Moderate Vision Research Articles

Managing Chronic Health Needs in Child Care and Schools—Visual Impairments

Patient Education| 2021 Managing Chronic Health Needs in Child Care and Schools—Visual Impairments Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Managing Chronic Health Needs in Child Care and Schools—Visual Impairments. Pediatric Patient Education 2021; 10.1542/ppe_document038 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Managing Chronic Health Needs in Child Care Visual impairment is present when a child cannot see well enough to interact with others and participate in daily child care or school activities (at the child’s developmental level).Low vision involves a decrease in sight (usually permanent) that interferes with a child’s ability to develop fine- and gross-motor skills and language and cognitive functions. It is an impairment in vision that, even with glasses and maximal medical treatment, adversely affects a child’s development.Partially sighted, legally blind, and low vision are terms used to describe the different levels of visual impairment related to a child’s needs in child care or another educational setting.A child who is partially sighted (also called moderate low vision, with typically 20/60–20/100 best-corrected at-a-distance visual acuity) has a visual problem that requires some special accommodations in child care and school. These children may also... © 2019 American Academy of Pediatrics. All rights reserved. You do not currently have access to this content.

A Delphi consensus to address unmet needs in the management of patients at risk of age‐related macular degeneration

PurposeProvide recommendations on preventive measures to adopt and follow‐up needed for patients at low, moderate and high risk of AMD using a Delphi consensus process.MethodsA Steering Committee drafted 25 statements on preventive measures and follow‐up for patients at risk of AMD; 14 comprised general recommendations, evaluation tools, lifestyle advice, and AREDS supplementation; based on STARS® score (1) (moderate, score 10–19; high, score ≥20), age (50–70 and >70) and AREDS classification (2), there were 5 statements for subjects at moderate risk of AMD and 6 for those at high risk. A panel of 30 experts voted on their level of agreement with the statements using an online platform.ResultsIn the first round, consensus was reached for 24 of the 25 statements. Among specific recommendations, it was held that the STARS® questionnaire and AREDS classification should be used to evaluate risk of AMD and define the best prevention strategy. In addition, all subjects at risk of AMD should be advised to stop smoking, adopt a Mediterranean diet and carry out regular physical activity. It was agreed that an AREDS‐based formulation significantly reduces the overall risk of moderate vision loss and developing advanced AMD in the long term. Subjects with moderate STARS® score, AREDS category 2, and 55–70 years of age should be asked to carry out self‐monitoring and have follow‐up every 2–3 years. Those with the same risk profile but with age >70 years should carry out self‐monitoring, be recommended specific nutritional supplements, and have annual follow‐up. All subjects with high‐risk and either AREDS category 1 or 2 over the age of 55 should be asked to carry out self‐monitoring. Patients with high‐risk STARS® score, AREDS category 1 and age >70 years should be recommended specific nutritional supplements, as should high‐risk subjects with AREDS category 2 >55 years. Independently of age, high‐risk subjects with AREDS category 2 should undergo follow‐up every 6 months.ConclusionsThese new consensus statements on preventive measures and follow‐up for patients at low, moderate and high risk of AMD can provide additional guidance for clinicians in routine practice.

Updates on Vision From the Global Burden of Disease Study

The Global Burden of Disease study estimates the prevalence of vision loss by WHO severity group, and the distribution of vision loss due to underlying causes such as cataract, glaucoma, and uncorrected refractive error. Data sources include national and local surveys, and scientific literature, with over 500 sources in 113 countries. Cause-specific prevalence estimates were proportionally fit into estimates of total vision loss by severity. Globally, 821.9 million (95% UI=682.2–970.4) people experienced moderate or worse distance vision loss or near vision loss in 2019 (age-standardized prevalence = 0.10, UI=0.08–0.12). Of these, 41.9 million (UI=36.4–46.8) were blind. The majority of Years Lived with Disability due to vision loss occurred in people with cataract and uncorrected refractive error. Vision loss numbers will continue to increase due to aging populations. Main causes of vision loss are correctable and, therefore, should be major targets of interventions.

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.

Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

SummaryBackgroundMany causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error.MethodsWe did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older.FindingsGlobal crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% [95% UI −1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by −15·4% [–16·8 to −14·3], while avoidable MSVI showed no change (0·5% [–0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7–18·0]), followed by glaucoma (3·6 million cases [2·8–4·4]), undercorrected refractive error (2·3 million cases [1·8–2·8]), age-related macular degeneration (1·8 million cases [1·3–2·4]), and diabetic retinopathy (0·86 million cases [0·59–1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2–101·0]) and cataract (78·8 million cases [67·2–91·4]).InterpretationResults suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached.FundingBrien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.

Prevalence and causes of vision loss in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019

Vision loss is an important public health issue in China, but a detailed understanding of national and regional trends in its prevalence and causes, which could inform health policy, has not been available. This study aimed to assess the prevalence, causes, and regional distribution of vision impairment and blindness in China in 1990 and 2019. Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used to estimate the prevalence of moderate and severe vision impairment and blindness in China and compare with other Group of 20 (G20) countries. We used GBD methodology to systematically analyse all available demographic and epidemiological data at the provincial level in China. We compared the age-standardised prevalences across provinces, and the changes in proportion of vision loss attributable to various eye diseases in 1990 and 2019. We used two different counterfactual scenarios with respect to population structure and age-specific prevalence to assess the contribution of population growth and ageing to trends in vision loss. In 2019, the age-standardised prevalence was 2·57% (uncertainty interval [UI] 2·28-2·86) for moderate vision impairment, 0·25% (0·22-0·29) for severe vision impairment, and 0·48% (0·43-0·54) for blindness in China, which were all below the global average, but the prevalence of moderate and severe vision impairment had increased more rapidly than in other G20 countries from 1990 to 2019. The prevalence of vision loss increased with age, and the main causes of vision loss varied across age groups. The leading causes of vision impairment in China were uncorrected refractive error, cataract, and macular degeneration in both 1990 and 2019 in the overall population. From 1990 to 2019, the number of people with moderate vision impairment increased by 133·67% (from 19·65 to 45·92 million), those with severe vision impairment increased by 147·14% (from 1·89 to 4·67 million), and those with blindness increased by 64·35% (from 5·29 to 8·69 million); in each case, 20·16% of the increase could be explained by population growth. The contributions to these changes by population ageing were 87·22% for moderate vision impairment, 116·06% for severe vision impairment, and 99·22% for blindness, and the contributions by age-specific prevalence were 26·29% for moderate vision impairment, 10·91% for severe vision impairment, and -55·04% for blindness. The prevalence and specific causes of vision loss differed across provinces. Although a comprehensive national policy to prevent blindness is in place, public awareness of visual health needs improving, and reducing the prevalence of moderate and severe vision impairment should be prioritised in future work. China National Key Research and Development Programme and Beijing Municipal Special Funds for Medical Research on Public Welfare Development and Reform.

Clinical Outcomes of Use of Low Vision Aids for Enhancement of Residual Vision in Diabetic Retinopathy

Purpose: To investigate clinical outcomes of use of low vision aids for enhancement of residual vision in people with Diabetic Retinopathy (DR).&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Hayatabad Medical Complex Peshawar, from January 2018 to December 2019.&#x0D; Methods: Eighty-one consecutive patients with DR were assessed in a low vision clinic for vision rehabilitation. Data regarding distance and near visual acuity (VA), refractive error, types of low vision aids (LVAs), VA with best correction and with LVAs were collected and analyzed.&#x0D; Results: A total of 81 people with DR, 63% were male. Mean age was 58.48 ± 13.54 years. With mean duration of 12.6 years of diabetes, 29.6% had Insulin dependent while 70.4% had non-Insulin dependent diabetes. At presentation, 63% had moderate vision impairment (0.5 &gt; VA &gt; 1.0), 14.8% had severe vision impairment (1.0 &gt; VA &gt; 1.3) and 22.2% had blindness (VA &lt; 1.3).With LVAs, 97.5% achieved distance VA of Log MAR 0.4 or better. Mean improvement in distance VA with LVAs was Log MAR 0.95 ± 0.19 (P = 0.000; 95% CI). Near VA improved significantly with LVAs and the number of participants who could see 1M or better with their own glasses increased from 7.4% to 97.5% (p &lt; 0.001). Binocular telescopes 2.1X were the most preferred low vision device for distance vision and prismatic magnifying spectacles for near vision.&#x0D; Conclusion: Visual rehabilitation through the use of LVAs was helpful in patients with low vision caused by diabetic retinopathy. Hence, improving the quality of life.&#x0D; Key Words: Diabetic retinopathy, blindness, visual rehabilitation, low vision aids, Pakistan.

Risk factors for self-reported cataract symptoms, diagnosis, and surgery uptake among older adults in India: Findings from the WHO SAGE data

ABSTRACT Visual impairments have a substantial impact on the well-being of older people, but their impact among older adults in low- and middle-income countries is under-researched. We examined risk factors for self-reported cataract symptoms, diagnosis, and surgery uptake in India. Cross-sectional data from the nationally representative WHO SAGE data (2007–2008) for India were analysed. We focused on a sub-sample of 6558 adults aged 50+, applying descriptive statistics and logistic regression. Nearly 1-in-5 respondents self-reported diagnosed cataracts, more than three-fifths (62%; n = 3879) reported cataract symptoms, and over half (51.8%) underwent surgery. Increasing age, self-reported diabetes, arthritis, low visual acuity, and moderate or severe vision problems were factors associated with self-reported diagnosed cataracts. Odds of cataract symptoms were higher with increasing age and among those with self-reported arthritis, depressive symptoms, low visual acuity, and with moderate or severe vision problems. Odds of cataract surgery were also higher with increasing age, self-reported diabetes, depressive symptoms, and among those with low visual acuity. A public health approach of behavioural modification, well-structured national outreach eye care services, and inclusion of local basic eye care services are recommended.

Population-based rapid assessment of avoidable blindness survey in Sohag governorate in Egypt

ObjectivesTo determine the prevalence and causes of blindness and vision impairment, and the coverage and quality of cataract surgical services, among population aged 50 years and older in Sohag governorate...

Association of Visual Acuity Improvement With Uncorrected Refractive Error in Patients New to Low Vision Clinics

There is substantial socioeconomic and individual burden from uncorrected refractive error (URE) and chronic ocular disease. Understanding the association of visual acuity (VA) reduction with URE and the adults most likely to benefit from refraction may help support clinical decision-making in ophthalmologic care and maximize patient outcomes. To assess the magnitude of VA improvement associated with URE among adults under ophthalmic care who obtain low vision rehabilitation (LVR) services and identify the characteristics of the patients who are most likely to experience improvement. This retrospective case series assessed patients 20 years or older who were new to the LVR clinics from August 1, 2013, to December 31, 2015, and who had habitual VA between 20/40 and counting fingers (not including) and underwent refraction. Data analysis was performed from April 4, 2018, to December 20, 2019. Patient demographics and clinical data, including habitual and refraction VA, refraction, and disease diagnosis. Habitual VA was categorized as mild (VA worse than 20/40 and at least 20/60), moderate (VA worse than 20/60 and better than 20/200), severe (VA 20/200 or worse and better than 20/500), and profound (VA 20/500 or worse) vision impairment (VI). At least 2-line VA improvement and any VA improvement (≥1-line) by refraction. Among the 2923 patients new to LVR clinics, 1773 (mean [SD] age, 70 [18.2] years; 1069 [60.3%] female) were included in these analyses. The mean habitual VA was 20/100 (mean [SD], 0.67 [0.36] logMAR). At least 2-line improvement was observed in 493 patients (27.8%), and any VA improvement was seen in 1023 patients (57.7%). At least 2-line improvement was observed in 54 patients (34.8%) with corneal disorders and was more likely seen among patients aged 40 to <65 years compared with those aged 20 to <40 years (odds ratio [OR], 1.57; 95% CI, 1.02-2.41), African American patients compared with white patients (OR, 1.41; 95% CI, 1.08-1.85), or patients with moderate VI compared with mild VI (OR, 1.36; 95% CI, 1.07-1.72). The findings suggest that URE is prevalent among patients with ocular disease and accessing LVR and that refractive evaluation should be considered for patients with ocular disease and reduced VA, especially working-age adults aged 40 to <65 years, African American patients, and those with moderate VI.

Response Retributivism: Defending the Duty to Punish

This paper offers a response retributive theory of punishment, taking the role of the punisher as well as the relations between the parties to punishment to be central to retributive justification. It proposes that punishment is justified in terms of the ethics of appropriate response, and more precisely, in terms of the duty agents have to dissociate from the devaluation inherent in the culpable wrongdoing of others. The paper demonstrates that on such account, while the harm and suffering involved in punishment are rightly imposed, they are not good, grounding a further duty to mitigate our retributive practices. The result is a moderate vision of retributive justification, which has the resources to justify, not only criminal punishment, but punishment as imposed across a wide variety of relations: private, institutional and political.

Test\u2013retest variability of microperimetry in geographic atrophy

PurposeMicroperimetry (MP) allows for measurement of retinal sensitivity at precise locations and is now commonly employed as a clinical trial endpoint. Test–retest reliability is important when evaluating treatment effects in patients with geographic atrophy (GA). This study aimed to determine the test–retest variability of MP in patients with moderate to severe GA using the MAIA MP device.MethodsIn this prospective study, patients with a confirmed diagnosis of foveal-involving GA were enrolled. Participants performed three MP assessments of a selected eye over two visits with the Macular Integrity Assessment (MAIA) 2 instrument (Centervue, Padova, Italy) utilizing a wide 30° grid, consisting of 93 stimuli (Goldmann III) using a 4-2 representation strategy, encompassing the entire area of GA and beyond. Mean retinal sensitivity (MS) was expressed as an average threshold value (dB) for the entire field tested. Coefficients of Repeatability at a 95% level (CoR95) were calculated for Point Wise Sensitivity (PWS). Fixation stability (FS) was assessed by evaluating the area of an elliptical representation encompassing 95% of the cloud of fixation points (CFP) dataset generated by the MAIA MP, known as the bivariate contour ellipse area (BCEA).ResultsA total of 8 subjects were enrolled (21 tests), with six subjects completing 3 MP assessments. BCVA in these patients ranged from 20/100 to 20/800. The mean area of GA was 18.7 ± 12.3 mm2. The average time to complete one MP assessment was 13 min 9 s and mean BCEA@95% was 38.5 ± 19.3°2. The MS was 14.3 ± 4.5 dB. No significant increase in MS was noted between testing pairs 1&2 and 2&3. The preferred retinal locus was maintained in the same quadrant on successive tests. The mean CoR95 for PWS were similar for testing pairs 1&2 (± 3.50 dB) and 2&3 (± 3.40).ConclusionMicroperimetry using a wide grid can be reliably performed in a reasonable amount of time in patients with moderate and severe vision loss secondary to GA. There was no learning effect seen between sequential assessments when analyzing MS or PWS. A change of approximately 4 dB in PWS provides a threshold for considering a true change in this patient cohort.

Short-term Postoperative Visual Acuity Decrease and Recovery after Ahmed Tube Shunt Procedure for Glaucoma

To elucidate the vision loss and recovery course after the Ahmed tube shunt procedure 6 months postoperatively. To identify risk factors associated with significant vision loss. Retrospective chart review. One eye of all adult patients who underwent an Ahmed glaucoma valve procedure from January 2008 to December 2017 with a minimum 6-month follow-up. Patients' preoperative and postoperative corrected visual acuity (CVA) were documented for 1 week, 1 month, 3 months, and 6 months postoperatively. Preoperative and postoperative CVA at various time points were compared using repeated-measures analysis of variance. The proportions of patients with mild (<3 lines of Snellen CVA loss), moderate (3-5 lines, inclusive), and severe (>5 lines) vision loss were calculated and compared using a chi-square test. Logistic regression analysis was conducted to identify risk factors associated with a loss of 3 or more lines of CVA 6 months after surgery. A total of 375 patients were included, whose mean preoperative CVA was 0.76. At 1 week postoperatively, mean CVA worsened to 0.96 (P < 0.05), but recovered back to preoperative level by the third postoperative month (P > 0.05). In terms of any vision loss, 55.6% of patients had worse CVA than preoperation at 1 week postoperatively, including 23.5% who had 3 or more lines of vision loss; these proportions decreased to 39.2% (P < 0.001) and 9.3%, respectively, by 6 months postoperatively. The most common causes of significant vision loss were preexisting ocular conditions and cataract progression. Postoperative antimetabolite injection was associated with a lower risk of 3 or more lines of CVA loss 6 months postoperatively (odds ratio, 0.44; P= 0.023). After the Ahmed tube shunt procedure, the worst CVA occurred at 1 week postoperatively and mean CVA returned to the preoperative level by month 3 postoperatively. Approximately 40% of patients had any CVA loss compared with preoperation, and 9.3% of patients had 3 or more lines of CVA loss at month 6 postoperatively. Postoperative antimetabolite injection was associated with a lower risk of 3 or more lines of postoperative vision loss.

Vision loss in anterior uveitis

AimsTo evaluate the long-term risk of permanent vision loss in subjects with anterior uveitis.MethodsRetrospective study of subjects attending uveitis clinic at Auckland District Health Board and Moorfields Eye Hospital between...

Prevalence and causes of vision loss in sub-Saharan Africa in 2015: magnitude, temporal trends and projections

BackgroundThis study aimed to assess the prevalence and causes of vision loss in sub-Saharan Africa (SSA) in 2015, compared with prior years, and to estimate expected values for 2020.MethodsA systematic...

Ocular complications and mortality in peripheral ulcerative keratitis and necrotising scleritis: The role of systemic immunosuppression.

Inflammatory ocular diseases are associated with systemic disease, ocular morbidity and mortality. To examine clinical characteristics of subjects with peripheral ulcerative keratitis (PUK) and necrotising scleritis. Retrospective case series in a single tertiary centre over 10 years. All patients presenting with necrotising scleritis, PUK or scleritis with corneal infiltrates. Fifty-two eyes (41 subjects) were identified. Demographic and clinical data analysis. Visual loss, ocular complications and mortality. Mean follow up was 7.0 ± 5.3 years, presentation age 51.3 ± 18.6 years, and 23 subjects (56.1%) were female. Overall, 27 eyes presented with PUK, 26 with necrotising scleritis, and 22 with corneal infiltrates associated with active scleritis. Associated systemic diagnosis was observed in 12 subjects at presentation, and in 21 subjects (51.2%) by final follow up. Recurrence occurred in 23 eyes (44.2%): 10 eyes experiencing PUK or necrotising scleritis; 13 eyes with non-necrotising scleritis. Perforation occurred in six eyes (11.5%). Moderate vision loss occurred in 10 eyes (19.2%) and severe loss in six eyes (11.5%). Five subjects (12.2%) were deceased by study conclusion, of whom four were not on immunomodulatory therapy (IMT). A marked difference in estimated survival was observed with IMT, with mean estimated survival of 10.7 years without treatment, compared to 24.7 years with IMT (P = .045). PUK and necrotising scleritis represent a severe inflammatory disease with high rates of perforation, visual loss and mortality. IMT was associated with a lower rate of mortality and longer estimated survival in this group.

Mengukuhkan Islam Nusantara: Kajian Sosiologis-Historis

Islam bring the message as a religion of “rohmatan lil 'alamin”. However, post-prophetic Islam turned into ideological extremism. The author will focus the discussion with the formulation of the problem: How does the process of changing Islam from rohmatan lil 'alamin become an ideology through sociological-historical analysis? How to restore Islam to be a rohmatan lil 'alamin for future Islamic development through sociological-historical analysis? The purpose of this discussion to trace the transformation of Islamic into ideology and explores Islam rahmatan lil alamin in Indonesia, for moderate vision of Islam Nusantara. The author will discuss using the theory of social construction (externalization, objectivity, internalization) by Peter L. Berger. The results revealed that, externally Islam brought by the Prophet Muhammad brought the teaching of rohmatan lil'alamin. The rohmatan lil 'alamin value is objectified by the Arabic characteristic of the ashobiyah. The ashobiyah nature of the Arab nation is internalized into society through ideological extremities. To restore Islam rohmatan lil 'alamin, the writer review Islam Nusantara. Islam is externalized in Indonesia through peaceful way. Islamic teachings finally objectified by the plural Indonesian society and influenced “Ethical Java”. Plural nature and maintain harmony in the ethics of Java is embedded character of moderation values ??(Tawassuth, Tawâzun, I'tidâl, Tasâmuh). This research contributes, to the development of Nusantara Islam which is a model of Islam that is not only centered on Arabia and realize Islam that preach rahmatan lil 'alamin.

Thirty Year Projected Magnitude (to 2050) of Near and Distance Vision Impairment and the Economic Impact if Existing Solutions are Implemented Globally

ABSTRACTPurpose: Recent global, regional and country-level prevalence estimates for blindness and vision impairment will be important when designing future public health policies. The aim of this paper is to contribute to this discussion by estimating the productivity impact of known effective interventions to treat all preventable cases of vision impairment at the global, regional and country-level up to 2050. We also provide estimates of potential reduction in the number of people with vision impairment, as well as averted vision-impaired years up to 2050.Methods: We combined recent estimates of the prevalence of blindness, distance and near vision impairment with the World Bank’s World Development Indicators (WDI) and estimated the global, regional and country-level productivity gains up to 2030, 2040 and 2050 from known effective interventions, primarily cataract surgery and treated uncorrected refractive errors. The magnitude of productivity gains relative to baseline depended on population size, estimated current and future prevalence of vision impairment, level of economic development, long-term wage growth, and long-term real interest rates.Results: Globally, we estimate that the number of people affected by blindness could be reduced from the estimated 114.6 million by 2050 to 58.3 million. This would be associated with over one billion blind life-years averted and US$ 984 billion in global productivity gains. These numbers are dwarfed by the impact of interventions to reduce the prevalence of Moderate and Severe Vision Impairment (MSVI) [Presenting Acuity <20/60 to 20/400 in the better-seeing eye]. We estimate that the number of people affected by MSVI could be reduced by 435.8 million people to 147.9 million by 2050. This reduction would translate to over 9 billion MSVI -life-years avoided and US$ 17 trillion in productivity gains by 2050. While other causes of VI would not be possible to eliminate completely based on current known effective treatments, low-cost interventions to eliminate VI from uncorrected presbyopia would avert 1.2 billion presbyopia life-years and achieve US$ 1.05 trillion in productivity gains by 2050. In total, the global productivity gains for all three categories are estimated to be US$ 19 trillion by 2050. East Asia makes up the greatest share of productivity gains due to the high number of people affected by VI and the region’s continuing economic growth.Conclusion: Implementation of currently known and effective treatments of avoidable blindness, MSVI and presbyopia would be expected to contribute significant productivity gains to the global economy at a fraction of the estimated costs to deliver them.

X-Chromosome Inactivation Is a Biomarker of Clinical Severity in Female Carriers of RPGR-Associated X-Linked Retinitis Pigmentosa

X-linked retinitis pigmentosa can manifest in female carriers with widely variable severity, whereas others remain unaffected. The contribution of X-chromosome inactivation (XCI) to phenotypic variation has been postulated but not demonstrated. Furthermore, the impact of genotype and genetic modifiers has been demonstrated in affected males but has not been well established in female carriers. The purpose of this study was to describe the scope of clinical phenotype in female carriers with mutations in RPGR and quantify the contribution of genotype, genetic modifiers, and XCI to phenotypic severity. Cohort study. Seventy-seven female carriers with RPGR mutations from 41 pedigrees. Coding single nucleotide polymorphisms were sequenced in candidate genetic modifier genes encoding known RPGR-interacting proteins. X-chromosome inactivation ratios were determined in genomic DNA isolated from blood (n= 42) and saliva (n= 20) using methylation status of X-linked polymorphic repeats. These genetic data were compared with disease severity based on quantitative clinical parameters. Visual acuity, Humphrey visual field (HVF) results, full-field electroretinography results, and dark adaptation. Most individuals at all ages were mildly affected or unaffected, whereas those who progressed to moderate or severe vision loss were older than 30 years. RPGR genotype was not associated with clinical severity. The D1264N variant in RPGRIP1L was associated with more severe disease. Skewed XCI toward inactivation of the normal RPGR allele was associated with more severe disease. The XCI ratio in both blood and saliva was a predictor of visual function as measured by HVF diameter, rod amplitude, flicker amplitude, and flicker implicit time. For carriers with extreme XCI skewing of 80:20 or more, 57% were affected severely compared with 8% for those with XCI of less than 80:20 (P= 0.002). Female carriers with mutations in RPGR demonstrate widely variable clinical severity. X-chromosome inactivation ratios correlate with clinical severity and may serve as a predictor of clinically significant disease. Because RPGR gene therapy trials are underway, a future imperative exists to determine which carriers require intervention and when to intervene. X-chromosome inactivation analysis may be useful for identifying candidates for early intervention.

Cross-Linking–Assisted Infection Reduction: A Randomized Clinical Trial Evaluating the Effect of Adjuvant Cross-Linking on Outcomes in Fungal Keratitis

To determine if there is a benefit to adjuvant corneal crosslinking (CXL) and to compare natamycin versus amphotericin B for filamentous fungal keratitis. Outcome-masked, 2×2 factorial design, randomized controlled clinical trial. Consecutive patients presenting with moderate vision loss from a smear-positive fungal ulcer at Aravind Eye Hospital, Madurai, India. Study eyes were randomized to 1 of 4 treatment combinations using an adaptive randomization protocol. The treatment arms included (1) topical natamycin 5% alone, (2) topical natamycin 5% plus CXL, (3) topical amphotericin B 0.15% alone, and (4) topical amphotericin 0.15% plus CXL. The primary outcome of the trial was microbiological cure at 24 hours on repeat culture. Secondary outcomes included best spectacle-corrected visual acuity (BSCVA) at 3 weeks and 3 months, percentage of study participants with epithelial healing at 3 days, 3 weeks, and 3 months, infiltrate or scar size at 3 weeks and 3 months, 3-day smear and culture, and adverse events. Those randomized to CXL regardless of medication (topical natamycin or amphotericin) had 1.32-fold increased odds of 24-hour culture positivity, although this was not statistically significant (95% confidence interval [CI], 0.57-3.06; P= 0.51). We were also unable to find a difference in 24-hour culture positivity between those randomized to amphotericin and those randomized to natamycin when evaluating as a group regardless of whether or not they received CXL (coefficient 1.10; 95% CI, 0.47-2.54; P= 0.84). The BSCVA was approximately 0.22 logarithm of the minimum angle of resolution (logMAR) (2.2 Snellen lines) worse on average at 3 weeks among those receiving CXL regardless of medication (95% CI,-0.04 to 0.40; P= 0.04) and 0.32 logMAR (3.2 Snellen lines) worse visual acuity at 3 months after controlling for baseline visual acuity (95% CI, 0.03-0.54; P= 0.02). There was no difference in infiltrate or scar size, percentage of epithelialized or adverse events when comparing CXL with no CXL or the 2 topical medications. There appears to be no benefit of adjuvant CXL in the primary treatment of moderate filamentous fungal ulcers, and it may result in decreased visual acuity.