社区居民青光眼相关知识的来源途径及干预效果调查分析

目的：了解社区居民青光眼相关知识宣教干预效果与来源途径情况,为提高居民青光眼知识知晓率提供参考依据。

方法：2023-07-01/09-30在金华市区城中街道桃园社区和江南街道南苑社区中,按数字表法随机抽取居民752人调查青光眼防治知识来源,综合性健康教育干预历时3 mo,对青光眼核心知识知晓率进行干预前后调查,评价干预效果。

结果：青光眼相关知识来源途径中广播电视为33.4%,手机网络为40.9%,卫生宣教为21.5%。宣教干预前青光眼相关知识总体知晓率为32.7%; 干预后总体知晓率为48.4%,干预前后比较有差异(χ²=37.130,P<0.001)。18道题目知晓率宣教干预前后比较有差异(χ²≥13.341,P<0.001)。

结论：社区居民青光眼相关知识知晓率偏低,手机网络和广播电视为青光眼相关知识主要来源途径,宣教干预是提升青光眼相关知识的有效手段。     

我国原发性青光眼诊断和治疗专家共识遵循情况的调查

目的了解眼科医师遵循我国原发性青光眼诊断和治疗专家共识的现状,评估在面授指导和网络教育后对其知晓度及依从性的效果。 方法采用横断面非随机抽样调查法,收集2018年10月至2019年8月填答我国原发性青光眼诊断和治疗专家共识问卷调查的临床眼科从业医师的数据,通过面授指导、网络直播和视频回放的方式进行专家共识的系列培训,培训前后通过微信两次发送问卷调查,比较参加培训和未参加培训医师对其知晓度和依从率的差异。采用卡方检验对计数资料进行组间比较,采用秩和检验对等级资料进行组间比较。采用因子分析对问卷的结构效度进行分析;采用最大方差法对因子进行旋转;采用Kaiser-Meyer-Olkin和Bartlett检验对数据结构进行检验。 结果第一次调查收到715份问卷,第二次调查收到515份问卷。正高级职称的医师和青光眼专科医师培训参与率更高( χ²＝11.54,59.114;P<0.05)。第一次调查共识依从率为7.55%~85.59%,在51.75%~85.59%之间居多。正常性青光眼、高眼压症的排他性诊断、原发性闭角型青光眼激发试验阴性的意义等基本概念知晓率较高(83.36%~85.59%)。依从率最低的是Goldman压平眼压计的使用(7.55%),其次是采用改良的PACG激发试验(14.45%~28.20%),对青光眼性视神经损害的ISNT原则正确理解率也较低(40.42%)。培训后再次问卷调查,未接受培训者总体依从率在17.38%~82.62%,接受培训者总体依从率在20.47%~96.34%。其中,房角镜宽窄分级的判断、青光眼性视神经损害和盘沿下方>上方>鼻侧>颞侧原则(ISNT原则)的理解、视野的判读、以及原发性闭角型青光眼的分类方法、正常眼压性青光眼的定义及高眼压症治疗时机等,接受培训者的知晓度较未接受培训的均提高至11%~26%,且有统计学意义(χ²＝5.687~31.568, P<0.05)。 结论目前我国原发性青光眼诊断和治疗专家共识的知晓度及依从率有待提高,通过面授指导联合网络培训的方式,可有效提高知晓度和依从率。若通过强制性培训、建立青光眼专家与非青光眼专家的团队协作等方式,将有助于推动专家共识和指南在临床工作中的实施。     

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。     

成都市白内障和青光眼及年龄相关性黄斑变性知晓率及知识水平调查

目的:调查成都市白内障、青光眼及年龄相关黄斑变性(age-related maeular degeneration,AMD)知晓率、知识水平及自报患病率情况.方法:本研究首先设计了一份关于白内障、青光眼及AMD知晓率及知识水平的结构化问卷,随后使用该问卷在成都市随机选择6个养老机构和四川大学华西医院非眼科门诊患者中进行了调查.本研究采用卡方检验分析各因素对于知晓率及知识水平的影响,并检验其他研究结果与本研究的差异.结果:在所有调查对象中,白内障、青光眼及AMD的知晓率分别为89.9％,68.9％和12.5％;在知晓相应疾病的人群中,具有一定知识水平的比例分别为70.9％,48.1％和44.9％;教育程度影响三种眼病的知晓率,信息来源影响三种眼病的知识水平.白内障、青光眼及AMD的自报患病所占比例分别为7.8％,1.1％和0.6％,40岁以上调查对象中分别为12.5％,1.6％和1.O％.在所有调查对象中,进行过视力测试、眼压测量及眼底检查的比例分别为72.1％,17.9％和20.2％.结论:首次根据本研究在中国大陆地区报道的相关数据,提高白内障、青光眼及AMD(尤其是后两者)知晓率及知识水平十分必要.同时,即便没有任何眼病史,我们也建议人们进行定期眼科检查.     

构筑我国防治青光眼的体系

青光眼是严重的不可逆的致盲性眼病,因此加强青光眼的防治工作非常必要。虽然我国已在防治青光眼方面做了大量工作,但是还存在着不少问题,主要表现在还没有将防治青光眼纳入全国防盲治盲的优先项目,还没有建立起全国性防治青光眼的队伍和机构,还没有在眼科医师中普及和及时更新防治青光眼的知识,还没有建立起青光眼的药品供应网络,还没有在公众中普及防治青光眼的知识。要解决上述问题,应当在我国构筑全国性防治青光眼的体系,其主要目标是提高青光眼的发现率,降低青光眼的致盲率,提高青光眼患者的生活质量,并节省因青光眼致盲的社会成本。为了能顺利地推行这项工作,需要采用公共卫生的途径,而不是仅仅依靠临床途径。在构筑全国防治青光眼的系统中,我们可以从以下几个方面着手开展工作,包括从我国各地的社会经济发展状况出发建立防治青光眼的机构;培训防治青光眼的专业队伍;建立防治青光眼的制度;以及加强防治青光眼的科研工作。     

青光眼防治:从医院到社区

青光眼为严重的不可逆性致盲眼病。根据目前流行病学数据估计我国青光眼患者至少1500万。但90%的患者未曾到医院就诊。从全民健康的角度出发,青光眼防治的重点是在未就诊的人群中进行早期筛查和及时干预。已确诊患者随访依从性的提高和实现,也依赖于社区眼科诊所的建立和青光眼随访工作的"去专家化"。青光眼防治从医院走向社区也是未来实现全民眼保健的必然要求。     

青年原发性闭角型青光眼的临床特征

目的分析青年原发性闭角型青光眼患者的临床特点及治疗效果。方法回顾性分析2009年6月至2019年6月山西省眼科医院17~40岁青年原发性闭角型青光眼51例(61眼)的病历资料,随访时间为6个月至2年。结果本研究中男15例(29.41%),女36例(70.59%),男女比例为1∶2.4。包括急性闭角型青光眼21眼(34.43%),慢性闭角型青光眼40眼(65.57%)。急性闭角型青光眼患者术后的视力较慢性闭角性青光眼提高且眼压控制明显。虹膜囊肿和瞳孔阻滞在急性闭角型青光眼中发生率高。晶状体厚度及眼轴长度在急性闭角型青光眼患与慢性闭角型青光眼差异无统计学意义,但前房深度慢性闭角型青光眼患者较浅。46眼(75.41%)行小梁切除术,14眼(22.95%)行抗青光眼联合白内障手术,1眼(1.64%)未行手术。术后并发症有前房积血、低眼压、脉络膜脱离、浅前房及睫状环阻塞性青光眼,多发生在慢性闭角型青光眼术后。结论青年闭角型青光眼因解剖因素在治疗时有其特殊性,急性闭角型青光眼常伴有虹膜囊肿,晶状体比较厚,而慢性闭角型青光眼常因为眼轴短,发病隐匿,术后容易引起并发症,尤其是睫状环阻塞性青光眼,治疗效果较差。     

原发性闭角型青光眼滤过术后白内障的手术观察

目的：探讨原发性闭角型青光眼(primary angle closure glaucoma,PACG)滤过术后发生白内障患者行白内障超声乳化术的临床疗效。

方法：对48例48眼原发性闭角型青光眼滤过术后发生白内障患者行白内障超声乳化术,术后随访3～12mo,观察患者视力、眼压以及术后并发症等情况。

结果：术后视力明显提高,85%的患者术后矫正视力达0.3～0.8,所有患者眼压控制在正常范围,未发现严重并发症。

结论：原发性闭角型青光眼抗青光眼术后行白内障超声乳化术可显著提高视力,对眼压及滤过泡影响较小,并发症少,安全有效。     

合并视网膜色素变性的青光眼临床特征

目的 分析合并视网膜色素变性（RP）的青光眼患者的临床特征。设计 回顾性病例系列。研究对象 2008年8月至2012年9月北京同仁眼科中心RP合并青光眼患者37例（62眼）及未合并青光眼的RP患者109例（215眼）。方法 对上述患者的门诊电子病历结合门诊病案资料进行回顾分析。主要指标 青光眼类型,矫正视力及眼压。结果 37例（62眼）RP合并青光眼者中急性闭角型青光眼9例（18眼,29.0%）,慢性闭角型青光眼21例（34眼,54.8%）,原发性开角型青光眼7例（10眼,16.1%）。RP合并青光眼及未合并青光眼者盲眼（视力<0.05）比例分别为58.9%和33.6%（P=0.000）。RP合并青光眼者的平均眼压（23.1±14.0）mm Hg。结论 此回顾性研究中RP合并的青光眼多为原发性闭角型,且视力损害加重。（眼科,2013, 22：42-44）     

抗青光眼术后恶性青光眼发生的危险因素分析

目的分析原发性闭角型青光眼患者小梁切除术后可能发生恶性青光眼的危险因素。方法行小梁切除术的原发性闭角型青光眼患者共436例542眼。详细记录其年龄、性别、青光眼分型、术前即时眼压、眼轴长度、前房深度、晶状体厚度以及相对晶状体位置。对术后发生恶性青光眼患者和其余患者的各组数据之间差别进行比较,并进行相应的统计学处理。结果在所有患者中,共发生恶性青光眼16例18眼,发生率为3·67%.发生恶性青光眼的患者与未发生组间在性别及分型上无显著性差异(P=0.83,P=0.15),而在年龄和术前眼压上存在显著性差异,恶性青光眼组的年龄明显小于未发生组(P=0·004),术前眼压则明显高于对方(P=0.000)。恶性青光眼患者的眼轴、前房深度和晶状体厚度都明显小于未发生组(P=0·001,P=0.018,P=0.002),但2组间相对晶状体位置无明显差别(P=0.080)。结论年龄相对较轻、术前高眼压及短眼轴是闭角型青光眼患者术后发生恶性青光眼的危险因素。     

北京市和宁城县非眼科住院患者及家属的青光眼与白内障意识调查

目的调查及比较北京市和宁城县人群中的青光眼和白内障的意识水平,以探索有效的眼病宣教方式。设计横断面调查。研究对象北京同仁医院和内蒙古宁城县医院的206名非眼科住院患者及家属。方法问卷调查。听说过青光眼或白内障病名者定义为有青光眼或白内障意识,至少能说出一个青光眼或白内障症状者定义为有青光眼或白内障知识。分析比较两种疾病间、城乡间眼病意识的差异,Logistic回归分析相关因素。主要指标有青光眼或白内障意识、知识的率。结果有青光眼意识者占全部的74．76％,在北京及宁城分别占90．38％、58．82％（P=0．000）。有白内障意识者占全部的92．94％,在北京及宁城分别占97．12％、86．36％（P=0．008）。有青光眼知识者占有青光眼意识者的48．7％,占全部的36．41％。有白内障知识者占有白内障意识者的59．50％,占全部的55．29％。青光眼、白内障之间及城乡之间均有显著性差异。Logistic回归分析显示,文化程度与青光眼或白内障的意识程度有关。最主要信息来源是听周围人谈论及通过电视节目。50．97％的人会主动学习青光眼或白内障相关知识,主要通过书籍（66％）及与医护人员交流（43％）。仅15．53％的人表示将参加医院举办的知识讲座。结论我国人群中青光眼意识和知识水平还比较低,对白内障的意识和知识水平好于青光眼;且城乡之间存在差别,这与文化程度差异有关。需要更有效的健康教育方式来提高青光眼或白内障的意识和知识水平。     

Knowledge and beliefs about common eye diseases

Purpose: To ascertain the level of knowledge of common causes of blindness in an adult Australian population and to relate this to use of eye care services.
Methods: A population-based study of common eye diseases in an urban population aged 49 years or older was conducted. The questions were concerned with the awareness and knowledge of and the ability to describe three common eye diseases, namely cataract, glaucoma and agerelated macular degeneration (AMD).
Results: Awareness of cataract (98%) and glaucoma (93%) were high in this population, but awareness of AMD was low (20%). Among people who were aware of the target eye disease, only 29% showed some knowledge of glaucoma, 26% showed some knowledge of AMD and 20% showed some knowledge of cataract; this was also low in people who had previous eye treatment, such as cataract surgery. Knowledge was related to education level, occupational prestige and knowledge of other eye diseases. After excluding people with a previous eye disease diagnosis, those people who were aware and had some knowledge of eye disease accessed eyecare services more frequently.
Conclusions: Knowledge of common eye diseases is generally lacking. Age-related macular degeneration is the leading cause of blindness in Australia, yet only 20% of the present study population had heard of it. As there are often no early symptoms for glaucoma, community awareness of this disease and the need for screening of people at risk may allow timely diagnosis and more effective therapy before advanced visual field loss has occurred. An informed public is more likely to present earlier with visual symptoms before irreversible visual loss has occurred and is more likely to comply better with recommended therapy.     

青光眼知晓度研究进展

青光眼是全球主要的致盲眼病之一,由于其发病相对隐匿,若不急性发作,不易被发现,故其致盲率相当高.90％以上的青光眼患者并不了解此病,提高人们对青光眼的知晓度,有利于青光眼患者更早地发现疾病,避免不可挽回的视觉损失.提高人们对青光眼的知晓度是早期发现、早期诊断、及时治疗、挽救青光眼患者残存视功能的有效途径.国内外许多学者对青光眼知晓度做了一定的研究.本文从青光眼知晓度的现状、获得青光眼知识的途径、影响青光眼知晓度的相关因素、青光眼知晓度对心理障碍及生存质量的影响、主动学习和健康教育方式对知晓度的影响几个方面,就近年来关于青光眼知晓度的相关研究进行综述.     

Awareness,knowledge, and practice: A survey of glaucoma in north Indian rural residents

Background:

Studies done on the prevalence of glaucoma have reported a high proportion of undiagnosed patients. Late diagnosis is related to increased risk of glaucoma associated with visual disability. Lack of awareness and non-availability of appropriate screening procedures are among the major reasons for non-diagnosis or late diagnosis of glaucoma. The present study has been undertaken to evaluate the level of awareness about glaucoma among the North Indian rural population.

Materials and Methods:

A group-administered, questionnaire-based survey, involving 5000 rural residents (aged 20 and above) was conducted through random sampling. The questionnaire was structured to evaluate the level of awareness and knowledge about glaucoma and the effect of gender, education status, and glaucoma diagnosis was also studied. The source of awareness about glaucoma was also questioned.

Results:

Of the 5000 individuals enrolled for the survey, responses from 4927 (98.5%; 95% Confidence Interval (CI): 98.2 - 98.9) participants, including 3104 males (63%; 95% CI: 61.7 - 64.3) and 1823 females (37%; 95% CI: 35.7 - 38.3) were evaluated. A total of 409 (~8.3%; 95% CI: 7.6 - 9.14) respondents were aware about glaucoma and only 93 (1.89%; 95% CI: 1.55 - 2.31) were qualified as having knowledge about glaucoma as per the set questionnaire. Education was the only variable significantly correlated (P value < 0.001) with the awareness and knowledge of glaucoma out of the parameters included in this study. Close acquaintance with a glaucoma patient was the most common source of information.

Conclusions:

There is a lack of awareness about glaucoma among the rural residents of North India. The study findings stress the need to spread awareness about glaucoma for prevention of glaucoma-related blindness.     

Determinants of glaucoma awareness in a general eye clinic

PURPOSE: Heightened public awareness about glaucoma may increase the chance of identifying undetected cases. To ascertain determinants of glaucoma awareness, we surveyed a population visiting a general eye clinic. DESIGN: Cross-sectional study. PARTICIPANTS: 1197 general eye clinic patients and their companions. METHODS: We designed and administered a questionnaire about glaucoma to general eye clinic patients and their companions. We created multivariate logistic regression models to ascertain the effect of demographic and clinical features on the likelihood of being unaware of glaucoma. MAIN OUTCOME MEASURES: Adjusted odds ratio (OR) with 95% confidence intervals of survey attributes associated with self-perceived unfamiliarity with glaucoma. RESULTS: Glaucoma awareness overall (72%) approached that found in the subgroup self-reporting a diagnosis of glaucoma (80%). Survey attributes associated with an increased likelihood of being unaware of glaucoma were African American race (OR = 1.69 [1.28-2.20], Hispanic ethnicity (OR = 2.13 [1.46-3.02]), and less than a college education (OR = 1.67 [1.37-2.05]). Age was also a determinant of glaucoma awareness (for ages 50-64 years, OR = 0.60 [0.44-0.80] and for ages 65-79 years, OR = 0.56 [0.41-0.75] compared with ages less than 35 years). A self-report of glaucoma was not a determinant of glaucoma awareness (OR = 0.63 [0.33-1.17]), although there was a trend toward enhanced glaucoma awareness in this subgroup. Finally, respondents with a history of employment in the health field (OR = 0.63 [0.49-0.82]) myopia (OR = 0.68 [0.56-0.82]), glaucoma in a first-degree relative (OR = 0.68 [0.53-0.87]), and respondents who reported having a dilated eye examination (OR = 0.53 [0.42-0.66]) were less likely to be unaware of glaucoma than those who did not have these attributes. CONCLUSIONS: Although glaucoma awareness in this population was high, Hispanics, African Americans, and those with less than a college education were more likely to be unfamiliar with the disease. Interestingly, a self-report of having glaucoma was not a statistically significant determinant of glaucoma awareness.     

对年龄相关性黄斑变性的公众认知度亟待提高

年龄相关性黄斑变性(AMD)是发达国家老龄人口主要的致盲原因,其所致的社会影响和经济负担均较大.但是目前公众对AMD的认知度依然不高.即使在西方发达国家,其公众认知度也在30%以下;对AMD致病危险因素的了解也不尽如人意,比如对吸烟可以增加患AMD危险性的认知度也只有32%.尽管在我国白内障盲仍然是主要的致盲原因,但是随着我国经济的快速发展,面对逐步进入老龄化社会的现实情况,广大人民群众对生活质量的要求越来越高,AMD也将成为一个不能忽视的公共卫生问题.因此,我们必须未雨绸缪,采取行动,提高国人对AMD的认知度.     

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。     

Glaucoma in developing countries

Objective: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries. Materials and Methods: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations. Results: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available. Conclusions: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.     

Epidemiology and screening of open-angle glaucoma

Two major prevalence surveys for chronic open-angle glaucoma have been published in the last year. These are discussed in relation to the comprehensive Baltimore Eye Survey of 2 years ago, which also studied the blindness arising from the disease and comparative figures for white and black individuals. The newer tests for identification of loss of visual function prior to visual field loss as demonstrated by conventional automated perimetry are considered. The three main screening tests for chronic open-angle glaucoma--ophthalmoscopy, tonometry, and perimetry--are evaluated in the light of case finding experience in the United Kingdom. The maximum detection of asymptomatic early chronic open-angle glaucoma in the community is likely to be best achieved by a combination of public awareness of glaucoma aided by patient-based associations and the promotion of improved glaucoma testing and case finding by the army of professionals who are already in place in most developed countries and who carry out primary eye examinations.