Publications (3)5.93 Total impact
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Article: Outcomes of cataract surgery: a population‐based developing world study in the Bhaktapur district, Nepal
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ABSTRACT: Background: To evaluate the visual outcome after cataract surgery in a population of Nepal.Design: Population-based cross-sectional study.Participants: Forty years and above residing in Bhaktapur district.Methods: Subjects were selected from 30 clusters using cluster sampling procedure. All underwent a detailed examination at the base hospital, including logarithm of minimal angle of resolution visual acuity, refraction, applanation tonometry, cataract grading, retinal examination and perimetry when indicated.Main Outcome Measures: Visual acuity after cataract surgery.Results: Out of 4003 subjects examined, 151 had undergone cataract surgery. Pseudophakia was present in 142 (94.0%), aphakia in nine (6%). Presenting and best-corrected visual acuity ≥6/18 was achieved in 123 (54.4%) and 164 (72.4%) eyes, respectively. Among the pseudophakic eyes, at presentation 122 (57.5%), 72 (33.9%), 18 (8.5%) and after best correction 162 (76.2%), 33 (15.8%), 17 (8.0%) had visual acuity of ≥6/18, <6/18–≥6/60 and <6/60, respectively. Retinal disease (35.5%), surgical complications (27.4%) and posterior capsular opacification (14.5%) were the principle causes of visual impairment after best correction in all eyes. There was no significant association in visual outcome based on age, sex, literacy and the duration of surgery.Conclusion: Correction of refractive errors, preoperative screening of coincidental diseases, reduction in surgical complication rates and monitoring of postoperative follow-up care has to be addressed seriously in order to improve the outcome of cataract surgery to meet standards proposed by the World Health Organization. In the future, longitudinal studies need to be undertaken to provide specific information on the outcomes of cataract surgery in this community.Clinical and Experimental Ophthalmology 11/2011; 39(9):851 - 857. · 1.98 Impact Factor -
Article: Preoperative visual acuity of people undergoing cataract surgery in rural and urban Nepal
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ABSTRACT: Background: Preoperative presenting visual acuity (PPVA) is not a commonly reported indicator for the delivery of cataract services. This study aimed to evaluate the PPVA of patients undergoing cataract surgery in rural and urban areas of Nepal.Design: A prospective, non-interventional study conducted from October 2007 to March 2008 in a tertiary hospital and outreach clinics of Nepal.Participants: A total of 3023 consecutive subjects from urban and rural settings (1323 from the tertiary hospital and1700 from outreach clinics) with cataract were included.Methods: Visual acuity was tested with a Snellen E-chart at 6 m by ophthalmic assistants. All Outreach Microsurgical Eye Clinic patients were examined by either ophthalmologists or senior ophthalmic assistants. Patients at the Tertiary Eye Care Centre were examined only by ophthalmologists.Main Outcome Measures: Preoperative presenting visual acuity of patients undergoing cataract surgery was measured in both the settings.Results: The sex ratio was 0.96 (male/female). Based on PPVA, 11.5% of patients operated were blind (PPVA < 3/60 in the better eye). The proportion of blind people operated was similar in rural (11.4%) to urban (11.6%) areas. The proportion of blind eyes operated was higher in rural (50.7%) compared to urban (38.9%) areas.Conclusion: Despite a comparatively high volume of cataract surgery carried out in Nepal every year, only about one in eight patients operated for cataract in the sample population was blind. PPVA is an important indicator for the progress towards eliminating cataract blindness.Clinical and Experimental Ophthalmology 07/2011; 39(6):501 - 505. · 1.98 Impact Factor -
Article: Rationale, methods and baseline demographics of the Bhaktapur Glaucoma Study
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ABSTRACT: Background: To describe the methodology and baseline data of a population-based study designed to determine the prevalence of glaucoma and to study the risk factors for glaucoma development in a Nepali population.Design: Population-based cross-sectional studyParticipants: Subjects 40 years and above residing in Bhaktapur District.Patients and Methods: Power calculations suggest that a sample size of 4758 is required. Thirty clusters were randomly selected from the 2 municipalities and 16 Village Development Committees of Bhaktapur District in Nepal. A door-to-door census was conducted in the selected clusters to identify citizens 40 years of age and older. Demographic details were collected and a structured interview, regarding awareness for cataract and glaucoma was taken. All individuals fulfilling the eligibility criteria were recruited and referred to the Tilganga Institute of Ophthalmology in Kathmandu for a detailed clinical examination including glaucoma diagnostic procedures. Peripheral blood samples were taken to facilitate future genetic analysis.Main Outcome Measures: Prevalence of glaucoma, risk factors and genetic screening.Results: A total of 4800 people were selected. The mean age of participants was 55.4 ± 12.3 years (range: 40–99) and 51.8% were female. In total, 64.8% of our cohort was aged less than 59 years and 60.5% were illiterate. Among the various ethnic races, 69.7% belonged to the Newar ethnic group.Conclusion: This study will determine the prevalence of glaucoma and allow for an increased understanding of the risk factors for glaucoma development in this region.Clinical and Experimental Ophthalmology 12/2010; 39(2):126 - 134. · 1.98 Impact Factor
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2010–2011
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Tilganga Institute of Ophthalmology
Kathmandu, CR, Nepal
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