Results in comparison between 30 gauge ultrathin wall and 27 gauge needle in sutureless intraocular lens flanged technique in diabetic patients: 24-month follow-up study.

AIMS: Intraoperative complications in cataract surgery are more common in diabetic patients. Solving aphakia in these circumstances remains a challenge, as the scleral structure has been shown to be different in diabetes. This study aims to analyze the role of a secondary sutureless scleral intraocular lens (IOL) flanged fixation in diabetic patients without capsular support and to compare the anatomical and functional outcomes using a 30 gauge (G) ultrathin wall needle vs. a 27G needle. METHODS: Retrospective, observational cohort study. 105 eyes (105 patients) who underwent PPV with secondary IOL fixation using a sutureless 27G (n = 51) or a 30G ultrathin wall (UTW) needle technique (n = 54) and had a 24 months postoperative follow up. Consecutive patients' records were reviewed for lens stability and centration parameters, intra- and postoperative complications at 7 days, 1, 3, 6, 12, and 24 months after surgery. Correlations between outcome measures and needle size (27G vs. 30G UTW) were analyzed. RESULTS: IOL displacement occurred in 30 patients (41.2%) in the 27G group and did not occur in the 30G UTW needle group (p < 0.001). Mean time until IOL displacement was 10.5 ± 7.0 months (range: 7 days-24 months). IOL centricity was significantly better in the 30G ultrathin wall needle group compared to 27 G (p = 0.001). Additional surgical interventions were necessary only in the 27G group (n = 14). CONCLUSIONS: Sutureless IOL flanged technique using a 30G UTW needle is more predictable and has less complications in aphakic diabetic patients, compared to a 27G needle technique.

Visual status of special needs children in special education schools in Calabar, Cross River State, Nigeria.

OBJECTIVE: The objective of this study was to determine visual status of children with special needs attending special schools in Calabar, Cross River State, Nigeria. SUBJECTS AND METHODS: A cross-sectional study of all children with special needs attending special education schools in Calabar Municipal Local Government Area, Cross River State, was performed. Data were obtained using interviewer-administered questionnaires on the caregivers and ocular examination of the children which included visual acuity, refraction, ocular alignment and motility tests and funduscopy. Data analysis was performed using the Statistical Package for the Social Sciences version 20. RESULTS: A total of 161 children with special needs out of the 176 enrolled were examined yielding a 91.5% response rate. The male-to-female ratio was 1.2:1. Their age range was 5-17 years with the mean age of 12.9 ± 3.3 years and a modal age group of ≥13 years. Twenty (12.4%) had visual impairment (VI). Uncorrected refractive error accounted for 12 (60%) of the VI. Children with learning disability (odds ratio [OR]: 3.28 and 95% confidence interval [CI]: 1.73-6.36) and developmental disability (OR: 1.90 and 95% CI: 1.10-3.20), respectively, had significantly higher occurrence of VI. Of the 161 children examined, only 11 (6.8%) have had their visual status assessed in the past. CONCLUSION: Children with special needs had higher prevalence of VI; however, only a few have had an assessment of their visual status in the past.

Scleral Fixation of Intraocular Lens with Ab Interno Technique.

INTRODUCTION: Implantation of scleral fixation intraocular lens for the surgical management of aphakia cases without capsular support is a safe procedure. METHODS: Prospective study was carried out at Lumbini Eye Institute, Bhairahawa. A total of 32 patients underwent scleral fixation intraocular lens implantation within a period of two years from February 2014 to February 2016. RESULTS: The age range was from 15 to 79 years; mean age was 47.56 ± 20.16 SD. Among them 14 (43.75%) were male and 18 (56.25%) were female. The follow-up lasted for 24 months. CONCLUSIONS: SFIOL for the surgical management of aphakia in the absence of capsular support is a safe procedure. The long-term follow-up is needed for an accurate evaluation of outcomes.

Encuestas nacionales de ceguera y deficiencia visual evitables en Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay / National surveys of avoidable blindness and visual impairment in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay

OBJETIVO: Describir la justificación y metodología usadas en la Evaluación Rápida de Ceguera Evitable empleada para efectuar encuestas a nivel nacional entre 2011 y 2013 en Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay. MÉTODOS: La encuesta se dirige a personas de 50 años o más, lo que reduce al mínimo los requisitos de tamaño de la muestra, que oscila entre 2 000 y 5 000 personas. Se emplean sistemas simples de muestreo y técnicas de examen; el análisis de datos es automático y no requiere de un experto en estadística. Es relativamente económica, ya que no toma mucho tiempo, no requiere equipos oftalmológicos costosos y puede ser llevada a cabo por el personal local. Los informes son generados mediante el propio programa informático de la evaluación. RESULTADOS: Los indicadores generados son la prevalencia de la ceguera y la deficiencia visual severa y moderada (discriminadas por causas evitables y cataratas); la prevalencia de afaquia o pseudofaquia; la cobertura de la cirugía de cataratas; el resultado visual de las cirugías de cataratas; las causas de resultados malos; las barreras de acceso a la cirugía de cataratas; y los indicadores de servicio de la cirugía de cataratas. Los resultados de cada una de las encuestas serán publicados de manera secuencial en números sucesivos de la revista, y en un artículo final de resumen se hará un análisis de los resultados en su conjunto y comparativo entre las encuestas y con aquellas publicadas anteriormente, que aportará un estado de la situación actual en ese grupo de países. CONCLUSIONES: La Evaluación Rápida de Ceguera Evitable es una metodología sólida, sencilla y económica para determinar la prevalencia de ceguera y deficiencia visual y la cobertura y calidad de los servicios de salud ocular, y representa una herramienta muy valiosa para medir el progreso de los programas de prevención de la ceguera y su impacto en la población.

OBJECTIVE: Describe the rationale and methodology of the Rapid Assessment of Avoidable Blindness applied in surveys at the national level in 2011-2013 in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay. METHODS: The survey includes individuals aged 50 years and older, minimizing required sample sizes, which vary from 2 000 to 5 000 people. It uses straightforward sampling and examination techniques, and data analysis is automatic and does not require a statistician. It is relatively inexpensive, as it does not take a long time, does not require expensive ophthalmic equipment, and can be carried out by local staff. Reports are generated by the assessment software package. RESULTS: Indicators measured are prevalence of blindness and of moderate and severe visual impairment (broken down into avoidable causes and cataracts); prevalence of aphakia or pseudophakia; cataract surgical coverage; visual outcome of cataract surgeries; causes of poor outcomes; access barriers to cataract surgery; and cataract surgery service indicators. Results of each survey will be published sequentially in successive issues of the Journal, and a final summary article will analyze results as a whole and in comparison with the other surveys in this group and with those previously published, which will provide a current picture of the situation in this group of countries. CONCLUSIONS: The Rapid Assessment of Avoidable Blindness is a robust, simple, and inexpensive methodology to determine prevalence of blindness and visual impairment as well as eye health service coverage and quality. It is a very valuable tool for measuring progress by blindness prevention programs and their impact on the population.

Rapid assessment of avoidable blindness in Uruguay: results of a nationwide survey / Evaluación rápida de la ceguera evitable en Uruguay: resultados de un estudio a escala nacional

OBJECTIVE: To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay. METHODS: All individuals aged ≥ 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction. RESULTS: Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) and glaucoma (14.3%) were the main causes of blindness. Prevalence of SVI and MVI was 0.9% (95% CI: 0.5-1.3) and 7.9% (95% CI: 6.0-9.7) respectively. Cataract was the main cause of SVI (65.7%), followed by uncorrected refractive error (14.3%), which was the main cause of MVI (55.2%). Cataract surgical coverage was 76.8% (calculated by eye) and 91.3% (calculated by individual). Of all eyes operated for cataract, 70.0% could see ≥ 20/60 and 15.3% could not see 20/200 post-surgery. CONCLUSIONS: Prevalence of blindness in Uruguay is low compared to other Latin American countries, but further reduction is feasible. Due to Uruguay's high cataract surgical coverage and growing proportion of people ≥ 50 years old, the impact of posterior pole diseases as a contributing factor to blindness might increase in future.

OBJETIVO: Investigar y describir la prevalencia y las causas de la ceguera y de la discapacidad visual moderada y grave en los adultos mayores residentes en Uruguay. MÉTODOS: Todas las personas de 50 años o más que vivían en los agrupamientos seleccionados aleatoriamente reunían los requisitos para participar. En cada unidad de enumeración censal seleccionada, se escogieron 50 residentes de = 50 años de edad para participar en el estudio mediante el empleo de un muestreo por segmentos compactos. Los participantes fueron sometidos a una medición de la agudeza visual (AV) y a un examen del cristalino; los que mostraban una AV de presentación (AVP) < 20/60 también fueron sometidos a oftalmoscopia directa. La discapacidad visual moderada (DVM) se definió como una AVP < 20/60–20/200, la discapacidad visual grave (DVG) como una AVP < 20/200–20/400, y la ceguera como una AVP< 20/400, todas ellas basadas en la visión del ojo que obtuvo un mejor resultado con la corrección disponible. RESULTADOS: De las 3 956 personas que reunieron los requisitos, se examinaron 3 729 (94,3%). La prevalencia ajustada por edad y sexo de la ceguera fue de 0,9% (intervalo de confianza (IC) de 95%: 0,5–1,3). La catarata (48,6%) y el glaucoma (14,3%) fueron las principales causas de ceguera. La prevalencia de la DVG y la DVM fue de 0,9% (IC de 95%: 0,5–1,3) y 7,9% (IC de 95%: 6,0–9,7), respectivamente. La catarata fue la causa principal de DVG (65,7%), seguida del error de refracción no corregido (14,3%), que fue la principal causa de DVM (55,2%). La cobertura quirúrgica de la catarata fue de 76,8% (calculada por ojo) y de 91,3% (calculada por persona). De todos los ojos operados de catarata, 70,0% presentaba una agudeza visual de = 20/60 y 15,3% tenía una agudeza visual < 20/200 después de la intervención quirúrgica. CONCLUSIONES: En Uruguay, la prevalencia de la ceguera es baja en comparación con otros países latinoamericanos, pero es factible lograr una reducción adicional. Como consecuencia de la alta cobertura quirúrgica de la catarata y la creciente proporción de personas de = 50 años en Uruguay, la repercusión de las enfermedades de la cámara ocular posterior como factor contribuyente a la ceguera podría aumentar en el futuro.

National surveys of avoidable blindness and visual impairment in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay.

OBJECTIVE: Describe the rationale and methodology of the Rapid Assessment of Avoidable Blindness applied in surveys at the national level in 2011-2013 in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay. METHODS: The survey includes individuals aged 50 years and older, minimizing required sample sizes, which vary from 2 000 to 5 000 people. It uses straightforward sampling and examination techniques, and data analysis is automatic and does not require a statistician. It is relatively inexpensive, as it does not take a long time, does not require expensive ophthalmic equipment, and can be carried out by local staff. Reports are generated by the assessment software package. RESULTS: Indicators measured are prevalence of blindness and of moderate and severe visual impairment (broken down into avoidable causes and cataracts); prevalence of aphakia or pseudophakia; cataract surgical coverage; visual outcome of cataract surgeries; causes of poor outcomes; access barriers to cataract surgery; and cataract surgery service indicators. Results of each survey will be published sequentially in successive issues of the Journal, and a final summary article will analyze results as a whole and in comparison with the other surveys in this group and with those previously published, which will provide a current picture of the situation in this group of countries. CONCLUSIONS: The Rapid Assessment of Avoidable Blindness is a robust, simple, and inexpensive methodology to determine prevalence of blindness and visual impairment as well as eye health service coverage and quality. It is a very valuable tool for measuring progress by blindness prevention programs and their impact on the population.

Rapid assessment of avoidable blindness in Uruguay: results of a nationwide survey.

OBJECTIVE: To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay. METHODS: All individuals aged ≥ 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction. RESULTS: Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) and glaucoma (14.3%) were the main causes of blindness. Prevalence of SVI and MVI was 0.9% (95% CI: 0.5-1.3) and 7.9% (95% CI: 6.0-9.7) respectively. Cataract was the main cause of SVI (65.7%), followed by uncorrected refractive error (14.3%), which was the main cause of MVI (55.2%). Cataract surgical coverage was 76.8% (calculated by eye) and 91.3% (calculated by individual). Of all eyes operated for cataract, 70.0% could see ≥ 20/60 and 15.3% could not see 20/200 post-surgery. CONCLUSIONS: Prevalence of blindness in Uruguay is low compared to other Latin American countries, but further reduction is feasible. Due to Uruguay's high cataract surgical coverage and growing proportion of people ≥ 50 years old, the impact of posterior pole diseases as a contributing factor to blindness might increase in future.

An epidemiological investigation of a Forkhead box protein E3 founder mutation underlying the high frequency of sclerocornea, aphakia, and microphthalmia in a Mexican village.

PURPOSE: To investigate the molecular epidemiological basis for the unusually high incidence of sclerocornea, aphakia, and microphthalmia in a village in the Tlaxcala province of central Mexico. METHODS: A population census was performed in a village to identify all sclerocornea, aphakia, and microphthalmia cases. Molecular analysis of the previously identified Forkhead box protein E3 (FOXE3) mutation, c.292T>C (p.Y98H), was performed with PCR amplification and direct DNA sequencing. In addition, DNA from 405 randomly selected unaffected villagers was analyzed to establish the carrier frequency of the causal mutation. To identify the number of generations since the mutation arose in the village, 17 polymorphic markers distributed in a region of 6 Mb around the mutated locus were genotyped in the affected individuals, followed by DMLE software analysis to calculate mutation age. RESULTS: A total of 22 patients with sclerocornea, aphakia, and microphthalmia were identified in the village, rendering a disease prevalence of 2.52 cases per 1,000 habitants (1 in 397). The FOXE3 homozygous mutation was identified in all 17 affected subjects who consented to molecular analysis. Haplotype analysis indicated that the mutation arose 5.0-6.5 generations ago (approximately 106-138 years). Among the 405 unaffected villagers who were genotyped, ten heterozygote carriers were identified, yielding a population carrier frequency of approximately 1 in 40 and a predicted incidence of affected of 1 in 6,400 based on random marriages between two carriers in the village. CONCLUSIONS: This study demonstrates that a cluster of patients with sclerocornea, aphakia, and microphthalmia in a small Mexican village is due to a FOXE3 p.Y98H founder mutation that arose in the village just over a century ago at a time when a population migrated from a nearby village because of land disputes. The actual disease incidence is higher than the calculated predicted value and suggests non-random marriages (i.e., consanguinity) within the population. We can now offer the community more informed genetic counseling based on an accurate genetic test, thus increasing the likelihood of a better outcome for the families.

Secondary intraocular lens interventions: predisposing factors, indications and coincident procedures.

To evaluate the predisposing factors, indications and coincident procedures in patients requiring a secondary intraocular lens (IOL)-related intervention. We reviewed data on 183 consecutive secondary IOL-related procedures. Information collected included demographics, predisposing factors, IOL status, indication for surgery, coincident procedures, and final IOL location and fixation method. Of the 183 procedures performed, 73 were secondary IOL implantations, 68 were IOL exchanges and 42 were IOL repositionings. Predisposing factors were found in 88.6 % of the cases, the most common being complicated cataract surgery (39.8 %) followed by trauma (20.2 %). The most common indications for surgery in the anterior chamber IOL and posterior chamber IOL groups were pseudophakic bullous keratopathy ± failed graft (77.2 %) and subluxated IOL (57.53 %), respectively. A malpositioned or subluxated lens was found in 47.86 % of all pseudophakic eyes. A simultaneous procedure was performed in 67 % of cases, anterior vitrectomy being the most common (43.7 %), followed by keratoplasty (35 %). Secondary IOL-related interventions were associated with predisposing factors, complicated cataract surgery being the most common. Patients implanted with anterior chamber IOLs seemed to have a more complicated course requiring more complex secondary surgeries and associated procedures.

Aphakic glaucoma after cataract surgery for isolated nontraumatic pediatric cataract.

PURPOSE: To compare eyes diagnosed with aphakic glaucoma to those that were not after pediatric cataract surgery (age <12 years) without intraocular lens implantations for isolated (e.g., no microcornea) nontraumatic cataract with at least 5 years follow-up. METHODS: Institutional retrospective institutional series (1985-2003). RESULTS: Of 269 aphakic eyes, 62 (23%) were diagnosed with glaucoma (36 of 130 patients, 27.7%) an average of 59.0 months [m] (standard deviation +/- 44 months; median 33.5 months; range 1 to 227 months) postoperatively with an average intraocular pressure at diagnosis of 34.6 mm Hg (standard deviation +/- 5.3). Eyes diagnosed with glaucoma had lower mean age at cataract diagnosis (6.9 months versus 11.1 months) and surgery (9.2 months vs. 13.3 months), more frequent need for a second surgery to clear the visual axis (23% [8/62] versus 5.3% [11/207]), a higher percentage of eyes operated before 10 months of age (88.7% [55/62] versus 74.5% [155/207]), and a longer mean follow-up (160.4 months versus 112.7 months). The incidence of diagnosed aphakic glaucoma in eyes operated at or before 10 months of age was more than double (26.2% versus 11.9% P<0.00001). CONCLUSIONS: Independent of obvious ocular abnormality other than cataract, earlier cataract diagnosis and surgery and second surgery to clear the visual axis more frequently occurred in aphakic children who were diagnosed with aphakic glaucoma. The incidence was more than double in eyes that had surgery at or before 10 months of age. A number of cases likely have delayed diagnosis because of difficulties in assessing young patients for early glaucoma.

Cataract surgery and the primary care practitioner.

Cataract surgery with intraocular lens implantation is the most frequently performed operation in the Medicare Part B population. Such patients will seek the advice of their primary care practitioner, and the safety of the procedure may depend on the information the practitioner provides to the surgeon and anesthesia team. This article reviews pertinent issues surrounding the decision to operate; how various intraocular lens implants are selected; how surgery is now performed; postoperative complications, activities, and care; the role of the primary care physician; and the issue of medical clearance for this procedure.

[Contact lens in children: epidemiological aspects]. / Lente de contato em crianças: aspectos epidemiológicos.

PURPOSE: To describe the epidemiology of children submitted to contact lens fit. METHODS: Retrospective study of 73 children that had been submitted to contact lens fit at the "Universidade Federal de São Paulo". This study analyzed sex distribution, age, diagnosis, indications and contact lens fitted at first examination. RESULTS: 34 children (46.6%) were male and 39 (53.4%) female, aged between 2 and 12 years with mean of 10.2 and standard deviation of 2.42. The most common diagnosis was aphakia, in 16 (21.9%) cases. Keratoconus was present in 14 (19.1%), leucoma in 11 (15%), anisometropia in 10 (13.7%), refractive errors in 9 (12.3%), irregular astigmatism in 7 (9.5%), ectopia lentis in 4 (5.4%), high myopia in one case (1.3%) and one child (1.3%) had no ocular pathology, just wishing to change eye color. 52 (71.2%) had medical indication, 9 (12.3%) had optical indication and 12 (16.4%) had cosmetic indication. Contact lenses were fitted in 103 eyes, the most tested lens was rigid gas permeable in 43 (41.7%), soft lens in 41 (39.8%) and cosmetic soft lens in 11 (10.6%). CONCLUSION: Aphakia was the most common diagnosis among children in use of contact lens. The incidence of medical indication was higher than the others and the most tested lens was the rigid gas permeable one.

Lente de contato em crianças: aspectos epidemiológicos / Contact lens in children: epidemiological aspects

OBJETIVO: Traçar o perfil epidemiológico de crianças encaminhadas para adaptação de lente de contato. MÉTODOS: Foi realizado estudo retrospectivo de pacientes registrados no Setor de lente de contato da Universidade Federal de São Paulo. Os pacientes com até 12 anos de idade foram avaliados quanto ao sexo, idade, diagnóstico, indicação e tipo de lente de contato testada na primeira consulta. RESULTADOS: Dos 73 prontuários avaliados, 34 (46,6 por cento) pertenciam a crianças do sexo masculino e 39 (53,4 por cento) a crianças do sexo feminino. A idade variou de 2 a 12 com média de 10,2 e desvio-padrão de 2,42 anos. O diagnóstico mais encontrado foi afacia em 16 (21,9 por cento) crianças, seguido de ceratocone em 14 (19,1 por cento), leucoma em 11 (15 por cento), anisometropia em 10 (13,7 por cento), ametropia em 9 (12,3 por cento), astigmatismo irregular em 7 (9,5 por cento) e ectopia lentis em 4 (5,4 por cento). Uma criança era alta míope (1,3 por cento) e outra emétrope (1,3 por cento) que possuía desejo de usar lente de contato estética. Em relação às indicações, 52 (71,2 por cento) pacientes tinham indicação médica, 9 (12,3 por cento) indicação óptica e 12 (16,4 por cento) indicação cosmética. Foram testadas lentes em 103 olhos sendo as mais testadas a rígida gás permeável esférica em 43 (41,7 por cento), a gelatinosa esférica em 41 (39,8 por cento) e a gelatinosa cosmética em 11 (10,6 por cento). CONCLUSÃO: O perfil epidemiológico dos usuários de lente de contato nessa faixa etária tem como diagnóstico mais prevalente a afacia, a indicação mais freqüente a de ordem médica e a lente mais testada a rígida gás permeável esférica.

PURPOSE: To describe the epidemiology of children submitted to contact lens fit. METHODS: Retrospective study of 73 children that had been submitted to contact lens fit at the "Universidade Federal de São Paulo". This study analyzed sex distribution, age, diagnosis, indications and contact lens fitted at first examination. RESULTS: 34 children (46.6 percent) were male and 39 (53.4 percent) female, aged between 2 and 12 years with mean of 10.2 and standard deviation of 2.42. The most common diagnosis was aphakia, in 16 (21.9 percent) cases. Keratoconus was present in 14 (19.1 percent), leucoma in 11 (15 percent), anisometropia in 10 (13.7 percent), refractive errors in 9 (12.3 percent), irregular astigmatism in 7 (9.5 percent), ectopia lentis in 4 (5.4 percent), high myopia in one case (1.3 percent) and one child (1.3 percent) had no ocular pathology, just wishing to change eye color. 52 (71.2 percent) had medical indication, 9 (12.3 percent) had optical indication and 12 (16.4 percent) had cosmetic indication. Contact lenses were fitted in 103 eyes, the most tested lens was rigid gas permeable in 43 (41.7 percent), soft lens in 41 (39.8 percent) and cosmetic soft lens in 11 (10.6 percent). CONCLUSION: Aphakia was the most common diagnosis among children in use of contact lens. The incidence of medical indication was higher than the others and the most tested lens was the rigid gas permeable one.

Changing pattern of childhood blindness in Maharashtra, India.

AIM: To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India. METHODS: Children aged <16 years with a visual acuity of <6/60 in the better eye, attending 35 schools for the blind were examined between 2002 and 2005, and causes were classified using the World Health Organization's system. RESULTS: 1985 students were examined, 1778 of whom fulfilled the eligibility criteria. The major causes of visual loss were congenital anomalies (microphthalmos or anophthalmos; 735, 41.3%), corneal conditions (mainly scarring; 395, 22.2%), cataract or aphakia (n = 107, 6%), and retinal disorders (mainly dystrophies; n = 199, 11.2%). More than one third of children (34.5%) were blind from conditions which could have been prevented or treated, 139 of whom were referred for surgery. Low vision devices improved near-acuity in 79 (4.4%) children, and 72 (4%) benefited from refraction. No variation in causes by sex or region was observed. CONCLUSIONS: Congenital anomalies accounted for 41% of blindness, which is higher than in a similar study conducted 10 years ago. Corneal scarring seems to be declining in importance, low vision and optical services need to be improved, and research is needed to determine the aetiology of congenital anomalies.

Análisis de las barreras, cobertura y resultados postoperatorios de cirugía de catarata determinados mediante encuesta rápida de ceguera evitable en la VIII región, Chile / Coverage of caratact surgery, its results and barriers in VIII region, Bío Bío, Chile

Objetivo: Determinar la cobertura de los servicios de cirugía de catarata, los resultados postoperatorios y las barreras para no ser operados en las personas de 50 años o mayores, en la VIII región del Bio-Bio de Chile. Materiales y método: Sesenta conglomerados de 50 personas fueron elegidas por muestreo sistemático, siendo examinadas 2915 personas (97 por ciento), entre noviembre del 2006 y marzo del 2007. Se completó registro que incluyó visión, barreras para no ser operados y detalles de la cirugía realizada al cristalino. La visión se tomó con optotipo "E" (tamaños 20/60 y 20/200), con la corrección disponible y/o agujero estenopeico. Los planos de las áreas seleccionadas, fueron provistos po el Instituto Nacional de Estadísticas de Chile. Resultados: El miedo es mencionado como la principal barrera de porqué una cirugía no se ha realizado. La cobertura de los servicios de catarata fue de 76 por ciento en personas ciegas y de un 51 por ciento en ojos ciegos. Al 96 por ciento de los casos se le implantó un lente intraocular, siendo la visión final mejor a 20/60 en un 66.7 por ciento y menos a 20/200 enun 15.6 por ciento. Conclusiones: La catarata es la principal causa de ceguera y de limitación visual. La principal barreras es el miedo a ser operado que debe ser atenuado con campañas informativas. Para controlar la ceguera se debe incrementar la cobertura de cirugía de catarata.

Purpose: To determine the coverage of cataract surgery, its results and barriers to be operated on, among people of 50 years or older, in VIII region, Bio-Bio, Chile. Methods: Sixty conglomerates of 50 people were chosen by systematic sampling, being examined 2915 cases (97 percent) between november 2006 and march 2007. A detailed registry that included visual acuity, barriers to be operated on, and details about the surgery performed was filled in every case. Visual acuity was taken with the "E" optotype (20/60 and 20/200 size), with the optical correction available and/or with a pinhole. Maps of selected areas were provided by National Statistics Institute of Chile. Results: Fear was mentioned as the main barrier to be operated on. Coverage of cataract service was 76 percent in blind people and 51 percent in blind eyes. An intraocular lens was implanted in 96 percent of cases, achieving a final visual acuity of 20/60 or better in 66.7 percent and a visual acuity less than 20/200 in 15.6 percent. Conclusions: Cataract is the main cause of blindness and visual limitation. Fear was refered as the main barrier to be operated on, and it should be attenuated with an informative campaign. In order to control preventable blindness, the coverage of cataract surgery should be increased.

Glaucoma in aphakia and pseudophakia in the Chennai Glaucoma Study.

AIM: To determine the prevalence of glaucoma among aphakes and pseudophakes in a rural population of southern India. METHODS: 3924 subjects aged 40 years or above underwent complete ophthalmic examination. Glaucoma in aphakia/pseudophakia was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria in aphakic/pseudophakic people. RESULTS: 54 subjects (37 aphakes, 17 pseudophakes) (1.38% of 3924 subjects, 11.2% of 482 aphakes/pseudophakes) had glaucoma in aphakia/pseudophakia. Aphakia, age, intraocular pressure (IOP), pseudoexfoliation, and peripheral anterior synechiae greater than or equal to 180 degrees of the angle were risk factors for glaucoma on univariate analysis. On multivariate analysis, IOP and aphakia were independent risk factors for glaucoma. 39 people (72.22%) with glaucoma had normal IOP at presentation. None of the people with glaucoma were aware of the disease. Blindness in one or both eyes was seen in 12 subjects (10 unilateral and two bilateral)-that is, 22.22% of people with glaucoma in aphakia/pseudophakia. CONCLUSIONS: Glaucoma is an important cause of ocular morbidity among aphakes and pseudophakes in this rural population of south India. This glaucoma, responsible for unilateral or bilateral blindness in 22.2% of those affected, was entirely undetected in this study population.

Cataract surgical coverage and outcome in the Tibet Autonomous Region of China.

BACKGROUND: A recently published, population based survey of the Tibet Autonomous Region (TAR) of China reported on low vision, blindness, and blinding conditions. This paper presents detailed findings from that survey regarding cataract, including prevalence, cataract surgical coverage, surgical outcome, and barriers to use of services. METHODS: The Tibet Eye Care Assessment (TECA) was a prevalence survey of people from randomly selected households from three of the seven provinces of the TAR (Lhoka, Nakchu, and Lingzhr), representing its three main environmental regions. The survey, conducted in 1999 and 2000, assessed visual acuity, cause of vision loss, and eye care services. RESULTS: Among the 15,900 people enumerated, 12,644 were examined (79.6%). Cataract prevalence was 5.2% and 13.8%, for the total population, and those over age 50, respectively. Cataract surgical coverage (vision <6/60) for people age 50 and older (85-90% of cataract blind) was 56% overall, 70% for men and 47% for women. The most common barriers to use of cataract surgical services were distance and cost. In the 216 eyes with cataract surgery, 60% were aphakic and 40% were pseudophakic. Pseudophakic surgery left 19% of eyes blind (<6/60) and an additional 20% of eyes with poor vision (6/24-6/60). Aphakic surgery left 24% of eyes blind and an additional 21% of eyes with poor vision. Even though more women remained blind than men, 28% versus 18% respectively, the different was not statistically significant (p = 0.25). CONCLUSIONS: Cataract surgical coverage was remarkably high despite the difficulty of providing services to such an isolated and sparse population. Cataract surgical outcome was poor for both aphakic and pseudophakic surgery. Two main priorities are improving cataract surgical quality and cataract surgical coverage, particularly for women.

The prevalence of eye disease in Leicester: a comparison of adults of Asian and European descent.

Random samples of people aged 40 years and over were drawn from lists of patients registered with two neighbouring inner-city general practices: one predominantly with Asian patients and the other predominantly with European patients. The people selected were invited to attend specially arranged eye clinics for examination by an ophthalmologist and an optician. We examined 377 people and found that, compared to people of European descent, Asians had a significantly higher prevalence of age-related cataract: 30% compared to 3% in people aged under 60 years and 78% compared to 54% in those aged 60 years and over. The age of onset of cataract seems to be earlier in Asians. After adjustment for age, there were no statistically significant ethnic differences in the prevalences of open-angle glaucoma, macular degeneration or diabetic retinopathy.

Distinctive cataract in the Stickler syndrome.

We determined the clinical characteristics of cataract in 133 patients with the Stickler syndrome. Cataracts of various types or aphakia were found in 115 of 231 eyes (49.8%) studied. The most frequent and distinctive lesions, described as wedge and fleck cataracts, accounted for 40 of the 93 cataracts (43.0%) observed. These distinctive opacities may serve as a clinical marker for the Stickler syndrome and facilitate early diagnosis.