Medical hypothesis, discovery & innovation in optometry

Ocular morbidity among elderly residents of old age homes in East Nepal

Medical hypothesis, discovery & innovation in optometry, Vol. 7 No. 1 (2026), 23 May 2026 , Page 8-14
https://doi.org/10.51329/mehdioptometry240

Abstract

Background: With the rapid growth of the aging population in Nepal, the number of older adults residing in old age homes has increased substantially. Elderly individuals living in institutional settings are at higher risk of visual impairment (VI) and blindness compared to their community-dwelling counterparts, largely due to limited access to eye care services and underutilization of available interventions. This study aimed to assess the prevalence of ocular morbidity and to identify the major causes of VI and blindness among elderly residents of old age homes in East Nepal.
Methods: A community-based cross-sectional study was conducted among individuals aged ≥ 60 years living in six old age homes in Koshi Province, Nepal. Distance visual acuity was assessed using an E-optotype Snellen chart at 6 meters, near visual acuity was evaluated using a reduced Snellen chart at 33 cm under standard illumination. Objective refraction was performed using a streak retinoscope, and both uncorrected and best-corrected distance visual acuity (UCDVA and BCDVA) were recorded for the better-seeing eye. Comprehensive ocular examination, including anterior and posterior segment evaluation, was performed using standard clinical techniques. In cases with multiple ocular conditions, the primary cause of VI was determined based on the condition contributing most to vision loss.
Results: A total of 236 elderly residents were enrolled, with a mean (standard deviation) age of 70.5 (9.5) years (range: 60–102). Nearly half of the participants (n = 116, 49.2%) were aged 60–69 years, the majority female (n = 146, 61.9%). Ocular morbidity was detected in 94.7% (n = 447) of eyes. The prevalence of VI and blindness based on presenting visual acuity was 57.4%; this decreased to 39.4% following refractive correction, indicating an 18% absolute reduction. Cataracts (n = 229 eyes, 48.5%) were the leading cause of VI and blindness, followed by refractive error, corneal opacity, retinopathy, and glaucoma. A statistically significant association was observed between age and VI/blindness (P < 0.05), whereas no significant association was found with sex (P > 0.05).
Conclusions: VI and blindness are highly prevalent among elderly residents in old age homes, with a substantial proportion attributable to avoidable causes. Timely refractive correction, regular comprehensive eye examinations, and increased uptake of cataract surgery could significantly reduce the burden of VI and improve quality of life in this vulnerable population. Strengthening outreach eye care services and integrating routine vision screening into residential care systems are essential to address this largely preventable public health challenge.
Keywords:
  • cross-sectional study
  • point prevalence
  • elderly
  • residential aged care facility
  • geriatric health service
  • old age homes
  • legal blindness
  • visual impairment
  • glaucomas
  • cataracts
  • federal democratic republic of Nepal

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