五所特殊教育学校视障学生视觉损伤及康复情况

目的：分析国内5所特殊教育学校视障学生的视觉损伤及康复现状,了解这些学校视障学生的眼健康状况,探讨影响视障学生视觉康复相关因素及今后工作重点。方法：横断面调查研究。采用WHO 盲及低视力眼检查记录表,对5所特殊教育学校视障班学生进行病史采集、视力检查、裂隙灯显微镜检查、医学验光及助视器验配。采用2003年世界卫生组织制定的视觉损伤分级诊断标准。采用 Wilcoxon符号秩和检验对数据进行分析。结果：共筛查视障学生330例（660眼）,其中可避免盲及低视力有170例（51.5%）,难避免盲及低视力有115例（34.8%）,因筛查条件受限不能确定45例（13.7%）。 324例视障学生中（除去6例不配合视力检查）,93例（28.7%）学生屈光矫正后视力有所提高,双眼中较好眼的最佳矫正视力（LogMAR）由1.44升至1.19,屈光矫正前后差异有统计学意义（Z=-3.523, P<0.001）。17例（5.2%）屈光矫正后视觉损伤等级有所下降。122例（37.7%）可验配使用中远助视器提高远视力,128例（39.5%）可验配使用近用助视器提高近视力。在1级、2级及3级视觉损伤的视障学生中,远用助视器验配比例分别达到83.7%、83.3%、65.3%,脱盲率达到17.8%,脱残率达到72.2%;近用助视器验配比例分别达到77.6%、81.3%、77.6%,脱盲率达到22.8%,脱残率达到 81.4%。结论：部分特殊教育学校视障学生尚缺乏系统的眼健康筛查及视觉康复服务,部分视障学生通过屈光矫正及助视器的使用即可有效脱盲、脱残。在特殊教育学校中普及眼健康筛查及助视器的康复使用,可作为今后开展视障学生康复工作的重点内容之一。     

Erblindung in Deutschland – heute und 2030

Due to demographic developments in Germany, it is inevitable that the number of age-related diseases will grow. The aim of this survey is to forecast the extent of this development in ophthalmology. How many people will be blind or visually impaired in 25 years from now? According to the German Federation of Blind and Visually Impaired People, the number of blind people in Germany is about 145,000 and the number of the partially sighted people can be estimated at approximately 500,000. These figures are based on the legal definitions of blindness and visual impairment, which are stricter in Germany than in other countries. Due to the ageing population, there will be one third more blind people and about 60% more new cases of blindness in 25 years time. In particular, the incidence rate of blindness due to age-related macular degeneration will rise sharply, but the number of blind people and new cases of blindness are only the top of the “iceberg”. The number of people suffering from age related eye diseases in future will be even larger. This large number of future patients already should be part of health economic considerations.     

Effect of vision loss on plasticity of the head and neck proprioception

AIM: To assess all available data to compare the efficacy of glucocorticoids treatment and orbital decompression for dysthyroid optic neuropathy (DON). METHODS: PubMed, EMBASE, the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcomes were the improvement in visual acuity and responder rate. Secondary outcomes were the proptosis reduction, change in diplopia, and clinical activity score (CAS). RESULTS: One randomized controlled trial, three retrospective case series and one prospective case series met the inclusion criteria. They were divided into intravenous high-dose glucocorticoids (ivGC) group and orbital decompression (OD) group. Both groups demonstrated improvement in visual acuity. In addition, the proportion of patients with improved vision in OD group was higher than that in ivGC group (P<0.001). Post-treatment proptosis reduction was also reported in both groups. Overall, weighted mean in proptosis reduction estimated at 1.64 and 5.45 mm in patients treated with ivGC and OD respectively. This study also presented results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in 5 included studies. The most common complication in ivGC group and OD group was Cushing’s syndrome and epistaxis respectively. CONCLUSION: The present systematic review shows that both glucocorticoids treatment and orbital decompression are effective in treating DON and orbital decompression may work better in improving visual acuity and reducing proptosis. However, high-quality, large-sample, controlled studies need to be performed in the future.     

Features of the development of a welfare system for visually disabled people in Denmark

PURPOSE: To describe the development of a formal system of welfare for blind and partially sighted people in Denmark. METHODS: The principal laws in Denmark relating to a formal system of welfare for blind and partially sighted people are noted and commented on. No such collection of laws has been found in the literature. The history of aid to visually disabled people in Denmark is described, as are the Danish classifications of visual impairment. DEVELOPMENT: Formalized welfare for blind and partially sighted people was started in Denmark in 1811, as a private initiative by the Kjaede Order. Later, the Danish state took over responsibility, and in 1858 the Royal Danish Institute for the Blind was established. Since then a series of laws concerning welfare for blind and partially sighted people have been issued in accordance with economic and social development in Denmark. In 1858 the Braille writing system for blind people was introduced. The Danish Association of the Blind was founded in 1911 and has profoundly influenced subsequent legislation. During the last 10 years, several visual centres have been established. Since 1968 prevention of blindness has also played a prominent role in Denmark. CONCLUSION: Great steps have been taken towards improving the welfare of blind and partially sighted people. However, being blind is still very difficult. Modern technologies and hectic lifestyles have created new problems for blind people. The obligations of the Danish state towards visually disabled people have, therefore, increased in recent years.     

Influence of lens position as detected by an anterior segment analysis system on postoperative refraction in cataract surgery

AIM: To predict postoperative intraocular lens (IOL) position using the Sirius anterior segment analysis system and investigate the effect of lens position and IOL type on postoperative refraction. METHODS: A total of 97 patients (102 eyes) were enrolled in the final analysis. An anterior segment biometry measurement was performed preoperatively with Sirius and Lenstar. The results of predicted lens position (PLP) and IOL power were automatically calculated by the software used by the instruments. Effective lens position (ELP) was measured manually using Sirius 3mo postoperatively. Pearson’s correlation analysis and linear regression analysis were used to determine the correlation of lens position to other parameters. RESULTS: PLP and ELP were positively correlated to axial length (AL; r=0.42, P<0.0001 and r=0.49, P<0.0001, respectively). There was a weak correlation between the peLP (ELP-PLP) and the prediction error of spherical refraction (peSR; r=0.34, P<0.0001). The peLP of Softec HD IOL differed statistically from those of both the TECNIS ZCB00 and Sensor AR40E IOLs. Multiple linear regression was used to obtain the prediction formula: ELP=0.66+0.63× [aqueous depth (AQD)+0.6LT] (r=0.61, P<0.0001), and a new variable (AQD+0.6 LT) was found to have the strongest correlation with ELP. CONCLUSION: The Sirius anterior segment analysis system is helpful to predict ELP, which reduces postoperative refraction error.     

Childhood visual experience affects adult voluntary ocular motor control.

PURPOSE: To quantify the effects of childhood visual experience/chronic visual deprivation upon adult voluntary ocular motor control. METHODS: Eye movements of blind and sighted adults were elicited and videotaped in total darkness. The videotaped responses were digitized using an eye tracker, yielding data from 10 congenitally blind (infantile onset, blindness before age 1 year), 16 adventitiously blind, and 9 sighted persons. RESULTS: Multivariate analysis of variance, trend analyses and post hoc tests revealed that primary position fixational stability and consistency of return to primary position were lowest in the congenitally blind vs. the adventitiously blind group, and highest in the sighted. Duration of adventitious blindness reduced primary position stability but not consistency of return to primary position. Secondary position maximum amplitudes: congenitally blind mean, 14 degrees; adventitiously blind mean, 40 degrees; sighted mean, 47 degrees. Average velocity (a form of Main Sequence) increased significantly with amplitude in all three groups. CONCLUSIONS: Visual deprivation can greatly attenuate but does not abolish human voluntary eye movement. Adventitious blindness exerts minimal to profound effects, commensurate with age of vision loss.     

Use of Cataract Services in Eastern Africa—A Study from Tanzania

Purpose: To establish the proportion of patients who are blind or have low vision prior to undergoing cataract surgery at tertiary referral centers in Tanzania. To assess which patient groups presenting for cataract surgery are more likely to be blind or visually impaired. Methods: Using pre-existing computerized audit systems we gathered data on pre-operative visual status, age, gender and presentation mode (walk-in or outreach) for 3765 patients undergoing 4258 cataract operations at 2 hospitals in Tanzania. Visual status was defined based on vision in the better eye. Results: 32% of operations were performed on blind patients, 37% on patients with low vision and 31% on normally sighted patients. Predictors of blindness at presentation were: female sex (OR 1.15; 95% CI 1.00–1.32); referral from a rural outreach program (OR 1.75; 95% CI 1.51–2.02) and older age (OR 1.02; 95% CI 1.01–1.02). Conclusions: It is not only the blind who present to cataract services in Tanzania. The demand for surgery amongst patients who or are normally sighted represents a positive move towards prevention, and not only cure of cataract blindness in Tanzania. However, it also highlights the need to target those left blind from cataract in order to deliver services to those most in need. Cataract programs targeting patients in rural areas and older patients are likely to increase the number of blind patients benefiting from cataract services.     

Visual performance and reading capacity of partially sighted persons in a rehabilitation center

Visual acuity and reading performance of 178 partially sighted patients from a rehabilitation center were measured using a TV text display device. A linear relation was demonstrated between visual acuity and reading speed for patients with visual acuity values below 15% of the normal value. With respect to reading performance, three groups of partially sighted patients could be distinguished: (1) 25% of the patients are unable to read visually and require tactile reading aids; (2) 50% are partially sighted and require high-magnification electronic reading aids; (3) 25% can read normal text by using optical magnifying devices. There is evidence that reading performance is related to the nature of the underlying ocular problem, such as refractive anomalies, macular degeneration, or other diseases.     

Augenerkrankungen in der staatlichen Blindenschule Ilvesheim

Purpose

Since 1868, the Department of Ophthalmology at the University of Heidelberg has been providing care for the pupils of the school for blind and visually handicapped children in Ilvesheim, Germany. Previous studies on the causes of low vision have demonstrated the effects of the advances in medicine and ophthalmology with an explicit decrease in the number of inflammatory corneal diseases, followed by a reduced number of students suffering from congenital cataract and glaucoma. The aim of the present study was to evaluate current data and to compare it to previous data.

Methods

Ophthalmological data and additional disorders could be evaluated in 268 students visiting the special education school Schloßschule Ilvesheim between 2000 and 2008. The findings were compared to the results of previous studies concerning the degree of visual impairment and diagnosis. The children were divided according to German social law into blind, severely visually handicapped and visually handicapped.

Results

Out of the 268 students 83 (31.0%) were premature infants and 69 of these had additional disabilities, 130 were blind and 51 severely visually handicapped. Of the students 142 had additional learning, mental and/or motor handicaps. The most frequent cause of blindness or severe visual impairment was optic nerve atrophy (36.2 % and 37.3 %, respectively). The frequency of hereditary retinal diseases among the blind children was slightly higher with 24.6 % as compared to the data analysis from 1981 and was 15.7 % and 17.1 % among the severely visually handicapped and visually handicapped, respectively. Retinopathy of prematurity was diagnosed in approximately 20% of blind and severely visually handicapped children.

Conclusions

As a result of the enormous advances of medical capabilities during the last decades the number of (formerly) premature infants has markedly increased. Most of these students are multiply handicapped and need extensive assistance. While the number of students suffering from hereditary retinal diseases was only minimally increasing during the last 40 years, the number of blind students without additional disabilities has decreased due to the improved technical means to integrate even blind students into main-stream schools.     

儿童盲和低视力的病因与屈光状态及远用助视器康复研究

目的：分析儿童盲和低视力的病因、屈光状态、屈光矫正和配用光学远用助视器矫正后的视力情况。

方法：选取2015-12/2018-04我科门诊接诊及盲校筛查的6～16岁低视力儿童和盲童212例422眼,通过相关检查明确病因和屈光状态,对部分患儿进行屈光矫正和光学远用助视器验配矫正,分析矫正后视力情况。

结果：儿童盲和低视力病因以先天性和遗传性眼病为主,本组病例中先天性白内障是首位原因(19.3%),低视力屈光不正以轻中度远视和近视多见(65.3%),屈光矫正后脱盲率(26.4%)和脱残率(14.6%)均低于联合远用助视器验配矫正后的脱盲率(58.3%)和脱残率(91.1%),差异均有统计学意义(P<0.01)。

结论：儿童盲和低视力病因复杂,应加强预防和筛查工作,低视力儿童应常规进行屈光矫正并配合使用远用助视器矫正,以利获得满意的康复效果。     

The frequency of amblyopia among visually impaired persons

PURPOSE: To investigate the frequency of amblyopia among visually handicapped patients. METHODS: The study is a retrospective investigation of all living patients registered in four Visual Rehabilitation Centres in a region in southern Sweden. The area's total population numbered 865,612 persons of whom 11,365 were registered as visually handicapped (with visual acuity < or = 0.3 in the better eye). RESULTS: Amblyopia was the main cause of decreased visual acuity in one eye in 1.72% (195 of 11,365) of the patients. The average age of the patients with amblyopia was 69 years (9-95 years) and 28.2% of these patients were less than 65 years old (the age for retirement in Sweden). The median visual acuity in the amblyopic eye among these patients was 0.1. The median visual acuity in the nonamblyopic eye was 0.2. The most common cause of decreased vision in the nonamblyopic eye was macular degeneration (39.5%). Bilateral amblyopia was present in 13 (6.7%) of the amblyopic patients. By comparing this study with earlier studies, we can calculate that about 1.2% of the persons with amblyopia 0.3 or lower will eventually become visually handicapped. CONCLUSION: A small but considerable number of patients who attend the Visual Rehabilitation Centres have amblyopia as a cause of their visual impairment. Since amblyopia can be treated if detected in childhood, later visual rehabilitation of these patients can be avoided or delayed, thereby reducing rehabilitation costs for society.     

Social Ophthalmology

The discipline of human ophthalmology may be divided into several components of which social ophthalmology, embracing fields of public health, prevention of blindness, epidemiology, genetics, rehabilitation and welfare services for visually handicapped people, is a large one of increasing importance as the post-industrial era gets under way. Sub-groups of social ophthalmology are tabulated. Experiences and comments are given on the following selected aspects: genetic counselling, personal counselling, counselling for adjustment, education, vocational guidance and employment placement, and governmental financial assistance, for visually handicapped people.     

Quality of life and visual rehabilitation: an observational study of low vision in three general practices in West Glamorgan

AIM: To survey low vision in an urban population and assess impact on quality of life, rehabilitation and support. METHODS: In a cross-sectional population survey, 66 patients were identified from databases of three general practices and surveyed by investigator administered questionnaire. Main outcome measures were ocular diagnoses, (US) National Eye Institute Visual Function-Questionnaire (NEI-VFQ) scores assessing visual and nonvisual disability, eligibility for, awareness and receipt of rehabilitation and support. RESULTS: Of 24,420 individuals on the lists of the three study practices, we found 101 registered as blind or partially sighted (prevalence 0.41%). A total of 66 patients participated with ocular diseases of age-related macular degeneration 39 (59%), glaucoma 11 (17%), diabetic retinopathy two (3%), retinitis pigmentosa two (3%), and 12 (18%) 'others'. Better eye visual acuity was counting fingers or worse in 32 (48.5%). NEI-VFQ scores were poor-overall mean 41.5% (SD 23.5). In all, 80% had a social services home visit with one-third of these still in contact. In all, 66% had undergone a low vision aid assessment and 57.6% of these used their aid. The awareness and receipt of benefits arising from registration as visually impaired were lower than for other supportive measures available for reasons unrelated to vision. None had a guide dog. CONCLUSIONS: We found expected patterns of low vision but poorer levels of function and support that may reflect age and deprivation in a population failed by the current systems for identification, registration, and rehabilitation based on legislation overtaken by demographic change and social provision independent of visual status.     

老年低视力和盲的病因及光学助视器在康复中的应用

目的:分析老年低视力和盲的病因及光学助视器在康复中的应用.方法:收集我院老年视力残疾患者87例,其中低视力74例,盲13例.其中男53例,女34例.先进行常规内外眼检查,必要时采用特殊检查,再进行病因分析.均屈光矫正,然后试配远用和近用光学助视器,检查配戴助视器后远、近视力,远视力≥0.05为脱盲,远视力≥0.3为脱残,近视力≥0.5为有效,<0.5为无效.结果:老年低视力患者致盲原因占首位的是高度近视,其次为黄斑变性、各类白内障、青光眼、糖尿病视网膜病变.经屈光矫正后视力提高≥2行者62例(71%),视力不矫正或矫正≤1行者25例(29%).联合远用助视器后视力≥0.3脱残者70例(80%),远视力≥0.05脱盲者10例(11%),<0.05者7例(8%),脱残率92%.配阅读眼镜及近用助视器后近视力>0.5者 60例(69%),<0.5者27例(31%).助视器经常使用者58例,不经常使用18例,基本不用或放弃者11例.结论:老年低视力及盲的病因占首位的是高度近视,其次是黄斑病变.光学助视器在其康复中的应用仍是目前可靠、经济、有效的矫治方法,应鼓励患者使用助视器,提高助视器的利用率,从而提高患者的生活质量.     

Need for optical and low vision services for children in schools for the blind in North India

CONTEXT: Children admitted in blind schools need low vision assessment for improving functional vision (useful residual vision). AIM: To ascertain the need for spectacles and magnifiers as low vision devices (LVD) in children with useful residual vision, attending blind schools. SETTING AND DESIGN: Cross-sectional study conducted in 13 blind schools in Delhi, North India. MATERIALS AND METHODS: Of a total of 703 children (less than 16 years of age) examined, 133 (18.91%) with useful residual vision were refracted and analyzed. High addition plus lenses (range 5-30 diopters) were used as spectacle magnifiers for near LVD assessment. "World health organization (WHO)/ prevention of blindness (PBL) eye examination record for children with blindness and low vision", was used to collect data. SPSS (statistical package for the social science), version 10.0 was used for analysis. RESULTS: Based on the vision of 133 children at initial examination, 70.7% children were blind and 12.0% were severely visually impaired (SVI). 20.3% children improved by at least one WHO category of blindness after refraction. With best correction, 50.4% children were still blind and 13.5% were SVI. Visual acuity in the better eye after refraction in 47 children (35.3%), improved with spectacles. Children with aphakia (17), coloboma (5), refractive error (5) and microphthalmos (4) benefited from spectacles. Of 124 children with low vision but having useful residual vision, 51 (41.1%) were able to read N-10 unaided or with distance spectacles and 30 children (22.6%) improved to N-10 with spectacle magnifiers and were prescribed the same. CONCLUSION: Visually impaired children with aphakia and congenital anomalies of the eye benefit from refraction and low vision services.     

Causes of blindness and visual impairment in the West of Scotland

AIMS: To determine the overall reported incidence and causes of registrable blindness and visual impairment in the West of Scotland and any trends that have occurred in the previous 16 years since data from the same area were published. METHODS: Data for analysis were obtained from BP1 registration forms returned to the Resource Centre for the Blind serving the Strathclyde region in the West of Scotland between 1 April 1996 and 31 March 1997. RESULTS: A total of 1595 visually handicapped people were registered during the study year. Of these, 99 forms (6.2%) were excluded from further analysis because of insufficient information. The remaining 1496 completed BP1 Forms were in respect of 530 males and 966 females. Of these, 253 males and 450 females were legally blind (total 703 or 47.0%) and 277 males and 516 females were partially sighted (total 793 or 53.0%). The five leading causes of blindness, in decreasing frequency, were age-related macular degeneration (ARMD), glaucoma, diabetic retinopathy, myopic degeneration, and optic atrophy. ARMD and diabetic retinopathy were the most common causes of blindness in those over 65 years and persons of working age, respectively. CONCLUSIONS: In adults, cataract is no longer a significant cause of registrable visual impairment. The proportions of registrations owing to glaucoma, diabetic retinopathy, and myopia have not significantly changed since 1983 and the proportion owing to macular degeneration has increased. In children, congenital glaucoma, cataract, and corneal infection were no longer causes of registration, but impairment of vision caused by brain damage is now a significant contributor.     

Causes of severe visual impairment and blindness in children attending schools for the visually handicapped in the Czech Republic

AIMS: To describe the causes of severe visual impairment and blindness in children in schools for the visually handicapped in the Czech Republic in 1998. METHODS: Pupils attending all 10 primary schools for the visually handicapped were examined. A modified WHO/PBL eye examination record for children with blindness and low vision was used. RESULTS: 229 children (146 males and 83 females) aged 6-15 years were included in the study: 47 children had severe visual impairment (20.5%) (visual acuity in their better eye less than 6/60), and 159 were blind (69.5%) (visual acuity in their better eye less than 3/60). Anatomically, the most affected parts of the eye were the retina (124, 54.2%), optic nerve (35, 15.3%), whole globe (25, 10.9%), lens (20, 8.7%), and uvea (12, 5.2%). Aetiologically (timing of insult leading to visual loss), the major cause of visual impairment was retinopathy of prematurity (ROP) (96, 41.9 %), followed by abnormalities of unknown timing of insult (97, 42.4%), and hereditary disease (21, 9.2%). In 90 children (40%), additional disabilities were present: mental disability (36, 16%), physical handicap (16, 7%), and/or a combination of both (19, 8%). It was estimated that 127 children (56%) suffer from visual impairment caused by potentially preventable and/or treatable conditions (for example, ROP, cataract, glaucoma). CONCLUSIONS: Establishing a study group for comprehensive evaluation of causes of visual handicap in children in the Czech Republic, as well as for detailed analysis of present practice of screening for ROP was recommended.     

Blindness and partial sight in an elderly population.

A cross sectional, prevalence survey of eye disease in the population over 75 years old of Melton Mowbray has been used to examine the accuracy and completeness of the Blind and Partially Sighted Registers. The Blind Register had high sensitivity and specificity but was found to underestimate the prevalence of blindness by a factor of 1.1. The Partially Sighted Register had high specificity, but the sensitivity was only 50% and it underestimated the prevalence of partial sight by a factor of 1.5. Seven persons eligible for registration, but previously not registered, were found, two as blind and five as partially sighted. This represented 21% of the registrable visually impaired population.     

Changes in blindness prevalence over 16 years in Malawi: reduced prevalence but increased numbers of blind

BACKGROUND/AIMS: In the coming two decades significant increases in the burden of blindness are anticipated unless concerted efforts are made to improve eye care in developing countries. Evidence of changing prevalence rates or numbers of blind people are few. The change in blindness prevalence and the number of blind people in an adult population of Malawi was measured over a 16 year period. METHODS: In 1999 a population based survey of blindness in adults (age 50+) was conducted in Chikwawa district of Malawi. Visual acuity and cause of vision loss were recorded for each eye independently. Blindness was defined as presenting better eye vision of <6/60. Findings from a 1983 survey of blindness in the same district (using similar methods) were re-analysed to be comparable with the survey conducted in 1999. RESULTS: Among 1630 enumerated adults 89% were examined. The age adjusted prevalence of blindness in the adult population was 5.4% and more common in women than men. In each age group the prevalence of blindness was lower in 1999 than in 1983; the overall reduction in blindness was 31%. During this period the 50+ population in Malawi increased almost twofold. Extrapolating the Chikwawa district data to the Malawi population reveals that the number of blind people has increased by 24%; the increase is primarily because of the large increase in the size of the most elderly group, aged 70 and above. CONCLUSION: The majority of blind people in Chikwawa (1983 and 1999) are in the age group 70 and over. This group has had the largest proportional increase in population size in this time. Services in this population have improved in the intervening 16 years and yet there was still an increase in the number of blind people. There was little change in excess blindness in women, suggesting that the same barriers that prevented utilisation of services in 1983 probably persist in 1999. Efforts to reach the most elderly and to reach women are needed to lead to a reduction in blind people in settings such as rural Malawi.