 |
       |
|
|
CATARACT - A PILOT STUDY
KAND PURUSHOTTAM*
*Intern, Rajiv Gandhi Medical College, Chhatrapati Shivaji Maharaj Hospital, Kalwa, Thane 400 605.
The significance of cataract in the lives of human beings is well documented. In this paper an attempt has been made to review the trend of distribution of cataract in the patients admitted for cataract surgery on the basis of their age, sex, type of cataract and the incidence of cataract in patients with past history of cataract surgery. An attempt has been made to highlight the aim of health care providers of seeking a balance between the challenges posed for prevention of early occurrence of cataract and providing adequate ophthalmic health care services, catering to the requirements of local population.
INTRODUCTION
The most disastrous result of an ocular disease, short of the relatively loss of life, is Blindness. Blindness due to opacification of lens afflicts 50 million people worldwide.[1] The clouding of the crystalline lens of eye is known as Cataract.[5] Cataract is a common disability of old age and, people are living longer. It impairs vision and reduces the quality of life. This is particularly significant and important in elderly, as they are likely to experience difficulties in daily life. Visual morbidity caused by age related cataract is reversible. It can be treated successfully by corrective surgical procedures. Cataract surgery is the most commonly performed operation, majority occurring in the elderly population. There are various documented factors associated with the development of cataract.
MATERIAL AND METHODS
The data was obtained from the Medical records Departments, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital Kalwa Thane. The sample of 139 patients admitted for corrective cataract surgery under the department of Ophthalmology during the period lasting for the duration from 1/1/2000 to 30/4/2000 was used for this retrospective pilot study. The secondary data collected during this study was analyzed, tabulated and discussed for the distribution of population having cataract on the basis of age, sex, type of cataract, incidence of cataract in second eye in patients having past history of cataract surgery. Primary data was not used. The study is of retrospective type and patients could not be interviewed to acquire detailed information regarding their socio-cultural, economic, educational and occupational background.
Age Drug ingestion Female gender Diarrhoea Brown iris colour Dehydration Lower socio-economic status Hypertension Educational status Myopia Environmental factors Diabetes mellitus Sunlight Family history Infra red radiation exposure Dietary deficiency Ultra violet radiation exposure Lifestyle Steroid therapy Smoking Hyperbaric oxygen therapy Alcohol
RESULTS
A total of 139 patients admitted for cataract surgery were studied. The mean age of the patients under study was 58.19 years. The incidence of cataract in patients above 40 years was 92.08%.
Amongst the total population under study, 54.67% of the patients were from the 40-60 years age group and 37.41% were aged above 60 years. Table 1 also shows the female sex preponderance of 51.74% in total and 53.94%, 51.92% in the 40-60 and the above 60 years age group, respectively. 42.4% of the total patients studied were posted for their second eye surgeries. Females in this category also showed preponderance over males within the age groups of 40-60 years of 67.85% and above 60 years of 57.14% (Table 2). Majority of the population who underwent the surgical procedure was above 40 years of age. The cataract was of senile type in 97.84% of this population. Among these 67.94% patients presented with immature cataract in the 40-60 age group and 57.4% from the above 60 age group (Table 3). For the group of patients studied the visual acuity at the time of surgery in the operated eye was less than 6/36 for 87.76% of the patients while those having visual acuity better than 6/18 were 0%. Patients having visual acuity of better than of equal to 6/36 constituted 12.23%.
Extra Capsular Cataract Extraction (ECCE) was the standard surgical procedure employed for all the patients for its obvious benefits of small incision, less trauma to corneal endothelium, minimal post-operative complications better anatomic placement of IOL.[2] No post-operative complications were reported in any of the operated cases. Posterior Chamber Intra Ocular Lens (PCIOL) implantation was done for all the patients following ECCE.
The results also encourage for the introduction of advanced procedures like phacoemulsification, which have further benefits over ECCE. The results of the present study indicate an increased incidence of cataract in the younger age group of 40-60 years. This type of change can be attributed to the changing life style patterns of this era.[4] With growing stress and workload in day-to-day life people are barely left with time for proper health care activities. Enormous dietary deficiencies arising out of changes in eating habits,[2,3] greater exposure to Ultra Violet radiation due to depleting ozone layer and increasing number of ozone holes also have had their share of contribution affecting positive health of people.[2,3] Increasing exposure to strong radiation in a diverse class of population due to television and computers have only added to this problem. The problem is further aggravated in a developing country like India where there are low literacy rates and the effectiveness of all the health care education efforts for the people, also presents as an unsolved question.
Age (years) Less than 40 40-60 Above 60 Total
Figures in brackets indicate percentage
Age (years) Less than 40 40-60 Above 60 Total
Figures in brackets indicate percentage
The observations regarding the female preponderance of cataract are found to be in accordance with the earlier documentation - in the Framingham eye study from 1973-75 females had higher prevalence than males in both lens changes (63 to 54.1%) and senile cataract (17.1% to 13.2%), Sperduto and Hiller noted that each of the 3 types of senile lens opacities was found more often in women than men.[2] In a separate investigation by Nishikon and Yamom the male to female ratio was 1:8 with a female predominance in the patients older than 65 years who were operated for senile cataract.[2]
Age (years) Less than 40 40-60 Above 60 Total
Figures in brackets indicate percentage
The female predominance is also evident from Table 2 showing the incidence of cataract in second eye with those having past history of cataract surgery.
Higher percentage of immature senile cataract (Table 3) shows growing concern among the population for better quality of life and hence presenting early to the physician, improving status of the diagnostic services and facilities and increasing number in availability and accessibility of the ophthalmic services to the population.
CONCLUSION
A greater stress and goal directed effort have to be carried out for educating people regarding the prevention of cataract and guidance for its appropriate treatment. Imparting knowledge to the literate and illiterate regarding the prevention of blindness especially due to cataract has to be taken up as a task to be achieved.
Increasing the frequency and coverage of the screening programmes for cataract along with regular eye check up camps has to be arranged. Interventional programmes targeting cataract have significantly decreased the burden of visual impairment in the elderly people. Early detection, close monitoring and timely surgical intervention have proved their immense importance in the management of senile cataract.
Provision for the expansion of the ophthalmic services and education of people must continue to ensure that with the emerging demands for our aging population, optimal high quality cataract surgery remains affordable to the local population.
ACKNOWLEDGEMENTS
I am grateful to Dr. S Kartikeyan, Department of Preventive and Social Medicine, Dr. Rakesh Barot, Department of Ophthalmology, The Dean, the Medical Records Department of Rajiv Gandhi Medical College Chhatrapati Shivaji Maharaj Hospital, Kalwa Thane 400 605 for their support and co-operation.
REFERENCES
1.Taylor A. "Association between Nutrition and Cataract". Nutr Rev 1989; 47 : 8, 225-34 from the website http://www.lef.org/featured articles/abstracts/abstracts 221-230.html
2.D Ocambo VV. Cataract, Senile, from the web site http://www.Emedicine. com/oph/topic49.htm
3.Truswel AS and Mitchell P. Nutrients and Degenerative Eye Diseases from the web site www.monash.edu.au/APJCN/VOL2/SUPPL/2S1p47.htm
4.Cataract Surgery Guidelines from the web site -http://rcophth.ac.uk/publications/guidelines/cataract_surgery3.html
5.Lavine J. Nutrition and Eye from the web sitehttp://www.vrg.org/nutrition/eye.htm#cataracts
 |