Clinical Ophthalmology (Jan 2023)
Incidence and Pattern of Neuro-Ophthalmological Disorders Presenting to Vitreoretinal Clinics in Bhutan: A 3-Year National Study
Abstract
Bhim B Rai,1,2 Ozge Sarac,3,4 Joshua P van Kleef,1 Ted Maddess1 1John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; 2Department of Ophthalmology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; 3Department of Ophthalmology, AYBU Ankara City Hospital, Ankara, Turkey; 4Wills Eye Hospital Neuro-Ophthalmology Department, Philadelphia, PA, USACorrespondence: Bhim B Rai, John Curtin School of Medical Research, Australian National University, 131 Garran Road, Acton, Canberra, ACT, 2607, Australia, Tel +61 2 6125 9253, Email [email protected]: To inform national health policy, we quantified the pattern of neuro-ophthalmological disorders (NODs) presenting to the national vitreoretinal clinics in Bhutan.Study Design: Retrospective cross-sectional study.Methods: We reviewed all new NODs patients over three years. Demographic data, presenting complaints, treatment history, systemic diseases, diagnostic procedures, and diagnoses were quantified. Logistic regression examined the odds of factors linked to more common NODs.Results: Of 226 patients, the majority were males (54.0%), farmers (60.2%), and urbanites (55.8%). Loss of vision was the most common presenting complaint (57.9%), followed by head or orbital trauma (19.5%). The best corrected visual acuity (BCVA) of 216 eyes (47.8%) was ≤ 6/60. Hypertension was the most common systemic disease (16.4%), followed by diabetes (3.5%), and intracranial space-occupying lesions (3.5%). Neuroimaging (37.6%) was the most common diagnostic test performed, followed by visual field testings (VFTs) (22.9%). With a NOD incidence of 7.8% p.a. (226/2913), optic atrophy (OA) was diagnosed in 134 patients (59.3%). Other common NODs were optic neuritis (15.5%), papilloedema (9.3%), and traumatic optic neuropathy (8.4%). Female gender increased the odds for glaucomatous OA by 2.65× (p = 0.044), and age by 1.09× per year (p < 0.001). Being female increased the odds of optic neuritis by 2.57× (p = 0.03).Conclusion: Over half of the NODs were OA, which could be curable with timely treatment. Improved treatment of glaucoma and non-communicable diseases would reduce the risk of NODs-induced visual loss in Bhutan. The need for improved neuro-ophthalmological assessment and a coordinated multidisciplinary approach to NODs are the highest priorities.Keywords: Bhutan eye diseases, neuro-ophthalmological disorders, optic atrophy, optic neuritis, papilloedema
