Biomedical subjects

J M Tielsch

Publications and source records attributed to J M Tielsch.

At least 91 records · Page 5Linked to original sources

PubMed1995

Diabetes, intraocular pressure, and primary open-angle glaucoma in the Baltimore Eye Survey.

BACKGROUND: The association of diabetes with primary-open angle glaucoma (POAG) has been controversial and often confused by varying definitions of both diabetes and POAG. The purpose of this study is to evaluate this association in a population-based sample of subjects from the Baltimore Eye Survey. METHODS: A stratified sample of residents in 16 cluster areas of east Baltimore was recruited for a detailed ophthalmologic screening examination. A total of 5308 black subjects and white subjects participated. Of these participants, 161 received a diagnosis of POAG. During a detailed interview with each subject, diabetes was defined based on a reported history of diabetes. Persons with diabetes were classified as "insulin-users" and "noninsulin-users" based on their current method of treatment. RESULTS: Diabetes was highly prevalent in this population, with 10.6% of white subjects and 17.2% of black subjects reporting a positive history. Diabetes was associated with higher intraocular pressure, but differences were not large (means, 17.4, 18.0, and 17.8 mmHg) among subjects without diabetes, those with diabetes who were not using insulin, and those with diabetes who were using insulin, respectively. Diabetes was not associated with POAG (age-race-adjusted odds ratio, 1.03; 95% confidence interval, 0.85, 1.25). This was true for both types of diabetes. Persons whose POAG had been diagnosed before the examination showed a positive association with diabetes (odds ratio, 1.7, 95% confidence interval, 1.03, 2.86), indicating that selection bias could explain the positive results of previous clinic-based investigations. CONCLUSION: There is no evidence from this population-based investigation that supports an association between diabetes and POAG.

Adult↗

PubMed1995

Automated perimetry detects visual field loss before manual Goldmann perimetry.

PURPOSE: To determine if automated perimetry detects visual field defects before manual Goldmann perimetry. METHODS: Subjects with ocular hypertension without field loss on detailed manual perimetry were followed prospectively with annual automated and manual perimetry. Subjects with field loss on manual perimetry were age-matched post hoc to subjects who did not have field loss. The automated fields 1 year before the development of field loss on manual perimetry were compared between the two groups. Subjects were recruited from ophthalmologists' offices, eye clinics, and a population-based glaucoma survey in the Baltimore area. Abnormal results detected on the Humphrey Field Analyzer were defined using the glaucoma hemifield test, mean defect, and corrected-pattern standard deviation. RESULTS: Forty subjects who had field loss during 8 years of follow-up were compared with 145 control subjects with ocular hypertension who did not have defects. Seventy-five percent of converters had abnormal results of the glaucoma hemifield test 1 year before field loss on manual perimetry, whereas 22% of controls had abnormal results of the glaucoma hemifield test (odds ratio, 13.4). The odds ratio of field loss developing on manual perimetry within 12 months was 3.3 for those with borderline results of the glaucoma hemifield test relative to the control subjects. The odds ratio was 6.0 for corrected-pattern standard deviation (P < 0.05) and 3.9 for mean deviation (P < 0.05). CONCLUSIONS: Those with field loss on manual perimetry were more likely to have had an abnormal automated field 1 year before conversion than those who did not convert. However, 22% of subjects in whom definitive field loss did not develop on manual perimetry during the study had abnormal automated fields at one visit and 15% had abnormal automated fields on two consecutive visits.

Aged↗

PubMed1995

The effects of regionalization on cost and outcome for one general high-risk surgical procedure.

PURPOSE: The effects of regionalization of tertiary care were studied by analyzing cost and outcome for pancreaticoduodenectomies in a state in which the majority of these high-risk procedures were performed in one hospital. METHODS: Using Maryland inpatient discharge data via a retrospective study, the authors compared cost and outcome data for a hospital with more than one half of the cases in the state to all other hospital providers as a group and with smaller groupings according to the volume of procedures performed. RESULTS: Hospital mortality, length of stay, and costs were significantly less at the high-volume regional medical center when compared with all other hospitals. Mortality and cost increased as volume decreased when hospitals were grouped according to volume. CONCLUSIONS: An academic medical center, functioning as a high-volume regional provider, can deliver tertiary care services with improved outcomes at lower costs than community hospitals.

Academic Medical Centers↗

PubMed1995

Geographic variation in utilization of cataract surgery.

Cataract surgery is the most frequently performed surgical procedure on Medicare beneficiaries, with an annual cost to the Medicare program of more than $3.4 billion. In this study, the relationship between demographic, environmental, and provider-related factors, and the likelihood that cataract surgery will be performed on a Medicare beneficiary were assessed. The association between likelihood of cataract surgery and patient age, sex, race, income, and latitude of residence was examined, as was the association with the supply of ophthalmologists and optometrists in each region, and the allowed charge for cataract surgery and cost of practice in a region. This cross-sectional, population-based study used administrative data. Both regional models, using least-squares regression and person-based models, using logistic regression were employed. A random 5% sample of 1986 and 1987 Medicare beneficiaries, 65 years of age and older, were included in the study. Medicare beneficiaries who lacked continuous Part A and Part B coverage during 1986 and 1987, or who were enrolled in a health maintenance organization at any time during this 2-year period of observation were excluded from the study to make certain that complete utilization data were available for each individual. Rate of cataract surgery per 1,000 Medicare beneficiaries in each Bureau of Economic Analysis Economic Area (BEAEA) and the likelihood of an individual with particular characteristics undergoing cataract surgery were determined in separate regression models. The mean annual rate of cataract surgery during 1986 and 1987 in the 181 BEAEAs was 25.4 surgeries per 1,000 persons 65 years of age or older (standard deviation = 6.2, coefficient of variation = 0.24). Both the regional model and the person-based model detected an association between a higher rate of and personal likelihood of cataract surgery and female gender, more southerly latitude, higher concentration of optometrists per 1,000 Medicare beneficiaries, and higher allowed charge for cataract surgery, after adjusting for variation in practice expense. The person-based model additionally demonstrated that increased likelihood of undergoing cataract surgery was associated with increasing age from 65 to 94 years, white race, and living in a zip-code area with mean income greater than $15,000. Neither analysis detected a statistically significant association between the concentration of ophthalmologists per 1,000 Medicare beneficiaries and the regional rate of, or an individual's likelihood of, cataract surgery. Compared with the geographic variation in provision of other surgical procedures, the variation in cataract surgery across large geographic areas observed in this analysis was relatively low.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

PubMed1994

Response of Bitot's spots to a single oral 100,000- or 200,000-IU dose of vitamin A.

PURPOSE: A randomized, controlled clinical trial was conducted in Indonesia to study the response of Bitot's spots to a 100,000-IU dose of vitamin A, which is known to be associated with fewer acute side effects than the currently recommended 200,000-IU dose. METHODS: A total of 114 children (ages 13 to 59 months) with Bitot's spots were given an ocular examination; serum retinol concentration was measured, and the relative dose response test carried out. After administering one 100,000- or 200,000-IU oral dose of vitamin A, ocular examinations were repeated weekly for seven weeks and then biweekly for 20 more weeks, or until lesions were healed on two consecutive examinations. RESULTS: Either dose of vitamin A was similarly effective in healing Bitot's spots. The most important factor in predicting responsiveness to treatment was baseline serum retinol concentration: children with lower pretreatment concentrations were more likely to have responsive lesions. No child had a relapse within the first three months after treatment. However, by six months, children who had received the higher dose were 82% less likely to have a relapse compared with children who had received the lower dose. CONCLUSIONS: Although either a 100,000- or 200,000-IU dose of vitamin A is similarly effective in healing Bitot's spots, a 200,000-IU dose provides longer protection. This benefit justifies the higher rates of transient mild side effects associated with the 200,000-IU dose. The current 200,000-IU dose of vitamin A recommended by the World Health Organization for prophylactic dosing should not be reduced.

Administration, Oral↗

PubMed1994

Undetected eye disease in a primary care clinic population.

BACKGROUND: Population-based data have indicated that a significant proportion of persons with undiagnosed ocular disease in the community are regular users of general medical services. This, combined with the high prevalence of chronic medical disorders known to be risk factors for ocular disease in such clinics, makes them an attractive site for screening. METHODS: The prevalence of ocular disease was estimated in a sample of 405 general medicine patients attending an adult primary care clinic in an urban teaching hospital. RESULTS: Overall, 205 (50.6%) of 405 patients were found to have clinically important ocular pathology. One third of those affected (n = 68) were unaware of their eye disease, and 26% (n = 18) of these 68 patients required immediate medical or surgical intervention. Patients 65 years or older (odds ratio [OR], 1.76), in fair or poor general health (OR, 1.78), with diabetes mellitus (OR, 2.07), or with self-reported fair or poor vision (OR, 3.03), were at increased risk for the presence of ocular disease. Among patients with eye disease, those who had no insurance coverage for eye care (OR, 3.45), those who had not had an eye examination during the previous 2 years (OR, 4.03), and those whose last eye examination was performed by an optometrist (OR, 7.25, reference ophthalmologist) were more likely to not be aware of their eye disease. CONCLUSIONS: Our results underscore the importance of screening for ocular disease in primary health care settings, especially for patients who are older than 65 years, are in poor health, report poor vision, have had infrequent eye examinations, or have inadequate insurance coverage for eye care.

Adult↗

PubMed1994

The context and consequences of ocular injuries from air guns.

There is little available information on the context of air-gun inflicted ocular injuries. To address this need, we performed a systematic telephone survey of victims of severe air-gun ocular injuries, collected between January 1986 and August 1992, through the auspices of the National Eye Trauma System and the Alabama Eye Injury Registry. One hundred forty interviews were completed with injury victims or their parents. Pump-action rifles with BB ammunition were the most common weapons. Victims and shooters were predominantly male (91% and 89%, respectively) and their mean age was 13 years. Of the injuries, 95% were inflicted by individuals known to the victim; 40% of these were relatives. People were the intended targets in 45% of the injuries. Ricochets accounted for 26% of the injuries. Of those victims with penetrating injuries, 84% had visual acuity less than 20/200 despite numerous surgical attempts. Adults were present at the scene of the injury in only 11% of the incidents, implying that unrestricted access to these weapons by children is likely the principal risk factor for injury.

Adolescent↗

PubMed1994

Family history and risk of primary open angle glaucoma. The Baltimore Eye Survey.

OBJECTIVE: Primary open angle glaucoma has been previously associated with a positive family history of glaucoma. We used data from the Baltimore Eye Survey to examine this association. DESIGN: A population-based prevalence survey identified 161 cases of primary open angle glaucoma among 5308 black and white residents of east Baltimore, Md, who were 40 years of age or older. Family history was ascertained by interview and included all first-degree relatives (parents, siblings, and children). RESULTS: Age-adjusted associations of primary open angle glaucoma with a history of glaucoma were higher in siblings (odds ratio [OR] = 3.69) than in parents (OR = 2.17) or children (OR = 1.12). Odds ratios were slightly higher in blacks than in whites, and there was evidence of selection bias, with ORs between two and three times higher for those who had prior knowledge of their glaucoma diagnosis than for those who first received their diagnosis by the study examination (history in siblings OR = 4.72 for those with prior knowledge vs 2.77 for those without). CONCLUSION: Family history is an important risk factor for primary open angle glaucoma, although clinic-based studies are likely to overstate its impact.

Adult↗

PubMed1994

Rigor of research methods in studies of the effectiveness and safety of cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team.

OBJECTIVE: To assess the rigor of research methods reported in studies of the safety or effectiveness of contemporary cataract surgery. DESIGN: Formal systematic identification of pertinent studies and critical appraisal of each study's research methods. SUBJECTS: From 6113 unique, potentially relevant citations that we identified, 90 original studies published between 1979 and 1991 that addressed visual acuity or complications following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phacoemulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation. MAIN OUTCOME MEASURES: Strength of study design, performance, and reporting in 11 methodologic areas assessed with a standardized abstraction form by two reviewers masked to authors, their institutions, and the journal of publication. Results of reviews were tallied to produce an overall quality score (measure of rigor in research methods) for each study. RESULTS: The mean (+/- SD) quality score was 43.1 +/- 20.1 out of a maximum possible score of 100. Studies received intermediate scores on description of baseline ocular disease and low scores on descriptions of other characteristics of enrolled patients, standardization of outcome assessment and follow-up duration, and handling of patient attrition. Eighty-three studies (92%) lacked a comparison group. The rigor of research methods in studies varied by the journal of publication, did not improve over time, and was no greater for studies with larger vs smaller sample sizes. CONCLUSIONS: The rigor of research methods in studies of cataract surgery can be improved if more attention is paid to fundamental principles of study design, data analysis, and reporting.

Cataract Extraction↗

PubMed1994

Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team.

OBJECTIVE: To better define the effectiveness and risks of modern cataract surgery. DESIGN: Meta-analysis (formal systematic identification, selection, review, and synthesis) of published literature. PATIENTS: Patients described in 90 studies published between 1979 and 1991 that addressed visual acuity (n = 17,390 eyes) or complications (n = 68,316 eyes) following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phaco-emulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation. MAIN OUTCOME MEASURES: The proportion of eyes with postoperative Snellen visual acuity of 20/40 or better and the proportion of eyes with each of 18 complications. RESULTS: The pooled percentage of eyes (weighted by sample size) with postoperative visual acuity of 20/40 or better was 95.5% (95% confidence interval [CI], 95.1% to 95.9%) among eyes without preexisting ocular comorbidity and 89.7% (95% CI, 89.3% to 90.2%) for all eyes. The pooled percentage of eyes experiencing complications (weighted by sample size and, when pertinent, by quality score of the individual studies but not adjusted for variation in duration of follow-up) ranged from 0.13% for endophthalmitis to 19.7% for posterior capsule opacification. Pooled proportions of eyes with other complications were as follows: bullous keratopathy, 0.3%; intraocular lens malposition/dislocation, 1.1%; clinically apparent cystoid macular edema, 1.5%; and retinal detachment, 0.7%. Pooled results for postoperative Snellen visual acuity and most complications were similar for surgery performed via phacoemulsification vs standard extracapsular cataract extraction, although comparisons of the outcomes between these procedures should be interpreted with caution. CONCLUSIONS: The published literature indicates that modern cataract surgery yields excellent visual acuity and, although not free of complications, is a very safe procedure regardless of the extraction technique used.

Aged↗

PubMed1994

The VF-14. An index of functional impairment in patients with cataract.

OBJECTIVE: To describe the development and the performance of a brief questionnaire designed to measure functional impairment caused by cataract (the VF-14). DESIGN: Observational cross-sectional study. Patients were recruited between July 15 and December 15, 1991. SETTING: Patients were recruited from the practices of 70 ophthalmologists, located in Columbus, Ohio (N = 21), St Louis, Mo (N = 26), and Houston, Tex (N = 23). PATIENTS: Seven hundred sixty-six patients undergoing cataract surgery for the first time. MAIN OUTCOME MEASURES: Preoperative best corrected visual acuity in each eye; scores on the VF-14, a new index of functional impairment in patients with cataract; patient reports of overall trouble and satisfaction with their vision; and scores on the Sickness Impact Profile, a measure of general health status. RESULTS: The VF-14 has high internal consistency (Cronbach's alpha = .85) and correlates more strongly with the overall self-rating of the amount of trouble and satisfaction patients have with their vision than do several measures of visual acuity or the Sickness Impact Profile score. The VF-14 score is moderately correlated with visual acuity in the better eye. CONCLUSIONS: The VF-14 is a reliable and valid measure of functional impairment caused by cataract and provides information not conveyed by visual acuity or a general measure of health status.

Cataract↗

PubMed1994

Screening for glaucoma in a medical clinic with photographs of the nerve fiber layer.

PURPOSE: To evaluate nerve fiber layer photography as a method for glaucoma screening in a general medical clinic setting. METHODS: One hundred seventy-one persons who attended an academic hospital medical clinic were administered a questionnaire and underwent a complete eye examination, including automated perimetry and photography of the optic disc and nerve fiber layer. RESULTS: Eighteen patients were diagnosed as having primary glaucoma; one, secondary glaucoma; and 21 were suspected of having glaucoma. Nerve fiber layer photographs were taken on 145 persons (85%) and were readable in 136 (80%) of the sample of 171 subjects. Nerve fiber layer atrophy was detected on masked evaluation in 64% of those with glaucoma, in 28% of those suspected of having glaucoma, and in 16% of persons who did not meet the criteria for glaucoma. CONCLUSIONS: Nerve fiber layer photography can be carried out as a screening method and can identify a substantial proportion of those with glaucoma. It compares favorably with tonometry, cup-disc ratio estimation, or screening visual field examination for glaucoma detection.

Adult↗

PubMed1994

Race-, age-, gender-, and refractive error-related differences in the normal optic disc.

OBJECTIVE: To determine race-, age-, gender-, and refractive error-related differences in the size and topography of the optic disc in healthy Americans. DESIGN: Population-based study. SETTING: Eastern and southeastern health districts of Baltimore, Md. PARTICIPANTS: A population-based sample of 4877 non-institutionalized black and white individuals aged 40 years or older without evidence of optic nerve disease. MAIN OUTCOME MEASURE: Race-, age-, gender-, and refractive error-related differences in optic disc measurements: disc area, neural rim area, cup area, cup-to-disc ratio, and neural rim area-to-disc area ratio. RESULTS: We analyzed simultaneous stereoscopic optic disc photographs from 3387 (1534 black and 1853 white) of the 4877 healthy individuals using an image analyzer (Topcon Image Analyzer, Topcon Instrument Corporation, Paramus, NJ). A total of 1490 individuals were excluded owing to the absence of good-quality images from either eye. The image analyzer defined the cup margin 150 microns below the surface of the disc margin. On average, blacks had significantly larger disc areas (blacks, 2.94 mm2; whites, 2.63 mm2), larger cup areas (blacks, 1.04 mm2; whites, 0.71 mm2), larger cup-to-disc ratios (blacks, 0.56; whites, 0.49), similar neural rim areas (blacks, 1.90 mm2; whites, 1.92 mm2), and smaller neural rim area-to-disc area ratios (blacks, 0.66; whites, 0.74) compared with whites. There were no age-related differences in any of the disc measurements. Male subjects had 2% to 3% larger optic discs compared with female subjects. No association between refractive error and any of the optic disc measurements studied was detected. CONCLUSIONS: Racial differences in the normal optic disc are present among urban Americans, and these differences must be considered in evaluation of the optic disc for glaucoma and other optic neuropathies. Among the individuals in our study, all of whom were 40 years of age or older, no progressive age-related decline in neural rim area was detectable. Neither gender nor refractive error were associated with any significant differences in the size and topography of the normal optic disc.

Adult↗

PubMed1994

National outcomes of cataract extraction. Retinal detachment and endophthalmitis after outpatient cataract surgery. Cataract Patient Outcomes Research Team.

BACKGROUND: A near-total shift to cataract extraction on an outpatient basis occurred as a result of an administrative ruling by the Health Care Financing Administration. No national study has been conducted to assess the possible effects of that decision on clinical outcomes of surgery. The authors compared the rates of retinal detachment (RD) repair and hospitalization for endophthalmitis after extracapsular cataract extraction (ECCE) (including phacoemulsification) in 1986 and 1987 with those following inpatient cataract extraction in 1984. METHODS: Using the 5% random sample of Medicare beneficiaries, we analyzed the claims of all individuals 66 years of age or older who underwent ECCE by nuclear expression or phacoemulsification in 1986 and 1987. A total of 57,103 patients were identified and followed to the end of 1988. Cumulative probability of RD repair and hospitalization for endophthalmitis was calculated by standard lifetable methods. These findings were compared with the cumulative probability of the same complications in a cohort of 330,000 patients who underwent cataract extraction on an inpatient basis in 1984. RESULTS: In the 1986-to-1987 cohort, the cumulative probability of RD within 3 years after cataract surgery was 0.81% and the cumulative probability of endophthalmitis within 1 year was 0.08%. The rate of RD is similar to that which we previously reported for 330,000 patients who underwent inpatient surgery in 1984, but the rate of endophthalmitis is significantly lower in the 1986-to-1987 outpatient cohort (0.08% versus 0.12%; z = 2.42; P = 0.01). CONCLUSIONS: The shift to outpatient cataract surgery was accompanied by no significant increase in the probability of RD repair and possibly a significant decrease in the rate of hospitalization for endophthalmitis.

Aged↗

PubMed1994

Variation in cataract surgery practice and clinical outcomes.

PURPOSE: To examine associations between surgical technique, patient and surgeon characteristics, and clinical outcomes of cataract surgery. METHODS: Seventy-five ophthalmologists were recruited from three cities based on a sampling scheme stratified by surgeon-reported annual volume of cataract surgery. Seven hundred seventy-two patients undergoing first eye cataract surgery were enrolled, with complete preoperative, perioperative, and 4-month postoperative clinical data on 717 patients (93%). RESULTS: Sixty-five percent of surgery was performed by phacoemulsification and 35% by standard extracapsular (ECCE) techniques. Performance of ECCE was associated with the presence of ocular comorbidity and 21 or more years in practice of the surgeon. Performance of phacoemulsification was associated with annual volume of cataract surgery, wherein high-volume (201-399 patients annually) and very high-volume (> 400 patients annually) surgeons had 3.7 and 3.9 times the likelihood of performing phacoemulsification compared with moderate-volume (51-200 cases annually) surgeons. The rates of intraoperative, perioperative, and 4-month postoperative adverse events and the amount of improvement in visual acuity did not differ either by surgical technique or volume stratum. The reported occurrence of posterior capsular opacification within 4 months of surgery was increased in the presence of cortical opacification, one city, and patients operated on by either high- or very high-volume surgeons. CONCLUSIONS: In this cohort, no difference in clinical outcomes, as measured by change in visual acuity or occurrence of postoperative adverse events (except for posterior capsular opacification), can be attributed to performance of phacoemulsification versus ECCE or to the reported annual volume of cataract surgery of the surgeon. Self-reported high and very high annual volume of cataract surgery is associated independently with performance of phacoemulsification and surgeon's report of posterior capsular opacification at 4 months after cataract surgery.

Aged↗

PubMed1994

National study of cataract surgery outcomes. Variation in 4-month postoperative outcomes as reflected in multiple outcome measures.

BACKGROUND: Although ophthalmologists have long recognized that visual acuity alone is an inadequate measure of visual impairment, the need for and outcomes of cataract surgery historically have been assessed in terms of visual acuity. PURPOSE: To examine the relation among different cataract surgery outcome measures, including a 14-item instrument designed to measure functional impairment caused by cataract (the VF-14), at 4 months after cataract surgery. METHODS: The authors performed a longitudinal study of 552 patients undergoing first eye cataract surgery by 1 of 75 ophthalmologists practicing in Columbus, Ohio, St. Louis, Missouri, or Houston, Texas. Patients were interviewed, and clinical data were obtained preoperatively (July 15, 1991-March 14, 1992) and 4 months postoperatively. RESULTS: The percentage of patients judged to be improved at 4 months after cataract surgery varied by the outcome measure used: Snellen visual acuity (96%); VF-14 score (89%); satisfaction with vision (85%); self-reported trouble with vision (80%); and Sickness Impact Profile score (67%). The change in patients' ratings of their trouble with vision and their satisfaction with vision were correlated more strongly with the change in VF-14 score than with the change in visual acuity (operated eye or better eye). The average change in VF-14 score was unrelated to the preoperative visual acuity in the eye undergoing surgery. CONCLUSION: Estimates of the proportion of patients benefiting from cataract surgery vary with the outcome measure used to measure benefit. Change in VF-14 score, a measure of functional impairment related to vision, may be a better measure of the benefit of cataract surgery than change in visual acuity.

Aged↗

PubMed1994

A 210-mumol dose of vitamin A provides more prolonged impact on vitamin A status than 105 mumol among preschool children.

A randomized controlled clinical trial was conducted to determine the relative protection afforded by two large doses of vitamin A against subclinical vitamin A deficiency among 345 preschool children. At baseline, children either had or were at high risk of developing non-corneal xerophthalmia. Vitamin A status was assessed by the relative dose response (RDR) test, serum retinol concentration, and ocular examination before and 3 and 6 mo following one oral dose of 105 mumol or 210 mumol of vitamin A. At 3 and 6 mo, mean serum retinol concentration was significantly higher in the 210-mumol group than in the 105-mumol group. The proportion of children with a positive RDR did not differ between groups at 3 mo, but by 6 mo there were three times more children positive in the 105-mumol group. Most of the observed difference was confined to children with xerophthalmia at baseline. The relative benefit of the 210-mumol dose was related to baseline vitamin A status. The current World Health Organization recommended prophylactic dose of 210 mumol seems appropriate.

Child, Preschool↗

PubMed1994

Changing prevalence of xerophthalmia in Indonesia, 1977-1992.

OBJECTIVE: The primary objective of this analysis was to determine if the prevalence of xerophthalmia in Indonesia has changed over the period 1977-78 to 1992. DESIGN: The design was two cross-sectional prevalence surveys conducted in the same rural sample locations 14 years apart. SETTING: The studies were conducted in 15 provinces of Indonesia using a stratified random selection of villages. SUBJECTS: All persons in selected villages < 6 years of age were eligible for participation. Children were recruited during a door-to-door census of villages and invited to present for an eye examination at a central point in the village. A total of 19,032 subjects were included in the 1977-78 and 18,508 children in the 1992 survey. RESULTS: Overall, the prevalence of active xerophthalmia among preschool children declined by 75% (1.33% in 1977-78 to 0.34% in 1992). Active corneal disease declined by 95% (1/1000 in 1977-78 to 0.05/1000 in 1992). While the overall declines were dramatic and highly significant (P < 0.0001), selected provinces continued to show rates higher than the WHO criteria for a problem of public health significance. CONCLUSIONS: The prevalence of xerophthalmia has declined significantly over the past 14 years in Indonesia. The specific reasons for this decline cannot be ascribed to any particular intervention due to the multitude of health and social changes that have occurred during this period.

Child, Preschool↗