基于体检中心的机会性眼病筛查的效果评价

背景 盲和低视力是中国重大的公共卫生问题,诊断延迟是导致不可逆性视力损伤的重要原因.构建简单易行、低成本高效益、易于推广的高危人群筛查和转诊模式,提高人群中未诊断和未治疗的视觉损伤患者的检出率和就诊率对中国眼健康和眼保健服务具有重要意义. 目的 评价基于体检中心的机会性眼病筛查的可行性和有效性.方法 采用横断面调查.对2016年4-9月在沈阳市第四人民医院体检中心进行健康体检的人群进行日常生活视力、眼压和免扩瞳眼底照相检查.眼底照片由2名眼科医生分别进行阅片和诊断,对于结果不一致的图像由第3位眼科医生进行判别.以世界卫生组织2009年盲和视觉损伤标准,按日常生活视力计算受检者中盲和中重度视觉损伤的比例.根据眼底阅片结果分析可疑青光眼、糖尿病视网膜病变(DR)、视网膜静脉阻塞等疾病的检出率. 结果 本项目6个月内共纳入15 303名受检者,其中15 197人完成了检查,受检率为99.3％.发现盲12例,占0.08％,中重度视觉损伤355例,占2.34％.结合眼压及免扩瞳眼底照相筛查出可疑青光眼患者228例,占1.50％,黄斑前膜80例,占0.53％,DR 63例,占0.41％,视网膜分支静脉阻塞37例,占0.24％,黄斑变性14例,占0.09％,黄斑裂孔9例,占0.06％,可疑高眼压征358例,占2.36％.超过95％的可疑眼病患者未接受过任何眼科检查和相应治疗. 结论 基于体检中心的机会性眼病筛查高效、简便、可行、易于推广,可能成为中国防盲治盲以及眼健康服务中的可选择模式.     

1038眼LASIK术中应用虹膜定位技术校正眼球旋转及瞳孔中心移位的研究

目的 通过在LASIK术中进行虹膜定位技术校正眼球旋转、瞳孔中心移位的临床研究,探讨虹膜定位技术对LASIK手术的作用及意义。方法 选择成功接受波前像差虹膜定位LASIK手术的近视患者606例1038眼,术前应用Wavescan像差仪取坐位行波前像差检查和虹膜识别,术中应用VISXStar S4 IR手术,记录眼球旋转及瞳孔中心移位,对前后眼球旋转及瞳孔中心移位进行比较。结果 眼球旋转：顺时针旋转510眼,右眼160眼（31%）,左眼350眼（69%）。逆时针旋转514眼,右眼367眼（71%）,左眼147眼（29%）。双眼差异显著,有统计学意义（P〈0.05）。14眼未发生旋转。平均旋转度数为2.72°±1.98°,右眼与左眼平均旋转度数无显著性差异（P〉0.05）。瞳孔中心移位：右眼与左眼瞳孔中心均多向鼻侧移位,右眼平面位移平均为（0.360±0.138）mm,左眼平面位移平均为（0.361±0.144）mm,右眼与左眼瞳孔中心平均位移比较无显著性差异（P〉0.05）。结论 Custom VueTM虹膜定位能够有效地校正术中的眼球旋转和瞳孔中心移位,使手术达到最佳效果。     

Bottle cork and cap injury to the eye: a review of 34 cases

Aim  To describe our series of bottle cork and cap injuries to the eye in order to report the visual impairment and clinical outcomes observed in 34 cases over an 8-year period. Methods  Retrospective review of the database of the Ophthalmology Institute of Modena from January 1999 to September 2007. All patients presented with closed-globe injury according to Kuhn et al.’s classification. All the cases were caused by sparkling wine: white in 24 cases and red in ten cases. Results  The incidence varied between six and two cases a year (average 3.89). Bottle cork and cap injuries represent 11% of all injuries admitted to our department in the period considered in our series. In details: nine patients recovered totally, 22 patients recovered partially, three patients had a severe visual outcome (<grade 3 according to trauma classification system, BCVA < 0.2). Five patients needed a surgical procedure. The most frequent ocular lesion was hyphema; the worst was retinal detachment due to a giant retinal tear and two patients suffered very severe visual impairment. Conclusions  To our knowledge, this is the largest series of bottle cork and cap injuries to the eye published to date. This kind of injury can be potentially sight-threatening, leading to severe visual loss in a small percentage of cases. We highlight the need for preventative measures such as labelling or devices to regulate cork pressure.     

Missing X and Y: a review of participant ages in population-based eye studies

Ophthalmic population-based studies have been used to establish the frequency of eye disease and the associated environmental and genetic factors that cause vision impairment and blindness. Most of these studies have concentrated on the diseases of ageing: cataract, age-related macular degeneration, glaucoma and diabetic retinopathy. Other studies have identified eye diseases in children but few studies of young adult eye disease exist. We conducted a systematic review of the ophthalmic literature to identify potential population-based eye studies and then note the age of participants in the studies. We then summarized the disease specific to young adults to show there is a need for further research to identify eye disease in this important and often-neglected group in the community. Eighty-four large population-based studies have been conducted worldwide: 9 in North America, 2 in South America, 17 in Africa, 35 in Asia, 11 in Australia and the Pacific, 6 in Europe, 4 in the Middle East and 1 that covered 3 continents. No studies specifically examined young adults. Twenty-six per cent of studies included young adults as part of all ages examined but none of these examined a large number of young adults.     

Systemic use of anti-inflammatory medications and age-related maculopathy: the Blue Mountains Eye Study

Purpose To assess whether an association exists between systemic use of anti-inflammatory medications at baseline and the prevalence or incidence of either late or early age-related maculopathy (ARM) in a population-based cohort. Methods 3654 participants of the Blue Mountains Eye Study baseline examination (1992–94) were followed during 1997–99. Use of anti-inflammatory medication was recorded during the baseline interview. After excluding 543 persons who died since baseline, 2334 (75% of the surviving participants) attended 5-year follow-up examinations. Retinal photographs taken during both examinations were graded using the Wisconsin Age-Related Maculopathy Grading System. Prevalence refers to the proportion of participants having ARM at baseline. Incidence refers to the proportion of participants without ARM at baseline who developed it over the 5-year period. Known ARM risk factors were adjusted for when assessing the relationship between use of anti-inflammatory medications and ARM. Results At baseline, 1010 (27.6%) of 3654 participants were current users of non-steroidal anti-inflammatory drugs (NSAIDs), 514 (14.1%) were past users and 1282 (35.1%) were ever users. The corresponding numbers of subjects reporting current, past or ever use of corticosteroids (including inhaled steroids) were 225 (6.2%), 519 (14.2) and 564 (15.4), respectively. Late ARM was present in 72 participants (2.0%) and early ARM was present in 171 participants (4.9%) at the baseline examination. During the follow-up period, 25 participants (1.1%) developed incident late ARM and 192 (8.7%) developed incident early ARM. After adjusting for age, sex, family history of ARM and smoking, no significant associations were evident for the use of NSAIDs or corticosteroids and the prevalence of either late or early ARM. There were also no associations found between use of these medications at baseline and the 5-year incidence of either late or early ARM. Conclusions No association was found between use of systemic anti-inflammatory medications and either the cross-sectional prevalence or longitudinal incidence of ARM in this population.     

Bevacizumab治疗新生血管性眼病的疗效和安全性

近年来,国外应用Bevacizumab治疗新生血管性眼病取得了良好的效果,受到了眼科界的广泛关注.作为一种效价比较高的药物,Bevacizumab已经被证明不仅具有抗眼部新生血管形成的作用,更能通过降低血管通透性达到抗渗出的效果.因此,有必要就Bevacizumab治疗新生血管性眼病的疗效和安全性进行综述,为玻璃体内注射Bevacizumab治疗新生血管性眼病的科学性、有效性及安全性提供理论依据.(中华眼科杂志,2008,44:281-284)     

Q值引导与标准LASIK治疗近视临床疗效的Meta分析

背景当前,临床上正广泛开展各种个体化的准分子激光角膜屈光手术。其中,Q值引导的个体化切削准分子激光原位角膜磨镶术（Q—LASIK）是目前的研究热点之一。目的系统评价Q值引导LASIK和标准LASIK治疗近视的临床疗效。方法检索MEDLINE、中国期刊全文数据库（CNKI）、Cochrane图书馆、EMbase,对有关比较Q值引导LASIK和标准LASIK临床疗效的临床试验文献进行Meta分析。Meta分析的内容包括术后裸眼视力、角膜前表面的Q值、高阶像差、残余屈光不正的等效球镜度。统计学分析采用ReviewManager5．0,连续性变量以加权均数差（WMD）（95％CI）或标准均数差（SMD）（95％cI）为疗效分析统计量,计数资料则用优势比OR（95％CI）。按照Jadad评分量表对有效检索文献的证据等级进行评价。结果共14篇文献,1617例患者2956眼（等效球镜为0—-10D）纳入研究,包括临床随机对照试验6篇和病例对照试验8篇。其中2篇按Jadad量表评分法为3分,质量较好,其余12篇为1～2分,质量欠佳。Meta分析显示,Q值引导LASIK组术后裸眼视力达20／20以上的跟数与标准LASIK组相比差异无统计学意义[OR=1．16,95％CI（0．61～2．19）,P=0．65],Q值引导LASIK术后裸眼视力较标准LASIK组好,差异有统计学意义[WMD=0．04,95％CI（0．00～0．08）,P〈0．05]。术后Q值引导组的Q值较标准组小,差异有统计学意义[SMD=-1．52,95％CI（-2．23—-0．81）,P=0．00J。术后Q值引导组的总高阶像差较标准组小,差异有统计学意义[SMD=-1．58,95％CI（-2．38,-0．77）,P〈0．05],术后Q值引导组的球差较标准组小,差异有统计学意义[SMD=-1．25,95％CI（-2．07,-0．43）,P〈0．05],而术后2组慧差的差异无统计学意义[WMD=-0．10,95％CI（-0．29～0．09）,P=0．31]。术后Q值引导组残余屈光不正的等效球镜度以及残余屈光不正的等效球镜度在±O．5D以内的眼数与标准LASIK组相比差异均无统计学意义[WMD=0．10,95％CI（-0．11～0．31）,P=0．34]、[OR=1．01,95％CI（0．52～1．96）,P=0．99]。结论与标准LASIK相比,Q值引导LASIK治疗近视术后裸眼视力更好,Q值更小,术后总高阶像差和球差更小,而术后彗差及残余屈光不正的等效球镜度两者基本相同。在评价Q值引导LASIK与标准LASIK的临床疗效方面,还需要更多高质量的临床随机对照研究文献。     

Chick eyes compensate for chromatic simulations of hyperopic and myopic defocus: Evidence that the eye uses longitudinal chromatic aberration to guide eye-growth

Longitudinal chromatic aberration (LCA) causes short wavelengths to be focused in front of long wavelengths. This chromatic signal is evidently used to guide ocular accommodation. We asked whether chick eyes exposed to static gratings simulating the chromatic effects of myopic or hyperopic defocus would “compensate” for the simulated defocus.We alternately exposed one eye of each chick to a sine-wave grating (5 or 2 cycle/deg) simulating myopic defocus (“MY defocus”: image focused in front of retina; hence, red contrast higher than blue) and the other eye to a grating of the same spatial frequency simulating hyperopic defocus (“HY defocus”: blue contrast higher than red). The chicks were placed in a drum with one eye covered with one grating, and then switched to another drum with the other grating with the other eye covered. To minimize the effects of altered eye-growth on image contrast, we studied only the earliest responses: first, we measured changes in choroidal thickness 45 min to 1 h after one 15-min episode in the drum, then we measured glycosaminoglycans (GAG) synthesis in sclera and choroid (by the incorporation of labeled sulfate in tissue culture) after a day of four 30-min episodes in the drum.The eyes compensated in the appropriate directions: The choroids of the eyes exposed to the HY simulation showed significantly more thinning (less thickening) over the course of the experiment than the choroids of the eyes exposed to the MY simulation (all groups mean:−17 μm; 5 c/d groups: −24 μm; paired t-test (one-tailed): p = 0.0006). The rate of scleral GAG synthesis in the eye exposed to the HY simulation was significantly greater than in the eye exposed to the MY simulation (HY/MY ratio = 1.20; one sample t-test (one-tailed): p = 0.015). There was no significant interaction between the sign of the simulated defocus and either the spatial frequency or the presence of a +3 D lens used to compensate for the 33 cm distance of the drum.Although previous work has shown that chromatic cues to defocus are not essential for lens-compensation, in that chicks can compensate in monochromatic light, our evidence implies that the eye may be able to infer whether the eye is myopic or hyperopic from the different chromatic contrasts that result from different signs of defocus.     

Measuring eye movements with a search coil: non-linear filter allows simultaneous recording of horizontal and vertical eye position by means of the phase modulation method

Measuring eye position from the phase angle of the signal induced by a rotating magnetic field in a search coil presents a number of advantages. So far, however, existing schemes using this principle either record eye position in one dimension only or require two search coils. We describe here a simple analog circuit which singles out a signal of given frequency from a frequency composite without changing the signal's phase. This makes it feasible to measure horizontal and vertical eye position with a single search coil by using two orthogonal rotating fields of different frequency.     

Influence of foveal distractors on saccadic eye movements: a dead zone for the global effect

Three experiments investigated the global effect with foveal distractors displayed in the same hemifield as more eccentric saccade targets. Distractors were x-letter strings of variable length and targets corresponded to the central letter of letter strings (e.g., 'xxxkxxx'). Results showed that only foveal distractors longer than four letters (about 1 degree) deviated the eyes in a center-of-gravity manner thus suggesting a dead zone for the global effect. Short distractors influenced the likelihood of small-amplitude saccades (less than about 1 degree) and the latency of longer saccades. The findings were interpreted based on the dissociation between fixation and saccadic neurons. Implications for eye movements in reading were discussed.     

Abnormal supranuclear eye movements in the child: a practical guide to examination and interpretation

Abnormal eye movements in the infant or young child can be congenital or acquired. They may be a result of abnormal early visual development or a sign of underlying neurologic or neuromuscular disease. It is important to be able to detect these abnormalities and to distinguish them from normal but immature eye movements. The spectrum of disease in children differs from that in adults. Serious, potentially fatal but treatable disorders can be acquired in infancy, and abnormal eye movements in a sometimes apparently well child should never be labeled as congenital or benign without careful investigation. Eye movement analysis can indicate the presence of an underlying condition and help the clinician to classify different neurologic diseases. It is important to carefully examine the ocular motor system in any children at risk of neurologic disease. This review provides a practical guide to the examination and interpretation of eye movements in the child and includes recent literature on eye movement disorders of childhood. We describe supranuclear abnormalities of the ocular motor system in the order in which we would normally examine it: saccades, pursuit, convergence, vestibulo-ocular reflex, and optokinetic nystagmus. Nystagmus, internuclear ophthalmoplegia, cranial nerve abnormalities, and “miswiring” phenomena (such as Duane's syndrome and synergistic divergence) are not discussed.     

Georg Bartisch: Ophthalmodouleia, der Augendienst, 1583. A treatise on service of the eyes and a review of the chapter on strabismus

In 1583, Georg Bartisch, oculist and cutter for bladder stones at the court of Duke August 1 of Saxony, published at his own expense a 273 page textbook of ophthalmology. It contained 91 wood cuts and, in the present volume, they are presented in brilliant colour as they were in the original books prepared for presentation. The book was one of the first medical treatises to be published in the German vernacular instead of traditional Latin. It has been translated into English and published in gothic type to simulate the original. Treatment of diseases of the eye by medicines or surgery are reported in great detail. It gives an account of ophthalmology at the time of the early Renaissance when enlightenment was beginning to overtake the darkness of the Middle Ages.     

Ocular Surface Disease Index© and the five-item dry eye questionnaire: A comparison in Indian patients with dry eye disease

Purpose:To compare the suitability of the Ocular Surface Disease Index (OSDI) and the 5-item Dry Eye Questionnaire (DEQ-5) in Indian patients with dry eyes.Methods:This cross-sectional study evaluated the OSDI and DEQ-5 in patients with tear film abnormalities. Tear film breakup time, tear film height, Schirmer’s I, lissamine green staining, and meibomian gland expressibility were performed on each patient.Results:There were 101 patients with symptoms and/or signs of tear film abnormality. Both OSDI and DEQ-5 questionnaires significantly correlated (ρ = 0.566, P < 0.0001) with each other. The OSDI questionnaire showed a good correlation with all dry eye tests, whereas the DEQ-5 correlated significantly only with the tear film breakup time and the lissamine green score. None of the questionnaires correlated with meibomian gland expressibility. The Bland–Altman analysis revealed a marginal bias (−0.01 unit) for DEQ-5. The DEQ-5 scored higher in patients with mild symptoms. While 101 (100%) patients answered all the questions in the DEQ-5, only 19 (18.8%) patients answered all the questions in the OSDI questionnaire. The least responses were recorded in the vision-function-related and environmental trigger subscales of the OSDI.Conclusion:The OSDI and DEQ-5 scores showed a moderate correlation. The OSDI questionnaire correlated with a higher number of dry eye tests than the DEQ-5. The large number of skipped questions in the vision-function-related and environmental trigger subscales of the OSDI suggests that the questionnaire is not adequately adapted to the Indian population. Patients with a negative OSDI score should be reassessed with the DEQ-5 to exclude symptom positivity.     

The eye movements of dyslexic children during reading and visual search: impact of the visual attention span

The eye movements of 14 French dyslexic children having a VA span reduction and 14 normal readers were compared in two tasks of visual search and text reading. The dyslexic participants made a higher number of rightward fixations in reading only. They simultaneously processed the same low number of letters in both tasks whereas normal readers processed far more letters in reading. Importantly, the children's VA span abilities related to the number of letters simultaneously processed in reading. The atypical eye movements of some dyslexic readers in reading thus appear to reflect difficulties to increase their VA span according to the task request.     

Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study

This report describes the prevalence of self-reported dry eye syndrome and associations with systemic and ocular factors in an older Australian population. Participants of the Extension Blue Mountains Eye Study, aged 50 or older (mean age 60.8 years, n = 1174) completed a comprehensive eye examination and dry eye questionnaire. At least one dry eye symptom was reported by 57.5% of participants, with 16.6% reporting moderate to severe symptoms, more frequent in women (age-adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.2). Three or more symptoms were reported by 15.3% of participants, also more frequent in women (age-adjusted OR 1.7, CI 1.2-2.4). No age-related trends or significant ocular associations were observed. After adjusting for age and sex, systemic factors significantly associated with dry eye syndrome included history of arthritis, asthma, gout, use of corticosteroids, antidepressants and hormone replacement therapy. In this older population, dry eye syndrome was common and has associations with female gender and systemic diseases.     

Prevalence of eye diseases in South Korea: data from the Korea National Health and Nutrition Examination Survey 2008-2009

Purpose

The aim of this study is to report on preliminary data regarding the prevalence of major eye diseases in Korea.

Methods

We obtained data from the Korea National Health and Nutrition Examination Survey, a nation-wide cross-sectional survey and examinations of the non-institutionalized civilian population in South Korea (n = 14,606), conducted from July 2008 to December 2009. Field survey teams included an ophthalmologist, nurses, and interviewers, traveled with a mobile examination unit and performed interviews and ophthalmologic examinations.

Results

The prevalence of visual impairment, myopia, hyperopia and astigmatism in participants over 5 years of age was 0.4 ± 0.1%, 53.7 ± 0.6%, 10.7 ± 0.4%, and 58.0 ± 0.6%, respectively. The prevalence of strabismus and blepharoptosis in participants over 3 years of age was 1.5 ± 0.1% and 11.0 ± 0.8%, respectively. In participants over 40 years of age, the prevalence of cataract, pterygium, early and late age-related macular degeneration, diabetic retinopathy and glaucoma was 40.2 ± 1.3%, 8.9 ± 0.5%, 5.1 ± 0.3%, 0.5 ± 0.1%, 13.4 ± 1.5%, and 2.1 ± 0.2%, respectively.

Conclusions

This is the first nation-wide epidemiologic study conducted in South Korea for assessment of the prevalence of eye diseases by both the Korean Ophthalmologic Society and the Korea Center for Disease Control and Prevention. This study will provide preliminary information for use in further investigation, prevention, and management of eye diseases in Korea.     

An unusual case of penetrating eye injury caused by a bird: A case report with review of the pertinent literature

Penetrating eye injuries caused by bird pecking are uncommon with less than 40 cases reported in the literature. In this article, we present a case of penetrating ocular injury caused by a bird along with pertinent literature review. An otherwise healthy 56-year old man presented to the emergency department complaining of right eye severe pain and decreased vision following trauma caused by a bittern bird. The patient was diagnosed with penetrating ocular injury & he underwent primary repair. On follow up, he was found to have traumatic cataract, which was operated, however, the surgery was complicated with IOL dislocation into the vitreous cavity. The patient was referred to retina service where he underwent pars plana vitrectomy with IOL repositioning in the sulcus. After two months, the patient’s uncorrected visual acuity improved from counting fingers at 2 feet to 20/30^?2. This case serves as a reminder that bird pecking is one of the causes of penetrating eye trauma.     

Dynamic interaction between "Go" and "Stop" signals in the saccadic eye movement system: New evidence against the functional independence of the underlying neural mechanisms

We investigated human oculomotor behaviour in a Go-NoGo saccadic task in which the saccadic response to a peripheral visual target was to be inhibited in a minority of trials (NoGo trials). Different from classical experimental paradigms on the inhibitory control of intended actions, in our task the inhibitory cue was identical to the saccadic target (used in Go trials) in timing, location and shape—the only difference being its colour. By analysing the latency and the metrics of saccades erroneously executed after a NoGo instruction (NoGo-escapes), we observed a characteristic pattern of performance: first, we observed a decrease in the amplitude of NoGo-escapes with increasing latency; second, we revealed a consistent population of long-latency small saccades opposite in direction to the NoGo cue; finally, we found a strong side-specific inhibitory effect in terms of saccadic reaction times, on trials immediately following a NoGo trial. In addition, we manipulated the readiness to initiate a saccade towards the visual target, by introducing a probability bias in the random sequence of target locations. We found that the capacity to inhibit the impending saccade was improved for the most likely target location, i.e. the condition corresponding to the increased readiness for movement execution. Overall, our results challenge the notion of a central inhibitory mechanism independent from movement preparation. More precisely, they indicate that the two mechanisms (action preparation and action inhibition) interact dynamically, possibly sharing spatially-specific mechanisms, and are similarly affected by particular contextual manipulations.     

Prevalence of blindness and low vision: a study in the rural Heilongjiang Province of China

Background: The prevalence of blind individuals in the north of China is unknown. The study aimed to investigate the prevalence and causes of blindness and low vision in rural areas in Heilongjiang province of China in 2008–2009. Design: Cross‐sectional study. Participants or Samples: A cluster random sampling method was used to recruit participants of all ages in rural areas of Heilongjiang. Methods: Trained professionals performed interviews and clinical examinations to measure visual acuity. The relationships between blindness or low vision and age, gender and education level were analysed. Main Outcome Measures: The main outcome measure was prevalence rates of bilateral blindness and bilateral low vision. Results: Of the 11 787 subjects, 10 384 (88.1%) were surveyed. The overall age‐adjusted prevalence rates were 0.7% (95% confidence interval: 0.5–0.8%) for bilateral blindness and 1.7% (95% confidence interval: 1.4–1.9%) for bilateral low vision. The prevalence rates of blindness and low vision were higher in the elderly and uneducated population (P < 0.05). The main causes for blindness and low vision were cataracts (44.1 and 46.0%, respectively) and refractive errors (17.7 and 42.5%, respectively). Conclusion: Blindness and low vision are highly prevalent among people with cataracts and refractive errors. Eye care planning must focus on treating the avoidable and curable forms of blindness.