Clinical Profile of Low Vision Patients Attending in Low Vision Clinic in a Tertiary Care Hospital.

The purpose of the study was to determine the disease profile of patients attending the low vision clinic of a tertiary eye care hospital at National Institute of Ophthalmology & Hospital (NIO&H), Dhaka, Bangladesh July 2016 to June 2017. Low vision and blindness are major causes of morbidity and an economic burden on the individual, family and the country. Low vision service has emerged as a major challenge faced by the developing countries .so prompt diagnosis; early treatment and early use of low vision devices can improve the quality of life. It was a prospective observational study conducted in low vision clinic at a tertiary care hospital in Bangladesh for one year. A total 419 patient, aged 6-60 years among them 267(63.7%) were male and 152(36.3%) were female. The leading causes of low vision in patient attending the low vision clinic were Retinitis pigmentosa (31.3%) macular dystrophy/stargards diseases & maculopathy (20.3%) and myopia with macular degeneration (14.8%). The percentage of visual impaired (6/18-6/60) were 38.3%, severely visual impaired (<6/60-3/60) were 24.4% & (<3/60) 37.3%. Almost all the patient was prescribed spectacles and Telescope for distant vision, Hand held magnifier and video magnifier were prescribed for near vision. Vision improved with low vision devices (6/18 or better) in 49.5%, (6/18-6/60) in 47.3%, (<6/60-3/60) in 2.8%, (<3/60) in 0.3% patient. Vision with low vision devices were significantly changes (p=0.001). The present study shows that hereditary ocular anomalies (Retinitis pigmentosa, macular dystrophy, myopic degeneration) and amblyopia were more common causes of low vision in this part of world.

[Study on the status of low vision among students of Beijing in 2017].

Objective: The purpose of this study was to describe the status quo and related factors on low vision (LV) among students of Beijing. Methods: All the students in Beijing were included as the subjects of interest, based on the reference of the Chinese National Survey on Students' Constitution and Health. Results: The overall rate of LV among students in Beijing was 58.6% in 2017, with 61.6% in females, higher than 55.9% in males. LV also appeared higher in urban than in rural areas. The rates of LV appeared as 46.8%, 78.0%, 89.0%, 71.0%, in students from primary, middle, high or vocational high schools, respectively. Rates on light, moderate or severe LV were 8.4%, 17.8% and 32.5%, respectively. Conclusions: The overall rate of LV among students in Beijing was considered high. Students in preschool, in 4-6 grades and the 2(nd) grade of middle schools, were at the key stages of developing vision-related problems. Factors as heavy load on homework, lack of outdoor activities and 'limit of vision space' as well as incorrect reading behavior during puberty, need to be of concern.

The prevalence of visually significant cataract in the Australian National Eye Health Survey.

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.

Disparities in Low-Vision Device Use Among Older US Medicare Recipients.

Importance: Low-vision assistive devices are not covered by Medicare and many private insurers, although there is evidence that they can improve functioning and quality of life. Little is known about whether sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries. Objective: To determine if sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries. Design, Setting, and Participants: Cross-sectional population-based survey. The National Health Interview Survey is an annually administered nationally representative US survey. Data used in this study were from the 2002, 2008, and 2016 National Health Interview Survey vision supplement. Participants who were Medicare beneficiaries 65 years and older with self-reported vision impairment were included. Main Outcomes and Measures: Multivariable logistic regression was performed to evaluate if sociodemographic or economic factors were associated with self-reported use of low-vision devices or low-vision rehabilitation among Medicare beneficiaries 65 years and older who self-reported vision impairment. Results: There were 3058 participants included in the study. The survey weighted proportion of participants who were men was 37.9% (95% CI, 35.8%-40.0%), while 79.1% (95% CI, 77.2%-80.9%) were non-Hispanic white, 10.2% (95% CI, 9.0%-11.5%) were non-Hispanic black, 6.7% (95% CI, 5.6%-8.1%) were Hispanic, and 4.0% (95% CI, 3.2%-5.0%) identified with another race/ethnicity. The weighted proportion who reported using low-vison devices and low-vision rehabilitation were 26.1% (95% CI, 24.2%-28.1%) and 3.5% (95% CI, 2.8%-4.3%), respectively. In a model adjusted for ocular diagnoses, Hispanic individuals (odds ratio, 0.61; 95% CI, 0.39-0.97) and individuals from other races/ethnicities (odds ratio, 0.39; 95% CI, 0.19-0.80), but not black individuals, were significantly less likely to report using low-vision devices than white individuals. In the model that was not adjusted for ocular diagnoses, black individuals (odds ratio, 0.73; 95% CI, 0.54-0.99) were also significantly less likely to report using low-vision devices. There were no significant racial/ethnic disparities for reported use of low-vision rehabilitation. Conclusions and Relevance: Additional research is needed to clarify the association between sociodemographics and use of low-vision services in the Medicare population. However, policy makers could consider expanding Medicare coverage to include low-vision devices in an effort to address significant disparities in the use of this evidence-based intervention.

CCDC102B confers risk of low vision and blindness in high myopia.

The incidence of high myopia is increasing worldwide with myopic maculopathy, a complication of myopia, often progressing to blindness. Our two-stage genome-wide association study of myopic maculopathy identifies a susceptibility locus at rs11873439 in an intron of CCDC102B (P = 1.77 × 10-12 and Pcorr = 1.61 × 10-10). In contrast, this SNP is not significantly associated with myopia itself. The association between rs11873439 and myopic maculopathy is further confirmed in 2317 highly myopic patients (P = 2.40 × 10-6 and Pcorr = 1.72 × 10-4). CCDC102B is strongly expressed in the retinal pigment epithelium and choroids, where atrophic changes initially occur in myopic maculopathy. The development of myopic maculopathy thus likely exhibits a unique background apart from the development of myopia itself; elucidation of the roles of CCDC102B in myopic maculopathy development may thus provide insights into preventive methods for blindness in patients with high myopia.

Prevalence and causes of blindness, visual impairment among different ethnical minority groups in Xinjiang Uygur autonomous region, China.

BACKGROUND: The aim of this cross-sectional study is to ascertain the prevalence and causes of blindness, visual impairment, uptake of cataract surgery among different ethnic groups in Xinjiang Uygur Autonomous Region, China. METHODS: Four thousand one hundred fifty people at 50 years and above from different minority ethnic groups were randomly selected for an eye examination. The four trained eye teams collected data using tumbling E visual chart, torch, portable slit lamp and direct ophthalmoscope in 2015. The World Health Organization's definition of blindness and visual impairment (VI) was used to classify patients in each ethnic group. Data were analyzed by different minority groups and were compared with Han Chinese. RESULTS: 3977 (95.8%) out of 4150 people were examined. The prevalence of blindness from the study population was 1.7% (95% confidence interval: 1.3-2.2%).There was no significant difference in prevalence of blindness between Han Chinese and people of Khazak and other minority ethnic groups, nor, between male and female. Cataract was the leading course (65.5%) of blindness and uncorrected refractive error was the most common cause of VI (36.3%) followed by myopic retinopathy. The most common barrier to cataract surgery was lack of awareness of service availability. CONCLUSIONS: This study documented a low blindness prevalence among people aged 50 years and over comparing to prevalence identified through studies of other regions in China. It still indicates blindness and un-operated cataract as the significant public health issue, with no evidence of eye health inequalities, but some inequities in accessing to cataract surgery amongst ethnic minority groups in Xinjiang.

Association of disease-specific causes of visual impairment and 10-year mortality amongst Indigenous Australians: the Central Australian Ocular Health Study.

IMPORTANCE: Visual impairment significantly impairs the length and quality of life, but little is known of its impact in Indigenous Australians. BACKGROUND: To investigate the association of disease-specific causes of visual impairment with all-cause mortality. DESIGN: A retrospective cohort analysis. PARTICIPANTS: A total of 1347 Indigenous Australians aged over 40 years. METHODS: Participants visiting remote medical clinics underwent clinical examinations including visual acuity, subjective refraction and slit-lamp examination of the anterior and posterior segments. The major ocular cause of visual impairment was determined. Patients were assessed periodically in these remote clinics for the succeeding 10 years after recruitment. Mortality rates were obtained from relevant departments. MAIN OUTCOME MEASURES: All-cause 10-year mortality and its association with disease-specific causes of visual impairment. RESULTS: The all-cause mortality rate for the entire cohort was 29.3% at the 10-year completion of follow-up. Of those with visual impairment, the overall mortality rate was 44.9%. The mortality rates differed for those with visual impairment due to cataract (59.8%), diabetic retinopathy (48.4%), trachoma (46.6%), 'other' (36.2%) and refractive error (33.4%) (P < 0.0001). Only those with visual impairment from diabetic retinopathy were any more likely to die during the 10 years of follow-up when compared with those without visual impairment (HR 1.70; 95% CI, 1.00-2.87; P = 0.049). CONCLUSIONS AND RELEVANCE: Visual impairment was associated with all-cause mortality in a cohort of Indigenous Australians. However, diabetic retinopathy was the only ocular disease that significantly increased the risk of mortality. Visual impairment secondary to diabetic retinopathy may be an important predictor of mortality.

The Prevalence and Causes of Vision Loss in Indigenous and Non-Indigenous Australians: The National Eye Health Survey.

PURPOSE: To conduct a nationwide survey on the prevalence and causes of vision loss in Indigenous and non-Indigenous Australians. DESIGN: Nationwide, cross-sectional, population-based survey. PARTICIPANTS: Indigenous Australians aged 40 years or older and non-Indigenous Australians aged 50 years and older. METHODS: Multistage random-cluster sampling was used to select 3098 non-Indigenous Australians and 1738 Indigenous Australians from 30 sites across 5 remoteness strata (response rate of 71.5%). Sociodemographic and health data were collected using an interviewer-administered questionnaire. Trained examiners conducted standardized eye examinations, including visual acuity, perimetry, slit-lamp examination, intraocular pressure, and fundus photography. The prevalence and main causes of bilateral presenting vision loss (visual acuity <6/12 in the better eye) were determined, and risk factors were identified. MAIN OUTCOME MEASURES: Prevalence and main causes of vision loss. RESULTS: The overall prevalence of vision loss in Australia was 6.6% (95% confidence interval [CI], 5.4-7.8). The prevalence of vision loss was 11.2% (95% CI, 9.5-13.1) in Indigenous Australians and 6.5% (95% CI, 5.3-7.9) in non-Indigenous Australians. Vision loss was 2.8 times more prevalent in Indigenous Australians than in non-Indigenous Australians after age and gender adjustment (17.7%, 95% CI, 14.5-21.0 vs. 6.4%, 95% CI, 5.2-7.6, P < 0.001). In non-Indigenous Australians, the leading causes of vision loss were uncorrected refractive error (61.3%), cataract (13.2%), and age-related macular degeneration (10.3%). In Indigenous Australians, the leading causes of vision loss were uncorrected refractive error (60.8%), cataract (20.1%), and diabetic retinopathy (5.2%). In non-Indigenous Australians, increasing age (odds ratio [OR], 1.72 per decade) and having not had an eye examination within the past year (OR, 1.61) were risk factors for vision loss. Risk factors in Indigenous Australians included older age (OR, 1.61 per decade), remoteness (OR, 2.02), gender (OR, 0.60 for men), and diabetes in combination with never having had an eye examination (OR, 14.47). CONCLUSIONS: Vision loss is more prevalent in Indigenous Australians than in non-Indigenous Australians, highlighting that improvements in eye healthcare in Indigenous communities are required. The leading causes of vision loss were uncorrected refractive error and cataract, which are readily treatable. Other countries with Indigenous communities may benefit from conducting similar surveys of Indigenous and non-Indigenous populations.

Visual Impairment in Preschool Children in the United States: Demographic and Geographic Variations From 2015 to 2060.

Importance: Visual impairment (VI) in early childhood can significantly impair development. Objective: To determine demographic and geographic variations in VI in children aged 3 to 5 years in the United States in 2015 and to estimate projected prevalence through 2060. Design, Setting, and Participants: Descriptive study reporting statistics estimated based on prevalence data from 2 major population-based studies conducted in the United States between 2003 and 2011. Using US census projections, prevalence of VI and cause-specific VI in the better eye were reported by race/ethnicity, state and region, and per capita prevalence of VI by state. The study included preschool children in the United States. Analyses for this study were conducted between February 2016 and March 2017. Main Outcomes and Measures: Prevalence of VI among children aged 3 to 5 years in the United States. Results: In 2015, more than 174 000 children aged 3 to 5 years in the United States were visually impaired. Almost 121 000 of these cases (69%) arose from simple uncorrected refractive error, and 43 000 (25%) from bilateral amblyopia. By 2060, the number of children aged 3 to 5 years with VI is projected to increase by 26%. In 2015, Hispanic white children accounted for the highest number of VI cases (66 000); this group will remain the most affected through 2060, with an increasingly large proportion of cases (37.7% in 2015 and 43.6% in 2060). The racial/ethnic group with the second most VI is projected to shift from non-Hispanic white children (26.3% in 2015 decreasing to 16.5% in 2060) to African American children (24.5% in 2015 and 22.0% in 2060). From 2015 to 2060, the states projected to have the most children with VI are California (26 600 in 2015 and 38 000 in 2060), Texas (21 500 in 2015 and 29 100 in 2060), and Florida (10 900 in 2015 and 13 900 in 2060). Conclusions and Relevance: These data suggest that the number of preschool children with VI is projected to increase disproportionally, especially among minority populations. Vision screening for refractive error and related eye diseases may prevent a high proportion of preschool children from experiencing unnecessary VI and associated developmental delays.

Prevalence and Causes of Visual Impairment and Blindness in Chinese American Adults: The Chinese American Eye Study.

IMPORTANCE: Visual impairment (VI) and blindness continue to be major public health problems worldwide. Despite previously published studies on VI in Chinese and other racial/ethnic populations, there are no data specific to Chinese American adults. OBJECTIVES: To determine the age- and sex-specific prevalence and causes of VI and blindness in adult Chinese Americans and to compare the prevalence to other racial/ethnic groups. DESIGN, SETTING, AND PARTICIPANTS: In this population-based, cross-sectional study of 10 US Census tracts in the city of Monterey Park, California, 4582 Chinese American adults 50 years and older underwent complete ophthalmologic examinations, including measurement of presenting and best-corrected visual acuity (BCVA) for distance using the Early Treatment Diabetic Retinopathy Study protocol from February 1, 2010, through October 31, 2013. MAIN OUTCOMES AND MEASURES: Age-specific prevalence and causes of VI and blindness for presenting and BCVA. RESULTS: Of the 5782 eligible adults, 4582 (79.2%) completed an in-clinic eye examination. Of the 4582 participants, most were born in China (3149 [68.7%]), female (2901 [63.3%]), and married (3458 [75.5%]). The mean (SD) age was 61 (9) years. The prevalence of presenting VI was 3.0% (95% CI, 2.5%-3.5%), with 60.0% of this prevalence being attributed to uncorrected refractive error. The overall age-adjusted prevalence for VI (BCVA of ≤20/40 in the better eye) was 1.2% (95% CI, 0.9%-1.5%). The overall age-adjusted prevalence of blindness (BCVA of ≤20/200 in the better-seeing eye) was 0.07% (95% CI, 0%-0.2%). The prevalence of VI and blindness was higher in older Chinese Americans compared with younger. The primary causes of VI were cataracts and myopic retinopathy; the primary cause of blindness was myopic retinopathy. CONCLUSIONS AND RELEVANCE: The prevalence of VI in Chinese Americans is similar to that of non-Hispanic white and Latino individuals in the United States and similar to or lower than the prevalence previously reported for Chinese adults from non-US studies. The prevalence of blindness is lower than that noted in other US or non-US studies. Myopic retinopathy is a frequent cause of VI and blindness in Chinese Americans that has not been commonly observed in other racial/ethnic groups. Because myopia frequently develops at a young age, Chinese Americans should be educated regarding the importance of regular screening of preschool and school-aged children to reduce the development and progression of myopia.

Low Vision Rehabilitation for Adult African Americans in Two Settings.

PURPOSE: The Vision Rehabilitation for African Americans with Central Vision Impairment (VISRAC) study is a demonstration project evaluating how modifications in vision rehabilitation can improve the use of functional vision. METHODS: Fifty-five African Americans 40 years of age and older with central vision impairment were randomly assigned to receive either clinic-based (CB) or home-based (HB) low vision rehabilitation services. Forty-eight subjects completed the study. The primary outcome was the change in functional vision in activities of daily living, as assessed with the Veteran's Administration Low-Vision Visual Function Questionnaire (VFQ-48). This included scores for overall visual ability and visual ability domains (reading, mobility, visual information processing, and visual motor skills). Each score was normalized into logit estimates by Rasch analysis. Linear regression models were used to compare the difference in the total score and each domain score between the two intervention groups. The significance level for each comparison was set at 0.05. RESULTS: Both CB and HB groups showed significant improvement in overall visual ability at the final visit compared with baseline. The CB group showed greater improvement than the HB group (mean of 1.28 vs. 0.87 logits change), though the group difference is not significant (p = 0.057). The CB group visual motor skills score showed significant improvement over the HB group score (mean of 3.30 vs. 1.34 logits change, p = 0.044). The differences in improvement of the reading and visual information processing scores were not significant (p = 0.054 and p = 0.509) between groups. Neither group had significant improvement in the mobility score, which was not part of the rehabilitation program. CONCLUSIONS: Vision rehabilitation is effective for this study population regardless of location. Possible reasons why the CB group performed better than the HB group include a number of psychosocial factors as well as the more standardized distraction-free work environment within the clinic setting.

Disparities in Vision Loss Due to Cataracts in Hispanic Women in the United States.

PURPOSE: To review the current literature on the prevalence of cataract in Hispanic females living in the United States. METHODS: Review relevant literature on cataract, eye disease, and health practices of Hispanics living in the U.S. RESULTS: Females comprise 64.5% of blind persons worldwide. Internationally, female gender is associated with lower awareness of cataract and other diseases of the eye and women are less likely to have cataract surgery than men in low- and middle-income countries. CONCLUSION: Hispanic women receive disparate care compared to their male counterparts. The etiology of this is likely multifactorial but possible contributors include genetics, gender roles, and personal healthcare decisions. Interventions to address this disparity should be targeted, efficient, and sustainable.

Visual Impairment in White, Chinese, Black, and Hispanic Participants from the Multi-Ethnic Study of Atherosclerosis Cohort.

PURPOSE: To describe the prevalence of visual impairment and examine its association with demographic, socioeconomic, and health characteristics in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. METHODS: Visual acuity data were obtained from 6134 participants, aged 46-87 years at time of examination between 2002 and 2004 (mean age 64 years, 47.6% male), from six communities in the United States. Visual impairment was defined as presenting visual acuity 20/50 or worse in the better-seeing eye. Risk factors were included in multivariable logistic regression models to determine their impact on visual impairment for men and women in each racial/ethnic group. RESULTS: Among all participants, 6.6% (n = 421) had visual impairment, including 5.6% of men (n = 178) and 7.5% of women (n = 243). Prevalence of impairment ranged from 4.2% (n = 52) and 6.0% (n = 77) in white men and women, respectively, to 7.6% (n = 37) and 11.6% (n = 44) in Chinese men and women, respectively. Older age was significantly associated with visual impairment in both men and women, particularly in those with lower socioeconomic status, but the effects of increasing age were more pronounced in men. Two-thirds of participants already wore distance correction, and not unexpectedly, a lower prevalence of visual impairment was seen in this group; however, 2.4% of men and 3.5% of women with current distance correction had correctable visual impairment, most notably among seniors. CONCLUSION: Even in the U.S. where prevalence of refractive correction is high, both visual impairment and uncorrected refractive error represent current public health challenges.

Prevalence and Causes of Visual Impairment in a Chinese Adult Population: The Taizhou Eye Study.

PURPOSE: To study the current prevalence and causes of low vision and blindness in an adult Chinese population. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: We used a random cluster sampling method and evaluated 10 234 eligible subjects ≥45 years old (response rate, 78.1%) in the Taizhou Eye Study. METHODS: Examinations were performed from July 2012 through December 2013. Participants underwent a detailed examination, including uncorrected visual acuity, best-corrected visual acuity (BCVA), intraocular pressure, axial length, slit-lamp, and fundus examinations to evaluate the prevalence and primary causes of visual impairment (VI). MAIN OUTCOME MEASURES: We defined low vision and blindness according to the World Health Organization (WHO) criteria (low vision: BCVA, <20/63-≥20/400; blindness: BCVA, <20/400 in the better eye) and United States criteria (low vision: BCVA, <20/40-≥20/200; blindness: BCVA, <20/200 in the better eye). RESULTS: Using the WHO BCVA criteria, the standardized prevalence of bilateral low vision and blindness were 5.1% and 1.0%, respectively. Using the United States BCVA criteria, the standardized prevalence were 12.8% and 1.5%, respectively. Using the WHO criteria, the primary causes of bilateral low vision and blindness were cataract (59.1% and 48.5%, respectively), myopic macular degeneration (17.6% and 17.2%, respectively), and age-related macular degeneration (11.6% and 10.1%, respectively). The primary causes of monocular low vision were cataract (55.6%), age-related macular degeneration (12.6%), and myopic macular degeneration (8.9%), whereas those of monocular blindness were cataract (46.8%), atrophy of eyeball or prosthetic eye (10.2%), and cornea opacity (7.3%). A further analysis revealed that in adults 45-59 years old, myopic macular degeneration (59.6% and 27.2%, respectively) and cataract (13.8% and 23.4%, respectively) were the leading causes of bilateral and monocular VI. In adults ≥60 years old, cataract (66.8% and 61.2%, respectively) and age-related macular degeneration (12.6% and 11.8%, respectively) were the primary causes of bilateral and monocular VI. CONCLUSIONS: The prevalence of low vision and blindness in Chinese adults remains a severe public health problem. In the Taizhou Eye Study, cataract was the leading cause of low vision and blindness. Myopic macular degeneration and cataract were the primary causes of VI in adults 45-59 years and ≥60 years old, respectively.

Visual Impairment and Blindness Avoided with Ranibizumab in Hispanic and Non-Hispanic Whites with Diabetic Macular Edema in the United States.

OBJECTIVE: To estimate visual impairment (VI) and blindness avoided with intravitreal ranibizumab 0.3 mg treatment for central-involved diabetic macular edema (DME) among Hispanic and non-Hispanic white individuals in the United States. DESIGN: Population-based model simulating visual acuity (VA) outcomes over 2 years after diagnosis and treatment of DME. PARTICIPANTS: Visual acuity changes with and without ranibizumab were based on data from the RISE, RIDE, and DRCR Network trials. METHODS: For the better-seeing eye, VA outcomes included VI, defined as worse than 20/40 in the better-seeing eye, and blindness, defined as VA of 20/200 or worse in the better-seeing eye. Incidence of 1 or both eyes with central-involved DME in 2010 were estimated based on the 2010 United States population, prevalence of diabetes mellitus, and 1-year central-involved DME incidence rate. Sixty-one percent of incident individuals had bilateral DME and 39% had unilateral DME, but DME could develop in the fellow eye. MAIN OUTCOMES MEASURES: Cases of VI and blindness avoided with ranibizumab treatment. RESULTS: Among approximately 102 million Hispanic and non-Hispanic white individuals in the United States 45 years of age and older in 2010, an estimated 37 274 had central-involved DME and VI eligible for ranibizumab treatment. Compared with no ranibizumab treatment, the model predicted that ranibizumab 0.3 mg every 4 weeks would reduce the number of individuals with VI from 11 438 (95% simulation interval [SI], 7249-16 077) to 6304 (95% SI, 3921-8981), a 45% (95% SI, 36%-53%) reduction at 2 years. Ranibizumab would reduce the number of incident eyes with VA worse than 20/40 from 16 910 (95% SI, 10 729-23 577) to 9361 (95% SI, 5839-13 245), a 45% (95% SI, 38%-51%) reduction. Ranibizumab was estimated to reduce the number of individuals with legal blindness by 75% (95% SI, 58%-88%) and the number of incident eyes with VA of 20/200 or worse by 76% (95% SI, 63%-87%). CONCLUSIONS: This model suggests that ranibizumab 0.3 mg every 4 weeks substantially reduces prevalence of VI and legal blindness 2 years after initiating treatment among Hispanic and non-Hispanic white individuals in the United States with central-involved DME that has caused vision loss.

Retinal damage and vision loss in African American multiple sclerosis patients.

OBJECTIVE: To determine whether African American (AA) multiple sclerosis (MS) patients exhibit more retinal damage and visual impairment compared to Caucasian American (CA) MS patients. METHODS: A total of 687 MS patients (81 AAs) and 110 healthy control (HC) subjects (14 AAs) were recruited at 3 academic hospitals between 2008 and 2012. Using mixed effects regression models, we compared high- and low-contrast visual acuity (HCVA and LCVA) and high-definition spectral domain optical coherence tomography measures of retinal architecture between MS patients of self-identified AA and CA ancestry. RESULTS: In HCs, baseline peripapillary retinal nerve fiber layer (RNFL) thickness was 6.1µm greater in AAs (p = 0.047), whereas ganglion cell/inner plexiform layer (GCIP) thickness did not differ by race. In MS patients, baseline RNFL did not differ by race, and GCIP was 3.98µm thinner in AAs (p = 0.004). AAs had faster RNFL and GCIP thinning rates compared to CAs (p = 0.004 and p = 0.046, respectively). AA MS patients had lower baseline HCVA (p = 0.02) and worse LCVA per year of disease duration (p = 0.039). Among patients with an acute optic neuritis (AON) history, AAs had greater loss of HCVA than CA patients (p = 0.012). INTERPRETATION: This multicenter investigation provides objective evidence that AA MS patients exhibit accelerated retinal damage compared to CA MS patients. Self-identified AA ancestry is associated with worse MS-related visual disability, particularly in the context of an AON history, suggesting a more aggressive inflammatory disease course among AA MS patients or a subpopulation therein.

Eye care use among a high-risk diabetic population seen in a public hospital's clinics.

IMPORTANCE: Little is known regarding eye care use among low-income persons with diabetes mellitus, especially African Americans. OBJECTIVE: To investigate eye care use among patients with diabetes who were seen in a county hospital clinic that primarily serves high-risk, low-income, non-Hispanic African American patients. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study with 2 years of follow-up examined eye care use among adult patients with diabetes seen in 2007 in an outpatient medical clinic of a large, urban county hospital that primarily serves low-income, non-Hispanic African American patients. Patients with a history of retinopathy and macular edema or a current diagnosis indicating ophthalmic complications were excluded. Eye care use was defined dichotomously as whether or not patients had a visit to the eye clinic for any eye care examination or procedure. We estimated crude and adjusted rate ratios (aRRs) and 95% CIs for the association between eye care use and selected clinical and demographic characteristics. RESULTS: There were 867 patients with diabetes identified: 61.9% were women, 76.2% were non-Hispanic African American, and 61.4% were indigent, with a mean age of 51.8 years. Eye care utilization rates were 33.2% within 1 and 45.0% within 2 years. For patients aged 19 to 39 years compared with those aged 65 years or older, significantly decreased eye care utilization rates were observed within 1 year (aRR, 0.48; 95% CI, 0.27-0.84) and within 2 years (aRR, 0.61; 95% CI, 0.38-0.99). CONCLUSIONS AND RELEVANCE: Overall eye care utilization rates were low. Additional education efforts to increase the perception of need among urban minority populations may be enhanced if focused on younger persons with diabetes.

Impact of glaucoma severity and laterality on vision-specific functioning: the Singapore Malay eye study.

PURPOSE: We determined the impact of glaucoma severity and laterality on vision-specific functioning (VF) in an Asian population. METHODS: The Singapore Malay Eye Study (SiMES) was a population-based cross-sectional study of 3280 Malays aged 40 to 80 years. VF was assessed using the VF-11 questionnaire. Associations between VF-11 score and glaucoma clinical indices (glaucoma severity in better and worse eyes, and laterality) were determined by multivariate regression modeling. Glaucoma severity was defined as mild, moderate, advanced, and severe based on the Hodapp-Anderson-Parish system. Rasch analysis was used to validate the VF-11 and determine its psychometric properties. RESULTS: Of 926 persons analyzed, 123 had glaucoma (13.3% glaucoma prevalence in analyzed sample). The mean ± SD VF score was 3.64 ± 1.05 log of odds units (Logits). In multivariate models adjusting for sociodemographic, ocular, and systemic variables, poorer VF was associated with increasingly worse eye visual field loss (ß = 0.016, 95% confidence interval [CI] 0.004-0.029, P < 0.001), but not that of the better eye (P > 0.05). Compared to controls, VF was reduced in individuals with worse eye advanced and severe glaucoma (ß = -0.65, 95% CI -1.03 to -0.28, P < 0.05), but not mild or moderate glaucoma (P > 0.05). Compared to controls, VF was reduced in unilateral (ß = -0.29, 95% CI -0.54 to -0.04, P < 0.05), but not bilateral glaucoma (P > 0.05). These associations remained significant after adjusting for presenting and best-corrected visual acuity. CONCLUSIONS: Among Singaporean Malays, unilateral, and advanced and severe glaucoma in the worse eye significantly impacts on VF. Identifying early-stage glaucoma, preventing progression, and visual rehabilitation in advanced glaucoma are important aspects of glaucoma management.