Markedly decreasing incidence of cause-specific blindness in Saxony (Eastern Germany).

PURPOSE: To analyze the recent time trend in Saxony. METHODS: Data were based on administrative files in Saxony (Eastern Germany) to assess recipients of blindness allowance newly registered between January 1, 2009, and December 31, 2017. We estimated age-sex standardized incidence of all-cause and cause-specific blindness and used Poisson regression to examine age- and sex-adjusted time trends. RESULTS: We identified 5114 new cases of blindness (63.3% female, 59.9% ≥ 80 years). We observed a markedly decrease in incidence of blindness: all-causes 2009: 15.7 per 100,000 person years [95% confidence interval: 14.6-17.0]; 2017: 8.9 [8.1-9.8]; age-related macular degeneration 2009: 6.9 [6.1-7.7], 2017: 3.8 [3.3-4.3]; glaucoma 2009: 2.6 [2.2-3.1], 2017: 1.8 [1.4-2.2]; diabetic retinopathy 2009: 1.5 [1.2-1.9], 2017: 0.7 [0.5-1.0]; myopia 2009: 0.7 [0.5-1.1], 2017: 0.4 [0.2-0.5]; optic atrophy 2009: 0.9 [0.6-1.2], 2017: 0.5 [0.3-0.7]; and cataract 2009: 0.5 [0.3-0.8], 2017: 0.1 [0.1-0.3]. The annual reduction was between 5 (glaucoma, relative risk 0.95 [0.92-0.98]) and 16% (cataract, relative risk 0.84 [0.78-0.91]). CONCLUSION: The age- and sex-standardized incidence of blindness decreased among all common causes of blindness in Saxony in the last decade.

[Legal aspects of quality assurance : Example of operative intravitreal injection therapy]. / Rechtliche Aspekte der Qualitätssicherung : Beispiel der intravitrealen operativen Injektionstherapie.

BACKGROUND: In the legal evaluation of medical treatments it is important to know which legal and contractual regulations apply. OBJECTIVE: This article discusses in which context treatment errors play a role and are identified as such. MATERIAL AND METHODS: Relevant German legal framework conditions are discussed and examples with reference to intravitreal injection therapy are given. RESULTS: The civil law treatment contract between physician and patient results in the medical obligations of a service contract. As a consequence, the physician is obliged to provide the patient with treatment according to the current generally accepted professional standard, including information obligations, the certainty of a diagnosis, the execution of treatment and aftercare. Before claims for compensation and damages for pain and suffering can be enforced, proof of a treatment error and the causal connection must be provided. In court, mostly expert opinions are used to assess what the professional standard is and whether the physician was sufficiently qualified, whether informed consent and documentation met the legal requirements and whether a (gross) treatment error must be assumed. The Patients' Rights Act emphasizes the importance of an open error culture by requiring a practitioner to inform patients of third party/own treatment errors on request or in order to avert health risks, if circumstances are discernible to the practitioner that justify the assumption of a treatment error. CONCLUSION: Although ophthalmologists cannot guarantee healing or success but only the treatment, there are many medical obligations for intravitreal therapy. Increased standards of quality assurance can be implemented within the framework of selective contracts.

[Career prospects for ophthalmologists under 49 years old : A survey in Germany]. / Berufliche Zukunftsperspektive von Augenärzten unter 49 Jahren : Eine Umfrage in Deutschland.

OBJECTIVE: In Germany, ophthalmological care is mainly provided on an outpatient basis. In general, the first point of contact is the local ophthalmologist. Within the framework of this study the organizational structure as well as its implementation and future prospects were examined from the perspective of younger ophthalmologists. METHODS: Data from a survey conducted by the German Association of Ophthalmologists (Berufsverband der Augenärzte Deutschlands) in 2016 were evaluated. All members under the age of 49 years received an online questionnaire on their current professional situation, their future prospects (e.g. employment, self-employment and organizational form) and on outpatient care. RESULTS: A total of 508 persons (54.9% women, mean age 40.8 ± 5.8 years, 85% board certified ophthalmologists) took part in the survey. While the frequency of self-employment and employment in a practice was similar for a specialist activity (after board certification) of up to 5 years (33% vs. 32%), the proportion of self-employment was significantly higher for ophthalmologists with at least 6 years of specialist activity (6-10 years: 70%, >10 years: 74%). Of the women 25% were employed in a practice compared to 14% of men, while more men were self-employed in a practice (62% vs. 43%). Of the qualified specialists 72.3% stated that they wanted to work in the same form of employment in 10 years time. The majority (69%) of physicians who planned to change their form of employment aimed for self-employment in a practice. CONCLUSION: Most ophthalmologists aimed to work as a self-employed ophthalmologist in a practice in the future. This wish becomes more frequent with longer periods of occupational activity.

Visual Impairment Is Associated With Depressive Symptoms-Results From the Nationwide German DEGS1 Study.

INTRODUCTION: Visual impairment (VI) is associated with a variety of comorbidities including physical and mental health in industrial countries. Our aim is to examine associations between self-reported impairment and depressive symptoms in the German population. METHODS: The point prevalence of self-reported VI in Germany was computed using data from the German Health Interview and Examination Survey for adults from 2008 to 2011 (N = 7.783, 50.5% female, age range 18-79 years). VI was surveyed by two questions, one for seeing faces at a distance of 4 m and one for reading newspapers. Depressive symptoms were evaluated with the Patient Health Questionnaire-9 questionnaire and 2-week prevalence was computed with weighted data. Depressive symptoms were defined by a value of ≥10. Logistic regression analysis was performed to analyze an association between self-reported VI and depressive symptoms. Multivariable analysis including adjustment for age, gender, socioeconomic status, and chronic diseases were carried out with weighted data. RESULTS: The 2-week prevalence of depressive symptoms was 20.8% (95% CI: 16.6-25.7%) for some difficulties in distance vision and 14.4% (95% CI: 7.5-25.9%) for severe difficulties in distance vision, while 17.0% (95% CI: 13.3-21.4%), respectively, 16.7% (95% CI: 10.7-25.1%) for near vision. Analysis revealed that depressive symptoms were associated with self-reported VI for reading, respectively, with low VI for distance vision. Multivariable regression analysis including potential confounders confirmed these findings. CONCLUSION: Depressive symptoms are a frequent finding in subjects with difficulties in distance and near vision with a prevalence of up to 24%. Depressive comorbidity should therefore be evaluated in subjects reporting VI.

Markedly Decreasing Incidence of Blindness in People With and Without Diabetes in Southern Germany.

OBJECTIVE: Studies comparing the incidence of blindness in persons with and without diabetes are scarce worldwide. In Germany, a decline in the incidence of blindness was found during the 1990s. The aim of this study was to analyze the recent time trend. RESEARCH DESIGN AND METHODS: Data were based on administrative files in southern Germany to assess recipients of blindness allowance newly registered between 1 January 2008 and 31 December 2012. We estimated age- and sex-standardized incidence of blindness in people with and people without diabetes and the corresponding relative risk. Poisson regression was used to examine age- and sex-adjusted time trends. RESULTS: We identified 1,897 new cases of blindness (23.7% of which were associated with diabetes). We observed a strong decrease in incidence in both the population with diabetes (2008, 17.3 per 100,000 person-years [95% CI 13.6-21.1], and 2012, 8.9 per 100,000 person-years [6.3-11.6]: 16% decrease [10-22] per year) and that without diabetes (2008, 9.3 per 100,000 person-years [8.3-10.3], and 2012, 6.6 [5.8-7.4]: 9% decrease [5-13] per year). The relative risk comparing those incidences was 1.70 (95% CI 1.32-2.16) and remained constant in the observation period. Regarding time trend, we found similar results for both sexes. CONCLUSIONS: We found a significant reduction in incidence of blindness in the populations with and without diabetes, which was more prominent among individuals with diabetes compared with the 1990s. Our findings may be explained by effective secondary prevention therapies and improved ophthalmologic care beyond diabetic retinopathy, particularly regarding macular degeneration, which means earlier detection and earlier and better treatment.

The Prevention and Treatment of Retinal Complications in Diabetes.

BACKGROUND: Microvascular complications of diabetes mellitus can cause retino pathy and maculopathy, which can irreversibly damage vision and lead to blindness. The prevalence of retinopathy is 9-16% in patients with type 2 diabetes and 24-27% in patients with type 1 diabetes. 0.2-0.5% of diabetics are blind. METHODS: The National Disease Management Guideline on the prevention and treatment of retinal complications in diabetes was updated according to recommendations developed by seven scientific medical societies and organizations and by patient representatives and then approved in a formal consensus process. These recommendations are based on international guidelines and systematic reviews of the literature. RESULTS: Regular ophthalmological examinations enable the detection of retinopathy in early, better treatable stages. The control intervals should be based on the individual risk profile: 2 years for low-risk patients and 1 year for others, or even shorter depending on the severity of retinopathy. General risk factors for retinopathy include the duration of diabetes, the degree of hyperglycemia, hypertension, and diabetic nephropathy. The general, individually adapted treatment strategies are aimed at improving the risk profile. The most important specifically ophthalmological treatment recommendations are for panretinal laser coagulation in proliferative diabetic retinopathy and, in case of clinically significant diabetic macular edema with foveal involvement, for the intravitreal application of medications (mainly, vascular endothelial growth factor [VEGF] inhibitors), if an improvement of vision with this treatment is thought to be possible. CONCLUSION: Regular, risk-adapted ophthalmological examinations, with standardized documentation of the findings for communication between ophthalmologists and the patients' treating primary care physicians/diabetologists, is essential for the prevention of diabetic retinal complications, and for their optimal treatment if they are already present.

Blindness and visual impairment in Germany: a slight fall in prevalence.

BACKGROUND: Some 70% of all cases of blindness in Germany are due to diseases of old age. As the population at large is aging, the prevalence of blindness and visual impairment would be expected to rise. To assess this, we studied prevalence trends in Germany over the past three decades. METHODS: We calculated the age- and sex-standardized prevalence of blindness in Germany using data from the archive of the blind registry of the Rhineland Regional Council (Landschaftsverband Rheinland, LVR) for the years 1978 to 2006. We then validated the findings with the aid of data on blindness and visual impairment from the Statistics on Severe Disability (Schwerbehindertenstatistik, SBS) that are published periodically by the German Federal Statistical Office. RESULTS: The number of registered blind persons in the Rhineland increased from 10,665 in 1978 to 12,706 in 1987 and 15,766 in 1997, but it changed little thereafter, remaining at 15,725 in 2006. There was a corresponding trend in the prevalence of blindness in the Rhineland, which rose from 116.8 to 165.6 per 100,000 persons from 1978 to 1997 but was roughly the same, at 163.1 per 100,000 persons, in 2006. The SBS data on blindness and visual impairment reveal a decline in prevalence from 392 to 372 per 100,000 persons between 1987 and 2005. The standardized prevalence rates for blindness and visual impairment in Germany have been declining slowly since about 1997. DISCUSSION: Blindness and visual impairment have become slightly less common in Germany, even though the population is aging. This may be due, at least in part, to better eye health care.

Evidence for a considerable decrease in total and cause-specific incidences of blindness in Germany.

The objectives of this study are to estimate the recent population-based incidences of all-cause and cause-specific blindness in Germany and compare them with results from a similar study conducted in 1994-1998. All blindness allowance recipients newly registered between January 2008 and December 2009 in a region in southern Germany (population, approximately 3.5 million) were assessed and their ophthalmological reports reviewed. The main causes of blindness were identified and their incidences estimated. There were 572 newly registered cases of blindness allowance. The all-cause incidence of blindness (per 100,000 person-years) in the general population was 8.4 (95 % confidence interval, 7.8-9.2), and the highest incidences were for macular degeneration (3.4; 3.0-3.9), diabetic retinopathy (0.8; 0.6-1.1) and glaucoma (0.7; 0.5-0.9). During the last two decades, blindness incidences decreased for all the main causes (standardised to the West German population 1991: 12.3; 11.9-12.7 in 1994-1998 vs. 7.3; 6.7-8.0 in 2008-2009). The highest absolute decrease was for macular degeneration and the highest relative decrease was for cataract. The most frequent main causes of blindness in Germany remained macular degeneration, diabetic retinopathy and glaucoma. Our findings suggest a remarkable decrease in the incidences of blindness, probably because of new diagnostic options and effective treatments.