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Prevalence of blindness and visual impairment in Pakistan: the Pakistan National Blindness and Visual Impairment Survey.

PURPOSE: To determine the prevalence of blindness and visual impairment in adults aged 30 years and older in Pakistan and to assess socio-demographic risk factors. METHODS: Multistage, stratified (rural/urban), cluster random sampling, with probability proportional-to-size procedures, was used to select a nationally representative, cross-sectional sample of adults 30 years of age or older. Each subject was interviewed; had visual acuity measured (logMAR; logarithm of the minimum angle of resolution); and underwent autorefraction, biometry, and fundus-optic disc examination. Those with less than 6/12 acuity in either eye underwent a detailed ophthalmic examination, including corrected distance visual acuity measurement and dilated ophthalmoscopy. RESULTS: A nationally representative sample of 16,507 adults (95.5% of those enumerated) was examined. The age- and gender-standardized prevalence of blindness was 2.7% (95% confidence interval [CI], 2.4%-2.9%). It has been estimated that there are 1,140,000 (962,000-1,330,000) blind adults in Pakistan (2003 statistics). Blindness prevalence varied throughout the country, being highest in the provinces of Punjab and Baluchistan and lowest in the North West Frontier Province. Rural areas had a higher prevalence of blindness than did urban areas (3.8% vs. 2.5%, P < 0.001). Increasing age and being female were significantly associated with presenting visual acuity of <6/60 (odds ratio [OR], 2.5; 95% CI, 2.3-2.7 and 1.3; 95% CI, 1.1-1.5, respectively). Educational status was also associated with presenting visual acuity of <6/60. Subjects who had attended primary school were 60% (P < 0.001) less likely to have acuity of <6/60 than were subjects who had never been to school. CONCLUSIONS: This comprehensive survey provides reliable estimates of the prevalence of visual impairment and blindness in Pakistan. A significant excess of visual impairment was found among the elderly and the uneducated. After adjustment for age differences, women were found to have a significant excess of severe visual impairment and blindness. Regional variations in the prevalence of blindness were also identified.

Adult↗

A focus group study of accessibility and related psychosocial issues in diabetes education for people with visual impairment.

PURPOSE: This study was conducted to identify accessibility and related psychosocial issues in diabetes care and education for visually impaired adults who have diabetes. METHODS: Two focus groups of adults with visual impairment and diabetes were conducted; data were recorded and analyzed. RESULTS: The 3 main issues identified were lack of access to up-to-date diabetes information in an accessible format, lack of understanding by healthcare providers of the needs and competencies of people with both visual impairment and diabetes, and lack of access to nonvisual diabetes self-management equipment. CONCLUSIONS: This study provides qualitative support for the view that visually impaired people in the United States may, as a group, be systematically excluded from receiving high quality diabetes care and education. Equal access to diabetes care and education for visually impaired people requires increased accessibility of diabetes care and education programs, and increased professional and public awareness that the diabetes programs are accessible. Some specific recommendations are to make all patient education materials available in low-vision/nonvisual formats and to teach all diabetes education professionals how to work effectively with visually impaired people.

Adult↗

Eventual entrainment of the human circadian pacemaker by melatonin is independent of the circadian phase of treatment initiation: clinical implications.

About 15% of the legally blind completely lack light perception. Most of these individuals have abnormally phased circadian rhythms and many free-run. Light treatment is not an option for them. However, melatonin treatment can be highly effective. A daily dose of 0.5 mg of melatonin usually results in entrainment. It has been suggested that treatment in individuals with circadian periods > 24 h should be initiated on the advance zone of the melatonin phase response curve, which was based on findings in which melatonin initiated on the delay zone were less likely to result in entrainment, even though treatment continued across all circadian phases. In the present study, 7 totally blind people started low-dose melatonin treatment (0.5 mg; 1 person was given 0.05 mg) on the delay zone. All entrained as circadian phase free-ran and the advance zone of the melatonin phase response curve coincided with the time of melatonin administration. These results are consistent with studies in other mammals. It does not appear that low-dose melatonin treatment needs to be initiated on the advance zone to induce eventual entrainment in blind people with free-running rhythms > 24 h. Therefore, it is not essential that circadian phase be ascertained before starting low-dose melatonin treatment of blind people.

Adult↗

Conducting research with visually impaired older adults.

Due to the frequency of eye disorders among older adults, qualitative researchers who involve older individuals in their work must be sensitive to the multiple ways in which visual deficits can influence the research process. The author addresses some of the difficulties encountered, insights gained, and strategies developed while conducting a phenomenological study in which all the participants were severely visually impaired. The author's insights, drawn from personal experiences, reflections, and log entries kept throughout the study, are shared to help other researchers design and implement studies in which the voices of individuals with severe visual impairments can be skillfully tapped.

Aged↗

How the blind "see" Braille: lessons from functional magnetic resonance imaging.

What does the visual cortex of the blind do during Braille reading? This process involves converting simple tactile information into meaningful patterns that have lexical and semantic properties. The perceptual processing of Braille might be mediated by the somatosensory system, whereas visual letter identity is accomplished within the visual system in sighted people. Recent advances in functional neuroimaging techniques, such as functional magnetic resonance imaging, have enabled exploration of the neural substrates of Braille reading. The primary visual cortex of early-onset blind subjects is functionally relevant to Braille reading, suggesting that the brain shows remarkable plasticity that potentially permits the additional processing of tactile information in the visual cortical areas.

Blindness↗

Intravitreal triamcinolone acetonide injection in blind painful eyes. Intraocular steroids as a treatment for blind painful red eyes.

PURPOSE: Phthisis bulbi results from different ocular conditions. We evaluated intravitreal triamcinolone acetonide as a treatment option in blind painful eyes. METHODS: Thirty-one patients with unilateral phthisis were randomly divided into two groups. Group A received 0.3 ml (12.5 mg) triamcinolone acetonide intravitreally and Group B 0.3 ml balanced salt solution after retrobulbar anesthesia. Treatment success was assessed by subjective response to pain and clinically by biomicroscopic evaluation of conjunctival congestion. Tonometry was done before and after treatment. Follow-ups were at 24 hours, 3 weeks, 3 and 6 months, and 1 and 2 years. RESULTS: Throughout the two-year follow-up, only two patients in Group A reported pain after the procedure and were retreated, one at week 4 and the other at week 7. Conjunctival congestion was significantly lower in Group A. Two patients with hypotony before treatment had normal tension after triamcinolone. All Group B patients were reinjected with triamcinolone because pain continued after balanced salt solution injection. No severe complications were found. CONCLUSIONS: Intravitreal triamcinolone acetonide may be effective and safe for treating blind painful eyes.

Adolescent↗

Etiology of childhood blindness in Izmir, Turkey.

PURPOSE: To identify the anatomic sites and the etiology of childhood blindness and to discern treatable and preventable causes. METHODS: The records of 998 patients seen in the authors' pediatric ophthalmology unit between June 1998 and May 2002 were examined retrospectively. A total of 148 patients who had visual impairment and blindness according to World Health Organization criteria were included in the study. They are classified according to the etiology based on time of insult and the anatomic site of visual loss. RESULTS: The most common anatomic site of visual loss was retina, with a rate of 25.0%. The etiology according to the time of insult was unknown in 45.2% of the patients, of whom 20.2% had cataract. Genetic disorders were responsible in 25.0% of the patients. In 69.6% of the patients, the causes of visual impairment were considered either preventable or treatable, including cataract, retinopathy of prematurity, genetic disorders, and refractive errors. CONCLUSIONS: A high percentage of our patients had avoidable causes of childhood blindness. Genetic counseling services, as well as national screening programs for amblyopia, red fundus reflex, and retinopathy of prematurity, should be established.

Adolescent↗

Prevalence of blindness and visual impairment among Jordanian diabetics.

PURPOSE: To investigate the prevalence of blindness and visual impairment among a population of Jordanian diabetics. METHODS: A total of 986 diabetic patients were fully assessed, including complete history, examination, and laboratory tests. All patients underwent detailed eye examination, which included visual acuity, slit-lamp examination, tonometry, funduscopy, and fundus fluorescein angiography (FFA). RESULTS: Of all patients examined, 53.2% were male and 46.8% were female. The mean age and duration of diabetes were 55.3 and 11.9 years. Of all patients, 93.3% had type 2 while 6.7% had type 1 diabetes mellitus (DM). Over half (50.3%) were on oral hypoglycemic agents, 34% on insulin, and 14.5% on both types of treatment, whereas only 1.2% were on diet alone. The mean value for HbA1c was 7.7%. The prevalence of blindness among participants was found to be 7.4%, while 10.1% were visually impaired. Diabetic retinopathy (DR) was present in 64.1%, 37.8% had cataract, and 8.7% had undergone cataract surgery. Using multivariate logistic regression analysis, visual impairment was significantly associated with age, treatment of diabetes, and DR, while only age and retinopathy were significantly related to blindness. CONCLUSIONS: DM is a common disease in Jordan and DR is highly prevalent among Jordanian diabetics. National screening and educational programs are highly needed to reduce the risk of blindness and visual impairment among diabetic patients.

Adolescent↗

Prevalence of congenital optic disc pits in adult Chinese: The Beijing Eye Study.

PURPOSE: To determine the prevalence of optic disc pits in the elderly Chinese population. METHODS. The Beijing Eye Study, a population-based, cross-sectional cohort study, included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%) with an age of 40+ years. The present study included 4027 (90.7%) subjects for whom readable optic disc photographs were available. RESULTS: A pit of the optic nerve head was detected in one (0.02%) patient. Prevalence was 0.02 +/-1.58% (95% confidence interval: -0.02, 0.07). CONCLUSIONS: A congenital optic disc pit was found in one subject of the present population-based study in mainland China. In a mathematical sense, the calculated prevalence of optic disc pits in the whole population would be 0.02 +/- 1.58% (95% confidence interval: -0.02, 0.07) or about 1:4.000 subjects. From a statistical point of view, however, population-based studies with about 10,000 subjects are necessary to confirm this finding.

Adult↗

The Tehran Eye Study: research design and eye examination protocol.

BACKGROUND: Visual impairment has a profound impact on society. The majority of visually impaired people live in developing countries, and since most disorders leading to visual impairment are preventable or curable, their control is a priority in these countries. Considering the complicated epidemiology of visual impairment and the wide variety of factors involved, region specific intervention strategies are required for every community. Therefore, providing appropriate data is one of the first steps in these communities, as it is in Iran. The objectives of this study are to describe the prevalence and causes of visual impairment in the population of Tehran city; the prevalence of refractive errors, lens opacity, ocular hypertension, and color blindness in this population, and also the familial aggregation of refractive errors, lens opacity, ocular hypertension, and color blindness within the study sample. METHODS DESIGN: Through a population-based, cross-sectional study, a total of 5300 Tehran citizens will be selected from 160 clusters using a stratified cluster random sampling strategy. The eligible people will be enumerated through a door-to-door household survey in the selected clusters and will be invited. All participants will be transferred to a clinic for measurements of uncorrected, best corrected and presenting visual acuity; manifest, subjective and cycloplegic refraction; color vision test; Goldmann applanation tonometry; examination of the external eye, anterior segment, media, and fundus; and an interview about demographic characteristics and history of eye diseases, eye trauma, diabetes mellitus, high blood pressure, and ophthalmologic cares. The study design and eye examination protocol are described. CONCLUSION: We expect that findings from the TES will show the status of visual problems and their causes in the community. This study can highlight the people who should be targeted by visual impairment prevention programs.

Blindness↗

Elderly Bedouins and Jews in Israel: the effects of visual impairment on perceived functional and health status.

Age-related vision impairment is a major cause of functional limitations in mobility and independent living. Research findings suggest that vision impairment in later life affects social, emotional, mental as well as physical well-being, and daily functioning. The purpose of this study was to examine the relationship between ethnicity and visual problems, i.e., whether Bedouin and Jewish elderly persons differed in terms of visual impairment prevalence and the extent to which visual impairment affected their ability to perform activities of everyday life. This study sampled 88 Bedouin and 111 Jewish elderly persons aged 60 and older in the southern region of Israel. The findings show that the majority of the respondents reported visual problems. Bedouin elderly tended to have more problems with distance sight as a result of living conditions than Jewish elderly. In terms of ability to perform ADL and IADL functions, elderly Bedouins reported more problems. The study findings are discussed in terms of policy and service provision. In addition, recommendations for additional research are presented.

Activities of Daily Living↗