NAYANA PROJECT

NAYANA - 14 years of service

Fourteen years of Nayana - Up & Still going strong.
41956 patients treated on the van as on date and trained of more than 200 doctors.

The NAYANA Story
Diabetic retinopathy is one of the major causes of preventable blindness in developing countries and Glaucoma is the second biggest cause of preventable blindness. However, due to lack of equipment and appropriate training, treatment for retinopathy or glaucoma is not available in all districts in Karnataka.

With more than 32 million people affected by diabetes, India is having the world's largest diabetic population and with this, also a large burden of diabetes-related complications such as diabetic retinopathy. It shares a common theme with glaucoma which needs similar expensive equipment and training.

In Karnataka, long travel distances tend to reduce the use of retinopathy detection and treatment facilities. Without appropriate screening, treatment and care, the consequences of diabetic retinopathy and glaucoma are likely to be severe, and one target for the project is therefore to reduce the travel distance from an average of 200 km to an average of 50 km.

Objective
The project aimed to create a program to improve treatment for diabetic retinopathy and glaucoma in remote areas. This level of continuous movement of sensitive medical equipment had never been attempted before anywhere in the world.

Approach
Vittala International Institute of Ophthalmology, Sri Keshava Trust (a vision health centered NGO) and Prabha Eye Clinic and Research Center have joined forces to improve treatment and care for diabetic retinopathy and glaucoma in remote areas in Karnataka. The project is based on two groups:

  • Local ophthalmologists in 8 districts of Karnataka, which are currently not delivering retinopathy treatment.
  • Local health providers in the target districts.

The ophthalmologists were provided with the necessary training and equipment to diagnose and treat people locally. Furthermore, six ophthalmologists received advanced training - enabling them to perform surgical management of diabetic retinopathy and glaucoma.

By conducting training programs for health providers, the project improved the rate of early detection as well as patient referrals to further treatment.

To avoid the costs and logistical hurdles of duplicating the sets of equipment required in many remote areas, a mobile van with diagnostic and therapeutic equipment has been created. The mobile unit will allow local ophthalmologists and specialists to get access to diagnostic and therapeutic equipment. In addition to this, installed video conferencing will allow for consultations with specialists at Vittala International Institute of Ophthalmology.

Treatment is provided for free to all patients with an income of less than USD 30 per month

Outcome
The mobile unit has visited 23 locations every month across 13 districts in the state of Karnataka, covering more than 226,000 km during 1007 days of operation. An average of 33 patients were seen per location.

  • 37890 persons with diabetes have been diagnosed/treated in the van. 14,533 had diabetes complications, and 12,832 cases of diabetic retinopathy were detected/treated in the van. A further 6700 patients with glaucoma receive diagnosis and treatment.
  • 2,163 laser treatments were performed on 7,744 patients. (432 sight restoring and sight saving vitreo retinal surgeries and 113 other surgeries for complicated eye conditions were performed). 68% of the patients have received free treatment, while 32% have paid for their services.
  • 229 general practitioners have received general diabetes and diabetes related eye condition training along with Glaucoma.
  • 107 ophthalmologists have undergone intensive continued medical education on diabetic eye disease with faculty from India and the USA.
  • Six fellows have completed training in medical and surgical retina, of these two have gone on to set up clinics in the project areas.
  • 250 field workers from participating clinics have received training in general diabetes counseling.

The project has become a role model for both private and public initiatives on NCD complications and has received considerable attention in the media as well as in scientific journals. Many projects around the world have adopted this model for care delivery.

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