Moderate Visual Impairment Research Articles

Queratocono en la comunidad de Tulcán, provincia del Carchi, Ecuador, 2022

Keratoconus is a bilateral, non-inflammatory degeneration that causes an increase in corneal curvature and is accompanied by irregular astigmatism. In order to characterize patients with keratoconus treated at Opticas Tulcán in the province of Carchi, Ecuador, from March to August 2021, an observational, descriptive, cross-sectional study was carried out. 48 patients diagnosed with keratoconus were studied. Sociodemographic variables such as age, sex, and clinical variables were studied, such as a history of ocular and general diseases, clinical signs, topographic values, and degree of keratoconus, for which the distribution of absolute frequencies and the percentage were produced as a summary measure. The data was processed using the statistical package SPSS version 19.0 for Windows and later tabulated or graphed. It was observed that the age group with the highest frequency was between 20 and 24 years of age (35.41%) with a predominance of the male sex. An insignificant percentage of family history of keratoconus was determined, 39.58% of the sample did not present associated general diseases and from the ocular point of view allergic keratoconjunctivitis predominated. Grade I keratoconus was the most representative, with the most evident topographic pattern being the symmetrical central cone and the most relevant sign being the Fleischer ring. There was a predominance of moderate visual impairment in 39 patients. Keratoconus is a real problem in patients treated at Opticas Tulcán, requiring early diagnosis and timely treatment.

Vision impairment and associated daily activity limitation: A systematic review and meta-analysis.

Vision impairment is a common disability that poses significant challenges to individuals' ability to perform activities essential for independent living, including activities of daily living (ADL) and instrumental activities of daily living (IADL). Despite extensive research, the extent and nature of these associations remain unclear, particularly across varying levels and types of vision impairment. This meta-analysis aims to estimate associations between vision impairment and difficulties with ADL and IADL. We conducted a systematic review of relevant literature from the inception of the databases to February 2024, using electronic database searches, including PubMed, MEDLINE (Ovid), EMBASE, Cochrane CENTRAL, and CDSR. The articles were screened for title and abstract and then for the full-text reports by two independent reviewers and study quality was appraised. Meta-analyses were performed using random effects models to calculate the pooled effect size, expressed as odds ratio (OR) with corresponding 95% confidence interval (CI) of each outcome. Forty-six studies involving 210,960 participants were included. A positive large correlation between vision impairment and difficulties with ADL (Correlation coefficient [r] = 0.55, 95% CI 0.37-0.68, p = 0.001) and IADL (r = 0.60, 95% CI 0.49-0.69, p = 0.001) was shown. We also found that vision impairment was associated with difficulties in ADL (OR = 1.77, 95% CI 1.56-2.01, p < 0.0001) and IADL (OR = 1.96, 95% CI 1.68-2.30, p < 0.0001). Subgroup analysis revealed that moderate to severe impairment resulted in difficulties in ADL (OR = 1.78, 95% CI 1.43-2.21, p = 0.02) and IADL (OR = 1.86, 95% CI 1.57-2.20, p = 0.0003). Further, there was a significant association between mild to moderate vision impairment and difficulties in IADL (OR = 1.38, 95% CI 1.23-1.55, p < 0.0001). Greater impact was observed in individuals with near vision impairment compared to those with distance vision impairment. Near vision impairment was significantly associated with higher difficulties in ADL (OR = 1.77, 95% CI 1.57-2.01, p < 0.0001) and IADL (OR = 1.79, 95% CI 1.32-2.42, p < 0.0001). In contrast, distance vision impairment showed lower but still significant associations with IADL (OR = 1.19, 95% CI 1.05-1.34, p = 0.005) and a nonsignificant association with ADL (OR = 1.12, 95% CI 0.90-1.40, p = 0.30). Meta-regression analysis indicated that for every one-year increase in age, ADL performance decreased by an average of 0.0147 units (p < 0.001), while IADL performance declined at a slower rate of 0.0047 units/year (p = 0.031). The present systematic review and meta-analysis using several statistical methods indicates that vision impairment including near vision impairment, is associated with difficulties in ADL and IADL. Thus, vision impairment remains an urgent and increasingly important public health priority. These findings highlight the need for targeted measures to raise public health awareness to provide rehabilitation and eye care examination strategies to reduce the risk of developing disabilities in adults and the elderly who have vision impairment.

Moderate vision impairment to hip motion during vertical jumps: A pilot randomized cross-over study

Objective: To examine performance and lower limb kinematics between participants with clear and unclear vision when performing a specifical submaximal jump. Measures include success rate, jump accuracy, and joint angle. Methods: 12 males, aged 22.2 ± 1.2 years, with moderate vision impairment (left vision: 0.12 ± 0.02, right vision: 0.13 ± 0.04) and no professional athletic background were recruited in the randomized and cross-over designed trial according to the effect size and statistical power. After collecting the anthropometric data, each participant was asked to finish 2 tasks of a specifical submaximal jump to touch a static or moving target with or without vision correction in random order and with a 1-week interval rest. The success rate was recorded by the experimenter, and the jump accuracy, and joint angle data were captured by inertial motion capture (IMC). Statistical analysis included the Χ2 test to analyze the success rates and the independent sample T-test to analyze jump accuracy and joint angle data. When data were not normally distributed the Mann-Whitney U test was used as a substitute. Result: The study found no significant differences in success rate or jumping accuracy between the group with moderate vision impairment and the group with normal vision. However, significant differences were observed in hip joint movements during both static and moving target tests. Hip minimum angles increased when participants wore optical correction and the target was static (Corrected: −6.07 (−9.61, −2.74), uncorrected: −4.52 (−7.46, −1.01); Z = −2.66, p = 0.008), but decreased in both hip minimum (Corrected: −5.14 (−9.31, 0.15), uncorrected: −7.08 (−10.92, −2.47); Z = −2.72, p = 0.006) and maximum (Corrected: 60.74 (48.67, 69.63), uncorrected: 56.27 (42.41, 65.05); Z = −2.83, p = 0.004) angles when the target was moving. Conclusions: No evidence was found to suggest that mild distance visual impairment on vertical jump success rate or vertical jumping accuracy including the horizontal plane and vertical axis. We found that mild distance visual impairment can affect hip joint movements during 75% vertical jumps whether the target is moving or static.

Review: Clinical findings and genetic characterization of children affected with X-linked retinoschisis in the Spanish population.

X-linked retinoschisis (XLRS) is an inherited retinal disorder due to mutations in retinoschisin 1, characterized by impaired central vision secondary to parafoveal cystic cavities and visual field loss by splitting through the retinal nerve fibre layer in the peripheral retina. It is the leading cause of juvenile macular degeneration in males, and currently there is no approved treatment but carbonic anhydrase inhibitors can be used. A retrospective review of the medical records of 17 children with confirmed XLRS seen in the Paediatric Ophthalmology Department of La Paz University Hospital from the 1st of January 2009 to the 1st of June of 2023 was conducted. Complete ophthalmological studies, genetic testing and full-field electroretinogram were performed. Topical brinzolamide was given to patients with foveoschisis, adding oral acetazolamide in those who did not improve with topical treatment alone or with very extensive foveoschisis at diagnosis. Surgical treatment was performed in retinal detahment (RD) or in no clearing hemovitreous cases. Mean age at diagnosis was 5,86 years and the most common reason for consultation was strabismus, followed by RD. The most frequently affected retinal later on Optic coherence tomography was the inner nuclear layer and throughout the follow-up we observed a decrease in central macular thickness. We found some genotype-phenotype correlation in our series and more severe phenotypes if the first amino acid of the protein is affected or in frameshift mutations. We found that medical treatment (topical and oral) improves foveoschisis, and that surgery shows poor outcomes, especially in younger patients.

Prevalence of Vision Loss in South and Central Asia in 2020: Magnitude and Temporal Trends

ABSTRACT Purpose To estimate the prevalence of vision loss for 2020 in South and Central Asia and analyze trends since 1990. Methods In a systematic literature review, we estimated the prevalence of blindness, visual impairment (VI) and presbyopia-related VI in 1990,2000,2010, and 2020. Results The study included 103 population-based studies. In South/Central Asia combined, age-standardized prevalence of blindness, moderate-to-severe VI (MSVI), moderate VI, severe VI, mild VI and presbyopia-related VI for all ages was 0.65% (95% uncertainty interval (UI):0.56/0.74), 5.06 (4.55/5.59), 4.40 (3.91/4.94), 0.65 (0.57/0.74), 3.21 (2.89/3.56), and 8.77 (6.37/11.48), respectively, with higher values for women than men. From 2000 to 2020, changes in age-standardized prevalence in South Asia were −36.85 (−36.94/−36.76), −7.01 (−7.13/−6.90), −5.86 (−5.99/−5.73), −13.96 (−14.09/−13.82), −9.55 (−9.66/−9.44), and −8.62 (−8.93/−8.31), respectively for men, and −38.50 (−38.59/−38.40), −10.12 (−10.22/−10.01), −9.23(−9.36/−9.10), −14.86 (−14.99/−14.73), −9.44 (−9.56/−9.33), and −7.78 (−8.09/−7.48), respectively for women. From 2000/2020, the changes in age-standardized prevalence figures in Central Asia were −21.44 (−21.58/−21.30), −2.75 (−2.87/−2.64), −2.17 (−2.30/−2.04), −7.12 (−7.26/−6.99), −5.36 (−5.48/−5.25), and −3.67(−4.02/−3.32), respectively for men, and −21.13 (−21.27/−20.99), −2.70 (−2.81/−2.58), −2.18 (−2.30/−2.05), −6.93 (−7.07/−6.80), −5.03 (−5.14/−4.91), and −2.65 (−3.00/−2.30), respectively, for women. In 2020, 11.94 million (9.98–14.07) and 0.30 million (0.24–0.36) individuals were blind, and 96.22 million (84.12–110.27) and 2.95 million (2.52–3.43) had MSVI in South Asia and Central Asia, respectively. Conclusions Despite a higher decrease between 2000 and 2020, the age-standardized prevalence of blindness and MSVI were higher in South Asia than in Central Asia in 2020. The number of people affected increased due to population growth and improved longevity.

Clinical profile and etiological spectrum of patients presenting with corneal hydrops over a 12-year period.

To describe the demographics, clinical characteristics, and management of corneal hydrops in patients presenting to a multi-tier ophthalmology hospital network in India. Cross-sectional hospital-based study. Of the total of 3,140,941 new patients presenting between October 2010 and March 2022, patients with a clinical diagnosis of corneal hydrops in at least one eye were included in the study. All the data was collected using an electronic medical record system. 1291 eyes of 1110 patients were diagnosed with corneal hydrops and included in the study and 961 patients (83.69%) had a unilateral affliction. Corneal hydrops was noted to be significantly more common in males (62.43%) and adults (62.7%). The most common age group at presentation was during the second decade of life with 472 (42.52%) patients. They were more commonly from the higher socio-economic status (77.3%) and from the urban geography (44.23%). In the 1291 eyes, 567 (43.92%) eyes had a visual impairment of blindness (> 20/400-20/1200) followed by moderate visual impairment (> 20/70-20/200) in 166 (12.86%) eyes. Overall, the most common etiology was keratoconus in 1,082 (83.81%) eyes followed by primary congenital glaucoma (PCG) in 91 (7.05%) eyes. Surgical intervention to hasten the recovery of hydrops was performed in 7.82% of eyes with ectasia and as a definite management in 7.05% eyes with PCG. Visual rehabilitation was with contact lenses in 29.1% eyes and keratoplasty in 13.94% eyes. Corneal hydrops is predominantly unilateral and is more common in males. Keratoconus was the commonest etiological condition; however, the risk of hydrops was highest in keratoglobus, followed by PMD. Most affected age was the second decade of life and visual impairment was severe in majority (60%). A surgical intervention was performed in a third of the cases.

Stakeholder insights on cost, quality, and incorporating patient voice in managed care decisions on neovascular (wet) age-related macular degeneration: Findings from the AMCP Market Insights program.

Wet age-related macular degeneration (AMD) is an acquired degeneration of the retina that can lead to central vision impairment. It is primarily treated with intravitreal injections of vascular endothelial growth factor inhibitors. Although vascular endothelial growth factor inhibitors can effectively prevent progression of vision loss in many patients, they require ongoing regular administration and are therefore associated with considerable treatment burden. To gain insights into the impact of wet AMD and its treatment, AMCP convened an expert panel of managed care stakeholders in April 2024 through its Market Insights program. Key issues related to wet AMD identified by participants included cost and affordability, provider-related considerations, biosimilar adoption, measuring and improving quality, and incorporating the patient voice. Suggested payer best practices related to these issues in wet AMD also emerged from the discussion.

THREE-YEAR CLINICAL OUTCOMES IN GEOGRAPHIC ATROPHY: An Analysis of 18,712 Patient Eyes.

To assess visual outcomes and rate of neovascular age-related macular degeneration (nAMD) development in eyes with geographic atrophy (GA). Retrospective analysis of 18,712 eyes with GA using the CorEvitas Vestrum Health Retina Database. Mean age at index was 78.6 years (SD = 7.9) and mean visual acuity was 67.5 letters (SD = 13.0, Snellen equivalent 20/45). In total, 18.9% of eyes developed nAMD within 36 months. Eyes with fellow-eye nAMD developed nAMD at over twice the rate of eyes with fellow-eye GA (relative risk 2.34, 95% confidence interval [2.20-2.49]). Mean visual acuity of eyes that did not develop nAMD declined by 12.4 letters (95% confidence interval [12.0-12.9]) within 36 months. Older age and moderate baseline visual impairment (visual acuity <20/40-20/100) independently correlated with accelerated rate of decline. Eyes of patients in the oldest quartile with moderate visual impairment experienced the worst outcomes, losing an average of 19.7 letters over 36 months (95% confidence interval [18.1-21.3]). By 36 months, 70% of eyes had vision below threshold for driving (visual acuity ≤20/40), 42% had low vision (visual acuity ≤20/70), and 23% were legally blind (visual acuity ≤20/200). Geographic atrophy is associated with significant disease burden. Eyes with GA lose an average of two to three lines of visual acuity within 36 months of follow-up. Older age and moderate baseline visual impairment independently correlate with poorer visual outcomes. Presence of nAMD in the fellow eye is associated with 2-fold higher risk of exudative conversion within 36 months.

Targeted Therapy on Age-Related Macular Degeneration

Abstract Age-related macular degeneration (AMD) is an eye-related condition in developed countries and can affect elderly individuals to lose their central vision. At first, physicians can spot early AMD by looking for accumulation called macular deposits underneath the retinal pigment epithelium (RPE) cells. It can be broadly divided into dry and wet types. One can analyse dry AMD by seeing many large drusen, and RPE layer detachment leads to central vision impairment. However, wet AMD can be identified by formation of choroidal neovascularisation by using various diagnosis methods. There are many risk factors like genetics and environmental factors (smoking, diet) that can increase the chances of getting and worsening AMD. The main goal in treating AMD is to slow down the disease at an early stage. Anti-vascular endothelial growth factor medications are used to treat central vision loss patients in order to prevent new blood vessel growth, which helps lessen the loss of vision. A healthy diet rich in antioxidants may help in preventing AMD; understanding the risk factors and improving lifestyle choices are more important. Even though we have made good strides in spotting this disease for better treatment, we still need more research to really understand how it works to reduce disease conditions by various agents. This review article of AMD covers the recent trends in diseases, development of risk factors, diagnosis methods, grading system, and possibilities for AMD therapy.

Optimizing the pterional approach in medial sphenoid wing meningioma: a detailed morphometric study on anterior clinoidectomy and its effect on operability score

BackgroundMedial sphenoid wing meningiomas are best treated through pterional craniotomy, as pterional craniotomy provides wide and multidirectional exposure of the anterior and middle cranial fossa. Anterior clinoidectomy can increase the exposure potential. To delineate the role of anterior clinoidectomy (AC) in the standard pterional craniotomy approach through the evaluation of operability score measures (manoeuvrability arc, depth of surgical field, and surgical angle of attack). All patients with inner sphenoidal wing meningioma who underwent microsurgical excision between February 2022 and October 2023 were enrolled in the study. Preoperative and postoperative imaging studies (MR contrast studies and 3D thin-slice CT scans of the brain) were performed to determine the tumour size, extent, and pattern of optic canal involvement by comparing pre- and postoperative operability score parameters.ResultsTwenty-five patients met our inclusion criteria: 2 males (8%) and 23 females (92%). The mean age (SD) was 49.08 ± 6.42 years, with an age range of 39–60 years. The preoperative visual manifestations were as follows: eight patients (32%) had mild visual impairment, five patients (20%) had moderate visual impairment, six patients (24%) had severe visual impairment, and five patients (20%) had blindness. There was a significant positive correlation between the operability score and extent of resection (gross total resection was correlated with a higher operability score) (r = 0.301, n = 25, p = 0.005).ConclusionsA well-planned manoeuvrable arc allows neurosurgeons to perform surgery with precision, ultimately impacting surgical outcomes and the potential for complete tumour removal with minimal patient morbidity.

Visual Impairment at Presentation in Pediatric Uveitis: A Multicentric Study in 477 Children Across Southern and Eastern India

ABSTRACT Objective To evaluate visual impairment (VI) at presentation in pediatric uveitis cases in southern and eastern India. Methods Retrospective analysis of 477 children across four tertiary centers (2015–2020). Best-documented visual acuity (ETDRS letters) in the better eye was used to categorize VI. Results Mean age at presentation was 11 ± 3.7 years; 43.8% were females, and 64.8% bilateral. Of 205 patients with complete investigations, 32.7% were undifferentiated uveitis, 31.7% infectious, 25.7% juvenile idiopathic arthritis-associated uveitis, and 10.2% other non-infectious uveitis. At presentation, 79.0% had none to mild VI, 12.6% moderate VI, and 8.4% severe VI to blindness. On generalized estimating equations analysis for individual eyes, prior oral steroids and older age were risk factors, while female gender, prior topical corticosteroids and immunosuppressive therapy were protective against moderate and/or severe VI. Conclusions Over a fifth of pediatric uveitis cases present with moderate/severe VI, especially in older age or with prior oral corticosteroid therapy.

Visual Impairment and Refractive Error Among Deaf and Hard of Hearing Learners in Ghana

Introduction This study aims to assess the prevalence of visual impairment and refractive error among learners who are deaf or hard of hearing in schools for Deaf students in Ghana. Methods A descriptive cross-sectional study design was used to assess the distance visual acuity with the logMAR “E” chart, and ocular health was assessed with an ophthalmoscope and handheld slit lamp with a 90 D lens. Results A total of 1,914 learners were examined in six schools for Deaf students in Ghana. Their ages ranged from 5 to 43 years ( M = 15.18 ± 4.53 years). There were more males (55.5%) than females (44.5%) in the study. Among the learners, 91.1% were deaf, followed by mild hard of hearing (4.0%) and profound hard of hearing (1.8%), among others. Also, 94.8% of the learners had typical vision, followed by moderate visual impairment (2.5%), mild visual impairment (1.4%), and blindness (1.3%) before the provision of spectacles. There was no association between visual impairment (i.e., blindness and visual impairment) and sex among the learners ( p &lt; .05). The leading causes of visual impairments were refractive error and cataracts, while the leading cause of ocular morbidity was allergic conjunctivitis. The prevalence of visual impairment was reduced by almost 2-fold after the provision of spectacles. Discussion The prevalence of deafblindness was low among the learners, with uncorrected refractive errors as the leading cause of mild and moderate visual impairment. If these learners had not been identified through this study, they would have continued to struggle to access the curriculum visually. Implications for Practitioners There is a need to assess hearing and visual functions among learners with disabilities in developing countries like Ghana.

Prevalence and Patterns of Ocular Comorbidities among Geriatric Population Residents in Rural Eastern India: A Cross-Sectional Study

Background: With the increase in overall life expectancy, the number of people above 60 years old will increase globally from 1 billion in 2020 to 1.4 billion in 2050 and is expected to double by 2.1 billion by 2050 with an increase in age-related comorbidities. Age-related ocular co-morbidities are a major comorbidity. According to India's visual impairment and blindness data, cataracts and severe and moderate visual impairment are the most common cases. Objective: To assess the ocular comorbidities among the geriatric population. Methods: A community-based cross-sectional study was undertaken in the field practice area of the Rural Health Training Center (RHTC), Jamujhari, Khordha, affiliated with the Department of Community Medicine, IMS &amp; SUM Hospital, Bhubaneswar. Stratified random sampling was done, and one stratum constituted three nearby adopted villages. Four strata were included to select the households, and the first household was selected randomly in each village. A socio-demographic profile and detailed clinical history were collected, and the required clinical examinations were conducted after obtaining consent. Results: The prevalence of ocular morbidity (OM) was found to be 96.8%. Refractive error (RE) has the highest prevalence (86.52%), including prescription-corrected glasses users, whereas age-related macular degeneration (ARMD) and ectropion (EC) have the lowest prevalence (3.2%). Conclusions: The study findings show a need for proactive management and earlier screening for better quality of life in the geriatric population.

Modified ILM flap techniques versus classical inverted ILM flap technique for large macular holes: a systematic review and meta-analysis of randomized controlled trials

BackgroundMacular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.MethodsWe searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the classic inverted ILM flap technique to modified ILM flap techniques as initial surgical treatment of eyes with large MHs of more than 400 microns. We sought to evaluate the following outcomes: (1) MH closure. (2) Best-corrected visual acuity (BCVA). (3) Foveal closure type (4) Rate of ellipsoid zone (EZ) defects and external limiting membrane (ELM) defects. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes.ResultsFour RCTs that enrolled 220 participants were deemed eligible. The analysis revealed no statistically significant differences in MH closure between both groups (95% CI: 0.20, 7.96; P = 0.81). No statistically significant differences in mean BCVA were found at 1 and 3 months between both groups (SMD: 0.04; 95% CI: −0.16, 0.23; P = 0.70 and SMD: −0.167; 95%CI: −1.240, 0.906; P = 0.760, respectively). In addition, there were no significant differences between the two groups in the pattern of foveal closure, namely U-shape, V-shape, and flap open at 3, 6, and 12 months (RR: 0.87; 95% CI: 0.67, 1.12; P = 0.28, RR: 0.96; 95% CI: 0.58, 1.61; P = 0.89, and RR: 1.95, 95% CI: 0.26, 14.50; P = 0.51, respectively). Finally, the analysis showed no statistically significant difference in both groups’ EZ and ELM defect rates at 3, 6, and 12 months (RR: 1; 95% CI: 0.85; 1.18: P = 1 and RR: 1.14; 95% CI: 0.90, 1.45; P = 0.27).ConclusionMacular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.

Optic nerve and chiasm hemangioblastomas in von Hippel-Lindau disease: report of 12 cases and review of the literature.

Optic nerve and chiasm hemangioblastomas are rare tumors, occurring sporadically or in the context of von Hippel-Lindau (VHL) disease. They have only been portrayed in isolated case reports and small cohorts. Their natural history and therapeutic strategies are only scarcely described. To better characterize these rare tumors, we retrospectively analyzed an optic nerve and chiasm hemangioblastoma series of 12 VHL patients. By combining our own experience to a review of all known cases in literature, we intended to create treatment recommendations for optic nerve and chiasm hemangioblastomas in VHL patients. We reviewed two electronic databases in the hospitals of our senior authors, searching for VHL patients with optic nerve or chiasm hemangioblastomas. Clinical data were summarized. Tumor size and growth rate were measured on contrast enhanced MRI. Comparable data were collected by literature review of all available cases in VHL patients (Pubmed, Trip, Google and Google Scholar). Of 269 VHL patients, 12 had optic nerve or chiasm hemangioblastomas. In 10 of 12 patients, tumors were diagnosed upon annual ophthalmoscopic/MRI screening. Of 8 patients who were asymptomatic at diagnosis, 7 showed absent or very slow annual progression, without developing significant vision impairment. One patient developed moderate vision impairment. Two symptomatic patients suffered from rapid tumor growth and progressive vision impairment. Both underwent late-stage surgery, resulting in incomplete resection and progressive vision impairment. One patient presented with acute vision field loss. A watchful-waiting approach was adopted because the hemangioblastoma was ineligible for vision-sparing surgery. One patient developed progressive vision impairment after watchful waiting. In the literature we found 45 patient cases with 48 hemangioblastomas. When optic nerve and chiasm hemangioblastomas are diagnosed, we suggest annual MRI follow-up as long as patients do not develop vision impairment. If tumors grow fast, threaten the contralateral eye, or if patients develop progressive vision deficiency; surgical resection must be considered because neurological impairment is irreversible, and resection of large tumors carries a higher risk of further visual decline.

Global estimates on the number of people blind or visually impaired by age-related macular degeneration: a meta-analysis from 2000 to 2020

BackgroundWe aimed to update estimates of global vision loss due to age-related macular degeneration (AMD).MethodsWe did a systematic review and meta-analysis of population-based surveys of eye diseases from January, 1980, to October, 2018. We fitted hierarchical models to estimate the prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness ( < 3/60) caused by AMD, stratified by age, region, and year.ResultsIn 2020, 1.85 million (95%UI: 1.35 to 2.43 million) people were estimated to be blind due to AMD, and another 6.23 million (95%UI: 5.04 to 7.58) with MSVI globally. High-income countries had the highest number of individuals with AMD-related blindness (0.60 million people; 0.46 to 0.77). The crude prevalence of AMD-related blindness in 2020 (among those aged ≥ 50 years) was 0.10% (0.07 to 0.12) globally, and the region with the highest prevalence of AMD-related blindness was North Africa/Middle East (0.22%; 0.16 to 0.30). Age-standardized prevalence (using the GBD 2019 data) of AMD-related MSVI in people aged ≥ 50 years in 2020 was 0.34% (0.27 to 0.41) globally, and the region with the highest prevalence of AMD-related MSVI was also North Africa/Middle East (0.55%; 0.44 to 0.68). From 2000 to 2020, the estimated crude prevalence of AMD-related blindness decreased globally by 19.29%, while the prevalence of MSVI increased by 10.08%.ConclusionsThe estimated increase in the number of individuals with AMD-related blindness and MSVI globally urges the creation of novel treatment modalities and the expansion of rehabilitation services.

A case of accelerated recovery in acute retinal pigment epitheliitis with early methylprednisolone intervention

We present a compelling case of acute retinal pigment epitheliitis (ARPE), also known as Krill’s disease, in a 26-year-old female ophthalmology resident, emphasizing the significance of early intervention and its impact on rapid symptom resolution. Comprehensive ocular examination, fluorescein angiography, and spectral domain-optical coherence tomography were employed for the diagnosis. The patient received pulsed methylprednisolone therapy that was initiated promptly due to professional exigencies. Within 3 days of initiating the methylprednisolone therapy, most of the symptoms, including central scotoma and visual impairment, resolved remarkably. This accelerated recovery challenges the conventional notion of ARPE as a self-limiting condition. The case underscores the importance of individualized treatment strategies in professional contexts, where swift resolution is imperative. Advanced imaging techniques, particularly spectral domain-optical coherence tomography, play a pivotal role in both diagnosis and monitoring the disease progression. Further research is crucial to refine the treatment protocols and unravel the intricacies of ARPE pathophysiology.

Prevalence and Pattern of Ocular Diseases among Rural Dwellers in Affa, Enugu State

Background: The prevalence and pattern of different ocular diseases among rural dwellers vary in different parts of the world. It is usually influenced by a numerous factor, including but not limited to utilization of eye care services, socio-economic status, and level of education. Aim: To identify the most prevalent eye diseases and their pattern of occurrence, among rural dwellers in South East Nigeria, with a view to influence targeted health policies and subsequently, targeted interventions to improve eye health in the region. Methods: The study was a cross sectional study involving patients willing to participate in the study during a one-day free eye outreach organized by the Ophthalmology department, ESUTH Parklane at Affa Community in Udi Local Government Area of Enugu state. A preliminary visit was made one week prior to the health outreach, by some members of the outreach team to mobilize the community, seek their consent and fix a date through their leaders. On the day for the outreach, the objective of the eye screening was explained to the participants in both English and their local language. Subsequently, informed consent was obtained and each subject registered and the bio-data documented. Registered participant had their unaided and aided Visual Acuity (VA) of each eye determined. Then, the anterior and posterior segment was examined. Data collected were recorded using a proforma and later inputted into a computer, cleaned and analysed using SPSS version 21. Results were presented in tables and represented in frequencies percentages. Association between variables were done using t-test and p- value of &lt;0.05 was considered significant. Results: One hundred and sixty-eight participants were screened during the outreach programme/study with mean age of 40+0.5years. There were more females 116 (69.1%) than males 52 (30.9%), giving a female to male ratio of 2:1 and they are predominantly Christians and farmers. The common ocular problems among the participants include cataract 53 (22.6%), refractive error 37 (15.8%), Pterygium 35 (14.9%). Cataract was the most common eye disease among the outreach participants and responsible for 22.6% of all ocular problems. Normal visual acuity was found more in participants &lt; 50 years of age, mild visual impairment occurred more in participants 51-70 years while moderate visual impairment to blindness were seen more in patients &gt;70 years. Conclusion: In this study, the commonest ocular problems among the participants include Cataract, Refractive error, and Pterygium which are reversible causes of visual impairment and blindness. Therefore, health policies and advocacies should be directed towards reducing the burden of these reversible causes of visual impairment and blindness among the rural dwellers which constitute greater proportion of our population.

Rapid assessment of avoidable blindness (RAAB): A 15-year follow-up in Gegharkunik province of Armenia

PurposeThis study assessed the changes in the prevalence of visual impairment (VI)/blindness, cataract surgical coverage (CSC), visual outcome after cataract surgery, and main barriers to cataract surgery among the population aged 50 years and older in Gegharkunik province of Armenia from 2003 - 4 to 2019. DesignA cross-sectional study. MethodsA multi-stage cluster sampling technique was used to conduct Rapid Assessment of Cataract Surgical Services (RACSS) and Rapid Assessment of Avoidable Blindness (RAAB) surveys in 2003–4 and 2019, respectively. Overall, 56 clusters (40 people in each cluster) were selected for RACSS, and 24 clusters (50 people in each cluster) for RAAB. Both surveys collected data on participants’ demographics, presenting/pinhole visual acuity (PVA/PinVA), the principal cause of VI, CSC, and barriers to cataract surgery. ResultsOverall, 1,787 people participated in RACSS and 1,099 people in RAAB. Between 2003–4 and 2019, age- and sex-adjusted prevalence of bilateral blindness decreased from 2.0 % to 1.4 % while severe VI decreased from 5.2 % to 2.2 % and moderate VI from 16.0 % to 7.3 %. Untreated cataract contributed to 71.9 % and 40.9 % of all blindness cases in 2003–4 and 2019, respectively. The CSC at the threshold <6/18 improved from 23.7 % in 2003–4 to 64.8 % in 2019. Both surveys mentioned the cost as the most common barrier to cataract surgery. ConclusionDespite substantial improvements, cataract remained the main cause of blindness in the province. Increasing financial coverage of cataract surgeries and improving the quality of surgeries could increase their utilization of services and help improve visual outcomes in the population.

Hazard Perception in Visually Impaired Drivers Who Use Bioptic Telescopes.

Bioptic telescopic spectacles can allow individuals with central vision impairment to obtain or maintain driving privileges. The purpose of this study was to (1) compare hazard perception ability among bioptic drivers and traditionally licensed controls, (2) assess the impact of bioptic telescopic spectacles on hazard perception in drivers with vision impairment, and (3) analyze the relationships among vision and hazard detection in bioptic drivers. Visual acuity, contrast sensitivity, and visual field were measured for each participant. All drivers completed the Driving Habits Questionnaire. Hazard perception testing was conducted using commercially available first-person video driving clips. Subjects signaled when they could first identify a traffic hazard requiring a change of speed or direction. Bioptic drivers were tested with and without their bioptic telescopes in alternating blocks. Hazard detection times for each clip were converted to z-scores, converted back to seconds using the average response time across all videos, and then compared among conditions. Twenty-one bioptic drivers and 21 normally sighted controls participated in the study. The hazard response time of bioptic drivers was improved when able to use the telescope (5.4 ± 1.4 seconds vs 6.3 ± 1.8 seconds without telescope); however, it remained significantly longer than for controls (4.0 ± 1.4 seconds). Poorer visual acuity, contrast sensitivity, and superior visual field sensitivity loss were related to longer hazard response times. Drivers with central vision loss had improved hazard response times with the use of bioptic telescopic spectacles, although their responses were still slower than normally sighted control drivers. The use of a bioptic telescope by licensed, visually impaired drivers improves their hazard detection speed on a video-based task, lending support to their use on the road.