Blindness as A Challenging Medical and Social Problem in China

China,a country with about one fifth of the world‘s population,has been gaining a rapid economic growth since 1980s,this country has around 5 million blind people,accounting for 18% of the blind in the world.The major causes of blindness include cataract corneal diseases,trachoma,glaucoma,vitreoretinopathy and a number of factors contributing to blindness in children,The principal cause of blidness in China was no longer trachoma but cataracts.Vitamin A deficiency remains a public health problem in the under-developed areas,Age-related conditions in china,such as vision loss due to cataract and retinal disorders,will increase accordingly if no preventive meaunes are taken.Glaucoma and diabetic retinopathy paapear to be predominant induction of the devastating blind.In this fast developing country blindness is not only a medical or health,but also a social problem..Developed strategies have been abopted simultaneously by national efforts under the leadership of the govermment ,international agencies,nongovernmental organizations,as well as private sectors in their every-day work to prevent and treat blindness.     

Outcome and number of cataract surgeries in India: policy issues for blindness control

Purpose: To assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India. Methods: In a population‐based sample of 5268 persons in two rural areas in the state of Andhra Pradesh, India, data on the visual outcome of cataract surgery were obtained on 129 eyes of 106 persons operated previously. These were compared with the visual outcome of cataract surgery performed during 1999 in 2394 eyes of 2213 persons at two new rural eye centres set up in these areas that pay particular attention to the quality of eye care. Blindness in an eye was defined as presenting distance visual acuity less than 6/60, and in a person as this acuity level in the better eye. These data were extrapolated to India. Results: In the population‐based sample, of the 129 operated eyes, 51 (39.5%) were blind after surgery, which included 41 (31.8%) from cataract surgery‐related causes. Of the 106 persons in the population sample who had had cataract surgery in one or both eyes, 26 (24.5%) were still blind. In contrast, for the cataract surgery at the two rural eye centres paying attention to quality, 3.1% of the eyes and 1.8% of the persons were blind soon after surgery, but these figures could increase 2.6 times over the lifetime of these persons. The 3.5 million cataract surgeries in India in 2000 are estimated to result in 0.32 million persons having blindness averted over their lifetime. To eliminate cataract blindness in India, an estimated 9 million good‐quality cataract surgeries are needed every year during 2001?2005, increasing to over 14 million surgeries needed every year during 2016?2020 on persons most likely to go blind from cataract. Conclusions: The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract. If adequate attention is given to the quality of eye care, for the current number of cataract surgeries in India it should be possible to increase by threefold the number in whom blindness can be averted with cataract surgery. In addition to improving quality, the annual number of cataract surgeries has to be at least threefold the current number during 2006?2010 if cataract blindness in India is to be eliminated.     

The WHO programme for the prevention of blindness and cataract in developing countries

In 1990, the WHO Programme for the Prevention of Blindness estimated that there were 13.5 million unoperated cases of cataract in the world. More than 95% of this backlog is found in developing countries. A conservative estimate of incidence of blindness due to cataract as 1/1000 population/year demonstrates that most developing countries are still unable to provide cataract surgery to the annual load of new cases. The situation is particularly worrying in Africa, south of the Sahara, where only one out of ten cataract ever gets operated on. The WHO Programme has developed a primary health care strategy for the large-scale management of cataract. Identification of cases requiring surgery should be possible at the community level, through training of auxiliary staff. Referral for surgery at the district or province hospital level is possible in most cases, given manpower development. This implies a need for training of cataract surgeons in many developing countries. There should be one cataract surgeon per 250,000 population. Increasing surgical productivity of existing ophthalmologists should be considered as well as improving management of intervention programmes.     

Intracapsular cataract extraction: Experience of a general surgeon in Niger, West Africa

Background: Cataract is the major cause of blindness in the world and affects an estimated 20 million persons globally. In Africa, there is an incidence of half a million new cases of cataract blindness annually, with a backlog of 3 million persons requiring sight-restoring surgery. The burden of this form of curable blindness resides mainly in less developed nations, which typically have limited numbers of ophthalmologists and medical resources. The experience and results of a general surgeon working in rural West Africa, without prior ophthalmic skills but with limited training in the field, are reported. Methods: Data on all consecutive planned intracapsular cataract extractions performed between January 1994 and July 1995 inclusive were collected prospectively and the visual outcome as well as surgical complications were analysed. Results: A total of 243 planned intracapsular cataract extractions were performed. Data were incomplete or missing in five cases leaving 238 for analysis. All the patients were blind pre-operatively, with visual acuities of 3/60 or less. Functional vision (6/60 or better) was restored in 95% of all cases. Conclusions: General surgeons can be satisfactorily trained in the art of intracapsular cataract extractions, with good visual outcomes. This is very useful in the setting of undeveloped countries where there are severe limitations of resources, and the recruitment of trained general surgeons will help reduce the burden of curable blindness in these regions.     

三亚市郊≥50岁人群低视力及盲流行病学调查

目的:调查海南省三亚市郊≥50岁人群中低视力及盲的发病率并分析其原因。方法:随机抽取28个抽样单位的≥50岁人群共2569例进行调查。对调查人员进行矫正视力、外眼、前房、晶状体、玻璃体及眼底检查。观察其低视力及盲的患病率,分析致盲的重要原因。结果:2569例中受检2206例,受检率85.87%,低视力和盲的患病率分别为3.85%和1.90%。致盲主要眼病依次为白内障、青光眼、角膜病、眼睑疾病及翼状胬肉。结论:白内障依然是低视力和盲的首要病因,但眼睑疾病及翼状胬肉致盲也不容忽视。     

海口市郊≥50岁人群的视力损伤及患盲病率调查

目的:调查海南省海口市郊≥50岁人群中视力损伤、严重视力损伤及盲的患病率,并分析其主要原因。方法:选取海口市郊≥50岁人群,随机抽取30个抽样单位的850例进行调查。对受检人员进行矫正视力、外眼、前房、晶状体、玻璃体及眼底检查,调查该人群视力损伤、严重视力损伤及盲的患病率并分析主要原因。结果:调查850例中受检人员为786例,受检率为92.47%,视力损伤、严重视力损伤及盲的患病率分别为2.67%,0.64%和2.54%。致视力损伤、严重视力损伤及盲主要眼病依次为白内障、眼后节疾病、角膜瘢痕及其他疾病。结论:海口市郊≥50岁人群视力损伤、严重视力损伤及盲的首要病因是白内障,眼后节疾病、角膜瘢痕等疾患所致盲也占一定比例。      

Turning the tide of corneal blindness

Corneal diseases represent the second leading cause of blindness in most developing world countries. Worldwide, major investments in public health infrastructure and primary eye care services have built a strong foundation for preventing future corneal blindness. However, there are an estimated 4.9 million bilaterally corneal blind persons worldwide who could potentially have their sight restored through corneal transplantation. Traditionally, barriers to increased corneal transplantation have been daunting, with limited tissue availability and lack of trained corneal surgeons making widespread keratoplasty services cost prohibitive and logistically unfeasible. The ascendancy of cataract surgical rates and more robust eye care infrastructure of several Asian and African countries now provide a solid base from which to dramatically expand corneal transplantation rates. India emerges as a clear global priority as it has the world's largest corneal blind population and strong infrastructural readiness to rapidly scale its keratoplasty numbers. Technological modernization of the eye bank infrastructure must follow suit. Two key factors are the development of professional eye bank managers and the establishment of Hospital Cornea Recovery Programs. Recent adaptation of these modern eye banking models in India have led to corresponding high growth rates in the procurement of transplantable tissues, improved utilization rates, operating efficiency realization, and increased financial sustainability. The widespread adaptation of lamellar keratoplasty techniques also holds promise to improve corneal transplant success rates. The global ophthalmic community is now poised to scale up widespread access to corneal transplantation to meet the needs of the millions who are currently blind.     

Prevalence of visual impairment and related factors in Nangarhar Province of Afghanistan: a cross sectional study

AIM: To determine the prevalence, main causes, and related factors of visual impairment (VI) among people aged 50y and over in Jalalabad City and four surrounding districts of Nangarhar Province of Afghanistan. METHODS: The data for the population based cross-sectional study was collected in 2015. The calculated sample size was 1353, allocated to urban-rural strata using probability proportion to size method. At the end of the study, 1281 people participated in to the study. VI was defined as presenting visual acuity (VA) of less than 6/18 and blindness as VA less than 3/60 in the better eye by using Snellen chart only. Data was analyzed using IBM SPSS 21.0 software. RESULTS: The prevalence of VI was 22.6% (95%CI, 20%-25%) of which 13.9% (95%CI, 12%-16%) was low vision and 8.7% (95%CI, 7%-10%) was blindness. The most common causes of the VI were cataract (52.8%), followed by uncorrected refractive error (URE) (26.9%) and glaucoma (8.6%). Number one cause of the low vision was URE (42%), followed by cataract, glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy (DR), while for blindness they are cataract (72%), other posterior segment disorders, glaucoma, URE and AMD. Illiteracy, bad economic status, hypertension and overweight were factors independently associated with both VI and low vision, whereas, age, illiteracy, bad economic status, hypertension and using of sunglasses were independently associated with blindness. CONCLUSION: Cataract, URE, glaucoma, AMD and DR are the leading causes of VI and blindness in the study area. They are mostly avoidable. In order to decrease the burden of VI and blindness in the study area as well as the whole country, it is strongly recommended to apply the prevention policies of VI and blindness.     

我国近五年葡萄膜炎临床与基础研究进展

葡萄膜炎是一类常见的致盲眼病,其病因复杂,种类繁多。我国眼科工作者对葡萄膜炎的诊断、治疗及基础研究给予了高度重视。近年来,我国一些大城市先后成立了葡萄膜炎专科或葡萄膜炎研究中心。过去5年中公开发表的594篇学术文章内容主要集中在病因、治疗、基础研究、并发症以及新的诊断技术等方面。虽然葡萄膜炎的临床诊断和治疗水平明显提高、基础研究也取得了较大的进展,但是仍然存在着一些问题,如免疫抑制剂的合理应用和制定个体化的治疗方案。加深对葡萄膜炎的认识、更新知识及改变陈旧观念,将有助于提高葡萄膜炎的诊治水平。     

上海市普陀区双眼盲流行病学调查

目的了解13年来上海市普陀区双眼盲患者的患病率、致盲疾病谱和发展趋势。方法对上海市普陀区自1993年至2005年,区内的双眼盲患者进行调查,对双眼视力低于0.1者用小孔镜检测视力进行登记并建立档案。分析现盲率、新盲患率和致盲的主要原因。结果1990初现盲率为0.476%,然后就大幅度下降并稳定在0.12%左右。1997年、2001年和2005年因白内障而新发病的盲患患者分别占新发病的盲患患者总数的62.6%、77.9%、67.9%。其中90%以上经手术治疗后得以复明。1997年新增盲人致盲的主要原因依次为白内障、视网膜退行性变、青光眼、角膜病;2005年新增盲人致盲的主要原因依次为视网膜退行性变、白内障、青光眼、视神经萎缩。结论该地区七年来现盲率一直稳定在0.12%左右;近年来视网膜退行性变成为致盲主要原因。     

Eye conditions and blindness in children: Priorities for research, programs, and policy with a focus on childhood cataract

The major causes of blindness in children encompass intrauterine and acquired infectious diseases, teratogens and developmental and molecular genetics, nutritional factors, the consequences of preterm birth, and tumors. A multidisciplinary approach is therefore needed. In terms of the major avoidable causes (i.e., those that can be prevented or treated) the available evidence shows that these vary in importance from country to country, as well as over time. This is because the underlying causes closely reflect socioeconomic development and the social determinants of health, as well as the provision of preventive and therapeutic programs and services from the community through to tertiary levels of care. The control of blindness in children therefore requires not only strategies that reflect the local epidemiology and the needs and priorities of communities, but also a well functioning, accessible health system which operates within an enabling and conducive policy environment. In this article we use cataract in children as an example and make the case for health financing systems that do not lead to 'catastrophic health expenditure' for affected families, and the integration of eye health for children into those elements of the health system that work closely with mothers and their children.     

多焦点人工晶状体植入的研究进展

白内障是导致患者视力下降乃至失明的主要原因之一,手术是治疗白内障确切有效的手段。随着科学技术的进步,传统的复明性白内障手术逐渐过渡到屈光性白内障手术。各种屈光性人工晶状体也应运而生,传统的单焦点人工晶状体(single focus intraocular lens, SIOL)不再是患者的唯一选择,多焦点人工晶状体(multifocal intraocular lens, MIOL)越来越被患者接受和认可。本文对现有的多焦点人工晶状体进行了归纳总结,通过分类列举,简述不同类型多焦点人工晶状体的多种特点及评估患者术后临床效果的方法,以期为眼科医生提供参考。     

白内障防盲行动中年轻医师的手术技能培养

眼科手术医师的技能培训多采用住院医师培训模式,其培训周期长、间断、技能重复训练率低、手术技能不稳定。我们探索的小切口白内障手术培训模式具备集中,实践性强,短时重复训练率高的特点。视频理论教学使学员对手术有整体连续性的认识;手术技巧训练顺序的合理安排使学员在保障手术安全性的条件下得到充分训练;PBL教学法有助于培养具有独立能力的手术者,安全控制机制的建立保障了患者手术安全性,也提高了学员的手术自信。     

Current estimates of the economic burden of blindness and visual impairment in India: A cost of illness study

Purpose:Currently, there are an estimated 4.95 million blind persons and 70 million vision impaired persons in India, out of which 0.24 million are blind children. Early detection and treatment of the leading causes of blindness such as cataract are important in reducing the prevalence of blindness and vision impairment. There are significant developments in the field of blindness prevention, management, and control since the “Vision 2020: The right to sight” initiative. Very few studies have analyzed the cost of blindness at the population level. This study was undertaken to update the information on the economic burden of blindness and visual impairment in India based on the prevalence of blindness in India. We used secondary and publicly available data and a few assumptions for our estimations.Methods:We used gross national income (GNI), disability weights, and loss of productivity metrics to calculate the economic burden of blindness and vision impairment based on the “cost of illness” methodology.Results:The estimated net loss of GNI due to blindness in India is INR 845 billion (Int$ 38.4 billion), with a per capita loss of GNI per blind person of INR 170,624 (Int$ 7,756). The cumulative loss of GNI due to avoidable blindness in India is INR 11,778.6 billion (Int$ 535 billion). The cumulative loss of GNI due to blindness increased almost three times in the past two decades. The potential loss of productivity due to vision impairment is INR 646 billion (Int$ 29.4 billion).Conclusion:These estimates provide adequate information for budgetary allocation and will help advocate the need for accelerated adoption of all four strategies of integrated people-centered eye care (IPCEC). Early detection and treatment of blindness, especially among children, is very important in reducing the economic burden; thus, there is a need for integrating primary eye care horizontally with all levels of primary healthcare.     

3.8 million blinded by cataract each year: projections from the first epidemiological study of incidence of cataract blindness in India.

Data from a population based longitudinal study of randomly selected communities in Central India have for the first time provided direct estimates of age specific incidence of blindness from cataract. Person-time denominators have been used to compute age specific incidence rates (risk) of blindness from cataract for populations aged 35 and older. These age specific incidence measures have been applied to the 'population at risk' in each 5-year age class in order to estimate the total number of new cases of cataract blindness that occur in the country each year. The findings indicate that an estimated 3.8 million persons become blind from cataract each year in India (approximate 95% confidence limits: 3 to 4.5 million). The reasons why the estimates are considered as minima, and their implications concerning future national planning of ophthalmic services, are briefly discussed.     

Causes of blindness in the adult population of the Republic of Ireland

BACKGROUND/AIM—Blindness in the developed countries affects 3.5 million people. This study was conducted on the causes of blindness in the Republic of Ireland based on the register of the National Council for the Blind of Ireland. The aim was to determine the prevalence of potentially avoidable blindness and to identify its causes.METHOD—Criteria for registration as blind are in Ireland: best corrected visual acuity of 6/60 (0.1) or less in the better eye or a visual field restricted to 20 degrees or less. Data on 5002 adults 16 years an older registered as blind were analysed. The causes of blindness are classified in 17 diagnostic categories.RESULTS—The leading causes of blindness are macular degeneration and glaucoma, each accounting for 16% (812 and 795). Cataract accounted for 11% (561), a third of these had an associated cause of blindness and one tenth had a cognitive deficit. Diabetic retinopathy ranked as the 11th cause of blindness and accounted for 3% (147). More than half of the patients were 65 years and older.CONCLUSION—25% of blindness was potentially avoidable. The treatable causes were glaucoma and diabetic retinopathy in the working population and glaucoma and cataract over 65 years of age. Glaucoma is the most important, which raises the question of a screening programme. The prevalence of blindness of 3% due to diabetic retinopathy is lower than in most other series.     

Causes of blindness in Northern Tanzania: a hospital and rural health centre based study

Objective:To identify the main causes of blindness in Northern Tanzania.Methods:Ophthalmic patients at the Kilimanjaro Christian Medical Centre and on outreach clinics in the Kilimanjaro region of Northern Tanzania were examined. The cause of blindness was documented for any eye seeing less than 3/60 Snellen. If more than one factor contributed to the visual loss, the single factor deemed to be the most visually disabling was documented.Results:1045 blind eyes of 781 patients were examined. 264 patients were bilaterally blind. The main cause of bilateral blindness was cataract [39%]. The other chief causes of blindness were glaucoma, trauma and corneal scarring. The most important cause of corneal scarring, approximately half the cases, was microbial keratitis. Refractive error alone was responsible for 4.2% of bilateral blindness, of which 2.7% was uncorrectedpost-cataract surgery aphakia. Conclusions:Treatable causes of blindness, including cataract and refractive error account for over a third of all blindness in Northern Tanzania. Trauma, glaucoma and microbial keratitis are other important causes of blindness in the region.     

陕西佛坪山区盲患病率调查

目的:调查陕西省秦岭南坡,国家级自然保护区佛坪山区盲患病率及主要致盲病因。方法:采用分层整群抽样方法、按照WHO盲目分级标准,对佛坪山区按27.30%抽样比例抽取8725例作为调查对象。结果:在受检的9089人中,实际受检人数8725人,受检率95.99%、以视力损伤标准A计算,双盲患病率(0.95%)。结论:秦岭南坡佛坪山区,致盲的眼病依次为白内障(46.99%)、角膜病(28.92%)、青光眼(12.05%)。盲的患病率明显高于1984年以前其它省市自治区的盲人患病率(0.19%~0.69%),并高于我省其它地区;白内障、角膜病、青光眼是三大主要致盲病因。     

The value of corneal transplantation in reducing blindness

PURPOSE: To analyse the role of keratoplasty in reducing world blindness due to corneal diseases. METHODS: Review of published literature. We collected and analysed articles published in the English language literature related to the prevalence and causes of blindness in different parts of the world, causes of corneal blindness, and outcome of corneal transplantation for various corneal diseases. RESULTS: A total of 80% of the world's blind live in developing countries. Retinal diseases are the most important causes of blindness (40-54%) in established economy nations while cataract (44-60%) and corneal diseases (8-25%) are the most common causes of blindness in countries with less developed economies. Keratitis during childhood, trauma, and keratitis during adulthood resulting in a vascularized corneal scar and adherent leucoma are the most frequent causes of corneal blindness in developing countries. Corneal diseases are responsible for 20% of childhood blindness. Nearly 80% of all corneal blindness is avoidable. The outcome of keratoplasty for vascularized corneal scar and adherent leucoma is unsatisfactory, necessitating repeat surgery in a high proportion of these cases. Other barriers for keratoplasty in these nations are suboptimal eye banking, lack of trained human resources, and infrastructure. CONCLUSIONS: Since the developing world carries most of the load of corneal blindness and the major causes of corneal blindness are corneal scar and active keratitis, development of corneal transplantation services need a comprehensive approach encompassing medical standards in eye banking, training of cornea specialists and eye banking personnel and exposure of ophthalmologists to care of corneal transplants for better follow-up care. However, concerted efforts should be made to develop and implement prevention strategies since most corneal blindness is preventable.     

The role of optometrists in India: An integral part of an eye health team

India has a proud tradition of blindness prevention, being the first country in the world to implement a blindness control programme which focused on a model to address blinding eye disease. However, with 133 million people blind or vision impaired due to the lack of an eye examination and provision of an appropriate pair of spectacles, it is imperative to establish a cadre of eye care professionals to work in conjunction with ophthalmologists to deliver comprehensive eye care. The integration of highly educated four year trained optometrists into primary health services is a practical means of correcting refractive error and detecting ocular disease, enabling co-managed care between ophthalmologists and optometrists. At present, the training of optometrists varies from two year trained ophthalmic assistants/optometrists or refractionists to four year degree trained optometrists. The profession of optometry in India is not regulated, integrated into the health care system or recognised by the majority of people in India as provider of comprehensive eye care services. In the last two years, the profession of optometry in India is beginning to take the necessary steps to gain recognition and regulation to become an independent primary health care profession. The formation of the Indian Optometry Federation as the single peak body of optometry in India and the soon to be established Optometry Council of India are key organisations working towards the development and regulation of optometry.