title: Utilization of eye care services among those with unilateral visual impairment in rural South India: Andhra Pradesh Eye Disease Study (APEDS).
abstract: OBJECTIVE
  To report on the utilization of eye care services and its associated factors among those with unilateral visual impairment (VI) in a rural South Indian population.
  
  
  METHODS
  A population based cross-sectional study was conducted in three districts (Adilabad, Mahbubnagar and West Godavari) in the state of Andhra Pradesh, India. A detailed interview and a comprehensive eye examination were conducted. Those with unilateral VI were asked questions about noticing any change in vision and on utilization of eye care services. The most important reason reported by the participant for not utilizing the services was used for the analysis. Multiple logistic regression models were used to examine the association between noticing a change in vision and socio-demographic variables such as age, gender, education and area of residence, severity and causes of VI.
  
  
  RESULTS
  Among the 4456 participants aged ≥16y who were administered the questionnaire, 53.2% were women, and 54.7% had no education. Of the 489 (11%; 95% CI: 10.1-11.9) people with unilateral VI, 399 (81.6%) participants reported noticing a change in their vision over the last five years but only 136 (34.1%) participants had sought eye care consultation. Those who had any education (OR: 1.9; 95% CI: 1.1-3.2), had blindness (OR: 2.7; 95% CI: 1.4-5.2), and cataract (OR: 2.1; 95% CI: 1.0-4.3) as a cause of unilateral VI were more like to seek eye care consultations. The most commonly reported reasons for not seeking eye care services were "do not have money for eye checkup" in 30.7% of the participants followed by "do not have a serious problem" (30.0%).
  
  
  CONCLUSIONS
  A large proportion of rural population though noticed a change in their vision did not seek eye care due to financial and person-related reasons. Eye care service providers need to address these barriers to enhance the uptake of eye care services among those with unilateral VI.
authors.affiliation: Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao, International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500034, India; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India; Wellcome Trust/DBT India Alliance Fellow, L V Prasad Eye Institute, Hyderabad 500034, India; School of Optometry & Vision Science, University of New South Wales, Sydney NSW 2052, Australia; Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Marmamula
authors.affiliation: Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao, International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500034, India.
authors.forename: Pyda
authors.initials: P
authors.lastname: Giridhar
authors.affiliation: Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao, International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500034, India; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India; School of Optometry & Vision Science, University of New South Wales, Sydney NSW 2052, Australia.
authors.forename: Rohit C
authors.initials: RC
authors.lastname: Khanna
keywords: Andhra Pradesh Eye Disease Study; India; socio-demographic variables; unilateral visual impairment