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H. Lai, M. Melia, K.D. Frick, R. Buhrmann, S.K. West; Impact of cataract and trichiasis on daily activities in a trachoma–endemic area . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1061.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the impact on vision related physical difficulties with daily activities caused by trichiasis, cataract, and both trichiasis and cataract in a trachoma endemic district in Tanzania. Method: Six villages were randomly selected, and all residents aged 40 years and older were invited to participate in an eye examination. Participants were questioned on the degree of physical difficulty they experienced with various daily activities, using a published scale. Vision related physical difficulty was scored on a 4–point scale: 0 for no difficulty, 1 for a little difficulty, 2 for much difficulty, and 3 for unable to do. Overall vision related physical difficulty was measured by taking the average score. Overall vision related physical disability was defined as an average score ≥2. Cataract was defined as nuclear grade ≥2 (range 0–3), cortical grade ≥ 2 (range 0–3), or presence of any posterior subcapsular cataract in either eye. Trichiasis was defined as one or more lashes touching the globe or evidence of epilation in either eye. Statistical tests were performed using non–parametric ANOVA and logistic regression analysis. Results: A total of 2743 participants aged 40 to 98 years, 55.7% female, were included in the study. The prevalence rates were 5.5% and 11.9% for trichiasis and cataract (all types), respectively. The co–morbidity rate of trichiasis and cataract was 1.5%. Medians of overall vision related physical difficulty scores were 0 for participants with neither trichiasis nor cataract; 0.38 for those with trichiasis only; 0.50 for those with cataract only; and 0.70 for those with co–morbidity of trichiasis and cataract (P <0.0001). Any vision related physical disability was reported in 2.6%, 11.0%, 17.5% and 31.0% of those with neither trichiasis nor cataract, those with trichiasis only, those with cataract only and those with both trichiasis and cataract, respectively. Vision related physical disability was strongly associated with trichiasis only (odds ratio and 95% confidence interval: 5.07, 1.15–22.34), cataract only (7.55, 1.87–30.47), and the co–morbidity of trichiasis and cataract (17.40, 1.95–155.40) after adjustment for age, sex, body mass index and number of eyes affected. Conclusion: Trichiasis and cataract appear to cause similar levels of disability, but in this area cataract is more prevalent in this age group. Prevention of trichiasis and surgery for cataract are important to forestall physical disability in this trachoma–endemic area.
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