Prevalence and pattern of vitreo-retinal diseases in Nepal: the Bhaktapur glaucoma study

Abstract

BackgroundVitreo-retinal diseases are among the leading causes of visual impairment and blindness worldwide. This study reports the prevalence and pattern of vitreo-retinal diseases in the Bhaktapur Glaucoma Study (BGS), a population based study conducted in Nepal.MethodsBGS was a population based cross-sectional study involving 4800 subjects aged 40 years and over from Bhaktapur district. Subjects were selected using a cluster sampling methodology and a door-to-door enumeration. All subjects underwent a detailed ocular examination at the base hospital which included log MAR visual acuity, refraction, applanation tonometry and a dilated fundus examination. Fundus photography, optical coherence tomography and fundus fluorescein angiography were performed where indicated.ResultsComplete data was available for 3966 (82.62%) out of the total of 4800 enumerated subjects. The mean age was 55.08 years (SD 11.51). The overall prevalence of vitreo-retinal disorders was 5.35% (95% CI, 4.67 - 6.09). Increasing age was associated with a higher prevalence of vitreo-retinal disorders (P < 0.001). The prevalence of diabetes mellitus was 7.69% (95% CI, 6.88 - 8.56). Age-related macular degeneration (AMD) was the most common vitreo-retinal disorder with a prevalence of 1.50% (95% CI, 1.15 - 1.94), increasing significantly with age. The prevalence of diabetic retinopathy among the study population was 0.78% (95% CI, 0.53 - 1.11) and among the diabetic population 10.16% (95% CI, 7.01 - 14.12). The population prevalence of other retinal disorders were hypertensive retinopathy 0.88%, macular scar 0.37%, retinal vein occlusion 0.50%, macular hole 0.20%, retinitis pigmentosa 0.12%. and retinal detachment 0.10%.The prevalence of low vision and blindness due to vitreo-retinal disorders was 1.53% (95% CI, 1.18 - 1.97) and 0.65% (95% CI, 0.43 - 0.96), respectively. The prevalence of low vision and blindness was 28.77% (95% CI, 22.78-35.37) and 12.26% (95% CI, 8.17-17.45), respectively among cases with vitreo-retinal disorders. Blindness was observed to be unilateral in 19 cases (73%), and bilateral in 7 cases (27%).ConclusionsThe prevalence of vitreo-retinal disorders in this Nepalese population was 5.35%, which increased significantly with age. AMD was the predominant retinal condition followed by diabetic retinopathy. One fourth of the subjects with vitreo-retinal disorder had low vision. Taking into consideration the aging population and emerging systemic diseases such as diabetes mellitus and hypertension, vitreo-retinal disorders could be of future public health importance.

Prevalence of and risk factors for age-related macular degeneration in Nepal: the Bhaktapur Retina Study

“…Of the remaining 38%, 15% of the subjects had passed away, 5% had moved to other places, and 18% were unable to visit the study site. The required sample size for this BRS was estimated to be 2,100 subjects after assuming 7% prevalence for vitreoretinal disorders in individuals at the age of 60 years or older, a relative precision of 25%, 85% compliance, and a design effect of 2 18. Since we were not able to include a sufficient number of participants from the original BGS participating clusters, we added extra clusters in a similar pattern to this study.…”

“…Venous blood sample was drawn for assessment of non-fasting blood sugar. The diagnosis of diabetes mellitus was based on either the use of diabetic medications or a random blood sugar level of ≥200 mg/dL 18,41. BP was measured for all subjects.…”

“…AMD was among the leading causes of blindness in Nepal, contributing to 8.7% of the total blindness in a population-based study 16. Retinal disease was the second most common cause of blindness, and among the retinal diseases, AMD was the most prevalent form of retinal disease 17,18. Although the wet variety of AMD constitutes only 10% of total AMD, it is the main cause of irreversible blindness 19.…”

Pattern of Macular Disorders in Himachal Pradesh, India

“…In the developing world, which harbours almost 90% of the world's blind population, retinal diseases are among the leading cause of blindness after cataract. [1] Retinal disease has had a low priority in prevention of blindness programmes in developing countries mainly because retinal diseases were considered an uncommon cause of blindness in the developing world. Populationbased surveys reported vitreo-retinal disorders to be responsible for 8.56% and 12.7% in Iran and India respectively.…”

The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

“…2 Reported prevalence of macular hole in Nepal is 0.2%. 3 Variable data is available from different parts of the world with its prevalence ranging from 0.09% to 0.2%. [3][4][5] Surgical treatment has been an accepted technique since Kelly and Wendel first reported the benefit of pars plana vitrectomy and gas tamponade in inducing closure of macular hole, flattening of the neurosensory rim and improvement in visual acuity.…”