Population-based cross-sectional study of barriers to utilisation of refraction services in South India: Rapid Assessment of Refractive Errors (RARE) Study

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.