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Emily Schehlein, Yadalla Dayakar, Joshua R Ehrlich, Joshua D Stein, David Hutton, Rengaraj Venkatesh; Detection of Posterior Segment Disease in Outreach Camps in Rural India. Invest. Ophthalmol. Vis. Sci. 2020;61(7):828.
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The Aravind Eye Care System (AECS) conducts screening camps in rural villages with the primary goal of detecting cataract and uncorrected refractive error. If cataract or another eye disease is detected, patients are transported or referred to the base hospital for further treatment. This study trialed a novel eye camp model that included digital fundus photography and an electronic medical record (EMR) in an effort to improve detection and follow-up rate of posterior segment diseases (PSDs).
A clustered randomized trial in the catchment area of Aravind Eye Care System - Pondicherry compared two interventions: the traditional eye camp and the novel (digital fundus photography and EMR) eye camp model (clinical trial registration CTRI/2019/05/019422). Randomization was at the level of the eye camp rather than the individual. The clinical protocols in the two arms were standardized and the same study team was used in both study arms. The primary study outcome was detection of PSD confirmed on subsequent clinic-based exam. All participants provided informed consent.
A total of 3,048 participants were recruited (50% in each study arm). In both camp types there were more men (60% conventional and 60.6% novel) than women. The proportion receiving a referral for PSD was significantly greater in the novel (8.3%) compared to the traditional (3.6%) eye camps (P < 0.01). Among those referred to the base hospital for suspicion of PSD, 30.9% (n=17) in the conventional camps and 36.2% (n=46) in the novel camps had glaucoma, 25.5% (n=14) in the conventional camps and 13.4% (n=17) in the novel camps had diabetic retinopathy, and 1.8% (n=1) in the conventional camps and 11.8% (n=15) in the novel camps had AMD. The remainder, (43.6% n=24 in the conventional camps and 41.7% n=53 in the novel camps) were characterized as ‘other’ and included other optic neuropathies, retinal vascular occlusions, and extraneous pathology. The total average time to conduct a conventional camp was 5 hours and 11 minutes, as compared to 6 hours and 53 minutes for a novel camp.
An eye camp model that includes digital fundus photography and EMR may increase identification of referable PSD, especially glaucoma and AMD. Further research is needed to determine whether this intervention is cost-effective and may contribute to decreasing the burden of preventable blindness and visual impairment in south India.
This is a 2020 ARVO Annual Meeting abstract.
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