Incidence Of Visual Impairment Research Articles

Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review.

The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people. Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature. Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results. In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.

Impact of CKD on Incidence of Visual Impairment: The Singapore Epidemiology of Eye Diseases Study

Impact of CKD on Incidence of Visual Impairment: The Singapore Epidemiology of Eye Diseases Study

A comparative study of regional variations in common visual impairments among school-age children

<b>Purpose:</b> This study aims to examine the incidence and age-related prevalence of eye conditions among school-age children living in Moscow Region (Russian Federation) and Riyadh (Saudi Arabia).<br /> <b>Methods:</b> The study sample includes 573 visually impaired children aged 7-17 years (13.85±1.24 years) in Russian Federation and 600 children (13.78±1.11 years) in Saudi Arabia.<br /> <b>Results:</b> Myopia in Russian Federation was with a prevalence rate of 35.6%, followed by astigmatism (21.3%), strabismus (16.2%), conjunctivitis (13.6%), hyperopia (10%). The incidence of visual impairment was lower for children from Saudi Arabia compared to Russian Federation (OR=1.01, 95% CI [0.85-1.17] in 2018, OR=0.93, 95% CI [0.83-1.03] in 2022 in Saudi Arabia and OR=1.36, 95% CI [1.25-1.47] in 2018 vs. OR=1.33, 95% CI [1.23-1.43] in 2022 in Russian Federation). In Saudi Arabia, myopia occurred in 10% of cases at 7-10 years, 20% at 11-13 years, and 25% at 14-17 years.<br /> <b>Conclusion:</b> The satisfactory state of the health system in Saudi Arabia compared with Russian Federation has resulted in a lower incidence of visual diseases among children. The possible causes of the myopia prevalence are worse medical system in the Russian Federation compared to Saudi Arabia, and climate in both countries.

Virtual reality as a means to explore assistive technologies for the visually impaired.

Visual impairment represents a significant health and economic burden affecting 596 million globally. The incidence of visual impairment is expected to double by 2050 as our population ages. Independent navigation is challenging for persons with visual impairment, as they often rely on non-visual sensory signals to find the optimal route. In this context, electronic travel aids are promising solutions that can be used for obstacle detection and/or route guidance. However, electronic travel aids have limitations such as low uptake and limited training that restrict their widespread use. Here, we present a virtual reality platform for testing, refining, and training with electronic travel aids. We demonstrate the viability on an electronic travel aid developed in-house, consist of a wearable haptic feedback device. We designed an experiment in which participants donned the electronic travel aid and performed a virtual task while experiencing a simulation of three different visual impairments: age-related macular degeneration, diabetic retinopathy, and glaucoma. Our experiments indicate that our electronic travel aid significantly improves the completion time for all the three visual impairments and reduces the number of collisions for diabetic retinopathy and glaucoma. Overall, the combination of virtual reality and electronic travel aid may have a beneficial role on mobility rehabilitation of persons with visual impairment, by allowing early-phase testing of electronic travel aid prototypes in safe, realistic, and controllable settings.

AZAR eye and vision cohort study

According to World Health Organization (WHO), currently, 2.2 billion people are living with visual impairment worldwide, of which almost half could have been prevented. There are both modifiable and unmodifiable factors leading to visual disability and, ultimately, blindness. Several population-based studies in different parts of Iran have tried to determine these factors concerning their specific population and environment-related characteristics. AZAR Eye and Vision cohort is the second-largest cohort study in the whole country. AZAR Eye and Vision cohort is the ophthalmologic branch of AZAR cohort which is the largest eye cohort study in the country, which is trying to determine the prevalence and incidence of visual impairment, blindness, and other major ophthalmologic conditions and their associated risk factors in East Azerbaijan province located in Iran, a middle eastern country. A recently emerging phenomenon is the drying of the ultra-salty lake of Urmia located in the West Azerbaijan province which is a direct neighbor of our studied population and has caused recurrent salt storms in the immediate near areas. This phenomenon could adversely affect visual health via different conditions which our study will elucidate. The enrollment phase took place between 2014 and 2017 and 11,208 participants were enrolled out of 15,000 participants in the primary cohort. The resurvey phase will begin five years after the enrollment phase. In this phase, 30% of the participants are randomly selected to be reexamined and complete questionnaires. The participants showing any issues such as diabetes and being a glaucoma suspect will be included in the resurvey phase, too. Data categories gathered include demographics, lifestyle factors, past medical and drug histories, and a diet quality and quantity questionnaire including 130 edible items. Urine, hair, nail, and 25-ml blood samples, were collected from the participants. Then they were referred to an optometrist to complete an ophthalmologic questionnaire and undergo eye examination and lensometry. Then they underwent slit-lamp examinations and pictures were taken of the lens and fundus. People with suspected visual impairment were referred to an ophthalmology clinic. The data are processed and a four-level quality check is performed on each block. The most common visual impairment is cataracts. This study’s most important aim is to evaluate the effect of local environmental and ethnic factors on eye diseases in this specific population.

Poremećaj vida i padovi kao faktori rizika za ortopedske prelome

The musculoskeletal system represents one of the most affected systems in general traumatology. Fractures of the locomotor system and their effects are among the most severe and demanding injuries for the community in general and for the health system in particular. There are different factors that have been established as risk factors for fractures, with falls representing the main cause. Given the fact that vision has a key role in preserving gait and balance, various conditions of visual impairments have been related to an increase in fall-related injuries, and fractures of the locomotor system, especially in older population. Indeed, with an increased life expectancy, there is a rise in the number of visually impaired individuals and subsequently a rise in the number of falls and fractures. In this study, a review of the incidence and risk factors of musculoskeletal system fractures and falls was conducted, with the incidence of visual impairments in the general population. Another review of different types of visual impairments was done that included potential risk factors for fractures, falls and soft tissue injuries of the hand and if there has been any association between these specific visual impairments and the risk of falling, getting a fracture or a soft tissue injury of the hand.

Dementia and risk of visual impairment in Chinese older adults

We had previously identified visual impairment increasing risk of incident dementia. While a bi-directional vision-cognition association has subsequently been proposed, no study has specifically examined the longitudinal association between dementia and incidence of clinically defined visual impairment. In this territory-wide community cohort study of 10,806 visually unimpaired older adults, we examined their visual acuity annually for 6 years and tested if dementia at baseline was independently associated with higher risk of incident visual impairment (LogMAR ≥ 0.50 in the better eye despite best correction, which is equivalent to moderate visual impairment according to the World Health Organization definition). By the end of Year 6, a total of 3151 (29.2%) participants developed visual impairment. However, we did not find baseline dementia associating with higher risk of incident visual impairment, after controlling for baseline visual acuity, cataract, glaucoma, diabetes, hypertension, hypercholesterolemia, heart diseases, stroke, Parkinson’s disease, depression, hearing and physical impairments, physical, intellectual and social activities, diet, smoking, age, sex, educational level, and socioeconomic status. Among different covariables, baseline visual acuity appears to be more important than dementia in contributing to the development of visual impairment. Our present findings highlight the need for re-evaluating whether dementia is indeed a risk factor for visual impairment.

Ambient gaseous pollutant exposure and incidence of visual impairment among children and adolescents: findings from a longitudinal, two-center cohort study in China.

Evidence on the effects of exposure to ambient gaseous pollutants on children's vision was consistently scarce. We aimed to explore the effect of ambient gaseous pollutant exposure on the incidence of visual impairment (VI) in children. From 2005 to 2018, a total of 340,313 children without VI participated in a longitudinal and two-center dynamic cohort. The logMAR acuity was used to assess visual function. The space-time extremely randomized trees model was used to estimate SO2 and CO exposures levels. The association between SO2 and CO and VI risks among children was assessed using a proportional hazards model with a restricted cubic spline. Subgroup analyses stratified by gender and grades were used to investigate the differences in an association of SO2 and CO exposures with childhood VI. A total of 158381 (46.54%) children experienced an new incident VI. A ten-unit (10μg/m3) increase in SO2 exposure concentrations was significantly associated with a 1.70 times higher risk of childhood VI. In addition, a 0.1-unit (0.1mg/m3) increase in CO exposure was significantly associated with a 1.22 times higher risk of childhood VI. The positive association between ambient gaseous pollutants (including SO2 and CO exposures) and childhood VI risks remained even after adjusting for other environmental variables. An increase in the incidence of VI in children was positively linked to SO2 and CO exposure. Such evidence might aid governments in developing strategies to interfere with children's eyesight by decreasing air pollution and changing school curricula.

The longitudinal association between cognitive impairment and incident visual impairment in a multiethnic Asian population: a prospective cohort study.

The relationship between baseline cognitive impairment (CI) and incident visual impairment (VI) in Asians is unclear. To determine the associations between baseline CI with incident VI and visual acuity (VA) at 6-year follow-up in multiethnic Asians. Cohort. Population-based. Two thousand three hundred and twenty-four adults aged ≥60years from the Singapore Epidemiology of Eye Diseases Study (response rate 64%). CI was defined using the validated Abbreviated Mental Test (AMT). VA was objectively measured using a LogMAR chart. Any incident VI was defined as having no VI (Snellen's VA better than or equal to 20/40) at baseline but present (VA worse than 20/40) at 6-year follow-up. VI severity was defined according to the International Classification of Diseases, 11th Revision. Associations were assessed using logistic and linear regression models. Of the 2,324 participants, 248 had CI at baseline. Presence of baseline CI was associated with more than twice the odds of any incident VI, incident mild and moderate-severe VI (OR [95% confidence interval]: 2.48 [1.55-3.90], 2.07 [1.17-3.55], and 2.61 [1.36-4.93], respectively) and worse VA (β [95% confidence interval]: 0.026 [0.006-0.046]) at 6-year follow-up. The leading causes of incident VI were cataract and under-corrected refractive error. Older adults with CI had more than double the odds of VI development and poorer VA than their cognitively intact counterparts, and most causes of incident VI were correctable. Strategies such as targeted vision screening and early intervention for early detection and management of vision loss in patients with cognitive decline are warranted.

Cost-effectiveness of artificial intelligence screening for diabetic retinopathy in rural China

BackgroundDiabetic retinopathy (DR) has become a leading cause of global blindness as a microvascular complication of diabetes. Regular screening of diabetic retinopathy is strongly recommended for people with diabetes so that timely treatment can be provided to reduce the incidence of visual impairment. However, DR screening is not well carried out due to lack of eye care facilities, especially in the rural areas of China. Artificial intelligence (AI) based DR screening has emerged as a novel strategy and show promising diagnostic performance in sensitivity and specificity, relieving the pressure of the shortage of facilities and ophthalmologists because of its quick and accurate diagnosis. In this study, we estimated the cost-effectiveness of AI screening for DR in rural China based on Markov model, providing evidence for extending use of AI screening for DR.MethodsWe estimated the cost-effectiveness of AI screening and compared it with ophthalmologist screening in which fundus images are evaluated by ophthalmologists. We developed a Markov model-based hybrid decision tree to analyze the costs, effectiveness and incremental cost-effectiveness ratio (ICER) of AI screening strategies relative to no screening strategies and ophthalmologist screening strategies (dominated) over 35 years (mean life expectancy of diabetes patients in rural China). The analysis was conducted from the health system perspective (included direct medical costs) and societal perspective (included medical and nonmedical costs). Effectiveness was analyzed with quality-adjusted life years (QALYs). The robustness of results was estimated by performing one-way sensitivity analysis and probabilistic analysis.ResultsFrom the health system perspective, AI screening and ophthalmologist screening had incremental costs of $180.19 and $215.05 but more quality-adjusted life years (QALYs) compared with no screening. AI screening had an ICER of $1,107.63. From the societal perspective which considers all direct and indirect costs, AI screening had an ICER of $10,347.12 compared with no screening, below the cost-effective threshold (1–3 times per capita GDP of Chinese in 2019).ConclusionsOur analysis demonstrates that AI-based screening is more cost-effective compared with conventional ophthalmologist screening and holds great promise to be an alternative approach for DR screening in the rural area of China.

A Dose-Response Relationship of Alcohol Consumption with Risk of Visual Impairment in Korean Adults: The Kangbuk Samsung Health Study.

Visual impairment is a global health problem that leads to poor quality of life. The aim of the study was to examine the dose–response relationship between alcohol consumption and incident visual impairment (VI). This longitudinal cohort study consisted of 287,352 Korean adults who attended health screenings between March 2011 and December 2017 and were followed for up to 8.8 years (median, 4.9 years). Participants were categorized based on their average alcohol consumption. VI was defined as bilateral visual acuity (VA) worse than 0.3 logMAR. We identified 8320 cases of new-onset bilateral VI (incidence rate, 6.0/1000 person-years). Increased alcohol intake was positively and dose-dependently associated with elevated incidence of VI (ptrend < 0.001). With lifetime abstinence (reference), the multivariable-adjusted hazard ratios (HRs) (95% confidence intervals (CIs)) for incident VI with alcohol intake of <10, 10 to <20, 20–39.9, and ≥40 g/day were 1.07 (0.96–1.19), 1.15 (1.03–1.30), 1.15 (1.01–1.30), and 1.23 (1.08–1.40), respectively. Frequent binge drinking (≥once/per week) was associated with elevated risk of VI (HRs, 1.22; 95% CIs: 1.13–1.32). Former drinkers, particularly men, were at a higher risk for incident VI than lifetime abstainers. Similar associations were observed on evaluating changes in alcohol consumption and other confounders as time-varying covariates. Alcohol consumption, both in moderation and excess, was associated with increased VI incidence.

Incidence of visual impairment in Canada: the Canadian Longitudinal Study on Aging

ObjectiveDetermine the 3-year incidence of visual impairment (VI) in Canada and its risk factors. DesignProspective 3-year cohort study ParticipantsData from 23 973 adults taking part in the Canadian Longitudinal Study on Aging Comprehensive Cohort baseline and 3-year follow-up exams were included. MethodsInclusion criteria were 45 to 85 years of age, community-dwelling, and living near one of the 11 data collection sites across 7 Canadian provinces. Presenting binocular visual acuity was measured using the Early Treatment of Diabetic Retinopathy study chart. Incidence of VI was defined as the development at follow-up of visual acuity worse than 20/40 in those with acuity better than or equal to 20/40 at baseline. Results3.88% (95% confidence interval [CI] 3.61–4.17) of Canadian adults developed VI over a 3-year period. There was a high degree of variability in the incidence between Canadian provinces with a low of 1.42% in Manitoba and a high of 7.33% in Nova Scotia. Uncorrected refractive error was the leading cause. Risk factors for incident VI included older age (odds ratio [OR] = 1.07, 95% CI 1.06–1.07), Black race (OR = 2.64, 95% CI 1.36–5.14), lower household income (OR = 1.73 for those making less than $20,000 per year, 95% CI 1.24–2.40), current smoker (OR = 1.78, 95% CI 1.37–2.32), and province. ConclusionThe incidence of visual impairment is common in older Canadian adults, varies markedly between provinces, and is largely owing to treatable causes. Risk factors for VI suggest subgroups that may benefit from interventions to improve access to eye care.

Smoking, urinary cotinine levels and incidence of visual impairment

The longitudinal relationship between smoking status and risk of developing visual impairment (VI) remains unclear. We examined the relationship of smoking status and urinary cotinine level, an objective measure of smoking, with incidence of VI. This cohort study included 279,069 individuals free of VI who were followed for up to 8.8 years (median 4.8 years). VI was defined as when bilateral visual acuity was worse than 0.5 (cutoffs of 0.3 Logarithm of the Minimum Angle of Resolution). During 1,324,429.8 person-years of follow-up, 7852 participants developed new-onset bilateral VI. Self-reported current smoking status was associated with increased risk of developing VI in both men and women, with a stronger association in women (P for interaction = 0.01). Multivariable adjusted hazard ratios (95% confidence intervals) for incident VI comparing current smokers to never-smokers were 1.14 (1.04–1.25) in men and 1.52 (1.28–1.80) in women. Urinary cotinine levels of ≥ 100 ng/ml were significantly associated with increased risk of incident VI, and these associations remained when introducing changes in urinary cotinine and other confounders during follow-up as time-varying covariates. Cigarette smoking assessed based on self-report and urinary cotinine level was associated with increased incidence of VI. Our findings identify smoking as an independent risk factor for VI.

Impact of visual impairment following stroke (IVIS study): a prospective clinical profile of central and peripheral visual deficits, eye movement abnormalities and visual perceptual deficits

Aim This study evaluates the spectrum of visual impairment in stroke survivors. Methods The Impact of Visual Impairment after Stroke (IVIS) study is a multi-centre, acute stroke unit, prospective epidemiology study. Comprehensive visual examination was offered to all stroke survivors. Results 1500 stroke admissions were recruited. 1204 stroke survivors had visual assessment. Reduced central vision was documented in 529, visual field loss in 308, ocular motility abnormalities in 533 stroke survivors, visual perception deficits in 59 stroke survivors and visual inattention in 315 stroke survivors. About half, regardless of visual impairment type, were visually asymptomatic. Recovery, whether full or partial, was best for central vision, ocular motility abnormalities and visual perception deficits (about 70% improvement) occurring over a mean follow-up period of 2–3 months. Conclusions Incidence of impaired central vision, visual field loss, ocular motility disorders and visual inattention was 29.4%, 24.8%, 39.3% and 26.2% respectively. Visual impairment was more likely to occur in more severe stroke and older stroke survivors. Asymptomatic cases raise concerns for acute stroke units where robust specialist vision screening is not routine. Those with partial/no recovery require specialist follow-up and management whilst the wide range of abnormalities highlight the need for specialist visual assessment acutely. Implications for rehabilitation Visual impairment is a common consequence of stroke. Incidence of visual impairment is about 60%. Significant numbers of stroke survivors are visually asymptomatic, highlighting the need for standardised vision assessments. Many stroke survivors have persistent long-term visual impairment, necessitating referral and access to specialist eye care services.

Cluster-randomised trial of community-based screening for eye disease in adults in Nepal: the Village-Integrated Eye Worker Trial II (VIEW II) trial protocol

IntroductionThe majority of blindness worldwide could be prevented or reversed with early diagnosis and treatment, yet identifying at-risk and prevalent cases of eye disease and linking them with care remain...

Six-Year Incidence and Causes of Low Vision and Blindness in a Rural Chinese Adult Population: The Handan Eye Study

ABSTRACT Purpose To determine the six-year incidence, risk factors, and causes of visual impairment in a Chinese population. Methods This was a population-based study of eye disease in Chinese adults in a rural district of Handan in China. 6,830 individuals were invited to participate in 2006 and 5,394 returned for follow-up in 2012. All participants underwent standardized eye examinations. Visual impairment was defined according to WHO criteria. The incidence of visual impairment was age- and gender-standardized to the 2010 China Census. Multivariable logistic regression analysis was used to determine risk factors for visual impairment. Results The leading causes of visual impairment were cataract and refractive error. Based on presenting visual acuity (PVA), the six-year incidence rates of low vision and blindness were 5.2% and 0.5%, respectively. Incidence of low vision was associated with older age (p < .001), less education (p < .001), diabetes (p < .05), and lower BMI (p < .001). The incidence of blindness was associated with diabetes (p < .05). Based on best-corrected visual acuity (BCVA), the six-year incidence rates of low vision and blindness were 0.8% and 0.1%, respectively. Incidence of low vision was associated with older age (p < .001) and lower BMI (p < .05). None of these factors were associated with the incidence of blindness. Conclusion In Handan, the incidence of visual impairment was high and associated with older age, less education, diabetes, and lower BMI. The majority of cases were due to unoperated cataract and uncorrected refractive error, reflecting the need for improved eye care in this region.

Prevalence and incidence of visual impairment in patients with proliferative diabetic retinopathy in India

To provide the real-world outcomes of people with proliferative diabetic retinopathy (PDR) in India and highlight opportunities for improvement of their disease status and to evaluate their visual acuity (VA) status. A multicenter retrospective study in which ten centers in India with established vitreoretinal services for over 10 years were invited to provide long-term data on PDR. This study population were of Indian nationality. Patients with a diagnosis of type 1 or 2 diabetes with a clinical diagnosis of active PDR in any or both eyes, who had long term follow-up for up to 10 years were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, diabetic retinopathy status in both eyes. Available follow-up data on VA were collected at 6 months post baseline, 5 years and 10 years within a ± 3 months window. Evaluating the presenting VA of people with PDR, short-term outcomes at 6 months and the incidence of visual impairment (VI) at 5 and 10 years are the main outcome of the study. Data was available for 516, 424 and 455 patients at baseline, 5 years and 10 years respectively. Gender and duration of diabetes did not have statistically significant effect on VI outcomes. Eyes receiving treatment early in the disease course (i.e. baseline VA ≥ 6/12) had significantly better VA outcomes at 10 years versus eyes treated at a later stage (i.e. baseline VA < 6/12) (p = <0.0001). On comparing eyes with stable treated PDR and persistent PDR at end of 10 year follow up, a significantly higher percentage of eyes in the stable treated group maintained VA of ≥ 6/12 (55.1% vs. 24.2%) (p = < 0.0001), indicating persistent disease activity due to inadequate treatment results in worse VA outcomes. We found no trend in VI or blindness with increasing levels of age at both 5- and 10-year time points (p > 0.05). The age standardized incidence for VI was 11.10% (95% CI 8.1, 14.2) and for blindness was found to be 7.7% (95% CI 5.2, 10.3). Our results suggest that despite robust recent clinical trial results showing that pan retinal photocoagulation is an excellent treatment for PDR, people with diabetes in India need to be made aware of annual screening and treatment of their eyes to avoid vision impairment and blindness.

Clinical and genetic characteristics of type I sialidosis patients in mainland China.

ObjectiveType I sialidosis (ST‐1) is a rare autosomal recessive inherited disorder. To date, there has been no study on ST‐1 patients in mainland China.MethodsWe reported in detail the cases of five Chinese ST‐1 patients from two centers, and summarized all worldwide cases. Then, we compared the differences between Chinese and foreign patients.ResultsA total of 77 genetically confirmed ST‐1 patients were identified: 12 from mainland China, 23 from Taiwan, 10 from other Asian regions, and 32 from European and American regions. The mean age of onset was 16.0 ± 6.7 years; the most common symptoms were myoclonus seizures (96.0%), followed by ataxia (94.3%), and blurred vision (67.2%). Compared to other groups, the onset age of patients from mainland China was much younger (10.8 ± 2.7 years). The incidence of visual impairment was lower in patients from other Asian regions than in patients from mainland China and Taiwan (28.6% vs. 81.8%–100%). Cherry‐red spots were less frequent in the Taiwanese patients than in patients from other regions (27.3% vs. 55.2%–90.0%). Furthermore, 48 different mutation types were identified. Chinese mainland and Taiwanese patients were more likely to carry the c.544A > G mutation (75% and 100%, respectively) than the patients from other regions (only 0%–10.0%). Approximately 50% of Chinese mainland patients carried the c.239C > T mutation, a much higher proportion than that found in the other populations. In addition, although the brain MRI of most patients was normal, 18F‐FDG‐PET analysis could reveal cerebellar and occipital lobe hypometabolism.InterpretationST‐1 patients in different regions are likely to have different mutation types; environmental factors may influence clinical manifestations. Larger studies enrolling more patients are required.

Visual impairment in high flow and low flow carotid cavernous fistula

Our aim is to study the varied posterior segment manifestations, level of visual impairment (VI) and its causes in carotid cavernous fistula (CCF) patients. A retrospective study was done, wherein data was obtained from 48 digital subtraction angiogram (DSA) proven CCF patients. CCF was classified according to Barrow et al., based on DSA into type A (high flow) and types B, C and D (low flow). High flow CCF was present in 8 (16.7%) and low flow CCF was present in 42 (83.3%). Compared to low flow group, patients in high flow group were younger and had a history of trauma (p < 0.05). Posterior segment findings ranged from familiar stasis retinopathy and optic neuropathy (both, glaucomatous and ischemic) to uncommon findings of central retinal artery occlusion, Terson syndrome and combined retinal and choroidal detachment. Retinal vein dilatation was the most common finding in both groups. The high flow CCF group had 6 (75%) patients that had VI. This was acute in 4 (50%) patients and delayed in 2 (25%). In the low flow group 10 (23.8%) of patients had delayed VI. The identification of “3 point sign” is a novel finding of this study, not described before. While none of three findings (disc hyperaemia, retinal vein dilatation and intra-retinal haemorrhage) in isolation were predictive of visual loss, but when present together results in visual loss. Posterior segment changes were varied, some are uncommon and can occur in various combinations. “3 point sign” must be identified at the earliest to prevent visual impairment. The incidence of VI in CCF patients is high.

Design and recent results of large-scale cohort epidemiology studies on refractive error in children in Shanghai

Between 2011 and 2013, two large-scale cohort epidemiology studies were launched in Shanghai: the SCALE study, which aimed to provide ocular public health services to cover the entire youth population in Shanghai, and the SCES, which was based on sample surveys and aimed to provide information on the prevalence and incidence of visual impairment and different types of refractive errors. A total of 910,245 children and adolescents were finally enrolled in the SCALE study; three possible methods for monitoring refractive error without mydriasis were tested, and the agreement between the refractive outcomes of three commonly used autorefractors were examined to ensure the accuracy of the results of the SCALE study. A total of 8,627 children were enrolled in the SCES, and the baseline prevalence of different refractive errors, different behaviors associated with 1 year myopic shifts, and the different patterns of 2-year myopia progression between internal migrant and local resident school children have been analyzed. In some subset samples of the SCALE study and the SCES, several refraction components such as choroidal thickness (ChT) and crystalline lens power were also measured, to further elucidate the relationships between the refraction components and myopia as well as the mechanism of myopia incidence and development. The three methods used in Shanghai to prevent and intervene with childhood myopia: increasing outdoor time, low concentration atropine, and use of orthokeratology lens are also addressed in this review.