Retinal laser services in Bhutan: a 3-year national survey
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RESEARCH ARTICLE
Open Access
Retinal laser services in Bhutan: a 3-year national survey Bhim B. Rai1,2* , Michael G. Morley3, Pema Zangmo2, Thukten Tshering2, Abi N. Khatiwara2, Paul S. Bernstein4 and Ted Maddess1
Abstract Background: We conducted this study to report on the indications and types of retinal laser therapy (RLT) performed in Bhutan, knowing which is critical for proper planning and successful delivery of the services. Methods: We reviewed the laser registers maintained in the laser rooms and vitreoretinal (VR) operating theatres (including paediatric cases managed under anaesthesia) over three years at the national and the two regional referral hospitals (RRHs). Intraoperative laser treatments (endolaser) were excluded. Patient demography, indications and types of RLT were recorded and quantified. Comparisons of the expected and observed frequencies used Chisquared tests. Results: A total of 685 patients, including 8 cases of bilateral retinopathy of prematurity (ROP) received RLT. The majority of patients (411 cases, 60.0%, p < 0.0001) were males. The mean age was 54.1 ± 14.1 years, median 56 years. The most common indications for RLT were diabetic retinopathy (DR) and diabetic macular oedema (DMO) (542 cases, 66.0%), followed by retinal vein occlusion (RVO) (91 cases, 13.3%). Pan-retinal photocoagulation was the most common type of RLT performed (337 cases, 49.2%), followed by modified grid laser (207 cases, 30.2%), sectoral laser (41 cases, 6.0%), and prophylactic laser photocoagulation (33 cases, 4.8%). Conclusions: The majority of patients were within working-age. Common indications for RLT were preventable such as DR, DMO and RVO, indicating need to control systemic diseases such as diabetes, hypertension, and dyslipidaemia. Currently, regular RLT is provided only at the national referral hospital in Thimphu, and periodically in the eastern and central RRHs when the retinal specialist visits. There is need to extend the retinal services to the eastern and central RRHs to improve accessibility and patient coverage in these regions challenged with difficult terrain and poor public transport system. Keywords: Laser therapy, Laser services in Bhutan, pan-retinal photocoagulation, Photocoagulation, Retinal laser
Background The therapeutic benefits of laser were first reported in 1954 [1]. This prompted the invention of xenon-arc laser in 1956 for prophylaxis of retinal detachment (RD), but it was limited by poor focus [2]. The first ophthalmic * Correspondence: [email protected] 1 John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia 2 Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan Full list of author information is available at the end of the article
laser was developed in 1960 using a ruby laser [3] marking a big leap forward in the history of retinal laser therapy (RLT) with its blue and green light emissions [4]. Another milestone was the invention of the 532 nm frequency-doubled neodymium-doped yttrium aluminiu
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