Article_WMC004197

Article ID: WMC004197 ISSN 2046-1690

Investigating Emerging Trends of Intraocular Lens(IOL's) Implantation in Rural India for CataractCorresponding Author:Mr. Shrikant D Pawar,Research Scientist, The University of Iowa, 143 Biology Building, 52242-1324 - United States of America

Submitting Author:Mr. Shrikant D Pawar,Research Scientist, The University of Iowa, 143 Biology Building, 52242-1324 - United States of America

Article ID: WMC004197

Article Type: Original Articles

Submitted on:13-Apr-2013, 05:05:57 PM GMT Published on: 15-Apr-2013, 05:49:25 AM GMT

Article URL: http://www.webmedcentral.com/article_view/4197

Subject Categories:OPHTHALMOLOGY

Keywords:Intra Ocular Len\'s, Cataract, and Parametric T-Test.

How to cite the article:Pawar SD, Gosavi T, Dole M, Dole S. Investigating Emerging Trends of Intraocular Lens(IOL's) Implantation in Rural India for Cataract . WebmedCentral OPHTHALMOLOGY 2013;4(4):WMC004197

Copyright: This is an open-access article distributed under the terms of the Creative Commons AttributionLicense(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal author and source are credited.

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Investigating Emerging Trends of Intraocular Lens(IOL's) Implantation in Rural India for CataractAuthor(s): Pawar SD, Gosavi T, Dole M, Dole S

Abstract

Purpose: Investigating emerging trends of intraocularlens (IOL's) implantation in Dr. Manohar Dole MedicalFoundation, Narayangaon, India, for Cataract fromApril 2003 till March 2011.

Materials and Methods: Survey was conducted at Dr.Manohar Dole Medical Foundation, Narayangaon,India, where patients were categorized by Intraocularlens (IOL's) implantations and conservative methodsof treatment. The Parametric T test was calculatedbetween number of patients operated for cataract withIOL and the conservative method of treatment to find ifthere is any significant difference between these twogroups.

Result: The significant Parametric P value of3.60833076940971E-36 was obtained stating that theoccurrence of observed difference just by chance isvery much unlikely.

Conclusion: We found a significant increase in IOLimplantation compared to conservative treatment inthe patients at Dr. Manohar Dole Medical Foundation,Narayangaon, India, for 9 subsequent years stating anemerging trend of operative procedures in rural partsof India.

Introduction

According to World Health Organization (WHO),causes of visual impairment in 2002 were glaucoma,age-related macular degeneration, corneal opacities,diabetic retinopathy, childhood blindness, trachoma,and onchocerciasis. The cataract being leading causeof visual impairment in all areas of the world during thelast ten years [9]. Cataract is the largest single causeof blindness in the world [1, 2]. In India approximately9 million people are blind from cataract every year [1,3]. The surgery for the cataract has been increased inpast few years growing from 1.2 million surgeries inyear 1992 to 4.8 million surgeries in year 2006 withuse of intraocular lens implantations of 90 % ofpatients [4]. The survey done by the Indian Council ofMedical Research (ICMR) in the year 1974 indicated aprevalence rate of 1.38 % in the general population(visual acuity <6/60 in the better eye). A survey (year’s

1999–2001) in 15 districts of the country indicated that8.5% of the population aged 50 years or more is blind[5]. The proportion of cataract surgeries with IOLimplantation was increased from less than 5% in year1994 to 90% in year’s 2005–2006 [6]. This articlehighlights the emerging trends of intraocular surgeriesin rural parts of India from year 2003 till present date.

Methods

Survey was conducted at Dr. Manohar Dole MedicalFoundation, Narayangaon, India, where patients werecategorized by Intraocular lens (IOL's) implantationsand conservative methods of treatment. The IOL'spatients were selected from cataract patients whowere further selected from total examined patients.The numbers for the patients were collected from April2003 till March 2011. Table 1 shows the number ofpatients observed during this survey.

Results

A comparison of number of patients with IntraocularLens Implantation with the conservative treatment wasplotted in R environment [8] shown in Figure no 1. Asobserved there was a steady rise of patients with IOLfrom April through June for year’s 2003 till 2011,followed by a drop through September and a sharpincrease from October through December. The IOL'swere done free of charge for maximum number ofpatients with a small number of patients being chargedfor complicated surgeries requiring visiting surgeons.

Having observed this difference in number of patientsfor 9 years between different treatment groups shownin Table no 3, we were interested to see whether thisdifference is statistically significant. We found aGaussian distribution for values and since weanalyzed two independent groups with differentsample size, a parametric unpaired T-test was usedfor seeing the significant difference [7]. The P valuewas calculated between number of patients operatedfor cataract with IOL and the conservative method oftreatment through year’s 2003 to 2011 for 12 months.The significant P value of 3.60833076940971E-36 wasobtained stating that the occurrence of observed



difference just by chance would be unlikely and so werejected the null hypothesis which assumed that theobserved difference simply occurred by chance.

We followed the details of paid patients for IOL fromthe year’s 2002 to 2005 which can be found in Tableno 2. The IOL patients were also compared with thePhaco emulsi f icat ion and foldable Phacoemulsification operated patients for cataract. As seenin Table and Figure no 2, the number of paid IOLoperated patients were greater than Phaco but lessthan paid foldable Phaco emulsification operatedpatients stating an average increase and subsequentdecrease in number of patients through year’s 2002 to2005.

Conclusions

We found a significant increase in IOL's implantationcompared to conservative treatment in the patients atDr. Manohar Dole Medical Foundation, Narayangaon,India, for 9 subsequent years. The possible causes forsuch rise could be due to the increased production ofIOL’s, sophisticated equipment’s for cataract surgery,infrastructure development and efforts by Governmentof India and the international non-governmentalorganizations (NGOs) for spreading awareness andtreatment facilities for cataract patients.

Acknowledgements

We are thankful to physicians, visiting surgeons,nurses and administrative staff of Dr. Manohar DoleMedical Foundation, Narayangaon, India, for their kindsupport in conducting this survey.

References

1. World Health Organization, International Agency forthe Prevention of Blindness. Report on the WorldVision 2002: Seeing is Believing, Vision 2020.Uxbridge: The Right to Sight; 2002.2. Resnikoff S, Pascolini D, Etya’ale D. Global data onvisual impairment in the year 2002. Bull World HealthOrgan 2004; 82:844–851.3. Venkatesh R, Muralikrihnan R, Civerchia Balent L.Outcomes of high volume cataract surgeries in adeveloping country. Br J Ophthalmol 2005;89:1079–1083.4 . Gove rnmen t o f I nd i a . V i s i on 2020 .www.vision2020india.org. New Delhi: Government of

India.5. Tewari HK, Jose R, Bachani D. Vision 2020 - TheRight to Sight, CME series no. 9. New Delhi: All IndiaOpthalmological Society, Syntho Pharmaceuticals Pvt.pp. 8–9.6. Anon. Performance at a glance 2002–2003.Quarterly Newsletter of National Program of Control ofBlindness and Vision 2020: The Right to SightInitiative 2003; 2:3.7. Morten W Fagerland. T-tests, non-parametric tests,and large studies--a paradox of statistical practice?.BMC Medical Research Methodology 2012; 12(78);doi: 10.1186/1471-2288-12-78.8. R Development Core Team (2008). R: A languageand environment for statistical computing. RFoundation for Statistical Computing, Vienna, Austria.ISBN 3-900051-07-0, URL http://www.R-project.org.9. World Health Organization Prevention of Blindnessand Deafness. (2012). Causes of blindness and visuali m p a i r m e n t . R e t r i e v e d f r o mhttp://www.who.int/blindness/causes/en/.



Illustrations

Illustration 1

Figure 1: Comparison of Intraocular Lens Implantation with the conservative treatment.



Illustration 2

Figure 2: Comparison for IOL, Phaco and foldable Phaco emulsification operated patients.



Illustration 3

Table 1: The number of patients observed during this survey.



Illustration 4

Table 2: Number of patients for IOL, Phaco and Foldable Phaco treatments from the yearÃ¢??s\n2002 till 2005.



Illustration 5

Table 3: Statistical comparison of number of patients with IOL and conservative treatment.



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