构筑我国防治青光眼的体系

青光眼是严重的不可逆的致盲性眼病,因此加强青光眼的防治工作非常必要。虽然我国已在防治青光眼方面做了大量工作,但是还存在着不少问题,主要表现在还没有将防治青光眼纳入全国防盲治盲的优先项目,还没有建立起全国性防治青光眼的队伍和机构,还没有在眼科医师中普及和及时更新防治青光眼的知识,还没有建立起青光眼的药品供应网络,还没有在公众中普及防治青光眼的知识。要解决上述问题,应当在我国构筑全国性防治青光眼的体系,其主要目标是提高青光眼的发现率,降低青光眼的致盲率,提高青光眼患者的生活质量,并节省因青光眼致盲的社会成本。为了能顺利地推行这项工作,需要采用公共卫生的途径,而不是仅仅依靠临床途径。在构筑全国防治青光眼的系统中,我们可以从以下几个方面着手开展工作,包括从我国各地的社会经济发展状况出发建立防治青光眼的机构;培训防治青光眼的专业队伍;建立防治青光眼的制度;以及加强防治青光眼的科研工作。     

Childhood blindness at a school for the blind in Riyadh, Saudi Arabia

PURPOSE: To determine the major causes of eye diseases leading to visual loss and blindness among children attending a school for the blind in Riyadh, Saudi Arabia. METHODS: A total of 217 school children with visual disabilities attending a school for the blind in Riyadh were included. All children were brought to The Eye Center, Riyadh, and had complete ophthalmologic examinations including visual acuity testing, biomicroscopy, ophthalmoscopy, tonometry and laboratory investigations. In addition, some patients were subjected to electroretinography (ERG), electrooculography (EOG), measurement of visual evoked potentials (VEP), and laboratory work-up for congenital disorders. RESULTS: There were 117 male students with an age range of 6-19 years and a mean age of 16 years. In addition, there were 100 females with an age range of 6-18 years and a mean age of 12 years. Of the 217 children, 194 (89%) were blind from genetically determined diseases or congenital disorders and 23 (11%) were blind from acquired diseases. The major causes of bilateral blindness in children were retinal degeneration, congenital glaucoma, and optic atrophy. The most common acquired causes of childhood blindness were infections and trauma. CONCLUSION: The etiological pattern of childhood blindness in Saudi Arabia has changed from microbial keratitis to genetically determined diseases of the retina and optic nerve. Currently, the most common causes of childhood blindness are genetically determined causes. Consanguineous marriages may account for the autosomal recessive disorders. Public education programs should include information for the prevention of trauma and genetic counseling. Eye examinations for preschool and school children are mandatory for the prevention and cure of blinding disorders.     

陕西省盲校盲童致盲原因调查分析

目的:了解陕西省儿童盲和严重视力损害的原因,以确定潜在的可预防性和可治疗性因素。方法:参照世界卫生组织儿童视力障碍检查法,2004-06对陕西省某盲校33名盲童的盲及低视力情况进行调查,分析其致盲原因。结果:33名盲童中2名为严重视力损害(6.06%),31名为盲(93.94%)。最常见致盲解剖部位依次为视网膜(36.37%)、青光眼(24.24%)、晶状体(15.15%)、视神经(9.09%)、角膜(9.09%)和全眼球(6.06%)。先天和遗传因素为盲校学生致盲致残的主要原因,占90.91%;后天性占9.09%。视网膜色素变性、先天性青光眼和先天性白内障等为主要原因,占先天因素的70%。可避免性盲16例(48.48%),其中可预防者3例(9.09%),可治疗性者13例(39.39%)。结论:营养性和感染性致盲已较少见,先天和遗传性因素是目前陕西省儿童盲的主要原因。     

Points of action in the campaign against blindness in developing countries

This article provides a survey of the problems of prevention of blindness in developing countries. The World Health Organization estimates that 31 million people are blind and 15 million people partially-sighted. The main cause of blindness is cataract. Other causes are trachoma, glaucoma, xerophthalmia, river blindness, corneal scars and leprosy. Prevention or treatment of these causes is possible in more than 80% of cases. The number of blind persons, however, is still increasing due to the increase in population and the immense shortage of all kinds of ophthalmological equipment and personnel. An effective strategy for the prevention of blindness in developing countries should focus on: more cheap cataract operations, increasing teaching facilities for ophthalmic personnel, integration of ophthalmic care into the general health system and the promotion of blindness prevention in political organizations.     

边远山区的盲目原因分析

本文分析了从1977年1月至1991年12月到广东省新丰县医院眼科就诊的408例盲目患者的盲目原因。显示白内障为首位致盲原因,占32.84％;不同年龄组的主要盲目原因有所不同,46岁以下者为眼外伤,46岁以上则为白内障和青光眼。提出青少年及壮年眼外伤的预防和老年性白内障的治疗应列为边远山区防盲治盲的重点。     

我国防盲与眼科流行病学研究的现状及发展

2005年以来的时期是我国防盲与眼科流行病学研究进展最显著的一个时期.全国眼病和视力残疾人抽样调查发现白内障(56.7%)、视网膜葡萄膜病(14.1%)和角膜病(10.3%)是目前我国盲和视力损伤的主要原因."视觉第一中国行动"二期、"百万贫困白内障患者复明工程"等重大防盲项目已取得巨大成就.2005年至2009年我国共施行了387.1万白内障复明手术,2009年百万人口白内障手术率达到796.2.全国已建成白内障无障碍县673个、无障碍市70个、无障碍省(自治区)2个.近5年已为175 501例低视力患者验配了助视器,为47 009例盲人提供了定向行走训练.初级眼保健和沙眼、糖尿病视网膜病变的防治也取得了一定成果.5年来,虽然基本完成了国家防盲任务,但远未达到"视觉2020"行动的目标要求,特别是还存在白内障手术率仍然偏低、主要致盲性眼病并未根治;流行病学研究缺少创新性、深度和广度不够等问题.今后,应切实把握好眼科流行病学的良好发展趋势,开展原创造性和分子流行病学研究;还应整合包括初级眼保健在内的各级眼保健力量,"高质量、低价格"地开展白内障、视网膜病、角膜病、沙眼、屈光不正、低视力、青光眼等防盲工作,争取早日达到"视觉2020"根治我国可避免盲的宏伟目标.     

青光眼为什么需要精准的个体化治疗?

青光眼是一类不可逆性神经致盲性眼病,其病理机制及诊疗研究于近10年虽发展迅速,但其致盲率仍高居不下.究其原因,盖因疾病自身的复杂程度及我们对疾病认知尚存局限,因而需要应用基于大数据、精准的个体化治疗思路来诊治青光眼,以降低致盲率.     

Uncorrected refractive error in the northern and eastern provinces of Sri Lanka

Background: The 2004 tsunami focused unprecedented international aid and resources on Sri Lanka. Among other responses, a program delivered by volunteer optometrists enabled many local people to access eye examinations and spectacles for the first time. The data collected from the eye‐care delivery program during 2005 are summarised in this report, as an evidence base for planning future eye‐care interventions in these provinces or similar areas. Methods: A total of 96 eye clinics were conducted by visiting volunteer optometrists in the northern and eastern provinces of Sri Lanka, at which 20,090 people were examined. Clinical records were reviewed for conditions causing visual impairment, conditions that could cause impaired vision in future if left untreated, eye‐care outcomes and barriers to seeking care. Results: Complete records were available for 14,669 people. Seventy‐nine per cent of this clinical population had never had an eye examination. Uncorrected refractive error including presbyopia caused visual impairment for 78 per cent (11,388) of people who presented for an eye examination. Cataract caused impaired vision for 15 per cent (2,180) of people and was the main reason for referral beyond primary eye‐care, although only five per cent (695) of people presenting were referred for cataract surgery, as local capacity constraints set a visual acuity requirement of 6/36 or worse. The gender and age profiles of people attending the clinics were not consistent with equitable blindness prevention. Conclusion: The high proportion of people who had not previously had an eye examination, particularly those with significant uncorrected refractive error, provides evidence for the acute need for further development and support of community‐level eye‐care services in the regions visited. Women and older people should be targeted by future programs to achieve equity of blindness prevention.     

Specific causes of blindness and vision impairment in a rural area of Southern Togo

PURPOSE: To determine prevalences of specific causes of blindness and visual impairment in a rural area of Southern Togo. Method: A transversal exhaustive screening was conducted. The sample consisted of the inhabitants aged 5 years and over. From the census, 2293 persons were expected, however, 1738 (75.80%) responded and underwent screening. Each participant had complete ocular examination, and data collected were processed for analysis. RESULTS: The mean age of all participants was 28.02 years, men were predominant. The prevalence of bilateral visual impairment was 2.13%, prevalence of unilateral impairment was 1.15%. Bilateral blindness prevalence was 2.47%, while unilateral blindness prevalence was 2. 65%. Main ocular blinding diseases and their prevalences were as follows: cataracts (8.34%), glaucoma (1.90%), corneal opacities (1. 09%). Women were more affected by bilateral visual impairment, bilateral blindness and cataract.: p= 0.0106 Men were more affected by glaucoma, corneal opacities and unilateral blindness.Participants aged 55 years and over were at high risk of blindness and visual impairment; p= 0.0104. CONCLUSION: This study demonstrated that prevalence of blindness is high, and its major causes are cataract, glaucoma and corneal opacities. A prevention strategy is therefore needed and targeted to these diseases.     

从防盲治盲到全面的眼健康

“十二五”时期,我国政府大力推进防盲治盲工作,主要致盲性眼病得到有效遏制,盲的患病率下降25%。但是随着我国社会经济快速发展,生活方式的改变,年龄相关性眼病逐渐增加,眼病谱也发生了改变,因此,防盲工作已从防盲、患病人群的治疗向眼健康管理、眼病的预防进行转变。“全国防盲治盲规划”转变为“十三五全国眼健康规划”。 “十三五”期间,眼健康规划的实施将成为“健康中国”的重要组成部分。应积极防治导致盲和视觉损伤的主要眼病,到2020年进一步提升公众的眼健康水平。（眼科,2017, 26： 1-3）     

山东省盲校盲童致盲原因调查

目的：确定山东省盲校16岁以下盲生致盲的解剖及发病原因,为防治儿童盲提供依据。方法：WHO儿童视力障碍检查法对山东省11所盲校盲生进行检查,诊断,结果：275名16岁以下盲生中,258人为严重视障或盲,占93．8％;主要病变部位为全眼球、视网膜、晶状体、视神经;主要致盲原因为先天异常及遗传性眼病;26．8％为潜在性可防治盲,以先天性白内障,青光眼为主,结论：本调查一定程度上反映了山东省儿童盲的现状,营养性及感染性盲病少见,无天异常及遗传性眼病是主要原因。     

减少青光眼导致的盲和视力损伤是防盲的重要内容

由于国际眼科学界和世界卫生组织(WHO)已经注意到青光眼问题的严重性和加强青光眼防治的重要性,因此WHO采取了一些可行措施,以加强全球因青光眼致盲和视力损伤的防治工作.之所以采取这些措施是由于青光眼已经对全球的公共卫生造成了沉重负担,而且采用目前循证的临床干预措施治疗青光眼是有效的.将防治青光眼纳入防盲的重点就意味着不仅采用临床的途径,还要采用公共卫生的途径,整合各种眼保健力量做好青光眼的防治工作,这是青光眼防治策略的重要改变.筛查和早期诊断青光眼是防治青光眼的一项非常重要的工作,目前主要通过加强机会性筛查青光眼的工作,以发现更多的未诊断和未治疗的青光眼患者.所采用的防治青光眼的策略应当与当地的社会经济状况相适应,这样才能有利于推进防盲工作的顺利开展.     

The control of conjunctival fibrosis as a paradigm for the prevention of ocular fibrosis-related blindness. “Fibrosis has many friends”

The processes involved in ocular fibrosis after disease or ocular tissue injury, including surgery play an important part in the development or failure of treatment of most blinding diseases. Ocular fibrosis is one of the biggest areas of unmet need in ophthalmology. Effective anti-scarring therapies could potentially revolutionise the management of many diseases like glaucoma worldwide. The response of a quiescent or activated conjunctiva to glaucoma surgery and aqueous flow with different stimulatory components and the response to different interventions and future therapeutics is a paradigm for scarring prevention in other parts of the eye and orbit. Evolution in our understanding of molecular and cellular mechanisms in ocular fibrosis is leading to the introduction of new and re-purposed therapeutic agents, targeting a wide range of key processes. This review provides current and futures perspectives on different approaches to conjunctival fibrosis following glaucoma surgery and highlights the challenges faced in implementing these therapies with maximal effect and minimal side effects.Subject terms: Inflammation, Conjunctival diseases     

Poverty and blindness in Africa

Africa carries a disproportionate responsibility in terms of blindness and visual impairment. With approximately 10 per cent of the world’s population, Africa has 19 per cent of the world’s blindness. It is no surprise that this reality also mirrors the situation in terms of the burden of world poverty. There is an increasing recognition of the need to highlight the link between poverty, development and health care. Blindness, disabling visual impairment and the overall lack of eye‐care services are too often the result of social, economic and developmental challenges of the developing world. The state of eye care in Africa stands in alarming contrast to that in the rest of the world. Poor practitioner‐to‐patient ratios, absence of eye‐care personnel, inadequate facilities, poor state funding and a lack of educational programs are the hallmarks of eye care in Africa, with preventable and treatable conditions being the leading cause of blindness. Eye diseases causing preventable blindness are often the result of a combination of factors such as poverty, lack of education and inadequate health‐care services. The challenge that Vision 2020 has set itself in Africa is enormous. Africa is not a homogenous entity, the inter‐ and intra‐country differences in economic development, prevalence of disease, delivery infrastructure and human resources amplify the challenges of meeting eye‐care needs. The successful implementation of Vision 2020 programs will be hindered without the development of a comprehensive, co‐ordinated strategy that is cognisant of the differences that exist and the need for comprehensive solutions that are rooted in the economic and political realities of the continent as well as the individual countries and regions within countries. This strategy should recognise the need for economic growth that results in greater state funded eye‐care services that focus on health promotion to ensure the prevention of eye disease, the development of eye clinics in hospitals and health clinics, and the training of the appropriate human resources.     

Abstracts

Purpose: To analyse trends in the incidence of registered age-related macular degeneration (ARMD) in the UK since 1950 and to compare these to trends in registration of other blinding diseases —cataract, glaucoma and optic atrophy over the same time period. Methods: Calculation of standardised registration ratios for ARMD, cataract, glaucoma and optic atrophy using published registratoin data from 1950 onwards. SRRs for each sex separately were calculated, adjusting for age in 5 year age-groups. Results: The absolute number of people registered blind annually has more than doubled since 1950. After adjustment for age, annual registration rates for blindness have fallen over the past 40 years, particularly with respect to cataract and glaucoma. Standardised registration ratios for ARMD exhibit a different pattern, increasing, but not consistently, over the same time period. Conclusions: These oberservations are consistent with the hypothesis that the incidence of registrable ARMD is increasing. Changes in the diagnosis and detection of this disease, however, cannot be excluded as an alternative explantation. Analysis of trends in national registration statistics may be useful for monitoring changes in the distribution of blinding eye disease in the population.     

Glaucoma screening: current trends, economic issues, technology, and challenges

PURPOSE OF REVIEW: Glaucoma is one of the leading causes of irreversible blindness worldwide. Early glaucoma detection and treatment are currently the only known methods for preventing blindness and low vision resulting from this frequently asymptomatic disease. RECENT FINDINGS: New technologies for detecting early glaucomatous damage are important in diagnosing optic nerve disease, not only in community screening settings but also in clinics. Imaging of the optic nerve head and macula and retinal nerve fiber layer analysis can provide quick, automated, and quantitative measurements in agreement with clinical estimates of optic disc structure and visual function. In the area of perimetry, frequency-doubling technology is a promising and feasible mass-screening method with reasonable sensitivity for detecting visual field loss. Central corneal thickness has emerged as a new risk factor for the development and progression of glaucoma, thereby complicating the role of tonometry and measurement of intraocular pressure as screening parameters for glaucoma. Along with technological advances, strides are also being made with public policy and legislative efforts to bring glaucoma onto the national and global health care agenda. These initiatives incorporate vision-screening goals into national disease prevention programs emphasizing the need for early glaucoma detection and treatment. SUMMARY: Glaucoma awareness needs to be increased through better education, and compliance with follow-up care needs to be improved to decrease the economic and social costs from glaucoma. In addition, screening models need to be developed that will be effective in developing countries where the risk of blindness from glaucoma is highest.     

Factors in adjustment to blindness

We wished to explore the relationship between certain blinding eye diseases, residual vision and psychosocial adjustment, including acceptance of blindness. One hundred and fourteen patients were grouped according to level of vision, age, type of disease, general physical health and duration of blindness. Psychological symptoms were measured by the Minnesota Multiphasic Personality Inventory (M.M.P.I.) and social function by an adaptation to blindness of the Gunzberg Progress Chart of Social Function. Social adjustment was best and psychological morbidity least in those with non-diabetic retinal disorders, those who had the best vision and those who accepted their blindness. Non-acceptance of blindness was associated with the most psychological distress and the lowest scores in social adjustment. People with glaucoma and diabetic retinal disorders seemed more poorly adjusted. An attempt should be made to identify those most prone to maladjustment so as to assist them in rehabilitation.     

Detection of Glaucoma Using Image Processing Techniques: A Critique

Objective: The primary objective of this article is to present a summary of different types of image processing methods employed for the detection of glaucoma, a serious eye disease. Introduction: Glaucoma affects the optic nerve in which retinal ganglion cells become dead, and this leads to loss of vision. The principal cause is the increase in intraocular pressure, which occurs in open-angle and angle-closure glaucoma, the two major types affecting the optic nerve. In the early stages of glaucoma, no perceptible symptoms appear. As the disease progresses, vision starts to become hazy, leading to blindness. Therefore, early detection of glaucoma is needed for prevention. Methodology/Approach: Manual analysis of ophthalmic images is fairly time-consuming and accuracy depends on the expertise of the professionals. Automatic analysis of retinal images is an important tool. Automation aids in the detection, diagnosis, and prevention of risks associated with the disease. Fundus images obtained from a fundus camera have been used for the analysis. Requisite pre-processing techniques have been applied to the image and, depending upon the technique, various classifiers have been used to detect glaucoma. Conclusion: The techniques mentioned in the present review have certain advantages and disadvantages. Based on this study, one can determine which technique provides an optimum result.     

加强原发性青光眼的机会性筛查工作

早期发现和确诊原发性青光眼患者有利于减少青光眼引起的盲和视力损伤.开展机会性筛查工作是更早、更及时地发现原发性青光眼患者的有效方法.机会性筛查是指一些人因为健康体检或者其他问题来眼科就诊时,眼科医师有意识地进行青光眼方面的必要检查而发现的有关青光眼的情况,这应当是眼科临床工作的一部分.由于原发性闭角型青光眼与原发性开角型青光眼是两种不同类型的青光眼,具有明显不同的发病机制和临床特征,因此所采用的机会性筛查方法应当不同.作为眼科医师应当明确认识原发性闭角型青光眼和原发性开角型青光眼的发生和发展是一个连续体的概念,注意筛查试验和诊断试验的重要区别,选择筛查试验方法要力求简便、易行,重视防治青光眼人力资源的开发和应用,这对于做好机会性筛查工作十分重要.     

加强原发性青光眼的机会性筛查工作

早期发现和确诊原发性青光眼患者有利于减少青光眼引起的盲和视力损伤.开展机会性筛查工作是更早、更及时地发现原发性青光眼患者的有效方法.机会性筛查是指一些人因为健康体检或者其他问题来眼科就诊时,眼科医师有意识地进行青光眼方面的必要检查而发现的有关青光眼的情况,这应当是眼科临床工作的一部分.由于原发性闭角型青光眼与原发性开角型青光眼是两种不同类型的青光眼,具有明显不同的发病机制和临床特征,因此所采用的机会性筛查方法应当不同.作为眼科医师应当明确认识原发性闭角型青光眼和原发性开角型青光眼的发生和发展是一个连续体的概念,注意筛查试验和诊断试验的重要区别,选择筛查试验方法要力求简便、易行,重视防治青光眼人力资源的开发和应用,这对于做好机会性筛查工作十分重要.