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COMMUNITY EYE CARE
Year : 1997  |  Volume : 45  |  Issue : 1  |  Page : 61-65

A study of ocular morbidity among elderly population in a rural area of central India


Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
M M Singh
Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 9475015

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  Abstract 

A cross-sectional study was conducted in five randomly selected villages in Wardha district of Maharashtra state to study the magnitude and factors related to the prevalence of ocular diseases among the elderly population. A total of 903 persons above 50 years were screened. The prevalence of low vision was 32% while that of blindness was 12.2% Ocular morbidity rate was 1.21 lesions per elderly person and it increased significantly with increasing age (p<0.001). Ocular diseases were found to be more prevalent among males, low socio-economic status group and landless labourers (p<0.001). There was a high prevalence of refractive errors (40.8%), cataract (40.4%), aphakia (11.1%) followed by pterygium (5.2%), glaucoma (3.1%) and corneal opacities (3%). Prevalence of diseases of the lens and iris increased significantly with increasing age (p<0.001). There is a need to evolve strategies for reducing the burden of ocular diseases and improve geriatric eye health under the existing infrastructure of health care delivery in our country.

Keywords: Ocular morbidity, Visual impairment, Cataract, Elderly population.


How to cite this article:
Singh M M, Murthy G V, Venkatraman R, Rao S P, Nayar S. A study of ocular morbidity among elderly population in a rural area of central India. Indian J Ophthalmol 1997;45:61-5

How to cite this URL:
Singh M M, Murthy G V, Venkatraman R, Rao S P, Nayar S. A study of ocular morbidity among elderly population in a rural area of central India. Indian J Ophthalmol [serial online] 1997 [cited 2019 May 25];45:61-5. Available from: http://www.ijo.in/text.asp?1997/45/1/61/15021



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Advancing age is susceptible to numerous diseases especially the degenerative disorders. The frequency of eye diseases has been suggested to start increasing around 40 years of age, with an even steeper increase beginning around 60 years of age.[1] Population based cross-sectional surveys depicting the magnitude of ocular diseases among the elderly population in India are scanty. A proper understanding of the magnitude of ocular diseases and the factors associated with their occurrence in the community would help in planning for geriatric eye care services. The present study was undertaken to determine the magnitude and the relationship of socio-demographic factors like age, sex, literacy, occupation, socio-economic status to the prevalence of ocular diseases in a rural area.


  Materials and methods Top


The study was conducted in 5 villages randomly selected out of 25 villages in the catchment area of a primary health centre, Anji in Wardha district of Maharashtra state in Central India, from October 1990 to April 1991.

An initial census was done to enlist all the individuals above 50 years of age in the study area. The total population of the villages was 7652 of which 903 (11.8%) were individuals above 50 years of age. All of them were included in the study by repeated visits to their homes.

A physician (MMS) trained in ophthalmology for two months specifically for this study carried out the survey. The elderly persons in the study population were interviewed and examined at their homes.

Each person was tested for visual acuity using Snellen dot charts (separately for distant and near vision). Improvement of vision using pinhole was recorded as the best visual acuity. A person was labelled blind when the visual acuity was less than counting fingers at three metres in the better eye.

External eye examination was done using a torchlight and a uniocular loupe (x 10). Confrontation test was performed to detect any gross diminution of field of vision. Fundoscopy was carried out by direct ophthalmoscope with dilatation of pupils whenever a person was found to have the visual acuity less than 6/9.

Refractive error was crudely estimated from lens power readings of the ophthalmoscope. Any lenticular opacity visible with distant direct ophthalmoscope against a red reflex was labelled as cataract.

Lacrimal sac disorders were diagnosed based on clinical signs and symptoms. Probing and syringing was performed to assess the patency of lacrimal ducts among the symptomatic subjects.

Diagnosis of retinal diseases were based on clinical findings. Glaucoma suspects and other doubtful cases were referred for final diagnosis to a consultant ophthalmologist (RV).

The socio-economic status of the families was ascertained by using a modified Uday Pareek scale designed especiall y for use in rural areas of India.[2]

Chi-square test was used to find out significant differences between comparable categorical groups. Trend of prevalence of number of ocular lesions per person in various age-groups was analysed by calculating correlation coefficient 'r' and its significance level was tested by using Student's 't' test. Direct age standardised morbidity rates were calculated for estimating ocular morbidity in relation to sex, socioeconomic status and occupation.


  Results Top


The study population consisted of 479 males and 424 females above 50 years of age. The age and sex wise distribution is shown in [Table - 1]. The population in 50 to 70 years age group was 79.3% in this study. The mean age was 64.6 years (64.7 years for males and 64.5 years for females).

Socio-economically, 55% belonged to lower group and 36.9% and 8.1% to in lower-middle and higher groups respectively.

The distribution of visual acuity is shown in [Table - 2]. Low vision was prevelent in 32% of population and 12.2% were blind. There was no significant difference between males and females regarding low vision (X[2] =1.21, 1 d.f; p>0.05) and blindness (X[2] = 0.19, 1 d.f.; p>0.05).

The ocular morbidity rate was 1.21 lesions per elderly person [Table - 3]. The number of ocular lesions increased significantly from 1.08 per person in the 50 to 59 years age-group to 1.88 per person in the 80 to 89 years age-group (r=+0.47; p<0.001).

The ocular diseases were found to be more prevalent among males (89.1%) than females (79.9%) (p<0.001) [Table - 4]. The prevalence of ocular diseases increased significantly among individuals from upper and middle socio-economic status to those belonging to lower socio-economic status (p<0.001). Similarly, landless labourers suffered from eye diseases more often (89.8%) than other occupational groups (81%) (p<0.001).

The prevalence of various ocular diseases are shown in Table 5. The overall prevalence of diseases of the lids and lacrimal apparatus was 36.5/1000 elderly population. Inflammatory conditions like chronic dacryocystitis, chalazion and blepharitis formed the commonest group of lesions (21/1000) in this category. Other diseases included two cases of stye and one case of trichiasis. Among diseases of cornea and conjunctiva, the degenerative conditions like pterygium and pingueculae predominated (76.5/1000 elderly population) followed by corneal opacities. Other diseases in this category included one case each of trachomatous pannus, corneal ulcer and interstitial keratitis. Active trachomatous lesions in the form of follicles and pannus was found to be low (4.4/1000).

Diseases of the lens and iris formed the most common group of ocular diseases (520.5/1000) among the elderly population. It comprised mainly of cataracts (404.2/1000). The prevalence of surgically operated cataracts and aphakia was 109.5/1000. The prevalence of cataracts among elderly males was slightly higher (412.2/1000) than females (372.6/1000) but not statistically significant (X[2] = 3.3, 1 d.f.; p>0.05).

Among retinal diseases, the commonest were degenerative conditions like age-related macular degeneration (5.25%) and choroidal sclerosis (1.37%).

Among the miscellaneous group of eye diseases refractive errors were found to be the most prevalent (407.5/1000). There were five cases of injury. Other diseases include one case each of amblyopia and nystagmus, and two cases of phthisis bulbi.

The age-specific prevalence of various groups of ocular diseases is shown in [Figure - 1]. Except for diseases of lids and lacrimal apparatus the prevalence of diseases of other categories increased with increasing age. This rising trend was significant for diseases of the lens and iris (X[2] =80.4, 3 d.f.; p<0.001) but not so for diseases of the retina (X[2] =5.1; 3 d.f.; p>0.05).


  Discussion Top


The present study found that one third of the elderly population above fifty years of age suffered from low vision and another 12.2% were blind. The prevalence of blindness was slightly lower than that reported by Sharma et al (15.6%) among elderly people from North India.[3]

The prevalence of ocular diseases among the elderly population was observed to be high. Each person above fifty years of age was susceptible to suffer from one or more ocular diseases. Ocular diseases were found to be more among males, people in the lower socio-economic strata, landless labourers and older age groups. Age was observed to have a profound influence on the occurrence of ocular morbidity. Hence, the confounding effect of age has been minimised by calculating age standardised morbidity rates when evaluating the effect of sex, socio-economic status and occupation on ocular morbidity. The higher prevalence of ocular diseases in old age could be due to increasing degenerative conditions, increased susceptibility to infections, lack of proper care of the eyes, among other reasons.

Regarding the pattern of various eye diseases, inflammatory conditions were the commonest among diseases of the lids and lacrimal apparatus. Comparable figures for the prevalence of chalazion have been observed in the present study as those reported by Singh among persons above 40 years of age in 1990 from other parts of Wardha district in Maharashtra.[4]

The prevalence of pterygium and pinguelae were high. Reports from various studies in India showed the prevalence of pterygium ranging from 0.075% in Punjab[5] to 10.42% in Maharashtra[4] in the general population. Studies on the prevalence of pingueculae in India are scanty.

Trachoma in active form was found to be low (0.4%) in the present study. Varying degrees of the prevalence of trachoma have been reported from different parts of India. Sharma et al observed 15.3% trachoma cases above 50 years of age in 1963.[6] Purohit et al reported a prevalence of 7.2% in 1976 above 60 years of age.[7] A low prevalence (2.1%) was reported above 50 years by Garg et al from Meerut in 1982.[8] The prevalence of trachoma, in general, appears to be declining over the years. However, because of regional variations, a definitive pattern could not be ascertained for our region since previous prevalence data of this region in older age groups are not available.

The high prevalence of cataract in the present study is in concordance with others studies from India.[4],[7],[9],[10]The Indian Council of Medical Research (ICMR) collaborative study showed variations in the prevalence of cataract ranging from 30.1% to 72.2% in different parts of India.[11] The prevalence was more in South India. However, the prevalence of cataract in the cluster from Maharashtra (543/1000 above 50 years of age) is comparable with that of the present study when aphakia is pooled for calculating prevalence of cataract. No significant difference in the prevalence of cataract was observed between males and females in the present study. A higher prevalence has been reported among males from a population based study conducted in Punjab.[5] Contrasting results have been reported from other studies.[9],[11]

The low prevalence of surgical aphakia in the present study indicates underutilisation of health services. The nearest health facility available for specialist eye care is located within 25 kilometres from the study villages. Besides this, mobile rural eye camps are being organised periodically by the medical institute and also by the state health sector. This indicates lack of awareness about eye health care or lack of confidence in the services for control of blindness in this area.

Among the various retinal diseases degenerative conditions such as age related macular degeneration (ARMD) were observed to be the commonest. There is a paucity of information regarding the prevalence of ARMD in India. Jain et al reported a prevalence rate of 4.7% for senile macular degeneration among the elderly population above 50 years from North India.[12] A slightly higher figure (5.25%) was observed in the present study. However, one has to keep in mind that direct ophthalmoscope was used to diagnose retinal diseases in the present study, which may not be accurate.

Refractive errors were also commonly observed (40.8%) in the present study. Purohit et al observed a high prevalence of refractive errors among males (52.65%) and females (54.9%) above 60 years.[7] Caution has to be exercised in assessing the accuracy of our method of estimating refractive error, i.e. lens power reading of the direct ophthalmoscope.

The prevalence of glaucoma was low (3.1%) in the present study. Prevalence of chronic simple glaucoma was observed to be 4.85% in a study subjects of above 30 years in Udaipur[13] The prevalence of glaucoma in our study may be an under estimation since a highly sensitive and specific screening method was not used for detection of glaucoma in the field.

This study highlights a high ocular morbidity rate in the elderly population above 50 years of age. The reported prevalence for various eye diseases could be an underestimation because of the lack of highly sensitive and specific screening method. However, the present data reveals the need for more comprehensive studies of the geriatric ocular problems incorporating the identification of risk factors so as to design proper strategies to reduce the bulk of ocular diseases in the community.

Community based ophthalmological surveys suffer from lack of uniform diagnostic criteria for screening except for some diseases like trachoma, vitamin A deficiency and cataract making it difficult to compare data from different regions. So, it is necessary to formulate uniform guidelines and diagnostic criteria for screening common ophthalmic conditions like pterygium, lacrimal sac disorders, glaucoma and ARMD.

Development of screening procedures using simple diagnostic criteria can be utilised for training of paramedical workers and ophthalmic assistants for early detection of these conditions, early referral and treatment. This will help in strengthening the ongoing activities of the National Programme for the Control of Blindness, and improve eye health care in our country.

 
  References Top

1.
Pizzarello LD. The dimensions of the problem of eye diseases among the elderly. Ophthalmology; 94:1191-1195, 1987.  Back to cited text no. 1
    
2.
Pareek U. Manual of socio-economic status scale (Rural), Mansayan, Delhi, 1964.  Back to cited text no. 2
    
3.
Sharma KL, Prasad BG. An epidemiological study of blindness in Banki block of Barabanki district, Uttar Pradesh. Ind J Med Res; 50:842-864, 1962.  Back to cited text no. 3
    
4.
Singh VP. A survey of ocular morbidity in the general population. Nagpur: University of Nagpur (MS Thesis), 1990.  Back to cited text no. 4
    
5.
Chatterjee A, Milton RC, Thyle S. Prevalence and aetiology of cataract in Punjab. Br J Ophthalmol; 66:35-42, 1982.  Back to cited text no. 5
    
6.
Sharma JD, Prasad BG, Bagchi SC. Prevalence of trachoma and other common eye diseases - a survey in a group of villages. J Ind Med Assoc; 40:206-208, 1963.  Back to cited text no. 6
    
7.
Purohit CK, Sharma R. A study of general health status of persons aged 60 years and above in the rural health training area, Naila. Ind J Med Res; 64:202-10, 1976.  Back to cited text no. 7
    
8.
Garg BS, Gupta SC, Mishra VN, Singh RB. A geriatric study of an urban area. Ind J Public Health; 27:79-84, 1980.  Back to cited text no. 8
    
9.
Raizada IN, Mathur A, Narang SK. A study of prevalence and risk factors of senile cataract in rural areas of Western U.P. Ind J Ophthalmol; 32:339-42, 1984.  Back to cited text no. 9
    
10.
Sindal SK, Bhat RB, Shaligram CJ. Incidence of blindness around Miraj. Ind J Ophthalmol; 27:16-19, 1979.  Back to cited text no. 10
    
11.
Mohan M. Indian Council of Medical Research-National Society for Prevention of Blindness collaborative study on prevalence of cataract. New Delhi, 1990.  Back to cited text no. 11
    
12.
Jain IS, Prasad P, Gupta A. et al. Senile macular degeneration in Northern India. Ind J Ophthalmol; 32:343-46, 1984.  Back to cited text no. 12
    
13.
Jain MR, Modi R. Survey of chronic simple glaucoma in the rural population of India (Udaipur) above the age group of 30 years. Ind J Ophthalmol; 31:656-57, 1983.  Back to cited text no. 13
    


    Figures

  [Figure - 1]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]



 

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