Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Prevalence of visual impairment, uncorrected refractive errors and effective refractive error coverage in Koshi Province, Nepal - Rapid Assessment of Refractive Errors

Eye (2023)Cite this article

Subjects

Abstract

Background/Objective

To determine the prevalence of visual impairment (VI), uncorrected refractive errors (URE), and effective refractive error coverage among individuals aged 15–50 years in Koshi Province, Nepal.

Methods

A population-based cross-sectional study was conducted in Koshi Province in which 4800 participants were selected from 80 clusters. The study teams visited the selected households and conducted eye examinations. This included monocular unaided (and aided) visual acuity assessment using a Snellen chart with tumbling E optotypes at a distance of 6 meters. Near vision was assessed binocularly using the N notation chart at a fixed distance of 40 cm for each individual. Torchlight examination and distance direct ophthalmoscopy was done. VI was defined as presenting visual acuity worse than 6/12 in the better eye. URE was defined as presenting visual acuity worse than 6/12 and improving to 6/12 or better on using a pinhole. Near Vision Impairment was defined as binocular presenting near vision worse than N8 among those age 35 years and older.

Results

In total, 4057 were examined (84.5% response rate). The prevalence of VI was 3.52% (95% CI:2.89–4.13; n = 143). The prevalence of URE in the better eye was 1.95% (95% CI:1.54–2.42; n = 79). The Refractive Error Coverage and Effective Refractive Error Coverage were 34.8% and 31.3% respectively. The prevalence of NVI was 34.24% (95% CI: 32.1–36.40; n = 666).

Conclusion

The prevalence of VI and  URE was low, attributed to the availability and uptake of services in Koshi province in Nepal.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Map of Nepal showing Koshi Province where the study was conducted.
Fig. 2: Categories of visual impairment based on unaided, presenting and pinhole visual acuity in the better eye.

Similar content being viewed by others

Data availability

The data that support the findings of this study are not openly available as authors are analyzing  the data for other manuscripts. Data are available from the corresponding author upon reasonable request.

References

  1. Bourne R, Steinmetz JD, Flaxman S, Briant PS, Taylor HR, Resnikoff S, et al. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9:e130–43.

    Article  Google Scholar 

  2. Steinmetz JD, Bourne RR, Briant PS, Flaxman SR, Taylor HR, Jonas JB, et al. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9:e144–60.

    Article  Google Scholar 

  3. Marmamula S, Keeffe JE, Rao GN. Rapid assessment methods in eye care: an overview. Indian J Ophthalmol. 2012;60:416–22.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Marmamula S, Keeffe JE, Rao GN. Uncorrected refractive errors, presbyopia and spectacle coverage: results from a rapid assessment of refractive error survey. Ophthalmic Epidemiol. 2009;16:269–74.

    Article  PubMed  Google Scholar 

  5. McCormick I, Mactaggart I, Bastawrous A, Burton MJ, Ramke J. Effective refractive error coverage: an eye health indicator to measure progress towards universal health coverage. Ophthalmic Physiol Opt. 2020;40:1–5.

    Article  PubMed  Google Scholar 

  6. Luque LC, Naidoo K, Chan VF, Silva JC, Naduvilath TJ, Peña F, et al. Prevalence of refractive error, presbyopia, and spectacle coverage in Bogota, Colombia: a rapid assessment of refractive error. Optom Vis Sci. 2019;96:579–86.

    Article  PubMed  Google Scholar 

  7. Mashayo ER, Chan VF, Ramson P, Chinanayi F, Naidoo KS. Prevalence of refractive error, presbyopia and spectacle coverage in Kahama District, Tanzania: a rapid assessment of refractive error. Clin Exp Optom. 2015;98:58–64.

    Article  PubMed  Google Scholar 

  8. Muhit M, Minto H, Parvin A, Jadoon MZ, Islam J, Yasmin S, et al. Prevalence of refractive error, presbyopia, and unmet need of spectacle coverage in a northern district of Bangladesh: Rapid Assessment of Refractive Error study. Ophthalmic Epidemiol. 2018;25:126–32.

  9. Nsubuga N, Ramson P, Govender P, Chan V, Wepo M, Naidoo KS. Uncorrected refractive errors, presbyopia and spectacle coverage in Kamuli District, Uganda. Afr Vision Eye Health. 75;2016;75:1-6.

  10. Loughman J, Nxele LL, Faria C, Thompson S, Ramson P, Chinanayi F, et al. Rapid assessment of refractive error, presbyopia, and visual impairment and associated quality of life in Nampula, Mozambique. J Vis Impair Blind. 2015;109:199–212.

  11. Naidoo KS, Chinanayi FS, Ramson P, Mashige KP. Rapid assessment of refractive error in the eThekwini Municipality of KwaZulu-Natal, Durban, South Africa. Clin Exp Optom. 2016;99:360–5.

    Article  PubMed  Google Scholar 

  12. Chan VF, Mebrahtu G, Ramson P, Wepo M, Naidoo KS. Prevalence of refractive error and spectacle coverage in Zoba Ma’ekel Eritrea: a rapid assessment of refractive error. Ophthalmic Epidemiol. 2013;20:131–7.

    Article  PubMed  Google Scholar 

  13. Marmamula S, Khanna RC, Kunkunu E, Rao GN. Population-based assessment of prevalence and causes of visual impairment in the state of Telangana, India: a cross-sectional study using the Rapid Assessment of Visual Impairment (RAVI) methodology. BMJ Open. 2016;6:e012617.

    PubMed  PubMed Central  Google Scholar 

  14. Bourne RR, Cicinelli MV, Sedighi T, Tapply IH, McCormick I, Jonas JB, et al. Effective refractive error coverage in adults aged 50 years and older: estimates from population-based surveys in 61 countries. Lancet Glob Health. 2022;10:e1754–63.

    Article  CAS  PubMed  Google Scholar 

  15. McCormick I, Mactaggart I, Resnikoff S, Muirhead D, Murthy GV, Silva JC, et al. Eye health indicators for universal health coverage: results of a global expert prioritisation process. Br J Ophthalmol. 2022;106:893–901.

    Article  PubMed  Google Scholar 

  16. Marmamula S, Khanna RC, Narsaiah S, Shekhar K, Rao GN. Prevalence of spectacles use in Andhra Pradesh, India: rapid assessment of visual impairment project. Clin Exp Ophthalmol. 2014;42:227–34.

    Article  PubMed  Google Scholar 

  17. Mashayo ER, Chan VF, Ramson P, Chinanayi F, Naidoo KSJC, Optometry E. Prevalence of refractive error, presbyopia and spectacle coverage in Kahama District, Tanzania: a rapid assessment of refractive error. Clin Exp Optom. 2015;98:58–64.

    Article  PubMed  Google Scholar 

  18. World Health Organization (WHO). 74th World Health Assembly Resolution. Geneva: WHO; 2021.

Download references

Acknowledgements

We express our gratitude to Dr Chet Raj Pant, Chairman and Dr Sailesh Mishra, Executive Director of NNJS for valuable guidance and support. Mr. Kumar Prithu, Hospital Manager, Md. Rafique, Mr. Dipendra Chaudhary of BEH for logistics and HR support. The Ophthalmic Assistants (Sabin Kumar Mahato, Bijay Tamang, Indrajeet Kumar Yadav, Shivram Chaudhary) and Community Eye Health Workers (Rita Pradhan, Parshuram Shrestha, Shrawn Majhi, Manish Khawash), Optometrists (Pankaj Ray Adhikari and Sanjay Kumar Shah), Similarly, Dhiraj Mandal, Gautam Majhi, Mithlesh Meheta, Rupesh Kumar, Sanjay Kamat are acknowledged for their contributions.

Funding

This study was funded by OneSight Essilor Luxottica Foundation, USA.

Author information

Authors and Affiliations

  1. Eastern Regional Eye Care Program, Biratnagar Eye Hospital, Biratnagar, Nepal

    Rajiv Ranjan Karn & Sudhir Kumar Thakur

  2. Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India

    Srinivas Marmamula & Ranindita Saha

  3. Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India

    Srinivas Marmamula

  4. Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India

    Srinivas Marmamula

  5. School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia

    Srinivas Marmamula

  6. Biratnagar Eye Hospital, Biratnagar, Nepal

    Rakshya Pant Sitoula & Amit Kumar Mehta

  7. Nepal Netra Jyoti Sangh, Kathmandu, Nepal

    Ranjan Shah

  8. Prashasa Health Consultants, Hyderabad, India

    Saibaba Saravanan

  9. OneSight Essilor Luxottica Foundation, Mason, OH, USA

    Rahul Ali

Authors
  1. Rajiv Ranjan Karn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Srinivas Marmamula
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sudhir Kumar Thakur
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rakshya Pant Sitoula
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ranjan Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amit Kumar Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ranindita Saha
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Saibaba Saravanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rahul Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: SM. Acquisition, analysis, or interpretation of data: RRK, RSH, AKM, SM. Drafting of the manuscript: RRK, SM, RSA. Critical revision of the manuscript for important intellectual content: SS, RSH, SKT, RPS. Statistical analysis: SM, RRK.

Corresponding author

Correspondence to Rajiv Ranjan Karn.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karn, R.R., Marmamula, S., Thakur, S.K. et al. Prevalence of visual impairment, uncorrected refractive errors and effective refractive error coverage in Koshi Province, Nepal - Rapid Assessment of Refractive Errors. Eye (2023). https://doi.org/10.1038/s41433-023-02786-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41433-023-02786-4

Search

Advanced search

Quick links