Gowri J Murthy, Praveen R Murthy, Krishna R Murthy, SK RaoVittala International Institute of Ophthalmology Bangalore, India
Glaucoma: 11.2 million persons aged 40 years and older with Glaucoma in India. 1 Need for case detection2 Need for continued care Cannot be serviced from Ivory towers – tertiary centres/ cities alone1) George R, Ve RS, Vijaya L. Glaucoma in India: estimated burden of disease J Glaucoma. 2010 Aug;19(6):391-7.2) Thomas R, Parikh R, Paul P, Muliyil J. Population-based screening versus case detection. Indian J Ophthalmol. 2002 Sep;50(3):233-7
Reality An ophthalmologist practicing in a rural / semi urban setting Cataract/ refraction based practice Lack of equipment. Lack of training.
Reach out To patients To our colleagues to empower them with knowledge, and equipment .
Nayana Mobile platform Co-operative sharing of expensive equipment between ophthalmologists. Improve clinical practice levels to uniform and global standards Provide diagnosis, treatment and management within a distance of 50 kms of the patients’ residence Increase compliance rates among patients for treatment
Nayana The mobile van is an Indian made custom built vehicle over a cargo chassis 2+1 drivers cabin A treatment chamber measuring 8 x 14 x 6.5 ft VIIO/PEC
Equipments Slit lamp and Diagnostic lenses for detecting Glaucoma and Retinal disorders Visual Field Analyzer YAG laser Pachymeter VIIO/PEC
Formation of a Mobile Clinic-Problems.• Transportation of delicate equipment .• Erratic power supply in rural areas with high voltage fluctuations• Temperature• Humidity• Dust VIIO/PEC
VITTALA INTERNATIONALINSTITUTE OFOPHTHALMOLOGY/PRABHA EYE CLINIC &RESEARCH CENTER
Internal environment Double-walled with wooden lining from inside The temperature is regulated with an air conditioner The humidity is maintained at 56% inside the cabin using a dehumidifier VIIO/PEC
Training Consultant or trained fellow on board the van Each participating ophthalmologist individually trained under supervision. Once trained, doctor independently manages his the patients on the van, using the equipment.
Training- Didactic lectures to participating doctors
Slit lamp and 78D fundusexamination, and YAG laser
Goals achieved Project functional for 6 yrs ( 2006- 2011) Covered 2000+ days of operation covering over 2,00,000 km Equipment purchased in 2006, is still functional with no major transport related breakdown.
Every Month The Van Visits 24 Locations Across 14 Districts covering over 2300 kms The Total Population Served is 18.31 Million Serves 86 practicing ophthalmologists Average of 35 Patients Per Location.
Goals Achieved > 42,000 patients seen on the van Close to 12000 lasers( Diode and YAG) performed on the van VIIO/PEC
Change in practice patterns Pre and post Nayana Chi square test and Mc Nemar testSl No Skill tested P value1 +78D examination 0.0392 Applanation tonometry 0.0393 Visual Field analysis 0.0014 Gonioscopic examination 0.5815 YAG Laser 0.0126 Ultrasound biomicroscope 0.012
Change in practice patternsSl No Skill tested P value7 Slit lamp examination 1.0008 Indirect ophthalmoscopic 0.021 examination9 FFA 0.00110 Retinal Laser 0.00111 B Scan 0.001
Sustainability Sound economic model. Patients who can afford to pay are charged for consultations and procedures on the van Revenue sharing with the local ophthalmologist . Running costs of the van are met by income generated.
Benefits of Being Under the Care ofa Local Ophthalmologist Practices locally Familiarity and trust Available to the patient all round the year, can provide counselling and follow up Cost effective to patient. VIIO/PEC
We wish to thank the participating doctors of the NAYANA project and World Diabetes Foundation for making this project a reality VIIO/PEC