Prevalence of and associated risk factors for pterygium in the high altitude communities of Upper Mustang, Nepal.

OBJECTIVE: To determine the prevalenceof and associated risk factors for pterygiumin the high altitude communities of the Upper Mustang region of Nepal, near the Tibet border. MATERIALS AND METHODS: Six villages of the Upper Mustang were selected based on the concentration of population. All subjects were permanent residents aged 16 years and older, and recruited through a household census with mobilization of local monks who had been trained as interviewers, and people were invited to attend the eye clinic for a complete examination. A cross-sectional studywas conducted which included the parameters oflaterality, severity, occupation, age, sex and altitude of residence. RESULTS: The study population comprised 1,319 individuals of which 637 (48.29%) weremale and682 (51.71%) were female.The overall prevalence of pterygium, was 10.08% (133 of 1,319), with 42.86% for males and 57.14% for females. The mean age of the subjects was45.83 years and the mean SD 17.94. The majority of the subjects had a unilateral pterygium. The right eye(n=63) was predominately affected, in 57.80% of the total subjects. Farmers and construction workers, which comprised of 36.09% and 28.57% respectively, had a higher prevalence of pterygium. The most affected age group was the 66 to 75 years group (n=31: 23.31%). The prevalence increased linearly with age. The severe Grade III and Grade IV pterygium were predominant in the age group of 56-65 years, comprising 28.58% of all the cases;the less severe Grade I was also predominant in the same age group,with 23.56%, and Grade II (0-2 mm) was predominant in the age group of 46-55, with 31.03%. CONCLUSION: Pterygiumisa significant public health problem in the high altitude communities of Nepal. It is more prevalent amongst the farmers than in the other professionals.

Phacoemulsification surgery by a nationally-trained cataract surgeon of Nepal.

INTRODUCTION: A one month phacoemulsification training course had been implemented by the Nepal Netra Jyoti Sangh (NNJS) in collaboration with Association for Ophthalmic Cooperation to Asia, Japan (AOCA). OBJECTIVE: To evaluate the visual outcomes of phacoemulsification surgery by a nationally trained surgeon in Nepal. MATERIALS AND METHODS: A retrospective study of patients that underwent phacoemulsification with foldable intraocular lens implantation during a period of 18 months was carried out. Cases that had a six-week follow-up period were included. Effective phaco time (EPT), intra-operative and postoperative complications were noted. Uncorrected visual acuity (UCVA) at day 1 and best corrected visual acuity (BCVA) at week 6 were noted. The data were analyzed using SPSS 11.5. RESULTS: A total of172 patients that had completed a 6 week follow-up evaluation were included in the study. The mean age of patients was 57.12±10.19 years. The mean effective phaco time (EPT) was 9.74±7.41 seconds. Posterior capsule rupture (PCR) with vitreous loss occurred in 2 eyes (1.2%), Descemet's membrane detachment in 1 eye (0.6%), capsulorhexis extension in 1 eye (0.6%) and wound site thermal injury (WSTI) occurred in 3 eyes (1.7%). Postoperative complications were mild to moderate striate keratopathy (9/ 172), corneal edema (1/172), corneal epithelial defect (1/172) and uveitis (1/172). At 6 weeks post-operatively, 165 eyes (95.9%) had a BCVA better than 6/18 and 7 eyes (4.1%) had a BCVA of 6/18 to 6/60. CONCLUSION: Patients undergoing phacoemulsification had a good visual outcome as a result of the procedure performed by cataract surgeon trained from AOCA/NNJS national phacoemulsification training program of Nepal.

Pattern of ocular trauma in the western region of Nepal.

INTRODUCTION: Ocular trauma is an important cause of unilateral blindness. OBJECTIVE: To determine the characteristics and visual outcome of ocular trauma in the western region of Nepal. MATERIALS AND METHODS: All cases of ocular trauma presenting in a one-year period to the Himalaya Eye Hospital were retrospectively reviewed. The demographic features, type and cause of trauma, time lapse before presenting to the hospital, management and results were noted. RESULTS: Eleven hundred eyes of 1,069 patients (31 bilateral injuries) were included in this study. Males were predominantly affected (69.3 %) compared to their female counterparts. The average age of the patients presenting with trauma was 28.3 years. On reviewing the causes of trauma, blunt trauma which accounted for 56.5 % was the commonest of all, followed by sharp injury accounting for 16.7 %. The commonest type of trauma was closed globe injury (73.3 %). The visual outcome was poorer in open globe injury as compared to closed globe injury. Of the total cases, only 52.9 % presented to the hospital within 24 hours.Over 7 % of them presented as late as one week. Among these patients, 74.8 % of them had regained normal vision (6/18) and 8 % of the total became blind (less than 3/60) according to the WHO criteria. CONCLUSION: Males are more prone to ocular trauma than the females. Open globe injury and late presentation are probably the worst prognostic factors for the visual outcome. There is a need of educating the community regarding the importance of seeking immediate medical care after ocular trauma in a country like Nepal.

Pseudoexfoliation syndrome in various ethnic population of Nepal.

Pseudoexfoliation syndrome is an ocular condition characterized by a distinctive deposition of fibrillar material in the anterior segment of the eye. Pseudoexfoliation syndrome is frequently associated with glaucoma. Though it is seen in all the population, prevalence varies considerably in different races. A hospital based study done in Nepal by our group showed that Gurung population is frequently affected by this disease than any others. To determine the fact a larger population based study was necessary. Thus a research was designed to survey the various populations in the community. Different population from Kathmandu valley, Kavrepalanchowk, Pokhara, and Ghandruk were evaluated in two different phases to include major ethnic population living in Nepal. Household surveys done to bring all the targeted population to base hospital and detail examination including anterior segment evaluation after dilatation of pupil, optic disc evaluation, intraocular pressure measurement, gonioscopy, visual field recording and photographic documentation was done. Total of4430 population surveyed while only 2135 fulfilled the criteria for inclusion. Gurungs irrespective of their place of residence showed higher prevalence of Pseudoexfoliation syndrome accounting for 7.8% in Kathmandu valley while 12.0% in Ghandruk. Tamangs were affected very rarely by this disease accounting only for 0.3%. Gurungs are at higher risk of developing Pseudoexfoliation syndrome than any others in Nepal.

Prevalence of blindness and cataract surgery in Gandaki Zone, Nepal.

BACKGROUND/AIM: Himalaya Eye Hospital (HEH), established in 1993, is rendering eye care services in the Gandaki and Dhaulagiri zones. The hospital has extensive community outreach activities along with services for outpatients, emergencies, and subspecialties such as vitreoretinal, paediatric, and low vision. The operation theatre is well equipped to match the surgical needs including phaco surgery for cataract. The hospital has performed more than 14 000 cataract surgeries and 250 000 treatment services during this period. The aim of this study was to estimate the prevalence of blindness, visual impairment, and cataract surgical coverage among the older adult population of three districts of Gandaki Zone, where 80% of the hospital's service recipients reside. METHODS: People aged 45 years and older were enrolled in the study using a stratified cluster design. Subjects in 25 randomly selected clusters from the listed 806 were recruited through door to door visits. Each recruited subject had visual acuity (VA) and clinical examination conducted by an ophthalmologist. The survey was preceded by pre-pilot and pilot studies to refine the operational method. To assess quality assurance the interobserver variation in VA measurement was also carried out in five different clusters. RESULTS: Out of 5863 selected subjects 85.3% were examined. Blindness defined as presenting VA <6/60 in both eyes was found in 2.6% (95% confidence interval (CI): 2.2 to 3.9), whereas 16.8% individuals examined had vision <6/19 in one or both eyes. Cataract was the principal cause of blindness in 60.5%, and refractive error was the dominant cause of vision impairment (<6/19) 83.3%. Cataract surgical coverage was 59.5% among the cataract blind and associated with younger age, literacy, and male sex. CONCLUSION: The finding suggests a positive impact of the HEH programme on the prevalence of blindness and cataract surgical services in the survey area. Strategies to further improve access and utilisation of facilities and increase cataract surgical coverage need to be developed.

Barriers to up take cataract surgery in Gandaki Zone, Nepal.

OBJECTIVE: Cataract though avoidable remains as leading cause of blindness in Nepal. Though, Himalaya Eye Hospital rendering high quality surgical service through its base hospital and out reach service in Gandaki Zone having cataract surgical rate is below 1500 per million. Therefore, it is mater of interest to investigate the reason and the finding would be helpful to plan the future cataract programme to CSR to desirable level, if we know the reason(s) that forced them living as blind in community and not seeking available surgical services. METHOD: All person with cataract affecting their visual acuity to <6/60 (corrected) in either eye found in stratified cluster design sampling were enrolled in the study. They were interviewed with structured questionnaire investigating their knowledge and attitude of their visual impairment and barriers for not seeking cataract surgical service to date. RESULTS: A total of 303 eligible subjects were enrolled in the study. Out of them 57.8% of people knew about the cataract and they also think their vision impairment is due to cataract. But 56.11% of people were not aware their vision will improve. Surgical camp attendant or operated patients were found to be effective media to spread the message that the cataract is curable. Among the barriers: fear for surgery 31.1%, lack of attendant and geographical distance 32.8%, financial 24.1% and other clinical reason were found to be 12% as a reason for not seeking available surgical service. CONCLUSION: The cataract service marketing, eye health education disseminating the information on cataract and its curability is not found to be adequate. Therefore, the future cataract programme should give more concentration on creating awareness on cataract and subsidizing the available surgical service and service need to be brought to more proximity for the needy poor people.