Rapid assessment of cataract surgical services in age group 50 years and above in lower DIR district Malakand, Pakistan

To assess the rapid assessment of cataract blindness and surgical services in age group 50 years and above. Design: A cross-sectional survey. Place and Duration of Study: This survey was conducted in District Lower Dir, Malakand Division, NWFP, Pakistan, from March 9-23, 2003. Patients and A community-based survey was carried out with systematic cluster random sampling. The survey was preceded by a pilot study in which the proforma and operational methods were field-tested and refined. One thousand, one hundred and fifty eligible adults of 50 years and older were selected by systematic random sampling from the whole lower Dir district of Malakand, Pakistan. A total of 1076 subjects [93.6%] were examined. The visual acuity of each eye was assessed using tumble Snellen's E Card method at 6 and 3 meters. Any subject having visual acuity <3/60 with or without obvious lens opacity or with aphakia [removal of lens] or pseudophakia [removal of cataract lens and implantation of artificial lens] was examined in detail. The surgical services were assessed by measuring the prevalence of pseudophakia, surgical outcome of visual acuity and also the effect of place of surgery on outcome. Prevalence of total bilateral blindness was 2.6%, and unilateral blindness 2.46%.Total prevalence of aphakia was 2.4%, which was almost equal in both sexes, male 2.3% and female 2.4%. Prevalence of unilateral aphakia was 0.3% in females being slightly higher than males, 0.16%.The prevalence of bilateral aphakia was 2.2% and 2% in males and females respectively. Prevalence of total pseudophakic eyes was 2.74%. Surgical outcome showed good, borderline and poor visual acuity of 40.5%, 22% and 14.3% respectively. Surgical outcome was also seemed to be better in private hospitals as compared to field camps. It is concluded that to reduce the prevalence of blindness there was a need to improve the quality of services in mobile camps and fixed facilities. At the same time the visual outcome of surgery could be improved by expanding the number of Intraocular lens procedures and routine monitoring of cataract outcome

Pattern of eye diseases in children of 5-15 years at Bazzertaline area [South Karachi] Pakistan

To assess the prevalence and pattern of eye diseases in children aged 5-15 years. Population based cross-sectional survey. Bazzertaline area of Karachi [South] from July to August, 2003. A community-based survey was carried out at the Bazzertaline Area, South Karachi, Pakistan on 5110 children 5-15 years of age. The socioeconomic status of the area was low, with many living below the poverty line. The survey used the WHO definitions of visual impairment as criteria for classification. St and ard Snell's literate and illiterate charts were used for assessing the visual acuity. An anterior segment examination with a torch light and loupe was carried out and the posterior segment examined with a direct ophthalmoscope, initially without pupil dilation. Suspected cases of amblyopia, albinism, traumatic cataract and squint, etc. were examined with pupil dilatation. Refractive error of 2% was found to be the primary ocular morbidity, followed by conjunctivitis 1.2%, and squint was found as third ocular morbidity with the prevalence of 0.6%. Those diseases that were less than 0.5% included unilateral amblyopia, corneal ulcer/opacity, cataract, aphakia, trauma, blepharitis, albinism, stye, chalazion and unilateral/bilateral blindness. Bilateral blindness was present in 2.7/1000 children, the major causes being cataract and corneal diseases. Low vision was found in 2.2%, the leading cause being uncorrected refractive error. Visual acuity according to 2.42%. Gender showed higher visual impairment in girls as compared to boys 1.72%. Only one case of vitamin-A deficiency was seen. Provision of spectacles would address the most commonly found problem of uncorrected refractive error. Lack of trained personnel and facilities for low vision services in addition to lack of advocacy and awareness in the community contribute to the pattern of eye disease in the area