title: Demand for Tertiary Eye Care Services in Developing Countries.
abstract: OBJECTIVE
  To analyze the experience of a large developing country tertiary ophthalmology system to identify generalizable information relevant for those planning similar centers elsewhere.
  
  
  METHODS
  Retrospective utilization analysis.
  
  
  METHODS
  A historical review of the development of the Aravind Eye Care system was undertaken to evaluate the services provided by various tertiary services of the system. Demand for services is inferred based on the utilization statistics described below and distance traveled by patients to obtain services.
  
  
  RESULTS
  Utilization of subspecialty services increased logarithmically for 17 years in all specialties. At all centers except one historically focused on glaucoma, retina services had the highest demand among subspecialty surgical services. The proportion of tertiary care patients among all new outpatients (39% in 2009 and 45% in 2013) and the proportion of specialty surgical and treatment procedures among all procedures (30% in 1997 and 49% 2013) increased over time. More patients traveled long distances (>100 kilometers) to receive specialty services than to receive cataract services (30% vs 23%).
  
  
  CONCLUSIONS
  These observations suggest that in regions where tertiary services are not widely available, (1) patients demand (travel further for) tertiary care more than general ophthalmology services; (2) demand for services can expand rapidly for many years; (3) tertiary care services tend to grow over time as a proportion of all services provided; and (4) retina services are the most highly demanded subspecialty surgical services. In such settings, it is likely that considerable latent demand exists; planned tertiary eye centers should anticipate sustained growth of tertiary services.
authors.affiliation: Aravind Eye Care System, Madurai, Tamilnadu, India.
authors.forename: Ganesh-Babu B
authors.initials: GB
authors.lastname: Subburaman
authors.affiliation: Ophthalmology, Children's Hospital of Los Angeles/ University of Southern California Keck School of Medicine, Los Angeles, California.
authors.forename: Luxme
authors.initials: L
authors.lastname: Hariharan
authors.affiliation: Aravind Eye Care System, Madurai, Tamilnadu, India. Electronic address: thulsi@aravind.org.
authors.forename: Thulasiraj D
authors.initials: TD
authors.lastname: Ravilla
authors.affiliation: Aravind Eye Care System, Madurai, Tamilnadu, India.
authors.forename: Ravindran D
authors.initials: RD
authors.lastname: Ravilla
authors.affiliation: Center for Preventive Ophthalmology and Biostatistics and Ocular Inflammation Service, Scheie Eye Institute, Department of Ophthalmology, and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: John H
authors.initials: JH
authors.lastname: Kempen
mesh_terms: D003906:Developing Countries; D005128:Eye Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D009885:Ophthalmology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D063128:Tertiary Health Care / Q000706:statistics & numerical data*; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy