According to World Health Organization (WHO), cataract is the leading cause of blindness and visual impairment throughout the world with approximately 50% of the worlds blind suffer from cataract.1 Most cases of blindness in the world are avoidable and preventable. WHO VISION 2020 targets elimination of cataract as one of blinding diseases by 2020 since its preventable.2 Most age related cataract surgery outcomes are poor in subSaharan Africa due to a number of factors such as poor patient selection, poor surgical techniques among others.3 The number of people undergoing cataract surgery of the past years has been increasing rapidly hence the need to investigate the outcomes of the cataract surgeries being performed. It’s therefore necessary to conduct a study on the outcome of agerelated cataract.
RESEARCH PROPOSAL OUTCOME OF AGE-RELATED CATARACT SURGERY IN JUBA MEDICAL COMPLEX DR AJA PAUL KUOL A THESIS PROPOSAL SUBMITTED IN PARTIAL FULFILLMENT FOR THE AWARD OF DEGREE OF MASTERS IN MEDICINE, (OPHTHALMOLOGY) AT THE UNIVERSITY OF NAIROBI 2014 DECLARATION I declare that this research proposal is my original work and has never been published or presented for a degree in any other University Dr Aja Paul SIGNATURE …………… DATE……………… PRINCIPAL INVESTIGATOR, Dr Aja Paul Kuol Department of Ophthalmology, University of Nairobi H58/63241/2013 SIGNATURE …………………………… DATE……………………………… ii APPROVAL BY SUPERVISORS: This proposal has been submitted with our approval as Supervisors: Dr Sheila Marco MB.CHB, M.Med (Nairobi), FEACO, Ophthalmologist (Glaucoma specialist) Signature .……………………………………… Date ………………………… Prof Jefitha Karimurio, MB.CHB, M.MED (Nairobi), MSC-CEH (London), FEACO, PhD (Melbourne) Department of Ophthalmology, University Of Nairobi Signature………………………………… Date …………………………… Dr.Wani Gindalang Mena, MBChB, MMED (Harari) Msc, ClinEpi Consultant Ophthalmologist, Head of Eye Unit, Juba Teaching Hospital-S.Sudan Signature………………………………… Date …………………………… iii TABLE OF CONTENTS DECLARATION ii APPROVAL BY SUPERVISORS: iii LIST OF ABBREVIATIONS AND ACRONYMS .v ABSTRACT vi 1.0 INTRODUCTION 1.1 Overview of cataract 1.2 Epidemiology .2 1.3 Cataract Surgery in South Sudan .3 2.0 LITERATURE REVIEW 2.1 Outcome of cataract surgery 3.0 JUSTIFICATION 11 4.0 OBJECTIVES OF THE STUDY 12 4.1 Main Objective 12 4.2 Specific Objectives 12 5.0 MATERIAL AND METHODS 13 5.1 Study Area 13 5.2 Study Design 14 5.3 Study Population: .14 5.4 Case Definition: .14 5.5 Target population .14 5.6 Sample Size 15 5.7 Study Period .15 5.8 Inclusion Criteria 16 5.9 Exclusion Criteria 16 5.10 Data Collection 16 5.12 Data Management and Analysis 17 5.12 Ethical Considerations 18 5.13 Study Limitations 18 6.0 REFERENCES .19 7.0 APPENDICES .23 7.1 APPENDIX I: QUESTIONNAIRE 23 7.2 APPENDIX II: W.H.O CLASSIFICATION OF BLINDNESS 26 7.3 APPENDIX III: DEFINITION OF TERMS 27 7.4 APPENDIX IV: WORK PLAN .28 7.5 APPENDIX V: BUDGET 29 iv LIST OF ABBREVIATIONS AND ACRONYMS BCVA Best corrected visual acuity ECCE Extra-capsular cataract extraction ICCE Intra capsular cataract extraction IOL Intra ocular lens JMC Juba Medical Complex VA Visual Acuity WHO World Health Organization v ABSTRACT Background: According to World Health Organization (WHO), cataract is the leading cause of blindness and visual impairment throughout the world WHO target is to eliminate cataract as one of blinding disease by 2020 Most age related cataract surgery outcomes are poor in sub-Saharan Africa due to patient selection, poor surgical techniques or uncorrected refracted errors among others In Juba, there are a lot of cataract surgeries being done As time goes, the number of patients waiting for cataract surgery is predicted to increase Further, there is no current published study finding with regard to age related cataract surgery It’s therefore necessary to conduct a study on the outcome of age-related cataract Objective: To determine the outcome of age related cataract surgery at Juba Medical Complex from March 2011 to March 2014 Study design: A retrospective hospital based case series Study population: Any patient 40 years of age and above who underwent age related cataract surgery in Juba Medical Complex within the study period Materials and methods: Data will be extracted from theatre registers and from the files of patients aged 40 years old and above who had age related cataract surgery All the necessary socio- demographic and clinical data of the patient will be captured using a standardized structured questionnaire and analyzed using STATA Version 13 Descriptive analysis will be used to determine means, frequencies and proportions of the various variables Proportionate test will be used to compare proportions Chisquare will be used to test factors associated with poor outcome Results will be presented in form of tables and graphs vi 1.0 INTRODUCTION According to World Health Organization (WHO), cataract is the leading cause of blindness and visual impairment throughout the world with approximately 50% of the world's blind suffer from cataract Most cases of blindness in the world are avoidable and preventable WHO VISION 2020 targets elimination of cataract as one of blinding diseases by 2020 since its preventable Most age related cataract surgery outcomes are poor in sub-Saharan Africa due to a number of factors such as poor patient selection, poor surgical techniques among others.3 The number of people undergoing cataract surgery of the past years has been increasing rapidly hence the need to investigate the outcomes of the cataract surgeries being performed It’s therefore necessary to conduct a study on the outcome of age-related cataract 1.1 Overview of cataract Cataracts are cloudy patches that develop in the lens of your eye and can cause blurred or misty vision.1,2,4 A cataract can occur in either or both eyes and cannot spread from one eye to the other Most cataracts are related to aging and are very common in older people, but there are other types of cataract due to other factors and they include traumatic cataract, congenital cataract, radiation cataract etc1,5,6 Cataract is usually detected through a comprehensive eye exam which includes visual acuity test, dilated eye exam and tonometry 6,7 The symptoms of early cataract may be treated or improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses However, when these measures not help, surgery becomes the only effective treatment.7,8 Cataract surgery is a procedure which involves removal of cloudy natural lens and replacing it with a clear optical device such as an intraocular lens (IOL) or contact lenses This is a technique which prevents the blindness from occurring Some of the cataract surgeries include: Phacoemulsification (phaco), Extracapsular Cataract Extraction (ECCE), Intracapsular Cataract Extraction (ICCE) and Small Incision Cataract Surgery (SICS) among others.7,8,9,10 Risk factors for age-related cataract include diabetes, prolonged exposure to sunlight, tobacco use and alcohol drinking among others.1,6,11 1.2 Epidemiology The prevalence of age-related cataract varies from region to region Globally, the estimated number of blind people is about 39 million and approximately 82% of people living with blindness are aged 50 years and above Surgical removal of the cataract is still the current effective treatment that is available to prevent the blindness.12 There are an estimated 39 million blind people and 285 million visually impaired people worldwide and about 90% of people who are visually impaired live in developing countries.13 Unoperated cataract contributes to 33% of the global causes of visual impairments About 65% of all people who are visually impaired are aged 50 and older and this constitutes 20% of worlds population In developed countries, for each decade after the age of 40 there is an expected increase in the prevalence of blindness and vision loss.13 According to WHO, life expectancy in South Sudan is low (54/55 years) because of the long civil war that the country had and majority of the patients develop cataract at younger age around 40 years In Sub-Saharan Africa the prevalence of blindness in people over the age of 50 is as high as 9%, and cataract is responsible for more than 50% of this blindness 14 About 7.1 of the world's 38 million blind people live in sub-Saharan Africa with 60% of Africa's blind being women and 50% of blindness in sub-Saharan Africa is due to cataract.14 The prevalence of blinding cataract in sub-Saharan Africa is approximately 0.5%.14 Cataract is the leading cause of blindness in the world: in 1998, an estimated 20 million people were blind due to cataract 15 Globally, at least 100 million eyes have visual acuity