Lecture 7: Epidemiology Study into Blindness In palestine

1. Liana Al-Labadi, O.D. Lecture 7: Epidemiology Study into Blindness In palestine http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

2. Epidemiology Study • Breaking News! • On July 30th, 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#pone-0011854-t003

3. 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#pone-0011854-t003

4. Prevalence • The World Health Organisation (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 • 1st step in achieving this target is to obtain baseline data on visual impairment at country & district levels in order to plan and monitor eye care programs http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

5. 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#pone-0011854-t003

6. 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!! http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

7. St John Eye Hospital • Established in 1882 as a charitable organisation • The largest single provider of ophthalmic care in the OPT • Provides services to all people irrespective of race, religion or ability to pay • An NGO that includes: • The main hospital in East Jerusalem • Permanent clinics in Gaza • Hebron Clinic • Anabta Clinic • Two mobile outreach services operating in the West Bank http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

8. Results- Prevalence • 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 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

9. Results- Causes • 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 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

10. Results- Country Comparison http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

11. Results- Cataract • 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 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

12. Results- Inequity • 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??? http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

13. Results- Post Operative Results • 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 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

14. Results- Diabetes • 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 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003

15. Conclusion • 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 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011854#pone-0011854-t003