The Profile of Eye Disease in Palestine- An 8‐year Experience at SJEH - Hebron.pdf

Objectives: We aimed to profile the spectrum of eye conditions and document the change in cases presenting at St John Eye Tertiary Hospital,
Hebron, Palestine. Patients and Methods: Charts of all new patients who presented to St. John Eye Hospital, Hebron, Palestine, between
2006 and 2013 were reviewed retrospectively. Age at presentation, sex, and clinical diagnosis were extracted from medical records. Data were
stored and analyzed. Results: The records of 33,183 patients were included in the study. Female:male ratio was 1:1. Patients aged 10–19 years
were the largest group (18%–24%). Refractive errors were the most common disorders seen (22%–32%). This was followed by followed by
conjunctival diseases (20%–24%) and cataract (8%–13%). Diabetic patients represented 7% of the total. Proliferative and nonproliferative
diabetic retinopathy increased over the study period. Refractive errors and cataract were more frequent in females than males, while ocular
trauma was more prominent in males than females. Conclusions: The most common cause of ocular morbidity in this study was refractive
errors. Most of the morbidities seen in this study were either treatable or preventable. Programs that raise the capacity of health providers and
screening programs should be conducted regularly and preferably in partnership with all health service providers.

1. The Profile of Eye Disease in Palestine: An 8-year Experience at
St. John Eye Hospital, Hebron

Pad ere daar
8 sa ye est oui Paste

‘Objectives: We smears the pcm fe ion nd document the cng css sing at Jc Ey Tiny Hoi,
‘con, alain Parts nd tied: Chas ll non pts no peste ot Tet Eye Hosp, eee, Paste, ba
210 2013 werereiewelnerogeich Age essa, sex ande dngnoss wer exce oa sete ecard: Drama
Added Rete Theres 0, pases mas induced hed, Female ato wae abet ope 10-19 ea
"vas lun rep se 2. Recke enor mus mot ction desde som 226 32%) Ti wa flamed owed
nat ee (10962009) nd era (8% 199, Diab aten repre 7 te oll. relate and rate
sera incas vee andy prod. Racine eras ad earac mas mars ep in onl anule ble omar
Sr va mer vorinel a ant an fat. Canchens he me Coon cae oca meaty Mi ty war rf
‘ers Most ofthe mores sec atest) wer eier dle Pese Program ae the cy of eal pias a
reina roms old e concep and ey in pri wih al eas vice pr

Keywords: Canet, cenit bee topa Palin, rebate eee

IwrRooucrion

ye disease are important reasons für medical easton
Data on causes of vision impairment are esta for the
evelopment of public heal policies and health service
planning © Worldwide, the lading causes in 2010 for
‘Visual impairment were corrected refractive errors
start and macular degeneration Fihni and cultural
factors superimposed by geopolitical and economic
factors affect the prevalence of diseases among different
populations.

‘nly a Fer studies documented the ee diese patem inthe
este ofthe Middle Ent and Noth Mica 9 This su
ed being amon the fist fe ofits ind in he region

reports from Pleine, a country with is unique political

‘Weaimedto dete he dstsbution nd change f pect
of eedseases at St.John Bye Hospital overan yea prod.
The information provided such dy provides à ating
point fr planing and pricing of lca nd national ee
Feat program in Palestine

tees

Panis ano Mernoos

Settings

St Jon Eye Hospital, Hebron, serves as area ete for
the Hebron Governorate (ize: 1060 an? with apepuation of
approsimaey 700000 habits). John ao provides
Primary and secondary eye car services to walk-in patients
‘Ath fist vst ll pati nd ol plane cent,
including visual acuity, refiactinveyclereiacton cae by
‘moplomeristand assessment of ocular mel inocua
pressure, slit-lamp examination nd dite ohiakmoscopy
aid out by a consult ophihalmologist Tess were
‘conducted to ei a dignos, and management inisted
“as required. Consultins with sbspecialio were made as
eses At end ofthe collation, cor mor diagnoses
are recorded in each patients ch

Aare onen os See Brat
"Ses Sh Jon PO Ba am
“unten 138 Fan.
Entero

Kor etre

RE SO EEE
ne Jn y pl en co |

2. [Povo oe tor mp Am rs og on Monday, December 10,2016, 6768.94 85)

Bye Eyecmáti ne

Design

Chats of all new patents who presented to St Jahn Bye
Hospital Hebrn, Palestine, between 2006 and 2013 were
retrospectively reviewed. Bahl approval ofthe study was
obtained from St John Eye Hospital Eshics Committe
Confidentiality ofthe study was maintained by concealing
the names of patents.

Dataset synthesis

Age presentation, ex, and clinica diagnosis were exacted
rom medical records. One principal diagnosis representing
‘the main complain about he outpatient services sgh The
lial ages ere groupe as apr prit into tenia!
estegorie [Table 1] Patents were classified by age Pants
‘whopresented fr amelica cheap and no disorder
‘were ecludod from the study.

Data analysis

Data were stored and analyz using Wizard Data Analysis
version 185 (Evan Mille Chico, Hines, USA) Ress
were summarized using descriptive tates as absolute or
relie Remi. Relations were explored and Charo
{est was used to compare variables, and P < 0.05 was
‘cided saintly nica

Resuurs

Patients profes

‘We evaluated charts of all he new paint who were s
during the study periods 2006-2013 (1 4986, 4847, 473
S288 4528, 3974, 3615, and 5430 Pants who had no ge
sordersranged 76-108 andthey were che Thehighet
Hague of consti was recorded among he ae ro
of 10-19 years. The high frequency (2 26) was in 2009
and lowest (19) in 2013 [Fig La, The review was dane
on 53.189 patients À minimal female ecos 50390 vas
seen [Pine 1.

(General patterns ol eyes diseases
Reini eos were he most commen disorders een
{@20% 329, followed by conjunctival diseases 219-249)
and carac (96-139) The relative frequency of various
‘conditions expressed asthe mean percentage presented
in Figure 2 The frequency and patem o eye diseases vated
across age groups [Tale 2] The difeenceinthepresetaticn,
Dy age soup was particularly evident in reactivo ears
amen the age groups of $-9 and 10-19 yeas (P< 001).
Conjunctival diseases were fequent anonsthe age groups of
$-Dyeasupto 40-19 yeas (P0001) Cataractwvas canon
among patents inthe age group of 50-59 and 60-69 yeas

iui

Fur 1: stron of uty option age an ge)
patas or oyes oie to)

Table 1: Anlomicl and cial categories and subcategories used 1 classy conditions included in he study

——
ce
Soe
==
a
ae
ie

ten che

orate
ten ted oe de cher
Prey

RO, mapa mac
Series RD. ap,
‘restr tne dpe e's
Peer
‘Sis mehren in
orga dues Cg

uals ion Dune

er

orense Kat te
‘engl pericos ale

Poteet bs doin

7
Nero phthahnatogy Ocular irauma: u

Psion cran,
eerie cnet
Sata mera

Mapa pens
en
fg hes

Inserate (hing epa
Sampo
gant ern Me deta

DR DES FBO Oe RD RE RES ETT
ton RAD fatal ety inn PAF Paes, Oey ho)

3. [Povo oe tor mp Am rs og on Monday, December 10,2016, 6768.94 85)

Bye Eyecmáti ne

‘Ocul tau was statistical signent among al inthe
age groups of 20-29 and 30-39 years (P< 0001. Diabetes
Hequene increased among olde patents in the age props
‘of 10-19, 69, and 70-79 yeas (P= 0.01),

Relractve eros, cataract, diabetic retinopathy, and
strabismus

Refractive errors were recorded more frequently and
statistical significant (Chixquae, P< 0.001) among
the age groups of 5-9 and 10-19 years and represented
the most commen disorders sen (can 26%) Figure 3a
shows the frequency of refractive errors across study
periods Cataract was more frequent among th age groups
‘of 50-39 and 60-69 years (Chi-square, P < 0.001) and
represented the hed mon common disorder seen (mein
1080, Figure 3b shows the frequency o atra Diabetic
patients represented 796 of eaves seen and were more
‘requent among paint in the thee age groups, Le. 40-
49, 60-69, and 70-79 years (Chisquare, P< 0.01). All
free categories Groiferative, nonprolferative, and no
Aiabeti reimopaly) showed a steady ineresse over the
study periods [Figure 3e]. Strabismus and amblyopia
‘acer represented 0% of cases and were more particularly

iden

was themos frequent ype Reftactive eros, atarat and
Ti and Irma disease were seen more in females than
sales. Diabetes was mor fequent among women i th
fist 6 years ofthe study. Ocular trauma and cojunctiva

Fur 2 Trove ars lares ey caters seen ig
vespa

disorders and retna/vitrcous morbidities were more
prominent in males han females (Table 2]

‘cular trauma and conjunctival disease
‘Ocular trauma represented the Ah most commen disorder
‘seen nan 799 and wa sitial signifiant (Chaque,
‘P= 0001) among adult inthe age group af 20-39 year.
Non-penerating injuries and corneal foreign bodies were
the most frequent presentations recorded [Figure 43].
Conjnetival diseases were more frequent among al fur ae
reps (5-19 years) Chiqui, P< 0001) rare
{he second most common disorder sen (mean 22%).

iatibution ef conjunctival diseases. Lid diseases were the
our most commen presentation in cur study (mean 6)
and were statistical significant among the ge stoup o
10-29 yeas (Chisqure, P < 0.001), Chalazion sje and

gue 3: The ends of the or pray ee conter or pe
‘uy ya, rae, eave ts (a etre) aná aba
anor)

Tale 2: Relave frequency of common five presentations by year and gender

Del ee disease (%) Sabine (5) Parco eos (5)

Se Coruna ses (Catane)

ie eee | OH AA A

4. [Povo oe tor mp Am rs og on Monday, December 10,2016, 6768.94 85)

Bye Eyecmáti ne

oe ee
Far & Tessie ave tes op aa)
a nuroa ton (1) oa sty prod

bcpharts were he most commen presentations recorded in
this caera I
Discussion

To ie bet of our knowledge, thi i he fist study onthe
spectrum of eye diseases in Palestinians. Convenience
Sampling (proximity and availability) prevents this study
ram assuming tobe representative ofthe population. Our
resul show that rate errors ad etarae were the fist
and thrd mos common morbidities sec forall age groups
inthis study which consistent with other report, an which

uncorrected reactive ears were fist and cataract vas
second

Refiactiveemors were the most commen disorders seen
2296-32) inthe whole sample and they were the most
‘amon morbidity seen in the $-19-yea<l children. in
agreement with epsom China, Bengal, Brazil, Australia.
and Kathmanda®" Refractive erorsaffest childhood
‘evelopment, and inthe absence of regular preshoo! or
Shoo eye screening for refractive ars, many cient
felactive ars may go untied nd il ot bene fo

‘such simple sohn (pi of glasses) Refractive ere
len aged $-19 yeas increased up to 2011 but ltr cn
showed a steady desrnse This could be partly tributed to
vision seeming proa" that was conducted in 2008 by
St Jon Bye Hostal in Hebron and target memben ofthe
School Hall Program (Minis of Healy, Hehrn) who were
‘conducting vision srening The objectives ofthe program
‘were to rise Ue screens awareness and capacity tem

Mi A

feier detection of rfactive cres and prope refaral to
“promets semis o lasses.

Conjunctival diene (Sof which were conti) were
{he second most canon discs sen fer allape group this
dy (2096-20) and were increns amon the age groups
‘5-9, 10-19, 20-29, 30-39, nd 40-49 years. Our fins
‘onc wth previous report that lr jette
‘oe common disc m len." Althoughenjunciie
docs not result in Bindes ii one athe leading causes o
absence from school in children an from work nthe alt
population wh potently serious implications on education
and productivity

‘Cataract was more camıman inthe age groups of 50-50 and
60-69 yeas. Cataract represente the tid mos common
order seen in this sty affecting one tn cn average m
‘aztec with several previous studies 9 Cataratas he
leading ease olinnes (5 09) nthe Occupied Palestinian
‘anitories and the lending cause of vista inpaiment
in older Americans Globally. cataract represents the
second most commen cause of moderate and ever vision
impairment in North Africa and Middle East (18.06)
Ctaract i abo he second most common cae of voidable.
visual inpainment (3°9%° weeldwide and te third mos
Hoquet me of idence of leal vs impinment in.
Austral 00

Diabetes mellitus represents the fh common cause of
presentation inthis study (around 76). 1s ete that
Percentages of diabetic patients wth n signe of reinopaty
wer inreains fom 19610 496 over the study perio, ile
the percentages of diabetics diagnosed wit proliferative
retinopaiy also showed an increase fem 296 o 5% over

I study period. Diabetic retinopathy represented the
fifty cause of moderate and severe vision impairment in
North Aiea and Middle East (24%) andthe ith cause of
blindness (3390! There are itd data onthe prevalence
of diabetes mellitus and dia retinopaiy in Palestine.
‘One study sugested thatthe prevalence of diabetes in men
and women aged 30-68 years was 11 3961813 Pin rua
and urban populations. respectively. and another study
Feprtedselfrepored diabetes melitus at 26.49% in the
‘over SOycar-ld people In 2012, St. John of Jerusalem
Bye Hospital, in parti with the United Nations Relief
and Works Agency fr Palestine Refuges nt a 3-ycar
Screening, treatment, and management program or dabei
retinopaly amen dabei pais in as Jersalem ane
‘West Bank, including the refugee population of the south
districts of the West Bank (Bethlehem and Hebron). The
program aimed to reduce the proliferation of prevenable
bei retinopathy inthe ceupiedPalesinian terior. An
‘estimated 40,00 patients wre sereene over 3 car ofthe
project The primary ebjective of the screening compet
‘ofthe projet was to detect he maximum number of cases
‘of sighthreatening retinopathy and efe them foe Ather
‘examination and management by an ophihalmologı

5. [Povo oe tor mp Am rs og on Monday, December 10,2016, 6768.94 85)

Bye Eyecmáti ne

while retaining hose with nonsighethreening disease
‘under parodie review. The final comes of te program
are eagerly mwa. Inthe older age groups, the prevent,
Stuy demonstrated that diabetes mellitus and cataract are
ianiianty nrensed, This association may explain the
‘ler report of posterior segment disease being found in
‘propetionaly more patients presenting vih “borderline”
“and "poo outcomes posiphacoamulsifiation and tht the
‘majority ofthese patients ad diabetic retinopathy 20

"Trauma and injury affected 76 al cases seen inthis stay
and were sin merenel in young asin the age
‘rep of 20-29 and 50-39 yeas Nonpenetating iy and
men! foreign bodies represented $9 96 af cases in this
‘ego. The hh frequency of juris in these age props
unbe tributo wok in construction y this age rom and
he commonnealct of rtectivesogsles at werk Ou reals
ae at variance fom diferent previous reports where runa
injury in hen ranked as te fst second, hic eth
sod commen did

Stakienus and amblyopia represented 6% fall cases sen
in our study and were particularly sen in he ag groups of
0-4 amd 5-0 years Other studies showed that fr ellen
‘aged 0-15 yeas, tama was the mos common mebidey
in Nigeria acc conjunctivitis was the most cammen
in Bhiopia® and refractive ors were the mot common
min Chia, Bengal anding" Fürthenore eracive
“or were the most common morbiity tea in p
between $ and 19 yeas” age group, and srabismus Ww
‘most commonly sen among he 0-.year-old chien. The
study abo Leds support wo the repeated association betwen
Feffactive ror and specifi fom fstab

‘The study i nite by its reospective dei, hospital chat
rather than whole community asthe bas, and ptetal for
selection bis introduced by sel or professions referale
"These lations could have increased the number of more
severe eases and consequnly overestimated the frequency
and marbiiy of ye dicas l ur sample compared tothe
backsrcun population However the study remains he fest
study ofits trem Pleine, ná being fran ge refer
hospital, it must reflect the spectnan of cular marty in
‘our commun

Conctusions
“The most cron cases of ocular morbidity in deren
frequency were refractive on, conjunctivitis, cataract,
chalazion/stye and blepharitis. diabetic retinopathy,
‘onpentrating trauma and foreign body, and convergent
fabian, Mos ofthese mobidis ae cher testable or
prevetbleand require terio of alla presionas fee
‘complete managanen becas ey lado visual patent
and probably Binds. Programs tht ase the capacity of
Ian provider and screening program shouldbe conducted
regularly and prefrably conducted in parnership wih ll
ea service provides

aes aT ae RT EE

Authors contributions
‘The author is responsible for concept ofthe study, data
collin amd analysis and fr dating, revising and approving
the final version of the mans.

Conflicts of interest
‘There are no confit of interest.

‘Compliance with ethical principles
il approval vas granted by the St John's Hospital Eis
‘Committe AÑ data were dede before analysis. No
consent was possible in such areospestive study

Rerenences

Fg cr A
© Betophtuimal 2012966148 -
eh
nn
De nn
Er
rem
Bamaduras MA, Gunsié AA, Khundekar RB Dubehe retinopathy,
a
EI
7. Madey TA, ter M, Alam MA, EI obio H, Slam DOM
Rae
reia
o aan anne
Kola het Sogdian Pact E
ovulo The Balas ej study BA Op 209, |
ee
ne
ern
le,
euren
ee
ren
Er tea es
en
EN mu ra a
BES
een
Pen
a
ER ee
ig See eu ee pe
ens

6. [Ponriate te om rn ys opa Monty, cantar 10,2018, 87883429]

Ba Byeenétens Pete

19 gi et SE OS Se OD, Qu A Best 3D, 21 Dnt RO, Sgt Cte Spel Case te etn
(2a chun of ie nl vil arma apor of” Fenn ait io ae IA amant ager

Amen, hy era yh Sint es Canc OM no Baan E Mr
20 Hed HE: aren A, Bis E Oncemn Goren OL 22 Supe OH, age AO Chou eye dunes m
Sarl a Tarmac aprons et bak yopaaon Souler Men Atay ho ay She ae Pa)
Fami Data Ora 301958 ERES
Reviewers: ators:
sum Osman (yah, Sau Arabia) Salama Besiyah (Abu Diobi, UAE)
‘Neha Elendy (Caio Ey) ln Eliana (Columbus, Ohio, USA)

Mi | We 1 Tae | au