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Introduction Refractive errors (myopia, hyperopia and astigmatism; presbyopia is not included in this study given the present paucity of data, but it is recognized that uncorrected, it could lead to [...], Estimates of the prevalence of visual impairment caused by uncorrected refractive errors in 2004 have been determined at regional and global levels for people aged 5 years and over from recent published and unpublished surveys. The estimates were based on the prevalence of visual acuity of less than 6/18 in the better eye with the current{y available refractive correction that could be improved to equal to or better than 6/18 by refraction or pinhole. A total of 153 million people (range of uncertainty: 123 million to 184 million) are estimated to be visually impaired from uncorrected refractive errors, of whom eight million are blind. This cause of visual impairment has been overlooked in previous estimates that were based on best-corrected vision. Combined with the 161 million people visually impaired estimated in 2002 according to best-corrected vision, 314 million people are visually impaired from all causes: uncorrected refractive errors become the main cause of low vision and the second cause of blindness. Uncorrected refractive errors can hamper performance at school, reduce employability and productivity, and generally impair quality of life. Yet the correction of refractive errors with appropriate spectacles is among the most cost-effective interventions in eye health care. The results presented in this paper help to unearth a formerly hidden problem of public health dimensions and promote policy development and implementation, programmatic decision-making and corrective interventions, as well as stimulate research. Resume Des estimations mondiales et regionales pour l'annee 2004 de la prevalence des deficiences visuelles dues a des defauts de refraction non corriges chez les plus de 5 ans ont ete etablies a partir d'enquetes recentes publiees et non publiees. Ces estimations ont ete obtenues d'apres la prevalence d'une acuite visuelle inferieure a 6/18 pour le meilleur des deux yeux avec la correction refractive actuellement disponible, susceptible d'etre ramenee a une valeur superieure ou egale a 6/18 par une correction refractive ou un trou stenopeique. On estime a 153 millions (plage d'incertitude : 123 a 184 millions) le nombre total de personnes souffrant d'une deficience visuelle due a un defaut de refraction non corrige, dont huit millions d'aveugles. La cause de la deficience visuelle a ete laissee de cote dans les estimations anterieures reposant sur la meilleure vision corrigee. Si l'on combine ce chiffre a l'estimation de 2002 du nombre d'individus deficients visuels etablie d'apres la meilleure vision corrigee, 314 miliions de personne presentent une deficience visuelle toutes causes confondues, les defauts de refraction non corriges devenant la principale cause de mauvaise vision et la seconde cause de cecite. Les defauts de refraction non corriges peuvent nuire aux resultats scolaires, reduire la capacite a occuper un emploi et la productivite et, de maniere generale, deteriorer la qualite de vie. La correction des defauts de refraction par des lunettes adaptees reste l'intervention la plus rentable en termes de soins ophtalmologiques. Les resultats presentes dans cet article contribuent a faire ressortir un ample probleme de sante publique formellement masque, a favoriser le developpement et la mise en ceuvre de politiques, ainsi que la prise de decisions programmatiques et de mesures correctives, et a stimuler la recherche. Resumen Se ha estimado la prevalencia de las discapacidades visuales causadas por los defectos de refraccion no corregidos en 2004 a nivel regional y mundial en la poblacion de 5 o mas anos a partir de encuestas recientes publicadas o ineditas. Las estimaciones se basaron en la prevalencia de una agudeza visual inferior a 6/18 en el mejor ojo con la correccion refractiva del momento, pero mejorable hasta 6/18 o mas con medidas de correccion de la refraccion o con un agujero estenopeico. Se estima que un total de 153 millones de personas (intervalo de incertidumbre: 123-184 millones) sufren discapacidad visual como consecuencia de defectos de refraccion no corregidos, incluidos ocho millones que padecen ceguera. Esta causa de discapacidad visual no se ba tenido debidamente en cuenta en estimaciones anteriores basadas en la mejor vision corregida. Si se suman a ello los 161 millones de personas con discapacidad visual estimados en 2002 de acuerdo con el criterio de la mejor vision corregida, se obtiene un total de 314 millones de personas con discapacidad visual por todas las causas: los defectos de refraccion no corregidos se convierten asi en la principal causa de disminucion de la agudeza visual y la segunda causa de ceguera. Los defectos de refraccion no corregidos pueden reducir el rendimiento escolar, la empleabilidad y la productividad, y por lo general merman la calidad de vida. Sin embargo, la correccion de esos defectos con unas gafas apropiadas es una de las intervenciones mas costoeficaces de la atencion oftalmologica. Los resultados aqui presentados pueden contribuir a hacer aflorar un problema hasta ahora oculto de gran trascendencia en el campo de la salud publica, y promover la formulacion y ejecucion de politicas, la toma de decisiones programaticas, las intervenciones correctivas y la realizacion de investigaciones en ese terreno. [TEXT NOT REPRODUCIBLE IN ASCII.]

Voir page 917 le resume en francais. En la pagina 918 figura un resumen en espanol. Introduction Trachoma is an eye disease caused by infection with the bacterium Chlamydia trachomatis. [...], Objective We aimed to summarize and map the existing global population-based data on active trachoma and trichiasis. Detailed distribution maps of various infectious diseases have proved a valuable tool in their control. Such maps play an important role in assessing the magnitude of the problem, defining priority areas for control, monitoring changes, and advocacy. Until now, information on trachoma prevalence at within country levels has not been systematically collated, analysed and reported. Methods We gathered the last 18 years' worth of reported data on active trachoma in children aged less than 10 years, and the last 25 years of reported trichiasis in adults aged 15 years and over from 139 population-based surveys in 33 countries. We collated these data into one database using the 'district' (second administrative level) as the standard unit of reporting. We used Geographical Information Systems as a database and cartographic tool to generate a global map of the prevalence of trachoma and trichiasis. Findings We obtained data on active trachoma and trichiasis from 18 countries in the WHO African Region, 6 in the Eastern Mediterranean Region, 3 in the South-East Asia Region, 3 in the Western Pacific Region and 2 in the Region of the Americas. In 23 countries suspected of having endemic trachoma no reliable district-level population-based data were available. In China and India, data were limited to a few districts. The data highlighted important regional differences and marked national variations in prevalence of active trachoma and trichiasis. Conclusion This is the first attempt to summarize and map the existing population-based data on active trachoma and trichiasis. The lack of data in many countries remains an important obstacle to trachoma control efforts. Keywords Trachoma/epidemiology; Eyelid diseases/epidemiology; Geographic information systems (source: MeSH, NLM). Objectif Il s'agissait de resumer et de cartographier les donnees mondiales tirees d'etudes en population concernant le trachome evolutif et le trichiasis. Pour la lutte contre differentes maladies infectieuses, des cartes de distribution detaillees se sont revelees des instruments utiles. Elles sont importantes pour evaluer l'ampleur du phenomene et pour definir les zones on il faut prioritairement lutter contre la maladie, suivre les evolutions et sensibiliser l'opinion. Jusqu'ici, les donnees sur la prevalence du trachome dans les differents pays n'ont pas fait l'objet d'une exploitation, d'une analyse et d'une notification systematiques. Methodes On a tire de 139 enquetes en population effectuees dans 33 pays les donnees sur le trachome evolutif relatives aux 18 dernieres annees chez les enfants de moins de dix ans et les donnees sur le trichiasis relatives aux 25 dernieres annees chez les individus de 15 ans et plus. Ces donnees ont ete regroupees dans une meme base de donnees en utilisant comme unite type de notification le 'district' (c'est-a-dire le deuxieme niveau administratif). Les systemes d'information geographique ont servi de base de donnees et d'outil cartographique pour etablir une carte mondiale de la prevalence du trachome et du trichiasis. Resultats Des donnees sur le trachome evolutif et le trichiasis ont ete obtenues aupres des pays suivants : 18 pays de la Region africaine de l'OMS, 6 de la Region de la Mediterranee orientale, de 3 de la Region de I'Asie du Sud-est, 3 de la Region du Pacifique occidental et 2 des Ameriques. Dans 23 pays ou le trachome est suppose endemique, on ne dispose d'aucune donnee fiable provenant d'etudes en population a l'echelle du district. Pour la Chine et I'Inde, on disposait de donnees pour quelques districts seulement. Les donnees ont fait ressortir d'importantes differences entre les Regions et des variations notables au niveau national de la prevalence du trachome evolutif et du trichiasis. Conclusion Il s'agit la de la premiere tentative pour recapituler et cartographier les donnees fournies par les etudes en population sur le trachome evolutif et le trichiasis. Le manque de donnees concernant de nombreux pays oppose un frein important aux efforts de lutte contre le trachome. Objetivo Decidimos resumir y cartografiar los datos disponibles basados en la poblacion mundial sobre el tracoma activo y la triquiasis. Los mapas detallados de la distribucion de diversas enfermedades infecciosas han demostrado ser un valioso instrumento para controlarlas. Esos mapas son una importante ayuda para la evaluacion de la magnitud del problema, la definicion de las areas prioritarias de control, la vigilancia de los cambios y la promocion. Hasta la fecha no se han compilado, analizado y notificado sistematicamente los datos sobre la prevalencia del tracoma a nivel intranacional. Metodos Reunimos los datos notificados en los ultimos 18 anos sobre el tracoma activo entre los menores de 10 anos, asi como los datos sobre triquiasis correspondientes a los ultimos 25 anos en la poblacion adulta de 15 o mas anos, a partir de 139 encuestas basadas en la poblacion de 33 paises. Compilamos dicha informacion en una base de datos utilizando el << distrito >> (segundo nivel administrativo) como unidad estandar de notificacion. Empleamos los Sistemas de Informacion Geografica como base de datos e instrumento de cartografia para generar un mapa mundial de la prevalencia del tracoma y la triquiasis. Resultados Obtuvimos datos sobre el tracoma activo y la triquiasis en 18 paises de la Region de Africa de la OMS, 6 de la Region del Mediterraneo Oriental, 3 de la Region de Asia Sudoriental, 3 de la Region del Pacifico Occidental y 2 de las Americas. En 23 paises con posible tracoma endemico no se pudieron conseguir datos fiables basados en la poblacion a nivel de distrito. En China y la India, los datos se limitaron a unos cuantos distritos. Los datos revelaron importantes diferencias regionales y marcadas variaciones nacionales en la prevalencia del tracoma activo y la triquiasis. Conclusion Este trabajo representa el primer intento de resumir y cartografiar los datos poblacionales disponibles sobre el tracoma activo y la triquiasis. La falta de datos en muchos paises sigue siendo un importante obstaculo para las iniciativas de control del tracoma. Mots cles Trachome/epidemiologie; Paupiere, Maladies/epidemiologie; Systemes d'information geographique (source: MeSH, INSERM). Palabras clave Tracoma/epidemiologia; Enfermedades de los parpados/epidemiologia; Sistemas de informacion geografica (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.]

Resume Donnees mondiales sur les deficiences visuelles pour l'annee 2002 Le present article estime la prevalence des deficiences visuelles et de leurs causes en 2002 a partir des meilleures donnees [...], This paper presents estimates of the prevalence of visual impairment and its causes in 2002, based on the best available evidence derived from recent studies. Estimates were determined from data on low vision and blindness as defined in the International statistical classification of diseases, injuries and causes of death, 10th revision. The number of people with visual impairment worldwide in 2002 was in excess of 161 million, of whom about 37 million were blind. The burden of visual impairment is not distributed uniformly throughout the world: the least developed regions carry the largest share. Visual impairment is also unequally distributed across age groups, being largely confined to adults 50 years of age and older. A distribution imbalance is also found with regard to gender throughout the world: females have a significantly higher risk of having visual impairment than males. Notwithstanding the progress in surgical intervention that has been made in many countries over the last few decades, cataract remains the leading cause of visual impairment in all regions of the world, except in the most developed countries. Other major causes of visual impairment are, in order of importance, glaucoma, age-related macular degeneration, diabetic retinopathy and trachoma. Keywords Vision, Low/epidemiology; Blindness/epidemiology; Vision, Low/etiology; Blindness/etiology; Cataract/complications; Glaucoma/complications; Macular degeneration/complications; Refractive errors/complications; Cost of illness; Age factors; Sex factors (source: MESH, NLIVl). Mots cles Baisse vision/epidemiologie; Cecite/epidemiologie; Baisse vision/etiologie; Cecite/etiologie; Cataracte/complication; Glaucome/complication; Degenerescence maculaire/complication; Troubles refraction oculaire/complication; Cout maladie; Facteur age; Facteur sexuel (source: MeSH, INSERM). Palabras clave Vision subnormal/epidemiologia; Ceguera/epidemiologia; Vision subnormal/etiologia; Ceguera/etiologia; Catarata/ complicaciones; Glaucoma/complicaciones; Degeneracion macular/complicaciones; Errores de refraccion/complicaciones; Costo de la enfermedad; Factores de edad; Factores sexuales (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII]

Introduction Cataracts are a major cause of blindness and of severe visual impairment leading to bilateral blindness in an estimated 20 million people worldwide. In developing countries 50-90% of all [...], Objective To estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles. Methods Effectiveness estimates are based on a review of the literature taking into account factors such as operative failure, complications and patient non-compliance. A population model was applied to follow the lifelong impact on individuals having cataract surgery. Costing estimates are based on primary data collected in 14 epidemiological subregions by regional costing teams and on a literature review. Costings were estimated for different geographical coverage levels using non-linear cost functions. Findings Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness. Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered. Providing extra-capsular cataract surgery to 95% of those who need it (95% coverage level) would avert over 3.5 million disability-adjusted life years (DALYs) per year globally. The cost effectiveness ranges from 57 International dollars (15) per DALY in the WHO South-East Asia Region where there is high overall child and adult mortality to 1$ 2307 per DALY in the WHO Western Pacific Region where there is low overall child and adult mortality. Conclusion Extra capsular surgery for cataracts at a high level of coverage is the most cost-effective way of restoring sight in all epidemiological subregions considered. Analysts from countries within a region are encouraged to further contextualize the results based on their own country's specific parameters. Keywords Cataract extraction/economics/complications; Lens implantation, Intraocular/complications; Eyeglasses/utilization; Treatment outcome; Patient compliance; Disability evaluation; Cost-benefit analysis; Cost of illness; Comparative study; Review literature; Meta-analysis (source: MeSH, NLM). Mots cles Extraction cataracte/econumie/complication; Implantation intraoculaire lentille/complication; Verres correcteurs/utilisation; Evaluation resultats traitement; Observance prescription; Evaluation incapacite; Analyse cout-benefice; Cout maladie; Etude comparative; Revue de la litterature; Meta-analyse (source: MeSH, INSERM). Palabras clave Extraccion de catarata/economia/complicaciones; Implantacion de lentes intraoculares/complicaciones; Anteojos/utilizacion; Resultado del tratamiento; Cooperacion del paciente; Evaluacion de la incapacidad; Analisis de costo-beneficio; Costo de la enfermedad; Estudio comparativo; Literatura de revision; Meta-analisis (fuente: DeCS, BIREME).

Eyesight plays a critical role in health and in people achieving a good quality of life. It has a pivotal influence on the way a person relates to and integrates [...]

Objective: To estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles. Methods: Effectiveness estimates are based on a review of the literature taking into account factors such as operative failure, complications and patient non-compliance. A population model was applied to follow the lifelong impact on individuals having cataract surgery. Costing estimates are based on primary data collected in 14 epidemiological subregions by regional costing teams and on a literature review. Costings were estimated for different geographical coverage levels using non-linear cost functions. Findings: Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness. Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered. Providing extra-capsular cataract surgery to 95% of those who need it (95% coverage level) would avert over 3.5 million disability-adjusted life years (DALYs) per year globally. The cost-effectiveness ranges from 57 international dollars (1$) per DALY in the WHO South-East Asia Region where there is high overall child and adult mortality to 1$ 2307 per DALY in the WHO Western Pacific Region where there is low overall child and adult mortality. Conclusion: Extra-capsular surgery for cataracts at a high level of coverage is the most cost-effective way of restoring sight in all epidemiological subregions considered. Analysts from countries within the region are encouraged to further contextualize the results based on their own country's specific parameters. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses the benefits of integrating eye care into health systems as the theme of the articles in the present issue of the magazine.