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1.
Clin Exp Ophthalmol ; 48(6): 730-738, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32363784

RESUMEN

IMPORTANCE: Projections of Australia's future burden of vision loss will inform eye health service delivery. BACKGROUND: This study aimed to forecast bilateral vision loss in Australia from 2020 to 2050. DESIGN: Population-based survey. PARTICIPANTS: Indigenous and non-indigenous Australians (n = 4253) aged ≥50 years from the National Eye Health Survey (NEHS, 2015-2016). METHODS: Using the age-and-sex-stratified prevalence of vision loss (better eye visual acuity <6/12) from the NEHS, the prevalence of, and number of people aged ≥50 years with, vision loss were forecast to 2050 using Australian census projections. MAIN OUTCOME MEASURE: Prevalence of, and number of Australians with, vision loss from 2020 to 2050. RESULTS: The prevalence of vision loss is predicted to increase from 6.7% to 7.5% by 2050. Owing to population dynamics, the estimated number of Australians ≥50 years old with vision loss will nearly double from 532 386 in 2016 to 1 015 021 in 2050. The greatest increase in vision loss is expected to occur in those aged ≥80 years (2.6-fold, 2016 = 144 240; 2050 = 376 296). The number of people with uncorrected refractive error is projected to increase 1.7-fold, from 331 914 in 2016 to 578 969 in 2050. CONCLUSIONS AND RELEVANCE: Due to population growth and ageing, the future burden of vision loss in Australia is likely to increase, but the magnitude of this change is uncertain due to a lack of available data on some relevant input variables. Nonetheless, efforts are required to ensure early detection and treatment of major eye conditions, particularly treatable conditions such as uncorrected refractive error and cataract.


Asunto(s)
Nativos de Hawái y Otras Islas del Pacífico , Trastornos de la Visión , Australia/epidemiología , Ceguera/epidemiología , Estudios Transversales , Encuestas Epidemiológicas , Humanos , Prevalencia , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/epidemiología
2.
Eye (Lond) ; 33(6): 957-964, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30755727

RESUMEN

PURPOSE: To describe the prevalence of visually significant cataract in Indigenous and non-Indigenous Australians. METHODS: A total of 3098 non-Indigenous Australians aged 50 years and over and 1738 Indigenous Australians aged 40 years and over, residing in 30 randomly selected Australian sites, were examined as part of the population-based National Eye Health Survey (NEHS). For those with visual acuity worse than 6/12, photos of the anterior and posterior segment were taken with a nonmydriatic fundus camera and assessed for cataract. Visually significant cataract was assigned in eyes with best-corrected visual acuity worse than 6/12 and cataract that was determined to be the primary cause of vision loss in that eye. RESULTS: In total, 99.2% (4797/4836) participants had complete data for visual acuity and cataract assessment. The overall weighted prevalence of visually significant cataract was 2.7% (95% CI: 2.0, 3.5) in non-Indigenous Australians and 4.3% (95% CI: 3.1, 5.9) among Indigenous Australians. After adjusting for age and gender, the odds of visually significant cataract were almost three times higher among Indigenous participants compared to non-Indigenous participants (adjusted odds ratio (OR) 2.95, 95% CI: 2.03, 4.29). Only 54.8% of non-Indigenous Australians and 38.9% of Indigenous Australians with visually significant cataract self-reported a known history of cataract. CONCLUSIONS: Our results suggest that continued efforts are required to build sustainable cataract surgery services within Indigenous communities. Furthermore, given the significant ageing of the Australian population, maintaining high cataract surgery rates amongst the non-Indigenous population is critical to reduce cataract-related vision loss.


Asunto(s)
Catarata/etnología , Etnicidad , Encuestas Epidemiológicas/métodos , Baja Visión/etnología , Agudeza Visual , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Catarata/complicaciones , Catarata/fisiopatología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Baja Visión/etiología , Baja Visión/fisiopatología
3.
Am J Ophthalmol ; 192: 184-197, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29885297

RESUMEN

PURPOSE: To assess outcomes of the treat-and-extend (T&E) injection regimen for neovascular age-related macular degeneration (AMD) as compared to either a monthly or a pro re nata (PRN) treatment strategy. DESIGN: Systematic review and meta-analysis. METHODS: Studies that compared the T&E regimen with either monthly or PRN dosing for treatment-naïve AMD were included. Trial eligibility, data extraction, and risk of bias were assessed according to Cochrane review methods. Estimates were pooled using random-effects meta-analysis. RESULTS: Four eligible studies were identified, all using ranibizumab (total N = 940 eyes), including 2 randomized controlled trials comparing T&E to monthly and 2 retrospective reviews comparing T&E to PRN. No studies evaluating aflibercept were identified. Improvements in vision and central retinal thickness were similar between T&E and monthly at 12 months, with a mean difference of -1.79 letters (95% confidence interval [CI]: 3.70, 0.13) and 3.76 µm (95% CI: -13.78, 21.30) in favor of monthly injections. In contrast, visual gains were higher in the T&E compared to the PRN group (difference of +6.18 letters, 95% CI: 3.28, 9.08). Fewer injections were required using the T&E regimen when compared to monthly (mean of -1.6 and -6.9 injections at 12 and 24 months, respectively). A mean of 1.44 more injections was required for the T&E compared to PRN regimen at 12 months; however, this was achieved with fewer visits. CONCLUSION: Despite the growing preference for the T&E regimen, there is limited head-to-head evidence comparing dosing strategies. The evidence available, however, suggests that at 12 months, T&E is comparable to monthly and superior to PRN dosing for both efficacy and safety outcomes when using ranibizumab.


Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Neovascularización Coroidal/tratamiento farmacológico , Ranibizumab/administración & dosificación , Degeneración Macular Húmeda/tratamiento farmacológico , Neovascularización Coroidal/fisiopatología , Protocolos Clínicos , Humanos , Inyecciones Intravítreas , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiología , Degeneración Macular Húmeda/fisiopatología
4.
Australas J Dermatol ; 58(2): 117-121, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-26821217

RESUMEN

BACKGROUND/OBJECTIVES: Paediatric melanoma is an uncommon presentation of melanoma that accounts for 3% of all paediatric cancers. The objective was to describe a series of paediatric melanoma cases presenting to a state-wide tertiary referral service over the past 19 years. METHODS: A search of the Victorian Melanoma Service database was performed to identify all patients under the age of 20 years diagnosed with melanoma from 1994 to 2013. Histological, demographic and phenotypical information for each patient was collected. Patients were matched against the Victorian Death Registry to identify those who had died. Fisher's exact test was used to examine associations. Melanoma-specific survival was estimated using the Kaplan-Meier method. RESULTS: A total of 65 paediatric melanoma patients were included for analysis, in whom 72.3% of melanomas were diagnosed when they were 16-19 years of age with a mean age at diagnosis of 16 years. The mean Breslow thickness was 1.4 mm. It was greatest (3.4 mm) in the youngest age group (< 12 years of age). Ten patients developed nodal metastatic disease, eight of which progressed to visceral metastatic disease. The 5-year melanoma-specific survival rate was 96.8%. CONCLUSION: This is the first descriptive epidemiological study of paediatric melanoma in Victoria. Further large, population-based, multi-institutional studies of paediatric melanoma are warranted to provide a clearer understanding of this group of melanoma patients.


Asunto(s)
Melanoma/mortalidad , Melanoma/secundario , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Tasa de Supervivencia , Victoria/epidemiología , Adulto Joven
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