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Purpose: To assess the influence of distance and near visual impairment on self-reported near visual functioning (VF) in a multinational study., Design: Population-based cross-sectional study., Participants: Participants aged 35 years or older were selected randomly with cluster sampling at 7 sites: rural sites in Nepal (Kaski) and India (Madurai), a semirural site in China (Shunyi), semiurban sites in South Africa (Durban) and Niger (Dosso), and urban sites in the United States (Los Angeles) and China (Guangzhou)., Methods: Binocular presenting distance and near visual acuity (VA) were measured with a logarithm of the minimum angle of resolution tumbling E chart at 4 m and 40 cm, respectively. A 12-item near VF questionnaire interview was administered by trained local interviewers, with responses scored from 100 to 0 as visual disability increased. Multiple linear regression was used to investigate the association of age, gender, education, and VA with overall eyesight, difficulty with activities, and social functioning subscale scores., Main Outcome Measures: Visual functioning subscale scores., Results: The study sample consisted of 6851 questionnaire respondents. The VF subscale scores decreased significantly with worse distance and near VA, and even mildly impaired VA could result in reduced VF. Lower VF subscale scores were associated with older age at 4 sites, female gender at 3 sites, and greater education at 2 sites. The influence of near VA was greater than distance VA at 3 sites, and at 1 site, distance VA was more influential than near VA. With study site included in the regression modeling, lower scores for the overall eyesight subscale (compared with the Shunyi reference site) were found in Guangzhou, Kaski, and Durban; lower difficulty in activities scores were found in Kaski and Durban, but better scores were found in Guangzhou and Madurai; and social functioning scores were lower in Kaski, Durban, and Dosso., Conclusions: Along the entire VA spectrum, lower levels of distance and near VA led to significant reductions in VF subscale scores, with wide variation both within and between study sites. The impact of near vision on VF should receive greater emphasis with further investigation in various socioeconomic and cultural settings., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare wear of standard, adjustable, and ready-made glasses among children., Design: Randomized, controlled, open-label, noninferiority trial., Participants: Students aged 11 to 16 years with presenting visual acuity (VA) ≤6/12 in both eyes, correctable to ≥6/7.5, subjective spherical equivalent refractive error (SER) ≤-1.0 diopters (D), astigmatism and anisometropia both <2.00 D, and no other ocular abnormalities., Methods: Participants were randomly allocated (1:1:1) to standard glasses, ready-made glasses, or adjustable glasses based on self-refraction. We recorded glasses wear on twice-weekly covert evaluation by head teachers (primary outcome), self-reported and investigator-observed wear, best-corrected visual acuity (BCVA) (not prespecified), children's satisfaction, and value attributed to glasses., Main Outcome Measure: Proportion of glasses wear on twice-weekly covert evaluation by head teachers over 2 months., Results: Among 379 eligible participants, 127 were allocated to standard glasses (mean age, 13.7 years; standard deviation [SD], 1.0 years; 54.3% were male), 125 to ready-made (mean age, 13.6; SD, 0.83; 45.6%), and 127 to adjustable (mean age, 13.4 years; SD, 0.85; 54.3%). Mean wear proportion of adjustable glasses was significantly lower than for standard glasses (45% vs. 58%; P = 0.01), although the adjusted difference (90% confidence interval [CI], -19.0% to -3.0%) did not meet the prespecified inferiority threshold of 20%. Self-reported (90.2% vs. 84.8%, P = 0.64) and investigator-observed (44.1% vs. 33.9%, P = 0.89) wear did not differ between standard and adjustable glasses, nor did satisfaction with (P = 0.97) or value attributed to study glasses (P = 0.55) or increase in quality of life (5.53 [SD, 4.47] vs. 5.68 [SD, 4.34] on a 100-point scale, P > 0.30). Best-corrected visual acuity with adjustable glasses was better (P < 0.001) than with standard glasses. Change in power of study lenses at the end of the study (adjustable: 0.65 D, 95% CI, 0.52-0.79; standard, 0.01 D; 95% CI, -0.006 to 0.03, P < 0.001) was greater for adjustable glasses, although interobserver variation in power measurements may explain this. Lens scratches and frame damage were more common with adjustable glasses, whereas lens breakage was less common than for standard glasses., Conclusions: Proportion of wear was lower with adjustable glasses, although VA was better and measures of satisfaction and quality of life were not inferior to standard glasses., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: The American Academy of Ophthalmology recommendations on screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy are revised in light of new information about the prevalence of toxicity, risk factors, fundus distribution, and effectiveness of screening tools., Pattern of Retinopathy: Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. DOSE: We recommend a maximum daily HCQ use of ≤5.0 mg/kg real weight, which correlates better with risk than ideal weight. There are no similar demographic data for CQ, but dose comparisons in older literature suggest using ≤2.3 mg/kg real weight., Risk of Toxicity: The risk of toxicity is dependent on daily dose and duration of use. At recommended doses, the risk of toxicity up to 5 years is under 1% and up to 10 years is under 2%, but it rises to almost 20% after 20 years. However, even after 20 years, a patient without toxicity has only a 4% risk of converting in the subsequent year., Major Risk Factors: High dose and long duration of use are the most significant risks. Other major factors are concomitant renal disease, or use of tamoxifen., Screening Schedule: A baseline fundus examination should be performed to rule out preexisting maculopathy. Begin annual screening after 5 years for patients on acceptable doses and without major risk factors., Screening Tests: The primary screening tests are automated visual fields plus spectral-domain optical coherence tomography (SD OCT). These should look beyond the central macula in Asian patients. The multifocal electroretinogram (mfERG) can provide objective corroboration for visual fields, and fundus autofluorescence (FAF) can show damage topographically. Modern screening should detect retinopathy before it is visible in the fundus., Toxicity: Retinopathy is not reversible, and there is no present therapy. Recognition at an early stage (before any RPE loss) is important to prevent central visual loss. However, questionable test results should be repeated or validated with additional procedures to avoid unnecessary cessation of valuable medication., Counseling: Patients (and prescribing physicians) should be informed about risk of toxicity, proper dose levels, and the importance of regular annual screening., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the prevalence of amblyopia, strabismus, and significant refractive error among African-American, American Indian, Asian, Hispanic, and non-Hispanic white preschoolers in the Vision In Preschoolers study., Design: Multicenter, cross-sectional study., Participants: Three- to 5-year old preschoolers (n=4040) in Head Start from 5 geographically disparate areas of the United States., Methods: All children who failed the mandatory Head Start screening and a sample of those who passed were enrolled. Study-certified pediatric optometrists and ophthalmologists performed comprehensive eye examinations including monocular distance visual acuity (VA), cover testing, and cycloplegic retinoscopy. Examination results were used to classify vision disorders, including amblyopia, strabismus, significant refractive errors, and unexplained reduced VA. Sampling weights were used to calculate prevalence rates, confidence intervals, and statistical tests for differences., Main Outcome Measures: Prevalence rates in each racial/ethnic group., Results: Overall, 86.5% of children invited to participate were examined, including 2072 African-American, 343 American Indian (323 from Oklahoma), 145 Asian, 796 Hispanic, and 481 non-Hispanic white children. The prevalence of any vision disorder was 21.4% and was similar across groups (P=0.40), ranging from 17.9% (American Indian) to 23.3% (Hispanic). Prevalence of amblyopia was similar among all groups (P=0.07), ranging from 3.0% (Asian) to 5.4% (non-Hispanic white). Prevalence of strabismus also was similar (P=0.12), ranging from 1.0% (Asian) to 4.6% (non-Hispanic white). Prevalence of hyperopia >3.25 diopter (D) varied (P=0.007), with the lowest rate in Asians (5.5%) and highest in non-Hispanic whites (11.9%). Prevalence of anisometropia varied (P=0.009), with the lowest rate in Asians (2.7%) and highest in Hispanics (7.1%). Myopia >2.00 D was relatively uncommon (<2.0%) in all groups with the lowest rate in American Indians (0.2%) and highest rate in Asians (1.9%). Prevalence of astigmatism >1.50 D varied (P=0.01), with the lowest rate among American Indians (4.3%) and highest among Hispanics (11.1%)., Conclusions: Among Head Start preschool children, the prevalence of amblyopia and strabismus was similar among 5 racial/ethnic groups. Prevalence of significant refractive errors, specifically hyperopia, astigmatism, and anisometropia, varied by group, with the highest rate of hyperopia in non-Hispanic whites, and the highest rates of astigmatism and anisometropia in Hispanics., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the prevalence and causes of decreased visual acuity (VA)., Design: Population-based cross-sectional study., Participants: Multi-ethnic sample of children 30 to 72 months of age identified in Los Angeles., Methods: All eligible children underwent a comprehensive ophthalmic evaluation including monocular VA testing, cover testing, cycloplegic autorefraction, fundus evaluation, and VA retesting with refractive correction. Decreased VA was defined as presenting or best-measured VA worse than 20/50 in children 30 to 47 months of age and worse than 20/40 for children 48 months of age and older. The prevalence and causes of decreased VA were determined, for both presenting and best-measured VA, in the better-seeing and the worse-seeing eyes., Main Outcome Measures: Prevalence and causes of decreased vision., Results: Presenting VA was assessed in 1840 children and best-measured VA was assessed in 1886 children. Presenting VA was decreased in the worse eye of 4.2% of Asian children and of 3.6% of non-Hispanic white (NHW) children. Close to one-fourth of these cases had no identifiable cause, and 81% of these resolved on retesting. Decreased presenting VA in the worse eye with an identifiable ophthalmic cause was present in 3.4% of Asian children and in 2.6% of NHW children. Decreased presenting VA attributable to simple refractive error (myopia ≥ 0.5 diopters [D]; hyperopia ≥ 3.0 D; astigmatism ≥ 2.0 D or ≥ 1.5 D for children older than 36 months) was present in the worse eye of 2.3% of Asian children and of 1.4% of NHW children and in the better eye of 0.5% of Asian children and of 0.3% of NHW children. Decreased best-measured VA attributable to a cause was present in the worse eye of 1.2% of both Asian children and NHW children and in the better eye of 0.2% of Asian and of 0.3% of NHW children. Amblyopia related to refractive error was the most common cause, and was 10 times as common as ocular disease. Severe visual impairment was rare., Conclusions: Seventy percent of all decreased VA in Asian and NHW preschool children and more than 90% of decreased VA with an identifiable cause is related to refractive error--either uncorrected refractive error or amblyopia resulting from refractive error., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objectives: It is estimated that 20% of children in the USA are affected by at least one chronic disease. Although the burden of chronic conditions is greater for minority populations of children, research that has explored the prevalence and risk factors of chronic disease across different racial/ethnic groups is scarce. The aim of this study was to examine racial/ethnic disparities in the prevalence rates of common physical, chronic diseases in White, Black and Hispanic children; and assess the effect of several factors on the risk of having a chronic disease., Methods: Using the 2007 National Survey of Childrens Health, prevalence estimates were calculated for asthma, hearing impairment, visual impairment, joint/bone/muscle problems, brain injury and other illnesses for each racial/ethnic group. Multivariate logistic regression analyses were conducted to examine the effects of several risk factors on the risk of each of these health conditions., Results: The findings show that the prevalence for all health conditions was significantly higher (25.3%) among Black children than White (19.8%) and Hispanic (18.6%) children. Furthermore, 19.5% of Black children have had or currently have asthma compared with 12.2% of White and Hispanic children. More Black and Hispanic children were covered by public health insurance, while 19% of Hispanic children were currently uninsured. White children whose mothers had a health problem were associated with asthma, hearing impairment, visual impairment and joint/bone/muscle problems, while Black children were more likely to report asthma and Hispanics reported visual impairment and joint/bone muscle problems. Hispanic children who were living in poverty or were uninsured were at lower risk for any chronic disease. Regardless of race/ethnicity, children living in a single-parent household were more likely to be associated with any health condition., Conclusions: This study provides evidence that racial/ethnic disparities in chronic physical conditions and health care among US children are extensive. It underscores that uninsured children who do not have access to the healthcare system are not being screened for chronic diseases, or are not obtaining medical care for such health problems. Healthcare providers should educate families about prevention measures and community services that might be able to assist them in improving the health of their children., (Published by Elsevier Ltd.)

Objective: To assess the association of correction of myopia, hyperopia, and astigmatism with self-reported near and distance visual function., Design: Population based, cross-sectional study., Participants: A random sample of 4272 Latinos older than 40 years of age from Arizona with both ophthalmic examination and questionnaire data, including answers to the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25)., Methods: Cases of refractive error (RE) were defined as subjects who met at least 1 of the following criteria in both eyes: myopia, sphere -0.5 diopters (D) or less; hyperopia, sphere 1.0 D or more; or astigmatism, cylinder 0.75 D or more. Uncorrected refractive error (URE) was defined as having RE and achieving 2 lines or more of improvement in visual acuity in both eyes after refraction. The association between RE category and near and distance vision difficulty (as measured by the NEI VFQ-25 near and distance vision subscores) was modeled with ordinal logistic regression, adjusting for age, gender, diabetes, hypertension, income, education, and acculturation., Main Outcome Measures: Association between RE correction and near and distance vision difficulty by type of RE (myopia, hyperopia, and astigmatism)., Results: Of 4272 participants, 54% had RE. Forty-eight percent of these had myopia, 41% had hyperopia, and 11% had astigmatism. Fourteen percent of myopes, 21% of hyperopes, and 22% of astigmatics had URE. Subjects with myopia, astigmatism, and hyperopia were significantly more likely to report more distance vision difficulty than subjects without RE, regardless of whether they had correction (odds ratios [ORs], 1.7-3.7; P<0.005 for all). Subjects with corrected myopia reported less near vision difficulty than subjects without RE (OR, 0.8; 95% confidence interval [CI], 0.7-0.9). Subjects with uncorrected hyperopia and uncorrected astigmatism reported more near vision difficulty than those without RE (OR, 1.6; 95% CI, 1.2-2.2; and OR, 1.7; 95% CI, 1.0-3.0, respectively). Self-reported distance and near visual function scores were sensitive to nonvision variables, namely, age, gender, diabetes, high blood pressure, acculturation score, income, and education., Conclusions: In this population, correction of any type of RE is not entirely sufficient to restore distance visual function to the level of those without RE. More research is necessary to determine the reasons for this shortcoming., (Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the association between self-rated vision and distance visual acuity by race and other factors., Design: Cross-sectional analysis within a longitudinal, population-based cohort study., Participants and Controls: Two thousand five hundred twenty individuals, 65 to 84 years of age, including 666 black participants and 1854 white participants., Methods: All participants reported their self-rated vision score. Binocular distance visual acuity was assessed. Based on the level of visual acuity and the self-reported vision score, participants were placed into concordant and discrepant groups., Main Outcome Measures: Multinomial logistic regression models were used to examine the characteristics associated with concordant and discrepant groups., Results: Black participants were more likely to be represented in the discordant group that reported good vision but had acuity worse than 20/40. In the multivariate analysis, a per-year decrement in years of education received increased the odds of being in both discrepant groups, one that reported good vision but had a visual acuity worse than 20/40 (odds ratio, 1.21; P<0.0001) and the other discrepant group that reported bad vision but had a visual acuity of 20/40 or better (odds ratio, 1.04; P<0.0001). A per-year decrement in years of education received also seemed to explain the excess risk of black race in the discrepant group that reported good vision but had a visual acuity worse than 20/40., Conclusions: Given the socioeconomically driven discrepancies in self-reported vision status, self-reported vision status should be used cautiously in surveillance surveys, especially when assessing vision inequalities between socioeconomic groups., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate risk factors associated with unilateral or bilateral decreased visual acuity (VA) in preschool children., Design: Population-based, cross-sectional prevalence study., Participants: Population-based samples of 6504 children ages 30 to 72 months from California and Maryland., Methods: Participants were preschool African-American, Hispanic, and non-Hispanic white children from Los Angeles, California, and Baltimore, Maryland. Data were obtained by a parental interview and a detailed ocular examination. Logistic regression models were used to evaluate the independent associations between demographic, behavioral, and clinical risk factors with unilateral and bilateral decreased VA., Main Outcome Measures: Odds ratios (ORs) for various risk factors associated with interocular difference (IOD) in VA of ≥2 lines with ≤20/32 in the worse eye, or bilateral decreased VA <20/40 or <20/50 if <48 months of age., Results: In multivariate logistic regression analysis, 2-line IOD with a VA of ≤20/32 was independently associated with Hispanic ethnicity (OR, 2.05), esotropia (OR, 8.98), spherical equivalent (SE) anisometropia (ORs ranging between 1.5 and 39.7 for SE anisometropia ranging between 0.50 to <1.00 diopters [D] and ≥2.00 D), and aniso-astigmatism in J0 or J45 (ORs ranging between 1.4 and ≥5.3 for J0 or J45 differences ranging between 0.25 to <0.50 D and ≥1.00 D). Bilateral decreased VA was independently associated with lack of health insurance (OR, 2.9), lower primary caregiver education (OR, 1.7), astigmatism (OR, 2.3 and 17.6 for astigmatism 1.00 to <2.00 D and ≥2.00 D), and SE hyperopia ≥4.00 D (OR, 10.8)., Conclusions: Anisometropia and esotropia are risk factors for IOD in VA. Astigmatism and high hyperopia are risk factors for bilateral decreased VA. Guidelines for the screening and management of decreased VA in preschool children should be considered in light of these risk associations., Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the prevalence and associations of visual impairment (VI) in preschool children., Design: Cross-sectional, population-based study., Participants: A total of 2461 children (73.8% participation rate), aged 6 to 72 months, were examined in the Sydney Paediatric Eye Disease Study during 2007-2009; of whom 1188, aged 30 to 72 months, with complete visual acuity (VA) data in both eyes, were included in this report., Methods: Measurement of VA was attempted on all children using the Electronic Visual Acuity (EVA) system or a logarithm of the minimum angle of resolution (logMAR) chart. Visual impairment was defined as presenting VA <20/40 in children aged ≥48 months and <20/50 in those aged <48 months. Post-cycloplegic refraction was measured, and myopia was defined as spherical equivalent (SE) ≤-0.50 diopters (D), hyperopia was defined as SE ≥2.00 D, astigmatism was defined as cylinder ≥1.00 D, and anisometropia was defined as SE difference ≥1.00 D between 2 eyes. Ethnicity, birth parameters, and sociodemographic information were collected in questionnaires completed by parents., Main Outcome Measures: Visual impairment prevalence and its associations with child demographic factors and birth parameters., Results: Visual impairment was found in 6.4% of the worse eye and 2.7% of the better eye in our sample. Refractive errors (69.7%) and amblyopia (26.3%) were the principal causes of VI in the worse eye. Astigmatism (51.3%) and hyperopia (28.9%) were the main refractive errors causing VI. In regression analysis controlling for other factors, VI was independently associated with low birthweight of <2500 g (odds ratio 2.4, 95% confidence interval, 1.1-5.3), but not with age, gender, ethnicity, or measures of socioeconomic status (P > 0.05)., Conclusions: Visual impairment in at least 1 eye was found in 6.4% of Australian preschool children, with bilateral VI found in 2.7%. Uncorrected refractive errors and amblyopia were the principal ocular conditions associated with VI. Low birthweight was a significant risk factor independent of age, gender, and ethnicity., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the impact of change in visual field (VF) on change in health-related quality of life (HRQoL) at the population level., Design: Prospective cohort study., Participants: Three thousand one hundred seventy-five Los Angles Latino Eye Study participants., Methods: Objective measures of VF and visual acuity and self-reported HRQoL were collected at baseline and at the 4-year follow-up. Analysis of covariance was used to evaluate mean differences in change of HRQoL across severity levels of change in VF and to test for effect modification by covariates., Main Outcome Measures: General and vision-specific HRQoL., Results: Of 3175 participants, 1430 (45%) showed a change in VF (≥1 decibel [dB]) and 1715 (54%) reported a clinically important change (≥5 points) in vision-specific HRQoL. Progressive worsening and improvement in the VF were associated with increasing losses and gains in vision-specific HRQoL for the composite score and 10 of its 11 subscales (all P(trend)<0.05). Losses in VF of more than 5 dB and gains of more than 3 dB were associated with clinically meaningful losses and gains in vision-specific HRQoL, respectively. Areas of vision-specific HRQoL most affected by greater losses in VF were driving, dependency, role-functioning, and mental health. The effect of change in VF (loss or gain) on mean change in vision-specific HRQoL varied by level of baseline vision loss (in VF, visual acuity, or both) and by change in visual acuity (all P(interaction)<0.05). Those with moderate or severe VF loss at baseline and with a more than 5 dB loss in VF during the study period had a mean loss of vision-specific HRQoL of 11.3 points, whereas those with no VF loss at baseline had a mean loss of 0.97 points. Similarly, with a more than 5 dB loss in VF and baseline visual acuity impairment (mild or severe), there was a loss in vision-specific HRQoL of 10.5 points, whereas with no visual acuity impairment at baseline, there was a loss of vision-specific HRQoL of 3.7 points., Conclusions: Both losses and gains in VF produce clinically meaningful changes in vision-specific HRQoL. In the presence of pre-existing vision loss (VF and visual acuity), similar levels of VF change produce greater losses in QOL., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the age-, gender-, and ethnicity-specific prevalence of myopia and hyperopia in African American and Hispanic children aged 6 to 72 months., Design: Population-based cross-sectional study., Participants: The Multi-Ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children aged 6 to 72 months in Los Angeles County, California. Seventy-seven percent of eligible children completed a comprehensive eye examination. This report focuses on results from 2994 African American and 3030 Hispanic children., Methods: Eligible children in 44 census tracts were identified during an in-home interview and scheduled for a comprehensive eye examination and in-clinic interview. Cycloplegic autorefraction was used to determine refractive error., Main Outcome Measures: The proportion of children with spherical equivalent (SE) myopia /= +2.00 D in the worse eye. Prevalence of myopia and hyperopia is also reported using alternative threshold definitions., Results: Prevalence of myopia was higher in African American (6.6%) compared with Hispanic children (3.7%; P<0.001). Hispanics showed a higher prevalence of hyperopia than African American children (26.9% vs. 20.8% respectively, P<0.001). The prevalence of myopia showed a significant decreasing trend with age (P<0.001). Hyperopia prevalence reached a low point at approximately 24 months of age but increased and remained higher than that thereafter. No significant gender differences were found in the prevalence of refractive error for either ethnic group., Conclusions: We observed ethnicity-related differences in both hyperopia and myopia prevalence in preschool children. The age-related decrease in myopia prevalence in preschool children could reflect early emmetropization and contrasts with the increase in myopia prevalence known to occur in older school-aged children. The limits of emmetropization are evident, however, in the persistently elevated prevalence of hyperopia beyond 24 months of age., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the prevalence and causes of decreased visual acuity (VA) in a population-based study of minority preschool children., Design: Population-based, cross-sectional study., Participants: Children 30 to 72 months of age in 44 census tracts in Los Angeles County., Methods: A population-based sample of children underwent comprehensive ophthalmic evaluation including monocular VA testing, cover testing, cycloplegic autorefraction, anterior segment and fundus evaluation, and VA retesting with refractive correction. The prevalence and etiology of decreased VA were determined, for both presenting and best-measured VA, and better eye and worse eye., Main Outcome Measures: Prevalence of decreased presenting and best-measured VA with an identifiable ophthalmic etiology., Results: Presenting VA was assessed in 3207 children and best-measured VA in 3364 children. Although nearly one third of cases of worse-eye decreased presenting VA were without an identifiable ophthalmic etiology, this proportion decreased with increasing age. Decreased presenting VA that resolved with retesting and was associated with uncorrected refractive error was present in the worse eye of 4.3% of African-American children and 5.3% of Hispanic children, and in the better eye of 1.9% of African-American children and 1.7% of Hispanic children. Decreased best-measured VA that was not immediately correctable with spectacles and that was because of ocular disease, unilateral or bilateral amblyopia, or probable bilateral ametropic amblyopia, was seen in the worse eye of 1.5% of African-American and 1.9% of Hispanic children, and in the better eye of 0.8% of African-American and 0.6% of Hispanic children. Amblyopia related to refractive error was the most common cause., Conclusions: More than 5% of African-American and Hispanic preschool children in Los Angeles County have either correctable visual impairment from uncorrected refractive error or visual impairment from amblyopia related to refractive error.

Objective: Evaluation of intraocular pressure (IOP) adjusted for central corneal thickness (CCT) screening for open-angle glaucoma (OAG) in an at-risk population., Study Design: Community-based screening clinic., Participants: Three hundred and forty-nine persons of black race, or >50 years of age, or with a positive family history of glaucoma., Methods: Ophthalmological examination including Goldmann applanation tonometry, ultrasonographic corneal pachymetry, and visual field testing. Glaucomatous optic nerve damage with visual field loss was the gold standard. IOP was adjusted for CCT based on 3 nomograms. Results were compared with screening using unadjusted IOP. Outcome measures included sensitivity, specificity, areas under the receiver operating characteristic (ROC) curves, positive and negative predictive values (PPVs and NPVs), as well as positive and negative likelihood ratios., Results: No significant difference in CCT was found between those with glaucoma (560 [SD 37] microm, n = 31) and those without (557 [SD 35] microm, n = 233). Screening adjusted IOPs for glaucoma with an IOP > 21 mm Hg resulted in PPVs of 23.8% to 25% and NPVs of 89.3% to 89.6%, similar to preadjustment values. Areas under the ROC curves varied from 0.544 to 0.571 post adjustment from the initial value of 0.574., Conclusions: IOP adjusted for CCT is unlikely to improve tonometry as a screening tool for OAG in an at-risk population.

Objective: To validate the VF-11, a vision-specific function scale and determine the relationship among vision impairment, ocular conditions, and vision-specific functioning in an Asian Malay population., Design: Population-based cross-sectional study., Participants: Persons aged 40 to 80 years of Malay ethnicity in Singapore., Methods: Of the 3280 participants, 3267 answered the VF-11 scale. Participants underwent an extensive and standardized examination procedure, which included visual acuity testing. Sociodemographic and medical data were recorded using a standardized questionnaire. Rasch analysis was initially used to validate the VF-11 and determine its measurement characteristics. Analyses were performed to explore the relationship between the overall functioning score and the presenting unilateral and bilateral vision and ocular conditions using linear regression models., Main Outcome Measure: Vision-specific functioning score., Results: The mean presenting visual acuity values in the better and worse eyes were 0.21 (+/-0.23) and 0.36 (+/-0.27) logarithm of the minimum angle of resolution, respectively. Some 46.4% of participants had some form of visual impairment in either eye, and 1.8% of participants had severe visual impairment in both eyes. By using Rasch analysis, it was shown that a modified VF-11 is a unidimensional, reliable, and valid scale to assess vision-specific functioning in this population. Participants with unilateral or bilateral visual impairment had significantly lower vision functioning scores. The independent association between severe vision loss in one or both eyes and functioning was considered to be clinically meaningful. Eye conditions were not independently associated with overall visual function with bilateral visual impairment in the model with the exception of glaucoma (P<0.05 and beta = -1.08). Compared with people with normal vision, people with mild/moderate visual impairment were 1.6 (95% confidence intervals [CI], 1.2-2.2; P = 0.01) and 2.2 (95% CI, 1.6-3.0; P = 0.007) times more likely to have moderate and poor vision function, respectively. Similarly, participants with severe visual impairment were 3.5 (95% CI, 1.1-12.7; P<0.001) and 13.6 (CI, 4.0-45.4; P<0.001) times more likely to have moderate and poor vision function, respectively., Conclusions: Presenting unilateral and bilateral vision impairment is significantly associated with poor vision-specific functioning across the spectrum of mild to severe vision impairment in this Asian Malay population.

Purpose: To evaluate the diagnostic ability of scanning laser polarimetry (GDx variable corneal compensator [VCC]) for early glaucoma in Asian Indian eyes., Design: Cross-sectional observational study., Participants: Two groups of patients (early glaucoma and normal) who satisfied the inclusion and exclusion criteria were included. Early glaucoma was diagnosed in presence of open angles, characteristic glaucomatous optic disc changes correlating with the visual field (VF) on automated perimetry (VF defect fulfilling at least 2 of 3 Anderson and Patella's criteria with mean deviation >or= -6 decibels). Normal subjects had visual acuity >or= 20/30 and intraocular pressure < 22 mmHg, with a normal optic disc and fields and no ocular abnormality., Methods: All patients underwent complete ophthalmic evaluation, including VF examination (24-2/30-2 Swedish interactive threshold algorithm standard program) and imaging with GDx VCC., Main Outcome Measures: Sensitivity, specificity, positive predictive value and negative predictive value, area under the receiving operating characteristic curve, and likelihood ratios (LRs) were calculated for various GDx VCC parameters., Results: Seventy-four eyes (74 patients) with early glaucoma and 104 eyes (104 normal subjects) were enrolled. TSNIT Std Dev (temporal-superior-nasal-inferior-temporal standard deviation) had the best combination of sensitivity and specificity-61.3 and 95.2, respectively-followed by nerve fiber index score > 50 (sensitivity, 52.7%; specificity, 99%). Nerve fiber index score > 50 had positive and negative predictive values of 74.3% and 97.6%, respectively, for an assumed glaucoma prevalence of 5%. Nerve fiber index score > 50 had a positive LR (+LR) of 54.8 for early glaucoma., Conclusions: GDx VCC has moderate sensitivity, with high specificity, in the diagnosis of early glaucoma. The high +LR for the nerve fiber index score can provide valuable diagnostic information for individual patients.

Purpose: To examine the association between health-related quality of life (HRQOL) and visual field (VF) loss in participants with open-angle glaucoma (OAG) in the Los Angeles Latino Eye Study (LALES)., Design: Population-based cross-sectional study., Participants: Two hundred thirteen participants with OAG and 2821 participants without glaucoma or VF loss., Methods: Participants in the LALES-a population-based prevalence study of eye disease in Latinos 40 years and older, residing in Los Angeles, California-underwent a detailed eye examination including an assessment of their VF using the Humphrey Automated Field Analyzer (Swedish interactive thresholding algorithm Standard 24-2). Open-angle glaucoma was determined by clinical examination. Mean deviation scores were used to assess severity of VF loss. Health-related QOL was assessed by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) and 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Linear regression and analysis of covariance were used to assess the relationship between HRQOL scores and VF loss after adjusting for sociodemographic variables and visual acuity., Main Outcome Measures: The 25-item NEI-VFQ and SF-12 scores., Results: A trend of worse NEI-VFQ-25 scores for most subscales was observed with worse VF loss (using both monocular and calculated binocular data). Open-angle glaucoma participants with VF loss had lower scores than participants with no VF loss. This association was also present in participants who were previously undiagnosed and untreated for OAG (N = 160). Participants with any central VF loss had lower NEI-VFQ-25 scores than those with unilateral or bilateral peripheral VF loss. There was no significant impact of severity or location of VF loss on SF-12 scores., Conclusion: Greater severity of VF loss in persons with OAG impacts vision-related QOL. This impact was present in persons who were previously unaware that they had glaucoma. Prevention of VF loss in persons with glaucoma is likely to reduce loss of vision-related QOL.

Purpose: To determine prevalence, primary causes, and risk indicators of visual impairment in cataract-operated eyes., Design: Population-based cross-sectional study of adult Latinos., Participants: Two hundred sixty-one participants with cataract extraction., Methods: Participants underwent an in-home interview and a comprehensive ophthalmologic examination. Visual impairment in the cataract-operated eye was defined by presenting visual acuity (PVA) of 20/40 or less or best-corrected visual acuity (BCVA) of 20/40 or less. The association of cataract extraction status (aphakic, pseudophakic) and severity of visual impairment was evaluated. Risk indicators associated with visual impairment by BCVA in the worse-seeing cataract-operated eye were evaluated., Main Outcome Measures: Visual acuity, causes of visual impairment, and risk indicators associated with visual impairment., Results: Of the 261 participants with at least one cataract extraction and a complete clinical examination, 100 (38%) participants had undergone a unilateral extraction and 161 (62%) had undergone bilateral extractions. The prevalence of visual impairment was 41% (n = 107) defined by BCVA and 60.5% (n = 158) defined by PVA in the worse-seeing cataract-operated eye, and 32.2% (n = 136) defined by BCVA versus 48.1% (n = 203) defined by PVA in all cataract-operated eyes. Uncorrected refractive error, age-related macular degeneration, and diabetic retinopathy were the primary causes of visual impairment, accounting for 49% in worse-seeing cataract-operated eyes and 57% in all cataract-operated eyes. Self-reported history of glaucoma, barriers to eye care, and unmarried participants were independent risk indicators associated with visual impairment (P<0.05)., Conclusions: Despite cataract surgery, a significant proportion of participants had residual visual impairment. Refractive correction eliminated visual impairment in 15% to 20% of the participants, demonstrating the need for regular ophthalmologic examinations in cataract-operated patients.

Objective: To examine the relationship between visual acuity and mortality in a Chinese population., Design: Population-based cohort study., Participants: Chinese persons in Singapore ages 40 to 79 years at baseline examination., Methods: The Tanjong Pagar Study in Singapore examined 1232 persons (response rate, 71.8%) at the baseline examination in 1997 and 1998. Participants had measurements of presenting and best-corrected visual acuity (VA) using standardized protocols. Mortality data were obtained from the National Death Registry, which linked subjects who had died since the baseline examination. Cause of death was determined from the International Classification of Diseases 9 codes. Analysis was performed on 1225 (99.4%) participants with VA data., Main Outcome Measure: All-cause mortality., Results: By December 31, 2004 (median follow-up, 6.8 years), 126 persons had died. Participants with presenting VA in the better eye worse than 20/40 (logarithm of the minimum angle of resolution [logMAR] score, 0.3) had a significantly higher mortality rate (hazard ratio [HR], 2.9; 95% confidence interval [CI], 1.4-6.3, adjusting for age, gender, hypertension, diabetes, smoking, heart attack, stroke, and income) as compared with participants with VA of 20/20 (logMAR, 0.0). Associations were similar for best-corrected VA in the better eye (HR, 2.7; 95% CI, 1.4-5.5). Among clinic participants with logMAR VA measurements, each 1-line difference in presenting VA (logMAR gain, 0.10) was associated with a 4-fold increased risk of mortality (HR, 4.4; 95% CI, 1.9-10.2)., Conclusions: In this Chinese population in Singapore, visual impairment was associated independently with an increased risk of mortality.

Purpose: To examine the relationship between type 2 diabetes mellitus (T2DM) and the risk of having open-angle glaucoma (OAG) in an adult Latino population., Design: Population-based cross-sectional study., Participants: Latinos 40 years and older (n = 5894) from 6 census tracts in Los Angeles, California., Methods: Participants from the Los Angeles Latino Eye Study (LALES), a large population-based study of self-identified adult Latinos, answered an interviewer-administered questionnaire and underwent a clinical and complete ocular examination, including visual field (VF) testing and stereo fundus photography. A participant was defined as having diabetes mellitus (DM) if she or he had a history of being treated for DM, the participant's glycosylated hemoglobin was measured at 7.0% or higher, or the participant had random blood glucose of 200 mg% or higher. Type 2 DM was defined if the participant was 30 years or older when diagnosed with DM. Open-angle glaucoma was defined as the presence of an open angle and a glaucomatous VF abnormality and/or evidence of glaucomatous optic disc damage in at least one eye. Logistic regression analysis was used to identify the risk of having OAG in persons with T2DM., Main Outcome Measure: Prevalence of OAG., Results: Of the 5894 participants with complete data, 1157 (19.6%) had T2DM and 288 (4.9%) had OAG. The prevalence of OAG was 40% higher in participants with T2DM than in those without T2DM (age/gender/intraocular pressure-adjusted odds ratio, 1.4; 95% confidence interval, 1.03-1.8; P = 0.03). Trend analysis revealed that a longer duration of T2DM (stratified into 5-year increments) was associated with a higher prevalence of OAG (P<0.0001)., Conclusion: The presence of T2DM and a longer duration of T2DM were independently associated with a higher risk of having OAG in the LALES cohort. The high prevalences of T2DM and OAG and their association in this fastest growing segment of the United States population have significant implications for designing screening programs targeting Latinos.

Purpose: To evaluate factors related to awareness of incident open-angle glaucoma (OAG) in the Barbados Eye Studies., Design: Cohort study with 81% to 85% response rate over 9 years., Participants: Four thousand three hundred fourteen participants of African descent, 40 to 84 years old at baseline., Methods: Standardized study visits included an interview on demographic, medical, health care, and other factors; various ophthalmic measurements; fundus photography; and comprehensive ophthalmologic examinations for those referred., Main Outcome Measures: Definite OAG was defined by both visual field and optic disc criteria after ophthalmologic confirmation, regardless of intraocular pressure (IOP). Definite incident participants without prior OAG diagnosis/treatment were considered unaware. Logistic regression analyses evaluated factors associated with OAG unawareness. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs)., Results: Over 9 years, 125 participants newly developed definite OAG, of whom 53% were previously unaware. At baseline, the unaware group had significantly lower mean IOP (OR, 0.86; 95% CI, 0.79-0.94) and more hyperopia (OR, 2.69; 95% CI, 1.08-6.69) than those aware. Most unaware and aware participants had > or =2 medical care visits in the previous year (72.7% vs. 83.1%). However, those in the unaware group sought eye care less frequently than those aware (last visit in preceding year, 33.4% vs. 64.4%); these visits were mainly for eyeglasses (71.4% vs. 12.5%), with most having glaucoma tests only during study visits (72.7% vs. 37.3%). The unaware group reported more visits to opticians/optometrists than to private ophthalmologists (OR, 4.20; 95% CI, 1.00-17.66) and fewer visits to a public ophthalmologic clinic (OR, 0.18; 95% CI, 0.04-0.86)., Conclusions: Over half of participants with incident OAG were unaware of their diagnosis. Unawareness was related to lower IOP, hyperopia, and eye care utilization patterns. Although persons in the unaware group had regular visits for medical care, visits for eye care and OAG testing were limited. Unawareness was 4 times more likely when opticians/optometrists were the regular eye care source, compared with private ophthalmologists, and about 80% less likely with a public ophthalmologic source. These findings highlight the high frequency of undiagnosed OAG and importance of comprehensive examinations in disease detection.

Objective: To compare the diagnostic accuracy of the Moorfields regression classification (MRC) and subjective optic disc evaluation in discriminating early to moderate glaucomatous from nonglaucomatous eyes., Design: Cross-sectional observational study., Participants: Two hundred thirty-three patients with glaucoma and 216 normal subjects were included in the analysis. Racial groups were defined by self-description., Methods: All subjects underwent confocal scanning laser ophthalmoscopy, stereophotography, and standard perimetry. Glaucoma was defined by visual field defect alone and confirmed with a second visual field test. Stereo photographs were graded as either normal or glaucomatous appearing in a masked fashion by 2 independent graders and adjudicated by a third grader in cases of disagreement. Mean disc area was compared between patients correctly and incorrectly diagnosed with either technique., Main Outcome Measures: Sensitivity and specificity of MRC and subjective evaluation of stereophotographs in the detection of glaucomatous visual field loss., Results: With the MRC, the sensitivity and specificity were higher using the 95% cutoff than using the 99.9% cutoff. Classification based on subjective photo assessment had a greater agreement with the diagnosis of glaucoma than the MRC for blacks (MRC, sensitivity = 62.5%, specificity = 93.2%; Photo, sensitivity = 76.5%, specificity = 91.5%) and whites (MRC, sensitivity = 67.0%, specificity = 92.2%; photo, sensitivity = 78.4%, specificity = 91.9%). Disc area was significantly larger in patients incorrectly diagnosed with the MRC (P = 0.0289)., Conclusions: Subjective optic disc grading by glaucoma specialists outperformed the MRC with the HRT II in both black and white subjects. Both subjective and objective diagnostic methods were associated with similar sensitivity and specificity between racial groups. The MRC was more likely to provide an incorrect diagnosis in subjects with larger optic discs.

Objective: To assess the impact of unilateral and bilateral visual impairment (VI) and its severity on health-related quality of life (HRQOL) in Latinos 40 years and older., Design: A cross-sectional population-based study, the Los Angeles Latino Eye Study (LALES)., Participants: Five thousand three hundred seventy-seven LALES participants., Methods: Health-related quality of life was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12). Visual acuity (VA) was measured by a standardized protocol. Based on the presenting VA, VI was classified as unilateral or bilateral impairment and as either mild (20/40-20/63) or moderate/severe (20/80 or worse)., Main Outcome Measures: National Eye Institute VFQ-25 and SF-12 composite and subscale scores., Results: The NEI VFQ mean composite score decreased from no VI (86) to bilateral moderate/severe VI (66) (P<0.006). Relative to participants with no VI, those with unilateral or bilateral VI at any severity level had significantly lower NEI VFQ-25 scores for 10 of the 12 subscales (P<0.05). The largest mean score differences between participants with and without VI were observed for subscales related to driving difficulties (42.5 points), vision-related dependency (29.1 points), distance vision (27.0 points), and vision-related mental health (24.5 points). No differences in SF-12 scores were found between participants with and without VI (P>0.05)., Conclusion: Relative to persons with no VI, persons with bilateral mild and unilateral or bilateral moderate/severe VI report greater difficulties in performing most vision-dependent daily activities and experience vision-related dependency and poorer vision-related mental health. Because most visual function subscale scores were significantly lower in persons with bilateral mild and/or unilateral/bilateral moderate/severe VI, health care providers should consider intervention in these persons. Our findings provide further insight into the relationship between severity level, bilaterality of VI, and self-reported visual function. These data can be used to refine the determination of visual disability in persons with VI.

Purpose: To assess the degree of visual field (VF) loss in subjects diagnosed with primary angle-closure glaucoma (PACG), and to compare the severity of such loss between those with symptomatic and asymptomatic disease., Design: Observational case series., Participants: Seventy-six consecutive subjects with PACG who presented at a Singapore hospital., Methods: Primary angle-closure glaucoma was defined as the presence of glaucomatous optic neuropathy and compatible VF loss associated with closed angles. There were 2 groups of subjects studied: group A consisted of those who presented with acute symptomatic angle closure, and group B consisted of those who were asymptomatic. Subjects underwent static automated threshold perimetry, and the first reliable VF was analyzed using the Advanced Glaucoma Intervention Study (AGIS) scoring system. The field tests were graded according to severity as mild, moderate, severe, and end-stage VF defects, based on AGIS scores of 0 to 5, 6 to 11, 12 to 17, and 18 to 20 respectively., Main Outcome Measures: Advanced Glaucoma Intervention Study scores of the first reliable threshold VF test., Results: The mean age of study subjects was 61.4+/-9.6 years (range: 33-84), and the majority of subjects were female (59%) and Chinese (91%). In group A (n = 40), most eyes had mild or moderate VF defects (23 eyes [57.5%]), whereas 7 eyes (17.5%) had end-stage defects. This was in contrast to group B (n = 36), in which the majority of eyes had end-stage VF loss (19 eyes [52.8%]), with only 5 eyes (13.7%) having mild VF defects. Mean AGIS scores were 9.1+/-7.6 for group A and 14.2+/-6.9 for group B (P = 0.004). Cup-to-disc ratio was a significant predictor for VF loss, but age, gender, and level of presenting intraocular pressure were not correlated with VF outcome., Conclusions: Eyes with asymptomatic PACG often present with severe to end-stage VF loss at the time of first presentation to hospital. In contrast, most PACG eyes with previous symptomatic angle closure present with mild or moderate VF defects. The visual morbidity of PACG may be related to the finding that the asymptomatic form of the disease is visually destructive.

Objective: To estimate the age- and gender-specific prevalence of posterior subcapsular (PSC), nuclear, cortical, and mixed lens opacities in a population-based sample of Latinos 40 years and older., Design: Population-based, cross-sectional study., Participants: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California., Methods: A population-based sample of Latinos underwent a complete eye examination, including assessment of presence and severity of lens opacification, using the slit lamp-based Lens Opacities Classification System II (LOCS II). All lens changes (including pseudophakia/aphakia); any nuclear, PSC, and cortical opacities; and nuclear-only, PSC-only, and cortical-only opacities were evaluated. Frequency distributions and chi-square test analyses were used to determine the age- and gender-specific prevalences for each opacity type., Main Outcome Measures: Prevalences of cortical, nuclear, and posterior subcapsular opacities., Results: Of the 7789 eligible subjects, 6357 completed a clinical examination (82% participation rate). Of all participants with LOCS II grading, 20% had all lens changes, 7.6% had cortical-only opacities, 3.5% had nuclear-only opacities, 0.4% had PSC-only opacities, and 5.9% had mixed-type opacities. The prevalence of all types of lens opacities increased with age (P<0.0001). Of all participants with mixed opacities, 49% had monocular visual impairment and 20% had binocular impairment. Of all 6357 participants, 3.9% had undergone cataract extraction in at least one eye., Conclusion: Our data provide the first population-based estimates of the prevalence and severity of lens opacities in Latinos. Cortical opacities were the most common type. The high rate of visual impairment from lens opacities suggests that programs that increase access to cataract surgery for older Latinos could help to reduce the burden of visual impairment in the United States.

Objective: To assess the association between presenting binocular visual acuity (VA) and self-reported visual function as measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25)., Design: A population-based, prevalence study of eye disease in Latinos 40 years and older residing in La Puente, California (Los Angeles Latino Eye Study [LALES])., Participants: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in La Puente., Methods: All participants completed a standardized interview, including the NEI-VFQ-25 to measure visual functioning, and a detailed eye examination. Two definitions of visual impairment were used: (1) presenting binocular distance VA of 20/40 or worse and (2) presenting binocular distance VA worse than 20/40. Analysis of variance was used to determine any systematic differences in mean NEI-VFQ-25 scores by visual impairment. Regression analyses were completed (1) to determine the association of age, gender, number of systemic comorbidities, depression, and VA with self-reported visual function and (2) to estimate a visual impairment-related difference for each subscale based on differences in VA., Main Outcome Measures: The NEI-VFQ-25 scores in persons with visual impairment., Results: Of the 5287 LALES participants with complete NEI-VFQ-25 data, 6.3% (including 20/40) and 4.2% (excluding 20/40) were visually impaired. In the visually impaired participants, the NEI-VFQ-25 subscale scores ranged from 46.2 (General Health) to 93.8 (Color Vision). In the regression model, only VA, depression, and number of comorbidities were significantly associated with all subscale scores (R(2) ranged from 0.09 for Ocular Pain to 0.33 for the composite score). For 9 of 11 subscales, a 5-point change was equivalent to a 1- or 2-line difference in VA. Relationships were similar regardless of the definition of visual impairment., Conclusion: In this population-based study of Latinos, the NEI-VFQ-25 was sensitive to differences in VA. A 5-point difference on the NEI-VFQ-25 seems to be a minimal criterion for a visual impairment-related difference. Self-reported visual function is essentially unchanged if the definition of visual impairment includes or excludes a VA of 20/40.

Objective: To present for black and white patients with medically uncontrolled glaucoma 10-year results of treatment with 1 of 2 randomly assigned surgical intervention sequences., Design: Randomized clinical trial., Participants: Three hundred thirty-two black patients (451 eyes) and 249 white patients (325 eyes). Eyes had glaucoma that could not be controlled with medications alone., Methods: Eyes were randomly assigned to 1 of 2 sequences: argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) or trabeculectomy-ALT-trabeculectomy (TAT). Second and third interventions were offered after failure of the preceding intervention. Minimum required intraocular pressure (IOP) for intervention failure ranged upward from 18 mmHg, the value depending on whether recent optic disc or visual field (VF) deterioration occurred, and on the magnitude of the field defect. Patients were observed every 6 months, with total potential follow-up ranging from 8 years, 4 months to 13 years., Main Outcome Measures: The averages over follow-up of (1) the percentage of eyes having moderate loss of VF and (2) the percentage of eyes having moderate loss of visual acuity (VA)., Results: Race-treatment interactions in VF and VA loss are significant for the 2 main outcome measures; therefore, results of treatment sequence differences are presented by race. In black patients the average percent of eyes with VF loss was less in the ATT sequence than in the TAT sequence, a difference that is not statistically significant at any visit. In white patients, conversely, after 18 months the average percent of eyes with VF loss was less in the TAT sequence, a difference that increases and is statistically significant in years 8 to 10. In both black and white patients, the average percent of eyes with VA loss was less in the ATT sequence; this difference is statistically significant throughout 10 follow-up years in black patients and is statistically significant only for the first year in white patients. In both black and white patients, average IOP reductions were greater in the TAT sequence, though the TAT-ATT difference was substantially greater in white patients. In both black and white patients, first-intervention failure rates were substantially lower for trabeculectomy than for trabeculoplasty. Ten-year cumulative incidence of unilateral VF impairment comparable to legal blindness was modest in eyes of black (ATT 11.9%, TAT 18.5%) and white (ATT 9.9%, TAT 7.3%) patients., Conclusions: Although IOP was lowered in both sequences in black and white patients with medically uncontrolled glaucoma, long-term visual function outcomes were better for the ATT sequence in black patients and better for the TAT sequence in white patients.

Purpose: To study the long-term clinical course of North American chronic angle-closure glaucoma (CACG) patients with optic disc damage and visual field loss in the presence of an angle closed at least partially by peripheral anterior synechiae and to compare it with a similar group of Singaporean patients., Design: A retrospective, interventional case-control study series., Participants: Fifty-one patients (80 eyes) diagnosed with CACG with glaucomatous optic nerve head and visual field damage at a New York hospital from January 1990 through December 1994. All study eyes underwent laser peripheral iridotomy (LPI)., Methods: The presenting features, management, and subsequent long-term intraocular pressure (IOP) outcome were analyzed and compared with 65 Asian patients (83 eyes) from a Singapore hospital who were similarly diagnosed during the same period., Main Outcome Measures: The long-term outcome after LPI was assessed in terms of IOP and the requirement for additional therapy., Results: The mean presenting IOP was higher in the Singapore eyes (40 +/- 15 mmHg) compared with the New York eyes (31 +/- 12.5 mmHg). All 80 New York eyes (100%) and 78 of 83 Singapore eyes (94%) required further treatment to control IOP during follow-up. Of the eyes with a subsequent rise in IOP, 33 of 80 eyes (41.3%) compared with 34 of 83 eyes (41.0%) of the Singapore patients were controlled with additional topical medication. Of the New York eyes, 25 of 80 (31.3%) eventually underwent filtering surgery, compared with 44 of 83 (53.0%) in the Singapore study. The other 22 eyes (27.5%) in the New York group went on to additional laser procedures, peripheral iridoplasty, laser trabeculoplasty, or a combination thereof, after which IOPs were controlled and no surgery was required. There was no similar comparison for the Singapore group, because these eyes went directly on to surgery., Conclusions: Despite the presence of a patent LPI, most eyes with CACG presenting with elevated IOP and having both optic disc and visual field damage in both populations required further treatment to control IOP. Results in the American population are similar to that reported in Asian patients.

Objective: To describe the causes of blindness and visual impairment in a population-based sample of Hispanics., Design: A cross-sectional study., Participants: A random sample of 4774 Hispanic residents of Santa Cruz and Pima Counties in Southern Arizona aged 40 years and older who participated in Proyecto VER (Vision Evaluation and Research)., Testing: Subjects were interviewed and underwent a thorough ophthalmic examination. Presenting and best-corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol, followed by a standardized ophthalmic examination to determine the causes of visual loss. Anterior and posterior segment specialists in ophthalmology confirmed the causes., Main Outcome Measures: Causes of visual loss (best-corrected acuity worse than 20/40)., Results: The response rate of eligible participants was more than 70%. Best-corrected acuity in the better seeing eye worse than 20/40 increased from 0.3% in those aged 40 to 49 to 5.6% in those aged 65 and older. The leading cause was cataract, accounting for 42% of all visual loss, followed by age-related macular degeneration (15%), and diabetic retinopathy (13%). Among 14 people who were bilaterally blind, open-angle glaucoma was the leading cause. Women had higher age-adjusted prevalence of severe cataract compared with men and were more likely to be visually impaired from cataract, diabetic retinopathy, and open-angle glaucoma, although gender differences were not statistically significant., Conclusions: Causes of visual impairment differ from those reported in Caucasian populations, with open-angle glaucoma being the leading cause of blindness. Further work on gender-based obstacles to eye care in the Hispanic community may be warranted.

Objective: This study aimed to provide a comparative analysis of American population-based prevalence of uncorrected binocular distance visual acuity in Hispanics and non-Hispanics., Design: The study design was a population-based survey., Participants: Data from the Hispanic Health and Nutrition Examination Survey between 1982 and 1984 and the National Health and Nutrition Examination Survey I from 1974 through 1975 were analyzed to investigate the epidemiology of uncorrected binocular distance visual acuity in adults 25 to 74 years of age in Cuban Americans (N = 391), Mexican Americans (N = 1350), Puerto Ricans (N = 504), African Americans (N = 245), and non-Hispanic white Americans (N = 2571)., Main Outcome Measure: Uncorrected binocular distance visual acuity in both eyes was assessed using Sloan letters or Landolt rings., Results: Prevalence rates of 20/50 or worse uncorrected binocular distance visual acuity were 22%, 24%, 19%, 18%, and 32% for African Americans, Cuban Americans, Mexican Americans, Puerto Ricans, and non-Hispanic whites, respectively. After adjustment for gender and age, the rates were significantly higher (P < 0.05) for non-Hispanic whites compared to each of the other ethnic groups. Significant increases in the prevalence of 20/50 or worse distance visual acuity were observed for increasing age groups (25-39, 40-59, and 60-74 years) within each gender-ethnic subgroup. Analysis of differences in prevalence by gender (controlling for age) indicated a slightly higher prevalence of 20/50 or worse distance visual acuity in women than in men (range of odds ratios, 1.1-2.1). Based on 1993 census population estimates in the United States, more than 42 million adults 25 to 74 years of age have an uncorrected binocular distance visual acuity of 20/50 or worse. Approximately 1.7 million of these adults are of Hispanic origin., Conclusion: The prevalence of impaired uncorrected binocular distance visual acuity generally is lower in Hispanics than in non-Hispanic whites.