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

Abstract

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...

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