普通人群青光眼认知度的研究进展

青光眼是常见的不可逆的致盲性眼病,由于其发病隐匿,易被忽视,致盲率高。了解并提高普通人群对青光眼的认知度是早期发现、早期诊断、及时治疗、挽救青光眼患者残余视功能的有效途径。笔者就近年来关于普通人群青光眼认知度的相关研究进行综述。国内对青光眼认知度调查的资料较少,且多局限于眼科就诊患者。发达国家或地区普通人群对青光眼的认知度较好(72%～79%),但对青光眼症状、发病机制和治疗手段的认识仍有限。     

改变青光眼作为首位不可逆致盲性眼病的现状

青光眼不仅常见,而且严重损伤患者的视功能,被认定为全球首位不可逆致盲性眼病.仔细观察发现诊断不及时、治疗不合理、随诊不规律是导致青光眼患者致盲的常见原因.机会性筛查是临床早期发现青光眼患者的主要手段.为了提高筛查的效率,筛查时应当密切关注青光眼的高危人群,包括原发性青光眼患者的直系亲属、老年人群和高度近视患者.此外,要...     

青光眼专刊简介

据世界卫生组织数据显示,青光眼是全球第二位致盲因素,仅次于白内障.青光眼致盲占全球致盲总数的50％,更为严峻的是青光眼患病人群趋于年轻化.青光眼发病机制、早期诊断、视功能检测、致病基因筛选以及视神经损伤等研究尚处于探索阶段.《眼科学报》特开设青光眼专刊,由中山眼科中心林明楷教授担任专刊主编,详细阐述近年来青光眼相关研究...     

社区慢性病管理对青光眼病情影响的初步研究

青光眼是最主要的致盲眼病…，若能早期发现、终身定期随访和监测及有效控制眼压，大多数因青光眼而致盲是可避免的。我中心对部分慢性青光眼患者进行社区为基础的慢性病管理，开展科普教育，定期随访眼压，对眼压异常者实现转诊，由上级医院进行眼压控制。研究目的在于评估该慢性病管理模式对青光眼患者关于青光眼知识的认知、视功能维持的作用。     

青光眼遗传学研究的现状与挑战

青光眼是常见且病变不可逆转的严重致盲眼病,遗传因素对于青光眼的发生具有重要作用。人类基因组计划的完成及相关分子遗传学技术在青光眼研究领域的应用,使青光眼的病因学研究取得了重要进展。目前人们难以预计新的研究成果将对青光眼的预防、早期诊断及治疗所产生的重要影响,但却引发出一系列值得思考的问题,这可能预示着青光眼遗传学研究方向的变化趋势。     

原发性开角型青光眼的早期诊断

青光眼是全世界成人致盲的主要眼病。原发性开角型青光眼做为青光眼的一种类型,其特点是病程进展较为缓慢,多数没有明显症状,不易早期发现。许多患者就诊时已经出现了较严重的视功能障碍,且近年来该病患病率在临床上所占的比例有所上升。而对原发性开角型青光眼的早期诊断,是延缓或停止视功能进行性损害的关键。因此,综合国内外近年来相关文献,对原发性开角型青光眼的早期诊断做以下综述。     

近视眼视盘形态学变化与开角型青光眼的相关性研究进展

近年来研究发现,近视尤其是高度近视的眼部形态改变与开角型青光眼的关系密切,这些形态改变 不仅是近视患者易患青光眼的危险因素,同时也对此类患者病程进展有着一定影响。开角型青光眼 是进行性、不可逆性的致盲性眼病,因此近视患者早期发现、确诊、病情进展时及时干预显得十分 重要。现笔者回顾近年文献,在形态学变化上就近视与开角型青光眼的相关性做一综述。     

青光眼心理特征和心理干预对青光眼患者影响的研究进展

青光眼是全世界范围内的主要致盲性眼病之一,虽然其病因至今尚未完全清楚,但社会心理因素在青光眼的临床诊疗过程中的作用逐渐引起人们的关注。我们就青光眼的心理特征的评价和心理干预对青光眼患者影响的研究概况做一综述。     

青光眼病临床治疗与实施健康教育体会

青光眼病是指眼压持续或间接性增高，以至造成视功能损害为主要特征的致盲性严重疾病。笔者在多年诊治232例青光眼病患者的临床实践中深切体会到：早期发现、早期诊断、早期治疗是防治青光眼病的关键；对住院患者手术前后实施健康教育尤为重要。如何及时有效地防治青光眼病，降低发病率，保护并促进眼疾患者康复是眼科工作者研究的重要课题。     

未成年人青光眼的流行病学

青光眼是未成年人盲和低视力的重要原因之一,其致盲不可逆,未成年盲人由于预期寿命更长,将给个人和社会带来沉重负担.近年的流行病学研究发现,未成年人青光眼中先天性青光眼为最常见的类型,存在男女性别差异,多数需要手术治疗,且各亚型的发病率及构成比受种族、经济发展水平、卫生条件等原因的影响各有不同.这些流行病学资料能帮助我们对未成年人青光眼进行早期诊断、治疗,防止视功能的进一步损害.     

重视原发性青光眼的早期诊断和干预

原发性青光眼是严重的不可逆转的致盲性眼病之一,早期诊断和干预是防止青光眼患者视功能严重丧失的关键措施。近年来,原发性青光眼的基础和临床研究均取得了重要进展,如对原发性闭角型青光眼（PACG）分类的认识,对PACG发病危险因素的认识,对PACG的处理,对原发性开角型青光眼（POAG）视乳头改变的认识,处理原发性青光眼中目标眼压概念的提出等,均有利于原发性青光眼的早期诊断和干预。加强对眼科医师青光眼早期诊断和干预的继续教育,向公众普及青光眼的防治知识,通过公共卫生的途径早期筛查原发性青光眼等措施,将使大量的原发性青光眼患者得到早期诊断和干预,从而降低青光眼的致盲率。     

青光眼公众知晓率亟待提升

青光眼是全球范围内第二大致盲性眼病,然而由于青光眼公众知晓率低等原因,使得青光眼的未诊断率居高不下。即使在发达国家,约50%的青光眼患者尚未察觉自己已经患病而未作任何治疗;在发展中国家,这个数字更是高达90%。根据对国内以及国际上青光眼认知度调查的结果分析来看,提高青光眼公众知晓率已迫在眉睫。我们倡议通过更广泛的形式及途径开展青光眼的宣传教育,以及增强基层医院眼科医生的技能培训并装备必要的检查设备,期望能在较短时间内显著提高我国青光眼的公众知晓率和疾病诊断率。     

普通眼科门诊青光眼认知度的调查

目的提高公众对青光眼的认知度及青光眼患者的检出率。方法采用问卷随机抽样调查646例普通眼科门诊就诊者。所有数据用χ^2检验和多因素logistic回归分析处理数据。结果66.6%的受访者表示对青光眼不了解,其中51.61%为已确诊的青光眼患者。青光眼的认知与性别、服用糖皮质激素史、高血压、糖尿病以及近视均无相关性（P〉0.05）,与年龄、教育程度、具有卫生部门工作经历、定期眼科检查、曾经接受散瞳检查、具有青光眼家族史等显著相关。心血管患者及服用降血压药物的受访者对青光眼的认知度高于其他人群。结论青光眼认知度问卷调查为青光眼患者的宣教和知识普及提供了目标人群,使早期防治有所提示。近视患者、糖皮质激素服用者、高龄人群、低教育程度者、糖尿病及高血压患者、无定期眼科保健者以及部分对青光眼缺乏认识的青光眼患者,是今后加强宣教的目标人群。     

急性原发性闭角型青光眼

Acute primary closed angle glaucoma is fast becoming one of the most important causes of blindness in the 21 st Century. World bhnding statistics show that there are 60 million people suffering from glaucoma. Of these,approximately 6 million are blind and 1.5 million (25%) are due to acute closed angle glaucoma. With the aging population, the number of patients blind from glaucoma will continue to increase.Attacks from acute primary closed angle glaucoma can lead to irreversible blindness to the affected eye.Blindness can be effectively prevented in acute primary closed angle glaucoma because the severity of symptoms will draw the attention of the patient who will then seek for medical care. Therefore, it is essential to educate the public,doctors and healthcare workers about the danger and symptoms of acute glaucoma. With early diagnosis and treatment to the affected eye and laser iridotomy to the fellow eye-bilateral blindness from acute glaucoma can be prevented.This paper highlights important clinical advances in the management of acute primary closed angle glaucoma and also poses several questions for discussion.(1) What evidence is there to suggest that bilateral blindness from acute primary closed angle glaucom is preventable?(2) In what way is Ultrasonic Biomicroscopy (UBM) useful in clinical research in glaucoma?(3) Will UBM be important in clinical diagnosis in primary closed angle glaucoma?(4) What is the scientific basis of treatment in acute primary closed angle glaucoma?(5) What are the essential procedures to preserve vision in chronic primary closed angle glaucoma?(6) What are the reasons for blindness after laser iridotomy?(7) What is the mechanism of laser iridoplasty?(8) What are the reasons why laser iridoplasty should be combined with laser iridotomy?(9) Why there is an intraocular pressure increase in 50% of eyes within 3 months after laser iridoplasty?(10) Can UBM explain the changes in the angle after lens removal in primary closed angle glaucoma?(11) Are there reasons why trabeculectomy is infrequently used in acute glaucoma, yet it is an important procedure in chronic primary closed angle glaucoma?(12) The scientific reasons why laser iridotomy is essential in the fellow eye.     

Prevalence and causes of blindness in Otibhor Okhae Teaching Hospital,Irrua, Edo State,Nigeria

PURPOSE This hospital-based retrospective study was aimed at providing baseline information on the causes of blindness in the locality. METHODS The case notes of all new patients attending the Eye Clinic of Otibhor Okhae Teaching Hospital, Irrua, Edo State, Nigeria, over a six-year period (January 1995-December 2000) were retrieved and analyzed. RESULTS Over 6% (555) of new patients seen during this period were uniocularly blind while 3.9% (354) were binocularly blind. The leading causes of uniocular blindness were cataract, open-angle glaucoma and corneal ulceration/leucoma. Binocular blindness was mainly due to cataract, open-angle glaucoma and aphakia. CONCLUSIONS The prevalence of blindness in the study population is high. Cataract, as the main cause of blindness, will require surgical relief, either in the teaching hospital or preferably in the patient’s locality. Appropriate interventions need to be evolved (in the form of either mobile clinics or a series of surgical eye camps) to stem the present trend toward high prevalence of avoidable blindness. Prevention of ocular trauma is an essential factor in the reduction of blindness in children. Health education and bringing ophthalmological care to the doorstep of underprivileged rural dwellers will improve their level of awareness.     

Glaucoma screening: current trends, economic issues, technology, and challenges

PURPOSE OF REVIEW: Glaucoma is one of the leading causes of irreversible blindness worldwide. Early glaucoma detection and treatment are currently the only known methods for preventing blindness and low vision resulting from this frequently asymptomatic disease. RECENT FINDINGS: New technologies for detecting early glaucomatous damage are important in diagnosing optic nerve disease, not only in community screening settings but also in clinics. Imaging of the optic nerve head and macula and retinal nerve fiber layer analysis can provide quick, automated, and quantitative measurements in agreement with clinical estimates of optic disc structure and visual function. In the area of perimetry, frequency-doubling technology is a promising and feasible mass-screening method with reasonable sensitivity for detecting visual field loss. Central corneal thickness has emerged as a new risk factor for the development and progression of glaucoma, thereby complicating the role of tonometry and measurement of intraocular pressure as screening parameters for glaucoma. Along with technological advances, strides are also being made with public policy and legislative efforts to bring glaucoma onto the national and global health care agenda. These initiatives incorporate vision-screening goals into national disease prevention programs emphasizing the need for early glaucoma detection and treatment. SUMMARY: Glaucoma awareness needs to be increased through better education, and compliance with follow-up care needs to be improved to decrease the economic and social costs from glaucoma. In addition, screening models need to be developed that will be effective in developing countries where the risk of blindness from glaucoma is highest.     

青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼

目的探讨青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼的发病机制、临床特点及预防。方法对4例（4只眼）青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼患者的临床资料进行回顾性分析。结果 4例（4只眼）在术后早期即出现Ⅱ°、Ⅲ°浅前房,通过眼底检查、手术及超声生物显微镜（UBM）检查发现睫状体脉络膜脱离、睫状环阻滞,经睫状体脉络膜上腔放液,并根据病情联合玻璃体水囊抽吸、前段玻璃体切除以及晶状体手术等,所有患眼眼压均恢复正常,前房加深,脉络膜脱离消失。结论睫状体脉络膜脱离是发生恶性青光眼的诱发因素,预防睫状体脉络膜脱离是预防恶性青光眼发生的关键;对术后早期即出现的Ⅱ°、Ⅲ°浅前房,及时进行UBM检查有助于明确诊断,可减少治疗的盲目性。     

青光眼视野损害的评价方法

青光眼是眼科常见的不可逆性致盲眼病,其主要损害是视网膜神经节细胞（RGCs）及其轴突的变性和丢失,最终可导致视野损害和视力下降。视野检查是青光眼早期诊断以及随访过程中观察病情进展最重要的视功能检查方法,但由于视野检查存在较强的主观性,因此如何建立客观、规范的视野评价和分析方法一直受到青光眼学者们的关注。就目前临床及研究中常用的视野缺损分级方法,包括视野指数、青光眼半视野检测（GHT）、晚期青光眼干预研究（AGIS）评分法、早期青光眼试验（EMGT）评分法、多中心青光眼初始治疗研究（CIGTS）评分法等,及其优缺点进行综述,希望能够对临床及科学研究中视野评价方法的选择有所帮助。     

Risk assessment in the management of patients with ocular hypertension

PURPOSE: To develop a model for estimating the global risk of disease progression in patients with ocular hypertension and to calculate the "number-needed-to-treat" (NNT) to prevent progression to blindness as an aid to practitioners in clinical decision making. DESIGN: Development of a mathematical model for estimating risk of glaucoma progression. METHODS: Population-based studies of patients with ocular hypertension and glaucoma were reviewed by a panel of glaucoma specialists. Measures of disease progression risks derived from three long-term studies and assumptions based on the available data were used to estimate the risk of progression from ocular hypertension to glaucoma and glaucoma to unilateral blindness for untreated and treated patients over a 15-year period. Using these estimates, the NNT (1/absolute risk reduction on treatment) to prevent unilateral blindness in one patient with ocular hypertension was calculated. RESULTS: In untreated patients, the estimated risk of progression from ocular hypertension to unilateral blindness was 1.5% to 10.5% and in treated patients, the estimated risk of progression was 0.3% to 2.4% over 15 years. From these estimates, between 12 and 83 patients with ocular hypertension will require treatment to prevent one patient from progressing to unilateral blindness over a 15-year period. CONCLUSION: Global risk assessment that incorporates all available data plays a vital role in managing patients with ocular hypertension. A more precise understanding of long-term vision loss should be factored into decisions pertaining to the initiation of glaucoma therapy. Undoubtedly, these estimates will evolve and change with the availability of new population-based epidemiologic information and improvements in multivariable model testing.     

代谢综合征及其组分与开角型青光眼相关性的研究进展

开角型青光眼是青光眼分型中的一种,也是引起致盲的主要原因之一。近年来,开角型青光眼的发病率和致盲率逐年增加,其发病原因尚不清楚,目前发现代谢综合征与开角型青光眼的发生发展有一定的相关性。但两者间的研究结果尚无统一认识。本文就目前开角型青光眼与代谢综合征及其组分的相关研究进行综述。