title: The utilization of eye care services by persons with glaucoma in rural south India.
abstract: OBJECTIVE
  To determine utilization of eye care services, in particular those relating to glaucoma, in a rural population of southern India aged 40 years or older.
  
  
  METHODS
  A total of 5,150 subjects aged 40 years or older selected through a random cluster sampling technique from three districts in southern India underwent detailed ocular examinations for vision impairment, blindness, and ocular morbidity. Information regarding previous use of eye care services was collected from this population through a questionnaire administered by trained social workers prior to ocular examinations.
  
  
  RESULTS
  One thousand eight hundred and twenty-seven persons (35.5%) gave a history of prior eye examinations, primarily from a general hospital (n = 1,073, 58.7%). Increasing age and education were associated with increased utilization of eye care services. Among the 3,323 persons who had never sought eye care, 912 (27.4%) had felt the need to have an eye examination but did not do so. Only one third of persons with vision impairment, cataracts, refractive errors, and glaucoma had previously utilized services. Of the 64 subjects diagnosed as having primary open-angle glaucoma, 32 (50%) had previously seen an ophthalmologist, but none had had an eye examination within 1 year before the study. Only six (19%) of the 32 had been diagnosed as having glaucoma (9% of all subjects found to have glaucoma in the survey). Thirteen (20.3%) of the 64 subjects were blind in either eye due to glaucoma, including one person who was bilaterally blind.
  
  
  CONCLUSIONS
  A large proportion of persons in a rural population of southern India who require eye care are currently not utilizing existing eye care services. Strategies to improve the uptake of services are required to reduce the burden of blindness due to glaucoma in southern India.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Robin
authors.forename: Praveen K
authors.initials: PK
authors.lastname: Nirmalan
authors.forename: Ramasamy
authors.initials: R
authors.lastname: Krishnadas
authors.forename: Rengappa
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: James
authors.initials: J
authors.lastname: Tielsch
authors.forename: Ravilla D
authors.initials: RD
authors.lastname: Thulasiraj
authors.forename: David S
authors.initials: DS
authors.lastname: Friedman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005901:Glaucoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data