Visual acuity of urban and rural adults in a coastal province of southern China: the Fujian Eye Study.

Background: Visual impairment (VI) and blindness remain the major public health problems worldwide and have a profound impact on an individual’s health and quality of life as well as on society. To broaden the mode of ophthalmologic epidemiological survey, and evaluate the prevalence and demographic associations of distance and near vision impairment in urban and rural population in a province of Southern China in which includes both coastal and inland areas. Methods: The Fujian Eye Study was a population-based cross-sectional study during 2018-2019. Residents aged ≥ 50 years in randomly sampled communities were recruited (10090 subjects). The survey covered urban and rural populations, and coastal and inland populations. Participants underwent a questionnaire about socioeconomic and biological factors and a series of standard examinations both physical and ocular. Findings: 8211 (81·4%) were eventually enrolled, including rural (3533 subjects) and urban (4678) population, or coastal (6434) and inland (1777) groups. Mean age was 64·39 (SD 8·87) years. Mean uncorrected distance visual acuity (UDVA) was 0·61 (0·30), best corrected visual acuity (BCVA) was 0·82 (0·28) and uncorrected near visual acuity (UNVA) was 0·28 (0·17). 0·45% of the participants were blind, 3·33% had distance vision impairment (DVI), 68·58% had present near vision impairment (PNVI), presbyopia was noted in 68·33% participants and 2·85% had combined vision impairment (CVI). The rate of PNVI was higher in rural population compared with urban population (70·48% vs 67·13%). DVI rate was higher in inland population compared with coastal population (5·08% vs 2·79%). CVI rate was higher in both rural and inland population (3·43% vs 2·33%, 3·97% vs 2·50%). VI was significantly correlated with socioeconomic or biological factors, including age, urban and rural region, coastal and inland area, educational background, income and refractive error, whereas sex was not significantly associated with VI. Interpretation: There was still high prevalence of blindness and VI in China. The percentage of PNVI was higher in rural population, DVI rate was higher in inland population, and CVI rate was higher in both rural and inland populations, which suggesting a need for increasing accessible services with improvement resources and advocacy for enhancing eye health literacy. Funding Statement: The National Natural Science Foundation of China. Declaration of Interests: XXL’s institute received financial support of the National Natural Science Foundation of China (no·81870672) from the National Natural Science Foundation Committee. All authors declare no competing interests. Ethics Approval Statement: The 2018–2019 FJES protocol was approved by the Ethics Committee of Xiamen Eye Center affiliated with Xiamen University, and informed consent was obtained from all participants.

PurposeTo describe the objective and design of the Fujian Eye Study and to introduce the general characteristics and vision condition of this study.MethodsThe Fujian Eye Study (FJES) is a population-based cross-sectional survey on the public eye health status of residents over 50 years old in the entire Fujian Province of Southern China, which contains both urban and rural areas and coastal and inland regions. 10,044 participants were enrolled using a two-stage cluster sampling design and underwent a questionnaire and a series of standard examinations both physical and ocular. The main subgroups of data collection included age, sex, region, refractive error, education background, income, eating habits, smartphone usage in the dark, complaints of eye discomfort, history of chronic diseases, consumption of tobacco, alcohol, or tea.Results8211 (81.8%) participants were finally included and were divided into urban populations (4678 subjects) and rural populations (3533 subjects) and coastal residents (6434 subjects) and inland residents (1777 subjects); 4836 participants were female. The mean age was 64.39 (SD 8.87) years (median 64 years; range 50–98 years). 227 (3.33%) had vision impairment (VI), 195 (2.87%) had low vision and 14 (0.21%) were blind. The mean presenting near visual acuity (PNVA) was 0.28 (0.17), the mean presenting distance visual acuity (PDVA) was 0.61 (0.30), and the mean best corrected visual acuity (BCVA) was 0.82 (0.28).ConclusionsThe FJES collected detailed questionnaire information and overall ocular and physical examinations, which provide the opportunity to identify risk factors and images of VI and eye diseases and to evaluate their associations with chronic diseases and basic personal information.

Objective To determine the incidence of refractive errors at children 3 to 9 years of age in the area of Tetovo, Macedonia in rural and urban population. Methods Population-based cross-sectional samples of children 3 to 9 years in rural and urban population were obtained through full ophthalmologic examination, and they underwent slit-lamp examination, ocular motility and refraction. They were presenting uncorrected and best-corrected visual acuity, along with refractive error under topical cycloplegia. Children 3 to 6 years of age with a visual acuity of 20/40 or worse and those 6 to 9 years of age with a visual acuity of 20/30 or worse underwent a complete ophthalmic examination to determine the cause of visual impairment. A spherical equivalent of -0.5 diopter (D) or worse was defined as myopia, +2.50 D or more was defined as hyperopia and a cylinder refraction greater than 0.75 D was considered astigmatism plus or minus. Results The uncorrected visual acuity was 20/45 or worse in the better eye of 119 children, 59 male / 60 female (5.1% of participants). According to results of cycloplegic refraction, 1.6% of the children were myopic, 7.3% were hyperopic and the incidence rate of astigmatism was approximately 0.7%. In the multivariate logistic regression myopia and hyperopia were correlated with age ( P = 0.040 and P Conclusions The study showed a considerable prevalence rates of refractive errors myopia, hypermethropia, astigmatism and amblyopia at children of 3-9 years of age in Tetovo. There was no correlation between sex of the children's and the refractive errors founds. There was a correlation with the need for corrective spectacles and the refractive errors they represent. Refractive errors was registered in high percentage at rural area than in urban area. Although with best corrected vision the prevalence of impairment was less in urban than in rural populations, blindness remained nearly twice as high in the rural population as in the urban population with both baseline and best corrected visual acuity.

The objective of this study was to evaluate the results of laser in situ keratomileusis (LASIK) for high myopia after a follow-up of two years. A total of 42 eyes from 33 patients with high myopia (range: -9.00 D to -25.50 D) were studied. LASIK was performed using an automated microkeratome (Steinway, USA) and OmniMed II excimer laser with the standard MKM program (Summit Technology, Inc., Waltham, MA) in all patients. The patients were followed up at one, three, six, 12 and 24 months. During follow-up manifest refraction and best corrected and uncorrected visual acuity were measured. Any complications were also analyzed. The two-year follow-up results were as follows. The mean postoperative manifest spherical equivalents (MSE) were -0.51 D at one month, -1.09 D at three months, -1.78 D at six months, -2.17 D at 12 months and -2.61 D at 24 months. Myopic regression continued during the two-year follow-up (p < 0.05). The accuracy of the intended postoperative correction within +/- 2.00 D was 73.8% at one month, 69.1% at three months, 52.4% at six months, 52.4% at 12 months, and 45.2% at 24 months. The best corrected visual acuity (BCVA) was unchanged or increased in 35 eyes (83.3%). Only three eyes (7.2%) lost two or more lines of BCVA. This was due to irregular astigmatism in one eye, macular degeneration in one eye, and rhegmatogenous retinal detachment in one eye. In this study, LASIK was effective and safe in the correction of high myopia, however continuous myopic regression was seen over the two-year follow-up. Refining the nomogram to adjust for progressive myopic regression will be necessary in order to obtain better results.

To assess the efficacy, duration of effect and safety of one intravitreal injection of bevacizumab in diabetic macular oedema (DMO). Bevacizumab (1 mg/0.04 ml) was injected intravitreally into eyes with DMO (29 with and nine without previous treatments). Best corrected visual acuity (BCVA), intraocular pressure and central retinal thickness (CRT) were measured; slit-lamp examination, macular biomicroscopy, optical coherence tomography and fluorescein angiography were performed before and at 2-4, 8 and 12 weeks post-injection. Best corrected VA and CRT were analysed in both groups. In the non-pretreated group, mean BCVA improved from 0.76 +/- 0.33 (baseline) to 0.57 +/- 0.30 and 0.54 +/- 0.27 at 2-4 weeks and 8 weeks post-injection, respectively (p = 0.02, p = 0.014, paired t-test). Mean CRT decreased from 632.4 +/- 196.0 microm (baseline) to 392.3 +/- 113.6 microm and 370.4 +/- 141.7 microm at the same time-points, respectively (p = 0.01, p = 0.01). There was no difference in BCVA or CRT at 12 weeks. In the pretreated group, mean BCVA improved from 0.62 +/- 0.30 (baseline) to 0.53 +/- 0.33 at 2-4 weeks post-injection (p = 0.01), and mean CRT decreased from 583.9 +/- 180.7 microm (baseline) to 404.1 +/- 197.9 microm at 2-4 weeks post-injection (p < 0.001). Mean BCVA was unchanged at 8 weeks and 12 weeks post-injection, although mean CRT remained lower at 8 weeks (p = 0.004). No ocular or systemic side-effects developed during follow-up. One intravitreal injection of bevacizumab for DMO seems to be effective and safe in both eyes that have been treated previously and eyes that have not. The therapeutic effect is temporary and repeat treatment may be needed.

Objective To analyze the correlation between ocular fundus characteristics, diopter and best corrected visual acuity (BCVA) in adolescents with high myopia. Methods The clinical data of 101 adolescent patients (195 eyes) with high myopia who was less than or equal to 18 years old and had diopter greater than -6 D were retrospectively analyzed. The correlation between ocular fundus characteristicss, diopter and BCVA was analyzed. Results There was a positive correlation of diopter with the posterior pole retinal atrophy, tigroid fundus, the paripapillary atrophy β zone, the tilted optic disc (r=0.886, 0.533, 0.544, 0.691; P=0.000, 0.030, 0.028, 0.009). There was a positive correlation of BCVA with the posterior pole retinal atrophy, tigroid fundus, the paripapillary atrophy β zone, the tilted optic disc (r=0.816, 0.041, 0.537, 0.711; P=0.000, 0.483, 0.030). Conclusions Tigroid fundus, posterior pole retinal choroid atrophy, the paripapillary atrophy β zone, tilted optic disc are related to BCVA and diopter in patients with myopia, of which the posterior polar lesion will seriously affect the level of visual acuity in patients. Key words: Adolescent myopia; Fundus characteristics; Diopter; Best corrected visual acuity

Background: Central serous chorioretinopathy (CSCR) is an idiopathic disorder in which there is leakage of fluid from hyper permeable choriocapillaris and the collection of fluid between neurosensory and neuropigmentry retina in the macular area that is responsible for decrease visual acuity. CSCR may be acute or chronic. Various treatment options include simple observation, argon laser photocoagulation of the leaking spot, photodynamic therapy (PDT), oral ketoconazole and oral rifampicin are available. Ranibizumab is a monoclonal antibody fragment that act as vascular endothelial growth factor inhibitor, stabilize blood retinal barrier and decrease leakage from choriocapillaris. This study aims to evaluate the role of intravitreal ranibizumab for rapid recovery in central serous chorioretinopathy. Patients and methods: This descriptive case series was carried out at Department of Ophthalmology, Nishtar Medical University Multan, Pakistan from 01-10-2019 till 30-04-2020. The study included twelve eyes of twelve patients suffering from acute CSCR. All patients were given a single injection of intravitreal ranibizumab (0.5mg/0.05ml) as a primary treatment and followed for two months after injection at one week, one month and two months interval to document efficacy of intravitreal ranibizumab. At each baseline and follow up visits, dilated fundus examination was carried out, ending up with patients’ best corrected visual acuity. Central retinal thickness (CRT) was also recorded and results were compared with prior visit results of patients. Major outcomes were the improvement in visual acuity and decrease in CRT. Baseline CRT values were also compared with post injection CRT values at one week, one month and two months intervals using paired sample t-test and best corrected visual acuity (BCVA) was compared using chi–square test. Results: Mean age of the patients was 39.6 years with a male to female ratio of 9:1. Best corrected visual acuity was 6/60 on Snellen chart at baseline. All patients exhibited mean improvement of best corrected visual acuity of three Snellen lines after one week. Eleven patients were back to best corrected visual acuity of 6/6 after one month. Remaining one patient gained best corrected visual acuity of 6/6 after two months of post injection. The mean CRT at presentation was 500 ± 80U (range; 386–580) which reduced significantly to 272 ± 52 U (range 220–338) from baseline after one month showing significant reduction (p&lt;0.001). At the last follow-up visit, the CRT was measured 230 ± 20 U (range 220—250) which shows complete resolution of sub-retinal fluid. Conclusion: Intravitreal ranibizumab can be used for rapid absorption of sub-retinal fluid in acute CSCR and significant reduction in CRT along with improvement in BCVA indicate that it may be safely employed in CSCR to achieve better clinical outcomes.

Purpose:To compare the prevalence of refractive errors and factors associated with spectacle use in a ruraland urban south Indian population.Materials and Methods:Four thousand eight hundred subjects (age >39 years) each from rural andurban Tamil Nadu were enumerated for a population-based study. All participants underwent a completeophthalmic evaluation including best-corrected visual acuity (BCVA), objective and subjective refraction. Outof 3924 rural responders 63.91% and out of 3850 urban responders 81.64% were phakic in the right eye withBCVA of 20/40 or better and were included in the study. Association of spectacle use and refractive errors withdifferent parameters were analysed using logistic regression.Statistical Analysis:Chi square, t test, Chi square for trend and Pearson′s correlation coefficient were usedfor analysis.Results:Spectacle use was significantly higher and positively associated with literacy and employment in theurban population. The age and gender-adjusted prevalence of emmetropia, myopia of spherical equivalent(SE) ≤-0.50 diopter sphere (DS), high myopia (SE ≤-5.00DS), hyperopia (SE >0.50DS) and astigmatism ≤0.50 diopter cylinder (DC) were 46.8%, 31.0%, 4.3%, 17.9% and 60.4% respectively in the ruralpopulation and 29.0%, 17.6%, 1.5%, 51.9%, 59.1% respectively in the urban population. The prevalenceof emmetropia decreased with age (p < 0.001); prevalence of myopia and high myopia increased with age (p = 0.001) and wereassociated with nuclear sclerosis (p = 0.001) in both populations. Hyperopia was commoner among womenthan men (p = 0.001); was positively associated with diabetes mellitus (p = 0.008) in the ruralpopulation and negatively with nuclear sclerosis (p = 0.001) in both populations.Conclusion:Spectacle use was found to be significantly lower in the rural population. The pattern ofrefractive errors was significantly different between both populations.

To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti-vascular endothelial growth factor (VEGF) treatment with Ranibizumab. A consecutive series of 39 study eyes with centre-involving DME were included in this study. In all subjects, best-corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD-OCT) cross-sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross-sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained. Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = -1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = -3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = -4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = -1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = -0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = -2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment. ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti-VEGF therapy with Ranibizumab in patients with DME.

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 report the surgical outcome of pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling in three highly myopic patients with macular retinoschisis and associated posterior staphyloma. We report three highly myopic patients with macular retinoschisis and foveal detachment who underwent simple PPV without ILM peeling, with long-acting gas tamponade. Main outcome evaluations included best corrected visual acuity, biomicroscopic appearance and optical coherence tomography findings. Pars plana vitrectomy without ILM peeling resulted in anatomic and functional improvement in all three operated eyes for follow-up periods of > or = 12 months. Pars plana vitrectomy without ILM peeling is effective for treating macular retinoschisis and foveal detachment in highly myopic eyes with posterior staphyloma. Visual and anatomic outcomes are comparable with those in previous studies in which ILM removal was performed.

Objective: To assess the surgical outcomes of cataract surgery combined with phakic posterior chamber intraocular lens (ICL) implantation in the contralateral eye for patients with high myopia and monocular cataract. Methods: This is a retrospective case series study. Clinical data were collected from 10 patients (20 eyes) with high myopia and monocular cataract who underwent phacoemulsification cataract extraction and intraocular lens implantation in the cataract eye (cataract surgery eye), and implantable Collamer lens (ICL) implantation in the contralateral eye (ICL implantation eye) at the Ophthalmology Department of the Army Characteristic Medical Center from June 2021 to December 2023. Among them, there were 4 males and 6 females, with an average age of (35.60±7.62) years. Uncorrected visual acuity was measured using the international standard visual acuity chart, and spherical equivalent (SE) and best corrected visual acuity (BCVA) were obtained through comprehensive optometry. Visual acuity was recorded in the form of logarithm of the minimum angle of resolution (logMAR). Objective visual quality parameters were obtained using a visual quality analysis system, and subjective visual quality was obtained through questionnaire surveys. Postoperative accommodative function and defocus curve were also examined. Various indicators before and 5 months after surgery were compared between the two eyes. Results: The BCVA in the cataract surgery eye significantly improved postoperatively (P<0.05), while no significant change was observed in the ICL implantation eye (P>0.05). Postoperative UCVA for the cataract surgery eye was 0.12±0.12 for distance, 0.18±0.18 for intermediate, and 0.28±0.20 for near vision. For the ICL implantation eye, these values were 0.10±0.11, 0.00 (0.00, 0.03), and 0.01 (0.00, 0.06), respectively. Objective scatter indices postoperatively were 2.20±1.82 for the cataract surgery eye and 0.90 (0.48, 1.90) for the ICL implantation eye. All patients became spectacle-independent postoperatively, with 6 experiencing halo phenomena that did not affect their daily life. The average patient satisfaction score was 9.5. The ICL implantation eye showed better accommodative amplitude and facility than the cataract surgery eye, with statistically significant differences (both P<0.05). The defocus curve indicated good binocular visual acuity, and no severe intraoperative or postoperative complications were reported. Conclusions: For patients with high myopia and monocular cataract, the combination of cataract surgery and ICL implantation in the contralateral eye effectively enhances postoperative visual acuity and quality, preserves natural accommodation, establishes binocular vision balance, and facilitates spectacle independence. The procedure is safe, reliable, and improves the quality of life and work.

Prevalence of Vision Impairment in Older Adults in Rural China: The China Nine-Province Survey

Purpose: The purpose of this meta-analysis is to evaluate the effect of posterior scleral reinforcement (PSR) on axial length (AL), spherical equivalents (SE) and best corrected visual acuity (BCVA) in children with high myopia. Methods: The databases PubMed, EMBASE, Wanfang Database, CNKI, CSTJ and Cochrane Library from inception to March 2021 were searched to identify the relevant studies which evaluated the efficacy of PSR for patients under 18 years old with high myopia. The main parameters include AL, SE and BCVA. Revman software version 5.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval were calculated using dersimonian-laird model. Results: 8 studies including 383 PSR treated and 281 control eyes were finally included. Our analysis indicated that PSR could slow down the increase of AL and the loss of vision loss (P&lt;.01). However, in the subgroup with a follow-up period shorter than three years, there was no statistical difference in BCVA changes between the PSR and control groups (WMD=-0.02, 95%CI -0.07 to 0.04, P=.58, I2=0%). The BCVA changes is significant after 3 years follow up (WMD=-0.13, 95%Cl -0.21 to -0.05, P=0.007). Conclusion: PSR can benefit children in controlling the growth of AL, SE and decrease of visual acuity. 3 years after PSR may be a critical time point. Given the limitations in our study, more research with larger sample sizes and more accurate data are required to reach a firmer conclusion.

To explore the relationship between the choroid vascular index (CVI) and best corrected visual acuity (BCVA) in a young population with high myopia (HM). Three hundred twenty-six patients with HM were recruited. All subjects underwent a comprehensive ophthalmic examination and enhanced depth imaging optical coherence tomography (EDI-OCT). The horizontal and vertical subfoveal choroidal areas within a 3-mm diameter centred over the fovea were selected. Choroid thickness (ChT), horizontal and vertical total choroidal area (TCAH and TCAV), luminal area (LAH and LAV) and stromal area (SAH and SAV) within the 3-mm diameter were assessed. CVI values (CVIH and CVIV), defined as the ratio of LA to TCA, were also calculated. The correlations among choroid parameters and ocular characteristics were analysed. The median age, spherical equivalent (SE) and BCVA were 22.4 years, -10.1 dioptres and 0.099 logMAR, respectively. The ChT was thickest on the temporal and superior sides of the macula and thinnest in the nasal region, with a significant difference. The value of CVIH was significantly greater than that of CVIV because SCAH was smaller than SCAV. Both CVIH and CVIV were closely correlated with BCVA in all patients. The CVI is significantly related to BCVA but is not affected by age, axial length or SE, suggesting that the CVI could be used as an adjunct tool for assessing the visual acuity status in patients with HM.