Refractive Error among Children Visiting the Department of Paediatric Opthalmology of a Tertiary Eye Care Center.

Introduction: Refractive error is the inability of eyes to focus clearly on images. Visual impairment due to refractive error has a major impact on children's education and daily activities. The hospital has no documentation of the ocular morbidity related to refractive errors in children. The aim of this study was to find out the prevalence of refractive error in children visiting the Department of Paediatric Ophthalmology of a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Outpatient Department of Paediatric Ophthalmology in a tertiary care centre from 8 September 2022 to 7 March 2023 after obtaining ethical approval from the Institutional Review Committee. A convenience sampling method was used. The point estimate was calculated at 95% Confidence Interval. Results: Among 3600 children, the prevalence of refractive error was seen in 668 children (18.56%) (15.61-21.51, 95% Confidence Interval). Refractive error was seen in 363 (54.34%) boys and 305 (45.66%) girls. Myopia was found in 340 (50.90%), astigmatism in 207 (30.99%), and hyperopia in 121 (18.11%). Conclusions: The prevalence of refractive error among children attending a tertiary care centre was found to be higher than studies done in similar settings. Regular screening of refractive error for visual impairment is recommended among school going children. Keywords: astigmatism; hyperopia; myopia; refractive error; visual impairment.

Prevalence of Retinitis Pigmentosa in a Tertiary Eye Hospital of Nepal.

INTRODUCTION: Retinitis Pigmentosa (RP) is a group of diffuse retinal degenerative diseases predominantly affecting the rod and cone photoreceptors. The prevalence of retinitis pigmentosa seen in literature is approximately 1:4000. Retinitis Pigmentosa is one of the the most common causes of blindness in the age group of 20 to 40 years. The objective of this study was to determine the profile of retinitis pigmentosa in Terai and Nepal-India border region considering patients seeking care at a Tertiary level Eye Hospital in the terai region (southern part) of Nepal. MATERIALS AND METHODS: A hospital-based, retrospective study was carried out at R. M. Kedia Eye Hospital. A total of 385 (83 males and 107 females from Nepal and 109 males and 86 females from India) diagnosed patients of Retinitis Pigmentosa were included in the study. Data was collected over a period of eleven years from 2008-2018. RESULTS: Out of 385 diagnosed Retinitis Pigmentosa patients, 192 (49.87%) were male and 193 (50.13%) were female with slightly female predominance. The prevalence of RP seen in our study was 0.03%. About 51% of the patients visited here were from India and nearby border areas/ villages which cover most of the rural areas of India. In this study it was found that 49.34% of the RP cases were from Nepal, of which 43.63% of cases were from Hindu community and 5.71% from Muslim community and about 50.66% cases of RP were from India, of which 37.67% from Hindu and 12.98% from Muslim community. The peak age of presentation of RP was at 30-39 years (29.09%), followed by 20-29 years (26.75%). The common marriage pattern of consanguinity was found in Muslim community in between the first cousins. In this study the hospital record did not show any evaluation for the syndromic disease in the hospital record, though RP is usually non syndromic and there are literatures where many syndromic forms have been identified. CONCLUSION: The prevalence of RP seen in the study was 0.03% (A total of 1101299 sample population of which 385 patients had RP). Since RP is an inherited disease and is one of the non-treatable causes of blindness which runs in the families, a role of counseling to reduce consanguineous marriages should be brought forward to reduce the disease process.

Visual Outcome of Pediatric Traumatic Cataract in Lumbini Eye Institute, Bhairahawa, Nepal.

INTRODUCTION: There are not many studies of pediatric trauma in Nepal. Therefore, this study was conducted to find out the visual outcome of pediatric traumatic cataract and causes of poor visual acuity. MATERIALS AND METHODS: In this hospital based prospective study, all children visiting the pediatric department of Lumbini Eye Institute and Research Center with traumatic cataract and visual outcome after surgery from July 2018 to August 2019 were evaluated. A total of 136 children ranging from age (0 months to 15 years) with traumatic cataract were included in the study. Data on age of presentation, sex and diagnosis were collected from clinical charts and analyzed. RESULTS: The study enrolled 136 cases with traumatic cataract. 72.1% male and 27.9% female patients were involved with the average age being 9.46 years (SD 2.95). Final visual acuity was better than 20/60 in 73 percent of the children. Visual acuity was poor in 27 percent of children. In children with poor visual acuity 44 percent of the patients had corneal opacity, 23 percent had retinal detachment and 18 percent had vitreous opacification secondary to trauma. Closed globe injury was seen in 72 percent of children and 28 percent had open globe injury. CONCLUSION: Male children were more prone to traumatic cataract than female children. Open globe injury with corneal laceration and opacity was the major cause of decreased visual acuity.

Need to improve awareness and treatment compliance in high-risk patients for diabetic complications in Nepal.

OBJECTIVE/INTRODUCTION: It is known that knowledge, awareness, and practice influence diabetic control. We compared factors pertaining to healthy lifestyle (exercising, avoiding smoking), self-help (attending appointments, following treatment regimens), and diabetic awareness in high-risk patients for diabetic complications, specifically, those on insulin versus non-insulin treatment, and also those with a longer diabetic duration (≥5 years) versus a shorter duration. METHODS: 200 consecutive patients with type 2 diabetes (52.0±11.6 years) attending diabetic clinic at a referral hospital in Nepal were recruited. A structured questionnaire explored non-clinical parameters including age, gender, diabetic duration, awareness about diabetes control, self-help, and lifestyle. Clinical data were also measured: HbA1c, fasting blood sugar (FBS), blood pressure, and treatment type (insulin, diet/tablet). RESULTS: A significantly higher proportion of patients on insulin (vs non-insulin) or with diabetic duration ≥5 years (vs <5 years) self-reported not doing regular exercise, forgetting to take medicine, and not knowing whether their diabetes was controlled (p≤0.005). HbA1c/FBS levels were significantly higher for patients on insulin or with a longer diabetic duration (p≤0.001). 92% of those on insulin (vs 31% on non-insulin) and 91% with diabetic duration ≥5 years (vs 28% of <5 years) self-reported to seeking medical help due to episodes of uncontrolled blood sugar in the last year (p<0.001). CONCLUSION: Poor self-help/lifestyle and reduced knowledge/awareness about diabetic control was found in patients on insulin or with longer diabetic duration. This is a worrying finding as these patients are already at high risk for developing diabetic complications. The findings highlight need for targeting this more vulnerable group and provide more support/diabetic educational tools.