Aging and Age Related Ocular Diseases (Ophthalmologica, 1)

Impact of Visual Impairment and Eye diseases on Mortality: the Singapore Malay Eye Study (SiMES)
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Although larger and confluent drusen are visible in the color image circle , the number and extent of drusen distribution is appreciated even more clearly in the angiogram. The hyperfluorescent drusen observed in the angiogram are of uniform size and often referred to as cuticular drusen. Smaller drusen are present in the foveal region asterisk. The natural history of dry AMD is progressive, with gradual loss of visual function that may span over many years time. Many patients with dry AMD are asymptomatic and unaware of the disease.

The margins of the regions of RPE atrophy are clearly delineated arrowheads. A choroidal nevus asterisk is indicated in eye a. These eyes would be expected to have poor central vision due to the extensive atrophy. Left untreated, the natural history of wet AMD advances further to a cicatrical stage referred to as a disciform scar. This process usually takes place over several months and typically results in a mm diameter fibrotic scar underlying the macula accompanied by a central scotoma with severe central vision loss in one eye Fig.

Thus, the risk of bilateral loss of central vision is high in those with the neovascular form of the disease Neovascularization associated with PEDs can be difficult to visualize clinically or image using fluorescein angiography; therefore, it is difficult to treat Figure 8 shows a color fundus picture a and an early b and late fluorescein angiogram c from an individual with a classic choroidal neovascularization CNV.

Subretinal blood and fluid arrowhead depicts edge is clearly visible within the macular region in a. The blood vessels have a lacey appearance asterisk in the early angiogram. Marked leakage of fluorescein asterisk , with indistinct edges of hyperfluorescence white area is clearly visible in the late angiogram.

Arrowhead depicts edge of macular lesion. Note the lacey appearance of vessels asterisk in the early angiogram. Figure 9 shows a similar set of fundus pictures from an individual with occult choroidal neovascularization. A single, small punctate region of hemorrhage arrow and a ring of exudates arrowhead depicts edge appear more pronounced than typically occur in classic CNV.

This patients had a minimal hyperfluorescence in the early phase of the angiogram, in contrast to that observed in the early stage of classic CNV. Speckled macular hyperfluorescence is visible in the late stage angiogram Fig. A single, small punctate region of hemorrhage asterisk and a ring of exudates arrowhead depicts edge occur. In the case shown in Figure10, the individual had a macular pigment epithelial detachment PED. A multilobulated, hyperfluorescent lesion with sharply demarcated borders arrow is clearly visible in the late stage angiogram of Figure 10a, arrow.

A multilobulated, hyperfluorescent lesion with sharply demarcated borders arrow is clearly visible in a The blister-like elevation of the retina and retinal pigment epithelial layer, which correlates with the PED shown a, is appreciated in the OCT view b. The end stage of such lesions of the macula as shown in the three previous patients is illustrated by the last patient Fig. The color fundus photograph shows that the patient has end stage cicatricial exudative AMD. A large disciform scar arrowhead covers the whole macular region. Such a patient would be almost totally blind in that eye. A large disciform scar arrowhead covering the macular region is distinctly visible.

Until quite recently, the majority of research on AMD and the development of therapeutics for the disease has focused upon late-stage neovascular events. No clear-cut sequence for the initiation and progression of AMD has been identified that would allow it to be monitored and treated in its earliest stages.

Moreover, the pathologic correlates of the different clinical phenotypes of AMD remain poorly understood, and there is a paucity of animal models that accurately mimic the characteristic features of the disease. Nevertheless, recent discoveries are beginning to provide a much clearer picture of the relevant cellular events, genetic factors, and biochemical processes that are associated with early AMD. This new information should hasten significantly the development of clinically effective diagnostics and therapeutics for the treatment of this devastating condition.

From a histopathologic standpoint, the earliest detectable changes associated with AMD occur at the interface between the macular retina and the underlying layer of connective tissue and blood vessels known as the choroid A section shows the normal anatomical relationships of the macular choroid CH with blood vessels BV , retinal pigment epithelium RPE and neural retina R ; the section passes directly through the fovea.

Drusen look like yellow-white spots in the retina Figures Elastin fiber destruction in the macula could also play a key role in the initiation of neovascular events because elastin degradation peptides are highly angiogenic and possess macrophage recruiting activity , These are identified based upon their morphological appearance and location. Both types of deposits have been proposed by various investigators to be involved in the pathogenesis of AMD Neutral lipid including esterified cholesterol and apolipoproteins B and E are abundant in these basal deposits and in drusen in the eyes of aged donors and donors with a documented history of AMD 88, 94, New choroidal blood vessels are located in both the sub-RPE and subretinal spaces arrows.

However, there is a strong relationship between macular BLamD and exudative AMD, disciform scarring, and visual loss 74, 84, BLamD-like deposits are also seen in other macular disorders with a clinical appearance similar to what is observed in AMD. The molecular composition and origin of BLamD has not yet been identified , but its morphological similarity to long-spacing collagen is striking. Electron microscopy has revealed that its banding pattern matches that of type VI collagen Figures 18 and 19 indicate a normal retinal choroidal interface Fig. The principal component of BLinD is a distinct form of membranous debris, thought to be comprised primarily of lipoprotein particles containing neutral lipids, including esterified cholesterol.

It is likely that BLinD is derived from local ocular sources e. RPE cells BLinD were initially described by Sarks and colleagues as lipid-like vesicles with varying diameters. It is believed that the pigmentary changes often observed in the macula of AMD eyes are attributable to degenerative changes in the highly melanized RPE cells Fig.

This notion has gained wide acceptance because most of the early clinical signs and histopathological changes have been localized to this cell layer It has long been recognized that the RPE is essential for the transport of ions, nutrients, and metabolites from the circulation to the neural retina and vice versa A viable RPE is also essential for normal photoreceptor cell metabolism and functioning of the visual cycle. Therefore, it is not surprising that RPE degeneration is accompanied by concomitant photoreceptor degeneration.

However, the nature of the insult s that causes RPE dysfunction has yet to be ascertained, although a variety of hypotheses have been advanced over the years including genetic factors, ischemia, oxidative stress, phagocytic overload, cigarette smoke, lipofuscin toxicity and, most recently, microbial infection The choriocapillaris has also been suspected to play a role in the etiology of AMD.

The density and diameters of the choriocapillaris capillaries decreases with age, and this decrease is even greater in patients with AMD. The overall loss appears most marked in regions of geographic atrophy , There is substantial evidence of photoreceptor involvement in early AMD, particularly in those patients with soft or large drusen in the macula Contrast sensitivity, the rate of recovery after photostress, the amplitude and latency of the foveal electroretinogram ERG response, and dark adaptation are all affected adversely in early AMD patients, including those with normal visual acuity , The responses of the fovea are reduced in amplitude.

In the 3-D map Fig. There are also drusen-associated reductions in photoreceptor cell densities, thus suggesting that degenerative changes in photoreceptors ultimately lead to cell death , Recent studies of the molecular composition of drusen have implicated local inflammation as a key element in the pathogenesis of AMD Drusen contain numerous proteins related to the process of inflammation or its aftermath , In particular, many of these proteins are associated with the complement cascade and its regulation.

Some of the proteinaceous components in drusen and the sub-RPE space are activated complement components and fragments associated with assembly of the membrane attack complex MAC , Other drusen components including vitronectin , clusterin, complement receptor 1 CR1 , and membrane cofactor protein MCP-1 are known complement regulatory proteins. Still others include known activators of the complement cascade such as cholesterol , C-reactive protein , and the amyloidogenic peptide amyloid b , Metallic zinc, an amyloid b binding molecule, is also a drusen constituent This continuous background level of activation is amplified rapidly by ubiquitous components present on the surfaces of many bacteria, viruses, as well as constituents present in cigarette smoke.

Although the liver is responsible for most circulating Factor H, the eye is also capable of producing it, in addition to other complement components. Not surprisingly, Factor H protein is also a molecular constituent of drusen It co-localizes with its ligand C3b a complement pathway component in substructural spherules within drusen that contain amyloid b, further implicating these structures as candidate complement activators , Finally, Factor H and C5b-9 MAC immunolabeling are more intense in the macula compared to tissues from more peripheral areas in the same eye Hageman and Mullins, unpublished.

We have advanced a working model of AMD pathobiology based upon our studies , and the work of others , Complement attack, in turn, induces significant bystander damage to macular cells and tissues, thus rendering them susceptible to additional RPE atrophy, photoreceptor degeneration, and CNV. The reader, who is interested, can see diagrams showing the way the complement cascade works, in a paper by Ricklin and Lambris, AMD is often regarded as a group of complex, late onset diseases caused by the convergence of multiple risk factors , Family history is a consistent risk factor according to most epidemiological studies of AMD conducted to date.

Twin studies also support a genetic basis for the disease, with the concordance of clinical features drusen and pigmentary changes for both early and late onset disease being approximately twice as high in monozygotic identical twins compared to dizygotic non-identical twins , Genome-wide linkage analyses of extended families with AMD have identified a number of chromosomal loci that are linked to AMD The most consistent occurs at chromosome 1q31 A number of other candidate genes have also been linked to AMD.

However, most of these results have not yet been replicated in subsequent studies. In contrast, the e4 allele of the apolipoprotein E APOE gene has consistently been shown to be protective for AMD , whereas the e2 allele appears to influence progression and to result in an earlier age of onset In early , four groups reported independently that common variants [single nucleotide polymorphisms SNPs ] in the gene encoding complement Factor H CFH confer major susceptibility to, or protection from, AMD , Individuals who possess a single copy of the risk-conferring CFH haplotype have fold higher lifetime risk of developing AMD, and those with two copies possess a fold higher lifetime risk.

Follow-up reports have since confirmed these findings in additional cohorts in the United States , , Iceland , the United Kingdom , and France Interestingly, the major CFH risk haplotype in the Japanese population appears to be different than that reported in other populations, although the protective haplotype is the same In early , a study showed that allelic variants in two other complement-related genes, Factor B BF and complement component C2, were linked to AMD These are paralogous genes located bp apart on chromosome 6p21, and both reside in the major histocompatibility complex MHC class III region.

BF is a component of the alternative pathway of complement, whereas C2 is a component of the classical pathway. In addition to the 1q31 locus, a region on chromosome 10q26 has been identified in several recent studies of AMD on a scale similar to that of the CFH TyrHis variant. A third study identified a coding change in the LOC gene as the significant allele that results in a non-synonymous substitution of alanine to serine at position 69 of the hypothetical protein.

In addition, a significant statistical relationship between the LOC variant and a history of cigarette smoking has been found Thus far, there is no published evidence for expression of the LOC gene product at either the RNA or protein levels; nor is there any indication of its likely functional properties. The molecular pathogenesis of AMD has only recently begun to be elucidated.

So, it is not surprising that the therapeutic approaches for AMD have been of only limited benefit to most patients. This due to the long study duration and large numbers of participants needed to achieve meaningful statistical results. Over the last 30 years epidemiological studies have repeatedly identified four risk factors for AMD: age, cigarette smoking, increased body mass index, and inheritance 10, 31, These same studies have produced conflicting information regarding the roles of dietary antioxidant supplementation and fat intake.

The study tried to determine whether antioxidant therapy prevented vision loss, slowed the progression of dry AMD, or prevented conversion from dry to wet AMD. The results of 6. The study results demonstrated that daily antioxidant therapy in the form of 15 mg beta carotene, mg vitamin C, 50 mg vitamin E, 80 mg zinc as zinc oxide , and 2mg copper as cupric oxide daily was superior to a placebo in delaying progression of advanced dry AMD, and in slowing conversion from dry to wet AMD. Specifically, the odds ratio of progression to advanced AMD was decreased to 0.

No benefit of antioxidant supplementation was demonstrated in the milder forms of AMD. However, because the early stages of AMD often persist for many years, it is quite possible that the study design was not long enough to demonstrate a benefit to patients with milder stages of AMD. Another therapeutic intervention is laser therapy for eyes with drusen. Therefore grid laser of eyes with drusen is not recommended if the fellow eye has CNV 36, Recent results of the PTAMD bilateral drusen study reported no decrease in CNV development but a four-letter gain in visual acuity in treated versus control eyes after three years of follow-up The larger CAPT study of treatment of one eye in the setting of bilateral drusen is ongoing but near completion of five years of follow-up.

Until the results of the CAPT study are known, prophylactic laser of eyes with bilateral drusen is not a recommended therapy. However, visual loss was common even in those eyes with successful obliteration of CNV Additionally, the closer the CNV was to the fovea, the poorer the visual outcome and the higher the rate of recurrence even in those who initially responded to treatment Vitrectomy surgery with evacuation of subretinal blood and neovascular membranes reported variable success rates.

Trial designs were nonstandard, results were conflicting, and long-term follow-up in these pilot trials was lacking. Given the potential morbidity and expense of major eye surgery, the National Eye Institute sponsored the prospective, randomized, controlled Submacular Surgery Trials SST. The results of the trial demonstrated that surgery did not increase the chance of stable or improved vision, and it prevented severe vision loss only in those eyes with large subretinal hemorrhages.

Submacular surgery was also associated with some risk of rhegmatogenous retinal detachment. Given these results, and the advent of less-invasive therapy with anti VEGF agents described below submacular surgery is no longer recommended for exudative AMD except, perhaps, in select cases with large submacular hemorrhage 45, Other surgical approaches, which have been investigated in small pilot trials, are macular translocation Machemer and Steinhorst, 47 , and limited macular translocation developed later by deJuan The former technique involves creation of a total retinal detachment, while the latter is limited to a partial retinal detachment.

Both techniques involve displacement of the macular retina from an area of CNV to a location where the retinal pigment epithelium is thought to be healthier. While pilot trials have suggested a benefit from these therapies for a small subset of patients, the emergence of less invasive and more broadly applicable pharmacological therapies for exudative AMD have resulted in much less frequent application of macular translocation in recent years.

Color photo 4 months after macular translocation and subsequent laser of CNVM. In the TAP study, subfoveal CNV was divided into subgroups based on initial visual acuity, lesion size, and fluorescein leakage characteristics: enrolled subjects were randomized to Visudyne tm or placebo Activated Visudyne tm generates singlet oxygen that damages the CNV endothelium resulting in thrombosis In the TAP study an average of 3.

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Over the course of the next several years, subgroup analysis of data from the TAP studies as well as additional trials with Visudyne tm treatment for lesions other than predominately classic CNV led to its application for other lesion types. However, the visual results for lesions that were predominantly occult CNV were less favorable than those with predominately classic CNV 51, As noted above, however, not all eyes fare well with PDT therapy.

Below is a photograph of an eye that did not demonstrate a significant benefit from PDT treatment with Visudyne. Similarly, low dose radiation therapy for AMD was investigated in multiple small pilot trials with conflicting results Although no definitive prospective clinical trial of radiation therapy for AMD has ever been conducted, the concept has become less popular in recent years, especially in light of the interest in pharmacological therapies for AMD.

The current era of therapy for exudative AMD utilizes administration of anti-neovascular agents periocularly or intraocularly. Macugen is administered by intravitreal injection i. The fragment blocks VEGF binding to its receptor on endothelial cells, thus inhibiting its biological activity. Another recently published trial comparing Lucentis alone to PDT alone demonstrated superior visual results with Lucentis. Although the initial trials with Lucentis utilized monthly intravitreal injection with the drug, more recent studies indicate that some patients my respond favorably to a treatment regimen utilizing fewer than 24 injections over a 2 year period Fung et al.

Currently, studies are underway to determine factors which might influence frequency and duration of treatment with Lucentis. It is important to note that Avastin tm has not yet undergone the toxicity studies and controlled trials that are required by the FDA for ocular application 58, Other anti-angiogenic therapies currently under study include anecortave acetate Retane, an antiangiogenic steroid 60, 61 , squalene and triamcinolone which carries a significant risk of causing cataract and steroid-induced glaucoma. Additional studies are underway to investigate the potential for a combination of Anti-VEGF therapy with Visudyne tm photodynamic therapy utilizing light doses lower than those applied in the TAP an VIP studies with Visudyne 62, 63, As a result of the anti-VEGF treatment much improvement can be seen in the macular area along with good visual restoration.

The OCT scans Fig. One concern with all anti-angiogenic agents is their potential for systemic inhibition of VEGF that may produce cardiovascular or cerebrovascular complications, or inhibit wound healing. Additional drawbacks to the intravitreally administered therapeutics include patient discomfort, intraocular infection endophthalmitis , retinal tear or detachment, and lens damage in phakic patients The incidence of endophthalmitis in published trials with Macugen and Lucentis were 0. Some patients do quite well with topical anesthetic alone while others require subconjunctival anesthetic injection ,,, Recent discoveries of the role that inflammation plays in AMD pathogenesis see above has led to an interest in investigating the anti-inflammatory effects of statins on AMD.

Several clinical population-based studies of the effects of statins on AMD development and progression have yielded conflicting results Thus, more studies in this area will be required to assess efficacy. In the near future, therapy for exudative AMD will likely involve multiple anti-neovascular agents, possibly coupled with less frequent application of photodynamic therapy, in order to maximize the beneficial effects of each and minimize the frequency of adverse side effects. Further on the horizon are anti-angiogenic agents in longer acting forms that require less frequent administration.

Complement Factor H is the first gene identified in multiple independent studies that confers a significant risk for the development of AMD. This finding, together with the subsequent identification of AMD-associated variants in the related complement genes BF and C2, provide compelling evidence that the innate immune system and, more specifically, uncontrolled regulation of the alternative pathway of complement, plays a central role in the pathobiology of AMD.

At this point, the most likely scenario is that exposure to infection or some other triggering event in genetically susceptible individuals, coupled with impaired complement regulatory function leads to the sustained activation of complement cascade, drusen formation and, eventually, development of AMD. The emergence of this new paradigm of AMD pathogenesis sets the stage for the rapid development of early diagnostics, novel bioassays, and new animal models that faithfully mimic aspects of the disease process.

Now that the genetic basis for a major proportion of AMD cases has been elucidated, what additional scientific progress may be anticipated, and what will be the significance of these new findings for the diagnosis and treatment of AMD? In the near term, a more comprehensive understanding of the genetic basis of AMD should rapidly emerge. It will not be surprising, for example, if genetic polymorphisms in additional complement components, complement regulators and, possibly, immune system effectors and inflammatory mediators are implicated in AMD. Secondly, it may be anticipated that the gene variants linked to AMD also contribute to other prevalent age-related diseases where chronic, local inflammatory processes are involved.

Based upon this new genetic information, it will be possible to devise genetic screening tests that will identify those individuals who are most at risk of developing AMD later in life. This will enable clinicians to monitor susceptible individuals from an early age, and to develop and test new preventive treatments in the early stages of the disease. Finally, the development of new diagnostic and pharmacological approaches will be hastened by the identification of the alternative pathway of complement as a prime therapeutic target.

As our understanding of the pathogenesis of AMD continues to improve, so does the prospects for new diagnostic and therapeutic approaches. Hopefully, we will eventually eradicate AMD and dramatically improve the quality of life in our older generation. J Gen Intern Med. Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women.

J Am Geriatr Soc. Effect of depression on vision function in age-related macular degeneration. Arch Ophthalmol. Abyad A. In-office screening for age-related hearing and vision loss. Berman K, Brodaty H. Psychosocial effects of age-related macular degeneration. Int Psychogeriatr. In: Limited AEP, editor. Melbourne: University of Melbourne; Sunness JS. The natural history of geographic atrophy, the advanced atrophic form of age-related macular degeneration.

Mol Vis. Global data on visual impairment in the year Bull World Health Organ. The epidemiology of age-related macular degeneration. Am J Ophthalmol. Risk factors for age-related macular degeneration: Pooled findings from three continents. Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. The prevalence of age-related maculopathy: the visual impairment project. Changing views on open-angle glaucoma: definitions and prevalences—The Rotterdam Study. Invest Ophthalmol Vis Sci. Five-year incidence of age-related maculopathy lesions: the Blue Mountains Eye Study.

Prevalence of age-related macular degeneration in the United States. Vision loss in Australia. Med J Aust. Andersen N. Age-related macular degeneration among the Inuit in Greenland. Int J Circumpolar Health. The prevalence of age-related maculopathy in the Rotterdam Study. Risk factors for age-related macular degeneration: findings from the Andhra Pradesh eye disease study in South India.

Prevalence of age-related macular degeneration in a population-based sample of Hispanic people in Arizona: Proyecto VER. Nine-year incidence of age-related macular degeneration in the Barbados Eye Studies. The epidemiology of age related eye diseases in Asia. Br J Ophthalmol. The Wisconsin age-related maculopathy grading system. AREDS report no. Control Clin Trials. Investigative Ophthalmology. Smoking and age-related macular degeneration: a review of association.

A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. Choroidal neovascularization in the Choroidal Neovascularization Prevention Trial. Clin Trials. Prophylactic treatment of age-related macular degeneration report number 1: nanometer laser to eyes with drusen. Unilaterally eligible patients. Friberg T. Argon laser photocoagulation for neovascular maculopathy.

Three-year results from randomized clinical trials. Macular Photocoagulation Study Group. Krypton laser photocoagulation for neovascular lesions of age-related macular degeneration. Results of a randomized clinical trial. Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration. Visual loss after successful photocoagulation of choroidal neovascularization.

Persistent and recurrent neovascularization after krypton laser photocoagulation for neovascular lesions of age-related macular degeneration. Age-related macular degeneration and choroidal neovascularization. Surgery for hemorrhagic choroidal neovascular lesions of age-related macular degeneration: ophthalmic findings: SST report no. Surgery for subfoveal choroidal neovascularization in age-related macular degeneration: ophthalmic findings: SST report no. Machemer R, Steinhorst UH. Retinal separation, retinotomy, and macular relocation: II.

A surgical approach for age-related macular degeneration? Graefes Arch Clin Exp Ophthalmol. Translocation of the retina for management of subfoveal choroidal neovascularization II: a preliminary report in humans. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials—TAP report.

Schmidt-Erfurth U, Hasan T. Mechanisms of action of photodynamic therapy with verteporfin for the treatment of age-related macular degeneration. Surv Ophthalmol. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization—verteporfin in photodynamic therapy report 2. Radiotherapy for age-related macular degeneration: no more pilot studies please.

Aging Eye 1: Vision

Pegaptanib for neovascular age-related macular degeneration. N Engl J Med. Optical coherence tomography findings after an intravitreal injection of bevacizumab avastin for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging. Intravitreal bevacizumab Avastin for neovascular age-related macular degeneration.

Vinores SA. Anecortave Alcon Laboratories. Anecortave acetate as monotherapy for treatment of subfoveal neovascularization in age-related macular degeneration: twelve-month clinical outcomes. Photodynamic therapy with verteporfin combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization. Severe steroid-induced glaucoma following intravitreal injection of triamcinolone acetonide. Infectious and noninfectious endophthalmitis after intravitreal high-dosage triamcinolone acetonide.

HMG CoA reductase inhibitors statins : do they have a role in age-related macular degeneration? Early drusen formation in the normal and aging eye and their relation to age-related maculopathy: a clinicopathological study. British Journal of Ophthalmology. In-depth interviews were conducted in Kenya and Bangladesh with adults over the age of 50 who had recently undergone cataract surgery. Older adults with visual impairment had greater difficulties with their daily activities than those without impairment.

These difficulties varied considerably according to older adults' lifestyle, environment, and social support, as well as the severity of their vision loss. Cataract in Senegal Williamson W et al. The authors analyzed them according to several aspects age, sex, aetiology and anatomical shape of the cataracts , according to the therapeutical results and complications.

Cataract in the Kingdom of Morocco: indications for surgery and functional results. This study sought to investigate the results of cataract surgery in different settings in the Kingdom of Morocco. Six to eight weeks post-operatively Comparative study of continuous and interrupted sutures in cataract surgery in eye camps. Singh G. In a comparative study performed to evaluate continuous and interrupted corneoscleral sutures under special conditions of eye operation camps, researchers performed 86 cataract extractions under local anaesthesia. The results and complications were comparable in the two groups.

Ambulatory surgery of cataracts in Eastern Senegal Rozot P et al. The epidemiologic data and surgical results of cataract extractions performed in a new department of Ophthalmology in Eastern Senegal were reviewed. The complication rate was low, showing that this kind of surgery was suitable to local socio-economical conditions. Outcome of cataract surgery in central India: a longitudinal follow-up study. An epidemiological follow-up study of patients who had intracapsular cataract extraction in a voluntary hospital and its associated eye camps in Central India has for the first time evaluated the outcome one year after surgery in terms of visual acuity, use of spectacles, and improvement in income and mobility.

Frown incision for minimizing induced astigmatism after small incision cataract surgery with rigid optic intraocular lens implantation. Singer JA. J Cataract Refract Surg ; A new technique, the frown incision, was developed and a series of 62 eyes with 6 mm and 7 mm incisions for intercapsular phacoemulsification and implantation of a 6 mm or 7 mm one-piece biconvex poly methyl methacrylate PMMA posterior chamber intraocular lens with single horizontal mattress suture closure was prospectively evaluated for induced astigmatism.

Cataract surgery in a leprosy population in Liberia. In Liberia, 43 eyes of 30 patients with ocular leprosy underwent cataract extraction; 33 eyes had extracapsular cataract extraction ECCE and 10 eyes had intracapsular cataract extraction ICCE. Assessment of cataract surgery in rural India.

Visual acuity outcome. Acta Ophthalmol Scand. A socio-epidemiological assessment of what happens to the visual outcome after camp-based intracapsular cataract extraction was conducted in 6 villages and periurban areas in North India. Dissatisfaction was generally due to lack of visual improvement. Stones in the eye": post cataract suture irritation--a transcultural study from Sierra Leone, West Africa. Winter JD. The pattern of cataract surgery in India: This study characterizes cataract surgery in India in terms of practice setting and surgical procedure.

Of the 1,, cataract cases reported, two-thirds were private patients. Among private patients, The pattern of cataract and the postoperative outcome of cataract extraction in Ethiopian leprosy patients as compared to nonleprosy patients. Lepr Rev. Sixty leprosy and nonleprosy patients were assessed and underwent intracapsular cataract extraction. Leprosy patients with cataract were much younger than nonleprosy patients. The leprosy group had a significantly higher rate of complications and this was seen more in paucibacillary cases.

Outcome of cataract surgery by a general medical doctor at district level, Zimbabwe: a retrospective follow-up study. From January until October , Zimbabwean patients underwent intracapsular cataract extraction by a general medical doctor. This factual report suggests that cataract surgery performed by a general medical doctor is an alternative for clearing the cataract backlog in developing countries.

Teichmann KD, et al. This study examined the outcome of phacoemulsification PE compared to standard extracapsular surgery before the introduction of state-of-the-art techniques capsulorhexis, hydrodissection, nuclear cracking, nuclear chopping, sutureless incisions and sophisticated equipment.

The outcome of PE was better than that of standard extracapsular cataract extraction in the same setting. The distribution of cataract surgery services in a public health eye care program in Nepal. Marseille E, Brand R. Health Policy. Equity is analyzed here by comparisons of surgical coverage rates for major sub-groups within the intended beneficiary population of the Nepal blindness program NBP.

Substantial differences in surgical coverage were found between males and females and between different age groups of the same gender. Intracapsular cataract extraction: experience of a general surgeon in Niger, West Africa. Chew A. Aust N Z J Ophthalmol. Data on all consecutive planned intracapsular cataract extractions performed between January and July inclusive were collected prospectively and the visual outcome as well as surgical complications were analyzed. Population-based assessment of the outcome of cataract surgery in an urban population in southern India. Dandona L et al.

The goal of this research was to assess the outcome of cataract surgery in an urban population in southern India. The very high rate of very poor and poor visual outcome, predominantly as a result of surgery-related causes and inadequate refractive correction, in this urban population of India suggests that more attention is needed to improve the visual outcome of cataract surgery. Cataract surgery in India: results of a survey of ophthalmologists. The aim of this study was to investigate cataract surgery procedures and caseloads among Indian ophthalmologists in private and government practices.

Surgeons operating in both private and government facilities carry an average annual caseload of cataract surgeries, which is twice that of their colleagues operating exclusively in either private or government settings. A population based eye survey of older adults in Tirunelveli district of south India: blindness, cataract surgery, and visual outcomes.

The goal of this study was to assess the prevalence of vision impairment, blindness, and cataract surgery and to evaluate visual acuity outcomes after cataract surgery in a south Indian population. Presenting blindness was associated with older age, female sex, and illiteracy. Cataract was the principal cause of blindness in at least one eye in The prevalence of cataract surgery was Evaluation of visual outcome of cataract surgery in an Indian eye camp.

The aim was to evaluate the results of cataract surgery performed in a rural Indian eye camp. This evaluation suggests that it is possible to obtain acceptable results from cataract extraction with experienced ophthalmologists in well conducted Indian eye camps. Community Eye Health. This study describes Cataract Surgical Coverage CSC as an indicator to measure the impact of cataract intervention programmes. The coverage for males was higher than for females. Monitoring visual outcome of cataract surgery in India.

Two simple methods of assessing visual outcome following cataract surgery were evaluated in India. The visual outcome following cataract surgery could be monitored on a regular basis by ophthalmologists, using either of the methods evaluated, an exercise which in itself is likely to improve the outcome of surgery. Visual outcomes after cataract surgery and cataract surgical coverage in India.

Visual outcomes of cataract operated persons eyes across seven major Indian states were assessed in Intra-capsular cataract extraction was the commonest surgical modality adopted Intraocular lens implants resulted in better visual outcomes with Cataract surgical coverage: results of a population-based survey at Nkhoma, Malawi. Eloff J, Foster A. The prevalence of blindness in this age group was 3. The cataract surgical coverage for people with blinding cataract was calculated at Visual outcome following cataract surgery in rural punjab.

In a cluster sample survey in rural areas of Punjab visual outcome after cataract surgery was assessed. Manual sutureless cataract surgery using a claw vectis. Two-handed sandwich methods of extracapsular cataract extraction using a self-sealing incision have proved difficult for many inexperienced surgeons. Authors developed a simpler 1-handed technique using a claw vectis-a vectis with a claw placed on its tip. When the nucleus is pulled through the scleral tunnel, it is fixed by the claw and is smoothly removed from a wound of a size comparable to that in the sandwich method.

Outcomes of extracapsular surgery in eye camps of eastern Nepal. This study assessed the outcome of eyes at 6 weeks and 14 and 32 months after extracapsular cataract surgery with and without implantation of intraocular lens in refugee camps of eastern Nepal. It was found that ECCE surgery in eye camps in this setting gave unacceptable outcomes because of a high rate of capsular rupture and posterior capsular opacification. High volume sutureless intraocular lens surgery in a rural eye camp in india.

Balent LC et al. Ophthalmic Surg Lasers. This study describes the use of small incision sutureless cataract surgery SISCS that permits high-volume, high-quality, and low-cost surgery. Postoperatively, There was little difference in visual results or complication rates among the three techniques. The most striking finding is the speed of SISCS, which enables experienced surgeons to perform the technique in 3.

Cataract surgery output and cost of hospitalization for cataract surgery in the University of Benin Teaching Hospital. Osahon AI. This study highlights the meager contribution of teaching hospitals to the prevention of blindness. Several factors including ignorance, poverty, socioeconomic and political tensions and teaching hospital bureaucracy are no doubt responsible for this. Hospitalization for cataract surgery is becoming very unpopular in the developed world as this tends to increase cost of surgery.

The Sivaganga eye survey: II. Outcomes of cataract surgery. The purpose of this research was to assess the clinical outcomes of cataract surgery in rural southern India. Visual acuity outcomes in pseudophakic eyes were good. More attention must be given to needless vision impairment among the cataract-operated because of inadequate aphakic correction, especially among those operated on in government facilities, the illiterate, and those living in rural villages.

On the practicalities of eye camp cataract extraction and intraocular lens implantation in Nepal. Ophthalmic Surg. Extracapsular cataract and lens implant surgery in developing countries: keeping it simple. Spencer MF. Extracapsular cataract extraction and posterior chamber lens implantation would be the ideal method of rehabilitating the cataract blind of the developing world.

However, these procedures usually have been considered too complex, time-consuming, and "high tech" to be used in these areas of the world. In the context of an appropriate support program, they can be performed rapidly and safely using a few simple, manual instruments. High volume efficient cataract surgery in developing countries. Christy NE. The use of simple, flexible, efficient eye departments which make good use of available personnel and appropriate technology can be a very effective method of offering eye care and cataract surgery to large numbers of patients in the tropics and elsewhere.

Mortality and cataract: findings from a population-based longitudinal study. A random sample of 11 village communities provided persons aged years, who were examined in and again reassessed in Procedures involving star-shaped capsulectomy for managing congenital cataracts in developing nations. The inexpensive instrumentation used and the low rate of perioperative complications encountered studied patients make the described two techniques attractive alternatives for managing congentital cataracts in developing nations. Is anterior chamber lens implantation after intracapsular cataract extraction safe in rural black patients in Africa?

Audit of outcome of an extracapsular cataract extraction and posterior chamber intraocular lens training course. Forty one patients The most common intraoperative complication was posterior capsular rent which occurred in 10 eyes 5. Controlling astigmatism in cataract surgery requiring relatively large self-sealing incisions. This stude evaluated the results of a modified self-sealing incision for achieving astigmatic neutrality in cataract surgery requiring a 6.

In cataract surgery using relatively large scleral self-sealing incisions, the BENT frown incision effectively achieved astigmatic neutrality. The incisions on the temporal or superior steep astigmatic axis with selective shape reduced astigmatism in almost all cases. Longitudinal study on visual outcome and spectacle use after intracapsular cataract extraction in northern India. BMC Ophthalmol. The aim of this study is to assess visual outcome and perceived benefits of post-operative use of aphakic spectacles. Following intracapsular cataract extraction, provision of the best correction after cataract surgery is desirable to obtain an optimal visual outcome.

Cataract blindness and visual outcome of cataract surgery in a tribal area in Pakistan. Anjum KM et al. This study estimated the rates of cataract blindness and cataract surgical coverage and assessed the visual outcome of cataract surgery. The overall prevalence of bilateral cataract blindness was 4. Women had a 2. Models for improving cataract surgical rates in southern China. This demonstration project in Guangdong Province was designed to test various strategies to improve the cataract surgical rate. The cataract surgery rate CSR per million was in the county where training took place, where the fee was lowered, and where both interventions took place.

The Sivaganga eye survey: I. Blindness and cataract surgery. Thulasiraj RD et al. The purpose of this research was to assess the prevalence of visual acuity impairment, blindness, and cataract surgery among older adults in rural southern India. Blindness with presenting visual acuity was associated with older age and illiteracy. Cataract was the principal cause of blindness in one or both eyes in Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial.

Gogate PM et al. To study "manual small incision cataract surgery MSICS " for the rehabilitation of cataract visually impaired and blind patients in community based, high volume, eye hospital setting; to compare the safety and effectiveness of MSICS with conventional extracapsular cataract surgery. Outcome and number of cataract surgeries in India: policy issues for blindness control. The goal of the research is to assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India.

In the population-based sample, of the operated eyes, 51 The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract. Monitoring cataract surgical outcome in a Nigerian mission hospital. Ezegwui IR, Ajewole J. This study sought to evaluate the visual outcome of cataract operations in a Nigerian mission hospital.

The main cause of poor visual outcome in the center is unsuspected co-morbidity. Cataract surgical coverage and outcome of cataract surgery in a rural district in Malawi. Courtright P; Chikwawa Survey Team. Can J Ophthalmol. The purpose of this study was to determine the cataract surgical coverage and the outcome of cataract surgery in a rural district in Malawi to assess past performance of cataract surgical services.

The cataract surgical coverage rate was Cataract surgical coverage in this population is similar to that reported from other countries in Africa. As in other settings, cataract surgical coverage was lower in women than in men. Coverage of cataract surgery per person and per eye: review of a community-based blindness survey in Oman. Khandekar R, Mohammed AJ. The purpose of this study was to compare the calculation of cataract surgery services coverage on a per eye and per person basis.

The two methods of calculating the coverage of cataract services give different results and both are useful for monitoring ophthalmic services. Current trends in cataract surgery in Thailand survey. J Med Assoc Thai. The aim of this study was to survey and investigate the current trend of cataract surgery in Thai ophthalmologists in In cataract surgery, The posterior capsular tear was the most common complication. Cataract surgical coverage and outcome in the Tibet Autonomous Region of China. Bassett KL et al. A recently published, population based survey of the Tibet Autonomous Region TAR of China reported on low vision, blindness, and blinding conditions.

This paper presents detailed findings from that survey regarding cataract, including prevalence, cataract surgical coverage, surgical outcome, and barriers to use of services. Visual experience during cataract surgery: a nation-wide survey on the knowledge of optometry students. Ophthalmic Physiol Opt. Many optometry students correctly believed that patients might experience a variety of visual sensations during cataract surgery under local anesthesia. The majority were also aware that patients might be frightened by this and felt that preoperative counseling would be helpful.

Niger J Clin Pract. This study reports the outcome of small incision cataract surgery in a developing country. Seventy-one eyes were included in this study. Uncorrected visual acuity at five days postop was good in 31 Six weeks postop, four 5. The most common intraoperative complication was rupture of the posterior capsule while retinal lesions were the most common cause of poor visual outcome. Visual outcomes and astigmatism after sutureless, manual cataract extraction in rural China: study of cataract outcomes and up-take of services SCOUTS in the caring is hip project, report 1.

Lam DS et al. This study examined the visual acuity and astigmatism of persons undergoing cataract extraction by local surgeons in rural China. Results confirm the effectiveness of skill transfer in this setting, with superior outcomes to most studies in rural Asia and to eyes in this cohort operated on at other facilities.

Visual function and postoperative care after cataract surgery in rural China: study of cataract outcomes and up-take of services SCOUTS in the caring is hip project, report 2. The aim of this research was to study the postoperative visual function and uptake of refraction and second-eye surgery among persons undergoing cataract surgery in rural China. Visual function was high in this cohort. Potential benefit of refraction and second-eye surgery was substantial, but uptake of services was modest.

Programs to improve service uptake should focus on reading glasses and cost-reduction strategies such as tiered pricing. This is a population-based prospective cohort study of cataract patients from 12 villages in Hai district of Kilimanjaro region, Tanzania. Among patients eligible for surgery , 31 could not be followed up after 1 year due to deaths, moving, and refusal.

Among the remaining patients, 18 accepted surgery in the first year and four accepted in the second year. Among these 22 patients, only five were blind or with severe visual impairment. The most elderly were those least likely to accept surgery. High-volume surgery in developing countries. Yorston D. This article reviews innovations in cataract surgery in poor countries that are intended to reverse barriers to access. Increasing the number of operations through close involvement with the community, and improved surgical outcomes, enables the cost of surgery to be reduced and leads to further growth in volume.

Outcomes of high volume cataract surgeries in a developing country. Venkatesh R et al. This study analyzed the outcome of high volume cataract surgery in a developing country, community based, high volume eye hospital. High volume surgery using appropriate techniques and standardized protocols does not compromise quality of outcomes.

Causes of poor outcome after cataract surgery in Satkhira district, Bangladesh. The aim of this study was to assess the frequency and causes of poor and borderline outcome after cataract surgery in a population-based case series in Satkhira district, Bangladesh. Borderline and poor outcomes were most commonly due to lack of spectacles Measuring cataract surgical services in children: an example from Tanzania. Br J Ophthalmol There were, on average, boys for every girls receiving surgery.

Cataract surgery in Togo Mensah A et al. This study attemped to estimate the number of cataract surgeries and the Cataract Surgery Rate CSR in the administrative regions. Public services predominated with Decentralised eye healthcares provided cataract extractions. SICS--a cost effective alternative to phacoemulsification for developing countries in Nepal.

Nowak R. Klin Oczna. The purpose of this study is to describe such a technique, little known in Poland--manual small incision cataract surgery SICS , where the whole nucleus is removed through a self-sealing sclero-corneal tunnel. Small-incision manual extracapsular cataract surgery in Ghana, West Africa.

Guzek JP, Ching A. The purpose of this study is to evaluate the results of small-incision manual extracapsular cataract extraction surgery ECCE in a district hospital in West Africa. The effect of glasses on visual function following cataract surgery in a cataract camp. Maki J et al. This study sought to investigate visual and functional impact of glasses following cataract surgery in a high-volume cataract camp as measured by the World Health Organization Prevention of Blindness Visual Function Questionnaire. Postoperative glasses result in modest improvements in visual acuity.

The net beneficial effect of glasses was small relative to cataract surgery itself. A nationwide survey on the knowledge and attitudes of Malaysian optometry students on patients' visual experiences during cataract surgery. Ann Acad Med Singapore. This study aims to determine optometry students' beliefs and knowledge of visual sensations experienced by patients during cataract surgery under regional and topical anesthesia.

Many optometry students are aware that patients might encounter a variety of visual sensations during cataract surgery under local anesthesia. Outcome of cataract surgery at one year in Kenya, the Philippines and Bangladesh. Lindfield R et al. The goal of this study was to assess the change in vision following cataract surgery in Kenya, Bangladesh and the Philippines and to identify causes and predictors of poor outcome.

There was no significant association between adverse outcome and gender, age, literacy, poverty or preoperative visual acuity. Cataract surgical coverage and outcome in Goro District, Central Ethiopia. Bejiga A, Tadesse S. Ethiop Med J. This study assessed cataract surgical coverage and outcome in Goro District, Central Ethiopia. Cataract surgical coverage found in this survey is reasonably comparable to reports from other developing countries.

However, the visual outcome after cataract surgery was significantly lower compared to the WHO recommendations. Cataract surgery and intraocular lens manufacturing in India. The purpose of this review is to update the reader regarding the Indian scenario of cataract surgery and intraocular lens manufacturing. Evaluation of a national eye care programme: re-survey after 10 years. Faal H et al. To goal of this study was to evaluate the long term results of glaucoma surgery among people in East Africa.

Nearly half of those with glaucoma among residents of rural African villages accepted the offer of surgical therapy. While technical success was achieved at satisfactory levels, the development of cataract must be considered an important issue for application of glaucoma surgical therapy programs. Cataract-related blindness in Morocco. The crude point prevalence of blindness was 0. National survey of blindness and low vision in The Gambia: results.

A population based survey of blindness and eye disease has been conducted throughout the whole country of The Gambia, and people were examined. Ocular pathology in West Cameroon Moussala M et al. In a study carried out in West Cameroon Province where patients were involved, the author aimed at studying the ocular pathology of this area. It appeared from this study that infectious and inflammatory diseases of the anterior segment of the eye and of the eye-lids are by far the most widespread.

Causes of blindness and visual impairment in urban and rural areas in Beijing: the Beijing Eye Study. This article evaluated the causes of visual impairment and blindness in adult Chinese in an urban and rural region of Beijing, China. The most frequent cause of low vision and blindness in adult Chinese is cataract, followed by degenerative myopia and glaucomatous optic neuropathy, with degenerative myopia dominating in younger groups and cataract dominating in elder groups.

Kyari F, Gudlavalleti et al. Blindness was associated with increasing age, being female, poor literacy, and residence in the North. Causes of blindness, low vision, and questionnaire-assessed poor visual function in Singaporean Chinese adults: The Tanjong Pagar Survey. The aim of this study was to determine the prevalence rates and causes of low vision, blindness, and patient-assessed deficient visual function among Singaporean Chinese adults.

The age- and gender-adjusted rates of low vision and blindness were 1. Glaucoma is a leading cause of blindness in Singaporean Chinese adult. Rapid assessment of cataract surgical coverage in rural Zululand. S Afr Med J. This study describes a simple and inexpensive assessment of CSC based on screening of pensioners at pension delivery sites in a rural district. CSC was found to be Blindness prevalence was Rapid assessment of avoidable blindness in Western Rwanda: blindness in a postconflict setting.

PLoS Med.

RPE lipofuscin in ageing and age-related macular degeneration

Among the people aged 50 years or above 2, are expected to be blind, 1, to have severe visual impairment, and 8, to have visual impairment. Rapid assessment of cataract blindness in India. Rapid assessment of avoidable blindness and needs assessment of cataract surgical services in Satkhira District, Bangladesh.

Wadud Z et al. Although the prevalence of blindness and visual impairment was lower than expected, the CSR is inadequate to meet the existing need, and the quality of surgery needs to be improved. Prevalence and causes of blindness in the Tunisian Republic. Results of a national survey conducted in This study sought to estimate the prevalence of visual impairment and blindness; to identify the major causes of visual impairment and blindness and to estimate their overall impact, particularly on cataracts. Magnitude and causes of blindness and low vision in Anambra State of Nigeria results of point prevalence survey.

Ezepue UF. The aim was to provide baseline data for the planning, implementation and evaluation of both the state's and the National Programme for Prevention of Blindness. The prevalence of blindness in the state is estimated to be 0. Rapid assessment of avoidable blindness in Nakuru district, Kenya Mathenge W et al. The prevalence of bilateral blindness was 2.

Definite avoidable causes of blindness i. Prevalence and causes of blindness and visual impairment in Limbe urban area, South West Province, Cameroon. Oye JE, Kuper H. This study estimated the magnitude and causes of visual impairment VI in people aged 50 years and over in Kunming using the Rapid Assessment for Avoidable Blindness methodology.

The main cause of blindness was cataract Evaluation of the first 5 years of a national eye health programme in Vanuatu. Williams C et al.

Aging and Age Related Ocular Diseases (Ophthalmologica, 1) - PDF Free Download

This study sought to evaluate against its objectives the achievements of the first 5 years of a national eye health programme in Vanuatu. The evaluation highlighted the limitations of inadequate project design and that, without addressing further human resource development and the Ministry of Health's wavering financial commitment, there are potential risks to ongoing services. Study design, baseline characteristics and the demand for cataract surgery. Acta Ophthalmol. Practically no hidden demand for cataract surgery was found in the study population as defined by the national criteria for cataract surgery in Finland.

This reflects the fact that the current Finnish health care system appears to recognize and treat cataract patients very well, even in rural areas. The aim of this research was to study the effect of posterior capsular opacification PCO on vision and visual function in patients undergoing cataract surgery in rural China, and to compare this with the effect of refractive error. The prevalence of PCO and impact on vision and visual function in this cohort was modest 1 year after surgery. Ocular biometry and determinants of refractive error in rural Myanmar: the Meiktila Eye Study.

Warrier S et al. This article describes the ocular biometry and determinants of refractive error in an adult population in Myanmar. NO is the strongest predictor of refractive error across all age groups in this population. Rapid Assessment of Avoidable Blindness in India. PLoS One. Cataract and refractive errors are major causes of blindness and low vision and control strategies should prioritize them.

Most blindness and low vision burden is avoidable.

Ophthalmologica

Australian Journal of Ophthalmology. Mexican Americans, on the other hand, are similar to whites, even after age- and sex-standardization of the data Zhang et al. Outdoor work and the risk of pterygia: a case-control study. Sex hormone receptors in the human eye. The human complement factor H: functional roles, genetic variations and disease associations. Dirani, M. Marked leakage of fluorescein asterisk , with indistinct edges of hyperfluorescence white area is clearly visible in the late angiogram.

Ophthalmic manpower in India--need for a serious review. Kumar R. With an ophthalmic surgeon:population ratio of , similar to that in the UK , an increasing amount of blindness in India, the output by ophthalmic surgeons continues to be low. Eye diseases and control of blindness in Zambia. Shukla SM. This paper discusses the present state of health services in Zambia both in terms of training of personnel and health care delivery. The training in ophthalmology of medical students is poor and of medical auxiliaries almost non-existent. Research of the exploitation of human resources in blind prevention and primary eye care.

Yan Ke Xue Bao. This research studied how to establish a relatively advanced blindness prevention and eye care cause in economically underdeveloped countryside. In , it rose to , Human resources development for the prevention of blindness in Anglophone West Africa. Odusote KA. Eight categories of eye care workers were identified and personnel to population ratios adopted for each. Curriculum was developed and training begun for two new cadres-Primary Eye care Trainers and Diplomate Ophthalmologist. Work capacity and surgical output for cataract in the national capital region of Delhi and neighbouring districts of north India.

The aims of this study were to ascertain time taken for cataract surgery by ophthalmologists in the National Capital Region of Delhi and neighbouring districts, and to determine what work output is feasible with the available ophthalmologists. Median surgical time was lowest for ophthalmologists working in the NGO sector 10 minutes , compared to the government Socio-cultural influences on eye health in a rural underserved community of Oyo state.

Fafowora OF. To enhance planning of an eye health programme for a rural underserved community, focus group discussions were conducted. The results suggest that the planned intervention is timely and appropriate. Basic ophthalmic assessment and care workshops for rural health workers. The inequitable distribution of medical services in Australia means that many rural dwellers do not have easy access to ophthalmic care.

In regions with no medical personnel, appropriately trained rural health workers may provide ophthalmic assessment, primary treatment, and, in some circumstances, definitive care. Attacking the backlog of India's curable blind. The Aravind Eye Hospital model. New programs incorporating local customs and efficiently using available resources must be created to prevent the escalation of blindness and to rehabilitate patients already disabled with cataracts.

We describe a system of high-quality, high-volume, cost-effective cataract surgery, using screening eye camps and a resident hospital. This study measured the productivity of cataract surgeons in Africa and assessed the factors that predict high productivity. More than 77, cataract surgeries were performed in the years through , resulting in an annual productivity rate of surgeries per surgeon. Higher productivity was associated with having 2 or more cataract surgical sets, a well-functioning operating microscope, 3 or more nursing support staff, and a community program that includes transporting patients to the hospital.

Narrowing the gap between eye care needs and service provision: the service-training nexus. Masnick K.

Hum Resour Health. This paper presents a highly flexible competencies-based multiple entry and exit training system that matches and adapts training to the prevailing population and service needs and demands, while lifting overall standards over time and highlighting the areas of potential benefit.

The underlying principles used to derive this model can be applied to many eye care systems in many developing countries. An assessment of the eye care workforce in Enugu State, south-eastern Nigeria. On the availability and distribution of an appropriate eye care workforce in reaching the goals of "VISION The right to sight", the global initiative for the elimination of avoidable blindness launched jointly by the World Health Organization and the International Agency for the Prevention of Blindness.

There is a sufficient eye care workforce in Enugu Urban. However, the misdistribution of the workforce creates a major barrier to uptake of eye care services. Cost analysis of eye camps and camp-based cataract surgery. Murthy GV, Sharma P. Natl Med J India. Reseachers estimated the costs incurred in performing cataract operations in makeshift comprehensive eye care camps and suggest that comprehensive eye camps are cost-effective. Cost-effective cataract surgery in developing nations. Schwab L. The logistics of providing cataract surgical care in developing nations are complex.

Simplifying the cataract operation, employing appropriate technology, and training non-physicians in intraocular surgery is efficient cost-effective strategy in many developing African nations. Potential lost productivity resulting from the global burden of uncorrected refractive error. Smith TS et al.

This study estimated the potential global economic productivity loss associated with the existing burden of visual impairment from uncorrected refractive error URE. An estimated Economic burden of blindness in India. The economic burden of blindness in India for the year based on our assumptions is Rs. Childhood blindness accounts for The cost of treating all cases of cataract blindness in India is Rs. The cost of cataract surgery in a public health eye care program in Nepal. Marseille E, Gilbert S. Using data from the Lumbini Zonal Eye Care Program in Nepal, the authors estimated marginal costs, capital costs, and average recurring costs for a public health cataract program with and without donor agency overhead expenditures.

Cost-effectiveness of cataract surgery in a public health eye care programme in Nepal. Marseille E. Presented is an assessment of the cost-effectiveness of cataract surgery using cost and services data from the Lumbini Zonal Eye Care Programme in Nepal. The analysis suggests that cataract surgery may be even more cost-effective than previously reported.

Cost-effectiveness of public-funded options for cataract surgery in Mysore, India. Researchers assessed the cost-effectiveness of public-funded options for delivering cataract surgery in Mysore, Karnataka State, India. Cost-effectiveness analysis of cataract surgery: a global and regional analysis. This study sought to estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles. Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness.

Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered. Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Analysis of costs and benefits of the Gambian Eye Care Program. In , fewer individuals were blind than would have been without GECP. Although the net benefit between the blindness surveys was negative, the net lifetime benefit was 1. Global cost-effectiveness of cataract surgery.

The aim of this research was to determine the cost-effectiveness of cataract surgery worldwide and to compare it with the cost-effectiveness of comparable medical interventions. The cost-utility of cataract surgery varies substantially, depending how the benefit is assessed and on the duration of the assumed benefit.

A7.1 Included references

Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive. The aim was to compare the cost of phacoemulsification with foldable lenses with that of manual small-incision cataract surgery SICS in a hospital setting. Phacoemulsification needs additional cost for the machine depreciation , replenishment of parts, and annual maintenance contract.

Manual SICS is far more economical than phacoemulsification. Its visual result is comparable with that of phacoemulsification and is as safe. Prevalence of diabetic retinopathy in rural China: the Handan Eye Study. Wang FH et al. This study describes the age- and gender-specific prevalence, characteristics, and severity of diabetic retinopathy DR in a rural population in northern China. Of participants 6. Prevalence and risk factors for cataracts in persons with type 2 diabetes mellitus.

Korean J Ophthalmol. This study was performed to quantitatively evaluate the prevalence and risk factors of cataracts in Korean patients with type 2 diabetes mellitus. The duration of diabetes was the most significant risk factor for cataracts in patients with diabetes. This finding indicates that the accumulated effect of hyperglycemia is related to lens transparency in patients with diabetes.

Diabetic eye disease in Central Africa. Rolfe M. Six hundred African diabetic patients were examined using a standardised technique based on the World Health Organisation Multinational Study, in which no country from Africa was represented. Prevalence of retinopathy in a Sri Lankan diabetes clinic. Ceylon Med J. The aim of this study was to determine the prevalence of diabetic retinopathy among patients with non-insulin dependent diabetes NIDDM attending a Sri Lankan diabetes clinic and assess the skills of non-ophthalmologist in screening for retinal disease.

Retinopathy accounts for significant visual handicap. Untreated cataract is more commonly associated with blindness. Prevalence and determinants of diabetic retinopathy and cataracts in West African type 2 diabetes patients. Rotimi C et al. Ethn Dis. This study aimed to quantify the prevalence of, and risk factors for, diabetic retinopathy and cataracts in patients with type 2 diabetes, and their spouse controls, enrolled from 5 centers in 2 West African countries Ghana and Nigeria.

Cataracts were a more important cause of vision impairment than was diabetic retinopathy in this cohort. The prevalence of cataracts in patients with diabetes was more than twice that of their spouse controls, indicating that type 2 diabetes is an important risk factor for cataract formation.

Diabetic retinopathy progression and visual outcome after phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes. This research sought to determine diabetic retinopathy or maculopathy progression and visual outcome following phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes. Retinopathy or maculopathy progression was noted in seven patients There was no significant difference in the number of operated and fellow eyes whose retinopathy or maculopathy progressed postoperatively.

Screening for diabetic retinopathy: a comparative study between hospital and community based screening and between paying and non-paying patients. J Ayub Med Coll Abbottabad. Prevalence of diabetes and diabetic retinopathy varies in the population considering the background and financial status. The prevalence of diabetic retinopathy was two times more in the affluent hospital patients as compared to poor hospital patients or rural population.

For each known diabetic, there were four previously undiscovered diabetics in the rural population, and two previously undiscovered diabetics in hospital based population. Prevalence of and factors associated with diabetic retinopathy among diabetics in Nepal: a hospital based study. Nepal Med Coll J. The objective of the study is to estimate the prevalence of and factors associated with Diabetic Retinopathy among diabetics in a Tertiary Eye Care Centre, Nepal. The prevalence of Diabetic Retinopathy was Screening uptake in a well-established diabetic retinopathy screening program: the role of geographical access and deprivation.

Diabetes Care. Aug The objective of this study was to identify criteria that affect uptake of diabetes retinal screening in a community screening program using mobile retinal digital photography units. Social deprivation is strongly associated with poor attendance at retinal screening events. Time traveled to screening event was not associated with attendance in this study of a mobile retinal screening service, which visited general practitioner surgeries. Prevalence and risk factors for diabetic retinopathy: a population-based assessment from Theni District, south India.

Namperumalsamy P et al. The aim of this study was to estimate the prevalence of diabetic retinopathy DR and the possible risk factors associated with DR, in a population of south India. Among the 25 persons screened for diabetes mellitus DM , DR was detected in 1. Visual impairment from age-related cataract among an indigenous African population.

VI from cataract remains a public health problem in the Akinyele district of Nigeria. The need for a comprehensive cataract surgical service using the VISION model is necessary in the district if the burden from the backlog of visually disabling cataract is to be reduced. Relationship between reproductive exposures and age-related cataract in women. Asia Pac J Public Health. The objective of this study is to evaluate the relationship between reproductive exposures and age-related cataract among women.

Females with 29 years or less of endogenous estrogen exposure of, have almost three times the risk of developing age related cataract. Age-related eye disease in the elderly members of rural African community. East Afr Med J. The results of eye examination of the elderly persons above age sixty years in a rural population in south-western Nigeria are presented. Cataract was the commonest cause of blindness and low vision.

Age-related macular degeneration ARMD and glaucoma were also important causes. Senile cataract and trachoma in Tunisia Ayed S et al. Risk factors for senile cataract which were evidenced are: diabetes or abnormal glucose test tolerance, high systemic blood pressure, especially diastolic, low education and non professional occupation, family history of cataract. Zhonghua Yi Xue Za Zhi. The aim of this study was to assess and compare the prevalence of age-related cataract ARC among adults aged 50 years or older in Western China.

Results indicated that ARC prevalence among the permanent rural residents aged 50 and above in Western China is higher than that in Eastern China.

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An overview of eye problems in Singapore's elderly. Singapore Med J. Medical problems increase in frequency with advancing age. Ophthalmic problems are no exception, and add to disability in the elderly. Cataract, glaucoma, diabetic retinopathy, retinal detachment and age-related maculopathy are common blinding problems in middle-aged to elderly patients. A rural population based case-control study of senile cataract in India.

Sreenivas V et al. J Epidemiol. This study seeks clues to the etiology of senile cataract, so that strategies to prevent or even delay cataract formation could be planned. Systolic blood pressure, duration of exposure to sunlight per day were associated with senile cataract. The prevalence of refractive errors and its determinants in the elderly population of Mashhad, Iran. Yekta AA et al. Thi aim of this study was to determine the prevalence rates of refractive errors in elderly people in Mashhad, Iran.

The prevalence of myopia was The rate of myopia showed an increase with age. Morbidity and health care utilisation among elderly people in Mmankgodi village, Botswana. J Epidemiol Community Health. This study evaluates the health status among the elderly in a village in Botswana and their pattern of health care utilization.

A7.2 Background references

The most frequent health problems were related to the musculoskeletal system. Eye diseases, including cataract and blindness, were also common. A population-based eye survey of older adults in a rural district of Rajasthan: I. Central vision impairment, blindness, and cataract surgery. Murthy GV et al. The aim of this study was to assess the prevalence of central vision blindness and cataract surgery in older adults in rural northwest India.

Blindness, particularly blindness because of cataract, continues to be a significant problem among the elderly living in remote areas of rural northwest India. Increased attention should be given to reaching women and the illiterate. Evaluation of the health and functional status of older Indians as a prelude to the development of a health programme. This study assessed the health and functional status of older Indians seeking health services. Multiple chronic illnesses, frequent acute illnesses and deficits of vision and hearing are the major health and functional problems of the health-seeking older population in India.

An epidemiological study on senile cataract in urban and rural areas of Chengdu Liu C et al. This study sought to find out the status and distribution characteristics of senile cataract, which is one of the common diseases affecting the quality of life of the elderly people. It was found that the prevalence of senile cataract was Ophthalmic survey of an old people's home in Nigeria Adio AO.

This study emphasizes the need for regular check up of our geriatric population to enable early detection of ocular health problems and thus prevent avoidable disability and dependency. Prevalence and causes of visual impairment among the elderly in Nantong, China. This study investigated the prevalence and causes of visual impairment among adults aged 60 and above in Nantong city, China. Blindness and low vision were prevalent in the urban area of China, especially in the elderly women, with cataract the most common cause in the Chinese elderly.

The study highlights an urgent necessity for launching some programs for blindness and low vision prevention, especially on the early treatment of cataract.