Cataract Surgical Rate and Socioeconomics: A Global Study.

PURPOSE: Cataract is the leading cause of blindness and cataract surgical rate (CSR) is used as a proxy indicator of access to cataract services in a country. The aim of this study was to explore the associations between the CSR and the economic development of countries in terms of gross domestic product per capital (GDP/P) and gross national income per capita (GNI/P). METHODS: We systematically searched OVID (Medline and Embase), Pubmed, Embase.com, ISI Web of Science, and Cochrane Library databases, and retrieved additional data from unpublished reports. Cataract surgical rates and economic indicators (GDP/P, GNI/P) were collected for each country from 2005 to 2014. Complete data were used for the 50 largest countries according to World Health Organization (WHO) population estimates. Linear correlations between GDP/P and CSR were calculated. Cataract surgical rate data over two periods were used for analysis: 2005 to 2009 and 2010 to 2014 (CSR in 2009 or nearest year, CSR in 2014 or nearest year). RESULTS: Over the study period, CSR data were available for 152 countries across both time periods. Most of the CSR data were obtained from nongovernment organization (NGO) reports, including WHO reports. A good linear correlation between CSR and GDP/P was found overall, nearest to 2009 (ß = 0.162, Linear: y = 0.162x + 282.242; R2 = 0.665, P < 0.001). Regression analysis of CSR nearest to 2014 produced similar findings, with significant correlations between CSR and GDP/P (Linear: y = 0.208x + 94.008; R2 = 0.785, P < 0.001). When using GNI/P as an economic indicator, similarly excellent lines of fit were obtained. After adjusting for time and country, CSR was significantly associated with GDP/P (Coefficient = 0.147, R2 = 0.759, P < 0.001), and GNI/P (Coefficient = 0.152, R2 = 0.757, P < 0.001). Most countries had an increase in CSRs over time, with the greatest increases observed for Iran and Argentina. CONCLUSION: Cataract surgical rate and economic indicators are closely associated, indicating the strong influence of resource availability on healthcare delivery. Considering this relationship, it is important to be innovative in delivery of low-cost services and invest strategically in capacity development to meet cataract surgical need in low-resource settings.

Evaluation of patient age as a risk factor for intraocular pressure elevation after intravitreal triamcinolone.

PURPOSE: To evaluate the effect of patient age on intraocular pressure (IOP) response after intravitreal injection of triamcinolone acetonide (IVTA). DESIGN: Interventional case series. METHODS: A total of 164 outpatients (164 eyes) aged 21 to 80 years (mean, 56.8 years), presenting with exudative age-related maculopathy (51) or macular edema of various etiologies (113), received IVTA (4 mg/0.1 ml). The primary outcome measure was IOP elevation >21 mm Hg. Patients were re-evaluated at one week, and one, three, and six months. RESULTS: The mean baseline IOP was 15.07 mm Hg; the mean rise was 6.6 mm Hg. IOP >21 mm Hg was observed in 42 (25.6%) patients. In the age group

Software for reading and grading diabetic retinopathy: Aravind Diabetic Retinopathy Screening 3.0.

OBJECTIVE: To evaluate the validity and reproducibility of software for reading digital images and grading diabetic retinopathy. RESEARCH DESIGN AND METHODS: A prospective, comparative observational study was conducted on a series of patients with type 2 diabetes who presented at the retina clinic of a tertiary care center in India. A total of 210 eyes of 105 patients were allocated to one of three ophthalmologists, who performed dilated indirect and direct ophthalmoscopy and subsequently assessed the digital images of the same group of patients who were masked to the patient's identity. The interobserver and intertest agreement between clinical assessments and grading of diabetic retinopathy using the software was estimated. RESULTS: Moderate nonproliferative diabetic retinopathy (NPDR) was most frequently diagnosed, both clinically and on evaluating digital images. The overall agreement between the clinical grading of diabetic retinopathy and the grading of images was 81.3% (kappa = 0.69, SE 0.04, P < 0.0001); there was good agreement (81.3%) for NPDR (kappa = 0.61, SE 0.05, P < 0.0001), but agreement was not as good (54.6%) for proliferative diabetic retinopathy (kappa = 0.29, SE 0.11, P = 0.005). Clinically significant macular edema was diagnosed in 33.3% (70 of 210) of eyes clinically and in 40.2% (84 of 209) of eyes by grading images, and there was good agreement (89.5%) between the two (kappa = 0.77, SE 0.07, P < 0.0001). CONCLUSIONS: Aravind Diabetic Retinopathy Screening 3.0 is a simple and valid tool to assist in the detection of sight-threatening retinopathy and could supplement dilated fundus examinations by ophthalmologists on patients to detect diabetic retinopathy.