Publications by authors named "Thulasiraj D Ravilla"

Background/aims: To propose an approach to determine the target ratio of cataract surgical rates (CSRs) of female to male subpopulations to increase sex parity in cataract surgical coverage (CSC), based on the sex gap in cataract burden and incidence, and demonstrate its application to Theni district, India.

Methods: A population-based longitudinal study between January 2016 and April 2018. We recruited 24 327 participants using random cluster sampling.

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Purpose: The purpose of this study was to improve the automated diagnosis of glaucomatous optic neuropathy (GON), we propose a generative adversarial network (GAN) model that translates Optain images to Topcon images.

Methods: We trained the GAN model on 725 paired images from Topcon and Optain cameras and externally validated it using an additional 843 paired images collected from the Aravind Eye Hospital in India. An optic disc segmentation model was used to assess the disparities in disc parameters across cameras.

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Objectives: To evaluate the accuracy of tele-ophthalmic examination (TOE) for common ocular conditions in comparison with the gold-standard in-person examination (IPE) for diagnosis and treatment advice.

Methods: In a prospective, diagnostic accuracy validation study, we recruited 339 consecutive new patients, aged ≥16 years, visiting a vision centre (VC) associated with Aravind Eye Hospital in south India during January and February, 2020. All participants underwent the TOE, followed by IPE on the same visit.

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Background/aims: To estimate the annual cataract surgery workload in Theni district, Tamil Nadu, India based on current utilisation of cataract services, prevalence of blindness and vision impairment (VI), and cataract burden-reduction goals.

Methods: We conducted a population-based longitudinal study between January 2016 and April 2018. We recruited 24 327 participants based on a random cluster sampling method; 7127 participants were ≥40 years.

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Eye care programs, in developing countries, are often planned using the prevalence of blindness and visual impairment, often estimated from Rapid Assessment of Avoidable Blindness (RAAB) surveys. A limitation of this planning approach is that it ignores the annual overall eye care requirements for a given population. Moreover, targets set are arbitrary, often influenced by capacity rather than need.

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Article Synopsis
  • Infant and neonatal mortality estimates often rely on retrospective surveys, which may suffer from biases like under-reporting and age misreporting, leading to inaccurate data.
  • This study analyzed data from 11 population-based cohort studies, finding that rigorous protocols and frequent follow-ups significantly enhance the accuracy of mortality data, particularly in capturing birth outcomes and reducing missed deaths.
  • Results showed that neonatal mortality rates were generally consistent with existing Demographic and Health Survey data in certain regions, while disparities were evident in others, highlighting the potential of prospective studies to provide better insights into infant mortality trends in low- and middle-income countries.
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Objective: We aim to assess the effectiveness of a cataract surgery outcome monitoring tool used for continuous quality improvement. The objectives are to study: (1) the quality parameters, (2) the monitoring process followed and (3) the impact on outcomes.

Design And Procedures: In this retrospective observational study we evaluated a quality improvement (QI) method which has been practiced at the focal institution since 2012: internal benchmarking of cataract surgery outcomes (CATQA).

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Article Synopsis
  • Cataracts are the top cause of blindness worldwide, and effective cataract surgical coverage (eCSC) is crucial to gauge the success of surgical interventions across different populations.
  • The World Health Assembly aims to increase eCSC by 30 percentage points by 2030, prompting the analysis of existing survey data to establish a baseline for this metric.
  • Findings show significant disparities in eCSC among countries, with high-income nations having better access and outcomes compared to low-income ones, and men generally experiencing higher eCSC than women.
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Objective: To study the impact of the coronavirus disease 2019 (COVID-19) pandemic on outpatient visits to eye care facilities in south India.

Methods: We used data on 7.69 million outpatient visits to primary (i.

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The eye care sector is well positioned to contribute to the advancement of universal health coverage within countries. Given the large unmet need for care associated with cataract and refractive error, coupled with the fact that highly cost-effective interventions exist, we propose that effective cataract surgery coverage (eCSC) and effective refractive error coverage (eREC) serve as ideal indicators to track progress in the uptake and quality of eye care services at the global level, and to monitor progress towards universal health coverage in general. Global targets for 2030 for these two indicators were endorsed by WHO Member States at the 74th World Health Assembly in May, 2021.

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Purpose: To compare patient preferences for eyeglasses prescribed using a low-cost, portable wavefront autorefractor versus standard subjective refraction (SR).

Design: Randomized, cross-over clinical trial.

Participants: Patients aged 18 to 40 years presenting with refractive errors (REs) to a tertiary eye hospital in Southern India.

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Objective: To assess the quality of eyeglass prescriptions provided by an affordable wavefront autorefractor operated by a minimally trained technician in a low-resource setting.

Methods And Analysis: 708 participants were recruited from consecutive patients registered for routine eye examinations at Aravind Eye Hospital in Madurai, India, or an affiliated rural satellite vision centre. Visual acuity (VA) and patient preference were compared between trial lenses set to two eyeglass prescriptions from (1) a novel wavefront autorefractor and (2) subjective refraction by an experienced refractionist.

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Importance: Studies in high-income countries provide limited evidence from randomized clinical trials on the benefits of teleretinal screening to identify diabetic retinopathy (DR).

Objective: To evaluate the effectiveness of teleretinal-screening hospital referral (TR) compared with universal hospital referral (UR) in people with diabetes.

Design, Setting, And Participants: A cluster randomized clinical trial of 8 diabetes clinics within 10 km from Aravind Eye Hospital (AEH), Madurai, India, was conducted.

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Purpose: To investigate prevalence and risk factors for myopia, hyperopia and astigmatism in southern India.

Methods: Randomly sampled villages were enumerated to identify people aged ≥40 years. Participants were interviewed for socioeconomic and lifestyle factors and attended a hospital-based ophthalmic examination including visual acuity measurement and objective and subjective measurement of refractive status.

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Purpose: The year 2015 status of eye care service profile in Southeast Asia countries was compared with year 2010 data to determine the state of preparedness to achieve the World Health Organization global action plan 2019.

Methods: Information was collected from the International Agency for Prevention of Blindness country chairs and from the recent PubMed referenced articles. The data included the following: blindness and low vision prevalence, national eye health policy, eye health expenses, presence of international non-governmental organizations, density of eye health personnel, and the cataract surgical rate and coverage.

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Background: Biomass cooking fuels are commonly used in Indian households, especially by the poorest socioeconomic groups. Cataract is highly prevalent in India and the major cause of vision loss. The evidence on biomass fuels and cataract is limited.

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Purpose: To analyze the experience of a large developing country tertiary ophthalmology system to identify generalizable information relevant for those planning similar centers elsewhere.

Design: 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.

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Objective: This study was designed to propose a classification scheme for platforms of surgical delivery in low- and middle-income countries (LMICs) and to review the literature documenting their effectiveness, cost-effectiveness, sustainability, and role in training. Approximately 28 % of the global burden of disease is surgical. In LMICs, much of this burden is borne by a rapidly growing international charitable sector, in fragmented platforms ranging from short-term trips to specialized hospitals.

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