Cause Of Visual Impairment Research Articles

Anti-VEGF Drugs in Age-Related Macular Degeneration: A Focus on Dosing Regimen-Related Safety and Efficacy.

Age-related macular degeneration (AMD) is one of the main causes of visual impairment and severe visual loss, and can progress to two advanced forms-neovascularization and atrophic. The field of anti-AMD drugs has undergone huge developments in recent years, from single-target intravitreal administration to current clinical studies with multi-target and non-invasive agents, offering interesting new pharmacological opportunities for the treatment of this disease. Hence, we summarize some of the approved anti-vascular endothelial growth factor (VEGF) drugs for neovascular AMD, especially their structural characteristics, clinical manifestations, dosing regimens, and safety issues of the anti-VEGF drugs highlighted. In addition, advances in atrophic AMD drug research are also briefly described.

Clinical Evaluation of MyoCare in Europe (CEME): study protocol for a prospective, multicenter, randomized, double-blinded, and controlled clinical trial

BackgroundMyopia prevalence has been increasing in the last decades, and its pathological consequences, including myopic maculopathy and high myopia-associated optic neuropathy, are now one of the most common causes of visual impairment. It is estimated that by 2050, more than 50% of Europeans and Americans will be myopes, which is alarming due to the high morbidity of myopes over − 6.00D. Once myopia has appeared, there are different options with scientific evidence to try to slow the axial length growth. Ophthalmic lenses are the less invasive treatment to control myopia, and there is evidence about the efficacy of different designs, mainly in the Asiatic population. However, new designs have been launched, and it is not known if efficacy is the same between Asiatic and European subjects. Thus, we have set up a randomized, controlled, double-blind, and multicenter trial to investigate the efficacy of a new design of ophthalmic lenses for myopia control in European children.MethodsA 2-year prospective, multicenter, randomized controlled, and double-blind clinical trial is used to investigate the efficacy of a new design of ophthalmic lenses to slow the progression of myopia. Three hundred children aged from 6 to 13 years old will be recruited and randomly assigned to a study or control group. The study group will be composed of 150 children wearing MyoCare while the control group will be composed of 150 children wearing Clearview. The inclusion criteria will be myopia with a spherical equivalent between − 0.75D and − 5.00D, astigmatism < 1.50D, and anisometropia < 1.00D and having a historical evolution of at least − 0.50 The primary outcome is to compare the mean annual progression of the spherical equivalent between both groups. The secondary outcomes are axial length, choroidal thickness, phorias, and accommodative status of both groups.DiscussionThis study will be the first randomized and controlled clinical trial in European children with spectacle lenses based on simultaneous competing defocus. The results will shed light on the clinical evidence of spectacle lenses relying on this new design for the management of myopia with results of efficacy in the non-Asiatic population.Trial registrationEU Clinical Trials Register (EudraCT) 2022–001696. Registered on 27 April 2022. ClinicalTrials.gov NCT05919654. Registered on 26 June 2023.

Effects of prematurity and retinopathy of prematurity on refractive errors and biometric optic components in school children: results of a tertiary center from Turkey.

To reveal refractive errors, the relationship between refractive errors and optical parameters, and the effect of prematurity and retinopathy of prematurity (ROP) on ocular development in school children with a history of prematurity. Premature children aged 8-12years were divided into 3 groups as those without ROP (Group 1), with ROP that did not require treatment (Group 2), and with laser-treated ROP (Group 3). Age-matched full-term healthy children were included in the control group. Demographic features were recorded. A detailed ophthalmologic examination was performed. Anterior chamber depth (ACD), trabecular-iris angle (TIA), iris thickness (IT), lens thickness (LT), vitreous body length (VBL),axial length (AL) were measured by ultrasound biomicroscopy (UBM). The results were compared between groups. Group 3 had the lowest best corrected visual acuity (0.81 ± 0.31 SL), the highest rates of myopia (55.9%) and astigmatism (50.0%). In the premature groups, ACD (p < 0.001), TIA (p < 0.001), IT (p = 0.016), VBL (p < 0.001) and AL (p < 0.001) were lower; LT (p < 0.001) was higher than in the control group. As birth weight (BW) and gestational age (GA) increased, ACD, TIA, VBL and AL increased, and LT decreased (p < 0.001). In the group 3, 35.2% anisometropia, 17.6% of esotropia and 5.9% of exotropia were detected. The frequency of myopia, astigmatism, hyperopia and anisometropia is increasing in premature children, especially in cases with laser-treated ROP. Premature cases are characterized by thicker lens, shallower ACD, narrower TIA and shorter AL. Refractive errors, anisometropia, amblyopia and strabismus are important causes of visual impairment in children with laser-treated ROP.

Significant improvements in cataract treatment and persistent inequalities in access to cataract surgery among older Poles from 2009 to 2019: results of the PolSenior and PolSenior2 surveys.

Cataract is the leading cause of visual impairment and blindness among older adults worldwide, that can be corrected through surgical interventions. However, diagnosis and treatment bias can be observed, and it is a major issue for improving health policies. Therefore, we assessed a declared prevalence of cataract and the frequency of surgical treatment of this condition in the Polish population in the years 2009-2019. To provide evidence of health inequalities, we compared operated and non-operated seniors using selected socioeconomic factors and identified variables affecting the availability of cataract surgery services over a 10-year follow-up period. An analysis based on a survey among 4,905 participants of the nationwide PolSenior study conducted in 2008-2009, and 5,031 participants of PolSenior2 conducted one decade later to assess the health of Poles over 65 years of age. Cataract diagnosis was declared by 25.5 and 28.2% of the study population in PolSenior and PolSenior2 surveys, respectively. Out of those diagnosed with cataract in PolSenior, 46.5% underwent surgical treatment for at least one eye. This rate increased up to 67.9% in the survey conducted 10 years later. Independent factors increasing the chance for cataract surgery in both cohorts included male sex and age > 75 years. Additional factors were self-reported good health status in PolSenior and lack of financial problems in purchasing medicines in PolSenior2. Over the investigated decade, the chances for cataract surgical treatment increased in single-living and widowed patients. The shortage of funds for medications remained the only significant barrier for surgery. Although the prevalence of cataract in the older adult population in Poland has not changed from 2009 to 2019, the rate of cataract surgeries has considerably increased over the analyzed decade. Patients with lower socioeconomic status and women have lower access to surgical cataract management.

Managing Pediatric Cataract Patients – The Whole Story: Aphakic Contact Lenses in Children – Techniques and Challenges

ABSTRACT Infantile cataract is one of the major causes of visual impairment in children. This article will discuss some of the techniques, challenges, complications, and compliance issues with aphakic contact lenses.

Effects of inflammation on myopia: evidence and potential mechanisms.

As the most common type of refractive error, myopia has become one of the leading causes of visual impairment. With the increasing prevalence of myopia, there is a growing need to better understand the factors involved in its development. Inflammation, one of the most fundamental pathophysiological processes in humans, is a rapid response triggered by harmful stimuli and conditions. Although controlled inflammatory responses are necessary, over-activated inflammation is the common soil for many diseases. The impact of inflammation on myopia has received rising attention in recent years. Elevated inflammation may contribute to myopia progression either directly or indirectly by inducing scleral remodeling, and myopia development may also increase ocular inflammation. This article provides a comprehensive review of the interplay between inflammation and myopia and the potential biological mechanisms, which may present new targets for understanding the pathology of myopia and developing myopia therapies.

Causes of Visual Impairment and Types of Low Vision Aids Prescribed in Low Vision Clinic, Sibu Hospital, Sarawak

This study was to determine the causes of visual impairment and to identify the low vision prescribing pattern among Low Vision Clinic (LVC) patients in the Sibu Hospital. This study was conducted retrospectively among 41 patients attending the LVC, Sibu Hospital. Patients’ demographic characteristics, causes of low vision and blindness, and types of low vision devices prescribed were recorded and analysed for 21 (52.5%) males and 19 (47.5%) females. The mean age was 39.38 ± 17.98 years. The main causes of visual impairment were retinal dystrophies in 12 cases (30.0%) followed by neurological causes in 9 cases (22.5%), glaucoma in 8 cases (20.0%), and acquired macular disorders in 4 cases (10.0%). A total of 27 low vision devices were dispensed, 85.2% (n = 23) were near devices and 14.8% (n = 4) were distance devices. The most frequently prescribed low vision devices (LVD) were video magnifiers (37.0%), followed by hand magnifiers (22.2%), spectacle magnifiers (14.8%), telescopes (14.8%) and stand magnifiers (11.1%). The main leading causes of visual impairment in LVC Sibu Hospital were retinal dystrophies. Video magnifiers were the most common type of low-vision device prescribed. A prompt comprehensive screening is urged for family members with retinal dystrophies to detect the diseases early and hence timely exposure to low vision care and rehabilitation. Familial counselling on inherited retinal diseases and better screening by primary eye care providers are required. Low vision services should be an integral part of the eye care systems in Malaysia.

Variations in the prevalence of vision impairment across regions among school children in Telangana State, South India.

Undetected vision impairment (VI) could negatively affect the overall development in children. School vision screening program is a viable and cost-effective approach for the early identification and management of VI. This study aims to estimate the prevalence of VI, its risk factors, and ocular morbidity among school children in Telangana, South India. Children aged 4-15 years attending schools in the study area were screened in this study. The vision screenings were performed in schools by trained community eye health workers using 6/12 tumbling E optotypes. Children who failed the test and/or presented with other eye conditions were referred to vision centers or secondary and tertiary eye care centers. A comprehensive eye examination was conducted in these centers, including cycloplegic refraction and fundus examination. A total of 774,184 children, with a mean age of 9.4 ± 3.27 years, were screened. Overall, 51.49% (N = 398,596) were male. In total, 4.33% [N = 33,528; 95% confidence interval (CI): 4.29-4.38] required referral services, while 1.16% (N = 9,002) had a presenting visual acuity of < 6/12. Multivariate analysis showed a high risk of VI among older children [Adj. odds ratio (OR): 5.75; 95% CI: 5.18-6.38], those with disabilities (Adj. OR: 5.12; 95% CI: 4.14-6.33), female gender (Adj. OR: 1.29; 95% CI: 1.24 - 1.35), and those residing in the urban areas (Adj. OR: 2.87; 95% CI: 2.42-3.39). The main cause of VI was uncorrected refractive errors (74.14%). The prevalence of VI among school children was 1.16% in Telangana, South India, and refractive error was the leading cause of VI among this population. Increasing age, urban location, female gender and other disabilities increase the risk of VI among children.

Visual Impairment from Uncorrected Refractive Error among Participants in a Novel Program to Improve Eye Care Access among Low-Income Adults in Michigan

To assess the rate of visual impairment (VI) from uncorrected refractive error (URE) and associations with demographic and socioeconomic factors among low-income patients presenting to the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program. Cross-sectional study. Adults ≥ 18 years without acute ocular symptoms. MI-SIGHT program participants received a telemedicine-based eye disease screening and ordered glasses through an online optical store. Participants were categorized based on refractive error (RE) status: VI from URE (presenting visual acuity [PVA], ≤ 20/50; best-corrected visual acuity [BCVA], ≥20/40), URE without VI (PVA, ≥ 20/40; ≥ 2-line improvement to BCVA), and no or adequately corrected RE (PVA, ≥ 20/40; < 2-line improvement to BCVA). Patient demographics, self-reported visual function, and satisfaction with glasses obtained through the program were compared among groups using analysis of variance, Kruskal-Wallis, chi-square, and Fisher exact testing. PVA, BCVA, and presence of VI (defined as PVA ≤ 20/50). Of 1171 participants enrolled in the MI-SIGHT program during the first year, average age was 55.1years (SD = 14.5), 37.7% were male, 54.1% identified as Black, and 1166 (99.6%) had both PVA and BCVA measured. VI was observed in 120 participants (10.3%); 96 had VI from URE (8.2%), 168 participants (14.4%) had URE without VI, and 878 (75.3%) had no or adequately corrected RE. A smaller percentage of participants with VI resulting from URE reported having a college degree, and a larger percentage reported income < $10 000 compared with participants with no or adequately corrected RE (3.2% vs. 14.2% [P= 0.02]; 45.5% vs. 21.6% [P< 0.0001], respectively). Visual function was lowest among participants with VI from URE, followed by those with URE without VI, and then those with no or adequately corrected RE (9-item National Eye Institute Visual Function Questionnaire composite score, 67.3 ± 19.6 vs. 77.0 ± 14.4 vs. 82.2 ± 13.3, respectively; P < 0.0001). In total, 71.2% (n= 830) ordered glasses for an average cost of $36.80 ± $32.60; 97.7% were satisfied with their glasses. URE was the main cause of VI at 2 clinics serving low-income communities and was associated with reduced vision-related quality of life. An online optical store with lower prices made eyeglasses accessible to low-income patients. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Role of NLRP3 in the immunopathogenesis of neurodegenerative eye diseases

Neurodegenerative eye pathology is one of the leading causes of visual impairment and blindness worldwide. Primary open-angle glaucoma (POAG) belongs to the group of neurodegenerative ophthalmic diseases and is characterized by a permanent or periodic increase in intraocular pressure, followed by development of typical visual field defects, decreased visual acuity and optic nerve atrophy. Recent studies show that local inflammation, triggered by the innate immune system is the first line of defense against the pathogens and tissue destruction products, playing an important role in the POAG pathogenesis. The aim was to study the neurodegenerative ophthalmic disorder in a rabbit model, and to compare the data on distribution of alleles and genotypes of the polymorphic marker rs7525979 of NLRP3 gene in the patients with POAG. At the first stage, we studied the complex tissue samples of the retina/retinal pigment epithelium (TCS/RPE) isolated from the eyes of 14 experimental animals and 7 intact rabbits without eye damage. Neurodegenerative pathology of the eye in rabbits was carried out in the Experimental Center at the Helmholtz National Medical Research Center by a single subretinal injection of 0.01 ml of 0.9% sodium chloride solution. NLRP3 gene expression levels in TCS/RPE samples were evaluated by real-time polymerase chain reaction (PCR-RV). At the second stage, peripheral blood samples were examined in patients who were diagnosed with POAG of various stages, as well as without glaucoma. DNA was isolated from blood samples, which was subsequently analyzed for the polymorphic markers study using PCR-RT technique. According to the results of the study, we noted an increased expression of the NLRP3 gene in the TCS/RPE samples from experimental animals with simulated retinal degeneration. Moreover, an association of alleles and genotypes of the NLRP3 gene was revealed in patients with POAG. The data obtained may be indicative for involvement of NLRP3 inflammasome components in development of neurodegenerative retinal lesions in POAG.

Efficient versus inefficient visual search as training for saccadic re-referencing to an extrafoveal location.

Central vision loss is one of the leading causes of visual impairment in the elderly and its frequency is increasing. Without formal training, patients adopt an unaffected region of the retina as a new fixation location, a preferred retinal locus (PRL). However, learning to use the PRL as a reference location for saccades, that is, saccadic re-referencing, is protracted and time-consuming. Recent studies showed that training with visual search tasks can expedite this process. However, visual search can be driven by salient external features - leading to efficient search, or by internal goals, usually leading to inefficient, attention-demanding search. We compared saccadic re-referencing training in the presence of a simulated central scotoma with either an efficient or an inefficient visual search task. Participants had to respond by fixating the target with an experimenter-defined retinal location in the lower visual field. We observed that comparable relative training gains were obtained in both tasks for a number of behavioral parameters, with higher training gains for the trained task, compared to the untrained task. The transfer to the untrained task was only observed for some parameters. Our findings thus confirm and extend previous research showing comparable efficiency for exogenously and endogenously driven visual search tasks for saccadic re-referencing training. Our results also show that transfer of training gains to related tasks may be limited and needs to be tested for saccadic re-referencing-training paradigms to assess its suitability as a training tool for patients.

Protective effect of ethyl ferulate against hypoxic injury in retinal cells and retinal neovascularization in an oxygen-induced retinopathy model

BackgroundPathological neovascularization is a major cause of visual impairment in hypoxia-induced retinopathy. Ethyl ferulate (EF), the natural ester derivative of ferulic acid commonly found in Ferula and Angelica Sinensis, has been shown to exert antioxidant, neuroprotective, and anti-inflammatory properties. However, whether EF exerts a protective effect on retinal neovascularization and the underlying mechanisms are not well known. PurposeThe aim of the study was to investigate the effect of EF on retinal neovascularization and explore its underlying molecular mechanisms. Study-design/methodsWe constructed hypoxia models induced by cobalt chloride (CoCl2) in ARPE-19 cells and Rhesus choroid-retinal vascular endothelial (RF/6A) cells in vitro, as well as a retinal neovascularization model in oxygen-induced retinopathy (OIR) mice in vivo. ResultsIn this work, we demonstrated that EF treatment inhibited hypoxia-induced vascular endothelial growth factor A (VEGFA) expression in ARPE-19 cells and abrogated hypoxia-induced tube formation in RF/6A cells. As expected, intravitreal injection of EF significantly suppressed retinal neovascularization in a dose-dependent manner in OIR retinas. We also found that hypoxia increased VEGFA expression by blocking autophagic flux, whereas EF treatment enhanced autophagic flux, thereby reducing VEGFA expression. Furthermore, EF activated the sequestosome 1 (p62) / nuclear factor E2-related factor 2 (Nrf-2) pathway via upregulating oxidative stress-induced growth inhibitor 1 (OSGIN1) expression, thus alleviating oxidative stress and reducing VEGFA expression. ConclusionAs a result of our findings, EF has an inhibitory effect on retinal neovascularization, implying a potential therapeutic strategy for hypoxia-induced retinopathy.

A proposed model of xeno-keratoplasty using 3D printing and decellularization.

Corneal opacity is a leading cause of vision impairment and suffering worldwide. Transplantation can effectively restore vision and reduce chronic discomfort. However, there is a considerable shortage of viable corneal graft tissues. Tissue engineering may address this issue by advancing xeno-keratoplasty as a viable alternative to conventional keratoplasty. In particular, livestock decellularization strategies offer the potential to generate bioartificial ocular prosthetics in sufficient supply to match existing and projected needs. To this end, we have examined the best practices and characterizations that have supported the current state-of-the-art driving preclinical and clinical applications. Identifying the challenges that delimit activities to supplement the donor corneal pool derived from acellular scaffolds allowed us to hypothesize a model for keratoprosthesis applications derived from livestock combining 3D printing and decellularization.

Challenges of refractive cataract surgery in the era of myopia epidemic: a mini-review.

Myopia is the leading cause of visual impairment in the world. With ever-increasing prevalence in these years, it creates an alarming global epidemic. In addition to the difficulty in seeing distant objects, myopia also increases the risk of cataract and advances its onset, greatly affecting the productivity of myopes of working age. Cataract management in myopic eyes, especially highly myopic eyes is originally more complicated than that in normal eyes, whereas the growing population of cataract with myopia, increasing popularity of corneal and lens based refractive surgery, and rising demand for spectacle independence after cataract surgery all further pose unprecedented challenges to ophthalmologists. Previous history of corneal refractive surgery and existence of implantable collamer lens will both affect the accuracy of biometry including measurement of corneal curvature and axial length before cataract surgery, which may result in larger intraocular lens (IOL) power prediction errors and a compromise in the surgical outcome especially in a refractive cataract surgery. A prudent choice of formula for cataract patients with different characteristics is essential in improving this condition. Besides, the characteristics of myopic eyes might affect the long-term stability of IOL, which is important for the maintenance of visual outcomes especially after the implantation of premium IOLs, thus a proper selection of IOL accordingly is crucial. In this mini-review, we provide an overview of the impact of myopia epidemic on treatment for cataract and to discuss new challenges that surgeons may encounter in the foreseeable future when planning refractive cataract surgery for myopic patients.

CPD: An introduction to cerebral visual impairment in children 3

In the third of a four part series looking at an important cause of visual impairment in children, Cirta Tooth outlines how CVI affects children’s development (C???? suitable for logging as one distance learning CPD point for optometrists and dispensing opticians)

Electrophysiological properties of layer 2/3 pyramidal neurons in the primary visual cortex of a retinitis pigmentosa mouse model (rd10).

Retinal degeneration is one of the main causes of visual impairment and blindness. One group of retinal degenerative diseases, leading to the loss of photoreceptors, is collectively termed retinitis pigmentosa. In this group of diseases, the remaining retina is largely spared from initial cell death making retinal ganglion cells an interesting target for vision restoration methods. However, it is unknown how downstream brain areas, in particular the visual cortex, are affected by the progression of blindness. Visual deprivation studies have shown dramatic changes in the electrophysiological properties of visual cortex neurons, but changes on a cellular level in retinitis pigmentosa have not been investigated yet. Therefore, we used the rd10 mouse model to perform patch-clamp recordings of pyramidal neurons in layer 2/3 of the primary visual cortex to screen for potential changes in electrophysiological properties resulting from retinal degeneration. Compared to wild-type C57BL/6 mice, we only found an increase in intrinsic excitability around the time point of maximal retinal degeneration. In addition, we saw an increase in the current amplitude of spontaneous putative inhibitory events after a longer progression of retinal degeneration. However, we did not observe a long-lasting shift in excitability after prolonged retinal degeneration. Together, our results provide evidence of an intact visual cortex with promising potential for future therapeutic strategies to restore vision.

Cataract referral pattern among Indian optometrists: A cross-sectional study

According to WHO (World Health Organization), cataract is the second leading cause for visual impairment or blindness globally. In the Indian context, Optometrist’s role in identification and appropriate referral of cataracts requiring surgery is of utmost important. The aim of the current study was to investigate the knowledge and cataract referral pattern among Indian optometrists. A cross-sectional study was carried out on 262 optometrists by distribution of a validated, well-structured questionnaire with data on participant demographics and optometric assessment practises, including participant age group and gender, primary clinical practise location, objective patient visual assessment methods, referral criteria for cataract surgery, and factors to be taken into account when deciding where and when to refer patients for cataract surgery was made. The analysis of survey questions with Likert scales was done using ordinal logistic regression. Categorical variables between groups were evaluated using Chi-square test. Statistical Significance was considered if P was less than 0.05. Visual acuity less than 6/18 and glare sensitivity were common benchmarks for cataract referral. A significant proportion of optometrists indicated driving dependent (55%), current employment (33%), high visual demand (31%) and post-operative vision less than 6/18 in other eye (34%) as important factors for urgent referral for cataract surgery to Ophthalmologists. Majority of the participants indicated surgical costs (53.8%), surgeon skills (56.9%) and caring environment/caring staff (49.2%) as extremely important factors in deciding where to refer for cataract surgery. While optometrists were able to refer patients for cataract surgery based on changes in visual acuity, Indian optometrists should also assess contrast sensitivity and take that into consideration when making this decision.

Causes and Pattern of Eye Diseases in Children Attending the Paediatric Eye Unit of Ahmadu Bello University Teaching Hospital, Shika, Zaria

Aim: The purpose was to determine the causes and pattern of eye diseases in children 0-15 years of age who attended the paediatric unit of the Ophthalmology department Ahmadu Bello University Teaching Hospital Shika, Zaria with a view of obtaining data for planning of children eye care. Methods: This was a descriptive cross-sectional study. All children that met the inclusion criteria were recruited. Subjects had visual acuity assessments as appropriate for age. Anterior segment examination was done using a loupe or slit lamp biomicroscope as appropriate while posterior segment was examined by direct ophthalmoscopy. Manual refraction was done using streak retinoscope (cycloplegic refraction when required). Results: A total of 12,516 patients attended the Ophthalmology out-patient clinic of the hospital during the 30- month study period (May 2014- October 2016), 1,760 old and new patients (14.1%) were patients 0-15 years of age (study population). A total of 448 children were recruited for the study. The male to female ratio M:F was 1.3:1. Allergic conjunctivitis 181 (40.4%), refractive error 42 (9.4%) and infective conjunctivitis 39 (8.7%) were the most common ocular disorders seen. The prevalence of visual impairment was 34.4%. Trauma was the most common cause of uniocular visual impairment. The proportion of blind eyes was 3.1% (n=12). Conclusions: Majority of the ocular disorders seen among the children were treatable causes of visual impairment. Public health education is necessary to create awareness on the causes of blindness. However, there was no statistically significant difference in the ocular disorders with respect to age and gender of the children.

Relationship between Unstable Housing, Food Insecurity, and Vision Status in the MI-SIGHT Community Eye Disease Screening Program

Assess rate of visual impairment (VI) from uncorrected refractive error (URE) and associations with demographic and socioeconomic factors among low-income patients presenting to the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program. Cross-sectional study. Adults ≥ 18 years without acute ocular symptoms. MI-SIGHT program participants received a telemedicine-based eye disease screening and ordered glasses through an online optical shop. Participants were categorized based on refractive error (RE) status: VI from URE (presenting visual acuity [PVA] ≤ 20/50, best corrected visual acuity [BCVA] ≥ 20/40), URE without VI (PVA ≥ 20/40, had ≥ 2 lines of improvement to BCVA), and no or adequately corrected RE (PVA ≥ 20/40, < 2 line improvement to BCVA). Patient demographics, self-reported visual function, and satisfaction with glasses obtained through the program were compared between groups using analysis of variance, Kruskal-Wallis, chi-square, and Fisher exact testing. PVA, BCVA, and presence of VI (defined as PVA ≤ 20/50). Of 1171 participants enrolled in the MI-SIGHT program during the first year, the average age was 55.1 years (standard deviation = 14.5), 37.7% were male, 54.1% identified as Black, and 1166 (99.6%) had both PVA and BCVA measured. VI was observed in 120 (10.3%); 96 had VI from URE (8.2%), 168 (14.4%) had URE without VI, and 878 (75.3%) had no or adequately corrected RE. A smaller percentage of participants with VI from URE reported having a college degree and a larger percentage reported income < $10 000 compared to participants with no or adequately corrected RE (3.2% versus 14.2%, P = 0.02; 45.5% versus 21.6%, respectively, P < 0.0001. Visual function was lowest among participants with VI from URE, followed by those with URE without VI, and then those with no or adequately corrected RE (VFQ9 composite score 67.3 ± 19.6 versus 77.0 ± 14.4 versus 82.2 ± 13.3, respectively; P < 0.0001). 71.2% (n = 830) ordered glasses for an average cost of $36.80 ± $32.60; 97.7% were satisfied with their glasses. URE was the main cause of VI at 2 clinics serving low-income communities and was associated with reduced vision-related quality of life. An online optical shop with lower prices made eyeglasses accessible to low-income patients. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Prevalence and Cause of Loss of Visual Acuity and Visual Field in Highly Myopic Eyes: The Beijing Eye Study

To explore prevalence and causes of loss of visual acuity and visual field in highly myopic eyes. Population-based study. The participants (n=4439) of the Beijing Eye Study underwent an ophthalmological and systemic examination including frequency doubling technology perimetry (FDT). High myopia was defined by a refractive error of ≤-6Dpt or axial length >26.0 mm. Prevalence of vision impairment causes. The study included 212 highly myopic eyes (154 participants;mean age:56.2±9.6 years;refractive error:-9.87±3.70 Dpt;range:-20.87 to -6.00Dpt; axial length:27.2±1.3mm;range:26.01-30.88mm). Moderate/severe vision impairment (MSVI) (best corrected visual acuity (BCVA) from <6/18 to 3/60) and blindness (BCVA <3/60 or <10° visual field around central fixation) was present in 40/212 (18.9%;95%CI:13.6,24.2) eyes, and in 10/212 (4.7%;95%CI:1.8, 7.6) eyes, respectively. BCVA decreased with more myopic refractive error (beta:-0.55;B:-0.08;95%CI:-0.09,-0.06;P<0.001). Primary (i.e., most influential) causes for MSVI and blindness were myopic macular degeneration (MMD) (29/50;58%), age-related macular degeneration (1/50;2%), and branch macular retinal vein occlusion (1/50;2%). Secondary causes were MMD (4/50;8%) and optic nerve atrophy (14/50 (28%), differentiated into a non-glaucomatous type (NGOA) (9/50;18%) and glaucomatous type (GOA) (5/50;10%). Prevalence of MMD as vision impairment cause (mean:40/212 (18.9%;95%CI:13.6,24.2) increased from 1/61 (1.6%;95%CI:0.00,4.9) in the group of -6.00 to ≥-7.00Dpt, to 16/25 (64.0%;95%CI:43.8,84.2) in the group of <-15.0Dpt. Higher MMD prevalence correlated with higher myopic refractive error (OR:0.70;95%CI:0.61;0.81;P<0.001) and higher prevalence of concomitant optic neuropathy (OR:86.2;95%CI:16.1,463;P<0.001). Optic neuropathy prevalence as cause of vision impairment (mean:19/212;9.0%;95%CI:5.0,13.0) increased from 0/61 (0%) in the refractive error group of -6.00Dpt to ≥-7.00Dpt, to 9/25 (36.0%;95%CI:16.0,56.0) in the group of <-15.0Dpt. Higher optic neuropathy prevalence correlated with more myopic refractive error (P<0.001) and older age (P=0.02). GOA prevalence (mean:6/212;2.8%;95%CI:1.0,5.0) and NGOA prevalence (mean:13/212 (6.1%;95%CI:3.0,9.0) increased from 0/61 (0%) in the group of -6.00 to ≥-7.00Dpt, to 4/25 (16.0%;95%CI:1.0,31.0) and 5/25 (20%;95%CI:3.0,37.0), respectively, in the group of <-15.0Dpt. In this population-based recruited, highly myopic cohort, prevalence of optic neuropathy (9.0%) as vision impairment cause was lower than MMD prevalence (18.9%), and it was an important reason for vision impairment in the group of <-15Dpt. MMD was vision impairment cause in 16/25 (64.0%) eyes with <-15.0Dpt refractive error.