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Purpose: To assess associations between atrial fibrillation/atrial flutter (AF) and ocular parameters and diseases., Methods: The population-based Ural Eye and Medical Study (UEMS) and the Ural Very Old Study (UVOS) included 4894 individuals (age: 40+ years) and 835 individuals (age: 85+ years), respectively., Results: In the UEMS, AF prevalence (80/4894; 1.6%; 95% CI: 1.3, 2.0) increased from 1/1029 (0.1%) in the age group of 40 to <50 years to 29/619 (4.7%) and 12/159 (7.5%) in the age groups of 70 to <80 years and 80+ years, respectively. Higher AF prevalence correlated with older age (OR: 1.08; 95% CI: 1.04, 1.12; p < 0.001), urban region of habitation (OR: 1.08; 95% CI: 1.04, 1.12; p < 0.001), higher prevalence of cardiovascular disease/stroke (OR: 2.50; 95% CI: 1.32, 4.72; p < 0.001) and lower prevalence of neck pain (OR: 0.35; 95% CI: 0.14, 0.85; p = 0.02), higher serum concentration of bilirubin (OR: 1.03; 95% CI: 1.02, 1.05; p < 0.001) and lower prothrombin index (OR: 0.96; 95% CI: 0.93, 0.99; p = 0.003), higher stage of arterial hypertension (OR: 1.52; 95% CI: 1.01, 2.28; p = 0.04) and higher ankle-brachial index (OR: 22.1; 95% CI: 4.45, 1.10; p < 0.001). In that model, AF prevalence was not associated with ocular parameters such as intraocular pressure (p = 0.52), retinal nerve fibre layer thickness (p = 0.70), refractive error (p = 0.13), axial length (p = 0.14), nuclear cataract degree (p = 0.50) and prevalence (p = 0.40), cortical cataract degree (p = 0.43) and presence (p = 0.17), lens pseudoexfoliation (p = 0.58), status after cataract surgery (p = 0.38), age-related macular degeneration prevalence (p = 0.63), open-angle glaucoma presence (p = 0.90) and stage (p = 0.55), angle-closure glaucoma prevalence (p = 0.99) and stage (p = 0.99), diabetic retinopathy prevalence presence (p = 0.37) and stage (p = 0.32), and myopic macular degeneration (p = 0.98). In the UVOS, similar results were obtained., Conclusions: In these multi-ethnic populations from Russia, AF prevalence was not associated with any major ocular disease and may not play a major role in the pathogenesis of these disorders., (© 2024 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Competing Interests: The authors have no funding or conflicts of interest to declare.

Competing Interests: The authors have no conflicts of interest to declare.

Background: Obesity is a public health challenge worldwide. The relationship between obesity and age-related eye diseases including cataract, glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy (DR) have remained elusive., Design and Methods: We conducted a systematic review of three electronic databases for longitudinal population-based studies that described associations between measures of obesity including body mass index (BMI), waist-circumference (WC), and waist-to-hip ratio (WHR), and age-related eye diseases., Results: Our search yielded 1731 articles, of which 14, 10, 16 and 8 articles met our eligibility criteria for cataract, glaucoma, AMD and DR, respectively. BMI-defined obesity was positively associated with incident cataract, incident AMD and incident DR in Western populations, but in Asian populations associations for incident AMD were not significant and associations for incident DR were inverse. WC-defined obesity was associated with incident glaucoma in non-Western populations. WHR-defined obesity but not BMI-defined obesity was associated with the incidence or progression of AMD in two Western studies., Conclusions: Overall, we found strong evidence supporting associations between obesity and age-related eye diseases. Further research on the association of abdominal obesity and effect of weight loss and physical activity on age-related eye diseases is warranted to support clinical and public health recommendations., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: To critically evaluate the potential impact of the coronavirus disease (COVID-19) pandemic on global ophthalmology and VISION 2020., Design: Perspective supplemented with epidemiologic insights from available online databases., Methods: We extracted data from the Global Vision Database (2017) and Global Burden of Disease Study (2017) to highlight temporal trends in global blindness since 1990, and provide a narrative overview of how COVID-19 may derail progress toward the goals of VISION 2020., Results: Over 2 decades of VISION 2020 advocacy and program implementation have culminated in a universal reduction of combined age-standardized prevalence of moderate-to-severe vision impairment (MSVI) across all world regions since 1990. Between 1990 and 2017, low-income countries observed large reductions in the age-standardized prevalence per 100,000 persons of vitamin A deficiency (25,155 to 19,187), undercorrected refractive disorders (2,286 to 2,040), cataract (1,846 to 1,690), onchocerciasis (5,577 to 2,871), trachoma (506 to 159), and leprosy (36 to 26). Despite these reductions, crude projections suggest that more than 700 million persons will experience MSVI or blindness by 2050, principally owing to our growing and ageing global population., Conclusions: Despite the many resounding successes of VISION 2020, the burden of global blindness and vision impairment is set to reach historic levels in the coming years. The impact of COVID-19, while yet to be fully determined, now threatens the hard-fought gains of global ophthalmology. The postpandemic years will require renewed effort and focus on vision advocacy and expanding eye care services worldwide., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Competing Interests: The authors declare that there is no conflict of interest.

Background: In current approaches to vision screening in the community, a simple and efficient process is needed to identify individuals who should be referred to tertiary eye care centres for vision loss related to eye diseases. The emergence of deep learning technology offers new opportunities to revolutionise this clinical referral pathway. We aimed to assess the performance of a newly developed deep learning algorithm for detection of disease-related visual impairment., Methods: In this proof-of-concept study, using retinal fundus images from 15 175 eyes with complete data related to best-corrected visual acuity or pinhole visual acuity from the Singapore Epidemiology of Eye Diseases Study, we first developed a single-modality deep learning algorithm based on retinal photographs alone for detection of any disease-related visual impairment (defined as eyes from patients with major eye diseases and best-corrected visual acuity of <20/40), and moderate or worse disease-related visual impairment (eyes with disease and best-corrected visual acuity of <20/60). After development of the algorithm, we tested it internally, using a new set of 3803 eyes from the Singapore Epidemiology of Eye Diseases Study. We then tested it externally using three population-based studies (the Beijing Eye study [6239 eyes], Central India Eye and Medical study [6526 eyes], and Blue Mountains Eye Study [2002 eyes]), and two clinical studies (the Chinese University of Hong Kong's Sight Threatening Diabetic Retinopathy study [971 eyes] and the Outram Polyclinic Study [1225 eyes]). The algorithm's performance in each dataset was assessed on the basis of the area under the receiver operating characteristic curve (AUC)., Findings: In the internal test dataset, the AUC for detection of any disease-related visual impairment was 94·2% (95% CI 93·0-95·3; sensitivity 90·7% [87·0-93·6]; specificity 86·8% [85·6-87·9]). The AUC for moderate or worse disease-related visual impairment was 93·9% (95% CI 92·2-95·6; sensitivity 94·6% [89·6-97·6]; specificity 81·3% [80·0-82·5]). Across the five external test datasets (16 993 eyes), the algorithm achieved AUCs ranging between 86·6% (83·4-89·7; sensitivity 87·5% [80·7-92·5]; specificity 70·0% [66·7-73·1]) and 93·6% (92·4-94·8; sensitivity 87·8% [84·1-90·9]; specificity 87·1% [86·2-88·0]) for any disease-related visual impairment, and the AUCs for moderate or worse disease-related visual impairment ranged between 85·9% (81·8-90·1; sensitivity 84·7% [73·0-92·8]; specificity 74·4% [71·4-77·2]) and 93·5% (91·7-95·3; sensitivity 90·3% [84·2-94·6]; specificity 84·2% [83·2-85·1])., Interpretation: This proof-of-concept study shows the potential of a single-modality, function-focused tool in identifying visual impairment related to major eye diseases, providing more timely and pinpointed referral of patients with disease-related visual impairment from the community to tertiary eye hospitals., Funding: National Medical Research Council, Singapore., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Screening for chronic kidney disease is a challenge in community and primary care settings, even in high-income countries. We developed an artificial intelligence deep learning algorithm (DLA) to detect chronic kidney disease from retinal images, which could add to existing chronic kidney disease screening strategies., Methods: We used data from three population-based, multiethnic, cross-sectional studies in Singapore and China. The Singapore Epidemiology of Eye Diseases study (SEED, patients aged ≥40 years) was used to develop (5188 patients) and validate (1297 patients) the DLA. External testing was done on two independent datasets: the Singapore Prospective Study Program (SP2, 3735 patients aged ≥25 years) and the Beijing Eye Study (BES, 1538 patients aged ≥40 years). Chronic kidney disease was defined as estimated glomerular filtration rate less than 60 mL/min per 1·73m 2 . Three models were trained: 1) image DLA; 2) risk factors (RF) including age, sex, ethnicity, diabetes, and hypertension; and 3) hybrid DLA combining image and RF. Model performances were evaluated using the area under the receiver operating characteristic curve (AUC)., Findings: In the SEED validation dataset, the AUC was 0·911 for image DLA (95% CI 0·886 -0·936), 0·916 for RF (0·891-0·941), and 0·938 for hybrid DLA (0·917-0·959). Corresponding estimates in the SP2 testing dataset were 0·733 for image DLA (95% CI 0·696-0·770), 0·829 for RF (0·797-0·861), and 0·810 for hybrid DLA (0·776-0·844); and in the BES testing dataset estimates were 0·835 for image DLA (0·767-0·903), 0·887 for RF (0·828-0·946), and 0·858 for hybrid DLA (0·794-0·922). AUC estimates were similar in subgroups of people with diabetes (image DLA 0·889 [95% CI 0·850-0·928], RF 0·899 [0·862-0·936], hybrid 0·925 [0·893-0·957]) and hypertension (image DLA 0·889 [95% CI 0·860-0·918], RF 0·889 [0·860-0·918], hybrid 0·918 [0·893-0·943])., Interpretation: A retinal image DLA shows good performance for estimating chronic kidney disease, underlying the feasibility of using retinal photography as an adjunctive or opportunistic screening tool for chronic kidney disease in community populations., Funding: National Medical Research Council, Singapore., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To assess associations between the amount of physical activity and the prevalence of ocular diseases., Methods: The participants of the population-based Beijing Eye Study underwent a detailed ophthalmological examination and an interview. Physical activity was assessed in a standardized questionnaire., Results: Out of 3468 study participants, information on their physical activity was available for 3031 (87.4%) individuals (age: 64.6 ± 9.7 years; range: 50-93 years). In multivariate analysis (regression coefficient r: 0.41), higher physical activity was associated with a lower prevalence of diabetic retinopathy [p = 0.009; standardized regression coefficient beta: -0.05; non-standardized regression coefficient B: -15.7; 95% confidence interval (CI): -27.6, -3.90] after adjusting for younger age, rural region of habitation, lower level of education, lower blood concentrations of triglycerides and low-density lipoproteins and higher blood concentrations of high-density lipoproteins, higher systolic blood pressure, lower body mass index and lower depression score. Other major ocular diseases such as open-angle glaucoma (p = 0.25), angle-closure glaucoma (p = 0.59), nuclear cataract (p = 0.78), cortical cataract (p = 0.54), posterior subcapsular cataract (p = 0.96), retinal vein occlusions (p = 0.93) and central serous choroidopathy (p = 0.39) were not statistically associated with physical activity in that model. The association between higher physical activity and prevalence of age-related macular degeneration (p = 0.04; β: 0.04; B: 4.87; 95% CI: 0.25, 9.50) was marginally significant., Conclusions: Higher physical activity and less sedentary lifestyle were associated with a lower prevalence of diabetic retinopathy, while the occurrence of other major ocular diseases such as any type of cataract and of glaucoma, retinal vein occlusions and central serous choroidopathy was statistically independent of physical activity or a more sedentary lifestyle., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: Systemic inflammation is potentially associated with ocular diseases such as late age-related macular degeneration (AMD). Using the serum concentration of high-sensitive C-reactive protein (hs-CRP) as surrogate of systemic inflammation, we examined potential associations between the serum hs-CRP concentration and the presence and degree of eye diseases., Methods: The population-based Beijing Eye Study included 3468 Chinese individuals. The study participants underwent a standardized interview and a detailed ophthalmic examination. The serum concentration of hs-CRP was determined., Results: Out of 3468 participants, 2452 (70.7%) individuals (mean age:63.4±9.4 year; range:50-91 years) had hs-CRP measurements (mean:1.96±4.07mg/L). In multivariate analysis, higher serum concentration of hs-CRP was significantly (regression coefficient r: 0.21) associated with a higher level of diabetic retinopathy (P = 0.007; standardized regression coefficient beta:0.06; non-standardized regression coefficient B:1.35; 95% confidence interval (CI):0.37,2.22) and polypoidal choroidal vasculopathy (P = 0.002;beta:0.06;B:6.22;95%CI:2.24,10.2) after adjusting for higher serum concentration of high-density lipoproteins (P<0.001;beta:-0.12;B:-1.31;95%CI:-1.77,-0.85), higher body mass index (P = 0.01;beta:0.06;B:0.06;95%CI:0.01, 0.11), lower level of education (P = 0.04;beta:-0.06;B:-0.22;95%CI:-0.42,-0.02), lower cognitive function score (P = 0.01;beta:-0.07;B:-0.08;95%CI:-0.13,-0.02). If the presences of other ocular diseases were added to the model, the presence of glaucoma (P = 0.99), open-angle glaucoma (P = 0.80), angle-closure glaucoma (P = 0.67), pseudoexfoliation (P = 0.18), nuclear cataract (P = 0.30), cortical cataract (P = 0.15), subcapsular cataract (P = 0.59), retinal vein occlusions (P = 0.33), central serous choroidopathy (P = 0.44), early stage of age-related macular degeneration (AMD) (P = 0.46), intermediate stage of AMD (P = 0.20) and late stage of AMD (P = 0.91) including geographic atrophy (P = 0.60) or neovascular AMD (P = 0.68) were not significantly associated with the serum concentration of hs-CRP., Conclusions: In Chinese aged 50+ years, higher serum concentration of hs-CRP was significantly associated with a higher level of diabetic retinopathy and higher frequency of polypoidal choroidal vasculopathy. Other major ocular disorders, namely glaucoma including open-angle glaucoma and angle-closure glaucoma, pseudoexfoliation, nuclear, cortical or subcapsular cataract, retinal vein occlusions, central serous choroidopathy, early, intermediate or late stage of AMD including geographic atrophy, were not significantly associated with hs-CRP serum concentrations. It suggests that these diseases, in contrast to diabetic retinopathy and polypoidal choroidal vasculopathy, were not associated with a major systemic inflammatory component., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To assess the prevalence of depression in the general population of Beijing and its association with ocular diseases., Methods: The population-based Beijing Eye Study was conducted in a rural and an urban region of Greater Beijing. The study participants underwent a detailed ophthalmological examination and an interview including questions on the socioeconomic background. Depressive symptoms were evaluated using a Chinese depression scale adapted from Zung´s self-rated depression scale. The total score of depression symptoms was 80. Depression was defined as having a depression score >44., Results: Out of 3468 study participants, 3267 (94.2%) individuals (1419 men) with an age of 64.5±9.7 years (range: 50-93 years) participated in the interview and answered all questions on depression. The mean depression score was 25.0±5.9 (median: 23.3; range:20-64). Depression (depression score >44) was present in 66 individuals (2.0%; 95% confidence interval (CI): 1.5, 2.5), and 5 individuals (0.2%; 95%CI: 0.02,0.3) had a depression score ≥59. In multivariate regression, analysis, a higher depression score was associated (regression coefficient r2: 0.22) with a higher number of days with dry eye feeling (P<0.001; standardized regression coefficient beta: 0.09; non-standardized regression coefficient B: 0.20; 95%CI: 0.12,0.29) and shorter corneal curvature radius (P = 0.03;beta:-0.04; B:1.01; 95%CI: -1.90,-0.12), after adjusting for age, gender, region of habitation, body mass index, cognitive function score, life quality score and blood concentration of triglycerides. Adding age-related macular degeneration (P = 0.10), glaucoma (P = 0.77), diabetic retinopathy (P = 0.77), nuclear cataract (P = 0.35), cortical cataract (P = 0.58) or posterior subcapsular cataract (P = 0.28) as single parameters to the model revealed no significant correlation with the depression score. Lower best corrected visual acuity showed a marginal significant association (P = 0.05; beta: 0.04; B: 1.56; 95%CI: -0.01, 3.13)., Conclusions: Dry eye feeling was the only common ocular disorder associated with an increased depression score, while the occurrence of age-related macular degeneration, any type of glaucoma, diabetic retinopathy, any type of cataract and keratoconus were not significantly associated with an increased depression score. Lower visual acuity was marginally associated. The prevalence of depression in the population aged 50+ years in Greater Beijing was 2.0% (96%CI: 1.5, 2.5)., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Since there is a scarcity on population-based health information available for Russia, we conducted this project to assess the prevalence of major ocular and systemic disorders and their associated risk factors., Methods: A population-based cross-sectional study (Ural Eye and Medical Study (UEMS)) was performed in Bashkortostan 1300 km east of Moscow. The sampling frame consisted of all inhabitants aged over 40 years and living in an urban study area in the capital city Ufa and a rural region at 65 km outside of Ufa. The target sample size was 2500 individuals for the urban region and 2500 persons for the rural region. The study participants underwent a detailed interview, a detailed ophthalmologic examination including biometry and optical coherence tomography, and clinical examination including assessment of electrocardiography, hearing test, blood sampling, spirometry, and hand grip dynamometry., Results: After a first study period, the study population included 4254 individuals with a mean age of 60.3 ± 11.1 years (range: 40-94 years), mean body weight of 74.8 ± 14.4 kg (range: 31-170 kg), body height of 163.6 ± 8.9 cm (range: 112-196), body mass index of 28.0 ± 5.1 kg/m 2 (range: 13.96-60.96 kg/m 2 ), mean systolic blood pressure of 133.7 ± 21.0 mmHg (range: 84-232 mmHg), and mean diastolic blood pressure of 81.2 ± 10.6 mmHg (range: 40-134 mmHg). Mean refractive error was -0.21 ± 1.94 D and mean intraocular pressure was 13.6 ± 3.9 mmHg., Conclusions: The UEMS provides population-based normative data for a Russian region on the quantitative traits such as axial length, quality of life and lifestyle including smoking and alcohol consumption, and prevalence and risk factors of ocular and systemic diseases such as diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, and depression.

To examine associations between cognitive function and ophthalmological parameters, the population-based Beijing Eye Study examined ophthalmologically and physically 3127 individuals (mean age: 64.2 ± 9.8 years). Using the mini-mental state examination, cognitive function was assessed as cognitive function score (CFS). Mean CFS was 26.3 ± 3.7 (median: 27; range: 2-30). Prevalence of mild (CFS: 23-19), moderate (CFS: 18-10) and severe cognitive dysfunction was 9.6% (95% confidence interval (CI): 8.5, 10.6), 3.2% (95% CI: 2.6, 3.9) and 0.6% (95% CI: 0.4,0.9), respectively. In multivariate analysis, better cognition (i.e., higher CFS) was significantly associated with better best corrected visual acuity (r 2  = 0.38), smaller amount of undercorrected visual acuity, lower prevalence of primary angle-closure glaucoma, and thicker subfoveal choroidal thickness. Prevalence of age-related macular degeneration, open-angle glaucoma, diabetic retinopathy, any type of cataract, retinal vein occlusions or pseudoexfoliation was not significantly correlated with CFS. Though the causal relationship is unclear, the associations of lower cognitive function with undercorrected visual acuity suggest the need for earlier and more regular refraction testing in the elderly so that providing adequate glasses to the elderly can be provided and vision-associated cognitive decline can be reduced. Associations of cognitive function with primary angle-closure glaucoma and leptochoroid should be further explored.

Importance: A deep learning system (DLS) is a machine learning technology with potential for screening diabetic retinopathy and related eye diseases., Objective: To evaluate the performance of a DLS in detecting referable diabetic retinopathy, vision-threatening diabetic retinopathy, possible glaucoma, and age-related macular degeneration (AMD) in community and clinic-based multiethnic populations with diabetes., Design, Setting, and Participants: Diagnostic performance of a DLS for diabetic retinopathy and related eye diseases was evaluated using 494 661 retinal images. A DLS was trained for detecting diabetic retinopathy (using 76 370 images), possible glaucoma (125 189 images), and AMD (72 610 images), and performance of DLS was evaluated for detecting diabetic retinopathy (using 112 648 images), possible glaucoma (71 896 images), and AMD (35 948 images). Training of the DLS was completed in May 2016, and validation of the DLS was completed in May 2017 for detection of referable diabetic retinopathy (moderate nonproliferative diabetic retinopathy or worse) and vision-threatening diabetic retinopathy (severe nonproliferative diabetic retinopathy or worse) using a primary validation data set in the Singapore National Diabetic Retinopathy Screening Program and 10 multiethnic cohorts with diabetes., Exposures: Use of a deep learning system., Main Outcomes and Measures: Area under the receiver operating characteristic curve (AUC) and sensitivity and specificity of the DLS with professional graders (retinal specialists, general ophthalmologists, trained graders, or optometrists) as the reference standard., Results: In the primary validation dataset (n = 14 880 patients; 71 896 images; mean [SD] age, 60.2 [2.2] years; 54.6% men), the prevalence of referable diabetic retinopathy was 3.0%; vision-threatening diabetic retinopathy, 0.6%; possible glaucoma, 0.1%; and AMD, 2.5%. The AUC of the DLS for referable diabetic retinopathy was 0.936 (95% CI, 0.925-0.943), sensitivity was 90.5% (95% CI, 87.3%-93.0%), and specificity was 91.6% (95% CI, 91.0%-92.2%). For vision-threatening diabetic retinopathy, AUC was 0.958 (95% CI, 0.956-0.961), sensitivity was 100% (95% CI, 94.1%-100.0%), and specificity was 91.1% (95% CI, 90.7%-91.4%). For possible glaucoma, AUC was 0.942 (95% CI, 0.929-0.954), sensitivity was 96.4% (95% CI, 81.7%-99.9%), and specificity was 87.2% (95% CI, 86.8%-87.5%). For AMD, AUC was 0.931 (95% CI, 0.928-0.935), sensitivity was 93.2% (95% CI, 91.1%-99.8%), and specificity was 88.7% (95% CI, 88.3%-89.0%). For referable diabetic retinopathy in the 10 additional datasets, AUC range was 0.889 to 0.983 (n = 40 752 images)., Conclusions and Relevance: In this evaluation of retinal images from multiethnic cohorts of patients with diabetes, the DLS had high sensitivity and specificity for identifying diabetic retinopathy and related eye diseases. Further research is necessary to evaluate the applicability of the DLS in health care settings and the utility of the DLS to improve vision outcomes.

Purpose: We measured scleral thickness in eyes of Chinese, and assessed interregional differences and associations with age and axial length., Methods: Using light microscopy, we histomorphometrically measured scleral thickness at various locations in eyeballs from Chinese patients that had been enucleated due to retinoblastoma, uveal melanoma, or absolute painful glaucoma., Results: The study included 281 globes from patients with a mean age of 24.8 ± 23.1 years (range, 1-83 years) and mean axial length of 24.3 ± 3.9 mm (range, 17.0-35.7 mm). In multivariate analysis in children aged ≤2 years, thicker posterior scleral thickness was marginally significantly associated with older age (P = 0.07; standardized correlation coefficient β, 0.21; correlation coefficient B, 62.2; 95% confidence interval [CI], -4.3,128.8) after adjusting for shorter axial length (P = 0.01). In participants aged ≥5 years, larger posterior scleral thickness was significantly associated only with shorter axial length (P < 0.001; β, -0.49; B, -24.1; 95% CI, -30.6,-17.6), but not with age (P = 0.93). The ratio of posterior scleral thickness to scleral thickness in the pars plana region decreased significantly with increasing axial length. The correlation coefficients were higher for the ratio of scleral thickness posterior pole/pars plana region than for posterior pole/ora serrata, posterior pole/equator, or posterior pole/midpoint posterior pole to equator. Scleral thickness measurements were not significantly (all P > 0.10) associated with adult glaucoma., Conclusions: Scleral thickness increased up to an age of 2 years, while afterwards scleral thickness was independent of age and decreased with longer axial length. Differences in the associations between the regional scleral thickness ratios and axial length suggested a scleral thinning taking place in axially elongated eyes predominantly in the posterior globe segment.

Purpose: To examine the relationship between major ocular diseases and mortality., Methods: The population-based longitudinal study Beijing Eye Study was performed in 2001 and repeated in 2011. The participants underwent a detailed ophthalmic examination at baseline in 2001., Results: Of 4439 subjects examined in 2001, 2695 (60.7%) subjects returned for the follow-up examination in 2011, while 379 (8.5%) subjects were dead and 1365 (30.8%) subjects were alive, however, did not agree to be re-examined. In multivariate regression analysis, mortality was significantly associated with the systemic parameters of older age (p < 0.001; Odds ratio (OR): 1.07; 95% confidence interval (CI): 1.05, 1.09), male gender (p < 0.001; OR: 0.56; 95% CI: 0.40, 0.78), lower level of education (p < 0.001; OR: 0.66; 95% CI: 0.59, 0.74) and smoking (p < 0.001; OR: 1.84; 95% CI: 1.36, 2.49) and with the ocular parameters of presence of diabetic retinopathy (p = 0.002; OR: 2.26; 95% CI: 1.34, 3.81), non-glaucomatous optic nerve damage (p = 0.001; OR: 4.90; 95% CI: 1.90, 12.7) and higher degree of nuclear cataract (p = 0.002; OR: 1.29; 95% CI: 1.10, 1.52). In that model, mortality was not significantly (all p > 0.05) associated with refractive error, cortical or subcapsular posterior cataract, intraocular pressure, best corrected visual acuity, visual field defects, prevalence of age-related macular degeneration, retinal vein occlusions, open-angle glaucoma and angle-closure glaucoma., Conclusions: After adjustment for age, gender, level of education and smoking, mortality was significantly higher in subjects with diabetic retinopathy, non-glaucomatous optic nerve damage and nuclear cataract. Other major ophthalmic parameters and disorders such as hyperopia, myopia, high myopia, pterygium, age-related macular degeneration, retinal vein occlusion, glaucoma and cortical or nuclear cataract were not significantly associated with mortality in the multivariate analysis., (© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Aim: To estimate the magnitude, temporal trends and subregional variation in the prevalence of blindness, and moderate/severe vision impairment (MSVI) in sub-Saharan Africa., Methods: A systematic review was conducted of published and unpublished population-based surveys as part of the Global Burden of Disease, Risk Factors and Injuries Study 2010. The prevalence of blindness and vision impairment by country and subregion was estimated., Results: In sub-Saharan Africa, 52 studies satisfied the inclusion criteria. The estimated age-standardised prevalence of blindness decreased by 32% from 1.9% (95% CI 1.5% to 2.2%) in 1990 to 1.3% (95% CI 1.1% to 1.5%) in 2010 and MSVI by 25% from 5.3% (95% CI 0.2% to 0.3%) to 4.0% (95% CI 0.2% to 0.3%) over that time. However, there was a 16% increase in the absolute numbers with blindness and a 28% increase in those with MSVI. The major causes of blindness in 2010 were; cataract 35%, other/unidentified causes 33.1%, refractive error 13.2%, macular degeneration 6.3%, trachoma 5.2%, glaucoma 4.4% and diabetic retinopathy 2.8%. In 2010, age-standardised prevalence of MSVI in Africa was 3.8% (95% CI 3.1% to 4.7%) for men and 4.2% (95% CI 3.6% to 5.3%) for women with subregional variations from 4.1% (95% CI 3.3% to 5.4%) in West Africa to 2.0% (95% CI 1.5% to 3.3%) in southern Africa for men; and 4.7% (95% CI 3.9% to 6.0%) in West Africa to 2.3% (95% CI 1.7% to 3.8%) in southern Africa for women., Conclusions: The age-standardised prevalence of blindness and MSVI decreased substantially from 1990 to 2010, although there was a moderate increase in the absolute numbers with blindness or MSVI. Significant subregional and gender disparities exist.

Aims: To describe the prevalence and causes of visual impairment and blindness in East Asia in 1990 and 2010., Method: Data from population-based studies conducted from 1980 to 2012 were identified, and eligibility for inclusion was assessed. Data on prevalence of blindness (presenting visual acuity <3/60 in the better eye) and moderate to severe visual impairment (MSVI; presenting visual acuity <6/18 to 3/60 in the better eye) and causes were extracted., Results: The age-standardised prevalence of blindness was 0.7% (95% CI 0.6 to 0.9) in 1990 and 0.4% (95% CI 0.3 to 0.5) in 2010, while that of MSVI was 3.6% (95% CI 2.3 to 4.4) and 2.3% (95% CI 1.7 to 2.8), respectively. These prevalence estimates were lower than those of other countries globally. The absolute numbers affected by blindness and MSVI in 2010 were 5.2 million and 33.3 million, respectively, and were higher among women than men. Cataract was the leading cause of blindness, whereas uncorrected refractive error was the leading cause of MSVI., Conclusions: There has been a significant reduction in prevalence of blindness in East Asia, but a substantial absolute number of people remain blind and visually impaired, largely caused by cataract and uncorrected refractive error.

Background: To describe the prevalence and causes of visual impairment and blindness in North Africa and the Middle East (NAME) in 1990 and 2010., Methods: Based on a systematic review of medical literature, we examined prevalence and causes of moderate and severe vision impairment (MSVI; presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60)., Results: In NAME, the age-standardised prevalence of blindness decreased from 2.1% to 1.1% and MSVI from 7.1% to 4.5%. In 2010, 3.119 million people were blind, and 13.700 million had MSVI. Women were generally more often affected than men. Main causes of blindness were cataract, uncorrected refractive error, macular degeneration and glaucoma. Main causes of MSVI were cataract and uncorrected refractive errors. Proportions of blindness and MSVI from trachoma significantly decreased., Conclusions: Although the absolute numbers of people with blindness and MSVI increased from 1990 to 2010, the overall age-standardised prevalence of blindness and MSVI among all ages and among those aged 50 years and older decreased significantly (p<0.05). Cataract and uncorrected refractive error were the major causes of blindness and MSVI.

Objective: To present regional estimates of the magnitude and temporal trends in the prevalence and causes of blindness and moderate/severe visual impairment (MSVI) in Latin America and the Caribbean (LAC)., Methods: A systematic review of cross-sectional population-representative data from published literature and unpublished studies was accessed and extracted to model the estimated prevalence of vision loss by region, country and globally, and the attributable cause fraction by region., Results: In the LAC combined region, estimated all-age both-gender age-standardised prevalence of blindness halved from 0.8% (0.6 to 1.1) in 1990 to 0.4% (0.4 to 0.6) in 2010 and MSVI decreased from 4.3% (3.1 to 5.3) to 2.7% (2.2 to 3.4). In the Caribbean, estimated all-age both-gender age-standardised prevalence of blindness decreased from 0.6% (0.4 to 0.8) in 1990 to 0.5% (0.4 to 0.6) in 2010 and MSVI decreased from 3.3% (1.3 to 4.1) in 1990 to 2.9% (1.8 to 3.8). In the LAC regions combined, there was an estimated 2.3 million blind and 14.1 million with MSVI in 2010. In 2010, cataract continues to contribute the largest proportion of blindness, except in Southern Latin America where macular degeneration is most common. In 2010, uncorrected refractive error was the most common cause of MSVI., Conclusions: While models suggest a decrease in age-standardised prevalence estimates, better data are needed to evaluate the disparities in the region. The increasing numbers of older people, coupled with the increase in vision loss associated with older age, will require further intervention to continue to reduce prevalence rates and to prevent a rise in absolute numbers of blind.

Background: To assess prevalence and causes of blindness and vision impairment in high-income regions and in Central/Eastern Europe in 1990 and 2010., Methods: Based on a systematic review of medical literature, prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity <3/60) was estimated for 1990 and 2010., Results: Age-standardised prevalence of blindness and MSVI decreased from 0.2% to 0.1% (3.314 million to 2.736 million people) and from 1.6% to 1.0% (25.362 million to 22.176 million), respectively. Women were generally more affected than men. Cataract was the most frequent cause of blindness in all subregions in 1990, but macular degeneration and uncorrected refractive error became the most frequent causes of blindness in 2010 in all high-income countries, except for Eastern/Central Europe, where cataract remained the leading cause. Glaucoma and diabetic retinopathy were fourth and fifth most common causes for blindness for all regions at both times. Uncorrected refractive error, followed by cataract, macular degeneration, glaucoma and diabetic retinopathy, was the most common cause for MSVI in 1990 and 2010., Conclusions: In highly developed countries, prevalence of blindness and MSVI has been reduced by 50% and 38%, respectively, and the number of blind people and people with MSVI decreased by 17.4% and 12.6%, respectively, even with the increasing number of older people in the population. In high-income countries, macular degeneration has become the most important cause of blindness, but uncorrected refractive errors continue to be the leading cause of MSVI.

Background: To examine the prevalence, patterns and trends of vision impairment and its causes from 1990 to 2010 in Central and South Asia., Methods: Based on the Global Burden of Diseases Study 2010 and ongoing literature searches, we examined prevalence and causes of moderate and severe vision impairment (MSVI; presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60)., Results: In Central Asia, the estimated age-standardised prevalence of blindness decreased from 0.4% (95% CI 0.3% to 0.6%) to 0.2% (95% CI 0.2% to 0.3%) and of MSVI from 3.0% (95% CI 1.9% to 4.7%) to 1.9% (95% CI 1.2% to 3.2%), and in South Asia blindness decreased from 1.7% (95% CI 1.4% to 2.1%) to 1.1% (95% CI 0.9% to 1.3%) and MSVI from 8.9% (95% CI 6.9% to 10.9%) to 6.4% (95% CI 5.2% to 8.2%). In 2010, 135 000 (95% CI 99,000 to 194,000) people were blind in Central Asia and 10,600,000 (95% CI 8,397,000 to 12,500,000) people in South Asia. MSVI was present in 1,178,000 (95% CI 772,000 to 2,243,000) people in the Central Asia, and in 71,600,000 (95% CI 57,600,000 to 92,600,000) people in South Asia. Women were generally more often affected than men. The leading causes of blindness (cataract) and MSVI (undercorrected refractive error) did not change from 1990 to 2010., Conclusions: The prevalence of blindness and MSVI in South Asia is still three times higher than in Central Asia and globally, with women generally more often affected than women. In both regions, cataract and undercorrected refractive error were major causes of blindness and MSVI.

Visual acuity is a major parameter for quality of vision and quality of life. Information on visual acuity and its associated factors in rural societies almost untouched by any industrialization is mostly non-available. It was, therefore, the purpose of our study to determine the distribution of visual acuity and its associated factors in a rural population not marked influenced by modern lifestyle. The population-based Central India Eye and Medical Study included 4711 subjects (aged 30+ years), who underwent a detailed ophthalmologic examination including visual acuity measurement. Visual acuity measurements were available for 4706 subjects with a mean age of 49.5±13.4 years (range: 30-100 years). BCVA decreased significantly (P<0.001) from the moderately hyperopic group (0.08±0.15 logMAR) to the emmetropic group (0.16±0.52 logMAR), the moderately myopic group (0.28±0.33 logMAR), the highly hyperopic group (0.66±0.62 logMAR) and finally the highly myopic group (1.32±0.92 logMAR). In multivariate analysis, BCVA was significantly associated with the systemic parameters of lower age (P<0.001), higher level of education (P<0.001), higher body stature (P<0.001) and higher body mass index (P<0.001), and with the ophthalmic parameters of more hyperopic refractive error (spherical equivalent) (P<0.001), shorter axial length (P<0.001), lower degree of nuclear cataract (P<0.001), and lower intraocular pressure (P = 0.006). The results suggest that in the rural population of Central India, major determinants of visual acuity were socioeconomic background, body stature and body mass index, age, refractive error, cataract and intraocular pressure.

Objective: To assess relationships between refractive error and ocular and general parameters., Methods: The Beijing Eye Study is a population-based study which included 4,439 Chinese subjects examined in 2001, with a follow-up examination in 2006, in which 3,251 (73.2%) subjects participated., Results: In multivariate regression analysis, increasing (hyperopic) refractive error was significantly associated with the systemic parameters of higher age (P < 0.001), rural region (P < 0.001), lower education level (P = 0.004), higher frequency of ever smoking (P = 0.02), and higher body mass index (P = 0.02). Adjusted for the systemic parameters, increasing (hyperopic) refractive error was significantly associated with higher best-corrected visual acuity (P < 0.001), lower anterior chamber depth (P < 0.001) and narrower chamber angle (P < 0.001), lower intraocular pressure (P = 0.001), lower amount of nuclear cataract (P = 0.007), smaller beta zone of parapapillary atrophy (P < 0.001), a lower prevalence of open-angle glaucoma (P = 0.01), and a higher prevalence of age-related macular degeneration (P = 0.04). Refractive error was not significantly (P > 0.05) associated with the prevalence of trachoma, non-glaucomatous optic nerve damage, and retinal vein occlusions, nor with mortality., Conclusions: In the adult Chinese population, hyperopic subjects compared with myopic subjects were older, lived predominately in the rural regions, had a lower level of education, smoked more, and were more obese. In addition, the hyperopic subjects had a lower intraocular pressure, a higher best-corrected visual acuity, a shallower anterior chamber depth and narrower anterior chamber angle, lower amount of nuclear cataract, smaller beta zone of parapapillary atrophy, a lower prevalence of open-angle glaucoma, and a higher prevalence of age-related macular degeneration.

Objective: To determine associations between educational level and ophthalmic diseases in Chinese., Methods: The population-based Beijing Eye Study, performed in 2006, enrolled 3,251 participants (age: 45+ years) out of 4,439 subjects invited to participate (response rate: 73.2%). The participants underwent an interview including questions concerning their educational level, and a detailed ophthalmic examination., Results: Data on the level of education were available for 3,221 (99.1%) subjects, with 1,484 (46.1%) subjects living in the rural region. The mean age was 60.4 +/- 10.1 years (range: 45-89 years). In a multivariate analysis, a higher level of education was significantly associated with myopic refractive error, higher best-corrected visual acuity, lower degree of nuclear cataract, and lower prevalence of angle-closure glaucoma, and with the systemic parameters of lower age, male gender, urban region, taller body height, and lower body mass index. It was not significantly associated with intraocular pressure, amount of subcapsular cataract and cortical cataract, cataract surgery, and the prevalences of diabetes mellitus, retinal vein occlusions, chronic open-angle glaucoma, and age-related macular degeneration, and with the systemic parameters of fasting serum concentrations of glucose, high-density lipoproteins, low-density lipoproteins, cholesterol and triglycerides, systolic and diastolic blood pressure., Conclusions: In the Greater Beijing area, a higher level of education was associated with myopic refractive error, higher best-corrected visual acuity, and lower prevalence of nuclear cataract and angle-closure glaucoma, after adjusting for the systemic parameters of younger age, male gender, urban region, taller body height, lower body mass index less smoking and less alcohol consumption. Educational level was not significantly associated with intraocular pressure, cortical cataract, blood pressure, and frequencies of age-related macular degeneration, retinal vein occlusions and chronic open-angle glaucoma.

Background: To determine whether body height is associated with ocular diseases., Methods: The population-based Beijing Eye Study 2006 included 3,251 (73.2%) subjects out of 4,439 subjects invited to be examined. Ocular and general parameters were examined for associations with body height., Results: Out of the 3,251 subjects included in the study, measurements of body height were available for 3,214 subjects (98.9%). In univariate analysis, short body height was significantly associated with a higher frequency of angle-closure glaucoma (P = 0.04), trachoma (P < 0.001), and pterygium (P = 0.02), a higher degree of cortical cataract (P < 0.001), and a higher frequency of arterial hypertension (P < 0.001). A multivariate analysis, including all confounding parameters which were significantly associated with body height in univariate analysis (i.e., age, gender, rural versus urban region, level of education) revealed that body height by itself was no longer significantly associated with the presence of any of the diseases tested., Conclusions: Angle-closure glaucoma, trachoma, pterygium, cortical cataract and arterial hypertension are present more often in adult Chinese with a short body stature. These associations are due to confounding factors such as age, level of education, and anterior chamber depth, which by themselves are associated with the ocular diseases mentioned.

Purpose: To assess the relationship of hypertension with major eye diseases and other ocular parameters., Design: Population-based study., Participants: The Beijing Eye Study is a population-based study that included 4439 Chinese subjects examined at the baseline examination in 2001; there was a follow-up examination in 2006, in which 3251 subjects participated, of whom 3222 had blood pressure measurements., Methods: All participants underwent an ophthalmic examination, anthropometric measurements, and blood pressure measurement. Hypertension was defined as a systolic blood pressure >or=140 mmHg and/or diastolic blood pressure >or=90 mmHg, and/or self-reported current treatment for hypertension with antihypertensive medication., Main Outcome Measures: Blood pressure and ocular parameters, including intraocular pressure and prevalence of major ophthalmic diseases., Results: Mean age of participants in the present study was 60.4+/-10.0 years. Hypertension was present in 1500 (46.6%) of the 3222 subjects who had their blood pressure measured. In multiple regression analysis, hypertension was associated with higher intraocular pressure (beta = 0.39; 95% confidence interval [CI], 0.12-0.66; P = 0.005), focal arteriolar narrowing (odds ratio [OR], 1.78; 95% CI, 1.34-2.36; P<0.001), arteriovenous nicking (OR, 1.50; 95% CI, 1.11-2.04; P = 0.009), generalized retinal arteriolar narrowing (OR, 1.65; 95% CI, 1.30-2.09; P<0.001), retinal vein occlusions (OR, 2.86; 95% CI, 1.21-6.80; P = 0.02), and diabetic retinopathy (OR, 1.90; 95% CI, 1.08-3.31; P = 0.02). Hypertension was not significantly associated with the prevalence of open-angle glaucoma (P = 0.19), angle-closure glaucoma (P = 0.15), age-related macular degeneration (AMD) (P = 0.73), nuclear cataract (P = 0.88), posterior subcapsular cataract (P = 0.30), cortical cataract (P = 0.10), or area of alpha zone (P = 0.05) or beta zone of parapapillary atrophy (P = 0.95)., Conclusions: In Chinese persons, while controlling for other systemic parameters, hypertension was associated with increased intraocular pressure, retinal microvascular abnormalities, and prevalence of retinal vein occlusion and diabetic retinopathy. Hypertension was not associated significantly with AMD, age-related cataract, or glaucoma.

The authors describe a 34-year-old woman who presented with headaches and marked papilledema after she had been taking oral hormonal therapy for the treatment of dysfunctional uterine bleeding. Neurological examination led to the diagnosis of a cerebral venous sinus thrombosis. After thrombolytic treatment, the headaches vanished and the papilledema in the right eye disappeared. Visual acuity increased to 20/25 in the right eye and 20/32 in the left eye. However, the marked papilledema in the left eye had resulted in a pronounced contraction of the posterior vitreous at the optic nerve head associated with a secondary folding of the macula and subretinal pigmentary irregularities in the foveal region., (Copyright 2009, SLACK Incorporated.)

Objective: To examine the associations between alcohol consumption and ocular diseases in the adult population of mainland China., Design: Population-based study., Participants: The Beijing Eye Study, performed in 2001, included 4439 subjects (age 40+ years) of 5324 individuals invited to participate (response rate 83.4%). The study was conducted in both a rural region (1973 subjects) and an urban region of Greater Beijing (2466 subjects)., Methods: All participants underwent an interview, including questions about alcohol consumption and a detailed ophthalmic examination, including photography of the cornea, lens, and fundus., Main Outcome Measures: Consumption of alcohol and systemic and ophthalmic parameters., Results: Information on alcohol consumption was obtained on 4141 subjects (93.3%), of whom 549 (13.3%) reported they consumed beer or wine. In multivariate analysis, alcohol consumption was significantly associated with the systemic parameters of lower age (P = 0.001), male gender (P<0.001), rural region (P<0.001), lower level of education (P = 0.01), and smoking (P<0.001). Alcohol consumption was not a significant risk factor for the prevalences of age-related macular degeneration (P = 0.24), open-angle glaucoma (P = 0.51), angle-closure glaucoma (P = 0.75), diabetic retinopathy (P = 0.35), retinal vein occlusion (P = 0.39), pterygium (P = 0.08), trachoma (P = 0.053), epiretinal membrane (P = 0.09), non-glaucomatous optic nerve atrophy (P = 0.55), dry eye (P = 0.86), cortical cataract (P = 0.67), subcapsular posterior cataract (P = 0.62), or nuclear cataract (P = 0.76), or with the ocular parameters of refractive error (P = 0.99), intraocular pressure (P = 0.19), retinal artery diameters (temporal inferior: P = 0.60), retinal vein diameters (temporal inferior: P = 0.41), or size of alpha zone and beta zone of parapapillary atrophy (P = 0.68)., Conclusions: When adjusted for the systemic parameters of age, gender, rural/urban region, level of education, and smoking, self-reported moderate consumption of alcohol does not have a significant effect on the prevalence of major ocular diseases or the physiologic parameters of intraocular pressure and refractive error.

Purpose: This review presents and summarizes the findings of the Beijing Eye Study., Methods: The Beijing Eye Study is a population-based study which included 4439 of 5324 subjects (aged > or = 40 years) who were initially examined in 2001. The study was repeated in 2006, when 3251 (73.2% of 4439, or 61.1% of 5324) of the original subjects participated. Participants underwent a series of examinations including: refractometry; pneumotonometry; biomicroscopy assisted by slit-lamp; optical coherence tomography of the anterior segment; photography of the cornea, lens, optic disc, macula and fundus; blood sampling for laboratory tests; blood pressure measurements, and determinations of anthropomorphic parameters. They were also asked to complete a questionnaire which included questions on socioeconomic parameters, and awareness and treatment of ocular and general diseases., Results: We present normative data for refractive error, anterior segment measurements, intraocular pressure and optic disc structures and their associations, frequency and causes of visual impairment, blindness and visual field defects, prevalences of trachoma, pterygia, open-angle glaucoma and angle-closure glaucoma, cortical, nuclear and posterior subcapsular cataract, age-related macular degeneration, retinal vein occlusions, diabetes mellitus and diabetic retinopathy, myelinated nerve fibres, and retinitis pigmentosa, and associated and risk factors., Discussion: These data may be helpful for dealing with public health issues in China and for assessing associated and risk factors of ocular and general diseases in general.

Objective: To evaluate the causes of visual impairment and blindness in adult Chinese in an urban and rural region of Beijing, China., Design: Population-based prevalence survey., Participants: From a rural region and an urban region of Greater Beijing, 4439 of 5324 > or=40-year-old invited subjects participated in the study (response rate, 83.4%). Using the World Health Organization (WHO) standard and the United States standard, blindness was defined as best-corrected visual acuity (BCVA) in the better-seeing eye of <20/400 and of <2/20, respectively, and visual impairment was defined as best-corrected vision of <20/60 and > or =20/400, and of <20/40 and > or =2/20, respectively., Methods: Determination of BCVA, pneumotonometry, frequency doubling perimetry, evaluation of photographs of the fundus and lens, and clinical examination., Main Outcome Measure: Causes of visual impairment and blindness., Results: Visual acuity measurements were available for 8816 eyes of 4409 subjects (99.3%). Using the WHO standard and the U.S. standard, 49 (1.1%) subjects and 95 (2.2%) subjects, respectively, had low vision, and 13 (0.3%) subjects and 15 (0.3%) subjects, respectively, were blind by definition. Taking the whole study population, the most frequent cause of low vision/blindness was cataract (36.7%/38.5%), followed by degenerative myopia (32.7%/7.7%), glaucoma (14.3%/7.7%), corneal opacity (6.1%/15.4%), and other optic nerve damage (2.0%/7.7%). Age-related macular degeneration (AMD) (2.0%/7.7%) and diabetic retinopathy (0%/7.7%) were responsible for a minority of cases. In subjects 40 to 49 years old, the most frequent cause of low vision and blindness was degenerative myopia. In the 50- to 59-year age group, the most frequent cause was cataract, followed by degenerative myopia. In the 60- to 69-year-old subjects and the > or =70-year group, the most frequent cause of low vision and blindness was cataract, followed by degenerative myopia and glaucoma., Conclusions: The most frequent cause of low vision and blindness in adult Chinese is cataract, followed by degenerative myopia and glaucomatous optic neuropathy, with degenerative myopia dominating in younger groups and cataract dominating in elder groups. In contrast to studies in Western countries, AMD and diabetic retinopathy appear to play a minor role as a cause of visual impairment in elderly Chinese.

To ascertain the safety of the retrobulbar catheter technique for intraoperative local anesthesia and titratable postoperative analgesia, 1,423 consecutive retinal or vitreoretinal surgeries were reviewed. Using a commercially available retrobulbar needle, a 28-gauge flexible catheter was introduced into the retrobulbar space before surgery and was removed the next morning. When pain occurred, a local anesthetic was re-injected intraoperatively or postoperatively through the catheter. None of the patients had intraoperative or postoperative complications. The retrobulbar catheter anesthesia may be a relatively safe procedure for prolonged intraoperative anesthesia and titratable postoperative analgesia in retinal and vitreoretinal surgery.

Within the last three years, triamcinolone acetonide has increasingly been applied intravitreally as treatment option for various intraocular neovascular edematous and proliferative disorders. The best response in terms of gain in visual acuity after the intravitreal injection of triamcinolone acetonide was found in eyes with intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. Visual acuity increased and degree of intraocular inflammation decreased in eyes with various types of non-infectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischemic retinopathies. Possibly, intravitreal triamcinolone may be helpful as adjunct therapy for exudative age-related macular degeneration, possibly in combination with photodynamic therapy. In eyes with chronic, therapy resistant, ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected, cataractogenesis, postoperative infectious and non-infectious endophthalmitis, and pseudo-endophthalmitis. Intravitreal triamcinolone injection can be combined with other intraocular surgeries including cataract surgery. Cataract surgery performed some months after the injection does not show a markedly elevated rate of complications. If vision increases and eventually decreases again after an intravitreal triamcinolone acetonide injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone depended on the dosage given. Given in a dosage of about 20mg to non-vitrectomized eyes, the duration of the effect and of the side-effects was 6-9 months. Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular edematous and neovascular disorders. One has to take into account the side-effects and the lack of long-term follow-up observations.

PurposeTo critically evaluate the potential impact of the coronavirus disease (COVID-19) pandemic on global ophthalmology and VISION 2020.DesignPerspective supplemented with epidemiologic insights from available online databases.MethodsWe extracted data from the Global Vision Database (2017) and Global Burden of Disease Study (2017) to highlight temporal trends in global blindness since 1990, and provide a narrative overview of how COVID-19 may derail progress toward the goals of VISION 2020.ResultsOver 2 decades of VISION 2020 advocacy and program implementation have culminated in a universal reduction of combined age-standardized prevalence of moderate-to-severe vision impairment (MSVI) across all world regions since 1990. Between 1990 and 2017, low-income countries observed large reductions in the age-standardized prevalence per 100,000 persons of vitamin A deficiency (25,155 to 19,187), undercorrected refractive disorders (2,286 to 2,040), cataract (1,846 to 1,690), onchocerciasis (5,577 to 2,871), trachoma (506 to 159), and leprosy (36 to 26). Despite these reductions, crude projections suggest that more than 700 million persons will experience MSVI or blindness by 2050, principally owing to our growing and ageing global population.ConclusionsDespite the many resounding successes of VISION 2020, the burden of global blindness and vision impairment is set to reach historic levels in the coming years. The impact of COVID-19, while yet to be fully determined, now threatens the hard-fought gains of global ophthalmology. The postpandemic years will require renewed effort and focus on vision advocacy and expanding eye care services worldwide.

Central corneal thickness (CCT) is a highly heritable trait associated with complex eye diseases such as keratoconus and glaucoma. We perform a genome-wide association meta-analysis of CCT and identify 19 novel regions. In addition to adding support for known connective tissue-related pathways, pathway analyses uncover previously unreported gene sets. Remarkably, >20% of the CCT-loci are near or within Mendelian disorder genes. These included FBN1, ADAMTS2 and TGFB2 which associate with connective tissue disorders (Marfan, Ehlers-Danlos and Loeys-Dietz syndromes), and the LUM-DCN-KERA gene complex involved in myopia, corneal dystrophies and cornea plana. Using index CCT-increasing variants, we find a significant inverse correlation in effect sizes between CCT and keratoconus (r = -0.62, P = 5.30 × 10-5) but not between CCT and primary open-angle glaucoma (r = -0.17, P = 0.2). Our findings provide evidence for shared genetic influences between CCT and keratoconus, and implicate candidate genes acting in collagen and extracellular matrix regulation.