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.

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.

Teleophthalmology Support for Primary Care Diagnosis and Management.

This study was performed to evaluate a healthcare strategy based on teleophthalmology for diagnosis and management of primary healthcare users. A descriptive cross-sectional study was conducted to review the medical records of patients from January 2013 to December 2014 from primary care units in the city of São Paulo. The units referred patients, who had diabetes or high blood pressure, and were users of chloroquine compounds, for a fundus examination. The images were sent to a reading center for review, diagnosis, and patient referrals. From 9173 analyzed patients, 570 (6.2%) were excluded because of poor image quality. Of the remaining patients, 4933 (57.3%) had diabetes, 7242 (84,2%) systemic hypertension, and 113 (1.3%) used chloroquine. Of these, 989 (11.5%) patients needed ophthalmologic treatment. The most frequently prescribed treatments were cataract extraction in 692 (70%) of 989 and photocoagulation in 245 (24.8%) of 989 cases. Overall, cataract extraction was indicated in 692 (8%) of 8603 cases and photocoagulation in 245 (2.8%) of 8603 cases. When only patients with diabetes were considered, the indication for photocoagulation increased to 4.5%.The results showed that non-medical professionals could produce good-quality ocular images for screening of ocular diseases in most cases; only 6.2% of ocular images did not meet quality requirements. Most patients referred for fundus examination did not need a specific treatment, indicating that this system could be an inexpensive and reliable tool for use in developing countries.

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.

Prevalence and causes of vision impairment and blindness in older adults in Brazil: the Sao Paulo Eye Study.

PURPOSE: Investigate prevalence and causes of vision impairment/blindness in older adults in a low-middle income area of Sao Paulo, Brazil. METHODS: Cluster sampling, based on geographically defined census sectors, was used in randomly selecting cross-sectionally persons 50 years of age or older. Subjects were enumerated through a door-to-door survey 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 less than 20/32. RESULTS: A total of 4,224 eligible persons in 2,870 households were enumerated, and 3,678 (87.1%) examined. The prevalence of presenting visual acuity > or = 20/32 in both eyes was 61.6% (95% confidence interval [CI]: 59.4%-63.9%), and 80.4% (95% CI: 78.8%-82.1%) with best correction. The prevalence of visual impairment (< 20/63 to > or =20/200) in the better eye was 4.74% (95% CI: 3.97%-5.53%), and 2.00% (95% CI: 1.52%-2.49%) with best correction. The prevalence of presenting bilateral blindness (< 20/200) was 1.51% (95% CI: 1.20%-1.82%), and 1.07% (95% CI: 0.79%-1.35%) with best correction. Presenting blindness was associated with older age and lack of schooling. Retinal disorders (35.3%) and cataract (28.3%) were the most common causes of blind eyes. Cataract (33.2%), refractive error (32.3%), and retinal disorders (20.3%) were the main causes of vision impairment < 20/63 to > or = 20/200, with refractive error (76.8%) and cataract (12.2%) as main causes for eyes with acuity < 20/32 to > or = 20/63. CONCLUSIONS: Vision impairment is a significant problem in older Brazilians reinforcing the need to implement prevention of blindness programs for elderly people with emphasis on those without schooling.

Intravitreal gas injection for the treatment of experimental vitreous hemorrhage in rabbits.

PURPOSE: To determine the effectiveness of intravitreous gas injection in the management and clearing of experimental vitreous hemorrhage. METHODS: A total of ten New Zealand white rabbits received an injection of 0.4 ml of autologous blood into the vitreous of the right eye. After 24 hours of the vitreous hemorrhage simulation, six eyes were randomly assigned for treatment with na intravitreous injection of 0.2 ml of 100% perfluoropropane gas (C3F8) (group A), while four eyes received a control injection of an equivalent volume of balanced salt solution (group B). The persistence of vitreous opacification, which was graded at pre-established time points during 32 days of follow-up, was evaluated on the basis of visibility of retinal details in each of the four quadrants. RESULTS: In the gas-treated group (A), a partial view of the retina in the four quadrants was possible at 15 days, while at 32 days, the vitreous cavity was completely free of blood in all eyes, allowing unobstructed observation of the fundus. No retinal details could be observed in the control group after 32 days of follow-up. CONCLUSIONS: Gas injection proved effective in the treatment of experimental vitreous hemorrhage. It was significantly better than the injection of balanced salt solution, according to criteria of extension, intensity, and clearing time. Its technical facility, lack of complications, and low cost encourage additional research into gas injection to add knowledge to this initial study and to clarify its potential usefulness to treat persistent vitreous hemorrhage as well as to elucidate some unique pathophysiology features of blood catabolism in the vitreous.

Epidemiologia do buraco macular / Macular hole epidemiology

Buraco macular é uma entidade decorrente de várias patologias, podendo apresentar-se de diversas formas, com diferentes prognósticos e tratamentos. Através da análise dos 1030 prontuários de maculopatia doSetor de Retina e Vítreo do Departamento de Oftalmologia UNIFESP/EPM, levantamos todos os casos de buraco de mácula de 1980 a 1995. O buraco macular idiopático foi o mais frequente, com dezoito pacientes (66,6 por cento), predominando no sexo feminino com média de 64 anos de idade e bilateral em cinco casos (18 por cento). Com relaçäo ao buraco macular secundário ao edema macular cistóide, observamos que sete (87,5 por cento) dos pacientes eram do sexo feminino, sendo que facectomia, dois casos (37,5 por cento) e uveíte, um caso (28,6 por cento) ..