Cause Of Visual Disability Research Articles

Experimental research on mesenchymal stem cells (MSCs) therapy for autoimmune uveitis

Autoimmune uveitis is a major cause of visual disability. Treatment of chronic and recurrent uveitis can be extremely difficult, as various complications of it could impede the long-term usage of corticosteroids and immunosuppressants. Mesenchymal stem cells are of both immunosuppressive and neurotrophic effect, and can enhance the antimicrobial ability of the body, thereby hold great promise in clinical application for treating uveitis. (Chin J Ophthalmol, 2018, 54: 712-715).

Study of lipid levels in diabetes mellitus with special reference to diabetic retinopathy

Background: Diabetic retinopathy is a very common, potentially preventable, long term, microvascular complication of diabetes mellitus and leading cause of visual disability and blindness. It is considered hallmark of generalized microangiopathy occurring in diabetic patient. The present study was designed to study the lipid levels in patients of diabetes mellitus and further analyse the data with reference to occurrence of diabetic retinopathy.Methods: It was a case control study of 30 cases consisting patients with diabetic retinopathy and 30 controls with diabetes and no diabetic retinopathy. Fasting lipid profile, FBS, PPBS, HbA1C and BMI were measured in all subjects.Results: 34 males (57%) and 26 (43%) females were recruited in the study. The mean duration of diabetes was 8.5±5 yrs. The average HbA1C was 8.2±1.3 in Diabetic Retinopathy (DR) group and 7.5±0.9 in patients with no Diabetic Retinopathy (NDR). 21 (70%) patients in DR group had dyslipidaemia, whereas 13 (43.3%) patients in NDR had dyslipidaemia, average cholesterol was 188.30±46.48 mg/dl in patients with DR, 182.50±34.74 mg/dl in patients without DR.Conclusions: Dyslipidaemia was found to be more common in patients having Diabetic Retinopathy than in those without DR and the association was statistically significant. Mean cholesterol levels were found to be higher in cases and mean HDL level was found to be higher in controls but the relationship was not found to be statistically significant. No association was found between other lipid fractions and retinopathy.

Efficacy and Safety of Lampalizumab for Geographic Atrophy Due to Age-Related Macular Degeneration

ImportanceGeographic atrophy (GA) secondary to age-related macular degeneration is a leading cause of visual disability in older individuals. A phase 2 trial suggested that lampalizumab, a selective complement factor D inhibitor, reduced the rate of GA enlargement, warranting phase 3 trials.ObjectiveTo assess the safety and efficacy of lampalizumab vs sham procedure on enlargement of GA.Design, Setting, and ParticipantsTwo identically designed phase 3 double-masked, randomized, sham-controlled clinical trials, Chroma and Spectri, enrolled participants from August 28, 2014, to October 6, 2016, at 275 sites in 23 countries. Participants were aged 50 years or older, with bilateral GA and no prior or active choroidal neovascularization in either eye and GA lesions in the study eye measuring 2.54 to 17.78 mm2 with diffuse or banded fundus autofluorescence patterns.InterventionsParticipants were randomized 2:1:2:1 to receive 10 mg of intravitreous lampalizumab every 4 weeks, sham procedure every 4 weeks, 10 mg of lampalizumab every 6 weeks, or sham procedure every 6 weeks, through 96 weeks.Main Outcomes and MeasuresSafety and efficacy assessed as mean change from baseline in GA lesion area at week 48 from centrally read fundus autofluorescence images of the lampalizumab arms vs pooled sham arms, in the intent-to-treat population and by complement factor I–profile genetic biomarker.ResultsA total of 906 participants (553 women and 353 men; mean [SD] age, 78.1 [8.1] years) were enrolled in Chroma and 975 participants (578 women and 397 men; mean [SD] age, 77.9 [8.1] years) were enrolled in Spectri; 1733 of the 1881 participants (92.1%) completed the studies through 48 weeks. The adjusted mean increases in GA lesion area from baseline at week 48 were 1.93 to 2.09 mm2 across all groups in both studies. Differences in adjusted mean change in GA lesion area (lampalizumab minus sham) were −0.02 mm2 (95% CI, −0.21 to 0.16 mm2; P = .80) for lampalizumab every 4 weeks in Chroma, 0.16 mm2 (95% CI, 0.00-0.31 mm2; P = .048) for lampalizumab every 4 weeks in Spectri, 0.05 mm2 (95% CI, −0.13 to 0.24 mm2; P = .59) for lampalizumab every 6 weeks in Chroma, and 0.09 mm2 (95% CI, −0.07 to 0.24 mm2; P = .27) for lampalizumab every 6 weeks in Spectri. No benefit of lampalizumab was observed across prespecified subgroups, including by complement factor I–profile biomarker. Endophthalmitis occurred after 5 of 12 447 injections (0.04%) or in 5 of 1252 treated participants (0.4%) through week 48.Conclusions and RelevanceIn Chroma and Spectri, the largest studies of GA conducted to date, lampalizumab did not reduce GA enlargement vs sham during 48 weeks of treatment. Results highlight the substantial and consistent enlargement of GA, at a mean of approximately 2 mm2 per year.Trial RegistrationClinicalTrials.gov Identifier: NCT02247479 and NCT02247531

Non-syndromic retinitis pigmentosa.

Retinitis pigmentosa (RP) encompasses a group of inherited retinal dystrophies characterized by the primary degeneration of rod and cone photoreceptors. RP is a leading cause of visual disability, with a worldwide prevalence of 1:4000. Although the majority of RP cases are non-syndromic, 20-30% of patients with RP also have an associated non-ocular condition. RP typically manifests with night blindness in adolescence, followed by concentric visual field loss, reflecting the principal dysfunction of rod photoreceptors; central vision loss occurs later in life due to cone dysfunction. Photoreceptor function measured with an electroretinogram is markedly reduced or even absent. Optical coherence tomography (OCT) and fundus autofluorescence (FAF) imaging show a progressive loss of outer retinal layers and altered lipofuscin distribution in a characteristic pattern. Over the past three decades, a vast number of disease-causing variants in more than 80 genes have been associated with non-syndromic RP. The wide heterogeneity of RP makes it challenging to describe the clinical findings and pathogenesis. In this review, we provide a comprehensive overview of the clinical characteristics of RP specific to genetically defined patient subsets. We supply a unique atlas with color fundus photographs of most RP subtypes, and we discuss the relevant considerations with respect to differential diagnoses. In addition, we discuss the genes involved in the pathogenesis of RP, as well as the retinal processes that are affected by pathogenic mutations in these genes. Finally, we review management strategies for patients with RP, including counseling, visual rehabilitation, and current and emerging therapeutic options.

Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD.

Age-related macular degeneration (AMD) is a well-characterized and extensively studied disease. It is currently considered the leading cause of visual disability among patients over 60 years. The hallmark of early AMD is the formation of drusen, pigmentary changes at the macula, and mild to moderate vision loss. There are two forms of AMD: the “dry” and the “wet” form that is less frequent but is responsible for 90% of acute blindness due to AMD. Risk factors have been associated with AMD progression, and they are taking relevance to understand how AMD develops: (1) advanced age and the exposition to environmental factors inducing high levels of oxidative stress damaging the macula and (2) this damage, which causes inflammation inducing a vicious cycle, altogether causing central vision loss. There is neither a cure nor treatment to prevent AMD. However, there are some treatments available for the wet form of AMD. This article will review some molecular and cellular mechanisms associated with the onset of AMD focusing on feasible treatments for each related factor in the development of this pathology such as vascular endothelial growth factor, oxidative stress, failure of the clearance of proteins and organelles, and glial cell dysfunction in AMD.

Causes and Three-year Incidence of Irreversible Visual Impairment in Jing-An District, Shanghai, China from 2010-2015

BackgroundThe registry system can be used to observe the distribution trend of diseases and analyze the related data to provide useful information in a way that enables the government to take appropriate interventional measures. The purpose of this study was to determine the causes and three-year incidence of newly registered disabled patients who were blind or had low vision in Jing-An District, Shanghai, China from 2010 to 2015.MethodsData from the registration system of visual disability in Jing-An District, Shanghai from 2010 to 2015 were collected and analyzed. In this registry, the only person with permanent visual impairment (VI) was identified as being a certified visually impaired person. The main causes of visual disability were obtained, the three-year incidence of visual disability was calculated, and the relationships between blindness or low vision and age, as well as those between blindness or low vision and gender, were analyzed.ResultsSix-hundred and forty-six newly certified people with VI were registered, including 206 blind patients and 440 low vision patients. The major causes of blindness were myopia macular degeneration (MMD, 23.30%), glaucoma (20.39%), and age-related macular degeneration (AMD, 17.96%). The three leading causes of low vision were MMD (58.86%), AMD (16.36%), and diabetic retinopathy (DR, 7.27%). DR (16.0%) was the first leading cause of blindness and the second leading cause of VI in patients aged 30–59 yrs. from 2010 to 2015. The three-year incidences of blindness in 2010–2012 and 2013–2015(P = 0.43), which remained stable throughout this time period, were 32.74/100000 and 36.51/100000, respectively. However, the three-year incidence of low vision was 64.51/100000 in 2010–2012 and 83.58/100000 in 2013–2015(P = 0.007), which shows that the incidence increased significantly due to the increase of patients with low vision caused by MMD and DR (P = 0.003 and P = 0.01, respectively).ConclusionsMMD, glaucoma, and AMD were the main causes of blindness, while DR was becoming a major cause of VI, especially in working-age people of Jing-An District, Shanghai, China.

Ophthalmologic Disease in HIV Infection: Recent Changes in Pathophysiology and Treatment.

Ophthalmologic conditions were among the earliest described findings in patients with the acquired immunodeficiency syndrome (AIDS). The purpose of this review is to highlight recent changes in the pathophysiology and management of ophthalmologic conditions in patients infected with the human immunodeficiency virus (HIV). The introduction of highly active antiretroviral therapy (HAART) in 1996 changed ophthalmologic findings from predominantly acute infectious diseases to chronic, slowly progressive, debilitating conditions. HIV-associated neuroretinal disorder infrequently leads to blindness, but it causes visual disability in a large percentage of patients. Cytomegalovirus retinitis is now seen less commonly in the USA, but it remains an important cause of blindness in HIV-infected patients from developing countries. Immune recovery uveitis has emerged as a major cause of visual disability in the USA. As HIV has become a chronic disease, visual disability due to chronic noninfectious diseases have become increasingly important.

Genetic anomalies in congenital cataract

SummaryDevelopmental anomalies of the anterior segment of the eye encompasse a spectrum of disorders affecting the cornea, iris, lens, ciliary body, and/or the trabecular meshwork. Besides, nonsyndromic congenital cataract (CC) is a common cause of visual disability in children. All these genetic disorders are highly clinically and genetically heterogeneous, making challenging a proper diagnosis based solely on a phenotype‐based approach. We develop a genotype‐based approach by using a targeted Next‐Generation Sequencing panel including 50 known genes. A cohort of 150 French index patients were recruited after detailed ophthalmic examination. All exons of the 50 genes were amplified using the kit TrueSeq Custom Amplicon (TSCA, Illumina). The subsequent amplified libraries were sequenced using a MiSeq (Illumina, Inc, San Diego, CA, USA) sequencer. All pathogenic variants were confirmed by Sanger sequencing, and familial analyses were performed. A large spectrum of molecular defects were identified with numerous novel variants. This NGS approach is an efficient tool to improve molecular diagnosis, and provides insight into the genotype‐phenotype correlation of all these ocular disorders in a cost‐effective way.

New Standards of Care in Ischemic Stroke.

Ischemic arterial strokes of the ophthalmic artery and its branches and posterior cerebral artery are common causes of visual disability. Etiologies of stroke affecting the retina, optic nerve, optic radiation, and visual cortex overlap with other types of ischemic strokes. Stenosis of the internal carotid is the most common cause of central retinal artery occlusion (CRAO). One-fourth of patients with CRAO have cerebral strokes. We report recent developments in the acute treatment and secondary prevention of ischemic stroke of relevance to clinicians who encounter patients with acute vision loss. A search of Pubmed and practice guidelines over the past 5 years was performed, with a focus on significant changes in treatment and prevention of ischemic stroke. Recent randomized controlled trials provide Level I evidence for the use of endovascular therapy with current stent retriever devices for patients with large vessel anterior circulation occlusions within 6 hours of presentation. Number needed to treat to achieve one additional patient with an independent functional outcome was in the range of 3-7, and benefit was additive to that of intravenous tissue plasminogen activator alone. Paroxysmal atrial fibrillation (AF) is a major cause of cryptogenic stroke with incidence expected to rise with the aging population. Since 2014, prolonged 30-day cardiac monitoring has been recommended as a part of transient ischemic attack and stroke workup in patients with cryptogenic stroke. Even longer term monitoring of 6 months to 1 year with external and implantable loop recorders improves rates of diagnosing AF. First available in 2010, the novel anticoagulants-dabigatran, apixaban, rivaroxaban, and edoxaban-have been compared with warfarin in the prevention of stroke in patients with nonvalvular AF. Apixaban demonstrated superiority in safety and efficacy, with the novel anticoagulants as a group having favorable risk-benefit profile at higher dosages compared with standard warfarin therapy. Endovascular therapy is now standard of care for eligible patients with anterior large vessel occlusions. Prolonged cardiac monitoring is recommended for patients with cryptogenic stroke. The novel anticoagulants are an alternative to warfarin in patients with AF.

Primary congenital and developmental glaucomas.

Glaucoma is the leading cause of irreversible blindness worldwide. Although most glaucoma patients are elderly, congenital glaucoma and glaucomas of childhood are also important causes of visual disability. Primary congenital glaucoma (PCG) is isolated, non-syndromic glaucoma that occurs in the first three years of life and is a major cause of childhood blindness. Other early-onset glaucomas may arise secondary to developmental abnormalities, such as glaucomas that occur with aniridia or as part of Axenfeld-Rieger syndrome. Congenital and childhood glaucomas have strong genetic bases and disease-causing mutations have been discovered in several genes. Mutations in three genes (CYP1B1, LTBP2, TEK) have been reported in PCG patients. Axenfeld-Rieger syndrome is caused by mutations in PITX2 or FOXC1 and aniridia is caused by PAX6 mutations. This review discusses the roles of these genes in primary congenital glaucoma and glaucomas of childhood.

Practice patterns for herpes simplex keratitis: A survey of ophthalmologists in Gulf Coast countries

PurposeHerpes simplex is a common cause of visual disability, and there are published evidence-based guidelines for therapy. This survey aims to determine the preferred practice patterns of ophthalmologists in Gulf Coast Countries regarding herpetic eye disease, as well as identify areas of controversy or barriers to acceptance of evidence-based protocols. MethodsAnonymous web-based survey of ophthalmologists in Saudi Arabia, Bahrain, the United Arab Emirates, and Oman. ResultsThere were 48 responses to the survey. For a first episode of epithelial dendritic keratitis, 28.2% reported “observation” rather than specific therapy. The majority of respondents utilize oral or topical antiviral for epithelial keratitis, with oral antiviral being the most popular (43.6%). The majority also included a corticosteroid with antiviral for stromal keratitis (83.9%) or iritis (70.3%). Over 90% prescribe a prophylactic antiviral after keratoplasty for herpetic eye disease, although the length of therapy ranged widely from <6months to indefinite. The perceived risk of recurrent disease was ranked as the most important factor when considering antiviral prophylaxis, followed by risk of adverse effects. Topical cyclosporine was utilized “never or almost never” by 76.9% of respondents. ConclusionsMost respondents report following evidence-based guidelines. There was less consensus in areas where there are remaining knowledge gaps, such as the length of antiviral prophylaxis after keratoplasty and the potential role for topical cyclosporine.

Real-World Outcomes of Anti-VEGF Treatment for Retinal Vein Occlusion in Portugal.

Retinal vein occlusion (RVO) is an important cause of visual disability in the modern world. We aim to evaluate the real-world outcomes of patients with RVO treated with anti-vascular endothelial growth factor (VEGF) in Portugal. We performed a retrospective, observational, multicenter study including 8 centers across Portugal and 200 patients treated with either ranibizumab or bevacizumab. Data were collected at 3 time points: time of diagnosis (0 time point) and 6 and 12 months after initiating treatment. Demographic and clinical data were collected. Median visual acuity (VA) and central macular thickness (CMT) improved in the branch RVO (BRVO), central RVO (CRVO), bevacizumab, and ranibizumab groups at 6 and 12 months compared to baseline, with CMT improving further only in the CRVO and ranibizumab groups between 6 and 12 months (p = 0.002 and p = 0.001, respectively). The CMT was lower in the ranibizumab group compared to the bevacizumab group both at 6 and 12 months (p<0.02). Median CMT improved in both the good and poor baseline VA groups at 6 and 12 months compared to baseline (p<0.001). Median VA only improved for the group with poor baseline VA at 6 and 12 months of follow-up (p<0.001). Regression analysis identified several baseline variables as predictors of visual outcomes at 6 and 12 months, with different results depending on the analyzed group. Both treatments were effective, although less effective than results reported in clinical trials. The morphologic response was better with ranibizumab compared to bevacizumab, although functionally there were no differences.

Evidence-Based Update on Ocular Chemical Injuries

Chemical injuries of the eye remain a serious cause of visual disability. The current literature is reviewed, with a focus on recent studies that inform evidence-based treatment decisions. Prevention continues to be a primary goal. In addition to conventional therapy (urgent irrigation, topical corticosteroids and antibiotics, oral vitamin C, possibly doxycycline and topical antioxidants), there is evidence that amniotic membrane, umbilical cord serum, or platelet-rich plasma may improve epithelial healing rates in moderate to severe burns. Reconstruction of the ocular surface continues to evolve; for unilateral disease, simple limbal epithelial transplant (SLET) is gaining momentum. For bilateral total limbal stem cell deficiency, treatment options include allogeneic keratolimbal allograft, ex vivo expansion of cultured epithelial sheets, and keratoprosthesis; each intervention represents a unique balance of risks and benefits. SLET appears to be simple and effective for unilateral limbal stem cell deficiency secondary to chemical injuries. The treatment of bilateral injuries requires additional studies to define the preferred practice patterns, as there is no clear consensus regarding the preferred intervention.

Incidence of diabetic eye disease in accordance with duration, glycemic control, blood and ocular pressure

Introduction. Diabetic retinopathy remains the leading cause of visual disability and blindness among professionally active adults in economically developed societies, which is of particular concern because the prevalence and incidence of diabetes mellitus is expected to increase sharply during the next decade. There are several known factors responsible for the development of diabetic retinopathy, duration of disease and blood sugar level being the most important ones. Material and Methods. Prospective study of 280 diabetic patients (diabetes mellitus type 2) divided into 3 groups according to the duration of diabetes mellitus. All diabetic patients underwent complete ophthalmological examination in artificial mydriasis and optic coherence tomography. A full medical history included patient age, the time elapsed from diabetes diagnosis, current treatment of diabetes, presence of hypertension and glycemic control assessed by glycosylated hemoglobin measurement. Results. The mean age of patients was 63.5 years (SD?6.5, range 57-70 years). Mean duration of diabetes was 7.3 years in group I, 12.4 years in group II and 17.2 years in group III. The average value of glycosylated hemoglobin was 6.58% in the group I, 7.64% in the group II and 8.29% in the third group of patients. No statistically significant difference in intraocular pressure and the level of blood pressure were found among groups. Cataract was present in 104 patients (37.1%). Complications related to diabetes among all patients included in our study were: nonproliferative diabetic retinopathy in 48.5%, proliferative diabetic retinopathy in 25.7% and diabetic macular edema in 22.5% of patients. Conclusion. The duration of diabetes is one of the most significant factors for the development of diabetic maculopathy and the progression from nonproliferative to its proliferative stage. There is significantly higher incidence of proliferative diabetic retinopathy and diabetic macular edema in patients with increased serum level of glycosylated hemoglobin. Diabetes accompanied by hypertension is related to worsening of the clinical course of diabetic eye diseases and developing diabetic macular edema and proliferative diabetic retinopathy.

Perceptual learning leads to long lasting visual improvement in patients with central vision loss.

Macular Degeneration (MD), a visual disease that produces central vision loss, is one of the main causes of visual disability in western countries. Patients with MD are forced to use a peripheral retinal locus (PRL) as a substitute of the fovea. However, the poor sensitivity of this region renders basic everyday tasks very hard for MD patients. We investigated whether perceptual learning (PL) with lateral masking in the PRL of MD patients, improved their residual visual functions. Observers were trained with two distinct contrast detection tasks: (i) a Yes/No task with no feedback (MD: N = 3; controls: N = 3), and (ii) a temporal two-alternative forced choice task with feedback on incorrect trials (i.e., temporal-2AFC; MD: N = 4; controls: N = 3). Observers had to detect a Gabor patch (target) flanked above and below by two high contrast patches (i.e., lateral masking). Stimulus presentation was monocular with durations varying between 133 and 250 ms. Participants underwent 24- 27 training sessions in total. Both PL procedures produced significant improvements in the trained task and learning transferred to visual acuity. Besides, the amount of transfer was greater for the temporal-2AFC task that induced a significant improvement of the contrast sensitivity for untrained spatial frequencies. Most importantly, follow-up tests on MD patients trained with the temporal-2AFC task showed that PL effects were retained between four and six months, suggesting long-term neural plasticity changes in the visual cortex. The results show for the first time that PL with a lateral masking configuration has strong, non-invasive and long lasting rehabilitative potential to improve residual vision in the PRL of patients with central vision loss.

Knowledge on Diabetic Retinopathy among Diabetes Mellitus Patients Attending the Colombo South Teaching Hospital, Sri Lanka

INTRODUCTION: Diabetic retinopathy is a chronic, progressive and potentially sight threatening disease and the most commonly diagnosed complication of diabetes. Its incidence increases with prolonged duration of diabetes and accounts for a significant amount of morbidities that are directly related to diabetes as it is one of the leading causes of visual handicap. This study was conducted to assess the knowledge of diabetic retinopathy among diagnosed diabetic patients, attending clinics at the Colombo South Teaching Hospital (CSTH). OBJECTIVES: (1) To assess the knowledge of diabetic retinopathy among diabetic patients at CSTH. (2) To assess the association between the duration of diabetes and the knowledge on diabetic retinopathy. (3) To assess the association between the education level and the knowledge on diabetic retinopathy. (4) To assess the association between the socio-economic background and the knowledge on diabetic retinopathy. METHODOLOGY: The data collection was carried out over a period of 12 weeks, during which an interviewer administered questionnaire was distributed among 200 respondents attending clinics at CSTH. Systematic random sampling was used as the sampling technique and data was analyzed using SPSS version 15.0. Descriptive data was presented as numbers and percentages and the difference between the categories was decided with the chi square test. RESULTS: Analysis of data revealed that 31% (62) of the study population had a good knowledge of diabetic retinopathy while 69.0% had poor knowledge, implying that a significant proportion of patients have a poor knowledge on diabetic retinopathy (DR). A significant association between the level of knowledge and the duration of the disease ( 5 years), was identified in the present study. Level of education and level of income had a significant association with knowledge. Educational level of the spouse too was a significant factor (P < 0.05) under the category of family support. Sources of information had a significant association with the level of knowledge. CONCLUSION: The knowledge of diabetic retinopathy (DR) in the study population was found to be poor. A statistically significant association between knowledge of diabetic retinopathy and the following variables, which included the duration of diabetes, socio-economic background, family support and the sources of information was identified.

Research progress in relative crystallin genes of congenital cataract

Congenital cataract is the common cause of visual disability in children. Nearly one third of congenital cataract cases may have a related genetic mutation. With the development of molecular genetics, especially gentechnik, more and more genes, such as crystallin genes, membrane protein genes, eytoskeletal protein genes and regulatory protein genes have been confirmed to participate in the process of congenital cataract. Furthermore, crystallin genes account for most of these genes and the crystallin has the highest amount of the whole protein in lens.It has been found that nearly one hundred mutations in crystallin genes are associated with the onset of congenital cataract. Researchers are exploring how these mutations further affect the function of cellular biology and eventually lead to cataract. Although more and more research results gradually reveal the pathogenesis of congenital cataract from the level of gene and protein, the specific pathogenesis is still unclear. The recent progression about inherited congenital cataract related with crysallin genes is summarized in this review.

An epidemiological study of visually disabled patients less than 40 years of age

Background: The human eye is like a camera that used to collect, focus and transmit light through a transparent media to create an image. Vision is one among the five basic special sense of human being. Normal binocular vision is a dynamic process that integrates sensory and motor information to derive meaning of the surroundings. Vision loss is a threat to human being than any other disability in the present day world. There are many causes for visual disability which includes damage to the eye and the failure of the brain to interpret the information from the eye correctly. Aim & Objectives: To study the following in patients with visual disability 1. Etiology 2. Magnitude of visual disability. Results: In this study of 156 patients, 31.41% were in the age group of 31- 40 years, 63.46% were found to be males and 42.94% were having 100% visual disability. Retinitis pigmentosa found to be a major cause of visual disability in this study group. Conclusion: Visual disability may be of varying degree and with the higher prevalence among men in the age group 31 – 40 years due to retinitis pigmentosa. Genetic counseling and testing help to determine individuals at risk. In our study, amblyopia is the commonest cause for visual disability in childhood(1 – 10 years). Hence if it is detected early and managed appropriately, visual disability due to amblyopia is reduced. Early intervention is imperative for rapid acceptance, better compliance with rehabilitation programs and higher standard of living. Keywords: Visual disability, causes, category/percentage of disability and rehabilitation

A study to evaluate the cause of blindness/low vision among certified visually disabled individuals in Mandya district of Karnataka

Aim: To identify the demographic characteristics, degree and cause of visual disability among certified visually disabled individuals in Mandya district, Karnataka, India in patients attending Ophthalmology OPD. Materials and Methods: Retrospective record based observational study was carried out in teaching Hospital of Mandya district. Data was collected from visual disability certificates of patients who attended our OPD during the period May 2013 to May 2016. The cause of the visual loss was ascertained. Information from the history, clinical examination and investigations was compiled. Results: In our study, a total of 152 patients were enrolled out of 170 cases. Children and young adults up to age of 30 years constituted around (48, 31.57%) of cases. Among certified visually disabled individuals there were more males (105, 69.08%) compared to females (47, 30.92%). Amount of visual disability percentage of 100%, 75% and 40% was seen in 102(67.10%), 36(23.68%) and 14(9.21%) people respectively. Congenital ocular malformations (32, 21.05%), Retinitis pigmentosa (27, 17.76%) and Optic atrophy (21, 13.81%) were responsible for more than 50% of the cases. Conclusion: Children and young adults constitute around one third of disabled individuals. Men are more common beneficiaries when compared to women showing gender bias. Congenital ocular malformation and Retinitis pigmentosa were the most common causes of certified visual disability. Keywords: Certification, Congenital Ocular malformation, Retinitis pigmentosa, Visually disabled, Optic atrophy

Understanding the patient's lived experience of neovascular age-related macular degeneration: a qualitative study.

In industrialised populations age-related macular degeneration (ARMD) is the leading cause of visual disability of the elderly. Successful new treatment with anti-endothelial growth factors for neovascular-classified ARMD has led to a divergence in treatment and experiences of people ARMD. This study aimed to understand the participant's experience of neovascular ARMD, including ongoing treatment with anti-vascular endothelial growth factor. Twenty-five participants from one clinical site were qualitatively interviewed to elicit their experiences of treatment for neovascular ARMD. Two major themes were identified. A life negotiated by neovascular ARMD captures the participants' experience of living with the condition and treatment regime for neovascular ARMD. The second major theme: Uncertainty displayed their appraisal of life, treatment and their perceived future. Anxieties concerning the injections, new limitations to lifestyles, and an uncertain future all emerged from the data analysis. However, thankfulness for the treatment, the importance of familiar patterns in treatments and recovery and a guarded optimism also emerged. Knowledge of the experiences, anxieties and concerns of this patient population can be used to inform clinical practice and lead to patient-centred care.