Prevalence of blindness and cataract surgery in Gandaki Zone, Nepal.
OBJECTIVE
Himalaya Eye Hospital (HEH), established in 1993, is rendering eye care services in the Gandaki and Dhaulagiri zones. The hospital has extensive community outreach activities along with services for outpatients, emergencies, and subspecialties such as vitreoretinal, paediatric, and low vision. The operation theatre is well equipped to match the surgical needs including phaco surgery for cataract. The hospital has performed more than 14 000 cataract surgeries and 250 000 treatment services during this period. The aim of this study was to estimate the prevalence of blindness, visual impairment, and cataract surgical coverage among the older adult population of three districts of Gandaki Zone, where 80% of the hospital's service recipients reside.


METHODS
People aged 45 years and older were enrolled in the study using a stratified cluster design. Subjects in 25 randomly selected clusters from the listed 806 were recruited through door to door visits. Each recruited subject had visual acuity (VA) and clinical examination conducted by an ophthalmologist. The survey was preceded by pre-pilot and pilot studies to refine the operational method. To assess quality assurance the interobserver variation in VA measurement was also carried out in five different clusters.


RESULTS
Out of 5863 selected subjects 85.3% were examined. Blindness defined as presenting VA <6/60 in both eyes was found in 2.6% (95% confidence interval (CI): 2.2 to 3.9), whereas 16.8% individuals examined had vision <6/19 in one or both eyes. Cataract was the principal cause of blindness in 60.5%, and refractive error was the dominant cause of vision impairment (<6/19) 83.3%. Cataract surgical coverage was 59.5% among the cataract blind and associated with younger age, literacy, and male sex.


CONCLUSIONS
The finding suggests a positive impact of the HEH programme on the prevalence of blindness and cataract surgical services in the survey area. Strategies to further improve access and utilisation of facilities and increase cataract surgical coverage need to be developed.
Sapkota
Y D
YD
Nepal Netra Jyoti Sangh, PO Box 335, Tripureshwor, Kathmandu, Nepal. yd_sapkota@hotmail.com
Pokharel
G P
GP
Nirmalan
P K
PK
Dulal
S
S
Maharjan
I M
IM
Prakash
K
K
D000367:Age Factors; D000368:Aged; D001766:Blindness / Q000453:epidemiology* / Q000209:etiology; D002386:Cataract / Q000150:complications / Q000453:epidemiology; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D004522:Educational Status; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D012737:Sex Factors; D014792:Visual Acuity