Showing papers in "Ophthalmic Epidemiology in 2014"
TL;DR: The results show that the prevalence of myopia and high myopia remained high and the prevalenceof astigmatism increased in young male adults in Singapore over a 13-year period after controlling for age, education and ethnicity.
Abstract: Purpose: To determine the differences in prevalence rates of refractive errors in young Singaporean males over a 13-year period between 1996–1997 and 2009–2010 Methods: Non-cycloplegic autorefraction data were obtained in a survey of 15,085 young male subjects (mean age 19.5 ± 1.4 years, range 16–25 years) in 1996–1997 using a Nikon NRK-8000 autorefractor. A second survey of 28,908 male subjects (mean age 19.8 ± 1.2 years, range 17–29 years) was conducted in 2009–2010 using a Huvitz MRK-3100 autorefractor. Results: The overall prevalence of myopia (spherical equivalent, SEq, worse than 0.5 diopters, D) was similar in 2009–2010 (81.6%) and 1996–1997 (79.2%; odds ratio 1.38, 95% confidence interval 1.31–1.46; p50.001). The prevalence of high myopia (SEq worse than 6.0D) increased from 13.1% in 1996–1997 to 14.7% in 2009–2010 (p50.001). The prevalence of refractive astigmatism increased significantly from 41.4% in 1996–1997 to 50.9% in 2009–2010 (p50.001). Conclusions: Our results show that the prevalence of myopia and high myopia remained high and the prevalence of astigmatism increased in young male adults in Singapore over a 13-year period after controlling for age, education and ethnicity.
95 citations
TL;DR: Harmonization of AMD classification reduced categorical differences in phenotypic definitions across the studies, resulted in a new 5-step AMD severity scale, and enhanced similarity of AMD prevalence among the four cohorts.
Abstract: Purpose: To describe methods to harmonize the classification of age-related macular degeneration (AMD) phenotypes across four population-based cohort studies: the Beaver Dam Eye Study (BDES), the Blue Mountains Eye Study (BMES), the Los Angeles Latino Eye Study (LALES), and the Rotterdam Study (RS). Methods: AMD grading protocols, definitions of categories, and grading forms from each study were compared to determine whether there were systematic differences in AMD severity definitions and lesion categorization among the three grading centers. Each center graded the same set of 60 images using their respective systems to determine presence and severity of AMD lesions. A common 5-step AMD severity scale and definitions of lesion measurement cutpoints and early and late AMD were developed from this exercise. Results: Applying this severity scale changed the age-sex adjusted prevalence of early AMD from 18.7% to 20.3% in BDES, from 4.7% to 14.4% in BMES, from 14.1% to 15.8% in LALES, and from 7.5% to 17.1% in RS. Age-sex adjusted prevalences of late AMD remained unchanged. Comparison of each center’s grades of the 60 images converted to the consortium scale showed that exact agreement of AMD severity among centers varied from 61.0–81.4%, and one-step agreement varied from 84.7–98.3%. Conclusion: Harmonization of AMD classification reduced categorical differences in phenotypic definitions across the studies, resulted in a new 5-step AMD severity scale, and enhanced similarity of AMD prevalence among the four cohorts. Despite harmonization it may still be difficult to remove systematic differences in grading, if present.
82 citations
TL;DR: The cross-sectional Anyang Childhood Eye Study (ACES) which examined the prevalence of amblyopia and strabismus in 7th-grade students in central China revealed the prevalence, particularly the proportion of exotropia, to be higher than previously reported.
Abstract: Purpose To determine the prevalence of amblyopia and strabismus in 7th-grade junior high school students in central China. Methods Using stratified cluster sampling, 2363 7th-grade students were recruited from four junior high schools in Anyang city into the cross-sectional Anyang Childhood Eye Study (ACES). All students underwent visual acuity (VA), cycloplegic autorefraction, cover test, and ocular movement examinations. Uncorrected VA and best-corrected VA (BCVA) were measured with a logarithm of the minimum angle of resolution (logMAR) chart. Cycloplegic autorefraction was performed after administration of 1.0% cyclopentolate and Mydrin-P. Strabismus was defined as heterotropia at near or distance fixation. Amblyopia was defined as BCVA ≤ 0.1 logMAR units in one or both eyes, without ocular pathology in either eye. Results Of the 2363 eligible students, 2260 (95.6%) completed all examinations. The mean age of the students was 12.4 ± 0.6 years. Amblyopia was present in 52 students (2.5%), of whom 33 (63.5%) had unilateral and 19 (36.6%) had bilateral amblyopia. Of those with unilateral amblyopia, 18 (54.5 %) had anisometropia and 7 (21.2%) had strabismus. Of those with bilateral amblyopia, 6 (31.6%) had significant refractive error. Strabismus was present in 108 students (5.0%), of whom 2 (1.9%) had esotropia, 102 (94.4%) had exotropia, 3 (2.8%) had vertical strabismus, and 1 (0.9%) had microstrabismus. Of the 108 students with strabismus, 9 (8.3%) had amblyopia. Conclusion The cross-sectional ACES which examined the prevalence of amblyopia and strabismus in 7th-grade students in central China revealed the prevalence of strabismus, particularly the proportion of exotropia, to be higher than previously reported.
72 citations
TL;DR: Poor HRQoL is strongly associated with the severity of self-reported visual impairment among people aged ≥65 years, and those with self- reported moderate/severe visual impairment have more fair/poor health.
Abstract: Purpose: To examine the association between health-related quality of life (HRQoL) and visual impairment among people aged ≥65 years.Methods: We used cross-sectional data from the 2006–2010 Behavioral Risk Factor Surveillance System to examine six HRQoL measures: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, and moderate/severe. We examined the association between self-reported visual impairment and HRQoL using logistic regression accounting for the survey’s complex design.Results: People with self-reported moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days compared to those reporting a little or no visual impairment. After controlling for all covariates (age, sex, marital status, race/ethnicity, education, income, diabetes, heart disease, stroke, heart ...
56 citations
TL;DR: This epidemiological survey demonstrates that the prevalence of generalized retinal dystrophy in the Danish population is 1:3454, with the most common hereditary pattern was autosomal recessive.
Abstract: Purpose: Generalized retinal dystrophy is a frequent cause of visual impairment and blindness in younger individuals and a subject of new clinical intervention trials. Nonetheless, there are few nation-wide population-based epidemiological data of generalized retinal dystrophy. The purpose of this study was to examine the prevalence and diagnostic spectrum of generalized retinal dystrophy in the Danish population.Methods: A population-based cross-sectional study with data from the Danish Retinitis Pigmentosa Registry that comprises all patients in Denmark with generalized retinal and chorioretinal dystrophies from the 19th century to the present. Among 3076 registered cases, the primary diagnosis of generalized retinal dystrophy was assessed by chart review, including fundus photographs and electroretinograms. Demographic data on the Danish population were retrieved from Statistics Denmark.Results: Of the 5,602,628 Danish citizens on January 1, 2013, 1622 patients were registered as having a gener...
42 citations
TL;DR: The design and findings of this study will be useful to conduct other ROP studies, evaluate telemedicine for other diseases, and evaluate reliability, feasibility, safety, and cost-effectiveness of the teleomedicine system.
Abstract: PURPOSE Detecting sight-threatening retinopathy of prematurity (ROP) relies on a diagnostic examination (DE) performed by an experienced ophthalmologist. An alternative may be a telemedicine system where retinal images of at-risk infants are graded by readers to determine features of ROP indicating the need for a DE. METHODS The multicenter Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) Study is a cohort study of 2000 infants with birth weights <1251 g. At each visit, ophthalmologists perform DEs and non-physician imagers obtain iris and five retinal images with the disc positioned in the center, right, left, up and down. Images are uploaded to a secure server for grading by non-physician readers for the detection of plus disease, stage 3 ROP and/or zone I disease, any of which indicates "referral-warranted ROP" (RW-ROP). Images from all infants with RW-ROP and a random sample of infants without RW-ROP (based on DEs) are selected for grading. Gradings are compared to DEs to determine the validity and evaluate reliability, feasibility, safety, and cost-effectiveness of the telemedicine system. RESULTS e-ROP is conducted in 12 Clinical Centers in the US and Canada with Study Headquarters, the Data Coordinating Center and the Image Reading Center in Philadelphia and the ROP Data Center in Oklahoma City. A total of 27 study center coordinators, 34 ophthalmologists, 26 imagers, and 4 readers have been certified. All study data are submitted using a secure web-based system. CONCLUSION The design and findings of this study will be useful to conduct other ROP studies or evaluate telemedicine for other diseases.
41 citations
TL;DR: Mapping NEI VFQ-25 scores to EQ-5D utilities provided low predictive power, independent of the modeling methodology applied, suggesting an inability of the EQ- 5D to discriminate vision-related activities, and highlighting that mapping exercises may lead to inaccurate utility values that do not represent patients’ preferences.
Abstract: Purpose: To develop a mapping algorithm for the estimation of EQ-5D-based utility scores from observed 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) scores, a disease-specific, patient-reported outcome measure used in several retinal disorders to evaluate vision-specific functioning.Methods: The dataset comprised 951 paired EQ-5D/NEI VFQ-25 observations from 344 patients in RESTORE, a 12-month, randomized, double-blind trial in individuals with visual impairment due to diabetic macular edema. EQ-5D index scores (utilities) were calculated based on the UK tariff. We evaluated 11 models using predictor sets based on the NEI VFQ-25 subscales to estimate utility as a function of NEI VFQ-25 score, based on four modeling techniques. Model performance was assessed by 10-fold cross-validation comparing root mean squared error (RMSE), mean absolute error (MAE) and correlation with EQ-5D score (Pearson and Spearman correlation coefficients).Results: Mapping results were simila...
35 citations
TL;DR: CREST is the first study to investigate the impact of supplementation with all three macular carotenoids in the context of a large, double-blind, randomized clinical trial.
Abstract: Purpose: The Central Retinal Enrichment Supplementation Trials (CREST) aim to investigate the potential impact of macular pigment (MP) enrichment, following supplementation with a formulation containing 10 mg lutein (L), 2 mg zeaxanthin (Z) and 10 mg meso-zeaxanthin (MZ), on visual function in normal subjects (Trial 1) and in subjects with early age-related macular degeneration (AMD; Trial 2). Methods: CREST is a single center, double-blind, randomized clinical trial. Trial 1 (12-month follow-up) subjects are randomly assigned to a formulation containing 10 mg L, 10 mg MZ and 2 mg Z (n = 60) or placebo (n = 60). Trial 2 (24-month follow-up) subjects are randomly assigned to a formulation containing 10 mg L, 10 mg MZ, 2 mg Z plus 500 mg vitamin C, 400 IU vitamin E, 25 mg zinc and 2 mg copper (Intervention A; n = 75) or 10 mg L and 2 mg Z plus 500 mg vitamin C, 400 IU vitamin E, 25 mg zinc and 2 mg copper (Intervention B; n = 75). Contrast sensitivity (CS) at 6 cycles per degree represents the primary outcome measure in each trial. Secondary outcomes include: CS at other spatial frequencies, MP, best-corrected visual acuity, glare disability, photostress recovery, light scatter, cognitive function, foveal architecture, serum carotenoid concentrations, and subjective visual function. For Trial 2, AMD morphology, reading speed and reading acuity are also being recorded. Conclusions: CREST is the first study to investigate the impact of supplementation with all three macular carotenoids in the context of a large, double-blind, randomized clinical trial.
35 citations
TL;DR: Simulations of pooled PCR results may estimate infection prevalence of an entire community yielding substantial cost savings if pool size is chosen correctly, and optimum pooling strategies to estimate community infection prevalence are suggested.
Abstract: Purpose: Trachoma is the leading cause of blindness from infection worldwide. Treatment programs require accurate Chlamydia trachomatis infection prevalence rates to guide decision making. The use of clinical examination is by far the most common way to monitor activity, but may yield overestimates of infection prevalence. Laboratory testing on individual specimens such as polymerase chain reaction (PCR) is highly sensitive and specific, but prohibitively expensive. Here we demonstrate simulations of pooled PCR results may estimate infection prevalence of an entire community yielding substantial cost savings if pool size is chosen correctly.Methods: Community infection prevalence was estimated using maximum likelihood estimation with data collected from a previously described study. Simulations for communities were performed to determine the accuracy of prevalence estimation using pooled results. The root mean squared error was then used to determine an acceptable inaccuracy in estimates allowing ...
32 citations
TL;DR: DR remains a threat to sight in people with diabetes in this elderly Kenyan population, and Screening diabetics may enable those requiring treatment to be identified in time to preserve their sight.
Abstract: Purpose: To estimate the prevalence of and factors associated with diabetic retinopathy (DR) among people aged ≥50 years in Nakuru, Kenya.Methods: Probability-proportional-to-size sampling was used to select 100 clusters of 50 people aged ≥50 years during 2007–2008. Households within clusters were selected through compact segment sampling. Participants underwent dilated slit lamp biomicroscopy (SLB) by an ophthalmologist and digital retinal photography. Images were graded for DR at the Moorfields Eye Hospital Reading Centre, UK. Diagnosis of DR was based on retinal images where available, otherwise on SLB. Anthropometric measures, including random glucose, and lifestyle factors were measured.Results: We examined 4414 adults (response rate 88.1%), of whom 287 had diabetes. A total of 277 of these were screened for DR by SLB, and 195 also underwent retinal photography. The prevalence of any DR diagnosed by retinal images among diabetics was 35.9% (95% confidence interval, CI, 29.7–42.6%). The most c...
32 citations
TL;DR: The prevalence of visual impairment remains high in Egypt, particularly among women, and there is a need for qualitative investigations to better understand the causes behind the excess in prevalence of blindness among women.
Abstract: Purpose: To estimate the prevalence, causes of and risk factors for vision loss in Upper Egypt.Methods: In this cross-sectional study, four villages in Upper Egypt were randomly selected; within these four villages, households were randomly selected and within the selected households all residents aged ≥40 years were enumerated and enrolled. Door-to-door eye examinations of household members were conducted. Data on relevant demographic and socioeconomic characteristics were collected. The prevalence and causes of vision loss and associated risk factors were assessed. Sex differences in prevalence and determinants were also evaluated.Results: The prevalence of best eye presenting visual impairment, severe visual impairment, and blindness were 23.9%, 6.4%, and 9.3% respectively. The prevalence of blindness among women significantly exceeded that among men (11.8% vs. 5.4%, respectively, p = 0.021). The prevalence of cataract was 22.9% (higher in women, 26.5% than men 17.2%, p = 0.018). The prevalence...
TL;DR: In this article, a multicenter, observational cohort study included 391 patients treated with ranibizumab for neovascular age-related macular degeneration (AMD) and to incorporate these factors into a prediction rule.
Abstract: Purpose: To validate known and determine new predictors of non-response to ranibizumab in patients with neovascular age-related macular degeneration (AMD) and to incorporate these factors into a prediction rule.Methods: This multicenter, observational cohort study included 391 patients treated with ranibizumab for neovascular AMD. We performed genetic analysis for single nucleotide polymorphisms in AMD-associated genes and collected questionnaires regarding environmental factors and disease history. The primary outcome was non-response to treatment, defined as a loss of visual acuity ≥30% of letters.Results: Of the 391 patients, 47 were classified as non-responsive. Independent predictors for non-response were age, baseline visual acuity, diabetes mellitus and accumulation of risk alleles in the CFH, ARMS2 and VEGF-A genes. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval 0.70–0.84). We derived a clinical prediction rule, with possible total risk scores ...
TL;DR: High rates of visual impairment were found in persons with type 2 diabetes, but cataract is still one of the main causes of blindness in this population.
Abstract: Purpose: To evaluate the prevalence of type 2 diabetes mellitus and diabetic retinopathy (DR) in a Brazilian population.Methods: Population-based, cross-sectional study conducted in 9 cities located in the Midwest region of the state of Sao Paulo, Brazil, between 2006 and 2007, including 4690 individuals aged ≥30 years. Diabetes was self-reported and DR was assessed by indirect ophthalmoscopy.Results: The prevalence of type 2 diabetes was 8.68% (95% confidence interval, CI, 7.87–9.48%), and DR was present in 7.62% (95% CI 5.02–10.20%) of participants with self-reported type 2 diabetes. Approximately 35.4% of individuals diagnosed with DR did not know they had diabetes prior to DR diagnosis. Prevalences of low vision and blindness were higher among those with diabetes and DR. Cataract was still a major cause of blindness in this population.Conclusion: This is the first large population-based study on DR in Brazil. High rates of visual impairment were found in persons with type 2 diabetes, but catar...
TL;DR: Assessment of spectacle-wear compliance and associated visual factors among children participating in Chile's school spectacle provision program found greater compliance in spectacle wear than that reported in most published studies.
Abstract: Purpose: Although international policies promote programs for correction of refractive errors in school children, recent studies report low compliance with respect to spectacle wear. Our aim was to assess spectacle-wear compliance and identify associated visual factors among children participating in Chile’s school spectacle provision program.Methods: A total of 270 school children were prescribed spectacles and monitored after 1 year. Visual acuity, refractive error, reasons for not wearing spectacles, and self-reported visual function were assessed. Compliance is reported as the proportion of children wearing spectacles at the 1-year visit. Factors associated with compliance and reasons for not wearing spectacles were examined using contingency table analyses. Logistic models were constructed to assess independently associated factors.Results: Only 204 children (76%) participated in the 1-year follow-up. Mean age was 10 years (range 4–19 years); 58% were girls, 42% boys. Overall compliance was 5...
TL;DR: Economic hardship and long distances to health facilities decrease acceptance even of free pediatric cataract surgical services, highlighting that just providing surgery free of cost may not be sufficient for the most economically disadvantaged in rural Africa.
Abstract: Purpose: To examine the demographic, sociocultural and socioeconomic factors that prevent families of cataract blind children from accepting free pediatric cataract surgery in Malawi.Methods: A total 58 parents of 62 children were recruited into the study. Of these, 53 parents partook in in-depth interviews and focus group discussions after the children were screened and the parents offered free cataract surgery. Overall, 37 parents accepted (acceptors) and 16 parents did not accept (non-acceptors) cataract surgery. All interviews were transcribed and iteratively analyzed. Household economic status was quantified using the Progress out of Poverty Index for Malawi.Results: Acceptors were better off economically (p = 0.13). Understanding of cataract, its causing blindness and impairment, as well as treatment options, by the decision makers in the families was poor. Decision-making involved a complex array of aspects needing consideration before accepting, of which distance to the health facility was...
TL;DR: Structural equation modeling is a modeling framework that encompasses many types of statistical models and can accommodate a variety of estimation and testing methods and includes model types frequently used by health researchers, including generalized linear modeling, mixed effectslinear modeling, and population average modeling.
Abstract: Structural equation modeling (SEM) is a modeling framework that encompasses many types of statistical models and can accommodate a variety of estimation and testing methods. SEM has been used primarily in social sciences but is increasingly used in epidemiology, public health, and the medical sciences. SEM provides many advantages for the analysis of survey and clinical data, including the ability to model latent constructs that may not be directly observable. Another major feature is simultaneous estimation of parameters in systems of equations that may include mediated relationships, correlated dependent variables, and in some instances feedback relationships. SEM allows for the specification of theoretically holistic models because multiple and varied relationships may be estimated together in the same model. SEM has recently expanded by adding generalized linear modeling capabilities that include the simultaneous estimation of parameters of different functional form for outcomes with different distributions in the same model. Therefore, mortality modeling and other relevant health outcomes may be evaluated. Random effects estimation using latent variables has been advanced in the SEM literature and software. In addition, SEM software has increased estimation options. Therefore, modern SEM is quite general and includes model types frequently used by health researchers, including generalized linear modeling, mixed effects linear modeling, and population average modeling. This article does not present any new information. It is meant as an introduction to SEM and its uses in ocular and other health research.
TL;DR: In multivariate analysis, increasing central corneal refractive power was associated with Indian race, shorter body height, non-smokers, absence of pterygium, shorter axial length, thinner corneas and greater anterior chamber depth.
Abstract: Purpose: To describe ethnic differences in the distribution of central corneal refractive power and steep cornea in a multiethnic Asian population.Methods: A total of 2968 Chinese, 2957 Indian and 2928 Malay participants aged over 40 years were included in this study. Each subject underwent standardized systematic and ocular examinations, interviewer-administered questionnaires, and blood investigations for risk factor assessment. Central corneal refractive power was measured using an autorefractor. Steep cornea was defined as central corneal refractive power exceeding 48 diopters (D) measured by keratometry.Results: Mean keratometry readings were 43.9 ± 1.5 D in Malays, 44.2 ± 1.5 D in Indians and 43.9 ± 1.5 D in Chinese. The prevalence of steep cornea was 0.6% (95% confidence interval, CI, 0.3–0.9%) in Malays, 1.0% (95% CI 0.7–1.4%) in Indians and 0.5% (95% CI 0.3–0.8%) in Chinese. In multivariate analysis, increasing central corneal refractive power was associated with Indian race, shorter body...
TL;DR: Eye trauma remains a significant public health concern with a high incidence in Wagga Wagga and the Murrumbidgee region and Protective eyewear compliance is low in work-related eye injuries.
Abstract: Purpose: To describe the epidemiology of eye trauma presenting to a regional referral health service in New South Wales, Australia.Methods: A two-stage retrospective and prospective case series study was conducted. Patients who presented with eye trauma to Wagga Wagga Base Hospital (WWBH) emergency department (ED) during a one-year review period formed the retrospective case series (RCS). Patient inclusion was determined using Systematized Nomenclature of Medicine Clinical Terms and International Classification of Diseases 10th revision codes applied to medical records. Patients presenting with eye trauma to the WWBH ED or its ophthalmology service over a prospective 80-day study period formed the prospective case series (PCS). The main outcome measures were patient demographics, eye trauma incidence for Wagga Wagga and the Murrumbidgee region and injury details.Results: A total of 411 and 117 eye injuries were identified for the RCS and PCS, respectively. Mean age was 35.5 ± 18.6 years (RCS) and ...
TL;DR: Subjects treated with fenofibric acid had a modest improvement in TMV, although the study was probably underpowered to detect a benefit over placebo after 1 year.
Abstract: Purpose: Fenofibrate reduced progression of diabetic retinopathy in two large randomized studies. The effect of 135 mg fenofibric acid on diabetic macular edema (DME) was evaluated in subjects with existing DME.Methods: In this double-blind, randomized, placebo-controlled study, 110 subjects with DME not requiring immediate photocoagulation or intraocular treatment with adequate diabetes and blood pressure control received either fenofibric acid or placebo once daily for 1 year. Total macula volume (TMV) and thickness were measured in the worse eye and all eligible eyes with time-domain optical coherence tomography at baseline and quarterly thereafter.Results: TMV decreased by −0.35 mm3 (within-group difference) after fenofibric acid treatment and by −0.11 mm3 after placebo. The between-group comparison of the change was −0.25 mm3 (95% confidence interval, CI, −0.645–0.155; p = 0.227, worse eye analysis). Weighted inner zone thickness and volume decreased by −18.7 µm and −0.13 mm3, respectively, f...
TL;DR: Cataract surgical outcomes in northern China were poor, and the establishment of cataract surgical services that are of high quality, affordable, and sensitive to high-risk groups are called for.
Abstract: Purpose: To report visual outcomes and barriers to uptake of cataract surgery among subjects of all ages in Mingshui County, Heilongjiang Province, China.Methods: Cluster sampling was used ...
TL;DR: Education targeting entire families to eliminate barriers and development of community support systems at the family level are required to achieve greater uptake of low-cost cataract surgery programs in rural China.
Abstract: Aims: To identify the reasons for poor uptake of cataract surgery in a program of outreach screening and low-cost surgery in Pucheng County, a rural area in northwestern China.Methods: Detailed interviews with a semi-structured questionnaire were conducted by telephone or face-to-face for participants who had been advised to attend a low-cost cataract surgery program but did not schedule the surgery within 3 months after the initial screening.Results: Among 432 eligible subjects, 355 (82.2%) were interviewed (mean age 70.6 ± 6.6 years, 73.8% female). A total of 138 subjects (38.9%) were interviewed by phone and 217 (61.1%) were interviewed face-to-face. Lack of family support (n = 106, 29.9%) and failure to understand the need for surgery (n = 96, 27.0%) were the two main reasons for not undergoing cataract surgery. Other factors included fear of surgery (n = 62, 17.5%), lack of faith in doctors (n = 36, 10.1%), financial constraints (n = 25, 7.0%) and lack of transportation (n = 4, 1.1%).Conclusi...
TL;DR: An orthoptist-led, time-of-school-entry vision screening service is ideal for successful childhood vision screening and is, thus, a valuable source of information regarding the prevalence of common visual problems among children.
Abstract: Purpose: To describe and assess an orthoptist-led vision screening service for school-entry (reception class) children, and report outcomes from one healthcare trust in the UK.Methods: A total of 3721 children (aged 4–5 years) in reception class primary school (155 state, 3 private) underwent orthoptist-conducted vision screening. Children who failed to meet the screening criteria were referred to hospital-based eye services for re-testing and final diagnosis.Results: The screening take-up rate was 96.41%; the remaining 3.59% refused/failed to consent to screening. The screening capture rate of participating children was 99.7%. A total of 11.14% of screened children failed to meet the screening criteria and were referred elsewhere; no abnormalities were found in 14% (false referral rate) of these children. Of the referred children, 53% had refractive errors requiring glasses and 42% had squints. The estimated percentages of common visual problems in screened children were 9.15% for refractive erro...
TL;DR: None of the tests evaluated achieved the combination of specificity and sensitivity needed for population-based screening and their current capability does not realize the objective of case detection in the setting of an ophthalmology clinic.
Abstract: Objective: To evaluate the van Herick test, anterior segment optical coherence tomography (AS-OCT), Pentacam and scanning peripheral anterior chamber depth analyzer (SPAC) for detecting primary angle-closure suspect (PACS) in a rural Chinese population.Methods: Eligible subjects aged ≥40 years were examined at the 5-year follow-up of the Handan Eye Study. PACS was defined as non-visibility of the posterior pigmented trabecular meshwork for ≥180° of the angle. Sensitivity, specificity, predictive values and receiver operating characteristic curves were used to assess the tests.Results: A total of 425 right eyes of 431 eligible subjects were analyzed. The area under the curve (AUC) for the van Herick test and AS-OCT were 0.711 and 0.799, respectively. The AUC for Pentacam anterior chamber depth was 0.834, while anterior chamber angle and anterior chamber volume had AUCs of 0.680 and 0.800, respectively. The AUC for SPAC was 0.779. AS-OCT had a specificity of 87% with a sensitivity of 73%. The best s...
TL;DR: The overall ocular survival rate for eyes with retinoblastoma was close to regional and international figures, and disease stage, laterality, and delay in diagnosis were significant predictors of enucleation.
Abstract: Purpose: To determine ocular survival and factors affecting globe survival in patients diagnosed with retinoblastoma at King Hussein Cancer Center (KHCC).Methods: A retrospective review of medical records of 71 Jordanian patients (45 males and 26 females) diagnosed with retinoblastoma (114 eyes) between June 2003 and May 2013 was conducted. Patient sociodemographic and relevant characteristics were collected from records. Patients with bilateral retinoblastoma were treated with chemoreduction and focal consolidation. Lens-sparing radiation therapy and enucleation were reserved for eyes that failed chemoreduction combined with focal therapy. In cases of unilateral retinoblastoma, primary enucleation was recommended for eyes with advanced unilateral disease (Reese-Ellsworth classification groups IV and V). Kaplan-Meier survival and Cox regression multilevel analysis were used to analyze the data.Results: Median age at diagnosis was 12 months. The follow-up period ranged from 0.25–160 months (mean 26...
TL;DR: Beyond accessibility and cost of surgery, other social and infrastructural factors need to be addressed to increase the uptake of cataract surgery in illiterate individuals in a tribal area of India.
Abstract: Purpose: To assess the reasons for refusing cataract surgery in illiterate individuals in a tribal area of India.Methods: A prospective study evaluated 1046 subjects who had undergone screening in eye camps and included 398 of 492 referred subjects with cataract who refused to seek cataract surgery. Subjects were assessed to elicit general and specific reasons for non-compliance. Multiple logistic regression analysis was applied to determine the associations; p < 0.05 was considered significant.Results: Overall, 83% (329/398) of subjects reported that they could manage with their current vision. The five most common reasons they did not proceed with cataract surgery were: fear of losing current vision, work priority, lack of support systems, a dependency due to old age, and expenses required after surgery. Odds of seeking treatment were lower among unemployed subjects (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19–0.86; p = 0.01) and in patients with family income <1000 Indian rupees per ...
TL;DR: Bilateral cataract patients in Vietnam are potentially at high risk of falls and in need of falls prevention interventions, and it may also be important for ophthalmologists and health professionals to consider contrast sensitivity measures when prioritizing cataracts patients for surgery and assessing their risk of fall.
Abstract: Purpose: To determine the prevalence of falls in the 12 months prior to cataract surgery and examine the associations between visual and other risk factors and falls among older bilateral cataract patients in Vietnam.Methods: Data collected from 413 patients in the week before scheduled cataract surgery included a questionnaire and three objective visual tests.Results: The outcome of interest was self-reported falls in the previous 12 months. A total of 13% (n = 53) of bilateral cataract patients reported 60 falls within the previous 12 months. After adjusting for age, sex, race, employment status, comorbidities, medication usage, refractive management, living status and the three objective visual tests in the worse eye, women (odds ratio, OR, 4.64, 95% confidence interval, CI, 1.85–11.66), and those who lived alone (OR 4.51, 95% CI 1.44–14.14) were at increased risk of a fall. Those who reported a comorbidity were at decreased risk of a fall (OR 0.43, 95% CI 0.19–0.95). Contrast sensitivity (OR 0...
TL;DR: The Singapore Malay Eye Study as discussed by the authors examined the association of reproductive factors and major eye diseases, including glaucoma, age-related macular degeneration (AMD), diabetic retinopathy and cataract, in Asian women.
Abstract: Purpose: To examine the association of reproductive factors and major eye diseases, including glaucoma, age-related macular degeneration (AMD), diabetic retinopathy and cataract, in Asian women.Methods: The Singapore Malay Eye Study is a population-based cross-sectional epidemiological study which examined 3280 persons (78.7% response) of Malay ethnicity aged 40–80 years; 1704 were female. Information on reproductive factors and use of hormone replacement therapy (HRT) was collected using an interviewer-administered questionnaire. Glaucoma was defined according to the International Society for Geographical and Epidemiological Ophthalmology criteria. Retinal photographs were graded for AMD following the Wisconsin grading system, and diabetic retinopathy according to the modified Airlie House classification system. Cataract was graded according to the Lens Opacity Classification System III.Results: A total of 1176 women reported having experienced menopause by the time of the study with 1073 (91%) h...
TL;DR: The HOMS examined about 70% of eligible Han Chinese offspring of Handan Eye Study participants in a rural region of northern China, providing key information about the prevalence of refractive errors and eye diseases in rural Chinese children.
Abstract: Purpose: The Handan Offspring Myopia Study (HOMS) aims to investigate the familial associations of myopia between parents and their offspring. Methods: Children aged 6–18 years, residing in 6 villages where all people aged 30 years had participated in The Handan Eye Study in 2006–2007, were selected for the current eye study between March and June 2010. A mobile clinic was set up in the 6 villages for comprehensive eye examinations, including visual acuity, ocular biometry, cycloplegic autorefraction and retinal photography. Results: Of 1238 eligible individuals, 878 children (70.2%; 52.6% male) from 541 families were recruited. Mean age of the children was 10.5 ± 2.5 years. The prevalence of myopia (spherical equivalent refraction 50.5 diopter) was 23.5% (males 16.8%, females 30.8%). The prevalence of low vision (presenting visual acuity 20/400 but 520/60) in the better eye was 7.1%. A higher number of females had low vision at the time of presentation (9.2%) compared to males (5.2%, p = 0.02). The prevalence of low vision in the worse eye was 10.6% (males 6.7%, females 14.9%, p50.001). The majority of visual impairment in the better-seeing (56/62, 90.3%) as well as the worse-seeing (84/93, 90.3%) eye was correctable. Conclusions: The HOMS examined about 70% of eligible Han Chinese offspring of Handan Eye Study participants in a rural region of northern China. Results from the HOMS will provide key information about the prevalence of refractive errors and eye diseases in rural Chinese children.
TL;DR: In this rural African population, duration and extent of vision loss, rather than cause, socioeconomic factors and comorbidities affected vision-related quality of life and the necessity of enhancing rehabilitation efforts for those with non-curable eye diseases.
Abstract: Purpose: To assess the impact of visual impairment (VI) on utility values in Sub-Saharan Africa and compare findings with other studies from low- and high-income countries.Methods: Patients with normal vision and various levels of VI were recruited from a secondary eye clinic in rural Kenya and interviewed using time trade-off (TTO). VI was classified using the World Health Organization definition of (normal vision, visual acuity ≥20/60, VI 20/80–20/200, severe VI 20/240–20/400, and blindness <20/400).Results: Mean age of the total sample (N = 303) was 50.3 years (standard deviation, SD, ±18.17 years), and 51.5% of patients were male. Most were small-scale farmers and illiteracy was high at 40%. Mean TTO scores per group were: normal vision 0.93 (SD ± 0.10), VI 0.88 (SD ± 0.14), severe VI 0.86 (SD ± 0.13), blindness 0.73 (SD ± 0.17; p ≤ 0.001). Lower TTO scores were independently associated with worse visual acuity (p ≤ 0.001), longer duration of disease (p ≤ 0.001) and illiteracy (p = 0.011), but...