ORIGINAL ARTICLE

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PREVALENCE OF EYE DISEASES AND VISUAL IMPAIRMENT IN URBAN POPULATION - A STUDY FROM UNIVERSITY OF MALAYA MEDICAL CENTRE

SC Reddy^{1, 2} MS (Ophth), FRCOphth (London)
I Tajunisah² M Ophth, FRCS (Glasgow)
KP Low³
AB Karmila³

1. Department of Ophthalmology, International Medical University, Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
2. 2Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
3. Phase II Medical students, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Address for correspondence: Assoc Prof Dr SC Reddy, Department of Ophthalmology, International Medical University, Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia. Tel: 06-7677798, Fax: 06-7677709, Email: rchandrasekhara@yahoo.com

INTRODUCTION

Diseases that cause visual impairment are known to significantly alter the quality of life of the individual through the prolonged period of morbidity. The geographical, economic, social and political aspects of the susceptible population, environmental hazards and trauma have been established as the main causative factors for eye disorders. Within the population, several factors such as age and gender also modify the prevalence of the eye disorders. 

In the National Eye Survey Malaysia conducted in 1996,¹ the prevalence of visual impairment in Malaysia was found to be 2.7% which was higher in rural areas (2.9%) than in urban areas (2.5%).¹ Prevalence of visual impairment in rural population in Selangor state has been reported to be varying from 5.6% ² to 18.9% ³. However, there is no data available on the prevalence of visual impairment in urban population from any State or University hospitals in Malaysia. Therefore, this study was undertaken to determine the prevalence of eye diseases and visual impairment among the patients attending the Eye Clinic of University of Malaya Medical Center, which provides medical care facilities to mostly urban population in Kuala Lumpur Federal Territory and Klang Valley. This work was conducted as a research project of Phase II medical students as part of their medical training.

METHODS

The medical records of all patients attending the Eye Clinic of University of Malaya Medical Center were reviewed from 19 May 2003 to 8 June 2003. In the morning from 8 a.m. to 1 p.m., new cases and follow-up patients were seen in the eye clinic. Patients with acute eye problems (pain, redness, injury, sudden loss of vision) were seen on the same day of referral to the clinic. The afternoon clinic (2 to 5 p.m.) was allocated for cataract patients called for investigations and review, patients from other wards referred for eye checkup and patients listed for laser photocoagulation. All these patients were included in this study.

Data obtained from their medical records included age, gender, race, visual acuity and ophthalmologic diagnosis and associated systemic diseases. Visual acuity was measured using a Snellen chart by trained auxiliary staff and all patients were then examined by the ophthalmologists. Patients with retinal diseases were examined after dilating pupils with tropicamide eye drops. Refraction was done by the qualified optometrist of the hospital. Visual acuity in young children and mentally retarded patients was tested whenever possible and in some instances, the visual acuity could not be recorded. When more than one eye disease were present in a patient, they were listed under the relevant subheading as per international statistical classification of diseases⁴ -- eyelids, lacrimal system, conjunctiva, cornea, sclera, uveal tract, lens, vitreous body, retina, glaucoma, optic nerve and visual pathway, orbit, strabismus, trauma to the eye, refractive error or visual disturbance. However, the percentage of prevalence of the eye diseases was calculated based on the total number of patients examined only. The findings were entered in a data sheet and analysed using SPSS software.

Taking the best corrected vision in the better eye into account, the visual impairment was categorised into four groups4 --- no visual impairment (visual acuity 6/6 --6/18), visual impairment (visual acuity < 6/18 --6/60), severe visual impairment (visual acuity < 6/60 -- 3/60) and blindness (visual acuity < 3/60 -- no perception to light).

RESULTS

A total of 1169 patients’ records were reviewed during the study period; 184 (15.7%) were new cases and the rest 985 (84.3%) were follow-up patients. More than half of the patients (601, 51.4%) were females and 568 (48.6%) were males; the mean age of patients was 51.1 ± 20.6 years (range 3 months to 90 years); 724 (61.9%) of patients were aged above 50 years; 109 (9.3%) were children below 12 years of age (Table 1). In this study, 452 were Chinese (38.7%), 367 Malays (31.4%), 328 Indians (28.1%) and the rest 22 (1.9%) were of other races (10 Punjabis, 7 Indonesians and 5 Bangladeshis).

Table 1: Age and gender distribution of patients

Age	Males	Females	Total (%)
1 month  - 10 years	40	36	76 (6.5)
11 – 20 years	38	35	73 (6.2)
21 – 30 years	24	45	69 (5.9)
31 – 40 years	39	23	62 (5.3)
41 – 50 years	78	87	165 (14.1)
51 – 60 years	116	142	258 (22.1)
61 – 70 years	148	158	306 (26.2)
71 – 80 years	79	71	150 (12.8)
81 – 90 years	6	4	10 (0.8)
Total	568	601	1169