Daudzai research book.docx

8/21/2019 Daudzai research book.docx

1/44

1


2/44

1.1 Introduction

The term cataract is derived from the Greek word “cataractos”, which means water fall.

Cataract is opacity or clouding of the crystalline lens which prevent light rays from

reaching the retina. Cataract is the main cause of low vision and lindness in the world!a"ority of cataract #$%&' is regarded as senile or age related with uncertain etiology.

(owever, it is a preventale cause for lindness rectified y the use of appropriate surgical

services. The asence of effective utili)ation of such services leaves many of those affected

y it with severely impaired vision. *ignificantly, a ma"ority of those living with lindness

due to cataract and poor access to services are in the developing +orld.1,,-

1.ack ground

1.2.1 World

According to WHO estimates of global data on blindness, there are an estimated 38

million blind people worldwide, and a further 110 million with low vision who are

at risk of becoming blind !ataract is the leading cause of blindness" accounting for

about half of all blindness in the world# and average prevalence of blindness isabout 0$% in the world# Age&related cataract accounts for nearl' half of these

blind individuals, and is particularl' common in developing countries( WHO

reports that there is a backlog of cataract of appro)imatel' 1(8 million people

with an annual increase of over * million newl' cataract&blind patients+he World

Health Organi-ation .WHO/ estimates that nearl' 18 million people are bilaterall'

blind from cataract in the world, representing almost half of all global cases of

blindness !ataract remains the leading cause of blindness and an important cause

of visual impairment across the globe(, +

2


3/44

1.2.2 Pakistan

akistan, a developing countr' situated in the World Health Organi-ations .WHO/

2astern editerranean 4egion .24&5/, is bordered b' 6ndia, !hina, 6ran, and

Afghanistan is the si)th most populous countr' in the world According to the

akistan 7ational lindness and 9isual 6mpairment surve' the prevalence of

blindness among individuals of all ages in akistan is 0:%!ataract accounts for

the most common cause .(1(%/ of avoidable blindness in akistan$

1.- /I*0 2CT3/*

he main non&modifiable risk factor for cataract is aging Other fre;uentl'

associated risk factors are trauma, uveitis, diabetes, ultraviolet light e)posure, and

smoking !hildren are occasionall' born with cataracts, mainl' due to genetic

disorders Women are at greater risk than men for developing cataracts and are less

likel' to have access to services(

1.4 Types of Cataract

Types of cataracts include5

• A sub capsular cataract occurs at the back of the lens eople with diabetes

or those taking high doses of steroid medications have a greater risk of

developing a subcapsular cataract

• A nuclear cataract forms deep in the central -one .nucleus/ of the lens

7uclear cataracts usuall' are associated with aging

• A cortical cataract is characteri-ed b' white, wedge&like opacities that start

in the peripher' of the lens and work their wa' to the center in a spoke&like

3


4/44

fashion his t'pe of cataract occurs in the lens corte), which is the part of

the lens that surrounds the central nucleus8

1.6 *ymptoms of Cataracts

Common symptoms of cataracts include5

• blurr' vision

• trouble seeing at night

• seeing colors as faded

• increased sensitivit' to glare

• halos surrounding lights

• double vision in the affected e'e

• fre;uent changes in glasses prescription8

1.7 Treatment of Cataracts

7on&surgical treatments for cataracts include stronger e'eglasses, magnif'ing

lenses, and sunglasses with an anti&glare coating


5/44

incision in the cornea After surger', an artificial intraocular lens is placed where

the natural lens was8

1.$ 8efinition and ackground of patient satisfaction

According to the 2nglish dictionar' =to satisf'> means =to suppl' full' with what

is desired, e)pected or needed>


6/44

cataract surger' is e)panding rapidl' hese medical and economic problems

caused b' cataract are reflected b' the numerous clinical and cost&effectiveness

studies, which mainl' describe the benefits of cataract surger' However, it is

important to also e)amine the ps'chosocial aspects of cataract surger' to how

much the patient satisfied from surger' 2speciall', when modern indications for

cataract surger' are based on dail' interference of visual function of the patient:

Although cataract surger' is routine surger', one should never forget the

uni;ueness of the surgical e)perience for the patient he e'e is an important

organ, both from a ph'siological and a ps'chological point of view With respect to

an outcome&related ;ualit' of care, point of view is that cataract surger' has

pro)imal and distal goalsB to improve vision, which results in better vision related

functioning that will subse;uentl' enhance the generic ;ualit' of life .@igure 18/1

@igure 181B ro)imal and distal goals of cataract surger'

9isual functioning and ;ualit' of life have been recogni-ed as important measures

of treatment effectiveness in addition to the more traditional outcome parameter

visual acuit' he difference between the more traditional definition of success of

cataract surger' from the doctors perspective and the patients defined success is

demonstrated b' the following ;uotations !iting an ophthalmologistB =' patient

has *0C*0 A patient ma' translate this medical

outcome into = his patient translation shows satisfaction levels are clearl'

related to clinical outcome10Eualit' of vision is the patients abilit' to see well in

6


7/44

the conte)t of his or her own individual visual re;uirements, that is, patients

satisfaction with the surger'

92TI:;T 3


8/44

8


9/44

/ationale

!ataract is one of the most fre;uentl' occurring causes of visual impairments among the ocular

disorders in the world and is the most important cause of reversible visual

impairment13,1#!ataract in elderl' patients can cause progressive painless vision loss 13, ecause

of the demographic shift in developed countries toward older age, the prevalence over the whole

population has increased 6n akistan appro)imatel' ($0,000 adults are estimated to be blind as a

result of cataract 1# he ma?or indication for cataract surger' is to improve as man' aspects of

the visual function as possible, such as contrast sensitivit', disabilit' glare and even visual fields

he goal is not onl' to improve functional vision, but also to improve performance in dail'

living activities 5espite this, controvers' remains regarding the effectiveness of surger' inimproving visual acuit' .9A/ in the elderl'1(,1+ 6n cataract patientFs G#0 'ears old, there is a

relationship between postoperative 9A and the abilit' to en?o' activities of dail' life 1$,18

revious reports

have focused primaril' on the patients 9A, while the effect of surger' on the patients ;ualit' of

life with respect to vision&dependent activities .visual function/ or satisfaction with the final

outcome of surger' has received less evaluative attention he decision to perform cataract

surger' should not be based solel' on 9A results*0

A growing bod' of research indicates that visual acuit' .9A/ alone is an inade;uate measure of

visual impairment he impact on visual function .9@/ is closel' related to patient&perceived

outcomes and has become a significant factor in the evaluation of the outcome of surgical

interventions Although patients ma' benefit from an increase in 9A and 9@ after cataract

surger', their satisfaction ma' be limited Assessment of patient satisfaction gives additional

9


10/44

information on the result of surger' and is therefore of further importance in evaluating surgical

outcome13

here have been a number of previous studies to find out onl' 9A after cataract surger' with

intraocular lens implants,1: but no stud' is done on a combination of all these criteria in

eshawar region, that is, 9A and satisfaction regarding the effect of 9A on the patients abilit' to

participate in their dail' living activities after cataract surger'


11/44

11


12/44

2I!5

Assessment of patient satisfaction level after cataract surger' in population

having age G#0 'ears

3=:CTI>:*5

• o evaluate the patient satisfaction level amongst patients operated for

cataract in H!

• o evaluate the effect of cataract surger' on 9A in patients having age G#0

'ears

12


13/44

13


14/44

atient satisfaction with surger' is an important outcome measure to include in the assessment of

surgical outcomes

he retrospective stud' carried out using operation theater records at the 4ural Health raining

!entre .4H!/, aithan, during *00$ Out of 81: cataract surger' patients operated in *00$ a

total of (0 were selected randoml'post&operative 9A was +C18 or better in n:.1:+%/, while *1

.#($%/patients had vision .I+C18&+C+0/ and 1+ .3#$%/ had vision I +C+0 in total #+

patientsAccording to score *# .(*1%/ good, 1# .30#%/ normal and 8 .1$3%/ were poor

satisfied with their visual outcome*1

According to a stud' conducted in the Jevel 66 hospital K7 mission, @eb *00+ to 7ov *00+ , A

total of 1#1 e'es of 13+ patients who completed the minimum + weeks A vision of +C18 or

better was obtained in 10* e'es .$*3%/, +C*#&+C+0 in *3.1+3%/ and L+C+0 in 1+ .103%/ at

their last follow up visit1** .8+(%/ good, 1# .::%/ normal and ( .3(%/ were poor satisfied

with their visual outcome

A stud' conducted at 5epartment of Ophthalmolog', edical Kniversit' of 9ienna, 9ienna,

Austria 6mprovements in visual outcomes were significantl' higher hree months

postoperativel', :#*% of the patients reported improved 9A and :*(% reported improvements

in visual function

Heritage edical 4esearch published a stud' through D Ophthalmolog' found that out of 1++

patients +*#% were 9er' satisfied,1:(%, Jad' 4eading Hospital,

eshawar b' ubashir 4ehman,Asim Ali


15/44

n$#.#:%/, while +0 .3:%/patients had vision .I+C18&+C+0/ and 1$ .1*%/ had vision I +C+0in

1(1 patientshe ;uestionnaire also indicated good patients satisfaction with the results

achieved**

According to stud' conducted in in tribal region of


16/44

16


17/44

!:T(38* 2;8 !2T(/I2?*5

9re survey @ *urvey !ethodology5

re surve' planning

5evelopment of erforma

raining on 6


18/44

future fieldwork and data anal'sis and interpretation was made through

supervisor guidance

. Training on I! *9** *tatistics B and !s :cel5

One week module was attended and creating Euestionnaire, 5ata 2ntr' and

5ata Anal'sis was learnt r Pia, 6 2)pert, 6!O, was the supervisor

-. 9rior Communication5

hrough communication with the concerned authorit' prior approval and

cooperation was sought

4. 9erforma developmentD 8esigning5

9ariables in the erforma were selected according to the aims and ob?ectives of

the stud' and was tested in e'e O5 at Ha'atabad edial !omple), eshawar

in one da' pilot surve' and then finali-ed for surve'

%. 9ilot *tudy5

A one da' pilot was conducted to get an idea of the number of patients of the

re;uired age group in O5, for making arrangements

6. *ample si)e5

18


19/44

All patients aged G #0 'ears who are operated for cataract and visiting e'e O5

for follow up during * weeks ie from 13th October *01# till *(th October

*01#

7. *tudy design5

5escriptive !ross&


20/44

his cross&sectional stud' was conducted for patient aged G #0 'ears who

operated for cataract and visiting for follow up

1. 8ata Collection !ethodology5

his hospital&based, descriptive cross&sectional stud' was conducted at 2'e

department"H! eshawar for three months, from sep*01# to

5ec*01#Approval from hospital ethical committee was obtained atients aged

G#0 'ears underwent cataract surger' was included in the stud' re&Operative

9isual acuit' recorded fromocular e)amination record and post&Operative 9A

with and =poor on basis of score categori-ed in

;uestionnaire atients who have no preoperative ocular e)amination record

were e)cluded from thestud'. Nlare was assessed b' trouble seeing street signs

during da'light and problems with oncoming headlights at night !olor

perception was assessed b' asking for trouble recogni-ing specific colors

5epth perception was assessed b' trouble pouring li;uids or going downstairs

Haloes were assessed b' asking for rings around light during night Eualit' of

vision was assessed during 9 watching, pla'ing or working outdoor, reading

time on watch and wall clock, driving at night and during rain, and using

computer and cell phone After asking all the above ;uestions the patients were

asked to give an overall satisfaction level

*tudy tools were reFuired5

• 9A !hart .snellens/

20


21/44

• rail frame with occluder

•


22/44

III. 93*T *A !:T(383?3GA

1. 8ata :ntry5

!ollected data was then entered in the pre created ;uestionnaire in 6


23/44

23


24/44

9reoperative >2

9isual Acuit' @re;uenc' ercent

+C+&+C18 7il 0

I+C18&+C+0 $ 1*(

I+C+0 #: 8$(

otal (+ 1000

6/6-6/18


25/44

9ost3perative >2

9isual Acuit' @re;uenc' ercent

+C+&+C18 3+ +#3

I+C18&+C+0 1* *1#

I+C+0 8 1#3

otal (+ 1000

6/6-6/18


26/44

Gender 8istriution

Nender @re;uenc' ercent

@emale 18 3*1

ale 38 +$:

otal (+ 1000

Females Males0

5

10

15

20

25

30

35

40

Gender Distribution

32.10%

26


27/44

Comparison of 9re and 9ost3perative >2

Visual acuity Pre!erati"e Pst!erati"e6/6-6/18 #il 36 $64.3


28/44

Distribution of atisfaction scores of cataract sur!er" patients

*core *atisfaction level ;umer#&age'

+0 Q 80 Nood *$ .#8*%/

30 Q (0 7ormal 18 .3*1%/

10 Q *0 oor 11 .1:+%/

60-80 )* 30-50 #rmal 10-20 Pr

0

5

10

15

20

25

30

*atisfaction level with *core

28


29/44

he stud' was conducted for three months from Ha'atabad edical !omple), eshawar ean age was

+1 'ears Nender distribution was anal'-ed as n38.+$:%/ of (+ patients were

males and n18.3*%/ were females

>isual outcome after cataract surgery

here were 3+ .+##%/ cataract operated people having good visual outcome .9A

+C+&+C18/, 1* .3+#%/ had .9A I+C18&+C+0/ and 8 .1#3%/ had 9A I+C+0

*atisfaction with surgery

he satisfaction level was high among operated in the sample *$ .#8*%/, normal

level studied 18 .3*%/, while 11 1:+% were poor satisfied.

29

>isual acuity 9reoperative 9ostoperative

6D66D1$ ;il -6#64.-&'

H6D1$6D6B 7#1.%&' 1 #1.4&'

H6D6B 4E #$7.%&' $#14.-&'

Total %6 #1BB&' %6 #1BB&'


30/44

*core ;umer #&age'

1B B Good 7 4$.B&

-B %B ;ormal 1$ -.1B&

6B $B 9oor 11 1E.6B&

30


31/44

he WHO suggests that 8(% of e'es undergoing cataract surger' should have

good outcome .+C+Q+C18/, 10% have borderline outcome .+C18Q+C+0/, while less

than (% havepoor outcome .+C+0/*#he visual results are similar to other

studieshis stud' showed that visual outcome in most of the operated e'es was

good .9A G+C18/ in .3+/ +##% cases,1*.*1#%/ was at orderline, while in some

8.1#3%/ respectivel' after cataract e)traction However our stud' was no similar

to WHOs standard but revealed good outcome results than population based

studies in Jower 5ir, akistan .3$3%/, !hakwal, akistan .3**%/, 7epal .*1%/,

!hina .3:%/*#

According to ubashir 4, Asim A < et al studies post&operative 9A +C18 or better

in n$#.#:%/, while +0 .3:%/patients had vision .I+C18&+C+0/ and 1$ .1*%/ had

vision I +C+0in 1(1 patients which is comparable to our results that was +##%,

*1#% and 1#3%

roportionatel' high number of people who had undergone cataract surger' and

were satisfied #8*% which can associated with stud' ofR9i?a' 5omple,

Arvind 9 Naikwad,et al (*1%,However our results about visual outcomes aremuch better than mentioned stud' Out of 81: cataract surger' patients operated in

*00$ a total of (0 were selected randoml' ost&operative 9A was +C18 or better in

n:.1:+%/, while *1 .#($%/patients had vision .I+C18&+C+0/ and 1+ .3#$%/ had

31


32/44

vision I +C+0 in total #+ patients and our results were .9A G+C18/ in .3+/ +##%

cases,1* .*1#%/ was at orderline, while in some 8.1#3%/ respectivel'

atient satisfaction with surger' is an important outcome measure to include in the

assessment of surgical outcomes he satisfaction level was high among operated in

the sample *$ .#8*%/, normal level studied 18 .3*%/, while 11 1:+% were poor

satisfied

According to stud' conducted in the Jevel 66 hospital K7 mission , vision of +C18

or better was obtained in 10* e'es .$*3%/, +C*#&+C+0 in *3.1+3%/ and L+C+0 in

1+ .103%/ at their last follow up visit, which were comparable to our stud',

he presenting visual acuit' was similar and comparable to those in other reviewed

studies 6t showed that most of our patients onl' seek medical attention when the'

are blind or almost blind in the two e'es, or at least one e'e his is slightl'

different from what obtains in developed countries, where patients seek medical

attention earlier and therefore present with better visual acuit'*(

he present stud' revealed that cataract surger' is an effective treatment in terms

of improvement of visual acuit', postoperative functioning, and patients opinion

about the ;ualit' of life Around (0% of the operated patients showed their score in

the range of +0&80 for visual satisfaction, more than *C3 patients found to be

satisfied after cataract surger'

32


33/44

33


34/44

his stud' clearl' shows the beneficial and favorable outcomes he patients who

are operated for cataract were full' satisfied from their surger' because the'

having better visual acuit' after cataract surger' and were able to perform their

dail' life activities

34


35/44

35


36/44

42!O275A6O7B

S ost&operative pseudophakic correction is necessar' for better visual outcomes herefore

vision centers with good and affordable 42 services needs to be established in the rural

area

S here is need to focus more on ;ualit' of the cataract surger' which in turn ma' help in

sustaining the surgical services at base hospital raining of surgeons, good instruments

and e;uipments and regular clinical audits in the hospital must be in place to ensure the

;ualit'

S here is a need to provide effective cataract surgical services in the rural areas at countr'

level

S here is a need to have outreach programs .screening at village and surger' at base

hospital or satellite !enters with free transportation facilit' or pa'ing them for the cost of

their return travels

36


37/44

S Awareness regarding cataract surger' is not enough in the communit' eoples ma'

educate and advertise in their villages about e'e care and facilit' available and refer

them he local print and electronic media, handbills&fl'ers and health talks b' health

workers ma' help

37


38/44

1 World Health Organisation Approaches to prevent visual impairment 6nBvision *0*0 the right

to sight Nlobal initiative for elimination of avoidable blindness action plan *00+&

*011WHONenevaB6A"*008

* Jimburg H, World Health Organisation anual for rapid assessment of cataract surgical

services revention of blindness and deafness, Neneva, WHO


39/44

+ uhammad ari; han,


40/44

1# 2 Xonestam and J Wachmeister, =6mpact of cataract surger' on the visual abilit' of

the ver' old,> American Dournal of Ophthalmolog',vol 13$, no 1, pp 1#(Q1((, *00#

1( P Dadoon,


41/44

*0 aneli o-affarieh,1 Harald Hein-l et al!linical outcomes of phacoemulsification cataract

surger' in diabetes patientsBvisual function .9@&1#/,visual acuit' and patient satisfaction,Acta

Ophthalmol


42/44

42


43/44

DATA ENTRY FORM FOR “ASSESSMENT OF SATISFACTION LEVEL AFTER CATARACT

SURGERY IN PATIENTS HAVING AGE ≥40 YEARS ATTENDING EYE UNIT HMC

PESHAWAR.”

Date ______________ OPD Reg No _____________

Name______________ Age______________ Area _____________

Gender [1] Male [2] Female O!"#$%&n

1): Teacher 2: Clerk 3: doctor 4: Engineer 5 : Mechanic 6: Ho!e"i#e $: Farmer

%: &ri'er (: Comter *erator 1+: ,ood ,orker 11: -!ine!!man 12: *ther

VA 'e(&re S!r)er*+ *& *.

[1] 6/6 [2] 6/( [3] 6/12 [4] 6/1% [5] 6/24 [6] 6/36 [$] 6/6+ [%] 0 6/6+

S!r)er* D&ne %n [1] ight Ee [2] e#t Ee [3] -oth Ee!

VA A($er S!r)er*+ *& *.

[1] 6/6 [2] 6/( [3] 6/12 [4] 6/1% [5] 6/24 [6] 6/36 [$] 6/6+ [%] 06/6+

43


44/44

1 &o o #eel di##erence in 'i!ion e!/7o2 8! or 9 according to or e;ectation! a#ter !rger e!/7o3 8! there a tro

Daudzai research book.docx

Documents

Transcript of Daudzai research book.docx