Visual impairment in children in middle- and lower-income countries.

Reducing visual impairment and blindness in children in resource-poor countries is one of the key components of the major global prevention of blindness initiative, VISION 2020 the Right to Sight. Although visual impairment and blindness among children is much less common than among adults, the potential lifespan of a child means that the lifelong impact of such impairment is very large. Over 10 years ago, it was estimated that, globally, 1.4 million children were blind. Much has changed in the past 10-20 years and there is a need to reassess both the magnitude and causes of global childhood blindness and visual impairment. While the widespread implementation of vitamin A supplementation and measles immunisation programmes have led to a reduction in vitamin A deficiency-related blindness in many poor countries, retinopathy of prematurity is now undergoing a third wave of endemicity, particularly in newly industrialising countries in Latin America and Asia. Childhood cataract is better recognised as an important potentially avoidable problem, as is paediatric glaucoma and refractive error in some populations. Trained paediatric ophthalmologists, although still too few, are growing in number in poor countries. A programmatic approach with a multidisciplinary team is essential to reducing childhood blindness. The elements of such programmes and the need for planning are discussed.

Visual impairment due to undiagnosed refractive error in working age adults in Britain.

BACKGROUND: Detection and treatment of undiagnosed refractive error (RE), with its attendant functional consequences, is a priority of VISION 2020, the global initiative against avoidable visual disability. The authors investigated the frequency of visual impairment due to undiagnosed RE and its associations with vision-related quality of life (VRQOL), general health and social circumstances in a contemporary and nationally representative population of British working-age adults. METHODS: 9271 members of the 1958 British birth cohort had visual acuity and VRQOL assessed at 44/45 years. The authors compared those with undiagnosed RE with those with diagnosed RE, defining undiagnosed RE as >or=0.2 logMAR units/2 lines acuity improvement in both eyes with pinhole in individuals without current or prior optical treatment or ophthalmic history. RESULTS: 144/9271 (1.6%) individuals had undiagnosed and 3513/9271 (37.9%) diagnosed RE. 18% (24/144) of those with undiagnosed RE were classifiable as visually impaired. Individuals with undiagnosed RE were more likely to have a manual (vs non-manual) occupation and to be separated, divorced or widowed, and less likely to be in social or professional organisations. There is also some evidence that they are more likely to express concern, embarrassment and frustration about their eyesight and worry about coping with life. CONCLUSION: A significant proportion of working age adults in Britain appear to have undiagnosed but visually significant RE. Improvements in existing opportunities for detecting RE in adults could benefit these individuals during their working lives and avoid the serious adverse consequences associated with vision impairment in later life.

A clinical evaluation of ophthalmic assessment in children with sensori-neural deafness.

BACKGROUND: Since 1991, children with sensori-neural deafness and their families within Southern Derbyshire have been supported by a multiagency approach to their diagnosis and management. RESULTS: One hundred and twenty-two children were seen at the Child Development Centre for an holistic assessment, and 110 of these children have had an ophthalmic assessment, of whom 48 (43.6%) were found to have ophthalmic abnormalities. These included 43 children (39.1%) with refractive errors, ranging from mild to severe. Of 82 children with uncomplicated deafness, 26 (31.7%) had refractive errors. The prevalence of ophthalmic problems was higher than the prevalence in hearing school children in the literature and in local pre-school children. There were six cases of Usher syndrome. Twenty-one children had more than one eye defect. The findings indicate that deaf and hearing impaired children are two to three times more likely to develop ophthalmic abnormalities than their hearing peers, which makes early detection of paramount importance. An important local outcome has been the establishment of guidelines for ophthalmic assessment to include assessment of vision and screening for Usher syndrome by electro-physiological testing at aged 7 years and above. Screening has been completed to date in 78 children with congenital sensori-neural deafness. CONCLUSIONS: Sensitive and efficient ophthalmic assessment and management are essential for all deaf and hearing impaired children and national guidelines need to be established for both assessment of vision and screening for Usher syndrome, based on further evaluated research.

[Ametropia and heterophoria "against the rules": a solution with prisms]. / Amétropie et héterophorie "contre la régle": une solution prismatique.

This study presents the results of the prescription of small prisms in ametropic patients whose glasses increase the associated heterophoria (which we have called heterophoria "against the rule"). It concerns the myopic eso (group I), the hyperopic exo (group II) and the presbyopic exo (group III) as a particular subgroup of the former. In a population of 211 patients wearing prisms, we have selected 53 in the first group, 34 in the second group and 20 in the third group. The 3 groups were compared according to the age and the fusional complaints of the patients. In 70 to 80% of the cases the associated ametropia was very small. In more than 60% of the cases the total prismatic prescription never exceeded 2 PD. A decrease or a suppression of the prisms was possible in 50% of the cases in groups I and II and in 15% in group III. Respectively 87%, 89% and 86% of the cases became asymptomatic in each category after a mean follow-up of 6.8--4.7--5.8 years (range: 2-12). No complaint was increasing during this period and no prismatic prescription exceeded a total amount of 5 PD. A familial factor was present in 18% of the cases. This study underlines the fact that the limit of tolerance of a latent phoric unbalance is more important that the amount of heterophoria itself. This observation is fundamental for understanding the apparent paradoxal behaviour of these patients and the efficacy of an apparent "homeopathic" prescription of prisms.

Descolamento do vítreo e erro refrativo / Vitreous detachment and refractive error

O objetivo dos autores é verificar quais os sintomas associados ao diagnóstico de descolamento do vítreo posterior e sua possível relaçäo com os erros refrativos. Säo analisados 70 olhos de 35 pacientes, sendo 14 homens, com idade entre 24 e 73 anos, examinados entre novembro de 97 e maio 98. Os resultados mostraram que 30 olhos eram míopes (11 alto miopes), 30 hipermétropes, 4 astigmatas e 6 emétropes. Entre as queixas, 60 (por cento) dos olhos apresentaram moscas volantes e 14,28 (por cento) fotopsias. A incidência de deslocamento do vítreo posterior é maior após a 5 (quinta) década

Acquired peripapillary changes and progression in glaucoma.

In a review of fundus photographs, changes in the degree of depigmentation or atrophy of the retinal pigment epithelium (RPE) were observed near the disc over time in 21% of cases with progressive glaucomatous cupping, but they also occurred as a natural phenomenon over time in 4% of eyes with nonprogressive glaucoma and in 3% of nonglaucomatous eyes. Thus, the peripapillary RPE shows some progressive alteration in normal individuals, but also may sometimes suffer along with the axons during glaucomatous damage. The acquired changes observed in the progressive glaucomatous eyes seem too small and too infrequent to account for the high prevalence of large haloes and crescents seen around the optic disc in glaucoma.