Blindness In Germany Research Articles

10years of screening for retinopathy of prematurity (2009-2019) : Results analysis of two German level-1 neonatal intensive care units (NICUs) with university on-site screening and atelemedical approach in the non-university NICU

Retinopathy of prematurity (ROP) is one of the most common causes of childhood blindness in Germany and worldwide and adequate screening is essential. The telemedical approach with objective documentation of retinal findings opens up the possibility of reliably diagnosing all ROP stages independent of the examiner, if a team of ophthalmologists specialized in ROP evaluates the images. A 10-year comparison of ROP screening at two level‑1 neonatal intensive care units (NICU): university and on-site vs. non-university and telemedical. Retrospective analysis of screened premature infants by gestational age (GA), birth weight (BW), sex, multiple births, time of ROP occurrence, treatment needs and time as well as examination frequency. From 2009 to2019, we screened 1191 infants of whom 29had been screened before by an external clinic. The internal 1162 infants were screened on-site with 3713 retinal examinations. We diagnosed34% with ROP and treated 5.4% (3.7% in Giessen, 7.2% in Siegen). Mean GA was 28.9weeks (± 2.5 weeks); mean BW 1155 g (± 417.5 g). The number of ROP diagnoses increased by 227.3% in Giessen and by 111.1% in Siegen due to the increasing number of premature births in neonatal care. Comparative analysis confirmed nationally and internationally increasing ROP screening and children with acute ROP. Telemedical screening was equivalent to on-site screening and safe. Both screening methods identified infants requiring treatment on time. No child with GA > 29weeks required treatment, analogous to Swedish ROP registry results; however, in the German ROP registry some premature babies with GA ≥ 30weeks required treatment.

Early health economic evaluation of the future potential of next generation artificial vision systems for treating blindness in Germany.

The next generation of artificial vision devices (AVDs), which is currently developed in pre-clinical settings, has the potential to improve the vision of blind patients with retinitis pigmentosa (RP) in a manner that they will be categorized as visual impaired but no more as blind. This unprecedented vision improvement will result in a mentionable quality of life gain which poses the question at which costs the next generation AVDs are to be regarded as cost-effective, from a German healthcare payer perspective. In order to answer this research question a Markov model was developed to simulate and to compare the costs and effects of next generation AVDs versus best supportive care (BSC). Applying the base case settings resulted in incremental costs of €107,925, in 2.03 incremental quality-adjusted life years (QALYs) and in a cost-effectiveness ratio of €53,165 per QALY gained. Probabilistic and deterministic sensitivity analyses as well as scenario analyses for the effect size and the AVD costs were performed in order to investigate the robustness of results. In these scenario analyses a strong variation of the cost-effectiveness results was obtained ranging from €23,512 (best case) to €176,958 (worst case) per QALY gained by AVD therapy. This early health economic evaluation has to handle with three main uncertainty factors: the effect size of next generation AVDs, the costs of next generation AVDs and the WTP threshold that might be applied in RP patients, which reflect the main limitations of the presented assessment. In conclusion the presented early cost-effectiveness evaluation has obtained that next generation AVDs have the potential to be a cost-effective therapy option in patients with RP in Germany. The innovative nature, the high unmet medical need and the expected unprecedented efficacy of next generation AVDs will highly likely lead to the case that even relatively high incremental cost-effectiveness ratios, that have been obtained when simulating various effect and pricing scenarios, will be regarded as acceptable from a German healthcare payer perspective.

PSS35 - The Future Health Economic Potential of Next Generation Artificial Vision Devices for Treating Blindness in Germany: an Early Cost-Utility Assessment

PSS35 - The Future Health Economic Potential of Next Generation Artificial Vision Devices for Treating Blindness in Germany: an Early Cost-Utility Assessment

Ätiologie und Pathogenese der altersabhängigen Makuladegeneration

Age-related macular degeneration (AMD) is the most common cause of blindness in Germany. Due to the demographic development a further increase of affected patients is to be expected. Improved understanding of AMD pathogenesis resulted from the molecular biological approaches in recent years and showed an association of genetic factors with AMD. The complement factor H gene and the second high-risk locus ARMS2 in particular were found to contribute a significant risk for development of the disease. Ageing and environmental factors, such as smoking, modulate the individual genetic risk profile. A detailed understanding of the complex AMD pathogenesis is also relevant in ophthalmological practice to understand new treatment strategies. In this review we aim to give an overview of the interplay of ageing, external environmental factors and genetic risk variants leading to AMD.

Recent data suggest a considerable decrease in total and cause-specific incidences of blindness in Germany – Decrease in the incidences of blindness in Germany

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Blindness and Visual Impairment in Germany

Some 70% of all cases of blindness in Germany are due to diseases of old age. As the population at large is aging, the prevalence of blindness and visual impairment would be expected to rise. To assess this, we studied prevalence trends in Germany over the past three decades. We calculated the age- and sex-standardized prevalence of blindness in Germany using data from the archive of the blind registry of the Rhineland Regional Council (Landschaftsverband Rheinland, LVR) for the years 1978 to 2006. We then validated the findings with the aid of data on blindness and visual impairment from the Statistics on Severe Disability (Schwerbehindertenstatistik, SBS) that are published periodically by the German Federal Statistical Office. The number of registered blind persons in the Rhineland increased from 10,665 in 1978 to 12,706 in 1987 and 15,766 in 1997, but it changed little thereafter, remaining at 15,725 in 2006. There was a corresponding trend in the prevalence of blindness in the Rhineland, which rose from 116.8 to 165.6 per 100,000 persons from 1978 to 1997 but was roughly the same, at 163.1 per 100,000 persons, in 2006. The SBS data on blindness and visual impairment reveal a decline in prevalence from 392 to 372 per 100,000 persons between 1987 and 2005. The standardized prevalence rates for blindness and visual impairment in Germany have been declining slowly since about 1997. Blindness and visual impairment have become slightly less common in Germany, even though the population is aging. This may be due, at least in part, to better eye health care.

Evidence for a considerable decrease in total and cause-specific incidences of blindness in Germany

The objectives of this study are to estimate the recent population-based incidences of all-cause and cause-specific blindness in Germany and compare them with results from a similar study conducted in 1994-1998. All blindness allowance recipients newly registered between January 2008 and December 2009 in a region in southern Germany (population, approximately 3.5 million) were assessed and their ophthalmological reports reviewed. The main causes of blindness were identified and their incidences estimated. There were 572 newly registered cases of blindness allowance. The all-cause incidence of blindness (per 100,000 person-years) in the general population was 8.4 (95% confidence interval, 7.8-9.2), and the highest incidences were for macular degeneration (3.4; 3.0-3.9), diabetic retinopathy (0.8; 0.6-1.1) and glaucoma (0.7; 0.5-0.9). During the last two decades, blindness incidences decreased for all the main causes (standardised to the West German population 1991: 12.3; 11.9-12.7 in 1994-1998 vs. 7.3; 6.7-8.0 in 2008-2009). The highest absolute decrease was for macular degeneration and the highest relative decrease was for cataract. The most frequent main causes of blindness in Germany remained macular degeneration, diabetic retinopathy and glaucoma. Our findings suggest a remarkable decrease in the incidences of blindness, probably because of new diagnostic options and effective treatments.

Versorgung von älteren Menschen mit neovaskulärer altersabhängiger Makuladegeneration

Neovascular (nv) age-related macular degeneration (AMD) is the leading cause of blindness in Germany and is usually treated with monthly injections of anti-VEGF agents. The current level and the estimated need of service provision for nv-AMD were assessed. Current levels of service provision with ranibizumab (Lucentis) were documented in 3,633 patients in the WAVE study, the currently largest observational study in Germany on the use of anti-VEGF agents. The expected need was calculated using German population figures for 2010 and available prevalence data. Both were stratified by age and gender and descriptively analyzed. A larger number of younger patients with nv-AMD (< 75 years) than expected were treated in the WAVE study. Expected need in the age groups 75-84 years and 84 years and older was much higher than the proportion of patients actually treated in these age groups (up to 3 times). Based on expected need, women accessed treatment less often than men. In the WAVE study, less elderly persons and in particular elderly women seemed to access treatment for nv-AMD than expected. Future studies should investigate barriers in accessing treatment for nv-AMD and how to address these problems.

Prevalence and causes of registered blindness in the largest federal state of Germany

AimAs no current estimates for the prevalence and causes of blindness in Germany are available, the database of Germany's largest welfare institution (covering 9.5 million people in the federal state...

Diabetische Makulopathie

Due to demographic change the incidence of diabetic retinopathy has risen in spite of new facilities and prevention campaigns and is still one of the leading causes of blindness in Germany. The combination of focal/grid laser photocoagulation and an intravitreal anti-VEGF (vascular endothelial growth factor) regimen is the first line approach for clinically significant macular edema with foveal involvement and is evidence-based. Vitreomacular interface abnormalities can be effectively treated by modern vitreomacular surgery. Unfortunately, no proven treatment modality can be provided for ischemic maculopathy. The management of systemic risks factors, such as hyperglycemia and arterial hypertension, remains a task of great importance despite all modifications and increase of knowledge during recent years. Innovative developments in the field of intravitreal pharmacotherapy have opened up new vistas. There are good prospects that modern ophthalmology will not be limited to preserving visual function but to allow improvements and consequently enhance health-related quality of life for diabetic patients.

Kunstlicht und Sehen - Stress für das Auge durch moderne Lichtquellen

Licht hat nicht nur toxische Wirkungen auf das Hormonsystem, sondern auch auf das Auge. Seit Langem ist bekannt, dass UV-Strahlung zu einer Eintrübung der Augenlinse führt und damit die Entstehung des Grauen Stars fördert. Allein in Deutschland müssen sich pro Jahr über 600 000 Patienten einer Staroperation unterziehen. Nach heutiger Erkenntnis hat die eingetrübte Augenlinse jedoch nicht nur Nachteile für den Betreffenden, sondern schützt durch ihre verminderte Durchlässigkeit auch die Stelle des schärfsten Sehens, die sogenannte Macula lutea. In den vergangenen Jahren ist auffällig geworden, dass Patienten in den fünf Jahren nach einer Staroperation mit Austausch der getrübten Linse durch eine transparente Kunstlinse statistisch signifikant häufiger eine altersbedingte Makuladegeneration (AMD) entwickeln. Diese bislang unheilbare Augenerkrankung führt zu einer fortschreitenden Zerstörung der Stelle des schärfsten Sehens und endet meist mit Erblindung. Die AMD ist mit 50 % die häufigste Ursache für erworbene Blindheit in Deutschland. Die Ursache der Erkrankung gilt als unbekannt, wobei aber hohes Alter, Sonnenexposition sowie Herz-Kreislauf-Erkrankungen begünstigend wirken sollen. In einer Vielzahl von Zellversuchen wurde festgestellt, dass blaues Licht die Rezeptorzellen der Netzhaut oxidativ schädigt und die Entwicklung der AMD vorantreiben kann. Daher werden mittlerweile anstatt farbloser Ersatzlinsen immer häufiger gelb gefärbte Kunstlinsen eingesetzt, um so die Makula zu schützen. Blaues Licht dringt auch im gesunden Auge ungehindert bis zur Netzhaut vor und erzeugt dort oxidativen Stress, wobei besonders die Mitochondrien (Zellkraftwerke) der Fotorezeptoren betroffen sind. Licht mit einer Wellenlänge über 650 nm kann hingegen durch eine Stimulation der Cytochromoxidase, einem wichtigen Enzym der Energiegewinnung in den Mitochondrien, derartige oxidative Schäden wieder kompensieren.

Steroide bei Sehnerverkrankungen?

Diseases of the optic nerve are the third most common cause of blindness in Germany. Common optic nerve diseases include optic nerve neuritis and traumatic optic neuropathy. These diseases are often treated with steroids. In the case of traumatic optic neuropathy, recent results indicate that such treatment is not of value, and can even be dangerous due to the side effects if the doses are high. Based on current results, the value of high dose steroid treatment for optic nerve neuritis is also questionable.

Blindness Incidence in Germany

Few data on the incidence of blindness in Germany are available. We analysed causes of legal blindness for the region Württemberg-Hohenzollern (population 5.5 million) in order to help fill in this gap. Material and Methods: Population-based investigation on the incidence of legal blindness (visual acuity <1/50) based on materials from the social servies. Age-dependent blindness incidences were modelled via logistic regression models. Results: 647 blind persons were newly registered in 1994 (blindness incidence 11.6/100,000). The blindness incidence is moderate in infants (4.5/100,000) and decreases further during childhood. At the age of 20 years, the incidence again rises to the former level and remains relatively constant. After the age of 60 years, the incidence increases sharply: 5-year odds ratios are 1.76 (CI: 1.68–1.85) in women and 1.72 (CI: 1.60–1.84) in men. The blindness incidence is higher in women, 15.6/100,000, compared to 12.2/100,000 in men. The major causes of blindness are: macular degeneration, 3.92/100,000; diabetic retinopathy, 2.01/100,000; glaucoma, 1.6/100,000; high myopia, 0.77/100,000; optic atrophy, 0.68/100,000; central nervous system-triggered blindness; 0.56/100,000, and tapetoretinal degenerations, 0.52/100,000. Discussion: Due to monetary incentives for the blind persons, social service files offer accurate and complete data. Besides macular degeneration, glaucoma and diabetic retinopathy are major causes of blindness. Thus, this study suggests further blindness prevention activities for diabetic retinopathy and glaucoma.

GONOCOCCUS INFECTION AS A CAUSE OF BLINDNESS, VULVOVAGINITIS AND ARTHRITIS.

CAUSE OF BLINDNESS. The most important of the causes of blindness with which we have to do is that resulting from a gonococcus infection of the eyes of the child at birth. Important— first, because it is the most common cause of blindness; second, because it affects the young child and a long lifetime of blindness may follow; and third, because it is preventable and curable in practically every case receiving proper care, and because it is one of the most dangerous maladies to vision when treatment is neglected or delayed. It is a veritable world plague. It occurs everywhere and no country has yet succeeded in getting it completely under control. So widespread is blindness resulting from it that Magnus, who has made careful statistical studies concerning it, says that out of 2,528 cases, of all ages, of complete blindness in Germany 10.88 per cent. were due to this