Mild Visual Impairment Research Articles

Visual Impairment and Major Eye Diseases in Stroke: The National Health and Nutrition Examination Survey, 2005-2008

Purpose: Major ocular diseases share common risk factors and pathogeneses with stroke. This study aimed to evaluate the relation between stroke and the prevalence of ocular diseases including visual impairment (VI) in the United States. Design: Cross-sectional study. Methods: We investigated the prevalence and associations of VI and major eye diseases with stroke among 4570 participants aged 40 years or older in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). The association of VI and major ocular diseases with stroke were estimated using univariate and multivariate logistic regression crude models and models adjusted for demographics and other clinical measurements factors. We also conducted stratified analyses by diabetes and hypertension status. Results: Among the 207 participants with stroke, the mean (SD) age was 67.34 (11.90) years, 59.5% were women (n=102), and 79.7% were non-Hispanic White (n=127). Major eye diseases were all risk factors for stroke, and the odds ratios (ORs) for mild and MSVI were 3.06 (95% confidence interval (CI): 2.02-4.64) and 2.16 (95% CI: 1.21-3.83), respectively. Any ocular disease was a risk factor for stroke with OR 4.46 (95% CI: 2.71-7.37), and the OR for other major eye diseases were as followed: DR, 3.44 (95%m CI: 1.84-6.45); cataract, 4.53 (95% CI: 2.75-7.46); AMD, 3.67 (95% CI: 2.29-5.89), and glaucoma, 2.7 (95% CI: 1.41-5.15) (all P <0.05). After multivariable adjustment, the associations were limited to only mild VI (OR=2.13, 95% CI: 1.32-3.43), AMD (OR=1.99, 95% CI: 1.18-3.34), and any ocular diseases (OR=1.88, 95% CI: 1.12-3.15) (all P <0.05). Significant associations between stroke and any ocular disease and DR were observed among diabetic participants, and significant relation between stroke and MSVI was found among hypertension patients. Conclusions: This sample of the US population demonstrates high prevalence and significant associations between VI and major ocular disease with stroke, which highlights the importance of ocular screening among stroke patients and potential common pathogeneses underlying these conditions. Funding: This study was supported by The Capital Health Research and Development of Special (2020-1-2052); Science & Technology Project of Beijing Municipal Science & Technology Commission (Z181100001818003); the Beijing Municipal Administration of Hospitals’ Ascent Plan (DFL20150201) Declaration of Interest: The authors declare no conflicts of interest.

Prevalence, Causes, and Factors Associated with Visual Impairment in a Chinese Elderly Population: The Rugao Longevity and Aging Study.

PurposeThis study aimed to explore the current prevalence, causes, and factors associated with visual impairment in a Chinese elderly population.MethodsA random sample of 2164 candidates aged ≥70 years was selected. Among them, 1914 participants (response rate: 88.4%) underwent comprehensive eye examinations. The prevalence and causes of visual impairment were estimated, and the associated factors were identified.ResultsThe standardized prevalence of mild visual impairment (<6/12 to ≥6/18), moderate to severe visual impairment (MSVI) (<6/18 to ≥3/60), and blindness (<3/60) in the better eye were 20.5%, 25.8%, and 3.4%, respectively. The leading cause of visual impairment was cataract (49.7%), followed by uncorrected refractive error (26.5%), myopic maculopathy (5.8%), and posterior capsular opacification (5.5%). Optical coherence tomography revealed that vitreoretinal interface abnormalities were the third most common cause of monocular mild visual impairment (2.2%) and MSVI (4.4%) in the elderly population. A large number of patients with visual impairment (81.7%) were amenable to undergo the interventions. Visual impairment was associated with advanced age (odds ratio [OR], 1.09 per year; p<0.001), female sex (OR, 1.59; p=0.003), self-reported visual impairment (OR, 1.91; p<0.001), cognitive impairment (OR, 1.40, p=0.005), and high educational level (OR, 0.75; primary, p=0.045; and OR, 0.53, secondary or higher; p<0.001).ConclusionVisual impairment was common in the Chinese elderly population and a severe health and social problem. Practicable policies are urgently needed to popularize eye health knowledge and promote treatments for visual impairment in elderly people in rural China.

Clinical delineation of SETBP1 haploinsufficiency disorder.

SETBP1 haploinsufficiency disorder (MIM#616078) is caused by haploinsufficiency of SETBP1 on chromosome 18q12.3, but there has not yet been any systematic evaluation of the major features of this monogenic syndrome, assessing penetrance and expressivity. We describe the first comprehensive study to delineate the associated clinical phenotype, with findings from 34 individuals, including 24 novel cases, all of whom have a SETBP1 loss-of-function variant or single (coding) gene deletion, confirmed by molecular diagnostics. The most commonly reported clinical features included mild motor developmental delay, speech impairment, intellectual disability, hypotonia, vision impairment, attention/concentration deficits, and hyperactivity. Although there is a mild overlap in certain facial features, the disorder does not lead to a distinctive recognizable facial gestalt. As well as providing insight into the clinical spectrum of SETBP1 haploinsufficiency disorder, this reports puts forward care recommendations for patient management.

Prevalence, Risk Factors, and Causes of Visual Impairment in an Elderly Chinese Uygur Population in Southern Xinjiang.

Purpose To investigate the prevalence, risk factors, and major causes of visual impairment (VI) in an elderly Chinese Uygur population in southern Xinjiang. Methods This was a population-based cross-sectional study. Participants aged 50 years and older from Haohan Country, Xinjiang Uygur Autonomous Region, were enrolled from August 2018 to December 2018 using cluster sampling. Participants underwent examinations including presenting visual acuity (PVA), pinhole vision, slit-lamp, intraocular pressure, and direct ophthalmoscopy. Participants' education and demographic information was collected by a questionnaire. The prevalence, risk factors, and major causes of vision loss were evaluated. Results A total of 1465 participants (85.4% response rate) were enrolled. The mean age of the subjects was 59.1 ± 9.7 years. The prevalence of mild VI, moderate VI, severe VI, and blindness in the better eye was 13.3%, 12.8%, 2.9%, and 3.4%, respectively. The prevalence of low vision and blindness in this study was higher than that in Altay & Tacheng and Changji in northern Xinjiang, lower than that in Luxi, and similar to that in Tibet. The multiple logistic regression analysis showed that age, education level, and body mass index (BMI) were significantly associated with low vision and blindness (P ≤ 0.001, <0.05, 0.002, respectively). The major causes of low vision were cataract (42.6%), refractive error (19.6%), and glaucoma (12.6%), whereas the primary causes of blindness were cataract (34%), glaucoma (34%), and retinitis pigmentosa (10%). Conclusions VI is an important public health issue among elderly Uygur individuals in the area, especially for those with low education levels. Cataract is the leading cause of low vision and blindness.

Objectively measured far vision impairment and sarcopenia among adults aged ≥ 65years from six low- and middle-income countries.

There are currently no studies on visual impairment and sarcopenia. We investigated the cross-sectional association between objectively measured far vision impairment and sarcopenia in a nationally representative sample of older adults aged 65years and over from six low- and middle-income countries (LMICs). Cross-sectional, community-based data from the study on global ageing and adult health (SAGE) were analyzed. Far vision acuity was measured using the tumbling E LogMAR chart and classified as: no vision impairment (6/12 or better); mild vision impairment (6/18 or better but worse than 6/12); moderate vision impairment (6/60 or better but worse than 6/18); severe vision impairment (worse than 6/60). Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Associations were assessed with multivariable logistic regression. Fourteen thousand five hundred andeighty five individuals aged ≥ 65years were included in the analysis [mean (SD) age 72.6 (11.5) years; 54.1% females]. After adjustment for multiple potential confounders, compared to those with no vision impairment, the OR (95% CI) for sarcopenia in those with mild, moderate, and severe vision impairment were 1.10 (0.87-1.40), 1.69 (1.25-2.27), and 3.38 (1.69-6.77), respectively. The estimates for females and males were similar. The odds for sarcopenia increased with increasing severity of far vision impairment among older people in LMICs. The mere co-occurrence of these conditions is concerning, and it may be prudent to implement interventions to address/prevent sarcopenia in those with far vision impairment through the promotion of physical activity and appropriate nutrition.

Terapinės hipotermijos reikšmė išnešiotų naujagimių, patyrusių hipoksiją arba asfiksiją gimstant, atokiosioms baigtims

Tyrimo tikslas. Nustatyti terapinės hipotermijos (TH) reikšmę naujagimių, patyrusių hipoksiją arba asfiksiją gimstant, atokiosioms baigtims. Tyrimo metodai. Atlikta sisteminė literatūros apžvalga naudojantis „PubMed“ (MEDLINE) ir ,,Cochrane“ bibliografinėmis medicininėmis duomenų bazėmis. Atrinkti straipsniai, nagrinėjantys terapinės hipotermijos dažnį bei įtaką išnešiotų naujagimių ankstyvosioms ir vėlyvosioms baigtims, kurie gimdami patyrė hipoksiją arba asfiksiją. Paieškai naudotos reikšminių žodžių kombinacijos anglų kalba: therapeutic hypothermia in neonates, neonatal cooling, hypoxic-ischemic encephalopathy and cooling, cooling asphyxiated newborns. Taip pat naudotas filtras: anglų kalba, straipsniai, ne senesni nei penkerių metų. Rezultatai. Įvykdžius sisteminę paiešką, į analizę įtraukti septyni viso teksto moksliniai straipsniai. Iš viso bendra tiriamųjų imtis buvo 2014 naujagimių. Į sisteminę analizę įtraukti straipsniai iš šių šalių: JAV, Jungtinės Karalystės, Nyderlandų, Bosnijos ir Hercegovinos. Visuose tyrimuose analizuota TH reikšmė naujagimių, patyrusių perinatalinę asfiksiją (PA), atokiosioms baigtims. Taip pat visi tyrėjai aprašė, jog TH buvo taikyta visiems gaivintiems naujagimiams, atitikusiems atrankos kriterijus pagal protokolus. Išvados. Esant TH atrankos kriterijams, visiems naujagimiams, patyrusiems asfiksiją gimstant, skiriama TH. Ankstyvosios atokiosios baigtys naujagimių, kuriems buvo taikyta TH: mirtis, hipoksinė išeminė encefalopatija (HIE), traukuliai. Nuo 10,8 iki 32 proc. tiriamųjų mirė stacionare. Lengva HIE buvo nustatyta nuo 14,3 iki 16,9 proc. tiriamųjų, vidutinio sunkumo – nuo 52,1 iki 88 proc. tiriamųjų, sunki – nuo 12,1 iki 28,6 proc. tiriamųjų. Traukulių dažnis – nuo 17,9 iki 75,9 proc. atvejų. Ankstyvųjų baigčių dažnis, netaikant TH, reikšmingai nesiskyrė. Vėlyvosios atokiosios baigtys naujagimių, kuriems buvo taikyta TH: negalia, motorinės raidos sutrikimai, cerebrinis paralyžius (CP), klausos, regos, kalbos ir intelekto sutrikimai. Lengva negalia buvo nustatyta nuo 10 iki 21 proc., vidutinio sunkumo – nuo 1,3 iki 10 proc., sunki – nuo 11,5 iki 25 proc. atvejų. Motorinės raidos sutrikimų arba CP dažnis – nuo 11,9 iki 68,9 proc. Lengvų klausos sutrikimų dažnis – nuo 1 iki 98,6 proc., lengvų regos sutrikimų dažnis – nuo 4 iki 85,3 proc., lengvų kalbos sutrikimų dažnis – nuo 21 iki 74,3 proc. Vėlyvųjų baigčių dažnis, netaikant TH, reikšmingai nesiskyrė. Tik lengvų kalbos sutrikimų dažnis buvo reikšmingai mažesnis, o intelekto koeficientas buvo didesnis taikant TH.

Mandated Kindergarten Eye Examinations in a US Suburban Clinic: Is It Worth the Cost?

PurposeThe state of Illinois has required an examination by an optometrist or ophthalmologist prior to mandatory kindergarten since 2008. This requirement has allowed us to gather information regarding disease prevalence in a local suburban population.MethodsA retrospective chart review was undertaken of kindergarten eye examinations performed at the Wheaton Eye Clinic between September 2008 and February 2017. Inclusion criteria included school eye examination as a reason for the visit, and a cycloplegic refraction was completed.ResultsOf 3612 patient charts identified, 1085 satisfied the inclusion criteria, of which 48% were female. The average age of the patients was 5.3 years (range, 3.8 to 6.7). Historical characteristics showed 143 (13%) were premature, 28 (3%) patients were autistic and 109 (10%) were developmentally delayed. On examination, 56 (5%) had <20/40 (WHO mild visual impairment) vision in better seeing eye, 34 (3%) had spherical equivalent refractive error in either eye > +3.50 diopters and one < −3.00 diopters. Fifty-eight patients (5%) were diagnosed with amblyopia and 101 patients (9.3%) were given glasses. Abnormal external exam finding was found in 218 (20%) while 16 (1.5%) had an abnormal fundus finding. Thirteen percent (146/1085) had a clinically relevant diagnosis in our examinations, with a cost of $1635/diagnosis. In total, our follow-up rate was 83% (78/94).ConclusionOur rate of treatable ocular conditions discovered via state-mandated kindergarten eye examinations is similar to large-scale screening programs. The cost per condition found with full examinations was substantially higher; however, follow-up was more consistent.

Visual acuity and risk of overall, injury-related, and cardiovascular mortality: the Kangbuk Samsung Health Study.

The associations of visual impairment (VI) with cardio-metabolic risk factors have been reported but its association with cardiovascular mortality remains uncertain. Therefore, we evaluated the association of visual acuity (VA) with overall, injury-related, and cardiovascular mortality. A cohort study was performed in 580 746 Korean adults (average age, 39.7 years) who were followed for a median of 8.1 years (maximum, 16 years). Presenting VA was measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Visual acuity in the better vision eye was categorized as normal vision (≥0.8), lowered vision (0.5-0.8), mild visual impairment (VI) (0.3-0.5), or moderate to severe VI (<0.3). Vital status and cause of death were ascertained through linkage to national death records. During 4 632 892.2 person-years of follow-up, 6585 overall deaths, 974 cardiovascular deaths, and 1163 injury-related deaths were identified. After adjustment for possible confounders, the multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for overall mortality among participants with lowered vision, minimal VI, and moderate to severe VI were 1.21 (1.13-1.29), 1.26 (1.15-1.37), and 1.54 (1.40-1.68), respectively, compared with those with normal vision. The corresponding HRs (95% CIs) for injury-related mortality were 1.12 (0.96-1.32), 0.98 (0.76-1.26), and 1.36 (1.04-1.79), respectively, and the corresponding HRs (95% CIs) for cardiovascular mortality were 1.32 (1.12-1.57), 1.43 (1.15-1.77), and 2.41 (1.94-2.99). In this large cohort of young and middle-aged individuals, VI was associated with increased risk of mortality especially due to cardiovascular disease.

Association between vision impairment and mortality: a systematic review and meta-analysis

SummaryBackgroundThe number of individuals with vision impairment worldwide is increasing because of an ageing population. We aimed to systematically identify studies describing the association between vision impairment and mortality, and to assess the association between vision impairment and all-cause mortality.MethodsFor this systematic review and meta-analysis, we searched MEDLINE (Ovid), Embase, and Global Health database on Feb 1, 2020, for studies published in English between database inception and Feb 1, 2020. We included prospective and retrospective cohort studies that measured the association between vision impairment and all-cause mortality in people aged 40 years or older who were followed up for 1 year or more. In a protocol amendment, we also included randomised controlled trials that met the same criteria as for cohort studies, in which the association between visual impairment and mortality was independent of the study intervention. Studies that did not report age-adjusted mortality data, or that focused only on populations with specific health conditions were excluded. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We graded the overall certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. We did a random-effects meta-analysis to calculate pooled maximally adjusted hazard ratios (HRs) for all-cause mortality for individuals with a visual acuity of <6/12 versus those with ≥6/12; <6/18 versus those with ≥6/18; <6/60 versus those with ≥6/18; and <6/60 versus those with ≥6/60.FindingsOur searches identified 3845 articles, of which 28 studies, representing 30 cohorts (446 088 participants) from 12 countries, were included in the systematic review. The meta-analysis included 17 studies, representing 18 cohorts (47 998 participants). There was variability in the methods used to assess and report vision impairment. Pooled HRs for all-cause mortality were 1·29 (95% CI 1·20–1·39) for visual acuity <6/12 versus ≥6/12, with low heterogeneity between studies (n=15; τ2=0·01, I2=31·46%); 1·43 (1·22–1·68) for visual acuity <6/18 versus ≥6/18, with low heterogeneity between studies (n=2; τ2=0·0, I2=0·0%); 1·89 (1·45–2·47) for visual acuity <6/60 versus ≥6/18 (n=1); and 1·02 (0·79–1·32) for visual acuity <6/60 versus ≥6/60 (n=2; τ2=0·02, I2=25·04%). Three studies received an assessment of low risk of bias across all six domains, and six studies had a high risk of bias in one or more domains. Effect sizes were greater for studies that used best-corrected visual acuity compared with those that used presenting visual acuity as the vision assessment method (p=0·0055), but the effect sizes did not vary in terms of risk of bias, study design, or participant-level factors (ie, age). We judged the evidence to be of moderate certainty.InterpretationThe hazard for all-cause mortality was higher in people with vision impairment compared with those that had normal vision or mild vision impairment, and the magnitude of this effect increased with more severe vision impairment. These findings have implications for promoting healthy longevity and achieving the Sustainable Development Goals.FundingWellcome Trust, Commonwealth Scholarship Commission, National Institutes of Health, Research to Prevent Blindness, the Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research, Moorfields Biomedical Research Centre, Sightsavers, the Fred Hollows Foundation, the Seva Foundation, the British Council for the Prevention of Blindness, and Christian Blind Mission.

Visual outcomes of cataract surgery: An observational study of ten years from a tertiary eye care hospital in Pakistan

Objectives:To observe and analyze the visual outcomes of cataract surgery of ten years at a tertiary eye care hospital, Karachi.Methods:An observational study with retrospective data search was conducted in Al Ibrahim Eye Hospital (AIEH), Karachi. Data of all adults (above 16 years) who underwent cataract surgery from 2010-2019 was retrieved from HIMS. Presence of opacity in the lens was labelled as cataract. Surgery was advised when patient’s BCVA was found to be ≤ 6/18. Visual assessments of the patients were done on day 01, one week and six weeks postoperatively. Postoperatively, 6/6 – 6/12 was considered as good, 6/18 as mild visual impairment, < 6/18 to 6/60 as moderate visual impairment and < 6/60 as severe visual impairment.Results:A total of 1,027,840 patients visited AIEH with different eye diseases. Among 1027840 individuals, cataract was identified in 88443 (8.6%). Surgery was advised to 58371 and performed in 38616. Records of operated cases (38616) were retrieved. Mean age of patients was 54.96±14.22 years. There were 20578 (53.29%) males and 18038 (46.71%) females who underwent surgery . At the end of sixth week, 3561 (18.4%), patients were found to have “good vision”, 12242 (63.43%) had mild visual impairment, 2676 (13.86%) had moderate visual impairment and 822 (4.26%) had severe visual impairment. Corneal Complications was the commonest cause (33.56%) at sixth week.Conclusions:The institution achieved WHO recommended criteria of “good visual outcome” (6/6 to 6/18) of 81.83% which is near to recommended ≥ 90% and severe visual impairment of 4.26%.

Vision and Cognitive Function in the Mid- to Later-Life Transition: the Study of Women’s Health Across the Nation

In this analysis of data from the Study of Women Across the Nation (SWAN), a longitudinal cohort study of mid-life women, we sought to describe the relationship between vision impairment (VI) during mid-life and future CF during the mid- to later-life transition period. Presenting visual acuity was assessed at baseline, between 1996-2000, using a Titmus occupational screener. “Mild” and “moderate to severe” VI were respectively categorized as visual acuity <20/40 and <20/60 in the better seeing eye. CF was measured at near-annual visits from 2003-2015 using the East Boston Memory Test immediate (EBMTi) and delayed (EBMTd) recall and Digit Span Backwards (DSB). Linear mixed models with a random intercept and slope for age were constructed to detect associations between vision and CF, adjusting for race, education, financial strain, alcohol use, and tobacco use. The sample included 341 women aged 42-53 years (mean: 46.6) at baseline with up to 16 years of follow-up. The prevalence of VA <20/40 and <20/60 was 12.9% and 7.6%, respectively. While mild VI was associated with lower EBMTi (β= -0.46, p=0.034), EBMTd (β= -0.49, p=0.031), and DSB (β= -0.78, p= 0.015) scores in unadjusted models, these relationships were not statistically significant after adjustment for covariates. After adjusting for covariates, baseline moderate to severe VI was associated with worse EBMTi (β= -0.87, p=0.001) and EBMTd (β= -0.52 p=0.039) scores. Altogether, moderate to severe VI during mid-life was associated with lower verbal episodic memory scores (EMBTi/d) over a 16-year period representing the transition from mid-life to later adulthood.

Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study

SummaryBackgroundTo contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990–2020, and forecasts for 2050.MethodsWe did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. Only studies with samples representative of the population and with clearly defined visual acuity testing protocols were included. We fitted hierarchical models to estimate 2020 prevalence (with 95% uncertainty intervals [UIs]) of mild vision impairment (presenting visual acuity ≥6/18 and <6/12), moderate and severe vision impairment (<6/18 to 3/60), and blindness (<3/60 or less than 10° visual field around central fixation); and vision impairment from uncorrected presbyopia (presenting near vision <N6 or <N8 at 40 cm where best-corrected distance visual acuity is ≥6/12). We forecast estimates of vision loss up to 2050.FindingsIn 2020, an estimated 43·3 million (95% UI 37·6–48·4) people were blind, of whom 23·9 million (55%; 20·8–26·8) were estimated to be female. We estimated 295 million (267–325) people to have moderate and severe vision impairment, of whom 163 million (55%; 147–179) were female; 258 million (233–285) to have mild vision impairment, of whom 142 million (55%; 128–157) were female; and 510 million (371–667) to have visual impairment from uncorrected presbyopia, of whom 280 million (55%; 205–365) were female. Globally, between 1990 and 2020, among adults aged 50 years or older, age-standardised prevalence of blindness decreased by 28·5% (–29·4 to −27·7) and prevalence of mild vision impairment decreased slightly (–0·3%, −0·8 to −0·2), whereas prevalence of moderate and severe vision impairment increased slightly (2·5%, 1·9 to 3·2; insufficient data were available to calculate this statistic for vision impairment from uncorrected presbyopia). In this period, the number of people who were blind increased by 50·6% (47·8 to 53·4) and the number with moderate and severe vision impairment increased by 91·7% (87·6 to 95·8). By 2050, we predict 61·0 million (52·9 to 69·3) people will be blind, 474 million (428 to 518) will have moderate and severe vision impairment, 360 million (322 to 400) will have mild vision impairment, and 866 million (629 to 1150) will have uncorrected presbyopia.InterpretationAge-adjusted prevalence of blindness has reduced over the past three decades, yet due to population growth, progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the global population grows and ages.FundingBrien Holden Vision Institute, Fondation Thea, Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.

Visual impairment among adults in Saudi Arabia

BackgroundTo estimate the prevalence of visual impairment, and identify its causes and associated factors among adults aged 40-years and over, attending for eye examination at a Riyadh public hospital in Saudi Arabia.MethodsThis was a retrospective cross‐sectional study conducted among 195 consecutive older adults who attended the outpatient ophthalmology clinic of King Abdul‐Aziz University Hospital between 1 February and 30 June 2018. All participants underwent comprehensive ophthalmic examination: visual acuity, refraction (objective and subjective), fundus photography and automated visual field assessment. Classification of visual impairment was based on the World Health Organization criteria: mild visual impairment if best‐corrected distance visual acuity < 6/12–6/18 in the better eye; moderate visual impairment if best‐corrected visual acuity < 6/18–6/60 in the better eye; and severe visual impairment if best‐corrected visual acuity < 6/60–3/60. Regression analysis was used to identify the factors associated with visual impairment.ResultsThe study participants included 107 (54.9 per cent) females, and the mean (SD) age was 61.1 ± 10.9-years. The overall prevalence of visual impairment (14.9 per cent, 29 cases), consisting of severe (0.5 per cent), moderate (9.7 per cent) and mild (4.6 per cent) forms, correlated significantly with age (R2 = 0.023, p = 0.04). The main causes of visual impairment were glaucoma (48.3 per cent), cataract (31.0 per cent), refractive error, and diabetic retinopathy (24.1 per cent each). The odds of having visual impairment increased by 22 per cent and eight per cent respectively in participants who had diabetic retinopathy (adjusted odds ratio 1.22, 95% confidence interval [CI] 1.05, 1.95) and glaucoma (1.08, CI 1.02, 1.40).ConclusionsThe prevalence of visual impairment among older adults attending the ophthalmology clinic in Riyadh city was high and driven by the high rate of diabetic retinopathy and glaucoma in this region. As part of their routine checks, there is need to make dilated fundus examination and intraocular pressure measurement mandatory tests in addition to refraction and visual acuity testing, when examining Saudi adults attending the hospital eye clinics in Riyadh province.

Sickle Cell Maculopathy: Prevalence, Associations and Impact on Visual Acuity

Aims: To investigate the prevalence of sickle cell maculopathy (SCM), and associations with age, sex, genotype, proliferative sickle cell retinopathy (PSR) stage, and the impact on visual acuity. Methods: Age, sex, and visual acuity were recorded and spectral domain OCT and ultra-wide-field images of the macula and retina were reviewed in a consecutive series of 74 adults with sickle cell disease. Results: The median age was 37 years (range 19–73 years) and 36 cases (48.6%) were male. SCM was present in at least 1 eye of 40 cases (54.1%) or in 67 of all eyes (42.3%). SCM prevalence was 54.8%, 62.5%, and 25% for the HbSS, HbSC, and HbS/BThal or other genotypes, respectively. SCM was observed in 41 (39.4%) of the eyes with PSR stages 0, 1, and 2, and in 21 (51.2%) of the eyes with PSR stages 3, 4, and 5, respectively. Mild visual impairment or worse was present in 3 eyes (4.8%) with SCM but this was secondary to other pathology. Conclusion: SCM is a frequent finding in the eyes of adults with sickle cell disease. The prevalence is similar for the HbSS and HbSC genotypes and is not related to the PSR stage. High-contrast distance visual acuity is typically preserved.

Prevalencia de alteraciones en la agudeza visual, discromatopsia y signos y síntomas asociados en una población estudiantil en la comunidad de El Carretón, Peravia, República Dominicana, durante el período octubre-diciembre del año 2019

Introducción: la baja agudeza visual es un problema educativo de interés mundial, cuya progresión es evitable con métodos de detección temprana y cooperación activa por parte de los padres y de la institución educativa. El presente estudio tiene como fin definir la cantidad de estudiantes de un centro educativo de El Carretón, Peravia, República Dominicana, que poseen algún tipo de condición que amerite atención oftalmológica especializada, y recalcar la falta de importancia que se le da a la salud oftalmológica en dicha localidad.&#x0D; Metodología: estudio prospectivo, descriptivo, transversal y observacional en el que se analizó la prevalencia de trastornos de la agudeza visual, discromatopsia y signos y síntomas asociados en una población estudiantil.&#x0D; Resultados: se puede apreciar que la agudeza visual en el ojo izquierdo fue normal en el 47 % de los casos, siendo mayor que en el ojo derecho (43 %). Los estudiantes de ocho (8) años de edad tuvieron predominancia en las alteraciones de la agudeza visual en ojo derecho, así como los estudiantes de doce (12) años de edad tuvieron predominancia en las alteraciones en el ojo izquierdo. El 77 % del porcentaje que presentó alteración en la agudeza visual tuvo como síntoma más común la cefalea, y un 10 % no presentó signos y síntomas asociados. Se observó que con el agujero estenopeico hubo mayor mejoría de la visión en el ojo derecho, con un 7 % en comparación con el ojo izquierdo, que fue de un 5 %.&#x0D; Conclusiones: los estudiantes con alteración de la AV presentaron en mayor frecuencia una discapacidad visual leve, tanto en el ojo derecho como en el ojo izquierdo. Los síntomas más asociados a las alteraciones de la vista fueron la cefalea y la visión borrosa. De los signos evaluados, no se evidenció ninguno en la población examinada. Ningún estudiante presentó discromatopsia.&#x0D; Recomendaciones: realizar campañas de salud pública que enfaticen la importancia de cuidado de los ojos. Involucrar al sistema educativo y a todas las instituciones relacionadas, como aliados en la creación de conciencia sobre la importancia de la identificación de afecciones oculares y el acceso a servicios de atención ocular para estudiantes.

Functional analysis and classification of homozygous and hypomorphic ABCA4 variants associated with Stargardt macular degeneration.

Stargardt macular degeneration (Stargardt disease 1 [STGD1]) is caused by mutations in the gene encoding ABCA4, an ATP-binding cassette protein that transports N-retinylidene-phosphatidylethanolamine (N-Ret-PE) across photoreceptor membranes. Reduced ABCA4 activity results in retinoid accumulation leading to photoreceptor degeneration. The disease onset and severity vary from severe loss in visual acuity in the first decade to mild visual impairment late in life. We determined the effect of 22 disease-causing missense mutations on the expression and ATPase activity of ABCA4 in the absence and presence of N-Ret-PE. Three classes were identified that correlated with the disease onset in homozygous STGD1 individuals: Class 1 exhibited reduced ABCA4 expression and ATPase activity that was not stimulated by N-Ret-PE; individuals homozygous for these variants had an early disease onset (≤13years); Class 2 showed reduced ATPase activity with limited stimulation by N-Ret-PE; these correlated with moderate disease onset (14-40years); and Class 3 displayed high expression and ATPase activity that was strongly activated by N-Ret-PE; these were associated with late disease onset (>40years). On the basis of our results, we introduce a functionality index for gauging the effect of missense mutations on STGD1 severity. Our studies support the mild phenotype exhibited by the p.Gly863Ala, p.Asn1868Ile, and p.Gly863Ala/p.Asn1868Ile variants.

Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge.

The demographic change in Germany will lead to an increase in irreversible age-related eye diseases. This will increase the need for specialised care facilities for visually impaired people. Due to reduced mobility, residents in such facilities often do not receive adequate ophthalmological care. New concepts must therefore be considered for this group of patients. One approach is to set up an ophthalmological examination unit within the facility combined with regular visits by an ophthalmologist. We now present the experience with such a model in a home for the blind. The project was initiated in 2009. Since then there have been visits by medical staff of the Eye Center at Medical Center, University of Freiburg, every two weeks. All patient records (2010 - 2017) were reviewed systematically. The following data were extracted in a structured and anonymous way: Age at first presentation, gender, ophthalmological diagnoses and if a therapy was initiated. This data set was finally analysed descriptively. Out of 130 residents aged between 48 and 100 years, half were between 78 and 90 years old. The youngest resident was 48, the oldest 100 years old. The median visual acuity was 0.2. Sixty percent of the residents had at least mild visual impairment according to the WHO (visual acuity < 0.5; category 1 - 6). In one of 6 - 7 residents, visual acuity could not be determined using Snellen charts. The most frequent ophthalmological diagnoses included cataract (44%), age-related macular degeneration (36%) and glaucoma (29%). In 67 residents (52%), the ophthalmological examination lead to treatment, such as application of local therapy or planning an operation. In every second resident, the ophthalmologist's visit lead to treatment during the observation period. This underlines the difficulty of providing ophthalmological care even in specialised institutions for the blind and visually impaired, which is possibly due to the residents' mobility problems. The concept presented here has established a low-threshold, sustainable and high-quality ophthalmological service on site. These positive experiences indicate that corresponding measures may also be useful for other locations. However, in order to implement such a project on a larger scale, suitable financing and accounting modalities for the construction measures, the nursing staff and the ophthalmological procedure still need to be developed.

Trends in Prevalence of Blindness and Distance and Near Vision Impairment Over 30 Years and Contribution to the Global Burden of Disease in 2020

Background: The Vision Loss Expert Group and Global Burden of Disease Study have extensively updated estimates of global vision loss burden in 2020, temporal changeover 3 decades and forecasts for 2050. Methods: A systematic review and meta-analysis was conducted of population-based datasets relevant to vision impairment (VI) from January 1980 to October 2018. Hierarchical models were fitted to estimate 2020 prevalence (with 95% uncertainty intervals, UI) of (1) mild VI (presenting visual acuity [PVA] 6/12). Findings: In 2020, an estimated 43.2 million (95% UI: 37.5-48.2 million; 55% female) people were blind, 295.3 (95% UI 267.0-325.5) million had MSVI, 257.3 (95% UI 232.2-284.7) million had mild VI, and 507.4 million (95% UI 369.3–663.8) were VI from uncorrected presbyopia. Globally among adults aged ≥50 years, age-standardised prevalence of blindness reduced by 29% between 1990 and 2020, while MSVI increased slightly (+2.4%). The number of blind people increased by 50.2% and MSVI by 91.6%. By 2050, we predict 895.5 million people blind/VI. Interpretation: It is encouraging that age-adjusted prevalence of blindness has reduced over the past 3 decades, yet due to population growth progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the global population grows and ages. Funding Statement: Brien Holden Vision Institute. Fondation Thea. Fred Hollows Foundation. Gates Foundation. Sightsavers International. University of Heidelberg. Declaration of Interests: A.M. Bron, Allergan (C) Baush and Lomb (C), Santen (C), Thea (C) - (C) stands for consultant. J Kempen: Consultant (DSMC Chair) for Gilead. Grants and contracts from National Institutes of Health/National Eye Institute; Sight for Souls; and Christoffel Blindenmission. No other authors had conflicts to declare.

Prevalence and causes of vision impairment and blindness in the Russian ural eye and medical study

To assess prevalence of mild vision impairment (MVI; best corrected visual acuity (BCVA) < 6/12 to 6/18 in the better eye), moderate-to-severe vision impairment (MSVI; BCVA < 6/18 but ≥ 3/60) and blindness (BCVA < 3/60) in a local population in Russia, we conducted the population-based Ural Eye and Medical Study. Out of 7,328 eligible individuals aged 40 + years, 5,899 (80.5%) individuals participated. MVI was present in 184 (3.1%; 95% confidence interval (CI) 2.7, 3.6) individuals, MSVI in 182 (3.1%; 95% CI 2.7, 3.5) individuals, and 11 individuals (0.19%; 95% CI 0.008, 0.30) were blind. Causes for MSVI were cataract (n = 109; 59.9%), late stage of age-related macular degeneration (n = 14; 7.7%; geographic atrophy and neovascular AMD in 7 (3.8%) individuals) each), myopic maculopathy (n = 11; 6.0%), glaucoma (n = 9; 4.9%), non-glaucomatous optic nerve damage (n = 5; 2.7%), and diabetic retinopathy (n = 4; 2.2%). Causes for blindness were cataract (n = 3; 27.3%), myopic maculopathy (n = 2; 18.2%), retinal dystrophies (n = 2; 18.2%), glaucoma (n = 1; 9.1%), and corneal scars (n = 1; 9.1%). Higher prevalence of MSVI/blindness was associated with age (P < 0.001; odds ratio (OR)1.10; 95% CI 1.08, 1.12), male gender (P < 0.001; OR 2.32; 95% CI 1.47, 3.66), educational level (P < 0.001; OR 0.83; 95% CI 0.76,0.92), manual grip force (P < 0.001; OR 0.94; 95% CI 0.92, 0.96), diabetes prevalence (P = 0.006; OR 1.67; 95% CI 1.08, 2.56) and axial length (P < 0.001; OR 1.43; 95% CI 1.26,1.62). In this population from Bashkortostan/Russia, prevalence of MVI, MSVI and blindness was 3.1%, 3.1% and 0.19%, respectively. Cataract was the most frequent cause of reversible vision impairment, while AMD, myopic maculopathy and glaucoma were the most common reasons for irreversible vision impairment.

Visual handicap certificates: A tool to evaluate the causes for permanent visual impairment in Northern Maharashtra

To analyse the causes of visual impairment amongst the patients coming for the visual handicap certificate and its application in eye health planning to prevent the blindness. A retrospective data analysis of medical records of 553 people who had applied for the visual handicap certification. Examination was done by the ophthalmologists appointed for the handicap board. BCVA &amp;#60; 20/60 to 20/120 in better eye was included in visual impairment Cat I(40%)and BCVA20/200 or less is blindness category II to IV(75%to100%). Data was analysed using SSPE software and Chi square test for significance. The prevalence of male patients was significantly higher than that of females (p&amp;#60;0.05), majority of them belonged to age group of 16 year to 45 years of age, 332 (60.03%) individuals had mild visual Impairment(&amp;#60; 40%), in 59(10.66%) individuals moderate visual impairment (40%) was found; in162(29.29%) individuals had sever visual impairment to blindness, over all phthisis (p=0.0001)was the most common cause followed by corneal opacity(p=0.0249)and Amblyopia (p=0.03). Most of the causes are preventable and some of them are emerging as complications of cataract surgery, increased road traffic accidents and occupational hazards. Visual handicap registers are useful for the rehabilitation of visually impaired individuals and to assess the pattern or causes of blindness in particular area. The most common etiological factors causing visual impairment in our study are preventable so we propose the empowerment of the school health system and general health delivery system, early detection of amblyogenic factors and its timely treatment, applying strict safety precautions to factory workers who are prone to ocular injuries and increased safety for road traffic in Northern part of Maharashtra.