Decreased vision, cataract most common problems in old age

Shahina Maqbool
Decreased vision is the most common complaint and cataract the most frequent disease in patients aged 70 years and above, reveals a retrospective study of 1,000 randomly selected Pakistani patients who presented at the Senior Citizens’ Clinic of Al-Shifa Trust Eye Hospital from January 2006 to April 2007.

Conducted by Dr. Amtul Aziz and Dr. Mehmood Ali, the study was aimed at determining the leading causes of visual impairment in patients aged 70 years and above, and calculating the frequency of various ocular diseases among them.

According to the study, decreased vision was the most common complaint, affecting 89% of the patients, followed by watering and discharge in 4.5%, pain in 2.8% and itching and irritation in 2.5% patients. The most frequent disease was cataract in 44.3% patients (18.1% had cataract in one eye while 26.2% had cataract in both eyes).

Visual impairment (visual acuity equal to or <6/60 in the better eye) was recorded in 21.1% of the patients. The major causes of visual impairment were cataract in 45% of the patients, glaucoma in 15.38% and retinal diseases in 14.61%. Intraocular pressure >22 mm of Hg in both eyes was found in 5.8% patients while 6.9% had >22 mm of Hg in one eye at the time of presentation.

As far as the management of these patients was concerned, 46.3% were advised surgeries, 12.9% were treated medically, 24.7% were refracted, and 14.9% were referred to specialized clinics. A majority of the patients (48.31%) was from Rawalpindi and Islamabad, while 10.6% were from AJK, 8.4% from NWFP and 20.3% were from nearby cities like Attock, Chakwal, Gujrat, Gujar Khan and Jhelum.

Cataract, glaucoma, and retinal and corneal diseases are still a major challenge for ophthalmologists in Pakistan because these diseases remain the main causes of visual impairment in elderly patients, thus affecting their quality of life.

“The elderly should be encouraged for an annual ocular examination so that early detection of visual impairment is done and permanent visual loss is prevented,” Dr. Amtul Aziz of the Department of Research at Al-Shifa Trust Eye Hospital said while talking to ‘The News’ here on Thursday.

World Health Organisation data on global patterns of blindness show that cataract accounts for 48% of global blindness, followed by glaucoma (12.3%), age-related macular degeneration (8.7%), corneal opacities (5.1%) and diabetic retinopathy (4.8%).

Recent WHO discussions on the growing incidence of chronic, age-related, non-communicable diseases indicate that visual health and its preservation are now receiving attention. In developing countries like Pakistan, various community programmes have been launched to screen elderly patients affected from various types of preventable or treatable ocular diseases. However, very few studies showing the frequency of various ocular diseases in these patients have been published. “The results of such studies will definitely help us focus our attention on more prevalent ocular diseases while planning future strategies in our country,” Dr. Amtul Aziz hoped.

Dr. Amtul regretted that although cataract has been the major stimulus for technological research and development in ophthalmology, Pakistan’s failure to adequately control cataract blindness continues to be a matter of concern. She recommended the development of national health education programmes to improve individual awareness of age-related ocular disorders and availability of current ophthalmic interventions for them.

“There is also need for the rapid expansion of such services at the district levels,” Dr. Amtul said. The elderly should be encouraged to come for annual ocular examination so that early detection of visual impairment is done and permanent visual loss is prevented.

Source: The News, 4/7/2008

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