北京市顺义区防盲治盲十八年

目的 探讨城市三级医院和医疗研究机构如何与基层卫生单位合作,创建防盲治盲模式单位,降低盲目患病率的经验。方法 北京协和医院眼科与北京市顺义区卫生局合作,开展防盲治盲项目,干预对象为北京市顺义区居民。防盲治盲措施：(1)于1984年进行眼病流行病学调查;(2)实施防盲治盲项目,重点开展白内障盲人的手术治疗;(3)评价1996年防盲治盲项目;(4)针对防盲治盲工作中存在的主要问题,改进工作,提高工作效率和手术质量。结果 参与单位发挥各自优势,密切合作,使北京市顺义区防盲治盲工作逐步深入、普及。1984年眼病流行病学调查基本上摸清了北京市顺义区眼病的现状。在1987年开始实施的防盲治盲项目中,建立县、乡、村三级初级眼保健网,建立发现和治疗白内障盲人的转诊系统。1996年防盲治盲项目评价表明,在人口增加及老龄化趋势加重的情况下,持续开展防盲治盲工作可降低盲目的患病率。结论 城市三级医院和医疗研究机构与基层卫生单位及科研工作与防盲治盲工作密切结合,可促进防盲治盲工作的深入和普及,逆转盲人增加的趋势。     

防盲治盲依然是我国眼科界面临的巨大挑战

近5年来,我国防盲治盲取得了重大进展.但是,我国盲和视力损伤的状况还没有从根本上得到改善.2006年第2次全国残疾人抽样调查结果表明,我国视力残疾的患病率为1.53%.以此推算,我国视力残疾的人数达2003.5万人.导致视力残疾的主要原因是白内障.我国根治白内障盲的进展缓慢,白内障手术率仍然相当低.如果不努力抓好防盲治盲工作,我国有可能不能实现"视觉2020"行动的目标.防盲治盲依然是我国眼科界面临的巨大挑战.目前,我国已经为进一步开展防盲治盲工作创造了一些有利的条件.我国已有大量开展防盲治盲的人力、财力资源;医疗卫生体制的改革有利于防盲治盲工作的开展;我国眼科事业的发展已经能够为防盲治盲提供足够的技术力量.在防盲治盲的实际中,我国眼科界还面临着探索建立持续、高效的防盲治盲机制的任务.最近我国实施的"百万贫困白内障患者复明工程"项目是我国防盲治盲工作中里程碑式的重大事件,必将加速推进我国的防盲治盲工作.     

防盲治盲依然是我国眼科界面临的巨大挑战

近5年来,我国防盲治盲取得了重大进展.但是,我国盲和视力损伤的状况还没有从根本上得到改善.2006年第2次全国残疾人抽样调查结果表明,我国视力残疾的患病率为1.53%.以此推算,我国视力残疾的人数达2003.5万人.导致视力残疾的主要原因是白内障.我国根治白内障盲的进展缓慢,白内障手术率仍然相当低.如果不努力抓好防盲治盲工作,我国有可能不能实现"视觉2020"行动的目标.防盲治盲依然是我国眼科界面临的巨大挑战.目前,我国已经为进一步开展防盲治盲工作创造了一些有利的条件.我国已有大量开展防盲治盲的人力、财力资源;医疗卫生体制的改革有利于防盲治盲工作的开展;我国眼科事业的发展已经能够为防盲治盲提供足够的技术力量.在防盲治盲的实际中,我国眼科界还面临着探索建立持续、高效的防盲治盲机制的任务.最近我国实施的"百万贫困白内障患者复明工程"项目是我国防盲治盲工作中里程碑式的重大事件,必将加速推进我国的防盲治盲工作.     

全国防盲治盲规划（2012--2015年）（二）

3．加强县级综合医院眼科能力建设,发挥其作为基层防盲治盲技术指导中心的作用。鼓励城市三级医院眼科、眼科医院与县级综合医院眼科建立紧密的合作关系,通过技术指导、人员培训等方式,使县级综合医院眼科具备常见眼病诊治和急诊处理能力,落实双向转诊。     

援建是边远地区眼科发展的重要举措

近年来我国的眼科事业发展迅速，但边远地区眼科建设仍明显滞后于内地，已引起我国政府、国内外的非政府机构等的关注。这些机构多采取流动医疗队的形式，赴边远地区短期内治疗大量白内障盲人，但没有形成防盲治盲的长效机制，当地群众仍然缺少眼科医疗服务。我们应当将防盲治盲与加强县级眼科建设结合起来，吸收多方资源，从人力和物力方面援建基层的眼科才是发展的关键。     

中国县级及以上医疗机构防盲工作开展情况调查分析

目的：了解中国县级及以上医疗机构防盲工作的开展情况，为“十四五”时期中国防盲治盲和眼健康水平的全面提升提供参考依据。方法：横断面调查研究。2015年对全国提供眼科服务的县级及以上医疗机构通过网上填报的方式进行普查，对中国不同地区、级别、类型和经营性质的医疗机构防盲工作情况进行对比统计分析。应用卡方检验对数据进行分析比较。结果：本次调查覆盖全国6 341家县级及以上医疗机构，东、中、西部地区均有半数医疗机构开展防盲治盲项目，77.09%的机构开展爱眼科普宣教活动，基层公益眼病筛查义诊和咨询活动的开展率超过半数。东部地区开展各项防盲活动的医疗机构绝对数量最多，但相对数量最低，医疗机构是否开展防盲治盲项目在地区分布上差异存在统计学意义（χ2 =42.587，P<0.001）。三级医疗机构、眼科专科医院防盲治盲活动的开展率最高。 不同类型医疗机构在是否开展爱眼科普宣教活动上差异有统计学意义（χ2 =89.041，P<0.001）。相比公立和营利性医疗机构，私营性医疗机构的基层平均服务次数和服务受众人次最高。结论：中国医 疗机构防盲治盲总体服务量偏低，机构间差距明显，防盲工作模式亟待创新发展。     

初级眼保健网络与防盲治盲工作方法的探讨

目的 探讨初级眼保健网络与防盲治盲工作的方法。方法 收集并回顾性分析南通市10年初级眼保健网络建设与防盲治盲工作资料。结果 10年建立了5级眼保健网络,举办各级培训班1007期,对6817259例人群进行了致盲眼病的调查,发现双眼盲13496例（0.20%）,并为83.16%的可治白内障盲患者做复明手术,脱盲率为98.22%。所辖的8个县均被评为全国防盲先进县。1997年南通市成为全国第一个防盲先进市。结论 初级眼保健是防盲工作的基础。结合初级卫生保健开展初级眼保健是切实可行的途径。复明手术经费的解决、质量的保证、查治结合是防盲治盲工作的关键。创建防盲先进县、市是开展防盲治盲工作的动力。     

《实用防盲技术》杂志征订启事

《实用防盲技术》杂志由安徽省卫生和计划生育委员会主管,安徽中国科技大学附属第一医院(安徽省立医院)主办,编委会编辑出版的全国性眼科专业学术期刊。出版物号ISSN1673-3835,CN34-1292/R,已加入中国核心期刊(遴选)数据库,万方数据数字化期刊群。本刊为季刊,A4国际开本48页,铜版纸印刷,照相图随文印刷。本刊的办刊宗旨为贯彻党和国家的防盲治盲工作方针,反映我国防盲治盲的现状和进展,传播国内外防盲治盲科技信息,推广防盲新技术,开展学术讨论和经验交流,促进我国防盲治盲工作,提高防盲治盲技术水平。本刊本着面向临床、基层,坚持理论与实践相结合,普及兼顾提高,注重实用性。     

《实用防盲技术》杂志征订启事

《实用防盲技术》杂志由安徽省卫生健康委员会主管,安徽中国科技大学附属第一医院(安徽省立医院)主办,编委会编辑出版的全国性眼科专业学术期刊。出版物号ISSNl673-3835,CN34-1292/R,已加入中国核心期刊(遴选)数据库,万方数据数字化期刊群。本刊为季刊,A4国际开本48页,铜版纸印刷,照相图随文印刷。本刊的办刊宗旨为贯彻党和国家的防盲治盲工作方针,反映我国防盲治盲的现状和进展,传播国内外防盲治盲科技信息,推广防盲新技术,开展学术讨论和经验交流,促进我国防盲治盲工作,提高防盲治盲技术水平。本刊本着面向临床、基层,坚持理论与实践相结合,普及兼顾提高,注重实用性。     

流动手术车白内障规模化手术运行机制的探讨

目的 探索流动手术在白内障规模化手术的运行机制。方法 启动“江可伯光明快车”，深入江门市恩平市、鹤山市的各乡镇、在当地政府、残联和卫生院的协调配合，以白内障患者晶状体核的硬度及手术易难程度不同分三级进行评估和管理，选择不同的手术方式开展规模化手术、旅行Phaco 939眼，ECCE179眼。结果 与当地市乡镇政府、残联和卫生院的密切合作，有利于发动组织病源、联合眼科设备、技术力量雄厚所形成的优势互补，可加快防盲治盲工作的进展术后第一天祼眼视力≥0.05者90.25％，≥0.3为48.48％。结论 利用眼科流动手术车开展规模化白内障手术解决了眼科技术力量薄弱的农村和边远地区致盲白内障患者的各种困扰，是加快白内障复明手术的有效运行机制。     

江苏省初级眼保健与防盲的调查研究

目的了解江苏省农村基层的眼保健与防盲工作状况。设计横断面调查研究。研究对象江苏省13个全国防盲先进县的34个乡76个村。方法对上述乡、村的防盲治盲人员、职责、业务、设备进行检查、评估,并作统计分析。主要指标按卫生部标准所规定的乡村初级眼保健与防盲的各项指标。结果所有乡、村达到或超过了卫生部颁布标准中有关组织网络、职责、设备指标。约50％的乡、村达到或超过了卫生部颁布标准规定的常见眼病的诊疗技术要求。部分乡、村存在统计报表不准确、白内障手术方法落后等不足。结论江苏省防盲先进地区的农村基层眼保健与防盲工作基本达到了卫生部颁布标准,但业务水平有待提高。(眼科,2006,15：355-358)     

Eye health is everyone’s responsibility: China’s first Western-style eye hospital improves in the prevention of blindness

AIM: To investigate the relationship between China’s first Western-style eye hospital development and the prevention of blindness in China and determine the main factor influencing eye health today.METHODS: Data about eye health, blindness and cataract surgery rate of China from public website of World Health Organization (WHO), ORBIS International, Ministry of Health (MOH) of China, Pubmed center and Historical Archives of Zhongshan Ophthalmic Center (ZOC) were reviewed and analyzed.RESULTS: ZOC is China’s first Western-style eye hospital. In 2012, the ORBIS Flying Eye Hospital has chosen ZOC once again as one of its destinations, 30 years after ORBIS expanded internationally to train eye care professionals and treat underserved patients in developing countries in 1982. During the past 30 years, cataract surgery rate and public awareness of blindness prevention were improved greatly in China, in which ZOC plays a very important role.CONCLUSION: ZOC, as China’s first Western-style eye hospital,has improved in the prevention of blindness. Eye health has become everyone’s responsibility.     

Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome.

AIMS: To provide epidemiological data on the current burden of serious eye injuries utilising the hospital eye service, to inform the planning and provision of eye health care, and health and safety strategies for the prevention of ocular injuries. METHODS: A prospective observational study was carried out of all patients with ocular trauma admitted to hospitals in Scotland, under the care of a consultant ophthalmologist, during a 1 year period. The population of Scotland represented the population at risk of injury. Visual outcome (Snellen visual acuity in the injured eye) was measured at the time of final discharge from ophthalmic care and at follow up. RESULTS: All ophthalmic departments in Scotland participated and a total of 415 residents of Scotland were admitted. The 1 year cumulative incidence of ocular trauma necessitating admission to hospital is estimated to be 8.14 per 100 000 population (95% CI 7.38 to 8.97). Some 13.2% (n = 26/197) of patients discharged from follow up had a poor visual outcome with a visual acuity less than 6/12 in the injured eye. Some 10.7% (21/197) patients at this time had a blinding outcome in the injured eye (visual acuity less than 6/60). No patient was registered blind or partially sighted during the study period. The home was the single most frequent place for blinding injuries to occur (52%, n = 11/21), followed by the workplace 24% (n = 5/21). The 1 year cumulative incidence of blinding outcome from serious ocular trauma is estimated to be 0.41 per 100 000 population per year (95% CI 0.26 to 0.64). CONCLUSION: The current burden of serious ocular trauma presenting to the hospital eye service has been quantified from this population based study, and for the first time, a direct estimate of the incidence of the subsequent blinding outcome from these injuries has been provided. Ocular trauma remains an important cause of avoidable and, predominantly, monocular visual morbidity (visual impairment and blindness), with over half of the blinding injuries now occurring in the home. Health education and safety strategies should now consider targeting the home for the prevention of the serious eye injuries in addition to the traditional work, sports, and leisure environments and their related activities.     

Uncorrected refractive error in the northern and eastern provinces of Sri Lanka

Background: The 2004 tsunami focused unprecedented international aid and resources on Sri Lanka. Among other responses, a program delivered by volunteer optometrists enabled many local people to access eye examinations and spectacles for the first time. The data collected from the eye‐care delivery program during 2005 are summarised in this report, as an evidence base for planning future eye‐care interventions in these provinces or similar areas. Methods: A total of 96 eye clinics were conducted by visiting volunteer optometrists in the northern and eastern provinces of Sri Lanka, at which 20,090 people were examined. Clinical records were reviewed for conditions causing visual impairment, conditions that could cause impaired vision in future if left untreated, eye‐care outcomes and barriers to seeking care. Results: Complete records were available for 14,669 people. Seventy‐nine per cent of this clinical population had never had an eye examination. Uncorrected refractive error including presbyopia caused visual impairment for 78 per cent (11,388) of people who presented for an eye examination. Cataract caused impaired vision for 15 per cent (2,180) of people and was the main reason for referral beyond primary eye‐care, although only five per cent (695) of people presenting were referred for cataract surgery, as local capacity constraints set a visual acuity requirement of 6/36 or worse. The gender and age profiles of people attending the clinics were not consistent with equitable blindness prevention. Conclusion: The high proportion of people who had not previously had an eye examination, particularly those with significant uncorrected refractive error, provides evidence for the acute need for further development and support of community‐level eye‐care services in the regions visited. Women and older people should be targeted by future programs to achieve equity of blindness prevention.     

Poverty and blindness in Africa

Africa carries a disproportionate responsibility in terms of blindness and visual impairment. With approximately 10 per cent of the world’s population, Africa has 19 per cent of the world’s blindness. It is no surprise that this reality also mirrors the situation in terms of the burden of world poverty. There is an increasing recognition of the need to highlight the link between poverty, development and health care. Blindness, disabling visual impairment and the overall lack of eye‐care services are too often the result of social, economic and developmental challenges of the developing world. The state of eye care in Africa stands in alarming contrast to that in the rest of the world. Poor practitioner‐to‐patient ratios, absence of eye‐care personnel, inadequate facilities, poor state funding and a lack of educational programs are the hallmarks of eye care in Africa, with preventable and treatable conditions being the leading cause of blindness. Eye diseases causing preventable blindness are often the result of a combination of factors such as poverty, lack of education and inadequate health‐care services. The challenge that Vision 2020 has set itself in Africa is enormous. Africa is not a homogenous entity, the inter‐ and intra‐country differences in economic development, prevalence of disease, delivery infrastructure and human resources amplify the challenges of meeting eye‐care needs. The successful implementation of Vision 2020 programs will be hindered without the development of a comprehensive, co‐ordinated strategy that is cognisant of the differences that exist and the need for comprehensive solutions that are rooted in the economic and political realities of the continent as well as the individual countries and regions within countries. This strategy should recognise the need for economic growth that results in greater state funded eye‐care services that focus on health promotion to ensure the prevention of eye disease, the development of eye clinics in hospitals and health clinics, and the training of the appropriate human resources.     

Prevalence and risk factors for eye diseases, blindness, and low vision in Lhasa, Tibet

AIM:To determine the prevalence and risk factors for eye diseases, blindness, and low vision in Tibet, and to assist the development of eye disease prevention and treatment schemes.METHODS:We carried out a survey of eye diseases among a population living at high altitude. A total of 1 115 Tibetan permanent residents aged 40 years or older from the towns and villages of Qushui County, Lhasa Prefecture, Tibet Autonomous Region, participated in this study. All participants completed a detailed questionnaire, and underwent presenting and pinhole visual acuity tests, and a comprehensive ophthalmic examination.RESULTS:There were 187 blind eyes (8.43%), 231 eyes with low vision (10.41%). The leading cause of visual impairment was cataract of 55.0% (101/187) blindness and of 50.2% (116/231) low vision, followed by fundus lesions of 22.9% blindness and 23.8% low vision, while only a low prevalence of glaucoma of 9.6% blindness and 1.7% low vision was observed. The analysis of 2 219 eyes showed that the most common external eye disease was pterygium (27.2%) in Tibet.CONCLUSION:The high prevalence of blindness and low vision in the Tibetan population at high altitude is a serious public health issue. There is a need to establish and maintain an appropriate effective eye care program in Tibet.     

西藏藏族自治区眼科医疗资源现况调查

背景 眼科医疗保健体系的不断完善是防盲治盲工作的有力保障,但目前西藏自治区的眼科医疗资源分配情况仍不能满足当地防盲治盲工作的需要.了解西藏地区眼科医疗资源现状有助于当地合理分配紧缺的医疗资源,推进防盲治盲工作的开展. 目的 对西藏自治区的眼科医疗资源分配进行调查,为尽快建立该地区的眼科医疗保健网络和有效提供资源供给提供依据. 方法 本研究组于2016年4-6月面向西藏藏族自治区各级医疗单位眼科科室负责人和眼科医生发放西藏自治区医疗机构眼科专业情况调查问卷.西藏地区21家医疗机构的21名眼科科室负责人和52名眼科医生就眼科专业情况参与调查,由经过统一培训的专职人员按照统一调查方式收集整理,以确保回答问卷的真实有效性.结果 所有调查问卷发放的全区覆盖率为100％并全部收回,问卷填写符合要求,应答率及问卷有效率均为100％.截止2016年6月,西藏自治区共有21所有眼科诊疗能力的医疗机构,按照国家统计局公布的2014年西藏人口状况计算,平均每15.1万人拥有1个眼科医疗机构,但无独立眼科专科医院.其中有眼科专科医生者19所,占90.5％,有独立眼科科室者13所,占61.9％,有眼科独立手术室11所,占52.4％.全区眼科共有病床数量120张,平均每10万人拥有眼科医生1.6名,其中硕士学历者3名,尚无主任医师;全区共有专业护士14人,其中全职和兼职者各7人.目前西藏藏族自治区具备了基本的诊断仪器和最基本的手术设备,2015年全区平均眼科手术量为326.2人次.结论 西藏藏族自治区的眼科医疗资源不足,尤其是基层乡镇卫生院和县级医院眼科医疗机构,制约当地眼科防盲治盲工作的开展.     

创建防盲先进县推动浙江省防盲治盲工作

目的 探讨创建防盲先进县的经验。方法 收集1996—1998年浙江省20个县(市)防盲治盲资料,以“全国防盲先进县标准”为依据对其进行汇总分析。结果 创建防盲先进县的有效方法是：将防盲治盲工作列入政府工作的议事日程,争取有关部门的高度重视与积极配合;建立防盲指导组;健全三级防盲治盲网络;培训防盲技术人员,配备必要眼科设备。20个县(市)中,经逐级检查验收,7个县(市)成为卫生部审批的全国防盲先进县,其中绍兴市成为全国防盲先进市。13个县(市)虽未达标,但仍做了大量的防盲治盲工作,推动了全省防盲工作的开展。全省1996-1998年白内障复明手术每年达2万例,眼科医师的数量由602人增加至1850人,裂隙灯与手术显微镜等眼科设备成倍增加。结论创建全国防盲先进县是推动防盲治盲工作的有效措施。