FOR SURGERY IN CHACHOENGSAO 6 T H Y E A R M E D I C A L S T U D E - PowerPoint PPT Presentation

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 , Military and Community medicine

RESEARCHERS Cherrin Pomsoong Natthanit Sae-Lee Phanornrat Phairoch

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

FISCAL YEAR OF RESEARCH • 2017

LOCATION • Bangkhla Hospital ,Chachoengsao province ,Thailand

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

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

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

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

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

CAUSES OF VISUAL IMPAIRMENT IN THAILAND refractive error cataract glaucoma vitreo-retinal ds. others 3% 7% 12% 44% 34% Eye health of priests and novices in rural area. Jenchitr W, et al. J Med Assoc Thai. 2008.

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

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.

เพื่อเป็นการตอบสนองต่อนโยบายขององค์การอนามัยโลก ( WHO) ทางส านักงาน หลักประกันสุขภาพแห่งชาติ (สปสช.) จึงก าหนดให้มีการคัดกรองผู้ป่วยตาม “โปรแกรม VISION2020 Thailand” ตามนโยบาย Service Plan ของกระทรวงสาธารณสุข ที่ให้ ความส าคัญสูงสุดต่อการแก้ปัญหาตาบอดและปัญหาสายตาเลือนราง มุ่งเน้นกลุ่มเป้าหมาย ผู้ป่วยต้อกระจกชนิดบอดและชนิดสายตาเลือนรางระดับรุนแรง ส่งเสริมและสนับสนุนการ ตรวจคัดกรองและลงทะเบียนเพื่อจัดล าดับความส าคัญของการผ่าตัด เพื่อค้นหาผู้ป่วยให้ ได้รับการผ่าตัดโดยเร็ว

CONCEPTUAL FRAMEWORK Independent Difficulties in daily life living Surgery VA Severity of subjective symptoms Evaluation tool Non-surgery • Diagnostic study -Sensitivity Cataract -Specificity -Predictive value Surgery -Likelihood ratio Ophthalmologist examination Non-surgery Clinical Slit lamp VA

OBJECTIVES • To study the prevalence of cataract in blurred vision patient • To evaluate NIKE clinical tool for indication in cataract surgery

METHOD : STUDY DESIGN • Quantitative study – Prevalence of cataract in blurred vision patient – Diagnostic study (NIKE clinical tool)

STUDY POPULATION Target population Blurred vision in Chachoengsao, Thailand Patient with cataract Study population

STUDY POPULATION Inclusion criteria Exclusion criteria - Cataract patient in - Patients who are not Chacheongsao province of willing to sign the inform Thailand consents

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.

STUDY PROCEDURE Blurred vision Ophthalmologist examination Cataract Non-cataract

STUDY PROCEDURE Patient with cataract Assent form Questionnaire Evaluation tool Ophthalmologist decision Surgery Non-surgery Surgery Non-surgery

NIKE : (Nationell Indikationsmodell for Katarakt Ekstraktion)

STATISTICAL ANALYTIC PLAN Descriptive Analytic • Demographic, behavioral data • Diagnostic study analyzed by descriptive statistics – Sensitivity • Prevalence – Specificity – Positive predictive value – Negative predictive value – Likelihood ratio

TIMELINE กิจกรรม 18-19 ม . ค . 20-26 ม . ค . 27 ม . ค .- 4 5-10 ก . พ . ก . พ . 1. ประสานงานหน่วยงานที่เกี่ยวข้อง × × 2. เก็บรวบรวมข้อมูล × - ด าเนินการเก็บข้อมูล - เก็บข้อมูลสุขภาพเชิงบุคคล × × - รวบรวมข้อมูลจากแหล่งข้อมูลทุติย ภูมิ × 3. วิเคราะห์ข้อมูลเชิงระบาดวิทยา × 4. แปลผล × 5. สรุปผลการศึกษา

RESULT

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)

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

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)

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

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)

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)