Investigation in status quo of evidence awareness of internship nursing students and countermeasures

Aim. The aim of this study was to evaluate the influence of glaucoma and age-related macular degeneration on the tear film break-up time and the quality of patients life. Methods. This was a questionaire study among 50-70 years patients with glaucoma (40 patients) and age-related macular degeneration (40 patients) of MA LUHS Clinic of the Eye Diseases between the years 2010 and 2011. Questionaire of ocular surface diseases (OSDI) and glaucoma symptoms scale (OSSG) were used. Data was analysed using SPSS Statistics 17.0. P values less than 0,05 were considered as statistically significant. Rezults. More pronounced dry eye syptoms are observed in glaucoma group patients. In daily activities (reading, driving, using a computer, watching TV) problems related to eyes most of the time limited AMD patients than glaucoma patiens. BUT is significantly longer in patients with AMD (8,8 sec.) than in glaucoma patients (3,5 sec.). Conlusions. Life quality in glaucoma patients is negatively affected because of the decreased tear break-up time and dry-eye symptoms. Life quality in age-related macular degeneration patients in negatively affected because of the general vision impairment. Glaucoma has a greater influence on the decreased tear break-up time. Article in Lithuanian doi:10.5200/sm-hs.2012.014

In 2020, an estimated 596 million people worldwide had distance vision impairment and a further 510 million had uncorrected near vision impairment.1 Most of these people live in low-income and middle-income countries (LMIC). Eye health is also affected by conditions that do not, at least initially, impair vision. Although these conditions are not currently included in global prevalence estimates, they contribute substantially to the unmet need for eye health services. Vision is important for many aspects of life, and vision impairment can profoundly affect individuals, families, and society. Eye health touches all lives, either directly or indirectly, through its impact on those close to us. The year 2020 marks the culmination of the global initiative to eliminate avoidable blindness, VISION 2020: The Right to Sight (appendix 1 p 7). This initiative provided the framework for national programmes to address eye health over the past 20 years. In 2019, WHO published the World report on vision,2 which was endorsed by the 73rd World Health Assembly in 2020. The report and resolution call for the advancing of eye health as an integral part of universal health coverage, by implementation of integrated people-centred eye care, following the approach outlined in a broader health services framework.3 The Lancet Global Health Commission on Global Eye Health contends that eye health should be part of the mainstream agenda to achieve universal health coverage and sustainable development. We define eye health as the state in which vision, ocular health, and functional ability are maximised, thereby contributing to overall health and wellbeing, social inclusion, and quality of life. Eye health can be considered both a process and an outcome. We define eye care services as those that contribute to any of vision, ocular health, or functional ability being maximised. This report broadly divides into two halves. First, we present evidence for the importance of eye health, supporting the case for urgent action. Second, looking beyond 2020, we examine approaches to enable delivery of eye health services within universal health coverage. In section 1 we summarise the visual system, vision impairment, and common conditions. In section 2, we synthesise several reviews done by the Commission on the relevance of eye health to the Sustainable Development Goals (SDGs), as well as its impact on quality of life, general health, and mortality. In section 3, we describe the magnitude and causes of vision impairment in 2020 and projected global and regional trends. We explore service needs of people with non-vision impairing eye conditions. We propose a more standardised approach to reporting population-based eye health surveys and examine the disability weights applied to vision impairment. In section 4, we summarise findings from a systematic review of eye health economics, identifying important areas for future work. We present a new estimate of global lost productivity associated with vision impairment for 2020, and an analysis of the cost-effectiveness ratios for cataract surgery and refractive error services. In section 5, we outline a bibliometric analysis of eye health research since 2000, and report a global Grand Challenges project, highlighting crucial issues for concerted research and action. Lastly, we address the question of how health systems can practically advance towards delivering high quality integrated people-centred eye care within universal health coverage.2 We argue that business as usual will be insufficient, as evidenced by new analysis of effective cataract surgical coverage data. We examine service delivery components: primary eye care and integration with general health services, workforce strengthening, financing, health information systems, indicators, advocacy, and approaches to increase quality and equity. The development of global eye health This Commission views global eye health through the global health framework articulated by Koplan and colleagues.4 Eye health started with an understanding of the anatomy, physiology, diseases of the eye, and the development of clinical ophthalmology, the medical and surgical discipline for diagnosis and treatment of eye diseases. From the mid-20th century onwards (figure 1), there have been major technological advances in microsurgical techniques for cataract and other conditions, and equipment for diagnosis and treatment of major non-communicable eye diseases, resulting in more effective interventions. There has been an enormous demographic transition, with ageing populations and epidemiological changes from infectious diseases and towards non-communicable diseases, requiring accessible and affordable eye services with long-term follow-up. The increase in demand, emphasis on better quality, and higher cost of more sophisticated diagnostic and treatment services is requiring an increase in resources, which presents enormous public health challenges. Open in a separate window Figure 1 The development of global eye health Blue circles indicate major global developments. Red circles indicate major treatments and programmatic developments. WHA=World Health Assembly. IAPB=International Agency for the Prevention of Blindness. RAAB=Rapid Assessment of Avoidable Blindness. RACSS=Rapid Assessment of Cataract Surgical Services.

The aim of the study was to investigate prevalence of visual impairment in rural central India. The population-based Central India Eye and Medical Study included 4711 subjects with an age of 30+ years. Presenting visual acuity (PRVA) and best-corrected visual acuity (BCVA) were recorded. Visual impairment and blindness were defined using the World Health Organization (WHO) standard and United States (US) standard. On the basis of PRVA and using WHO and US standards, 1049 [22%; 95% confidence interval (CI): 21.1, 23.5] subjects and 1290 (27%; 95% CI: 26.1, 28.7) subjects, respectively, were visually impaired, and 35 (0.7%; 95% CI: 0.5, 1.0) subjects and 116 (2.5%; 95% CI: 2.0, 2.9) subjects, respectively, were blind. The corresponding age-standardized prevalence figures were 17%, 21%, 0.5% and 2%, respectively. Using best-correcting glasses could eliminate PRVA-visual impairment/blindness in 729 subjects (67% of all subjects with visual impairment/blindness). On the basis of BCVA and using WHO and US standards, 333 (7%; 95% CI: 6.3, 7.8) subjects and 473 (10%; 95% CI: 9.2, 10.9) subjects, respectively, had visual impairment, and 22 (0.5%; 95% CI: 0.3, 0.7) and 31 (0.7%; 95% CI: 0.4, 0.9) subjects, respectively, were blind. Corresponding age-standardized prevalence figures were 5%, 8%, 0.4% and 0.5%, respectively. Causes for BCVA-visual impairment/blindness were cataract (75%), postoperative posterior capsular opacification (4%), surgical complications (2%), corneal opacifications (2%), age-related macular degeneration (2%), other macular diseases (1%), and glaucoma (1%). Age-standardized prevalence of PRVA-visual impairment/blindness (WHO definition) in the adult population of rural central India was 17%. Most frequent cause was undercorrected refractive error. Supply of correct glasses is the most efficient way to improve vision in the rural central India.

To investigate the prevalence of blindness and low vision and the leading causes of blindness in residents aged≥60 years in Dachang Blocks of Baoshan District, Shanghai, China. A cross-sectional study was carried out by Shanghai Eye Disease Prevention & Treatment Center and the Center for Disease Control and Prevention in Baoshan District of Shanghai from October to December in 2009. Randomly cluster sampling was used to identify the adults aged≥60 years who had lived in Dachang Blocks of Baoshan District, Shanghai for more than 10 years. Presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) based on autorefraction and subjective refraction were measured separately in each eye. External eye, anterior segment and ocular fundus were examined by the ophthalmologist using slit lamp-microscopes direct ophthalmoscopy and non-mydriatic digital camera. And the leading causes of visual impairment were assured. The Chi square test was used between the groups of rate comparison. Of 5199 enumerated subjects≥60 years of age, 87.42% (4545/5199) were examined. All subjects were urban population who were originally changed from the rural population in nearly 10 years. In this population, with best-corrected visual acuity, 30 persons were diagnosed as blindness, 145 persons were diagnosed as low vision. The prevalence of blindness and low vision were 0.67%, 3.19%, respectively. Low vision was associated with female gender. It was statistically significant difference (χ2=4.88, P<0.05). The leading causes of blindness were cataract, macular degeneration, ocular absence or atrophy, glaucoma, and diabetic retinopathy or corneal diseases. With presenting visual acuity, 39 persons were diagnosed as blindness, 401 persons were diagnosed as low vision. The prevalence of blindness and low vision were 0.86%, 8.82%, respectively. Blindness and low vision were associated with older age. The prevalence of blindness and low vision increased rapidly in aged 75 years or older people. The leading causes of blindness were cataract, uncorrected refractive error, macular degeneration, ocular absence or atrophy, glaucoma. Low vision was associated with female gender. It had statistically significant difference (χ2=13.345, P<0.01). In rapidly urbanized and aging community of Shanghai, cataract, uncorrected refractive error, macular degeneration were the leading causes of blindness with presenting visual acuity. The prevalence of low vision in females was higher than that of males which had statistically significant difference. These kinds of residents needed more targeted eye health education and services.

Objective: To investigate the distribution characteristics of eye diseases and the prevalence and causes of blindness and low vision among adults aged ≥50 years in the communities of Hangzhou in China. Methods: This was a cross sectional investigation, clusters of randomly selected individuals of at least 50 years old from some larger communities in Hangzhou China were sampled, and 2 953 individuals were enrolled. The selected participants underwent detailed ophthalmic examinations that included visual acuity, autorefraction, intraocular pressure, slit-lamp assessment of the anterior surface, direct ophthalmoscopy of posterior segment, and fundus photography. The prevalence and causes of blindness and moderate-to-severe visual impairment were calculated for subjects at different ages, sexes, and educational levels. The data were analyzed by the χ2 test. Results: From the enrolled individuals, 2 363 (80%) were examined. In this population, the prevalence of blindness and moderate-to-severe visual impairment was 1.6% (38 cases), and it increased with age ( χ2=38.094, P < 0.001). We also found that the lower the level of education, the higher the incidence of blindness ( χ2=39.497, P < 0.001). Retinal diseases (30 eyes, 39.5%), cataract (26 eyes, 34.2%), and glaucoma (12 eyes, 15.8%) were the leading causes of blindness and visual impairment. In addition, the prevalence of eye diseases in this population were uncorrected ametropia (2 048 cases, 86.7%), cataract (1 065 cases, 44.7%), pterygium (219 cases, 9.3%), age-related macular degeneration (81 cases, 3.5%), glaucoma (52 cases, 2.2%), strabismus (46 cases, 2.0%), and diabetic retinopathy (39 cases, 1.7%). Conclusions: The prevalence of blindness and moderate-to-severe visual impairment were low. The most common reasons for vision impairment of older adults aged 50 years or older in the Hangzhou communities were uncorrected refractive errors and cataracts. The leading causes of blindness and visual impairment were abnormal fundus and cataract. Key words: eye disease; prevalence; community; Hangzhou

Background Blindness and low vision represent significant public health issues in China.Late diagnosis is the major reason for the irreversible vision impairment.A feasible, cost-effective screening and referral program is very important for the eye health care, prevention and treatment of blindness in China. Objective This study was to evaluate the feasibility and effectiveness of a health examination center-based opportunistic eye disease screening program. Methods This was a cross-sectional study.Subjects undergoing a routine physical examination at the health examination center of the Fourth People's Hospital of Shenyang were invited to attend this program.Presenting visual acuity, intraocular pressure, and nonmydriatic fundus photography were obtained.Optic disc photographs were evaluated independently by two ophthalmologists.Blindness and moderate to severe vision impairment were defined based on the criteria of World Health Organization Visual Impairment Classification in 2009.Glaucoma, diabetic retinopathy(DR) and other suspected eye diseases were diagnosed according to the fundus photography and intraocular pressure.This study was approved by Ethic Committe of the Fourth People's Hospital of Shenyang, the informed consent of each subject was obtained. Results Totally, 15 303 subjects were enrolled and 15 197 of them finished the exanimations, giving a response rate of 99.3%.The overall percentage of blindness and moderate to severe visual impairment was 0.08% (12/15 197) and 2.34% (355/15 197). Two hundred and twenty-eight (1.50%) subjects were defined as glaucoma suspects and 80 individuals (0.53%) were diagnosed as epimacular membrane.Other suspected eye diseases included DR (0.41%), branchial retinal vessel occlusion (0.24%), macular degeneration (0.09%), and macular hole (0.06%). More than 95% of the eye disease suspects have never been previously diagnosed or treated.A total of 358 subjects (2.36%) were defined as ocular hypertension suspects. Conclusions This health examination center-based opportunistic eye disease screening shows a good efficiency and feasibility.It may become an optional program in the national eye health care project, as well as the work of prevention and treatment of blindness. Key words: Opportunistic eye disease screening; Prevention and treatment of blindness; Eye health care

The Glaucoma Guidelines of the Swedish Ophthalmological Society

Objective To explore the prevalence of age-related eye diseases (AREDs) among people aged 70 years or above in Hangzhou and evaluate the impact of AREDs on visual function (VF) and visual-related quality of life (QOL) in elders. Methods This study involved a total 2 111 elderly people (≥70 years). All participants received visual acuity and comprehensive eye examinations and complete VF and QoL questionnaires. Results The main cause of visual impairment was AREDs. And the causes were age-related cataract (79.82%), AMD (45.64%), glaucoma (10.95%) and diabetic retinopathy (DR, 7.30%). VF and QoL scores declined gradually with age. And the scores declined more rapidly with declined visual acuity among the elders. VF and QoL scores in patients with age-related cataract, AMD, glaucoma and DR were successively lower. After adjusting for age, gender and visual acuity, the elders with AREDs had lower scores across all domains of VF and QoL. Scores for subscales of VF and QoL domains were significantly lower among those with DR and glaucoma compared with those with age-related cataract and AMD. Conclusion Age, presenting vision and AREDs are associated with VF and QoL in this elderly population. And senile people with glaucoma and DR have severe declines in VF and QoL, independent of presenting visual acuity. Key words: Elderly population; Eye diseases, age-related; Visual function; Quality of life

More than 1 billion people worldwide have vision impairment or blindness from potentially preventable or correctable causes. Quality of life, an important measure of physical, emotional, and social well-being, appears to be negatively associated with vision impairment, and increasingly, ophthalmic interventions are being assessed for their association with quality of life. To examine the association between vision impairment or eye disease and quality of life, and the outcome of ophthalmic interventions on quality of life globally and across the life span, through an umbrella review or systematic review of systematic reviews. The electronic databases MEDLINE, Ovid, Embase, Cochrane Database of Systematic Reviews, Proquest Dissertations, and Theses Global were searched from inception through June 29, 2020, using a comprehensive search strategy. Systematic reviews addressing vision impairment, eye disease, or ophthalmic interventions and quantitatively or qualitatively assessing health-related, vision-related, or disease-specific quality of life were included. Article screening, quality appraisal, and data extraction were performed by 4 reviewers working independently and in duplicate. The Joanna Briggs Institute critical appraisal and data extraction forms for umbrella reviews were used. Nine systematic reviews evaluated the association between quality of life and vision impairment, age-related macular degeneration, glaucoma, diabetic retinopathy, or mendelian eye conditions (including retinitis pigmentosa). Of these, 5 were reviews of quantitative observational studies, 3 were reviews of qualitative studies, and 1 was a review of qualitative and quantitative studies. All found an association between vision impairment and lower quality of life. Sixty systematic reviews addressed at least 1 ophthalmic intervention in association with quality of life. Overall, 33 unique interventions were investigated, of which 25 were found to improve quality of life compared with baseline measurements or a group receiving no intervention. These interventions included timely cataract surgery, anti-vascular endothelial growth factor therapy for age-related macular degeneration, and macular edema. There is a consistent association between vision impairment, eye diseases, and reduced quality of life. These findings support pursuing ophthalmic interventions, such as timely cataract surgery and anti-vascular endothelial growth factor therapy, for common retinal diseases, where indicated, to improve quality of life for millions of people globally each year.

Objective To analyze visual impairment before and after refraction in a population of Dachang county,Baoshan,Shanghai aged 60 years and older.Methods Epidemiologieal survey.Cluster sampling was used to select samples.The participants underwent a detailed ophthalmic and medical examination,including slit lamp,the presenting visual acuity testing,subjective refraction and standardized questionnaire.The definitions of blindness and visual impairment which were based on the presenting VA in the better eye were defined by criteria of WHO.The population characteristics of correctable visual impairment were also determined.Results Among the 5199 people entered in the project,4545 were examined (response rate,87.42％).The prevalence of blindness and visual impairment was 0.86％ and 8.84％,respectively.After refraction,The prevalence was 0.66％ and 3.01％,respectively.The prevalence of correctable visual impairment was 5.81％(264/4545),older age and female gender were important risk factors of correctable visual impairment.The leading cause of correctable visual impairment was cataract (45.83％),followed by refractive error (43.18％),macular degeneration (7.95％),diabetic retinoPathy (1.52％),glaucoma (1.14％) and corneal opacity (0.38％).Spectacle coverage was 44.12％,man was higher than woman.The prevalence of spectacle coverage was declining with the increasing of age.Conclusion Uncorrected refractive error was an important cause of visual impairment in older persons.The use of refractive correction is the necessary step to diagnose blindness and visual impairment. Key words: Blindness; Visual impairment; Refractive error; Spectacle coverage

Cohort Studies: Design and Pitfalls

To analyse the association of psychosocial adaptation with quality of life and to examine the influential factors for Chinese people with visual impairments. The status of psychosocial adaptation is the main influential factor for quality of life. The correlation between psychosocial adaptation and quality of life for various diseases has been studied previously. However, there have been few reports on the impact of psychosocial adaptation on quality of life in people with visual impairments. Survey. In this study, subjects with visual impairment (n = 213) were interviewed to assess their demographics, disease-related information, psychosocial adaptation status and quality of life. The psychosocial adaptation questionnaire and quality of life scale for visually impaired patients were used to survey psychosocial adaptation and quality of life. Correlation and multiple stepwise regression analyses were used to study the association of psychosocial adaptation with quality of life in visually impaired patients. Psychosocial adaptation was significantly associated with quality of life, including the sense of belonging and psychological dimensions. The results also showed that there was statistical significance for the impact of occupational status, payment, monthly income (family), vision classification and psychosocial adaptation on quality of life, and the status of psychosocial adaptation was the main factor affecting the quality of life in people with visual impairments. It was found that the status of psychosocial adaptation was conspicuously associated with multiple dimensions of quality of life. Therefore, psychosocial adaptation status should be given close attention in clinical care. Our results could be used to guide nurses in making a plan for health education and nursing that improves the quality of life for the visually impaired.

To provide an overview of some of the current activities in eye research in the Nordic countries. The presentations at the biannual Nordic Congress of Ophthalmology, held in Tampere, Finland in 2002, were reviewed and the contributions found most noteworthy are included in this article along with a limited discussion of each research field. However, space requirements prevented the inclusion of many interesting scientific contributions. Important contributions in various subfields of eye research and ophthalmology are reviewed. These include cornea, cataract, paediatric ophthalmology, glaucoma, diabetic eye disease, age-related macular degeneration, physiology and pharmacology and oncology. Eye research is very active in the Nordic countries and significant contributions are being made to ophthalmology in several fields on a world scale. We hope to continue to review Nordic contributions to eye research after each Nordic Congress of Ophthalmology and plan to make the reviews more systematic and comprehensive in the future.

Objective: To investigate the visual function, major causes of visual impairment, vision-related quality of life and rehabilitation needs of low vision patients in two communities of Beijing. Methods: Visually disabled people registered in the Desheng community, Xicheng district and the Jiuxianqiao community, Chaoyang district in Beijing were included in this cross sectional epidemiological study from September 2013 to April 2015. Interviews, visual acuity tests, slit lamp examination, and funduscopy were performed. Vision-related quality of life, a questionnaire about living conditions and rehabilitation needs were recorded during home visits. Data were analyzed with a χ2 test, t test or rank-sum test. Logistic regression were used to identify the factors relevant to vision-related quality of life. Results: There were 388 visually disabled people registered in these two communities. One hundred fifty-one patients (39.0%) were visited and evaluated at home. Of the 151 participants, 110(74.3%) were identified as low vision according to the Bangkok-Madrid standard. Among them, 66 patients (60.0%) had a best corrected visual acuity for either eye that was lower than 0.05 or the residual visual field radius was less than 10°. The main causes for visual impairment were retinal or uveal diseases 55(50.0%), glaucoma 15(13.6%), or congenital or inherited diseases 15(13.6%). Their main rehabilitation needs were going outside by themselves and reading, which amounted to 81.8%. The average score for quality of life was 47.3±26.7 with a personal interview using the low vision quality-of-life questionnaire (LVQOL). No significant relationship was found between score and sex, age, or vision function among low vision patients. But for all participants, age and residual visual field were the main factors related to quality of life (P<0.001). Conclusions: Low vision people accounted for the major portion of visually disabled people in two Beijing communities. Their visual function is poor, and quality of life drops dramatically. The main causes of their visual impairments are irreversible eye diseases. They need the most help are going outside and reading. Key words: low vision; vision related quality of life; visual rehabilitation; community; Beijing

To estimate the prevalence of cataract, glaucoma, age-related maculopathy (ARM) and diabetic retinopathy (DR) in the adult Finnish population. 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. 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 < or = 0.25) were ARM (37%), unoperated cataract (27%), glaucoma (22%) and DR (7%). 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.