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Jan 25, 2023 123 likes •670 views

PREVALENCE OF CATARACT &CLINICAL EVALUATION FOR SURGERY IN CHACHOENGSAO 6 T H Y E A R M E D I C A L S T U D E N T , 2 0 1 7 P H R A M O N G K U T K L A O C O L L E G E O F M E D I C I N E DIVISIONS OF RESEARCH Epidemiology ,

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PREVALENCE OF CATARACT &CLINICAL EVALUATION FOR SURGERY IN CHACHOENGSAO

6 T H Y E A R M E D I C A L S T U D E N T , 2 0 1 7 P H R A M O N G K U T K L A O C O L L E G E O F M E D I C I N E

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DIVISIONS OF RESEARCH

  • Epidemiology , Military and Community medicine
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RESEARCHERS

Cherrin Pomsoong Natthanit Sae-Lee Phanornrat Phairoch

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ADVISOR

  • Department of Community and military medicine

–Col. Ram Rangsin –Sec.Lt. Wisit Kaewput –Sec.Lt. Anupong Sirirungreung –Lt. Nutcha Hempatawee

  • Bangkhla Hospital

–Dr. Direk Pakagul

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FISCAL YEAR OF RESEARCH

  • 2017
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LOCATION

  • Bangkhla Hospital ,Chachoengsao province ,Thailand
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BACKGROUND

Cataract is recognized as the leading cause of visual impairment and blindness in the world, including in Thailand.

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BACKGROUND

Global estimates of visual impairment: 2010, S.P.Mariotti, D. Pascolini, Br J Ophthalmol. 2012 May;96(5):614‐8.

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Global estimates of visual impairment: 2010, S.P.Mariotti, D. Pascolini, Br J Ophthalmol. 2012 May;96(5):614‐8.

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Global estimates of visual impairment: 2010, S.P.Mariotti, D. Pascolini, Br J Ophthalmol. 2012 May;96(5):614‐8.

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Global estimates of visual impairment: 2010, S.P.Mariotti, D. Pascolini, Br J Ophthalmol. 2012 May;96(5):614‐8.

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CAUSES OF VISUAL IMPAIRMENT IN THAILAND

44% 34% 12% 3% 7% refractive error cataract glaucoma vitreo-retinal ds.

  • thers

Eye health of priests and novices in rural area.Jenchitr W, et al. J Med Assoc Thai. 2008.

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Sustaining a visual impairment may have a substantial impact on various life domains such as work, interpersonal relations, mobility and social and mental well-being

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Mission

  • The VISION 2020 Global Initiative is to eliminate the main

causes of all preventable and treatable blindness as a public health issue by the year 2020.

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เพื่อเป็นการตอบสนองต่อนโยบายขององค์การอนามัยโลก (WHO) ทางส านักงาน หลักประกันสุขภาพแห่งชาติ (สปสช.) จึงก าหนดให้มีการคัดกรองผู้ป่วยตาม “โปรแกรม VISION2020Thailand” ตามนโยบาย Service Plan ของกระทรวงสาธารณสุข ที่ให้ ความส าคัญสูงสุดต่อการแก้ปัญหาตาบอดและปัญหาสายตาเลือนราง มุ่งเน้นกลุ่มเป้าหมาย ผู้ป่วยต้อกระจกชนิดบอดและชนิดสายตาเลือนรางระดับรุนแรง ส่งเสริมและสนับสนุนการ ตรวจคัดกรองและลงทะเบียนเพื่อจัดล าดับความส าคัญของการผ่าตัด เพื่อค้นหาผู้ป่วยให้ ได้รับการผ่าตัดโดยเร็ว

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CONCEPTUAL FRAMEWORK

Evaluation tool

VA

Independent living

Severity of subjective symptoms Difficulties in daily life

Ophthalmologist examination

VA

Clinical Slit lamp

  • Diagnostic study
  • Sensitivity
  • Specificity
  • Predictive value
  • Likelihood ratio

Cataract

Surgery Non-surgery Surgery Non-surgery

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OBJECTIVES

  • To study the prevalence of cataract in blurred vision patient
  • To evaluate NIKE clinical tool for indication in cataract surgery
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METHOD : STUDY DESIGN

  • Quantitative study

–Prevalence of cataract in blurred vision patient –Diagnostic study (NIKE clinical tool)

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STUDY POPULATION

Target population Study population

Blurred vision in Chachoengsao, Thailand Patient with cataract

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STUDY POPULATION

Inclusion criteria

  • Cataract patient in

Chacheongsao province of Thailand Exclusion criteria

  • Patients who are not

willing to sign the inform consents

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SAMPLE SIZE DETERMINATION

Prevalence of the cataract patients in Chacheongsao province of Thailand

P = 29 % according to research conducted by Eye publication, London(2017)

d= (15% of P ) = 0.0435 Z= 1.96

n = 418

Hashemi H. The prevalence of visual impairment and blindness in underserved rural areas: a crucial issue for future. Eye (Lond). 2017 Aug;31(8):1221-1228.

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STUDY PROCEDURE

Blurred vision Ophthalmologist examination Cataract Non-cataract

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STUDY PROCEDURE

Patient with cataract Assent form

Questionnaire

Evaluation tool Ophthalmologist decision

Surgery Non-surgery Surgery Non-surgery

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NIKE : (Nationell Indikationsmodell for Katarakt Ekstraktion)

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STATISTICAL ANALYTIC PLAN

Descriptive Analytic

  • Demographic, behavioral data

analyzed by descriptive statistics

  • Prevalence
  • Diagnostic study

–Sensitivity –Specificity –Positive predictive value –Negative predictive value –Likelihood ratio

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TIMELINE

กิจกรรม 18-19 ม.ค. 20-26 ม.ค. 27ม.ค.- 4 ก.พ. 5-10 ก.พ. 1.ประสานงานหน่วยงานที่เกี่ยวข้อง × 2.เก็บรวบรวมข้อมูล ×

  • ด าเนินการเก็บข้อมูล

×

  • เก็บข้อมูลสุขภาพเชิงบุคคล

×

  • รวบรวมข้อมูลจากแหล่งข้อมูลทุติย

ภูมิ × 3.วิเคราะห์ข้อมูลเชิงระบาดวิทยา × 4.แปลผล × 5.สรุปผลการศึกษา ×

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RESULT

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TABLE : DEMOGRAPHIC DATA

N (%) Gender (N=589) Male 228 (38.7) Female 361 (61.3) Age 67.8 ± 10 (28-96) BMI (N=589) Underweight 43 (7.3) Normal 200 (34.0) Overweight 130 (22.1) Class 1 Obesity 151 (25.6) Class 2 Obesity 60 (10.2) Class 3 Obesity 5 (0.8)

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N (%) Educational status (N=589) Primary school 481 (81.7) Secondary school 56 (9.5) Bachelor degree 19 (3.2) Not study 33 (5.6) Province (N=589) Chachoengsao 563 (95.6) Prachinburi 12 (2.0) Chonburi 4 (0.7) Other 10 (1.7)

TABLE : DEMOGRAPHIC DATA

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N (%) District (N=589) Bangkhla 344 (61.1) Panomsarakham 64 (11.4) Klongkuen 49 (8.7) Plangyao 31 (5.5) Ratchasarn 24 (4.3) Bangpakong 11 (2.0) Baanpo 16 (2.8) Muang 13 (2.3) Bangnampleaw 5 (0.9) Sanamchaikate 3 (0.5) Thatakeab 3 (0.5)

TABLE : DEMOGRAPHIC DATA

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N (%) Locality (N=344) Bangkhla 88 (25.6) Pak Nam 57 (16.6) Hua Sai 50 (14.5) Tha Thonglang 44 (12.8) Samet Nuea 37 (10.8) Bang Krachet 30 (8.7) Samet Tai 17 (4.9) Sao Cha-ngok 11 (3.2) BangSuan 10 (2.9)

TABLE : DEMOGRAPHIC DATA

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N (%) Rights (N=589) Government 58 (9.8) Local 4 (0.7) State enterprise 2 (0.3) Gold card Bangkla 312 (53.0) Gold card others 201 (34.1) Insurance 12 (2.0)

TABLE : DEMOGRAPHIC DATA

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N (%)

DM No 430 (73.0) Yes 159 (27.0) HT No 265 (45.0) Yes 324 (55.0) CAD No 555 (94.2) Yes 34 (5.8) Stroke No 569 (96.6) Yes 20 (3.4)

TABLE : MEDICAL DATA

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N (%) DLP No 527 (89.5) Yes 62 (10.5) COPD No 579 (98.3) Yes 10 (1.7) Asthma No 582 (98.8) Yes 7 (1.2) CKD No 577 (98.0) Yes 12 (2.0)

TABLE : MEDICAL DATA

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N (%) Thyroid No 584 (99.2) Yes 5 (0.8) steroid No 479 (81.3) Yes 110 (18.7) ASA Never 437 (74.2) Nowaday 12 (2.0) Used to 140 (23.8) ASAday 21.6 ± 59.1 (7-365)

TABLE : MEDICAL DATA

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N (%) sunlight Less than 5 hours 372 (63.2) 5 - 9 hours 132 (22.4) More than 9 hours 85 (14.4) smoking No 430 (73.0) Yes 159 (27.0) CataractSx No 416 (70.6) Yes RE 105 (17.8) Yes LE 68 (11.5)

TABLE : MEDICAL DATA

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N (%) DTX 120.2 ± 41.3 (52-367) SBP1 150.1 ± 21.7 (99-243) DBP1 80.5 ± 17.8 (44-280)

TABLE : MEDICAL DATA

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TABLE : EYE EXAMINATION

VA RE (N=589) PH RE (N=483) LE (N=589) PH LE (N=473) 20/20 27 (4.6) 59 (12.2) 34 (5.8) 37 (7.8) 20/30 91 (15.4) 130 (26.9) 86 (14.6) 115 (24.3) 20/40 38 (6.5) 79 (16.4) 38 (6.5) 95 (20.1) 20/50 49 (8.3) 43 (8.9) 58 (9.8) 43 (9.1) 20/70‎ 122 (20.7) 33 (6.8) 98 (16.6) 41 (8.7) 20/100 39 (6.6) 68 (14.1) 36 (6.1) 59 (12.5) 20/200‎ 93 (15.8) 30 (6.2) 95 (16.1) 16 (3.4) >20/200 61 (10.4) 41 (8.5) 84 (14.3) 67 (14.2) FC 48 (8.2) 45 (7.6) HM 13 (2.2) 11 (1.9) PJ 2 (0.3) 2 (0.3) PL 1 (0.2) 0 (0) NoPL 4 (0.7) 2 (0.3) No eye 1 (0.2) 0 (0)

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TABLE : EYE EXAMINATION

IOP (N=360) RE 14.0 ± 4.1 (8-47) LE 14.2 ± 4.1 (8-38)

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TABLE : CATARACT AND PTERYGIUM

Diagnosis (N=589) Cataract 291 (49.4) Pterygium 69 (11.7) Cataract (N=291) BE 132 (45.4) RE 74 (25.4) LE 85 (29.2) Pterygium (N=69) BE 28 (40.6) RE 8 (11.6) LE 33 (47.8)

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TABLE : OPHTHALMOLOGIST EXAMINATION

Lens RE (N=206) LE (N=217) NS 178 (86.4) 202 (93.1) Brunescent 17 (8.3) 4 (1.8) ASC 8 (3.9) 6 (2.8) PSC 74 (35.9) 68 (31.3) Polar 1 (0.5) 3 (1.4) Cortic 37 (18.0) 36 (16.6) Mature 12 (5.8) 7 (3.2) IOL 67 (32.5) 35 (16.1)

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TABLE : MANAGEMENT

Treatment (N=362) Set OR 261 (72.1) Refer 37 (10.2) No Sx 64 (17.7) Set OR (N=261) RE PE + IOL 75 (28.7) ECCE + IOL 34 (13.0) Pterygium excision 20 (7.7) LE PE + IOL 84 (32.2) ECCE + IOL 27 (10.3) Pterygium excision 23 (8.8) Refer (N=37) Glaucoma 17 (46.0) PCO 8 (21.6) Retinal disease 6 (16.2) NPDR, PDR 4 (10.8)

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PREVALENCE

Prevalence cataract in Chachoengsao = (number of cases)/population × 100

Prevalence cataract in Chachoengsao = 49.41

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TABLE: DIAGNOSTIC TEST EVALUATION

Surgery Non-surgery Total NIKE Surgery 200 56 256 NIKE Non-surgery 20 15 35 Total 220 71 291 Ophthalmologist decision

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  • Sensitivity = 90.91 %
  • Specificity = 21.13 %
  • Accuracy = 73.88 %
  • Positive Predictive value = 78.12%
  • Negative Predictive value = 42.86 %
  • Likelihood Ratios for positive test = 1.15
  • Likelihood Ratios for negative test = 0.43

INTERPRETATION

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INTERPRETATION

  • Likelihood Ratios for positive test = 1.15

– Prevalence or Pre-test probability = 75.60 % – Pre-test odds = 3.10 – Post-test odds = 3.56 – Post-test probability = 78.08%

  • Likelihood Ratios for negative test = 0.43

– Prevalence or Pre-test probability = 75.60 % – Pre-test odds = 3.10 – Post-test odds = 1.33 – Post-test probability = 57.12 %

  • Diagnostic odds ratio = 2.67
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FAGAN NOMOGRAM

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CONCLUSION

  • Prevalence of cataract in Chachoengsao, Thailand is more than patient in

London.

  • NIKE can use to screen patients who have visual impairment to
  • phthalmologist for proper management for example cataract surgery. It

unable to indicate for surgery

  • This clinical tool is proper for local community inaccessible to physician
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BANGKHLA TEAM

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THANK YOU