Public Eye Health and Community Optometry

Visual Impairment is a public eye health challenge that affects millions of people worldwide. Over 80% of the visual impairment avoidable. A multi-prong approach is needed to address the burden of visual impairment which is more rampant in rural areas. Public Eye Health and Community Eye Care deals with both research to understand the burden of visual impairment using epidemiological tools and also evaluation of service delivery models to address the burden of visual impairment. Understanding the research methods used in eye health, basic understanding of epidemiology and bio statistics will form the core content of this course.

Projects:

Hyderabad Ocular Morbidity among Elderly Study (HOMES)

Visual impairment is more common among the elderly people living in residential care when compared to those living in non-institutionalized environments. A significant number of them have impairment that can be corrected by simple interventions such as the use of spectacles and cataract surgery. Studies have shown that visual impairments in the elderly affect all dimensions of their life such as mobility, self-care, driving and participation in social and religious activities, general health and in overall quality of life.This research aims to investigate the prevalence and causes of visual impairment, and assess the impact of an intervention including the provision of cataract surgery and spectacles on the visual functions of elderly individuals living in residential care in India.


This study is funded by Wellcome and Department of Biotechnology India alliance (2016 - 2020) as a part of early career fellowship awarded to Dr Srinivas Marmamula

Rapid Assessment of Visual Impairment (RAVI) project

The Rapid Assessment of Visual Impairment is methodology that is developed at the institute and is being implanted in several locations in India. This is a quick and a low cost methodology that can provide the information on burden and causes of visual impairment in a given region.

Andhra Pradesh Eye Disease Study (APEDS)

The Andhra Pradesh Eye Disease Study, popularly known as APEDS has three phases:

  • APEDS I : 1996 to 2000 : Population based cross section study
  • APEDS II: 2009 - 2010: A study to trace the original cohort of APEDS I
  • APEDS III: 2012 - 2015 (scheduled): A study to assess incidence (among non-cases) and progression (among cases) of blinding eye conditions among the surviving cohort of APEDS I participants

APEDS I

The Andhra Pradesh Eye Disease Study (APEDS I) was conducted by L V Prasad Eye Institute in in 3 rural (West Godavari, Adilabad, Mahbubnagar) and 1 urban area (Hyderabad) of Andhra Pradesh, India during 1996 and 2000. Multi stage sampling methodology was used to select 11,786 subjects of all ages from 24 urban clusters and 70 rural clusters and 10,293 participants were examined. A comprehensive eye examination and a detailed interview related to demographics and other risk factors were carried out.The aim of this study was to determining the prevalence and cause of visual impairment and to assess the risk factors associated with major eye diseases. The effect of blindness and VI on quality of life (QOL) and barriers that prevent the uptake of eye care services were also studied. The findings of this study were published into over 50 peer-reviewed journals.

Major findings:

The prevalence of blindness (presenting visual acuity <6/60 or central visual field <20 degrees in the better eye) was 1.84%, and moderate visual impairment (presenting visual acuity <6/18-6/60 or equivalent visual field loss in the better eye) was 8.1%. Cataract and refractive error were responsible for 60.3% of blindness and 85.7% of moderate visual impairment. Increasing age, decreasing socioeconomic status, female gender, and rural area of residence were associated with higher risk of blindness.

APEDS I was funded by Hyderabad Eye Research Foundation, Hyderabad,India, and Christoffel-Blindenmission, Bensheim, Germany.


APEDS II

A tracing exercise was carried out during 2009 and 2010 in three rural locations (Tanuku, West Godavari district,Mudhol in Adilabad district and Thoodukurthy in Mahabubnagardistrict) to assess the availability of the APEDS I participants. The status of availability in Tanuku, Mudhole and Thoodukurthy were 72%, 75% and 59% respectively. Overall 69% of the original cohort was available. About 18% participants migrated from their villages, 11% died and information was not available on remaining 2% of the participants. , there was no information available. Tracing exercise in urban area of Hyderabad was not possible due to the enormous infrastructure changes happened in Hyderabad in past 14 years.

APEDS II was funded by International Centre for Eye Health (ICEH), London, UK and Hyderabad Eye Research Foundation, Hyderabad,India.


APEDS III

Encouraged by availability of nearly 70% of the participants of the original APEDS I cohort, APEDS III was planned with the following main objectives.

  1. To assess the cumulative incidence (i.e. new cases) of and risk factors for blindness, visual impairment (VI), cataract, diabetic retinopathy, refractive error and glaucoma in those 30 years and above.
  2. To assess the cumulative incidence (i.e. new cases) of and risk factors for refractive error (myopia) in those 10-29 years.
  3. To investigate progression of and risk factors for blindness/VI, refractive error, lens opacities; glaucoma; diabetic retinopathy

APEDS III was launched in year 2012 in Thoodukurthy in Mahbubnagar district and concluded in Tanuku, West Godavari district in March 2016. Data from this study is being analysed.

Dr Srinivas Marmamula was a clinician in APEDS and a co-investiagtor on APEDS III. Dr Rohit Khanna is the principal Investigator for APEDS III.

APEDS III is funded by Lion Club International Foundation, USA, Hyderabad Eye Research Foundation, India and Dept. of Biotechnology, Centre of Excellence grant, Govt. of India.

The Team



Relevant Publications


A. Peer-reviewed publications (Total publications=40)

  1. Marmamula S, Khanna RC, Kunkunu E, Rao GN. Population-based assessment of prevalence and causes of visual impairment in the state of Telangana, India: a cross-sectional study using the Rapid Assessment of Visual Impairment (RAVI) methodology. BMJ Open. 2016 Dec 15;6(12):e012617. doi:10.1136/bmjopen-2016-012617. PubMed PMID: 27979835.
  2. Marmamula S, Khanna RC, Shekhar K, Rao GN. Outcomes of Cataract Surgery in Urban and Rural Population in the South Indian State of Andhra Pradesh: Rapid Assessment of Visual Impairment (RAVI) Project. PLoS One. 2016 Dec 5;11(12):e0167708. doi: 10.1371/journal.pone.0167708. PubMed PMID: 27918589; PubMed Central PMCID: PMC5137898.
  3. Marmamula S, Khanna RC, Rao GN. Unilateral visual impairment in rural south India-Andhra Pradesh Eye Disease Study (APEDS). Int J Ophthalmol. 2016 May 18;9(5):763-7. doi: 10.18240/ijo.2016.05.23. eCollection 2016. PubMed PMID:27275437; PubMed Central PMCID: PMC4886893.
  4. Marmamula S, Shekhar K, Banerjee S, Khanna RC, Rao GN. Population-Based Assessment of Unilateral Visual Impairment in the South Indian State of Andhra Pradesh: Rapid Assessment of Visual Impairment (RAVI) Project. Ophthalmic Epidemiol. 2016 Jun;23(3):171-5. doi: 10.3109/09286586.2015.1051235. Epub 2016 Mar 30. PubMed PMID: 27028047.
  5. Khanna RC, Murthy GV, Marmamula S, Mettla AL, Giridhar P, Banerjee S, Shekhar K, Chakrabarti S, Gilbert C, Rao GN; Andhra Pradesh Eye Disease Study Group. Longitudinal Andhra Pradesh Eye Disease Study (APEDS3): rationale, study design and research methodology. Clin Experiment Ophthalmol. 2015 Aug 18. doi:10.1111/ceo.12633. [Epub ahead of print] PubMed PMID: 26283446.
  6. Marmamula S, Khanna RC, Shekhar K, Rao GN. A population-based cross-sectional study of barriers to uptake of eye care services in South India: the Rapid Assessment of Visual Impairment (RAVI) project. BMJ Open. 2014 Jun 12;4(6):e005125.
  7. Marmamula S, Shekhar K, Banerjee S, Khanna RC, Rao GN. Population based assessment of unilateral visual impairment in south Indian state of Andhra Pradesh: Rapid Assessment of Visual Impairment (RAVI) Project. Ophthalmic Epidemiology 2016 Mar 30:1-5. [Epub ahead of print]
  8. Marmamula S, Keeffe JE, Narsaiah S, Khanna RC, Rao GN. Population-based assessment of sensitivity and specificity of a pinhole for detection of significant refractive errors in the community. ClinExpOptom. 2014 Nov;97(6):523-7.
  9. Marmamula S, Khanna RC, Narsaiah S, Shekhar K, Rao GN. Prevalence of spectacles use in Andhra Pradesh, India: rapid assessment of visual impairment project. Clin Experiment Ophthalmol. 2014 Apr;42(3):227-34.
  10. Marmamula S, Keeffe JE, Narsaiah S, Khanna RC, Rao GN, MD. Changing Trends in the Prevalence of Visual Impairment, Uncorrected Refractive Errors and Use of Spectacles in Mahbubnagar District in South India. Indian J Ophthalmol. 2013 Dec;61(12):755-8
  11. Marmamula S, Khanna RC, Rao GN. Population-based assessment of prevalence and risk factors for pterygium in the South Indian state of andhra pradesh: the andhra pradesh eye disease study. Invest Ophthalmol Vis Sci 2013;54:5359-5366.
  12. Marmamula S, Narsaiah S, Shekhar K, Khanna RC. Presbyopia, spectacles use and spectacle correction coverage for near vision among cloth weaving communities in Prakasam district in South India. Ophthalmic Physiol Opt 2013.
  13. Marmamula S, Narsaiah S, Shekhar K, Khanna RC, Rao GN. Visual Impairment in the South Indian State of Andhra Pradesh: Andhra Pradesh - Rapid Assessment of Visual Impairment (AP-RAVI) Project. PLoS One 2013;8:e70120.
  14. Marmamula S, Ravuri CS, Boon MY, Khanna RC. A cross-sectional study of visual impairment in elderly population in residential care in the South Indian state of Andhra Pradesh: a cross-sectional study. BMJ open 2013;3.
  15. Marmamula S, Ravuri LVCS, Boon MY, Khanna RC. Spectacle Coverage and Spectacles Use among Elderly Population in Residential Care in the South Indian State of Andhra Pradesh. BioMed Research International 2013;2013:5.
  16. Marmamula S, Narsaiah S, Shekhar K, Khanna RC. Visual Impairment among Weaving Communities in Prakasam District in South India. PLoS One. 2013;8(2):e55924. Epub 2013 Feb 7.
  17. Khanna RC, Marmamula S, Krishnaiah S, Giridhar P, Chakrabarti S, Rao GN. Changing trends in the prevalence of blindness and visual impairment in a rural district of India: systematic observations over a decade. Indian J Ophthalmol. 2012 Sep-Oct;60(5):492-7.
  18. Marmamula S, Keeffe JE, Rao GN. Rapid assessment methods in eye care: an overview. Indian J Ophthalmol. 2012 Sep-Oct;60(5):416-22.
  19. Gothwal VK, Srinivas M, Rao GN. A new look at the WHOQOL as health-related quality of life instrument among visually impaired people using Rasch analysis. Qual Life Res. 2012 May 22.
  20. Marmamula S, Madala SR, Rao GN. Prevalence of uncorrected refractive errors, presbyopia and spectacle coverage in marine fishing communities in South India: Rapid Assessment of Visual Impairment (RAVI) project. Ophthalmic Physiol Opt.2012 Mar;32(2):149-55.
  21. Marmamula S, Madala SR, Rao GN. Rapid assessment of visual impairment (RAVI) in marine fishing communities in South India--study protocol and main findings. BMC Ophthalmol. 2011 Sep 19;11:26.
  22. Marmamula S, Keeffe JE, Raman U, Rao GN. Population-based cross-sectional study of barriers to utilization of refraction services in South India: Rapid Assessment of Refractive Errors (RARE) Study. BMJ Open. 2011 Jul 15;1(1):e000172.
  23. Kovai V, Rao GN, Holden B, Krishnaiah S, Bhattacharya SK, Marmamula S, Khanna R. An estimate of patient costs and benefits of the new primary eye care model utilization through vision centers in Andhra Pradesh, India. Asia Pac J Public Health. 2010 Oct;22(4):426-35.
  24. Marmamula S, Keeffe JE, Rao GN. Uncorrected refractive errors, presbyopia and spectacle coverage: results from a rapid assessment of refractive error survey. Ophthalmic Epidemiol 2009;16:269-274.
  25. Krishnaiah S, Srinivas M, Khanna RC, Rao GN. Prevalence and risk factors for refractive errors in the South Indian adult population: The Andhra Pradesh Eye disease study. ClinOphthalmol. 2009;3:17-27.
  26. Krishnaiah S, Nirmalan PK, Shamanna BR, Srinivas M, Rao GN, Thomas R. Ocular trauma in a rural population of southern India: the Andhra Pradesh Eye Disease Study. Ophthalmology. 2006 Jul;113(7):1159-64.
  27. Krishnaiah S, Kovai V, Srinivas M, Shamanna BR, Rao GN, Thomas R. Awareness of glaucoma in the rural population of Southern India. Indian J Ophthalmol. 2005 Sep;53(3):205-8.
  28. Dandona L, Dandona R, Anand R, Srinivas M, Rajashekar V. Outcome and number of cataract surgeries in India: policy issues for blindness control. Clin Experiment Ophthalmol. 2003 Feb;31(1):23-31.
  29. Dandona R, Dandona L, Srinivas M, Giridhar P, Nutheti R, Rao GN. Planning low vision services in India: a population-based perspective. Ophthalmology. 2002 Oct;109(10):1871-8.
  30. Dandona R, Dandona L, Kovai V, Giridhar P, Prasad MN, Srinivas M.Population-based study of spectacles use in southern India. Indian J Ophthalmol. 2002 Jun;50(2):145-55.
  31. Dandona R, Dandona L, Srinivas M, Giridhar P, Prasad MN, Vilas K, McCarty CA, Rao GN. Moderate visual impairment in India: the Andhra Pradesh Eye Disease Study. Br J Ophthalmol. 2002 Apr;86(4):373-7.
  32. Dandona R, Dandona L, Srinivas M, Giridhar P, McCarty CA, Rao GN. Population-based assessment of refractive error in India: the Andhra Pradesh eye disease study. Clin Experiment Ophthalmol. 2002 Apr;30(2):84-93.
  33. Dandona R, Dandona L, Srinivas M, Sahare P, Narsaiah S, Muņoz SR, PokharelGP,Ellwein LB. Refractive error in children in a rural population in India. Invest Ophthalmol Vis Sci. 2002 Mar;43(3):615-22.
  34. Dandona L, Dandona R, Srinivas M, Mandal P, McCarty CA, Rao GN. Unilateral visual impairment in an urban population in southern India. Indian J Ophthalmol. 2000 Mar;48(1):59-64.
  35. Dandona L, Dandona R, Srinivas M, John RK, McCarty CA, Rao GN. Ocular trauma in an urban population in southern India: the Andhra Pradesh Eye Disease Study. Clin Experiment Ophthalmol. 2000 Oct;28(5):350-6.
  36. Dandona L, Dandona R, Mandal P, Srinivas M, John RK, McCarty CA, Rao GN. Angle-closure glaucoma in an urban population in southern India. The Andhra Pradesh eye disease study. Ophthalmology. 2000 Sep;107(9):1710-6.
  37. Dandona L, Dandona R, Srinivas M, Mandal P, John RK, McCarty CA, Rao GN. Open-angle glaucoma in an urban population in southern India: the Andhra Pradesh eye disease study. Ophthalmology. 2000 Sep;107(9):1702-9.
  38. Dandona R, Dandona L, Naduvilath TJ, Srinivas M, McCarty CA, Rao GN. Refractive errors in an urban population in Southern India: the Andhra Pradesh Eye Disease Study. Invest Ophthalmol Vis Sci. 1999 Nov;40(12):2810-8.
  39. Dandona L, Dandona R, Naduvilath TJ, McCarty CA, Mandal P, Srinivas M, Nanda A, Rao GN. Population-based assessment of the outcome of cataract surgery in an urban population in southern India. Am J Ophthalmol. 1999 Jun;127(6):650-8.
  40. Dandona L, Dandona R, Naduvilath TJ, McCarty CA, Nanda A, Srinivas M, Mandal P, Rao GN. Is current eye-care-policy focus almost exclusively on cataract adequate to deal with blindness in India? Lancet. 1998 May 2;351(9112):1312-6.
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