Reaching out to patients and ophthalmologists

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Nayana is a project aimed at assisting ophthalmologists in rural Karnataka to access cutting-edge eye care equipment and thereby provide comprehensive eye care to patients living in rural areas.

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Reaching out to patients and ophthalmologists

  1. 1. Gowri J Murthy, Praveen R Murthy, Krishna R Murthy, SK RaoVittala International Institute of Ophthalmology Bangalore, India
  2. 2.  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
  3. 3. Reality An ophthalmologist practicing in a rural / semi urban setting  Cataract/ refraction based practice  Lack of equipment.  Lack of training.
  4. 4. Reach out To patients To our colleagues  to empower them with knowledge, and equipment .
  5. 5. The architect-Dr K R Murthy 1943-2008
  6. 6. 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
  7. 7. 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
  8. 8. Equipments Slit lamp and Diagnostic lenses for detecting Glaucoma and Retinal disorders Visual Field Analyzer YAG laser Pachymeter VIIO/PEC
  9. 9. Equipment on Van Fundus camera Diode laser B-Scan Ultrasound Biomicroscope A-Scan Biometer VIIO/PEC
  10. 10. 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
  11. 11. VITTALA INTERNATIONALINSTITUTE OFOPHTHALMOLOGY/PRABHA EYE CLINIC &RESEARCH CENTER
  12. 12. 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
  13. 13. 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.
  14. 14. Training- Didactic lectures to participating doctors
  15. 15. Slit lamp and 78D fundusexamination, and YAG laser
  16. 16. Using the Fundus Camera
  17. 17. 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.
  18. 18.  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.
  19. 19. Goals Achieved > 42,000 patients seen on the van Close to 12000 lasers( Diode and YAG) performed on the van VIIO/PEC
  20. 20. 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
  21. 21. 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
  22. 22. 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.
  23. 23. 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
  24. 24. We wish to thank the participating doctors of the NAYANA project and World Diabetes Foundation for making this project a reality VIIO/PEC

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