Eye diseases associated with obstructive sleep apnea syndrome in an Asian population.

Background: Sleep apnea syndrome is one of the leading causes of excessive daytime sleepiness. There is no literature exploring the prevalence of sleep-associated disorders in the eye of Asians with obstructive sleep apnea syndrome (OSA). Objective: Study the prevalence of eye abnormalities in Asian patients with OSA. Material and method: Asian patients with definite OSA diagnosis via the polysomnography were recruited into the study. Complete eye examination and special investigations were performed to define eye diseases: floppy eyelids, dry eyes, keratoconus, Fuchs’ endothelial dystrophy, recurrent corneal erosions, open-angle glaucoma, ophthalmoplegia, papilledema and optic neuropathy. Results: One-hundred Asian OSA patients were examined. We found that floppy eyelids, dry eyes, and normal tension glaucoma were more prevalent compared to the normal population. Abnormal endothelial change and papilledema were detected. Optic neuropathy and ophthalmoplegia were not found in this study, although some patients did have subnormal contrast sensitivity. Conclusion: There is a higher prevalence of floppy eyelids, dry eyes, and glaucoma in OSA patients. Complete eye examination is recommended in OSA patients to detect early eye abnormalities.

Eye health in the priests and novices in central Bangkok.

BACKGROUND: Early detection and proper management of eye diseases in priests and novices is cost effective, and minimize serious ocular damage and permanent loss of vision. Therefore, the Department of Ophthalmology, Priest Hospital set-up an eye examination project for the priests and novices who came for physical examination. The laboratory test was part of the Sustained and Holistic Healthcare Program for Priests and Novices as Commemoration of His Majesty the King's 60 Years of Accession to the Throne. OBJECTIVE: To evaluate eye health status and screening for refractive error in priests and novices and to provide free spectacles and eye health education to fulfill the criteria of voluntary Buddhist eye health workers. MATERIAL AND METHOD: Between February and June 2006, the Department of Ophthalmology, Priest Hospital conducted eye examination for the priests and novices in 28 temples in central Bangkok. The priest and novices with refractive error and abnormal eye examination received appointment for repeated refraction and complete eye examination in Priest Hospital. RESULTS: Six hundred forty nine priests and novices had complete eye examination. Normal visual acuity (Snellen VA 20/20) was found in 355 (54.69%) cases. The most common eye diseases were refractive error with 294 cases (45.30%), cataract with 41 cases (6.32%), glaucoma with 10 cases (1.54%) and vitreoretinal diseases, which included diabetic retinopathy, age related macular degeneration and branch retinal venous occlusion with eight cases (1.23%). Three novices had amblyopia (0.46%). CONCLUSION: Most of the priests and novices in central Bangkok had good eye health. Half of the eye problems were refractive errors. Since most of other eye diseases reported in priests were associated with aging and systemic diseases as hypertension, diabetes, and ischemic heart disease, regular ophthalmic examination should be provided in this risk group. Eye health education should be provided for sustainable eye health development as voluntary eye health workers in Buddhism.

Eye health of priests and novices in rural area.

BACKGROUND: Early detection and treatment of eye diseases is important to minimize visual morbidity and permanent visual loss in general and priests' population. OBJECTIVE: To evaluate eye health status, visual acuity and eye diseases of the priests and novices, to estimate the prevalence and causes of visual impairment, and to provide eye health education. MATERIAL AND METHOD: Between May 2006 and March 2007, the priests and novices in selected village (stratified population cluster random sampling) of 22 provinces in The First National Survey of Blindness and Visual Impairment Program in Thailand (TVIP) had their visual acuity (VA) and intraocular pressure (IOP) measured and eye examined by ophthalmic nurses. An ophthalmologist examined the anterior and posterior segment and took fundus pictures. RESULTS: Two hundred sixty eight priests and novices were examined. Their age ranged between 12 and 88 years with a mean of 48.5 years. Most priests and novices had normal vision (20/20-20/40 - 67.54%). No priest and novices had bilateral blindness. Almost half (48.13%) had eyeglasses and 2.24% had bilateral low vision. Unilateral low vision and unilateral blindness were 3.73% and 3.36%. One eye blindness and one eye low vision was only 0.37%. Refractive error was the leading cause of visual impairment (22.39%), followed by cataract (17.54%), glaucoma (5.97%), vitreo-retinal diseases (1.49%), and glaucoma suspected (occludable angle and ocular hypertension) (3.35%). Fifty five priests (20.52%) were referred for further investigation and treatment. CONCLUSION: Because the mean age of the priests and novices in this survey was only 48.5 years, the prevalence of visual impairment was low. Most of the cases were avoidable or preventable. The implementation of an effective screening program and access to eye treatment with standard of care remains a priority for the priests in rural areas. For sustainable development, eye health education must be promoted.

Glaucoma care and clinical profile in Priest Hospital, Thailand.

OBJECTIVE: To assess the prevalence, mechanism and status of glaucoma, and to investigate the magnitude of visual impairment from glaucoma and its relating factors in Buddhist priest and novices. MATERIAL AND METHOD: Cross-sectional study of 190 patients treated in Glaucoma service, Priest hospital was performed. One hundred thirty seven patients with glaucoma and suspected glaucoma had comprehensive ophthalmic examination included interview on medical and ocular history, visual acuity, applanation tonometry, gonioscopy, optic disc, visual field evaluation, and retinal nerve fiber layer thickness measurement (Stratus Optical Coherence Tomography; Stratus OCT). RESULTS: Glaucoma was diagnosed in 106 (77%) patients (181 eyes); 31 patients (23%) were glaucoma suspects. Open angle glaucoma (OAG) was found in 53 (50%) cases and classified into 36 (33%) primary open angle glaucoma and 17 (16%) normal tension glaucoma (NTG). Five (4.6%) patients had pseudoexfoliative glaucoma, 24 (23%) had primary angle-closure glaucoma (PACG), 10 (9.4%) had angle-closure glaucoma secondary to other causes (SACG), seven (6.6%) had secondary open angle glaucoma and seven (6.6%) were diagnosed of juvenile glaucoma. Among 31 glaucoma suspects, 18 cases were diagnosed based on disc appearance, eight based on intraocular pressure (IOP), two based on visual field and three cases had primary angle closure (PAC). The prevalence of glaucoma increased with age, with the highest prevalence (33%) in the age range 71 to 80 years. The Glaucoma service of Priest hospital diagnosed glaucoma in 53% of the priest. Rate of glaucoma was higher in priest from rural area than those from Bangkok and urban area. The mean baseline IOP was 26.5 +/- 14.7 mmHg. The mean treated IOP was 14.5 +/- 7.9 mmHg. The average mean deviation (MD) was -14.45 +/- 11.11. OCT showed average RNFL thickness of 70.8 +/- 35.6 microm. Glaucoma medications was received by 72% of the priest, 18% had laser treatment, and 22 % had glaucoma surgery. At diagnosis, two patients were blind according to WHO criteria, 29 (28%) patients were unilaterally blind, and seven (6.5%) had low vision. After treatment, 31 (29%) patients had unilateral blindness and none had bilateral blindness. The main associated diseases were hypertension, dyslipidemia, and diabetes. Transportation and financial condition were the major barriers in receiving eye care. CONCLUSIONS: OAG comprised 50% of all glaucoma, 23% of PACG, and 16% of all subtypes of secondary glaucoma. The prevalence of glaucoma in priest rose significantly with age. In the treated glaucoma patients, 47% retained good visual outcome. Delayed diagnosis was a major factor for unsatisfactory outcome as 28% of patients had monocular blindness at diagnosis and 53% were previously unaware of their disease.

Diabetic retinopathy in Priest Hospital.

BACKGROUND: Diabetic retinopathy (DR) is common complication of DM and is one of the leading causes of visual loss in working age population in developed and developing countries. The known risk of retinopathy is directly related to the degree and duration of hyperglycemia. Priests are one of the disadvantageous groups because they cannot select their food and have poor access to health care. These two reasons are suspected to be causes of high prevalence of DM and DR in the priests. OBJECTIVES: To perform complete eye examinations and take fundus pictures at DR screening to estimate the prevalence of DR in the priests and to perform appropriate treatment. MATERIAL AND METHODS: Retrospective review of the medical records of the priests and novices who had diabetes in Priest Hospital between October 2005 and September 2007 was done. Appointment for crosssectional DR screening for those who never had an eye exam and to complete DR treatment. RESULTS: Four hundred and fourteen diabetic priests and novices were enrolled in the study with the mean age was 61.65 years. Only 297 (71.74 %) of the diabetic priests had a visual acuity measurement previously. DR screening program was done in 176 priests. The result revealed that 123 priests had no DR (69.89 %), 33 (18.75%) had non-proliferative DR (NPDR), 20 (11.36%) had proliferative DR (PDR), and 11 (6.25% or 33.33% of NPDR) had clinically significant macula edema (CSME). From the previously diagnosed patients, 15 (28.3%) had Laser treatment performed and 2 (3.77%) had pars plana vitrectomy (PPV). CONCLUSION: Although Priest Hospital sent DR screening postcards to diabetic priests twice, only 176 (42.51%) priests came, and of those, 53 (30.11%) had DR. There is poor co-operation from the priests because of their lack of medical knowledge about DM complication and DR. The priest who came for the appointment were concerned with their health therefore, they had low prevalence of DR with moderate glycemic control. DR in the priests led to low vision (11.83%) and blindness (5.92%). For the priests, adherence to clinical guidelines for glycemic and BP control was low, even in a well-developed health care system with free ophthalmic care access because they cannot select their food and have poor transportation services to health care facilities.

Intravitreal bevacizumab for ahmed glaucoma valve implantation in neovascular glaucoma: a case report.

OBJECTIVE: To report the short-term efficacy and safety of intravitreal Bevacizumab injection in conjunction with implantation of Ahmed glaucoma valve in a patient with refractory neovascular glaucoma (NVG) caused by proliferative diabetic retinopathy (PDR). MATERIAL AND METHOD: A patient with NVG and vitreous hemorrhage caused by PDR was initially treated with 1.25 mg intravitreal Bevacizumab injection. One week after injection, intraocular pressure (IOP) did not improve with partial regression of the anterior segment new vessels. The patient underwent pars planar vitrectomy with panretinal photocoagulation (PRP) combined with trabeculectomy. Despite the initial good response, the patient developed recurrent hyphema and vitreous hemorrhage with uncontrolled IOP on full medications. Ahmed glaucoma valve implantation combined with the second intravitreal injection of 1.25 mg Bevacizumab was performed. RESULTS: At 48 hours postoperative, IOP markedly decreased. Iris neovascularization was not visible. The rapid resolution of hyphema and vitreous hemorrhage was noted. At 6 weeks follow-up, the patient gained visual acuity (VA) from hand motion to 20/100. The IOP was 8 mmHg with no recurrence of iris rubeosis. Vitreous hemorrhage had cleared revealed the view of fundus with full PRP and no new retinal vessels. At 8 weeks postoperative, there was small recurrent iris neovascularization without any rise in IOP. No intervention was done except careful follow-up. At 3 months, the patient retained VA of 20/100 with the IOP of 9 mmHg. Small iris rubeosis presented with no changes in appearance. No serious ocular or systemic adverse effects occurred after intravitreal Bevacizumab injections. CONCLUSIONS: Ahmed glaucoma valve implantation in combination with intravitreal Bevacizumab injection is effective in controlling IOP in refractory neovascular glaucoma. This approach may increase visual outcome in cases with extensive neovascularization, before PRP takes effect, weeks later The long-term efficacy and safety of this anti-proliferative agent in glaucoma drainage implants still requires further investigation.