A Comprehensive Review of Sex Disparities in Symptoms,Pathophysiology, and Epidemiology of Dry Eye Syndrome

ABSTRACT

Introduction: The etiology, frequency, manifestation, and treatment of dry eye syndrome are commonly influenced by sex and gender. Materials and Methods: This study aims to review the differences in epidemiology, pathophysiology, and associated diseases between the sexes. The terms men and male and women and female are used interchangeably throughout the review to refer to biological sex. Results: There are numerous objective and subjective markers of dry eye syndrome but not one diagnostic criterion. There are numerous associated conditions with dry eye syndrome varying from autoimmune to allergic. Large epidemiologic studies reviewed suggest that there does indeed exist a difference between dry eye symptoms between men and women, with women having dry eye signs and reporting dry eye symptoms more often than men. The increased prevalence in women could be correlated to an increased association with certain systemic diseases, specifically autoimmune diseases, and to hormonal variations. Several studies found equivocal data about prevalence of dry eye symptoms between men and women. Discussion: Interpreting studies that investigate epidemiology, pathogenesis, and treatment of dry-eye conditions is complicated by the lack of universally adapted diagnostic criteria and standardized, specific diagnostic tests, and inter-study variability in the definition of dry eye syndrome.     

Rationale,Design, and Demographic Characteristics of the Handan Offspring Myopia Study

Abstract

Purpose: The Handan Offspring Myopia Study (HOMS) aims to investigate the familial associations of myopia between parents and their offspring.

Methods: Children aged 6–18 years, residing in 6 villages where all people aged ≥30 years had participated in The Handan Eye Study in 2006–2007, were selected for the current eye study between March and June 2010. A mobile clinic was set up in the 6 villages for comprehensive eye examinations, including visual acuity, ocular biometry, cycloplegic autorefraction and retinal photography.

Results: Of 1238 eligible individuals, 878 children (70.2%; 52.6% male) from 541 families were recruited. Mean age of the children was 10.5?±?2.5 years. The prevalence of myopia (spherical equivalent refraction <?0.5 diopter) was 23.5% (males 16.8%, females 30.8%). The prevalence of low vision (presenting visual acuity ≥20/400 but <20/60) in the better eye was 7.1%. A higher number of females had low vision at the time of presentation (9.2%) compared to males (5.2%, p?=?0.02). The prevalence of low vision in the worse eye was 10.6% (males 6.7%, females 14.9%, p?<?0.001). The majority of visual impairment in the better-seeing (56/62, 90.3%) as well as the worse-seeing (84/93, 90.3%) eye was correctable.

Conclusions: The HOMS examined about 70% of eligible Han Chinese offspring of Handan Eye Study participants in a rural region of northern China. Results from the HOMS will provide key information about the prevalence of refractive errors and eye diseases in rural Chinese children.     

The Chinese American Eye Study: Design and Methods

Abstract

Purpose: To summarize the study design, operational strategies and procedures of the Chinese American Eye Study (CHES), a population-based assessment of the prevalence of visual impairment, ocular disease, and visual functioning in Chinese Americans.

Methods: This population-based, cross-sectional study included 4570 Chinese participants aged 50 years and older, residing in the city of Monterey Park, California. Each eligible participant completed a detailed interview and eye examination. The interview included an assessment of demographic, behavioral and ocular risk factors and health-related and vision-related quality of life. The eye examination included measurements of visual acuity, intraocular pressure, visual fields, fundus and optic disc photography, a detailed anterior and posterior segment examination, and measurements of blood pressure, glycosylated hemoglobin levels, and blood glucose levels.

Results: The objectives of the CHES are to obtain prevalence estimates of visual impairment, refractive error, diabetic retinopathy, open-angle and angle-closure glaucoma, lens opacities, and age-related macular degeneration in Chinese Americans. In addition, outcomes include effect estimates for risk factors associated with eye diseases. Lastly, CHES will investigate the genetic determinants of myopia and glaucoma.

Conclusion: The CHES will provide information about the prevalence and risk factors of ocular diseases in one of the fastest growing minority groups in the United States.     

Perceptions and Understanding of Genetics and Genetic Eye Disease and Attitudes to Genetic Testing and Gene Therapy in a Primary Eye Care Setting

Background: Genetic eye pathology represents a significant percentage of the causes of blindness in industrialized countries. This study explores the level of understanding and perceptions of genetics and inherited eye diseases and the attitudes to genetic testing and gene therapy.

Methods: The study was conducted in two parts. Participant groups included were: undergraduate students of optometry, primary eye care professionals and members of the general public. A preliminary study aimed to understand perceptions and to explore the level of knowledge about genetics in general, eye genetics and gene therapy. A second survey was designed to explore attitudes to genetic testing and gene therapy.

Results: The majority of participants (82%) perceived genetics as an important science. However, none of them showed a high level of understanding of genetics and inherited eye diseases. Undergraduate students and primary eye care professionals were better informed about inherited eye diseases than the general public (p?=?0.001). The majority (80%) across all three groups had a positive attitude to genetic testing and gene therapy. There was a lack of knowledge about the genetic services available among all groups of participants.

Conclusion: This calls for serious thinking about the level of dissemination of information about genetics and inherited eye diseases. It shows a broadly supportive attitude to genomic medicine among the public. Improving public awareness and education in inherited eye diseases can improve the utility of genetic testing and therapy.     

赖氨酰氧化酶在眼部疾病的研究进展

赖氨酰氧化酶(LOX)是细胞外具有铜结合部位的氨基氧化酶,大量研究已经证实LOX可能参与许多疾病的病理发生过程。目前LOX导致疾病发展的常见变异的潜在机制仍然未知,但潜在的作用可能在于通过组织特异性的可变剪接或表达调控来影响LOX的生物学活性。但无论是在正常或病理情况下,关于眼组织中LOX的信息很少。近年有相关研究发现LOX可能参与许多眼部疾病的发生和发展,现就以近年来LOX参与的眼部疾病的研究进展做一综述。     

Visual impairment in a Taiwanese population: Prevalence,causes, and socioeconomic factors

PURPOSE We sought to estimate the prevalence of visual impairment among an elderly population in urban Taiwan, determine the causes of visual impairment, and gain information about certain socioeconomic factors associated with visual impairment.

METHODS A population-based survey of ocular diseases in residents aged 50 years or older was conducted in Peitou Precinct, Taipei, Taiwan. All participants underwent a comprehensive ophthalmic examination, including visual acuity measurement, using standardized protocols. Demographic data, marital status, employment status, and educational level were gathered through an interview.

RESULTS A total of 2034 participants completed the visual acuity measurements. The prevalence of visual impairment (defined as best-corrected visual acuity in the better eye <6/18) among this population was 2.75% (95% confidence intervals: 2.04%–3.46%). Three major causes of visual impairment were cataract (30.4%), high myopic macular degeneration (25.0%), and age-related macular degeneration (14.3%). In multivariate analysis, age was positively correlated with visual impairment (P < 0.001), and higher education level was associated with a significant decrease in the odds of being visually impaired (P < 0.001). No relation was found between visual impairment and sex, or marital and employment status.

CONCLUSIONS This study provides the first information about the prevalence and causes of visual impairment in Taiwan, and identifies age and educational level as the most important factors related to visual impairment. Additional educational programs should be developed to improve individual awareness of age-related ocular diseases and the availability of current ophthalmic intervention.     

Towards Gaining the Best Information About Vision to Assist the Recovery of a Patient with Stroke

Abstract

Aim: The aim of this paper is to report on the development and evaluation of a tool, to be used by any healthcare practitioner, to screen for the presence of eye issues and problems in patients who have been diagnosed to have had a stroke. Practitioners caring for patients with stroke often detect stroke-related vision defects but miss pre-existing eye diseases, the need for glasses, and reduced acuity. In stroke units where orthoptists are employed the detection of eye conditions is high (83%) . The availability of orthoptists to work in stroke units is limited, so affected patients are likely to have undetected vision-based problems that may decrease the responsiveness to rehabilitation or prevent adaptations being made that can assist the patient with tasks.

Research design: A retrospective study using patient data collected from 100 patient case histories.

Methodology: The tool is a single page, tick-box checklist. It has 3 sections, each with actions to be implemented as required. The sections are:

a. questions about ocular history and symptoms

b. observation of ocular conditions (red eye, ptosis)

c. tests requiring responses that could be affected by vision defects (ability to fix and follow)

The tool was tested against 100 case histories of patients admitted to hospital following a stroke, comparing the ocular information noted by nonorthoptic healthcare practitioners and information from the orthoptic assessment.

Results: Of the 498 ocular conditions found by the orthoptic assessment, the tool identified 309 (62%). Nonorthoptic healthcare practitioners identified 85 (17%) ocular conditions.

Conclusion: In the absence of orthoptic services, the tool has the capacity to enable improved detection of vision conditions resulting in improved management as well as enhancing the response for rehabilitation.

The study has at all times followed the principles as outlined in the Declaration of Helsinki.     

New Systematic Review Methodology for Visual Impairment and Blindness for the 2010 Global Burden of Disease Study

Abstract

Purpose: To describe a systematic review of population-based prevalence studies of visual impairment (VI) and blindness worldwide over the past 32 years that informs the Global Burden of Diseases, Injuries and Risk Factors Study.

Methods: A systematic review (Stage 1) of medical literature from 1 January 1980 to 31 January 2012 identified indexed articles containing data on incidence, prevalence and causes of blindness and VI. Only cross-sectional population-based representative studies were selected from which to extract data for a database of age- and sex-specific data of prevalence of four distance and one near vision loss categories (presenting and best-corrected). Unpublished data and data from studies using rapid assessment methodology were later added (Stage 2).

Results: Stage 1 identified 14,908 references, of which 204 articles met the inclusion criteria. Stage 2 added unpublished data from 44 rapid assessment studies and four other surveys. This resulted in a final dataset of 252 articles of 243 studies, of which 238 (98%) reported distance vision loss categories. A total of 37 studies of the final dataset reported prevalence of mild VI and four reported near VI.

Conclusion: We report a comprehensive systematic review of over 30 years of VI/blindness studies. While there has been an increase in population-based studies conducted in the 2000s compared to previous decades, there is limited information from certain regions (eg, Central Africa and Central and Eastern Europe, and the Caribbean and Latin America), and younger age groups, and minimal data regarding prevalence of near vision and mild distance VI.     

Eye Care Use Among Rural Adults in China: The Handan Eye Study

Abstract

Purpose: To assess the use of eye care services in a rural population in North China and to analyze the factors associated with underuse of these services.

Methods: In a cross-sectional population-based study, demographic, health and vision-related information including use of eye care services were determined during a face-to-face interview. A single visit to an eye care provider qualified as “use” of eye care services.

Results: Of 6612 participants, 754 (11.4%, 95% confidence interval, CI, 8.7–14.1%) had used eye care services. The most common reason cited for not seeing an eye care provider was “no need” (n?=?5754). Of the 5754 who thought that there was no need to see an ophthalmologist, 3458 (60.1%) were found to have one or more type of eye disease, including glaucoma (56, 1.0%), cataract (1056, 18.4%), age-related macular degeneration (AMD; 164, 2.9%) and refractive error (3048, 53.0%). Also, 74 (1.3%) and 409 (7.1%) of the 5754 participants had visual impairment (<20/60) according to best-corrected visual acuity and presenting visual acuity, respectively. In a multiple regression model, participants who had glaucoma (adjusted odds ratio, OR, 4.0, 95% CI 3.0–5.4), AMD (adjusted OR 1.6, 95% CI 1.2–2.3) or refractive error (adjusted OR 1.4, 95% CI 1.1–1.8), were more likely to visit an eye care provider.

Conclusion: A high proportion of the Chinese rural population had never used eye care services although three fifths had eye diseases. Further efforts towards better education of the general population about common eye problems as well as increasing the number of ocular health providers would be necessary in future.     

Measurement of fusional vergence: a systematic review

ABSTRACT

Background: Fusional amplitudes are important for clinical practice in diagnosing and managing binocular vision anomalies. Several measurement methods can be used to assess fusional amplitudes. However, those methods are not interchangeable, and measurement repeatability has been questioned.

Objectives: To compare the normative values of tests for the measurement of fusional vergence and to investigate sources of heterogeneity of diagnostic accuracy including: age, variation in method of assessment, study design and size, type (convergent, divergent, vertical, cyclo) and severity of strabismus (constant/intermittent/latent).

Data sources: Bibliographic databases were searched up to March 2018, including Cochrane registers, PubMed, Web of Science^TM, Google Scholar and Science Citation Index. Trial registers and conference proceedings were hand searched.

Review methods: The review observed and reported according to the PRISMA guidelines and was registered with PROSPERO. The I² was used to show the percentage of observed total variation across studies that is due to real heterogeneity rather than chance. The results of the different studies and the overall effect (meta-analysis under the random effects model) are shown.

Results: Eighty-one studies were included in the review. Heterogenous information about break vergence amplitudes is reported for the step vergence method (I² > 50%; p < 0.05) in children. Four parameters were reported consistently to affect measurements; age, method of assessment, order of testing and target size. For the smooth vergence technique break vergence values heterogeneity was not present in children and adults (I² = 0%; p > 0.05).

Limitations: The results are based on cross-sectional studies that were performed independently of each other, with different examiners, methods of examination and different populations.

Conclusions: The source of heterogeneity between studies for vergence break points measured with the step vergence method seems to be linked with age. Normal vergences reported in children had considerable heterogeneity compared with adults. In clinical practice, the population-based vergence ranges measured with the step vergence method in children should not be used as one single criterion. For the smooth vergence technique, normative population data can be used.     

The importance of epidemiology in understanding eye disease

Most leading causes of visual impairment are age related, so the health care implications of an increasing prevalence of eye disease in the elderly are significant. Epidemiological research provides the foundation to address immediate and long-term needs associated with visual impairment and eye disease. It contributes to a community's knowledge of the presence, diagnosis, characteristics, and distribution of eye conditions affecting the elderly. Obtaining accurate epidemiological information on the extent of visual impairment and eye disease in the community is essential to determine and estimate the cost of primary and secondary eye health care needs.     

The Pavagada Pediatric Eye Disease Study: Objectives,Methodology and Participant Characteristics

ABSTRACT

Purpose: To explain the objectives and methodology of a population-based survey of children ≤15 years in rural South India.

Methods: A population-based cross sectional survey was performed by trained field workers (1st phase). Children with eye disease were referred to the peripheral rural hospital (2nd phase) to be examined by a general ophthalmologist. If major eye disease (cataract, strabismus) was identified they were referred to a pediatric ophthalmologist (3rd phase).

Results: The sample size was 29,850. In the 1st phase, 23,100 children were screened (response rate 77.39%). There were about 33% of children in each of the three stratified age groups (0–5, 6–10 and 11–15 years), with a nearly equal sex distribution in each group (range 47% to 52%). Of the 23,100 screened, 1538 were referred to the peripheral rural hospital. The general ophthalmologist evaluated 647 patients (42%) who came to the peripheral rural hospital (2nd phase) and referred 59 children to the pediatric ophthalmologist (3rd phase). The pediatric ophthalmologist, in addition to evaluating the 59 children referred from the 2nd phase, also evaluated those who did not report (891/1538) to the peripheral rural hospital. This evaluation was done in the field itself. All the 1538 children referred by the field workers were thus seen by an ophthalmologist (647 by the general ophthalmologist, 891 by the pediatric ophthalmologist and 59 by both).

Conclusion: The study is expected to provide information about the prevalence of pediatric ocular morbidity that could help plan intervention strategies in this area.     

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.     

Disparities in Vision Loss Due to Cataracts in Hispanic Women in the United States

ABSTRACT

Purpose: To review the current literature on the prevalence of cataract in Hispanic females living in the United States. Methods: Review relevant literature on cataract, eye disease, and health practices of Hispanics living in the U.S. Results: Females comprise 64.5% of blind persons worldwide. Internationally, female gender is associated with lower awareness of cataract and other diseases of the eye and women are less likely to have cataract surgery than men in low- and middle-income countries. Conclusion: Hispanic women receive disparate care compared to their male counterparts. The etiology of this is likely multifactorial but possible contributors include genetics, gender roles, and personal healthcare decisions. Interventions to address this disparity should be targeted, efficient, and sustainable.     

Volkswirtschaftliche Kosten von Augenerkrankungen

Background

Eye diseases that are relevant regarding their macroeconomic costs and their impact on society include cataract, diabetic retinopathy, age-related maculopathy, glaucoma and refractive errors.

Objectives

The aim of this article is to provide a comprehensive overview of direct and indirect costs for major eye disease categories for Germany, based on existing literature and data sources.

Methods

A semi-structured literature search was performed in the databases Medline and Embase and in the search machine Google for relevant original papers and reviews on costs of eye diseases with relevance for or transferability to Germany (last research date October 2013). In addition, manual searching was performed in important national databases and information sources, such as the Federal Office of Statistics and scientific societies.

Results

The direct costs for these diseases add up to approximately 2.6 billion Euros yearly for the Federal Republic of Germany, including out of the pocket payments from patients but excluding optical aids (e.g. glasses). In addition to those direct costs there are also indirect costs which are caused e.g. by loss of employment or productivity or by a reduction in health-related quality of life. These indirect costs can only be roughly estimated. Including the indirect costs for the eye diseases investigated, a total yearly macroeconomic cost ranging between 4 and 12 billion Euros is estimated for Germany.

Conclusion

The costs for the eye diseases cataract, diabetic retinopathy, age-related maculopathy, glaucoma and refractive errors have a macroeconomic relevant dimension. Based on the predicted demographic changes with an ageing society an increase of the prevalence and thus also an increase of costs for eye diseases is expected in the future.     

兰州市小学生干眼患病情况及相关因素分析

目的：探讨甘肃省兰州市小学生干眼的患病情况及相关因素。

方法：利用随机整群抽样的方法于2017-10/11期间在甘肃省兰州市城关区抽取2所小学共1 347人作为调查对象,均进行干眼问卷调查及相关眼科检查确定诊断,并应用卡方检验、Mann-Whitney U检验、Logistic回归分析探讨小学生干眼患病现状及影响因素。

结果：实际受检者共有1 268人,应答率为94.14%; 诊断干眼271例,患病率为21.37%。经统计学分析发现：男生、高年级组小学生、经常使用滴眼液、不良用眼习惯、配戴角膜接触镜、视频终端设备日使用时间长、学习压力大为干眼患病危险因素。

结论：干眼已成为困扰小学生生活及学习的主要疾病之一,应引起广泛重视。综合考虑以上影响因素,合理用眼,改善生活方式有助于减轻干眼对小学生眼部健康的损害。     

Prevalence of Childhood Blindness and Ocular Morbidity in a Rural Pediatric Population in Southern India: The Pavagada Pediatric Eye Disease Study-1

Purpose: To determine the prevalence of childhood blindness and ocular morbidity in a rural pediatric population in South India.

Methods: A population-based, cross-sectional survey of children was conducted in three phases in Pavagada and Madhugiri taluks (subdivisions) of Tumkur district in the state of Karnataka, India. In the first phase, trained fieldworkers screened 23,100 children. In the second phase, children with eye diseases were referred to the peripheral hospital to be examined by a general ophthalmologist. In the third phase, children with major eye diseases were examined by a pediatric ophthalmologist.

Results: The prevalence of ocular morbidity was 2.66% (95% confidence interval, CI, 2.46–2.87%). The most commonly observed ocular morbidity was Bitot spots (1%) followed by refractive error (0.6%). In total, 18 children were blind and the prevalence of childhood blindness (best-corrected visual acuity <3/60) was 0.08% (95% CI 0.04–0.11%); 8 (44.44%) had retinal blindness, 5 (27.76%) had lens-related blindness, 2 (11.11%) had bilateral microphthalmos, 1 (5.56%) was blind due to anterior staphyloma in the right eye and anophthalmos in the left eye, 1 (5.56%) had bilateral uveal coloboma and 1 (5.56%) had cortical visual impairment.

Conclusions: Nearly half of the blindness in the population was due to unavoidable causes (retinal). In addition to providing eye care services, an appropriate service delivery model would include the provision of rehabilitative and low vision services and implementation of genetic studies to understand the causes and increase awareness of inherited eye diseases.     

Female Reproductive Factors and Major Eye Diseases in Asian Women –The Singapore Malay Eye Study

Abstract

Purpose: To examine the association of reproductive factors and major eye diseases, including glaucoma, age-related macular degeneration (AMD), diabetic retinopathy and cataract, in Asian women.

Methods: The Singapore Malay Eye Study is a population-based cross-sectional epidemiological study which examined 3280 persons (78.7% response) of Malay ethnicity aged 40–80 years; 1704 were female. Information on reproductive factors and use of hormone replacement therapy (HRT) was collected using an interviewer-administered questionnaire. Glaucoma was defined according to the International Society for Geographical and Epidemiological Ophthalmology criteria. Retinal photographs were graded for AMD following the Wisconsin grading system, and diabetic retinopathy according to the modified Airlie House classification system. Cataract was graded according to the Lens Opacity Classification System III.

Results: A total of 1176 women reported having experienced menopause by the time of the study with 1073 (91%) having a natural menopause, 88 (7.5%) a hysterectomy and 9 (0.8%) due to other reasons; HRT was used by 70 (6%) women. Women whose age at menopause was ≤52 years were 3.5 times more likely to have glaucoma (95% confidence interval, CI, 1.23–9.98, p value?=?0.02) than those whose age at menopause was ≥53 years. Age of menopause was not associated with AMD (age-adjusted odds ratio, OR, 1.22, 95% CI 0.65–2.31), diabetic retinopathy (age-adjusted OR 1.01, 95% CI 0.66–1.54) or cataract (age-adjusted OR 1.38, 95% CI 0.95–2.00). Use of HRT was not associated with any of these eye diseases.

Conclusion: Women who had menopause at a younger age were more likely to have glaucoma. This association needs to be confirmed in other studies.     

Racial and Ethnic Differences in the Association Between Diabetes Mellitus and Dry Eye Disease

Purpose:To examine the association between dry eye and diabetes mellitus among a large North Carolina patient population.

Methods:A retrospective cross-sectional study of patients seen within the University of North Carolina medical system between July 1, 2008, and September 1, 2017, was performed. De-identified medical records contained within the Carolina Data Warehouse of adult patients who have had an ocular evaluation were studied.

Four categories of disease states were identified by ICD-9 and ICD-10 codes. Patients were grouped based on being diagnosed with Dry Eye Disease (ICD-9: 375.15, 370.33, and ICD-10: H04.12, H16.221), Diabetes Mellitus (ICD-9: 250.00–250.93 and ICD-10: E08-E11, E13), neither, or both diseases. Odds ratios of the association between diabetes and dry eye were calculated for the following racial/ethnic groups: Non-Hispanic White, Non-Hispanic Black/African American, Asian, and Hispanic.

Results:A total of 81,480 patients were included in the analysis; of those, 8978 patients had dry eye disease and 18,361 patients had diabetes. The remaining 54,141 patients had neither disease. Dry eye prevalence among patients with diabetes was 14.39% (95% CI: 13.89–14.91%) and 10.11% (95%CI: 9.88–10.35%) among patients without diabetes. The odds of a patient with diabetes having dry eye are 1.15 (95% CI: 1.09–1.21) times that of a patient without diabetes. Asian patients with diabetes demonstrated the highest odds of having dry eye at 1.49 (95% CI: 1.12–1.98).

Conclusions:Dry eye is common among patients with diabetes, and the association between these diseases is strongest among Asian patients. Race and ethnicity are important demographic factors that may guide providers in the diagnosis and treatment of dry eye in the setting of diabetes.     

Demografischer Wandel

Background

Demographic change not only affects patients with ophthalmological diseases but also ophthalmologists.

Objectives

The aim of this article is to evaluate the consequences of an aging society on health care provision. How can these challenges be overcome?

Material and methods

Evaluation of publications from the German Federal Statistical Office about the current and projected population, analysis of own studies about health care provision, utilization, and delivery as well as the presentation and discussion of regulatory and organizational conditions.

Results

There is a continuous increase in chronic and age-related diseases. At the same time the prevalence of multimorbidity and the number of patients dependent on long-term care is rising, leading to an increase in the demand for ophthalmological care. Regarding health care providers we observed a cutback in qualified ophthalmological personnel, especially for remote areas thus causing difficulties in providing adequate eye care to the population.

Conclusion

To deliver health care to a growing number of patients with a decreasing number of medical professionals is the major challenge of demographic change. This will have an enormous impact on ophthalmological health care in terms of maintaining high quality health services covering a nationwide area.