Eye health of priests and novices in rural area.

BACKGROUND: Early detection and treatment of eye diseases is important to minimize visual morbidity and permanent visual loss in general and priests' population. OBJECTIVE: To evaluate eye health status, visual acuity and eye diseases of the priests and novices, to estimate the prevalence and causes of visual impairment, and to provide eye health education. MATERIAL AND METHOD: Between May 2006 and March 2007, the priests and novices in selected village (stratified population cluster random sampling) of 22 provinces in The First National Survey of Blindness and Visual Impairment Program in Thailand (TVIP) had their visual acuity (VA) and intraocular pressure (IOP) measured and eye examined by ophthalmic nurses. An ophthalmologist examined the anterior and posterior segment and took fundus pictures. RESULTS: Two hundred sixty eight priests and novices were examined. Their age ranged between 12 and 88 years with a mean of 48.5 years. Most priests and novices had normal vision (20/20-20/40 - 67.54%). No priest and novices had bilateral blindness. Almost half (48.13%) had eyeglasses and 2.24% had bilateral low vision. Unilateral low vision and unilateral blindness were 3.73% and 3.36%. One eye blindness and one eye low vision was only 0.37%. Refractive error was the leading cause of visual impairment (22.39%), followed by cataract (17.54%), glaucoma (5.97%), vitreo-retinal diseases (1.49%), and glaucoma suspected (occludable angle and ocular hypertension) (3.35%). Fifty five priests (20.52%) were referred for further investigation and treatment. CONCLUSION: Because the mean age of the priests and novices in this survey was only 48.5 years, the prevalence of visual impairment was low. Most of the cases were avoidable or preventable. The implementation of an effective screening program and access to eye treatment with standard of care remains a priority for the priests in rural areas. For sustainable development, eye health education must be promoted.

Visual acuity in patients having cataract surgery by different techniques.

BACKGROUND: Question of different techniques of cataract surgery would offer different post-operative visual acuity (VA) has been asked. OBJECTIVES: To compare the pre-and post-operative VA of cataract patients operated by different techniques as Extracapsular Cataract Extraction (ECCE), Phacoemulsification (PE), and Manual Phaco Fragmentation (MPF) and compare in different age groups. METHOD: The post-operative visual acuity of cataract patients was collected from 72 hospitals in Bangkok and rural part of Thailand. Techniques of cataract surgery were recorded. The cases with pre-operative and intraoperative complication and cases operated without intraocular lens (IOLs) implantation were ruled out. RESULTS: VA of cataract patients post-operation was statistically significant better than pre-operation at p-value (less than 0.05) and the result persisted for every age group. Cataract patients operated by PE had better post-operative VA than patients operated by ECCE and MPF even if MPF had the best post-operative VA. This is because the total cases were less than the other procedure. CONCLUSION: Due to the nature of retrospective study, the cause of poor post-operative VA was due to astigmatism. The pre-operative astigmatism was not recorded thus preventing a complete analysis.

Visual acuity in patients having foldable and non-foldable intra-ocular lens for cataract surgery.

BACKGROUND: Intra-ocular lens (IOLs) is the most commonly use organ substitute worldwide. Question of different type of IOLs which would offer different post operative visual acuity (VA) has been asked. OBJECTIVES: To compare the pre-operative and post operative visual acuity (VA) of cataract patients operated-patient and the use of non foldable and foldable IOLs in different age groups. METHOD: Retrospective study of post operative VA of cataract patients-operated from Priest, Lerdsin Hospital in Bangkok and Lampang Hospital in northern part of Thailand. Methods to operate and type of IOLs implantation were recorded. The cases with pre-operative and intra-operative complications were excluded. RESULTS: Post operative VA of cataract patients was better than pre-operation VA with statistically significant at p-value less than 0.05 and the results persisted for every age group. With phacoemulsification (PE) techniques, non-foldable IOLs offered better post operative VA than foldable IOLs in every age group except in age group of less than 40 and age group over 59 that showed statistically significant different at p-value less than 0.05. CONCLUSION: Due to the nature of retrospective study, the cause of poor post operative VA was due to astigmatism which the pre-operative astigmatism were not recorded to fulfill complete analysis.

Economic evaluation of treatment administration strategies of ganciclovir for cytomegalovirus retinitis in HIV/AIDS patients in Thailand: a simulation study.

BACKGROUND: There are many effective interventions, via various routes (intravenous [IV], oral [OR], intravitreal injection [IVT] and intraocular implantation [IMP]), for treating cytomegalovirus retinitis (CMVR) that have become available. There are large variations in treating CMVR in clinical practice in Thailand. OBJECTIVE: To evaluate the incremental cost-effectiveness ratio (ICER) of providing (i) IVT, (ii) IV/OR and (iii) IMP ganciclovir to patients with HIV/AIDS and CMVR versus providing no treatment. DESIGN: A simulation study for which the input parameters were derived from a systematic review of the literature, a hospital-based survey and patient interviews. SETTING: The analysis assumed a Thai healthcare system perspective. However, the model was run using both societal and healthcare provider perspectives. RESULTS: Our results suggest that IVT ganciclovir was cost effective and the best option for treating patients with CMVR irrespective of whether patients received antiretroviral treatment (ART). In patients receiving ART, moving from IVT to IV/OR ganciclovir was also likely to be a cost-effective option. Offering IMP ganciclovir was not likely to be cost effective. Providing treatments for patients with bilateral CMVR was more cost effective than providing treatments for those with unilateral CMVR, and offering treatments for patients receiving ART was better value for money than treating patients without ART. CONCLUSIONS: Our models suggest that IV/OR ganciclovir should be recommended for the treatment of unilateral and bilateral CMVR for patients receiving ART in the Thai healthcare system. IVT ganciclovir may also have a role in the treatment of CMVR patients not receiving ART.