The need for routine eye examinations

PURPOSE: To determine the incidence and causes of vision loss to assist in the objective determination of the preferred frequency of routine screening for those with normal vision. METHODS: A prospective, population-based study of people aged 40 or more years. Standardized examination protocols were used that included presenting and best corrected visual acuity, visual field testing, and comprehensive eye examination with dilation. RESULTS: There were 2529 people with a full data set, including 1590 with a normal baseline examination. The 5-year incidence of vision loss (<6/12 presenting acuity in the worse eye) was 2.39%. Overall, 24 (63%) of 38 of those with vision loss had noticed a change in their vision, and 18 (75%) of these 24 had attended an eye examination. This left only 14 (0.88%) people who had had normal baseline examination results and had asymptomatic vision loss develop over this 5-year period. CONCLUSIONS: Frequent routine eye examinations of those with normal examination results will have a low yield and may not be cost effective. Health promotion messages should target those who notice a change in vision and those at higher risk such as those with diabetes or a family history of eye disease.     

Ultraviolet radiation and the anterior eye

The eye is on the one hand dependent on visible light energy and on the other hand can be damaged by these and the contiguous ultraviolet (UV) and infrared wavelengths. Diseases of the eye in which sunlight has been implicated have been termed the ophthalmohelioses, and these conditions pose a significant problem to the eye health of many communities. The ophthalmohelioses have a tremendous impact on patients' quality of life and have significant implications on the cost of health care. Although cataract is not entirely caused by insolation, it now seems certain that sunlight plays a contributory role-cataract extraction is one of the, if not the most, commonly performed surgical procedures in many societies. Pterygium, typically afflicting a younger population, adds a tremendous burden, both human and financial, in many countries. We review evidence that peripheral light focusing by the anterior eye to the sites of usual locations of pterygium and cataract plays a role in the pathogenesis of these conditions. Recognition of the light pathways involved with foci at stem cell niches has directed our investigations into inflammatory and matrix metalloproteinase-related pathophysiologic mechanisms. An understanding of the intracellular mechanisms involved has provided some insight into how medical treatments have been developed for the effective management of ocular surface squamous neoplasia. The concept of peripheral light focusing has also provided direction in the prevention of these diseases. This has resulted in improved sunglass design and the further development of UV-blocking contact lenses. With the development of ocular UV fluorescence photographic techniques, we have been able to demonstrate preclinical ocular surface evidence of solar damage. Evidence that diet may play a role in the development of certain conditions is reviewed. The conundrum of the public health message about solar exposure is also reviewed, and in this context, the potential role of vitamin D deficiency is summarized. The eye may play a role in the development of individualized assessment techniques of solar damage, perhaps allowing us to provide better advice to both individuals and populations.