Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: The Bhaktapur Glaucoma Study

<p>Abstract</p> <p>Background</p> <p>Cataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal.</p> <p>Methods</p> <p>Subjects aged 40 years and above was selected using a cluster sampling methodology and a door to door enumeration was conducted for a population based cross sectional study. During the community field work, 11499 subjects underwent a structured interview regarding awareness (heard of) and knowledge (understanding of the disease) of cataract and glaucoma. At the base hospital 4003 out of 4800 (83.39%) subjects underwent a detailed ocular examination including log MAR visual acuity, refraction, applanation tonometry, cataract grading (LOCSΙΙ), retinal examination and SITA standard perimetry when indicated.</p> <p>Results</p> <p>The age-sex adjusted prevalence of blindness (best corrected <3/60) and low vision (best corrected <6/18 ≥3/60) was 0.43% (95%C.I. 0.25 - 0.68) and 3.97% (95% C.I. 3.40 - 4.60) respectively. Cataract (53.3%) was the principal cause of blindness. The leading causes of low vision were cataract (60.8%) followed by refractive error (12%). The cataract surgical coverage was 90.36% and was higher in the younger age group, females and illiterate subjects. Pseudophakia was seen in 94%. Awareness of cataract (6.7%) and glaucoma (2.4%) was very low. Among subjects who were aware, 70.4% had knowledge of cataract and 45.5% of glaucoma. Cataract was commonly known to be a 'pearl like dot' white opacity in the eye while glaucoma was known to cause blindness. Awareness remained unchanged in different age groups for cataract while for glaucoma there was an increase in awareness with age. Women were significantly less aware (odds ratio (OR): 0.63; 95%, confidence interval (CI): 0.54 - 0.74) for cataract and (OR: 0.64; 95% CI: 0.50 - 0.81) for glaucoma. Literacy was also correlated with awareness.</p> <p>Conclusion</p> <p>The low prevalence of visual impairment and the high cataract surgical coverage suggests that cataract intervention programs have been successful in Bhaktapur. Awareness and knowledge of cataract and glaucoma was very poor among this population. Eye care programs needs to be directed towards preventing visual impairment from refractive errors, screening for incurable chronic eye diseases and promoting health education in order to raise awareness on cataract and glaucoma among this population.</p

Release and toxicity comparison between industrial- and sunscreen-derived nano-ZnO particles

Many consumer products containing ZnO have raised concern for safety in regard to environmental impact and the public health. Widely used sunscreens for protecting against UV and avoiding sunburns represent a great exposure to nano-ZnO, one of the ingredients commonly applied in sunscreens. Applying nanoproducts on beaches may release nanoparticles unintentionally into the ocean. Despite the accumulation of such nanoproducts in the ocean harming or being detrimental to critical marine organisms, few studies have investigated the release and potential toxicity of nanoparticles extracted from products and compared them with those from industrial-type nanoparticles. Results show that the cytotoxicity of both industrial- and sunscreen-derived nano-ZnO to the marine diatom algae, Thalassiosira pseudonana, increased as exposure increases over time, as measured by growth inhibition (%) of the algae at a constant concentration of nano-ZnO (10 mg/L). The extent of toxicity appeared to be higher from industrial-type nano-ZnO compared with sunscreen-extracted nano-ZnO, though the extent becomes similar when concentrations increase to 50 mg/L. On the other hand, at a fixed exposure time of 48 h, the cytotoxicity increases as concentrations increase with the higher toxicity shown from the industrial-type compared with sunscreen-induced nano-ZnO. Results indicate that while industrial-type nano-ZnO shows higher toxicity than sunscreen-derived nano-ZnO, the release and extent of toxicity from nano-ZnO extracted from sunscreen are not trivial and should be monitored for the development of safe manufacturing of nanomaterials-induced products