Towards universal eye health in the Republic of Moldova: a global action plan 2014-2019

Introduction: The prevalence of low vision and vision impairment was found to be 19.5% in people aged over 50 years in a Rapid Assessment of Avoidable Blindness and Diabetic Retinopathy (RAAB+DR) survey conducted in Moldova in 2012.1 This means that there are approximately 169 000 people over the age of 50 years who have some form of low vision. The major causes of blindness and severe vision impairment are cataracts, glaucoma, age related macular degeneration and other posterior segment causes. The main causes of moderate visual impairment are refractive errors followed by cataract. Diabetic retinopathy was found in over half of the people aged 50 years and over who had diabetes, with 14.6% suffering from sight threatening retinopathy. These findings highlight the need to develop a national action plan on eye health care. Aim: To develop a National Eye Health Plan for Moldova. Method: A National Eye Health Plan based on the Global Eye Health Action Plan2 adopted by the Sixty-sixth World Health Assembly will be developed for Moldova to address the causes of avoidable blindness and rehabilitation needs of those with permanent or untreatable vision impairment. Discussion: The goal of Global Action Plan is to reduce avoidable visual impairment as a global public health problem and secure access to rehabilitation services for the visually impaired. The Moldovan National Eye Health Plan will incorporate strategies in line with the Global Action Plan focusing on comprehensive services that include treatment, health promotion, prevention and rehabilitation services. Integration of eye care and rehabilitation services into the health system with proper development of human resources, financing, medicines and technologies will be a feature of the Eye Health Plan. This will also include strategies to improve access to eye care and rehabilitation services for all. The National Eye Care Plan will contribute to reducing visual impairment and ensuring equitable and affordable access for all to good quality eye care and rehabilitation services in Moldova

Optical nerve papil druss. Clinical case

Summary. The Optic nerve head drusen (ONHD) are globular formations composed of proteinaceous material (made up of mucoproteins and mucopolysaccharides) that can calcify with age. These deposits develop on the Optic nerve head and can lead to an elevated disc, causing a pseudoedema appearance of the optic nerve disk. According to the recent studies the prevalence of ONHD has been estimated at 0.3–0.5% among adults and children and about 73–90% of ONHD cases are bilateral. Accumulations of drusen usually do not cause any symptoms. Most people do not know about this condition until it is accidentally discovered at an eye exam for another condition or during a routine exam. We report a case of ONHD that was initially suspected to be a papiloedema.Introducere: Drusenele Papilei Nervului Optic (DPNO) sunt formațiuni globulare compuse din material proteic (format din mucoproteine și mucopolizaharide) care se pot calcifia odată cu înaintarea în vârstă. Aceste depozite se dezvoltă pe papila nervului optic (PNO) și pot duce la elevarea acesteia, cauzând un aspect de pseudoedem. Conform unor studii recente, prevalența DPNO a fost estimată la 0,3–0,5% la adulți și copii (Auw-Haedrich C et all, 2002), iar aproximativ 73– 90% din ONHD sunt bilaterale (Flores-Rodriguez P et all, 2012). Cauza predominantă se consideră a fi tulburarea metabolismului axonal în prezența unui canal scleral mic (Wilkins 2004, Giovannini 2005), care cauzează depunerea de cristale de calciu în mitocondrii, care sunt extrudate în spațiul extracelular. Calcificările continue ale acestor microcorpi se unesc şi formează grupări de drusene. Prezentăm rezultatele examinării şi diagnosticării unui caz clinic de DPNO. Date obiective: pacienta, 30 ani, s-a prezentat la Centrul ”LOW VISION” pentru Tomografia în Coerență Optică (OCT) nerv optic (NO). A fost referită de către medicul neurolog cu suspiciune la edem al PNO. Acuze: ambii ochi (OU) – vedere înceţoşată, oboseală oculară, cefalee uşoară periodică (aprox. de 1 an). Antecedente oculare: fără intervenții chirurgicale sau traumatisme oculare anterioare. Istoric medical: neagravat, nu administrează medicamente în mod sistematic. Istoricul social: pacienta lucrează la calculator în medie 8-10 ore/zi. Nu fumează şi nu consumă alcool. Examen ocular: Vis OD/OS = 1,0/1,0. Autorefractometria: OD sph +0.25 cyl +0.12 ax 174, OS sph +0.25 cyl +0,12 ax 180. Anexele intacte – OU. Motilitatea în volum deplin – OU. Presiunea intraoculară(PIO): OD/OS=14/12 mm Hg (iCare). Examenul biomicroscopic: Pupilele: sferice, reactive OD=OS, fără defect pupilar aferent relativ. Mediile optice – transparente - OU. Examenul fundului de ochi dilatat: OU - aspect „nodular” (“lumpy-bumpy”) – elevaţii gălbui ale PNO, vasele, macula şi retina periferică cu aspect normal. Câmpul vizual (CV) (autoperimetria standard): a evidențiat mărirea petelor oarbe și scotoame peripapilare mici. Fotoretina – DPNO au prezentat elevarea suprafeţei şi elevaţii gălbui ale PNO, cavităţi optice goale cu conținut hipofluorescent și reflex posterior. Tomografia în coerență optică a NO – subțierea stratului de fibre nervoase (RNFL). Autofluorescența – structuri hiporeflective sferoidale (indicând o structură internă uniformă), cu foci hiperreflective. Discuții: Acumulările de drusen nu produc, de obicei, niciun simptom. Majoritatea persoanelor nu cunosc despre această condiție, până când nu este descoperită accidental la un control oftalmologic pentru o altă afecțiune sau în timpul unui examen de rutină. Pe măsură ce DPNO se măresc, acestea pot comprima fibrele NO și influență aportul vascular, ducând la complicații multiple, inclusiv defecte ale CV, ocluzie vasculară și hemoragie (Sowka 2001). Concluzii: În cazul pacientei s-a constatat la OU: DPNO, care au simulat un edem al PNO. Pacientei i s-a recomandat să respecte regimul de lucru la calculator, să picure lacrimi artificiale, să facă examen oftalmologic regulat, cu monitorizarea PIO și a CV. În prezent, nu există un tratament definitiv pentru DPNO, iar pacienții diagnosticați cu DPNO trebuie să fie supuși examinărilor regulate ale CV, PIO, OCT PNO, procedurii de ultrasonografie și de angiografie fluorescentă în scopul diagnosticării precoce a complicațiilor posibile. De asemenea, pacienţii care au defecte severe ale CV, necesită consultanță individuală cu privire la job-ul pe care îl desfășoară şi permisiunea de a conduce un autoturism

Instituirea specialităţii de optometrie în Republica Moldova: premise şi direcţii de dezvoltare

Background. Optometry is a healthcare profession that is autonomous and regulated. Optometrists are the primary healthcare practitioners of the eye who provide comprehensive eye care. This paper attests the necessity and importance of establishing the specialty of Optometry in the Republic of Moldova. Objective of the study. Reflecting the premises for establishing the optometry specialty in the Republic of Moldova and determining the strategic directions for the development of this profession. Material and Methods. A descriptive study was performed. Historical, statistical and comparative methods were used. Results. The Optometry specialty has been approved for the Training Domain Professional Nomenclature and higher education specialties (GD, Nr. 482/2017). Enrolled 53 students in the period 2017-2019, in the Optometry specialty. 34 students from the specialty of Optometry and 4 professors from SUMPh "Nicolae Testemitanu" attended practical internships and exchange of experience at the University of South-Eastern Norway. 7 students from the University of South-Eastern Norway followed the practical undergraduate internship (12 weeks) at SUMPh "Nicolae Testemitanu" and other 2 students have consolidated their research skills within the Master's program at SUMPh "Nicolae Testemitanu". Conclusion. Optometrists trained at USMF "Nicolae Testemitanu" will ensure the prevention and reduction of cases of preventable blindness. One of the priorities is the accreditation of the diploma at European level according to ECOO and the elaboration of the master's and doctoral program in optometry. Introducere. Optometria este o profesie autonomă din domeniul medical care se ocupă cu măsurarea și studiul acuității vizuale și a deficienţelor de vedere, cât și cu identificarea soluțiilor necesare corectării lor. Lucrarea dată atestă necesitatea şi importanţa instituirii specialităţii de Optometrie în Moldova. Scopul lucrării. Reflectarea premiselor de instituire a specialităţii de optometrie în Republica Moldova şi determinarea direcţiilor strategice de dezvoltare a acestei profesii. Material și Metode. A fost efectuat un studiu descriptiv. Au fost utilizate metodele istorică, statistică și comparativă. Rezultate. A fost instituită specialitatea de optometrie în cadrul USMF „Nicolae Testemițanu" aprobată prin Hotărârea de Guvern, (HG Nr. 482/2017). Au fost înmatriculaţi 53 de studenţi în perioada 2017-2019, la specialitatea Optometrie. 34 de studenţi de la specialitatea de Optometrie și 4 profesori din cadrul USMF „Nicolae Testemițanu" au urmat stagii practice și schimb de experiență la Universitatea de Sud-Est din Norvegia. 7 studenți din cadrul Universității de Sud-Est din Norvegia au urmat stagiul practic de licență (12 săptămâni) şi 2 studenți şi-au consolidat abilităţile de cercetare în cadrul programului Masterat la USMF „Nicolae Testemițanu". Concluzii. Optometriştii formaţi în cadrul USMF „Nicolae Testemițanu" vor asigura prevenirea şi reducerea cazurilor de cecitate evitabilă. Una din priorităţi este acreditarea diplomei la nivel european şi elaborarea programului de masterat și doctorat în optometrie

Заболеваемость глаз в Республике Молдова

A descriptive study analysing the morbidity situation of the eye diseases and its annexes between the years 2003 and 2007 has been carried out. These constitute a mean annual figure of 3.5% from the total number of reported cases and include the adult population. The prevalence of this phenomen in adult has increased by 5.7 cases per 10 000 population (207,3 cases in 2003 and 213,0 cases in 2007). The year 2007 as compared to 2003 its incidence decreased by 13,7 cases per 10 000 population(90,3 cases and 76,6 cases respectively). The internal structure of the prevalence of the eye diseases and its annexes is characterized by myopia – running first, followed by cataract and glaucoma the last, while the incidence structure has cataract as a leader. In children the annual mean figure is about 4% from the total number of reported cases. Myopia comes first in the internal structure of morbidity followed by cataract among children.Болезни глаз взрослого населения в Республике Молдова за период 2003-2007 гг. составили в среднем 3,5% из общего числа болезней зарегистрированных в течение календарного года. За период исследования уровень болезненности вырос на 5,7 случаев на 10 тыс. населения (с 207,3 в 2003 г. до 213,0 на 10 тыс. населения в 2007г.). Уровень собственно заболеваемости по сравнению с 2003 г. уменьшился на 13,7 случаев на 10 тыс. населения (90,3 и соответственно 76,6 на 10 тыс. населения). В структуре заболеваемости глаз за 2007 г. I место занимает катаракта – 19,5%, на II месте миопия – 16,7%, на III месте – глаукома – 10,9%. Болезни глаз детского населения в Республике Молдова за период 2003- 2007 гг. составили в среднем 4% из общего числа болезней зарегистрированных в течение календарного года. Миопия занимает первое место в структуре заболеваемости среди детей

Disability from diseases of the eye and its annexes in the Republic of Moldova during the years 2002-2009

Catedra Oftalmologie USMF „Nicolae Testemiţanu”The study describes and analyses the epidemiological situation in the Republic of Moldova from the diseases of the eye and its annexes in the years 2002-2009. In the disability structure the eye and its annexes diseases as to the causes rank the 8th among the working-age population and constitute 6.2%. One third of the disabled belong to the age group 50-59 years– 30.9 ± 1.2%, the greater part (54.5%) being attributed grade III disability, while every fifth referred to grade I disability (20.3%). Knowledge of the socio-hygienic situation of the disability caused by diseases of the eye and its annexes will permit elaborate and optimize the preventive measures against these diseases and rehabilitation. A fost întreprins un studiu descriptiv dedicat analizei epidemiologice a invalidităţii prin boli de ochi şi anexele sale pe perioada anilor 2002-2009. În structura invalidităţii populaţiei Republicii Moldova în vârsta aptă de muncă după cauze, bolile de ochi şi anexele sale ocupă locul VIII şi constituie 6.2%. Fiecare al treilea bolnav ce deţine grad de invaliditate este în grupul de vârstă de 50-59 ani – 30,9 ± 1,2%. Cota cea mai mare (54,5%) revine gradului III de invaliditate, iar fiecare a cincia persoană încadrată în grad de invaliditate deţine gradul I (20,3%). Cunoaterea sitaţiei social – igienice a invalidităţii a bolilor de ochi şi anexele sale va permite elaborarea şi optimizarea măsurilor de profilaxie şi reabilitare a acestor afecţiuni

The role of an optometrist in medical system of the Republic of Moldova

Background: In 2017 optometry specialty was established at Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, decision approved by the Government (HG Nr. 482/2017). The first class of optometrists graduated in June 2021, and is going to be engaged in national primary health care. High prevalence of visual impairments and increasing incidence of eye diseases represent the premises of optometry establishment as a specialty in the Republic of Moldova. According to Vision Atlas, in 2020 in the Republic of Moldova, there were an estimated number of 830 000 people with vision loss, of these, 19 000 people were blind. In comparison with neighbouring countries (Romania, Ukraine), Republic of Moldova is distinguished by its higher prevalence of vision loss of 22%, followed by Ukraine with a prevalence of 19% and Romania with 18%. Thus, Eastern Europe faces a high prevalence of visual impairments compared to Western and Northern European countries. The prevalence of visual impairments is 22.4%, and blindness is 0.50%. In this context, the optometrist will have a vital role in the prophylaxis of visual impairments and the prevention of preventable blindness. Objective of the Study: To describe the role of an optometrist in the assessment of visual impairments; to assess the public’s knowledge and attitude regarding the new specialty. Materials and Methods: A descriptive, sociological study was performed, based on a populationbased random questionnaire. Observational, historical, statistical and comparative methods were applied. Public’s knowledge of the differences between ophthalmologists and optometrists was estimated. Results: The questionnaire was completed by 110 people, females represented 60.9% (n = 67) of the total number of respondents, and males 39.1% (n = 43). A similar distribution by genre can be noticed in the study Gaurav Dubey, 2019, with an inverse value. Participants from urban areas constitute 66% (n = 73) and from rural areas - 34% (n = 37). Their clinical profile showed previous spectacle or contact lens wear 59.1% (n = 65), other 40.9% (n = 45) do not have such experience. Therefore, more than a half of participants interacted with national ophthalmological medical system. The majority 74.5% (n = 82) of the respondents reported a high level of awareness of the optometry term, only 25.5% (n = 28) had never interacted with the given term. Respondents chose the exclusive responsibility of optometrists, in order to assess their knowledge of the differences between ophthalmologists and optometrists. The respondents when asked about the optometrist functions (multiple choice questions used), so (46.2%), thinks the optometrist prescribes spectacles and contact lenses; (26.8%) – sells glasses and chooses frames; (18.28%) – diagnoses eye diseases. Nevertheless, the wrong options as medical treatment of eye diseases (7.4%) and surgical treatment (1.1%) were selected as well. The connection between selecting wrong options and educational/economic status has not been established. Educational and professional status of the respondents determined a high level of awareness according to the results of the research. It is recommended to include participants with a more variable socio-demographic status, in order to ensure a higher representativity of the population in the next conducted surveys. These findings of the questionnaire seem to indicate only the general tendency among the society. Conclusions: Optometry as a health care field remains to be explored, as it is a new specialty in Republic of Moldova. The evolution of optometry is accelerated all over the world, however it is geographically dispersed. The study showed a relatively high level of public knowledge regarding optometry, among people with secondary/higher, medical degree. Also, there is an essential demand of more complex researches among people with variable representative sample