Role of Outreach Camps in Reducing the Burden of Cataracts in South India

Nayak RR

ISSN 0972-5997

Published Quarterly

Mangalore, India

editor.ojhas@gmail.com

Custom Search

OJHAS Vol. 13, Issue 1: (Jan-Mar 2014)

Short Report
Role of Outreach Camps in Reducing the Burden of Cataracts in South India

Authors
Rajesh Nayak R, Ajay Kamath R, Madhurima Nayak A, Gurudutt Kamath M, Manjunath Kamath M, Susan D'Souza,
Department of Ophthalmology, Kasturba Medical College, Mangalore.

Address for Correspondence
Dr. Madhurima A Nayak,
CII 12, KMC staff quarters,
Light House Hill Road,
Mangalore 575003,
India.
E-mail: 14maddy@gmail.com

Citation
Nayak RR, Kamath AR, Nayak MA, Kamath GM, Kamath MM, D'Souza S. Role of Outreach Camps in Reducing the Burden of Cataracts in South India. Online J Health Allied Scs. 2014;13(1):5. Available at URL: http://www.ojhas.org/issue49/2014-1-5.html

Open Access Archives
http://cogprints.org/view/subjects/OJHAS.html
http://openmed.nic.in/view/subjects/ojhas.html

Submitted: Mar 10, 2014; Accepted: Apr 22, 2014; Published: May 15, 2014

This work is licensed under a Creative Commons Attribution-No Derivative Works 2.5 India License

This Article

Abstract: Aim: To establish the efficacy of rural outreach programme in reducing blindness caused by cataract by comparative analysis of visual outcome. Materials and Methods: Records of patients attending outreach camps conducted during 10 years i.e., 2001-02 to 2010-11 were studied. The total number of patients attending the camp and those who were detected to have visually significant cataract were noted. Similarly, the number of patients attending the outpatient department of the department of Ophthalmology and the number detected with visually significant cataract were noted. Data was tabulated and analyzed. Result: Out of 1, 16,615 patients visiting the outpatient department during those ten years, 3,014 were detected to have cataract (2.58%). 744 camps were conducted during the period of ten years, screening 60,086 patients and 6711 (11.17%) of them were detected to have cataract and were operated. These results were statistically significant. Conclusions: High numbers of cataracts were detected in the rural parts of South India with the help of outreach camps, while compared to tertiary care centres. They were given treatment in the form of cataract extraction and implantation of intraocular lens. Hence, conducting outreach camps forms an integral part in decreasing the visual morbidity due to cataract.
Key Words: Outreach camps; Cataract surgery; Mobile ophthalmic unit

Introduction:

Cataract is the most common cause of treatable blindness in the world. In India in the year 2000, 50-70% of preventable blindness was due to senile cataract.^1-6

Improving the health of the common man is the need of the hour to decrease the disease burden of the country. Outreach camps in the form of mobile ophthalmic units help to detect cataract and provides affordable treatment in the rural and semi urban parts of the country. In a country like India, dominated by ignorance about health problems, awareness provided by these outreach programs is necessary to eliminate cataract associated blindness. Patients selected for surgery are brought to a tertiary care centre and they undergo cataract extraction. With growing availability of facilities in the form of IOL implantation and phacoemulsification, the visual outcome is far superior to conventional eye camps. Also, postoperative care, too is provided free of cost.

Outreach camps cover a wider area than the tertiary centre and thus the unrecognized rural and poor population is benefited. This study aims to emphasize the need and efficacy of outreach programs in decreasing blindness due to cataract in India.

Materials and Methods:

This is a record based retrospective study. Various camps that were conducted in Dakshina Kannada district were included. The number of patients screened at an outreach camp and the number of patients detected with cataract were noted. Also, hospital outpatient records of a tertiary care hospital in Mangalore were analyzed. The number of outpatients seen and the number of cataract surgeries performed during ten years were noted. The results were analyzed using chi square test.

Results:

A total of 1,16,615 patients were seen at the outpatient department of the tertiary care hospital, of which 3014 (2.58%) underwent cataract surgeries [Table 1]. A total of 744 camps were conducted during which 60,086 patients were screened, and 6711 (11.17%) were detected to have cataract [Table 2]. These results were statistically significant [Table 3] (p<0.001). A total of 9,275 surgeries were performed and 9635 of them were implanted with an intraocular lens, remaining 70 patients were given aphakic spectacle correction or a secondary IOL.

Table 1: Number of visually significant cataract detected and operated at the tertiary care centre during ten years.
Year	Hospital OPD	Cataract surgeries	Percentage
2001-02	11199	255	2.27
2002-03	8760	173	1.97
2003-04	7951	193	2.42
2004-05	10486	137	1.30
2005-06	11628	215	1.84
2006-07	11766	349	2.96
2007-08	13584	338	2.48
2008-09	14933	409	2.73
2009-10	15310	476	3.10
2010-11	10998	469	4.26
Total	1,16,615	3014	2.58%

Table 2: Number of patients with visually significant cataract detected by the mobile ophthalmic unit (MOU) and operated during ten years
Year	MOU OPD	MOU cataract surgeries	Percentage	No. of camps
2001-02	5599	836	14.93%	65
2002-03	4629	690	14.90%	54
2003-04	3975	700	17.61%	77
2004-05	5423	769	14.18%	57
2005-06	5814	744	12.79%	62
2006-07	5888	720	12.22%	73
2007-08	6972	668	9.58%	73
2008-09	7466	598	8.01%	96
2009-10	7655	518	6.76%	98
2010-11	6665	468	7.02%	89
Total	60086	6711	11.17%	744

Table 3: Percentage of patients with cataract detected at camps (MOU) and at a tertiary care centre.
Year	Percent of cataracts at hospital	Percent of cataract surgeries at camp	Z
2001-02	2.27%	14.93%	31.373*
2002-03	1.97%	14.90%	28.979*
2003-04	2.42%	17.61%	29.674*
2004-05	1.30%	14.18%	33.212*
2005-06	1.84%	12.79%	29.91*
2006-07	2.96%	12.22%	24.327*
2007-08	2.48%	9.58%	22.316*
2008-09	2.73%	8.01%	17.945*
2009-10	3.10%	6.76%	12.841*
2010-11	4.26%	7.02%	7.0926*
*p<0.001, percentage of patients with cataract detected at camps (MOU) are significantly higher than those at a tertiary care centre.

Discussion:

Cataract is the most common cause of treatable blindness. There is neither medical treatment nor any preventive measure to decrease cataract formation. There is a need to recognize the population which does not seek medical aid due to various reasons. Studies have shown that well organized outreach camps are necessary to diagnose and treat cataract in rural areas. There is little information regarding modern eye camps and their role in decreasing the burden of cataract. This study aims to highlight the role of such camps.

An outreach camp is organized with the help of local primary and community health centres where patients are educated about the need for eye examination and cataract surgery, which can improve their quality of life. In contrast to older eye camps where surgeries were performed at the camp site and aphakic spectacle correction was provided, modern day outreach camps have the facility to bring patients to a centre where cataract surgeries are performed in an operation theatre with aseptic precautions. Also facilities like phacoemulsification with foldable IOLs are provided to the patients. Post operatively, they are provided topical medications free of cost and called for follow-up. Thus, there are decreased chances of postoperative complications.

These camps were conducted two to three times a week. The Mobile Ophthalmic Unit consisted of an Ophthalmologist, an optometrist and an organizer who was familiar with the location of the camp. Patients with cataract were identified and brought back to the tertiary care centre where surgery was performed by a group of 5 surgeons. Pre-operative work up and A-scan biometry were performed at the hospital. Patients with pterygium, squint and dacryocystorhinstomy were also brought along with the cataract patients. The treatment thus given was free of cost and they were provided free food. Patients requiring further investigations like FFA, OCT and perimetry were called at a later date and examined. This set up is advantageous in recognizing the patients with cataract and also dealing with other associated ocular or systemic problems, if any.

An outreach camp based report by Vivekananda Mission Ashram in West Bengal reported that 35% of the patients attending the camp were advised surgery.⁷ A study by Vijaya et al., showed a prevalence of 13.4% cataracts at rural eye camps.⁸ Our study has reported a mean of 11.05% of cataracts recognized at the outreach camps. This can be explained by the large number of Medical College Hospitals in Dakshina Kannada district.

Traditionally eye camps were not conducted at hospitals. High volume cataract surgeries were performed in rural areas. The trend of using intraocular lenses for high volume cataract surgeries is not new. Civertia et al, in 1996 reported the largest number of intraocular lenses implanted in a public eye camp.⁹

A study by Kapoor et. al., in Ludhiana in 1997, showed that only 3.6% of the eyes underwent IOL implantation¹⁰, compared to our study wherein only 0.0075% patients were not implanted with IOL; and all these were operated before 2006. In a study by Vijay et al., 55.4% patients in a rural camp were implanted with an IOL, whereas the urban arm had a higher percentage of pseudophakics (72.8%).⁸ This shows the change in trend in cataract surgery toward IOL implantation, as IOLs are more easily available.

The limitations of this study are that the visual outcome could not be compared between the two groups due to insufficient data. The type of surgery performed, whether ECCE, SICS or phacoemulsification were not documented and hence could not be analyzed. Also, whether PCIOL or ACIOL was used was not documented. The operative and postoperative complications could not be compared between the two groups. Thus, documentation of more details regarding these camps is required to understand their role better. Nevertheless, outreach camps play a significant role in reducing the burden of cataract.

References

Thulasiraj RD, Nirmalan PK, Ramakrishnan R, Krishandas R, Manimekalai TK, Baburajan NP, et al. Blindness and Vision Impairment in a Rural South Indian Population: The Aravind Comprehensive Eye Survey. Ophthalmology. 2003;110:1491-1498.
Thulasiraj RD, Rahamathulla R, Saraswati A, Selvaraj S, Ellwein LB. The Sivaganga eye survey: I, Blindness and cataract surgery. Ophthal Epidemiol. 2002;9:299-312.
Nirmalan PK, Thulasiraj RD, Maneksha V, Rahmathullah R, Ramakrishnan R, Padmavathi A, et al. A population based eye survey of older adults in Tirunelveli district of south India: Blindness, cataract surgery and visual outcomes. Br J Ophthalmol. 2002;86:505-512.
Murthy GV, Gupta S, Ellwein LB, Munoz SR, Bachani D, Dada VK. A Population-based Eye Survey of Older Adults in a Rural District of Rajasthan: I, Central Vision Impairment, Blindness and Cataract Surgery. Ophthalmology. 2001;108:679-685.
Mohan M. National Survey of Blindness-India. NPCB-WHO Report. New Delhi: Ministry of Health and Family Welfare, Government of India; 1989.
Mohan M. Collaborative Study on Blindness (1971-1974): A report. New Delhi, India: Indian Council of Medical Research; 1987. pp. 1-65.
Sil AK. Outreach eye camps: a case study from West Bengal, India. Community Eye Health. 2006 June;19(58):22-23.
Vijaya L, George R, Rashima A, Raju P, Arvind H, Baskaran M, et. al. Outcomes of cataract surgery in a rural and urban south Indian population. Indian J Ophthalmol. 2010 May-Jun;58(3):223-228
Civerchia L, Ravindran RD, Apoorvananda SW, Ramakrishnan R, BalentA, Spencer MH et al. High-volume intraocular lens surgery in a rural eye camp in India. Ophthalmic Surg Lasers. 1996 Mar;27(3):200-208.
Kapoor H, Chatterjee A, Daniel R, Foster A. Evaluation of visual outcome of cataract surgery in an Indian eye camp. Br J Ophthalmol. 1999;83:343-346.