Screening For Eye Disease Research Articles

Screening for dry eye disease using infrared ocular thermography.

To evaluate the efficacy of infrared (IR) ocular thermography in screening for dry eye disease (DED). IR ocular thermography was performed on 62 dry eye and 63 age- and sex-matched control subjects. Marking of ocular surface and temperature acquisition was done using a novel 'diamond' demarcation method. 30 static- and 30 dynamic-metrics were studied and receiver operating characteristic curves were plotted. Efficacy of the temperature metrics in detecting DED were evaluated singly and in combination in terms of their area under the curve (AUC), Youden's index and discrimination power (DP). Absolute temperature of the extreme nasal conjunctiva 5s and 10s after eye opening were best detectors for DED. With threshold value for the first metric set at 34.7°C, sensitivity and specificity was 87.1% (95% CI: 76.2-94.3%) and 50.8% (95% CI: 37.9-63.6%) respectively. With threshold value for the second metric set at 34.5°C, sensitivity and specificity was 77.6% (95% CI: 64.7-87.5%) and 61.9% (95% CI: 48.8-73.9%) respectively. The two metrics had moderate accuracy and limited performances with AUC of 72% (95% CI: 63-81%) and 73% (95% CI: 64-82%); Youden index of about 0.4 and DP of 1.07 and 1.05 respectively. None of the dynamic metrics was good detector for DED. Combining metrics was not able to increase the AUC. This work suggests some utility for the application of IR ocular thermography for evaluation of dry eye patients.

Visual Impairment and Blindness in Adults in the United States: Demographic and Geographic Variations From 2015 to 2050.

The number of individuals with visual impairment (VI) and blindness is increasing in the United States and around the globe as a result of shifting demographics and aging populations. Tracking the number and characteristics of individuals with VI and blindness is especially important given the negative effect of these conditions on physical and mental health. To determine the demographic and geographic variations in VI and blindness in adults in the US population in 2015 and to estimate the projected prevalence through 2050. In this population-based, cross-sectional study, data were pooled from adults 40 years and older from 6 major population-based studies on VI and blindness in the United States. Prevalence of VI and blindness were reported by age, sex, race/ethnicity, and per capita prevalence by state using the US Census projections (January 1, 2015, through December 31, 2050). Prevalence of VI and blindness. In 2015, a total of 1.02 million people were blind, and approximately 3.22 million people in the United States had VI (best-corrected visual acuity in the better-seeing eye), whereas up to 8.2 million people had VI due to uncorrected refractive error. By 2050, the numbers of these conditions are projected to double to approximately 2.01 million people with blindness, 6.95 million people with VI, and 16.4 million with VI due to uncorrected refractive error. The highest numbers of these conditions in 2015 were among non-Hispanic white individuals (2.28 million), women (1.84 million), and older adults (1.61 million), and these groups will remain the most affected through 2050. However, African American individuals experience the highest prevalence of visual impairment and blindness. By 2050, the highest prevalence of VI among minorities will shift from African American individuals (15.2% in 2015 to 16.3% in 2050) to Hispanic individuals (9.9% in 2015 to 20.3% in 2050). From 2015 to 2050, the states projected to have the highest per capita prevalence of VI are Florida (2.56% in 2015 to 3.98% in 2050) and Hawaii (2.35% in 2015 and 3.93% in 2050), and the states projected to have the highest projected per capita prevalence of blindness are Mississippi (0.83% in 2015 to 1.25% in 2050) and Louisiana (0.79% in 2015 to 1.20% in 2050). These data suggest that vision screening for refractive error and early eye disease may reduce or prevent a high proportion of individuals from experiencing unnecessary vision loss and blindness, decrease associated costs to the US economy for medical services and lost productivity, and contribute to better quality of life. Targeted education and screening programs for non-Hispanic white women and minorities should become increasingly important because of the projected growth of these populations and their relative contribution to the overall numbers of these conditions.

Advances in retinal imaging for diabetic retinopathy and diabetic macular edema.

Diabetic retinopathy and diabetic macular edema (DME) are leading causes of blindness throughout the world, and cause significant visual morbidity. Ocular imaging has played a significant role in the management of diabetic eye disease, and the advent of advanced imaging modalities will be of great value as our understanding of diabetic eye diseases increase, and the management options become increasingly varied and complex. Color fundus photography has established roles in screening for diabetic eye disease, early detection of progression, and monitoring of treatment response. Fluorescein angiography (FA) detects areas of capillary nonperfusion, as well as leakage from both microaneurysms and neovascularization. Recent advances in retinal imaging modalities complement traditional fundus photography and provide invaluable new information for clinicians. Ultra-widefield imaging, which can be used to produce both color fundus photographs and FAs, now allows unprecedented views of the posterior pole. The pathologies that are detected in the periphery of the retina have the potential to change the grading of disease severity, and may be of prognostic significance to disease progression. Studies have shown that peripheral ischemia may be related to the presence and severity of DME. Optical coherence tomography (OCT) provides structural detail of the retina, and the quantitative and qualitative features are useful in the monitoring of diabetic eye disease. A relatively recent innovation, OCT angiography, produces images of the fine blood vessels at the macula and optic disc, without the need for contrast agents. This paper will review the roles of each of these imaging modalities for diabetic eye disease.

Diabetic retinopathy care in India: An endocrinology perspective.

Diabetes is a disease that affects over 65 million persons in India.[1] Diabetes-related eye disease, of which retinopathy is the most important, affects nearly one out of every ten persons with diabetes, according to point prevalence estimates.[2] However, the prevalence increases with increasing duration of diabetes, and it is common in subjects with high-glucose levels and on more complex regimens. For example, in a study of 17,995 subjects with diabetes from across India, the overall prevalence of retinopathy was about 15%. In subjects on diet control, the prevalence of diabetic retinopathy was 4.4%, on oral drugs, the prevalence was 12.5%, and in subjects on insulin, the prevalence was nearly 27%.[3] Clearly, these results show that increasing duration of diabetes associated with glycemic deterioration requiring increased treatment regimen complexity are all associated with a higher prevalence of retinopathy. Retinopathy assessment is more objective and operator-independent than that of other microvascular complications, and is therefore a better marker for monitoring diabetes-related complications. Retinopathy is duration-dependent, and as endocrinologists succeed in taking care of acute co-morbidities, in an aging diabetic population, the burden of retinopathy is bound to increase. This should be limited by early detection and management of retinopathy aided by prompt referrals and teamwork between the endocrinologists and the ophthalmologists. Therefore, the Indian Journal of Endocrinology and Metabolism (IJEM) has embarked on this special supplement – aimed at documenting the current status of diabetic retinopathy and related health-care management scenario in India. It has been clearly shown that glucose control can reduce the onset and progression of diabetic eye disease. The vast majority of diabetes in the country is treated by general physicians, and training them in the management of diabetes-related complications is the need of the hour. Like diabetic neuropathy and nephropathy, retinopathy too can be detected early. Making a dilated fundus examination by trained ophthalmologists is the norm in referral centers specializing in endocrinology and diabetes. But, what about primary care practitioners with little access to such facilities? Simple handheld ophthalmoscopes can, but do not completely supplement the need for a specialist examination. Technology is coming to help, as there are nonmydriatic fundus cameras which screen for retinopathy in a matter of minutes. Mobile eye clinics with the ability to screen for retinal disease are practicable solutions.[4] Mobile diabetes clinics (different from mobile eye clinics) which carry out screening of eye, foot, and kidney disease, bringing diabetes care to the door step, have been another innovation, as they are diabetes-specific and also screen for complications beyond retinopathy.[5] Finally, the stage is set for the arrival of the smartphone as a tool for retinopathy diagnosis, as technology start-ups are increasingly applying point of care; smartphone-based retinal photography to augment the diagnosis.[6] Retinal therapies, consisting of anti-vascular endothelial growth factor agents such as aflibercept, bevacizumab, or ranibizumab, and surgical approaches are all excellent tools in the hands of ophthalmologists.[7] However, as the average reader of IJEM would ask - How best can an endocrinologist prevent diabetic retinopathy? Well, glucose control is probably the most important factor, and keeping the glycated hemoglobin close to 6.5% without hypoglycemia can help. While a sudden control of blood glucose levels may cause a transient deterioration of retinopathy in the long term, strict glucose control will help eventually reduce complication risk. Individuals with type 2 diabetes and pre-existing retinopathy are more prone to such deterioration after intensive glucose control, when compared to subjects without baseline retinopathy.[8] In landmark diabetes intervention studies such as Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study, in addition to glucose control, the control of hypertension was shown to be quintessential.[9,10] Studies focusing on lipid control have also shown a trend toward a favorable outcome in retinopathy.[11,12] Given that endocrinologists see tertiary-level cases, which are more likely to represent advanced disease, a prompt referral to an ophthalmologist is very important to prevent and treat diabetic retinopathy. This supplement, designed to document the current status of diabetes-related eye care infrastructure in the country, is a valuable resource for physicians, diabetologists, and endocrinologists. In addition to the estimates of the burden of disease in the country, the document also suggests the need for an increased national focus on this cause of avoidable blindness.

An approach to locate optic disc in retinal images with pathological changes

Automatic optic disc (OD) detection is an essential step for screening of eye diseases. An OD localization method is proposed in this paper, which aims to locate OD robustly in retinal image with pathological changes. There are mainly three steps in this approach: region-of-interest (ROI) detection, candidate pixel detection, and confidence score calculation. The features of vessel direction, intensity, OD edges, and size of bright regions were extracted and employed in the proposed OD locating approach. Compared with the OD locating method based on vessel direction only, the proposed method could handle the following cases better: OD partially appears in retinal image, retinal vessels are not obvious in retinal image, or there are bright lesions in retinal images. Four public databases with total 340 retinal images were tested to evaluate the performance of our method. The proposed method can achieve an accuracy of 100%, 95.8%, 99.2%, 97.8% for DRIVE database, STARE database, DIARETDB0 database, DIARETDB1 database respectively. Comparison studies showed that the proposed approach is especially robust in the retinal images with diseases.

Non invasive assessment of the human tear film dynamics

Dry eye disease, or keratoconjunctivitis sicca, is a multifactorial syndrome with altered tear film homeostasis leading to ocular irritations. These alterations cause discomfort and stress for the patient, but only a few objective parameters allow for proper differential diagnosis into different subtypes of this condition. The mostly invasively performed standard assessment procedures for tear film diagnosis are manifold, but often correlate quite poorly with the subjectively reported symptoms. Due to the inherent limitations, e.g. the subjectivity of the commonly performed invasive tests, a number of devices have been developed to assess the human tear film non-invasively. Since the production, delivery, distribution and drainage of the tear film is a dynamic process, we have focused our review on non-invasive methods which are capable of continuous or repetitive observations of the tear film during an inter-blink interval. These dynamic methods include (1) Interferometry, (2) Pattern Projection, (3) Aberrometry, (4) Thermography; and (5) Evaporimetry. These techniques are discussed with respect to their diagnostic value, both for screening and differential diagnostic of Dry Eye Disease. Many of the parameters obtained from these tests have been shown to have the potential to reliably discriminate patients from healthy subjects, especially when the tests are performed automatically and objectively. The differentiation into subtypes based solely on a single, dynamic parameter may not be feasible, but the combination of non-invasively performed procedures may provide good discrimination results.

Effective Segmentation of Optic Disc in Retinal images for diagnosing Eye Diseases that leads to Blindness

Human Eye is one of the most sophisticated organ, with cornea ,retinal pigment epithelium, bruch membrane, macula, vitreous body, retina and optic nerve. Retinal image analysis is broadly used for screening the patients affected from sight threatening eye diseases like Diabetic Retinopathy (DR) and glaucoma. Optic disc (OD) margin is the mandatory landmark in establishing a frame of reference of classifying retinal and optic nerve pathology. Trustworthy and efficient OD localization and segmentation are important tasks in automatic eye disease screening. This paper presents a fully automated method for OD segmentation algorithm developed for retinal disease screening. First, preprocessing step used to remove noise by illumination correction and contrast enhancement. Second, a thresholding technique using Atanassov’s intuitionistic fuzzy set (A-IFS) is employed. This approach uses A-IFS histon, an encrustation of the histogram consist of the pixels that belong to the set of similar pixels, in roughness index A-IFS histon & histogram correlated to upper and lower approximations and optimum threshold value is identified which pixel belong to background or to object(OD). This approach is evaluated by means of three publicly available databases DRIVE, MESSIDOR, DIARETDB0, the experimental outcome shows that the overall performance is with 99% correct optic disc localization.

Predictive Value of Screening Tests for Visually Significant Eye Disease

To determine the predictive value of ophthalmic screening tests with visually significant eye disease in a cohort of American Indian/Alaskan Natives from the Pacific Northwest. Validity assessment of a possible screening protocol. Ophthalmic technicians performed a screening examination including medical and ocular history, best-corrected visual acuity, limbal anterior chamber depth assessment, frequency-doubling technology perimetry (FDT, C-20-5), confocal scanning laser ophthalmoscopy, nonmydriatic digital photography, and tonometry on 429 participants. An ophthalmologist performed a comprehensive eye examination on subjects with 1 or more abnormal screening tests and a random selection of those with normal screening tests. We used univariate and multivariate logistic regression to determine the association between abnormal screening test results and visually significant eye disease. We also determined the predictive value of screening tests with ocular disease. Univariate analysis identified history of eye disease or diabetes mellitus (P < .001), visual acuity <20/40 (P < .001), abnormal/poor-quality confocal scanning laser ophthalmoscopy (P < .001), abnormal FDT (P < .001), and abnormal/poor-quality nonmydriatic imaging (P < .001) as associated with visually significant eye disease. A multivariate analysis found visually significant eye disease to be associated (P < .001; receiver operating characteristic curve area= 0.827, negative predictive value= 84%) with 4 screening tests: visual acuity <20/40, abnormal/poor-quality nonmydriatic imaging, abnormal FDT, and abnormal/poor-quality confocal scanning laser ophthalmoscopy. Ophthalmic technicians performing a subset of screening tests may provide an accurate and efficient means of screening for eye disease in an American Indian/Alaskan Native population. Confirmation of these results in other populations, particularly those with a different profile of disease prevalence, is needed.

Screening of dry eye disease in visual display terminal workers during occupational health examinations: The Moriguchi study.

The aim of this study was to estimate the prevalence of dry eye disease (DED) in Japanese visual display terminal (VDT) workers and identify simple methods for screening DED during occupational health examinations. This study involved 369 (331 men and 38 women; mean age, 44.4 [8.8] years) workers engaged in PC development with approximately 6 hours of VDT use daily. The participants completed questionnaires on dry eye and physical symptoms affecting QoL, and their ability to keep their eyes open for 10 seconds was tested for DED screening. They also underwent assessment of conjunctival and corneal vital staining with lissamine green and fluorescein, measurement of tear film breakup time, and Schirmer's test for DED diagnosis. Sensitivity, specificity, and positive predictive value of the screening methods were assessed. The DED group included 218 (definite, 14; probable, 204) participants. They had markedly high frequencies of 11 dry eye symptoms, especially ocular fatigue (OR, 17.1; 95% CI, 9.9 to 29.7) and dry sensation (OR, 8.2; 95% CI, 3.6 to 18.4), and were more often unable to keep their eyes open for 10 s. With either ocular fatigue or dry sensation as the cutoff criterion, the sensitivity, specificity, and positive predictive value were 89.9, 66.9, and 79.7%, respectively. Approximately 60% of the VDT workers were diagnosed with DED on the basis of diverse eye symptoms affecting their ability to work. The dry eye symptom questionnaire and 10-s eye-opening test are simple, noninvasive, and inexpensive methods for screening DED during occupational health examinations.

Monitoring of patients on long-term glucocorticoid therapy: a population-based cohort study.

About 1% of the general population receives long-term systemic glucocorticoids. The monitoring provided to these patients is unknown. We conducted a population-based cohort study using The Health Improvement Network database. A total of 100,944 adult patients prescribed systemic glucocorticoids for >3 months between January 2000 and December 2012 were studied. The monitoring done before prescribing glucocorticoid therapy and during exposure to the drug was examined. This included measurement of body weight, blood pressure, lipids, glucose and potassium levels, referrals for dual-energy X-ray absorptiometry (DEXA-scan) or to an ophthalmologist/optician, and vaccinations. We assessed factors associated with the odds of being monitored before and during exposure. Before glucocorticoid initiation, weight and blood pressure were monitored in < 20% and < 50% of patients, respectively. Glucose and lipid levels were monitored in less than one-third of the patients, while DEXA-scan and eye monitoring were offered to <15% of them. Vaccination against flu and pneumococcus was given to 57% and 46% of the patients, respectively. During exposure to the drug, <60% of patients who were prescribed the drug for more than a year had their weight, glucose, or lipid levels recorded at least once and <25% of patients were referred at least once for DEXA-scan or screening for eye diseases. Overall, the odds of being monitored were higher in older patients and in those with comorbidities. There were variations in the level of monitoring provided across the UK, but the monitoring has improved over the last 12 years. Although the extent of monitoring of people on long-term glucocorticoids has improved over time, the overall monitoring provided is not satisfactory, particularly in young patients and those without comorbidities.

A Field Test of Web-Based Screening for Dry Eye Disease to Enhance Awareness of Eye Problems Among General Internet Users: A Latent Strategy to Promote Health

BackgroundA Web-based self-check system including a brief questionnaire would seem to be a suitable tool for rapid disease screening.ObjectiveThe purpose of this preliminary study was to test a Web-based self-screening questionnaire for drawing attention to dry eye disease among general Internet users and identifying those with a higher risk of developing the condition.MethodsA survey website was launched and used to recruit participants from general Internet users. In the first phase, volunteers were asked to complete a Web-based self-screening questionnaire containing 12 questions on dry eye symptoms. The second phase focused on the respondents who reported five or more dry eye symptoms and expressed their intention to seek medical attention. These participants performed the Schirmer test, for evaluating tear production, and completed a paper-based lifestyle questionnaire to provide relevant background data.ResultsOf the 1689 visitors to the website, 980 (58.0%) volunteers completed the Web-based self-screening questionnaire. Among these, 355 (36.2%) respondents reported five or more dry eye symptoms. Then, 99 (27.9%) of the symptomatic participants performed the Schirmer test and completed the paper-based lifestyle questionnaire. Out of these, 32 (32.2%) had abnormal tear production (≤5 mm).ConclusionsThe proposed Web-based self-screening questionnaire seems to be a promising tool for raising awareness of dry eye disease among general Internet users and identifying those with a higher risk of developing the condition, although further research is needed to validate its effectiveness.

Screening for eye disease: Our role, responsibility and opportunity of research

Optometry is a healthcare profession that is concerned with eyes and related structures, vision, and visual system. Optometrists are health professionals who are qualified to detect and measure eye refractive disorders, to treat such disorders by prescribing, supplying and fitting adequate optical aids, to evaluate and characterize vision-related physiologic attributes and functions, to provide advice on eye care and eye health, but also to detect and perform screening for eye disease.1 Optometrists are trained to act as effective screening agents for all types of ocular pathological conditions,2 since glaucoma3,4 to retinal disorders, such as age-related macular degeneration (AMD)5 or diabetic retinopathy.6,7 An effective referral8,9 is the final aim of our screening activity, but without ignoring or refusing our duties and responsibilities as health professionals. Optometric professional responsibility encompasses the duties to act in a professional manner, obey the law, avoid conflicts of interest, and put the interests of our patients ahead of our own interests. Eye disease screening and referral is also part of this professional responsibility and we cannot delegate it without a justification in the benefit of patient. There are even optometrists in some countries that are qualified to prescribe therapeutic drugs to treat some of the eye disease conditions that they are able to detect.10 Therefore, we should not forget this screening role and we must try to have a continuous training in this area during all our professional life. Optometrists have also the opportunity of contributing to the research in eye disease, allowing showing our great potential and commitment with the development of Optometry in all its branches. Indeed, the number of scientific articles by optometrists on the study of different ocular pathological conditions, especially on how to make more effective their detection, has increased significantly in the last years. In the current issue of Journal of Optometry, we compile different scientific articles providing new insights into optometric eye disease screening field as well as defining new clinical methodologies and strategies for an effective referral and eye disease optometric management. A review of the current concept of epidemic keratoconjunctivitis management,11 a description of the clinical evidence of the central areolar choroidal dystrophy with associated dominant drusen,12 and the description of a new method for evaluating optic nerve head drusen with fundus photography13 and a new procedure based on background chromatic contrast preference with potential diagnostic use for AMD14 are included in this issue. This is an additional contribution to the research on eye disease screening. These types of contributions are necessary for improving and optimizing the optometrist's clinical practice and eye disease screening role. Educational programmes on eye disease and detection as well as research on this area are crucial to continue with our role of screening agents, to be committed with our professional responsibility, to be considered as active health professionals; it is simply indispensable to practice the optometry.

Fast Localization and Segmentation of Optic Disk in Retinal Images Using Directional Matched Filtering and Level Sets

The optic disk (OD) center and margin are typically requisite landmarks in establishing a frame of reference for classifying retinal and optic nerve pathology. Reliable and efficient OD localization and segmentation are important tasks in automatic eye disease screening. This paper presents a new, fast, and fully automatic OD localization and segmentation algorithm developed for retinal disease screening. First, OD location candidates are identified using template matching. The template is designed to adapt to different image resolutions. Then, vessel characteristics (patterns) on the OD are used to determine OD location. Initialized by the detected OD center and estimated OD radius, a fast, hybrid level-set model, which combines region and local gradient information, is applied to the segmentation of the disk boundary. Morphological filtering is used to remove blood vessels and bright regions other than the OD that affect segmentation in the peripapillary region. Optimization of the model parameters and their effect on the model performance are considered. Evaluation was based on 1200 images from the publicly available MESSIDOR database. The OD location methodology succeeded in 1189 out of 1200 images (99% success). The average mean absolute distance between the segmented boundary and the reference standard is 10% of the estimated OD radius for all image sizes. Its efficiency, robustness, and accuracy make the OD localization and segmentation scheme described herein suitable for automatic retinal disease screening in a variety of clinical settings.

Survey of ophthalmic abnormalities in the labradoodle in the UK

One-hundred and seventy-five labradoodles underwent slit-lamp biomicroscopy and direct and indirect ophthalmoscopy between January 2008 and December 2009. These examinations were performed at shows by the first author. In addition,...

Novel use of trypan blue in ocular surface staining: redefining implications for this vital dye

Diferentes aplicações do azul de tripano (AT) foram descritas para cirurgia intraocular, com elevados patamares de eficácia e segurança. Neste relato, é descrito a aplicação do AT como corante vital para superfíce ocular, de modo a estudar a integridade das células da superfície corneana e conjuntival na superfície ocular. Tal abordagem permite um diagnóstico mais sensível de desordens da superfície ocular, destacando-se disfunção lacrimal ou síndrome do olho seco. O AT tem propriedades distintas da fluoresceína, com a qual se [...]

Binocular Optical Coherence Tomography

The use of optical coherence tomography (OCT) in the field of ophthalmology has increased rapidly in recent years and may continue on this trajectory as more indications for OCT imaging are described. Recent pressures on the healthcare system, such as rising costs, increasing demand, and decreasing reimbursements, suggest that continued growth in OCT use may be unsustainable unless cheaper and more efficient methods are developed. Binocular OCT has the potential to decrease the cost, increase the quality, and improve the efficiency not just of OCT imaging, but of eye care as a whole. Binocular OCT devices should be cheaper to build and operate than conventional OCT instruments. They may be able to replace labor-intensive, qualitative tests with patient-operated, quantitative examinations. They could also usher in a new era of comprehensive, remote eye care and eye disease screening that has the potential to reengineer the practice of ophthalmology.

Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: The Bhaktapur Glaucoma Study

BackgroundCataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal.MethodsSubjects aged 40 years and above was selected using a cluster sampling methodology and a door to door enumeration was conducted for a population based cross sectional study. During the community field work, 11499 subjects underwent a structured interview regarding awareness (heard of) and knowledge (understanding of the disease) of cataract and glaucoma. At the base hospital 4003 out of 4800 (83.39%) subjects underwent a detailed ocular examination including log MAR visual acuity, refraction, applanation tonometry, cataract grading (LOCSΙΙ), retinal examination and SITA standard perimetry when indicated.ResultsThe age-sex adjusted prevalence of blindness (best corrected <3/60) and low vision (best corrected <6/18 ≥3/60) was 0.43% (95%C.I. 0.25 - 0.68) and 3.97% (95% C.I. 3.40 - 4.60) respectively. Cataract (53.3%) was the principal cause of blindness. The leading causes of low vision were cataract (60.8%) followed by refractive error (12%). The cataract surgical coverage was 90.36% and was higher in the younger age group, females and illiterate subjects. Pseudophakia was seen in 94%. Awareness of cataract (6.7%) and glaucoma (2.4%) was very low. Among subjects who were aware, 70.4% had knowledge of cataract and 45.5% of glaucoma. Cataract was commonly known to be a 'pearl like dot' white opacity in the eye while glaucoma was known to cause blindness. Awareness remained unchanged in different age groups for cataract while for glaucoma there was an increase in awareness with age. Women were significantly less aware (odds ratio (OR): 0.63; 95%, confidence interval (CI): 0.54 - 0.74) for cataract and (OR: 0.64; 95% CI: 0.50 - 0.81) for glaucoma. Literacy was also correlated with awareness.ConclusionThe low prevalence of visual impairment and the high cataract surgical coverage suggests that cataract intervention programs have been successful in Bhaktapur. Awareness and knowledge of cataract and glaucoma was very poor among this population. Eye care programs needs to be directed towards preventing visual impairment from refractive errors, screening for incurable chronic eye diseases and promoting health education in order to raise awareness on cataract and glaucoma among this population.

Screening for eye disease in the elderly: is it worth it?

Should we be screening for eye disorders in the elderly population? Visual impairment in the elderly can be associated with reduced functional status and quality of life, low social contact, depression, and falls and hip fractures (Dargent-Molina et al, 1996). It therefore would seem sensible to identify those elderly patients who have or are at risk of developing sight-threatening eye disorders, and offer them treatment. However, screening for disease of any kind raises a number of issues.

Image-quality standardization for diabetic retinopathy screening

Screening for diabetic eye disease in the UK relies on the correct interpretation of a digital retinal image to identify pathological features in the retina. The lesions that mark the early stages of disease are small, and a number of nonharmful features of similar appearance may confound detection. Early recognition of pathology and prompt treatment can preserve sight. It is, therefore, essential that each component of the digital imaging system is of a sufficient standard to maximize the probability of early detection. The imaging pathway between the patient’s eye and a final diagnostic outcome is discussed in this article, with reference to appropriate national standards for equipment and processes.

A pilot study of ocular diseases screening for neonates in China

To explore the clinical strategies for the screening of newborn eye diseases and obtain information concerning the incidence of newborn ocular diseases. Newborns in a baby-friendly nursery were evaluated for mass screening of eye diseases 2 to 7 days after birth (including reaction to light stimulation, external ocular examination and test for pupil red reflex) and those with abnormalities were subjected to diagnostic examination (external ocular examination with a hand-held slit-lamp, pupil red reflex and mydriatic examination). Newborns in neonatal intensive care unit (NICU) were subjected to screening 5 to 14 days after birth and then, together with those with high risk factors, received a comprehensive examination for screening and diagnostic purposes. The suspected cases were referred to department of ophthalmology for definite diagnosis. Among the 15,398 (91.65%) newborns who were enrolled the screening program, 12 different eye diseases (involving 1266 cases) were detected, with a prevalence of 8.22%. Of these eye diseases, 7 were congenital ocular diseases, involving 809 cases (5. 254%) and including congenital ptosis in 2 cases (0.013%), congenital corneal opacity in 6 cases (0.039%), persistent pupillary membrane in 724 cases (4.702%), congenital cataract in 15 cases (0.097%), persistent hyaloid artery in 54 cases (0.351%), obstruction of nasolacrimal duct in 7 cases (0.046%) and lacrimal gland prolapse in 1 cases (0.007%). Five different diseases (457 cases, 2. 968%) detected were acquired in nature, including neonatal conjunctivitis in 391 case (2.539%), vitreous hemorrhage in 6 cases (0.039%), retinal hemorrhage in 34 cases (0.221%), and neonatal dacryocystitis in 23 cases (0.149%). Of 27 premature babies with body weight lower than 1500 g, 3 had retinopathy of prematurity (ROP, 6 eyes involved). Early intervention is of great importance for the prevention and treatment of neonatal ocular diseases. The screening of newborn ocular diseases is not only feasible but also effective in the monitoring and control of the eye diseases in neonates.