Number of People Blind or Visually Impaired by Glaucoma Worldwide and in World Regions 1990 – 2010: A Meta-Analysis

Objective: To assess the number of individuals visually impaired or blind due to glaucoma and to examine regional differences and temporal changes in this parameter for the period from 1990 to 2012. Methods: As part of the Global Burden of Diseases (GBD) Study 2010, we performed a systematic literature review for the period from 1980 to 2012. We primarily identified 14,908 relevant manuscripts, out of which 243 high-quality, population-based studies remained after review by an expert panel that involved application of selection criteria that dwelt on population representativeness and clarity of visual acuity methods used. Sixty-six specified the proportion attributable to glaucoma. The software tool DisMod-MR (Disease Modeling–Metaregression) of the GBD was used to calculate fraction of vision impairment due to glaucoma. Results: In 2010, 2.1 million (95% Uncertainty Interval (UI):1.9,2.6) people were blind, and 4.2 (95% UI:3.7,5.8) million were visually impaired due to glaucoma. Glaucoma caused worldwide 6.6% (95% UI:5.9,7.9) of all blindness in 2010 and 2.2% (95% UI:2.0,2.8) of all moderate and severe visual impairment (MSVI). These figures were lower in regions with younger populations (10%). From 1990 to 2010, the number of blind or visually impaired due to glaucoma increased by 0.8 million (95%UI:0.7, 1.1) or 62% and by 2.3 million (95%UI:2.1,3.5) or 83%, respectively. Percentage of global blindness caused by glaucoma increased between 1990 and 2010 from 4.4% (4.0,5.1) to 6.6%. Age-standardized prevalence of glaucoma related blindness and MSVI did not differ markedly between world regions nor between women. Significance: By 2010, one out of 15 blind people was blind due to glaucoma, and one of 45 visually impaired people was visually impaired, highlighting the increasing global burden of glaucoma

Measures of socioeconomic status and self-reported glaucoma in the UK Biobank cohort

Purpose: To determine ocular, demographic, and socioeconomic associations with self-reported glaucoma in the UK Biobank.Methods: Biobank is a study of UK residents aged 40–69 years registered with the National Health Service. Data were collected on visual acuity, intraocular pressure (IOP), corneal biomechanics, and questionnaire from 112?690 participants. Relationships between ocular, demographic, and socioeconomic variables with reported diagnosis of glaucoma were examined.Results: In all, 1916 (1.7%) people in UK Biobank reported glaucoma diagnosis. Participants reporting glaucoma were more likely to be older (mean 61.4 vs 56.7 years, P<0.001) and male (2.1% vs 1.4%, P=0.001). The rate of reported glaucoma was significantly higher in Black (3.28%, P<0.001) and Asian (2.14%, P=0.009) participants compared with White participants (1.62%, reference). Cases of reported glaucoma had a higher mean IOP (18?mm?Hg both eyes, P<0.001), lower corneal hysteresis (9.96 right eye, 9.89 left eye, P<0.001), and lower visual acuity (0.09 logMAR right eye, 0.08 logMAR left eye, P<0.001) compared with those without (16?mm?Hg both eyes, hysteresis 10.67 right eye, 10.63 left eye, 0.03 logMAR right eye, 0.02 logMAR left eye). The mean Townsend deprivation index was ?0.72 for those reporting glaucoma and ?0.95 for those without (P<0.001), indicating greater relative deprivation in those reporting glaucoma. Multivariable logistic regression showed that people in the lowest income group (<£18?000/year) were significantly more likely to report a diagnosis of glaucoma compared with any other income level (P<0.01). We observed increasing glaucoma risk across the full range of income categories, with highest risk among those of lowest income, and no evidence of a threshold effect.Conclusions: In a large UK cohort, individuals reporting glaucoma had more adverse socioeconomic characteristics. Study of the mechanisms explaining these effects may aid our understanding of health inequality and will help inform public health interventions

Retinal nerve fiber layer thickness and cognitive ability in older people:the Lothian Birth Cohort 1936 study

BACKGROUND: This study aims to examine the relationship between the retinal nerve fiber layer (RNFL) thickness as measured by optical coherence tomography (OCT) and lifetime cognitive change in healthy older people. METHODS: In a narrow-age sample population from the Lothian Birth Cohort 1936 who were all aged approximately 72 years when tested, participants underwent RNFL measurements using OCT. General linear modeling was used to calculate the effect of RNFL thickness on three domains; general cognitive ability (g-factor), general processing speed (g-speed) and general memory ability (g-memory) using age at time of assessment and gender as co-variates. RESULTS: Of 105 participants, 96 completed OCT scans that were of suitable quality for assessment were analyzed. Using age and gender as covariates, we found only one significant association, between the inferior area RNFL thickness and g-speed (p = 0.049, η(2) = 0.045). Interestingly, when we included age 11 IQ as a covariate in addition to age and gender, there were several statistically significant associations (p = 0.029 to 0.048, η(2) = 0.00 to 0.059) in a negative direction; decreasing scores on measures of g-factor and g-speed were associated with increasing RNFL thickness (r = −0.229 to −0.243, p < 0.05). No significant associations were found between RNFL thickness and g-memory ability. When we considered the number of years of education as a covariate, we found no significant associations between the RNFL thickness and cognitive scores. CONCLUSIONS: In a community dwelling cohort of healthy older people, increased RNFL thickness appeared to be associated with lower general processing speed and lower general cognitive ability when age 11 IQ scores were included as a covariate

Retinal Vascular Fractal Dimension, Childhood IQ, and Cognitive Ability in Old Age: The Lothian Birth Cohort Study 1936

<div><p>Purpose</p><p>Cerebral microvascular disease is associated with dementia. Differences in the topography of the retinal vascular network may be a marker for cerebrovascular disease. The association between cerebral microvascular state and non-pathological cognitive ageing is less clear, particularly because studies are rarely able to adjust for pre-morbid cognitive ability level. We measured retinal vascular fractal dimension (<i>D</i>_<i>f</i>) as a potential marker of cerebral microvascular disease. We examined the extent to which it contributes to differences in non-pathological cognitive ability in old age, after adjusting for childhood mental ability.</p><p>Methods</p><p>Participants from the Lothian Birth Cohort 1936 Study (LBC1936) had cognitive ability assessments and retinal photographs taken of both eyes aged around 73 years (<i>n</i> = 648). IQ scores were available from childhood. Retinal vascular <i>D</i>_<i>f</i> was calculated with monofractal and multifractal analysis, performed on custom-written software. Multiple regression models were applied to determine associations between retinal vascular <i>D</i>_<i>f</i> and general cognitive ability (<i>g</i>), processing speed, and memory.</p><p>Results</p><p>Only three out of 24 comparisons (two eyes × four <i>D</i>_<i>f</i> parameters × three cognitive measures) were found to be significant. This is little more than would be expected by chance. No single association was verified by an equivalent association in the contralateral eye.</p><p>Conclusions</p><p>The results show little evidence that fractal measures of retinal vascular differences are associated with non-pathological cognitive ageing.</p></div

Te Pihopatanga o Aotearoa Liturgical Theologies: The Theological Impact of 'Word Changes' in te reo Maori liturgical texts of Te Pihopatanga o Aotearoa

The focus of this thesis is the theological impact of 'word changes' that are in Te Pīhopatanga ō Aotearoa (abbreviated as Te Pīhopatanga) te reo Māori / Māori language liturgical texts. This research is contextual because it has a specific Māori Aotearoa/New Zealand focus. It is liturgical because it focuses on te reo Māori liturgical texts. It is theological as well for te reo Māori 'word changes' are interpreted and evaluated for their theological impact. I develop an analytical framework to identify, interpret and evaluate the word changes and their theologies. The framework is made relevant to the Māori and Christian context of Te Pīhopatanga. In the process of identifying the word changes I note the existence of a complex relationship between Te Pīhopatanga liturgists and the wider Māori community. This relationship is explored and aspects from this exploration are considered in the theological interpretation and evaluation of the word changes. In that interpretation and evaluation several theological tensions are identified in some of the experimental texts. The outcome of such tensions is a number of 'questionable theologies' that inadvertently receive a form of Te Pīhopatanga validation. This research then proposes that theological tensions should be addressed by Te Pīhopatanga community at the liturgical experimentation stage. I propose strategies and tools to further develop the management of liturgical experimentation. I envisage this as a Te Pīhopatanga community engagement in theological self-empowerment. The proposals are drawn from a Te Pīhopatanga context. Liturgical theological insights are aligned to Te Pīhopatanga context. An outcome that emerges from the process of concentrating on 'word changes' in a te reo Māori liturgical text is a Te Pīhopatanga liturgical theological method of identifying and evaluating Te Pīhopatanga liturgical theologies

Screening for prevention of optic nerve damage due to chronic open angle glaucoma.

BACKGROUND: Open angle glaucoma (OAG) is a primary, progressive optic neuropathy; the onset is without symptoms and progression occurs silently until the advanced stages of the disease, when it affects central vision. The blindness caused by OAG is irreversible. It has often been assumed to be a condition that fulfils the criteria for population screening, although this has not been supported by other in-depth non-systematic reviews. The focus of this review was to examine the evidence for the effectiveness of screening for OAG. OBJECTIVES: To determine the impact of screening for OAG compared with opportunistic case findings or current referral practices on the prevalence of and the degree of optic nerve damage due to OAG in screened and unscreened populations. SEARCH STRATEGY: We included any randomised controlled trial (RCT) evaluating population-based screening programmes for OAG with a minimum one year follow up. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (which contains the Cochrane Eyes and Vision Trials Register) (Issue 1, 2006), MEDLINE (1950 to February 2006) and EMBASE (1988 to February 2006). We also searched the National Research Register (Issue 1, 2006) and Zetoc for grey literature (29 June 2006). There were no language or date restrictions in the electronic searches. SELECTION CRITERIA: We planned to include RCTs, including cluster RCTs. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the study abstracts identified by the electronic searches. We did not find any trials that met the inclusion criteria. MAIN RESULTS: As no trials were identified, no formal analysis was performed. AUTHORS' CONCLUSIONS: On the basis of current evidence, population-based screening for chronic OAG cannot be recommended, although much can be done to improve awareness and encourage at risk individuals to seek testing. In wealthy countries with equitable access to high quality eye care and health education, blindness from chronic OAG should become increasingly rare; much greater challenges face poor and emerging economies and countries where there are substantial health and wealth inequalities. Effectiveness of screening for OAG can be established only by high quality RCTs

Start-up and operation of a continuous stirred tank reactor performing stable anammox process with Candidatus Brocadia fulgida

Nitrogen removal from wastewater is an energy and resource intense operation. In response, anaerobic ammonium oxidising (anammox) bacteria are being increasingly applied as a cost effective and sustainable wastewater treatment. Despite their utilisation worldwide, very little is understood about kinetic parameters and factors impacting their niche differentiation. The lack of enriched planktonic cultures is limiting further investigations into anammox bacteria and the optimisation of wastewater treatment. In this study, a Continuously Stirred Tank Reactor (CSTR) inoculated with Candidatus Brocadia fulgida to obtain an enriched planktonic culture. Ca. Brocadia fulgida was selected due to Ca. Brocadias widespread application in Wastewater Treatment Plants (WWTPs), and the lack of planktonic cultures of this anammox species. The cultivation of anammox bacteria is a time-consuming operation, due to the slow growth rate. This operation was conducted for 84 days, and variety of analytical and microbial techniques were used to monitor bioreactor performance and anammox bacteria enrichment. An analysis of consumption and production patterns was performed to investigate anammox metabolism. Changes in the microbial community were also assessed, which indicated a culture enriched in anammox bacteria. The establishment of a planktonic culture enriched in Ca. Brocadia fulgida in a CSTR was not achieved, and further research is needed in order to successfully apply this innovative approach to anammox bacteria cultivation