Regional Disparities in Prevalence and Causes of Visual Impairment and Blindness, Cataract Surgical Coverage and Ocular Findings in Adults 50 Years and Older in Brazil: A Comparative Analysis between Two Population-Based Cross-Sectional Surveys Performed Within a 10-Year Interval.

PURPOSE: To investigate disparities in the prevalence and causes of visual impairment and blindness, cataract surgical coverage, and ocular findings in older adults from two Brazilian geo-socio-demographic areas, São Paulo and Parintins cities. METHODS: Data from two population-based studies including participants 50 years and older from the cities of São Paulo (São Paulo Eye Study - SPES, 2004) and Parintins (Brazilian Amazon Region Eye Survey - BARES, 2014) were aggregated. RESULTS: A total of 5318 participants (3677 from SPES;1641 from BARES) were included. The prevalence of severe visual impairment (SVI) and blindness were, respectively, 0.74% (0.46-1.02) and 0.77% (0.48-1.05) in SPES and 1.72% (1.09-2.35) and 3.44% (2.55-4.33) in BARES. SVI and blindness were associated with BARES study [OR = 2.27 (1.30-3.95); p = .004 - SVI] [OR:4.07 (2.51-6.60); p < .001- blindness]; and older age [OR = 10.93 (4.20-28.45); p < .001 - SPES; OR = 17.96 (8.75-36.83); p < .001 - BARES] while higher education level was a protective factor [OR = 0.21 (0.05-0.95) - SPES; p = .042; OR = 0.21 (0.05-0.91); p = .037 - BARES]. Cataract was the main cause of bilateral severe visual impairment (25.93% in SPES and 64.29% in BARES) and bilateral blindness (21.43% in SPES and 35.71% in BARES). Cataract surgical coverage was significantly lower in BARES (36.32%) compared to SPES (57.75%). CONCLUSION: The prevalence of SVI and blindness was three times higher in older adults from the Brazilian Amazon compared to those living in São Paulo city, despite a 10-year interval between the two studies. These disparities should be mitigated by initiatives to promote access to eye care services targeting underprivileged and remote Brazilian areas.

Impact of pterygium on central corneal thickness measured by optical coherence tomography in older adults.

PURPOSE: To measure the central corneal thickness (CCT) using anterior segment optical coherence tomography (AS-OCT) in older adults with and without pterygium from the Brazilian Amazon Region Eye Survey (BARES). METHODS: BARES is a population-based epidemiological cross-sectional study conducted in Parintins city. Participants were residents ≥45 years of age identified through a door-to-door interview. Eligible participants were invited for a comprehensive eye exam. Pterygium occurrence and severity were assessed by ophthalmologists through slit-lamp examination considering its location (nasal or/and temporal) and severity (lesion with extension <3 mm, ≥3 mm not reaching the pupillary margin or ≥3 mm reaching the pupillary margin). CCTs were obtained and measurements from the more severely affected eye were included. Images were analyzed offline by masked observers. RESULTS: A total of 671 subjects, 533 (79.4%) with pterygium in at least one eye and 138 (20.6%) without pterygium in either eye, were examined. The mean CCT evaluated by multiple linear regression and adjusted for demographic variables and pterygium severity was 521 ± 34 µm (median = 521; range = 304-665). Decreased CCT was significantly associated with age and pterygium severity. Individuals aged 65-74 years had CCT 7 µm thinner than those aged 45-54 years (p = 0.044), individuals aged 75 years and older had CCT 15 µm thinner than those aged 45-54 years (p = 0.001), and eyes with severe pterygium had CCT 33 µm thinner than eyes without pterygium (p < 0.001). CONCLUSIONS: The CCT analysis in this population-based sample shows that a thinner cornea is associated with pterygium severity and older age.

Prevalence of ocular findings regardless of visual acuity status in older adults from the Brazilian Amazon Region.

Recently, it has been recommended that population-based studies report not only frequencies of vision impairment and blindness but also any ocular abnormalities that might lead an individual to seek for eyecare services. The current study aimed to determine prevalence of ocular findings regardless of visual acuity (VA) status in older adults from the Brazilian Amazon Region. Disturbances were grouped into: Eyelids; Anterior Segment; Posterior Segment; Increased intraocular pressure; and Overall Globe. The presence of an ocular finding was considered positive when any abnormality was noted, regardless of VA. Refractive errors were not considered. A total 2384 eligible persons were enumerated and 2041 (85.6%) examined. The prevalence of ocular disturbances in either eye was 87.0% and was associated with male gender, older age, lower education, and rural residence. Overall, main findings were pterygium, cataract, and pinguecula, occurring in 58.8%, 45.4% and 17.4%, respectively. Among individuals with 20/20 VA in both eyes, the most frequent findings were pterygium, pinguecula, and glaucoma cupping, occurring in 47.4%, 31.2% and 6.5%, respectively. The high prevalence of ocular findings observed in this population reinforces that different conditions might not immediately decrease VA but can indicate risk and/or discomfort symptoms and should be considered when planning public health ophthalmic services.

Pterygium in adults from the Brazilian Amazon Region: prevalence, visual status and refractive errors.

AIMS: To determine prevalence of pterygium, its role as main cause of unilateral and bilateral visual impairment and blindness and its impact on refractive errors from adults living in a high ultraviolet exposure area in the Brazilian Amazon Region. METHODS: Cluster sampling was used in randomly selecting subjects ≥45 years of age from urban and rural areas of Parintins city. Eligible subjects were enumerated through a door-to-door household survey and invited for an eye exam including refraction. Pterygium was assessed considering location (nasal, temporal or both) and size (<3 mm or ≥3 mm reaching or not pupillary margin). RESULTS: A total of 2384 persons were enumerated and 2041 (85.6%) were examined. Prevalence of pterygium was 58.8% (95% CI 53.8% to 63.7%) and associated with male gender (OR=1.63; 95% CI 1.37 to 1.94; p=0.001), while higher education was a protective factor (OR=0.63; 95% CI 0.44 to 0.92; p=0.018). Older age and rural residence were associated with pterygium ≥3 mm reaching or not pupillary margin, while higher education was a protective factor for pterygium ≥3 mm reaching pupillary margin. Prevalence of pterygium as cause of visual impairment and blindness was 14.3% and 3.9%, respectively. Significantly higher hyperopic refractive errors were found in eyes with pterygium ≥3 mm reaching or not pupillary margin. CONCLUSIONS: Pterygium was highly prevalent and the second cause of visual impairment and blindness after provision of refractive correction. Risk factors for pterygium were male gender, advanced age, lower education and rural residency. Strategies to provide pterygium early detection and proper management should be considered by healthcare authorities in this population.

Population-Based Cataract Surgery Complications and Their Impact on Visual Status in the Brazilian Amazon Region.

PURPOSE: To investigate cataract surgery prevalence, complications, visual outcomes, and coverage in a population of older adults from the Brazilian Amazon region. DESIGN: Population-based cross-sectional study. METHODS: Individuals ≥45 years of age from urban and rural areas of Parintins City, Brazil, were identified by cluster random sampling. Participants underwent ophthalmic examination, including uncorrected visual acuity, acuity with presenting correction (APC), and best-corrected visual acuity (BCVA) from each eye. In those with previous cataract surgery, surgical technique and complications including its contribution to vision impairment were noted. The association of surgical complications and surgical coverage with sociodemographic variables was assessed by multiple logistic regression. RESULTS: A total of 2,384 persons were determined to be eligible, and 2,041 (85.6%) were examined. Overall, prevalence of cataract surgery was 8.6%, with 11.3% urban and 5.0% rural. Surgical complications were associated with males, older age, and urban residency and were found in 60.4%, with posterior capsule opacification in 29.6% and posterior capsule rupture in 16.3%. Among the 270 eyes having cataract surgery, APC ≥20/32 was found in 44.4%, APC 20/40 to 20/63 in 20.8%, APC <20/63 to 20/200 in 14.4%, APC <20/200 to 20/400 in 2.6%, and APC <20/400 in 17.8%. Low surgical coverage was found with 57.9% of those with visual impairment due to cataract not being treated surgically. CONCLUSIONS: Although a reasonable prevalence of cataract surgery was found, a high complication rate, poor visual outcomes, and low cataract surgery coverage indicated that actions to improve quality and appropriate postsurgical management should be planned and implemented by public health authorities.

Prevalence and Causes of Visual Impairment and Blindness in Adults Aged 45 Years and Older from Parintins: The Brazilian Amazon Region Eye Survey.

Purpose: To determine the prevalence and causes of visual impairment and blindness in adults aged 45 years and older from Parintins, Brazilian Amazon Region. Methods: A random cluster sampling method was used to identify subjects 45 years of age and older from urban and rural census sectors of Parintins city, Amazonas State, from March 2014 to May 2015. Participants underwent a detailed ocular examination, including presenting (PVA) and best corrected visual acuity (BCVA). The main cause of PVA<20/32 per eye was determined. Results: A total of 2384 subjects were enumerated and 2041 (85.6%) examined. The prevalence of presenting mild visual impairment - MiVI (<20/32 - ≥20/63) in the better-seeing eye was 17.0% [95% CI: 15.3-18.7%], and 8.5% [95% CI: 7.3-9.7%] with best correction. The prevalence of presenting moderate visual impairment - MVI (<20/63 - ≥20/200) was 18.4% [95% CI: 16.2-20.6%], and 6.9% [95% CI: 5.8-8.0%] with best correction. The prevalence of presenting bilateral VA <20/200 was 4.3% [95% CI: 3.6-5.0%], and 3.3% [95% CI: 2.5-4.0%] with best correction and increased with older age. Cataract (47.8%) and glaucoma (7.5%) were its main causes. In less severely affected eyes, uncorrected refractive errors (MVI: 42.6%; MiVI: 79.0%), cataract (MVI: 40.6%; MiVI: 13.7%) and pterygium (MVI: 7.6%; MiVI: 2.7%) were the main causes. Conclusions: Most cases of visual impairment in Parintins are either preventable or treatable, and public health initiatives should target cataract surgical services and refraction with spectacle provision.

Presbyopia and Ocular Conditions Causing Near Vision Impairment in Older Adults From the Brazilian Amazon Region.

PURPOSE: To investigate the prevalence and causes of near vision impairment (NVI) in a population of older adults from the Brazilian Amazon Region. DESIGN: Population-based cross-sectional study. METHODS: Cluster sampling was used in randomly selecting subjects 45 years of age and older from urban and rural areas of Parintins city, Brazil. Participants underwent ophthalmic examination, including uncorrected (UCNVA), presenting (PNVA), and best-corrected near visual acuity (BCNVA) from each eye; biomicroscopy; funduscopy; and subjective refraction, including testing with additional lenses for near vision optical correction. A principal cause for NVI was assigned by the ophthalmologist and presbyopia was defined as UCNVA ≤ 20/40 changing to > 20/40 with BCNVA. Free-of-charge glasses were provided for those in need. RESULTS: A total of 2384 subjects were enumerated and 2025 had reliable NVA measurements from both eyes. The prevalence of NVI in the better-seeing eye was 96.5% with UCNVA, decreasing to 81.1% with PNVA and to 20.5% with BCNVA. Presbyopia was the principal cause of NVI in 71.8%, followed by cataract (16.5%) and pterygium (2.5%), and was associated with younger age and high schooling. Glasses for near vision were prescribed and provided to 1414 (69.8%) participants. CONCLUSIONS: A high prevalence of NVI was detected even in those wearing glasses for near. Prescription and provision of low-cost reading glasses should be considered by Brazilian health authorities to address this easily and promptly correctable form of vision impairment.

Vision Status in Older Adults: The Brazilian Amazon Region Eye Survey.

Older adults living in remote areas with limited access to health services are at higher risk to develop visual impairment and blindness. We conducted a population-based survey to determine the vision status in subjects 45 years of age and older from urban and rural areas of Parintins city, Brazilian Amazon Region. Participants underwent ophthalmic examination, including uncorrected (UCVA), presenting (PVA) and best-corrected visual acuity (BCVA). Vision status was described as lines of visual acuity (VA) impairment and lines of VA improvement from UCVA to BCVA and from PVA to BCVA in the better-seeing eye. A total of 2384 subjects were enumerated, 2041 (85.6%) were examined, with reliable VA measurements obtained from 2025 participants. Vision status in lines of VA impairment was (mean ± standard deviation): 3.44 ± 3.53 for UCVA, 2.85 ± 3.52 for PVA and 1.50 ± 3.51 for BCVA. Female gender, older age and lower education were associated with ≥6 lines of UCVA impairment. Lines of improvement ≥3 was found in 626 (30.9%) participants and associated with female gender and rural residency. In conclusion, a third of participants could have at least three lines of VA improvement with proper refraction. Strategies to improve access to eye care and affordable glasses are needed.

Vision status, ophthalmic assessment, and quality of life in the very old.

PURPOSE: To determine the vision status, ophthalmic findings, and quality of life among the very elderly. METHODS: This was a cross-sectional observational study of individuals aged 80 years and above. A comprehensive ophthalmic exam was performed with mea surement of both the presenting (PVA) and best-corrected visual acuity. The Quality of Life Short Form-36 (SF-36) and the Visual Function Questionnaire (VFQ-25) were also administered. RESULTS: A total of 150 non-institutionalized participants were assigned to three age groups: 80-89 years (n=70), 90-99 years (n=50), and 100 years and older (n=30). PVA and best-corrected visual acuity were normal (≥20/30) in 20 (13.3%) and 37 participants (24.7%), respectively. Regarding PVA, mild visual impairment (<20/30 to ≥20/60) was found in in 53 (35.4%), moderate visual impairment (<20/60 to ≥20/200) in 50 (33.3%), severe visual impairment (<20/200 to ≥20/400) in 8 (5.3%), and blindness (<20/400) in 19 (12.7%) participants. Regarding best-corrected visual acuity, mild, moderate, and severe visual impairments were present in 55 (36.7%), 38 (25.3%), and 5 (3.3%) participants, respectively, and blindness was present in 15 (10%). The main causes of visual impairment/blindness were cataract (43.8%), refractive errors (21.5%), age-related macular degeneration (17.7%), and myopic degeneration (3.8%). SF-36 scores were worse in those with low visual acuity, while VFQ-25 domain scores were poorer in those with vision impairment/blindness. CONCLUSION: Vision impairment and blindness was present in three-quarters of this sample, but it was notable that adequate correction with spectacles improved visual acuity. This reinforces the need for regular ophthalmic care in elderly patients to improve their quality of life by optimizing vision.

Vision status, ophthalmic assessment, and quality of life in the very old / Visão, avaliação oftalmológica e qualidade de vida em longevos

ABSTRACT Purpose: To determine the vision status, ophthalmic findings, and quality of life among the very elderly. Methods: This was a cross-sectional observational study of individuals aged 80 years and above. A comprehensive ophthalmic exam was performed with mea surement of both the presenting (PVA) and best-corrected visual acuity. The Quality of Life Short Form-36 (SF-36) and the Visual Function Questionnaire (VFQ-25) were also administered. Results: A total of 150 non-institutionalized participants were assigned to three age groups: 80-89 years (n=70), 90-99 years (n=50), and 100 years and older (n=30). PVA and best-corrected visual acuity were normal (≥20/30) in 20 (13.3%) and 37 participants (24.7%), respectively. Regarding PVA, mild visual impairment (<20/30 to ≥20/60) was found in in 53 (35.4%), moderate visual impairment (<20/60 to ≥20/200) in 50 (33.3%), severe visual impairment (<20/200 to ≥20/400) in 8 (5.3%), and blindness (<20/400) in 19 (12.7%) participants. Regarding best-corrected visual acuity, mild, moderate, and severe visual impairments were present in 55 (36.7%), 38 (25.3%), and 5 (3.3%) participants, respectively, and blindness was present in 15 (10%). The main causes of visual impairment/blindness were cataract (43.8%), refractive errors (21.5%), age-related macular degeneration (17.7%), and myopic degeneration (3.8%). SF-36 scores were worse in those with low visual acuity, while VFQ-25 domain scores were poorer in those with vision impairment/blindness. Conclusion: Vision impairment and blindness was present in three-quarters of this sample, but it was notable that adequate correction with spectacles improved visual acuity. This reinforces the need for regular ophthalmic care in elderly patients to improve their quality of life by optimizing vision.

RESUMO Objetivos: Determinar a visão, achados oftalmológicos e qualidade de vida em longevos. Métodos: Estudo observacional transversal em indivíduos com idade entre 80 anos ou mais. Realizado exame oftalmológico com medida da acuidade visual apresentada e da acuidade visual melhor corrigida. Foram administrados os questionários: Qualidade de Vida Forma Curta - 36 (SF-36) e Qualidade de Função Visual (VFQ-25). Resultados: Total de 150 indivíduos não-institucionalizados foram estudados, divididos em três faixas etárias: 80 a 89 anos (n=70); 90 a 99 anos (n=50) e 100 anos ou mais (n=30). Acuidade visual apresentada normal (≥20/30) foi encontrada em 20 (13,3%) participantes; deficiência visual leve (<20/30 a ≥20/60), em 53 (35,4%); deficiência visual moderada (< 20/60 a ≥20/200) em 50 (33,3%); deficiência visual grave (<20/200 para ≥20/400) em 8 (5,3%) e cegueira (<20/400) em 19 (12,7%). A acuidade visual com a melhor correção aumentou para 37 (24,7%) indivíduos normais; deficiência leve aumentou para 55 (36,7%); deficiência visual moderada diminuiu para 38 (25,3%); deficiência visual grave foi reduzida para 5 (3,3%) e cegueira foi reduzida para 15 (10%). As principais causas de deficiência visual/cegueira foram: catarata (43,8%) erro refrativo (21,5%), degeneração macular relacionada à idade (17,7%), e degeneração miópica (3,8%). A pontuação no Questionário de Qualidade de Vida foi pior naqueles com baixa visão para perto. No questionário VFQ -25 os domínios com menor pontuação ocorreram nos indivíduos com baixa visão/cegueira. Conclusão: Deficiência visual/cegueira mostrou-se presente em três quartos desta amostra de longevos. A prescrição de óculos adequados proporcionou melhora da acuidade visual, reforçando a necessidade de atendimento oftalmológico regular desses pacientes para assegurar a qualidade de vida e de visão.

Pigmentos maculares / Macular pigments

A luteína e a zeaxantina são pigmentos amarelos que se localizam na mácula. Devido à sua localização, diminuem e filtram a quantidade de luz principalmente azul que chega aos fotorreceptores, atuam como antioxidantes e podem melhorar a qualidade visual. Esta é uma revisão do seu mecanismo de incorporação, ação, possíveis aplicações e conhecimento científico a respeito.

Lutein and Zeaxanthin are yellow pigments located at the macula. Because of your location macular pigments decrease and filter the amount of blue light that reach photoreceptors, protect the outer retina from oxidative stress and may improve the vision quality. This is a review regarding incorporation mechanism, function and knowledge update.

[Macular pigments]. / Pigmentos maculares.

Lutein and Zeaxanthin are yellow pigments located at the macula. Because of your location macular pigments decrease and filter the amount of blue light that reach photoreceptors, protect the outer retina from oxidative stress and may improve the vision quality. This is a review regarding incorporation mechanism, function and knowledge update.

Lipemia retinalis in a 35-day-old infant with hyperlipoproteinemia: case report.

A rare case of hyperlipropoteinemia in a 35-day-old infant who presented not only high blood levels of cholesterol and triglycerides but also an ocular manifestation described as lipemia retinalis. The fundoscopic abnormality cleared as the levels of chilomicrons in plasma dropped. Lipemia retinalis is an important and reliable parameter of high levels of chilomicrons and triglycerides and should be considered as a significant clue while diagnosing.

Lipemia retinalis in a 35-day-old infant with hyperlipoproteinemia: case report / Lipemia retinalis em recém-nascido com 35 dias: relato de caso

A rare case of hyperlipropoteinemia in a 35-day-old infant who presented not only high blood levels of cholesterol and triglycerides but also an ocular manifestation described as lipemia retinalis. The fundoscopic abnormality cleared as the levels of chilomicrons in plasma dropped. Lipemia retinalis is an important and reliable parameter of high levels of chilomicrons and triglycerides and should be considered as a significant clue while diagnosing.

Caso raro de hiperlipoproteinemia em recém-nascido com 35 dias de idade. Identificados altos níveis de colesterol e triglicérides associados a manifestãção ocular descrita como lipemia retinalis. As alterações oculares mostraram melhora uma vez que os níveis séricos foram controlados. Lipemia retinalis é parâmetro confiável e importante a ser considerado como suspeita de alterações de colesterol e triglicérides em crianças e em adultos.

[Primary intraocular B-cell lymphoma: case report]. / Linfoma intra-ocular primário de células tipo B: relato de caso.

Ocular non-Hodgkin's lymphoma is a rare condition that can involve the retina, the vitreous and the optic nerve. It can occur alone or can be associated with lymphoma of the central nervous system and a frequent manifestation is a posterior uveitis of difficult treatment. This kind of ocular tumor is difficult and a challenge to diagnosis. We describe a case of non-Hodgkin's intraocular B-cell lymphoma in a 47-year-old woman who had a posterior uveitis as the first manifestation. We emphasize the importance of a careful investigation and of the general clinical examination since this is the most common type in the eye. We expect to call the attention to this disease that many times appears in an unspecific form with unspecific symptoms.

Linfoma intra-ocular primário de células tipo B: relato de caso / Primary intraocular B-cell lymphoma: case report

O linfoma não-Hodgkin primariamente intra-ocular é raro, e caracterizado por uma forma extranodal que pode envolver retina, espaço sub-retiniano, vítreo e nervo óptico. Ocorre independente ou associado ao linfoma do sistema nervoso central e freqüentemente na forma de uveíte de difícil tratamento. Esta forma de linfoma é um dos tumores intra-oculares mais desafiantes de se diagnosticar. Relatamos um caso de linfoma não-Hodgkin intra-ocular difuso de células grandes tipo B numa paciente de 47 anos e cuja manifestação inicial foi uma uveíte posterior; enfatizamos a importância de investigação detalhada e da avaliação sistêmica; pois esta é a forma mais freqüente de acometimento ocular. Com esse relato esperamos abordar os principais aspectos desde quadro clínico até diagnóstico chamando a atenção para essa doença que muitas vezes aparece inicialmente com sintomas vagos e inespecíficos.

Ocular non-Hodgkin's lymphoma is a rare condition that can involve the retina, the vitreous and the optic nerve. It can occur alone or can be associated with lymphoma of the central nervous system and a frequent manifestation is a posterior uveitis of difficult treatment. This kind of ocular tumor is difficult and a challenge to diagnosis. We describe a case of non-Hodgkin's intraocular B-cell lymphoma in a 47-year-old woman who had a posterior uveitis as the first manifestation. We emphasize the importance of a careful investigation and of the general clinical examination since this is the most common type in the eye. We expect to call the attention to this disease that many times appears in an unspecific form with unspecific symptoms.

[Ocular findings in patients older than 99 years]. / Achados oculares em pacientes com mais de 99 anos.

PURPOSE: To determine vision conditions and ocular findings in patients older than 99 years. METHODS: Patients were recruited by media advertisement and examined at the Vision Institute of UNIFESP. The following examinations were performed: visual acuity, ectoscopy, refraction, biomicroscopy, tear film break-up time, Schirmer basal test, tonometry, direct and indirect ophthalmoscopy. Complementary examinations such as optical coherence tomography were performed when indicated. RESULTS: Thirty patients older than 99 years were identified. Mean age of 101.5+/-1.8, 25 females and 5 males. Most common systemic disease, according to history, was arterial hypertension. In 11 patients (55%), the best corrected far visual acuity was 20/100 or better. The best corrected near visual acuity was J4 or better also in 55% (11 patients) and 63.0% (7 patients) of these were the ones that had not been submitted to cataract surgery. The most frequent visual complaint was low vision for reading (55%) and other 8 patients (40%) reported no disturbance (satisfied with their vision). Lens opacity was present in 9 patients (60%) and 8 patients (40%) had previous cataract surgery (5 aphakic eyes, 9 pseudophakic eyes). Cataract was identified as important for impairment of vision in 5 patients but only 2 of them wanted to be submitted to surgery. The main cause of visual impairment was age-related macular degeneration, present in all patients, 95% with no exudative form. Vision improved with new refractive prescription in 4 patients. CONCLUSION: Once we understand the needs we can plan specific diagnostic and treatment strategies. This sample showed that most were female (83.3%), with good general health (35%), most with systemic arterial hypertension (40%), complaining of low vision for reading (55%) because of age-related macular degeneration (100%, 95% dry form). Only 40% had been previously submitted to cataract surgery. Most of the patients with cataract said to be satisfied with their vision; of the 5 patients that could be operated only 2 decided to do it. Low vision for reading, AMD and cataract were the main findings.

Achados oculares em pacientes com mais de 99 anos / Ocular findings in patients older than 99 years

OBJETIVO: Determinar as condições visuais e oculares em indivíduos com mais de 99 anos. MÉTODO: Estudo prospectivo e descritivo de série casos. Trinta idosos com mais de 99 anos se inscreveram no Instituto da Visão da Universidade Federal de São Paulo, de forma voluntária, respondendo à busca ativa. O exame oftalmológico constou de anamnese, ectoscopia, acuidade visual, exame refracional, citologia e cultura de cílios e conjuntiva com antibiograma, teste de Schirmer basal, tempo de ruptura do filme lacrimal, coloração com Rosa Bengala da conjuntiva e córnea, exame de biomicroscopia, tonometria de aplanação e fundoscopia direta e indireta. Foram realizados exames complementares, como retinografia e tomografia de coerência óptica, quando indicados. RESULTADOS: Trinta pacientes acima de 99 anos (média de 101,5±1,8 anos), dos quais, 25 mulheres e 5 homens, foram examinados; destes, 10 não tinham condições de exame completo, em razão de limitações de saúde e mobilidade. A doença sistêmica mais encontrada foi hipertensão arterial (8 pacientes = 40 por cento). Cinco pacientes (25 por cento) negaram qualquer doença ou uso de medicação. A melhor acuidade visual corrigida para longe foi de 20/100 ou melhor em 11 pacientes (55 por cento) e para perto variou de J4 ou melhor também em 11 pacientes (55 por cento), sendo que sete destes idosos (63 por cento) não haviam sido submetidos à cirurgia de catarata. A principal queixa foi dificuldade para leitura em 55 por cento e 40 por cento demonstrou estar satisfeito com a sua visão. A melhora da acuidade com prescrição de óculos novos ocorreu em 4 casos (20 por cento). Catarata foi identificada como comprometendo a visão de forma significativa em 5 casos (25 por cento); porém, apenas 2 concordaram com a cirurgia. A principal causa de baixa visão foi a degeneração macular relacionada à idade, presente em todos os casos; na maioria da vezes (95 por cento), na forma seca. CONCLUSÃO: As necessidades da população nessa faixa etária...

PURPOSE: To determine vision conditions and ocular findings in patients older than 99 years. METHODS: Patients were recruited by media advertisement and examined at the Vision Institute of UNIFESP. The following examinations were performed: visual acuity, ectoscopy, refraction, biomicroscopy, tear film break-up time, Schirmer basal test, tonometry, direct and indirect ophthalmoscopy. Complementary examinations such as optical coherence tomography were performed when indicated. RESULTS: Thirty patients older than 99 years were identified. Mean age of 101.5±1.8, 25 females and 5 males. Most common systemic disease, according to history, was arterial hypertension. In 11 patients (55 percent), the best corrected far visual acuity was 20/100 or better. The best corrected near visual acuity was J4 or better also in 55 percent (11 patients) and 63.0 percent (7 patients) of these were the ones that had not been submitted to cataract surgery. The most frequent visual complaint was low vision for reading (55 percent) and other 8 patients (40 percent) reported no disturbance (satisfied with their vision). Lens opacity was present in 9 patients (60 percent) and 8 patients (40 percent) had previous cataract surgery (5 aphakic eyes, 9 pseudophakic eyes). Cataract was identified as important for impairment of vision in 5 patients but only 2 of them wanted to be submitted to surgery. The main cause of visual impairment was age-related macular degeneration, present in all patients, 95 percent with no exudative form. Vision improved with new refractive prescription in 4 patients. CONCLUSION: Once we understand the needs we can plan specific diagnostic and treatment strategies. This sample showed that most were female (83.3 percent), with good general health (35 percent), most with systemic arterial hypertension (40 percent), complaining of low vision for reading (55 percent) because of age-related macular degeneration (100 percent, 95 percent dry form). Only 40 percent had been...

Injeção subconjuntival de soro autógeno no tratamento de queimadura ocular por álcali em coelhos / Subconjunctival injection of autogenous blood in the treatment of ocular alcali burn in rabbits

OBJETIVO: Estudar a ação da injeção subconjuntival de soro autógeno na evolução das complicações, após queimadura ocular grave por álcali induzida experimentalmente em coelhos. MÉTODOS: Foram utilizados trinta olhos de coelhos da raça Nova Zelândia, divididos em dois grupos, de 15 coelhos cada, ambos submetidos à queimadura grave por álcali. Em 15 olhos (grupo tratado), efetuamos, imediatamente após a queimadura, injeção de soro autógeno subconjuntival. Os resultados foram avaliados e comparados logo após a queimadura e nos dias 1, 3, 7, 15 e 30 por meio de ectoscopia biomicroscopia ocular. RESULTADOS: O grupo tratado apresentou melhor resposta de reepitelização da córnea, na fase inicial do processo do que o grupo controle (grupo sem soro autógeno), diferença esta estaticamente significante, assim como resultado final com um menor número de complicações. CONCLUSAO: Os resultados obtidos neste estudo experimental sugerem que soro autógeno pode ter efeito no processo de cicatrização dos olhos após queimadura alcalina, diminuindo complicações tardias e melhorando o prognóstico quanto à estabilidade do processo inflamatório cicatricial.