Abstracts

Purpose: To analyse trends in the incidence of registered age-related macular degeneration (ARMD) in the UK since 1950 and to compare these to trends in registration of other blinding diseases —cataract, glaucoma and optic atrophy over the same time period. Methods: Calculation of standardised registration ratios for ARMD, cataract, glaucoma and optic atrophy using published registratoin data from 1950 onwards. SRRs for each sex separately were calculated, adjusting for age in 5 year age-groups. Results: The absolute number of people registered blind annually has more than doubled since 1950. After adjustment for age, annual registration rates for blindness have fallen over the past 40 years, particularly with respect to cataract and glaucoma. Standardised registration ratios for ARMD exhibit a different pattern, increasing, but not consistently, over the same time period. Conclusions: These oberservations are consistent with the hypothesis that the incidence of registrable ARMD is increasing. Changes in the diagnosis and detection of this disease, however, cannot be excluded as an alternative explantation. Analysis of trends in national registration statistics may be useful for monitoring changes in the distribution of blinding eye disease in the population.     

Incidence of visual impairment and blindness in indigenous Australians within Central Australia: the Central Australian Ocular Health Study

Background: To estimate the incidence and causes of visual impairment and blindness among indigenous Australians living in Central Australia. Design: Clinic‐based cohort study. Participants: A total of 1884 individuals aged ≥20 years living in one of 30 remote communities within the statistical local area of ‘Central Australia’. Methods: From those initially recruited, 608 (32%) participants were reviewed again between 6 months and 3 years (median 2 years). Patients underwent Snellen visual acuity testing and subjective refraction. Following this, an assessment of their anterior and posterior segments was made. Baseline results were compared with those who were reviewed. Main Outcome Measures: The annual incidence rates and causes of bilateral visual impairment (vision worse than Snellen visual acuity 6/12 in the better eye) and bilateral blindness (Snellen visual acuity worse than 6/60 in the better eye). Results: The annual incidence of bilateral visual impairment and blindness was 6.82% (8.12% for those aged ≥40 years) per year and 0.50% (0.62% for those aged ≥40 years) per year, respectively. Refractive error, followed by cataract and diabetic retinopathy, were the main causes for incident bilateral visual impairment and blindness. Conclusion: This study has demonstrated rates of incident bilateral blindness and visual impairment among the indigenous Australian population within Central Australia, which are substantially higher than those from the non‐indigenous population. Services need to address the underlying causes of this incident vision loss to reduce visual morbidity in indigenous Australians living in central Australia.     

Incidence of blindness in southern Germany due to glaucoma and degenerative conditions

PURPOSE: To estimate population-based incidence rates of registered blindness separately, to determine its main causes. METHODS: The files of all newly registered blindness-allowance recipients in Württemberg-Hohenzollern, Germany (population: approximately 5 million), between 1994 and 1998 were reviewed. From ophthalmological reports on file the fulfillment of the German criteria for blindness (visual acuity of 1/50 or less or equivalent reduction of visual function) was ascertained, and the causes of blindness were obtained. Incidence rates of blindness due to macular degeneration, glaucoma, cataract, optic atrophy, and diabetic retinopathy were estimated. RESULTS: There were 3531 newly registered blindness-allowance recipients (67.1% female; mean age, 72.8 +/- 21.0 years). Standardized incidence rates in the general population (per 100,000 person-years; 95% confidence interval): All causes 12.27 (11.87-12.68), macular degeneration 5.29 (5.02-5.55), cataract 3.32 (3.11-3.52), optic atrophy 2.86 (2.66-3.05), glaucoma 2.43 (2.25-2.61), diabetic retinopathy 2.13 (1.96-2.30), other or unknown causes 5.17 (4.91-5.43). In many cases, blindness was attributable to more than one cause. Assuming that incidence rates are the same in other parts of the country, 9,939 (9,608-10,270) new cases of blindness were estimated to occur in Germany per year. CONCLUSIONS: The most common single cause of blindness was macular degeneration. Incidence rates of blindness due to such treatable conditions as glaucoma were also high. This finding suggests that the taking of measures for secondary prevention (e.g., early detection and optimal treatment of patients with glaucoma and diabetic retinopathy) should be intensified.     

The incidence of visual impairment due to diabetic retinopathy in Leeds

AIM: A key aim of the photographic screening model for diabetic retinopathy advocated by the National Screening Committee is a reduction in new blindness due to diabetic retinopathy within 5 years. This study determines the incidence of visual impairment due to diabetic retinopathy in Leeds in 2002 and provides a benchmark against which the success of the retinopathy screening programme in Leeds will be judged. METHODS: A retrospective review of all blind and partially sighted registrations for 2002 was conducted. The 2001 Census data and the diabetes prevalence model developed by the Yorkshire and Humber Public Health Observatory were used to determine the total and diabetic populations of Leeds. RESULTS: Diabetic retinopathy was the primary cause of registration in 24 of the 398 completed records obtained; seven patients were registered blind and 17 partially sighted. For the total population in 2002, the incidence of blind and partially sighted registration due to diabetic retinopathy was 10 per million and 24 per million per year, respectively. For the diabetic population of Leeds in 2002, the incidence of blind and partial sighted registration due to diabetic retinopathy was 337 and 817 per million per year, respectively. CONCLUSIONS: The incidence of blind registration due to diabetic retinopathy in Leeds in 2002 is similar to the estimate provided by the National Screening Committee but higher than the figure from other UK centres.     

Visual impairment certification secondary to ARMD in Leeds, 2005–2010: is the incidence falling?

Aim

The aim of this study was to evaluate trends in visual impairment certification due to age-related macular degeneration (ARMD) in the Leeds metropolitan area between 2005 and 2010.

Methods

In this retrospective study, the primary causes of visual impairment certification in the Leeds metropolitan area between 2005 and 2010 were reviewed. ARMD was considered to be the cause of certification when recorded as the primary factor contributing to visual impairment in one or both eyes. The incidence of visual impairment certification due to ARMD was calculated using population estimates from the Office of National Statistics.

Results

ARMD was the primary cause of visual impairment certification in all study years, accounting for 58.7 and 50.8% of certifications in 2005 and 2010, respectively. For the same period, the incidence of certification due to ARMD fell from 364 to 248 per million population per year. This was largely the result of a fall in the incidence of visual impairment certification due to neovascular ARMD from 225 to 137 per million population per year, beginning in 2008 after the introduction of a local commissioning policy on the use of intra-vitreal ranibizumab.

Conclusion

The incidence of visual impairment certification due to ARMD in the Leeds metropolitan area appears to be falling. This is largely the result of a decrease in certification secondary to neovascular ARMD. This represents a change in the previously described trend for ARMD visual impairment certification.     

Trends in blind registration in the adult population of the Republic of Ireland 1996-2003

BACKGROUND/AIM: The Republic of Ireland has a centralised database of all registered, blind people in the country. The last study of the national blind register was undertaken in 1996. The current study sought, firstly, to investigate and identify any recent changes in the register composition. Secondly, there is concern that many eligible people are not appropriately registered. To examine this further, registration levels among patients attending an Irish outpatient ophthalmology clinic were determined. METHODS: Criteria for blind registration in Ireland are (1) a best corrected visual acuity of 6/60 or less in the better eye, or (2) a visual field subtending an angle of 20 degrees or less. The National Council for the Blind in Ireland (NCBI) is the sole custodian of a national registration database recording all eligible, registered people. This computerised database was analysed to provide information on the demographics and blind registration condition of those on the register in 2003. This information was compared with the results of the 1996 study. To assess the accuracy of the current register, the registration status of eligible patients attending the outpatient clinic of a busy, tertiary referral ophthalmology department, over a 9 week period, was studied. RESULTS: 6862 adults were registered as blind on the NCBI register in Ireland in 2003, representing an increase of 37% since 1996. The leading causes of registration were age related macular degeneration (ARMD) (25%), glaucoma (12%), and retinitis pigmentosa (7%). Comparing the 1996 and 2003 data, dramatic increases in the numbers registered caused by ARMD (from 812 to 1729 people, a 113% increase) and diabetic retinopathy (DR) (from 147 people to 323 people, a 120% increase) were found. The numbers registered as a result of glaucoma were relatively stable (795 in 1996 and 811 in 2003). A substantial drop, of 53%, was noted in the number of people registered as a result of cataracts, from 561 people to 261. Of the 672 new cases registered in 2003, ARMD accounted for 44%, glaucoma 13%, and DR 7%. Over the 9 week study period 75 patients, out of a total 2320 patients who attended the outpatient department, fulfilled the blind registration criteria. It was found that 21% (16 of 75) of the eligible clinic outpatients had not been appropriately registered. CONCLUSION: An overall increase in adult blind registration of 37% in the Republic of Ireland was found between 1996 and 2003. There were large increases in registered blindness as a result of ARMD (113%) and DR (120%). A notable decrease in registration as a result of cataracts was discovered. Vigilance by clinicians is necessary to ensure that eligible patients are registered.     

Is the incidence of registrable age-related macular degeneration increasing?

AIMS/BACKGROUND: Age-related macular degeneration (ARMD) is a growing public health problem in Britain; currently its aetiology is unclear. The aim of this study was to test the hypothesis that the age specific incidence of blinding ARMD has increased in Britain in the past 50 years, using data on cause of visual loss in people registered as blind, published every 10 years since 1950. METHODS: Data were abstracted from published sources for the years 1950, 1960, 1970, and 1980. Data for the standard year, 1990, were provided in a database from the Office of Population Censuses and Surveys. The numbers of new registrations attributed to ARMD per head of population were compared with registrations for cataract, glaucoma, and optic atrophy. Indirect standardisation was used to control for changes in the age structure of the population over time. RESULTS: After controlling for changes in the age structure of the population, registration rates for all causes, cataract, glaucoma, and optic atrophy have decreased while registrations attributed to ARMD have increased in the order of 30-40%. CONCLUSIONS: These findings are compatible with the hypothesis that the incidence of ARMD is increasing in Britain. It is difficult to exclude potential sources of bias in these data, however, particularly with respect to classification and coding of cause; more reliable population based data on ARMD in Britain are needed.     

The burden of genetically determined eye disease.

We determined the underlying aetiology of blindness for the registered blind population of the Province of Newfoundland and Labrador. In both 1981 and 1984 single-gene disorders accounted for 30% of total blindness and congenital defects for another 10-11%. Genetically determined conditions, diabetes, and senile macular degeneration (SMD) were the three leading causes of registration in each year, 1980-4. We calculated mean ages of registration and mean ages of death over the last four years for five major aetiological groups. Patients with genetic conditions were registered at a much younger age and had a correspondingly longer duration of blindness (21 years as compared with 5 years for either diabetes or SMD). Total 'person-years of blindness' was then calculated from the product of this duration of blindness and the total numbers registered in each group. This index shows that the overall individual and population impact of monogenic blindness is overwhelmingly greater than that of other causes (6849 person-years compared with 270 for diabetes and 430 for SMD). In view of this frequency and duration of monogenic blindness, and also of the substantial hereditary liability to relatively common causes of blindness such as glaucoma, diabetic retinopathy, and high myopia, we suggest that more attention needs to be paid to elucidating the genetic contribution to blindness.     

Unrecognized and unregistered blindness in people 70 or older in Jing’an district, Shanghai, China

AIM: To evaluate the efficacy of a registration system for the blind people and to monitor the blindness due to uncorrected refractive error and cataract in Jing’an district, Shanghai, China.#$NLMETHODS: Five hundred and ten blind people, based on visual acuity screening in a population aged 70 or older were enrolled into the study. Four hundred and forty subjects were interviewed. The following data were collected on each patient:demographic data, number of hospital visits for eye related problems, distance visual acuity, visual fields, ophthalmic diagnoses, education and registration status. If the eligible subject was not registered as blind, the reason for non-registration was recorded.#$NLRESULTS: Ten point nine one percent blindness was due to cataract, 27.5% due to uncorrected refractive error, and only 61.59% met the eligible blindness criteria (uncorrected refractive error and cataract are not considered as eligible blindness). The first four leading causes of eligible blindness were age related macular degeneration (25.09%), myopic macular degeneration (21.40%), glaucoma (18.82%) and corneal disease (8.12%). Only 68.27% eligible blind people were registered. The patients with macular degeneration and glaucoma tended not to register. Blind people with an above primary school education were 2.59 times more likely to be registered than those who were illiterate or had only a primary school education (OR=2.59, 95%CI:1.49-4.48, P<0.01). Patients who had 4 or more visits to the hospital requesting eye care services in a year were 2.2 times more likely to be registered than those with less than 4 visits to the hospital (OR=2.54, 95%CI:1.47-4.38, P<0.001). The first two leading reasons of misregistration were unknowing the registration system (48%) and unwilling to register (21%). #$NLCONCLUSION: Under-registration of the eligible blind people exists in the registry system. Education and the number of hospital visits for eye care services were factors associated with registration levels. Uncorrected refractive error and cataract are important causes of blindness.     

Causes of blindness and visual impairment in the West of Scotland

AIMS: To determine the overall reported incidence and causes of registrable blindness and visual impairment in the West of Scotland and any trends that have occurred in the previous 16 years since data from the same area were published. METHODS: Data for analysis were obtained from BP1 registration forms returned to the Resource Centre for the Blind serving the Strathclyde region in the West of Scotland between 1 April 1996 and 31 March 1997. RESULTS: A total of 1595 visually handicapped people were registered during the study year. Of these, 99 forms (6.2%) were excluded from further analysis because of insufficient information. The remaining 1496 completed BP1 Forms were in respect of 530 males and 966 females. Of these, 253 males and 450 females were legally blind (total 703 or 47.0%) and 277 males and 516 females were partially sighted (total 793 or 53.0%). The five leading causes of blindness, in decreasing frequency, were age-related macular degeneration (ARMD), glaucoma, diabetic retinopathy, myopic degeneration, and optic atrophy. ARMD and diabetic retinopathy were the most common causes of blindness in those over 65 years and persons of working age, respectively. CONCLUSIONS: In adults, cataract is no longer a significant cause of registrable visual impairment. The proportions of registrations owing to glaucoma, diabetic retinopathy, and myopia have not significantly changed since 1983 and the proportion owing to macular degeneration has increased. In children, congenital glaucoma, cataract, and corneal infection were no longer causes of registration, but impairment of vision caused by brain damage is now a significant contributor.     

Incidence of visual loss in rural southwest Uganda

BACKGROUND: Surveys have been conducted to measure prevalence of eye disease in Africa, but not of incidence, which is needed to forecast trends. The incidence of visual loss is reported in southwest Uganda. METHODS: A rural population residing in 15 neighbouring villages was followed between 1994-5 (R1) and 1997-8 (R2). Survey staff screened adult residents (13 years or older) for visual acuity using laminated Snellen's E optotype cards at each survey. Those who failed (VA >6/18) were evaluated by an ophthalmic clinical officer and an ophthalmologist. Incidence of visual loss (per 1000 person years (PY)) was calculated among those who had normal vision at R1. RESULTS: 2124 people were studied at both survey rounds (60.9% of those screened at R1); 48% were male. Participants in R1 were older (34.7 versus 31.5 years at R2, p<0.001). Visual loss in R2 occurred in 56 (2.8%) of 1997, yielding a crude incidence rate of 9.9, and an age standardised incidence rate of 13.2, per 1000 PY. Incidence of visual loss increased with age from 1.21 per 1000 PY among people aged 13-34 to 64.2 per 1000 PY in those aged 65 years or older (p for trend >0.001). The six commonest causes of visual loss were: cataract, refractive error, macular degeneration, chorioretinitis, glaucoma, and corneal opacity. If similar rates are assumed for the whole of Uganda, it is estimated that 30 348 people would develop bilateral blindness or bilateral visual impairment, per year. CONCLUSIONS: Cataract and refractive error were the major causes of incident visual loss in south west Uganda. These data are valuable for forecasting and planning eye services.     

Retinal detachment and its relation to cataract surgery.

In Western Australia during the period 1 January 1976 to 31 December 1987 1089 eyes of 1044 patients in hospital were operated upon for primary rhegmatogenous retinal detachment due to causes other than penetrating trauma. Of these eyes 295 (27%) were aphakic or pseudophakic. During this period the annual number of cataract operations in the State increased by a factor of 245%, while aphakic and pseudophakic retinal detachment operations rose by only 55%. The declining risk of retinal detachment following cataract surgery is attributed to improvements in microsurgical techniques. In 1983 and 1984 the incidence of aphakic and pseudophakic retinal detachments dropped significantly (p less than 0.05). At about this time extracapsular cataract surgery became widespread in the State, and this may explain the observed fall in retinal detachment operations. Since 1984 the incidence has risen owing to the rapidly increasing prevalence of pseudophakia in the resident population.     

Trends in cataract surgery and postoperative endophthalmitis in Western Australia (1980-1998): the Endophthalmitis Population Study of Western Australia

Objectives: Postoperative endophthalmitis results from an intraocular infection and usually occurs following cataract surgery. It has significant morbidity and causes severe visual impairment or blindness of the eye. The aim of this study was to assess the trends in the incidence rates of cataract surgery and postoperative endophthalmitis in Western Australia for the period 1980?1998. Methods: The Western Australian Record Linkage Project was used to link the morbidity records for all patients treated for cataract surgery in Western Australia in 1980?1998. Patient records were selected using the international classification for diagnosis and procedure codes pertaining to cataract surgery and postoperative endophthalmitis. All cases of postoperative endophthalmitis were validated by case‐note review. The separate databases of the Royal Perth Hospital microbiology and anaesthetic departments as well as the vitreo‐retinal surgeon logbooks were used to cross‐validate the hospital morbidity database. Trends in the incidence rates of cataract surgery and postoperative endophthalmitis were assessed by Poisson regression. Results: There were 94 653 cataract procedures performed for 63 007 patients in Western Australia during the 19‐year period. The majority (88%) of cataract procedures performed were in patients aged 60 years or older. Postoperative endophthalmitis developed in 188 patients, with serious visual impairment occurring in 70.6% of patients for whom visual acuity data was available at presentation. The incidence rate of cataract surgery increased more than three‐fold from 1981 (102 per 100 000 person years) to 1998 (345 per 100 000 person years), mainly due to the increase in extracapsular cataract extraction during the 1980s and phacoemulsification extraction from 1990 onwards. In contrast, the average annual incidence rate of postoperative endophthalmitis remained relatively unchanged at around 2 per 1000 cataract procedures over the same period. Conclusion: Cataract surgery is becoming more prevalent in the elderly as the life expectancy of the population increases. There has been a dramatic shift in surgical practice during the last 30 years with small‐incision phacoemulsification being the predominant method of intervention used since 1990. Despite changes in surgical practice the incidence rate of postoperative endophthalmitis has remained the same.     

Diabetic blindness significantly reduced in the Warmia and Mazury Region of Poland: Saint Vincent Declaration targets achieved

PURPOSE: The authors' aim was to verify if the targets of the Saint Vincent Declaration concerning the reduction of diabetes-related blindness in the Warmia and Mazury Region, Poland, had been achieved. METHODS: A register of World Health Organization-defined blindness due to diabetes was conducted in the Warmia and Mazury Region between 1989 and 2004. The incidence rate of blindness as the number of new cases/100,000 diabetic population/year and 100,000 total population/year was estimated for three subperiods differing in political-economic system and diabetologic care delivery: 1989-1994, 1995-1999, and 2000-2004. RESULTS: The major cause of blindness among diabetic patients was diabetic eye disease (97%). Out of 70 patients with Type 1 diabetes, 53% lost vision due to proliferative diabetologic vitreoretinopathy, 20% due to neovascularization with glaucoma, while clinically significant macula edema and cataract associated with proliferative diabetologic vitreoretinopathy or clinically significant macula edema predominated in 210 patients with Type 2 diabetes. The incidence rate of blindness due to diabetes in the diabetic population ranged from 102.4/100,000 (confidence interval [CI]: 65.7-139.0) to 13.3/100,000 (3.8-24.9). The incidence rate of blindness due to Type 1 diabetes ranged from 1.3/100,000 (CI: 0.5-2.2) to 0.1/100,000 (CI: -0.1-0.4). The incidence rate of blindness due to Type 2 diabetes was variable in the first subperiod, and it next decreased by 19% each year from 3.9/100,000 (CI: 2.5-5.3) to 0.7/100,000 (CI: 0.1-1.2); p<0.001. CONCLUSIONS: The Saint Vincent Declaration target of reducing diabetes-related blindness by one third appears to have been achieved in the Warmia and Mazury Region.     

Rapid assessment of avoidable blindness and needs assessment of cataract surgical services in Satkhira District, Bangladesh

AIMS: To estimate the magnitude and causes of blindness in people aged > or =50 years in Satkhira district, Bangladesh, and to assess the availability of cataract surgical services. METHODS: 106 clusters of 50 people aged > or =50 years were selected by probability-proportionate to size sampling. Households were selected by compact segment sampling. Eligible participants had their visual acuity measured. Those with visual acuity <6/18 were examined by an ophthalmologist. A needs assessment of surgical services was conducted by interviewing service providers. RESULTS: 4868 people were examined (response rate 91.9%). The prevalence of bilateral blindness was 2.9% (95% confidence interval (CI) 2.4% to 3.5%), that of severe visual impairment was 1.6% (95% CI 1.2% to 2.0%) and that of visual impairment was 8.4% (95% CI 7.5% to 9.3%). 79% of bilateral blindness was due to cataract. The cataract surgical coverage was moderate; 61% of people with bilateral cataract blindness (visual acuity <3/60) had undergone surgery. 20% of the 213 eyes that had undergone cataract surgery had a best-corrected poor outcome (visual acuity <6/60). The cataract surgical rate (CSR) in Satkhira was 547 cataract surgeries per million people per year. CONCLUSIONS: Although the prevalence of blindness and visual impairment was lower than expected, the CSR is inadequate to meet the existing need, and the quality of surgery needs to be improved.     

Glaucoma blindness in Denmark.

In order to evaluate the prevalence and the incidence of glaucoma blindness in Denmark, all registration forms of persons greater than or equal to 50 years of age at admission, admitted to the Danish Association of the Blind (DAB) between 1955 and 1987 with glaucoma as main cause of blindness, were examined. In 1987 6.7% of DAB-members greater than or equal to 50 years of age suffered from blindness caused at least partially by glaucoma, equivalent to an estimated prevalence of 45 per 100,000 of the Danish population greater than or equal to 50 years. The estimated annual incidence of blindness due to glaucoma was 7 per 100,000 greater than or equal to 65 years, and in an equal number of patients glaucoma was a contributory cause of blindness. The incidence of blindness due to glaucoma was decreasing in the young age groups (less than 65 years) throughout the study period. Glaucoma blindness seems to occur at a later age now than earlier, leaving the patients blind for a shorter time. This pattern may be explained by improved health services but could also be due to a change in the spontaneous course of glaucoma. The proportion of glaucoma blindness in the glaucoma population was estimated to be 4-5%.     

抗VEGF药物在湿性年龄相关性黄斑变性中的应用进展

年龄相关性黄斑变性(ARMD)是导致老年人不可逆失明的主要原因之一,ARMD致失明患者中,以脉络膜新生血管(CNV)为特征的湿性ARMD比例达到90%。随着我国老年人口比例的不断上升,湿性ARMD已经成为一个日益严重的社会医学问题。目前,针对湿性ARMD的治疗方案主要是抗血管内皮生长因子(VEGF)药物的应用,这类药物抑制了CNV的发展,提高了患者视力,改善了预后,降低了致盲率。但是在治疗过程中的无反应、长期用药后的维持和用药后的耐受、不良反应以及用药的经济效益也是我们需要关注的。本文就近年来临床用于治疗湿性ARMD的药物进行综述。     

Estimating the yearly number of eyes with treatable neovascular age-related macular degeneration using a direct standardization method and a markov model

PURPOSE: To estimate the number of treatable eyes with neovascular subfoveal age-related macular degeneration (ARMD) in France. METHODS: A literature search for studies documenting neovascular ARMD incidence rates and direct standardization according to age and gender were performed. Projection to the year 2025 was based on OECD (Organization for Economic and Co-operation Development) data. A cohort of patients aged 75 years was simulated by a seven-state Markov model. The mean treatment duration was fixed arbitrarily at 2 years. The probability of ARMD in the second eye was fixed at 30% at 5 years. Monthly mortality incidence was modeled from INSEE (Institut National de la Statistique et des Etudes Economiques) mortality tables. The time horizon of the model was 25 years. Sensitivity analyses were performed. RESULTS: Based on the Rotterdam Study, 30,192 citizens per year will develop ARMD in one eye. Among them, 17,585 will be neovascular and 13,805 neovascular subfoveal ARMD. Taking into account the second eye, mortality, and a 2-year treatment duration, the number of neovascular subfoveal treatable eyes yearly would be 37,019 by 2025. Treatment duration was the most sensitive parameter. The number of eyes would be 18,899, 53,204, 67,535, and 80,162, for treatment lasting 1, 3, 4, and 5 years, respectively. A 2% yearly increase is expected up to 2025, due to population aging and the 1950s baby boom. CONCLUSIONS: According to the study model, the yearly number of subfoveal neovascular ARMD treatable eyes in France will be 37,019 by 2025. Average treatment duration was the most sensitive parameter.     

Cataract blindness and visual outcome of cataract surgery in a tribal area in Pakistan

AIM: To estimate the rates of cataract blindness and cataract surgical coverage and to assess the visual outcome of cataract surgery among individuals aged > or =50 years in Orakzai Agency, Pakistan. METHODS: 1600 individuals aged > or =50 years were selected using probability proportional to size sampling. The main outcome measure was bilateral cataract blindness which was defined as visual acuity of <3/60 in the better eye with best available correction and with obvious central lens opacities/absence of red reflex in both eyes. RESULTS: A total of 1549 people were examined; the coverage rate was 96.8%. Of individuals who were examined, 958 (61.8%) were men. The overall prevalence of bilateral cataract blindness was 4.8% (95% CI: 3.8% to 5.9%). Women had a 2.1-fold greater prevalence of bilateral cataract blindness than men (7.1% (5.0% to 9.2%) v 3.4% (2.3% to 4.6%); p = <0.0001). However, cataract surgical coverage rates were lower for women than men. The overall quality of previous cataract surgery was poor: 43.1% eyes with cataract surgery had VA <6/60. 73.3% people with bilateral cataract blindness reported they could not undergo cataract surgery because they were too poor to afford its cost. CONCLUSION: The unacceptably high rates of cataract blindness and poor affordability and visual outcome of cataract surgery calls for the establishment, in the agency, of static cataract surgical services that are high quality, affordable, and gender sensitive.     

National Registry for the Blind in Israel: Estimation of prevalence and incidence rates and causes of blindness

OBJECTIVE To describe the population registered as blind in Israel and estimate the prevalence and incidence of blindness, by age, sex and the causes of blindness. METHODS Israel has maintained a Registry for the Blind since 1987. Patients are identified by ophthalmologists and registered if they have a visual acuity of =0.05 (20/400) or a visual field of &lt;20 degrees radius in their better eye. The Registry consists of all eligible citizens living in Israel at the time of registration. This report includes prevalence data on 18,891 persons enrolled in the Registry from 1987–1999 and still alive and living in Israel in 1999, and incidence data on 2,511 persons newly registered in 1999. Data were collected on visual acuity and visual field loss, cause of blindness, and patient demographics. RESULTS In 1999, the estimated prevalence rate of blindness nation-wide was 0.31% and the estimated incidence rate was 0.037%. The major causes of blindness in the complete Registry were age related macular degeneration (AMD) and glaucoma (14%), followed by diabetic retinopathy (11%), cataract and myopic maculopathy (10%), and optic atrophy (8.4%). The leading causes of newly diagnosed blindness were age-related macular degeneration (AMD) (20%), glaucoma (14%), diabetic retinopathy (12%), myopic maculopathy (11%), and optic atrophy and cataract (10%). CONCLUSIONS Israel has one of the few nationwide blindness registries in the world. The prevalence and incidence of blindness in Israel appear to be comparable to other western countries Comparisons are difficult because of different definitions of blindness, age distributions, and the uniqueness of the Israeli Registry.