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ACADEMIC EMERGENCY MEDICINE 2011; 18:928-933 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by nonophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of nonmydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs). Methods: Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mm Hg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a nonmydriatic fundus camera. Photographs were reviewed by a neuroophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of nonmydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems. Results: A total of 350 patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high-quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] = 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient's total ED visit. Conclusions: Nonmydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by nonphysician staff, is well-received by staff and patients, and requires a trivial amount of time to perform. [ABSTRACT FROM AUTHOR]

Background: To validate the German-translated VF-14, a vision-specific scale, and determine the relationship between the severity of vision impairment, ocular conditions, and visual functioning. Methods: This was a clinic-based, cross-sectional study with 184 patients with low vision and 90 normal-sighted controls recruited from a German eye hospital. Participants underwent a clinical examination and completed the German VF-14 scale. The validity of the VF-14 scale was assessed using Rasch analysis. The main outcome measure was the visual functioning overall score. Results: The participants' mean ± SD [standard deviation] age was 59.4 ± 21.8 years ,and there were more female (58.4%) than male participants. The main cause of vision loss was age-related macular degeneration [AMD] ( n = 54, 19.7%). Rasch analysis substantiated the German VF-14 to be a valid scale to assess visual functioning in the sample. Visual functioning consistently declined with worsening vision. In adjusted-multivariate analysis models, compared to control participants, those with mild, or moderate/severe vision impairment recorded significantly poorer visual functioning scores ( p < 0.05). The independent association was clinically significant for those with moderate/severe vision impairment. The main ocular conditions were also found to be independently associated with worse visual functioning, with clinical significance found for AMD, diabetic retinopathy, and other retinal diseases. Conclusions: Using a psychometrically valid German-translated VF-14, even mild vision impairment was independently associated with poor visual functioning. These findings reinforce the importance of early preventative and rehabilitative efforts to prevent longitudinal deterioration in vision loss. [ABSTRACT FROM AUTHOR]

The authors assessed the role of economic inequality in visual impairment and decomposed the gap between high and low income groups. Study data were extracted from the first phase of the Shahroud Eye Cohort Study, performed in 2009, with 5,190 participants aged between 40 and 64 years. The participants were divided into low, medium, and high economic groups according to their assets by using a principal component analysis. The gap between low and high economic groups was decomposed to its determinants by using the Blinder-Oaxaca method. The prevalence of visual impairment, a presenting vision worse than 20/40 in the better eye, was 3.57% and 11.07% in the high and low economic groups, respectively. Age and education were the major factors in the decomposition model, contributing to 41.38% of the gap. Insurance status, gender, and education of the head of the household had no effect on this gap. Economic inequality in visual impairment was noteworthy. Although part of the gap between low and high economic groups was explained by differences in age and education, the greater part (58.62%) could be due to differences in health-care access and utilization. [ABSTRACT FROM PUBLISHER]

Purpose: To conduct a global survey of low vision services to describe the needs, priorities, and barriers in provision and coverage. Methods: Data were mainly derived from a survey and from some secondary sources. The survey was distributed to Vision 2020 contacts, government, and non-government organizations (NGOs) in 195 countries during 2006--2008. Themes in the survey were: epidemiology of low vision, policies on low vision, provision of services, human resources, barriers to service delivery, equipment availability, and monitoring and evaluation of service outcomes. Contradictory and/or incomplete data were returned for further clarification and verification. The Human Poverty Index was used to compare the findings from developed and developing countries. Results: Service availability was established for 178/195 countries, with 115 having some low vision service. Approximately half the countries in the African and Western Pacific regions have no services. Few countries have >10 low vision health professionals per 10 million of population. In many of the countries NGOs were the main providers and funders. Funding and awareness were frequently cited as barriers to service access. Women, people with disabilities, and rural dwellers were less likely to access services. There were few reports of monitoring and evaluation into the quality and impact of services. Conclusion: This global survey provides the first consolidated baseline of low vision service provision. Where data are available, coverage of services is generally poor. Low vision health professional numbers are low. Services in over half of the world''s countries are funded by NGOs, raising issues of sustainability. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the association between vision and hearing impairment and depressive-anxiety syndrome in a large population participating in the Faenza Project, Northern Italy. Method: The study population consisted of 7389 participants not affected by dementia, 4408 (59.7%), of whom were women, mean age ± standard deviation (±SD) 71.9 (±7.7) years. Information about previous or current psychiatric symptoms, including sleeping and eating habits, non-verbal language and ability in activity of daily living was used to investigate depressive and anxiety syndrome. A semi-structured interview was administered to survey the presence of sensory impairment. Logistic regression analyses were used to evaluate the association between sensory impairment and depressive-anxiety syndrome estimating Odds ratio (OR) and 95% confidence interval (95% CI). Results: The prevalence of vision and hearing impairment was 1.4% and 0.2%, respectively, with an increasing trend in people aged 75+ years (p < 0.001). The prevalence of depressive syndrome was higher among vision-impaired participants (20.2% vs. 9.3%, p < 0.001), especially women (22.9%) and persons aged 75+ years (22.1%). The prevalence of anxiety syndrome was higher in the hearing-impaired group (25.0% vs. 11.0%, p = 0.09). Vision-impaired participants, especially women and participants aged 75+ years had have a twofold higher probability to have depressive syndrome (OR = 2.03, 95% CI = 1.21-3.38), and hearing-impaired individuals showed an increased probability of presenting anxiety syndrome (OR = 2.71, 95% CI = 0.86-8.55), although these results were not statistically significant. Conclusion: This study's findings suggest that sensory impairment in older adults can increase their probability of experiencing depressive and anxiety syndrome. Correction of these deficits could improve the quality of life in this population. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association between visual acuity (VA) and 4-year mortality in an older population-based cohort. Methods: Five thousand and fifty-seven persons aged 50 to 96 years (91.0% of the eligible population) residents of the Southern Harbin, Heilongjiang Provence, China participated in the study. At baseline (2006), the main ocular diseases were diagnosed from a basic ocular examination including presenting and best-corrected VA. Of the 5,057 participants in the baseline survey, those who died after the study were identified and the death certificate was checked. The physicians in charge of the health of the village population were asked for the presumed cause of death. The rate of death was determined in the follow-up survey in 2010. We evaluated the association of visual impairment (VI) and mortality using multiple logistic regression. Results: Between the baseline examination and the censoring cutpoint study, a total of 214 subjects (4.2%) were dead. Females with VI were less likely to have died relative to male gender with VI ( P < 0.05). Compared with participants who reported better presenting VA (VA ≥≥ 20/60), the risk of mortality was significantly higher for those reporting moderate VI (20/400 ≤≤ VA < 20/60) (Odds Ratio [OR], 2.1; 95% confidence interval [CI],1--4.1) and those reporting severe VI (VA < 20/400) (OR,3.6; 95% CI, 2.0--6.6). Similar associations were obtained for best-corrected VA in the better eye (OR, 3.1; 95% CI: 1.5--6.4 and 3.9; 95%CI: 2.1--7.2, respectively). Conclusion: In this Chinese population-based cohort we found that visual impairment predicted a significantly elevated mortality. [ABSTRACT FROM AUTHOR]

Purpose: To assess risk factors associated with the occurrence of penetrating ocular injuries among patients presenting to an eye hospital at Ibadan, Nigeria. Materials and Methods: All cases of penetrating ocular injury presenting over a 10 - year period, were identified by retrospective chart review. All current cases of penetrating ocular injury identified were included. All information was obtained retrospectively from the medical records. Results: The cohort consisted of 135 cases. The follow-up was for an average period of 24.6 weeks (range, 12-312 weeks). Injuries were most likely to occur at home, in a domestic setting (58%). The most common mechanism of injury was projectile missiles hitting the eye. The age range for injuries was 9 months to 70 years. Penetrating ocular injury was most frequent in the 20-29 years group (31.9%) followed by the 0-9 years age group (31.1%). Males were more frequently involved than females (ratio 4:1). The final acuity was better than 6/18 in 14.8% and less than 3/60 in 59.3% of cases. Conclusions: Penetrating ocular injury occurs, most frequently, in a domestic setting and mostly as a result of working with sharp objects. Preventive measures are recommended to reduce visual disabilities due to ocular injuries. [ABSTRACT FROM AUTHOR]

Wojciechowski R. Nature and nurture: the complex genetics of myopia and refractive error. The refractive errors, myopia and hyperopia, are optical defects of the visual system that can cause blurred vision. Uncorrected refractive errors are the most common causes of visual impairment worldwide. It is estimated that 2.5 billion people will be affected by myopia alone within the next decade. Experimental, epidemiological and clinical research has shown that refractive development is influenced by both environmental and genetic factors. Animal models have showed that eye growth and refractive maturation during infancy are tightly regulated by visually guided mechanisms. Observational data in human populations provide compelling evidence that environmental influences and individual behavioral factors play crucial roles in myopia susceptibility. Nevertheless, the majority of the variance of refractive error within populations is thought to be because of hereditary factors. Genetic linkage studies have mapped two dozen loci, while association studies have implicated more than 25 different genes in refractive variation. Many of these genes are involved in common biological pathways known to mediate extracellular matrix (ECM) composition and regulate connective tissue remodeling. Other associated genomic regions suggest novel mechanisms in the etiology of human myopia, such as mitochondrial-mediated cell death or photoreceptor-mediated visual signal transmission. Taken together, observational and experimental studies have revealed the complex nature of human refractive variation, which likely involves variants in several genes and functional pathways. Multiway interactions between genes and/or environmental factors may also be important in determining individual risks of myopia, and may help explain the complex pattern of refractive error in human populations. [ABSTRACT FROM AUTHOR]

Myopia, or nearsightedness, is a worldwide common type of refractive error. It is a non-life-threatening disorder with huge social and economic consequences due to its increasing prevalence. Axial length (AL) is the primary determinant of non-syndromic myopia. It is a parameter representing the combination of anterior chamber depth, lens thickness and vitreous chamber depth of the eye. AL can also be treated as an endophenotype of myopia and may provide extra advantages in the investigation of its genetic basis. The study of AL will not only identify the determinants of eye elongation, but also provide aetiological evidence for myopia. The purpose of this review is to outline the current state of AL research. Epidemiological evidence, genetic determinants, the relationship with other eye components and relative animal models of AL are summarised. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study aimed to investigate the prevalence of impairment of visual function amongst European drivers. A total of 2422 drivers from five European countries underwent a battery of visual function tests, including tests for visual acuity (VA), visual field (VF), contrast sensitivity, straylight (glare sensitivity) and useful field of view (UFOV). Subjects belonged to the following age categories: 45-54 years; 55-64 years; 65-74 years, and ≥ 75 years. A group of subjects aged 20-30 years served as a reference group. Results were compared with current standards for the visual function of drivers in the EU. Visual acuity in 0.5% of the younger group and 5.3% of the eldest group was below the standard required for driving. Visual acuity after proper refraction adhered to the standard in the majority of cases. Visual field results were below standard or questionable in 2.7% and 2.4%, respectively, of subjects in the eldest group. In this eldest group, impaired contrast sensitivity was present in 6.3%, increased glare sensitivity in 29.5% and impaired UFOV in 21.6% of subjects, but, as there are no standards for these criteria, the exact level of prevalence depends on the definition of impairment. Prevalences of impairment of visual functions that are not included in current standards (particularly contrast sensitivity and glare sensitivity) are much higher than prevalences of functions that are included (VA and VF). [ABSTRACT FROM AUTHOR]

Background: Cataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal. Methods: Subjects aged 40 years and above was selected using a cluster sampling methodology and a door to door enumeration was conducted for a population based cross sectional study. During the community field work, 11499 subjects underwent a structured interview regarding awareness (heard of) and knowledge (understanding of the disease) of cataract and glaucoma. At the base hospital 4003 out of 4800 (83.39%) subjects underwent a detailed ocular examination including log MAR visual acuity, refraction, applanation tonometry, cataract grading (LOCSII), retinal examination and SITA standard perimetry when indicated. Results: The age-sex adjusted prevalence of blindness (best corrected <3/60) and low vision (best corrected <6/18 ≥3/60) was 0.43% (95%C.I. 0.25 - 0.68) and 3.97% (95% C.I. 3.40 - 4.60) respectively. Cataract (53.3%) was the principal cause of blindness. The leading causes of low vision were cataract (60.8%) followed by refractive error (12%). The cataract surgical coverage was 90.36% and was higher in the younger age group, females and illiterate subjects. Pseudophakia was seen in 94%. Awareness of cataract (6.7%) and glaucoma (2.4%) was very low. Among subjects who were aware, 70.4% had knowledge of cataract and 45.5% of glaucoma. Cataract was commonly known to be a 'pearl like dot' white opacity in the eye while glaucoma was known to cause blindness. Awareness remained unchanged in different age groups for cataract while for glaucoma there was an increase in awareness with age. Women were significantly less aware (odds ratio (OR): 0.63; 95%, confidence interval (CI): 0.54 - 0.74) for cataract and (OR: 0.64; 95% CI: 0.50 - 0.81) for glaucoma. Literacy was also correlated with awareness. Conclusion: The low prevalence of visual impairment and the high cataract surgical coverage suggests that cataract intervention programs have been successful in Bhaktapur. Awareness and knowledge of cataract and glaucoma was very poor among this population. Eye care programs needs to be directed towards preventing visual impairment from refractive errors, screening for incurable chronic eye diseases and promoting health education in order to raise awareness on cataract and glaucoma among this population. [ABSTRACT FROM AUTHOR]

Aim: The aim was to identify the presenting symptoms and social risk factors for late presentation of primary glaucoma in newly diagnosed cases. Materials and Methods: It was a case-control study in a tertiary eye care center in Maharashtra, India. Newly diagnosed patients with primary glaucoma were classified as cases (late presenters) where there was no perception of light in one eye or severe visual field loss affecting an area within 20° of fixation or a cup-disc (C:D) ratio =0.8 and controls (early presenters), presenting relative scotoma within 20° of fixation or a C:D ratio <0.8, but >0.5. All patients underwent a comprehensive ocular examination including gonioscopy, perimetry, and detailed family and social history. Occupation, education, and socioeconomic status were graded. SPSS version 12.0 was used, and univariate and multivariate logistic regression analysis was performed. Results: Gradual progressive painless loss of vision was the commonest symptom (175, 87.5%). Primary angle closure glaucoma was more common in females (P = 0.001) and lower socioeconomic groups (P = 0.05). Patients who were less educated were more likely to have late presentation of glaucoma (P < 0.001, odds ratio = 0.07; 95% CI, 0.02-0.25). Knowledge of family history of glaucoma (P = 0.80, odds ratio = 1.16; 95% CI, 0.36-3.71) and eye clinic attendance in past 2 years still resulted in late presentation (P = 0.45, odds ratio = 1.34, 95% CI, 0.63-2.82). Conclusion: Lack of education and awareness of glaucoma were major risk factors for late presentation. [ABSTRACT FROM AUTHOR]

Purpose: To assess the impact of cataract surgery on vision related quality of life (VRQoL) and generic health related quality of life (HRQoL) in Kenya, Bangladesh and the Philippines. Methods: A multi-center intervention study was conducted. At baseline 651 cases aged ≥50 years with visually impairing cataract (corrected visual acuity (VA) <6/24) and 561 age- gender-matched controls with normal vision (VA>6/18) were interviewed about VRQoL (using the World Health Organization/ Prevention of Blindness and Deafness 20-item Visual Functioning Questionnaire [WHO/PBD VF20]) and generic HRQoL (EuroQol). Cases were offered free/subsidized cataract surgery. Approximately 1 year later participants were re-interviewed. Results: Response rate at follow up was 84% for operated cases and 80% for controls. At baseline, cases had significantly poorer VRQoL scores, were more likely to report problems with the EuroQol 5D five descriptive (EQ−SD) domains (mobility, daily activities, self-care, pain, depression/anxiety) and had significantly poorer self-rated health compared to controls. At follow up VRQoL scores of operated cases improved significantly to approximately equal those of controls. Effect sizes were large (> 0.8) regardless of pre-operative VA. Poor outcome from surgery (VA < 6/60) was associated with smaller VRQoL gains. Among operated cases frequency of reported problems with all the EQ-5D reduced significantly compared to baseline in Kenya and the Philippines, and in mobility, daily activities and self-care in Bangladesh. Self-rated health scores increased significantly in each country. HRQoL of controls remained stable from baseline to follow up. Conclusion: This study among adults undergoing cataract surgery in 3 different low-income settings found evidence of improved VRQoL and generic HRQoL to approximately equal that of controls with normal vision. [ABSTRACT FROM AUTHOR]

Purpose: The visual functioning index (VFI) was one of the first questionnaires developed using classical test theory to assess outcomes of cataract surgery. However, it was not Rasch-validated. The objective of this study was to examine the psychometric properties of the VFI using Rasch analysis in patients with cataract. Methods: The 11-item VFI was self-administered to 243 patients (mean age 73.9 years) drawn from a cataract surgery waiting list. We examined the response category thresholds, item fit statistics, differential item functioning and unidimensionality for the VFI and its three subscales. Results: Category thresholds were ordered. The person separation and reliability were low, indicating the poor discriminatory ability of the VFI. No items misfit but there was suboptimal targeting of item difficulty to patient ability. On the whole the items in the VFI were too easy for the sample. Only one item showed moderate differential item functioning. Conclusion: The VFI does not meet the stringent requirements of the Rasch model. However adding more items to suit the more able patients with cataract as well as those awaiting second-eye cataract surgery could optimize the VFI. [ABSTRACT FROM AUTHOR]

Purpose: To develop and validate a patient-reported outcome measure of refractive error for persons living in developing countries. Methods: A 21-item visual function questionnaire was developed from existing instruments through pilot testing in 51 urban Indian adults with refractive error. This was then administered to 400 adults aged 18 to 45 in Delhi, India. Rasch analysis was performed to determine item fit, differential item functioning (DIF), targeting of the instrument to the study population, and instrument precision. Results: The removal of 5 items from the instrument resulted in better fit to the Rasch model. Reducing the number of possible responses from five to four further improved fit. Analysis of the person-item map including the Fisher information function demonstrated acceptable targeting of the instrument to this population. The person separation index was good (2.03), demonstrating ability to differentiate between 3 strata of respondents. Conclusions: Revisions to existing instruments to measure visual function in persons with refractive error resulted in an instrument that conformed to the Rasch model. Identifying activities that are more difficult to perform with refractive error in this setting might further improve the instrument. The 16-item instrument was able to differentiate among levels of impairment due to uncorrected refractive error and could be used to assess refractive programs in similar settings. [ABSTRACT FROM AUTHOR]

Purpose: To study the epidemiology of ocular trauma among the elderly in a developing country. Method: This is a multi-center retrospective clinical study of patients aged 65 years and above managed for ocular trauma between 2001 and 2007 at 4 hospitals in southwestern Nigeria. Age, sex, occupation, residential address, location at time of injury, activity preceding injury, agent of injury, treatment modalities offered and presenting visual acuity were recorded in a predesigned form. Type of injury was classified according to Birmingham Eye Trauma Terminology. Data were recorded and analyzed with descriptive statistics and Chi square using SPSS 11 (SPSS Inc., Chicago, IL) and statistical significance accepted at P < 0.05. Results: 78 patients with overall mean age of 70.1 ± 5.5 years and male to female ratio of 1.9: 1 ( P = 0.007) were studied. Mean age for males was 70.0 ± 5.4 years and 70.1 ± 5.7 years for females. Eye injury occurred most commonly on the farm (37.2%), during farm related activities (35.9%) with sticks/twigs (41.1%) being commonest agent of ocular trauma among the elderly. However, injury occurred most frequently at home (51.9%) and during a fight/dispute (25.9%) with inciting agents being most frequently (33.3%) home related in elderly females. Eye injury was mainly of closed globe variety (85.9%); open globe injury was associated with higher incidence of hospitalization ( P < 0.0001) and visual impairment ( P = 0.004) at presentation. Conclusion: Although eye injury in elderly occurred more commonly on the farm during farm related activities, gender related differences are present with injury occurring more commonly in the home and during assaults/disputes. [ABSTRACT FROM AUTHOR]

AIM: To determine the prevalence and causes of visual impairment and blindness among indigenous Australians living in central Australia. METHODS: 1884 individuals aged 20 years or older, living in one of 30 remote communities within the statistical local area of "Central Australia", were recruited for this study, from which 1883 were assessable. This equated to 36% of those ≥20 years old and 67% of those ≥40 years old within this district. Participants were recruited as they presented to the eye clinic at each remote community. Patients underwent Snellen visual acuity testing and subjective refraction. After this, an assessment of their anterior and posterior segments was made. Rates and causes of bilateral visual impairment (vision worse than Snellen visual acuity 6/12 in the better eye) and bilateral blindness (Snellen visual acuity worse than 6/60 in the better eye) were presented. RESULTS: 19.4% (365/1883) had bilateral visual impairment (25.1% of those ≥40 years old) and 2.8% (53/1883) had bilateral blindness (3.6% of those ≥40 years old). Refractive error followed by cataract were the main causes for bilateral visual impairment and blindness. Following these, diabetic eye disease and trachomatous corneal opacification were the main causes of bilateral visual impairment and bilateral blindness, respectively. CONCLUSION: This study indicates that bilateral visual impairment and blindness are, respectively, 25.1% and 3.6% among indigenous Australians, four to seven times higher than among the non-indigenous Australian population. Trachoma is the leading cause of bilateral blindness after refractive error and cataract. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the distribution, and demographic and socioeconomic correlates of refractive error and related ocular biometry in an older British population. METHODS: Refractive error was measured using an auto-refractor without cycloplegia. Pseudophakic individuals and those who had undergone refractive surgery were excluded from analysis. Axial length and anterior chamber depth were measured using partial coherence laser interferometry. Occupation category and highest educational achievement were recorded. RESULTS: Biometric data were available for 2519 people (1090 men, 1429 women; 93.2% of all participants) aged 48 to 88 years. Refractive data were available for both eyes in 2210 bilaterally phakic participants. Among phakic individuals, axial length of the eye was strongly inversely correlated with refractive error in both men and women (p<0.001). Axial length of the eye was strongly, independently related to height, weight and social class, but most strongly related to educational achievement. In contrast, anterior chamber depth varied with age and sex, but not with socioeconomic status. There was a significant inverse association between anterior chamber depth and refraction in women (p<0.001) but not in men (p=0.495). CONCLUSION: Refractive error in this predominantly white older UK population was associated with axial biometry and sociodemographic characteristics. Educational status was the strongest determinant of axial length. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have provided population-based estimates of the vision impairment, eye disease and eye care in the United States. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) this study reports the overall and age-race-specific prevalence of self-reported vision impairment, eye diseases, and eye care utilization among older adults. Methods: Between 2005 and 2008 residents aged 50 and older in 17 states responded to BRFSS questions concerning difficulty with distance and near vision-related tasks, self-reported eye diseases and reported eye care insurance and service utilization. Results: The overall prevalence of difficulty with distance and near vision was 16.6 and 32.8%, respectively with no meaningful change with increasing age. The prevalence of cataract, glaucoma, and macular degeneration was 19.6%, 6.4, and 5.8%; all of which increased dramatically with age. Nearly 69% of Whites and Blacks and 65% of Hispanics visited an eye care provider in the past year. Overall, among the approximately one-third of participants who did not visit an eye care provider in the past year, half indicated that they did not have any reason to go and 20% cited it was due to cost/insurance. Conclusion: The continued and expanding use of the BRFSS Visual Impairment and Access to Eye Care module represents a unique opportunity to obtain population-based estimates of vision impairment, eye disease and perhaps most uniquely, eye care utilization. Moreover, the integration of this and other BRFSS modules will provide researchers the opportunity to evaluate the relationship between these estimates and other measures of health status and health care utilization. However, the self-reported nature of the BRFSS data is an important limitation that must be considered when interpreting the results. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prevalence of cataract, glaucoma, age-related maculopathy (ARM) and diabetic retinopathy (DR) in the adult Finnish population. Methods: A representative cross-sectional sample of the Finnish population aged 30 years and older. Of the 7979 eligible people, 7413 (93%) were interviewed and/or examined. The interview included self-reported doctor-made diagnoses of cataract, glaucoma, degenerative fundus changes (mainly ARM) or DR. Information on self-reported eye diseases was complemented with data from national registers, and case records were gathered for non-participants and persons with visual acuity (VA) < 0.5 or reporting difficulties in vision or eye diseases without assessed VA. Results: Based on self-reported and/or register-based data the estimated total prevalences of cataract, glaucoma, ARM and DR in the study population were 10%, 5%, 4% and 1%, respectively. All these chronic eye diseases increased with age (p < 0.001). The corresponding prevalences for persons aged 65 and older were 34%, 13%, 12% and 2%, respectively. Cataract and glaucoma were more common in women than in men [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26–1.91; OR 1.57, 95% CI 1.24–1.98, respectively]. The most prevalent eye diseases in people with visual impairment (VA ≤ 0.25) were ARM (37%), unoperated cataract (27%), glaucoma (22%) and DR (7%). Conclusion: The high prevalence of these mainly age-related eye diseases, together with increasing life expectancy, mean that continuous efforts are needed to identify and treat eye diseases in order to maintain patients’ quality of life and to alleviate the social and economic burden of serious eye diseases. [ABSTRACT FROM AUTHOR]

This article, based on a report prepared for the International Council of Ophthalmology (ICO) and the International Society for Low Vision Research and Rehabilitation (ISLRR), explores the assessment of various aspects of visual functioning as needed to document the outcomes of vision rehabilitation. Documenting patient abilities and functional vision (how the person functions) is distinct from the measurement of visual functions (how the eye functions) and also from the assessment of quality of life. All three areas are important, but their assessment should not be mixed. Observation of task performance offers the most objective measure of functional vision, but it is time-consuming and not feasible for many tasks. Where possible, timing and error rates provide an easy score. Patient response questionnaires provide an alternative. They may save time and can cover a wider area, but the responses are subjective and proper scoring presents problems. Simple Likert scoring still predominates but Rasch analysis, needed to provide better result scales, is gaining ground. Selection of questions is another problem. If the range of difficulties does not match the range of patient abilities, and if the difficulties are not distributed evenly, the results are not optimal. This may be an argument to use different outcome questions for different conditions. Generic questionnaires are appropriate for the assessment of generic quality of life, but not for specific rehabilitation outcomes. Different questionnaires are also needed for screening, intake and outcomes. Intake questions must be relevant to actual needs to allow prioritization of rehabilitation goals; the activity inventory presents a prototype. Outcome questions should be targeted at predefined rehabilitation goals. The Appendix cites some promising examples. The Low Vision Intervention Trial (LOVIT) is an example of a properly designed randomized control study, and has demonstrated the remarkable effectiveness of vision rehabilitation. It is hoped that further similar studies will follow. [ABSTRACT FROM AUTHOR]

Purpose: To present a comprehensive estimate of the total number of people with visual impairment in the adult Japanese population by age, gender, severity and cause, and to estimate future prevalence based on population projections and expected demographic changes. Methods: Definitions of visual impairment used in this study were based on the United States criteria. Total visual impairment was calculated as the sum of low vision and blindness. The prevalence estimates were based on input from a number of Japanese epidemiological surveys, census material and official population projections. Results: There were an estimated 1.64 million people with visual impairment in 2007 in Japan. Of these, 187,800 were estimated to be blind. The prevalence of visual impairment in Japan increased with age and half of the people with visual impairment were aged 70 years or older. The leading causes of visual impairment in Japan were glaucoma (24.3%), diabetic retinopathy (20.6%), degenerative myopia (12.2%), age-related macular degeneration (10.9%), and cataract (7.2%). These five major causes comprised three-quarters of all visual impairment. The prevalence of visual impairment was projected to increase from 1.3% of the population in 2007 to 2.0% by 2050. Conclusions: This comprehensive study presents the prevalence of total visual impairment in the adult Japanese population. The projected increases in the prevalence of visual impairment over time reflect the demographic changes of a declining and aging Japanese population. These projections highlight that the burden of disease due to visual impairment and imposed on society is likely to increase. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the variation in retinal nerve fibre layer (RNFL), optic nerve head (ONH) and macular measurements in healthy Turkish subjects using Stratus optical coherence tomography (OCT). The design is a cross-sectional study of 398 eyes in 199 normal subjects aged between 5 and 70 years. The participants underwent a detailed ophthalmologic examination including imaging with Stratus OCT. RNFL, optic disc and macula fast scan methods were used to obtain the peripapillary RNFL thickness, ONH and macular parameters. The effects on the findings of age, gender and laterality of the eye tested were assessed. The average RNFL thickness and the thickness measured in the superior and temporal quadrants were statistically significantly negatively correlated with age. Similar results were found for mean macular thickness, macular RNFL thickness and for total macular volume. There was no effect of age on ONH measurements. The RNFL thickness in the temporal quadrant was significantly greater in females than in males (p<0.05). The mean macular thickness in 1–3 mm was greater in males than in females (p<0.05). The nasal RNFL thickness was significantly thicker in the right eyes than in the left eyes (p<0.05). We conclude that, in healthy subjects, as age increases there is a significant reduction in peripapillary and macular RNFL thickness and in macular thickness and volume. The hypothesis that RNFL and macular measurements are not symmetrical between the two eyes merits further study. [ABSTRACT FROM AUTHOR]

Background: Although a leading cause of visual impairment and a treatable cause of blindness globally, the pattern of refractive errors in many populations is unknown. This study determined the pattern of refractive ocular conditions, reasons for spectacles renewal and the effect of correction on refractive errors in a resource-limited community. Methods: A retrospective review of case records of 1,413 consecutive patients seen in a private optometry practice, Nigeria between January 2006 and July 2007. Results: A total number of 1,216 (86.1%) patients comprising of (486, 40%) males and (730, 60%) females with a mean age of 41.02 years SD 14.19 were analyzed. The age distribution peaked at peri-adolescent and the middle age years. The main ocular complaints were spectacles loss and discomfort (412, 33.9%), blurred near vision (399, 32.8%) and asthenopia (255, 20.9%). The mean duration of ocular symptoms before consultation was 2.05 years SD 1.92. The most common refractive errors include presbyopia (431, 35.3%), hyperopic astigmatism (240, 19.7%) and presbyopia with hyperopia (276, 22.7%). Only (59, 4.9%) had myopia. Following correction, there were reductions in magnitudes of the blind (VA<3/60) and visually impaired (VA<6/18-3/60) patients by (18, 58.1%) and (89, 81.7%) respectively. The main reasons for renewal of spectacles were broken lenses/frame/scratched lenses/lenses' falling off (47, 63.4%). Conclusions: Adequate correction of refractive errors reduces visual impairment and avoidable blindness and to achieve optimal control of refractive errors in the community, services should be targeted at individuals in the periadolescent and the middle age years. [ABSTRACT FROM AUTHOR]

The article reports on the global initiative to eliminate the avoidable blindness in developing countries in 2020. It cites the contemporary causes of blindness in children like vitamin A deficiency, measles-related, and intra-uterine and genetic causes such as cataract and congenital anomalies. It mentions the reassessment of research, training, and programmatic needs due to the changing patterns of global childhood blindness.

Purpose: To estimate the magnitude and causes of blindness and low vision in The Netherlands from 2000 to 2020. Methods: Recent population-based blindness surveys in established market economies were reviewed. Age and gender specific prevalence and causes of blindness and low vision were extracted and calculated for six population subgroups in The Netherlands. A mathematical model was developed to relate the epidemiologic data with demographic data for each subgroup for each year between 2000 and 2020. Results: In 2008 an estimated 311,000 people are visually impaired in The Netherlands: 77,000 are blind and 234,000 have low vision. With the current intervention the number may increase by 18% to 367,000 in 2020. Visual impairment is most prevalent among residents of nursing homes and care institutions for the elderly, intellectually disabled persons and people aged 50+ living independently. Of all people with visual impairment 31% is male (97,000) and 69% female (214,000). More than half of all visual impairment (56%; 174,000 persons) is avoidable. A variation of around 20% might be applied to the numbers in these estimates. Conclusions: The aim of VISION 2020: The Right to Sight to reduce avoidable visual impairment is also relevant for developed countries like The Netherlands. Vision screening and awareness campaigns focusing on the identified risk groups can reduce avoidable blindness considerably. Regular updates of the model will ensure that the prognoses remain valid and relevant. With appropriate demographic data, the model can also be used in other established market economies. [ABSTRACT FROM AUTHOR]

Aim: To assess the awareness and knowledge levels about glaucoma and its determinants in an urban population of Chennai in south India. Materials and Methods: Chennai glaucoma study (CGS) was a population based prevalence study to estimate the prevalence of glaucoma in a rural and urban south Indian population. A total of 3850 subjects aged 40 years or above participated in the urban arm of CGS. A systematic random sample of 1926 (50.0%) subjects completed a questionnaire that assesses their awareness and knowledge level of glaucoma. Respondents "having heard of glaucoma" even before they were contacted/recruited for the study were defined as "aware" and respondents having some understanding of the eye disease were defined as "knowledgeable". Results: Overall 13.5% were aware of glaucoma, the age-gender adjusted rate for awareness was 13.3% (95% CI: 11.57 to 15.03). Two clinicians graded knowledge on glaucoma, based on the subject's knowledge of risk factors, definitions and treatment aspects of glaucoma. Overall 8.7% had some knowledge about glaucoma. Among those who had knowledge 0.5% had good knowledge about glaucoma, 4% had fair knowledge and 4.2% had poor knowledge. We observed a very good agreement between the clinicians in grading knowledge (k =0.92). Determinants of glaucoma awareness and knowledge were higher levels of education, females, age, religion and family history of glaucoma. Conclusion: Awareness and knowledge about glaucoma was very low among the urban population of Chennai. We have found that younger subjects and men were less aware of glaucoma. Subjects with lower levels of education were less aware and knew less about glaucoma than their counterparts. The study findings stress the need for health education for effective prevention of blindness due to glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To determine visual function (VF) status in older people, to establish its degree of correlation with visual acuity (VA), and to assess its association with other physical and mental functional limitations. Participants: A sample of 1,160 persons aged 65 years or over were selected by simple randomization. Methods: The participants' VF (The Visual Function Index-VF-14), VA, self-reported vision, mental and physical function (Katz Index, Pfeiffer's test, and Geriatric Depression Scale), and socio-demographic data were determined. Multiple linear regression was used to assess the association between VF and its conditioning factors. Statistical adjustment was made for the possible confounding variables. Results: Of the studied subjects, 6.3% (95% confidence interval (CI) = 4.93-7.82) had VA of less than 6/18 in the better eye and 20.9% (95% CI = 18.6-23.3) had VA of less than 6/12. The best corrected VA of each participant demonstrated moderate correlation with his or her VF-14 score (r = 0.416; p < 0.001). Using multiple regression analysis, the variables associated with VF status were: visual impairment, self-reported poor vision, dependence in daily activities, cognitive impairment, depressive symptoms, female gender and older age. These independent variables explain 34.4% (r2 = 0.344) of the variation in the data. Conclusions: VF impairment is common in older persons and when associated with other limitations, it may be considered a major health problem with important consequences. As a complement to the preventive care guidelines on VA in older persons, assessment of VF impairment in clinical practice, using appropriate visual screening tools, is advisable. [ABSTRACT FROM AUTHOR]

AimsTo determine the intraoperative and postoperative complications and visual outcome of eyes undergoing cataract extraction after previous retinal detachment repair by pars plana vitrectomy (PPV).MethodsRetrospective analysis of 72 patients who had cataract extraction by phacoemulsification having had retinal detachment repair by vitrectomy and internal tamponade.ResultsBest-corrected visual acuity (BCVA) had improved in 53 (74%) of eyes at 3 weeks after cataract surgery and 65 (90%) at final follow-up. Fifty-three eyes (74%) attained 6/12 visual acuity at final follow-up compared with 19 (26%) eyes with a preoperative vision better than 6/12. There was a significant improvement in BCVA after cataract extraction (P<0.001). Poor vision was usually related to retinal comorbidity.Intraoperative events occurred in nine eyes (12.5%) including capsulorrhexis tears, zonular dehiscence and vitreous loss. Postoperative events occurred in 15 eyes (20.8%). Retinal re-detachment occurred in four eyes (5.6%).ConclusionsCataract extraction after retinal detachment surgery by vitrectomy generally results in a significant visual improvement, however, there is an increased intraoperative and postoperative complication rate. The risk of retinal re-detachment may previously have been underestimated.Eye (2009) 23, 1377–1381; doi:10.1038/eye.2008.255; published online 5 September 2008 [ABSTRACT FROM AUTHOR]

ObjectiveTo study the effect of optical coherence tomography (OCT) scan circle displacement on retinal nerve fibre layer (RNFL) measurement errors using cubic spline models.MethodsForty-nine normal subjects were included in the analysis. In one randomly selected eye in each subject, RNFL thickness around the optic disc was measured by taking 16 circular scans of different sizes (scan radius ranged from 1 to 2.5 mm). The RNFL profile in each eye was constructed with a mathematical model using a smoothing spline approximation. Scan circle (diameter 3.4 mm) RNFL measurements (total average, superior, nasal, inferior, and temporal RNFL thicknesses) obtained from eight directions (superior, superonasal, nasal, inferonasal, inferior, inferotemporal, temporal, and superotemporal) displaced at different distances (0.1, 0.2, 0.3, 0.4, 0.5, 0.6, and 0.7 mm) from the disc centre were then computed by a computer program and compared to the ‘reference standard’ where the scan circle is centred at the optic disc. RNFL measurement error was calculated as the absolute of (RNFL thickness (displaced) – RNFL thickness (reference standard)).ResultsThe respective mean average, superior, nasal, inferior, and temporal RNFL measurement errors were 2.3±2.0, 4.9±4.5, 4.1±3.8, 6.2±7.6, and 3.8±3.5 μm upon 0.1 mm scan circle displacement, and 12.1±11.4, 27.8±18.4, 21.7±18.6, 34.8±22.9, and 15.2±10.7 μm upon 0.7 mm scan circle displacement. Significant differences of average and quadrant RNFL thicknesses were evident between centred and displaced scan circle measurements (all with P<0.001). RNFL measurement error increased in a monotonic fashion with increasing distance away from the disc and the change was direction-dependent.ConclusionsRNFL measurement error varies with the direction and distance of scan displacement. The superior and the inferior RNFL measurements are most vulnerable to scan displacement errors, whereas the average RNFL thickness is the least susceptible. Obtaining a well-centred scan is essential for reliable RNFL measurement in OCT.Eye (2009) 23, 1436–1441; doi:10.1038/eye.2008.258; published online 19 September 2008 [ABSTRACT FROM AUTHOR]

PurposeTo investigate the relationship between socioeconomic status and the extent of visual field loss in POAG and treated OHT patients at their first presentation to Manchester Royal Eye Hospital.MethodsA cohort of 113 glaucoma patients seen between 1995 and 2005 was reviewed. The clinical parameters intraocular pressure, C : D ratio, family history of glaucoma, visual acuity, extent of visual field loss, and demographic parameters: age, gender, ethnicity, and residential postcode were extracted from hospital records. The socioeconomic status of each patient was estimated from the patient's residential postcode with the ACORN index (group 1: affluent and group 2: socioeconomically deprived).ResultsIn comparison to group 1 (n=49), patients in group 2 (n=64) presented with more advanced field loss, lower educational attainment (18 vs 98% with no or unknown qualification), and were less aware of glaucoma in the family (27 vs 17%). Patients with a number of systemic health problems had worse vision, more severe visual field loss, and worse clinical attendance (P<0.05).ConclusionsThe extent of visual field loss in glaucoma patients at first presentation is related to a combination of clinical and socioeconomic factors including the patient's postcode. This finding could be used to target future case-finding resources.Eye (2009) 23, 1038–1044; doi:10.1038/eye.2008.245; published online 8 August 2008 [ABSTRACT FROM AUTHOR]

Background/aims: Refractive errors, especially if undercorrected, are a common and important cause of poor vision, particularly in Asia. The knowledge and beliefs of refractive errors and possible impact of undercorrection in a population-based study in Singapore are described. Methods: This study was a substudy on 503 subjects with refractive error from a population-based survey of 3280 adult Malays in Singapore aged 40 to 80 years. The Health Belief Model was used to develop a questionnaire, subjects with refractive errors were evaluated on their health beliefs towards adopting health-seeking behaviour for correction of refractive error, and the responses were compared between undercorrected subjects and subjects with corrected refractive errors. Results: Of persons with myopia, 79.5% had heard of myopia, 79.2% of hyperopes had heard of hyperopia, while only 7.7% of those with astigmatism had heard of astigmatism. Adults who had never previously visited an eye-care specialist were less likely to have heard of astigmatism and to know that they have refractive error (p<0.01). Adults with undercorrected refractive error were more likely to be female (61.1% vs 49.3%) and not wear spectacles (41.7% vs 22.3%). Knowledge on astigmatism (1.4% vs 5.6%) and refractive errors (62.6% vs 77.5%) were significantly lower in the undercorrected group. Conclusions: The lack of knowledge and awareness of refractive errors are important risk factors for undercorrected refractive error in an urban Singapore population. [ABSTRACT FROM AUTHOR]

Aims: To evaluate a vision-related quality of life (QOL) scale (World Health Organization Prevention of Blindness and Deafness Visual Function 20—WHO/PBD VF20) and explore the impact of cataract visual impairment on vision- and health-related QOL in people ⩾50 years from Satkhira district, Bangladesh. Method: 217 cases visually impaired from cataract and 280 controls with normal vision were interviewed about vision-related QOL (WHO/PBD VF20), generic health-related QOL (EuroQol generic health instrument, EQ-5D) and socio-demographic information. The validity and reliability of the WHO/PBD VF20 were evaluated using standard psychometric tests and criteria. Results: Evidence for validity and reliability of the WHO/PBD VF20 was found. Worsening general functioning, psychosocial and overall eyesight scores were associated with increased visual loss (p for trend<0.001). Cases were more likely to report problems with each EQ-5D descriptive domain and had poorer self-rated health than controls with normal vision (p<0.001). Conclusion: Demonstration of the validity and reliability of the WHO/PBD VF20 in this population supports its suitability as a tool for assessing vision-related QOL in low-income settings. The poorer health-related QOL in cases compared with controls suggests an impact of cataract visual impairment on perceived health and well-being, beyond vision-specific experience. [ABSTRACT FROM AUTHOR]

The article discusses the present and future of glaucoma treatment. Different treatments used at present are: ocular hypotensive medical treatment, laser surgery and incisional surgery. Before considering the various treatments for glaucoma, the author advises ophthalmologists not to forget the main therapeutic goal: to prevent significant visual impairment in a patient's lifetime.

Chronic open-angle glaucoma is the most frequent type of glaucoma and a leading cause for blindness. The role of intraocular pressure (IOP) in the pathogenesis of open-angle glaucoma has been challenged by patients with typical glaucomatous optic disc changes and visual field loss in whom the IOP never exceeded normal values (normal-tension glaucoma), as well as by patients with persistently elevated IOP who do not develop glaucomatous disc or field changes. Recent research has demonstrated that the cerebrospinal fluid (CSF) is not evenly distributed in all CSF spaces and that the subarachnoid space of the optic nerve can turn into a CSF compartment on its own. The biochemical components in this optic nerve compartment can differ markedly from normal CSF and some of its components (such as L-PGDS) may produce a toxic effect on the optic nerve and may therefore play an important role in the pathophysiology of open-angle glaucoma. [ABSTRACT FROM AUTHOR]

Background: Information is lacking on the impact of visual impairment on the quality of life of elderly Africans. This study aims to examine the impact of self-reported visual impairment on the quality life of an elderly Nigerian sample. Results: Four hundred and fifty-three (22.3%) of the respondents reported impairment for distant vision, 377 (18.4%) reported near vision, and 312 (15.2) reported impairment for both far and near. Impairment of near vision had a significant impact on all domains of quality of life. Distant vision had less impact, with a significant decrement only in the domain of environment. After adjusting for the possible effects of age, sex, and co-occurring chronic physical illness, near-vision impairment accounted for 3.92% decrement in the overall quality of life of elderly persons. Conclusion: Impairment of vision is associated with significant decrement in diverse areas of quality of life in this elderly sample. Problems with near vision were nevertheless more likely than those of distant vision to affect quality of life. [ABSTRACT FROM AUTHOR]

Abstract Purpose  To assess the pattern and the local spatial frequency distribution of visual field defects (VFDs) in eyes with clinically diagnosed optic neuritis (ON) and their currently unaffected fellow eyes, using threshold-related, slightly supraliminal perimetry, ensuring high spatial resolution. Methods  Records obtained with the Tübingen Automatic perimeter (TAP, Oculus Inc., Dudenhofen, Germany) and the Octopus 101 perimeter (Haag-Streit Inc, Koeniz, Switzerland), using a standardized grid of 191 static targets within the central 30° visual field, were analysed retrospectively. VFDs were assigned to 15 classes. Results  Visual fields (VF) from 99 patients (26 male and 73 female subjects, aged from 18 to 51 years) with clinically diagnosed, acute ON (52 right eyes, 48 left eyes affected, one bilateral involvement) were evaluated. Central scotomas were the most common finding in associated eyes, covering 41% of all VFDs in affected eyes. Nerve fibre bundle defects were found in 29% and paracentral scotomas in 14% of all VFDs. Fellow eyes were perimetrically normal in 65% of the clinically monocular ONs. Nerve fibre bundle defects were found in 21% and diffuse scotomas in 9% of the fellow eyes. Conclusions  Central scotomas and retinal nerve fibre bundle defects are the most common VFDs in acute ON. Small central and paracentral scotomas that most probably would have been missed by automated thresholding perimetry with its relatively coarse grid could be detected by threshold-related, slightly supraliminal strategy. Of the fellow eyes in clinically apparent monocular optic neuritis, 35% present with visual field defects. [ABSTRACT FROM AUTHOR]

Editorial. Discusses the epidemiological, ethnic and racial risk factors, which determine the occurrence of ocular disorders, primarily open-angle glaucoma. Influence of racial and ethnic factors in ocular disorders; Reason for the greater incidence of blindness from cataract in black individuals than white individuals; Importance of lifestyle in influencing the occurrence of ocular diseases in black women. [ABSTRACT FROM AUTHOR]

Aim: To assess the impact of cataract surgery in nursing home residents on health-related quality of life, as compared to those who have cataracts but who do not undergo surgery. Methods: A prospective cohort study enrolled 30 nursing home residents (≥60 years old) who had cataracts and underwent cataract surgery, and evaluated vision-targeted and generic health-related quality of life and depressive symptoms before and approximately 4 months after surgery. This cataract surgery group was compared to 15 nursing home residents who had cataracts but who did not have surgery, over the same timeframe. Results: Visual acuity for near and distance and contrast sensitivity improved following cataract surgery (p<0.001). Adjusting for age differences in the two groups, the cataract surgery group exhibited significant score improvement in the general vision (p=0.005), reading (p =0.001), psychological distress (p =0.015), and social interaction (p=0.033) subscales of the Nursing Home Vision-targeted Health-Related Quality of Life Questionnaire and the VF-14 (p=0.004). There were no group differences in the SF-36, Geriatric Depression Scale or the Cataract Symptom Score. Conclusion: Nursing home residents who underwent cataract surgery because of functional problems experienced significant improvements in their vision-targeted health-related quality of life, in addition to dramatically improved vision. [ABSTRACT FROM AUTHOR]

Purpose: A recently devised 3D computer-automated threshold Amsler grid test was used to identify early and distinctive defects in people with suspected glaucoma. Further, the location, shape and depth of these field defects were characterised. Finally, the visual fields were compared with those obtained by standard automated perimetry. Patients and methods: Glaucoma suspects were defined as those having elevated intraocular pressure (>21 mm Hg) or cup-to-disc ratio of >0.5. 33 patients and 66 eyes with risk factors for glaucoma were examined. 15 patients and 23 eyes with no risk factors were tested as controls. The recently developed 3D computer-automated threshold Amsler grid test was used. The test exhibits a grid on a computer screen at a preselected greyscale and angular resolution, and allows patients to trace those areas on the grid that are missing in their visual field using a touch screen. The 5-minute test required that the patients repeatedly outline scotomas on a touch screen with varied displays of contrast while maintaining their gaze on a central fixation marker. A 3D depiction of the visual field defects was then obtained that was further characterised by the location, shape and depth of the scotomas. The exam was repeated three times per eye. The results were compared to Humphrey visual field tests (ie, achromatic standard or SITA standard 30-2 or 24-2). Results: In this pilot study 79% of the eyes tested in the glaucoma-suspect group repeatedly demonstrated visual field loss with the 3D perimetry. The 3D depictions of visual field loss associated with these risk factors were all characteristic of or compatible with glaucoma. 71% of the eyes demonstrated arcuate defects or a nasal step. Constricted visual fields were shown in 29% of the eyes. No visual field changes were detected in the control group. Conclusions: The 3D computer-automated threshold Amsler grid test may demonstrate visual field abnormalities characteristic of glaucoma in glaucoma suspects with normal achromatic Humphrey visual field testing. This test may be used as a screening tool for the early detection of glaucoma. [ABSTRACT FROM AUTHOR]

PurposeTo investigate the epidemiological characteristics and related risk factors for primary rhegmatogenous retinal detachment (RRD) in Taiwan.MethodsThe case–control study was based on retrospective chart review of hospital patients treated for primary RRD from 1995 to 2001, inclusively. The preoperative fundus findings and refractive status were collected for each patient. Controls were selected from a nationwide survey of visual impairment in the adult population during the same period. Risk factors for RRD were analysed by logistic regression. A total of 1032 RRD cases and 3537 controls were enrolled for the study.ResultsA pronounced bipeak pattern was evident in the age distribution for primary RRD in the third and sixth decades of life. Atrophic hole with lattice degeneration was preferential to younger (20–30 years) and highly myopic individuals (−7.4±5 D), whereas the flap tear tended to occur in middle-aged individuals (50–60 years) and those with moderate myopia (−4.1±5 D). The odds ratio for primary RRD with myopia, male gender, and older age (>40 years) were 1.33/D, 2.15, and 1.69, respectively.ConclusionsMyopia is an important RRD risk factor for young Taiwanese. The increasing prevalence of myopia has predisposed the young population to RRD.Eye (2007) 21, 1056–1061; doi:10.1038/sj.eye.6702397; published online 12 May 2006 [ABSTRACT FROM AUTHOR]

Background: It is known that unmet expectations are a common cause of patient dissatisfaction with health care. The purpose of this study was to determine the expectations of patients attending their first low vision clinic appointment in a specialist ophthalmic hospital and to determine how well their expectations were met by the low vision clinic. Method: Fifteen adults with age-related macular degeneration (AMD) and significant vision loss were recruited. A one-to-one, semistructured interview was performed by a research psychologist to determine the difficulties patients were experiencing and their expectations of the low vision clinic. At a further interview 3 months later patients were again asked what difficulties they were experiencing and to comment on the perceived benefits of the low vision clinic. Results: Ninety-three percent (93%) (14/15) reported difficulty with reading. Other frequently reported problems included shopping (7/15), face recognition (5/15), crossing roads (4/15) and television (4/15). Seven patients (47%) expected to be prescribed new conventional spectacles to overcome these difficulties. Only 4 (27%) expected to receive magnifiers, 2 expected advice and 1 expected to receive a closed-circuit television magnifier. The most frequently reported benefit from the clinic was in extra help with reading or writing (6 participants; 40%). Eight patients would unequivocally recommend the low vision clinic to a friend or family member with similar vision, and only 3 (20%) would not recommend the low vision clinic. Conclusions: Whilst most patients attending a low vision clinic have visual problems amenable to low vision rehabilitation, many have false expectations of the purpose of the clinic. In particular, many expect conventional spectacles to ameliorate their visual disability. Despite this, most patients would recommend a friend with similar vision to attend the low vision clinic. [ABSTRACT FROM AUTHOR]

AimIn adults modern vitreoretinal surgery allows many traumatised eyes to be salvaged. However, one third of serious eye injuries occur in the paediatric age group and trauma is a leading cause of monocular blindness in childhood. This study aims to report the indications, complications and outcomes for vitreoretinal surgical intervention after childhood ocular trauma.MethodsRetrospective case note review of 61 children (age 16 years or less) undergoing vitreoretinal surgical procedures following ocular trauma at a tertiary referral centre.ResultsTwenty-eight children (45.9%) had open globe injuries (OGI) and 33 closed globe injuries (CGI, 54.1%). The mean age of children with OGI was 9.5 years and with CGI 12.3 years (P=0.0068). Forty-seven children had traumatic retinal detachments (77.1%), which in 17 cases were treated with conventional scleral buckling surgery and in 30 by vitrectomy. Retinal re-attachment was achieved after one procedure in 70.6% with scleral buckling and 46.7% with vitrectomy. Fourteen children (22.9%) had attached retinas but required vitrectomy for other reasons. After a mean follow-up of 19.6 months, the median visual acuity (VA) of the children improved from counting fingers at presentation to 6/36 at final review (P=0.0031). Traumatic retinal detachment requiring vitrectomy was associated with poor visual outcome (P=0.0003).ConclusionVitreoretinal intervention resulted in an improvement in vision in 32 children (57.1%) and stabilised 11 at their presenting acuity (19.6%). Two thirds of the children attained a final VA of 6/60 or better. Proliferative vitreoretinopathy was the cause of redetachment in 68.2% of cases and was significantly associated with a poor outcome (P<0.0001).Eye (2007) 21, 793–798; doi:10.1038/sj.eye.6702332; published online 7 April 2006 [ABSTRACT FROM AUTHOR]

Background: There has been increasing interest in the use of measures of health related quality of life (HRQoL) and health state utility values in Age Related Macular Degeneration (ARMD). Visual acuity has been found to be an important determinant of such measures in previous studies. More recently, another measure of visual impairment, contrast sensitivity has received considerable attention. We designed a study to examine whether the contribution of contrast sensitivity in explaining HRQoL and health utilities over and above that of visual acuity.Methods: 209 patients with unilateral or bilateral ARMD were recruited into a cross-sectional study of patients from a large teaching hospital. Patients underwent visual tests (near and distant visual acuity, contrast sensitivity) and completed a vision function questionnaire, the VF-14, HUI3, and time trade-off.Results: Using multivariate regression analysis, the study revealed that contrast sensitivity remained a statistically significant predictor of all outcome measures even when visual acuity was included. This result was supported by the correlation coefficients between measures.Conclusions: The measurement of contrast sensitivity appears to be better related to a person's HRQoL and health utility. Future studies should consider incorporating contrast sensitivity in addition to visual acuity. Studies, in particular economic evaluations, may underestimate the effect of treatment unless contrast sensitivity is considered. [ABSTRACT FROM AUTHOR]

Background: Public understanding of age-related macular degeneration (AMD) is lower than that of other eye diseases such as cataract or glaucoma. The purpose of this study was to determine what reasons people with AMD give for their vision loss. Methods: Fifteen adults with AMD causing significant visual loss performed a detailed one-to-one semi-structured interview. Qualitative analysis techniques were used to identify themes and frequency of responses. Results: Sixty percent (9/15) of the participants identified aging as the principal cause of their vision loss. Two participants (13%) volunteered smoking as being a contributing factor. Common misconceptions included vision loss being attributable to trauma (2/15), medical or surgical intervention (2/15), and overuse of the eyes in earlier life (2/15). No patients mentioned genetic factors as being of importance. Conclusion: Patients with macular disease attribute their vision loss to many factors. Less than two-thirds identify their vision problem as being related to aging. Few appear to be aware of the role of smoking in AMD pathogenesis, and many feel their vision loss is due to medical intervention, trauma, or "using up" their vision. Low-vision practitioners should ensure that patients are correctly counseled as to the cause of their vision loss. Patient education with regard to AMD needs to be made more available in a clinical setting and in health information campaigns. [ABSTRACT FROM AUTHOR]

Background Blindness and low vision are thought to be common in southern Sudan. However, the magnitude and geographical distribution are largely unknown. We aimed to estimate the prevalence of blindness and low vision, identify the main causes of blindness and low vision, and estimate targets for blindness prevention programs in Mankien payam (district), southern Sudan. Methods and Findings A cross-sectional survey of the population aged 5 y and above was conducted in May 2005 using a two-stage cluster random sampling with probability proportional to size. The Snellen E chart was used to test visual acuity, and participants also underwent basic eye examination. Vision status was defined using World Health Organization categories of visual impairment based on presenting visual acuity (VA). A total of 2,954 persons were enumerated and 2,499 (84.6%) examined. Prevalence of blindness (presenting VA of less than 3/60 in the better eye) was 4.1% (95% confidence interval [CI], 3.4–4.8); prevalence of low vision (presenting VA of at least 3/60 but less than 18/60 in the better eye) was 7.7% (95% CI, 6.7–8.7); whereas prevalence of monocular visual impairment (presenting VA of at least 18/60 in better eye and VA of less than 18/60 in other eye) was 4.4% (95% CI, 3.6–5.3). The main causes of blindness were considered to be cataract (41.2%) and trachoma (35.3%), whereas low vision was mainly caused by trachoma (58.1%) and cataract (29.3%). It is estimated that in Mankien payam 1,154 persons aged 5 y and above (lower and upper bounds = 782–1,799) are blind, and 2,291 persons (lower and upper bounds = 1,820–2,898) have low vision. Conclusions Blindness is a serious public health problem in Mankien, and there is urgent need to implement comprehensive blindness prevention programs. Further surveys are essential to confirm these tragic findings and estimate prevalence of blindness and low vision in the entire region of southern Sudan in order to facilitate planning of VISION 2020 objectives. [ABSTRACT FROM AUTHOR]

PurposeTo obtain the first representative and valid population-based prevalence figures on visual impairment and blindness in adults with intellectual disabilities (ID) and to identify risk groups.MethodsStudy design: Cross-sectional survey. An age-Down's syndrome-stratified random sample of 1598 persons from a base population of 9012 adult users of ID services with mild to profound intellectual disabilities was screened. Participants underwent protocollised on-site screening of visual functions. Results were related to degree of ID, occurrence of Down's syndrome (DS) and age. Main outcome measure: Prevalences of visual impairment and blindness in the study population and in subgroups and weighted prevalences in the total Dutch population using ID services.ResultsPrevalences of visual impairment ranged from 2.2% (95% confidence interval (CI), 0.5–6.4) in young adults with mild ID and no Down's syndrome to 66.7% (95% CI, 41.0–86.7) in older adults with profound ID and Down's syndrome; prevalences of blindness ranged from 0.7% (95% CI, 0.1–4.1) to 38.9% (95% CI, 28.1–50.3). Weighted prevalences of visual impairment and blindness in the total Dutch population of adult users of intellectual disabity services are 13.8% (95% CI, 9.3–18.4) and 5.0% (95% CI, 3.8–6.2), respectively. Prior to this study, visual impairment or blindness had remained undiagnosed in 106/261 (40.6%) persons.ConclusionsAs compared to published figures for the general Dutch population aged 55 years and over (visual impairment 1.4%, blindness 0.5%), prevalences of visual impairment and blindness are higher in all subgroups with intellectual disabilities, including the young and mildly handicapped group. The diagnosis is too often missed. All persons with severe or profound intellectual disabilities, and all older adults with Down's syndrome, should be considered visually impaired until proved otherwise.Eye (2006) 20, 1004–1010. doi:10.1038/sj.eye.6702059; published online 9 September 2005 [ABSTRACT FROM AUTHOR]

Background: A rapid assessment methodology was used to determine the suitability of donated recycled spectacles for the Pacific nation of Tuvalu. Methods: Spectacles (102) from a donated cache were examined. Those with astigmatism of >1.00 D, anisometropia of >0.50 D, significant central lens scratches, broken frame, poor cosmetic fit and comfort, or unsuitable frame appearance were excluded. The refractive errors (≥ ±0.50 D distance or near) of 320 Tuvaluans were determined. Results: Of the spectacles, 62.7% had >1.00 DC and/or >0.50 D anisometropia, 30% were broken and/or scratched and 50% were uncomfortable or cosmetically unacceptable. Only 13% were optically satisfactory, physically intact, and cosmetically appropriate. Of the people, 8.8% had >1.00 DC and/or >0.50 D anisometropia, requiring custom-made spectacles. A further 8.1% needed a −0.50 to −2.00 DS correction, for which there were no spectacles in this cache. For the other 83.1% (266), if the cache contained at least 5538 spectacles, each would eventually find a suitable pair. Conclusion: If the scheme to Tuvalu is typical, refractive error will remain largely uncorrected if only donated recycled spectacles are available. No amount of efficiency and effectiveness in the delivery chain can justify the output and outcome of this recycling scheme. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether iris colour influences size and shape of the optic nerve head and risk for glaucoma progression. Methods: The hospital-based observational study included 1973 eyes of 1012 Caucasian subjects with ocular hypertension or chronic open-angle glaucoma. For all patients, colour stereo optic disc photographs were evaluated, and corneal pachymetry and achromatic perimetry were performed. Main outcome measures were optic nerve head parameters, the development or progression of visual field defects and iris colour. Results: In most of the study groups, size of the optic disc, neuroretinal rim, alpha zone and beta zone of parapapillary atrophy, retinal vessel diameter and central corneal thickness did not differ significantly between eyes with blue, green, brown and mixed iris colour. In the normal-pressure glaucoma group, neuroretinal rim area was smallest in the population with mixed-coloured eyes and largest in the group of eyes with brown irides ( P = 0.001 after correction for inter-eye dependency and multiple testing). For the ocular hypertensive subjects and glaucoma patients with follow-up examinations, the rate of development or progression of glaucomatous visual field loss was not significantly associated with iris colour ( P = 0.060). Conclusions: In Caucasian subjects, iris colour does not have a major association with the size of the optic nerve head structures, central corneal thickness and retinal arterial diameter. In Caucasian patients with ocular hypertension or chronic open-angle glaucoma, an influence of iris colour on the risk for development or progression of glaucomatous visual field defects could not be confirmed. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to develop a means of rapidly assessing eye health in a cost- and time-effective way to monitor changes over time. Methods: Key features of the five main eye diseases that cause vision loss in Australia were assessed. Participation was volunteer-based from randomly selected Melbourne suburbs. Recruitment was by mail. Anterior segments and fundi were photographed with a digital non-mydriatic fundus camera. Visual fields were tested with Frequency Doubling Technology. A questionnaire collected information about demographics, general health and lifestyle. Findings from this rapid assessment were compared with those from a population-based study. Results: A total of 1695 people, aged between 70 and 79 years (mean 74), were recruited. The rates and causes of visual impairment were similar between the rapid assessment method and the population-based study. Among the 134 people (8%) with visual impairment at presentation, 98 (73%) had undercorrected refractive error, 17 (13%) had age-related macular degeneration, 11 (8%) had cataract, 2 (2%) had diabetic retinopathy and 2 (2%) had glaucoma. Screening costs per participant were only about AU$145, compared with AU$433 in the Melbourne Visual Impairment Project (VIP). The application of Frequency Doubling Technology as well as the use of a non-mydriatic digital camera for fundus and lens photography resulted in an average examination time of less than half the time needed in the VIP. Data collection took 3 months rather than 4 years in the VIP. Conclusion: The rapid assessment method was efficient in time and cost and produced results comparable to a normal population-based survey. Repeating the study design for a similarly sampled group every 2 years would allow the assessment of changes in the prevalence of undiagnosed eye disease. [ABSTRACT FROM AUTHOR]