Cataract in leprosy patients: cataract surgical coverage, barriers to acceptance of surgery, and outcome of surgery in a population based survey in Korea

Ocular complications of leprosy in yemen

OBJECTIVES

This study was conducted to identify the main ocular- and vision-threatening complications of leprosy in Yemen.

METHODS

This is a cross-sectional observational study which took place from February to July 2010. Leprosy patients attending the Skin and Venereal Diseases Hospital in the City of Light in Taiz, Yemen, who consented to participate in the study, were enrolled. Detailed demographic and medical histories were taken and clinical examination findings were recorded. A detailed eye examination, including visual acuity (VA), slit-lamp, and fundus examinations, was conducted on each patient by a qualified ophthalmologist.

RESULTS

A total of 192 patients (180 male, 12 female, with a male to female ratio of 15:1) were included in the study. The majority of the patients (157; 81.8%) were over 40 years. Over two-thirds of the patients (129; 67.2%) had had leprosy for more than 20 years. Ocular complications were found in 97% of cases; 150 (39.1%) of the patients' eyes had at least one pathology. Eyelid involvement was the most common problem observed in 102 (26.5%) patients. Half of the eyes (192; 50%) had a VA of <6/60. The main cause of blindness among these patients was corneal opacity detected in 69 out of 192 patients (35.9%).

CONCLUSION

Ocular complications are frequent among leprosy patients in Yemen. They are true vision-threatening lesions. It is important to prevent these lesions through early diagnosis and adequate treatment.

Control of blinding eye diseases in leprosy: strategies for India

Over half of the people affected by leprosy worldwide are in India, many of whom are severely disabled when they present for care. Changes in policy and the integration of the leprosy programme with general health services has given rise to new challenges for the control of blinding eye disease in leprosy patients. This paper looks at the challenges posed: management, materials, manpower, money, and mobility--all of which are common barriers to the availability, access, and utilization of services--and to monitoring existing programmes. We consider strategies to overcome these challenges and fulfill the goal of VISION 2020--eliminating avoidable blindness--through the provision of comprehensive eye care and strengthening the existing infrastructure. Formal cooperation between national governments, non-governmental organisations, and International Development Agencies will need to continue, although possibly, in different roles and with plans modified to be relevant to the local needs of leprosy patients.

Prevention of blindness in leprosy and the role of the Vision 2020 Programme

Leprosy control programmes are highly successful. As a result, leprosy control will be more and more integrated into the general health services. The existing vertical, specialized control programmes will be dismantled. Eye complications in leprosy have decreased. This is a result of earlier diagnosis and highly effective multidrug treatment (MDT) of leprosy, combined with timely treatment of secondary nerve damage by steroids. Most ocular morbidity is now found among elderly and disabled leprosy patients who were diagnosed before effective MDT treatment became available. Many of these patients live in leprosy settlements. Age-related cataract has become the leading cause of blindness in leprosy. The second cause of blindness is corneal opacification, mainly as a result of neglected exposure keratitis and corneal anaesthesia. The miotic pupils in late multibacillary leprosy, in combination with small central lens opacities, may also lead to blindness. The Vision 2020 Initiative prioritises cataract surgery. Leprosy patients should be actively included. Disabled leprosy patients can also benefit from screening programmes for refractive errors and the provision of spectacles and low vision aids. Determining the most feasible surgical methods for lagophthalmos surgery remains a challenge. For all health and eye care staff, training in leprosy and its eye complications is needed, as well as a change in attitude towards leprosy patients. Staff must be prepared to welcome them in the general health services.

Cataract surgical coverage and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria

AIMS

To determine the coverage, outcome, and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria.

METHODS

People 30 years and above resident in eight leprosy villages were examined. Cataract blind people were questioned about the reasons they had not been treated. Subjects who had received an operation for cataract were examined to determine the outcome and, where applicable, the causes of poor outcome.

RESULTS

480 people were examined. Cataract was the commonest cause of blindness. The cataract surgical coverage (people) was 39.2% for orthodox surgery and 29.7% for couching. After surgery, visual acuity > or =3/60 had been restored to 82.1% of eyes that had had orthodox surgery, but only 58.6% of eyes that had been couched. Cost was the commonest reason given for not seeking treatment for cataract.

CONCLUSIONS

Cataract is the major cause of blindness in this population but cataract surgical needs are currently not being met. There is a need for better collaboration between leprosy control and ophthalmic services, improved education of people affected by leprosy, a commitment to improving orthodox cataract surgery outcomes, and consideration of a possible role for traditional healers as sources of referral for orthodox surgical services.

Prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria

AIMS

To determine the prevalence and spectrum of ocular pathology, and the prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria.

METHODS

People affected by leprosy, aged 30 years and above, resident in eight leprosy villages were invited to participate. Ocular examination was undertaken of each consenting individual.

RESULTS

480 people were examined. 456 (48%) of 960 eyes had at least one ocular lesion, but only 37% of all lesions were leprosy related and potentially sight threatening. The prevalence of blindness (VA<3/60 with available correction) was 10.4%. An additional 7.5% of subjects were severely visually impaired (3/60< or =VA<6/60). Cataract was the commonest cause of blindness. Other major causes were non-trachomatous corneal opacity and trachoma.

CONCLUSIONS

Blindness and low vision are highly prevalent among leprosy patients in this setting. Only a third of the burden of ocular pathology is related to the direct effects of leprosy. Efforts to reduce the backlog of cataract and trichiasis, to improve early detection and management of lagophthalmos, and to provide refractive services are urgently required.

[Tropical ophthalmology--prevention and therapy"Vision 2020--the right to sight"]

Worldwide 45 million people are blind, 180 million people are visually handicapped, 90% of all blind people are living in developing countries and 80% of blindness is preventable. The global economic productivity loss due to blindness was estimated to be 19 billion US$ in the year 2000. The initiative "Vision 2020-the right to sight" aims to increase the cataract surgical rate and to eliminate diseases such as trachoma and onchocerciasis as well as avoidable blindness in children. It is planned that blindness in 100 million people can be avoided by the year 2020.