Risk Of Sight-threatening Complications Research Articles

The value of herpes zoster prevention in people aging with HIV: A narrative review.

Review the evidence on the incidence and impact of herpes zoster among people living with HIV and the potential impact of recombinant zoster vaccine for people aging with HIV. Narrative review. Although antiretroviral therapy has substantially reduced the risk of herpes zoster among people living with HIV, they remain at an increased risk compared with the general population. Among people aging with HIV, aging per se is now the main risk factor for herpes zoster. Beyond pain, herpes zoster is also associated with a risk of sight-threatening complications in case of trigeminal involvement, disseminated diseases and stroke. Post-herpetic neuralgia is also a potential threat to the quality of life of people aging with HIV. The recombinant zoster vaccine has demonstrated high and sustained efficacy in the prevention of herpes zoster, post-herpetic neuralgia, and other herpes zoster complications in the general population. Immunogenicity data among people living with HIV with high CD4+ T-cell count and controlled viral load are comparable to those among the general population. Real-life effectiveness data indicate high vaccine efficacy among immunocompromised patients other than people living with HIV. High vaccine price, vaccine hesitancy, and limited disease and vaccine awareness represent potential hurdles for high vaccine uptake among people aging with HIV in Europe. Herpes zoster, and its complications, is a vaccine-preventable disease of aging people. Given its impact on quality of life, herpes zoster prevention using recombinant zoster vaccine is a safe strategy to be considered in every person aging with HIV.

Myopia and its progression in children in London, UK: a retrospective evaluation

Purpose: Worldwide, the prevalence of myopia is increasing. Myopia begins at younger ages and progresses faster, leading to more adults with high myopia and risk of sight-threatening complications. No data are available about myopia trends in children in urban areas in the UK. We present a 10-year review of children attending a secondary and tertiary eye care facility in London, focussing on the proportion of glasses prescriptions for myopia and progression rates. Methods: We collated refraction and demographic data from children under the age of 17 years seen at Moorfields Eye Hospital, London, UK, between 2008 and 2017. Results: We included 63,854 datasets from 23,593 children (51.2% boys, median age 5.4 years, interquartile range IQR 3.8–7.1). The proportion of myopic prescriptions increased from 24 to 32%. In n = 3355 with initial mild/moderate myopia, median progression rate was −0.16 (−0.5 to 0.04) D/year. In those with progression (n = 2095), the rate was -0.40 (−0.19 to −0.74) D/year, slightly higher in girls than in boys (−0.42 vs −0.38 D/year; p = 0.02). Progression was faster in initial moderate than initial mild myopia (−0.54 vs −0.37 D/year; p < 0.001), and before than after average age of onset of puberty (−0.41 vs −0.35 D/year; p = 0.013). There was no statistically significant difference between children of different ethnic backgrounds. Conclusions: In this cohort, the proportion of glasses prescriptions for myopia and the rate of progression are higher than previously reported for European countries. Living in an urban environment may result in similar progression rates despite different genetic backgrounds.

Awareness and practices regarding eye diseases among patients with diabetes: a cross sectional analysis of the CoDiab-VD cohort

BackgroundThe increasing prevalence of diabetes is leading to a rise of eye diseases, augmenting the risk of sight-threatening complications. The aim of this study was to evaluate prevalence, awareness and practices regarding eye diseases among patients with diabetes in the canton of Vaud, Switzerland.MethodsA cohort of 323 patients with diabetes completed a self-administered questionnaire assessing prevalence, awareness and practices regarding eye diseases, besides health status and quality of care measures. Descriptive analyses followed by exploratory subgroup analyses and linear regressions were performed to investigate factors associated with awareness and practices.ResultsWhile diabetic retinopathy was reported by 40.9% of patients with type 1 diabetes and 9.8% of patients with type 2 diabetes, 35.8% and 12.6% of all participants reported cataract and glaucoma, respectively. Awareness that diabetes could damage the eyes was reported by almost all participants; the majority was also aware of the importance of glycemic control and regular eye examination in preventing eye diseases. In contrast, only 70.5% of participants underwent an eye examination by an ophthalmologist during the past year. Eye examination was associated with better patients’ awareness. Barriers mentioned by patients revealed a lack of knowledge about screening guidelines, in particular regarding the preventive nature of eye examinations.ConclusionsDespite high levels of awareness regarding diabetic eye diseases, a significant proportion of patients with diabetes did not report annual eye examination. Both healthcare strategic efforts targeting the promotion of regular eye examination and initiatives aiming at improving knowledge of screening guidelines should be encouraged.Trial registrationClinicalTrials.gov on 9th July 2013, identifier NCT01902043 (retrospectively registered).

Vernal Keratoconjunctivitis in School Children in Rwanda: Clinical Presentation, Impact on School Attendance, and Access to Medical Care

We sought to describe the clinical presentation, effect on visual acuity, impact on school attendance, and access to appropriate eye care in children with vernal keratoconjunctivitis (VKC) in Rwanda (Central Africa). Case-control study nested within a cross-sectional survey. We examined 3041 children; 121 had VKC. Primary schools were randomly selected and children were interviewed using a questionnaire on VKC-related symptoms. Data on health-seeking behavior and school attendance were recorded. Children received a full eye examination, including visual acuity using a LogMar E Chart. Description of the clinical findings, unaided visual acuity, prior attendance for medical eye care, and the impact of VKC on school attendance. Of the 121 children with VKC, 119 (98.4%) had only limbal disease. Ocular itching (n = 101; 83.5%) was the predominant symptom and this was seasonal in 66 children (65.4%), constant but with variable intensity in 18 (17.8%), and constant with constant intensity in 17 children (16.8%). Children with VKC were >6 times more likely to have corneal astigmatism >2 diopters in their worse eye (odds ratio [OR], 6.31; 95% confidence interval [CI], 3.26-12.26; P<0.001) than controls. Eight affected eyes had astigmatism >4 diopters or irregular astigmatism incompatible with autokeratometry. Although 4 eyes (1.7%) had uncorrected low vision from VKC-induced corneal astigmatism or keratoconus, only 1 child was visually impaired in both eyes. School nonattendance for an ocular reason during the last 3 months was 5 times more likely in children with VKC (n = 44; 36.4%) than among those without (n = 297; 10.2%; OR, 5.04; 95% CI, 3.40-7.47; P < 0.001). Repeating a school year or having ever dropped out of school was not more common among children with VKC than those without. Medical eye care had been sought by 54 (44.6%) children with VKC. This survey of prevalence and treatment of VKC in an African community adds to the argument for better primary eye care, including a safe topical medication. Long-term follow-up of this cohort is required to ascertain the overall risk of sight-threatening complications.

Surgical management of primary open-angle glaucoma in Africans

Trabeculectomy and its various modifications have been the ‘gold standard’ in the management of glaucoma. However, the risk of sight-threatening complications has remained unacceptably high and some have questioned the belief that trabeculectomy is the best form of treatment for glaucoma. In black Africans, there is the additional problem of a higher tendency for trabeculectomy failure. Compliance with medical therapy is poor. Lasers are expensive and not readily available. Nonpenetrating glaucoma surgeries have been reported to be less effective than trabeculectomy but with a better safety profile. However, the skill for these procedures is not yet readily available in Africa. Tube shunt and cyclodestructive procedures are available for refractory or complicated cases. Newer techniques such as canalostomy are being developed. Further research to find a new surgical procedure that is inexpensive, effective, long lasting or permanent, as well as rapid and simple to perform, is required to tackle the problem in sub-Saharan Africa.