cataract in the 21st century liana al-labadi, o.d. lecture 6 thanks to the ohio state college of...
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Cataract in the 21st century
Liana Al-Labadi, O.D.Lecture 6
Thanks To The Ohio State College of Optometry
Cataract
Definition
An ocular opacity, partial or complete, of one or both eyes, on or in the lens or capsule
This opacity usually impairs vision and causes blindness if not treated
The “cloudy” appearance of the eye resulted in the origin of the name cataract
http://www.herbalgranny.com/wp-content/uploads/2010/09/cataract.jpg
Cataract
Major public health problem throughout the world
Developing countries: resources are unavailable &/or inadequate to provide for surgical correction
Cataract accounts for the majority of all blindness
Developed countries: Increasing demand for cataract surgery has placed a burden on medial resources
The Ohio State College of Optometry
Cataract
Leading cause of blindness worldwide, accounting for vision loss in half of those blind
India: 3.8 million persons are blind from cataract
Africa: 2 million persons are blind from cataract
Projections indicate that the worldwide prevalence of blindness from cataract could reach 40 millions by 2025
The Ohio State College of Optometry
Cataract
Major public health problem throughout the world
Magnitude of the problem is likely to worsen in coming decades as the number of older persons in the world’s population increases.
Less developed regions: The population age 55 & older will nearly quadruple between the years 1980 & 2025
In the U.S.A, projections indicate an 82% increase in the number of persons age 55 & older between 1980 & 2030
The Ohio State College of Optometry
Cataract
Cataract Surgery
The most frequent operation in the US among persons over age 60
In spite of this simple procedure, cataracts still accounts for ~9% of blindness in the US
http://i.ytimg.com/vi/orWBAG4qBSM/0.jpg
Cataract- Epidemiology Study
OPT Epidemiology study
On July 30th, 2010 the St John of Jerusalem Eye Hospital group announced the publication of its seminal 2008 Epidemiology Study into Blindness in the occupied Palestinian Territory (OPT)
The study was published in PLoS ONE
An international, peer-reviewed, open-access, online publication.
Publishes reports on primary research from any scientific discipline.
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
Cataract- Epidemiology Study
Purpose: No recent data on the prevalence and causes of blindness in the occupied Palestinian Territories
No robust or comprehensive study of blindness in Palestinians has been conducted for over 20 years.
Aim of study: Estimate the prevalence & causes of blindness & visual impairment in people over 50 years of ago
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
Cataract- Epidemiology StudyPrevalence: The World Health Organization (WHO) estimates that there are 45 million people in the world who are blind.
This is expected to rise to 76 million by 2020 if current services are not improved
VISION 2020
A joint initiative by the WHO and the International Association for the Prevention of Blindness that aims to eliminate avoidable blindness by the year 2020
1st step in achieving this target is to obtain baseline data on visual impairment
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
Prevalence:The prevalence of blindness may be increased four-fold in areas affected by violent conflict
The WHO estimates that the number of blind people in 2002 in the Eastern Mediterranean Region-B (which includes the OPT) was over 1 million people, and that the prevalence of blindness in adults aged 50 years and above in this region was 5.6%
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
Cataract- Epidemiology Study
Population:OPT (Total Population = 3,761,600)
East Jerusalem & West Bank
2,345,100 people (2007 figures)
Gaza Strip
1,416,500 (2007 figures)
9% of the total population is over the age of 50!!
Cataract- Epidemiology Study
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
Results:
The prevalence of bilateral blindness was 3.4% in people 50 years & older
Estimate of blindness for the total population is 0.4%
The prevalence of blindness was higher in Gaza than in the West Bank; and higher among women than men
Cataract- Epidemiology Study
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
Results:
Avoidable causes of blindness accounted for 80% of bilateral blindness
Cataract
Refractive Error
Aphakia
Surgical Complications
Corneal Scarring
Phthysis
Cataract was the main cause of avoidable blindness
Cataract- Epidemiology Study
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
CountryPrevalence of
BlindnessLeading Cause of blindness
Palestine 0.4% Cataract
Israel 0.3%Macular Degeneration &
Glaucoma
Lebanon 0.6% Cataract & Refractive Error
Oman 1.1%Cataract & Trachmatous
corneal scarring
Cataract- Epidemiology Study
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
The results of the study suggest that 6,000 people in the OPT are blind due to cataract
Reasons for not attending Cataract Surgery
Education & beliefs play the largest factor
“old age and need not felt” --> most common reason
“Could not afford”
“Contraindication”
“Fear of operation”
“Unaware of treatment”
“Cannot obtain checkpoint pass”
Any expansion of surgical services need to be combined with education programs that raise public awareness and support health services to provide early identification and referral.
Increasing number of cataract surgeons & operations may not itself reduce the prevalence of blindness in the population
Cataract- Epidemiology Study
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
Women have a greater prevalence of blindness & lower cataract surgical coverage
Women in the study were more likely to express poverty as a reason not to have the surgery compared to men
Inequity between the sexes???
Cataract- Epidemiology Study
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
Cataract Surgery:
Study shows there is poor outcome after cataract surgery= BIG CONCERN
Requires further research & auditing of surgical cases
Post-operative refractive error was a major cause of poor and borderline outcome
Need to provide these patients with glasses after cataract surgery
Cataract- Epidemiology Study
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
The number of people with diabetes mellitus in the Middle East is expected to grow from the 2000 estimate of 20 million to just under 60 million in 2030
The study shows that there is a high proportion of people with poor vision due to diabetic retinopathy
This points to an urgent need to plan future diabetic eye services
Cataract- Epidemiology Study
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003
Study shows that most blindness in the OPT is avoidable
Goals:
Raising health awareness
Gender equity
Better outcomes of Cataract Surgery
Improving accessibility
The implementation of strategic & sustainable interventions in the delivery of eye services
Conclusion
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003