Methods for a population-based Comprehensive Eye care Workload Assessment (CEWA) Study in Southern India

Abstract

AbstractEye care programs, in developing countries, are often planned using the cataract surgical rate (CSR) targets - retrospectively estimated from Rapid Assessment (RAAB) surveys. A limitation of this approach is that it ignores the annual overall eye care requirements for a given population. Moreover, targets set are arbitrary, often influenced by capacity rather than need. To address this lacunae, we implemented a novel study design to estimate the annual need for comprehensive eye care in a 1.2 million population.We conducted a population-based longitudinal study in Theni district, Tamil Nadu, India. All permanent residents of all ages were included. We conducted the study in three phases, (i) household-level enumeration and enrolment, (ii) basic eye examination (BEE) at household one-year post-enrolment, and (iii) assessment of eye care utilization and full eye examination (FEE) at central locations. All people aged 40 and above were invited to the FEE. Those aged less than 40 years were invited to the when FEE if indicated.We conducted three pilot studies to test the study and clinical examination protocols. In the main study we enrolled 24,327 subjects (58% aged below 40 years and 42% aged 40 years and above). Of those less than 40 years, 72% completed the BEE, of whom 20% were referred for FEE and 70% of people aged ≥40 years underwent a comprehensive eye examination at central location.Our study design provides appropriate long-term public health intervention planning, resource allocation, efficient delivery of care, and designing of eye care services for resource-limited settings.