Prevalence of age-related macular degeneration in Nakuru, Kenya: a cross-sectional population-based study.

BACKGROUND: Diseases of the posterior segment of the eye, including age-related macular degeneration (AMD), have recently been recognised as the leading or second leading cause of blindness in several African countries. However, prevalence of AMD alone has not been assessed. We hypothesized that AMD is an important cause of visual impairment among elderly people in Nakuru, Kenya, and therefore sought to assess the prevalence and predictors of AMD in a diverse adult Kenyan population. METHODS AND FINDINGS: In a population-based cross-sectional survey in the Nakuru District of Kenya, 100 clusters of 50 people 50 y of age or older were selected by probability-proportional-to-size sampling between 26 January 2007 and 11 November 2008. Households within clusters were selected through compact segment sampling. All participants underwent a standardised interview and comprehensive eye examination, including dilated slit lamp examination by an ophthalmologist and digital retinal photography. Images were graded for the presence and severity of AMD lesions following a modified version of the International Classification and Grading System for Age-Related Maculopathy. Comparison was made between slit lamp biomicroscopy (SLB) and photographic grading. Of 4,381 participants, fundus photographs were gradable for 3,304 persons (75.4%), and SLB was completed for 4,312 (98%). Early and late AMD prevalence were 11.2% and 1.2%, respectively, among participants graded on images. Prevalence of AMD by SLB was 6.7% and 0.7% for early and late AMD, respectively. SLB underdiagnosed AMD relative to photographic grading by a factor of 1.7. After controlling for age, women had a higher prevalence of early AMD than men (odds ratio 1.5; 95% CI, 1.2-1.9). Overall prevalence rose significantly with each decade of age. We estimate that, in Kenya, 283,900 to 362,800 people 50 y and older have early AMD and 25,200 to 50,500 have late AMD, based on population estimates in 2007. CONCLUSIONS: AMD is an important cause of visual impairment and blindness in Kenya. Greater availability of low vision services and ophthalmologist training in diagnosis and treatment of AMD would be appropriate next steps. Please see later in the article for the Editors' Summary

Glaucomatous vertical vessel density asymmetry of the temporal raphe detected with optical coherence tomography angiography.

Changes in retinal vasculature and ocular circulation may play an important role in the glaucoma development and progression. We evaluated the vertical asymmetry across the temporal raphe of the deep retinal layer vessel density, using swept-source optical coherence tomography angiography (SS-OCTA), and its relationship with the central visual field (VF) loss. Thirty-four eyes of 27 patients with open-angle glaucoma were included. SS-OCTA macular scanning was performed within a 3 × 3 mm (300 × 300 pixels) volume, centred on the fovea. The relationships between the vertical asymmetrical deep retinal vessel density reduction (ADRVD) across the temporal raphe and various ocular parameters were analysed. Twenty-two glaucomatous eyes with ADRVDs had central VF loss. Contrarily, ADRVDs were not found in any of the 12 eyes without central VF loss. Thirteen eyes (59.1%) with central VF loss had ADRVDs topographically corresponding to the central VF loss and macular ganglion cell complex thinning. The glaucomatous eyes with ADRVDs exhibited inferior rather than superior central VF loss (P = 0.032). Thus, ADRVD specifically indicates the glaucomatous central visual loss. Further analysis of ADRVD may improve our understanding on glaucoma pathogenesis, offering new treatment insights

A Rule Based Segmentation Approaches to Extract Retinal Blood Vessels in Fundus Image

The physiological structures of the retinal blood vessel are one of the key features that visible in the retinal images and contain the information associate with the anatomical abnormalities. It is accepted all over the world to judge the cardiovascular and retinal disease. To avoid the risk of visual impairment, appropriate vessel segmentation is mandatory. Here has proposed a segmentation algorithm that efficiently extracts the blood vessels from the retinal fundus image. The proposed segmentation algorithm is performed Lab and Principle Component (PC) based gray level conversion, Contrast Limited Adaptive Histogram Equalization (CLAHE), morphological operations, Local Property-Based Pixel Correction (LPBPC). For appropriate detection proposed vessels correction algorithm LPBPC that check the feature of the vessels and remove the wrong vessel detection. To measure the appropriateness of the proposed algorithm, the experimental results are compared with the corresponding ground truth images. The experimental results have shown that the proposed blood vessel algorithm is more accurate than the existing algorithms

Eye Disease Detection Using Computer Vision

Glaucoma and Diabetic Retinopathy(DR) are among the leading causes of blindness. Belated handling of Cataract can impact the vision causing blindness. Often the scarcity of experts can lead to delayed diagnosis, resulting in untreatable conditions. But detection of these diseases at earliest stage and treatment can aid patient in avoiding vision loss. An automatic disease detection system can help this by providing accurate and early diagnosis. In proposed system, diagnosis will be obtained using image processing and mining techniques on fundus image. Feature extraction using DCT. K-NN classification algorithm will be used to classify the image in a specific class (Normal,Glaucoma,DR or Cataract)

Ocular findings in patients with homozygous familial hypercholesterolaemia

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Ophthalmology Johannesburg, 2017.Homozygous familial hypercholesterolaemia is a fatal disease if untreated and has a high prevalence of premature coronary artery disease. Ocular findings may help with earlier identification and coronary artery disease risk stratification. Objectives: The primary objective was to determine ocular findings in patients with homozygous familial hypercholesterolaemia. The secondary objective was to correlate ocular findings with clinical and biochemical data. Design and Method: A cross-sectional study was conducted in 2011. Thirty patients were recruited from the Lipid Clinic at Charlotte Maxeke Johannesburg Academic Hospital. Results: Xanthelasma palpebrarum, corneal arcus, retinal arteriosclerosis and visual field defects were detected. Xanthelasma palpebrarum and corneal arcus were common in patients with overt coronary artery disease. Conclusion: In addition to well-known ocular features of hyperlipidaemia, i.e. xanthelasma palpebrarum, corneal arcus and retinal arteriosclerosis, we detected visual field defects. The assessment of xanthelasma palpebrarum and corneal arcus may help to prognosticate coronary artery disease risk.LG201

Macular pigment optical density measurements by one-wavelength reflection photometry – Influence of cataract surgery on the measurement results

Purpose: The main objective of the present study was the investigation of possible influence of lens opacification on macular pigment optical density (MPOD) measurements. Methods: 86 eyes of 64 patients (mean age 73.4(±8.3)years) were included in the study. MPOD was prospectively measured using one-wavelength reflection method (Visucam500, Carl Zeiss Meditec AG) before and after cataract extraction with implantation of a blue-light filtering intraocular lens (AlconSN60WF). The median of the maximum optical density (MaxOD) and the median of the mean optical density (MeanOD) measurements of macular pigment across the subject group were evaluated. Results: Statistically significant differences were noticed between pre-operative and post-operative measurements, the absolute values were generally lower after cataract extraction. The following median(lower/upper quartile) differences across the group were determined: MaxOD -33.8%(-46.2%/-19.1%), MeanOD -44.0%(-54.6%/-26.6%). Larger changes were observed in elderly patients (<70years of age: (n=25eyes) MaxOD -13.4%(-20.5%/3.6%), MeanOD -23.6%(-30.5%/-15.3%) versus patients ≥70years: (n=61eyes) MaxOD -40.5%(-53.2%/-30.1%), MeanOD -47.2%(-57.8%/-40.1%)) and in patients with progressed stage of cataract. MaxOD for lens opacification grade 1:(n=9eyes) -27.4%(-42.1%/-19.6%), 2:(n=26eyes) -35.0%(-44.2%/-25.3%), 3:(n=21eyes) -34.4%(-45.4%/-11.4%), 4:(n=25eyes) -32.6%(-53.2%/-6.4%) and 5:(n=5eyes) -53.5%(-61.7%/-38.7%) and MeanOD for cataract stage 1:(n=9eyes) -42.6%(-46.0%/-26.0%), 2:(n=26eyes) -44.1%(-51.8%/26.2%), 3:(n=21eyes) -45.7%(-54.7%/-24.7%), 4:(n=25eyes) -39.5%(-59.4%/-26.1%), 5:(n=5eyes) -57.0%(-66.1%/-51.4%). Conclusions: As established by comparison of pre- to post-operative measurements, cataract presented a strong effect on MPOD measured by one-wavelength reflection method. Particular care should therefore be taken when evaluating MPOD using this method in elderly patients with progressed stage of cataract. Future optimization of correcting parameters of scattered light and consideration of cataract influence may allow more precise evaluation of MPOD