Disproportionate poor Visual outcome post Cataract Surgery in Tobacco addicts in a rural North Indian population of Uttar Pradesh

Abstract

Background: There are approximately 267 million tobacco users in India.Tobacco use is more prevalent among men and rural illiterate population belonging to low Socio-economic strata. The most prevalent form of tobacco use in India is smokeless tobacco eg. Khaini, Gutkha,Zarda etc which are manufactured as cottage small scale industry, hence, available easily followed by bidi smoking which is more common in rural areas as compared to urban areas. Many people don’t realize that tobacco use can lead to vision loss. It increases the risk of Age related Macular degeneration, Cataracts, Glaucoma, Diabetic retinopathy and Dry eye syndrome which is further aggravated if accompani ed with poor
nutrition. Carcinogenic, Cardiovascular etc health hazards of tobacco use have been extensively advertised and studied but,its hazardous effects on Ocular health needs to be extensively highlighted to prevent blindness/low vision and thereby preventing physical, social and economic burden on the society.Materials& Methods: This is a Community based study involving 220 patients having Immature cataracts with H/O chronic tobacco use from rural population of Uttar Pradesh in North India coming from low Socio-economic strata with no major Ocular pathology who underwent Cataract surgery (Manual Small incision cataract surgery/Phacoemulsification) with best input in form of surgical techniques & skills, equipments,material used and uncomplicated surgeries. These patients were subjected to questionnaire in their local language to check the lifestyle & intake of tobacco either in form of bidi smoking as well as consuming Gutkha/ Khaini. Comprehensive & extensive Ocular examination was performed preoperatively and post operatively.Serum Vitamin B6, Folic acid and B12 levels were checked to assess nutritional status of these patients. Best corrected visual acuity(BCVA) preoperatively as well as postoperatively was disproportionate to the grade of cataract and best surgical input.There was no awareness of Ocular health hazards in these patients subsequent to chronic tobacco use in form of bidi smoking accompanied with Gutkha/Khaini consumption and their nutritional status was poor.These patients were informed of poor visual prognosis preoperatively as well as postoperatively and were counseled extensively against tobacco use and its ocular health hazards.Results: The visual outcome in these patients was not good. None of the patients in this study achieved Visual acuity better than 6/24 despite best surgical input. There was colour vision deficiency and Visual field defects in most of the patients. All had a very strong history of chronic bidi smoking along with Gutkha/ Khaini consumption and had Vitamin B6,Folic acid & B12 deficiency indicating poor nutritional status.Conclusion: Lack of awareness,low socioeconomic status,ignorance,easy availability of tobacco products leads to tobacco addiction especially in rural population.Chronic tobacco use in any form associated with Nutritional deficiencies can lead to permanent low visual outcome despite uncomplicated best surgical input and therefore,extensive multisectorial efforts are needed to highlight and emphasize the ocular health hazards of tobacco abuse at the community level to protect people from evil of tobacco abuse.