[Avoidable visual impairment among residents in care institutions: lessons from an intervention project in the Den Bosch region]. / Onnodige slechtziendheid onder ouderen in zorginstellingen: lessen uit een interventieproject in de regio Den Bosch.

INTRODUCTION: Many elderly in care institutions in The Netherlands are visually impaired (visual acuity < 0.3). They fall more frequently, are more depressed and require more care. In this project visually impaired residents were identified and referred for adequate eye care. The aim of this study is to evaluate the intervention, including validation of the screening, assessment of the prevalence and causes of visual impairment as well as the outcome of the treatment. The effectiveness of the care chain is also evaluated. MATERIALS AND METHODS: 640 residents were offered a basic eye examination and 210 of them were referred, via their general practitioner, to an optometrist (10), ophthalmologist (98), or centre for visually impaired persons (1). RESULTS: Compliance in this study was poor. The prevalence of visual impairment (24%) was lower than in comparable studies. Cataract was the main cause in 51%. Overall 17 (8.1%) residents were treated by ophthalmologists and nine (4.3%) were referred to optical shops. Constraints in the care chain are identified. DISCUSSION: Vision screening in care institutions for elderly is feasible and useful. The care chain should be shorter and simpler. That will increase the effectiveness of this intervention, and thereby the quality of life for many residents.

[Increase in the demand for eye-care services in the Netherlands 2010-2020]. / Toename in de vraag naar oogzorg in Nederland 2010-2020.

OBJECTIVE: The demand for eye-care services in the Netherlands is increasing. This article indicates the causes and attempts to provide an estimate of the increase between 2010 and 2020 and to indicate what will be the consequences. DESIGN: Descriptive study. METHOD: In the absence of data on the numbers of blind and visually impaired people in the Netherlands, we used data from the records of general practitioners, yearly statistics for the number of relevant activities in hospitals and a mathematical model to calculate the number of blind and visually impaired in the Netherlands. The data mentioned were extrapolated to the population of 2020. Additionally, the expected number of new treatments of neovascular age-related macular degeneration (AMD) and macular oedema in diabetic retinopathy and retinal venous occlusion were calculated by a model. RESULTS: The number of people over 65 in the Netherlands increases by 34% between 2010 and 2020. The registrations by general practitioners show an increase of 43% of patients with eye conditions. Modelling of the new treatment methods demonstrates a threefold increase of the number of treatments. Finally, it appears that the number of blind and visually impaired people increases by 20%. The prevalence of visual impairment is the highest in elderly in health-care institutions, mentally handicapped and elderly living independently. CONCLUSION: The demand for eye-care services will increase by 200-300% between 2010 and 2020. The most important cause for this is the new treatment for 'wet' AMD and macular oedema using intravitreal angiogenesis inhibitors. The capacity of eye care services needs to be increased, partly by a redistribution of tasks between different professional groups within the eye care sector. Routine vision screening of elderly in care institutions and people with a mental handicap can reduce the number of Dutch people with avoidable visual impairment. For elderly living independently, provision of information and selective screening is indicated.

[Elderly people with visual impairment in The Netherlands]. / Visuele beperkingen bij ouderen in Nederland--risicogroepen en mogelijkheden tot interventie.

AIM: To estimate the number of elderly people with visual impairment in The Netherlands, now and in the future. Possibilities for intervention are discussed. METHODS AND MATERIALS: Estimates are based on a recent report on behalf of Foundation InZicht, ZonMw, in which prevalence data from population-based studies on blindness and low vision and its causes in The Netherlands, western Europe, The United States and Australia are related to the latest demographic data for The Netherlands. RESULTS: Of the 16.4 million Dutch in 2008 2.4 million (14.7%) are 65 years of age and older. Of this last group 155,000 persons are living in nursing homes or residential homes, the others are living in their own homes. In 2008 an estimated 77,000 persons are blind and 234,000 have low vision. Of them 79% is 65 years of age or older. Of the older people in care institutions 20% is blind (32,000) and 22% has low vision (34,000). In 62% of them the visual impairment is treatable or could have been prevented ('avoidable'). Of the older people living independently 1.2% is blind (27,000) and 6.8% has low vision (154,000). In 57% of them the affliction is avoidable. CONCLUSION: In 2008 247,000 elderly suffer from a visual impairment that could have been treated or prevented in 143,000 (58%) of them. Screening and treatment of elderly in care institutions seems indicated, as is health education to and goal-oriented screening of elderly who live independently.