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Glaucoma: HELP
Articles from Nepal
Based on 28 articles published since 2008
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These are the 28 published articles about Glaucoma that originated from Nepal during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Article Performance of an iPad Application to Detect Moderate and Advanced Visual Field Loss in Nepal. 2017

Johnson, Chris A / Thapa, Suman / George Kong, Yu Xiang / Robin, Alan L. ·Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: chris-a-johnson@uiowa.edu. · Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal. · Cambridge University Hospital, NHS, Cambridge, United Kingdom; Centre of Eye Research Australia, Department of Ophthalmology, The University of Melbourne, Melbourne, Australia; Royal Victorian Eye and Ear Hospital, Victoria, Australia. · Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan. ·Am J Ophthalmol · Pubmed #28844641.

ABSTRACT: PURPOSE: To evaluate the accuracy and efficiency of Visual Fields Easy (VFE), a free iPad app, for performing suprathreshold perimetric screening. DESIGN: Prospective, cross-sectional validation study. METHODS: We performed screening visual fields using a calibrated iPad 2 with the VFE application on 206 subjects (411 eyes): 210 normal (NL), 183 glaucoma (GL), and 18 diabetic retinopathy (DR) at Tilganga Institute of Ophthalmology, Kathmandu, Nepal. We correlated the results with a Humphrey Field Analyzer using 24-2 SITA Standard tests on 373 of these eyes (198 NL, 160 GL, 15 DR). RESULTS: The number of missed locations on the VFE correlated with mean deviation (MD, r = 0.79), pattern standard deviation (PSD, r = 0.60), and number of locations that were worse than the 95% confidence limits for total deviation (r = 0.51) and pattern deviation (r = 0.68) using SITA Standard. iPad suprathreshold perimetry was able to detect most visual field deficits with moderate (MD of -6 to -12 dB) and advanced (MD worse than -12 dB) loss, but had greater difficulty in detecting early (MD better than -6 dB) loss, primarily owing to an elevated false-positive response rate. The average time to perform the Visual Fields Easy test was 3 minutes, 18 seconds (standard deviation = 16.88 seconds). DISCUSSION: The Visual Fields Easy test procedure is a portable, fast, effective procedure for detecting moderate and advanced visual field loss. Improvements are currently underway to monitor eye and head tracking during testing, reduce testing time, improve performance, and eliminate the need to touch the video screen surface.

2 Article Glaucoma Screening in Nepal: Cup-to-Disc Estimate With Standard Mydriatic Fundus Camera Compared to Portable Nonmydriatic Camera. 2017

Miller, Sarah E / Thapa, Suman / Robin, Alan L / Niziol, Leslie M / Ramulu, Pradeep Y / Woodward, Maria A / Paudyal, Indira / Pitha, Ian / Kim, Tyson N / Newman-Casey, Paula Anne. ·School of Public Health, University of Michigan, Ann Arbor, Michigan. · Tilganga Institute of Ophthalmology, Kathmandu, Nepal. · Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland. · Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan. · Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland. · Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland. · Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan. Electronic address: panewman@med.umich.edu. ·Am J Ophthalmol · Pubmed #28734816.

ABSTRACT: PURPOSE: To compare cup-to-disc ratio (CDR) measurements from images taken with a portable, 45-degree nonmydriatic fundus camera to images from a traditional tabletop mydriatic fundus camera. DESIGN: Prospective, cross-sectional, comparative instrument validation study. METHODS: Setting: Clinic-based. STUDY POPULATION: A total of 422 eyes of 211 subjects were recruited from the Tilganga Institute of Ophthalmology (Kathmandu, Nepal). Two masked readers measured CDR and noted possible evidence of glaucoma (CDR ≥ 0.7 or the presence of a notch or disc hemorrhage) from fundus photographs taken with a nonmydriatic portable camera and a mydriatic standard camera. Each image was graded twice. MAIN OUTCOME MEASURES: Effect of camera modality on CDR measurement; inter- and intraobserver agreement for each camera for the diagnosis of glaucoma. RESULTS: A total of 196 eyes (46.5%) were diagnosed with glaucoma by chart review; 41.2%-59.0% of eyes were remotely diagnosed with glaucoma over grader, repeat measurement, and camera modality. There was no significant difference in CDR measurement between cameras after adjusting for grader and measurement order (estimate = 0.004, 95% confidence interval [CI], 0.003-0.011, P = .24). There was moderate interobserver reliability for the diagnosis of glaucoma (Pictor: κ = 0.54, CI, 0.46-0.61; Topcon: κ = 0.63, CI, 0.55-0.70) and moderate intraobserver agreement upon repeat grading (Pictor: κ = 0.63 and 0.64, for graders 1 and 2, respectively; Topcon: κ = 0.72 and 0.80, for graders 1 and 2, respectively). CONCLUSIONS: A portable, nonmydriatic, fundus camera can facilitate remote evaluation of disc images on par with standard mydriatic fundus photography.

3 Article Genome-wide association study identifies five new susceptibility loci for primary angle closure glaucoma. 2016

Khor, Chiea Chuen / Do, Tan / Jia, Hongyan / Nakano, Masakazu / George, Ronnie / Abu-Amero, Khaled / Duvesh, Roopam / Chen, Li Jia / Li, Zheng / Nongpiur, Monisha E / Perera, Shamira A / Qiao, Chunyan / Wong, Hon-Tym / Sakai, Hiroshi / Barbosa de Melo, Mônica / Lee, Mei-Chin / Chan, Anita S / Azhany, Yaakub / Dao, Thi Lam Huong / Ikeda, Yoko / Perez-Grossmann, Rodolfo A / Zarnowski, Tomasz / Day, Alexander C / Jonas, Jost B / Tam, Pancy O S / Tran, Tuan Anh / Ayub, Humaira / Akhtar, Farah / Micheal, Shazia / Chew, Paul T K / Aljasim, Leyla A / Dada, Tanuj / Luu, Tam Thi / Awadalla, Mona S / Kitnarong, Naris / Wanichwecharungruang, Boonsong / Aung, Yee Yee / Mohamed-Noor, Jelinar / Vijayan, Saravanan / Sarangapani, Sripriya / Husain, Rahat / Jap, Aliza / Baskaran, Mani / Goh, David / Su, Daniel H / Wang, Huaizhou / Yong, Vernon K / Yip, Leonard W / Trinh, Tuyet Bach / Makornwattana, Manchima / Nguyen, Thanh Thu / Leuenberger, Edgar U / Park, Ki-Ho / Wiyogo, Widya Artini / Kumar, Rajesh S / Tello, Celso / Kurimoto, Yasuo / Thapa, Suman S / Pathanapitoon, Kessara / Salmon, John F / Sohn, Yong Ho / Fea, Antonio / Ozaki, Mineo / Lai, Jimmy S M / Tantisevi, Visanee / Khaing, Chaw Chaw / Mizoguchi, Takanori / Nakano, Satoko / Kim, Chan-Yun / Tang, Guangxian / Fan, Sujie / Wu, Renyi / Meng, Hailin / Nguyen, Thi Thuy Giang / Tran, Tien Dat / Ueno, Morio / Martinez, Jose Maria / Ramli, Norlina / Aung, Yin Mon / Reyes, Rigo Daniel / Vernon, Stephen A / Fang, Seng Kheong / Xie, Zhicheng / Chen, Xiao Yin / Foo, Jia Nee / Sim, Kar Seng / Wong, Tina T / Quek, Desmond T / Venkatesh, Rengaraj / Kavitha, Srinivasan / Krishnadas, Subbiah R / Soumittra, Nagaswamy / Shantha, Balekudaru / Lim, Boon-Ang / Ogle, Jeanne / de Vasconcellos, José P C / Costa, Vital P / Abe, Ricardo Y / de Souza, Bruno B / Sng, Chelvin C / Aquino, Maria C / Kosior-Jarecka, Ewa / Fong, Guillermo Barreto / Tamanaja, Vania Castro / Fujita, Ricardo / Jiang, Yuzhen / Waseem, Naushin / Low, Sancy / Pham, Huan Nguyen / Al-Shahwan, Sami / Craven, E Randy / Khan, Muhammad Imran / Dada, Rrima / Mohanty, Kuldeep / Faiq, Muneeb A / Hewitt, Alex W / Burdon, Kathryn P / Gan, Eng Hui / Prutthipongsit, Anuwat / Patthanathamrongkasem, Thipnapa / Catacutan, Mary Ann T / Felarca, Irene R / Liao, Chona S / Rusmayani, Emma / Istiantoro, Vira Wardhana / Consolandi, Giulia / Pignata, Giulia / Lavia, Carlo / Rojanapongpun, Prin / Mangkornkanokpong, Lerprat / Chansangpetch, Sunee / Chan, Jonathan C H / Choy, Bonnie N K / Shum, Jennifer W H / Than, Hlaing May / Oo, Khin Thida / Han, Aye Thi / Yong, Victor H / Ng, Xiao-Yu / Goh, Shuang Ru / Chong, Yaan Fun / Hibberd, Martin L / Seielstad, Mark / Png, Eileen / Dunstan, Sarah J / Chau, Nguyen Van Vinh / Bei, Jinxin / Zeng, Yi Xin / Karkey, Abhilasha / Basnyat, Buddha / Pasutto, Francesca / Paoli, Daniela / Frezzotti, Paolo / Wang, Jie Jin / Mitchell, Paul / Fingert, John H / Allingham, R Rand / Hauser, Michael A / Lim, Soon Thye / Chew, Soo Hong / Ebstein, Richard P / Sakuntabhai, Anavaj / Park, Kyu Hyung / Ahn, Jeeyun / Boland, Greet / Snippe, Harm / Stead, Richard / Quino, Raquel / Zaw, Su Nyunt / Lukasik, Urszula / Shetty, Rohit / Zahari, Mimiwati / Bae, Hyoung Won / Oo, Nay Lin / Kubota, Toshiaki / Manassakorn, Anita / Ho, Wing Lau / Dallorto, Laura / Hwang, Young Hoon / Kiire, Christine A / Kuroda, Masako / Djamal, Zeiras Eka / Peregrino, Jovell Ian M / Ghosh, Arkasubhra / Jeoung, Jin Wook / Hoan, Tung S / Srisamran, Nuttamon / Sandragasu, Thayanithi / Set, Saw Htoo / Doan, Vi Huyen / Bhattacharya, Shomi S / Ho, Ching-Lin / Tan, Donald T / Sihota, Ramanjit / Loon, Seng-Chee / Mori, Kazuhiko / Kinoshita, Shigeru / Hollander, Anneke I den / Qamar, Raheel / Wang, Ya-Xing / Teo, Yik Y / Tai, E-Shyong / Hartleben-Matkin, Curt / Lozano-Giral, David / Saw, Seang Mei / Cheng, Ching-Yu / Zenteno, Juan C / Pang, Chi Pui / Bui, Huong T T / Hee, Owen / Craig, Jamie E / Edward, Deepak P / Yonahara, Michiko / Neto, Jamil Miguel / Guevara-Fujita, Maria L / Xu, Liang / Ritch, Robert / Liza-Sharmini, Ahmad Tajudin / Wong, Tien Y / Al-Obeidan, Saleh / Do, Nhu Hon / Sundaresan, Periasamy / Tham, Clement C / Foster, Paul J / Vijaya, Lingam / Tashiro, Kei / Vithana, Eranga N / Wang, Ningli / Aung, Tin. ·Genome Institute of Singapore, A-STAR, Singapore. · Singapore Eye Research Institute, Singapore National Eye Centre and Eye ACP, Duke-National University of Singapore, Singapore. · Department of Biochemistry, National University of Singapore, Singapore. · Vietnam National Institute of Ophthalmology, Hanoi, Vietnam. · Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China. · Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan. · Jadhavbhai Nathamal Singhvi Department of Glaucoma, Medical Research Foundation, Sankara Nethralaya, Chennai, India. · Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. · Department of Ophthalmology, College of Medicine, University of Florida, Jacksonville, Florida, USA. · Department of Genetics, Aravind Medical Research Foundation, Madurai, India. · Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China. · Department of Ophthalmology, Tan Tock Seng Hospital, NHG Eye Institute, Singapore. · Department of Ophthalmology, University of the Ryukyus, Okinawa, Nishihara, Japan. · Center of Molecular Biology and Genetic Engineering, University of Campinas, Campinas, Brazil. · Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia and Hospital Universiti Sains Malaysia, Kelantan, Malaysia. · Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. · Instituto de Glaucoma y Catarata, Lima, Peru. · Department of Diagnostics and Microsurgery of Glaucoma, Medical University, Lublin, Poland. · NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK. · Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK. · Division of Genetics, UCL Institute of Ophthalmology, London, UK. · Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht Karls University Heidelberg, Heidelberg, Germany. · Ho Chi Minh City Eye Hospital, Ho Chi Minh City, Vietnam. · Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan. · Pakistan Institute of Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. · Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, the Netherlands. · Department of Ophthalmology, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. · All India Institute of Medical Sciences, New Delhi, India. · Department of Glaucoma, Da Nang Eye Hospital, Da Nang City, Vietnam. · Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia. · Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. · Glaucoma Services, Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand. · College of Medicine, Rangsit University, Bangkok, Thailand. · Mandalay Eye Department, Mandalay Eye ENT Hospital, University of Medicine Mandalay, Mandalay, Myanmar. · Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia. · Vision Research Foundation, Sankara Nethralaya, Chennai, India. · Division of Ophthalmology, Changi General Hospital, Singapore. · Department of Ophthalmology, Thammasat University Faculty of Medicine, Rangsit, Thailand. · Eye Department, Viet Tiep General Hospital, Hai Phong, Vietnam. · Asian Eye Institute, Manila, Philippines. · Division of Ophthalmology, University of the East, Manila, Philippines. · Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea. · Glaucoma Service Jakarta Eye Center, Jakarta, Indonesia. · Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. · Narayana Nethralaya Eye Hospital, Bangalore, India. · Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA. · Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan. · Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal. · Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK. · Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Republic of Korea. · Dipartimento di Scienze Chirurgiche, Università di Torino, Turin, Italy. · Ozaki Eye Hospital, Hyuga, Japan. · Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan. · Department of Ophthalmology, University of Hong Kong, Hong Kong, China. · Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. · Department of Ophthalmology, No. 1 Defence Services General Hospital, Yangon, Myanmar. · Mizoguchi Eye Hospital, Sasebo, Japan. · Department of Ophthalmology, Oita University Faculty of Medicine, Oita, Japan. · Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea. · Shijiazhuang First Eye Hospital, Shijiazhuang, China. · Handan Eye Hospital, Handan, China. · Eye Institute and Affiliated Xiamen Eye Center, Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China. · Anyang Eye Hospital, Anyang, China. · Department of Ophthalmology, Pasig City General Hospital, Pasig City, Philippines. · University of Malaya, Eye Research Centre, Kuala Lumpur, Malaysia. · Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. · Myanmar Eye Centre, Pun Hlaing Silom Hospital, Yangon, Myanmar. · Myanmar Eye Centre, Shwe La Min Hospital, Yangon, Myanmar. · Department of Ophthalmology/Glaucoma Section, Asian Hospital and Medical Center, Muntinlupa City, Philippines. · Binan Doctors Eye Center, Binan Doctors Hospital, Laguna, Philippines. · Department of Ophthalmology, University Hospital Nottingham, University of Nottingham, Nottingham, UK. · BMI Park Hospital Nottingham, Nottingham, UK. · International Specialist Eye Centre, Kuala Lumpur, Malaysia. · Glaucoma Clinic, Aravind Eye Hospital, Pondicherry, India. · Glaucoma Clinic, Aravind Eye Hospital, Madurai, India. · Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil. · Instituto de Ciencias Médicas, Lima, Peru. · Hospital Nacional Arzobispo Loayza, Lima, Peru. · Centro de Genética y Biología Molecular, Universidad de San Martín de Porres, Lima, Peru. · Wilmer Eye Institute, Johns Hopkins Hospital School of Medicine, Baltimore, Maryland, USA. · Department of Human Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands. · Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. · Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia. · Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. · Department of Ophthalmology, Queen Mary Hospital, Hong Kong, China. · Department of Ophthalmology, North Okkalarpa General Hospital, Yangon, Myanmar. · Institute for Human Genetics, University of California, San Francisco, San Francisco, California, USA. · Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. · Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia. · Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. · Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. · Department of Experimental Research, Sun Yat-sen University Cancer Center, Guangzhou, China. · Peking Union Medical College, Beijing, China. · Oxford University Clinical Research Unit-Nepal, Patan Academy of Health Sciences, Patan Hospital, Patan, Nepal. · Institute of Human Genetics, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. · Department of Ophthalmology, Monfalcone Hospital, Gorizia, Italy. · Department of Surgery, Section of Ophthalmology, University of Siena, Siena, Italy. · Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia. · Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA. · Wynn Institute for Vision Research, University of Iowa, Iowa City, Iowa, USA. · Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, USA. · Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. · Division of Medical Oncology, National Cancer Centre, Singapore. · Department of Economics, National University of Singapore, Singapore. · Department of Psychology, National University of Singapore, Singapore. · Institut Pasteur, Functional Genetics of Infectious Diseases Unit, Department of Genomes and Genetics, Paris, France. · Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, Paris, France. · Department of Ophthalmology, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea. · Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea. · Department of Medical Microbiology and Virology, University Medical Center Utrecht, Utrecht, the Netherlands. · GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India. · Department of Biochemistry, Al-Nafees Medical College and Hospital, Isra University, Islamabad, Pakistan. · Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China. · Saw Swee Hock School of Public Health, National University of Singapore, Singapore. · Life Sciences Institute, National University of Singapore, Singapore. · National University of Singapore Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore. · Department of Statistics and Applied Probability, National University of Singapore, Singapore. · Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Department of Glaucoma, Institute of Ophthalmology 'Conde de Valenciana', Mexico City, Mexico. · Department of Genetics, Institute of Ophthalmology 'Conde de Valenciana', Mexico City, Mexico. · Department of Biochemistry, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico. ·Nat Genet · Pubmed #27064256.

ABSTRACT: Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG.

4 Article Comparison of retinal nerve fiber layer and macular thickness for discriminating primary open-angle glaucoma and normal-tension glaucoma using optical coherence tomography. 2016

Khanal, Safal / Davey, Pinakin Gunvant / Racette, Lyne / Thapa, Madhu. ·School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. safalkhanal@iom.edu.np, s.khanal@auckland.ac.nz. · College of Optometry, Western University of Health Sciences, Pomona, California, USA. safalkhanal@iom.edu.np, s.khanal@auckland.ac.nz. · College of Optometry, Western University of Health Sciences, Pomona, California, USA. · Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA. · BP Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Kathmandu, Nepal. ·Clin Exp Optom · Pubmed #26996257.

ABSTRACT: PURPOSE: The aim of this study was to evaluate the discrimination capabilities of macular and peripapillary retinal nerve fiber layer (pRNFL) thickness parameters as measured using spectral domain optical coherence tomography (SD-OCT) between primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). METHODS: A total of 90 subjects were enrolled: 30 healthy subjects, 30 subjects with POAG and 30 subjects with NTG, consecutively. Retinal nerve fiber layer thickness, macular thickness and volume measurements were obtained with circular and radial SD-OCT scans. All parameters were compared between groups using an analysis of variance test. Areas under receiver-operating characteristic (AROC) curves with sensitivities at specificities greater than or equal to 90 per cent were generated to compare discrimination capabilities of various parameters between POAG and NTG. RESULTS: Macular thickness and volume measurements were the highest in normal subjects, followed by NTG and POAG (p < 0.05). Average retinal nerve fiber layer thickness had perfect discrimination for normal-POAG (AROC: 1.000; sensitivity: 100 per cent) and near perfect discrimination for normal-NTG (AROC: 0.979; sensitivity: 93 per cent) as well as NTG-POAG pairs (AROC: 0.900; sensitivity: 60 per cent). Inferior outer macular thickness (IOMT) and total volume were the best macular thickness and volume parameters having similar AROCs and sensitivities between normal and POAG (IOMT, AROC: 0.987; sensitivity: 92 per cent and total volume, AROC: 0.997; sensitivity: 97 per cent), normal and NTG (IOMT, AROC: 0.862, sensitivity: 47 per cent and total volume, AROC: 0.898, sensitivity: 67 per cent) and also between NTG and POAG (IOMT, AROC: 0.910, sensitivity: 53 per cent and total volume, AROC: 0.922, sensitivity: 77 per cent). In each comparison group, there was no statistically significant difference in AROCs between average retinal nerve fiber layer and inferior outer macular thickness, as well as total volume. CONCLUSIONS: The macular parameters offer comparable performance to pRNFL parameters for the discrimination of NTG and POAG. Average retinal nerve fiber layer thickness, total macular volume and inferior outer macular thickness were the best SD-OCT parameters with superior discriminating capabilities.

5 Article Intraeye retinal nerve fiber layer and macular thickness asymmetry measurements for the discrimination of primary open-angle glaucoma and normal tension glaucoma. 2016

Khanal, Safal / Davey, Pinakin Gunvant / Racette, Lyne / Thapa, Madhu. ·School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, New Zealand. Electronic address: s.khanal@auckland.ac.nz. · College of Optometry, Western University of Health Sciences, Pomona, USA. · Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, USA. · B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Nepal. ·J Optom · Pubmed #26652244.

ABSTRACT: PURPOSE: The aim of this study was to evaluate the diagnostic capability of intraeye retinal nerve fiber layer (RNFL) thickness and macular thickness (MT) asymmetry measurements for the discrimination of normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) using spectral domain optical coherence tomography (SD-OCT). METHODS: A total of 90 subjects were enrolled including 30 consecutive healthy subjects, 30 consecutive subjects with POAG, and 30 consecutive subjects with NTG. RNFL thicknesses around the optic disc as well as MT measurements were taken with circular and radial SD-OCT scans. Intraeye retinal and MT asymmetry were calculated as the absolute difference between superior and inferior hemispheres of the eye using posterior pole asymmetry analysis protocol. Analysis of variance was used for comparison and areas under the receiver operating characteristic (AROC) were obtained for different parameters among the three diagnostic groups. RESULTS: There was a significant difference in MT asymmetry for all comparison groups (normal-NTG, p<0.05; normal-POAG, p<0.001; and NTG-POAG, p<0.001). Intraeye retinal nerve fiber thickness asymmetry measurements were not different between the groups (normal-NTG, p<0.187; normal-POAG, p<0.056; and NTG-POAG, p<0.837). The area under ROC curves exceeded 0.800 for all the studied parameters, including the MT asymmetry except for intraeye RNFL thickness asymmetry which had the lowest AROC as well as the least sensitivity for identifying subjects with NTG from normal (AROC=0.626, sensitivity=30%); POAG from normal (AROC=0.644, sensitivity=37%) and NTG from POAG (AROC=0.533, sensitivity=13%). CONCLUSION: The intraeye MT asymmetry holds significant potential as a distinguishing parameter for NTG and POAG.

6 Article Comparison of Phacotrabeculectomy and Phacotrabeculectomy with Subconjunctival 5-Fluorouracil. 2014

Gurung, N K / Gautam, P / Gurung, S / Bhattarai, B. ·Department of Glaucoma Lumbini Eye Institute, Bhairahawa, Nepal. ·JNMA J Nepal Med Assoc · Pubmed #26982901.

ABSTRACT: INTRODUCTION: Glaucoma is the second leading cause of blindness worldwide. Phacotrabeculectomy is a technique in which glaucoma and cataract surgery performed. METHODS: Prospective study was carried out in the department of glaucoma at Lumbini Eye Institute, Bhairahawa.100 patients who underwent phacotrabeculectomy within a period of two years. Patients were divided into two groups those who received 5FU (n=47) and no antifibrotic agent (n= 53) RESULTS: The age range was from 38 to 80 years; mean age of 62.97±9.14 SD. 55% were male and 45% were female.The postoperative IOP reduction in last follow- up group A was mean=13.08±1.57SD and mean=13.23±1.73SD in group B. This was statically significant with P <0.001. Bleb survival was almost similar in two groups 3.17(78.31%) in group A and 3.20 (78.93%) in group B. 85% visual acuity was improved in both groups. CONCLUSIONS: Phacotrabeculectomy and phacotrabeculectomy with inj. 5FU, both were equally effective surgical techniques in terms of visual acuity, IOP control and bleb survival.There was no significant statistical difference vis-à-vis the success of Phacotrabeculectomy using of either these two techniques.

7 Article Hypertension in Primary Open Angle Glaucoma. 2014

Pokharel, S / Sherpa, D / Malla, O K. ·Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. · Depatment of Ophthalmology, National Academy of Medical Sciences, Kathmandu, Nepal. ·JNMA J Nepal Med Assoc · Pubmed #26905702.

ABSTRACT: INTRODUCTION: The impact of vascular factors in POAG is well known and controversial. Some reports have shown high blood pressure in POAG, some low systolic blood pressure and some described no difference in blood pressure between POAG and controls. However decreased ocular perfusion pressure was found in most of the studies. Our study aims to assess the role of hypertension in POAG . METHODS: It was cross-sectional case-control hospital based study carried out from 1st June 2012 to 1st June 2013. There were 40 cases and 100 controls included in the study. The role of hypertension were compared with those hypertensive patients with glaucoma (cases) and hypertensive patients without glaucoma (controls). RESULTS: Age above 50 years (odds ratio: 4.827 with 95% CI 1.862-12.517), male genders (odds ratio: 3.10 with 95% CI 1.356-7.146) and low diastolic perfusion pressure (odds ratio: 3.857 with 95% CI 1.362-11.224) showed strongly positive association with POAG. High systolic blood pressure (odds ratio: 1.476 95% CI 0.627-3.476), high diastolic blood pressure (odds ratio: 1.348 95% CI 0.587-3.096) and low systolic perfusion pressure (odds ratio: 1.8661 with 95% CI 0.649- 5.335) were weakly associated with glaucoma in our study. CONCLUSIONS: Age above 50 years, male gender and low diastolic perfusion pressure were strong risk factor for the development of POAG.

8 Article Understanding and living with glaucoma and non-communicable diseases like hypertension and diabetes in the Jhaukhel-Duwakot Health Demographic Surveillance Site: a qualitative study from Nepal. 2014

Shakya-Vaidya, Suraj / Povlsen, Lene / Shrestha, Binjwala / Grjibovski, Andrej M / Krettek, Alexandra. ·Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; suraj.shakya-vaidya@gu.se. · Nordic School of Public Health NHV, Gothenburg, Sweden. · Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal. · Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway. · Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health NHV, Gothenburg, Sweden. ·Glob Health Action · Pubmed #25361727.

ABSTRACT: BACKGROUND: Primary open-angle glaucoma (POAG) is one of the most common causes of irreversible blindness. A possible association between POAG and non-communicable diseases such as hypertension and diabetes suggests that the incidence of POAG may increase. People with POAG in Nepal usually present late to hospital and have poor knowledge of glaucoma. OBJECTIVES: Anticipating a knowledge gap regarding these diseases, this study aimed to explore the knowledge of POAG, hypertension, and diabetes in the community and barriers to health care. DESIGN: We conducted this qualitative study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), a peri-urban community near Kathmandu, a capital city of Nepal. To study how disease influences knowledge, we conducted focus group discussions separately for men and women with and without pre-existing POAG, hypertension, and diabetes. Data were analyzed using the framework analysis approach. RESULTS: Although people suffering from POAG, hypertension, and/or diabetes exhibited adequate knowledge of hypertension and diabetes, they lacked in-depth knowledge of POAG. People believed mostly in internal health locus of control. Perception of disease consequences and impact of disease on daily life was influenced by pre-existing POAG, hypertension, and/or diabetes but only in men. Gender disparity was observed regarding health literacy, health perception, and health barriers, which put women in a more difficult situation to tackle their health. We also revealed a gap between knowledge, attitude, and practice of health among women and healthy men. CONCLUSION: Although people in JD-HDSS exhibited adequate knowledge regarding hypertension and diabetes, they lacked in-depth knowledge about POAG. This study demonstrated gender difference in health literacy and access to health care, making women more vulnerable towards disease. We also demonstrated a gap between knowledge, attitude, and practice of health. However, tailored health literacy programs may bring changes in the health status in the community.

9 Article Retinal nerve fiber layer thickness in glaucomatous Nepalese eyes and its relation with visual field sensitivity. 2014

Khanal, Safal / Thapa, Madhu / Racette, Lyne / Johnson, Richard / Davey, Pinakin Gunvant / Joshi, Mahesh Raj / Shrestha, Gauri Shankar. ·B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Nepal. Electronic address: safalkhanal@iom.edu.np. · B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Nepal. · Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, USA. · University of Auckland, Auckland, New Zealand. · College of Optometry, Western University of Health Sciences, Pomona, USA. · Glasgow Caledonian University, Glasgow, UK. ·J Optom · Pubmed #25323643.

ABSTRACT: BACKGROUND: To evaluate peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous Nepalese eyes using spectral domain optical coherence tomography (SD-OCT) and study its relationship with visual field sensitivity. METHODS: A total of 120 eyes comprising primary open angle glaucoma (POAG), glaucoma suspects (GS), normal tension glaucoma (NTG) and healthy subjects (n=30 cases in each group) underwent a complete ophthalmic examination, including optic nerve head (ONH) evaluation and standard automated perimetry (SAP). RNFL thickness measurements around the optic disk were taken with circular spectral domain optical coherence tomography (SD-OCT) scans. Analysis of variance (ANOVA) was used for comparison of RNFL parameters among various study groups. The relationship of RNFL parameters with visual field (VF) global indices was evaluated with regression analysis. RESULTS: The mean pRNFL thickness was significantly less in the POAG (64.30±14.45μm, p<0.01), NTG (85.43±9.79μm, p<0.001) and GS (102.0±9.37μm, p<0.001) groups than in the healthy group (109.8±8.32μm). The RNFL was significantly thinner across all quadrants in all study group pairs (p<0.05) except for normal vs. GS (only superior and inferior quadrant, significant). Linear regression plots with RNFL thickness as a predictor of MD and LV demonstrated a strong and statistically significant degree of determination in the POAG group (R(2)=0.203 and 0.175, p=0.013 and 0.021). CONCLUSION: The RNFL thickness measurements with SD-OCT are lower in glaucomatous eyes as compared to age-matched GS and normal eyes in the Nepalese population. A high resolution SD-OCT could aid significantly in the early diagnosis of glaucoma in Nepal.

10 Article Glaucoma awareness in a hospital presenting population in eastern Nepal. 2014

Gyawali, Rajendra / Sarkar, Neelima. ·*Department of Ophthalmology, Nobel Medical College Teaching Hospital and Research Center, Biratnagar, Morang, Nepal †Department of Optometry, Malé Eye Clinic, Malé, Maldives. ·J Glaucoma · Pubmed #23429616.

ABSTRACT: OBJECTIVE: The aim of this study was to assess awareness and knowledge regarding glaucoma among people attending free eye clinic in eastern region of Nepal. METHODS: All the consecutive patients aged 35 years or older, who presented to the free eye clinic, were invited to participate in this cross-sectional survey conducted in June-July 2010. All the participants were residents of Morang district of eastern Nepal. Data on demographics and awareness of glaucoma were collected through face-to-face interview using a pretested structured questionnaire. Participants who have heard about glaucoma were considered as aware and those giving an agreeable definition were considered as having knowledge on glaucoma. RESULTS: A total of 348 subjects participated in this study. The mean age of the participants was 48.3±12.0 years. The majority of them were females, residents of rural areas, and literates. Among the total participants, 211 (60.6%) were aware of the term glaucoma. Only 19 (5.5%) of the total participants had some knowledge of glaucoma. The awareness on glaucoma was significantly associated with higher level of education, family history of glaucoma, and previous history of eye check up. CONCLUSIONS: Knowledge of glaucoma in this population is very low. No particular groups of people are aware of glaucoma in this part of the country. Health education should be broadly targeted at the population to educate people about the risk factors of glaucoma and thereby prevent needless blindness.

11 Article Unusual case of bilateral angle closure glaucoma. 2013

Thapa, Madhu / Khanal, Safal / Kumar, Prajwal / Shrestha, Gulsan Bahadhur / Sharma, Ananda Kumar. ·B.P. Koirala Lions center for Ophthalmic studies, Institute of Medicine, Maharajgunj, Kathmandu, Nepal. ·JNMA J Nepal Med Assoc · Pubmed #24362670.

ABSTRACT: Bilateral angle closure glaucoma is a rare ocular emergency which can be a potentially blinding condition. A case of 72 years male, who developed headache and vomiting after five days of demise of his mother followed by blurring of vision. He was taken to the general hospital where all the routine tests and CT Scan head failed to reveal the cause. After two days of admission, patient was referred for ophthalmic consultation. On ocular examination he was diagnosed as a case of bilateral angle closure glaucoma. After two hours of treatment patient was comfortable with normal intraocular pressure and reasonably good vision.

12 Article Do non-communicable diseases such as hypertension and diabetes associate with primary open-angle glaucoma? Insights from a case-control study in Nepal. 2013

Shakya-Vaidya, Suraj / Aryal, Umesh Raj / Upadhyay, Madan / Krettek, Alexandra. ·Department of Ophthalmology, Nepal Medical College Teaching Hospital, Kathmandu, Nepal; Nordic School of Public Health NHV, Gothenburg, Sweden. ·Glob Health Action · Pubmed #24192283.

ABSTRACT: BACKGROUND: Non-communicable diseases (NCDs) such as hypertension and diabetes are rapidly emerging public health problems worldwide, and they associate with primary open-angle glaucoma (POAG). POAG is the most common cause of irreversible blindness. The most effective ways to prevent glaucoma blindness involve identifying high-risk populations and conducting routine screening for early case detection. This study investigated whether POAG associates with hypertension and diabetes in a Nepalese population. METHODS: To explore the history of systemic illness, our hospital-based case-control study used non-random consecutive sampling in the general eye clinics in three hospitals across Nepal to enroll patients newly diagnosed with POAG and controls without POAG. The study protocol included history taking, ocular examination, and interviews with 173 POAG cases and 510 controls. Data analysis comprised descriptive and inferential statistics. Descriptive statistics computed the percentage, mean, and standard deviation (SD); inferential statistics used McNemar's test to measure associations between diseases. RESULTS: POAG affected males more frequently than females. The odds of members of the Gurung ethnic group having POAG were 2.05 times higher than for other ethnic groups. Hypertension and diabetes were strongly associated with POAG. The overall odds of POAG increased 2.72-fold among hypertensive and 3.50-fold among diabetic patients. CONCLUSION: POAG associates significantly with hypertension and diabetes in Nepal. Thus, periodic glaucoma screening for hypertension and diabetes patients in addition to opportunistic screening at eye clinics may aid in detecting more POAG cases at an early stage and hence in reducing avoidable blindness.

13 Article Results of the Bhaktapur Glaucoma Study, Nepal. 2013

Thapa, S S / Poudyal, I / Khanal, S / van Rens, G. ·Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal. ·Nepal J Ophthalmol · Pubmed #23584652.

ABSTRACT: INTRODUCTION: The Bhaktapur Glaucoma Study is a population-based, cross-sectional and longitudinal study undertaken in one of the districts of Nepal. OBJECTIVES: To determine the prevalence of glaucoma in Bhaktapur district, Nepal. MATERIALS AND METHODS: Thirty clusters were randomly selected and a door-to-door census was conducted to identify citizens 40 years of age and older. Four thousand eight hundred individuals fulfilling the eligibility criteria were referred to the base hospital in Kathmandu for a detailed clinical examination. The diagnosis of glaucoma was based upon criteria described by the International Society for Geographic and Epidemiological Ophthalmology (ISGEO). RESULTS: Complete data was available on 3991 subjects (response rate 83.15 %). The mean IOP was 13.3 mm Hg (97.5th and 99.5th percentiles, 18 and 20 mm Hg, respectively) and mean VCDR 0.26 (97.5th and 99.5th percentiles, 0.6 and 0.8 mm Hg, respectively). Seventy-five subjects had glaucoma, an age-sex-standardized prevalence of 1.80 (95 % confidence interval (CI), 1.68 - 1.92). The age-and sex-standardized prevalence of POAG was 1.24 % (CI, 1.14 - 1.34), PACG 0.39 % (CI, 0.34 - 0.45) and secondary glaucoma 0.15 % (CI, 0.07-0.36). The prevalence of glaucoma increased with increase in age and there was no significant difference in gender. Nine eyes were blind and two subjects bilaterally blind from glaucoma. CONCLUSION: The overall prevalence of glaucoma was 1.9 %. POAG was the most common form of glaucoma. Visual morbidity from PACG, however, was higher. A large majority of the subjects with POAG had not been previously diagnosed and had intraocular pressure within the normal range.

14 Article A population-based survey of the prevalence and types of glaucoma in Nepal: the Bhaktapur Glaucoma Study. 2012

Thapa, Suman S / Paudyal, Indira / Khanal, Shankar / Twyana, Shankha N / Paudyal, Govinda / Gurung, Reeta / Ruit, Sanduk / van Rens, Ger H M B. ·Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal. ssthapa@tilganga.com.np ·Ophthalmology · Pubmed #22305097.

ABSTRACT: OBJECTIVE: To determine the prevalence and types of glaucoma in a Nepalese population. DESIGN: Cross-sectional, population-based survey. PARTICIPANTS: A total of 4800 subjects aged 40 years or older from the Bhaktapur district of Kathmandu valley. METHODS: Subjects aged 40 years or older were selected using a cluster sampling procedure and door-to-door enumeration for a population-based, cross-sectional study. All subjects underwent a detailed ocular examination at the base hospital, which included logarithm of minimal angle of resolution visual acuity, refraction, applanation tonometry, gonioscopy, Lens Opacities Classification System II cataract grading, retinal examination, and Swedish Interactive Thresholding Algorithm standard perimetry when indicated. MAIN OUTCOME MEASURES: Diagnosis of glaucoma was based on criteria described by the International Society for Geographic and Epidemiological Ophthalmology. RESULTS: A total of 4003 subjects underwent a comprehensive eye examination (response rate 83.4%), and complete data were available in 3991 subjects. The mean intraocular pressure was 13.3 mmHg (97.5th and 99.5th percentiles, 18 and 20 mmHg, respectively), and the mean vertical cup-to-disc ratio was 0.26 (97.5th and 99.5th percentiles, 0.6 and 0.8 mmHg, respectively). There were 75 subjects with glaucoma, an age- and sex-standardized prevalence of 1.80 (95% confidence interval [CI], 1.68-1.92). Age- and sex-standardized prevalence was 1.24% (95% CI, 1.14-1.34) for primary open-angle glaucoma (POAG), 0.39% (95% CI, 0.34-0.45) for primary angle-closure glaucoma (PACG), and 0.15% (95% CI, 0.07-0.36) for secondary glaucoma. The prevalence of glaucoma increased with an increase in age with no significant difference in gender. Primary angle-closure glaucoma was 3 times more common in women. Nine eyes were blind, and 2 subjects were bilaterally blind from glaucoma. CONCLUSIONS: The overall prevalence of glaucoma was 1.9%. Of all glaucoma cases, POAG accounted for 68%, PACG accounted for 22.67%, and secondary glaucoma accounted for 9.33%. Among the subjects with POAG, 96.08% had not been previously diagnosed.

15 Article Central corneal thickness and intraocular pressure in a Nepalese population: the Bhaktapur Glaucoma Study. 2012

Thapa, Suman S / Paudyal, Indira / Khanal, Shankar / Paudel, Nabin / Mansberger, Steven L / van Rens, Ger H M B. ·Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal. suman.thapa@tilganga.org ·J Glaucoma · Pubmed #21499121.

ABSTRACT: PURPOSE: The purpose of the study was to evaluate the characteristics of central corneal thickness and its association with age, sex, and intraocular pressure in a Nepalese population. PATIENTS AND METHODS: The study design was a cross-sectional, population-based survey. Two thousand three hundred thirty patients aged 40 years and older were examined at Tilganga Institute of Ophthalmology, a tertiary referral eye centre in Kathmandu, Nepal. All patients underwent a complete ophthalmic examination that included measurements of central corneal thickness with an ultrasonic pachymeter and intraocular pressure with a Goldman type applanation tonometer. RESULTS: The main outcome measures were central corneal thickness and intraocular pressure. Mean age of the 2330 patients examined was 51.3 years (SD±9.56). The mean central corneal thickness and mean intraocular pressure was 539.10 μm (SD±33.73) and 13.33 mm Hg (SD±2.26), respectively. Central corneal thickness showed an average decrease of 2.67 μm (95% confidence interval, 2.21-4.1) per decade increase in age. A 100 μm increase in central corneal thickness was associated with a 1.03 mm Hg (95% confidence interval, 0.79-1.26) increase in intraocular pressure after adjusting for age and sex. CONCLUSIONS: The changes in central corneal thickness values cause a significant variation in intraocular pressure in this population, suggesting that measurement of central corneal thickness will have implications in the diagnosis and management of glaucoma.

16 Article Ocular morbidity among primary school children of Dhulikhel, Nepal. 2011

Sherpa, D / Panta, C R / Joshi, N. ·Nepal Eye Hospital, Tripureshwor, Kathmandu. dakki_sherpa@yahoo.com ·Nepal J Ophthalmol · Pubmed #21876593.

ABSTRACT: BACKGROUND: Knowledge of disease pattern in children can help design preventive and curative strategies. OBJECTIVE: To study the pattern of ocular morbidity among the primary school children. SUBJECTS AND METHODS: All the children of randomly-selected five government primary schools of Dhulikhel were included in this study. A complete eye examination was done in all children including color vision, loupe examination, refraction and Schiotz tonometry. Funduscopy and automated perimetry were done in selected children. RESULTS: A total of 466 primary school children were included in the study, of which 466 children 47 (10.08 %) had ocular morbidity. Refractive error was the commonest type of ocular morbidity in 11 (2.36 %). Hypermetropia was the commonest type of refractive error (0.84 %) in contrast to myopia (0.64 %). Conjunctivitis was the second common type of ocular morbidity (1.71 %). Glaucoma suspects accounted for 1.28 %, xexophthalmia 1.07 %, blephatitis 0.85 %, amblyopia 0.43 %, color blindness 0.43 %, conjunctival nevus 0.43 %, glaucoma 0.43 %, and strabismus 0.43 %, while congenital abnormalities were less common. CONCLUSION: Refractive error is the commonest form of ocular morbidity in primary school children.

17 Article Ocular manifestations in herpes zoster ophthalmicus. 2011

Puri, L R / Shrestha, G B / Shah, D N / Chaudhary, M / Thakur, A. ·Sagarmatha Choudhary Eye Hospital, Lahan, Nepal. drlila_raj@yahoo.com ·Nepal J Ophthalmol · Pubmed #21876592.

ABSTRACT: BACKGROUND: Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual disability, severe post-herpetic neuralgia and rarely fatal cerebral complications. AIM: To identify the pattern of ocular manifestation in herpes zoster ophthalmicus. MATERIALS AND METHODS: A cross-sectional descriptive study was under taken including the clinically diagnosed cases of HZO. All of them underwent a complete ophthalmological evaluation. RESULTS: Sixty-eight cases of HZO were examined, of which 37 (54.4 %) were male and 31 (45.6%) female. The mean age was 48.7 ± 18.5 years. Most of the patients (64.7 %) were above the age of 40 years. 77.94 % of the patients had some form of ocular involvement. Pain (77.9 %) was the commonest ocular complaint. In young patients less than 35 years, HIV was the most common risk factor (19.3 %).Visual status was good in the majority (73.5 %) of patients at presentation. Lid and adnexal findings (45.8 %) were most common ocular involvement followed by conjunctivitis (41.1 %). Corneal complication was seen in 38.2 % of cases, uveitis in 19.1 % and post-herpetic neuralgia (PHN) and secondary glaucoma each in 5.8 %. CONCLUSION: Eyelid and ocular adnexal involvement is most commonly found in patients with herpes zoster ophthalmicus followed by corneal complication and uveitis. There needs to be awareness of ocular involvement, which can be sight threatening, among the HZO patients and other medical departments and an increased emphasis on regular ophthalmic examination.

18 Article Glaucoma at a tertiary referral eye hospital in Nepal. 2011

Paudyal, I / Thapa, S S / Paudyal, G / Gurung, R / Ruit, S. ·Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal. indurup@gmail.com ·Nepal J Ophthalmol · Pubmed #21876584.

ABSTRACT: BACKGROUND: Glaucoma is an important cause of blindness. OBJECTIVE: To report the distribution of various types of glaucoma among patients presenting to a tertiary eye hospital in Nepal. MATERIALS AND METHODS: All new patients visiting the hospital between March 2007 and February 2008 underwent a comprehensive eye examination. Whenever glaucoma was suspected, patients were referred to fellowship-trained glaucoma specialists. Patients received a comprehensive glaucoma workup including applanation tonometry, stereoscopic examination of the optic nerve head performed by the glaucoma specialists, and a Humphrey visual field analysis (SITA 24 - 2). RESULTS: 447 patients were newly diagnosed with glaucoma. 171 (38.2 %) patients had primary open-angle glaucoma (POAG), while 143 (32 %) had primary angle-closure glaucoma (PACG). The average age of presentation of patients with POAG was 65.78 ± 9.1 years, while the average age for PACG patients was 54.6 ±12.8 years. 30 (21 %) patients with PACG had acute angle-closure on presentation, while 113 (79 %) had chronic angle closure glaucoma. 107 (75 %) of these patients with PACG had visual acuity of less than 3/60 (20/400) in the worse eye at presentation. The most common form of secondary glaucoma was lens-induced (5.3 %), followed by neovascular (3.2 %) and uveitic glaucoma (3.2 %). CONCLUSION: The most common glaucoma seen in a tertiary referral eye hospital of Nepal is primary open-angle glaucoma. Among the angle-closure glaucoma, chronic angle-closure is the most common. Lens-induced glaucoma is still the commonest cause of secondary glaucoma.

19 Article Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: the Bhaktapur Glaucoma Study. 2011

Thapa, Suman S / Berg, Rosa V D / Khanal, Shankar / Paudyal, Indira / Pandey, Pooja / Maharjan, Nhukesh / Twyana, Shankha N / Paudyal, Govinda / Gurung, Reeta / Ruit, Sanduk / Rens, Ger H M B V. ·Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal. ssthapa@tilganga.com.np ·BMC Ophthalmol · Pubmed #21255382.

ABSTRACT: BACKGROUND: Cataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal. METHODS: Subjects aged 40 years and above was selected using a cluster sampling methodology and a door to door enumeration was conducted for a population based cross sectional study. During the community field work, 11499 subjects underwent a structured interview regarding awareness (heard of) and knowledge (understanding of the disease) of cataract and glaucoma. At the base hospital 4003 out of 4800 (83.39%) subjects underwent a detailed ocular examination including log MAR visual acuity, refraction, applanation tonometry, cataract grading (LOCSΙΙ), retinal examination and SITA standard perimetry when indicated. RESULTS: The age-sex adjusted prevalence of blindness (best corrected <3/60) and low vision (best corrected <6/18 ≥ 3/60) was 0.43% (95%C.I. 0.25 - 0.68) and 3.97% (95% C.I. 3.40 - 4.60) respectively. Cataract (53.3%) was the principal cause of blindness. The leading causes of low vision were cataract (60.8%) followed by refractive error (12%). The cataract surgical coverage was 90.36% and was higher in the younger age group, females and illiterate subjects. Pseudophakia was seen in 94%. Awareness of cataract (6.7%) and glaucoma (2.4%) was very low. Among subjects who were aware, 70.4% had knowledge of cataract and 45.5% of glaucoma. Cataract was commonly known to be a 'pearl like dot' white opacity in the eye while glaucoma was known to cause blindness. Awareness remained unchanged in different age groups for cataract while for glaucoma there was an increase in awareness with age. Women were significantly less aware (odds ratio (OR): 0.63; 95%, confidence interval (CI): 0.54 - 0.74) for cataract and (OR: 0.64; 95% CI: 0.50 - 0.81) for glaucoma. Literacy was also correlated with awareness. CONCLUSION: The low prevalence of visual impairment and the high cataract surgical coverage suggests that cataract intervention programs have been successful in Bhaktapur. Awareness and knowledge of cataract and glaucoma was very poor among this population. Eye care programs needs to be directed towards preventing visual impairment from refractive errors, screening for incurable chronic eye diseases and promoting health education in order to raise awareness on cataract and glaucoma among this population.

20 Article Comparison of axial lengths in occludable angle and angle-closure glaucoma--the Bhaktapur Glaucoma Study. 2011

Thapa, Suman S / Paudyal, Indira / Khanal, Shankar / Paudel, Nabin / van Rens, Ger H M B. ·Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal. ssthapa@tilganga.com.np ·Optom Vis Sci · Pubmed #21150676.

ABSTRACT: PURPOSE: To compare the anterior chamber depth (ACD) and axial length of eyes in a population-based sample among normal, occludable angle, and primary angle-closure glaucoma (PACG) groups. METHODS: Totally, 3979 subjects from a population-based glaucoma prevalence study underwent complete ocular examination including four mirror gonioscopy. An angle in which >270 degrees of the posterior trabecular meshwork could not be seen was considered occludable. PACG was considered when there were features of primary angle closure (eye with an occludable angle, peripheral anterior synechiae, increased intraocular pressure, iris whorling, lens opacities, or excessive pigment deposition on the trabecular surface) and optic disc with glaucomatous damage. A handheld ultrasonic biometer was used to measure the ACD and the axial length of subjects. The ACD and axial length were measured on all subjects with occludable angles (n = 86), PACG (n = 17) and a random subgroup of normal subjects (n = 685). The measurements were compared among the groups and statistically analyzed using independent t-test, one-way analysis of variance, χ2 test, and logistic regression. RESULTS: The mean age among occludable angle and angle-closure glaucoma groups was 59.64 ± 9.70 and 71.23 ± 8.5 years, respectively, which was significantly higher (p < 0.001) than the mean of 54.03 ± 10.90 years among normal subjects. In the occludable angle group, the ACD (2.55 ± 0.69) was significantly different (p < 0.001) than the normal group (2.85 ± 0.39). The axial length (22.08 ± 0.83) in the occludable angle group was also considerably different (p < 0.001) when compared with the normal group (22.62 ± 0.90). In PACG group, the ACD and axial length were 2.48 ± 0.22 and 22.02 ± 0.59, respectively. The risk of having an occludable angle decreased with per unit millimeter increase in ACD (odds ratio, 0.24; 95% confidence intervals, 0.12-0.50) and axial length (odds ratio, 0.49; 95% confidence intervals, 0.36-0.67) after adjusting the effect of age and sex. CONCLUSIONS: The eyes in Nepalese population with occludable angle and angle-closure glaucoma appear to have significantly shallower anterior chambers and shorter axial lengths when compared with the normal group.

21 Article Rationale, methods and baseline demographics of the Bhaktapur Glaucoma Study. 2011

Thapa, Suman S / Rana, Pooja P / Twayana, Shankhar N / Shrestha, Mohan K / Paudel, Indira / Paudyal, Govinda / Gurung, Reeta / Ruit, Sanduk / Hewitt, Alex W / Craig, Jamie E / van Rens, Ger. ·Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal. ssthapa@tilganga.com.np ·Clin Exp Ophthalmol · Pubmed #21040314.

ABSTRACT: BACKGROUND: To describe the methodology and baseline data of a population-based study designed to determine the prevalence of glaucoma and to study the risk factors for glaucoma development in a Nepali population. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Subjects 40 years and above residing in Bhaktapur District. PATIENTS AND METHODS: Power calculations suggest that a sample size of 4758 is required. Thirty clusters were randomly selected from the 2 municipalities and 16 Village Development Committees of Bhaktapur District in Nepal. A door-to-door census was conducted in the selected clusters to identify citizens 40 years of age and older. Demographic details were collected and a structured interview, regarding awareness for cataract and glaucoma was taken. All individuals fulfilling the eligibility criteria were recruited and referred to the Tilganga Institute of Ophthalmology in Kathmandu for a detailed clinical examination including glaucoma diagnostic procedures. Peripheral blood samples were taken to facilitate future genetic analysis. MAIN OUTCOME MEASURES: Prevalence of glaucoma, risk factors and genetic screening. RESULTS: A total of 4800 people were selected. The mean age of participants was 55.4 ± 12.3 years (range: 40-99) and 51.8% were female. In total, 64.8% of our cohort was aged less than 59 years and 60.5% were illiterate. Among the various ethnic races, 69.7% belonged to the Newar ethnic group. CONCLUSION: This study will determine the prevalence of glaucoma and allow for an increased understanding of the risk factors for glaucoma development in this region.

22 Article Effectiveness of intra-operative and post-operative use of 5-fluorouracil in trabeculectomy--a randomized clinical trial. 2010

Malla, P / Karki, P / Das, H. ·Department of Ophthalmology, B P Koirala Institute of Health Sciences, Dharan, Nepal. prasannaashrestha@hotmail.com ·Nepal J Ophthalmol · Pubmed #21141322.

ABSTRACT: INTRODUCTION: The success rate of trabeculectomy is limited by postoperative scarring. OBJECTIVE: To evaluate the effectiveness of intra-operative and post-operative use of 5-Fluorouracil (5-FU) in trabeculectomy. MATERIALS AND METHODS: Thirty consecutive eyes undergoing trabeculectomy were randomized systematically into 3 groups of ten patients each. Group A served as a control; in Group B intraoperative 5-FU was used, whereas Group C received post-operative sub-conjunctival 5-FU. The variables studied were pre- and post-operative intraocular pressure, post-operative bleb characteristics and complications. STATISTICS: Data were evaluated using the SPSS ver 10.0 program. ANOVA, paired t test and chi2 tests were performed. RESULTS: The means of age in years of patients in group A, B and C were 49 +/- 9.23, 56.50 +/- 8.39 and 52.10 +/- 8.96 respectively (p = 0.222). The means of pre-operative IOP in groups A, B and C were 37.80 +/- 10 mmHg, 42.00 +/- 11.22 mmHg and 29.40 +/- 12.82 mmHg respectively. The medians of pre-operative anterior chamber depth (ACD) in groups B and C were 3 and 2 in group A according to van Herrick's grading. The mean values of final IOP were 11.90 +/- 3.50, 11.70 +/- 4.24, 11.00 +/- 2.83 mmHg (p = 0.841). The median post-operative anterior chamber depth in all the groups was similar compared to the pre-operative anterior chamber depth (p = 0.510). The final bleb scores in all the groups were similar (p = 0.873). CONCLUSION: The intra-operative and post-operative use of 5-FU in trabeculectomy is almost equally effective in terms of IOP control and bleb characteristics.

23 Article Profile of the glaucomas and intervention in a large eye care centre in south-east Nepal. 2010

Sarkar, S / Mardin, C / Hennig, A. ·Sagarmatha Choudhary Eye Hospital, Laban, Siraha, Nepal. ·Nepal J Ophthalmol · Pubmed #21141320.

ABSTRACT: INTRODUCTION: Glaucoma is the second leading cause of blindness worldwide. OBJECTIVE: To estimate the prevalence and risk factors of glaucoma and modes of therapeutical intervention in a rural population of a developing country. PATIENTS AND METHODS: A single centre-based cross-sectional study was carried out over a seven-month period in Sagarmatha Choudhary Eye Hospital (SCEH), Lahan/NEPAL, including the patients with glaucoma. OUTCOME MEASUREMENT: The patients' demography, type of the glaucomas, visual acuity, vertical cup-disc ratio, intra-ocular pressure and visual field findings were the parameters studied. RESULTS: A total of 3986 eyes with suspected glaucoma were identified. 53.7% of the patients were between 41-60 years of age. 53.9% were male. 26.5% were blind or severely visually impaired. 37.2% had IOP more than 35 mmHg. 46.4% had vertical cup-disc ratio (VCDR) higher than 0.8. Severe visual field defects were found in 28.4% eyes. 35.3% eyes had primary angle-closure glaucoma, 22.6% eyes primary open-angle glaucoma, and 14.6% eyes normaltension glaucoma. 10.2% eyes suffered from lens induced glaucoma. Only in 9 eyes was pseudoexfoliation syndrome with glaucoma diagnosed. 25.7% eyes were advised for trabeculectomy. 11.5% eyes underwent extra-capsular cataract surgery. IOP lowering medication was prescribed in 5.9% patients. CONCLUSIONS: The most common glaucoma seen in the out-patient department of a large eyecare centre in South-East Nepal is primary angle-closure glaucoma. 25% of the glaucoma patients are visually impaired or blind at the time of presentation. In more than one-fourth of the patients, trabeculectomy is the therapy of choice.

24 Article Management of glaucoma in a case of familial aniridia by trabeculectomy. 2009

Barthakur, R / Shrestha, S P / Bhat, K S / Natarajan, M. ·Department of Ophthalmology, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal. rimli.barthakur@gmail.com ·Nepal J Ophthalmol · Pubmed #21141025.

ABSTRACT: Aniridia is a rare developmental disorder. Glaucoma and complications associated with glaucoma surgery are a major cause of blindness in patients with aniridia. We describe here a case of a nine year old boy who presented with familial aniridia of both eyes along with glaucoma. He was treated by trabeculectomy of both eyes, which was successful in controlling the glaucoma.

25 Article A randomised clinical trial comparing the outcome of trabeculectomy using triangular versus rectangular scleral flaps. 2009

Sharma, A / Das, H / Adhikari, S / Lavaju, P / Shrestha, B G. ·Department of Ophthalmology, B P Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. ophth_eye@yahoo.com ·Nepal J Ophthalmol · Pubmed #21141017.

ABSTRACT: BACKGROUND: trabeculectomy is the standard surgical procedure for management of glaucoma. OBJECTIVE: to compare the outcome of triangular and rectangular scleral flaps in trabeculectomy. MATERIALS AND METHODS: this study was carried out in the Department ofOphthalmology, BPKIHS, Dharan, over a period of one year. A total of 22 patients undergoing trabeculectomy were randomized to undergo either trabeculectomy with triangular scleral flap (Group A= 11 eyes) or trabeculectomy with rectangular flap (Group B = 11 eyes). OUTCOME MEASUREMENT: the parameters studied were intraocular pressure (IOP), anterior chamber depth (ACD), bleb characteristics and surgical complications. STATISTICS: P value of<0.05 was considered significant. All calculations were executed using SPSS 11.0 software program. RESULTS: the age ranged between 40 to 76 years with the mean of 56.5 +/- 9.25 years. The most common preoperative diagnosis was angle closure glaucoma. The postoperative percentage of IOP reduction (Group A=68.9%; Group B=66.51%) was statically significant in both the groups (p=0.001). Trabeculectomy was almost equally effective with complete surgical success of 91% in group A, and 82% in group B (p=0.534). Final bleb scores were almost similar in both the groups with 3.27 +/- 1.5 in group A and 3.36 +/- 1.21 in group B (p=0.877). Hypotony with the IOP less than 6 mmHg was found in the first post-operative day in 2 patients in Group A and in 1 in Group B. All of them improved spontaneously within a week. CONCLUSION: both triangular and rectangular scleral flaps in trabeculectomy are equally effective in terms of post surgical IOP control, bleb characteristics and complications.

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