1. Cataract in the 21st century Liana Al-Labadi, O.D. Lecture 6 Thanks To The Ohio State College of Optometry

2. Cataract Definition An ocular opacity, partial or complete, of one or both eyes, on or in the lens or capsule This opacity usually impairs vision and causes blindness if not treated The “cloudy” appearance of the eye resulted in the origin of the name cataract http://www.herbalgranny.com/wp-content/uploads/2010/09/cataract.jpg

3. Cataract Major public health problem throughout the world Developing countries: resources are unavailable &/or inadequate to provide for surgical correction Cataract accounts for the majority of all blindness Developed countries: Increasing demand for cataract surgery has placed a burden on medial resources The Ohio State College of Optometry

4. Cataract Leading cause of blindness worldwide, accounting for vision loss in half of those blind India: 3.8 million persons are blind from cataract Africa: 2 million persons are blind from cataract Projections indicate that the worldwide prevalence of blindness from cataract could reach 40 millions by 2025 The Ohio State College of Optometry

5. Cataract Major public health problem throughout the world Magnitude of the problem is likely to worsen in coming decades as the number of older persons in the world’s population increases. Less developed regions: The population age 55 & older will nearly quadruple between the years 1980 & 2025 In the U.S.A, projections indicate an 82% increase in the number of persons age 55 & older between 1980 & 2030 The Ohio State College of Optometry

6. Cataract Cataract Surgery The most frequent operation in the US among persons over age 60 In spite of this simple procedure, cataracts still accounts for ~9% of blindness in the US http://i.ytimg.com/vi/orWBAG4qBSM/0.jpg

7. Cataract- Epidemiology Study OPT Epidemiology study On July 30 th, 2010 the St John of Jerusalem Eye Hospital group announced the publication of its seminal 2008 Epidemiology Study into Blindness in the occupied Palestinian Territory (OPT) The study was published in PLoS ONE An international, peer-reviewed, open-access, online publication. Publishes reports on primary research from any scientific discipline. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

8. Cataract- Epidemiology Study Purpose: No recent data on the prevalence and causes of blindness in the occupied Palestinian Territories No robust or comprehensive study of blindness in Palestinians has been conducted for over 20 years. Aim of study: Estimate the prevalence & causes of blindness & visual impairment in people over 50 years of ago http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

9. Cataract- Epidemiology Study Prevalence: The World Health Organization (WHO) estimates that there are 45 million people in the world who are blind. This is expected to rise to 76 million by 2020 if current services are not improved VISION 2020 A joint initiative by the WHO and the International Association for the Prevention of Blindness that aims to eliminate avoidable blindness by the year 2020 1 st step in achieving this target is to obtain baseline data on visual impairment http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

10. Prevalence: The prevalence of blindness may be increased four-fold in areas affected by violent conflict The WHO estimates that the number of blind people in 2002 in the Eastern Mediterranean Region-B (which includes the OPT) was over 1 million people, and that the prevalence of blindness in adults aged 50 years and above in this region was 5.6% http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003 Cataract- Epidemiology Study

11. Population: OPT (Total Population = 3,761,600) East Jerusalem & West Bank 2,345,100 people (2007 figures) Gaza Strip 1,416,500 (2007 figures) 9% of the total population is over the age of 50!! Cataract- Epidemiology Study http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

12. Results: The prevalence of bilateral blindness was 3.4% in people 50 years & older Estimate of blindness for the total population is 0.4% The prevalence of blindness was higher in Gaza than in the West Bank; and higher among women than men Cataract- Epidemiology Study http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

13. Results: Avoidable causes of blindness accounted for 80% of bilateral blindness Cataract Refractive Error Aphakia Surgical Complications Corneal Scarring Phthysis Cataract was the main cause of avoidable blindness Cataract- Epidemiology Study http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

14. Country Prevalence of Blindness Leading Cause of blindness Palestine0.4%Cataract Israel0.3%Macular Degeneration & Glaucoma Lebanon0.6%Cataract & Refractive Error Oman1.1% Cataract & Trachmatous corneal scarring Cataract- Epidemiology Study http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

15. The results of the study suggest that 6,000 people in the OPT are blind due to cataract Reasons for not attending Cataract Surgery Education & beliefs play the largest factor “old age and need not felt” --> most common reason “Could not afford” “Contraindication” “Fear of operation” “Unaware of treatment” “Cannot obtain checkpoint pass” Any expansion of surgical services need to be combined with education programs that raise public awareness and support health services to provide early identification and referral. Increasing number of cataract surgeons & operations may not itself reduce the prevalence of blindness in the population Cataract- Epidemiology Study http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

16. Women have a greater prevalence of blindness & lower cataract surgical coverage Women in the study were more likely to express poverty as a reason not to have the surgery compared to men Inequity between the sexes??? Cataract- Epidemiology Study http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

17. Cataract Surgery: Study shows there is poor outcome after cataract surgery= BIG CONCERN Requires further research & auditing of surgical cases Post-operative refractive error was a major cause of poor and borderline outcome Need to provide these patients with glasses after cataract surgery Cataract- Epidemiology Study http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

18. The number of people with diabetes mellitus in the Middle East is expected to grow from the 2000 estimate of 20 million to just under 60 million in 2030 The study shows that there is a high proportion of people with poor vision due to diabetic retinopathy This points to an urgent need to plan future diabetic eye services Cataract- Epidemiology Study http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

19. Study shows that most blindness in the OPT is avoidable Goals: Raising health awareness Gender equity Better outcomes of Cataract Surgery Improving accessibility The implementation of strategic & sustainable interventions in the delivery of eye services Conclusion http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003