Women make up nearly 55% of the global population with vision impairment. Lack of access to eye care is one of the main reasons more women live with vision impairment than men. In a developing and largely conservative nation like India, the inability to travel far from home, reduced final freedom, and lack of family support to seek eye care make them an underserved demographic in eye care, especially in rural areas. Three layers of LVPEI’s five-tier pyramid model are dedicated to bringing eye care to the doorstep of village households in Telangana, Andhra Pradesh, Odisha, and Karnataka. But is the model working for women?
To answer that question, Dr. Srinivas Marmamula, Network Associate Director of Public Health Research and Training at LVPEI and Dr. Harithaa P. Chadalavada, an ophthalmologist turned public health researcher discuss their latest research paper that describes the age and gender distribution of patients with vision impairment and their access to eye care across the LVPEI network.
What got you interested in public health research?
Dr. Chadalavada: Research on public health can lead to answers in areas where straightforward, financially viable treatments can have a significant impact. For instance, patients with untreated refractive problems can regain their vision with the right prescription glasses. The elegance shown in these simple but efficient solutions makes me interested in this area.
Dr. Marmamula: As a trained optometrist and public health specialist, I wanted to pursue a career that went beyond routine optometrist duties. I led several public health projects at LVPEI, and every project comes with unique challenges. It is tackling these challenges that keeps things exciting and novel for me. You become a social agent in this field: your work will have a direct impact on society.
More young and middle-aged people visited vision centers compared to secondary and tertiary centers. Why?
Dr. Marmamula: Most visits to vision centers involve routine eye exams that include refractive errors, which frequently affect younger age groups. Young people don't want to spend a lot of time at a clinic unless there is an emergency because they frequently have busy lives. In that sense, vision centers are more easily accessible, one can simply walk in to have one's eyes examined.
Older people can have more complex issues like cataract or glaucoma, which cannot be addressed at vision centers. That is why you see more older people at secondary and tertiary centers.
The center of excellence (CoE) was visited by patients mostly in their twenties or fifties. What is the reason behind this trend?
Dr. Marmamula: It is possible that a lot of young people visit the CoE because of refractive surgeries, squint correction, and cosmetic eye procedures. Many young adults want to get rid of their glasses and get contact lenses or refractive surgeries. That is perhaps why there is a peak of 20-year-olds in our dataset.
People in their fifties can have more complicated problems that cannot be handled at secondary or tertiary centers. The CoE is equipped to handle even the most complex eye cases and also serves as a referral center, which is why you see a bimodal distribution of patient footfall in our paper.
More women visited secondary centers compared to men. The scenario is opposite for every other layer of the LVPEI pyramid. What factors make women more likely to visit secondary centers?
Dr. Chadalavada: Accessibility. Secondary centers are conveniently located, particularly for women living in rural or suburban areas. Now, vision centers are even more accessible and a subset of women with vision impairment did visit vision centers, but they are not equipped to handle more complex cases. So, women with more serious eye problems are likely to visit secondary centers.
Compared to men, who often have better financial wherewithal to visit a clinic-even in the absence of a condition-many women may only devote time and money when they have vision impairment. This tendency should explain the nature of access to our centers by women.
Was there a difference between younger and older women regarding footfall in vision centers and secondary centers?
Dr. Chadalavada: The incidence of patient visits gets higher with age. So, the older the patient, the more likely they are to visit a clinic. This is true for all layers of LVPEI, irrespective of gender.
What are some other measures that can be taken to improve eye care access for women, especially in a state like Odisha which had a higher gender disparity in eye care access?
Dr. Marmamula: Awareness is key. People should know that LVPEI’s services are available. For many people these services are even free. I think we need more information, education, and communication (IEC) campaigns to spread awareness among the people.
65% of patients in this study did not have vision impairment. What does that mean—did they have an eye condition that did not impair them? What strategies can LVPEI adopt to focus on non-vision impairing conditions?
Dr. Chadalavada: Most public eye health studies are focused on vision impairment. However, several disorders that do not impair vision, like ptosis, conjunctivitis, or pterygium, do not receive adequate attention. Even early stages of cataract, diabetic retinopathy, or glaucoma will not impair vision, but that doesn’t mean the patient should not seek medical help. However, we did not investigate the details of the non-vision impairing conditions in our study.
Dr. Marmamula: It is possible that the patients came for a routine eye examination, and they had no vision related problems. However, they could have had non-vision impairing conditions which needed treatment. Even then, an increasing trend of people going for preventive eye check-ups is a good thing that can help catch ocular diseases at an early stage. It is something LVPEI should promote.
How can this study improve LVPEI’s eye care model?
Dr. Chadalavada: We now have the data that shows the demographic profiles of patients visiting different levels of the LVPEI pyramid. The study also shows that non-vision impairing conditions need some attention. In areas with high gender disparity for eye care access, like Odisha, we can plan future eye care programs that have a greater focus on women.
What is the future direction of your research?
Dr. Chadalavada: The next step is to dig deep into the data and evaluate the conditions causing vision impairment and various non-vision impairing conditions for which people came to LVPEI.
Drs. Srinivas Marmamula and Harithaa P. Chadalavada spoke to Sayantan Mitra, Science Writer, LVPEI. Read more about their research here.
Citation
Chadalavada HP, Marmamula S, Khanna RC. Vision impairment and access to eye care in an integrated network of eye care system in Southern and Eastern India. Indian J Ophthalmol. 2024;72(2):264-269
