Article Text

Population-based cross-sectional study of barriers to utilisation of refraction services in South India: Rapid Assessment of Refractive Errors (RARE) Study
  1. Srinivas Marmamula1,2,3,
  2. Jill E Keeffe2,4,
  3. Usha Raman1,5,
  4. Gullapalli N Rao1,3
  1. 1International Centre for Advancement of Rural Eye care, LV Prasad Eye Institute, Hyderabad, India
  2. 2Vision Cooperative Research Centre, Sydney, Australia
  3. 3Bausch & Lomb School of Optometry, LV Prasad Eye Institute, Hyderabad, India
  4. 4Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
  5. 5Centre for Communication, LV Prasad Eye Institute, Hyderabad, India
  1. Correspondence to Dr Srinivas Marmamula; srioptom{at}


Aim To assess the barriers to the uptake of refraction services in the age group of 15–49 years in rural Andhra Pradesh, India.

Methods A population-based cross-sectional study was conducted using cluster random sampling to enumerate 3300 individuals from 55 clusters. A validated questionnaire was used to elicit information on barriers to utilisation of services among individuals with uncorrected refractive error (presenting visual acuity <6/12 but improving to ≥6/12 on using a pinhole) and presbyopia (binocular near vision <N8 in individuals aged >35 years with binocular distance visual acuity of ≥6/12).

Results 3095 (94%) were available for examination. Those with uncorrected refractive errors cited affordability as the main barrier to the uptake of eye-care services. Among people with uncorrected presbyopia, lack of ‘felt need’ was the leading barrier.

Conclusion The barriers that were ‘relatively easy to change’ were reported by those with uncorrected refractive errors in contrast to ‘difficult to change’ barriers reported by those with uncorrected presbyopia. Together, the data on prevalence and an understanding of the barriers for the uptake of services are critical to the planning of refractive error services.

  • Barriers
  • presbyopia
  • rapid assessment
  • uncorrected refractive errors
  • epidemiology
  • public health

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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Supplementary materials


  • To cite: Marmamula S, Keeffe JE, Raman U, et al. Population-based cross-sectional study of barriers to utilisation of refraction services in South India: Rapid Assessment of Refractive Errors (RARE) Study. BMJ Open 2011;1:e000172. doi:10.1136/bmjopen-2011-000172

  • Funding The financial support for this study was provided in part by the Vision Co-operative Research Centre, Australia as part of SM's doctoral programme and by Hyderabad Eye Research Foundation. GNR and JEK supervised the project and provided technical inputs. UR reviewed the earlier drafts of the manuscripts and provided inputs.

  • Competing interests None.

  • Ethics approval Institutional Review Board of LV Prasad Eye Institute.

  • Contributors SM conceived the idea, and planned and implemented the study; JEK helped in designing the study protocol, supervised the project and contributed in interpreting the data, writing and revising the manuscript; UR and GNR helped in interpreting the data, reviewed the earlier and revised versions of the manuscript. All authors approved the final version of the manuscript.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.