Public Health at LVPEI - LV Prasad Eye Institute

Public Health at LVPEIAnnual Activity Report2009-2010International Centre for Advancementof Rural Eye care (ICARE)L V Prasad Eye Institute, India

Associate Director & Head, ICARERohit Khanna, MBBS, DOMS, MSc (CEH)New Projects & DevelopmentV Rajashekar, MSW, DCEHAdministrationBabu Rao, MCom, DCEHFacultySayed Imtiaz Ahmed, MAS Krishnaiah, MScSuresh Kuruganti, MBBS, MPH (USA)Shobha Naveen, MDSiddharth S Pujari, MBBS, MS, MPHGiridhar Pyda, PhDPadmaja K Rani, MS, FNBS Sheeladevi, MCom, MHMM Srinivas, MA, MScKovai Vilas, M PhilJachin David Williams, MA, DCEH, BMSWould you like to support our sight restoration initiatives for the rural poor? L V Prasad EyeInstitute, a not-for-profit organisation is managed by two trusts: Hyderabad Eye Institute (HEI)and Hyderabad Eye Research Foundation (HERF). Contributions to HERF are 175% exempt undersection 35 (i) (ii) and donations to HEI are 50% exempt under section 80G of the Income Tax Act.For more information, please email: sjbala@lvpei.org or call +91 40 30612567.Cover page: Sidam Rani of Varthamannur village in Adilabad district gazes upon her little niece. She was operated upon forbilateral cataract at the Adilabad centre one and a half years ago. Unfortunately, as we go to press, we learn that Sidam Ranipassed away due to high fever some months ago.

The year at a glanceThe LVPEI pyramid of service delivery touches all levels of society, from remote rural villages tobusy urban centres. From primary eye care to advanced tertiary (quaternary), we have providedeye care services to thousands of people, without compromising on quality. This year, wereached a total of 1,312,035 people including 111,287 children through these various levelsof care, including almost a million (934,433) who received eye care services entirelyfree of cost. Of these 535,431 were covered as part of our community programs and 665,317through our higher-level facilities.Reaching the underserved – community eye healthVillages surveyed 473Population covered by door to door surveys 535,431Community screening programs 630Population screened 62,409Schools covered 695Children screened 111,287Entirelyfree of cost100%Total population covered 535,431Total children screened 111,287(through our community programs)These numbers do not include data from our partner centresAddressing visual impairment and referralsTotalPrimary eye care: 63 Vision CentresOutpatient visits 101,979100%Sight restoration surgeries and referralsSecondary eye care: 17 Service CentresOutpatient visits 225,197 43%Surgeries performed 28,603 69%Completing the circle – tertiary eye careBhubaneswar VisakhapatnamOutpatient visits 67,695 58,331 126,026 21%Surgeries performed 6211 6511 12,722 37%Advanced tertiary (quaternary) care – HyderabadOutpatient visits 212,115 30%Surgeries performed 27,787 43%Total outpatient visits 665,317Total surgeries 69,112(at our primary, secondary, tertiary and advanced tertiary facilities)43%52%Excellence Equity EfficiencyPAGE1

IntroductionLV Prasad Eye Institute (LVPEI) is a comprehensive eye health facility with its main campuslocated in Hyderabad, India. A World Health Organization Collaborating Centre for Preventionof Blindness, the Institute offers comprehensive patient care, sight enhancement and rehabilitationservices and high-impact rural eye health programs. It also pursues cutting edge research and providestraining in human resources for all levels of eye care personnel.The Institute’s mission is to provide equitable and efficient eye care to all sections of society. In the past23 years we have reached over 11.5 million people. We have provided outpatient services to 6 millionpeople and surgical care to over 600,000 patients — 52 percent of them totally free of cost, regardless ofcomplexity. We have trained over 12,000 eye care personnel from India and abroad. The LVPEI systemis now a network that spans two tertiary centres in Bhubaneswar and Visakhapatnam, 17 secondary and63 primary care centres covering the remotest rural areas in the state of Andhra Pradesh, India.LVPEI is a not-for-profit organization governed by two trusts: the Hyderabad Eye Institute and theHyderabad Eye Research Foundation.LVPEI’s Network of Vision Centres and Service CentresCentre of Excellence (1)Tertiary Care Centres (2)Secondary Care Centres (17)Vision Centres (63, including 2 in Hyderabad)Andhra PradeshExcellence Equity EfficiencyPAGE2

Eliminating avoidable blindnessIndia has had a National Programme for the Control of Blindness since 1976, but eye health remainsa major public health problem. Since the launch of VISION 2020: The Right to Sight, the joint globalinitiative of the World Health Organization and the International Agency for the Prevention of Blindness(IAPB), there has been renewed focus on planning and implementing interventions to address the problemof avoidable blindness in populations worldwide.From its inception L V Prasad Eye Institute (established in 1986) realized that access to high quality carecannot be limited to cities, and that care available to the poorest of the poor cannot compromise onquality. Thus was born the idea of taking the best possible eye care to the most disadvantaged sectionsof society, at all levels of service delivery – from the community to advanced tertiary.Today, hundreds of people who cannot afford it, receive care from some of the best eye healthprofessionals, while hundreds more benefit from LVPEI’s rural affiliates and satellite clinics in urbanslums. Almost 2 million outpatients have been treated in rural Andhra Pradesh alone, over 71% ofthem were examined in our outpatient department totally free of cost. More than two-thirds of almost200,000 surgeries have been performed absolutely free of cost. Our rural and urban community eyehealth programs include surveys of over 3,900 villages with a total population of over 3 million. Teamsof community eye health workers including local volunteers have conducted over 3000 communityscreening and 1600 school screening programs. The services provided, apart from surgeries, includeprescription of spectacles, follow-up visits, referrals, training and community rehabilitation.(List of collaborations on page 13)International Centre for Advancement of Rural Eye careThe International Centre for Advancement of Rural Eye care (ICARE) plans and manages LVPEI’scommunity eye care services, as an organized large-scale effort to reduce blindness in rural andunreached India, and other parts of the developing world, over the long term. ICARE was established in1998 with the support of Christoffel Blindenmission of Germany and Sightsavers of the United Kingdom.Subsequently, Operation Eyesight Universal has supported several of its initiatives.Between 1996 and 2000, LVPEI planned and conducted a seminal study on preventable blindness andvision impairment. Widely recognized as the first scientifically designed epidemiological study of itskind in the developing world, the Andhra Pradesh Eye Disease Study (APEDS) helped LVPEI define andcrystallize a sustainable model of eye care service delivery, the Eye Health Pyramid, that focused on thecreation of permanent infrastructure and adequately trained human resources at all levels, from theadvanced tertiary to the community. For the first time, APEDS showed that uncorrected refractive errorwas one of the most common causes of visual impairment and the second leading cause of treatableblindness. It laid the foundation for an effective blindness control plan in Andhra Pradesh to beginwith, and an approach to tackling avoidable blindness across the developing world eventually, throughthe pyramidal model of eye care service delivery, addressing equity and quality within a high-quality,sustainable framework.These and other related studies have served to build a strong foundation of understanding that feeds ourwork in advocacy, training, service delivery and infrastructure development in regions where we have apresence. It is such ongoing epidemiological work that continues to inform and direct the work of LVPEI,through ICARE, to serve the most disadvantaged populations.Excellence Equity EfficiencyPAGE3

The Village Vision ComplexIn 1998, the first secondary service centre was established by LVPEI in Mudhol (Adilabad district,northwestern Andhra Pradesh) to provide high quality comprehensive eye care with permanentinfrastructure, as a replacement strategy for temporary eye camps that were the norm earlier. Thenwas born the idea of the Vision Centre, a one-room clinic staffed by a trained technician to take eyecare even closer to the point of need – to the remotest villages across the state. These would be thefirst point of care for people in villages and hamlets with no access to eye or any other health care. Thefirst Vision Centre, started in 2002 in the village of Chagallu, was part of an evolving design to completearticulation as the LVPEI Eye Health Pyramid.The three levels at the base of the pyramid are crucial to the realization of LVPEI’s vision: to createexcellent and equitable eye health systems that reach all in need. The Service Centres operate at thesecondary level of care, the Vision Centres at the primary. And below this, to ensure that access isprovided to every individual in the farthest of rural communities, is a community based interventionprogram based on door-to-door screening and home-based rehabilitation programs. The grouping ofthese three levels of services is termed as the “Village Vision Complex”.Therefore, the Village Vision Complex comprises a Service Centre with 10 Vision Centres linked toit, covering a rural area within a 50 km radius of 15-20 villages and a population of about 50,000.Each Vision Centre establishes community linkages through screening, health awareness and educationprograms. Those who cannot be treated with primary or secondary level intervention are referred tothe nearest tertiary eye care centre and, on return, their follow-up is managed through the serviceCentre. Similarly, consultants and eye care program managers at the tertiary centres learn from theexperience at the base of the pyramid and feed this understanding into researching and developing newmodes and models of care.The Village Vision Complexes have two distinguishing features: local ownership and local staffing. TheService Centres and Vision Centres are built with significant contributions from individuals in thecommunity. The para-medical workers managing the Vision Centres are young people drawn fromthe local area and trained at LVPEI’s Hyderabad campuses for a year, thus making for employmentgeneration. Sustainability is achieved through a business model that combines cross-subsidization andrevenue generation from low cost spectacle sales.These centres have now become a hub for other community development activities – through thewindow of eye care other services can reach underserved communities. LVPEI’s Community Linkage inIntegration of Primary health (CLIP) program attempts to educate and train community health workersin all aspects of primary care, from better nutrition to sanitation and preventive health care.By March 2010, six such Village Vision Complexes were put in place – two in Adilabad, three in Prakasamand one in Mahaboobnagar district. In the next three years, we will have another seven such complexes inplace in Krishna, Khammam, Srikakulum, Vizianagaram, Visakhapatnam and Nalgonda districts in AndhraPradesh and Bellary district in Karnataka.The Australian Government’s “AvoidableCentre component of the LVPEI Eyein the developing countries of thehas also implemented the eye healthbeginning 2009.Blindness Initiative” is implementing the VisionHealth Pyramid to provide primary eye careWestern Pacific. The Government of Indiapyramid as part of its 11 th Five Year Plan,Excellence Equity EfficiencyPAGE4

Primary Eye Care – Vision CentresDr A P J Abdul Kalam with the key functionariesSeeing is BelievingStandard Chartered Bank’s ‘Seeing is Believing’program, working with the International Agencyfor Prevention of Blindness (IAPB) will set up 40Vision Centres to provide primary eye care in ruralareas with technical support from L V Prasad EyeInstitute. Aravind Eye Hospital (Madurai), VenuCharitable Society (Delhi), Shroff Charitable EyeHospital (Delhi) and Shri Sadguru Seva Sangh Trust(Chitrakoot, Madhya Pradesh) will each develop 10Vision Centres. The India Consortium launch of theprogram, in New Delhi on April 8, 2009, was attendedby former President of India Dr APJ Abdul Kalam,Mr Jaspal Bindra (CEO Asia, Standard CharteredBank), Mr Benedict Cheong (CEO, Temasek Foundation) and Dr Taraprasad Das (Director, LVPEI,Bhubaneswar). LVPEI’s contribution to the project was richly acknowledged and the Vision Centreconcept appreciated by all. LVPEI coordinated the development and evaluation of these Vision Centres.6 New Vision CentresThis year six new Vision Centres (VC) were established anddedicated in Prakasam district, Andhra Pradesh, betweenAugust 22 and September 5, 2009. Fully equipped with therequisite infrastructure and trained Vision Technicians,the new Vision Centres bring the total to 63. Of these 30VCs in Prakasam district of Andhra Pradesh are supportedby the Lavelle Fund for the Blind, Inc., New York.Over 3 million people now have access to comprehensiveand high quality primary eye care through the 30 VCslinked to three secondary care Service Centres forreferrals. This is the first comprehensive and largest eyecare program providing primary and secondary eye carecovering the entire Prakasam district, thus adding a newdimension to LVPEI’s community eye health program inAndhra Pradesh. Most of the Vision Centres’ buildings areThe newly opened Ulavapadu Vision Centre receivesa tremendous response from the villagerssupported by the local community, which is invaluable in terms of financial viability, local ownership andmorale building. Local key persons participated in the opening ceremony including village presidents andMandal development officers along with the ICARE field staff.AFIRST‘NAMASTE’TO EYE CAREFirst Namaste to Eye CareA 10-minute film on LVPEI’s Vision Centre concept was madeby the Communications Department, Central Audio-VisualUnit and ICARE. The film outlines the institute’s primary eyecare initiatives across rural Andhra Pradesh.Excellence Equity EfficiencyPAGE5

Service DeliveryDuring the year 101,979 people were seen at our 63 primary care Vision Centres,affiliated to secondary care service centres.PerformanceRURAL (61)Bhosle Gopal Rao Patel Eye Centre, Mudhol#(Bhainsa, Kubeer, Nandipet, Navipet, Kallur, Lokeshwaram,Tannur, Echoda & Indervelly)Seshanna Chennawar Eye Centre, Adilabad#(Utnoor, Boath, Jainath, Bela, Narnoor, Jainoor, Jannaram,Medarpet, Talamadugu & Gudihathnoor)Kuchukulla Ramachandra Reddy Eye Centre,Thoodukurthy#(Wanaparthy, Achampet, Nagarkurnool, Kothakota, Kollapur,Ghanapuram, Bijnapally, Telkapally, Kalwakurthy & Lingala)Venkata Lakshmi Eye Centre, Karamchedu#(Parchuru, Panguluru, Pedanandipadu, Yeddanapudi, Marturu,Ballikuruva, Epurupalem, Chinnaganjam, Naguluppalapadu &Vetapalem)Sudhakar & Sreekanth Ravi Eye Centre,Markapuram#(Tripuranthakam, Yerragondapalem, Dornala, Cumbum,Bestavaripeta, Giddalur, Podili, Darsi, Kurichedu &Chimakurthi)Sudhakar & Sreekanth Ravi Eye Centre,Kandukuru#(Tangutur, Kondapi, Lingasamudram,Chandrasekharapuram, Singarayakonda, Pamuru,Ulavapadu, Medarmet, Santhanuthalapadu & Kothapatnam)Siloam Eye Centre, Madanapalle#(Nimmanapalle & B Kothakota)ScreeningSpectaclesprescribed*Spectaclesdispensed*Referred toService Centre22,124 8132 7264 426914,362 5737 4612 266622,942 8174 5899 586913,874 5810 4940 287011,720 4320 3343 27209454 3858 2682 1856636 171 90 202URBAN (2)LVPEI-VST Screening Centre, Ramnagar andVision Screening Centre, Kismatpur6867 3581 2705 1590Total 101,979 39,783 31,535 22,042*Some spectacles sold to patients referred by Service Centres. Also includes non-prescription spectacles like sunglasses,photochromatic glasses, etc.#Vision Centres affiliated to the service centre.Excellence Equity EfficiencyPAGE6

Alert vision technician ‘sights’ glaucomaVenkataramana, the Ichoda Vision Centre technician, regularly insists on a slit lamp examination forall patients. Three years ago, his insistence proved to be a blessing for a casual visitor Shivudu, whohad come to the Vision Centre merely to buy a pair of dark glasses. Venkataramana insisted then thatShivudu have an eye examination first. Fortunately for Shivudu, an alert Venkataramana detected higheye pressure during the eye examination – he appeared to have glaucoma in both his eyes, an irreversibleeye disease.Venkataramana referred Shivudu to LVPEI’s secondary care Bhosle Gopal Rao Patel Service Centre inAdilabad, where Shivudu was advised to immediately undergo laser treatment. Shivudu underwent YAGlaser at LVPEI’s Seshanna Chennawar Eye Care Centre in Mudhol. Since then, a grateful Shivudu hasbeen a responsible patient, following up on repeat consultations for controlling his glaucoma.Today, Shivudu continues to sell confectioneryto kirana shops in Ichoda for a living. However,now he does so with a mission. He talks to hisclientele, who are in the age group of 25 to 45,about the benefits of undergoing a complete eyeexamination. Thus many many families are beingtouched by the word-of-mouth publicity for eyecare!For Shivudu it was serendipity that Venkataramanainsisted on a slit lamp examination. The dedicationand commitment of vision technicians likeVenkataramana enable the Institute to realizeits vision to provide eye care to those living inremote areas of Andhra Pradesh.Shivudu with his ‘sight saver’ VenkataramanaEye care at the doorstepInauguration of the Ulavapadu Vision CentreSenior citizens await their turn for an eye examination onthe inaugural day of the Santanutalapdu Vision CentreExcellence Equity EfficiencyPAGE7

Secondary Eye Care – Service CentresWork on the 9 th satellite secondary level Service Centre at Paloncha, Khammam district, is under way,with the support of Navabharat Ventures Limited. Construction is in progress, the recruited staff areundergoing training and the centre is expected to be operational in the last quarter of 2010.Anniversariesth• The 7 anniversary of Venkata Lakshmi Eye Centre, Karamchedu (3 rd satellite centre) wascelebrated on June 7, 2009th• The 4 anniversary of Seshanna Chennawar Eye Centre, Adilabad (5 th satellite centre) wascelebrated on June 9, 2009nd• The 2 anniversary of Swarna Bharat Eye Centre, Venkatachalam, Nellore (6 th satellite centre)was celebrated on June 25, 2009. Dr Kasthuri Rangan, MP and former Chairman of ISRO, Mr VenkaiahNaidu of Swarna Bharat Trust were the chief guests. A community screening program was organisedwith special focus on paediatric care.• Kuchukalla Ramachandra Reddy Eye Centre (2 nd satellite centre) celebrated its 11 th anniversaryon October 24, 2009.• ICARE celebrated its 11 th anniversary on December 17, 2009.• Bhosle Gopal Rao Patel Eye Centre, Mudhole, LVPEI’s 1 st satellite centre celebrated its 13 thanniversary on December 20, 2009.• The Sudhakar & Sreekanth Ravi Eye Centre at Markapuram (Andhra Pradesh), the 7 th secondarycare Service Centre of LVPEI, celebrated its 2 nd anniversary on January 3, 2010. Established with thesupport of Sudhakar Ravi & Sreekanth Ravi (USA) in 2008, it is part of the Prakasam District Eye HealthInitiative of LVPEI. Since its inception, the centre has seen 23,415 outpatients (51% examined free ofcost) and performed 2154 surgeries — 70% of them totally free. Its 10 satellite primary care VCs offereye care to the neighbouring villages free of cost. In two years, the 10 Vision Centres have screened23,749 patients, while 55,362 more have been screened in community care programs. Additionally,5590 schoolchildren have been screened. Thus, over 102,500 persons around Markapuram havereceived eye care till date.• Sudhakar & Sreekanth Ravi Eye Centre in Kandukuru, Prakasam district, LVPEI’s 8 th satellitecentre, celebrated its 1 st anniversary on February 1, 2010.rd• The 3 anniversary of Siloam Eye Centre, Madanapalle, Chittoor district, was celebrated on March11, 2010.The eye care team at Sudhakar & Sreekanth Ravi Eye CentreMrs A Alluramma (Housekeeping Services) cuts a cake atMarkapuram. Also seen are Mr A Sathish (ophthalmologist), DrA Suresh (MLA, Yerragondapalem), Dr Srinivas (Medical Officer,Tripuranthakam PHC) and Dr Vaibhev Mittal (LVPEI fellow)Excellence Equity EfficiencyPAGE8

Service DeliveryDuring the year 225,197 people received eye care at our 17 secondary care centres,43% of them were examined free of cost. A total of 28,603 surgeries were performed,69% of them entirely free of cost.Rural satellite & partner centresOutpatientvisitsPayingSurgeriesOutpatientvisitsNon–payingSurgeriesSatellite CentresBhosle Gopal Rao Patel Eye CentreMudhol, Adilabad District12,124 1254 4893 863Kuchukulla Ramachandra Reddy Eye CentreThoodukurthy, Mahabubnagar District6779 404 2902 779Seshanna Chennawar Eye CentreAdilabad District7588 411 4294 686Siloam Eye CentreMadanapalle, Chittoor District11,051 538 1398 324Venkata Lakshmi Eye CentreKaramchedu, Prakasam District4147 216 4432 782Swarna Bharat Eye CentreVenkatachalam, Nellore District827 33 3340 353Sudhakar & Sreekanth Ravi Eye CentreMarkapuram, Prakasam District5153 341 4084 636Sudhakar & Sreekanth Ravi Eye CentreKandukuru, Prakasam District1677 11 1211 151Partner CentresMullapudi Venkatarayudu Eye CentreTanuku, West Godavari District12,097 1018 2956 422Smt. Rajeshwari Ramakrishnan Lions Eye HospitalNidadavole, West Godavari District11,105 1063 10,051 4436St. Gregorius Balagram Eye HospitalYacharam, Ranga Reddy District5186 176 1143 406Lions Club of Suryapet Eye HospitalSuryapet, Nalgonda District4688 353 10,932 1040The Rotary Eye HospitalProddatur, Kadapa District10,064 1061 6254 2087Paramahansa Yogananda NetralayaVemagiri, Rajahmundry12,068 720 2643 355Urban Partner Centres in HyderabadM S Reddy Lions Eye Hospital, Moula Ali 8565 497 9528 2061Kishore Chand Chordia Eye CentreBegum Bazaar5132 290 16,730 1904Balanagar Lions Eye HospitalBalanagar11,158 571 8997 2,361Total 129,409 8957 95,788 9,646Excellence Equity EfficiencyPAGE9

Community Eye CareService DeliveryDuring the year 535,431 people were reached through our community eye careprograms, and provided community based rehabilitation to 194 people.Community SurveysHOUSEFICCL-LVPEI CEHPFICCL-LVPEI CSPSatellites WDF 1 WDF II Clip TotalSlums/villages surveyed – 28 – 426 18 – 1 473Population covered bydoor to door surveysIdentified with eyeproblems & referred forfurther examination– 70,476 – 424,356 25,936 13,859 804 535,431– 12,676 – 82,178 – – 431 95,285Community ScreeningPrograms (CSP)CSPs organized 63 32 10 327 – – – 432People screened 6177 2768 4276 22,285 12,240 13,859 804 62,409Prescribed spectacles 1726 895 2364 4177 – – – 9162Referred to base hospital 759 482 614 5415 2543 – – 7270Within normal limits 1262 705 490 3152 – – – 5609School Screening ProgramsHOUSEFICCL-LVPEI CEHPSight forKidsU-Specs Satellites WDF 1 TotalTeachers trained 15 14 153 21 453 218 874Schools covered 17 13 153 9 491 12 695Children screened 9405 1686 15,085 2271 76,724 – 105,171Identified with eye problems 1150 200 368 263 4282 – 6263Prescribed spectacles 192 21 27 214 1230 – 1684Anganwadi Screening Programsfor children 0-5 years of agePrograms organized – 2 – – 196 – 198Children screened – 102 – – 6014 – 6116Identified with eye problems – 26 – – 407 – 433Referred to base hospital – 26 – – 232 – 258HOUSE: Hyderabad Outreach Urban Slums Eye-care ProgramFICCL-LVPEI CEHP: Fullerton India Credit Company Limited - LVPEI Comprehensive Eye Health Program in Malkajgiri slums, HyderabadFICCL-LVPEI CSP: Fullerton India Credit Company Limited - LVPEI Community Screening Programs in Andhra PradeshSatellites: Satellite Centres of LVPEI in Adilabad, Mahabubnagar, Prakasam, Nellore and Chittoor districtsWDF 1: Diabetes prevention program through Child to Family CommunicationWDF II: Capacity building program to address diabetes & diabetic retinopathyCLIP: Community Linkage for Integration of Primary healthSight for Kids: Primary schoolchildren’s eye health program with the support of Lions Clubs International and Johnson & Johnson Ltd.U-Specs: Children provided refractive error correction (myopic) servicesExcellence Equity EfficiencyPAGE10

“What else can make me happy?”“What else can make me happy?” was the light-hearted question posed by Adepalli Lakshmi whenwe met her at her home in Lova Nagar slum in an urban slum of Hyderabad during a follow-up visit.She was washing clothes and greeted us with a big grateful smile. Though we knew she was happy withLVPEI’s eye care services, it was a joy to see her active and productive. “All these days, my hands wereidle. What a relief it is now! Now I am able to do so many things for my family. What else can make mehappy at this age?”Lakshmi is a 65-year-old housewife who underwent cataract surgery at LVPEI. She lives in a small hut withher husband Buchaiah, her son Narsinga Rao and daughter in-law Lalitha, who are daily wage labourers.Lakshmi suffered from blurred vision for five years but could not see a doctor due to financial constraints.Bhavani, a community eye health worker identified Lakshmi’s condition, during a door-to-door surveyconducted under LVPEI’s Community Health Program in partnership with FICCL on June 20, 2009.Lakshmi underwent an eye examination during the community screening program held in Malkajgiri,Hyderabad and was referred to an LVPEI partner centre for cataract surgery. She was operated on1 st July 2009.Lakshmi says, “It is only due to this program that I could have a free cataract surgery to restore my vision.I am doing all my personal and household chores and helping my family without any difficulty.”(As reported by a community health specialist, ICARE)Excellence Equity EfficiencyPAGE11

Accompaniment ProgramNationalOperation Eyesight UniversalLVPEI is assisting all the Operation Eyesight Universal (OEU) partner hospitals in India in training andmentoring to represent the interests of their stakeholders more effectively and ensure greater impactin their areas of work. Regular developmental visits to all partner centres along with the OEU team areundertaken by clinical and non-clinical teams. This year, the following partner’s centres were visited andevaluated:• Siliguri Greater Lions Eye Hospital, Siliguri, West Bengal• Indore Eye Hospital, Indore, Madhya Pradesh• Thakur Sitaram Seva Kendra, Malda, West Bengal• Assumption Eye Unit, Kanhirapuzha, Kerala• Webster Memorial Eye Hospital, Gudalur, Tamil Nadu• Garnett Memorial Eye Hospital, Mettupalyam, Tamil Nadu• Thakur OEU Lions Eye Hospital, Garividi village, Sreeramnagar, Andhra PradeshCentre for Community Ophthalmology capacity building programLVPEI is partnering with Seva Foundation, USA to provide eye care to the blind and visually impaired inunderserved areas across the states of India. LVPEI (along with 8 other institutes globally) is part of theCentre for Community Ophthalmology (CCO) network, which is Seva’s Clinton Global Initiative So OneMillion Eyes See Again, wherein 100 hospitals will perform an additional 1 million surgeries every year by2015.The CCO network will assist 100 hospitals to scale up their capacity to perform safe and affordablecataract surgeries and provide comprehensive eye care services to rural communities around the world.Existing facilities will be expanded and transformed into efficient self-sustaining centres, while new oneswill be developed to deliver quality eye care to communities. This will be accomplished through trainingof all levels of staff and the development of community eye care programs.An initial grant was released to LVPEI for needs assessment and capacity building of 13 hospitals; needsassessment visits were made to 6 hospitals in 5 states.C L Gupta Eye Institute,Moradabad, Uttar PradeshThis partner hospital (inaugurated onSeptember 21, 2009) is a model ofLVPEI’s tertiary care centres, and providescomprehensive eye care to all irrespectiveof their socio-economic status in westernUttar Pradesh. Till March 31, 2010, thecentre had seen over 10,000 outpatientsand performed close to 1000 surgeries in allsubspecialties of eye care.C L Gupta Eye Institute, MoradabadExcellence Equity EfficiencyPAGE12

Rotary Mahanagar Netralaya, KolkataAn MoU has been signed with Rotary Mahanagar Netralaya, Kolkata, West Bengal. A monitoring visit wasmade to the hospital in February 2010.Seeing is BelievingAs part of Standard Chartered Bank’s ‘Seeing is Believing’ project to set up 40 Vision Centres across 6states over a period of 3 years, monitoring visits were made to evaluate the Vision Centres establishedby Shri Sadguru Seva Trust in Chitrakoot (Madhya Pradesh state), LAICO–Aravind Eye Care Systemin Theni and Madurai (Tamil Nadu), Venu Charitable Society (New Delhi) and Shroff Charitable EyeHospital, New Delhi.OthersSituational analysis was carried out for the development of a comprehensive eye care facility at Bellary,Karnataka and in Nalgonda district, Andhra Pradesh. Needs assessment visits were done and discussionsare in progress for capacity building of 6 other hospitals in various states of the country.International• In continuation with the initiative by the International Agency for Prevention of Blindness and theLavelle Fund for the Blind, Inc., New York, USA to assist capacity building institutions and strengthentheir ability to provide training and consultation, two needs assessment visits were made byDr Prashant Garg to the University of Nairobi, Kenya. It is proposed to develop the Universityinto a Centre of Excellence.• LVPEI has signed an MoU with the Islamia Eye Hospital in Dhaka, Bangladesh, whereinconsultants and senior administrators from LVPEI are working with the teams in Dhaka to developIslamia Hospital into a Centre of Excellence and an apex centre in eye care. The MoU covers athree-year period, from 2009 – 2012 and is facilitated by a capacity building grant made by theAgency for the Prevention of Blindness (IAPB) and the Lavelle Fund for the Blind, Inc. New York,USA. Founded in 1960 by renowned philanthropist Mr M S Ispahani, Islamia is Bangladesh’s biggesteye hospital, serving 300,000 outpatients and performing 25,000 surgical procedures annually. Afew years ago, LVPEI helped develop the hospital’s cornea specialty services and cornea fellowshiptraining program.• Technical support is being provided to Tilganga Hospital in Nepal to conduct the Rapid Assessmentof Refractive Errors project.... and the Network growsIn operation Partnerships In processCentre of Excellence 1 2Tertiary Centres 2 16 (11 National & 5 International) 1Service Centres 8 9 3Vision Centres 63 70Capacity building collaborationsIn operation Partnerships In processTechnical consultancy(in specific areas) 6 14 7Partner hospitals 6(4-year partnerships)Excellence Equity EfficiencyPAGE13

National Collaborating CentresIndia Partners: Tertiary Centres­¬­¬­¬­¬­¬­¬­¬­¬­¬­¬­¬Suryodaya Eye Centre, Kolkata, West BengalC L Gupta Eye Institute, Moradabad, Uttar PradeshMGM Eye Institute, Raipur, ChattisgarhAlakh Nayan Mandir Eye Institute, Udaipur, RajasthanLions Karnavati Shantaben Vishubhai Patel Eye Hospital, Ahmedabad, GujaratLittle Flower Eye Hospital, Angamally, KeralaCalcutta Medical Research Institute, Kolkata, West BengalJupiter Eye Centre, Mumbai, MaharashtraSilguri Greater Lions Eye Hospital, Siliguri, West BengalIndore Eye Hospital, Indore, Madhya PradeshPerfect Vision Eye Hospital, Faridabad, HaryanaIndia Partners: Secondary CentresLVPEI - OEU Collaborating hospitalsChandra Prabha Eye Hospital, Jorhat, AssamBausch & Lomb Advanced Cataract Centre, Haldwani, UttaranchalBausch & Lomb Advanced Cataract Centre, Sri Ganga Nagar, RajasthanIndia Partners: Primary CentresIndiaShri Sadguru Seva Sangh Trust, ChitrakootVenu Charitable Society, DelhiShroff Charitable Eye Hospital, DelhiAravind Eye Hospital, MaduraiExcellence Equity EfficiencyPAGE14

Operations Research: Public Health ProjectsName of the Project Project Investigators Supported by DurationDeveloping Comprehensive ModelsVillage vision complex: AComprehensive Eye Healthprogram in Prakasam districtICARE – LVPEI team Ravi Brothers, USA August 2005 toJuly 2010Capacity building program toaddress diabetes and diabeticretinopathy in Prakasam districtDr Ajit Babu Majji 1Ms S SheeladeviWorld DiabetesFoundation,DenmarkSeptember 2008to August 2013Diabetes prevention programthrough Child to FamilyCommunication for change inlifestyle and health promotion inPrakasam districtMs S SheeladeviWorld DiabetesFoundation,DenmarkAugust 2006 toMarch 2011Eliminating Childhood BlindnessNimmagadda Prasad – LVPEIChildren’s Eye Health InitiativeMs S SheeladeviMr S BhattacharyaMs Korani JyothiNimmagaddaFoundation, IndiaJuly 2007 toJune 2020Pediatric Ophthalmology Learningand Training Centre (POLTC )Dr Giridhar PydaORBIS International,USAOctober 2006 toMarch 2010Sight for Kids Mr Jachin D Williams Lions ClubInternationalFoundation, USANovember 2005to March 2011Universal Spectacles (u–Specs)Mr Jachin D WilliamsDr Rohit KhannaPhilips Electronics,IndiaJune 2009 toDecember 2009Empowering Rural CommunitiesCommunity Linkage for Integrationof Primary health (CLIP)Dr Sayed ImtiazAhmedMr S BhattacharyaMs Jayanthi SagarL V Prasad EyeInstitute, IndiaFebruary 2009 toFebruary 2010Mapping Rural Eye Care NeedsRapid Assessment of RefractiveErrors (RARE)Mr M SrinivasDr Jill E Keeffe 2Dr Gullapalli N RaoL V Prasad EyeInstitute, IndiaVision CRC,Australia2009 to 2010Follow-up of Andhra Pradesh EyeDisease Study A Feasibility Study ofthe Revisit of the Respondents ofthe Baseline StudyDr Rohit KhannaDr Giridhar PydaInternationalCentre for EyeHealth, LondonJune 2009 toMarch 20101Consultant, L V Prasad Eye Institute, Hyderabad, India2Head, Population Health Unit, Centre for Eye Research Australia,The University of Melbourne, AustraliaExcellence Equity EfficiencyPAGE15

Developing Comprehensive ModelsCapacity building program to address diabetes & diabetic retinopathyThe capacity building program is aimed at addressing the problem of diabetes and diabetic retinopathyin Prakasam district (Andhra Pradesh) over a five-year period — September 2008 to August 2013.Supported by the World Diabetes Foundation, district-level systems are being set up to offercomprehensive services to the diabetic population through training and infrastructure development,active screening and referral services to established linkages, while also increasing awareness amongstakeholders in the community.Significant achievementsUnder the project the facilities for managing diabetes were upgraded at 30 select Primary Health Centres(PHC) in the district. The centres were provided with ECG machines, glucometers, scales for measuringweight and height and monofilament. A training program was organized for all the medical officers onECG operations and interpretation.Active collaboration was achieved with the state government’s ‘104 services’ that take medical services tothe doorsteps of people living in remote rural areas. A comprehensive training program was conductedfor the paramedical teams and areferral system has been set upwithin the 104 services so thatpersons identified with diabetes arereferred to the nearest eye carefacility.Service delivery: A total of 13,859 persons were registered duringthe year; 23,584 persons have beenregistered till date.Training highlightsAnnual CumulativeTarget for3 yearsOphthalmologists 13 15 30Mid level ophthalmic assistants 26 46 30General medical practitioners 104 104 100Paramedics 242 248 160Community health workers 588 661 650Ms Sunitha Sapur, nutritionist, looks onas a man with diabetes talks about thedisease and its managementWorld Diabetes Day at LVPEIICARE – LVPEI commemorated World Diabetes Day on November 14,2009 at Ongole as part of its ongoing World Diabetes Foundation (WDF)program in Prakasam district of Andhra Pradesh. A workshop for people withdiabetes was conducted to emphasize the importance of lifestyle changes,with a yoga demonstration and a food exhibition arranged according totraffic signal colours. Items on the red table were prohibited for peoplewith diabetes, those in the orange table were to be eaten judiciously andthose in the green table were safe. About 85 diabetic patients from 6villages attended the workshop and formed a self-support group.The workshop was inaugurated by Dr Neeradha, District Medical andHealth Officer. Other guests included cardiologist Dr Keshava, and DrMurali, ophthalmologist and District Blindness Control Society programmanager, general physician Dr Srinivasulu, Yoga specialist Dr Prasada Rao,and nutritionist Ms Sunitha Sapur.Airtel and Reliance Communication teamed up with the Institute to sendan SMS to clients about free eye check-up for people with diabetes at the Hyderabad campus on November 15,2009. Almost 100 people came for screening — most of them were unaware till then that unchecked diabetescould lead to vision impairment.Excellence Equity EfficiencyPAGE16

Developing Comprehensive ModelsDiabetes prevention program through Child to Family CommunicationThe diabetes prevention program through Child to Family Communication in Prakasam district, supportedby the World Diabetes Foundation, was launched in May 2006. The field work was completed bySeptember 2009.Using a preventive approach, the project addressed the lack of awareness among communities aboutdiabetes and identified high risk groups in target areas to counsel them about lifestyle modifications. Asustainable district level model was set up using the child-to-family communication strategy and educationand sensitization training was imparted through schoolchildren between 9 and 12 years of age. Thetrained children served as messengers of health and helped identify high risk persons in their families andimmediate neighborhoods. They covered allage groups, particularly those between 10and 50 years of age who usually do not seekcurative services or visit health camps. Annual CumulativeSchools covered 12 679Creating awareness through discussions with self help groupsHighlightsVillages covered 18 513Training programsSchoolchildren trained 1453 119,743Teachers trained 218 8288NGOs 13 183Primary Health Centre doctors – 97Self-help group representatives 204 41, 108Screening by trained children & staffFamilies 5635 528,150Persons 25,936 2,403,978Persons screened & tested for diabetes 12,240 131,786Referred for eye examination 2543 24,288World Sight Day 2009commemoratedWorld Sight Day was commemoratedon October 8, 2009 with supportfrom Fullerton India Credit CompanyLimited (FICCL) and the British Library.A community screening and eye healthawareness program was organised at thevenue of the Institute’s ComprehensiveEye Health Project in an urban slum ofHyderabad. Later schoolchildren sangsongs on eye health.Dr Srivalli Kaza, Consultant, LVPEI,gave a talk on this year’s global themeof World Sight Day ‘Gender and EyeHealth — equal access to care’ at theBritish Library, which was followed by avision screening program.An elderly woman accompanied by her grandchildren undergoesan eye examination in an urban slumRight to eye care for all of us,boys and girls!Excellence Equity EfficiencyPAGE17

Developing Comprehensive ModelsThe circle of careP Raghavamma, a widow of 65 years,washes clothes for a living. She did not believeher granddaughter Swarna Bhulakshmi(studying in the 7 th standard in a school inKunkalamarru village, Prakasam district ofAndhra Pradesh state), when she calculatedher risk score and performed a urine sugarestimation using strips and told Raghavammathat she had high blood sugar. She arguedwith the child saying she had checked herblood sugar a year ago and found it to benormal. She declared that she took herblood pressure medicines regularly and wasvery careful about her health.When the project staff screened her againBhulakshmi conducts a diabetes risk assessment on her grandmother using a glucometer she was shocked to seeher blood sugar reading as 333 mg/dl. Thenshe recalled the symptoms she had noticed during the past year, including frequent urination, excessivehunger, thirst and tiredness. She was counselled by the project staff about the care she needed to takeand became more careful about her diet and condition.Bhulakshmi was happy that she could help diagnose her grandmother’s diabetes so she could takemeasures to control it.A Kondaiah, 61, works in R K Puram panchayat, Chirala. His diabetes was identified through a communityscreening program conducted by ICARE, LVPEI. He had no knowledge of diabetes – its causes, symptomsor treatment. He admitted that it was only through the awareness program that he learnt about thedisease. Since then, he and his family have made a conscious effort to change their food habits andlifestyle. “We have reduced the use of oil while cooking. We have also increased our physical activity,”says Kondaiah. There has been a significant drop in his sugar level since.P Srinivasu Rao, who teaches computersin a school, also became aware of his diabeticcondition through an LVPEI communityscreening program. He is 39 years old. Hewas advised to consult a physician, regulatehis diet and exercise regularly. He began goingfor walks but delayed consulting a physicianuntil a second visit by the LVPEI staff, whofound that his sugar level had increasedfurther. However, proper medication, regularexercise, changes in diet and following aregular mealtime schedule have enabled himto lead a healthier life. He advises everyonewith diabetes to work with NGOs and helpthem create awareness about the diseaseamong their family and friends. He also adviseshis friends and acquaintances to reduce theirintake of alcohol and quit smoking.14-year-old P Gangabhavani studies in Vivekanand School in the9 th class. She screens her grandmother Cherukuri Jayamma,72 years old, for diabetes.Excellence Equity EfficiencyPAGE18

Eliminating Childhood BlindnessNimmagadda Prasad – LVPEI Children’s Eye Health InitiativeThe Nimmagadda Prasad – LVPEI Children’s Eye Health Initiative (NLCEHI), supported by theNimmagadda Foundation has completed its third year. Launched on July 7, 2007 the programaddresses the problem of childhood blindness in Andhra Pradesh. The year 2009-2010 was a remarkableperiod for NLCEHI in terms of training schoolteachers to identify children with eye problems followedby eye care service delivery. A total of 69,958children have benefited through various levelsof services this year, including school screeningsand outpatient services at our facilities.Training programs, covering identification of eyedisease, referrals, service delivery and eye healthawareness, were organized for community eyecare teams that included community eye careworkers, vision technicians and Vision Centrecoordinators.HighlightsAnnual CumulativeTeachers trained 376 2560Schools covered 265 500Schoolchildren screened 33,720 90,491Identified with eye problems 3555 6266Prescribed spectacles 4648 7746Surgeries performed 3136 9428Clear vision for 3 brothersA 7 th class student, Vikranth lives in Budwel Village, Rajendra Nagar, Hyderabad. He had lived with blurred visionand severe headaches for 2 years. He had difficulty in copying notes from the blackboard and had to dependon his classmates to help him out. He could not watch television also.A bright student, Vikranth used to top his class; now he had been pushed to the 10 th rank. Shocked by his poorperformance, his father Mr Krishna discussed the matter with Vikranth and found that poor vision was theculprit. Vikranth’s father approached the community eye care team of LVPEI, who were at that time conductinga school screening program where his children were studying. He took an appointment for Vikranth at LVPEI’sKismatpur Eye Clinic.Vikranth was brought to the clinic along with other children from his school, who had also been identifiedwith eye conditions. He underwent a detailed eye examination by Vision Technician Mr Venkanna. Vikranth’stwo brothers were also diagnosed with refractive errors and prescribed spectacles. All the three childrenwere provided spectacles free of cost under the Nimmagadda Prasad LVPEI Children’s Eye Health Initiative,supported by Nimmagadda Foundation.Many children in rural areas are not aware of their vision problems, until they have an eye examination. Untreatedeye conditions affect their lives, studies and productivity. LVPEI’s teacher training programs empower teachersto detect eye problems among children and encourage them to undergo eye examinations. Mr Krishna ishappy that his children’s problem was detected and they can now do well at school.Vikranth is brought to Kismatpur Eye Clinic for an eye examinationVision Technician Mr Venkanna examines Vikranth’s eyesExcellence Equity EfficiencyPAGE19

Eliminating Childhood BlindnessSight for KidsA structured child eye health program for primary schoolchildren in Hyderabad, Sight for Kids issupported by Johnson & Johnson, Lions Club International Foundation (LCIF) and the LionsEye Hospitals of Greater Hyderabad. Theprogram identifies children between 5-9 yearsHighlightswith vision problems, providing treatment andsight restoration services. The strategy forAnnual Cumulativecovering the child population within a limitedtime period is through training of schoolteachersto increase eye health awareness, identifychildren with eye problems, and refer them forappropriate treatment.Schools covered 153 846Teachers trained 153 890Children screened 15,085 72,575Identified with eye ailments 368 2069A young beneficiary of the Sight for Kids programshares his experiencesSight for Kids milestoneThe Sight for Kids (SFK) Greater Hyderabad team celebrated amilestone in its efforts to eliminate avoidable blindness amongchildren: LVPEI’s collaborative project along with Lions ClubInternational Foundation and Johnson & Johnson completed screeningof 10 million schoolchildren across 20 countries! At a felicitationprogram in Hyderabad on September 11, 2009, Ln Manohar Raju andLn B R Rao appreciated LVPEI’s 5-year involvement in the program,especially its tertiary level eye care services. Mr Jachin Williams andMs Korani Jyothi received a certificate of appreciation on behalf ofICARE – LVPEI.Pediatric Ophthalmology Learning and Training CentreLVPEI, Hyderabad, is one of the three Pediatric Ophthalmology Learning and Training Centres(POLTC) supported by ORBIS in India and south-east Asia for developing human resources inpediatric ophthalmology. Five pediatric eye careteams were trained at each centre, comprising anophthalmologist, anesthetist, optometrist, nurse,counselor, and an outreach coordinator. Threebatches of nurses, counselors, optometristsand outreach coordinators and four batches ofophthalmologists have completed their training. Forall the parameters the target was well exceeded.HighlightsAnnualCumulative TargetChildren screened 48,368 1,28,323 55,000Surgeries performed 4652 14,837 1800Treated for othereye conditions4976 22,285 4000New hope for SangeethaSangeetha Pedireddy, 15, is studying in the 9 th standard in Asifabad in Adilabad district ofAndhra Pradesh. The youngest of 6 sisters and a brother, she has lost both their parents.She and 2 other sisters live with her brother, his wife and two children.Ten years ago Sangeetha’s vision in the left eye had diminished following an injury with acycle rod. The family could not afford to seek treatment and she lived with the conditionfor a decade. In April 2009, a POLTC trainee and supervisor of community eye careservices visited Asifabad to create awareness about eye conditions. These efforts helpin identification, early detection and management of eye diseases among children at theprimary, secondary and tertiary levels.Excellence Equity EfficiencyPAGE20

Eliminating Childhood BlindnessWhile the field workers visit raised their hopes, Sangeetha and her family could not afford to go toAdilabad, which was 150 km away. Later, the field supervisor came on a follow-up visit and tookSangeetha to LVPEI’s secondary care Seshanna Chennawar Eye Centre at Adilabad, where she underwenta cataract surgery free of cost. She was referred to L V Prasad Eye Institute, Hyderabad for furthermanagement. She found a great improvement in her vision.LVPEI, in collaboration with ORBIS, is creating skilled pediatric eye care teams to combat childhoodblindness to help many children like Sangeetha see again.Universal SpectaclesUniversal Spectacles (U–Specs) is a new technical strategy for providing spectacles to myopic childrenbelow 16 years of age and requiring refractive error correction between 0 to –3.00 that can be easilydispensed by Vision Guardians (community eye health volunteers).The De Oude Beuk Foundation and V U Medical Centre University of Amsterdam, Netherlands,in partnership with Philips India Limited developed U-Specs to:• correct poor vision due to refractive errors by providing affordable “U– specs” to people in developingcountries with limited access to proper eye care,• contribute to the local economy by allocating the value chain of U–Specs and correspondinginvestments, and• reduce one-third of all avoidable blindness and visual impairment caused by refractive error.To test the U–Specs service delivery strategy, LVPEI conducted a comparative study between VisionGuardians and Vision Technicians on refraction for simple myopia for powers 0 to -3 in children below16 years of age.Headed for an eye examination ... seems like fun!Excellence Equity EfficiencyPAGE21

Empowering Rural CommunitiesCommunity Linkage for Integration of Primary healthThe Community Linkage in Integration of Primary health (CLIP) project (inaugurated on December 22,2008) aims to enhance the scope of LVPEI’s pyramidal model by providing affordable, accessible andquality healthcare to the community in its service area. The eye care model focuses on visual impairmentand blindness, providing eye care services with appropriate linkages and referrals. This network ofinfrastructure and manpower empowers LVPEI to play a larger role, by linking other public and privatehealth services and government welfare schemes — such as the Rajiv Aarogya Sri scheme, EMRI andHMRI services — to offer total health care.To begin with service delivery is being done through Village Health Volunteers, selected from Ada village(population 804) and trained by LVPEI in preventive and promotive health care, early detection andreferral of cases. Working closely with government machinery, they ensure community participationin all activities, creating long-term sustainability. Training programs on sanitation and hygiene, healthpromotion and maternal and child health were conducted, while volunteers and field coordinatorsnetwork with district and mandal level health care providers.Under the project 61 health awareness sessions were organised; 800 people were screened, of which 431were identified with eye problems and referred to our Vision Centres.The project data analysis is in progress, following which the activities will be consolidated to make theproject more broad-based, using the experience of Ada village.Mapping the villageExcellence Equity EfficiencyPAGE22

Mapping Rural Eye Care NeedsRapid Assessment of Refractive Error SurveyUncorrected refractive errors (URE) are the leading cause of visual impairment in most parts of thedeveloped and developing world. Despite the availability of a simple remedy, uncorrected refractiveerrors cause 16% of the blindness and 46% of the visual impairment across all age groups in the Indianstate of Andhra Pradesh. Population-based cross-sectional studies provide reliable information to setpriorities and plan services but are prohibitively expensive, time consuming and require expertise inepidemiology. Hence, a novel rapid assessment is used to provide baseline data to monitor and evaluatethe impact of the service delivery using simple, inexpensive equipment and within a limited time.Unaided, aided and pinhole visual acuity was assessed using a LogMAR chart at a distance of 4 meters.Near vision was assessed using the N notation chart at the subject’s customary working distance. A briefpersonal interview helped collect demographic information such as education level, occupation, use ofspectacles (where applicable) and past utilization of eye care services. All people with visual acuity 30 years age groups, to determine the prevalence of eyediseases and the burden of blindness and low vision in a representative sample of Andhra Pradesh, riskfactors associated with major eye diseases, the effect of blindness and low vision on quality of life andthe barriers to eye care services. ICARE – LVPEI, in collaboration with the International Centre forEye Health (ICEH), London, UK proposed to conduct a feasibility study to estimate migration andmortality rates and, consequently, the proportion of the surviving cohort to enable researchers to assessthe possibility of repeating a cross-sectional study on the surviving cohort. The ‘tracing’ exercise wasundertaken in the rural areas of APEDS, namely Tanuku in West Godavari district, Mudhol in Adilabaddistrict, and Thoodukurthy in Mahabubnagar district. The exercise would also identify households andsubjects willing to be re-examined in the follow-up study.The tracing exercise was done from June 2009 to March 2010. The status of availability in Tanuku,Mudhol and Thoodukurthy was 72%, 75% and 59% respectively, which means an overall survival statusof 69%. The main reasons for absence were migration to cities and death.Excellence Equity EfficiencyPAGE23

Education & TrainingA new cadre of community eye health leadersThe Graduation Day of the 1 st batch of Master of Community EyeHealth (MCEH) was held on February 10, 2010. Eleven candidatescompleted the MCEH – a one-year postgraduate coursework programin Community Eye Health offered by LVPEI, in collaboration with theUniversity of New South Wales (UNSW), Sydney, Australia. Dr SrinivasReddy from the Andhra Pradesh Right to Sight Society (APRTSS) toppedthe classThe graduating masters of community Eye HealthDiploma in Eye Health ManagementProf Fiona Stapleton presents thedegree to Dr Srinivasa ReddyThe graduates, mostly from thegovernment health sector, includedophthalmic assistants, programmanagers and ophthalmologists whowill apply their learning to help thecommunities they work with, thustaking forward the global preventionof blindness program. The secondbatch of MCEH started on February19, 2010. Seven students haveenrolled, including one from Nepal.The convocation for the first Diploma in Eye Health Management (DEHM) program (2008 batch) washeld on July 18, 2009. Nine students, hailing from all parts of the state, received their certificates. Thismarked the completion of the first year of the revamped program, whichunderwent substantial changes following review and feedback from bothparticipants and the service departments of LVPEI. The DEHM program aimsto inculcate administrative and managerial skills specific to LVPEI while alsocontributing to the overall human resources need in eye care.Dr Usha Gopinathan,Executive Director, LVPEI,presents the certificateto Ms Sukanya ErapaniAt the convocation the course conveners, faculty and students shared theirexperiences and their expectations of the years ahead in a challenging workenvironment. The students will be posted at LVPEI secondary centres invarious administrative positions. The 2 nd batch of 8 DEHM students startedtraining on August 3, 2009.Outgoing Diploma in Eye Health Management students with the ICARE-LVPEI faculty and senior managementExcellence Equity EfficiencyPAGE24

Diploma inCommunity Eye HealthCertificate Course in ProgramManagement and EvaluationThe 9 th Diploma in Community Eye Health (DCEH) program concludedon June 24, 2009. Eight students were declared successful, includingone from Nepal. The 10 th batch started from November 30, 2009. Ofthe 12 students enrolled, 2 are from Nepal.WorkshopsThe first Certificate Course in Program Management and Evaluation wasconducted from December 7-19, 2009. This was the first time that ashorter version of the 6-week course was conducted. Of the 6 candidates,3 were sponsored by Operation Eyesight Universal, and 1 each by VenuEye Institute (New Delhi), Emmanuel Hospitals Association (New Delhi) andBawri Nethralaya (Shillong).Public Private PartnershipICARE, in collaboration with Sightsavers and the Andhra Pradesh District Blindness Control Society(DBCS), conducted a District Programme Managers Training on Cataract ManagementProtocol (April 27-28, 2009). The program’s main objective was to update District Program Managers(DPM) about current best practices for cataract management and formulate a common minimum clinicalprotocol. A total of 23 DPMs, AP NPCB Joint Director, Director — AP Right to Sight Society andSightsavers’ representatives participated in the program.Vision Entrepreneurs training programVision Spring’s Vision Entrepreneurs training program on Community Eye Health and SchoolScreening was held from May 14-15, 2009 with 31 participants.ICARE partners meetThe 9 th Satellite-Partners meeting was held on December 24, 2009. Partners discussed their hospitals’current situation, explored the range of opportunities available, planned strategies to optimize theseopportunities, and developed a framework for a joint proposal.A core group was formed to leverage opportunities to go tothe next level.Dr Rohit Khanna, Assistant Director, Head, ICARE, addresses the district program managersExcellence Equity EfficiencyPAGE25

A successful career in nursingI applied for the Ophthalmic Nursing Assistant (ONA) training program“ in May 2003 and attended the entrance exam and interview on 15 th June2003. The entrance examination consisted of multiple choice questions inphysics, chemistry, biology, English and general knowledge. A fortnightlater I received a call letter informing me that I had been selected for theprogram.I was asked to report at L V Prasad Eye Institute on 1 st July 2003. It wasthe first day of my training — of the 15 people in my batch I was theonly one from outside Andhra Pradesh. The training included orientationto LVPEI’s policies and procedures, hospital departments and functions,orientation to the ONA program and, eventually, ophthalmic theory andpracticals.Bhavani Yamini, our nursing educator was very dedicated and an excellentteacher. She taught me all the qualities that a good nurse should have —sincerity, dedication and how to provide nursing care to patients with love.The first year of my training began with theory classes — 2 hours in the morning and 2 hours in the evening.For the rest of the time we were asked to study in the library. After 3 months we were posted in peripheralareas like reception, patient counseling, OPD, laboratories, microbiology, and Eye Bank, which was the mostmemorable posting. I remember the first call I attended for collecting a cornea from a deceased donor inOsmania Hospital. The Eye Bank technician took me to the mortuary and the sight of so many bodies wassuch a shock to me that I was unable to eat for a week.I completed my first year of training with a first division. During the 2 nd year, I was posted in the operationtheatre. This was very hard work. I learnt how to prepare a patient for surgery and also how to take careof post-operative patients who have had surgery under general anesthesia.After I completed my training on June 30 th 2005, I went to Bilaspur for 3 months to train nurses at a centrerun by Bausch & Lomb. I also trained 2 nurses for 3 months at a hospital in Haldwani (Uttaranchal).Around this time I got the news that I had been selected for the best ONA award for the year 2005 inrecognition of my excellent all-round performance with a certificate and cash prize. I went to LVPEI toreceive my award.It’s an honour to be trained at LVPEI. I have trained several nurses till now and take classes for them. I canmanage the ward and the operation theatre and I believe I do a good job of teaching the nurses. I thankLVPEI for everything.My aim is to work whole-heartedly with dedication and love towards patients. Any nurse that I train I willgive all the knowledge that I have gained from LVPEI.On 11 th January 2006 I joined Chandraprabha Eye Hospital in Jorhat, which has a collaboration with LVPEI. Ihave been working with Dr Narayan Bardoloi for four years now. He is a great man, but humble and patient.He is an excellent phaco surgeon. This hospital has taught me many things, but my greatest achievement hasbeen increased self-confidence.Gayatri KhongwarOphthalmic NurseChandraprabha Eye HospitalJorhatAssamExcellence Equity EfficiencyPAGE26

Training ProgramsMaster in Community Eye Health(a collaborative programme with the University of New South Wales, Australia)2009 2010Mr Md Abdul Aleem nalgonda, Andhra Pradesh Mr Ramesh Chandra Bhatta Kailali, NepalMr Ravi Burugu Warangal, Andhra Pradesh dr Sumathi Matta Kurnool, Andhra PradeshMr Ch Ravi Kumar Adilabad, Andhra Pradesh Mr Sreenivas N G S West Godavari, Andhra PradeshMr C Dattatri Rao Mahabubnagar, Andhra Pradesh Mr Satyanarayana S Guntur, Andhra PradeshMr E Shiva Shanker Mahabubnagar, Andhra Pradesh Mr Sreenivasa Rao Madala Ongole, Andhra PradeshMr B Subba Rao East Godavari, Andhra Pradesh Mr Franklin Daniel S Hyderabad, Andhra PradeshMr G Balakrishna West Godavari, Andhra Pradesh Dr Vasantha Suram Hyderabad, Andhra PradeshMr K GopalHyderabad, Andhra PradeshDr P Srinivasa ReddyHyderabad, Andhra PradeshMr N Rajashekar RaoRanga Reddy, Andhra PradeshMr A Harinath NehruMedak, Andhra PradeshDiploma in Community Eye Health (6 months)Mr Sanjeev Adhikari Rupandem, Nepal Mr Sri Kumar B Ranga Reddy, Andhra PradeshMr Hari Bahadur Karki Kathmandu, Nepal Mr Srihari Nath J Ranga Reddy, Andhra PradeshMr Dhanje Naik D Guntur, Andhra Pradesh Mr Pratap D Vizianagaram, Andhra PradeshMr Mohan Kumar N Medak, Andhra Pradesh Mr Venkat Narsimlu N Nizamabad, Andhra PradeshMr V Chandra Sekhara Rao Srikakulam, Andhra Pradesh Mr Ramesh S nalgonda, Andhra PradeshDiploma in Eye Health Management (1 year)Mr Devichandar Rao C Mahaboobnagar, Andhra Pradesh Mr Guruprasad Minnakuri Prakasam, Andhra PradeshMr Partha Sarathy Gopalagary Hyderabad, Andhra Pradesh Mr Shaik Assemul Mogini Prakasam, Andhra PradeshMr Arun Babu Kagita Guntur, Andhar Pradesh Mr Pradeep Kumar T Adilabad, Andhra PradeshMr Kishore Babu Kagita Guntur, Andhar Pradesh Mr Micah Philip Mulanthuruthy, KeralaCertificate Course in Program Management and Evaluation (2 weeks)Ms Amba Anand new Delhi dr Amarendra Deka Shillong, MeghalayaMr Dharmendra Kumar Singh New Delhi Mr M Prakash Coimbatore, ChennaiDr Sydney Thyle new Delhi Mr Shaik Mahaboob Sharief Hyderabad, Andhra PradeshInternship in Public Health (3 months)Mr Rishabh KaulBirla Institute of Technology & Science, PilaniU-Specs Project (3 months)Ms Pia Brodtrageruniversity of Vienna, Department of African Studies, AustriaVision Technicians (1 year)Assam GujaratUttar Pradesh OrissaMr Sri Dhanjit BhattacharyaMr Amrit DekaMr Sri Shyamanta DekaMr Kamal HazarikaMs Priyam Krishna SarmaMs Archana RambhaiMs Darshika ChavdharyMr R GopalMr Rohit KumarMs Tasleem QamarMr Mohan SainiMr Banti SinghMr Rajendra SinghMr Kartik JenaMr Panchanana MadhualMs Pankajini NayakMs Suryasmita NayakMr Prashant Kumar PandaMs Subhashree PatraMr Nihar Ranjan SahooMs Kshyanaprava SamalMs Rubina SwainExcellence Equity EfficiencyPAGE27

AdilabadMs T AlekhyaMr D Susheel KumarMr S Vinay KumarMr P MaheshMr S SanjeevMr K ShekarMs K SwapnaChittoorMr M Jayaseela BabuMs K Shireen TajGunturMs Aila JyotsnaHyderabadMs M LivizaKhammamMr K ChaithanyaMr Koutam ShyamrajMs N DivyaMs M ShamanthaKrishnaMr B Siva Koteswara RaoKurnoolMs ThulesammaMadanapalleMs Hima BinduMahaboobnagarMr Atheeq AhmedAndhra PradeshNalgondaMr B SaiduluPrakashamMr V V CheninaiahMr Johnny KMr T Govinda RajuMr Shalem RajuMs T SukanyaMs K UshanjaliMr P NagarjunaMr Bysani PraveenMr Allam SrinivasuluRangareddyMs HariniField Workers Training ProgramSrikakulamMr Botla Satya KishoreMr Muddada Appala NaiduMr Ch RajeshMr Kolla Govinda RajuMr Ch Venkata RamanaMr K Eswara RaoMr Palli Haranadha RaoMr M RamuVisakhapatnamMr Karun KumarMs R PadmajaMr K Appala RajuMr Molli Appala RajuMr Gollapalli SatyanaratanaMr N SrinivasMr Gadadhala Sayanna Puspur, Lokeshwam CoordinatorMr Sonkamble Babu Rao Mudhol Community Eye Health WorkerMr Shiva Prasad Valgot Navipet, Nizamabad Community Eye Health WorkerBhosle Gopal Rao Patel Eye Centre, Mudhol,Adilabad districtMs Toom Sunitha Polepally, Bijinapally Community Eye Health WorkerMr Kumara Venkataiah Nakkalapally, Nagarkurnool Community Eye Health WorkerMr Madhava Rao Chadalawada KaramcheduCommunity Eye Health WorkerMr Suneetha Rao Ericherla Karamchedu Community Eye Health WorkerMr Santosh Meshram Jainath, Adilabad Community Eye Health WorkerMr Mukkera Rakesh Jainath, Adilabad Community Eye Health WorkerMr Shaik Ameenulla Madanapalle CoordinatorMr Subba Narasaiah Madanapalle Community Eye Health WorkerMr Ram Prasad Sharma L Thotapalli Gudur, Nellore Community Eye Health WorkerMr Chinnaiah Nalabalapu Kasumuru, Venkatachalam Community Eye Health WorkerMr Guravaiah Naidu Akula Markapuram Community Eye Health WorkerMr Mohana Rao Kudumula ABM Palem, Markapuram Community Eye Health WorkerMr Manohar Banala Oguru, Kandukuru Community Eye Health WorkerMr Sundara Rao Ittadi Palukuru, Kandukuru Community Eye Health WorkerKuchukulla Ramachandra Reddy Eye Centre,Thoodukurthy, Mahaboobnagar districtVenkata Lakshmi Eye Centre, Karamchedu,Prakasam districtSeshanna Chennawar Eye Centre, Adilabad,Adilabad districtSiloam Eye Centre, Madanapalle,Chittoor districtSwarna Bharat Eye Centre, Venkatachalam,Nellore districtSudhakar & Sreekanth Ravi Eye Centre,Markapuram, Prakasam districtSudhakar & Sreekanth Ravi Eye Centre,Kandukuru, Prakasam districtVision Centre Coordinators Exposure Course (1 week)Bhosle Gopal Rao Patel Eye Centre, Mudhol, Adilabad districtMr Narsaiah Saggam Mudhol, Adilabad Vision TechnicianVenkata Lakshmi Eye Centre, Karamchedu, Prakasam districtMr Srinivasa Rao Yarllagadda Pedanandipadu, Prakasam Vision TechnicianSeshanna Chennawar Eye Centre, Adilabad, Adilabad districtMr Ilaiah Devi Mavala, Adilabad district CoordinatorMr Venkata Ramanaiah S Echoda, Adilabad Vision TechnicianSudhakar & Sreekanth Ravi Eye Centre, Markapuram, Prakasam districtMr Santhosh Kumar Keshetty Markapuram, Prakasam district CoordinatorGreen awardsThe Institute’s Kismatpur and Kallam Anji Reddy campus gardens won the first and second prizerespectively in the category ‘Gardens Maintained by Private Institutions’, at the Andhra PradeshHorticulture Department competition (December 2009). Mr Basha has been the constant gardener,with support from Mrs Mani Kumari and the other garden staff.Excellence Equity EfficiencyPAGE28

The Latter-day Saint Charities (LDSC) from SaltLake City, Utah, USA, LVPEI’s long-term partnersin providing primary eye care to the underservedcommunities in rural Andhra Pradesh, haveextended support for establishing 30 more VisionCentres in Andhra Pradesh. Mr Bill and MrsKaren Laduke present a cheque to Dr G ChandraSekhar, Director, LVPEI, Hyderabad.

ICARE programs are supported by• Andhra Pradesh Right to Sight Society, India• Fred Hollows Foundation, Australia• Fullerton India Credit Company Limited, India• Johnson & Johnson Ltd, India• Latter-day Saint Charities, USA• Lavelle Fund for the Blind, Inc., USA• Lions Club International Foundation, USA• Nimmagadda Foundation, India• ORBIS International, USA• Sudhakar & Sreekanth Ravi, USA• Vision Cooperative Research Centres (Vision CRC), Australia• World Diabetes Foundation, DenmarkAll the secondary Service Centreswere developed with partial supportfrom local philanthropists• Dr D Rama Naidu Charitable Trust• Swarna Bharat Trust• Mr Seshanna Chennawar• Mr Bhosle Narayana Rao Patel• Mr Kuchukulla Damodar ReddyKey SupportChristoffel - BlindenmissionFor All The World To SeeInternational Centre for Advancement of Rural Eye care (ICARE)L V Prasad Eye InstituteKismatpur CampusDon Bosco Nagar PO, Near Kali MandirHyderabad - 500 086Andhra Pradesh, IndiaTel: +91 40 30615605, Fax: +91 40 24011293Email: icaresecretary@lvpei.org,Website: www.lvpei.org