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.

1. Gowri J Murthy, Praveen R Murthy, Krishna R Murthy, SK Rao
Vittala International Institute of Ophthalmology
Bangalore, India

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 alone
1) 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. Reality
 An ophthalmologist practicing in a rural / semi urban
setting
 Cataract/ refraction based practice
 Lack of equipment.
 Lack of training.

4. Reach out
 To patients
 To our colleagues
 to empower them with
knowledge, and equipment .

5. The architect-
Dr K R Murthy
1943-2008

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. 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. Equipments
 Slit lamp and Diagnostic
lenses for detecting
Glaucoma and Retinal
disorders
 Visual Field Analyzer
 YAG laser
 Pachymeter
VIIO/PEC

9. Equipment on Van
 Fundus camera
 Diode laser
 B-Scan
 Ultrasound Biomicroscope
 A-Scan Biometer
VIIO/PEC

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. VITTALA INTERNATIONAL
INSTITUTE OF
OPHTHALMOLOGY/PRABH
A EYE CLINIC &
RESEARCH CENTER

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. 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. Training- Didactic lectures to participating doctors

15. Slit lamp and 78D fundus
examination, and YAG laser

16. Using the Fundus Camera

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.  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. Goals Achieved
 > 42,000 patients seen on the van
 Close to 12000 lasers( Diode and YAG) performed on
the van
VIIO/PEC

20. Change in practice patterns
Pre and post Nayana
Chi square test and Mc Nemar test
Sl No Skill tested P value
1 +78D examination 0.039
2 Applanation tonometry 0.039
3 Visual Field analysis 0.001
4 Gonioscopic examination 0.581
5 YAG Laser 0.012
6 Ultrasound biomicroscope 0.012

21. Change in practice patterns
Sl No Skill tested P value
7 Slit lamp examination 1.000
8 Indirect ophthalmoscopic 0.021
examination
9 FFA 0.001
10 Retinal Laser 0.001
11 B Scan 0.001

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. Benefits of Being Under the Care of
a 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. We wish to thank the participating
doctors of the NAYANA project
and
World Diabetes Foundation
for making this project a reality
VIIO/PEC