Cataract in a rural Sri Lankan population.

The aims of this study are to determine the prevalence of and risk factors for cataract, the cataract surgical coverage (CSC) and self-reported barriers to cataract surgery in a rural region of central the Kandy District of central Sri Lanka. A population-based, cross-sectional ophthalmic survey of the inhabitants of rural villages in central Sri Lanka was conducted; 1375 individuals participated (79.9%; age >/= 40 years, average age 57) and 1318 (95.9%) had an examinable lens in at least one eye. Data collection included district, age, gender, occupation, education level, smoking history, height, weight and dilated lens assessment using Lens Opacities Classification System III grading: nuclear (≥4), cortical (≥2) and posterior subcapsular (≥2) cataracts. Aphakic and pseudophakic eyes were included as operated cataracts for statistical analysis. Participants with cataract-induced visual impairment (acuity < 6/18 in the better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery. The prevalence of any cataract including operated eyes was 33.1% (95% CI, 22.4 – 43.7%): 26.0% cortical; 7.9% posterior sub-capsular and 4.5% nuclear cataracts. No significant association was found between cataract and gender, smoking or outdoor occupation. Low level of education (secondary or higher vs no education: OR 0.6, CI 0.4-0.9, P=0.04) and shorter stature were associated with a higher likelihood of any cataract. (OR 1.7, CI 1.1-2.7, P=0.02) Cataract surgical coverage per individual for visual acuity cut-offs of <6/18, <6/60 and <3/60 was 41.9%, 76.8% and 82.7%, respectively; and per eye was 34.0%, 60.3% and 65.2%, respectively. Cataract surgical coverage was higher for men than women, and two thirds refused referral for surgery, for the following reasons: no desire to improve vision, fear of surgery and lack of awareness were the most frequently reported barriers. The overall prevalence of cataract in central Sri Lanka is similar to that in other developing Asian regions except for the unusually low prevalence of nuclear cataract. Illiteracy and height appear to be significant predictors for cataract in this population and further investigation is required to explore their influence. Cataract surgical coverage in central Sri Lanka is higher than that in neighbouring developing regions, however improved community education may further increase surgical uptake.Thesis (M.Opht.) -- University of Adelaide, School of Medicine, 201

Cervical Carcinoma Manifesting as Progressive Bilateral Visual Loss

We report a patient with bilateral choroidal metastasis from disseminated cervical squamous cell carcinoma. A 52-year-old woman presented with progressive bilateral visual loss due to choroidal masses in both eyes. The fundus examination revealed posterior serous retinal detachment in both eyes associated with creamy choroidal lesions. A thorough systemic work-up revealed choroidal metastasis from a squamous cell carcinoma of the cervix. This case highlights the importance of a thorough systemic evaluation in patients with choroidal tumours

Desferrioxamine-related ocular toxicity: A case report

A 29-year-old lady receiving repeated blood transfusions for β thalassemia since childhood, presented with rapidly deteriorating symptoms of night blindness and peripheral visual field loss. She was recently commenced on high-dose intravenous desferrioxamine for reducing the systemic iron overload. Clinical and investigative findings were consistent with desferrioxamine-related pigmentary retinopathy and optic neuropathy. Recovery was partial following cessation of desferrioxamine. This report highlights the ocular side-effects of desferrioxamine mesylate and the need to be vigilant in patients on high doses of desferrioxamine

Transcanalicular approach to adult lacrimal duct obstruction: A review of instruments and methods

Developments in fiberoptic technology and increasing interest in minimally invasive surgery have fueled advances in transcanalicular surgery. This article presents a review of instruments and methods for diagnostic and therapeutic approaches to adult lacrimal drainage obstruction. Available endocanalicular probes, microendoscopes, lasers, microdrills, trephines, and antegrade lacrimal balloon catheters are discussed and compared. Developments in microendoscopy, laser transcanalicular dacryocystorhinostomy, laser canaliculoplasty, transcanalicular drilling and trephination, and transcanalicular balloon dacryoplasty are also discussed in detail. Transcanalicular surgery provides a minimally invasive approach to adult lacrimal drainage obstruction that may also address the pathology causing the obstruction. Long-term success rates of transcanalicular dacryocystorhinostomy appear to be improving, but cost and a paucity of data on long-term results continue to limit the use of transcanalicular surgery.Paul A. Athanasiov, Venkatesh C. Prabhakaran, Geva Mannor, John J. Woog and Dinesh Selv

Cataract prevalence varies substantially with assessment systems: Comparison of clinical and photographic grading in a population-based study

10.3109/09286586.2011.594205Ophthalmic Epidemiology184164-170OPEP