老年人视力残障及相关眼病

目的调查分析老年人的视力残障状况和致病原因。方法对年度体检中≥60岁的老年人常规检查视力、眼前节、眼底及眼压。对视力低于正常者予以验光矫正和相关眼病检查。筛选出双眼或单眼矫正视力<0.3者进行眼病统计分析。结果893例中单眼或双眼视力<0.3者121例(13.55%)。其中双眼盲和低视力患者43例(4.82%);单眼盲和单眼低视力78例(8.73%)。随年龄增长视力残障的发生率显著增加,各年龄组间差异有极显著性(P<0.001)。121例患者的164只患眼中,125(76.22%)只眼患有2种或2种以上的致盲性眼病,其中白内障居首位。采用Logistic逐步回归和相关分析显示,影响视力最主要的眼病是年龄相关性黄斑变性和高度近视眼底黄斑萎缩,其次是青光眼和白内障。结论老年人随增龄致盲性眼病的患病率显著增加。随着医疗技术的进步和普及,老年人视力残障的发生率可望减少,然而致盲眼病谱可能发生改变,难治性眼病增多。对视力残障老年患者除积极治疗原发眼病,还应重视康复治疗。     

90岁以上老年人眼部状况及疾病分析

目的　调查 90岁及以上长寿老年人的视力状况和眼部疾病情况。　方法　对 135例90岁以上老年人常规检测视力 ,外眼、眼前节、眼底及眼压。对合作者进行验光 ,矫正屈光不正。　结果　 135例老年人右眼视力平均 0 4 6± 0 5 0 ,左眼 0 4 9± 0 5 0。盲和低视力分别为 7(5 9% )例和14 (10 3% )例。 4 3例 (81 1% )老年人验光后视力提高 1～ 5行 (平均 3行 ) ,验光前、后视力改善差异有统计学意义 (P <0 0 1)。所有老年人均有眼睑下垂、角膜类脂环、眼底动脉硬化、老视等老年性眼部变化。平均每位老人患有 2 4 (2～ 7)种眼病和 7 6 (3～ 12 )种全身主要脏器病变。对视力产生普遍影响的因素是屈光不正 ,诸多眼病中白内障居首位 ,严重影响视力的眼病是黄斑病变和各种原因的视神经萎缩。　结论　 90岁以上老年人盲和低视力的发生率高 ,其原因既有衰老退化因素 ,又有老年人常见眼病和屈光不正的影响。     

天津市60岁及以上人群盲和低视力患病率及致盲原因

目的探讨天津市60岁及以上人群的盲和低视力患病率及致盲原因。方法采用分层整群随机抽样方法抽取天津市60岁及以上居民5 872例为调查对象,进行基本情况问卷调查及眼部检查。结果实际共检查5 520名调查对象,按世界卫生组织视力损伤标准,单眼低视力患者290例(5.25%),双眼低视力患者243例(4.40%),单眼盲患者266例(4.82%),双眼盲患者145例(2.63%)。盲和低视力患病率与患者性别、年龄、文化程度、年收入、亲属是否患病等因素有关;单眼低视力主要致病原因为白内障(45.17%),屈光不正(22.07%)、黄斑变性(8.28%),双眼低视力患者主要致病原因为白内障(50.62%)、屈光不正(19.75%)、黄斑变性(11.11%),单盲主要致病原因为白内障(54.51%)、眼球萎缩/缺如(9.77%)、屈光不正(9.02%),双盲主要致病原因为白内障(44.82%)、青光眼(10.34%)、黄斑变性(7.59%)。结论天津地区老年人群盲和低视力患病率较高,白内障为老年人的常见眼病。     

湘潭农村老年人盲及低视力调查

湘潭农村老年人盲及低视力调查李惠民１９８５～１９９２年全国残疾人抽样调查中，对本地视力残疾人（盲及低视力）进行了调查及防盲治盲，先后为１６１９２人进行了眼病检查和治疗，其中６０岁以上老年人８０８６人，占总受检人数的４９．９％。共查出老年盲及低视力患者...     

新疆库车县60岁及以上维吾尔族农民盲及致盲原因流行病学调查

目的 了解新疆60岁及以上维吾尔族(下简称维族)农民盲患病率及主要致盲眼病. 方法 采用整群随机抽样的方法随机抽取了库车县年龄≥60岁的1 125名维吾尔族农民进行视力调查和眼部检查,按世界卫生组织盲目标准进行分类,并对所有针孔视力低于0.3者进行致盲原因分析.结果 共有905名老年维族农民接受了检查,受检率为80.4%.双眼盲患病率为5.65%,双盲患病率随年龄的增长相应的增长,80岁组双盲患病率为60岁组的5.8倍,其差异有统计学意义(χ2=34.0,P﹤0.01).男性双盲患病率略高于女性,其差异无统计学意义(χ2=2.1,P＞0.05).文盲组双盲患病率是非文盲组的2.37倍,其差异有统计学意义(χ2=8.1,P﹤0.05).主要的致盲眼病为白内障、青光眼及眼底病变. 结论 库车县老年维族农民的双盲患病率为5.65%,主要的致盲眼病为白内障.提高白内障手术覆盖率是降低盲患病率的关键.     

重庆市55岁以上中老年人群眼病调查

目的了解重庆市55岁及以上中老年人低视力和盲的患病率及致盲原因。方法 2009年10月至2011年10月随机整群抽样55岁及以上常住居民2 600名进行眼病筛查及视力检查。结果 2 600例中,眼部严重损伤784例(30.2%)。盲眼134例,其中双眼盲29例(1.12%),男女比较差异显著(P<0.01);56～65岁、66～75岁及76～85岁3个年龄组间矫正视力不同区间差异显著(P<0.01);导致中老年人盲的前3位疾病是黄斑变性、白内障、视网膜静脉阻塞,分别占22.4%、18.7%、15.7%,造成低视力的前3位疾病是白内障、屈光不正、黄斑变性,分别占43.8%、26.9%、14.2%。结论老年人群患眼病比例较其他人群明显增高,白内障是老年人最常见眼病;对眼底病相关因素、分类、病因等的了解可为防盲工作策略的制订提供参考。     

湿性年龄相关性黄斑变性的治疗进展

年龄相关性黄斑变性(age-related macular degene-ration,AMD)是出现不可逆性视力损伤的重要原因之一,也是全球老年人致盲的首要疾病之一[1].据统计,AMD是目前欧美等发达国家老年人群(≥60岁)的首位致盲性眼病,其中65岁以上人群患病率约为11％,80岁以上人群患病率约为64％,可引起...     

辽宁省大中城市及郊区老年人支气管哮喘患病率调查

目的　调查辽宁省大、中城市及其郊区老年人支气管哮喘 (哮喘 )的患病情况 ,为老年人哮喘的防治提供依据。　方法　以分层整群不等比随机抽样对照方法 ,抽取全省人口的 2 5‰以上人口共 1162 76人 ,对其中≥ 60岁的 12 73 5名老年人哮喘患病情况进行分析。　结果　确诊老年哮喘患者 52 2例 ,患病率为 4 0 9% ,显著高于我省同期现患病率的 1 2 5% ,其中男 2 0 7例、女 3 15例 ,女性显著高于男性 (P <0 0 1)。农村老年人哮喘患病率显著高于城市 (患病率分别为 5 2 4%和3 0 1% ,P <0 0 1)。城市工业区老年人哮喘患病率高于文化区 (患病率分别为 3 85%和 2 44% ,P<0 0 5) ,起病年龄在 60岁以上者 50例 ,占 9 58%。本次调查确诊为哮喘者 2 13例 ,漏诊率为40 80 %。　结论　哮喘是老年人的常见疾病 ,加强其防治极为重要     

遵义市老年性白内障的患病情况及影响因素

目的探讨遵义市老年性白内障的患病情况及影响因素。方法选取2014年1~12月在遵义市某医院体检的1 500例居民,年龄50~86岁,根据调查数据计算老年性白内障的发病率、致低视力率及致盲率。采用Logistic回归法和单因素法分析危险因素。结果 1 500例调查对象中,共280例(18.67%)检测出老年性白内障。280例老年性白内障中白内障致盲者11例(3.93%)。白内障致低视力者50例(17.86%)。280例老年性白内障中女105例,患病率为21.60%;男175例,患病为17.26%。50~80岁,随着年龄增长,男性及女性老年性白内障发生率都呈升高趋势(P0.05)。随着年龄增长,老年性白内障引起的视力损伤比例逐渐上升趋势。老年性白内障引起的视力损伤中女性比例高于男性,差异具有统计学意义(P0.05)。性别、吸烟、高血压、年龄及糖尿病5个因素均为老年性白内障的危险因素。结论老年性白内障是多种因素作用的结果,遵义市年龄50岁及以上的居民白内障患病率较高,应采取针对性预防措施,以降低老年性白内障对高龄人群健康可能带来的损害。     

与年龄相关的黄斑变性视力损害

与年龄相关的黄斑变性(AMD)在西方国家是最主要的致盲原因(Sorsby1966,Ghafour 1983,Klie 1989)。有关AMD患者不同视力损害的流行病学资料却较少报道。作者研究9万人中随机调查1000名60～80岁丹麦老年人,以揭示萎缩型和渗出型AMD患者视力损害的情况。被检者依年龄分为60～64岁、65～69岁、70～74岁和75～80岁四个年龄组。除常规眼部检查外,眼底检查包括直接、间接眼底镜及裂隙灯加三面镜检查和彩色眼底照象。视力用Snellen E字视力表检查,E字照度700lux,视力表周围照度为400lux。     

Common eye diseases of elderly people: identifying and treating causes of vision loss

Of the 38 million people who are blind, the majority, 22 million, are 60 years of age or older. The most common causes of vision loss in elderly people are age-related macular degeneration (AMD), cataract, glaucoma, and diabetic retinopathy. Of these, AMD is the leading cause of registered blindness in people over the age of 50 years in the western world. However, until recently, the treatment options for people with AMD have been severely limited. Verteporfin therapy is a new treatment that is efficacious and safe in selected patients with AMD who are at high risk of central vision loss. Physicians who are in regular contact with elderly people can help to minimize vision loss in this group of patients by being alert to the symptoms and signs of age-related eye diseases. This paper reviews each of the common eye diseases, with an emphasis on AMD because of the recent advances in treatment.     

Visual impairment in an aged care ward

Introduction: Visual impairment is common in older people, and is a risk factor for falls and hip fractures, reduced independence and quality of life. Objectives: To assess the prevalence and causes of visual impairment in an aged care ward, and to evaluate whether routine eye assessment, and referral to an eye specialist was worthwhile to detect patients with low vision that could be correctable. Method: Clinical eye examination of 100 consecutive inpatients and review of medical records. Patients with a new diagnosis of visual impairment were referred for ophthalmology or optometry assessment. Results: The prevalence of low vision was 36% and the prevalence of blindness was 9%. There were 18 patients referred for specialist review, three patients were recommended a new treatment but only two received treatment. Conclusion: Visual impairment was prevalent. Although refractive error and cataracts were common, in only a few cases did detection and specialist referral lead to improved visual outcomes.     

老年人屈光不正172例临床分析

目的探讨老年人屈光不正的病因、特点及与合并眼病间的关系。方法应用自动电脑验光仪对６０～８６岁患者１７２例３２８只眼验光后矫正视力检查。结果本组轻度远视及远视散光较多，共２３４眼（７１．３％），逆规则散光发生率高，２１８限中发生１４３眼（６５．６％），并随年龄增长而增多。３１２眼（９５．１％）矫正后视力提高，其中２６２眼≥１．０，占７９．９％。合并眼病中以白内障最多见，共２１３眼。结论屈光不正是老年人视力障碍的常见原因之一，矫正后多数视力可提高。     

The Prevalence and Causes of Visual Impairment and Blindness Among Older Adults in the City of Lodz,Poland

To investigate the prevalence and causes of visual impairment and blindness in a sample of Polish older adults.The study was designed in a cross-sectional and observational manner. Data concerning the vision status were assessed in 2214 eyes from 1107 subjects of European Caucasian origin; most of whom live in the city of Lodz, in central Poland. Visual impairment was defined as distance visual acuity <20/40 in the worse-seeing eye. Low vision was defined as best-corrected visual acuity (BCVA) <20/40 but >20/200 in better-seeing eye, and blindness was defined as BCVA ≤20/200 in both eyes (United States criteria).Visual impairment was found in 27.5% subjects in the worse-seeing eye. Multiple regression analysis showed that increasing age (OR 0.98, 95% CI 0.97–0.99) and female gender (OR 1.47, 95% CI 1.11–1.93) were independent risk factors. No association was found between visual impairment and socioeconomic status of subjects. Noncorrectable visual impairment was found in 7.0% of subjects, including 5.2% of subjects with unilateral and 1.8% of subjects with bilateral visual impairment. Low vision and blindness accounted for 1.3% and 0.5%, respectively, and were only associated with older age (OR 1.05, 95% CI 1.02–1.10). Retinal diseases represented the major cause of noncorrectable visual impairment and accounted for more than half of causes of blindness.Provision of appropriate refractive correction improves visual acuity in 75% subjects presenting with visual impairment. Retinal diseases are a major cause of noncorrectable visual impairment and blindness in this older population.     

Ocular manifestations of inflammatory bowel disease

Extraintestinal manifestations of inflammatory bowel disease (IBD) occur in one third of patients. Ocular complications are infrequent, occurring in less than 10% of cases, but can be associated with significant morbidity, including blindness. Ocular complaints are often nonspecific; clinical relevance may not be appreciated by patient or physician and, thus, be misdiagnosed. Evaluation of the eye should be a routine component in the care of patients with IBD. Clinicians must be aware of the spectrum of ocular symptoms and know that these complaints may precede a diagnosis of ulcerative colitis (UC) or Crohn's disease (CD). We review ocular pathology in IBD to alert clinicians to the diverse, at times confusing, spectrum of eye disorders associated with these diseases. Clinical manifestations include blurred vision, teary, burning or itchy eyes, ocular pain, photophobia, conjunctival or scleral hyperemia, loss of visual acuity, and possible blindness. Many patients are unaware that IBD has a risk of eye complications and, therefore, patient education is vital.     

Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia

BACKGROUND: The prevalence of blindness and visual impairment are high in Ethiopia and use of services is limited. Determining the barriers to use of eye care services is critical for planning strategies to prevent blindness. METHODS: A population-based survey of the magnitude and causes of blindness and visual impairment in adults 40 years and older in the Gurage Zone, central Ethiopia was conducted. Among those individuals who had binocular or monocular vision <6/18, an interview to assess use of eye care services and reasons for a failure to use such services was undertaken. RESULTS: Of 850 adults with visual impairment or blindness, 802 were interviewed. Cataract surgery accounted for the primary service currently needed by the blind, followed by trichiasis surgery; service needs were higher for women than for men. Use of services (27.8% of sample) was associated with being male, binocular vision loss, and blindness. The primary reason for a failure to use eye care services were indirect costs (overall, reported by 40% of respondents) associated with accessing the service. There were significant differences between men and women in the reasons for not using the services and between cataract and trichiasis cases but not when comparing binocular vs. monocular conditions, or patients with visual impairment vs. blindness. CONCLUSION: The majority of the causes of visual impairment and blindness are treatable (cataract) or preventable (trachomatous trichiasis). The main barrier for seeking service is related to the indirect medical costs of the service. This suggests that efforts are needed to create mechanisms that 'bridge' communities and eye care facilities. A holistic approach that deals both with the organization of services and the sociocultural factors in communities that affect use is needed. The organization of trichiasis surgery at peripheral health centres and screening programmes which identify and facilitate transport to hospital for cataract patients is one approach. The indirect burden of accessing eye care on the family may be lessened by encouraging patients to have surgery earlier (before they require assistance to reach the hospital), and by improving the efficiency of existing services. Promotion of services must be gender-sensitive, ensuring that specific characteristics of the sociocultural roles of women be considered in order to improve uptake among women. Training and placement of cataract surgeons in rural hospitals would also enhance provision of eye care for the rural population.     

孕产妇行心血管手术的麻醉分析

目的：分析孕产妇行心血管手术的麻醉管理.方法：回顾性分析我院9例孕产妇行心血管手术的麻醉资料.平均年龄（28.3±4.7）岁,妊娠8w至产后2d,术中行二尖瓣手术2例,二尖瓣＋主动脉瓣置换＋冠状动脉旁路移植术1例,主动脉瓣手术1例,黏液瘤切除术3例,Bentall＋主动脉弓置换术2例.3例先行剖宫产的患者采用小剂量氯胺酮或雷米芬太尼麻醉诱导,待胎儿娩出后再使用芬太尼或舒芬太尼加深麻醉外,另6例均采用芬太尼或舒芬太尼麻醉诱导.心血管手术中采用芬太尼或舒芬太尼为主的静吸复合麻醉,其中芬太尼平均用量（50±0.5）μg/kg,舒芬太尼平均用量（5.3±2.0）μg/kg.1例孕妇心脏复跳后因心功能低下采用体外膜肺（ECMO）辅助后脱机.结果：孕产妇术后顺利康复6例,死亡3例,术后病死率为33.3％,死亡原因为低心排血综合征、肺部感染与肾功能衰竭,其中3例行血液透析治疗,1例行ECMO及主动脉内球囊反搏（IABP）辅助治疗.术后新生儿健康成活5例,家属放弃抢救胎儿2例,人工流产2例,胎儿丢失率为44.4％.结论：孕产妇实施心血管手术的危险性较高,加强围术期麻醉管理,选择恰当的手术时机与手术方式,采取多学科合作的综合处理,有利于母婴顺利度过围术期.     

Longitudinal analysis of the relationship between regular eye examinations and changes in visual and functional status

OBJECTIVES: To determine whether regular eye examinations are associated with a greater or lesser rate of loss of ability to read newsprint, onset of blindness or low vision, or onset of limitations in instrumental activities of daily living (IADLs) and activities of daily living (ADLs). DESIGN: A sample of 14,215 Medicare beneficiaries observed between 1994 and 1999 linked to the 1994 and 1999 National Long-Term Care Surveys (NLTCS). Effects of annual examinations were assessed using instrumental variables. SETTING: The Medicare-linked NLTCS is representative of U.S. elderly persons from 1994 to 1999. PARTICIPANTS: Longitudinal observational study of persons aged 65 and older. MEASUREMENTS: Change in self-reported and provider-reported vision and change in functional limitations associated with vision related to the number of years with eye examinations and other factors. RESULTS: Persons with more-regular eye examinations between 1994 and 1998 were less likely to have experienced a decline in vision or in functional status between 1994 and 1999. On average, an additional year with an eye examination was associated with a decrease in the probability of becoming unable to read newsprint of 0.12 (P=.03), a lower probability of onset of low vision or blindness of 0.009 (P=.06), and a decrease in the probability that the number of functional limitations increased of 0.13 (P=.002) for IADLs and 0.05 (P=.003) for ADLs. CONCLUSION: Elderly persons who have regular eye examinations experience less decline in vision and functional status.     

80岁以上白内障患者门诊手术安全性的评价

目的 探讨80岁以上老年人白内障门诊行超声乳化人工晶体植入术的安全性及临床效果。方法 对184例（226眼）80岁以上老年白内障门诊患者行超声乳化人工晶体植入术，观察其安全性、术中、术后并发症及视力恢复等。结果 226眼均安全地在门诊实行手术，术中无严重全身并发症发生。术后3个月198眼（87．6％）视力＞0．5，102眼（45．1％）＞1．0，主要并发症为角膜水肿58眼（26．2％），后囊破裂12眼（5．3％），后囊混浊16眼（7．1％）。结论 80岁以上老年白内障患者门诊行超声乳化人工晶体植入术是安全有效的，关键是术前认真进行眼部及全身状况检查，并作全身疾病的相应处理，手术中减少刺激并尽量减少术后并发症。