Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: The Bhaktapur Glaucoma Study

Abstract

BackgroundCataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal.MethodsSubjects aged 40 years and above was selected using a cluster sampling methodology and a door to door enumeration was conducted for a population based cross sectional study. During the community field work, 11499 subjects underwent a structured interview regarding awareness (heard of) and knowledge (understanding of the disease) of cataract and glaucoma. At the base hospital 4003 out of 4800 (83.39%) subjects underwent a detailed ocular examination including log MAR visual acuity, refraction, applanation tonometry, cataract grading (LOCSΙΙ), retinal examination and SITA standard perimetry when indicated.ResultsThe age-sex adjusted prevalence of blindness (best corrected <3/60) and low vision (best corrected <6/18 ≥3/60) was 0.43% (95%C.I. 0.25 - 0.68) and 3.97% (95% C.I. 3.40 - 4.60) respectively. Cataract (53.3%) was the principal cause of blindness. The leading causes of low vision were cataract (60.8%) followed by refractive error (12%). The cataract surgical coverage was 90.36% and was higher in the younger age group, females and illiterate subjects. Pseudophakia was seen in 94%. Awareness of cataract (6.7%) and glaucoma (2.4%) was very low. Among subjects who were aware, 70.4% had knowledge of cataract and 45.5% of glaucoma. Cataract was commonly known to be a 'pearl like dot' white opacity in the eye while glaucoma was known to cause blindness. Awareness remained unchanged in different age groups for cataract while for glaucoma there was an increase in awareness with age. Women were significantly less aware (odds ratio (OR): 0.63; 95%, confidence interval (CI): 0.54 - 0.74) for cataract and (OR: 0.64; 95% CI: 0.50 - 0.81) for glaucoma. Literacy was also correlated with awareness.ConclusionThe low prevalence of visual impairment and the high cataract surgical coverage suggests that cataract intervention programs have been successful in Bhaktapur. Awareness and knowledge of cataract and glaucoma was very poor among this population. Eye care programs needs to be directed towards preventing visual impairment from refractive errors, screening for incurable chronic eye diseases and promoting health education in order to raise awareness on cataract and glaucoma among this population.

Awareness of and attitude towards glaucoma among an adult rural population of Osun State, Southwest Nigeria

“…Furthermore, males and those with increased age had greater awareness of glaucoma. Similar findings were reported in another study 11. In contrast to a hospital population study within the same region of this study, those who worked in the ophthalmic unit, and had higher social class had more awareness of eye diseases including glaucoma 8…”

“…Similar findings were reported in a Canadian study 10. However this observation is in contrast to findings reported by other authors from Ethiopia11 and Nepal12 where males predominated. The differences between studies may be cultural where women are not allowed to express themselves fully.…”

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

“…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.…”

Glaucoma Awareness in a Hospital Presenting Population in Eastern Nepal

“…Various studies in developing/ underdeveloped countries have shown a low rate of awareness, 5,[8][9][10][11] whereas relatively higher level of awareness is reported from developed countries. Various studies in developing/ underdeveloped countries have shown a low rate of awareness, 5,[8][9][10][11] whereas relatively higher level of awareness is reported from developed countries.…”