Diabetic Retinopathy and Blindness: An Epidemiological Overview

Prevalence of diabetes is rising worldwide. In the course of the last 20 years, blindness and low vision due to diabetic eye complications have increased in large regions in Eastern Europe, North Africa/Middle East, Asia, Latin America, and Oceania. The magnitude and trends of vision-threatening disease are presented. Systemic risk factors for progression to sight-threatening disease are reviewed. The impact of economic and cultural background on early diagnosis and adherence to treatment is highlighted. Current management of diabetic macular edema, proliferative diabetic retinopathy, neovascular glaucoma, and cataract surgery of diabetic patients is outlined, and its contribution to preventing vision loss is reviewed

Trends in registered blindness in eastern Bulgaria

Purpose: The purpose of the study was to evaluate the incidence and causes of registered blindness and low vision in Eastern Bulgaria.Methods: Documentation per each included patient based on archives of the Expert Disability committee was evaluated and divided in two intervals. The cumulative incidence per 100 000 was calculated in 3 severity groups for bilateral and monocular blindness and by residence.Results: The incidence of binocular blindness decreased from 63.79 to 41.61 for males and from 64.21 to 41.14 for females during the second period. Meanwhile, monocular blindness increased from 41.14 to 65.14 for males and from 33.01 to 48.83 for females. It rapidly increases after 60 years of age and is the highest for those over 80. Patients with visual acuity (VA) below 0.05 comprise 40-35%, between 0.06 and 0.1 - 22- 35%, and 0.15 to 0.3 - 38-34%. The proportion and incidence of patients with VA below 0.05 have decreased two times during the second period among residents of cities and remained high - 42-48% in the rural population. Severe monocular blindness was significantly higher among males across the whole population. In the age group below 19 years, the leading causes of binocular blindness were retinopathy of prematurity (ROP), congenital glaucoma, microphthalmos and congenital cataract and for monocular impairment - trauma and amblyopia. For those above 20, the main causes were glaucoma, end-stage diabetic retinopathy, cataract - both with significant reduction in the incidence, AMD and trauma.Conclusions: Systematic evaluation of the deteriorated quality of life and estimation of the cost of vision loss and eye diseases to individuals and their families as well as extended family caregivers and thirdparty payers, the health care system and Bulgarian society is essential in the development of evidence-based interventions that translate research into enhanced clinical and community practice and prevention of unnecessary visual impairment

High-Risk Diabetic Maculopathy: Features and Management

A substantial group of patients with diabetic macular edema in our clinical practice is at high risk for profound and irreversible vision deterioration. Early identification of modifiable factors with long-term negative impact and their management, close monitoring and timely adjustments in the treatment can significantly reduce the probability of visual disability in the individual patient. This approach can also provide important guidelines for proactive decision making in order to avoid the risk of suboptimal response and unsatisfactory outcome

Quality of life for glaucoma patients

Visual impairments are a serious problem due to the limitations that they impose in everyday life and the loss of independence.  Aim of the study: to analyze the way the demographic variables (gender, age, place of residence, education, marital status and employment status) affect the quality of life; the way the quality of life changes and which activities are affected by the impairment of the visual functions. Material and methods: 54 individuals with proven glaucoma and permanent low vision have been surveyed (assessment criteria of the impairment degree is the correction of the better eye). With a view to do this we used LWQOL Wolffson J S 2000. The questionnaire contains four chapters: demographic, general diseases, ophthalmological status and psychometric section including four dimensions (Distance, mobility and illumination vision; Adaptation; Reading and fine work and Everyday activities). We have determined the reliability of the questionnaire with the help of the Cronbach`s alpha coefficient. Results:  The average quality of life score is 81,5 ± 17,4. The quality of life impairs with ageing (94,5±13.6 for individuals above 80 years of age). Although the difference in terms of place of residence is insignificant, the worst quality of life is shown by the village residents (82,8 ± 13,1). For the married individuals a higher quality of life is observed contrary to those who live alone. The lowest quality of life is observed for the individuals who live with their children (87,8 ± 19,7). The low educational degree correlates with a low quality of life. Regarding the employment status the worst indicators are observed for the retired individuals followed by those who have retired due to an illness. The most affected activities are those related to illumination, mobility and fine work.Conclusions: the quality of life impairment for glaucoma patients is directly associated to the demographic indicators and the visual impairment degree. The low percentage of usage of auxiliary means (7,40 %) by the questioned patients shows low motivation and insufficient level of information.

Epidemiology of Blindness and Low Vision in Kuwait // Епидемиология на слепотата и слабото зрение в националното население на Кувейт

The study sets itself the objective to estimate the morbidity and cumulative incidence rates of visual impairment causing primary disability due to blindness among Kuwaiti nationals and its dynamic trend in a ten year period. Design: A.A national cross-sectional population-based study. B. A national population-based observational register of visual impairment study. Settings, participants and methods: A. 4945 participants (83,61 percent of the pre-calculated sample size), 2222 males (44,9 percent ) and 2723 females (55,1 percent ) from all governorates of Kuwait, underwent a detailed ophthalmologic examination, including measurement of best-corrected visual acuity , intraocular pressure assessment, anterior and posterior segment evaluation, and other instrumental tests as needed. B.A total of 700 incident cases of legal blindness, 421 males and 279 females, evaluated and registered by the Visual Disability Committee for the period of January 2000 to December 2009. Blindness, low vision and main causes were classified according to WHO ID-10 categories. Results: The prevalence of blindness was 0.22 percent (95 percent CI0.02 percent - 0.41 percent) for the males and 0.40 percent (95 percent CI 0.17 percent - 0.63 percent) for the females. Low vision prevalence was 0.63 percent (95 percent CI 0.30 percent - 0.95 percent) for the male population and 1.28 percent (95 percent CI 0.86 percent - 1.70 percent) for the females. The odds ratio for blindness and low vision was 1.98 fold for female gender for the total population and 3.884 for those over 40 years of age. Among males, blindness and low vision were associated with increasing age, reported low family income and being illiterate or having preschool education. Among females , blindness and low vision were associated with increasing age, being diabetic, being single, widow or divorced over the age of 40,reported elevated blood pressure , and low family income. Leading causes of blindness and low vision were cataract - 0.41 percent (0.14 percent - 0.68 percent) for the males and 0.55 percent (0.27 percent - 0.83 percent) for the females, and diabetic retinopathy0.05 percent (0.0 percent - 0.14 percent), for the male population and 0.40 percent (0.0.16 percent - 0.64 percent) for the females. Cumulative age-specific incidence rate of legal blindness per 100 000 person years of observation between 2000 and 2005 was 9.97 totally, 13.33 for the males and 6.69 for the females. It increased during the next 5 year period to 16.82 totally, 21.15 for the males and 12.65 for the females. Incidence of blindness was lowest in the age group below 20 years - 7.35 for the period 2000-2004, increasing to 18.64 for the next 5 years, among those from 21 to 40 increased from 10.65 to 15.89, double in the next one - from 41 to 60 years - from 14.80 to 28.68, and tripled among those above 61 -from 23.16 to 66.37. The majority of the patients had visual acuity of light perception to finger counting at 1 m, and males were twice more in all categories except the group with no light perception. The incidence of retinitis pigmentosa is highest, and it doubled from 1.93 to 4.39. End-stage diabetic eye complications rapidly increased to 2.29 and became second leading cause of blindness, followed by glaucoma with dramatic rise from 0.24 to 1.67. A national program for prevention of avoidable blindness is presented based on the leading causes of blindness, together with decentralization of qualified ophthalmic services involved, reshuffling of resources and personnel, sustainability of high professional care standards, social awareness and support.Цел: Оценка на болестността и първичната инвалидност поради слепота сред местното население на Кувейт и тяхната динамика в 10-годишен период. Организация, участници и методи : A. Национално трасверзално популационно проучване - 4945 участници ( 83.61 пр. от предварително изчислената извадка) ,2222 мъже и 2723 жени от всички общини на Кувейт, са изследвани през 2006-2008 г. за зрителна острота с пълна корекция, тонометрия и изследване на предния и заден сегмент ,както и други инструментални тестове при нужда. Б. Анализ на националния регистър на слепите и слабо зрящите от 2000 до 2009 година - общо 700 лица със слепота в границите на инвалидността ,421 мъже и 279 жени, първично освидетелствани от Комисията за зрителна инвалидност. Слепотата, слабото зрение и етиологията са класифицирани по категории според МКБ-10 Резултати : Болестността поради слепота е 0.22 пр. (95 пр. CI 0.02 пр. - 0.41 пр. ) при мъжете и 0.40 пр. (95 пр. CI 0.17 пр. - 0.63 пр. ) при жените. Болестността поради слабо зрение е 0.63 пр. (95 пр. CI 0.30 пр. - 0.95 пр. ) при мъжете и 1.28 пр. (95 пр. CI 0.86 пр. - 1.70 пр. )при жените. Съотношението на шансовете за слепота и слабо зрение мъже: жени е 1:1.98 за цялото население, и 1:3.884 при тези над 40 години. При мъжете ,слепотата и слабото зрение се асоциират по важност с нарастване на възрастта, ниски семейни доходи и неграмотност или малограмотност. При жените ,слепотата и слабото зрение се асоциират по важност с нарастване на възрастта, диабет, самотно живеещи над 40 годишна възраст, хипертония и ниски семейни доходи. Основни причини за слепота и слабо зрение са катаракта - 0.41 пр. (0.14 пр. - 0.68 пр. ) при мъжете и 0.55 пр. ( 0.27 пр. - 0.83 пр. ) при жените, и диабетна ретинопатия - 0.05 пр. ( 0.0 пр. - 0.14 пр. ), при мъжете и 0.40 пр. ( 0.0.16 пр. - 0.64 пр. ) при жените. Кумулативната възрастово -специфична първична инвалидност на 100 000 човекогодини на наблюдение от 2000г. до 2005г. е 9.97 общо ,13.33 при мъжете и 6.69 при жените. Тя се увеличава през следващите 5 години до 16.82 общо, 21.15 при мъжете и 12.65 при жените. Първичната инвалидност е най-ниска при лицата под 20 годишна възраст - 7.35 за периода 2000-2004, която се увеличава до 18.64 през следващите 5 години; при лицата от 20 до 40 години тя се увеличава от 10.65 до 15.89; удвоява се в следващата група - от 41 до 60 години - от 14.80 до 28.68, и се утроява при лицата над 61 - от 23.16 на 66.37. Болшинството пациенти са със зрение от прецепция на светлина до броене на пръсти, и мъжете са двукратно повече във всички категории с изключение на групата с липса на перцепция на светлина. Най-висока е първичната инвалидност поради пигментен ретинит и тя се удвоява от 1.93 до 4.39.Диабетните усложнения в окото бързо се увеличават до 2.29 и са на второ място, следвани от глаукомно болните, които се увеличават 7-кратно от 0.24 до 1.67. Разработена е национална програма за превенция на предотвратимата слепота според водещите заболявания, която предвижда децентрализация на специализираната офталмологична помощ, прегрупиране на ресурсите и кадрите, повишаване на професионалните стандарти и колаборация с обществеността

50 години Катедра „Социална медицина и организация на здравеопазването`

22 Май 201