Transcript The Prevalence of Five Major Causes of Low Vision in Ahmedabad

The Prevalence of Five Major Causes
of Low Vision in Ahmedabad
Population and their Respective
Management with Residual Visual
Function
By
Dadhija Paritoshbhai Dave
Study Project for B.Optometry
AIM
• The Prevalence of Five Major Causes of Low
Vision in Ahmedabad Population and their
Respective Management with Residual Visual
Function
REVIEW OF LITERATURE
• S.A.Khan concluded that the main causes for Low Vision are
Retinitis Pigmentosa , Diabetic Retinopathy , Macular Diseases and
Myopic Degeneration. This study was carried out in Tertiary Eye
Care Hospitals of South India8
• As per Dandona R , the most frequent causes of Low Vision
included Retinal Diseases , Amblyopia , Optic Atrophy , Glaucoma
and Corneal Diseases in the southern part of India (Andhra
Pradesh)9
• HB Thapa , S.Gurung , A.Sherchan , AS Karthikeyan and RP Kandel
described in their study the leading causes are Lens Related Causes
(Aphakia/Pseudophakia/Cataract) , Refractive Errors , Amblyopia ,
All Globe Abnormalities , Corneal Pathology , Retinal Diseases
(Different Maculopathies ,Retinal scars , Retinal Hemorrhages , Vein
Occlusion) and Other causes (Albinism , Nystagmus , Different
Associated Syndromes) in Nepal Population10
MATERIAL AND METHODOLOGY
• A prospective study was done to determine the Causes of Low Vision and
its Management in Ahmedabad City. Patients were conducted, at “BLIND
SCHOOL”, Vastrapur, and “Nagari Eye Hospital”, Ellisbridge, Ahmedabad.
Total of 350 Patients falling in Inclusion Criteria were examined
Inclusion criteria:
• Patient falling in criteria of Low Vision Definition that is Better Eye seeing ≤
6/18 to Perception of light after refraction and surgical correction
• Patient with Other Physical and Mental Disability like Deaf , Intellectual
Disable etc
Exclusion criteria:
• Patient not falling in criteria of Low Vision (Normal Patients)
• Patient those are totally Blind or having no perception of light
METHODOLOGY
History and Eye Examination
• External eye examination
• Anterior segment examination by torch and/or slit lamp biomicroscope
• Fundus examination by direct and/or indirect ophthalmoscope
Visual Acuity
• Distant visual acuity was assessed with Distance Snellen chart.
• Near vision was assessed by N series near chart of continuous text.
• Patients with visual acuity equal/less than 6/18 to perception of light in the
better eye, underwent tests for refraction and management
Refraction
• Objective Refraction – Retinoscope.
• Subjective Refraction – Trial Frame , Full Aperture Trial lenses
• Patient were assessed using the optimal illumination of a 40 watt halogen
lamp, with the light source directed at an angle of 45° to the page,
minimizing glare for near .As per subjective refraction spectacles were
advised
Cont….
Color Vision
• Panel D-15 (Binocularly)
Contrast Sensitivity
• Peli Robson Chart
Visual Field
• Amslers Grid
• Confrontation Test
Low Vision Aids
Optical Devices
• For Distance – Telescopes
• For Near – Different Magnifiers (Spectacle Magnifier , Stand
Magnifier , Bar Magnifier , Dome Magnifier , Hand Held Magnifier
and Illuminated Stand Magnifier ) were tried with patients having
less vision
Non-Optical Devices
• Large Print Books, Bold Line Notebook , Felt tip pen ,
Typoscopes , Reading lamp , Reading Stand , Peaked Caps ,
Torch were advised.
Training
• Orientation and Mobility Training, Rehabilitation Training
and Tactile Training. Braille and Talkative Instruments were
advised to them.
• The Data Collected from the study was inputed in Excel
Sheet and analysis was made with calculations to find out 5
major causes of Low Vision in Ahmedabad Population
RESULT
Other Causes founded in 19.44% were Aphakia , Pseudophakia , Cataract ,
Refractive Error associated with Amblyopia , Macular Dystrophy, Diabetic Retinopathy, Glaucoma,
Retinopathy of Prematurity and Retinal Detachment
LOW VISION AIDS
AIDS
PATIENTS
PERCENTAGE
CAUSES
DEVICES
Only Training
115
32.86%
Advanced RP , Retinal Dystrophy
, Severe Optic Atrophy , ARMD
Training Advise like Orientation
and Mobility , Rehabilitation and
Tactile Training.Along with it
Braille and Talkative Instruments
were advised.
Near Devices
86
24.57%
Microcornea ,
Microophthalmos,Iris Coloboma ,
Retinal Coloboma with
Nystagmus , High Hypermetropia
Spectacle Magnifier , Stand
Magnifier , Bar Magnifier ,
Dome Magnifier , Hand Held
Magnifier and Illuminated Stand
Magnifier
Distance
Devices
Near
Distance
Devices
57
16.29%
Myopic Degeneration , High
Myopia
RP , Microcornea ,
Microophthalmos,Iris
Coloboma,Retinal Coloboma with
Nystagmus, Glaucoma , Albinism
, Macular Dystrophy , Diabetic
Retinopathy , Aphakia ,
Pseudoaphakia , Cataract
Telescopes
Refraction
High Add
Total
and 27
+ 65
350
7.71%
18.57%
100%
Spectacle Magnifier , Stand
Magnifier , Bar Magnifier ,
Dome Magnifier , Hand Held
Magnifier and Illuminated Stand
Magnifier,Telescopes
Refractive Error , Amblyopia ,
Spectacle for Near and Distance
Aphakia , Pseudophakia , Cataract Correction
DISCUSSION
This study presents five major causes of Low Vision in Ahmedabad
Population.According to this study which was carried out in 350 Patients ,
248 Patients (70.86%) were males.The major causes in Ahmedabad
Population are :
• Microcornea , Microphthalmos, Retinal Coloboma and Nystagmus 22.57%
• Optic Atrophy - 19.42%
• Retinitis Pigmentosa – 17.43%
• Myopic Degeneration – 14.85%
• Albinism – 6.29%
• Others – 19.44% (Aphakia , Pseudophakia , Cataract , Refractive Error
associated with Amblyopia , Macular Dystrophy, Diabetic Retinopathy,
Glaucoma, Retinopathy of Prematurity and Retinal Detachment)
.
According to the study done by Mr.S.A.Khan in 450 Patients in Southern India , the
leading causes were :
• Retinitis Pigmentosa – 19% ,
• Diabetic Retinopathy – 13% ,
• Macular Diseases – 17.7% ,
• Myopic Degeneration – 9%.
• Out of 450 Patients , 297 (72%) were males
As per study of Mr.S.A.Khan , 72% of Patients were males. Similarly in this study the
maximum patients that is 70.86% were males.
According to study of Mr.S.A Khan , Retinitis Pigmentosa was major cause with 19% where
as in this study Retinitis Pigmentosa was third major cause with 17.43%.
As per study of Mr.S.A.Khan Myopic Degeneration was the fourth major cause in
Southern India same as Myopic Degeneration is the fourth Major Cause in the
Ahmedabad Population
But Diabetic Retionpathy and Macular Diseases are not the major causes in Ahmedabad
Population where as they were one of the major causes in southern India as per study
of Mr.S.A.Khan
According to study of Dandona R., the study which was carried out in Southern part of India
that is Andhra Pradesh ,
• Retinal Diseases was major cause with 35.20% , followed by
• Refractive Errors & Amblyopia – 25.70% ,
• Optic Atrophy – 14.30% ,
• Glaucoma – 11.04% ,
• Corneal Diseases – 8.60%.
This study was performed on 144 Patients.
Relating this study to our , we found that the Optic Atrophy which was third major causes in
Andhra Pradesh which constituted to 14.30% , was the Second major cause in Ahmedabad
Population with 19.42%.
R.Dandona studied that 11.04% people of Andhra Pradesh were having Glaucoma as there
Low Vision Disorder which contributed to fourth major cause.However in this study ,
Glaucoma was not found to major cause of Low Vision.
Similarly Refractive Error and Amblyopia were not the major causes in Ahmedabad Population.
Microcornea which is one of the Corneal Dystrophy , associated with Microphthalmia , Retinal
Coloboma and Nystagmus was the most leading cause in Ahmedabad Population.In Study
of Dandona R different types of Corneal Diseases formed 8.60%.
HB Thapa , S.Gurung , A.Sherchan , AS Karthikeyan and RP Kandel studied that the leading causes of
Low Vision were :
• Lens Related Causes (Aphakia / Pseudoaphakia / Cataract ) – 35.55% , followed by
• Refractive Error and Amblyopia – 19.23% ,
• Retinitis Pigmentosa – 10.84% ,
• Whole Globe Abnormalities – 10.24% ,
• Corneal Pathologies – 7.24% ,
• Retinal Diseases – 6.64% and Others – 10.25% (Albinism , Nystagmus and Associated Different
Syndromes).
This study was carried out in 166 Nepali Patients.Out of these , 70% of Patients were males
According to our study , 70.86% Patients were males out of 350 patients which is similar to study of
HB Thapa and group which has 70% Patients as males.
In study of HB Thapa and Group Lens Related Causes was major cause with 35.55% whereas in
Ahmedabad Population that is not the Major Cause.Similarly in study by Dandona R and S.A.Khan
, Lens Related Causes were not Major Causes.
Refractive Error contributes to second major cause in Nepal with 19.23% but in Ahmedabad
Population it was not major cause.
Retitinis Pigmentosa was third major cause with 10.84% in Nepal.Similarly in Ahmedabad Population
it was third major cause with 17.43%.However in study of Mr.S.A.Khan , Retinitis Pigmentosa was
the most major cause with 19%.
Corneal Pathologies contributed to fifth major cause in Nepal Population with 7.24%.Similarly in
study of Dandona R , Corneal Diseases was fifth major cause with 8.60%.However in
Ahmedabad Population Microcornea which is one of the Corneal Dystrophy , associated with
Microphthalmia , Retinal Coloboma and Nystagmus was the most leading cause with 22.57%
in Ahmedabad Population.
Albinism was found in very less people in Nepal as reason for causing low vision but in
Ahmedabad Population it is the fifth leading cause of Low Vision with 6.29%
As per study by HB Thapa , S.Gurung , A.Sherchan , AS Karthikeyan and RP Kandel , Training was
advised in 6.02% Patients , Near Magnification was given in 54.23% Patients , Spectacles as
per Refraction were advised in 19.27% Patients , Distance Devices were given in 20.48%
Patients.However, as per our study Training was advised in 32.86% Patients, Near
Magnification was given in 24.57% Patients, Spectacles as per Refraction were advised in
18.57% Patients, Distance Devices were given in 16.29% Patients and Near and Distance
Devices were advised in 7.71%.
This shows that severity of Low Vision was more in Ahmedabad Population as compared to
Nepal Population
•
There are so many studies done on different causes of Low Vision in the different regions of
the world , but in Ahmedabad Population not a single study was done. So this study is about
the leading five major causes of Low Vision in Ahmedabad Population
CONCLUSION
By this study we conclude the Five Major Causes
of Low Vision in Ahmedabad Population and
their respective management gives better
lifestyle to low vision patient with their
residual visual function.
REFRENCES
1.
World Health Organization. Global initiative for the elimination of avoidable blindness.
WHO/PBL/97.61. Geneva: WHO, 1997.
2.
International Classification of Diseases ICD -10 2010;2
3.
World Health Organization 1997
http://www.who.int/blindness/causes/priority/en/index5.html
4.
A.K.Khurana Comprehensive Ophthalmology Fourth Edition
5.
World Health Organization 2006 , Retrived December 16 2006
http://en.wikipedia.org/wiki/Blindness
6.
World Health Organization Fact Sheet Number 282 June 2012
http://www.who.int/mediacentre/factsheets/fs282/en/
7.
AO Oduntan Prevalence and Causes of Low Vision Worldwide S Afr Optom 2005;64:44-54
8.
S.A.Khan To obtain data on the characteristics and causes of low-vision patients seen at a
tertiary eye care hospital in India. Indian Journal of Ophthalmology 2000;48:201-207
9.
Dandona R, Dandona L, Srinivas M, Giridhar P, Nutheti R, Rao GN .To assess the prevalence
and causes of low vision in a population in southern India for planning low vision services.
International Centre for Advancement of Rural Eye Care, L. V. Prasad Eye Institute,
Hyderabad, India http://www.ncbi.nlm.nih.gov/pubmed/12359608
10. HB Thapa, S Gurung, A Sherchan, AS Karthikeyan, RP Kandel Hospital based study on causes of low
vision and patient preference for different types of low vision devices Journal of Institute of
Medicine 2007;29:2
11. Shah SP, Minto H, Jadoon Z, on behalf of the Pakistan National Eye Survey Study Groupet al.
Prevalence and causes of functional low vision and implications for services: The Pakistan National
Blindness and Visual Impairment Survey. Invest Ophthalmol Vis Sci. 2008;49:887–893.
12. Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive Error Study in Children: sampling
and measurement methods for a multi-country survey.Am J Ophthalmol. 200;129:421–426.
13. Pokharel GP, Negrel AD, Munoz SR, Ellwein LB. Refractive Error Study in Children: results from
Mechi Zone, Nepal. Am J Ophthalmol. 2000;129:436–444.
14. Gilbert C, Rahi J, Quinn G. Visual impairment and blindness in children. Johnson G Minassian D
Weale R West S eds. Epidemiology of Eye Disease.2003; 2nd ed. Edward Arnold Ltd. London. chap
16
15. http://laico.org/v2020resource/files/Prevalence_causesoflowvision_worldwide.pdf
16. http://www.cehjournal.org/download/ceh_16_45_014.pdf
17. http://eso.sankaranethralaya.org/drev/selected-abstracts/14_Sarika%20Gopalakrishnan_1.pdf
18. http://www.nepjol.info/index.php/JIOM/article/view/678
PATIENT PROFORMA
APPENDIX
•
DATE: _____/______/_______
•
NAME OF PATIENT:
•
ADDRESS:
•
AGE: ____________
•
COMPLAIN: ________________________________________________________________
•
HISTORY: __________________________________________________________________
•
History of Eye Surgery:
____________________________________________________________________________
•
History of Systemic illness:
____________________________________________________________________________
•
Cause / Duration of Low Vision / Blindness:
____________________________________________________________________________
•
Other Disability:
____________________________________________________________________________
GENDER: __________________
•
Family History: _______________________________________________________________
•
Medical History: ______________________________________________________________
•
Education: ___________________________________________________________________
•
Financial Status:
•
Use of glasses:
•
•
Previous Glass Prescription
Sph
cyl
RE:
LE:
•
Previous Low Vision care:
•
Source of Low Vision Device:
•
Low Vision Device:
•
Currently being used:
Sufficient
Yes
/
Local
/
Non-Sufficient
No
axis
Yes /
VA
No
Prescribed
/
Imported
Yes / No
/
Self Purchased
•
If Yes then details of it: ________________________________________________________
•
Distance Inspection: ___________________________________________________________
•
External Examination:
RE
•
•
•
•
•
•
•
•
•
•
•
•
Lids / Lacrimal Apparatus:
Conjunctiva:
Cornea:
Anterior Chamber:
Iris / Pupil:
Lens:
Cover Test:
Ocular Movement:
Fundus Evaluation:
Literacy: Print / Braille / Print + Braille / Not literate
Fixation: OD: Central / Eccentric
OS: Central / Eccentric
•
•
•
Unaided Vision :
Sph
cyl
RE:
LE:
Pinhole Vision:
•
•
•
RE:
LE:
axis
LE
VA
Objective Refraction: (Retinoscopy)
•
Sph
cyl
axis
• RE:
• LE:
VA
•
•
•
•
•
Subjective correction with Visual Acuity:
Sph
cyl
axis
RE:
LE:
BE:
•
Near Vision : Test used
_________________________________________________________
•
Unaided Near Visual Acuity:
•
•
•
RE:
LE:
BE:
•
•
•
Aided Near Visual Acuity:
RE:
N
LE:
N
N
N
N
VA
•
At ____________ Working Distance
•
With BE ___________________ N _____________ Working Distance
•
Low Vision Device for Distance
•
Telescope : _____ X
•
•
•
Visual Acuity with Telescope
RE: _______
LE: _______
•
Not Tried :
•
Low Vision Device for Near:
•
•
Magnifier: Prescribed /
Type: With ____ D
•
Visual Acuity _____ in reduced Snellen N Notation
•
Combination of 2 Devices for Near :
______________________________________________________________________
•
Reading Speed with Low Vision Device: ______________________________________________
Not
•
Additional Illumination:
•
With Additional Illumination: Improved /
•
Binocular Vision : Yes / No
•
Visual Field : Done /
•
•
•
Limitation of Visual Field :
RE:
LE:
•
Contrast Sensitivity :
____________________________________________________________
•
Test used
_____________________________________________________________________
•
Glare / Photophobia : Yes / No
•
In Sunlight : No Problem /
•
Preferred Indoor light: Normal
Required
/
Not Required
Remain Same /
Facing Difficulty
Not Done
Uncomfortable
/
/
Extralight
Can Hardly Seen
/
Reduced
• Orientation and Mobility Problem : Yes / No
• When : In Daytime / At night
• Colour vision :
______________________________________________________
• Non-Optical Devices :
_______________________________________________________
• Rehabilitation Service or Training Required :
Yes /
No
• Advise:
______________________________________________________
• Follow up Date: ________________