Principal Cause Of Blindness Research Articles

The association between the utilization of SGLT2 inhibitors and diabetic retinopathy; a systematic review and meta-analysis of cohort studies

Introduction: Diabetic retinopathy is one of the principal causes of blindness globally. The impact of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, a category of anti-diabetic medications, on diabetic retinopathy remains undetermined. Consequently, this study aimed to examine the association between the utilization of SGLT2 inhibitors and the incidence of diabetic retinopathy. Materials and Methods: This investigation systematically searched databases, including Web of Science, Cochrane, ProQuest, PubMed, and Google Scholar, until March 7, 2024. A systematic review and meta-analysis methodology was employed. Data were analyzed using STATA software version 14, considering a significance level of tests at P<0.05. Results: The application of SGLT2 inhibitors was connected with a diminished diabetic retinopathy risk (odds ratio [OR]: 0.77, 95% CI: 0.69, 0.86). Among women, SGLT2 inhibitor use did not notably influence diabetic retinopathy risk (OR: 0.84, 95% CI: 0.69, 1.03). However, among men, employing SGLT2 inhibitors decreased the risk (OR: 0.81, 95% CI: 0.71, 0.92). In comparison to dipeptidyl peptidase-4 inhibitors (OR: 0.70, 95% CI: 0.53, 0.94) and pioglitazone (OR: 0.75, 95% CI: 0.74, 0.76), SGLT2 inhibitors lowered the risk of diabetic retinopathy. However, when compared to sulfonylureas (OR: 0.45, 95% CI: 0.17, 1.17) and GLP1-RA (OR: 0.70, 95% CI: 0.42, 1.17), SGLT2 inhibitors did not notably affect diabetic retinopathy. Moreover, using SGLT2 inhibitors in the age groups of 50-54 years (OR: 0.74, 95% CI: 0.55, 0.98), 55-59 years (OR: 0.65, 95% CI: 0.53, 0.79), and 60-64 years (OR: 0.89, 95% CI: 0.82, 0.97) was linked to lower diabetic retinopathy risk. Nevertheless, in the 65-69 age group, SGLT2 inhibitor administration did not significantly alter the diabetic retinopathy risk (OR: 1.04, 95% CI: 0.94, 1.15). Conclusion: The intake of SGLT2 inhibitors has been linked to a diminution in the hazard of diabetic retinopathy. However, further research in this domain is recommended, given the need for studies examined. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (CRD42024523959) and Research Registry (UIN: reviewregistry1808) website.

A Study on Refractive Outcome Following Manual Small Incision Cataract Surgery with Rigid PCIOL

Introduction: Cataract is a significant and increasing global problem with vast economic and social implications[1]. It is the principal cause of blindness in India accounting for 62.6% (92). The prevalence of blinding cataract will only increase as people live longer, so cataract will continue to be, by far, the most important treatable cause of blindness. It is estimated that the present number of 20 million of cataract blind will double by year 2030.[2] . Materials and Methods: Study design: Cross sectional observational study Source of data: All the patients admitted with small incision cataract surgery (SICS) with PCIOL implant, in the department of Ophthalmology Rajarajeshwari Medical College and Hospital, Bangalore Study period: 18 months (Jan 2021- June 2022) Sample size: 200 patients. Results and Observations: In our study, at 1st post operative week, most patients had visual acuity score of better than 6/9 and least had less than 6/60 score. A follow up of patients at 2nd week, 6th week and end of 6th week showed that visual acuity improved at 2nd and 6th post-operative weeks.. Most patients were in the refraction range of < -0.50. Conclusion: From our study we conclude that the uncorrected visual acuity of cataract patients improved in the early and late post-operative weeks, after undergoing Manual Small Incision Cataract Surgery with Rigid PCIOL (MSICS) to a great extent. MSICS can be accepted as an alternative to phacoemulsification in developing countries like India. Keywords: Cataract, Small incision, Astigmatic, Visual outcome

The second rapid assessment of avoidable blindness survey in Palestine: A national cross‐sectional study

Aim: To assess prevalence and main causes of blindness, vision impairment and cataract surgical coverage in Palestinians aged 50 years and older.Methods: The survey was part of a larger population‐based survey using the rapid assessment of avoidable blindness (RAAB) methodology to estimate prevalence of vision impairment, blindness and disability in individuals aged 50 years and older in Palestine. It was a nationally representative, cross‐sectional, population‐based survey in Gaza Strip and West Bank. A sample size of 4224 participants aged 50 years and older was determined in 69 clusters in the West Bank and 52 clusters in the Gaza Strip. Within each cluster, 35 people aged 50 years or older were examined in their homes.Results: The total examined was 3848. Adjusted prevalence of blindness was 2.6%. This is a non‐significant decrease from 3.4% in 2008. The prevalence of blindness in Gaza (4.0%) was higher than the prevalence of blindness in the West Bank (1.8%). The prevalence was higher among females than males.Adjusted prevalence of severe vision impairment, moderate vision impairment and mild vision impairment was 1.4%, 10.2% and 11.6%, respectively. Principal cause of blindness, severe and moderate vision impairment was untreated cataract followed by diabetic retinopathy. Refractive error was the principal cause of mild vision impairment. More than 80% of vision impairment was avoidable.Unmet need for cataract surgery varied from 0.9% among blind participants to 6.5% among participants with mild vision impairment. Effective cataract surgical coverage was low in general and varied from 42.4% among blind operated participants to 25.9% among participants with mild vision impairment.Conclusions: Around 80% of vision impairment was avoidable. Untreated cataract and diabetic retinopathy were the main causes of blindness, severe and moderate vision impairment. Refractive error was the principal cause of mild vision impairment. Effective cataract surgical coverage was low.

Early-life peripheral infections reprogram retinal microglia and aggravate neovascular age-related macular degeneration in later life.

Pathological neovascularization in age-related macular degeneration (nvAMD) drives the principal cause of blindness in the elderly. While there is a robust genetic association between genes of innate immunity and AMD, genome-to-phenome relationships are low, suggesting a critical contribution of environmental triggers of disease. Possible insight comes from the observation that a past history of infection with pathogens such as Chlamydia pneumoniae, or other systemic inflammation, can predispose to nvAMD in later life. Using a mouse model of nvAMD with prior C. pneumoniae infection, endotoxin exposure, and genetic ablation of distinct immune cell populations, we demonstrated that peripheral infections elicited epigenetic reprogramming that led to a persistent memory state in retinal CX3CR1+ mononuclear phagocytes (MNPs). The immune imprinting persisted long after the initial inflammation had subsided and ultimately exacerbated choroidal neovascularization in a model of nvAMD. Single-cell assay for transposase-accessible chromatin sequencing (scATAC-seq) identified activating transcription factor 3 (ATF3) as a central mediator of retina-resident MNP reprogramming following peripheral inflammation. ATF3 polarized MNPs toward a reparative phenotype biased toward production of proangiogenic factors in response to subsequent injury. Therefore, a past history of bacterial endotoxin-induced inflammation can lead to immunological reprograming within CNS-resident MNPs and aggravate pathological angiogenesis in the aging retina.

The prevalence of diabetic retinopathy in the occupied Palestinian territories: a national cross-sectional study

BackgroundDiabetic retinopathy is a complication of diabetes that affects the eyes and can lead to blindness if not adequately managed. No national or population-based estimates of diabetic retinopathy in Palestine exist. High-quality ophthalmic services are not available at the primary health care level for patients with diabetes in all sectors. Specialised eye centres are lacking. St John of Jerusalem Eye Hospital Group, which consists of five facilities in the West Bank and Gaza Strip, is the only provider of expert eye care in Palestine. The aim of this study was to determine the population prevalence of diabetic retinopathy among people with diabetes aged 50 years and older in Palestine. MethodsThis survey was part of a larger population-based survey using the rapid assessment of avoidable blindness (RAAB) methodology to estimate prevalence of vision impairment, blindness, and disability in individuals aged 50 years and older in Palestine. It was a nationally representative, cross-sectional, population-based survey in Gaza Strip and West Bank. Based on an expected prevalence of blindness of 3·4% in individuals aged 50 years and older, 20% precision level, 95% confidence level, 10% non-response rate, and a design effect of 1·4 to account for clustering, a sample size of 4224 participants aged 50 years and older was determined. 69 clusters in the West Bank and 52 clusters in the Gaza Strip were selected with probability proportionate to size from a list of areas from the Palestinian Central Bureau of Statistics population and housing census of 2017. Within each cluster, 35 people aged 50 years or older were randomly selected for examination in their homes. Three teams collected data; each consisted of a nurse and an ophthalmologist. Dilated fundus examination and Scottish diabetic retinopathy grading were done by the ophthalmologist in each team. Participants were classified as having diabetes if they had been diagnosed by a health professional, or if their random blood glucose (RBG) was 200 mg/dL or above on the day of data collection, as measured by a portable glucometer. Ethical approval was obtained from the St John of Jerusalem Eye Hospital Group and the London School of Hygiene & Tropical Medicine ethics committees. Informed oral witnessed consent was obtained from all participants. FindingsThe survey was conducted between July, 2018, and April, 2019. 4224 individuals were asked to participate, of whom 376 did not, leaving 3848 participants. The number of previously diagnosed and newly diagnosed patients with diabetes was 1176 (486 male, 690 female) and 103 (55 male, 48 female), respectively. The overall prevalence of diabetes across West Bank and Gaza was 33·2% (95% CI 31·5–34·9; 1279 of 3848 participants). The prevalence was higher in women (738 of 2047 [36·1%, 95% CI 33·6–38·5]) than in men (541 of 1801 [30·0%, 27·9–32·2), and in Gaza Strip (639 [35·8%] of 1783) than in West Bank (640 [31·0%] of 2065; p=0·002). Only 539 (46·3%) of 1164 patients with diagnosed diabetes who consented to blood blucose measurement had controlled blood glucose (RBG <200 mg/dL). 483 (41·1%) of 1176 patients with previously diagnosed diabetes had never had an eye check-up or had not been checked in the 2 years before the survey. 327 (25·6%) of 1279 patients with diabetes refused dilated fundus examination; 952 patients did undergo this examination, and 457 (48·0%, 95% CI 43·5–52·6) had diabetic retinopathy or maculopathy. Vision impairment was more common in those with diabetes (428 [33·5%] of 1279) than in those without (652 [25·4%] of 2569). 43 (3·4%) of 1279 participants with diabetes had blindness, compared with 65 (2·5%) of 2569 patients without diabetes. The principal cause of blindness in Gaza Strip was diabetic retinopathy (23 [32·4%] of 71) and in West Bank was untreated cataract (19 [51·4%] of 37). Diabetic retinopathy was the main cause of blindness, severe visual impairment, and moderate visual impairment among patients with diabetes. InterpretationDiabetes and diabetic retinopathy are substantial health problems in Palestine. Earlier detection and proper management at primary health care clinics and by outreach clinics for marginalised populations could be key. Referral networks between health-care sectors and specialised eye centres might provide the necessary infrastructure. FundingFred Hollows Foundation, Australia, German Federal Ministry for Economic Cooperation and Development.

LONGL-Net: temporal correlation structure guided deep learning model to predict longitudinal age-related macular degeneration severity.

Age-related macular degeneration (AMD) is the principal cause of blindness in developed countries, and its prevalence will increase to 288 million people in 2040. Therefore, automated grading and prediction methods can be highly beneficial for recognizing susceptible subjects to late-AMD and enabling clinicians to start preventive actions for them. Clinically, AMD severity is quantified by Color Fundus Photographs (CFP) of the retina, and many machine-learning-based methods are proposed for grading AMD severity. However, few models were developed to predict the longitudinal progression status, i.e. predicting future late-AMD risk based on the current CFP, which is more clinically interesting. In this paper, we propose a new deep-learning-based classification model (LONGL-Net) that can simultaneously grade the current CFP and predict the longitudinal outcome, i.e. whether the subject will be in late-AMD in the future time-point. We design a new temporal-correlation-structure-guided Generative Adversarial Network model that learns the interrelations of temporal changes in CFPs in consecutive time-points and provides interpretability for the classifier's decisions by forecasting AMD symptoms in the future CFPs. We used about 30,000 CFP images from 4,628 participants in the Age-Related Eye Disease Study. Our classifier showed average 0.905 (95% CI: 0.886–0.922) AUC and 0.762 (95% CI: 0.733–0.792) accuracy on the 3-class classification problem of simultaneously grading current time-point's AMD condition and predicting late AMD progression of subjects in the future time-point. We further validated our model on the UK Biobank dataset, where our model showed average 0.905 accuracy and 0.797 sensitivity in grading 300 CFP images.

Exploring neovascular age-related macular degeneration and diabetic macular edema and advances in treatment

Retinal and choroidal vascular diseases are principal causes of blindness for adults in developed countries around the world. Neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) are 2 significant contributors to this global vision loss and confer substantial social and economic burdens on patients and society. Anti-vascular endothelial growth factor intravitreal injection therapy has dominated as the standard of care treatment for over 15 years, but poor adherence and high treatment burden have led to suboptimal visual outcomes in the real world compared with the clinical trial results. New treatments are emerging that expand the therapeutic targets and use innovative delivery mechanisms with longer durability to ease the treatment burden. Understanding the benefits and drawbacks of these therapies is key to designing new treatment pathways that improve visual outcomes while decreasing the treatment burden on patients and healthcare institutions.

Common haplotypes at the CFH locus and low-frequency variants in CFHR2 and CFHR5 associate with systemic FHR concentrations and age-related macular degeneration

SummaryAge-related macular degeneration (AMD) is the principal cause of blindness in the elderly population. A strong effect on AMD risk has been reported for genetic variants at the CFH locus, encompassing complement factor H (CFH) and the complement-factor-H-related (CFHR) genes, but the underlying mechanisms are not fully understood. We aimed to dissect the role of factor H (FH) and FH-related (FHR) proteins in AMD in a cohort of 202 controls and 216 individuals with AMD. We detected elevated systemic levels of FHR-1 (p = 1.84 × 10−6), FHR-2 (p = 1.47 × 10−4), FHR-3 (p = 1.05 × 10−5) and FHR-4A (p = 1.22 × 10−2) in AMD, whereas FH concentrations remained unchanged. Common AMD genetic variants and haplotypes at the CFH locus strongly associated with FHR protein concentrations (e.g., FH p.Tyr402His and FHR-2 concentrations, p = 3.68 × 10−17), whereas the association with FH concentrations was limited. Furthermore, in an International AMD Genomics Consortium cohort of 17,596 controls and 15,894 individuals with AMD, we found that low-frequency and rare protein-altering CFHR2 and CFHR5 variants associated with AMD independently of all previously reported genome-wide association study (GWAS) signals (p = 5.03 × 10−3 and p = 2.81 × 10−6, respectively). Low-frequency variants in CFHR2 and CFHR5 led to reduced or absent FHR-2 and FHR-5 concentrations (e.g., p.Cys72Tyr in CFHR2 and FHR-2, p = 2.46 × 10−16). Finally, we showed localization of FHR-2 and FHR-5 in the choriocapillaris and in drusen. Our study identifies FHR proteins as key proteins in the AMD disease mechanism. Consequently, therapies that modulate FHR proteins might be effective for treating or preventing progression of AMD. Such therapies could target specific individuals with AMD on the basis of their genotypes at the CFH locus.

Cell therapy with hiPSC-derived RPE cells and RPCs prevents visual function loss in a rat model of retinal degeneration

Photoreceptor loss is the principal cause of blindness in retinal degenerative diseases (RDDs). Whereas some therapies exist for early stages of RDDs, no effective treatment is currently available for later stages, and once photoreceptors are lost, the only option to rescue vision is cell transplantation. With the use of the Royal College of Surgeons (RCS) rat model of retinal degeneration, we sought to determine whether combined transplantation of human-induced pluripotent stem cell (hiPSC)-derived retinal precursor cells (RPCs) and retinal pigment epithelial (RPE) cells was superior to RPE or RPC transplantation alone in preserving retinal from degeneration. hiPSC-derived RPCs and RPE cells expressing (GFP) were transplanted into the subretinal space of rats. In vivo monitoring showed that grafted cells survived 12 weeks in the subretinal space, and rats treated with RPE + RPC therapy exhibited better conservation of the outer nuclear layer (ONL) and visual response than RPE-treated or RPC-treated rats. Transplanted RPE cells integrated in the host RPE layer, whereas RPC mostly remained in the subretinal space, although a limited number of cells integrated in the ONL. In conclusion, the combined transplantation of hiPSC-derived RPE and RPCs is a potentially superior therapeutic approach to protect retina from degeneration in RDDs.

Esculetin and idebenone ameliorate galactose-induced cataract in a rat model.

Cataract is the principal cause of blindness. The enzyme, aldose reductase (AR) is a key player in polyol pathway. Buildup of polyols and oxidative stress are the main causes of cataractogenesis. This study investigated the cytoprotective properties of esculetin and idebenone in galactose-induced cataract. Rats were partitioned into four groups each of ten rats. Control group was fed with normal diet; group 2 rats were fed with galactose diet (50%); groups 3, 4 rats were fed with galactose diet concurrently with either esculetin (50mg/kg BW) or idebenone (100mg/kg BW), for 20days. The study revealed that esculetin and idebenone significantly reduced the elevated levels of Bax/Bcl-2 ratio, malondialdehyde, and DNA fragmentation and increased total antioxidant capacity level in lenses compared to the cataract-induced group. Only esculetin decreased AR, galactitol, and advanced glycated end products levels in lenses. Histopathological examinations supported the biochemical findings. Esculetin and idebenone may have chemopreventive effects for sugar cataract. PRACTICAL APPLICATIONS: Cataract is an age-related disease that might cause blindness in older adult people. Presently, no absolute pharmacological treatment is accessible for cataract. The use of natural products or their derivatives attract particular attention in modern medicines as they are believed to be safer with few or no side effects. Esculetin is a polyphenolic compound found in many medicinal plants. Idebenone is a synthetic analogue of coenzyme Q10. The current study is an approach to explore the anticataract effects of esculetin and idebenone in galactose-induced cataract in rats. Our study proved that both agents have anticataractogenic potentials due to their antioxidant and antiapoptotic properties.

Retinopathy of prematurity, frequency and risk factors in very low birth weight infants.

Retinopathy of prematurity (ROP) is the principal cause of blindness during childhood. The objective of this study was to analyze the frequency of ROP and risk factors associated with ROP in a cohort of very low birth weight infants. A cases (ROP) and controls (no ROP) study of infants less than 1500 g was conducted. Perinatal and neonatal variables were analyzed. For the statistical analysis, χ2 test, Student's t-test and Mann-Whitney's U-test were used. For the study, 282 neonates were included: 152 (53.9%) with ROP and 130 (46.1%) without ROP. The most frequent stages observed were stage 1 and 2, with 139 (91.4%) patients, and stages 3 to 5, with only 13 patients (8.5%). In those neonates with ROP compared with neonates without ROP, the birth weight was less (902.7 vs. 1037.9 g) and the difference was significant (p < 0.0001). Also, the difference with gestational age (28.2 vs. 29.6; p < 0.0001), total ventilation days (32.8 vs. 16.1; p < 0.00001) and total oxygen days (87.7 vs. 62.6; p < 0.0001) was significant in neonates with ROP and neonates without the disease. Bronchopulmonary dysplasia, intraventricular hemorrhage and late onset sepsis were significant with patients with ROP. The frequency of ROP reported here is higher than the reported in Mexican population, with less cases of severe ROP. The neonatal surveillance in babies with less birth weight and gestational age is important to decrease the incidence of ROP.

Prevalence and causes of blindness and visual impairment; and cataract surgical services in Katsina state of Nigeria

AimTo generate data on blindness and visual impairment for planning and monitoring a comprehensive eye care programme in Katsina state of Nigeria.MethodA rapid assessment of avoidable blindness (RAAB) survey methodology...

Association of PON2 and PON3 polymorphism with risk of developing cataract

PurposeParaoxonases (PON) are calcium bound enzymes offering protection against oxidative stress by working as endogenous free-radical scavenging molecules. Oxidative stress has been implicated in pathophysiology of many diseases including cataract. Lens opacity is an age related disorder which is a principal cause of blindness in Pakistani population. Relationship of PON2 and PON3 polymorphism with genetic predisposition for incidence of cataract has not been investigated till date. Objective of the current study was to explore possible association between PON2 and PON3 polymorphism with incidence of cataract in local population. MethodsOur study design comprised of fifty-one cataractous and fifty-nine healthy individuals. Identification of single nucleotide polymorphism (SNP) at positions (C311S and G148A) for PON2 and C133A for PON3 was conducted using restriction fragment length polymorphism (RFLP). ResultsStatistical analysis revealed significant association of PON2 G148 allele with incidence of cataract. GG allele was found to be higher in cataract patients as compared to control (p < 0.001) suggesting distribution of PON2 G148A genotype and allele frequency is linked with cataractogenesis. There was no noticeable association between PON2 C311S and PON3 C133A. Significant difference was observed in distribution of 311CS/148A combined genotype with highest frequency in control individuals (88.89%), while 311S/148G combined genotypes showed the highest frequencies among the cataract patients (71.42%). ConclusionOur data suggests mutation at G148A might be related with incidence of cataract in studied population.

Estimating the magnitude of diabetes mellitus and diabetic retinopathy in an older age urban population in Pune, western India

ObjectiveTo estimate magnitude of diabetes mellitus (DM) and diabetic retinopathy (DR) in a high risk population in Pune, western India.MethodsDR module in rapid assessment of avoidable blindness (RAAB) survey methodology...

Automatic Segmentation of Optic Disc and Cup in Retinal Fundus Images Using Improved Two‐Layer Level Set Method

Glaucoma is a group of eye conditions, which can seriously damage optic nerves because of an elevated intraocular pressure. Nowadays, glaucoma has become one of the principal causes of blindness that results in irreversible visual loss. Early screening and treatment of glaucoma can prevent further progression of optic nerve degeneration effectively. The vertical cup‐to‐disc ratio (CDR) is a commonly used measurement for the detection of glaucoma, and therefore accurate segmentation of optic disc (OD) and optic cup (OC) regions in retinal fundus images is of great significance. In this paper, we present a prior shape constraint‐based two‐layer level set method for OD and OC segmentation in fundus images. This method uses two different layers of one level set function to represent the OD and OC boundaries. In this method, the distance regularized term is designed to guarantee that the distance between the OD and OC varies smoothly. By introducing the prior shape constraint term energy, the final segmentation results of OD and OC are always in the shape of approximate ellipses. In addition, the proposed method has the property of dealing with the intensity inhomogeneity of fundus images through the local fitting energy embedded. Experiments on images from the Baidu Research database demonstrate that the proposed method has superior performance in terms of accuracy and effectiveness.

Rapid Assessment of Avoidable Blindness in Kurdistan, Iran.

Purpose:To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology.Methods:In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling “E” chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI.Results:A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%).Conclusion:The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan.

Blindness and Visual Impairment Profile and Rapid Assessment of Avoidable Blindness in South East Asia: Analysis of New Data. 2017 APAO Holmes Lecture.

The International Agency for Prevention of Blindness (IAPB) South East Asia region (SEAR) that consists of 11 countries contains 26% of the world's population (1,761,000,000). In this region 12 million are blind and 78.5 million are visually impaired. This amounts to 30% of global blindness and 32% of global visual impairment. Rapid assessment of avoidable blindness (RAAB) survey analysis. RAAB, either a repeat or a first time survey, was completed in 8 countries in this decade (2010 onwards). These include Bangladesh, Bhutan, India, Indonesia, Maldives, Sri Lanka, Thailand, and Timor Leste. Cataract is the principal cause of blindness and severe visual impairment in all countries. Refractive error is the principal cause of moderate visual impairment in 4 countries: Bangladesh, India, Maldives, and Sri Lanka; cataract continues to be the principal cause of moderate visual impairment in 4 other countries: Bhutan, Indonesia, Thailand, and Timor Leste. Outcome of cataract surgery is suboptimal in the Maldives and Timor Leste. Rigorous focus is necessary to improve cataract surgery outcomes and correction of refractive error without neglecting the quality of care. At the same time allowances must be made for care of the emerging causes of visual impairment and blindness such as glaucoma and posterior segment disorders, particularly diabetic retinopathy.

Associations between fruits, vegetables, vitamin A, β-carotene and flavonol dietary intake, and age-related macular degeneration in elderly women in Korea: the Fifth Korea National Health and Nutrition Examination Survey.

Age-related macular degeneration (AMD) is one of the principal causes of blindness. This study investigated the association between diet and the prevalence of AMD in elderly Korean women. Study subjects were women aged ⩾65 years (n=1008) from the Korea National Health and Nutrition Examination Survey (2010-2012). The presence of early- and late-onset AMD was determined on the basis of a fundus photograph from a health examination survey. Food intake was estimated using 24 h recall. The prevalence of AMD was 18.8% in elderly women in Korea. Multiple logistic regression analysis showed a significant negative association between vegetable intake and AMD (odds ratio (OR) 0.44, 95% confidence interval (CI) 0.25, 0.77, P for trend=0.002) after adjusting for age, body mass index, postmenopausal period, duration of hormone replacement therapy, residential area, education level, family income, smoking status, alcohol consumption, dietary supplement use and total energy intake. After adjusting for potential confounders, the ORs between extreme quartiles were 0.55 (95% CI 0.29, 1.05, P for trend=0.070) for fruit and vegetable intake, 0.38 (95% CI 0.21, 0.68, P for trend=0.001) for vitamin A, 0.36 (95% CI 0.19, 0.67, P for trend<0.001) for β-carotene and 0.45 (95% CI 0.25, 0.82, P for trend=0.008) for flavonols. These results suggest that higher consumption of fruits and vegetables containing antioxidant nutrients and phytochemicals may provide some protection against AMD.

Different-sized incisions for phacoemulsification in age-related cataract

Different-sized incisions for phacoemulsification in age-related cataract

Prevalence of visual impairment and outcomes of cataract surgery in Chaonan, South China.

PurposeTo estimate the prevalence and causes of blindness and visual impairment (VI), and report the outcomes of cataract surgery in Chaonan Region, Guangdong Province, southern ChinaDesignCross-sectional population-based surveyParticipantsA total of 3484 participants including 1397 men (40.1%) and 2087 women (59.9%) aged ≥50 years were examined (94.2% response rate).MethodA two-stage cluster sampling procedure was used to select 3700 participants aged ≥50 years from 74 clusters of Chaonan Region. Participants were examined according to the Rapid Assessment of Avoidable Blindness (RAAB) method. Blindness and visual impairment (VI) were defined by the World Health Organization criteria. Participants with visual acuity (VA) < 6/18 in either eye were examined by ophthalmologists. The primary causes of blindness and VI were reported with reference to the participant’s better eye.Main outcome measuresPrevalence and main causes of blindness, severe visual impairment (SVI), VI and the outcomes of cataract surgeryResultsThe standardized prevalence rates of blindness, SVI, and VI were 2.4% (95% confidence interval [CI], 1.9–2.9%), 1.0% (95% CI, 0.7–1.4%), and 6.4% (95% CI, 5.6%– 7.1%), respectively. The principal cause of blindness and SVI was cataract, accounting for 67.1% and 67.6% respectively, and the principal cause of VI was refractive error (46.9%). One hundred and fifty five out of 3484 (4.4%) people (211 eyes) had cataract surgery. Of the 211 eyes that had cataract surgery, 96.7% were pseudophakic. 67.2% of the 211 operated eyes had a presenting visual acuity (PVA) of 6/18 or better.ConclusionsThe prevalence of blindness, SVI, and VI was high among rural residents in Chaonan. Cataract remained the leading cause of avoidable blindness. Outcomes of cataract surgery performed in rural private clinics were suboptimal. Quality-control initiatives such as hands-on training program should be introduced to improve cataract surgery outcomes.