1. By Dadhija Paritoshbhai Dave Study Project for B.Optometry
The Prevalence of Five Major Causes of Low Vision in Ahmedabad Population and their Respective Management with Residual Visual Function By
Dadhija Paritoshbhai Dave
Study Project for B.Optometry

2. AIM
The Prevalence of Five Major Causes of Low Vision in Ahmedabad Population and their Respective Management with Residual Visual Function

3. REVIEW OF LITERATURE
S.A.Khan concluded that the main causes for Low Vision are Retinitis Pigmentosa , Diabetic Retinopathy , Macular Diseases and Myopic Degeneration. This study was carried out in Tertiary Eye Care Hospitals of South India8
As per Dandona R , the most frequent causes of Low Vision included Retinal Diseases , Amblyopia , Optic Atrophy , Glaucoma and Corneal Diseases in the southern part of India (Andhra Pradesh)9
HB Thapa , S.Gurung , A.Sherchan , AS Karthikeyan and RP Kandel described in their study the leading causes are Lens Related Causes (Aphakia/Pseudophakia/Cataract) , Refractive Errors , Amblyopia , All Globe Abnormalities , Corneal Pathology , Retinal Diseases (Different Maculopathies ,Retinal scars , Retinal Hemorrhages , Vein Occlusion) and Other causes (Albinism , Nystagmus , Different Associated Syndromes) in Nepal Population10

4. MATERIAL AND METHODOLOGY
A prospective study was done to determine the Causes of Low Vision and its Management in Ahmedabad City. Patients were conducted, at “BLIND SCHOOL”, Vastrapur, and “Nagari Eye Hospital”, Ellisbridge, Ahmedabad. Total of 350 Patients falling in Inclusion Criteria were examined
Inclusion criteria:
Patient falling in criteria of Low Vision Definition that is Better Eye seeing ≤ 6/18 to Perception of light after refraction and surgical correction
Patient with Other Physical and Mental Disability like Deaf , Intellectual Disable etc
Exclusion criteria:
Patient not falling in criteria of Low Vision (Normal Patients)
Patient those are totally Blind or having no perception of light

5. METHODOLOGY History and Eye Examination External eye examination
Anterior segment examination by torch and/or slit lamp biomicroscope
Fundus examination by direct and/or indirect ophthalmoscope
Visual Acuity
Distant visual acuity was assessed with Distance Snellen chart.
Near vision was assessed by N series near chart of continuous text.
Patients with visual acuity equal/less than 6/18 to perception of light in the better eye, underwent tests for refraction and management
Refraction
Objective Refraction – Retinoscope.
Subjective Refraction – Trial Frame , Full Aperture Trial lenses
Patient were assessed using the optimal illumination of a 40 watt halogen lamp, with the light source directed at an angle of 45° to the page, minimizing glare for near .As per subjective refraction spectacles were advised

6. Cont…. Color Vision Panel D-15 (Binocularly) Contrast Sensitivity
Peli Robson Chart
Visual Field
Amslers Grid
Confrontation Test
Low Vision Aids
Optical Devices
For Distance – Telescopes
For Near – Different Magnifiers (Spectacle Magnifier , Stand Magnifier , Bar Magnifier , Dome Magnifier , Hand Held Magnifier and Illuminated Stand Magnifier ) were tried with patients having less vision 

7. Non-Optical Devices
Large Print Books, Bold Line Notebook , Felt tip pen , Typoscopes , Reading lamp , Reading Stand , Peaked Caps , Torch were advised.
Training
Orientation and Mobility Training, Rehabilitation Training and Tactile Training. Braille and Talkative Instruments were advised to them.
The Data Collected from the study was inputed in Excel Sheet and analysis was made with calculations to find out 5 major causes of Low Vision in Ahmedabad Population

8. RESULT

10. Other Causes founded in 19
Other Causes founded in 19.44% were Aphakia , Pseudophakia , Cataract ,
Refractive Error associated with Amblyopia , Macular Dystrophy, Diabetic Retinopathy, Glaucoma,
Retinopathy of Prematurity and Retinal Detachment

12. LOW VISION AIDS Only Training 115 32.86%
PATIENTS
PERCENTAGE
CAUSES
DEVICES
Only Training
115
32.86%
Advanced RP , Retinal Dystrophy , Severe Optic Atrophy , ARMD
Training Advise like Orientation and Mobility , Rehabilitation and Tactile Training.Along with it Braille and Talkative Instruments were advised.
Near Devices 86
24.57%
Microcornea , Microophthalmos,Iris Coloboma , Retinal Coloboma with Nystagmus , High Hypermetropia
Spectacle Magnifier , Stand Magnifier , Bar Magnifier , Dome Magnifier , Hand Held Magnifier and Illuminated Stand Magnifier
Distance Devices 57
16.29%
Myopic Degeneration , High Myopia
Telescopes
Near and Distance Devices 27
7.71%
RP , Microcornea , Microophthalmos,Iris Coloboma,Retinal Coloboma with Nystagmus, Glaucoma , Albinism , Macular Dystrophy , Diabetic Retinopathy , Aphakia , Pseudoaphakia , Cataract
Spectacle Magnifier , Stand Magnifier , Bar Magnifier , Dome Magnifier , Hand Held Magnifier and Illuminated Stand Magnifier,Telescopes
Refraction + High Add 65
18.57%
Refractive Error , Amblyopia , Aphakia , Pseudophakia , Cataract
Spectacle for Near and Distance Correction
Total
350
100%

13. DISCUSSION
This study presents five major causes of Low Vision in Ahmedabad Population.According to this study which was carried out in 350 Patients , 248 Patients (70.86%) were males.The major causes in Ahmedabad Population are :
Microcornea , Microphthalmos, Retinal Coloboma and Nystagmus %
Optic Atrophy %
Retinitis Pigmentosa – 17.43%
Myopic Degeneration – 14.85%
Albinism – 6.29%
Others – 19.44% (Aphakia , Pseudophakia , Cataract , Refractive Error associated with Amblyopia , Macular Dystrophy, Diabetic Retinopathy, Glaucoma, Retinopathy of Prematurity and Retinal Detachment) .

14. According to the study done by Mr. S. A
According to the study done by Mr.S.A.Khan in 450 Patients in Southern India , the leading causes were :
Retinitis Pigmentosa – 19% ,
Diabetic Retinopathy – 13% ,
Macular Diseases – 17.7% ,
Myopic Degeneration – 9%.
Out of 450 Patients , 297 (72%) were males
As per study of Mr.S.A.Khan , 72% of Patients were males. Similarly in this study the maximum patients that is 70.86% were males.
According to study of Mr.S.A Khan , Retinitis Pigmentosa was major cause with 19% where as in this study Retinitis Pigmentosa was third major cause with 17.43%.
As per study of Mr.S.A.Khan Myopic Degeneration was the fourth major cause in Southern India same as Myopic Degeneration is the fourth Major Cause in the Ahmedabad Population
But Diabetic Retionpathy and Macular Diseases are not the major causes in Ahmedabad Population where as they were one of the major causes in southern India as per study of Mr.S.A.Khan

15. According to study of Dandona R
According to study of Dandona R., the study which was carried out in Southern part of India that is Andhra Pradesh ,
Retinal Diseases was major cause with 35.20% , followed by
Refractive Errors & Amblyopia – 25.70% ,
Optic Atrophy – 14.30% ,
Glaucoma – 11.04% ,
Corneal Diseases – 8.60%.
This study was performed on 144 Patients.
Relating this study to our , we found that the Optic Atrophy which was third major causes in Andhra Pradesh which constituted to 14.30% , was the Second major cause in Ahmedabad Population with 19.42%.
R.Dandona studied that 11.04% people of Andhra Pradesh were having Glaucoma as there Low Vision Disorder which contributed to fourth major cause.However in this study , Glaucoma was not found to major cause of Low Vision.
Similarly Refractive Error and Amblyopia were not the major causes in Ahmedabad Population.
Microcornea which is one of the Corneal Dystrophy , associated with Microphthalmia , Retinal Coloboma and Nystagmus was the most leading cause in Ahmedabad Population.In Study of Dandona R different types of Corneal Diseases formed 8.60%.

16. HB Thapa , S.Gurung , A.Sherchan , AS Karthikeyan and RP Kandel studied that the leading causes of Low Vision were :
Lens Related Causes (Aphakia / Pseudoaphakia / Cataract ) – 35.55% , followed by
Refractive Error and Amblyopia – 19.23% ,
Retinitis Pigmentosa – 10.84% ,
Whole Globe Abnormalities – 10.24% ,
Corneal Pathologies – 7.24% ,
Retinal Diseases – 6.64% and Others – 10.25% (Albinism , Nystagmus and Associated Different Syndromes).
This study was carried out in 166 Nepali Patients.Out of these , 70% of Patients were males
According to our study , 70.86% Patients were males out of 350 patients which is similar to study of HB Thapa and group which has 70% Patients as males.
In study of HB Thapa and Group Lens Related Causes was major cause with 35.55% whereas in Ahmedabad Population that is not the Major Cause.Similarly in study by Dandona R and S.A.Khan , Lens Related Causes were not Major Causes.
Refractive Error contributes to second major cause in Nepal with 19.23% but in Ahmedabad Population it was not major cause.
Retitinis Pigmentosa was third major cause with 10.84% in Nepal.Similarly in Ahmedabad Population it was third major cause with 17.43%.However in study of Mr.S.A.Khan , Retinitis Pigmentosa was the most major cause with 19%.

17.  Corneal Pathologies contributed to fifth major cause in Nepal Population with 7.24%.Similarly in study of Dandona R , Corneal Diseases was fifth major cause with 8.60%.However in Ahmedabad Population Microcornea which is one of the Corneal Dystrophy , associated with Microphthalmia , Retinal Coloboma and Nystagmus was the most leading cause with 22.57% in Ahmedabad Population.
Albinism was found in very less people in Nepal as reason for causing low vision but in Ahmedabad Population it is the fifth leading cause of Low Vision with 6.29%
As per study by HB Thapa , S.Gurung , A.Sherchan , AS Karthikeyan and RP Kandel , Training was advised in 6.02% Patients , Near Magnification was given in 54.23% Patients , Spectacles as per Refraction were advised in 19.27% Patients , Distance Devices were given in 20.48% Patients.However, as per our study Training was advised in 32.86% Patients, Near Magnification was given in 24.57% Patients, Spectacles as per Refraction were advised in 18.57% Patients, Distance Devices were given in 16.29% Patients and Near and Distance Devices were advised in 7.71%.
This shows that severity of Low Vision was more in Ahmedabad Population as compared to Nepal Population
There are so many studies done on different causes of Low Vision in the different regions of the world , but in Ahmedabad Population not a single study was done. So this study is about the leading five major causes of Low Vision in Ahmedabad Population

18. CONCLUSION
By this study we conclude the Five Major Causes of Low Vision in Ahmedabad Population and their respective management gives better lifestyle to low vision patient with their residual visual function.

19. REFRENCES
World Health Organization. Global initiative for the elimination of avoidable blindness. WHO/PBL/ Geneva: WHO, 1997. 
International Classification of Diseases ICD ;2
World Health Organization
A.K.Khurana Comprehensive Ophthalmology Fourth Edition
World Health Organization 2006 , Retrived December
World Health Organization Fact Sheet Number 282 June
AO Oduntan Prevalence and Causes of Low Vision Worldwide S Afr Optom 2005;64:44-54
S.A.Khan To obtain data on the characteristics and causes of low-vision patients seen at a tertiary eye care hospital in India. Indian Journal of Ophthalmology 2000;48:
Dandona R, Dandona L, Srinivas M, Giridhar P, Nutheti R, Rao GN .To assess the prevalence and causes of low vision in a population in southern India for planning low vision services. International Centre for Advancement of Rural Eye Care, L. V. Prasad Eye Institute, Hyderabad, India

20. 10. HB Thapa, S Gurung, A Sherchan, AS Karthikeyan, RP Kandel Hospital based study on causes of low vision and patient preference for different types of low vision devices Journal of Institute of Medicine 2007;29:2
11. Shah SP, Minto H, Jadoon Z, on behalf of the Pakistan National Eye Survey Study Groupet al. Prevalence and causes of functional low vision and implications for services: The Pakistan National Blindness and Visual Impairment Survey. Invest Ophthalmol Vis Sci. 2008;49:887–893.
12. Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive Error Study in Children: sampling and measurement methods for a multi-country survey.Am J Ophthalmol. 200;129:421–426.
13. Pokharel GP, Negrel AD, Munoz SR, Ellwein LB. Refractive Error Study in Children: results from Mechi Zone, Nepal. Am J Ophthalmol. 2000;129:436–444.
14. Gilbert C, Rahi J, Quinn G. Visual impairment and blindness in children. Johnson G Minassian D Weale R West S eds. Epidemiology of Eye Disease.2003; 2nd ed. Edward Arnold Ltd. London. chap 16
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21. APPENDIX PATIENT PROFORMA DATE: _____/______/_______ NAME OF PATIENT:
NAME OF PATIENT:
ADDRESS:
AGE: ____________ GENDER: __________________
COMPLAIN: ________________________________________________________________
HISTORY: __________________________________________________________________
History of Eye Surgery: ____________________________________________________________________________
History of Systemic illness: ____________________________________________________________________________
Cause / Duration of Low Vision / Blindness:
____________________________________________________________________________
Other Disability: ____________________________________________________________________________

22. Family History: _______________________________________________________________
Medical History: ______________________________________________________________
Education: ___________________________________________________________________
Financial Status: Sufficient / Non-Sufficient
Use of glasses: Yes / No
Previous Glass Prescription
Sph cyl axis VA
RE:
LE:
Previous Low Vision care: Yes / No
Source of Low Vision Device: Prescribed / Self Purchased
Low Vision Device: Local / Imported
Currently being used: Yes / No

23. If Yes then details of it: ________________________________________________________
Distance Inspection: ___________________________________________________________
External Examination:
RE LE
Lids / Lacrimal Apparatus:
Conjunctiva:
Cornea:
Anterior Chamber:
Iris / Pupil:
Lens:
Cover Test:
Ocular Movement:
Fundus Evaluation:
Literacy: Print / Braille / Print + Braille / Not literate
Fixation: OD: Central / Eccentric
OS: Central / Eccentric
Unaided Vision :
Sph cyl axis VA
RE:
LE:
Pinhole Vision:

24. Objective Refraction: (Retinoscopy)
Sph cyl axis VA
RE:
LE:
Subjective correction with Visual Acuity:
BE:
Near Vision : Test used _________________________________________________________
Unaided Near Visual Acuity:
RE: N
LE: N
BE: N
Aided Near Visual Acuity:
RE: N
LE: N

25. At ____________ Working Distance
With BE ___________________ N _____________ Working Distance
Low Vision Device for Distance
Telescope : _____ X
Visual Acuity with Telescope
RE: _______
LE: _______
Not Tried :
Low Vision Device for Near:
Magnifier: Prescribed / Not
Type: With ____ D
Visual Acuity _____ in reduced Snellen N Notation
Combination of 2 Devices for Near : ______________________________________________________________________
Reading Speed with Low Vision Device: ______________________________________________

26. Additional Illumination: Required / Not Required
With Additional Illumination: Improved / Remain Same / Facing Difficulty
Binocular Vision : Yes / No
Visual Field : Done / Not Done
Limitation of Visual Field :
RE:
LE:
Contrast Sensitivity : ____________________________________________________________
Test used _____________________________________________________________________
Glare / Photophobia : Yes / No
In Sunlight : No Problem / Uncomfortable / Can Hardly Seen
Preferred Indoor light: Normal / Extralight / Reduced

27. Orientation and Mobility Problem : Yes / No
When : In Daytime / At night
Colour vision : ______________________________________________________
Non-Optical Devices : _______________________________________________________
Rehabilitation Service or Training Required : Yes / No
Advise: ______________________________________________________
Follow up Date: ________________

28. THANK YOU