INTRODUCTION
The word zari means gold thread and zardosi embroidery is heavily encrusted gold thread work, which is extremely intricate. In earlier days, zardosi embroidery work was done by using only real gold and silver threads.[1] Zardozi embroidery as a handicraft is an enviable possession of our national heritage that contributes substantially to Indian economy. Zardozi as a craft is omnipresent in India, in urban as well as their rural hinterland in homogenous clusters. The traditional craft of Zardozi today, assumes variegated approaches and forms.[2] This requires high precision and a great amount of visual effort. Given the socioeconomic conditions and working circumstances of the zardozi workers, it is highly likely that they develop visual problems at some point in their lives. Zari artisans suffer from wide range of health issues, musculoskeletal, and visual problems in particular related to their occupation.[3] These may range from simple asthenopic symptoms to severe visual disturbances. These visual disturbances affect their quality of life and work efficiency. The inquisitiveness in this craft, led us to undertake the present study, to assess the visual problems existing today among zardozi workers. Thus, the present study was conducted to study visual problems of zari artisans.
MATERIALS AND METHODS
Study design
The present study was a cross sectional study.
Study setting
The study was conducted at Zardozi industries in Lucknow city of Uttar Pradesh.
Study population
This study included the patients of varying age groups coming to the Ophthalmic outpatient department with no apparent ocular symptoms other than aesthenopia or diminution of vision. The exclusion criteria included patients who refused to provide consent, congenital abnormalities, macular pathology, and history of recent intraocular surgery in the past 3 months.
Study duration
The study was conducted during January 2022–May 2022.
Sample size and sampling
Two hundred and forty individuals with a background of an occupation in the Zardozi industry were enrolled in the study. A list of all zardozi industries were made and simple random sampling was used to pick one industry from the list and all the individuals who were willing to participate in the study were included.
Data collection
A detailed history was elicited from the patient regarding the age of onset of work, duration of work, working conditions, socioeconomic status, and nutritional status. All the patients were subjected to a thorough systemic and local examination. Thorough ocular evaluation was done on all selected patients both clinically and with the help of diagnostic instruments. Visual acuity was tested using Snellen’s chart; anterior segment evaluation was done using diffuse torch light and slit-lamp examination. Orthoptic evaluation was performed to gauge the fusional range of the patient using Royal air Force ruler for Near point of Convergence and prism bars were used to test for the positive fusional range of the study subjects. Goldmann applanation tonometry was done to measure the IOP. To observe the fundus with good depth perception, examination under +90D lens was performed. The refractive status of the patients was assessed both objectively by refraction under full cycloplegia as well as subjectively.
Data analysis
Data was entered and analysed with SPSS IBM version 22.0 (IBM Corp., Armonk, NY, USA) Proportions and means were calculated. Chi-square test was applied to find associations. A P < 0.05 is considered to be significant.
Ethical considerations
Privacy and confidentiality of all study participants were maintained. The study was conducted after the approval of Institutional Ethics Committee of AIIMS, Raebareli.
RESULTS
We studied 240 zardozi workers of varying age group with mean (SD) age of the study participants was 27 ± 12 years from North India.
The mean age of the study
Majority of the study participants were males and in the age group of 21-30 years. Majority of the artisans were working in the industry for more than 15 years. Most of the artisans had hypermetropia and common ocular symptom was diminution of vision [Table 1 and Figure 1].
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Table 1: Sociodemographic profile of the study participants (n=240)
Figure 1: Ocular symptoms of the study participants (n = 240)
Among the study participants, Poor convergence status was associated with hypermetropia and majority of those who had >25 positive fusional range had hypermetropia. This was found to be statistically significant.(P = 0.001,0.0098 respectively) [Table 2].
Table 2: Correlation of convergence status and fusional range with refractive status
In our study, we analyzed that irrespective of the working hours, majority of the workers had either poor convergence or fatigue of convergence. Although with the increase in the hours of work, fall in convergence was seen, but it was not statistically significant (P = 0.527) On comparing the working hours with the fusional range, we found that in all the groups most of the patients had positive fusional range of <15 (P = 0.23) [Table 3].
Table 3: Correlation of convergence status and fusional range with hours of work
Lower fusional range (<15) was associated with poor convergence status. This was statistically significant (P < 0.001) [Table 4].
Table 4: Correlation of the fusional range with convergence status of the worker
DISCUSSION
The art of Zardozi is a visually demanding profession. The strenuous and long duration of work and poor working conditions of the Zari workers gives rise to the various ocular symptoms like diminution of vision, which was reported by 54.16% patients in our study followed by eye strain by 37.5% patients. Other complaints were headache, watering, redness, itching, and blurring of vision. These findings in our study were in concordance with the study carried out by Wood V[4] in the UK showed that the workers doing near vision work have experienced eye problems such as tiredness, headache, impaired visual performance, red or sore eyes as in such a case, the workers are required to pay a higher visual attention.
Ocular symptoms
The Zari work demands immense precision. The workers need to pay excessive care toward the details of the product, and therefore, their work demands high visual attention leading to these various visual symptoms. The symptoms of these workers can be categorized into visual symptoms, ocular symptoms, asthenopia (eye strain), and musculoskeletal symptoms. The causes of vision problems in these workers are a combination of poor workplace conditions, and improper work habits (prolonged work exposure, sitting in nonoptimal posture), high concentration, continuous looking at a fixed object, and lesser blinking of eyelids. When one looks at any close object, the eyes perform three simultaneous actions. Visual symptoms of prolonged and strenuous near work include blurred vision or squinting (constant, intermittent, or when changing viewing distance), frequently losing place and diplopia.[4–6]
Visual impairment and blindness
In a study done among the Weaving Communities in South India by Marmamula et al.,[7] it was found that 14% subjects had visual impairment, including blindness in 4.6% and moderate visual impairment in 9.4% individuals. Refractive error (54%) was the leading cause of all visual impairment followed by cataract, similar to our study where 188 out of 240 workers were found to be ametropic. In our study, we found that almost all the individuals had some or the other form of ocular problems which included headache, ocular strain, watering, burning sensation, etc., which was similar to the study by Untimanon etal.[5] in which they assessed the visual problems among jewelery workers and found that burning sensation was the most common ocular complaint among the workers followed by ocular pain, irritation, redness, itching, and watering. Studies have shown that the workers of the electronics industries doing similar close work also suffered from different eye problems. Studies have shown that the workers of a semiconductor manufacturing industry working in 12-hour shifts using microscope, experienced eye fatigue. Lin etal.[8] found that the operators engaged in microscope work had also experienced different visual strain symptoms.
Hypermetropia
The majority of our study subjects started working in these Zari industries at a very young age and as many as 55.83% of the participants have been working for over 10 years. These workers also work under poor work conditions with small work places, poor illumination conditions, poor ventilation, and poor working posture as the workers are huddled around a low working frame under a single light bulb creating the average illumination in the working place of 580 lux as compared to required conditions of 1500-2000 lux for work requiring fine precision and detailed work. When assessed for the refractive status, majority (78.33%) were found to be ametropic. Out of all studied population, 43.33% were hypermetropic and 35.0% were myopic (P < 0.001). This explains a large number of people having aesthenopic symptoms in our study.
In our study, 44.58% participants exhibited poor convergence while 26.67% showed fatigue of convergence, out of these most of them were hypermetropes 56.07% and 34.38%, respectively. It has been found that subjects with convergence insufficiency (CI) complain more after doing near work. Pang etal.[9] found in a study that after 30 min of close work there was a significant increase in the NPC break among their study subjects (P = 0.007).
We found that more number of hypermetropes developed poor convergence as supported by other researchers where Gupta etal.[10] found that 52% of the patients with CI were hyperopic followed by myopes (34%) and emmetropes (14%). Kumar and Pant[11] evaluated refractive errors in patients with CI and found that 38% had low myopia, 57% were emmetropic, and 5% had hyperopia > 1 D. Junghans etal.[12] found that the mean symptom scores for CI were significantly higher for students with hyperopia over 2 D than for those with milder hyperopia, emmetropia, mild myopia or myopia over-2 D.
Convergence
In our study, we found that 77.08% of the study population had positive fusional range of <15 and among this group itself 44.32% of the subjects were hypermetropic. No statistically significant difference was seen between working hours and convergence status but most of the patients working for >8 h/day had positive fusional range of <15. Significant difference was seen between positive fusional range and convergence status (P < 0.001) where majority of patients with <15 positive fusional range were having poor convergence. The recovery point at which fusion is re-established after being broken can also be an indicator of fusional potential. As with low convergence amplitudes the recovery point will be receded as well.[13] Numerous previous authors have made assertions regarding the proportion of one’s accommodative amplitude which may be used continuously without causing discomfort, based on the assumption that the human ciliary muscle is likely to become fatigued with prolonged contraction.[14] This may provide a reasonable explanation to the change in positive fusional range in CI after prolonged near work as found in our study subjects.
Strengths and limitation
The present study was able to find out visual acuity problems among zari artisans. This is one of the unique study in India with no previous similar studies done. The study assessed refraction, fusion range and convergence status altogether. The limitation is that the study was conducted in one major zari industry of one state and it may not be representative of other state working conditions.
Summary of the study
The study was able to identify hidden vision problems among zari artisans. Adhering to the ergonomic principles could avoid health issues and thereby increase the productivity. Hypermetropia was the most common symptom found in addition to poor convergence and poor positive fusional range.
CONCLUSION
Majority of the subjects had asthenopic symptoms, poor convergence, poor positive fusional range, and poor nutritional status and working conditions. The causes of vision problems in these workers are a combination of poor workplace conditions, improper work habits (prolonged work exposure and sitting in nonoptimal posture) high concentration, continuous looking at a fixed object, and lesser blinking of eyelids. Adequate lighting conditions, proper ventilation and hygiene, short breaks in between, proper nutrition, correction of refractive error if any, and periodic regular eye checkup should be done to overcome these visual problems in Zardozi artisans.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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