1: Ophthalmic Epidemiol. 2010 Aug;17(4):251-65. 

Prevalence and relationship between diabetic retinopathy and nephropathy, and
its risk factors in the North-East of Spain, a population-based study.

Pedro RA, Ramon SA, Marc BB, Juan FB, Isabel MM.

Ophthalmic Service, Hospital Universitario Sant Joan, Universidad Rovira I
Virgili, Reus, Spain. promero@grupsagessa.com

PURPOSE: To determine the prevalence of microangiopathy, and its risk factors in
a population-based study of diabetes mellitus patients in the north-eastern area
of Spain. METHODS: A population-based transversal study of 8,187 type 2 (83.37%
of the diagnosed patients) and 488 type 1 (85.76% of the diagnosed patients)
underwent a detailed medical history that included: diagnoses of diabetic
retinopathy, macular edema, microalbuminuria or overt nephropathy. A study of
its risk factors, and the relationship between diabetic retinopathy and renal
lesion was performed. RESULTS: In type 1 diabetes patients we observed a
prevalence of 36.47% of diabetic retinopathy and 5.73% with macular edema; in
type 2 diabetes patients the prevalence of diabetic retinopathy was 26.11% and
6.44% with macular edema. Microalbuminuria prevalence was 25.61% in type 1 and
17.78% in type 2 patients, and overt nephropathy prevalence was 8.60% in type 1
and 6.74% in type 2 diabetic patients. The risk factors for diabetic retinopathy
were: diabetes duration, high glycosylated level, and arterial hypertension, and
insulin treatment in type 2. The Total-cholesterol/High Density-cholesterol
(TC/HDL) ratio and triglycerides were significant for diabetic macular edema
(DME). Microalbuminuria and overt nephropathy were well correlated to diabetes
duration, arterial hypertension and glycosylated haemoglobin. CONCLUSIONS:
Prevalence and risk factors for microangiopathy are similar to other studies,
and the important finding is that the TC/HDL ratio was significant for DME.
Microalbuminuria is a risk factor for diabetic retinopathy in type 1 diabetes
mellitus patients but not for type 2. Overt nephropathy is well correlated with
diabetic retinopathy.

PMID: 20642348  [PubMed - in process]

2: Ophthalmic Epidemiol. 2010 Aug;17(4):242-50. 

Non-standard vision measures predict mortality in elders: the Smith-Kettlewell
Institute (SKI) study.

Lott LA, Schneck ME, Haegerstrom-Portnoy G, Brabyn JA.

Smith-Kettlewell Eye Research Institute, San Francisco, California 94115, USA.
lott@ski.org

PURPOSE: To determine which vision tests predict mortality within 10 years in a
community-based elderly sample. METHODS: Nine hundred residents of Marin County,
California 58 to 101 years of age (mean 75 years at baseline), underwent a
battery of tests, including high contrast acuity, low contrast acuity, low
contrast/low luminance acuity, acuity in glare, contrast sensitivity, color
vision, stereopsis, standard and attentional fields. The association between the
vision tests and mortality within 10 years of baseline was assessed with Cox
Proportional Hazards models controlling for age, sex, education level,
depression, cognitive status and self-reported medical conditions. RESULTS:
Forty-three percent of the sample died within 10 years of baseline. When
controlling for mortality-related covariates, impairment in any of the vision
measures was associated with increased risk of death. However, non-standard
vision measures (ie, impairment in low contrast/low luminance acuity, standard
field integrity and the impact of the attentional task on field integrity) were
more highly associated with mortality than standard high contrast acuity.
CONCLUSIONS: In agreement with other studies, we find that visual impairment is
a significant predictor of death. However, the strongest relationship was found
for measures other than high contrast acuity. These results suggest that
non-standard vision measures may be more sensitive indicators of generalized
aging in the most elderly.

Publication Types:
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 20642347  [PubMed - in process]

3: Ophthalmic Epidemiol. 2010 Aug;17(4):234-41. 

Prevalence of dry eye disease in Mongolians at high altitude in China: the Henan
eye study.

Guo B, Lu P, Chen X, Zhang W, Chen R.

West China Hospital, Sichuan University, Chengdu, China.

PURPOSE: To estimate the prevalence of dry eye disease, analyze the associations
between dry eye symptoms and signs, and identify the risk factors in an elderly
Mongolian population at high altitude in China. Methods: A population-based
survey was conducted in 2006. A total of 2,486 Mongolians age 40 and older were
selected. Symptoms of dry eye were assessed using a 6-item validated
questionnaire. Dry eye disease was defined if participants reported one or more
symptoms often or all the time. Positive signs included a tear-film breakup time
of or= 1 in one or both eyes. Presence of dry eye symptoms and positive
signs were analyzed. Correlations between symptoms and signs, and risk factors
were evaluated in a multivariate model. RESULTS: Of the 1,816 participants,
50.1% (95% confidence interval, 47.8-52.4) were symptomatic. Tear-film breakup
time of or= 1 was 6.0% (95% confidence interval, 4.9-7.1).
The correlation between dry eye symptoms and positive signs (tear-film breakup
time of or=1 [r = 0.361, P <
0.001]) were statistically significant. Independent risk factors included
increased age, age-related cataract and pterygium. CONCLUSION: This study
demonstrates a high prevalence rate of dry eye disease in a Mongolian
population. Dry eye signs were significantly associated with dry eye symptoms.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 20642346  [PubMed - in process]

4: Ophthalmic Epidemiol. 2010 Aug;17(4):225-33. 

A survey of visual impairment and blindness in children attending four schools
for the blind in Cambodia.

Sia DI, Muecke J, Hammerton M, Ngy M, Kong A, Morse A, Holmes M, Piseth H,
Hamilton C, Selva D.

South Australian Institute of Ophthalmology, Royal Adelaide Hospital, North
Terrace, Adelaide, South Australia, Australia. daviditsia@gmail.com

PURPOSE: To identify the causes of blindness and severe visual impairment
(BL/SVI) in children attending four schools for the blind in Cambodia and to
provide spectacles, low vision aids, orientation and mobility training and
ophthalmic treatment. METHODS: Children < 16 years of age were recruited from
all 4 schools for the blind in Cambodia. Causes of visual impairment and
blindness were determined and categorized using World Health Organization
methods. RESULTS: Of the 95 children examined, 54.7% were blind (BL) and 10.5%
were severely visually impaired (SVI). The major anatomical site of BL/SVI was
the lens in 27.4%, cornea in 25.8%, retina in 21% and whole globe in 17.7%. The
major underlying etiologies of BL/SVI were hereditary factors (mainly cataract
and retinal dystrophies) in 45.2%, undetermined/unknown (mainly microphthalmia
and anterior segment dysgenesis) in 38.7% and childhood factors in 11.3%.
Avoidable causes of BL/SVI accounted for 50% of the cases; 12.9% of the total
were preventable with measles being the commonest cause (8.1% of the total);
37.1% were treatable with cataracts and glaucoma being the commonest causes
(22.6% and 4.8% respectively). More than 35% of children required an optical
device and 27.4% had potential for visual improvement with intervention.
CONCLUSION: Half of the BL/SVI causes were potentially avoidable. The data
support the need for increased coverage of measles immunization. There is also a
need to develop specialized pediatric ophthalmic services for the management of
surgically remediable conditions, to provide optometric, low vision and
orientation and mobility services. Genetic risk counseling services also may be
considered.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 20642345  [PubMed - in process]

5: Ophthalmic Epidemiol. 2010 Aug;17(4):217-24. 

Quality of life in sarcoidosis: comparing the impact of ocular and non-ocular
involvement of the disease.

Saligan LN, Levy-Clarke G, Wu T, Faia LJ, Wroblewski K, Yeh S, Nussenblatt RB,
Sen HN.

National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892,
USA.

PURPOSE: To compare the differences in vision and health-related quality of life
(HRQOL) of individuals with ocular and non-ocular sarcoidosis; and to examine
the impact of specific demographic and clinical factors on the noted
differences. METHODS: A cross-sectional study using non-randomized prospective
cohort was conducted at the National Eye Institute (protocol number: 06-EI-0239,
NCT00379275) from August 31, 2006 until November 15, 2007. Each participant
completed vision and HRQOL questionnaires, the Sarcoidosis Health Questionnaire
(SHQ) and the National Eye Institute Visual Function Questionnaire (NEI-VFQ),
along with a demographic/environmental exposure survey. Clinical data were
collected through an ophthalmic exam as part of the research protocol. RESULTS:
The study enrolled 75 biopsy-proven and 20 clinically presumed sarcoidosis
participants which were divided into two cohorts, ocular (N = 60) and non-ocular
groups (N = 35). The ocular group had significantly lower (P < 0.01) total
NEI-VFQ scores compared to the non-ocular group. Multiple linear regression
analysis showed that participants with ocular sarcoidosis who had an annual
household income of < $50,000 (P < 0.01) had significantly lower total SHQ
scores while participants with ocular sarcoidosis whose visual acuity was 20/100
or worse had significantly lower total NEI-VFQ scores (P = 0.03). CONCLUSIONS:
Ocular involvement impacts both overall and vision-related quality of life among
sarcoidosis patients. Lower economic status appears to have a significant impact
on the quality of life of sarcoidosis patients. Assessment of visual function
and general health status provide pertinent information for individuals with
sarcoidosis and should be included in their care to assess burden of their
disease on their quality of life.

PMID: 20642344  [PubMed - in process]

6: Ophthalmic Epidemiol. 2010 Aug;17(4):211-6. 

Prevalence of and risk factors for primary open-angle glaucoma in central Sri
Lanka: the Kandy eye study.

Sia DI, Edussuriya K, Sennanayake S, Senaratne T, Selva D, Casson RJ.

University of Adelaide, Adelaide, Australia. daviditsia@gmail.com

PURPOSE: To report the prevalence and risk factors associated with primary
open-angle glaucoma (POAG) in the Kandy district of central Sri Lanka. METHODS:
A cross-sectional, population-based ophthalmic survey of the inhabitants >or= 40
years of age from villages in the Kandy District, Sri Lanka was conducted.
Selection was randomized using a cluster sampling process; 1721 eligible
participants were identified, 1375 participated in the study and sufficient
examination data to diagnose glaucoma in at least one eye was obtained in 1244
participants. A detailed ophthalmic history and examination including ocular
biometry was made of each participant. Primary open-angle glaucoma was
classified into three levels according to diagnostic evidence. RESULTS: The
overall prevalence of POAG was 2.3% (95% CI 1.5-3.2). In the univariate
analyses, increasing age (P = 0.001), intraocular pressure (IOP) (P < 0.001),
myopia (P < 0.001) and axial length (P = 0.003) were significantly associated
with POAG. In the multivariate analysis, age (P = 0.001), mean IOP (P < 0.001)
and mean axial length (P = 0.008) were significant risk factors of POAG.
CONCLUSIONS: The prevalence of POAG in the population aged >or=40 years in
central Sri Lanka was 2.3%. POAG in this population was independently associated
with increasing age, IOP and axial length.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 20642343  [PubMed - in process]

7: Ophthalmic Epidemiol. 2010 Aug;17(4):203-10. 

A randomized controlled trial assessing the effectiveness of strategies
delivering low vision rehabilitation: design and baseline characteristics of
study participants.

Christy B, Keeffe JE, Nirmalan PK, Rao GN.

Dr P R K Prasad Center for Rehabilitation of the Blind and Visually Impaired,
Hyderabad, India. beula@lvpei.org

PURPOSE: To design a randomized controlled trial (RCT) to compare the
effectiveness of four different strategies to deliver low vision rehabilitation
services. METHODS: The four arms of the RCT comprised-center based
rehabilitation, home based rehabilitation, a mix of center based and home based
rehabilitation, and center based rehabilitation with home based non
interventional supplementary visits by rehabilitation workers. Outcomes were
assessed 9 months after baseline and included measuring changes in adaptation to
age-related vision loss, quality of life, impact of vision impairment and
effectiveness of low vision rehabilitation training. The socio-demographic and
vision characteristics of the sample in each of the 4 arms were compared to
ensure that outcomes are not associated with differences between the groups.
RESULTS: Four hundred and thirty six individuals were enrolled in the study; 393
individuals completed the study. One-fifth of participants were children aged 8
to 16 years. At baseline, socio-demographic and clinical characteristics were
similar between individuals in the four arms of the trial. Socio-demographic and
clinical characteristics did not differ significantly, except for age, between
the 393 individuals who completed the trial and the 43 individuals who dropped
out of the study. Twenty six (60.46%) of the forty three drop outs were from the
center based arm of the trial. CONCLUSIONS: Information from this trial has the
potential to shape policy and practice pertaining to low vision rehabilitation
services.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 20642342  [PubMed - in process]

8: Ophthalmic Epidemiol. 2010 Aug;17(4):196-202. 

The importance of biometry to cataract outcomes in a surgical unit in Africa.

Briesen S, Roberts H, Lewallen S.

Eye-Clinic Dardenne, Bonn, Germany. sebbriesen@yahoo.de

PURPOSE: To determine how much difference biometry makes to refractive outcomes
in a population in Sub-Saharan Africa compared to using standard-power
intraocular lenses (IOLs). METHODS: In a secondary eye-clinic in Kenya,
IOL-powers in half diopters (D) were implanted according to biometry prediction
in patients undergoing routine cataract surgery with small-incision techniques.
A model was generated to predict refractive outcomes if standard-IOLs had been
used. RESULTS: Three-hundred-twenty-five eyes of 290 patients were operated on;
232 (71%) using phacoemulsification, the remainder using manual small-incision
cataract surgery. Two-hundred-sixty-seven eyes (82.2%) achieved corrected visual
acuity (VA) >or=6/18 and 202 eyes (62%) uncorrected VA >or=6/18. Pre-existing
comorbidity was the single most common reason for a worse postoperative VA.
Restricting analysis to one eye per patient, with biometry 71.1% had a good
refractive outcome (defined as +1 to -1.5 D spherical equivalent), 27.6% became
more than -1.5 D myopic and 1.3% more than +1.00 D hyperopic. With
standard-power-IOLs 57.3% would have had a good refractive outcome and 16% would
have become >1 D hyperopic. Using the post-op refractive data for A-constant
optimization could potentially further increase good refractive outcomes to over
80%. CONCLUSION: Biometry in combination with small-incision techniques improves
refractive outcomes and decreases undesired postoperative hyperopia. Assuming
good surgical skills, better outcomes with biometry justify cataract operation
at an earlier stage, thereby reducing intra- and postoperative complications and
avoiding years of visual disability.

PMID: 20642341  [PubMed - in process]

9: Ophthalmic Epidemiol. 2010 Aug;17(4):185-95. 

Prevelence and causes of visual impairment and blindness in older adults in an
area of India with a high cataract surgical rate.

Murthy GV, Vashist P, John N, Pokharel G, Ellwein LB.

International Centre for Eye Health, London School of Hygiene & Tropical
Medicine, London. GVS.Murthy@ishtm.ac.uk

BACKGROUND: The cataract surgical rate (CSR) in Gujarat, India is reported to be
above 10,000 per million population. This study was conducted to investigate the
prevalence and causes of vision impairment/blindness among older adults in a
high CSR area. METHODS: Geographically defined cluster sampling was used in
randomly selecting persons >or= 50 years of age in Navsari district. Subjects in
35 study clusters were enumerated and invited for measurement of presenting and
best-corrected visual acuity and an ocular examination. The principal cause was
identified for eyes with presenting visual acuity < 20/32. RESULTS: A total of
5158 eligible persons were enumerated and 4738 (91.9%) examined. Prevalence of
presenting visual impairment < 20/63 to 20/200 in the better eye was 29.3% (95%
confidence interval [CI]: 27.5-31.2) and 13.5% (95% CI: 12.0-14.9) with best
correction. The prevalence of presenting bilateral blindness (< 20/200) was 6.9%
(95% CI: 5.7-8.1), and 3.1% (95% CI: 2.5-3.7) with best correction. Presenting
and best-corrected blindness were both associated with older age and illiteracy;
gender and rural/urban residence were not significant. Cataract in one or both
eyes was the main cause of bilateral blindness (82.6%), followed by retinal
disorders (8.9%). Cataract (50.3%) and refractive error (35.4%) were the main
causes in eyes with vision acuity < 20/63 to 20/200, and refractive error
(86.6%) in eyes with acuity < 20/32 to 20/63. CONCLUSIONS: Visual impairment and
blindness is a significant problem among the elderly in Gujarat. Despite a
reportedly high CSR, cataract remains the predominant cause of blindness.

Publication Types:
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 20642340  [PubMed - in process]