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PubMed2004

[The prevalence and its screening methods of primary open angle glaucoma in defined population-based study of rural and urban in Beijing].

OBJECTIVE: The purpose of the study is to determine the prevalence of primary open-angle glaucoma (POAG) in persons aged 40 or above in Beijing, China. METHODS: From June 2001 to October 2001, the screening population was identified by a door-to-door census in five metropolitan resident areas in the north of Beijing and three villages in a county south to Beijing. The screening included visual acuity, frequency doubling perimetry (FDP, C-20 screening program), non-contact tonometry, slit lamp microscopy, anterior chamber depth (Van Herick method), and fundus photography. The suspect glaucoma and definite glaucoma patients were asked to have an examination of Octopus 1-2-3 perimetry (G1X TOP threshold program), repeat tonometry, gonioscopy and fundus stereo-photography at Beijing Tongren Hospital. RESULTS: There were 4451 subjects who were examined at the study sites. The response rates in rural and urban were 79.58% and 87.13%, respectively. In this 40 years-old or above population, the prevalences of POAG were 1.97% in rural men, 2.07% in urban men, 1.04% in rural women and 1.42% in urban women. In this study, 92.30% POAG patients in rural and 87.30% POAG patients in urban were new diagnosed cases. The prevalence of POAG increased with age and the change was exponential. In 50% POAG patients first IOP measurement was less than 21 mm Hg (1 mm Hg = 0.133 kPa). The prevalence of monocular eye blindness was 15.40% and 10.90% in rural and urban, respectively. CONCLUSIONS: Owing to use fundus photography and integrated evaluation of optic disc, it is possible to diagnose in earlier stage of POAG. This study identifies more patients with POAG than any previous population-based studies of China, and is similar to other studies of Asia such as in India and Singapore. The reason of lower POAG prevalence in rural women than in urban may be that the anterior chamber depth of rural women is shallower than that of urban women. It may cause difficult to differentiate the chronic primary angle closure glaucoma from POAG at screening sites, so the part POAG patients may be included in primary angle closure glaucoma patients.

Adult↗
PubMed2000

Community screening for visual impairment in the elderly.

BACKGROUND: While the aims of multicomponent screening of older people are broad, any benefit arising from the inclusion of a vision component in the assessment will necessarily be dependent on improved vision. OBJECTIVES: The objective of this review is to assess the effects on vision of mass screening of older people for visual impairment. SEARCH STRATEGY: We searched the Cochrane Eye and Vision Group specialised register, the Cochrane Controlled Trials Register - Central, MEDLINE, EMBASE, SciSearch and reference lists of relevant trial reports and review articles. We contacted investigators to identify additional published and unpublished trials. The most recent searches were conducted in April 1998. SELECTION CRITERIA: We included randomised trials of visual or multicomponent screening for vision impairment in people aged 65 or over in a community setting. DATA COLLECTION AND ANALYSIS: Both reviewers independently extracted data and assessed trial quality. MAIN RESULTS: Visual outcome data were available for 3494 people in five trials of multicomponent assessment. Length of follow up ranged from two to four years. All the trials used self-reported measures for visual impairment, both as screening tools and as outcome measures. In four of the trials people reporting visual problems were referred to either the eye services or to a physician. In one trial people reporting visual problems received information about resources in the community designed to assist those with poor vision. The proportions of participants in the intervention and control groups who reported visual problems at the time of outcome assessment were 0.26 and 0.23 respectively (relative risk for visual impairment 1.03, 95% confidence interval 0.92 to 1.15). REVIEWER'S CONCLUSIONS: There is no evidence that community-based screening of asymptomatic older people results in improvements in vision.

Aged↗
PubMed2000

Fred Hollows lecture: digital screening for eye disease.

The purpose of this study was to explore progress, in the adaptation to community screening for blinding eye disease, of digital imaging devices and technology for storage and transmission. Available imaging systems were compared to gold standard clinical photography in terms of sensitivity and specificity for diagnosis of common blinding eye conditions. Since the use of expensive non-portable imaging devices is likely to be limited for widespread community screening purposes, a portable fundus camera (Nidek, Chiyoda-ku, Japan) and a prototype monocular digital indirect ophthalmoscope constructed at the Lions Eye Institute (LEI) were selected for comparative trials for the screening of optic disc cupping, glaucoma and clinical signs of diabetic retinopathy. Fifty-one eyes of 27 consecutive patients being assessed at the LEI clinic for glaucoma were dilated and photographed with a Zeiss retinal camera, and digital images were taken with the portable Nidek NM100 fundus camera (Carl Zeiss, Oberkochen, Germany) or with a prototype digital monocular indirect ophthalmoscope. Vertical cup: disc ratios (VCDR) were measured on the disc photographs by one ophthalmologist while three other clinicians were presented with compressed digital images in random order to estimate VCDR. Field trials were also carried out to demonstrate the practicality of compression, local storage and then transmission by mobile telephone ISDN lines and satellite, of optic discs and fundus images of patients with diabetes in either rural Western Australia or Surabaya, Indonesia. Kappa values of correlations of measurement of agreement between measured and estimated VCDR were 0.87, 0.45 and 0.84, respectively, for the three observers, corresponding to a specificity of 79-97% and a sensitivity of 70-95%. The portable Nidek fundus camera was also assessed for specificity and sensitivity in the diagnosis of diabetic retinopathy in comparison to standard Zeiss fundus camera photographs. Of 49 eyes in 25 consecutive patients attending the LEI clinic for assessment of diabetic retinopathy, three ophthalmologists assessed photographs and images in random order. When used for screening diabetic retinopathy, the digital images of the Nidek camera were graded as adequate quality in only 56% of eyes compared to 93% of the photographs. The kappa value of agreement in analysis of diabetic retinopathy was only 0.30. The prototype digital monocular indirect ophthalmoscope compared favourably with the Nidek camera. At 1:5 compression, images of size 36 kB transmitted from Surabaya to Perth took 29 s on the mobile telephone, while uncompressed images took 170 s. Images compressed 1:5 were transmitted in 60 s using the satellite telephone, while the uncompressed images took 240 s. Satellite transmission was more expensive but the lines were more stable than telephone connections from Indonesia. Digital imaging is becoming a powerful tool for ophthalmology in clinical records, teaching and research, and interoffice diagnostic opinions. It also has enormous potential for community screening for blinding eye diseases, such as glaucoma and diabetic retinopathy. Inexpensive portable imaging devices that are easy to use, and on which local health workers might be trained, must be developed and validated in terms of sensitivity and specificity of performance. The technology of image capture, image compression, transmission, data base storage and analysis is rapidly evolving and becoming less expensive.

Diabetic Retinopathy↗
PubMed1990

Refractive error in a Puerto Rican rural population.

The distribution of refractive error in migrant workers and their families living in Patillas, Puerto Rico was studied. A total of 1,109 patients with an age range of 5-81 years and above was screened using the modified clinical technique. The refractive distribution of the total screened indicated that 10.2 percent had myopia, 17.7 percent had hyperopia and the rest had a combination of other refractive error (astigmatism, anisometropia and emmetropia). Myopia was most frequent in the age group 11-20 years (16.7 percent) and 21-30 years (16.8 percent) and decreased in the younger and older age groups. Frequency of hyperopia increased from age 31-70 years and then decreased thereafter. Hyperopic astigmatism was more common than myopic astigmatism across all age groups.

Adolescent↗
PubMed1995

[Evaluation of published recommendations for screening studies of retinopathy of prematurity].

PURPOSE: Evaluation of different and partially contradictory guidelines for screening for retinopathy of prematurity published in Germany. PATIENTS: The data on 1219 preterm infants examined in Bern (n = 900) and Berlin (n = 319) were analyzed. A total of 680 preterm infants (56%) had a birth weight below 1500 g. The remaining infants were examined because oxygen had to be supplied or surgery done before or around the estimated delivery time. RESULTS: Stage 3 retinopathy was found in 88/1219 (7.2%) preterm infants. Only 5/88 infants weighed more than 1500 g at birth. Three of these infants had a birth weight below 2000 g and needed supplemental oxygen for a prolonged period of time. The other 2 infants had birth weights of more than 2000 g and were severely ill. Of 1219 preterm infants, 37 (3%) developed threshold retinopathy (according to the criteria of the multicenter trial); 35/37 infants weighed less than 1230 g at birth. The remaining 2 children (1650 g and 2185 g birth weight) were severely ill. CONCLUSIONS: Preterm infants should be screened for retinopathy of prematurity: (1) if the birth weight is below 1500 g; (2) if the birth weight is below 2000 g and oxygen supply was necessary for more than 30 days; (3) if infants are very sick or must undergo multiple surgery before term. The first examination should be scheduled for the 6th week postnatal and not before 31 weeks postmenstrual age.

Berlin↗
PubMed2002

Conducting community-based, culturally specific, eye disease screening clinics for urban African Americans with diabetes.

The purpose of this study was to evaluate the need for, and efficacy of, community-based culturally specific eye disease screening clinics for urban African Americans with diabetes. The study employed a variety of culturally specific methods in the design and performance of 43 community-based eye disease screening clinics in southeastern Michigan. One thousand, thirty-seven subjects were recruited for the study. Of that number, 817 identified themselves as African Americans and are the focus of this report. Of the 817 African-American patients screened, 84 (10%) needed to be examined by an ophthalmologist immediately (< 30 days), and 180 (22%) needed to be examined soon (within 1 to 3 months), while 544 (67%) were advised to return for another exam a year later. The project demonstrated that it was possible to use culturally specific techniques to identify a significant number of urban African Americans with diabetes in need of eye screening and treatment. However, lack of health insurance proved to be the primary barrier to receiving needed treatment. Although the project was successful, it is not a solution to what is essentially a health systems problem, ie, inadequate access to appropriate diabetes care for a significant number of our population.

Black or African American↗
PubMed1991

Enlisting the eccentric photoscreener in a public hospital eye department.

We analysed retrospectively non-acute new referrals of children to Waikato Hospital over one year. It was found that children were required to wait unacceptably long to be seen. Almost half the children with established amblyopia were not seen until after the age of five years (42% were not referred until after that age). On the other hand, half the children seen had no significant pathology, and the high level of non-attendance also wasted clinic time. An attempt was made to address these problems by holding regular screening clinics using a photoscreener, assessing all children within three weeks of referral so that children with pathology could be examined and treated promptly. Preliminary investigations into mass community photoscreening produced an average recall rate of 11% (54% of whom fell into our definition of pathological). We feel that enlisting the photoscreener has provided a much more efficient paediatric service, which it is hoped will lead to a reduction in visual loss due to amblyopia.

Adolescent↗
PubMed2001

Commonly missed diagnoses in the childhood eye examination.

Early and accurate detection of eye disorders in children can present a challenge for family physicians. Visual acuity screening, preferably performed before four years of age, is essential for diagnosing amblyopia. Cover testing may disclose small-angle or intermittent strabismus. Leukocoria, which is detected with an ophthalmoscope, may indicate retinoblastoma or cataract. Children with glaucoma may have light sensitivity and enlargement of the cornea, and conjunctivitis that does not respond quickly to treatment may reflect more serious ocular inflammation. Children with serious eye injuries often present to the primary care physician. Nystagmus and many systemic conditions are associated with specific eye findings.

Amblyopia↗
PubMed1998

Timing of initial screening examinations for retinopathy of prematurity.

OBJECTIVE: To test a screening protocol for retinopathy of prematurity (ROP) that uses the dual criteria of postconceptional age and chronological age, rather than a single parameter, to determine precisely when to begin eye examinations. METHODS: We retrospectively reviewed medical records of 179 infants (326 eyes) who had undergone laser treatment for threshold ROP. We entered their chronological and postconceptional ages at treatment into a database and evaluated various screening parameters to determine the combination of criteria that would allow us to safely postpone the initial eye examinations. RESULTS: Screening infants at 7 weeks of chronological age or 34 weeks of postconceptional age (whichever comes first), but not before 5 weeks of chronological age, seems to reliably detect the onset of threshold ROP while reducing the number of unnecessary early examinations. CONCLUSION: Simultaneously applied dual criteria of chronological age and postconceptional age may be a superior method of determining when to initiate ROP examinations and is preferable to using either chronological age or postconceptional age alone.

Age of Onset↗
PubMedDate not supplied

Compliance with a standard of care for retinopathy of prematurity in one neonatal intensive care unit.

Standards of care are an integral part of providing safe and proper health care to the public. One such standard is the screening of premature infants for retinopathy of prematurity. In a retrospective chart review of 67 infants in an intensive care nursery, a high incidence of non-compliance with the standard was found in infants with over 1251-g birth weight, but that infants under 1251-g birth weight and eligible for participation in an investigation of retinopathy of prematurity had a high degree of compliance with the standard. These findings resulted in the adoption of recommendations to improve compliance with the standard.

Female↗
PubMed1997

Detection, prevention, and rehabilitation of amblyopia.

The necessity of visual preschool screening for reducing the prevalence of amblyopia is widely accepted. The beneficial results of large-scale screening programs conducted in Scandinavia are reported. Screening monocular visual acuity at 3.5 to 4 years of age appears to be an excellent basis for detecting and treating amblyopia and an acceptable compromise between the pitfalls encountered in screening younger children and the cost-to-benefit ratio. In this respect, several preschoolers' visual acuity charts have been evaluated. New recently developed small-target random stereotests and binocular suppression tests have also been developed with the aim of correcting the many false negatives (anisometropic amblyopia or bilateral high ametropia) induced by the usual stereotests. Longitudinal studies demonstrate that correction of high refractive errors decreases the risk of amblyopia and does not impede emmetropization. The validity of various photoscreening and videoscreening procedures for detecting refractive errors in infants prior to the onset of strabismus or amblyopia, as well as alternatives to conventional occlusion therapy, is discussed.

Amblyopia↗
PubMed1994

Commissioning diabetic eye screening by optometrists: a local initiative at the primary-secondary care interface.

The rationale behind the decision of a London family health services authority (Lambeth, Southwark, and Lewisham) to embark on a programme for diabetic eye screening by optometrists is outlined, discussing the way in which the scheme was set up and its possible future development. This family health services authority brought together a range of professionals across primary and secondary care to reach agreement on development of the service, and a consensus on clinical guidelines for operation of the scheme. This was particularly difficult in an area served by four hospitals which provide care to diabetics. Development of the scheme identified key questions about quality which have promoted a separate research agenda.

Accreditation↗
PubMed1991

Epidemiology of glaucoma in Japan--a nationwide glaucoma survey.

A population-based, collaborative glaucoma survey was conducted in seven regions throughout Japan, during the years of 1988 and 1989. The total number of subjects examined was 8,126 out of 16,078 residents aged 40 years or older, representing a participation rate of 50.54%. There were no significant differences in background factors between participants and randomly sampled nonparticipants. A mainstay of the screening consisted of tonometry and fundus photography with nonmydriatic camera, followed by automatic perimetry as a recall examination. Overall prevalences obtained were primary open-angle glaucoma (POAG) 0.58%, low-tension glaucoma (LTG) 2.04%, primary angle closure glaucoma (PACG) 0.34%, other types of glaucomas 0.60%, and ocular hypertension (OH) 1.37% at the time of screening. The very high prevalence of LTG and extremely low prevalence of OH in the Japanese might reflect a racial peculiarity in the age-specific trend of the intraocular pressure. The prevalence of PACG was found much higher in Japanese than in Caucasians, with a predilection for women. Racial peculiarities as revealed in this study were discussed, with particular reference to the refractive status in the Japanese that showed progressive decrease in myopia with age.

Adult↗
PubMed1994

Screening of infants for significant refractive error using videorefraction.

Isotropic photorefraction has been suggested as a suitable method for screening infants for refractive error. Recently published data suggested that reasonable consistency with retinoscopy results might be achieved using cycloplegic videophotorefraction (VPR) for spherical refractive error but that results might be unreliable for astigmatic errors. Non-cycloplegic VPR did not appear to produce results consistent with retinoscopy. A practical idea of how many children might be identified using this technique and how many missed was needed by personnel designing screening projects. Hence the VPR was tested by screening a population of 247 infants for significant refractive error, and comparing the results with cycloplegic retinoscopy. Sensitivity and specificity scores were calculated for a range of test levels of ametropia. Without cycloplegia, sensitivity of VPR was poor. With cycloplegia the situation was much improved, with sensitivity for hyperopia +4.00 D or over of 83.3% and specificity of 90.6%. Sensitivity for astigmatism of 1 D or greater (84.6%) was high but specificity was poor (45.6%). Acceptable sensitivity was achieved for identifying children in this age group at risk of developing squint and amblyopia due to refractive error, providing cycloplegia was used.

Amblyopia↗
PubMed1991

Detecting and treating retinopathy in patients with type I diabetes mellitus. Savings associated with improved implementation of current guidelines. American Academy of Ophthalmology.

Diabetic retinopathy is the leading cause of acquired blindness among Americans of working age. The resulting economic and societal burdens are of profound magnitude. Epidemiologic and clinical trials data were used to analyze the impact of improved recruitment of patients with Type I diabetes mellitus into screening and treatment programs. The analysis predicted annual savings of $101.0 million and 47,374 person-years-sight at the currently estimated 60% screening and treatment implementation level. If all patients received appropriate eye care, the predicted savings exceed 167.0 million and 79,236 person-years-sight. Approximately two thirds of all savings result from treatment of proliferative diabetic retinopathy, while nearly one third arises from treatment of clinically significant macular edema. Additional savings of $9571 are realized with each recruitment of a newly diagnosed patient with diabetes. Initiating screening immediately upon diagnosis of diabetes, rather than the currently recommended 5-year deferral, would be cost effective if 1 additional individual in 56 were recruited. This model suggests that improved delivery of ophthalmic care to patients with diabetes would yield substantial financial and visual savings, thus making major recruitment programs such as the National Eye Institute's National Eye Health Education Program and the American Academy of Ophthalmology's Diabetes 2000, both economically and clinically effective.

Adult↗
PubMed2003

The Kariapatti pediatric eye evaluation project: baseline ophthalmic data of children aged 15 years or younger in Southern India.

PURPOSE: To estimate the prevalence of ocular morbidity among children of rural southern India before developing a service delivery model for community-based pediatric eye care. DESIGN: Population-based cross sectional study. METHODS: Trained field-workers performed door-to-door enumeration in 74 randomly selected villages of the Kariapatti block in southern India to identify children aged 15 years or younger and performed visual acuity measurements using Cambridge crowded cards and external eye examination with torchlight. Pediatric ophthalmologists further examined subjects with ocular problems identified by the field-worker. The clinical team performed repeat visual acuity measurements with Cambridge crowded cards, refraction, slit-lamp anterior segment examinations, and dilated posterior segment examinations at the screening site. The ophthalmologist identified and recorded one major cause for each visually impaired eye. RESULTS: Field-workers screened 10605 (94.6%) of 11206 children enumerated, and identified 1441 (13.6%) children as requiring further clinical examination. An additional 449 children identified as normal by the field-worker were randomly chosen for repeat examinations at the screening sites. In all, 1578 (83.5%) of these 1890 children were examined at the screening site. According to World Health Organization criteria, 6.2 of 10000 children were blind; 42.9% of this blindness was potentially avoidable. Refractive errors (0.55%, 95% confidence interval: 0.41, 0.69) and strabismus (0.43%, 95% confidence interval: 0.30, 0.55) were the major ocular morbidity in this population. CONCLUSIONS: Developing an appropriate service delivery model for this region will require a balance between the relatively low prevalence of morbidity and blindness and the need for service in this population.

Adolescent↗
PubMed1996

Advanced cicatricial retinopathy of prematurity--outcome and complications.

AIMS: To assess the outcome and complications of patients with advanced retinopathy of prematurity (ROP). METHODS: All patients with eyes achieving stage 4 or 5 retinopathy of prematurity were reviewed. Twenty one eyes were diagnosed during ROP screening in maternity hospitals and 10 eyes were of infants transferred for treatment. RESULTS: Thirty one eyes of 17 patients were included. Thirteen eyes were treated for acute disease but progressed to stage 4 or 5; seven had cryotherapy and six diode laser photocoagulation. Cataract was found in 17 eyes (54.8%), glaucoma in seven eyes (22.6%), microphthalmos in 15 (48.4%), and corneal opacification in four eyes (12.9%). Fifteen eyes had surgical procedures; two (6.5%) had trabeculectomy, four (12.9%) had lensectomy, and nine (29%) retinal detachment repair. Transferred infants had their initial eye examination later than infants in hospitals screened by the authors and 80% of them had progressed beyond threshold ROP by the time they were transferred for treatment. Twenty nine eyes (93.6%) had visual acuities of 3/60 or less and only two eyes (6.5%) achieved 6/18 or less. CONCLUSION: The visual outcome of the eyes undergoing retinal re-attachment surgery was disappointing. Cataract, microphthalmos, and glaucoma were the most frequent complications, and surgical intervention was often required. The need for children who are blind as a result of ROP to have long term follow up is shown.

Cataract↗
PubMed1999

Use of collaborative audit to assist local implementation of the SIGN guideline for prevention of visual impairment in diabetes.

OBJECTIVES: To use audit to inform the local implementation of a national clinical guideline for the prevention of visual impairment in diabetes. DESIGN: Computer and patient record search in hospital and general practice to determine levels of morbidity and follow-up. Questionnaire to each practice to determine models and techniques of eye screening. SETTING: Ayrshire and Arran Health Board area, Scotland. SUBJECTS: All known diabetic patients. MAIN MEASURES: Proportion of diabetic patients who have had diabetic eye review and monitoring of risk factors within one year. Proportion of diabetic patients who have risk factors recorded within target level. Proportion of eye screening centres with recommended mechanisms in place. RESULTS: Both district general hospitals, and 59 of the 63 general practices, in the area took part in the audit. A total of 6,217 diabetic patients were included; the prevalence of diabetes in this population was 1.65%. Twenty-seven per cent were insulin treated. Seventy-two per cent of diabetics who were not registered blind had a record of having had fundoscopy performed through dilated pupils within one year. Sixty-nine per cent of those who were not registered blind had had corrected visual acuity measured within one year. Eighty-five per cent of diabetics had HbA1C recorded within one year and of these 65% had a level of 8% or less. Eighty-eight per cent had a blood pressure recording within twelve months and 52% of recorded pressures were 140/90 mmHg or less. Smoking status was recorded for 89% of patients and 75% of patients with a record were non-smokers. Representatives of 57 practices returned a completed questionnaire. All these practices had a Snellen chart, but only 83% had near vision testing equipment and only 54% had a pinhole occluder. CONCLUSIONS: An area wide collaborative audit provided local data to inform the process of guideline implementation and baseline data from which to evaluate this process. Wide stakeholder involvement increased interest, motivation and support for the process. The audit highlighted specific areas for change and provided the local stimulus for change.

Cooperative Behavior↗