Study of Characteristic Retinal Findings among Hypertensive Population Attending a Tertiary Care Hospital in Nepal.

Background Systemic hypertension is one of the most common chronic, debilitating diseases prevalent in the modern era, with many complications in terms of stroke, chronic kidney disease, coronary artery disease and retinopathy. When it comes to the eye, as a target organ damage, it leads to one of the many vision threatening conditions, hence degrading the quality of life. Early detection and subsequent management of patients at risk of hypertensive retinopathy serves to be a crucial panacea in the treatment course. Objective To investigate the characteristics retinal findings among hypertensive population and analyze the associated risk factors. Method A hospital based prospective study was conducted, among 250 patients presenting to ophthalmology outpatient department in Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH), over a time span of 6 months, to analyze hypertensive retinopathy and its implications. Fundus examination under mydriasis was done on all subjects and hypertensive retinopathy was graded according to the modified Scheie classification. Result Most patients belonged to age group of 56-65 years (30%). Nearly half (48%, N=120) of the hypertensive population had some forms of retinopathy. Grade II hypertensive retinopathy (24.8%) was the most common hypertensive change observed. Majority (55%) of the patients with retinopathy were smokers. About two-third of the subjects (67.5%) had been diagnosed to have hypertension and under treatment for over 5 years. Conclusion The occurrence of retinopathy among hypertensive patients attending ophthalmology department is higher. Awareness regarding systemic hypertension and its effect on ocular health is very important to be disseminated among public. Timely referral among medical specialities could diagnose and prevent curable blindness among hypertensive patients.

Refractive and Binocular Vision Status and Associated Asthenopia among Clinical Microscopists.

Background Clinical microscopists are at a greater risk of developing binocular vision anomalies and asthenopia. Objective To assess the refractive and binocular vision status and to explore the association between the presence of asthenopic symptoms and microscopy work among clinical microscopists working at medical laboratory department. Method This cross-sectional study involved 37 clinical microscopists working at medical laboratory department of Dhulikhel Hospital, Nepal. The study was conducted from January to December 2013. Only those participants who had been using microscope for at least a year were enrolled in this study. Each participant underwent distance visual acuity (VA) assessment, refractions, and orthoptic evaluation, including measurement of distance and near phoria, near point of convergence (NPC), near point of accommodation (NPA), positive fusional vergence (PFV), adduction, and calculation of accommodation convergence/accommodation (AC/A) ratio. The tear test was also carried out in each subject. Information about use of glasses, microscopy work (duration, and time spent per day in microscope), and visual symptoms associated with the use of microscope such as eye strain, headache, double vision, and near vision were collected. Result The mean age of the clinical microscopists was 29 ± 5.7 years. The prevalence of refractive error was 56.76% and the mean spherical equivalent (SE) refractive error was -0.77 ± 0.86 D. Refractive error had neither correlation with microscopy work and asthenopic symptoms associated with it, and nor with binocular vision parametersNPC, AA and AC/A ratio. However, there was a positive association between asthenopic symptoms and microscopy work. There was statistically significant difference between symptomatic and asymptomatic subjects for binocular vision parameters, including NPC, AA and positive fusional vergence (PFV) for near. Conclusion Microscopy work has an impact on near binocular vision. Asthenopic symptoms bear a positive association with microscopy work. Refractive error has no significant correlation with either microscopy works or associated asthenopic symptoms.

Ocular Survey in Kathmandu University Medical Students.

Background Medical students spend long time in academic activities that increases the risk of developing refractive errors and dry eyes that can affect their learning and social abilities. Only a few studies are available regarding ocular problems and its contribution to visual impairment among medical students in Nepal. Objective To evaluate the ocular problems among the medical students in a University hospital. Method An observational, descriptive, cross-sectional study was conducted among five batches undergraduate medical students until 2022 of Kathmandu University School of Medical Sciences, Dhulikhel, Kavre. A self-administered questionnaire was used to obtain demographic data and information on visual problems followed by a detailed ocular examination that included refraction, color vision and Schirmer test. Result Total of 284 medical students (with 568 eyes) with mean age of 22.8 years, 179 males and 105 females were enrolled. Among them, 270 (47.5%) eyes were emmetropic. Simple Myopia was the commonest followed by Compound Myopic Astigmatism. The mean spherical equivalent in right and left eye were -0.914 ± 1.54 and -0.886 ± 1.53 respectively. Approximately 18% students had some form of dry eye. Nineteen students (6.7%) had color vision deficiency and 13 (4.6%) had deuteranomalia, 3(1.1%) had deuteranopia and 3(1.1%) had protanomalia. Conclusion Eye defects, like refractive errors, dry eyes and color blindness, are common among medical students. They need to be advised for frequent eye check up in order to diagnose eye defects timely and arrest visual impairment at early stage.

A Hospital Based Study of Prevalence of Dry Eye in Tertiary Care Hospital of Nepal.

Background Dry eye is a common disorder of the tear film that results from decreased tear production, excessive tear evaporation, or abnormality in mucin or lipid components of the tear film associated with symptoms of ocular discomfort. Objective To determine the prevalence of dry eye among patients above 40 years attending out-patient department in a Tertiary Care Hospital of Nepal. Method This was a prospective hospital-based study done at the Department of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital for a period of six months from September 2016 to February 2017. All the patients above 40 years of age, attending out patients department were screened by ophthalmologist using the Ocular Surface Disease Index (OSDI). Those patients who were diagnosed of dry eye by OSDI were further evaluated by Schirmer's test and Tear film breakup time (TBUT). Result Out of 4470 patients attending Ophthalmology outpatient department 1599 patients were of age above 40 years. The overall prevalence of dry eye according to OSDI questionnaire was 25% (400). The mean age of patient with dry eye was 54 yrs. 169 were males (42.2%) and 231 were females (57.7%). Among them Schirmer's test was positive in 16.7% (67) and TBUT was positive in 85.7% (343) of the patients with dry eye. Conclusion Dry eye is a common condition among patients attending ophthalmology outpatient department in tertiary care center and is leading cause of ocular discomfort. The prevalence of dry eye was higher among indoor workers than in outdoor workers. Further studies are needed to establish association and risk factor of dry eye.

Knowledge and Attitude on Eye Donation among Undergraduate Medical Students of Kathmandu University School of Medical Sciences, Nepal.

Background Corneal blindness accounts for a significant proportion of avoidable visual impairment in developing countries. Eye donation is voluntary and awareness in undergraduate medical students being a future practitioner in any field are expected to be linked to patients during death in hospitals. Objective To assess the awareness of medical students on eye donation at Kathmandu University School of Medical Sciences (KUSMS). Method This was a cross-sectional study conducted among undergraduate medical students of KUSMS. Students' responses were recorded using a predesigned, pretested, semistructured questionnaire inquiring knowledge and attitude of eye donation, sources of information, their willingness to donate eyes as well as the reasons for donating/ not donating eyes. Result Less than half of the medical students (45.6%) were aware of eye donation only after death. Newspapers (72.2%) were the major source of information. The final year medical students were more aware (Average knowledge score = 11.56 ± 2.05) than their juniors. 80.7% of the students were willing to donate their eyes. The adjudged reasons for willingness to donate were that eye donation is a noble work and pleasure in helping a blind person while the reasons for unwillingness to donate were lack of awareness followed by family objection to eye donation. Conclusion Future medical practitioners possessed satisfactory knowledge about eye donation. Educating this cadre of human resources to sensitize them towards the need for eye donation would be a crucial step towards reducing the global burden of corneal blindness.

Pattern and Prevalence of Refractive Error and Secondary Visual Impairment in Patients Attending a Tertiary Hospital in Dhulikhel, Nepal.

Background Uncorrected refractive error is one of the most important causes of visual impairment worldwide. Objective To ascertain the pattern and prevalence of refractive error and secondary visual impairment in subjects attending Ophthalmology department. Method A prospective hospital-based study was designed where presenting visual acuity, age of presentation, refractive status, best corrected visual acuity and status of visual impairment were assessed in participants, ages ranging from 3-39 years presenting to the Ophthalmology department of Dhulikhel Hospital, Kathmandu University Hospital. History of use of spectacle was noted and participants were categorized into different visual impairment categories as per their presenting visual acuity. Result Out of a total of 4500 total clients examined during the study period, 388 (8.62%) had refractive error where 219 (56.44%) were females and 169 (43.56%) were males. Mean age at presentation was 22.70±7.69 years (range, 3-39 years). Astigmatism was the most common subtype seen in 373 eyes (48.06%), followed by myopia (366 eyes, 47.16%) and hypermetropia (31 eyes, 4.0%). Only 40.50% subjects who required refractive correction were using spectacle. 62.37% (242 clients) had some of visual impairment during their presentation. There was statistically significant improvement in visual acuity after refractive correction (p=0.00). Conclusion Uncorrected refractive error is one of the most important causes of visual impairment. Lack of awareness, infrequent ocular examination and lack of community or preschool vision screening were the main causes for the late presentation and significant visual impairment associated with the condition. Social stigma, economical limitation and negative counseling and attitudes about spectacle wear were primary factors behind the unsatisfactory spectacle use.

A Hospital Based Study of Pterygium in Tertiary Care Hospital of Nepal.

Background Pterygium, a triangular fibrovascular subepithelial growth of degenerative bulbar conjunctival tissue over the limbus onto the cornea, is one of the common ocular conditions that may result in discomfort, tearing, photophobia and significant visual impairment. Little is known about its epidemiology in Nepalese context. Objective The current study aims to analyze the epidemiology of pterygium in a hospital-based population in Kavre District, a mid hilly region of central Nepal. Method This was a prospective hospital based study carried out in the Department of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital for a period of one year from January to December 2013. All the patients with pterygium, aged 21 years and above attending the outpatients department were included into the study. The epidemiological data was collected using a standard questionnaire and complete ocular examination was performed by the Ophthalmologist. Result A total of 7925 patients were seen in the Ophthalmology outpatient department during a one year period, out of which 5622 patients (age range 20-80 years) were eligible for the study. A total of 137 patients, 43(31.4%) males and 94 females (68.6%) had different grades of pterygium with mean age of 48.6± 12.8 years. The overall prevalence of pterygium was 2.4 %. Majority of the patients with pterygium were between 41-60 years. Fifty-eight percent of pterygium were of grade I followed by 41% of grade II. Unilateral and nasal pterygia were common. Conclusion The prevalence of pterygium is low in this hospital based population, majority of cases affecting females and old age population.