The magnitude and pattern of presbyopia among patients seen on outreach with Lions sightfirst eye hospital Loresho

Abstract

Objective: To determine the magnitude and pattern of presbyopia among patients aged 35 years and above as seen on outreach with Lions Sightfirst Eye Hospital. Method: Cross sectional outreach camp based study of presbyopia at various centres visited by Lions sightfirst eye hospital was carried out on patients 35 years old above. Those with prior intraocular surgery, unclear ocular media or BCY A for distance ofless than 6/60 were excluded. The BCY A for distance was determined after refracting using appropriate plus or minus lenses and illiterate E distance chart at 6m before assessing presence and severity of presbyopia with an illiterate E near chart and plus lenses. Data was collected using a questionnaire and input and analysed using SPSS version 11.5 and Epi info version 3.4.1. A case was a patient aged 35 years and above found to improve by at least I line on the near chart with addition with plus lenses. Results: A total of 442 patients were examined of which 177 (40%) were male and 265 (60%) female. Males were found to be older than females p<O.OOl. Refractive errors were found in 16.1% of those examined. Presbyopia was found in 388(87.8%) of those examined, males= 151(85.3%) and females= 237(89.4%). 0 significant difference in frequency of presbyopia by sex p=0.195 but males required a higher presbyopia correction p=O.OOl. Females had significant earlier presentation of presbyopia p=0.008. Those with less education were found to have more severe presbyopia by age p=0.004. Overall presbyopia was found to start at an earlier age and have a more gradual incline in

severity then plateau at a later age (65 years) compared to studies carried out in Caucasians. The power used to correct the presbyopia was also less for age-matched individuals compared to Caucasians. Spectacle coverage was found to be 33%.44% of those with presbyopia were not aware their condition could be corrected with spectacles. 20% ofspectacles made available and examined during the study were found to be of incorrect power. Males were more likely to have spectacle correction p=O.OI. Spectacle uptake was not significantly influenced by education status or distance travelled to the outreach centre. Conclusion: Prevalence of presbyopia was found in 87.8% in patients aged 35 years and above attending outreach camps. Females had an earlier presentation while less education and increasing age were associated with more severe presbyopia. Spectacle coverage was 33% while 20% of spectacles examined had incorrect power. Recommendation: Awareness needs to be done in the communities about presbyopia showing that it can easily be corrected with spectacles. Health workers need heightened awareness to detect and treat those patients in their mid-thirties who are not symptomatic. Follow-up of previously treated patients is essential for change of prescription. Policy makers should incorporate presbyopia detection and management in the national eye health care plan. More studies to support above findings as well as design a protocol for presbyopia correction appropriate for our setup.