The Prevalence of Five Major Causes of Low Vision in Ahmedabad Population and their Respective Management with Residual Visual Function

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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

2
AIM

• The Prevalence of Five Major Causes of Low Vision
  in Ahmedabad Population and their Respective
  Management with Residual Visual Function

3
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

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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

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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

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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 

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• 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

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RESULT
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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
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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 57 16.29 Myopic Degeneration , High Myopia Telescopes
Near and Distance Devices 27 7.71 RP , Microcornea , Microophthalmos,Iris Coloboma,Retinal Coloboma with Nystagmus, Glaucoma , Albinism , Macular Dystrophy , Diabetic Retinopathy , Aphakia , Pseudoaphakia , Cataract Spectacle Magnifier , Stand Magnifier , Bar Magnifier , Dome Magnifier , Hand Held Magnifier and Illuminated Stand Magnifier,Telescopes
Refraction High Add 65 18.57 Refractive Error , Amblyopia , Aphakia , Pseudophakia , Cataract Spectacle for Near and Distance Correction
Total 350 100
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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)
• .
•  

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• 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

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• 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.

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• 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.

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•  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

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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.

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REFRENCES

• World Health Organization. Global initiative for
  the elimination of avoidable blindness.
  WHO/PBL/97.61. Geneva WHO, 1997. 
• International Classification of Diseases ICD -10
  20102
•  
• 3. World Health Organization 1997
  http//www.who.int/blindness/causes/priority/en/in
  dex5.html
• 4. A.K.Khurana Comprehensive
  Ophthalmology Fourth Edition
• 5. World Health Organization 2006
  , Retrived December 16 2006 http//en.wikipedia.or
  g/wiki/Blindness
• 6. World Health Organization Fact
  Sheet Number 282 June 2012 http//www.who.int/medi
  acentre/factsheets/fs282/en/
• 7. AO Oduntan Prevalence and
  Causes of Low Vision Worldwide S Afr Optom
  20056444-54
• 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 200048201-207
• 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.ni
  h.gov/pubmed/12359608

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• 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 2007292
• 11. Shah SP, Minto H, Jadoon Z, on behalf of
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• 12. Negrel AD, Maul E, Pokharel GP, Zhao J,
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• 15. http//laico.org/v2020resource/files/Prevalen
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APPENDIX

• PATIENT PROFORMA
• DATE _____/______/_______
•  
• NAME OF PATIENT
• ADDRESS
• AGE ____________
  GENDER __________________
• COMPLAIN ________________________________________
  ________________________
•  
• HISTORY _________________________________________
  _________________________
•  
• History of Eye Surgery __________________________
  __________________________________________________
  
•  
• History of Systemic illness _____________________
  __________________________________________________
  _____
• Cause / Duration of Low Vision / Blindness

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• Family History __________________________________
  _____________________________
• Medical History _________________________________
  _____________________________
• Education _______________________________________
  ____________________________
• Financial Status Sufficient /
  Non-Sufficient
• Use of glasses Yes / No
• Previous Glass Prescription
• Sph cyl
  axis VA
• RE
• LE
•  
• Previous Low Vision care Yes / No
• Source of Low Vision Device Prescribed
  / Self Purchased

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• If Yes then details of it _______________________
  _________________________________
• Distance Inspection _____________________________
  ______________________________
•  
• External Examination
  
• 
  RE
  LE
  
• 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

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• Objective Refraction (Retinoscopy)
• Sph cyl
  axis VA
• RE
• LE
• Subjective correction with Visual Acuity
• Sph cyl axis VA
• RE
• LE
• BE
• Near Vision Test used __________________________
  _______________________________
•  
• Unaided Near Visual Acuity
• RE N
• LE N
• BE N

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• 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 / Not
• Type With ____ D

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• Additional Illumination Required /
  Not Required
• With Additional Illumination Improved /
  Remain Same / Facing Difficulty
• Binocular Vision Yes / No
• Visual Field Done / Not Done
• Limitation of Visual Field
• RE
• LE
• Contrast Sensitivity ___________________________
  _________________________________
• Test used ________________________________________
  _____________________________
• Glare / Photophobia Yes / No
• In Sunlight No Problem / Uncomfortable
  / Can Hardly Seen

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• 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 ________________

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THANK YOU