Assessment of visual morbidity amongst diabetic retinopathy at tertiary eye care center, Nepal: a cross-sectional descriptive study.

BACKGROUND: Diabetic retinopathy (DR) is one of the leading causes of preventable blindness in low and middle income countries. In Nepal, there are less studies regarding DR and they too are limited around Kathmandu valley. This study was done to assess visual morbidity in patients with DR at a peripheral tertiary eye care center of Nepal. METHODS: This was a prospective, hospital based, cross-sectional study in which all consecutive cases of DR were evaluated. DR was classified according to Early Treatment Diabetic Retinopathy Study Research Group - report no. 10 Table A5-1 (Modified Airlie House Classification). Data entry and analysis was done in an SPSS unit version 20. Wherever applicable, variables were set as 100 eyes. RESULTS: Total number of patients included in this study was 50. Commonest age group was 50-69 yrs. (43/77 yrs.; min/max) comprising 80% of the total population (n = 50) and the predominant population was male (76%). Non proliferative diabetic retinopathy (NPDR) was found in 69%, proliferative diabetic retinopathy (PDR) in 31% and advanced diabetic eye disease (ADED) in 3% (n = 100). CONCLUSIONS: All the stages of DR were present at significant proportions in this study, noteworthy was the percentage of PDR. This study shows an urgency to gather a national data on DR, raise awareness among diabetics and train effective man power at a local level to diagnose DR at an early stage.

Clinical and cost impact of a pediatric cataract follow-up program in western Nepal and adjacent northern Indian States.

BACKGROUND: High-quality, comprehensive pediatric cataract surgery programs have recently developed in low-income countries, but postoperative care has lagged. This study evaluated the post-cataract surgery follow-up program implemented in March 2011 at the Lumbini Eye Institute in Bhairahawa, Nepal, which included a full-time pediatric counselor and program director, a specific database, a tracking system, and cell phone reminders. METHODS: Baseline data for all cataract surgical patients <16 years of age were obtained retrospectively from hospital administrative records for 2009, the year prior to program introduction, and prospectively for all cases between March 1, 2011, and February 28, 2012. The statistical significance of the difference in the proportion of children attending follow-up in 2009 versus 2011-12 was calculated, and the overall program costs for 2011-12 was determined based on hospital records. RESULTS: In 2011-12, 334 children (248 males [74%]) underwent cataract surgery, including 89 Nepali (27%) and 245 Indian (73%) children. The proportion of boys was significantly higher in 2011-12 compared to 2009, but there were no differences in terms of age or distance to hospital. In 2009, 87%, 60%, and 37% attended their first, second, and third follow-up visits, respectively. Follow-up rates improved significantly to 96%, 81%, and 57%, respectively, after the implementation of the postoperative follow-up program. The 2011-12 program is estimated to have cost US$17,444. CONCLUSIONS: The new post-cataract surgery program resulted in improved follow-up at relatively little additional cost.

Pattern of fungal isolates in cases of corneal ulcer in the western periphery of Nepal.

PURPOSE: To find out the epidemiologic features in 686 consecutive cases of fungal keratitis presenting in a tertiary eye hospital in the western region of Nepal. MATERIALS AND METHODS: A prospective hospital - based study was carried out on 1880 consecutive patients presenting with corneal ulcer in the outpatient department and cornea clinic of Lumbini Eye Institute, Bhairawa, Nepal. The socio-demographic data, predisposing risk factors, prior treatment modalities, laboratory results and the distribution pattern of fungus species were analyzed. RESULTS: Diagnosis of fungus keratitis was established in 686 (36 %) out of the total study group of 1880 cases. The spectrum of fungi isolated were Fusarium species (Fusarium spp.) in 219 (31.9 %), followed by unidentified dematiaceous 151 (22 %), curvularia 122 (17.7 %) and unidentified hyaline in 111 cases (16.1 %). Men (59.3 %) were more commonly affected than women (40.6 %). The young adults age group of 31-40 years was most commonly involved (26.6 %). Corneal trauma (58 %) and topical steroids (12 %) were the most common predisposing risk factors noted. CONCLUSION: In contrast to the other studies done in Nepal, we found Fusarium to be the most common fungal isolate causing corneal ulcer followed by unidentified dematiaceous, unidentified hyaline and curvularia. Corneal trauma was the commonest predisposing risk factor in causing fungal keratitis.

Causes of vision impairment and assessment of need for low vision services for students of blind schools in Nepal.

BACKGROUND: The present study is first of its kind to evaluate causes of visual impairment of blind students in Nepal and assess their need for low vision rehabilitation services. AIM: To evaluate causes of vision impairment of students enrolled in blind schools in Nepal and assess the need for low vision rehabilitation services in these students. MATERIALS AND METHODS: A survey was conducted in 12 blind schools in Nepal, which were registered with Nepal Association for Welfare of Blindness (NAWB).It was conducted by a team of an ophthalmologist and an optometrist, by using standard eye examination protocols of the World Health Organization Prevention of Blindness Program (WHO/PBL). RESULTS: Of the 345 students enrolled in 12 schools, 285 students were examined (response rate of 82.61%). The students were in the 5 - 29 years age group. Nearly three-fourth of the children had become blind within one year of age and 52.3% visually impaired at birth and 20.7% developed vision impairment within one year of age. After refraction, 26 students (9.12%) had mild visual impairment, 21 students (7.37%) had severe visual impairment and 238 students (83.51%) were blind. The main cause of vision impairment was found to be corneal 35.79% and retina diseases, mainly dystrophy, 20.35% followed by problems with the whole globe, lens and optic nerve, accounting for 13.33%, 12.63% and 12.98% respectively. The major etiological factors were those of childhood such as Vitamin A deficiency, measles and similar causes (42.11%) followed by hereditary causes (25.26%). Of the total students examined, 48.07% were visually impaired due to preventable causes and 16.14% treatable aggregating to 64.21% of avoidable blindness. Fifty seven (28.22%) students could read smaller than 2 M print size after low vision assessment for near and 33(15.78%) students benefited with telescopic trial for distance low vision. CONCLUSION: In Nepal, renewed focus on providing best possible quality of life for visually impaired children by proper low vision assessment and eye health education focusing on, general public and community health workers, with governmental and institutional support is required to achieve Vision 2020 objectives to decrease childhood blindness.