Outcomes of cataract surgery: a population-based developing world study in the Bhaktapur district, Nepal

Thapa, Suman; Khanal, Shankar; Paudyal, Indira; Twyana, Shankha Narayan; Ruit, Sanduk; Rens, Ger H. M. B. van

doi:10.1111/j.1442-9071.2011.02576.x

Cited by 20 publications

(18 citation statements)

References 25 publications

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“…AMD, sequelae of retinal vein occlusion, retinal detachment and macular scar were the major causes of blindness in our study. The rate of visual impairment and blindness from vitreo-retinal disorders in our study was consistent with findings from previous studies conducted in Nepal [18-22]. A higher rate of blindness among females in our study could probably be due to the fact that males had better access to health care services than females.…”

Section: Discussionsupporting

confidence: 92%

“…A recent population based study conducted in the Bhaktapur district reported that vitreo-retinal diseases were the second major cause of blindness following cataract, while being the most common cause of blindness among pseudophakics [21,22]. This paper will further elaborate the findings from this population based study regarding the prevalence, types and visual impairment from vitreo-retinal disorders in this district.…”

Section: Introductionmentioning

confidence: 75%

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Prevalence and pattern of vitreo-retinal diseases in Nepal: the Bhaktapur glaucoma study

Thapa

Paudyal

et al. 2013

BMC Ophthalmol

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BackgroundVitreo-retinal diseases are among the leading causes of visual impairment and blindness worldwide. This study reports the prevalence and pattern of vitreo-retinal diseases in the Bhaktapur Glaucoma Study (BGS), a population based study conducted in Nepal.MethodsBGS was a population based cross-sectional study involving 4800 subjects aged 40 years and over from Bhaktapur district. Subjects were selected using a cluster sampling methodology and a door-to-door enumeration. All subjects underwent a detailed ocular examination at the base hospital which included log MAR visual acuity, refraction, applanation tonometry and a dilated fundus examination. Fundus photography, optical coherence tomography and fundus fluorescein angiography were performed where indicated.ResultsComplete data was available for 3966 (82.62%) out of the total of 4800 enumerated subjects. The mean age was 55.08 years (SD 11.51). The overall prevalence of vitreo-retinal disorders was 5.35% (95% CI, 4.67 - 6.09). Increasing age was associated with a higher prevalence of vitreo-retinal disorders (P < 0.001). The prevalence of diabetes mellitus was 7.69% (95% CI, 6.88 - 8.56). Age-related macular degeneration (AMD) was the most common vitreo-retinal disorder with a prevalence of 1.50% (95% CI, 1.15 - 1.94), increasing significantly with age. The prevalence of diabetic retinopathy among the study population was 0.78% (95% CI, 0.53 - 1.11) and among the diabetic population 10.16% (95% CI, 7.01 - 14.12). The population prevalence of other retinal disorders were hypertensive retinopathy 0.88%, macular scar 0.37%, retinal vein occlusion 0.50%, macular hole 0.20%, retinitis pigmentosa 0.12%. and retinal detachment 0.10%.The prevalence of low vision and blindness due to vitreo-retinal disorders was 1.53% (95% CI, 1.18 - 1.97) and 0.65% (95% CI, 0.43 - 0.96), respectively. The prevalence of low vision and blindness was 28.77% (95% CI, 22.78-35.37) and 12.26% (95% CI, 8.17-17.45), respectively among cases with vitreo-retinal disorders. Blindness was observed to be unilateral in 19 cases (73%), and bilateral in 7 cases (27%).ConclusionsThe prevalence of vitreo-retinal disorders in this Nepalese population was 5.35%, which increased significantly with age. AMD was the predominant retinal condition followed by diabetic retinopathy. One fourth of the subjects with vitreo-retinal disorder had low vision. Taking into consideration the aging population and emerging systemic diseases such as diabetes mellitus and hypertension, vitreo-retinal disorders could be of future public health importance.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 75%

Prevalence and pattern of vitreo-retinal diseases in Nepal: the Bhaktapur glaucoma study

Thapa

Paudyal

et al. 2013

BMC Ophthalmol

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“…Reliable visual fields were those with fixation loss, false-negative, and false-positive values of 33% or less. 9–11 If a visual field was unreliable, the subject then completed testing during study enrollment to achieve a reliable field. A patient was considered to have “severe” glaucoma if either eye had (1) optic nerve abnormalities consistent with glaucoma as detailed above and (2) visual field abnormalities in both hemifields and/or loss within 5 degrees of fixation in at least one hemifield in the worse eye or (3) visual acuity so severely diminished by glaucoma that HVF testing could not be performed (in this latter case, the cup-to-disc ratio was required to be 0.9 or greater).…”

Section: Methodsmentioning

confidence: 99%

The Association Between Compliance With Recommended Follow-up and Glaucomatous Disease Severity in a County Hospital Population

Ung

Murakami

Zhang

et al. 2013

American Journal of Ophthalmology

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Purpose To assess the association between insufficient follow-up and clinical parameters such as disease severity and medication use among glaucoma patients at a metropolitan county hospital. Design Cross-sectional study Methods Two-hundred and six patients with established glaucoma were recruited from San Francisco General Hospital. Subjects were classified based upon compliance with recommended follow-up examination intervals over the year preceding commencement of the study as determined by patient medical records. Glaucoma severity was determined based upon the American Academy of Ophthalmology Preferred Practice Patterns guidelines. Multivariate logistic regression analysis was used to assess the relationship between adherence with follow-up visits and disease severity. Results After adjustment for the impact of potential confounding variables, subjects with severe glaucomatous disease were found to have been less adherent to their recommended follow-up than those patients with mild or moderate glaucomatous disease (adjusted OR 1.89, 95% CI 1.21–2.94; P = .01). Subjects who were on glaucoma medications were found to be less adherent to follow-up recommendations (adjusted OR 3.29, 95% CI 1.41–7.65, P = .01). Conclusion Subjects with poor follow-up adherence were significantly more likely to have severe glaucomatous disease suggesting that poor follow-up may contribute to disease worsening or, alternatively, those with more severe disease are less inclined to follow up at appropriate intervals.

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“…1 It is becoming increasingly evident that pre-operative screening of co-morbidities, correction of refractive errors and post-operative follow-up care are key points in achieving the sight-restoring potential of modern cataract surgery. 21 …”

Section: Introductionmentioning

confidence: 99%

Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study

Mitsuhiro

Berezovsky

Belfort

et al. 2014

Ophthalmic Epidemiology

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Purpose To determine uptake, barriers and outcomes in the follow-up of patients referred for free-of-charge, expedited cataract surgery in the Sao Paulo Eye Study (SPES). Methods SPES was a population-based study of urban, low-middle income residents ≥50 years old. Presenting (PVA) and best-corrected (BCVA) visual acuity, refraction, and slit-lamp examination were performed in 3,677 participants. For subjects with cataract as a principal cause of BCVA ≤ 20/40, surgery was offered free-of-charge. Two years after the baseline study, surgery uptake, barriers to surgery, and visual outcomes were analyzed. Results Among 210 (5.71%) participants who had cataract surgery indication at baseline, 164 (78.1%) were successfully contacted and 55 (33.5%) reported being operated on for cataract, with 51 agreeing to be re-examined. In a multiple logistic regression model, age, gender, schooling, previous cataract surgery, and PVA at baseline were not significantly associated with surgery uptake. Co-existing health conditions (20.4%), fear of surgery (12.2%) and fear of losing eyesight (11.6%) were the most frequent barriers for cataract surgery adherence. Among the 69 eyes operated on in the interval between baseline and follow-up, PVA ≥20/63 was observed in 50 (72.6%; 95% confidence interval 62.2%-82.3%), PVA <20/63-20/200 in 11 (15.9%; 8.9%-22.9%) and PVA <20/200 in 8 (11.6%; 5.3%-17.9%). Conclusions Quality of surgery is an increasing determinant of uptake rates. Although free-of-charge and expedited cataract surgery were offered, surgical outcomes might have influenced the low uptake. Besides cataract surgery campaigns, improvement of surgeon skills, accurate biometry, treatment of ocular comorbidities, postoperative follow-up, and eye-care education are needed.

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Outcomes of cataract surgery: a population-based developing world study in the Bhaktapur district, Nepal

Cited by 20 publications

References 25 publications

Prevalence and pattern of vitreo-retinal diseases in Nepal: the Bhaktapur glaucoma study

Prevalence and pattern of vitreo-retinal diseases in Nepal: the Bhaktapur glaucoma study

The Association Between Compliance With Recommended Follow-up and Glaucomatous Disease Severity in a County Hospital Population

Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study

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