1. Access to low vision services in a resource limited setting: Profile and Barriers
Asik Pradhan1, Monica Chaudhry2 , Sanjeeb Bhandari1 1Tilganga Institute of Ophthalmology, Kathmandu, Nepal 2Department of Optometry and Vision Science, Amity University, Gurgaon, Haryana, India
Introduction
Visual impairment is one of the most common disabilities that degrades quality of life and exerts a significant impact on the socioeconomic development of individuals and societies.
An estimated 230,000 people of all ages are reported to have low vision in Nepal in Low vision service coverage is less than 1%(1,500 out of 230,000).1
It is estimated that 65% of the country’s blindness is due to cataract and 30,240 childhood blindness. Low vision in children is 3 times the blindness.1 This huge population of visually impaired individuals could benefit from low vision services.
Visual rehabilitation services may be limited due to a number of barriers. This study seeks to identify the common barriers from patient’s perspective and reasons for unwillingness to pursue low vision aids from those who were referred for low vision care.
The common causes identified were Retinitis Pigmentosa(21%) followed by Refractive Error & Amblyopia (15%) and Macular disorders other than AMD (12%).
Monocular handheld telescope (51%) was the commonly preferred device for distance whereas, stand magnifier (22%) was the commonly preferred near aid followed by spectacle magnifier (20%).
61% of the participants did not like to use low vision devices. The main reason for unwillingness responded by 50% of the study population was the use of low vision device not being practical enough followed by social stigma (6%).
The main barrier to assessing low vision services in our study was predominantly lack of unawareness (78.5%). A poorer level of visual acuity was strongly associated with greater awareness.4
Miscommunications by eye care professionals (13%) was the other common barrier. Individuals with low vision found that their eye doctor's attitude ranged from providing information about their vision condition,4 to referral for rehabilitation,4,5 to providing little or no information, to stating nothing can be done.5,6
Limited number of vision rehabilitation centers, lack of human resources, lack of awareness among low vision recipients could be a probable reason in this study.
Conclusions
Main barrier identified in this study was lack of awareness about low vision services
Eye care provider can help to decrease these barriers by educating patients in the early stages of vision loss regarding the availability and effectiveness of low vision rehabilitation and by making appropriate referrals.
Purpose
To access profile of low vision patients in a resource limited setting.
To know the barriers to access low vision services from patient’s perspective.
Figure 1: Visual Impairment according to age group
Recommendation
Proper information to the patients may help in minimizing lack of awareness and miscommunications by the eyecare professionals about the low vision services.
Community based eyecare services would be one of the better alternative to serve visually impaired population in developing countries.
Accessibility of advanced low vision devices is required for more low vision patients to accept its use.
Methods
A prospective, cross-sectional, interview based study.
A complete proforma was developed, informed consent taken and data on socio-demographic data, visual impairment, BCVA, causes of low vision and type of LVD's preferred were collected.
Visual functions were analysed. The magnifiers were demonstrated and visual functions were reassessed.
Visual impairment was categorized based on WHO Classification (ICD-10)2
A pretested, semi-structured questionnaire was used to evaluate barriers for accessing low vision care.
References
Table 2: Barriers to access low vision services
World Health Organization. Mid-term review Vision 2020: The Right to Sight, Nepal. October 2011.
World Health Organization. International Statistical Classification of Disease and Related Health Problems (ICD-10). Available at: Last Assessed March 10, 2016
Nepal life expectancy at birth. [Internet], Available at: Last Accessed April 9, 2016.
Overbury O, Wittich W. Barriers to low vision rehabilitation: the Montreal Barriers Study. Invest Ophthalmol Vis Sci. 2011; 52:
Gold D, Zuvela B, Hodge Wg. Perspectives on low vision service in Canada: a pilot study. Can J Ophthalmol, 2006;41:
Pollard TL, Simpson JA, Lamoureux EL, Keeffe JE. Barriers to accessing low vision services. Ophthalmic Physiol Opt. 2003;23:321-7.
Discussion
A predominance of males (ratio>2:1) observed in our study may be baffled by prevailing gender based discrimination in this part of the world.
The lesser number of patients in the older age group (>65 years) might be due to lower life expectancy (65.81 years)3 in the country.
28% of the total patients in our study were pediatric population which suggests implementation of a special education assimilating visual rehabilitation should be included at a national level.
83% of the patients did not find low vision devices to be practical enough followed by social stigma (10%) which may be due to more number of bilaterally blind people in our study and lack of advanced and information technology based low vision devices in a resource poor setting.
Results
Of the 135 low vision patients enrolled in this study, 71% were males and 29% were females. The ratio of male to female was 2.5:1.
The age of patients ranged from 4 years to 85 years with a mean age of 32.4 ± years. Of the total, 73% were in a visually demanding profession (student, teacher, engineer, lawyer etc).
23% of the total patients were bilaterally blind whereas; 12% had severe visual impairment.