昆明市老年人群白内障手术覆盖率及手术效果调查

目的 了解昆明市≥50岁人群中白内障的手术覆盖率及手术效果.方法 多阶段随机抽取昆明市≥50岁者2 760例,通过入户调查,采集相关信息和进行眼部检查,记录晶状体状态、白内障手术情况、妨碍患者接受白内障手术的原因,同时根据术后视力分析白内障手术的效果.结果 共91例(123眼)接受过白内障手术.经年龄和性别矫正后,在视力<0.1的患者中白内障手术覆盖率为46.4%,视力<0.1的白内障患眼中白内障手术覆盖率为29.2%.在手术后的123眼中,效果良好者(最佳矫正视力>0.3)仅为47.9%,人工晶状体植入率为64.8%,患者对手术的满意率为77.7%.未接受白内障手术的患者,主要原因是"没意识到自己患有白内障"和"负担不起手术费用".结论 昆明地区≥50岁人群白内障手术覆盖率较低,手术效果总体较差、人工晶状体的植入率较低,患者对手术的满意程度较低.需要采取积极措施改善昆明地区的白内障手术服务.     

白内障手术与心血管疾病

我们在行白内障手术过程中经常会碰到一个棘手的问题 ,即需手术治疗的白内障患者 ,同时患有心血管疾病 ,白内障手术虽然对全身的直接创伤较小 ,但精神上的恐惧、麻醉及眼心反射等均可增加心血管病人手术的危险性〔1〕。特别是 5 0岁以上病人 ,心血管疾病的患病率及术中危险性增     

北京市城乡限定人群白内障手术负荷量及术后视力评价

目的：探讨北京限定区域城市及农村人群白内障患病率、低视力及手术负荷量，分析白内障手术覆盖率及术后视力情况。方法：晶状体图像资料完整的40岁以上受试者4364人(农村1909人，城市2455人)，所有受试者均进行问卷调查及眼部检查。眼部检查包括裸眼及矫正视力、电脑验光、眼压、散瞳后裂隙灯检查，数码照相采集晶状体图象及眼底照相。白内障手术负荷量入选标准：(1)符合白内障诊断；(2)除外角膜病、青光眼、眼底病、严重沙眼性角膜混浊等影响视力的疾病；(3)标准一：单眼矫正视力≤0.3；标准二：双眼矫正视力≤0.3。结果：本次调查白内障患病率为16.3％，其中双眼矫正视力≤0.3者14例，手术负荷量为0.32％(农村0.52％，城市0.16％)；单眼矫正视力≤0.3者67例，手术负荷量为1.54％(农村1.89％，城市1.26％)。对白内障手术需求女性大于男性，随年龄增加，需求上升，农村高龄女性需求最大。已行白内障手术者共55例(72只眼)，总的白内障手术覆盖率为7.03％，其中农村为4.71％，城市为9.03％，女性6.69％，男性为7.33％，农村女性的手术覆盖率最低，为3.77％。白内障手术后矫正视力≤0.3者占18.06％。术后视力不佳的原因为后发性白内障、眼底病变及其它手术并发症等。结论：白内障手术需求农村高于城市，农村高龄女性需求最大；白内障手术后总体视力提高欠佳；白内障手术需求远远超过现有的手术能力。     

白内障手术与糖尿病

手术加重糖尿病病情,而糖尿病又会影响手术效果,因此,如何使糖尿病患者安全度过围手术期是治疗中的一个重要问题。现将1994年3月~2003年10月施行的白内障手术的糖尿病108例(120眼)的相关资料进行回顾性分析,旨在探讨围手术期的合理处理方法。1资料和方法1·1一般资料本组合并糖     

白内障手术服务快速评估法在白内障干预工作中的应用及意义

白内障手术服务快速评估法(RACSS)是WHO推出的用于评估一个国家或地区白内障盲情的一种简单方法。建议国内各级防盲机构在评估中国的每年白内障手术量时采用白内障手术覆盖率指标。为了提高评估效率,我们建议筛查人群为≥60岁者。为了了解每年的手术趋势,在其白内障手术服务调查记录表中加入“哪年做的白内障手术”的内容。     

南通市新城桥街道60岁及以上人群白内障流行病学调查

目的调查江苏省南通市城市人口中60岁及以上人群白障患病率、白内障盲人手术覆盖率和白内障人社会负担率,了解白内障患病情况及评价近十年来南通市实施以白内障手术治疗为主的防盲治盲工作效果。方法随机整群抽取新城桥街道14个社区中的8个,并对所有60岁及以上人群进行视力和眼部检查。了解接受白内障手术情况。结果3040例受检者中,白内障患病率为34.87%。2002年南通市城市人口60岁及以上人群白内障手术率为8553。以较好眼小孔视力<0.05为盲标准,白内障盲人手术覆盖率为60%,女性和文盲分别为50%和30%。白内障盲人社会负担率为2.14%,女性和文盲分别为2.63%和4.40%。以双眼日常生活视力<0.1为盲的标准,白内障盲人手术覆盖率为57.33%,女性和文盲分别为50%和31.82%。白内障盲人的社会负担率为2.47%,女性和文盲分别为2.99%和4.84%。结论白内障盲人所造成的社会负担率较重,在女性和文盲中,白内障是严重的公共卫生问题。防盲工作的首要任务仍是根治白内障盲。     

高度重视白内障手术中的并发症

近 4 0年来 ,由于眼科显微手术技术的普及和高质量人工晶状体的问世 ,白内障手术有了突破性进展 ;尤其近 2 0年来 ,囊外摘除、超声乳化吸除技术的不断改进 ,使白内障手术技术日趋完善 ,手术疗效为世人瞩目。白内障手术宗旨重在复明。随着生活水平日益提高 ,人们对视力的恢复具有更高要求 ,但在目前防盲治盲工作中 ,白内障手术的效果尚不尽如人意。据统计 1988～ 1996年间 ,全国完成白内障手术 175万例 ,脱盲率为 98% ,脱残率为 89% ,即在白内障手术后仍有 3 5万人未能脱盲 ;有 19 2 5万人视力≤ 0 3。在其他有关防盲手术质量的调查中 ,亦有…     

青岛开发区沿海社区50 岁以上人群白内障流行病学调查

目的：通过对青岛开发区沿海社区50 岁以上人群白内障的患病及治疗情况进行调查,了解该地区白内障流行病学状况。方法：调查研究。在2013 年2 月到2015 年1 月期间采用整群随机抽样方法,调查青岛开发区沿海社区9 028 例50 岁以上居民年龄相关性白内障患病情况,通过制订统一的检查方法和诊断标准,固定普查人员深入到社区集中检查。采用χ2 检验对结果进行统计学分析。结果：9 028例接受调查,共发现白内障患者2 008例,患病率为22.24%。70岁以上人群白内障患病率（60.03%）与70岁以下人群（12.70%）相比明显较高,差异有统计学意义（χ2=1 882,P <0.001）;女性患病率（27.11%）明显高于男性（17.05%）（ χ2=132,P <0.01）。糖尿病患者白内障患病率为66.94%,高于非糖尿病者（21.01%）（ χ2=154,P <0.01）。本次调查中发现白内障盲人166例,其中114例已经接受手术,白内障盲人手术覆盖率为68.67%。白内障盲人社会负担率为1.84%,不同年龄段社会负担率不同,随着年龄增长,白内障盲人社会负担率增加（χ2=154,P <0.01）,优势比为5.83。结论：白内障目前仍然是致盲的主要原因,社会上还有大量的白内障盲人得不到及时有效的治疗,给社会和家庭带来较重的负担,白内障复明工作任重而道远。     

无锡市50岁及以上人群白内障患病率和手术情况调查

背景 白内障是主要的致盲眼病,中国白内障患者逐年增加,由此带来的社会问题日益严重.目的 调查无锡市50岁及以上人群白内障患病率、白内障患者手术覆盖率及白内障患者的社会负担率.方法 采用整群随机抽样的方法.收集2010年1-12月无锡市滨湖区28个调查点50岁及以上人群共6722名居民,进行详细的病史采集和眼部检查,统计该人群中白内障的患病率及手术覆盖率,评估白内障患者的视功能.本研究遵循医学伦理学准则,经江苏省卫生厅批准,受检者在检查前均签署知情同意书.结果 受检者共6 150例,应答率91.5％.受检者中诊断为白内障者1 564例,白内障的患病率为25.43％.高龄、女性、文盲、有高血压病、糖尿病病史、吸烟史、饮酒史的人群白内障患病率明显增高,差异均有统计学意义（x2=927.835、18.508、303.968、11.934、17.956、32.091、35.290,P＜0.01）.以双眼最佳矫正视力＜0.05作为盲的标准,已行手术的白内障盲者与未手术的白内障盲者的总优势比值为3.15（85/27）,白内障盲者总手术覆盖率为75.89％（85/112）,白内障盲者社会总负担率为1.82％（112/6 150）.随着年龄的增长和受教育程度的降低,白内障盲的手术覆盖率逐渐降低,这种趋势差异无统计学意义（P＞0.05）,而白内障盲者的社会负担率逐渐增加的趋势差异有统计学意义（P＜0.01）.结论 高龄、女性和文盲的白内障是无锡地区比较严重的问题,白内障盲者的社会负担率仍然比较高,白内障仍然是防盲、治盲的工作重点.     

Psychometric properties of the 25-item NEI-VFQ in a Hispanic population: Proyecto VER

PURPOSE. To assess the psychometric properties of the NEI-VFQ-25 in a population-based study of older Hispanic persons living in the United States, explore other demographic factors that affect participant response, and observe the comparability of the Spanish and English versions of the instrument. METHODS. A sample of randomly selected block groups in Tucson and Nogales, Arizona, were selected for study. Participants were interviewed at home; a majority of the interviews were conducted in Spanish. The home interview included questions from the NEI-VFQ-25 and HHANES. Presenting acuity was done using ETDRS methodology, followed by a standardized eye examination by an ophthalmologist. The authors analyzed the internal consistency of the NEI-VFQ-25 responses using Cronbach's alpha coefficient and the construct validity by assessing the relationship between presenting acuity and scale scores, adjusting for age and gender. A second model was also explored to determine whether other demographic variables affected scale scores; differences in reporting between the Spanish and English versions was observed in this model, used in a subset of the population that minimized interviewer effect. RESULTS. Of the 4774 participants in the study, 99.7% had completed questionnaires, not completed by proxy. The highest nonresponse rate occurred in the Driving scale, with 25% of participants not driving for reasons other than problems with vision. Internal consistency was high, with Cronbach alpha ranging between 0.65 and 0.86 for scales with multiple items. Adjusting for age and gender, those with presenting acuity worse than 20/40 scored significantly lower than those with presenting acuity 20/40 or better, for all scales. The demographic variables with the most consistent association across the NEI-VFQ-25 scales were presenting acuity, income, and gender. No significant differences in reporting were found between the Spanish and English versions of the questionnaire in the subset of the population. CONCLUSIONS. In this study of Hispanic people age 40 years or older, the NEI-VFQ-25 was sensitive to presenting acuity and other demographic variables, such as age, gender, and income. The findings from this psychometric analysis provide evidence of the reliability and validity of some of the scales in the 25-item NEI-VFQ when used among people with a range of visual acuity level, providing other explanatory variables are also considered.     

Barriers to Uptake of Free Pediatric Cataract Surgery in Malawi

Purpose: To examine the demographic, sociocultural and socioeconomic factors that prevent families of cataract blind children from accepting free pediatric cataract surgery in Malawi.

Methods: A total 58 parents of 62 children were recruited into the study. Of these, 53 parents partook in in-depth interviews and focus group discussions after the children were screened and the parents offered free cataract surgery. Overall, 37 parents accepted (acceptors) and 16 parents did not accept (non-acceptors) cataract surgery. All interviews were transcribed and iteratively analyzed. Household economic status was quantified using the Progress out of Poverty Index for Malawi.

Results: Acceptors were better off economically (p?=?0.13). Understanding of cataract, its causing blindness and impairment, as well as treatment options, by the decision makers in the families was poor. Decision-making involved a complex array of aspects needing consideration before accepting, of which distance to the health facility was a frequently mentioned barrier. Non-acceptors were more likely to come from twice the distance compared to acceptors (p?=?0.0098). Non-acceptors were more likely to be peasant (subsistence) farmers than acceptors (p?=?0.048). Non-acceptors were more likely to live in a house made of mud bricks with a roof of grass thatch (p?=?0.001). There was no significant difference in acceptance rate between educated and non-educated mothers (p?=?0.11). Intensive counseling as provided in this project increased the likelihood of accepting surgery.

Conclusion: Economic hardship and long distances to health facilities decrease acceptance even of free pediatric cataract surgical services, highlighting that just providing surgery free of cost may not be sufficient for the most economically disadvantaged in rural Africa.     

Follow-Up Survey of Cataract Surgical Coverage and Barriers to Cataract Surgery at Nkhoma,Malawi

Purpose: Nkhoma Eye Hospital, Malawi provides high volume, high quality free cataract surgery to people in its catchment region of Central-Malawi. However, a previous survey in 2000 indicated that only 1 in 7 people with bilateral blindness from cataract had received surgery in a 10-mile radius of Nkhoma.

Methods: We conducted a population-based survey in 2006 in the 32 villages within a 10-mile radius of Nkhoma Hospital in people aged ≥ 40 years in order to investigate the cataract surgical coverage (CSC) and barriers to cataract surgery.

Results: The prevalence of blindness (visual acuity [VA] <3/60 in better eye) in 835 people aged ≥ 40 was 1.3% (95% CI 0.5–2.1), of which 36.4% was due to cataract. Overall, the CSC was 83.3%, and for eyes (VA<3/60) was 66.0%. The CSC was lower in females compared to males (73.3% vs. 100.0%. P?<?0.001). The most common barrier to surgery was cost (58%).

Conclusion: Our results demonstrate a 5-fold increase in coverage in the 6 years, primarily by increasing efficiency of the service provider and providing a community screening and referral service. Supporting the ophthalmic personnel with appropriate infrastructure and management has been central to this shift. Implementing an active case finding and referral mechanism has enabled this unit to provide regular high volume cataract surgery. There is a need to understand the factors influencing perceptions about cost as a barrier in this community and the disparity between need and access to services for women.     

Risk factors for Type II diabetes and diabetic retinopathy in a mexican-american population: Proyecto VER

PURPOSE: Risk factors for type II diabetes and diabetic retinopathy were determined in a population-based study of Mexican-Americans. DESIGN: Proyecto VER (Vision, Evaluation, and Research) is a cross-sectional study in a random sample of the self-described Hispanic populations in Tucson and Nogales, Arizona, age 40 and older. METHODS: Of 6,659 eligible subjects, 4,774 (72%) participated in the home questionnaire and clinic visit. Diabetes was defined as self-report of a physician diagnosis or hemoglobin A(1c) value of > or = 7.0%. Only type II diabetes was included. Diabetic retinopathy was assessed on stereo fundus photographs of all persons with diabetes. Questions were asked about demographic, personal, socioeconomic, and diabetes related variables. RESULTS: 1023 (21.4%) of the sample had type II diabetes, and 68% were in the low-income group (annual income less than $20,000). Diabetes was associated with Native-American ancestry, higher acculturation, low income, less education, and increasing body mass index after age and gender adjustment. Persons with previously undiscovered diabetes were more likely to have no regular source of care, no insurance, and currently smoke compared with persons with known diabetes. Only low income was related to proliferative retinopathy, once adjusted for other factors (odds ratio [OR] = 3.93, 95%, confidence limitations [CL] = 1.31-11.80). CONCLUSIONS: Several socioeconomic and other factors were associated with diabetes, but few were related to diabetic retinopathy. Persons in the low-income group appeared to be at greater risk of diabetes and the ocular complications of diabetes compared with those with more income. Further longitudinal studies in this population are needed to confirm the associations.     

Barriers for Poor Cataract Surgery Uptake among Patients with Operable Cataract in a Program of Outreach Screening and Low-cost Surgery in Rural China

Aims: To identify the reasons for poor uptake of cataract surgery in a program of outreach screening and low-cost surgery in Pucheng County, a rural area in northwestern China.

Methods: Detailed interviews with a semi-structured questionnaire were conducted by telephone or face-to-face for participants who had been advised to attend a low-cost cataract surgery program but did not schedule the surgery within 3 months after the initial screening.

Results: Among 432 eligible subjects, 355 (82.2%) were interviewed (mean age 70.6?±?6.6 years, 73.8% female). A total of 138 subjects (38.9%) were interviewed by phone and 217 (61.1%) were interviewed face-to-face. Lack of family support (n?=?106, 29.9%) and failure to understand the need for surgery (n?=?96, 27.0%) were the two main reasons for not undergoing cataract surgery. Other factors included fear of surgery (n?=?62, 17.5%), lack of faith in doctors (n?=?36, 10.1%), financial constraints (n?=?25, 7.0%) and lack of transportation (n?=?4, 1.1%).

Conclusion: The principal barriers to low-cost cataract surgery uptake in rural China included lack of family support and failure to understand the need for surgery. Education targeting entire families to eliminate these barriers and development of community support systems at the family level are required to achieve greater uptake of low-cost cataract surgery programs in rural China.     

Blindness, visual impairment and the problem of uncorrected refractive error in a Mexican-American population: Proyecto VER

PURPOSE: To report the prevalence of blindness and visual impairment and the contribution of uncorrected refractive error to visual loss, in a population-based sample of Mexican Americans aged 40 and older. METHODS: Proyecto VER is a population-based study of blindness and visual impairment in Mexican Americans in Arizona. Block groups in Tucson and Nogales were randomly selected with probability proportional to the size of the Mexican-American population aged 40 and older. Participants had a complete ophthalmic evaluation, including assessment of presenting and best corrected visual acuity using standardized procedures. Those with presenting visual acuity worse than 20/30 had refraction to determine best corrected vision. A home questionnaire and a clinic examination provided data on education, perception of visual impairment, income, and acculturation. RESULTS: The prevalence of presenting visual acuity worse than 20/40 was 8.2%, with uncorrected refractive error accounting for 73% of the impaired acuity. In multivariate models comparing those who improved two or more lines on the acuity chart with proper refraction with those who had adequate optical correction, uncorrected refractive error showed a strong association with age, less than 13 years of education (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.5-2.0), low acculturation index (OR 1.3, CI 1.1-1.3), lack of insurance coverage (OR 1.4, CI 1.1-1.7), and not having seen an eye-care provider in the past 2 years (OR 2.5, CI 2.1-3.0). Prevalence of best corrected acuity worse than 20/40 increased from 0.3% in those aged 40 to 49 years to 18% in those aged 80 years or more. CONCLUSIONS: Visual loss in this Mexican-American population is higher than has been reported in whites and is comparable to that in African Americans. Almost three quarters of those with visual acuity impairment would improve with optical correction. Socioeconomic factors that are probable markers of limited access to health care services were associated with uncorrected refractive error. These data suggest that education programs and interventions to improve access to eye care could significantly decrease the burden of visual loss among Mexican Americans.     

Coverage of Hospital-based Cataract Surgery and Barriers to the Uptake of Surgery among Cataract Blind Persons in Nigeria: The Nigeria National Blindness and Visual Impairment Survey

Purpose: To determine cataract surgical coverage, and barriers to modern cataract surgery in Nigeria.

Methods: Multistage stratified cluster random sampling was used to identify a nationally representative sample of 15,027 persons aged 40+ years. All underwent visual acuity testing, frequency doubling technology visual field testing, autorefraction, and measurement of best corrected vision if <6/12 in one or both eyes. An ophthalmologist examined the anterior segment and fundus through an undilated pupil for all participants. Participants were examined by a second ophthalmologist using a slit lamp and dilated fundus examination using a 90 diopter condensing lens if vision was <6/12 in one or both eyes, there were optic disc changes suggestive of glaucoma, and 1 in 7 participants regardless of findings. All those who had undergone cataract surgery were asked where and when this had taken place. Individuals who were severely visually impaired or blind from unoperated cataract were asked to explain why they had not undergone surgery.

Results: A total of 13,591 participants were examined (response rate 89.9%). Prevalence of cataract surgery was 1.6% (95% confidence interval 1.4–1.8), significantly higher among those aged ≥70 years. Cataract surgical coverage (persons) in Nigeria was 38.3%. Coverage was 1.7 times higher among males than females. Coverage was only 9.1% among women in the South-South geopolitical zone. Over one third of those who were cataract blind said they could not afford surgery (36%).

Conclusions: Cataract surgical coverage in Nigeria was among the lowest in the world. Urgent initiatives are necessary to improve surgical output and access to surgery.