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。     

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。     

新疆乌鲁木齐市体检人群青光眼患病情况及相关因素分析

目的:探讨青光眼在限定人群患病情况、性别、年龄分布特点,为青光眼防治提供流行病资料。方法:2008-03/2008-08,对50岁及以上眼科体检人群,总计1743人进行青光眼调查。检查项目包括常规视力、裂隙灯显微镜、周边前房深度、眼压及直接眼底镜检查。对可疑青光眼患者进一步详细检查眼压、前房角镜、视野检查及眼底检查。结果:体检人群中确诊为青光眼者36人,患病率为2.06%,其中原发性闭角型青光眼、原发性开角型青光眼、继发性青光眼患病率分别为:1.55%、0.40%和0.11%,男性青光眼患者的患病率为1.51%,女性为2.53%,女性青光眼患者明显高于男性,原发性闭角型青光眼明显高于原发性开角型青光眼,且各型青光眼患病率随年龄增长而增高。结论:50岁及以上体检人群青光眼患病率与既往青光眼流行病调查的患病率接近,且原发性闭角型青光眼患病率高于原发性开角型青光眼患病率,女性原发性闭角型青光眼患病率高于男性,与青光眼的流行病学调查结果亦接近。     

亚在地区青光眼的流行病学

Primary open angle glaucoma is the second most important cause of permanent blindness in the Asia-Pacific region. Thus it is very important to identify epidemiological and other risk factors which are associated with open angle glaucoma. The risk for glaucoma optic nerve damage increases with the age and with the level of the intraocular pressure. In this paper, I will highlight our study of several risk factors for development of the open angle glaucoma like (1) elevated intraocular pressure, (2) myopia, (3) suspicious large optic disc cup, (4) cupping with disc haemorrhages and (5) nerve fibre defect. The general and systemic conditions which are implicated as risk factors are (1) family history of glaucoma. (2) increase in age, (3) diabetes mellitus, (4) cardiovascular conditions like central retinal vein occlusion etc. (5) the endocrine disorders with increased thyroid and increased corticosteroids responsiveness in patients with glaucoma will be discussed.     

5058例青光眼住院患者构成及相关因素分析

目的了解青光眼住院患者的类型构成、性别、年龄分布、变化特点及相关因素。设计回顾性病例系列。研究对象住院的青光眼患者5058例。方法对邢台眼科医院2004年6月-2009年5月间住院的青光眼患者5058例进行统计学分析。主要指标青光眼的类型、年龄、性别及所占的百分比。结果5058例青光眼住院患者中,原发性青光眼、继发性青光眼和先天性青光眼各占青光眼总数的59．07％、37．92％和3．01％,其中原发性闭角型青光眼占原发性青光眼的88．65％,原发性开角型青光眼占11．35％。在原发性闭角型青光眼中,急性闭角青光眼占53．15％,慢性闭角型青光眼占46．85％;其中40岁以上女性占69．54％,男性26．95％。而原发性开角型青光眼患者中,40岁以上女性28．02％,男性占44．5％。2004年6月-2005年5月原发性青光眼住院患者中原发性开角型青光眼占11．32％,而于2008年6月-2009年5月间原发性开角型青光眼占12．44％,统计学检验无显著性差异。结论中原地区青光眼住院患者构成仍以原发性闭角型青光眼为主要类型,原发性开角型青光眼的构成仍然较低,可能与地域经济文化状况有关。     

城乡特定区域人群眼压分布特征研究

目的　探讨人群中眼压的分布特征以及眼压与年龄、近视、糖尿病性视网膜病变、核性白内障、青光眼等因素的关系。方法　选择 40岁以上居民 44 5 1例 ,进行视力、屈光、倍频视野、裂隙灯眼前节数码照相、散瞳眼底照相等检查。采用非接触眼压计测量眼压。每例受试者随机选一眼用于数据统计与分析。结果　双眼眼压资料完整者 44 2 9例。 70岁以上组的平均眼压显著低于 70岁以下各组 (P <0 0 5 )。正常人眼压呈轻微偏向右侧的近似正态性分布 (偏度系数0 2 71) ,平均眼压 ( 15 90± 2 82 )mmHg ,95 %可信限区间 (CI) 10 3 7～ 2 1 43mmHg。近视、糖尿病性视网膜病变、青光眼者的眼压均高于无上述疾患者 (P <0 0 5 )。白内障手术后与无白内障手术史者眼压无统计学差异。年龄、核性白内障与眼压呈一定程度的负相关 ,而近视、糖尿病性视网膜病变、青光眼与眼压呈一定程度的正相关 (P <0 0 5 )。结论　在人群中非接触眼压计测得的眼压正常值范围与Goldmann压平眼压计正常值 10～ 2 1mmHg非常近似。 70岁后眼压有下降的趋势。白内障手术后眼压并无明显降低     

4066位农民青光眼普查分析

采用随机抽样方法，对４０６６位农民进行青光眼有关各项检查。查出青光眼１７人，患病率为４１．８／万，从年龄分组看，患病率２１￣３０岁组中为６．８６／万；３１￣４０岁组中为３２．９／万，４１￣５０岁组中为６０．１／万；５１￣６０岁组中为８９．８／万组中为１１．４２／万，结论是农村青光眼患病率较较市为低，青光眼患率随年龄增长而增高，女性患病率高于男性。     

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。     

北京市社区青光眼筛查模式初步研究

目的探讨社区青光眼筛查模式的可行性。设计人群横断面研究。研究对象北京市东城区社区≥50岁居民6886人。方法2007年9月～2008年4月在北京市东城区18个社区进行青光眼为主的眼病筛查。由社区工作人员组织,在进行视力检查及简单问卷后,在社区对所有受试者进行非散瞳眼底数码照相。眼底图像不清楚者,用眼底照相机照眼前节照片。图像上传至浏览器／服务器架构的数据库,由专业人员集中阅片。可疑青光眼的诊断主要依据视乳头及视网膜神经纤维层形态学改变,并转到专科医院进一步诊治。主要指标可疑青光眼的患病率。结果发现可疑青光眼405例（5．88％）,男性占38％,平均年龄（71．0±7．8）岁。50～59、60～69、70～79、80岁以上者分别占8．O％、24．O％、56．6％、11．4％。经北京同仁医院眼科检查后诊断青光眼146例,占可疑青光眼的36．05％,占筛查总人数的2．12％,其中87例（59．59％）不知道自己患有青光眼。此外,筛查出需手术治疗的白内障289例（4．20％）：糖尿病视网膜病变557例（8．09％）;其他眼病375例（5．45％）。结论以非散瞳数码眼底照相为基础的社区青光眼筛查模式是可行的。它可以实现对青光眼、糖尿病视网膜病变及白内障等多种致盲性眼病联合筛查。组织实施及人员培训是关键。     

Knowledge and awareness of glaucoma in Mexican patients with and without glaucoma diagnosis in an Ophthalmology Referral Center

AIM: To assess and compare knowledge and awareness of glaucoma in subjects with and without glaucoma diagnosis attending an Ophthalmology Referral Center. METHODS: This cross-sectional study was conducted at Asociación Para Evitar la Ceguera in Mexico City, using a questionnaire formulated by a group of experts following the Delphi panel rules, and pre-tested in a pilot study. The questionnaire was applied and compared between: glaucoma patients, relatives of glaucoma patients and patients without glaucoma. Socio-demographic data was collected to assess correlation with the level of knowledge using Logistic regression models, estimating the odds ratios (OR), 95% confidence intervals, and P<0.05. RESULTS: Three hundred and ninety-four subjects were enrolled; with a median age of 61y. One hundred and thirty-four (34%) were patients with glaucoma, 152 (38.6%) patients without glaucoma, and 108 (27.4%) relatives of patients with glaucoma. Two hundred and ninety-one (73.9%) participants were aware of the term “glaucoma”. Regarding knowledge 46.7% had moderate knowledge, 37.8% had poor knowledge, and 15.5% good knowledge. Overall, relatives of glaucoma patients had the highest scores, and patients without glaucoma got the lowest scores. A positive correlation was found between better knowledge and frequent ophthalmological examinations OR 2.24 (P=0.02), higher education level OR 4.17 (P=0.00) and having a family member with glaucoma OR 3.28 (P=0.00). CONCLUSION: Awareness and knowledge of glaucoma in subjects attending an Ophthalmology Referral Center is predominantly moderate or poor. This has important implications regarding attitudes that can result in lack of follow up in ophthalmological care.     

Factors affecting awareness and knowledge of glaucoma among patients presenting to an urban emergency department

Background:  Until advanced, glaucoma is asymptomatic. For early diagnosis to occur, patients may need to be aware of it and seek assessment regularly. People who have risk factors for glaucoma may have a greater awareness of the disease.
Methods:  Patients presenting to an urban hospital emergency department were surveyed with a brief questionnaire to assess their knowledge of glaucoma. Data was collected about their gender, age, family history of glaucoma and presence of systemic hypertension, diabetes, Raynaud's phenomenon, migraines and myopia.
Results:  Women (Odds ratio 2.3; 95% CI 1.4−3.7; P  < 0.01), people who were 40 years or older (Odds ratio 2.2; 95% CI 1.1−4.4; P  < 0.05) and those who were aware of a family history of glaucoma (Odds ratio 15.7; CI 5.5−45.3; P  < 0.01) knew significantly more about the disease than others. People with other risk factors did not demonstrate significantly greater knowledge despite 89% of all participants having had a previous eye examination.
Conclusion:  This information may be useful to predict which patients may know about glaucoma when they present for an eye examination and who should be targeted in public health campaigns.     

Baerveldt implant in refractory glaucoma: long-term results and factors influencing outcome

Purpose: To evaluate the clinical outcome of patients who received aBaerveldt implant for refractory glaucoma and to identify factors which mayinfluence the outcome. Methods: Retrospective study including 51 eyesof 51 patients with medically uncontrolled glaucoma who underwent Baerveldtimplant surgery between June 1994 and December 1998. Criteria for successwere intraocular pressure (IOP) 21 mmHg and >6 mmHg, necessityof further antiglaucoma medications, absence of additional glaucoma surgeryand no loss of light perception. Results: Over a mean follow-up of 37.6(SD: ± 18.8) months, the mean intraocular pressure decreased from 34.8(±12.5) mmHg to 14.0 (±4.3) mmHg at month 60. Qualified successrate, achieved when IOP was below 21 mmHg and higher than 6 mmHg withmedications was 25/48 (52%), complete success rate (same IOP limits withoutmedication) was 14/48 (29%). Seven eyes had major complications or lostlight perception. Postoperative visual acuity improved or remained within oneSnellen line of the preoperative visual acuity in 35 patients (73%). Factorsassociated with a better prognosis were a preoperative visual acuity better than 20/400 and etiology of glaucoma. Conclusion: The Baerveldt implant iseffective in lowering intraocular pressure in most patients with refractoryglaucoma. Long-term results are promising with satisfactory IOP control.     

Issues in the epidemiology and population-based screening of primary angle-closure glaucoma

Among Caucasians, it is well known that 75–95% of primary glaucoma is due to open-angle glaucoma (POAG), with angle-closure (PACG) comprising only a very small minority of cases. These figures are reversed among other groups such as Asians and Eskimos, where PACG makes up 80–90% of primary glaucoma. Among Eskimos, the prevalence of PACG has been reported as 2–8%, as compared to 0.1% among Caucasians. It appears that a population tendency toward shallow anterior chambers may explain the excess burden of PACG morbidity. Among Asians, the prevalence of PACG is intermediate between Caucasians and Eskimos. Existing biometrical data do not show a clear tendency toward shallower anterior chambers among Asians. PACG may be screened for on a population basis by means of various techniques that estimate axial or limbal anterior chamber depth, measure intraocular pressure, or evaluate the optic disc or visual fields. Demographic information and medical and family history will also be of great importance in screening for PACG in large populations. Groups at increased risk for the disease include women, individuals over 50, first-degree relatives of PACG probands, and hyperopes.