Visual Status, Ocular Profiles and Associated Quality of Life of Workers in the Weaving Community of Salem District, Tamil Nadu, South India

Abstract

Purpose:

To evaluate the visual status, ocular profiles, and associated quality of life (QoL) among workers in the weaving community of Salem District, Tamil Nadu, South India.

Method:

This study was conducted in rural weaving and textile factories within Salem District, South India, focusing on weaving-related work. From an estimated population of 8,010 employees, 1,230 participants were selected for the study. Three suitable factories were chosen after obtaining appropriate permissions. The inclusion criteria were workers aged 18–60 years actively involved in production roles, while administrative staff were excluded. Visual acuity, was assessed, and refractive errors, including myopia, hypermetropia, and astigmatism, were measured. Visual impairment was defined as a visual acuity of less than 6/12 in either eye. For participants under 40 years of age, additional evaluations included near point of accommodation and near point of convergence. Comprehensive data collection involved recording demographic information, conducting detained eye examination, and assessing quality of life using the low vision quality of life questionnaire (LVQOL).

Results:

The study included 1,230 participants, with a mean age of 39.46 ± 10.84 years, of whom 74.4% were male. Visual impairment (VI) was observed in 35.04% of participants, with the majority (83.75%) of Vi cases had uncorrected refractive errors (URE) and 7.19% had cataracts. Visual impairment was more prevalent in the 51–60 age group, affecting 48.1% of individuals in this category. Females demonstrated higher odds of spectacle usage compared to males (OR 0.729, 95% CI 0.548–0.969), especially among workers in sewing and presser roles. A low mean near point of convergence (NPC) of 8.84 ± 3.29 cm was noted, with 36% of participants exhibiting reduced amplitudes of accommodation. Color vision defects were identified in 6.0% of females and 4.6% of males. A significant associations was found between occupation, gender, and spectacle usage (X2, N = 122, P = 0.029). Quality of life, as measured by the LVQOL, ranged from 1.8 to 5.0, with a mean score of 4.386 ± 0.6445. A statistically significant correlation was identified between presenting visual acuity and LVQOL scores, indicating that participants with visual impairment had lower overall LVQOL scores (Spearman correlation, P < 0.01).

Conclusion:

Uncorrected refractive error (URE) emerged out as the primary cause of visual impairment among workers in the weaving industry. Additionally, presenting visual acuity significantly influenced the quality of life (QoL) of participants. These findings underscore the urgent need for timely interventions to enhance both worker performance and overall QoL within the weaving industry.

INTRODUCTION

The World Health Organization (WHO) defines refractive error as a condition in which blurred vision occurs due to the inability of the eye to focus images on the retina.[1] Common types of refractive errors include myopia, hypermetropia, astigmatism, and age-related presbyopia, all of which can be effectively managed through corrective measures such as glasses, contact lenses, or laser eye surgery.[2]

Uncorrected refractive error (URE) is one of the leading causes of global vision impairment and blindness, affecting 10.2% of the population in India, with 33% of these being presbyopic.[3,4] URE significantly impacts health, social life, economy, and overall well-being, with an estimated annual global productivity loss of US$202.[3]

India’s weaving industry, the second largest provider of rural employment, employs approximately 12.5 million workers.[5] Tamil Nadu’s textile hub, Salem, with over 400,000 looms and 800,000 employees, accounts for approximately 25% of India’s total textile production.[6] The handloom sector in Salem, employing 8,010 workers, is a significant part of this landscape.[7]

A study conducted in Andhra Pradesh, South India, revealed a significant burden of vision impairment caused by URE among weavers.[8] Tasks requiring good near vision, accommodation, color vision, and proper convergence are essential for weavers, as their daily activities often demand precise visual tasks.[9] Similar research on northern Indian tea pickers showed that improved near vision not only boosted their work productivity but also had a positive effect on their income and overall quality of life.[9]

Despite the importance of vision in the weaving industry, there is a lack of comprehensive research on the visual and ocular health of workers, as well as the impact of these conditions on their quality of life (QoL). This study aims to assess the visual status, ocular profiles, and QoL of workers in the Salem District’s weaving community in Tamil Nadu, South India.

METHODOLOGY

This cross-sectional study was conducted in rural weaving and textile factories in the Salem District of Tamil Nadu, South India, focusing on workers engaged in weaving-related activities. Purposive sampling was used to select three factories that met the inclusion criteria from a list provided by the Weaving Association in Salem.[7] The sample size of 1,230 employees was calculated using a 95% confidence level and a 0.5 margin of error.[7]

The study included workers aged 18–60 who contributed to production. Procedures involved collecting demographic data, conducting comprehensive eye examinations, and administering the Low Vision Quality of Life Questionnaire (LVQOL). Eye examinations assessed visual acuity, refractive errors, myopia, near point of convergence, and amplitude of accommodation (for participants under 40), as well as color vision, confrontation field tests, stereopsis, anterior segment evaluation, retinal assessment, and intraocular pressure measurement.[10,11,12]

Participants received counseling, spectacles, and referrals based on the examination results. The LVQOL questionnaire assessed the association between visual status and quality of life, and it is a validated tool in previous research on individuals with mild visual impairment.[13,14]

Data were recorded in Microsoft Excel and analyzed using SPSS v27. Descriptive statistics summarized the data, and odds ratios with 95% confidence intervals assessed spectacle usage between genders. A Chi-square test determined associations between gender, occupation, visual acuity, spectacle usage, and color vision.

Ethical approval was obtained from the University of KwaZulu-Natal’s Biomedical Research Ethics Committee (BREC/00001219/2020) and the ACE Independent Ethics Committee in India. Written consent was obtained from participants, and the study adhered to the principles of the Declaration of Helsinki. The study was conducted from March 2022 to August 2022.

RESULTS

A total of 1,230 participants were included in the study, with a mean age of 39.46 ± 10.84 years. Among them, 915 (74.4%) were male, and 315 (25.6%) were female. The highest refractive error in terms of spherical equivalents was −10.63D for myopia and +4.63D for hypermetropia. Notably, 347 participants (36%), comprising 41% male and 34% female, exhibited a reduced near point of accommodation (NPA). This reduction in NPA was age-matched, with the majority (63%) falling within the 21–30 age group, followed by the 31–40 age group (59%). Regarding the near point of convergence (NPC), the findings were in line with expectations, with a mean of 8.84 ± 3.29cm. Additionally, 20.0% of participants in the 21–30 age group and 19.7% in the 31–40 age group had reduced NPC [Table 1].

Table 1.

Descriptive statistics - vision and ocular profiles of the participants

Description	N	Range	Minimum	Maximum	Mean	Std. Deviation	Variance
Age	1 230	53	18	71	39.46	10.84	117.55
RE: R. Error (SE)*	1 230	15.26	−10.63	4.63	-0.31	1.59	2.53
LE: R. Error (SE)*	1 230	13.38	−10.63	2.75	-0.35	1.65	2.72
RE: BCVA**	1 230	1	0	1	0.05	0.18	0.03
LE: BCVA**	1 230	1	0	1	0.04	0.16	0.03
NPA (Binocular)	1 230	25	6	30	14.02	3.88	15.09
NPC	1 230	21	4	21	8.84	3.29	10.87
RE: IOP***	1 230	14	8	22	14.1	1.16	1.34
LE: IOP***	1 230	22	6	22	14.06	1.29	1.67

*= Refractive Error Spherical Equivalent, ** = Best corrected visual acuity in logMar, *** = Intra ocular pressure (mm/hg)

No significant difference in refractive error was observed between the right and left eyes. Therefore, data from the right eyes were used to report the refractive status, as previously done in another study.[2] The prevalence of myopia, hypermetropia, astigmatism, and presbyopia was 38%, 25%, 20%, and 54%, respectively, with myopia being the most prevalent (45%) among quality check workers. Spectacle usage was comparable in the age groups 51–60 (33.3%) and those over 60 (33.1%) years. Across different occupations, the range of spectacle usage varied from 19% to 27.2% with 24% of the total workforce wearing spectacles [see Figure 1]. The odds of spectacle usage were higher among females than males (OR: 0.729; 95% CI: 0.548–0.969).

Figure 1.

Refractive status and spectacle usage

Among the participants,32.2% in the 41–50 age group and 28.1% in the 31–40 age group had no visual impairment (VI), while 35.04% had VI. Of those with VI, 83.7% had it due to refractive error (RE), and 7.19% had it due to cataracts. In the 51–60 age group, 48.1% had VI. Occupations included 59.7% in sewing and pressing and 16.8% in loom weaving. Cataracts were more prevalent in the 51–60 age group (10.6%) and those over 60 (19.4%). Color vision defects were observed in 17.1% of weavers and 6.3% of those in sewing and pressing [Table 2].

Table 2.

Demographic profiles of VI and URE in participants with VI, cataract and color vision defects

Demographics	Participants	No Visual Impairment	Visual Impairment	URE In Participants with VI N (%)	Cataract	Color Vision Defect
		N (%)	N (%)		N (%)	N (%)
Age Group
18-20	28	17 (60.7)	11 (39.3)	10 (91)	-	1 (3.6)
21-30	265	196 (74.0)	69 (26.03)	52 (75)	1 (0.4)	5 (1.9)
31-40	345	230 (66.7)	115 (33.3)	103 (90)	4 (1.2) *	10 (2.9)
41-50	396	244 (61.6)	152 (38.3)	123 (81)	2 (0.5)	25 (6.3) *
51-60	160	83(51.8)	77 (48.1)	67 (87)	17 (10.6) *	8 (5.0) *
Above 60	36	29 (80.5)	7 (19.4)	6 (86)	7 (19.4)	12 (33.3)
Gender
Male	915	593 (64.8)	322 (35.2)	269 (84)	16 (1.7)	42 (4.6) *
Female	315	206 (65.4)	109 (34.6)	92 (84)	15 (4.7)	19 (6.0) *
Occupation
Loom Weaver	207	120 (58.0)	87 (42.0)	71 (82)	-	3 (1.4)
Sewing and Presser	734	505 (68.8)	229 (31.2)	195 (85)	23 (3.1)	46 (6.3) *
Tailor	122	83 (68.0)	39 (31.9)	29 (74)	3 (2.5)	5 (4.1)
Weaver	35	15 (42.9)	20 (57.1)	17 (85)	3 (8.5)	6 (17.1) *
Weaving QC	132	76 (57.6)	56 (42.4)	49 (88)	2 (1.5)	1 (0.8)

*P<0.01 indicates statistical significance

A chi-square test was performed to determine the association between gender, occupation, color vision, and spectacle usage. The association between gender and color vision was significant, X² (4, N = 769) =17.04, P = 0.002, with more females having color vision defects than males. The relationship between occupation and spectacle usage was significant for tailors X² (1, N = 122) =4.78, P = 0.03.

All 1,230 participants completed the LVQOL questionnaire, with a minimum score of 2.3 and a maximum score of 5 (mean =4.63 ± 0.44). Reading and fine work had the lowest mean score (4.38 ± 0.65), whilst distance vision, mobility, and lighting had a mean score of 4.55 ± 0.56 [Table 3].

Table 3.

Descriptive statistics for LVQOL questionnaire

Variables	N	Minimum	Maximum	Mean	Std. Deviation
Distance Vision, Mobility and Lighting	1 230	1.7	5.0	4.55	0.56
Adjustment	1 230	2.0	5.0	4.77	0.54
Reading and fine works	1 230	1.8	5.0	4.39	0.64
Activities of daily living	1 230	2.0	5.0	4.79	0.45
Overall	1 230	2.3	5.0	4.63	0.44

A Spearman’s rank-order correlation was run to investigate the relationship between presenting VA and LVQOL score. There was a weak, negative correlation presenting VA and LVQOL score, which was statistically significant (r_s (1230) = −196, P < 0.0001)

Reading and fine work, with the lowest mean score, was further analyzed in relation to occupation and gender. It was found to be lower in male participants (41%) and in the tailoring, sewing, and pressing group (27%). Female participants (38%) in the loom weaver group had LVQOL scores of 3 and below “Figure 2”.

Figure 2.

LVQOL scores of 3 or below for reading and fine works; comparing gender and different occupation groups

Across various occupations, 26% reported LVQOL scores of 3 or below, indicating moderate to significant difficulty in reading and fine work tasks. The tailoring group had the highest proportion, with 32% falling into this category.

DISCUSSION

This study is the first to examine the visual health, ocular characteristics, and their impact on the quality of life (QoL) of weaving industry workers in Tamil Nadu’s Salem District, South India. Our findings revealed a notable prevalence of myopia (38%), particularly among quality check workers (45%), consistent with rates in other weaving communities.[15,16,17] This trend may be attributed to prolonged close working distances, emphasizing the need to raise worker awareness about maintaining good visual hygiene, ergonomic practices, and taking regular breaks from prolonged near tasks to mitigate the risks of myopia.

Accurate near vision is crucial for work quality in the weaving industry, and our study highlights that hypermetropia and uncorrected presbyopia can hinder productivity.[18] Addressing these vision issues is crucial, given that 25% of individuals have hypermetropia and 54% have presbyopia, yet only 24% of spectacle users have had these errors corrected.[16,19]

In addition to correcting refractive errors, ensuring good accommodation and convergence is essential for weavers engaged in near tasks. Our study revealed a receded NPC among participants under 40, highlighting the need for comprehensive eye examinations that include binocular vision assessment. Such assessments can address both refractive errors and binocular vision anomalies, leading to clearer and more comfortable vision, which enhances performance in near-visual tasks and overall productivity.[20]

The study identified visual impairment (VI) in 35% of participants, primarily due to refractive errors, with cataracts as the secondary cause. Notably, the incidence of cataracts (2.6%) was considerably lower than in a previous study on weavers in Prakasam district, Andhra Pradesh, India,[8] possibly due to cataract screening and interventions conducted as part of corporate social responsibility initiatives.

Color vision, which is crucial in the weaving and textile industry, was found to be more impaired in females compared to males, possibly linked to cataract-related changes. Addressing secondary color vision issues arising from cataracts is important for improving work quality.[21,22] Employers should consider screening workers for color vision defects before assigning roles that require normal color vision.

Maintaining optimal visual acuity, which is crucial for daily activities and overall quality of life, was found to be challenging for 27% of participants in near tasks, particularly among tailors, who had a higher prevalence of presbyopia.[23] Laviers et al.[24] (2010) stressed the importance of addressing vision correction for presbyopes to enhance vision-related quality of life, underscoring the need to provide vision correction for both distance and near vision among weaving industry workers.

An intriguing observation regarding spectacle users and their LVQOL scores revealed that users in specific groups had the lowest LVQOL scores, possibly due to limited access to regular eye care services and the lack of timely prescription updates [Figure 3]. This emphasizes the need for regular vision and ocular health examinations, as well as timely replacement of spectacle lenses when necessary.

Figure 3.

LVQOL scores of 3 or below for occupation groups, comparing reading and fine works with and without spectacle usage

Limitations and recommendations

The study was limited to three companies in a factory setting, potentially leading to an underestimation of vision and ocular issues within the broader weaving community. Cataract cases were lower than expected, possibly due to limited evaluation methods. However, referrals were made for individuals with persistent vision issues. This study examined various weaving occupations with distinct visual demands, highlighting the need for research on the specific vision requirements for each task. Vision standards exist for industries such as goldsmithing and hairdressing, warranting the development of similar visual standards for weaving-related occupations and the establishment of minimum vision standards to be established for weavers.

CONCLUSION

Workers in the weaving industries of Salem, Tamil Nadu, India were found to have increased VI with advancing age. URE and presbyopia were the primary causes of VI, with less than half of the presbyopic participants wearing spectacle. More females used spectacles compared to their male counterparts. Binocular vision and color vision tests should be included in vision and ocular health screenings for workers in this industry. Visual impairment directly impacts the QoL of workers, making access to eye care services and timely updates of optical corrections crucial for boosting productivity and improving the overall QoL of the worker.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.