Integrated Model of Primary and Secondary Eye Care for Underserved Rural Areas: the L V Prasad Eye Institute Experience

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2012 Sep 5

PMID 22944748

Citations 101

Authors

Gullapalli N Rao

Rohit C Khanna

Sashi Mohan Athota

Varda Rajshekar

Padmaja Kumari Rani

Affiliations

Soon will be listed here.

Abstract

Blindness is a major global public health problem and recent estimates from World Health Organization (WHO) showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS) provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP). It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI) developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion) in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.

Citing Articles

Estimating the need for diabetic retinopathy services in north India: evidence from a population-based survey in the catchment population of an eye care provider in central Uttar Pradesh.

Sabherwal S, McCormick I, Javed M, Sood I, B R S, Buttan S BMJ Open. 2025; 15(1):e091773.

PMID: 39819921 PMC: 11883894. DOI: 10.1136/bmjopen-2024-091773.

Uptake of eye care services in South India: Retrospective mapping of self-reported barriers using the Theoretical Domains Framework.

Yelagondula V, Marmamula S, Varada R, Subramanian A, Lawrenson J Ophthalmic Physiol Opt. 2024; 45(2):450-457.

PMID: 39602082 PMC: 11823384. DOI: 10.1111/opo.13424.

Clinical Presentation and Treatment Outcomes of Adult-Onset Coats Disease.

Hansraj S, Raval V, Jalali S, Sahoo N, Das A J Vitreoretin Dis. 2024; :24741264241286580.

PMID: 39539824 PMC: 11556389. DOI: 10.1177/24741264241286580.

Clinical profile and etiological spectrum of patients presenting with corneal hydrops over a 12-year period.

Bevara A, Das A, Chaurasia S Int Ophthalmol. 2024; 44(1):411.

PMID: 39499370 DOI: 10.1007/s10792-024-03336-x.

Clinico-demographic profile and visual outcomes of pseudophakic bullous keratopathy in a multi-tier eyecare network in India.

Das A, Kaup S, Das S Indian J Ophthalmol. 2024; 73(3):363-369.

PMID: 39297483 PMC: 7617352. DOI: 10.4103/IJO.IJO_323_24.

References

Dandona L, Dandona R, Naduvilath T, McCarty C, Mandal P, Srinivas M . Population-based assessment of the outcome of cataract surgery in an urban population in southern India. Am J Ophthalmol. 1999; 127(6):650-8. DOI: 10.1016/s0002-9394(99)00044-6. View

Angra S, Murthy G, Gupta S, Angra V . Cataract related blindness in India & its social implications. Indian J Med Res. 1997; 106:312-24. View

Dandona L, Dandona R, Naduvilath T, McCarty C, Srinivas M, Mandal P . Burden of moderate visual impairment in an urban population in southern India. Ophthalmology. 1999; 106(3):497-504. DOI: 10.1016/S0161-6420(99)90107-0. View

Marmamula S, Madala S, Rao G . Rapid assessment of visual impairment (RAVI) in marine fishing communities in South India--study protocol and main findings. BMC Ophthalmol. 2011; 11:26. PMC: 3184277. DOI: 10.1186/1471-2415-11-26. View

Marmamula S, Keeffe J, Rao G . Uncorrected refractive errors, presbyopia and spectacle coverage: results from a rapid assessment of refractive error survey. Ophthalmic Epidemiol. 2009; 16(5):269-74. View

AGARWAL L . National programme for prevention of visual impairment and control of blindness. Indian J Ophthalmol. 1978; 25(4):1-5. View

Dandona L, Dandona R, Srinivas M, Giridhar P, Vilas K, Prasad M . Blindness in the Indian state of Andhra Pradesh. Invest Ophthalmol Vis Sci. 2001; 42(5):908-16. View

Pascolini D, Mariotti S . Global estimates of visual impairment: 2010. Br J Ophthalmol. 2011; 96(5):614-8. DOI: 10.1136/bjophthalmol-2011-300539. View

Marmamula S, Madala S, Rao G . 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; 32(2):149-55. DOI: 10.1111/j.1475-1313.2012.00893.x. View

10.

Dineen B . Health promotion and community participation in eye care services. Community Eye Health. 2007; 12(31):35-6. PMC: 1706014. View

11.

Zineldin M, Camgoz-Akdag H, Vasicheva V . Measuring, evaluating and improving hospital quality parameters/dimensions--an integrated healthcare quality approach. Int J Health Care Qual Assur. 2011; 24(8):654-62. DOI: 10.1108/09526861111174215. View

12.

Shamanna B, Nirmalan P, Saravanan S . Roles and responsibilities in the secondary level eye care model. Community Eye Health. 2007; 18(56):120-1. PMC: 1705694. View

13.

Kovai V, Krishnaiah S, Shamanna B, Thomas R, Rao G . Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India. Indian J Ophthalmol. 2007; 55(5):365-71. PMC: 2636013. DOI: 10.4103/0301-4738.33823. View

14.

Dandona L, Dandona R, Anand R, Srinivas M, Rajashekar V . Outcome and number of cataract surgeries in India: policy issues for blindness control. Clin Exp Ophthalmol. 2003; 31(1):23-31. DOI: 10.1046/j.1442-9071.2003.00595.x. View

15.

Fletcher A, Donoghue M, Devavaram J, Thulasiraj R, Scott S, Abdalla M . Low uptake of eye services in rural India: a challenge for programs of blindness prevention. Arch Ophthalmol. 1999; 117(10):1393-9. DOI: 10.1001/archopht.117.10.1393. View

16.

Kovai V, Rao G, Holden B, Sannapaneni K, Bhattacharya S, Khanna R . Comparison of patient satisfaction with services of vision centers in rural areas of Andhra Pradesh, India. Indian J Ophthalmol. 2010; 58(5):407-13. PMC: 2992916. DOI: 10.4103/0301-4738.67056. View

17.

Zineldin M . The quality of health care and patient satisfaction: an exploratory investigation of the 5Qs model at some Egyptian and Jordanian medical clinics. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006; 19(1):60-92. DOI: 10.1108/09526860610642609. View

18.

Pararajasegaram R . The global initiative for the elimination of avoidable blindness. Community Eye Health. 2007; 11(26):29. PMC: 1706052. View

19.

Marmamula S, Keeffe J, Raman U, Rao G . Population-based cross-sectional study of barriers to utilisation of refraction services in South India: Rapid Assessment of Refractive Errors (RARE) Study. BMJ Open. 2011; 1(1):e000172. PMC: 3191577. DOI: 10.1136/bmjopen-2011-000172. View

20.

Rao G . An infrastructure model for the implementation of VISION 2020: the right to sight. Can J Ophthalmol. 2004; 39(6):589-90, 593-4. DOI: 10.1016/s0008-4182(04)80023-1. View