Detection of Posterior Segment Eye Disease in Rural Eye Camps in South India: A Non-Randomized Cluster Trial.

Abstract

PURPOSE\nRural screening camps in India have historically focused on detection of cataract and uncorrected refractive error. This study aimed to increase detection, referral, and follow-up for posterior segment diseases (PSD) in rural eye camps using a novel technology-driven eye camp model.\n\n\nDESIGN\nA clustered non-randomized trial in the catchment area of Aravind Eye Care System (AECS) -Pondicherry to compare two eye camp models, the traditional AECS eye camp and the novel, technology-driven, eye camp models.\n\n\nPARTICIPANTS\nPatients aged 40-75 years who attended free camps conducted by AECS-Pondicherry. Those with corneal pathology were excluded since this precluded an adequate view to the posterior segment to screen for PSD.\n\n\nMETHODS\nThe clinical protocols in the two arms were standardized and the same study team was used in both study arms. The unit of allocation to the two study arms was at the level of the eye camp rather than the level of the individual study participant.\n\n\nMAIN OUTCOME MEASURES\nThe primary study outcome was detection of suspected PSD (glaucoma, diabetic retinopathy, age-related macular degeneration, other PSDs). Secondary outcomes included: i) the proportion of referred participants who received an exam at the base hospital and ii) the proportion with confirmed PSD upon exam at the base hospital.\n\n\nRESULTS\nThe study included 11 traditional and 18 novel eye camps with a total of 3,048 participants (50% in each study arm). The mean age of all participants was 58.4+9.1 years and 1434 (47%) were male. The proportion receiving a referral for PSD was significantly greater in the novel (8.3%) compared to the traditional (3.6%) eye camps (p<.001; RR=2.31 [95% CI 2.30-2.34]). Among the 183 participants referred from the camps for PSD, 73 (39.9%) followed-up for further evaluation at the base hospital.\n\n\nCONCLUSIONS\nIn a resource-constrained setting, use of digital fundus photography in novel eye camps resulted in increased detection and referral of PSD. Follow-up rates at the base-hospital remained low and future interventions may be undertaken in an effort to address this. Further research is needed to determine whether this intervention is cost-effective and may contribute to prevention of avoidable blindness and visual impairment in south India. Further research is also needed to improve follow-up of patients referred from camps for suspicion of PSD.