.SettingKhammam and Warangal districts in Telangana, India.ParticipantsIn total, 5357 participants aged ≥40 years were examined from two districts in the 2011–2012 study and 4923 participants were examined in the 2017 study.Main outcome measuresAge-adjusted and gender-adjusted temporal trends in the prevalence and causes of VI.Blindness and moderate VI (MVI) were defined as presenting visual acuity worse than 6/60 and 6/18–6/60 in the better eye, respectively. VI included MVI and blindness.ResultsNearly 2500 participants were examined in each location in both the 2011–2012 and 2017 studies. In Khammam district, overall VI declined by 2.5% from 15.5% to 13.0% (p<0.001). While there was no significant change in MVI (p=0.566), blindness declined by 3.0% from 5.4% to 2.4% (p<0.001). In Warangal district, the overall VI remained unchanged (p=0.60). While MVI increased by 3% from 9.3% to 12.3% (p=0.001), blindness declined by 3.5% from 6.5% to 3.0% (p<0.001). While MVI due to cataract increased in both districts, there was a significant decline in MVI due to refractive errors in Khammam.ConclusionThere was a significant decline in VI in Khammam district but not in Warangal district. The differential trends in prevalence and causes of VI can be explained by the availability and uptake of eye care services in these two districts.

Background This study aims to assess the temporal trends in the prevalence of spectacle use and spectacle coverage for refractive errors in population‐based studies conducted during 2011–2012 and 2017 among those aged ≥ 40 years in the state of Telangana, India. An intervention in the form of 10 vision centres and a secondary centre was established in one district (Khammam) after the 2011–2012 study and another district (Warangal) was left to secular trends. Methods In both the studies, multi‐stage cluster random sampling methodology was used to select the participants. In addition to a clinical examination, a questionnaire was used for collecting information on current and previous use of spectacles, type of spectacles and details of the spectacle providers. The same questionnaire was used in both the studies. Results In total, 2,485 participants were examined in the 2011–2012 study and 2,711 participants were examined in the 2017 study in Khammam. Similarly, 2,438 and 2,646 participants were examined in Warangal in the two studies, respectively. In Khammam, the age and gender‐adjusted prevalence of current spectacle use increased from 30.0 per cent (95% CI 28.2–31.9) to 34.8 per cent (95% CI 33.0–36.6) in the 2011–2012 and 2017 studies, respectively (p < 0.01). However, in the Warangal district, the age and gender‐adjusted prevalence of current spectacle use declined from 32.8 per cent (95% CI 31.0–34.7) to 27.6 per cent (95% CI 25.9–29.3) during the 2011–2012 and 2017 studies, respectively (p < 0.01). In Khammam, the spectacle coverage increased from 26.9 per cent to 35.6 per cent, but it declined from 43.8 per cent to 35.7 per cent in Warangal between the studies in 2011–2012 and 2017. Conclusions An increase in spectacle use and coverage was observed in Khammam where the secondary centre and vision centres were established, compared to Warangal where there was no such intervention. The results suggest a positive impact of the intervention in the Khammam district and suggest replication of the model to address the burden of uncorrected refractive errors.

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