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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 18  |  Issue : 4  |  Page : 181-185

Ocular morbidities among the geriatric persons, attending the ophthalmology outpatient department of a tertiary care hospital in eastern Odisha: A cross-sectional study


1 Department of Community Medicine, SOA(Deemed to be University), IMS and SUM Hospital, Bhubaneswar, Odisha, India
2 Department of Ophthalmology, Agarwal Eye Hospital, Bhubaneswar, Odisha, India
3 Department of Community Medicine, SCB Medical College, Utkal University, Cuttack, Odisha, India
4 Department of Community Medicine, FM Medical College, FM University, Balasore, Odisha, India

Date of Submission02-Sep-2022
Date of Decision28-Sep-2022
Date of Acceptance28-Sep-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Dr. Tapas Ranjan Behera
Department of Community Medicine, FM Medical College, FM University, Balasore, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_45_22

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  Abstract 


Background: According to the census of 2011, 13% of the Indian population was 60 years of age or older. As the geriatric population is the most vulnerable part of society, they are prone to all type of diseases including eye problems which are preventable or correctable but requires constant medical, financial, and social support. This study will find the magnitude of various ocular morbidities and their relationship with sociodemographic factors among geriatrics. Objective: 1. To find the magnitude of ocular morbidities among the elderly. 2. To study the relationship of different sociodemographic factors with ocular morbidities. 3. To estimate the average time spent for getting ophthalmic care at the outpatient department (OPD). Subjects and Methods: It was a hospital-based cross-sectional study conducted in the Ophthalmology OPD of Sriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, from January to December 2016. A total of 1320 geriatric persons were enrolled during this period. Ethical clearance was obtained. Results: Out of the 1320 geriatric patients, 58.86% were in the age group of 60–69 years, 35.22% in 70–79 years, and 5.9% ≥80 years with a mean age of 67.7 ± 6.7 years. Males accounted for 70.98% and females for 29.02%. Different ocular morbidities detected are cataract (59.2%), refractive error (18%), ocular injury (5.9%), diabetic retinopathy (3.9%), glaucoma and chronic dacryocystitis (3%), and foreign body in the eye (2%). The total waiting time in the ophthalmology OPD to get ophthalmic care was 7.8 ± 3.2 min. The total consultation time in the OPD was 75.59 ± 27.15 min. Conclusion: The most common cause of visual impairment/blindness in the geriatric age group are cataract and refractive errors which are treated/corrected free of cost at any government health facility under the National Programme for Control of Blindness. People should be aware of the causes, prevention modalities, and treatment of the causes of blindness.

Keywords: Cataract, geriatric, ocular morbidity, time motion


How to cite this article:
Mohanty S, Mohanty S, Mohanty M, Behera TR. Ocular morbidities among the geriatric persons, attending the ophthalmology outpatient department of a tertiary care hospital in eastern Odisha: A cross-sectional study. J Indian Acad Geriatr 2022;18:181-5

How to cite this URL:
Mohanty S, Mohanty S, Mohanty M, Behera TR. Ocular morbidities among the geriatric persons, attending the ophthalmology outpatient department of a tertiary care hospital in eastern Odisha: A cross-sectional study. J Indian Acad Geriatr [serial online] 2022 [cited 2023 Feb 8];18:181-5. Available from: http://www.jiag.com/text.asp?2022/18/4/181/365772




  Introduction Top


India has acquired the label of “an aging nation” with 7.7% of its population being more than 60 years old. The demographic transition is attributed to the decreasing fertility and mortality rates due to the availability of better health-care services.[1]

An Indian Council of Medical Research report on the chronic morbidity profile in the elderly states that hearing impairment is the most common morbidity followed by visual impairment.[2]

Globally, there is a changing trend in the prevalence of blindness and visual impairment. Before the launch of the VISION 2020: The Right to Sight program of the World Health Organization and International Agency for Prevention of Blindness in 1999, it was estimated that the total number of blind persons globally was around 45 million, and in absence of a definitive and accelerated interventional strategy, the number would increase to 76 million by the year 2020.[3]

The International Classification of Disease-10 and related health problems, tenth revision defines “blindness” as “visual acuity (VA) of <3/60 or corresponding visual field loss in the better eye with best possible correction”.[4]

In the outpatient department (OPD), the waiting and consultation times are the most important determinants to measure the quality of services in health-care provision.[5]

Dissatisfaction with the health-care system reported by patients was a long waiting period in the clinic. Many studies documented the negative association between increased waiting time and patient satisfaction.[6]

Sriram Chandra Bhanja (SCB) Medical College and Hospital, Cuttack, is the premiere apex teaching hospital of Odisha for any type of referral services. The department of ophthalmology is recognized as one of the Regional Institute of Ophthalmology (RIO) out of 20 RIOs in India since 2008 and provides all types of preventive, promotive, and curative services under the National Programme for Control of Blindness.

Thus, for better understanding of geriatric ocular morbidities and services provided at a tertiary care teaching hospital, the present study was carried out with the following objectives:

  1. To find the magnitude of ocular morbidities among the elderly
  2. To study the relationship of different sociodemographic factors with ocular morbidities
  3. To estimate the average time spent for getting ophthalmic care at the OPD.



  Subjects and Methods Top


The present cross-sectional study was conducted in the Ophthalmology OPD of SCB Medical College, Cuttack, Odisha, for 1 year from January 2016 to December 2016.

The study participants were persons aged 60 years and above attending the Ophthalmology OPD of SCB Medical College and Hospital, Cuttack, who gave their consent to participate.

On average, 247 patients per day were registered in the Ophthalmology OPD of SCB Medical College and Hospital out of which 57 patients (23%) belong to the geriatric age group (as per data from the OPD Registration System of Ophthalmology OPD of SCB Medical College and Hospital, 2015). Out of the daily geriatric attendance, 20% were selected randomly which comes to be 11 persons. There are 5 working days/week and 4 weeks/month, hence 20 working days/month. The data were collected for 6 months from January 2016 to June 2016. Hence, a total of 1320 geriatric persons were selected randomly as the study population (11 persons/day × 20 working days/month × 6 months = 1320).

A semi-structured questionnaire was designed and pretested in the department of ophthalmology and a necessary correction was accordingly made in that questionnaire and was finalized. The final questionnaire was thus administered to each geriatric person after taking their consent. The written consent of an individual geriatric person was taken. Ethical clearance for the study from the Institutional Ethical Committee of SCB Medical College, Cuttack was obtained.

The study participants were interviewed using the predesigned pretested questionnaire after taking their written consent and after they availed the health care in the OPD of Ophthalmology Department of SCB Medical College and Hospital, Cuttack. The basic demographic profile of individual geriatric person was collected. The ocular morbidity diagnosed in the consultation room was also noted with its onset and duration of symptoms. The previous health-seeking behavior for this particular ocular morbidity of these geriatric patients was also collected. The average time spent by each geriatric patient for availing the ophthalmological care at this OPD on that particular day was also noted.

Data were analyzed by Chi-square test and Z-test, at a 95% confidence interval; P < 0.05 was considered significant, and Data were analysed using the Statistical Package for Social Sciences version 21, IBM Corp, Armonk, NY, USA.


  Results Top


A total of 1320 patients aged 60 years and above were enrolled as study participants. Males accounted for 70.98% and females for 29.02%. Maximum (58.86%) participants were in the age group of 60–69 years and 5.92% were above 80 years of age with a mean age of 67.7 ± 6.7 years. Two-thirds of the study population (75.1%) were from rural areas. The majority (54.9%) belonged to the general caste and around 50% were from three-generation families and 19.2% were illiterate. The maximum number of the geriatric study population (27%) were having educational status up to primary schooling and only 6% of them had professional qualifications. The majority (59.2%) of the geriatric persons were unskilled by their occupation previously and only 22.7% were skilled workers by their occupation. However, 24.8% of the study population were unemployed during the study period and 22.8% had retired from their present services. A nearly equal percentage of geriatric persons belonged to the above poverty line (54.6%) and below poverty line (BPL) (45.4%) but only 56.6% of the BPL geriatric persons have BPL cards with them.

The majority of the geriatric persons reported to the ophthalmology OPD with chief complaints of difficulty in vision (69.1%), followed by postoperative checkup (12.1%), routine checkup (8%), ocular pain (4.9%), watering of eyes (3.9%), and redness of eyes (2%) [Table 1].
Table 1: Chief complaints among the study population about seeking eye care

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The different ocular morbidities among the study participants in either eye or both eyes are cataract (59.2%), refractive error (18%), ocular injury (5.9%), and diabetic retinopathy (3.9%). Other ocular morbidities found were glaucoma (3%), chronic dacryocystitis (3%), and foreign body in the eyes (2%). Other ocular morbidities detected in the geriatric persons were entropion (1.1%), postcataract opacity (1.1%), uveitis (1%), viral keratitis (1%), pterygium (1%), and recurrent chalazion (1%) [Table 2].
Table 2: Ocular morbidities among study participants

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A statistically significant association between age and the number of visually impaired individuals (P = 0.006) is shown in [Table 3].
Table 3: Comparison of visual acuity in different age groups

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Out of 557 males diagnosed with cataract in the study participants, 39 (7%) had normal vision and 518 (93%) had low vision. Similarly, out of 224 females diagnosed with cataract, 27 (12%) had normal vision and 197 (88%) had low vision. A statistically significant association between sex and the number of visually impaired individuals was observed in the study (P = 0.021).

There was a significant association between age, gender, caste, education, and present occupation with cataract among the geriatric population. However, there was no statistically significant difference between economic status and cataract [Table 4].
Table 4: Effect of different demographic variables on cataract

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The time spent for getting ophthalmic care at the OPD was also studied. The different activities in an ophthalmology OPD range from registration, optometrist room for a preliminary eye examination dilation is performed by a nurse or an attendant, for every new patient, before the patient is sent to the ophthalmologist for consultation. The total waiting time in the ophthalmology OPD to get any ophthalmic care was 7.8 ± 3.2 min. The total consultation time in the OPD was 75.59 ± 27.15 min [Table 5].
Table 5: Time spent on availing eye care services

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  Discussion Top


The prevalence of ocular diseases among the elderly population was observed to be high. Each person above 60 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 socioeconomic strata, and older age groups.[7]

In our study, out of 1320 study participants, 59.2% had cataract, 18% had refractive error, 5.9% had ocular injury, and 3.9% had diabetic retinopathy. Other ocular morbidities found were glaucoma in 3%, chronic dacryocystitis in 3%, and foreign body in the eyes in 2%.

In a study by Baldev et al. in the field practice area of the peripheral centers of Christian Medical College and Hospital, Ludhiana in 2015 with a sample size of 450 participants found that among the various causes of visual impairment cataract accounted for 43.7%, refractive error 32.6%, posterior capsular thickening 7.4%, corneal opacity and corneal degeneration 4.4%, respectively, glaucoma 3.7%, diabetic retinopathy 1.5%, pterygium 1.5%, and Age related Macular Degeneration (ARMD) 0.8%.[8]

Another study by Piramanayagam et al. in the Trichy District of Tamil Nadu in 2010 with 552 participants of more than 60 years found that the most common ocular diseases were cataract (36%) and refractive error (20.3%). Others include diseases of lacrimal apparatus (4.6%), pterygium (4.1%), corneal scar (1.7%), and acute keratitis or corneal ulcer (1.7%).[9]

Another study by Murthy et al. in Navsari District, Gujarat in 2007 among persons ≥50 years of age found that the predominant cause of bilateral blindness was cataract (82.6%), followed by macular degeneration, retinal detachment, diabetic retinopathy, and other retinal disorders (8.9%).[10]

In our study, 5.9% of participants presented with ocular injury. A study by Shrote et al. to know some epidemiological determinants of ocular morbid conditions in the rural area of Central India found that 0.76% of the study population had an ocular injury.[11]

Glaucoma accounted for 3% of our study. In a study done by Vijaya et al. in rural South India, glaucoma accounted for 4.29% of blindness.[12]

There was a significant association between the age and gender of study participants with visual impairment in our study. In a similar study by Baldev et al. in the field practice area of the peripheral centers of Christian Medical College and Hospital, Ludhiana in 2015 among the elderly population, there was a statistically significant (P < 0.001) relationship between increasing age and the number of visually impaired and blind individuals.[8]

A significant association between age, gender, caste, occupation, and education with cataract was found in the study participants. A study by Pisudde et al. in 2015 among the elderly population in the Wardha district of Maharashtra found that 36.3% of study participants had cataract and it was found to be significantly associated with increasing age.[13] Another study by Kumar et al. in 2016 in rural areas of Bundelkhand, UP among the elderly population found that the prevalence of cataract was 41% and was significantly associated with age and education.[7]

In the present study, the total waiting time in the ophthalmology OPD to get ophthalmic care was 7.8 ± 3.2 min. The total consultation time in the OPD was 75.59 ± 27.15 min. A study by Lowalekar and Ravichandran at Indore, Madhya Pradesh at Rajas Eye Hospital found that typically five patients are accommodated in a 15 min slot. There is no provision for a vacant slot for the walk-in patients who do not have an appointment for the day. It was found in their study that even though average processing times added up to less than an hour, the patients were waiting for more than 2 h in the system.[14] In another study in OPD of Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, using the basis of the six sigma methodology (Define, Measure, Analyse, Improve & Control (DMAIC) method), found that only 49.27% of patients were seen within 60 min by the physician and 64% of the patients had to wait for more than 3 h for a cardiac consultation with 24% of patients waiting anywhere between 2 and 3 h.[15]


  Conclusion Top


The Situation analysis on ocular morbidities among the geriatric persons in SCB Medical College & Hospital, Cuttack has thrown some light on the magnitude of different ocular morbidities among the elderly population. The time spent for availing ophthalmic care at the OPD was also assessed. Among 1320 study subjects common ocular morbidity was Cataract (59.2%) followed by Refractive error. A statistically significant association was found between age, gender, caste, education and present occupation with cataract.The total waiting time in the ophthalmology OPD to get an ophthalmic care was 7.8 ± 3.2 minutes. The total consultation time in the OPD was 75.59 ± 27.15 minutes.The leading cause of ocular morbidity in this study was Cataract. The magnitude of visual impairment and blindness due to cataract among the geriatric population can be reduced by surgery. Various Government initiatives like good quality geriatric health care at primary level, Cataract surgery and health education would further help to prevent the cause of blindness in this vulnerable population. This will improve the quality of life in the elderly population. There should be separate geriatric clinics in both government and private hospitals to deal with the problems faced by the elderly so as to reduce the waiting and consultation time. One of the initiatives taken by Govt. of Odisha in this regard is online registration for OPD Consultation tickets.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Thylefors B, Négrel AD, Pararajasegaram R, Dadzie KY. Global data on blindness. Bull World Health Organ 1995;73:115-21.  Back to cited text no. 4
    
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Haussmann RK. Waiting time as an index of quality of nursing care. Health Serv Res 1970;5:92-105.  Back to cited text no. 5
    
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Baldev VF, Chopra R, Batra N, Singh S. Pattern of ocular morbidity in the elderly population of Northern India. J Clin Diagn Res 2017;11:C20-3.  Back to cited text no. 8
    
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Piramanayagam A, Bayapareddy N, Pallavi M, Madhavi E, Nagarjuna Reddy N, Radhakrishna L. A cross sectional study of the morbidity pattern among the elderly people: South India. Int J Med Res Health Sci 2013;2:372-9.  Back to cited text no. 9
    
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Murthy GV, Vashist P, John N, Pokharel G, Ellwein LB. Prevelence and causes of visual impairment and blindness in older adults in an area of India with a high cataract surgical rate. Ophthalmic Epidemiol 2010;17:185-95.  Back to cited text no. 10
    
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Shrote VK, Thakre SS, Thakre SB, Brahmapurkar KP, Giri VC. Study of some epidemiological determinants of ocular morbid conditions in the rural area of central India. J Dent Med Sci 2012;2:34-8.  Back to cited text no. 11
    
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Vijaya L, George R, Arvind H, Baskaran M, Raju P, Ramesh SV, et al. Prevalence and causes of blindness in the rural population of the Chennai glaucoma study. Br J Ophthalmol 2006;90:407-10.  Back to cited text no. 12
    
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Pisudde PM, Taywade ML, Sushma K, Mehendale AM, Shukla AK. An epidemiological study of common ocular morbidities among elderly population in the Wardha, District, Maharashtra, India. Epidemiology (Sunnyvale) 2015;S2:002. [Doi: 10.4172/2161-1165.S2-002].  Back to cited text no. 13
    
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Lowalekar H, Ravichandran N. Managing the outpatient department waiting time at rajas eye hospital. IMJ 2012;4:36-46.  Back to cited text no. 14
    
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Dinesh TA, Singh S, Nair P, Remya TR. Reducing waiting time in outpatient services of large university teaching hospital – A six sigma approach. Manag Health XVII/1/2013;17:31-7.  Back to cited text no. 15
    



 
 
    Tables

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



 

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