Clinical description and review of migraine aura without headache.

BACKGROUND: Migraine aura without headache (MAWOH) is a type of migraine that seems to be reported more frequently in ophthalmic than neurologic or general medical practice. The clinical characteristics of this condition are described relative to its relationship with other forms of migraine, patient age, gender distribution, laterality, personal or family history, visual aura, and precipitating factors. As a result of its prevalence, it is a condition with which every optometrist and ophthalmologist should be familiar. Since MAWOH is a common cause of photopsia and transient vision loss, it is also important to consider it in the differential diagnosis of these conditions-especially in older patients. METHODS: The clinical investigations of MAWOH by prospective and retrospective case series are reviewed. This review includes an analysis by study of the number of patients, migraine history, and type of visual symptom. Comparison of clinical characteristics is used to distinguish MAWOH from other types of migraine. CONCLUSION: Migraine aura without headache is a type of migraine that is reported frequently in ophthalmic practice. Because it is related to photopsia and/or transient vision loss, specific clinical procedures should be performed to assist in the differential diagnosis of these conditions.     

南通市新城桥街道60岁及以上人群盲和低视力的现况调查

目的调查江苏省南通市城市人口中60岁及以上人群盲和低视力的患病率及其原因。方法采用随机整群抽样方法,抽取新城桥街道14个社区中的8个,并对所有60岁及以上人群进行检查。分别检查小孔视力和日常生活视力,应用裂隙灯显微镜和直接检眼镜等仪器检查受检者外眼、眼前节及眼底等情况。正式调查前先进行预试验。结果共检录3352人,受检人数为3040人,应答率90．69％。按小孔视力和世界卫生组织视力损伤标准,双眼盲和低视力患病率分别为1．35％和1．84％,其中女性分别为1．92％和2．33％,男性为0．66％和1．24％;盲和低视力患病率随着年龄的增长而增加;致盲和低视力的首要原因为白内障。按日常生活视力和视力损伤标准,双眼盲和视力损伤的患病率分别为1．58％和13．59％,其中女性分别为2．10％和15．98％,男性为0．95％和10．66％;盲和视力损伤的患病率亦随年龄的增长而增加;致双眼盲的首要原因亦为白内障。结论南通市60岁及以上城市人群盲的患病率低于华北、华南及西部地区。女性与文盲的盲和低视力患病率分别高于男性与非文盲。南通市城市人口中致盲的主要原因依次为白内障、眼底异常、屈光不正及角膜瘢痕或混浊等。     

Prevalence of pigmented lens striae in a black population: a potential indicator of age-related pigment dispersal in the anterior segment.

PURPOSE: To determine the prevalence of pigmented striae of the anterior lens capsule, with or without associated glaucoma, in a black primary eye care population. METHODS: Over a 16-month period, five practitioners searched for pigmented lens striae (PLS) among consecutive patients who underwent pupillary dilation during routine eye care provided within the primary care service of an urban eye clinic in Chicago, Illinois. RESULTS: Meeting the inclusion criteria were 1608 blacks (mean age +/- SD, 40.9 +/- 23.7 years; range, 5 to 100; 1056 females, 552 males). Among the group, 29 (1.8%) subjects had PLS (mean age, 66.5 +/- 11.3 years; range, 33 to 88; 25 females, 4 males). PLS were bilateral 89% of the time. Sixteen of the 29 (55%) blacks had central corneal endothelial pigment dusting (14 bilateral), frequently creating a well-formed Krukenberg's spindle. Trabecular pigmentation varied among the PLS subjects from mild to heavy. Using multiple logistic regression, age (in years) (odds ratio, 1.05; 95% confidence interval, 1.02 to 1.07; p = 0.0003), female gender (odds ratio, 4.46; 95% confidence interval; 1.03 to 19.19; p = 0.045), and hyperopic refractive error (in diopters) (odds ratio, 1.35; 95% confidence interval; 1.09 to 1.67; p = 0.006) were significant predictors of PLS. CONCLUSIONS: PLS were present in about 1.8% (2.4% females, 0.7% males) of our black population, and they were frequently associated with other signs of intraocular pigment dispersion. Age, female gender, and refractive error were significant predictors for PLS. This is new information that is helpful for understanding a clinical sign that may be an indicator of age-related pigment dispersal within the anterior segment.     

Visual acuity in an Australian Aboriginal population

Background: Australia is a developed country, However; Aboriginal Australians have rates of blindness comparable to Third World countries. There have been well-funded eye health programs for 15 years in Central Australia. This paper examines if there has been an improvement in visual disability of one traditional group of Aboriginal Australians. Methods: Results from an eye health survey of the Anangu Pitjantjatjara of South Australia in 1990 are presented. These data are compared with results for ‘blindness’ and ‘poor vision’ from a national survey undertaken in 1976. The two surveys were comparable in design, both were cross-sectional population-based prevalence surveys. Prevalence rates were adjusted for the size of the source population. Results: Young rural Aboriginal Australians have good visual acuity. Low vision and blindness (WHO definitions) occur in 19.6% and 10.4% of 60+ year olds, respectively. Women were more likely than men to be blind or have low vision (OR= 1.93; 1.06-3.58). There was a decline in ‘poor vision’ between surveys (OR=2.86; 1.86-4.75) but not in ‘blindness’. Conclusion: Although there has been a reduction in the prevalence of visual disability in rural Aboriginal Australians, improvements in the provision of eye care for the elderly need to occur.     

The prevalence and symptoms of migraine in a consecutive series of patients attending an optometric practice.

The purpose of the investigation was to determine the prevalence of migraine in optometric practice and to document the variety of presentation. One thousand consecutively presenting patients of a suburban optometric practice were asked questions to establish whether they experience migraine or have experienced it in the past. Those with a history of migraine were asked further questions to establish the type of migraine and to document the variety of the symptoms they experienced. Eleven percent of male and 23% of female patients currently had migraine or had experienced it in the past. When corrected for the age distribution of the population of the state from which the sample was drawn, it is estimated that the general population prevalence of migraine is 9.5% for men and 19.7% for women. Half of the sample of migraineurs had not experienced a migraine within the last 12 months. A third had a known family history of migraine. Nearly half had not had a formal medical diagnosis of their migraine but only 7 had attended for optometric examination because of their migraine symptoms. Four of these patients had single migraine-like episodes and three had migraine equivalents (acephalic migraine, experiencing the visual aura without headache). Optometrists must be thoroughly familiar with migraine and its varied presentation because of its high prevalence, the explanatory value in offering a formal diagnosis of migraine, and the risk that headache or visual aura may be wrongly ascribed to migraine when there is some more sinister cause of the symptoms.     

Neuro-ophthalmologic manifestations of primary headache disorders

Headaches are the most common disorders of the central nervous system affecting 46% of the adult population worldwide. Headaches may be lifelong illnesses, often associated with substantial disability for the individual and the population as a whole. The International Classification of Headache Disorders (ICHD-II) codifies headache disorders into fourteen categories, predominantly primary headaches and secondary headache disorders. Primary headache disorders, mainly migraine and trigeminal autonomic cephalgias (TACs), are frequently associated with neuro-ophthalmologic manifestations. Ophthalmologists are often the first physicians to be involved in the deciphering of headache-related visual disturbances. This article reviews two major primary headache disorders, migraine and trigeminal autonomic cephalgias, and discusses their neuro-ophthalmic complications, clinical presentation, and treatment.     

Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1996

BACKGROUND: A national eye survey was conducted in 1996 to determine the prevalence of blindness and low vision and their major causes among the Malaysian population of all ages. METHODS: A stratified two stage cluster sampling design was used to randomly select primary and secondary sampling units. Interviews, visual acuity tests, and eye examinations on all individuals in the sampled households were performed. Estimates were weighted by factors adjusting for selection probability, non-response, and sampling coverage. RESULTS: The overall response rate was 69% (that is, living quarters response rate was 72.8% and household response rate was 95.1%). The age adjusted prevalence of bilateral blindness and low vision was 0.29% (95% CI 0.19 to 0.39%), and 2.44% (95% CI 2.18 to 2.69%) respectively. Females had a higher age adjusted prevalence of low vision compared to males. There was no significant difference in the prevalence of bilateral low vision and blindness among the four ethnic groups, and urban and rural residents. Cataract was the leading cause of blindness (39%) followed by retinal diseases (24%). Uncorrected refractive errors (48%) and cataract (36%) were the major causes of low vision. CONCLUSION: Malaysia has blindness and visual impairment rates that are comparable with other countries in the South East Asia region. However, cataract and uncorrected refractive errors, though readily treatable, are still the leading causes of blindness, suggesting the need for an evaluation on accessibility and availability of eye care services and barriers to eye care utilisation in the country.     

Prevalence of migraine in low-tension glaucoma and primary open-angle glaucoma in Japanese.

We studied the prevalence of migraine in low-tension glaucoma (LTG) and primary open-angle glaucoma (POAG). Seventy seven Japanese patients with LTG, 73 with POAG, and 75 normal subjects were randomly selected and tested with a headache questionnaire. The prevalence of headache with or without typical migrainous features (unilateral headache or ocular pain, nausea, vomiting, and visual disturbance before headache) was 51% in LTG, 42% in POAG, and 44% in normal patients. The prevalence of headache with two migrainous features or more (probable migraine) was 17% in LTG, 11% in POAG, and 12% in normal subjects. The prevalence of headache with three migrainous features (classical migraine) was 5% in LTG, 3% in POAG, and 3% in normal subjects. There was no statistically significant difference in the prevalence of any types of migraine between the three groups of patients (p greater than 0.05). These results suggest there is no significant relationship between migraine and LTG or POAG in Japanese patients.     

The Current Status of Visual Disability in the Elderly Population of Taiwan

Purpose This study was conducted to explore the prevalence and the associated factors of visual impairment and blindness among the elderly Taiwanese population.Methods A nationwide population-based visual health care screening program of elderly people aged 65 years or older was conducted between 1 July 2002 and 31 December 2002 in Taiwan. Based on the same standardized protocol used by the Bureau of Health Promotion, Department of Health, and a stratified random sampling design, 3160 out of 5000 elderly subjects were selected by a two-stage visual care screening method. The overall response rate was 63.2%.Results The mean age of the elderly participants was 72.4 ± 5.1 years. The overall prevalence of glaucoma, corneal diseases, trauma, cataracts, myopic or diabetic retinopathy, and age-related macular degeneration among the elderly population was 2.1%, 6.3%, 0.9%, 60.2%, 7.5%, and 2.9%, respectively. The overall prevalence of visual disability (visual acuity of the better eye <0.5) was 17.7%, including 17.1% with visual impairment and 0.6% with blindness. Based on logistic regression, the significant independent factors of visual disability (visual impairment plus blindness) were sex (male vs. female, odds ratio (OR) = 0.62, 95% confidence interval (CI), 0.51–0.76), age (70–74 years vs. 65–69 years, OR = 1.60, 95% CI, 1.24–2.06; 75–79 years vs. 65–69 years, OR = 2.52, 95% CI, 1.92–3.32, 80yrs vs. 65–69yrs, OR = 4.86, 95% CI, 3.52–6.70), corneal diseases (OR = 2.26, 95% CI, 1.61–3.16), myopic or diabetic retinopathy (OR = 1.69, 95% CI, 1.20–2.39), age-related macular degeneration (OR = 4.96, 95% CI, 3.16–7.78), and cataract (OR = 3.40, 95% CI, 2.67–4.33).Conclusions The geographic difference in the prevalence of vision-related eye disease, visual impairment, and blindness point to the importance of taking actions that suit local circumstances. Our results also revealed that visual impairment and blindness are important visual health problems in the elderly Taiwanese population. Age-related macular degeneration, cataracts, corneal diseases, myopic or diabetic retinopathy, female sex, and aging were the leading causes of visual disability. Further organized preventive strategies for eye care are recommended in this population. Jpn J Ophthalmol 2005;49: 166–172 © Japanese Ophthalmological Society 2005     

The prevalence of trachomatous trichiasis in Oman (Oman eye study 2005)

PURPOSE: 1. To estimate the prevalence and identify the determinants of Trachomatous Trichiasis (TT) among the > 40 years old Omani population. 2. To compare the results of the present study to those of the survey conducted in 1996 and propose public health policies for eye care in Oman. METHODS: Ophthalmologists randomly selected 75 houses in 24 clusters. The visual status per eye was noted. The anterior segment of the eye was examined to detect TT, using the WHO simplified grading. Frequencies, the age sex standardized prevalence and their 95% Confidence Intervals (unadjusted for clustering) were calculated and the numbers of people with TT in the population were estimated. RESULTS: Persons examined numbered 2,339. The prevalence of TT among the > 40 years old Omani population was 4.14% (CI 95% 3.3 to 4.9). The gender variation [OR = 1.51 (CI 95% 1.01 to 2.37)] and regional variation of TT was significant (p < 0.001). The standardized prevalence of TT in the > 40 years old Omani population had declined from 7.25% in 1996 to 3.96% in 2005. Predictors of TT were female gender, and age > 60 years. CONCLUSIONS: Trichiasis is still a public health problem in Oman. The prevalence is higher than the "< 1 TT case per 1000" target set for the "Ultimate Intervention Goals" for the "Elimination of Blinding Trachoma." The TT surgery rate in Oman should be increased to reach this goal. The underlying causes of low coverage should be identified and addressed through a program approach.     

Awareness and use of eye care services in Fiji

PURPOSE: To determine the awareness, use, and barriers to use of eye services in Fiji's Central Province. METHODS: A cross-sectional survey study design with random clusters of households was used. Semi-structured interviews were conducted (152 females and 22 males). For 267 household members, presenting distance and near visual acuities were measured, and the perception of and satisfaction with their vision were recorded. RESULTS: Most (86%; 150/174) respondents were aware of at least one conventional eye care service. However, only 66% (121/183) of household members with previous eye problems had consulted one of these; the proportion was even lower for those in the older age groups (p < 0.01). Rural dwellers expressed satisfaction with their vision, despite being more likely to regard it as limiting their activities and being less likely to seek conventional care. A higher proportion of females were reported to have (or have had) eye problems (60:40) and were found to have bilateral visual impairment (60:40). Despite this, females and males attended the hospital eye clinic (47:53) or sought treatment from conventional services (51:49) nearly equally. The reasons given for not seeking conventional care were "fatalistic attitude" ("did not bother", "could manage", or accepted the condition: 57%), expense (12%), and fear (8%). CONCLUSION: Central Province Fijians, particularly the old, rural, and female, under-utilise conventional eye care services. As in developing countries elsewhere, fatalistic attitudes to visual impairment are a significant contributor to this. To improve eye health, planning and implementation of eye care services must overcome under-utilisation by addressing local barriers to uptake through community participation in education and affirmative action.     

Gender inequality in vision loss and eye diseases: Evidence from the Sultanate of Oman

Purpose:

The data from surveys of vision loss and monitoring of services were used to assess changes in gender inequality in Oman.

Study Design:

Retrospective review of data collection instruments.

Materials and Method:

The data sets of 12 years between 1996 and 2007 were abstracted to assess the gender equality for vision loss, eye disease prevalence, and service use. They included two surveys (1996 and 2005), Health Information from eye units (1998 and 2007), and eye screening in schools.

Results:

In 1996, the prevalence of bilateral blindness in ≥ 40 years of age was higher in females [Odd''s Ratio (OR) = 0.36 (95% Confidence Interval (CI) 0.24 – 0.53)]. Gender differences in the prevalence of cataract [OR = 0.82 (95% CI 0.63 – 1.03)] were not significant while trachomatous trichaisis (TT) was less in males [OR = 0.33 (95% CI 0.22-0.48)]. In 2005, gender differences in the prevalence of bilateral blindness [OR = 0.97 (95% CI 0.71 – 1.34)] and TT [OR = 0.66 (95% CI 0.42- 1.04)] were not statistically significant. But males were associated with higher prevalence of cataract [OR = 1.26 (95% CI 1.00 – 1.59)]. Surgery rates for cataract, glaucoma and TT were not different by gender. More male compared to female patients with diabetic retinopathy were treated. Myopia was significantly higher in girls. Compliance of spectacle wear was higher in girls.

Conclusions:

Gender inequality for eye care seems to have reduced in the last 10 years in Oman. However, apart from TT and glaucoma patients the difference in service utilization by gender was not statistically significant.     

Blindness and eye diseases in Tibet: findings from a randomised, population based survey

BACKGROUND: Public health officials of the Tibet Autonomous Region (TAR) of China requested a survey of blindness, eye diseases, and eye care service utilisation to assist the development of a 10 year blindness prevention and treatment plan. The objective of the survey was to determine the prevalence of blindness and visual impairment, as well as cataract surgical coverage and surgical outcome in the TAR. METHODS: The Tibet Eye Care Assessment was a cross sectional prevalence study of three of the seven prefectures (provinces) of the TAR (Lhoka, Nakchu, and Lingzhr) selected to represent its three main environmental regions. The survey sample was selected using a random multistage cluster method. Two teams conducted the survey in a standardised fashion in each prefecture, Lhoka during May and Nakchu during June 1999, and Lingzhr during May 2000. Visual acuity, cause of vision loss, trachoma, and vitamin A deficiency were included in the clinical examination. RESULTS: Among the 15,900 people enumerated, 12,644 were examined for an overall response rate of 79.6%. The crude prevalence of blindness (presenting better eye visual acuity of less than 6/60) was 2.3%; age and sex adjusted blindness prevalence was 1.4% (95% CI 1.3 to 1.5). Visual impairment (better eye presenting visual acuity of 6/24 to 6/60) was found in 10.9% (95% CI 10.5 to 11.2) of the population (age and sex adjusted). Cataract was the primary cause of blindness (50.7%), followed by macular degeneration (12.7%) and corneal opacity (9.7%). CONCLUSION: Blindness is a serious public health problem in Tibet, with prevalence higher than in similar studies in eastern China. As elsewhere in the world, women have an excess burden of blindness compared to men. About 75% of blindness in Tibet can be either prevented or treated. Eye care planning for Tibet must focus on cataract, particularly among women.     

Visual impairment, causes of vision loss, and falls: the singapore malay eye study

PURPOSE: To report associations of visual impairment and the main causes of vision loss with falls in an older Asian population. METHODS: The population-based Singapore Malay Eye Study examined 3280 (78.7% response rate) Malay adults 40 to 80 years of age. Details about any fall in the previous 12 months and personal and sociodemographic information were collected. Presenting visual acuity (PVA) was measured. Mild or moderate visual impairment (0.3 < logMar < 1.0), severe visual impairment (logMAR > or = 1.0), and the primary causes of visual impairment were determined by ophthalmologists at examination. RESULTS: Of the 3280 participants, 3266 (99.6%) provided information about falls. Of these, 14.7% (n = 480) reported having fallen in the past 12 months. After adjustment for gender, age, body mass index, history of angina, heart attack, stroke, hypertension, diabetes, and self-rated health, the results showed that severe visual impairment in the worse eye significantly increased the risk of falling (60%; OR = 1.6; 95% CI 1.1 to 2.3). Severe visual impairment in one eye and mild or moderate visual impairment in the other also doubled the risk of falls (OR = 2.1; 95% CI 1.4-3.1). Having glaucoma (n = 21) increased the risk of falling by more than fourfold (OR = 4.2; 95% CI 1.2-12.3) after adjustment for visual acuity. Although mild or moderate visual impairment was not significantly associated with falls, odds ratios tended toward the direction of risk. CONCLUSIONS: Findings from this Asian population provide further evidence in support of the association between severe visual impairment and falls in older persons.     

Correctable visual impairment in an elderly Chinese population in Taiwan: the Shihpai Eye Study

PURPOSE: To investigate the prevalence and risk factors of correctable visual impairment and the quality of life of persons with correctable visual impairment in a metropolitan senior population. METHODS: The study was a community-based, cross-sectional survey of vision and eye diseases among noninstitutionalized subjects aged 65 years and older in the Shihpai community of Taipei, Taiwan. The study consisted of a structured questionnaire followed by a comprehensive standardized ophthalmic examination included presenting and best corrected visual acuity, tonometry, slit lamp biomicroscopy, and direct and indirect ophthalmoscopy. RESULTS: A total of 1361 subjects (response rate, 66.6%) participated in both completion of the questionnaire and ophthalmic examination. The prevalence of correctable visual impairment (presenting visual acuity in the better eye <6/12 that improved to no impairment [>/=6/12] after refractive correction) was 9.55% (95% confidence interval [CI], 7.97%-11.13%). Under multiple logistic regression analysis, older age (>/=75 years; odds ratio [OR], 2.41; 95% CI, 1.56-3.70) and nonemmetropic eyes (myopia; OR, 6.80; 95% CI, 3.77-12.77 vs. hyperopia; OR, 2.13; 95% CI, 1.29-3.51) were significantly related to correctable visual impairment. A higher level of education (OR, 0.52; 95% CI, 0.32-0.83) and wearing distance eyeglasses during the eye examination (OR, 0.23; 95% CI, 0.12-0.43) were protective factors for correctable visual impairment. Subjects with correctable visual impairment scored significantly lower in the physical functioning dimension of the SF-36 questionnaire (P < 0.001). CONCLUSIONS: The results demonstrate that approximately 10% of the senior population in the Shihpai district has a correctable visual impairment. Thus, it is important to educate the public about the importance of regular examination and the possibility of improving visual acuity by wearing glasses.     

Visual and ocular effects from the use of flat-panel displays

AIM: To evaluate the prevalence of eye symptoms in a non-presbyopic population of video display unit (VDU) users with flat-panel displays. METHODS: One hundred and sixteen VDU users with flat-panel display from an urban population participated in the study; their ages ranging from 20 to 34y. There were 60 females and 56 males. An eye examination to rule out the presence of significant uncorrected refractive errors, general binocular dysfunctions and eye conditions was carried out. In order to determine and quantify the type and nature of eye symptoms, participants were asked to answer written questionnaire and the results were grouped by gender, age and number of hours a day spent using a VDU. RESULTS: Seventy-two percent of participants reported eye symptoms related to VDU use. Eye symptoms from moderate-to-severe were found in 23% of participants. The main symptom was moderate-to-severe tired eyes (14%); followed by sensitivity to bright lights (12%), blurred vision at far distances (10%), eyestrain or dry eye or irritated or burning eyes (9%), difficulty in refocusing from one distance to another or headache (8%) and blurred vision at near or intermediate distances (<4%). Eye symptoms were greater among females (P=0.005) and increased with VDU use, markedly above 6h spent using a VDU in a typical day (P=0.01). CONCLUSION: Significant eye symptoms relate to VDU use often occur and should not be underestimated. The increasing use of electronic devices with flat-panel display should prompt users to take appropriate measures to prevent or to relieve the eye symptoms arising from their use.     

The Prevalence of Trachomatous Trichiasis in Oman (Oman Eye Study 2005)

Purpose: 1. To estimate the prevalence and identify the determinants of Trachomatous Trichiasis (TT) among the > 40 years old Omani population. 2. To compare the results of the present study to those of the survey conducted in 1996 and propose public health policies for eye care in Oman. Methods: Ophthalmologists randomly selected 75 houses in 24 clusters. The visual status per eye was noted. The anterior segment of the eye was examined to detect TT, using the WHO simplified grading. Frequencies, the age sex standardized prevalence and their 95% Confidence Intervals (unadjusted for clustering) were calculated and the numbers of people with TT in the population were estimated. Results: Persons examined numbered 2,339. The prevalence of TT among the > 40 years old Omani population was 4.14% (CI 95% 3.3 to 4.9). The gender variation [OR = 1.51 (CI 95% 1.01 to 2.37)] and regional variation of TT was significant (p < 0.001). The standardized prevalence of TT in the > 40 years old Omani population had declined from 7.25% in 1996 to 3.96% in 2005. Predictors of TT were female gender, and age > 60 years. Conclusions: Trichiasis is still a public health problem in Oman. The prevalence is higher than the “< 1 TT case per 1000” target set for the “Ultimate Intervention Goals” for the “Elimination of Blinding Trachoma.” The TT surgery rate in Oman should be increased to reach this goal. The underlying causes of low coverage should be identified and addressed through a program approach.     

中国陕西省农村原发性闭角型青光眼流行病学调查

目的：调查陕西省农村≥40岁人群原发性闭角型青光眼的患病率及影响因素。方法：2003—07／12，采用按比例随机整群抽样的方法在陕南、陕北及关中3个地区农村调查8500人，其中≥40岁人群3500人，所有受检人员均进行标准问卷调查，包括询问青光眼确诊史、家族史、发作史及手术史，并进行了相关的眼科检查，包括视力、外眼、Van Herick周边前房深度评估、眼底检查。≥50岁人群及怀疑有高眼压者对其应用压平式眼压计测量眼压。对可疑青光眼者进行进一步检查，包括复查眼压、前房角镜检查、暗室试验、视野检查。结果：8500人中有6815人完成了青光眼的相关检查，总受检率为80．18％，其中≥40岁人群3500人中有2835人完成了青光眼的相关检查，受检率为81．00％。VanHerick周边前房深度分级：2级、1级和0级分别占10．4名、3．0％和0．2％。≥40岁人群原发性闭角型青光眼患者有3l例，其患病率为1．09％，通过多因素logistic回归分析显示随着年龄的增长患病率显著增加（P=0．008）。虽然女性较男性多见（OR：1．77，95％CI为0．77-4．10），文盲较非文盲多见（OR：1．71，95％CI为0．76～3．87），但其差异无统计学意义（P不同性别=0．180，P不同文化程度=0．199）。事前未被诊断为青光眼的患者占67．74％（21例），在另外10例有确诊史的青光眼患者中只有6例（60％）曾作过虹膜根切术。48．39％（15例）原发性闭角型青光眼患者存在不同程度的视力损伤，其中盲目占29．03％。70．97％（22例）为慢性闭角型青光眼。结论：陕西省农村≥40岁人群的窄房角比例高于亚洲其他国家人群。原发性闭角型青光眼的患病率与国内其他报道相近，且随着年龄的增长而增加，大部分患者无青光眼确诊史。     

Clinical impact of migraine for the management of glaucoma patients

Migraine is a common and debilitating primary headache disorder that affects 10–15% of the general population, particularly people of working age. Migraine is relevant to providers of clinical eye-care because migraine attacks are associated with a range of visual sensory symptoms, and because of growing evidence that the results of standard tests of visual function necessary for the diagnosis and monitoring of glaucoma (visual fields, electrophysiology, ocular imaging) can be abnormal due to migraine. These abnormalities are measureable in-between migraine events (the interictal period), despite patients being asymptomatic and otherwise healthy. This picture is further complicated by epidemiological data that suggests an increased prevalence of migraine in patients with glaucoma, particularly in patients with normal tension glaucoma. We discuss how migraine, as a co-morbidity, can confound the results and interpretation of clinical tests that form part of contemporary glaucoma evaluation, and provide practical evidence-based recommendations for the clinical testing and management of patients with migraine who attend eye-care settings.     

The content of optometric eye examinations for a young myope with headaches

BACKGROUND: A recent review found standardised patient (SP) methodology to be the gold standard methodology for evaluating clinical care. We used this to investigate the content of optometric eye care for a young myopic patient with headaches suggestive of migraine. METHODS: We recruited 100 community optometrists who consented to be visited by an unannounced actor for an eye examination and to have that eye examination recorded. The actor received extensive training to enable accurate reporting of the content of the eye examinations, via an audio recording and a checklist completed for each clinical encounter. The actor presented as a 20-year-old student seeking a private eye examination and complaining of symptoms suggestive of migraine headaches. The results of each clinical encounter were recorded on a pre-designed checklist based on evidence-based reviews on headaches, clinical guidelines and the views of an expert panel of optometrists. RESULTS: The presence of headache was detected in 98% of cases. Eight standard headache questions were considered to be the gold standard for primary care headache investigation. Although none of the optometrists asked all of these questions, 22% asked at least four of the eight questions. Sixty-nine per cent of practitioners asked the patient to seek a medical opinion regarding the headaches. The proportion of the tests recommended by the expert panel that was carried out varied from 33% to 89% and the durations of the eye examination varied from 5 to 50 min. CONCLUSION: SP encounters are an effective way of measuring clinical care within optometry and should be considered for further comparative measurements of quality of care. As in research using SPs in other healthcare disciplines, our study has highlighted substantial differences between different practitioners in the duration and depth of their clinical investigations. This highlights the fact that not all eye examinations are the same and that there is no such thing as a 'standard sight test'. We recommend that future optometric continuing education could usefully focus on migraine diagnosis and assessment.