Utilisation of eyecare services in an urban population in southern India: the Andhra Pradesh eye disease study

Aim-To assess utilisation of eyecare services by people with visual impairm ent <6/18 or equivalent visual field loss in the better eye in the urban po pulation of Hyderabad in southern India. Methods-2522 subjects of all ages, representative of the population of Hyde rabad city, underwent a detailed interview and dilated examination as part of the population based Andhra Pradesh eye disease study. Subjects more tha n 15 years of age were interviewed regarding the use of eyecare services. Results-Of 250 subjects with presenting distance visual acuity <6/18 or equ ivalent visual field loss in the better eye, information on utilisation of eyecare services was available for 229 (91.6%). Of these 229 subjects, 44 ( 19%) had visual acuity <6/60 or equivalent visual field lass in the better eye, and 202 (88.2%) had noticed decrease in vision over the past 5 years. Multivariate analysis showed that this decrease is vision was noticed signi ficantly less by subjects with refractive error as the cause of visual impa irment (odds ratio 0.34, 95% confidence interval 0.12-0.93). Of the 229 sub jects who were visually impaired, 108 (59%) did not seek treatment. Multiva riate analysis revealed that the odds for seeking treatment were significan tly lower for Hindus than Muslims (odds ratio 0.53, 95% confidence interval 0.28-0.98). The reasons for not seeking treatment could be classified as p ersonal (49.5%), economic (30.8%), and social (19.6%). Conclusion-A large proportion of subjects with visual impairment in this ur ban population in India did not seek treatment even after noticing decrease in vision. Projecting these data to the 155 million urban population >15 y ears of age in India, there may be 4.9 million (95% confidence interval 4.3 -5.5 million) people in urban India who are not seeking treatment for their visual impairment even after noticing decrease in vision. These data sugge st that efforts have to be made to better understand the reasons for this p henomenon so that optimal utilisation of the available eyecare services in urban India can be planned.