PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO ASSESS THE KNOWLEDGE REGARDING SELECTED EYE DISORDERS AMONG GERIATRICS AT SELECTED RURAL AREAS OF TUMKUR”. WIHT A VIEW TO DEVELOP INFORMATION BOOKLET”

SUBMITTED BY:

RAGHUL RATHEESAN 1ST YEAR M.SC MEDICAL SURGICAL NURSING SRIDEVI COLLEGE OF NURSING TUMKUR

1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTAION.

2 RAGHUL RATHEESAN NAME OF THE CANDIDATE AND 1. 1ST YEAR M.SC ADDRESS. MEDICAL SURGICAL NURSING SRIDEVI COLLEGE OF NURSING TUMKUR

SRIDEVI COLLEGE OF NURSING 2. NAME OF THE INSTITUTION. TUMKUR.

3. COURSE OF STUDY AND SUBJECT. FIRST YEAR M.SC NURSING

4. DATE OF ADMISSION TO COURSE.

5. “A STUDY TO ASSESS THE KNOWLEDGE REGARDING SELECTED EYE DISORDERS TITLE OF THE TOPIC. AMONG GERIATRICS AT SELECTED RURAL AREAS OF TUMKUR”. WIHT A VIEW TO DEVELOP INFORMATION BOOKLET”

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

“The eye sees only what the mind is prepared to comprehend” Robertson davies. As defined by world health organization (WHO), it is a "state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity." Health isa 3 dynamic condition resulting from a body's constant adjustment and adaptation in response to stresses and changes in the environment for maintaining an inner equilibrium called homeostasis.1

When a person gets old, there may be various health problems that can occur. The problems are due to the changes that occur in the body when a person gets old. Read on to find the various changes that occur in old age, so eye disorder is one of the major problem in the world.2

Eye disorders!! .Any abnormalities or unusual things that happen in any parts of the eye. These unusual things can be in color, shape, size, functions, sensations or position of the eye. The various common major eye disorders like cataract, glaucoma, blindness these diseases are more common in old age peoples.3

Vision loss among the elderly is a major health care problem. Approximately one person in three has some form of vision-reducing eye disease by the age of 65. The most common causes of vision loss among the elderly are age-related macular degeneration, glaucoma, cataract and diabetic retinopathy. Age-related macular degeneration is characterized by the loss of central vision. Primary open-angle glaucoma results in optic nerve damage and visual field loss.4

Population in the united-states is increasing rapidly. By the year 2030, approximately 70 million American’s will be over 65 years of age. Loss of vision among the elderly is a major health care problem: approximately one in three elderly persons has some form of vision-reducing eye disease by the age of 65Vision impairment is associated with a decreased ability to perform activities of daily living and an increased risk for depression. This article reviews the four most common causes of vision impairment in the elderly: age-related macular degeneration, glaucoma, cataract and diabetic retinopathy.4

4 Blindness is an important symptom of many eye disorders. Lopez and Murray have estimated the load of blindness as 23million for the world and 9 million for India comprising the three major disorders namely cataract, glaucoma and trachoma. The Disability Adjusted Life Years(DALYS) for the major eye disorders has been estimated at 27 million for the world and 7 million for India. Blindness is one of the major health problem especially in developing countries like India where it leads to loss of many man hours. ICMR in the past decades has carried out numerous studies on the prevalence, epidemiology and treatment of various causes of blindness in the country.5

Cataract is a common cause of vision impairment in the elderly and the most common cause of blindness worldwide. In the United States, the potentially blinding effect of cataract among the elderly is dramatically reduced because cataract surgery is readily available, effective and safe. The prevalence of cataract increases with age from less than 5 percent in persons under 65 years of age to approximately 50 percent in those 75 years of age and older. Exposure to ultraviolet light may contribute to the progression of cataract formation. Patients with visually significant cataracts may complain of blurred vision or glare. Cataract progression is typically slow, with gradual loss of vision over months to years.4

Glaucoma comprises a group of disorders characterized by glaucomatous optic nerve damage and visual field loss. It is a significant cause of blindness in the United States and is the most common cause of blindness among black Americans. Primary open-angle glaucoma is responsible for approximately 10 percent of cases of blindness in the United States. Primary open-angle glaucoma affects men and women equally. Common factors associated with primary open-angle glaucoma include a family history of glaucoma, increasing age, high degree of myopia, hypertension and diabetes. open-angle glaucoma is a chronic, slowly progressive disorder. Persons with primary open-angle glaucoma Primary are generally asymptomatic until late in the course of the disease, after suffering significant visual field loss.4Age-related macular degeneration (AMD) is the leading cause of loss of vision in people over 65 years of age. AMD is characterized by degeneration of the macula, the area of the retina responsible for central vision . Risk factors for AMD include advancing age, family history of AMD and cardiovascular risk factors such as hypertension and cigarette smoking. AMD can be divided into two categories: nonexudative (or “dry”) AMD and exudative.4

5 Approximately 90 percent of persons with AMD have the nonexudative form of the disease. Nonexudative AMD is the most common form of AMD, although it accounts for only 10 to 20 percent of cases of severe loss of vision in patients with AMD. Types of nonexudative AMD include drusen and geographic atrophy. When most people try to imagine being blind, their only point of reference is what they see with their eyes closed: nothing. The only understanding of blindness that most sighted people have, therefore, is that blindness means the absence of sight.4

Most people experience grief as they lose their vision. However, as the grief is very different when blindness is all you've known-or when you assumed that you were blind and then experience vision loss and don't understand why it hurts. The "blindness community's" response to vision loss typically is to blindfold a person who is partially sighted, force the acceptance of blindness by disallowing the use of any residual vision. It's completely discounting something that is just as much a part of what the person can do as the limitations are. The person then magnifies limitations and feels those judgmental things when she acknowledges her abilities. She has learned that she is "blind" and acknowledging abilities equals failure to "accept" blindness.4

NEED FOR THE STUDY:

The maintenance and promotion of health is achieved through different combination of physical, mental, and social well-being, together sometimes referred to as the“healthtriangle”Greek roots ophthalmos meaning eye and logos meaning word, thought, or discourse;ophthalmology.literally means "the science of eyes".5

Most of us will experience temporary eye problems from time to time, including itching, blurriness or fatigue. Most of these eye problems are short-lived and will probably go away on their own with no complications. However, sudden eye problems and those that last for more than a couple of days should be checked by an eye doctor. The following is a list of

6 common eye problems and their possible causes.5

There are an estimated 45 million blind people and 135 million visually impaired people worldwide (World Health Organization. Global initiative for the prevention of avoidable blindness. WHO/PBL/97.61. Geneva: WHO, 1997 Every 5 seconds one person in our world goes blind. Every minute one child goes blind. 75 million people will be blind by (2020). 45 million people in the world are blind.135 million people in the world are visually impaired.90% of the world’s blind people live in developing countries. 33.3 million of the world’s blind people live in developing countries.More than half of the world’s blind live in India (9 million), Africa (7 million) China (6 million) and Arab region (7 million).5–10 times are people who live in the developing world more likely to go blind the people who live in highly industrialized countries.6

"More well trained professional optometrists will immensely help India as it will give us time to concentrate on surgery, our primary specialization. Anyway India has just one eye surgeon per 100,000 people. At present, patients come to us even for eye power check-up. The government also needs to standardize optometric education to maintain quality," he says, The main causes of blindness in India are as follows: - Cataract (62.60%) Refractive Error (19.70%) Corneal Blindness (0.90%), Glaucoma (5.80%), Surgical Complications (1.20%) Posterior Capsular Opacification (0.90%) Posterior Segment Disorder (4.70%) and Others (4.19%). The estimated national prevalence of childhood blindness /low vision is 0.80 per thousand. The main causes of blindness in India are as follows: - Cataract (62.60%) Refractive Error (19.70%) Corneal Blindness (0.90%), Glaucoma (5.80%), Surgical Complications (1.20%) Posterior Capsular Opacification (0.90%) Posterior Segment Disorder (4.70%) and Others (4.19%). The estimated national prevalence of childhood blindness /low vision is 0.80 per thousand.6

According to Ajeet Bhardwaj, outgoing president of the Asia Pacific Optometrists Organization, India has 12,000 ophthalmologists who have no time to conduct blindness preventing surgeries because they are flooded with general eye check-up of patients."For India, it is vital that ophthalmologists focus on surgeries and optometrists take charge of primary eye care refractive errors like presbyopia, contact lenses, low-vision aids and vision 7 therapies. This is how most developed countries managed to control and eliminate avoidable blindness," Bhardwaj says.7

Bhardwaj says 153 million people in the country require reading glasses but do not have access to them. Optometrists are eye physicians concerned with vision care, eye diseases and prescribe eyeglasses, contact lenses and medications to treat eye disorders.7

An article was published, the statistical data related to previllance of eye disorders worldwide, according to that  285 million people are visually impaired worldwide: 39 million are blind and 246 have low vision.  About 90% of the world's visually impaired live in developing countries.  Globally, uncorrected refractive errors are the main cause of visual impairment; cataracts remain the leading cause of blindness in middle- and low-income countries.  The number of people visually impaired from infectious diseases has greatly reduced in the last 20 years.  80% of all visual impairment can be avoided or cured.7

Glaucoma is the second leading cause of preventable blindness in India. It is also the leading cause of irreversible blindness in the country. it has been estimated that approximately 12 million Indians will be affected by the year 2010. with a rapidly growing ageing population, this figure will increase to 16 million by 2020.8

Above statistical data and from research studies and from the investigation personal experience investigation felt the necessity to teach the old age people regarding eye disorders.8

8 6.2 REVIEW OF LITERATURE

The purpose of review of literature is to obtain comprehensive knowledge base of Geriatrics age in rural population. The review of literature is presented in the following sub headings:- 1) Studies on cataract. 2) Studies on glaucoma. 3) Studies on blindness. 4) Studies on assist knowledge of geriatrics regarding eye disorders.

1) Studies related to cataract.

9  This was supported by a study conducted by Lau JT, et al.(2002) with the aim on knowledge about cataract in the hongkong chinese population. Subjects aged 40 and above in the shatin district of hongkong were randomly selected as part of a larger study of causes of adult visual loss. The subjects received eye examinations in which the primary cause of visual disability was recorded. The respondents were asked by trained interviewers in a standardized fashion about their knowledge of cataract. Out of the 2538 eyes examined, 7.0% had visual acuity less then 6/18. Fully 69.6% of the visual disability for those aged 60 or above was caused by cataract. Awareness of cataract in particular was high, in that over 90% of respondents had heard of it. However, only 22.9% of them could describe cataract symptoms correctly. Over 40% of subjects did not know that surgery was an appropriate treatment for cataract.9

 This was supported by a study conducted by Rajesh sinha, et al.(2009) with the aim on the prevalence of cataract was carried out in urban and rural field practice areas of the department of preventive and social medicine,I.G. medical college Shimla. All the persons aged 60 years and above were included in the survey, which was covered. There were 465 aged persons in the study population, of which only 406 could be examined. Senile cataract was present in 140 persons, thus the prevalence rate was34.48%. the prevalence was higher in females and in the rural area. Incident nuclear cataract occurred in 13.1% cortical cataract in 8.0%, and posterior sub capsular cataract in 3.4% of rights eyes. The cumulative incidence of nuclear cataract in right eyes increased form 2.9% in persons aged 43 to 54 years at baseline to 40.0% in those aged 75 years or older. For cortical and posterior sub capsular cataract, the corresponding values were 1.9% and 21.8% and 1.4% and 7.3%, respectively. Women were more likely than men to have nuclear cataract even after adjusting for age.10

 This was supported by a study conducted by Limburg H, et al.(1998) with the aim was conducted on incidence of cataract carried out in Karnataka in persons 50 years of ageand older in 19 districts of Karnataka state, India. Presentation of the results of rapid assessments of bilateral cataract blindness in persons 50 years of age and older in 19 districts of Karanataka state, India. A total of 21,950 persons 50 years of age and older in 19 out of 20 districts were examined. In each district, 15 clusters were randomly selected and in each 10 cluster systematic Random cluster sampling was used.it was found that the prevalence in females was higher than in males. Cataract surgical coverage, an indicators for coverage and service utilization, varied from 42% to 68% in different districts. On average, males had a higher coverage than females. Of all aphakic eyes in the sample, 26.4% could not see 6/60. Barriers to cataract surgery are linked to service providers. It was concluded that rapid assessments for cataract blindness in persons aged 50 years and older can be conducted at district level in India with existing resources and at affordable costs. The results suggest an increase in cataract surgery requires a shifts in health education strategy and massages. The large variation in prevalence justifies district-level surveys.11

2) Studies related to glaucoma

 This was supported by a study conducted with the aim was conducted byPan Yet al(2011).research finding were published in an article according to that, Glaucoma is a major eye problem afflicting millions of people worldwide. As the population increases, the number of people with glaucoma also increases, with glaucoma becoming an increasing public health concern. That paper presents the natural history of open angle and angle closure glaucoma. Researcher examined the glaucomatous progression in terms of changes in optic disk morphology and visual fields as well as the risk factors for progression. According to that study review highlights the attitude of glaucoma globally and the need for a greater understanding of this disease and its natural progression.12

 This was supported by a study conducted with the aim was conducted by Rossetti Let al(2010).patients with glaucoma with an objective to provide guidance in managing glaucoma patients more effectively, researcher focuses on the importance of detecting progression and measuring its rate within the management of primary open-angle glaucoma today. recent findings strongly indicate that continued monitoring of visual fields (vfs) and reassessment of target intraocular pressures (iops) depending on vf progression rates are mandatory in the management of glaucoma. The study highlights the visual function changes observed as glaucoma progresses and discusses disease impact on patients' quality of life. Hence the researcher concluded that, patient's individual rate of vf progression by using newly developed analyse will be helpful to forecast the potential future development of the glaucoma. an 11 individualized treatment approach then requires that in patients in whom the risk of becoming visually impaired\ or blind during their lifetime is higher, a more intensive medical iop- lowering therapy such as fixed combinations can be considered as treatment option.13

 This was supported by a study conducted with the aim was conducted by Lee P Pet al(2010).to assess the degree of consensus among glaucoma experts on the measurement, characterization, and potential implications of intraocular pressure (IOP) and its fluctuation for glaucoma treatment. A multinational panel of 9 glaucoma experts used a modified Delphi process to rate the level of agreement with 72 statements characterizing methods of measuring IOP, after receiving a literature review, panelists rated each statement on a 9-point Likert scale with each statement were determined using a binomially distributed statistical definition. The study finding found to be consensus in 46% of 81 statements, nonconsensus in 6%, and indeterminate status in 48%. Categories having the highest proportion of statements with consensus were importance of IOP reduction (4/4 statements), importance of long-term IOP fluctuation and reduction (6/9), and impact of medication on short-term and long-term IOP fluctuation (6/10 for each). Hence the researcher concluded that, modified Delphi process was useful in identifying areas of consensus regarding IOP measurement and importance of IOP fluctuation among glaucoma experts. Concurrently, the need for additional investigations assessing the role of IOP changes in glaucoma management is highlighted by the indeterminate and non-consensus ratings.14

3)Studies related to blindness:

 This was supported by a study conducted with the aim by Mganga Het al(2011).hadbeen conducted in africa with an aim to review the literature on vision loss in Africa and summarize the findings related to gender equity.for the study researcher collected information from across sub saharanafrica on the evidence of gender inequity and reasons for this inequity. finally, the results were used to generate suggestions on how gender equity could be improved.in all published surveys (except one), cataract surgical coverage among women was lower than cataract surgical coverage among men. Evidence suggests that a variety of approaches are needed to improve the use of eye care services. three main strategies are needed to address gender inequity in visionloss. First, it is important to address transport 12 needs. second, counselling of patients and family members is required. finally, programs need to put in place pricing systems that make the services affordable the population. hence the researcher concluded that vision 2020 can be achieved in africa, but investment is needed in a variety ofstrategies that will ensure that eye care services are affordable, accessible, and acceptable to women and girls.15

 This was supported by a study conducted by Rushood AAet al(2010).with an objective to evaluate the concept of quality assured mobile eye services (MES) in implementing the vision 2020 initiative. For the study the researcher used Literature review as well as the medical records of Al-Basar International Foundation (BIF) on MES. More than 38 countries have been included in this exercise during which more than 620 eye camps have been conducted. More than two million people have benefited from the services provided including medicines and glasses in these eye camps and about 180,000 sight restoring surgeries performed for cataract, glaucoma, blindness. Hence the researcher concluded that Quality assured MES are a very important means of tackling the problems of blindness and implementing the vision 2020 initiative. The adoption of this concept by major stake-holders in the prevention of blindness (e.g. WHO, IAPB) will bring an additional momentum to the achievement of this noble goal.16

4) STUDIES ON ASSIST KNOWLEDGE OF GERIATRICS REGARDING EYE DISORDERS.

 A study was conducted by Adriono G, Wang D in Indonesia on adult diabetic patients to assess the use of eye care and its predictors among diabetic patients in Indonesia. For the study researcher took 196 diabetic adult patients from several hospital and gathered all of their data using self reported questionnaire and record review, and an eye examination by an eye care professional with dilation of the pupil within the preceding year. researcher found results as, among 196 participants, 166 (84.7%) had not undergone ocular examination in the last year, including 100 of 119 patients (84.0%) at the university clinic. fewer than half (82 of 166 [49.4%]) of all patients reported being told of the need for eye examinations by their physician. in regression analyses, factors associated with having an eye examination were 13 higher diabetic retinopathy knowledge score (odds ratio = 1.52; p = .01) and years since being diagnosed as having diabetes. The most common reasons given by subjects for not having had eye examinations concerned lack of knowledge about the need for care (97 of 160 subjects [60.6%]),while financial barriers were cited by only 22 of 160 subjects (13.8%). hence the researcher concluded that the annual eye examination were improved by providing good health education regarding eye disorders, so there is need for intervention on eye disorders for adult population17

 A study was conducted by Woo JH et al, on smoking patients attending ophthalmology OPD with an aims to assess the awareness of blindness. For the study researcher took 200 patients and chosen a cross-sectional survey using a structured interview of randomly selected current smokers attending an eye clinic was conducted. The knowledge blindness, was assessed. The awareness of blindness were evaluated. Out of 200 current smokers aged from 14 to 83 years, only 42.5% (85 patients) were aware that smoking causes blindness. Smokers' perception of harm caused by smoking was 6.53±3.21 (mean±SD) on a visual analogue scale of 0 to 10. Patients placed blindness as the second most important motivating factor to quit smoking immediately, within 1 year and 5 years, after lung cancer. Hence the researcher concluded that the awareness of the risk of blindness from smoking was lowest compared with five other smokingrelated diseases among eye patients who smoke. However, blindness remains a key motivational factor in smoking cessation and hence should be emphasized as an important negative health consequence of smoking in public health education and antismoking campaigns.18

14 STATEMENT OF THE PROBLEM:

A STUDY TO ASSESS THE KNOWLEDGE REGARDING SELECTED EYE DISORDERS AMONG GERIATRICS AT SELECTED RURAL AREAS OF TUMKUR”. WIHT A VIEW TO DEVELOP INFORMATION BOOKLET

6.3 OBJECTIVES OF THE STUDY:

 To assess the knowledge of geriatric regarding selected eye disorders.  To find out the association between knowledge of geriatrics with demographic variables.  To prepare and distribute an informational booklet on selected eye disorder.

6.4 OPERATIONAL DEFINITIONS: o Assess: The scoring of obtained response to a structured questionnaire.

o Knowledge: It refers to response of the geriatrics to the questions stated in the questionnaire regarding the selected eye disorders. 15 o EYE DISORDERS: Any abnormalities or unusual things that happen in any parts of the eye. These unusual things can be in color, shape, size, functions, sensations or position of the eye

o GERIATRICS: It refers to the persons who have crossed the age of more than 60 years

o INFORMATION BOOKLET: In this study it refers to the material to provide total information to the geriatrics regarding eye disorder.

6.5 HYPOTHESES:

H1:. There will be a significant association between the knowledge of geriatrics with the selected demographic variables.

6.6 ASSUMPTIONS

 Geriatrics of rural area may have minimal knowledge regarding the selected eye disorders.  Geriatrics would be co-operative and willing to express their knowledge regarding eye disorders  The response given by the geriatrics to the questionnaire will represent their true measures of knowledge regarding eye disorder  The knowledge of geriatrics is influenced by demographic factors like education, religion, age, etc.

6.7 DELIMITATIONS OF THE STUDY:.

 Geriatrics who are available at the period of study.  Are willing to participate in the study. 16 6.8VARIABLES

Variables are characteristics that vary among the subjects being studied. It is the focus of the study and reflects the empirical aspects of the concepts being studied and the investigator measures the variable.  Research variables in this study are the knowledge of geriatrics regarding eye disorders.  Extraneous variables in this study are Age, Education, Religion, etc.

6.9 PILOT STUDY

The pilot study will be conducted on 10 samples to assess the reliability and feasibility of the tool using co-relation and coefficient technique.

7. MATERIALS AND METHODS OF THE STUDY :

7.1.1 SOURCE OF DATA COLLECTION:

The data will be collected from the geriatrics at selected rural areas of Tumkur.

7.1.2 RESEARCH DESIGN:

The design is selected for the present study is descriptive design.

7.1.3 RESEARCH APPROACH:

The non-experimental descriptive survey approach will be considered appropriate for this study.

7.1.4 RESEARCH SETTING:

The geriatrics at selected rural areas of Tumkur.

7.1.5 POPULATION: 17  TARGET POPULATION:-

Target population of the study is geriatrics.

 ACCESSIBLE POPULATION:-

The population of present study includes the geriatrics at selected rural areas of Tumkur

 DATA COLLECTION TECHNIQUE

1. The data collection procedure will be carried out for a period of 6 weeks. 2. The study will be initiated after obtaining prior permission from the concerned authorities. 3. The data will be collected from the geriatrics by using interview method

7.2.1 SAMPLING TECHNIQUE

Non- probability convenient sampling will be used for the study. 7.2.2 SAMPLE SIZE

Total sample of the study will consist of 100 geriatrics age residing in rural area and who will be available during the data collection.

SAMPLING CRITERIA

7.2.3 INCLUSIVE CRITERIA

. Geriatrics who are willing to participate in the study. . Geriatrics who knows Kannada.  Above 60 years people.

 Both male and females 18 7.2.4 EXCLUSIVE CRITIRIA

 Those who are not co-operating.  Not available during the study.

7.2.5 TOOLS FOR DATA COLLECTION

The structured questionnaire is used to collect data from the geriatrics. Content validity will be established by requesting the experts to go through the developed tool and give their valuable suggestions. The structured questionnaire should consist of the fo llowing sections. SECTION A : Questionnaire related to the demographic data. SECTION B: Questionnaires to structured interview schedule regarding selected eye disorders.

7.2.6 PLAN FOR DATA ANALYSIS

The data collected will be analyzed by means of descriptive and inferential statistics.

(A) DISCRIPTIVE STATISTICS: Mean percentage& standard deviation of subject will be used to qualifying the level o f knowledge regarding the selected eye disorders.

(B) INFERENTIAL STATISTICS :

Paired t-test will be used to determine the Correlation between the 19 knowledge and practice of geriatrics regarding selected eye disorders.

The chi square will be used to find out the association between socio demographical variables o f geriatrics with pre test knowledge scores. The data will be planned to present in the form of tables and figures.

7.2.7 TIME AND URATION OF THE STUDY.

The time and duration of study will be limited to 6 week o r as per guidelines o f university.

7.3 DOSE THE STUDY REQURIRE ANY INVESTIGATION OR INTERVERTION TO B E CONDUCTED ON PAT IENT OR HUMAN OR ANIMAL? IF SO PLEASE DISCRIBE BRIEFLY.

No, since the study is descriptive, study interventions are not required.

7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTIONS?

Yes, ethical clearance has been obtained from the institution

20 8. LIST OF REFERENCE.

1. k. park .preventive and social medicine; concept of health and disease; 18 edition;18 th p.13.

2. Deena David. Old age health problems Changes that occur in the body o f person; Health and fitness;2009sept21/4021 . avilable from:http://www.surching.com.

3. Lasik, lasek. www.online info. Definition, causes and different way of treatment.2009-2011. Available from:http://www.online-eye- info.com.

4. David A, Quillen, M.D; Co mmon causes of visio n loss in elder ly patients;American family physician. 1999jul;1:60(1): 99-108. Available from: www.aafp.org/afp/1999/0701/p99,html.

5. Available fro m: VRL:http://www.who.int/mediacenter/factsheets287/en/.

6. Present status of the national programme o f control of blind ness in india. Community eye health j. 2008mar; 21;(65) : available fro m: www:cehjournal. org/indian/journal/21/jeeh-21-65-s103:ht ml.

7. Ajeetbhardwaj. prevention of avoidable blindness and visual impair ment. Times 21 of India[2007]. plan for the 2011oct. Available fro m: http://Www.Who.Int/Mediacentre/Factsheets/Fs282.

8. R Gorge, L Vijaya. Taking glaucoma a challenging in India; Indian journal of ophthalmology; 2008March6,valume:56/Issue:2/page97-98.Avilable from: http://www.ijo.in/article.asp? issn=03014738;year=2008;volume=56;issue=2;spage=97;page=98;aulast=George.

9. Lau JT, Lee V, Fan D, Lau M, Michon J. Knowledge about Cataract Glauco ma, and age related muscular degeneratio n in the Ho nkong Chinese population; Br J Ophthalmic. 2002-oct;86(10):1080-4.

10. RejeshSinha, Chandra shekharkumar. Etiopathogenesis o f cataract; Journal review Indian J ophthalmol.2009 May-Jun; 57(3):245-249.

11. Limburgh H, Kumar R. follow-up study of blindness attributed to cataract in Karnataka State; Indian Ophthalmic Epidemiology; volume 5, Number 4, Dec- 1998, p. 211-223(13).

12. Pan Y, Varma R. Natural history of glaucoma. Doheny Eye Institute, University of So uthern California, Los Angeles, CA 90033, USA Indian J Ophthalmol. 2011 Jan;59 Suppl:S19-23. Available fro m: http://www.ncbi. nlm. nih. gov/pubmed/21150029.

13. Rossetti L, Goni F. Focusing on glaucoma progressio n and the clinical importance of progression rate measurement: a review. Department of Ophthalmology, University Hospital, Lund University, Malmö , Sweden.Eye (Lond). 2010 Oct;24Suppl 1:S1- 7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20944656.

14. Lee PP, Sultan MB. Assessing the Importance of IOP Variables in Glaucoma 22 Using a Modified Delphi Pro cess: IOP Consensus Panel; Glaucoma Service, Duke University Eye Center , Durham, NC 27710, USA J Glaucoma. 2010 Jun-Jul;19(5):281-7. Available from: http://www. ncbi.nlm.nih.gov/pubmed/19855301.

15.Mganga H, Courtright P.Overcoming gender inequity in pr evention of blindness and visual impairment in Africa. Middle East Africa Journal Ophthalmol. 2011 Apr;18(2):98-101. Available from: http://www.ncbi.nlm. nih.gov/pubmed/21731318.

16.Rushoo d AA. Mobile eye services: Al-Basar International Fo undation. Department of Ophthalmology, Co llege of Medicine, King Faisal University, Dammam, Kingdom o f Saudi Arabia. J Family Community Med. 2010 Jan;17(1):46-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22022671.

17.Adriono G, Wang D . Use of eye care ser vices among diabetic patients in urban Available from: ur Indonesia . http://www.ncbi.nlm.nih.go v/pubmed/21746983.

18. Handa S,Woo JH. Awareness of blindness and other smoking-related diseases and its impact on motivation for smoking cessation in eye patients.2011 Sep;25(9):1170-6. Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/21701524

23