Indian Journal of Ophthalmology

: 1995  |  Volume : 43  |  Issue : 4  |  Page : 177--179

Changing trends in the intraocular lens acceptance in rural Tamil Nadu

N Venkatesh Prajna, Raheem Rahamatullah 
 From Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India

Correspondence Address:
N Venkatesh Prajna
Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, 1 Anna Nagar, Madurai 625 020


A retrospective analysis spanning a 3-year period (1992-1994) was done to determine the rate of acceptance and affordability of intraocular lenses among the rural population of Tamil Nadu. The acceptance rate increased at an average of almost 70 to 100% as compared to a 17 to 20% increase in the total number of cataract surgeries performed per year. Analysing by mode of admission, the proportion of intraocular lens acceptance was more among the patients who directly presented at the hospital than the patients referred from eye camps. The overall acceptance rate was high and the ophthalmologist should be prepared to meet the likelihood of greater demand for intraocular lens from this population.

How to cite this article:
Prajna N V, Rahamatullah R. Changing trends in the intraocular lens acceptance in rural Tamil Nadu.Indian J Ophthalmol 1995;43:177-179

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Prajna N V, Rahamatullah R. Changing trends in the intraocular lens acceptance in rural Tamil Nadu. Indian J Ophthalmol [serial online] 1995 [cited 2023 Jun 2 ];43:177-179
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Cataract is the single greatest cause of blindness in the world today and more so in developing countries such as India.[1][2][3] The WHO-NPCB survey (1986-1989) estimated that 12 million people were blind (visual acuity less than 6/60) accounting for 1.49% of the total population,[4] of which, 81% were blind due to cataract. It was also estimated that 1.2 million cataract operations were performed annually in India,[5] of which, approximately 1 million were intracapsular cataract extractions.[6] However, the recent statistical data provided by the Government of India estimate that approximately 1.9 million cataract operations are being performed in the country[5] and a survey conducted by the All India Ophthalmological Society amongst its members revealed that one-fifth of cataract surgeries performed by them were extracapsular cataract surgeries with posterior chamber intraocular lens implantation.[7]

However, no data are available on the magnitude of intraocular lens (IOL) acceptance among the general population, despite anecdotal references to their increasing popularity among the urban population. The majority of the cataract patients reside in rural areas and the issue of preference, acceptance and, more importantly, the affordability of IOL among this group of people has not been addressed so far. We therefore made a retrospective analysis of the acceptance rate of intraocular lenses among the rural population of Tamil Nadu attending the free section of Aravind Eye Hospital, over the past 3 years (1992-1994), in this study.


The medical records of patients who had undergone cataract surgery at the free section over the past three years (1992-1994) were reviewed. The patients were recruited from two main sources, namely: (a) direct mode - this source includes patients who present to the hospital directly seeking treatment and constitute 40% of the total admissions and (b) camp patients - this source includes patients from outreach screening camps, conducted by the base hospital. Patients with operable cataract are advised surgery, and if willing are transported to the hospital. The surgery is then performed at the base hospital. This group contributes the remainder 60%.

Patients, irrespective of their mode of admission, were subjected to thorough clinical examination and were given preoperative counselling by trained social workers. Patients desirous of having an IOL were required to pay Rs.500 which included the cost of the intraocular lens and postoperative medications. The cost was kept the same throughout the study period.

The chi-square test with Mantel Haenszel test for linear association was used to determine the significance of trend.


The total number of cataract surgeries (with and without IOL) performed at the free section of Aravind Eye Hospital during the period 1992-1994 is shown in [Table:1][Table 2][Table:3]. The overall acceptance rate of IOL showed a gradual increase -12% in 1992,24.5% in 1993, and 38% in 1994 [Figure:1] and was statistically significant (P <0.001). The IOL acceptance rate increased by almost 70 to 100% as compared to a 17 to 20% increase in the total number of surgeries performed per year.

Analysis by the mode of admission revealed that the IOL acceptance is more marked among the patients admitted through the direct mode. The acceptance rate increased from 25.6% in 1992 to 47.6% in 1993 and further to 63% in 1994 [Figure:2]. The acceptance rate among the camp patients acquired an interesting trend. Though the percentages were modest when compared to the direct mode patients, it almost increased by 100% every year - 4.9% in 1992, 11.6% in 1993, and 22% in 1994 [Figure:2]. This implied that even though the acceptance rate among the camp patients is slow, it was steadily increasing.


Our data from this study clearly show that IOL implantation during cataract surgery is becoming increasingly popular among rural patients. Even though there are no obvious socioeconomic differences between the two groups of patients, the demand for IOL was more marked among the patients who seek surgery compared to patients who were recruited from camps. The direct mode patients were from younger age group, had better preoperative visual acuity and sought surgery at an earlier stage. Early surgery helped in preventing blindness and consequently the mode of affordability.

The magnitude of IOL acceptance among these patients has surpassed even our expectations and projections. Since this change seems to occur from within the community, there is every reason to expect the demand to increase in an exponential fashion. This clearly indicates that the rural patient is prepared to meet the cost of an IOL provided the visual results are convincing. Earlier studies have indicated that a satisfied aphakic patient acts as a motivator for others in the community.[8] Similarly, as long as the pseudophakic patients are satisfied with their visual outcome, this increasing trend of acceptance is poised for a quantum leap far beyond our expectations.

In the coming years the prevalence of blinding cataract is bound to increase due to the ever increasing backlog and increase in longevity of the general population. However, the resources available are not expected to increase proportionately. The sharing of the cost of surgery, at least partially, by the patient will help in the self-sustenance of the eye care programmes. The advantages of IOL surgery may accelerate this change.

It will be prudent on our part to acknowledge and take notice of this slow and steady revolution occurring within the rural community. Performing IOL surgery will become a basic necessity and not a luxury in the not too distant future. As a primary step, special thrust should be given to expose the residents in ophthalmology to the technique of microsurgery so as to enable them to meet the emerging needs of the society.

While randomized controlled trials are required to determine the safety and efficacy of IOL implantation over conventional intracapsular cataract extraction, this study highlights the changing demands of the cataract patient.


1WHO Programme Advisory Group. Report of the eighth meeting of the WHO programme advisory group on the prevention of blindness. Geneva, Switzerland, World Health Organization, March 1989, Publication 89.17.
2West SK, Quigley HA. Cataract blindness: What to do ? Arch Ophthalmol 109:1665-1666, 1991.
3Foster A, Johnson GJ. Magnitude and causes of blindness in the developing world. Int Ophthalmol 14:135-140, 1990.
4Ministry of Health and Family Welfare. Problem of blindness in India. In: Status of National Programme for Control of Blindness (NPCB), Govt. of India, 1993, pp. 2.
5Ministry of Health and Family Welfare. Problem of blindness in India. In: Status of National Programme for Control of Blindness (NPCB), Govt. of India, 1993, pp. 10.
6Venkataswamy G. Ophthalmology in India. Arch Ophthalmol 107:931-932, 1989.
7Gupta AK, Ellwein LB. The pattern of cataract surgery in India. Indian J Ophthalmol 43:3-8, 1995.
8Brilliant GE, Lepkowski JM, Zurita B, Thulasiraj RD. Social determinants of cataract surgery utilization in South India. Arch Ophthalmol 109:584-589, 1991.