Use of cataract surgery in urban Beijing: a post screening follow-up of the elderly with visual impairment due to age-related cataract.

OBJECTIVE: To understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing. METHODS: From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. RESULTS: At the follow-up examination 116 of the 158 patients were available and 36 (31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery (OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function (P=0.11) or quality of life scores (P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need (50.0%), feeling of being "too old" (19.2%), and worry about the quality of surgery (9.6%). Cost was cited by 1 (1.9%) subject as the main reason for not seeking surgery. CONCLUSIONS: The data suggest that in China's capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people's perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.

Gonioscopy and ultrasound biomicroscopy in the detection of angle closure in patients with shallow anterior chamber.

OBJECTIVE: To assess the agreement between gonioscopy and ultrasound biomicroscopy (UBM) in detecting angle closure in Chinese patients with shallow anterior chamber. METHODS: An observational comparative study of the two different examination methods was conducted. Patients with normal intraocular pressure and temporal peripheral anterior chamber depth less than a quarter of corneal thickness based on slit lamp examination were included in this study from December 2007 to May 2009 in the outpatient clinic of First Hospital of Tsinghua University. Gonioscopy was performed with a Goldman goniolens in dark room first and followed by full beam light and indentation. If the filtering trabecular meshwork was invisible or any peripheral anterior synechia was found, that quadrant of the angle was considered closed. UBM was first undertaken in a darkened room then repeated with normal room lighting. If iridotrabecular apposition was showed, that quadrant of the angle was considered closed. The status of angle closure of each quadrant with different methods was recorded. RESULTS: 85 eyes of 46 patients were included in this study. The agreement between gonioscopy and UBM was poor (Κ<0.4) with Kappa analysis in both dark and light conditions in each quadrant. The accordance of agreement between gonioscopy and UBM was hardly affected by age or sex, while in dark condition, eyes with deeper anterior chamber (P=0.005) or plateau iris configuration tended to produce different results (P=0.075) in the 2 methods. CONCLUSION: Gonioscopy and UBM are both indispensable methods for detecting angle closure, neither can completely replace the other.

Comparison between ophthalmologists and community health workers in screening of shallow anterior chamber with oblique flashlight test.

OBJECTIVE: To study the agreement between ophthalmologists and community health workers in detecting shallow anterior chamber with oblique flashlight test. METHODS: Totally 425 subjects were given an eye examination in a community health center. The anterior chamber depth of each subject was examined by one ophthalmologist and two trained community health workers (one nurse and one non-professional health worker) using oblique flashlight test. Inter-observer agreement was determined using the weighted kappa statistic. RESULTS: Among the enrolled subjects, 148 (35%) were male and 277 (65%) were female. Good agreement was noted in all the three observers. The comparison between the ophthalmologist and the nurse showed a kappa statistic of 0.42 for both eyes (P < 0.001). The kappa statistic was 0.54 and 0.52 for right and left eyes respectively between the ophthalmologist and the non-professional health worker (P<0.001). As for agreement between the nurse and the non-professional health, worker, the kappa statistic was 0.49 and 0.38 for right and left eyes, respectively (P < 0.001). CONCLUSION: The oblique flashlight test may be used as an applicable tool by trained community health workers for screening of shallow anterior chamber and play a role in blindness prevention in community.

Association of candidate gene polymorphisms with diabetic retinopathy in Chinese patients with type 2 diabetes.

AIM: To investigate the association between a set of six candidate genes and the risk of diabetic retinopathy (DR) in an urban community cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: A population-based cross-sectional study. The diabetic subjects were recruited from an urban community in Beijing and categorized into groups of proliferative diabetic retinopathy (PDR), non-proliferative diabetic retinopathy (NPDR), or diabetic without any retinopathy (DWR) based on the fundus photography and duration of diabetes. Six candidate genes, including advanced glycation end product specific receptor (AGER), aldose reductase (AKR1B1), inducible nitric oxide synthase (iNOS), pigment epithelium derived factor (PEDF), tumor necrosis factor-alpha (TNF-α), and paraoxonase 1 (PON1), were chosen based on Meta-analysis of genetic association studies for DR and biochemical pathways implicated in DR progression. The allele and genotype distribution of 21 functional single-nucleotide polymorphisms (SNPs) in those 6 candidate genes were investigated using MassARRAY genotyping system. RESULTS: Among 1461 diabetic patients recruited from community, 569 were selected in following genotyping analysis, including 97 patients with PDR, 217 with NPDR, and 255 with DWR. For the promoter variant rs1051993 in AGER gene, the distribution of allele and genotype in PDR group differed from that in DWR group (allele: P=0.011; genotype: P=0.01). Compared with DWR, patients with PDR had lower frequencies of heterozygous genotype GT (9.8% for DWR, 1% for PDR, OR: 0.10, 95%CI: 0.01-0.72) and minor allele T (4.9% for DWR, 0.5% for PDR, OR: 0.10, 95%CI: 0.01-0.75). In multivariate model, the distribution of genotype for rs1051993 in PDR group was significantly different from that in DWR group (GT vs GG: OR: 0.07, 95%CI: 0.01-0.61, P<0.001). No association with DR was observed in other genotyped SNPs. CONCLUSION: The data suggest a significant association of the promoter variant rs1051993 in AGER gene with PDR in Chinese cohort with T2DM.

The Beijing Desheng Diabetic Eye Study: rationale, design, methodology and baseline data.

AIM: To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study (BDDES), and to determine the prevalence of diabetic retinopathy (DR) and possible risk factors in patients with type 2 diabetes mellitus (T2DM) in an urban community of Beijing, China. METHODS: Community-based prospective cohort study of persons diagnosed with T2DM aged 30y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions. RESULTS: A total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male (P=0.031), lower income level (P=0.011), lower education background (P=0.022), longer duration of diabetes (P=0.001), younger age at diabetic onset (P=0.001), higher systolic blood pressure (P=0.007), higher glycosylated hemoglobin A1c levels (P=0.001), high albuminuria (P=0.03), and use of insulin (P<0.001). For vision-threatening DR, four factors were significant: younger age at diabetic onset (P<0.001), higher systolic blood pressure (P=0.042), high albuminuria (P<0.001), and use of insulin (P<0.001). CONCLUSION: The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.

The relationship between insulin resistance/ß-cell dysfunction and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus: the Desheng Diabetic Eye Study.

AIM: To investigate the relationship between insulin resistance (IR)/ß-cell dysfunction and diabetic retinopathy (DR) in Chinese patients with type 2 diabetes mellitus (T2DM), and to explore further whether there were differences in the relationship among diabetic patients with higher and lower body mass index (BMI). METHODS: Cross-sectional study. A total of 1466 subjects with T2DM were recruited in a local Desheng Community of urban Beijing from November 2009 to June 2012 for the cohort of Beijing Desheng Diabetic Eye Study. Standardized evaluation was carried out for each participant, including questionnaire, ocular and anthropometric examinations, and laboratory tests. Seven fields 30° color fundus photographs were used for DR grading according to the Early Treatment Diabetic Retinopathy Study protocols. Homeostatis Model Assessment (HOMA) method was employed for IR and ß-cell function assessment. RESULTS: After excluding those participants who were treated with insulin (n=352) or had missing data of fasting insulin (n=96), and further excluding those with poor quality of retinal photographs (n=10), a total of 1008 subjects were included for the final analysis, 406 (40.3%) were men and 602 (59.7%) were women, age ranging from 34 to 86 (64.87±8.28)y. Any DR (levels 14 and above) was present in 278 (27.6%) subjects. After adjusting for possible covariates, the presence of any DR did not correlate with HOMA IR [odds ratio (OR) 1.51, 95% confidence interval (CI) 0.87-2.61, P=0.14] or HOMA ß-cell (OR 0.71, 95%CI 0.40-1.26, P=0.25). After stratification by BMI, the presence of any DR was associated positively with HOMA IR (OR 2.46, 95%CI: 1.18-5.12, P=0.016), and negatively with HOMA ß-cell (OR 0.40, 95%CI: 0.19-0.87, P=0.021) in the group of patients with higher BMI (≥25 kg/m2). In the group of patients with lower BMI (<25 kg/m2), the presence of any DR was not associated with HOMA IR (OR 1.00, 95%CI: 0.43-2.33, P=1.00) or HOMA ß-cell (OR 1.41, 95%CI: 0.60-3.32, P=0.43). CONCLUSION: The data suggest that higher IR and lower ß-cell function are associated with the presence of DR in the subgroup of diabetic patients with higher BMI. However, this association is not statistically significant in diabetic patients with lower BMI.

Predictors for attending annual eye screening for diabetic retinopathy amongst patients with diabetes in an urban community of Beijing.

AIM: To gain a better understanding of possible factors that may influence the decision of diabetes persons to participate in annual eye screening in an urban community setting of China. METHODS: A structured interview including questions on attendance of eye screening, knowledge and awareness of diabetic retinopathy was conducted. The presence and degree of retinopathy were assessed using two field non-mydriatic retinal photography. RESULTS: Totally 720 diabetes persons were recruited and 519 were enrolled in this cross-sectional study. In this urban setting of Beijing, among diabetes patients of average of 10y duration, 77% confirmed having undergone at least one eye examination and 61% reported having at least one eye examination with dilated pupil. As for the last 12mo, the number decreased to 210 (47%) and 131 (30%) separately. Most of the participants (95%) were aware that diabetes could affect their vision and that regular eye examination was necessary. Very few of them (12%) however were aware that the early stages of diabetic retinopathy presented without symptoms of vision loss. Having attended patient education on diabetes was effective in building awareness about diabetic eye disease and was a significant positive predictor for attending eye screening [education in a year, Adj. OR=0.47 (0.29-0.74), P<0.001, education years ago, Adj. OR=0.56 (0.33-0.96), P=0.036]. The duration of disease also increased the likelihood of having undergone eye screening (Adj. OR=0.96, P<0.05). CONCLUSION: Being exposed to education about the complications of diabetes increases the probability of attending diabetic eye screening. An appropriate patient knowledge building strategy should be made available to patients from the time of diagnosis.

[Discussion of several problems in ophthalmic research in China].

Based on the manuscripts received by several ophthalmologic journals, major issues regarding current ophthalmic research aspects in China were analyzed and discussed, including the selection of project, the design of research, the choice of statistical treatments and the techniques of writing research manuscripts. This article provides suggestions for Chinese ophthalmologists to improve the quality of their research work.

C-reactive protein and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus.

AIM: To investigate the relationship between C-reactive protein (CRP) and diabetic retinopathy (DR) in a cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: Community-based observational cohort study. There were 1131 participants recruited from November 2009 to September 2011 in Desheng community in urban Beijing. Patients diagnosed T2DM were recruited and underwent a standardized evaluation consisting of a questionnaire, ocular and anthropometric examinations and laboratory investigation. The presence and severity of DR were assessed by seven fields 30° color fundus photographs. Subjects were then classified into groups with no DR, any DR, or vision-threatening DR. CRP was analyzed from serum of study subjects. RESULTS: A total of 1007 patients with T2DM were included for analysis, including 408 (40.5%) men and 599 (59.5%) women. The median CRP level was 1.5 mg/L for women and 1.1 mg/L for men (P=0.004, OR 0.37, 95% CI 0.18-0.74). After adjusting for possible covariates, higher levels of CRP were associated with lower prevalence of any DR (P=0.02, OR 0.55, 95% CI 0.35-0.89), but not associated with vision-threatening DR (P=0.62, OR 0.78, 95% CI 0.28-2.14). After stratification by sex, the inverse association between CRP and DR was found to be statistically significant in men (P=0.006, OR 0.35, 95% CI 0.16-0.73), but not in women (P=0.58, OR 0.88, 95% CI 0.29-1.16). CONCLUSION: The data drawn from a Chinese population with T2DM suggest that increasing CRP levels may be inversely associated with development of DR.

[Modulation of cell proliferation and collagen synthesis of porcine Tenon's fibroblasts by extracts of lens and vitreous with treatment of dexamethasone].

OBJECTIVE: To demonstrate the effects of lens extract (LE), vitreous extract (VE) and dexamethasone on the modulating of the proliferation and collagen synthesis of Tenon's capsule fibroblast. METHODS: Cell proliferation and collagen synthesis of Tenon's fibroblast were measured using MTT and reverse transcription polymerase chain reaction techniques in the presence or absence of LE, VE, or dexamethasone, respectively. RESULTS: The growth of Tenon's fibroblasts was stimulated by LE and VE in dose and time-dependent manners. Dexamethasone significantly inhibited the proliferation of the cells either in the presence or absence of LE and VE. Similarly, LE and VE significantly stimulated the collagen synthesis of the cells. However, dexamethasone showed no significant effect on the LE or VE-enhanced collagen synthesis of the cells. CONCLUSION: These results suggested that there might be some ingredients in LE or VE that could stimulate the cell proliferation and collagen synthesis of Tenon's capsule fibroblasts. These ingredients, if released, may affect the success rate of filtration surgery for glaucoma. The application of glucocorticoid itself might not be sufficient to retard the scar formation following the filtering surgery in refractory glaucoma after cataract surgery or vitrectomy.

[Treatment of thyroid-associated ophthalmopathy: comparative study between prednisone and COP therapy].

OBJECTIVE: To evaluate the efficacy of two therapies, high-dose prednisone and COP in the treatment of patients with active thyroid-associated ophthalmopathy (TAO). METHODS: According to severity and compliance, the patients admitted in Peking Union Medical College Hospital from August 2000 to July 2003 were divided into two groups. Thirteen patients with active TAO were treated with high-dose prednisone. The initial dosage was 1.5-2.0 mg.kg(-1).d(-1) (maximal dosage 200 mg), tapering gradually, and shifting to alternate-day treatment. Fourteen patients in the COP group were treated with cyclophosphamide (CTX), oncovin (VCR) and prednisone. This therapy was modified from CHOP in the treatment of patients with non-Hodgkin's lymphoma: CTX 600 mg/m(2), VCR 1.1 mg/m(2) were administrated by intravenous infusion every 2-4 weeks, prednisone was given orally at 1 mg.kg(-1).d(-1) for seven days after each infusion. The duration of treatment for both groups was approximately 10 months. The parameters including clinical activity score (CAS), thickness of extra-ocular muscle as well as 24 h urinary GAG were used to evaluate the efficacy of treatment in both groups. RESULTS: There was no significant difference in age and sex between two groups. However the patients in the COP group were more severe than that in prednisone group (P < 0.05). CAS in the patients treated with prednisone before and after treatment were 4.4 +/- 1.8, 1.6 +/- 1.1 respectively, that in patients treated with COP were 6.5 +/- 1.6, 1.9 +/- 1.3 respectively. All these changes were highly significant (P < 0.01). The thickness of extra-ocular muscles in the patients treated with prednisone decreased from (6.5 +/- 1.5) mm to (5.8 +/- 1.1) mm, that in patients treated with COP decreased from (6.8 +/- 1.7) mm to (5.3 +/- 1.1) mm. Both changes were highly significant (P < 0.01). Comparative study of the changes in the thickness of extra-ocular muscle by percentage between two groups demonstrated that the muscle thickness in patients treated with COP was decreased by (23.7 +/- 4.3)%, that in patients treated with prednisone was by (13.3 +/- 4.6)%. The difference between the two groups was highly significant (P < 0.01). The 24 h urinary GAG level in patients treated by prednisone decreased from (33.6 +/- 6.6) mg/24 h before treatment to (16.7 +/- 2.5) mg/24 h after treatment. Those in COP group were (40.6 +/- 10.1) mg/24 h and (15.7 +/- 5.1) mg/24 h respectively. The difference was significant (P < 0.01) in each group. There were no serious complications during treatment. CONCLUSIONS: Both the prednisone and COP therapy are effective in the treatment of patients with active TAO. The preliminary results indicate that COP is more effective than prednisone, it suggests that COP might be feasible for treating patients with progressive and severe TAO.

Measurement of macular pigment optical density among healthy Chinese people and patients with early-stage age-related macular degeneration.

AIM: To measure the macular pigment optical density (MPOD) in healthy Chinese people and patients with early age-related macular degeneration (AMD). METHODS: Cross-sectional population based study. Demographic and lifestyle characteristics were ascertained by questionnaire. A food frequency questionnaire was completed for all participants. Participants underwent general physical and ophthalmic examinations and MPOD was measured by heterochromatic flicker photometry. Foveal architecture was measured by optical coherence tomography. RESULTS: MPOD of 225 participants (122 healthy and 103 early AMD) was 0.48±0.18. Patients with early AMD (0.52±0.19) tended to have higher MPOD levels than healthy people (0.47±0.17), but the difference was not statistically significant (P=0.06). Participants with carrot or corn oil intake every week tended to have higher levels of MPOD (P=0.002 and 0.008 respectively) while those with corn intake had relatively lower level of MPOD (P=0.01). MPOD increased with the center foveal thickness (P=0.01). CONCLUSION: Our findings show that there is no statistically significant association between MPOD and early AMD in the studied population. MPOD is related to center foveal thickness and diets would influence MPOD levels.

[Visual fields changes in chronic angle closure glaucoma patients after their intraocular pressures were well controlled].

OBJECTIVE: To investigate the progression of visual field loss and to explore the prognosis of glaucomatous optic neuropathy in patients with chronic angle-closure glaucoma (CACG) after their intraocular pressures were well controlled under 21 mmHg. METHODS: Forty-seven eyes of 29 patients in the Department of Ophthalmology in PUMC Hospital were included. All the patients had at least two separate tests of visual fields using the 24-2 program of the Humphery Visual Field Analyzer after their intraocular pressure were well controlled under 21 mmHg after sugery. The visual fields of patients were followed routinely for at least 1 year. In addition, all patients were divided into 2 groups according to follow-up period: 1-2 years group and over 2 years group. Visual field scores were calculated with the Advanced Glaucoma Intervention Study (AGIS) method. The visual fields were divided 5 sections and the sensitivity and defect depth of each section were calculated. RESULT: No statistically significant differences were found in terms of AGIS scores, localized sensitivities and localized defects within the time interval of the observation. CONCLUSION: Glaucomatous optic neuropathy is not likely to progressively deteriorate in CACG cases once their intraocular pressure are well controlled under 21 mmHg.

[Static and dynamic contrast sensitivity of myopic eyes before and after laser in situ keratomileusis].

OBJECTIVE: To evaluate the static and dynamic contrast sensitivity changes in myopic patients before and after laser in situ keratomileusis (LASIK). METHODS: Seventy-three eyes in 37 patients with myopia (with or without astigmatism) who received LASIK were tested for static and dynamic contrast sensitivities using the METRO VISION MON ELEC I system at 0.7, 1.4, 2.7, 5.5, 11, and 22 cpd and cps prior to LASIK, and at one-, three-, and six-month intervals after LASIK. RESULTS: All eyes gained naked visual acuity of more than 0.5 after LASIK. The contrast sensitivity was depressed at all frequencies 1 month after LASIK, as compared to one week prior to LASIK. The depression at 2.7, 5.5, 11 (P < 0.01) and 22 cpd (P < 0.05) was statistically significant for static contrast sensitivity, and also at 5.5 (P < 0.01) and 11 cps (P < 0.05) for dynamic contrast sensitivity. Myopic eyes between 6.25 D and 14.0 D, and astigmatic eyes 2 DC and more, suffered more static and dynamic contrast sensitivity depression than the myopic eyes between 1.25 D and 6.00 D and astigmatic eyes less than 2 DC. Contrast sensitivities were improved and exceeded preoperative levels 3 months after LASIK, and improved even more 6 months after LASIK. All sequences were statistically significant for static contrast sensitivity (P < 0.01), while only 2.7, 5.5, and 11 cps were statistically significant for dynamic contrast sensitivity (P < 0.01). The astigmatic eyes 2 DC and more showed less improvement, even below the preoperative level at 1.4 cps of dynamic contrast sensitivity. CONCLUSIONS: While temporary depression of contrast sensitivity for myopic eyes after LASIK was seen, contrast sensitivity soon returned to exceed preoperative levels at 3 months after LASIK, while improving even more 6 months after LASIK.

[Receptor mediated endocytosis of retinal pigment epithelial cell].

OBJECTIVE: To evaluate the possibility and mechanism of the turnover of the negatively charged macromolecule by retinal pigment epithelial (RPE) cells. METHODS: Cultured porcine RPE eye cups were incubated with fluorescence labeled formaldehyde treated serum albumin (F-FSA), a classical ligand for scavenger receptors. The endocytosis of F-FSA by RPE cells under different conditions was evaluated systematically by fluorescent microscopy and electron microscopy. RESULTS: The amount of F-FSA ingested by RPE cells depends on the incubation time and the concentration of ligand. Similar ligands compete for the binding site of RPE cells. Small vesicles containing F-FSA are noticed in the cytosol of RPE cells as demonstrated by electron microscopy. CONCLUSION: The RPE cells can effectively ingest negatively charged macromolecules, possibly by scavenger receptor mediated endocytosis.

[An epidemiological study of visual disability and visual rehabilitation in Beijing].

OBJECTIVE: To investigate the status of visual disability and the demands for visual rehabilitation services in Beijing. METHODS: Five hundred and fifty-five persons with visual disability in Beijing from the Second National Survey on Disability of China were involved in this study. Their visual disability and demands for rehabilitation were evaluated. RESULTS: About three fourth of the visual disabled persons were over 60 years of age. Cataract, retinal and choroidal diseases, and glaucoma were the three leading causes of the visual impairment. Medical service was the number one (82.0%) demand for the persons with visual disability, although 89.4% of them had previously received some kinds of medial services. People who had received visual aid devices or rehabilitation training were 26.7% and 5.8%, respectively, while more people showed their demand for these service (36.6% and 11.9%, respectively). The demand for visual rehabilitation varied in different groups of age and severity of disability. CONCLUSION: Accessibility of high quality medical services for preventable blindness diseases should be further promoted. Public health education on visual rehabilitation is also needed.

[A cross-sectional study on prevalance and risk factors of disabilities in aged 0-6 years children in Beijing, China].

OBJECTIVE: To explore the epidemiological status of disabilities on vision impairment (VI), hearing loss (HL), mental retardation (MR), autism spectrum disorder (ASD) and motor disorder (MD) in aged 0-6 years old children in Beijing. METHODS: A total of 28 738 children under 7 years old were recruited from permanent residents of Beijing City by 2-phase cluster sampling. The screening procedure was 2-phase, and the diagnosis criteria were developed by the experts group. RESULTS: The overall disability rate was 11.45 per thousand (95 % CI:10.22-12.68). The false negative rates in HL and ASD were 0.14 per thousand, 0.80 per thousand, respectively, with a adjusted overall rate of 12.19per thousand. The prevalence rates of different kind disabilities from high to low were MR 9.31per thousand, MD 2.12per thousand, ASD 1.53per thousand (0.73per thousand before adjusted), HL 1.04per thousand (0.91per thousand before adjusted) VI 0.73per thousand. The results of logistic regression analysis showed that the possible non-biological risk factors for those disabilities were being male, living in city area, advancing age, mother with low education, mother engaged in labor work, and family with low income. It was primarily (49.62%) those prenatal factors other them the known suspected factors that causing disabilities. CONCLUSIONS: Compared with data from a countrywide study in 1987, the overall disability rate had a mild decrease (16.36%) with the most (56.85%) appeared in HL. It is indispensable to establish a disabilities surveillance program for the early recognition and intervention of children with disabilities. It is also crucial to clarify a disability definition for children combined with their characteristics of growth and development. We strongly recommended in developing a new definition on children' disabilities and establishing new criteria according to the contents of developmental disabilities of Center for Disease Control, USA.