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Clinical Trial
. 2019 May 9;14(5):e0216398.
doi: 10.1371/journal.pone.0216398. eCollection 2019.

Changing trends of blindness, visual impairment and cataract surgery in Bhutan: 2009-2018

Nor Tshering Lepcha  1 , Indra Prasad Sharma  1 , Yuddha Dhoj Sapkota  2 , Taraprasad Das  3 , Tshering Phuntsho  1 , Ngawang Tenzin  1 , Bindiganavale Ramaswamy Shamanna  4 , Sonam Peldon  5
Affiliations
Clinical Trial

Changing trends of blindness, visual impairment and cataract surgery in Bhutan: 2009-2018

Nor Tshering Lepcha et al. PLoS One. .

Abstract

Purpose: To obtain new rapid assessment of avoidable blindness (RAAB) data on the prevalence, causes and trends of blindness, visual impairment and cataract surgery; and compare the new 2018 data with the older RAAB 2009 data.

Methodology: The second nationwide RAAB used android based mRAAB technique and technology for data collection. Using the compact segment sampling probability proportionate to size, 5,050 participants from 101 clusters of 50 people aged 50 years and older were enrolled through house-to-house visits. Eligible participants received ophthalmic examination and interview by the ophthalmologist-led emuneration team as per the RAAB protocol.

Results: The age-sex adjusted magnitude of bilateral blindness in Bhutan was 1.0% (95% Confidence Interval, CI 0.5-1.4) with relatively higher prevalence in rural population (Odds Ratio, OR 1.5, p = 0.13) and women (OR 1.6, p = 0.06). Untreated cataract accounted for the most of blindness (53.8%), severe vision impairment (57.1%), and moderate visual impairment (65.3%); uncorrected refractive error was the main cause of early visual impairment (46.7%). Cataract Surgical Coverage was 86.1% with relatively better coverage in men (76.7% men; 73.1% female) and urban population (79.2% urban; 70.2% rural). Good cataract surgical outcome was achieved in 67.3% and leading cause of poor outcome was ocular comorbidity (43.6%). Accessibility was a significant barrier to the uptake of cataract surgical services.

Conclusion: There is a 33% reduction in blindness from 1.5% to 1.0%, since the first RAAB survey in 2009. In order to further reduce blindness and visual impairment, Bhutan should continue to implement long-term strategic action plan for eye health focused on strengthening primary eye care and comprehensive eye care service.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The comparision of cataract surgery visual outcome between 2009 and 2018.
Fig 2
Fig 2. Cataract service indicators to measure progress from 2009 to 2018.
See this image and copyright information in PMC

References

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    1. Constitution of Bhutan, Royal Government of Bhutan. Article 9, No. 21, p. 20, 2008. Available from: http://www.nab.gov.bt/en/business/constitution_of_bhutan [last accessed Aug 2018].

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