refractive errors: a solution in sight – our...
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Refractive Errors: A solution in sight– our experiencep
R D ThulasirajExecutive DirectorLAICO – Aravind Eye Care System
Current Status in IndiaCurrent Status in India
Very low use of spectacles in the presence of significant refractive errorp ese ce o s g ca t e act e e o
Refractive Error in Children
5% prevalence5% prevalenceOf those who need glasses only 5-7% are wearing themwearing them
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Refractive Error in Adults
Almost all those > 45 years need glassesAlmost all those > 45 years need glassesLess than 10% are wearing them
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Possible Reasonsfor Low Levels of Spectacle usageThose attributable to the Providers:Those attributable to the Providers:
Failure to create awarenessFailure to reach outFailure to reach outFailure to create accessible delivery systemAffordability
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Possible Reasonsfor Low Levels of uptake Those attributable to the community &Those attributable to the community &
customer:Lack of desire to use spectaclesLack of desire to use spectaclesDo not perceive the need for spectaclesS i l/C lt l B iSocial/Cultural BarriersHealth beliefs
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Market Size estimation - India
(i illi )(in millions)
Age Group Popln. % of Popln.
Ref. Error % Nos.p
<20 Years 465 39% 5% 23
20-45 years 461 39% 5% 2320 45 years 461 39% 5% 23
>45 years 263 22% 90% 237
T t l 1189 24% 283Total 1189 24% 283
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Some lessons learnt
Refractive error patients are not likely to p yseek care on their ownHas an impact on productivityHas an impact on productivityParticular about the looks – “Vanity” element is important even amongst rural,element is important even amongst rural, poorThere is a willingness to pay for theThere is a willingness to pay for the spectacles
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Spectacles & Productivity (the study)
A study was done in a textile factory - Madura CoatsA study was done in a textile factory Madura Coats238 workers were studiedBaseline productivity was recordedp ySpectacles were provided to all those who needed them and were followed upQuantitative data assessed using production data Qualitative assessments using focus group and semi-structured interviews were done on the employers and the workers
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Spectacles & Productivity (R l )(Results)
79% (187 of the 238 workers) required spectacles and of these
4% (7) were wearing appropriate spectacles4% (8) were having incorrect spectacles92% (172) have never worn spectacles
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Spectacles & Productivity (Results)
Data showed higherData showed higher Production - estimated at 10%Workers reported improved efficiency and better quality of lifebetter quality of lifeThe employers wanted the service to bethe service to be provided to all employees
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Refraction Eye Camps for Industries & Offices
Selling the idea to the ManagementSelling the idea to the ManagementFinalizing the details – date, place & payment for the glassespayment for the glassesExamining the staff/workersOn the spot dispensing – Edged & Fitted, ReadymadeFollow-up on usage and satisfaction –workers & Management
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g
Refraction Camps 2010-11E l i l f l i W k lExclusively for employees in Workplaces
Number of Refraction camps 255
Employees screened 55,276Employees screened 55,276Glasses prescribed & Rate of demand
16,673 30%Rate of demandGlasses ordered &Rate of acceptance
14,243 85%Rate of acceptance
On the spot delivery 8,572 60%
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Aravind Eye HospitalsS h l E H l h S hSchool Eye Health Scheme
Training of teachersTraining of teachersTraining of teachersTraining of teachersScreeningScreening of of all all children by the teachers children by the teachers 2nd Level screening by 2nd Level screening by the the OphOph..Assistant Assistant Fixing a date for final Fixing a date for final examination so that examination so that parents can be presentparents can be presentparents can be presentparents can be present
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School Children Screening 2010-11
Schools covered in the year 2010-11 468
Teachers trained for a day (1 teacher : 300 students)
1,522
Total strength of students screened 455,623
Students confirmed with eye defectsStudents confirmed with eye defects by Ophthalmologist 25,672
% of students having Ref error and% of students having Ref.error and other eye defects in total strength 5.6%
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Aravind Eye Hospitals R f ti S i i lRefraction Services in regular eye camps
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Refraction Services in Outreach 2010-11
OutreachModels
Number of
Camps
Out patients
seen
Glasses prescribed
and % in OP
Orders taken / Acceptance
rate
Delivered on the spotp
Screening Camps 1,381 312,129 68,447 (22%) 58,644 (86%) 46,345 (79%)
WorkplaceWorkplace Camps 255 55,276 16,673 (30%) 14,243 (85%) 8,572 (60%)
Mobile Refraction Camps 84 6,405 2,182 (34%) 1,550 (71%) 644 (42%)C p
School ScreeningCamps 468 455,623 14,157 (3.1%) 14,069 (99%) 161
Paediatric 132 29 132 606 (2%) 569 (94%) 21ed cScreening Camps 132 29,132 606 (2%) 569 (94%) 21
Vision Centres 36 201,512 31,818 (16%) 29,893 (94%) Not available
Total 2 356 10 60 077 133 833 118 968 (88%) 55 743+
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Total 2,356 10,60,077 133,833 118,968 (88%) 55,743+
Costs associated – Provider
C t t dCost towards:creating awareness and acceptance of spectacles
i d idi f ti iscreening and providing refraction services
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Costs Associated – Patient
Cost of spectacles - Rs. 250Cost of spectacles Rs. 250 Cost of getting glasses: Rs.150 to 250 Involves 2 to 4 trips for:
Examination Ordering the glassesGetting the glassesGetting the glassesEnsuring that the glasses are right
The above costs can be reduced to 0 with theThe above costs can be reduced to 0 with the strategy of free examination and on the spot delivery
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Financing the Refraction Correction services
From the Indian experience, the patients are the sustainable sourceAverage value of spectacles ordered:
In Regular Community camps: Rs. 250 In Industry Refraction camps: Rs. 350In Free Hospital: Rs. 300In Paying Hospital: Rs. 650
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Financing the Refraction Correction services
Patient revenue can cover the costs of providing the Refraction Service and the cost of SpectaclesFor the poor, surplus from the above or p pexternal subsidies may be used
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Summary
Refraction services can be developed by:Using all current patient contacts at the hospital, community and school to promote refraction servicesservicesProviding refraction correction to Industries & OfficesOfficesAdapting low cost methods to provide “on the spot” delivery of spectacles
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