Search

Background: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. Methods: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from

BackgroundThis study aimed to assess the prevalence and causes of vision loss in sub-Saharan Africa (SSA) in 2015, compared with prior years, and to estimate expected values for 2020.MethodsA systematic review and meta-analysis assessed the prevalence of blindness (presenting distance visual acuity In SSA, age-standardised prevalence of blindness, MSVI and MVI in 2015 were 1.03% (80% uncertainty interval (UI) 0.39–1.81), 3.64% (80% UI 1.71–5.94) and 2.94% (80% UI 1.05–5.34), respectively, for male and 1.08% (80% UI 0.40–1.93), 3.84% (80% UI 1.72–6.37) and 3.06% (80% UI 1.07–5.61) for females, constituting a significant decrease since 2010 for both genders. There were an estimated 4.28 million blind individuals and 17.36 million individuals with MSVI; 101.08 million individuals were estimated to have near vision loss due to presbyopia. Cataract was the most common cause of blindness (40.1%), whereas undercorrected refractive error (URE) (48.5%) was the most common cause of MSVI. Sub-Saharan West Africa had the highest proportion of blindness compared with the other SSA subregions.ConclusionsCataract and URE, two of the major causes of blindness and vision impairment, are reversible with treatment and thus promising targets to alleviate vision impairment in SSA.

BackgroundTo determine the prevalence and causes of blindness and vision impairment (VI) in East Asia in 2015 and to forecast the trend to 2020.MethodsThrough a systematic literature review and meta-analysis, we estimated prevalence of blindness (presenting visual acuity ResultsIn 2015, age-standardised prevalence of blindness, MSVI, mild VI and uncorrected presbyopia was 0.37% (80% uncertainty interval (UI) 0.12%–0.68%), 3.06% (80% UI 1.35%–5.16%) and 2.65% (80% UI 0.92%–4.91%), 32.91% (80% UI 18.72%–48.47%), respectively, in East Asia. Cataract was the leading cause of blindness (43.6%), followed by uncorrected refractive error (12.9%), glaucoma, age-related macular degeneration, corneal diseases, trachoma and diabetic retinopathy (DR). The leading cause for MSVI was uncorrected refractive error, followed by cataract, age-related macular degeneration, glaucoma, corneal disease, trachoma and DR. The burden of VI due to uncorrected refractive error, cataracts, glaucoma and DR has continued to rise over the decades reported.ConclusionsAddressing the public healthcare barriers for cataract and uncorrected refractive error can help eliminate almost 57% of all blindness cases in this region. Therefore, public healthcare efforts should be focused on effective screening and effective patient education, with access to high-quality healthcare.

To assess the visual and anatomic outcomes of central serous chorioretinopathy (CSC) after verteporfin photodynamic therapy (PDT).Retrospective case series.Patients with CSC who underwent PDT.Members of the Macula Society were surveyed to retrospectively collect data on PDT treatment for CSC. Patient demographic information, PDT treatment parameters, fluorescein angiographic information, optical coherence tomography (OCT) metrics, pre- and post-treatment visual acuity (VA), and adverse outcomes were collected online using standardized forms.Visual acuities over time and presence or absence of subretinal fluid (SRF).Data were submitted on 265 eyes of 237 patients with CSC with a mean age of 52 (standard deviation [± 11]) years; 61 were women (26%). Mean baseline logarithm of the minimum angle of resolution (logMAR) VA was 0.39±0.36 (20/50). Baseline VAs were ≥20/32 in 115 eyes (43%), 20/40 to 20/80 in 97 eyes (37%), and ≤20/100 in 47 eyes (18%). Normal fluence was used for PDT treatment in 130 treatments (49%), half-fluence was used in 128 treatments (48%), and very low fluence or missing information was used in 7 treatments (3%). The number of PDT treatments was 1 in 89%, 2 in 7%, and 3 in 3% of eyes. Post-PDT follow-up ranged from 1 month to more than 1 year. Post-PDT VA was correlated with baseline VA (r = 0.70, P 0.001). Visual acuity improved ≥3 lines in1%, 29%, and 48% of eyes with baseline VA ≥20/32, 20/40 to 20/80, and ≤20/100, respectively. Subretinal fluid resolved in 81% by the last post-PDT visit. There was no difference in the response to PDT when analyzed by age, race, fluence setting, fluorescein angiography (FA) leakage type, corticosteroid exposure, or fluid location (subretinal or pigment epithelial detachment; all P 0.01). Complications were rare: Retinal pigment epithelial atrophy was seen in 4% of patients, and acute severe visual decrease was seen in 1.5% of patients.Photodynamic therapy was associated with improved VA and resolution of SRF. Adverse side effects were rare.

Optical coherence tomography (OCT) angiography (OCT-A) represents an innovative imaging technique which can delineate the retinal and choroidal vascular networks. OCT-A in the assessment of chorio-retinal dystrophies reveal alterations especially located at the level of the deep capillary plexus and the choriocapillaris. This information can have a direct implication on the understanding of the pathogenesis of dystrophies and for their future therapeutic management.

Objective:\ud \ud To assess the number of individuals visually impaired or blind due to glaucoma and to examine regional differences and temporal changes in this parameter for the period from 1990 to 2012.\ud \ud Methods:\ud \ud As part of the Global Burden of Diseases (GBD) Study 2010, we performed a systematic literature review for the period from 1980 to 2012. We primarily identified 14,908 relevant manuscripts, out of which 243 high-quality, population-based studies remained after review by an expert panel that involved application of selection criteria that dwelt on population representativeness and clarity of visual acuity methods used. Sixty-six specified the proportion attributable to glaucoma. The software tool DisMod-MR (Disease Modeling–Metaregression) of the GBD was used to calculate fraction of vision impairment due to glaucoma.\ud \ud Results:\ud \ud In 2010, 2.1 million (95% Uncertainty Interval (UI):1.9,2.6) people were blind, and 4.2 (95% UI:3.7,5.8) million were visually impaired due to glaucoma. Glaucoma caused worldwide 6.6% (95% UI:5.9,7.9) of all blindness in 2010 and 2.2% (95% UI:2.0,2.8) of all moderate and severe visual impairment (MSVI). These figures were lower in regions with younger populations (10%). From 1990 to 2010, the number of blind or visually impaired due to glaucoma increased by 0.8 million (95%UI:0.7, 1.1) or 62% and by 2.3 million (95%UI:2.1,3.5) or 83%, respectively. Percentage of global blindness caused by glaucoma increased between 1990 and 2010 from 4.4% (4.0,5.1) to 6.6%. Age-standardized prevalence of glaucoma related blindness and MSVI did not differ markedly between world regions nor between women.\ud \ud Significance:\ud \ud By 2010, one out of 15 blind people was blind due to glaucoma, and one of 45 visually impaired people was visually impaired, highlighting the increasing global burden of glaucoma.

In the article listed above, there is an error in Table 1. The value for "Number of people (000s)with blindness in 2010" for "Asia, Southeast" should read 49 (35d76) and not 499 (35d76). The authors regret the error. The online version reflects this change.

Purpose To describe a short questionnaire for a rapid assessment of risk factors for AMD, and assess its feasibility and relevance in a large-scale Italian study. Methods Risk factors having shown the most consistent associations with AMD in the literature were included in the STARS (Simplified Théa AMD Risk-assessment Scale) questionnaire, which was designed to be simple, quick and easy to fill in. Its feasibility and relevance were assessed in an Italian nationwide study. Between May and September 2010, all patients of both genders, aged 55 years or more, consulting the participating ophthalmologists during one week of consultations, were invited to take part in the study. Items on demography, medical history, and lifestyle were filled in by the patient. The ophthalmologist then performed the eye examinatio,and filled in the second part of the questionnaire (iris colour, cataract extraction, refraction, AMD classification). Patients affected by soft drusen and/or pigmentary abnormalities were classified as early AMD, whereas patients affected by geographic atrophy and/or neovascular AMD were classified as late AMD. Subjects with early and late AMD were compared to those without AMD using polytomous nominal logistic regression. Results One hundred and seventy-seven ophthalmologists prospectively recruited 12,639 subjects. Overall, 6061 (48.0%) were affected by early AMD, 1483 (11.7%) by late AMD, whereas 5095 (40.3%) were not affected by AMD. In the final multivariate model, age, female gender, North-African origin, family history of AMD, smoking, obesity, history of cardiovascular diseases,cataract surgery, myopia, hyperopia, living in a sunny area and usual solar protection were significantly associated with increased risk for both early and late AMD. High fruit consumption was associated with a significantly decreased risk for early and late AMD, while consumption of green vegetables and fish were not significantly associated with early or late AMD.Consumption of alcohol (beer or wine) and clear iris wereassociated with increased risk for early but not late AMD. Conclusions The STARS questionnaire can easily be implemented in the practice of ophthalmologists. It may prove useful as a screening tool, after improvement and further validation.

To evaluate the direct costs of patients affected by Age-related Macular Degeneration (AMD) in Italy, from the perspective of the payers. A retrospective study, conducted in seven centers of North and Centre South Italy. 497 patients affected by AMD were enrolled and divided into six subgroups: new and previous drusen, new and previous geographic atrophy, new and previous Choroidal NeoVascularization (CNV). Newly diagnosed subgroups included patients with a diagnosis of AMD made less than 6 months before the enrolment into the study. The high mean age (74 years) and the high proportion in the sample of retired people (76%) reflected the expected characteristics of patients with AMD. The mean cost per patient by group was: €105,7 and 91,7 for new and previous drusen, €85,4 and €180,9 for new and previous geographic atrophy, €264,3 and €290,1 for new and previous CNV. The study provides some potentially useful information about the costs of AMD in Italy: the analysis did not confirm statistical differences between new and previous diagnosed patients.

Purpose To assess the effects of intravitreal bevacizumab injection (IVBI) in the treatment of choroideal neovascularization (CNV) secondary to pattern dystrophy (PD) of the retinal pigment epithelium. Methods Prospective interventional case series. Patients with PD complicated by CNV were considered. All patients underwent a complete ophthalmologic examination, including ETDRS visual acuity, electroretinogram, electrooculogram, optical coherence tomography, fluorescein angiography, and indocyanine green angiography. The protocol required 3 monthly consecutive IVBI, followed by repeat injections on the basis of OCT parameters and angiographic features over the 24-month follow-up. Results Twelve patients completed the planned visits and were considered for the purpose of the study. Mean best corrected visual acuity (BCVA) and mean central macular thickness (CMT) at the baseline were 0.73±0.34 (logMAR±SD) and 276±95µm SD, respectively. At three-month examination, mean BCVA significantly improved to 0.48±0.27, whereas mean CMT decreased to 220±71µm SD. At 12-month examination, mean BCVA was 0.45±0.24, and mean CMT was 209±53µm. At the 24-month examination, mean BCVA showed a substantial stabilization whereas mean CMT decreased to 199±34µm. No side-effect or complication was registered. Conclusions IVBI is a valuable treatment for subfoveal CNV associated with PD over a 2-year follow-up. Further studies are necessary to validate our results, and to examine other morpho-functional parameters such as fundus autofluorescence and retinal sensitivity changes.

Background: To describe the prevalence and causes of visual impairment and blindness in North Africa and the Middle East (NAME) in 1990 and 2010. Methods: Based on a systematic review of medical literature, we examined prevalence and causes of moderate and severe vision impairment (MSVI; presenting visual acuity

Purpose To describe the effectiveness of subthreshold laser treatment (SLT) with infrared micropulse diode laser for the treatment of retinal arterial macroaneurysms (RAM) associated with macular exudation. Methods Interventional case series including 8 cases of RAM who underwent treatment with SLT. Complete ophthalmic examinations, including Early Treatment of Diabetic Retinopathy Study visual acuity (ETDRS-VA), OCT and fluorescein angiography, were performed at the moment of the study entry and at 3-month intervals, with a planned follow-up of 12 months. Main outcome measures were the decrease in mean foveal thickness (MFT) on OCT, and the changes in ETDRS-VA. Results The change in MFT from the initial values was statistically significant (p

Purpose To assess the effects of intravitreal bevacizumab (Avastin) injections in the treatment of choroideal neovascularization (CNV) with large submacular hemorrhage (LSH) secondary to age-related macular degeneration (AMD). Methods Prospective interventional case series. Patients with occult CNV with LSH greater the 50% of the entire lesion were considered. The protocol required 3 monthly consecutive injections, followed by repeat injections over the 12-month follow-up on the basis of OCT parameters, angiographic features, visual acuity response. Results Eight patients were enrolled in the study and prospectively followed up. Mean visual acuity and mean foveal thickness (FT) at baseline were 0.72±0.35 (logMAR±SD) and 296±86µm SD, respectively. At three-month examination, mean visual acuity improved to 0.46±0.28 SD and mean FT decreased to 240±105µm SD. At 12-month examination, mean visual acuity was 0.48±0.32 SD, and mean FT 238±50µm SD. A progressive resolution of macular bleeding was registered in 7 patients. Neither side-effect or complication was registered. Conclusions Intravitreal bevacizumab seems to be a beneficial treatment for CNV with LSH secondary to AMD. A randomized clinical trial with greater number of patients and control group is needed to confirm our preliminary results.

Purpose Yo describe fundus autofluorescence (FAF) characteristics of Adult-onset Foveomacular Vitelliform Dystrophy (AOFVD) and to find a correlation with the functional responses. Methods Patients affected by AOFVD underwent a complete ophthalmologic examination, including ETDRS visual acuity, blue-light autofluorescence (BL-FAF) and near-infrared autofluorescence (NIR-FAF) performed using the HRA confocal scanning laser ophthalmoscope, and microperimetry (MP-1 Microperimeter, Nidek). Results 15 patients affected by AOFVD were enrolled. Three different patterns were identified on BL-FAF and 2 on NIR-AF. Patchy pattern both on BL-FAF and on NIR-FAF reveal the worst functional response, showing lowest visual acuity and retinal sensitivity values. Conclusions A functional correlate with visual acuity and retinal sensitivity, measured by means of microperimetry, can be found. Longitudinal studies investigating the natural course of FAF patterns of AOFVD may be useful both to identify genetic influence and prognostic factors, and to determine specific clinical and functional correlates.

Purpose: To evaluate the effects of the therapy combining intravitreal triamcinolone injection (IVT) and subthreshold grid laser treatment with infrared micropulse 810 nm diode laser for macular edema secondary to branch retinal vein occlusion (BRVO). Methods: Prospective interventional case series, including 11 patients (11 eyes) with macular edema secondary to BRVO. All the patients received IVT (4 mg) and 3 weeks later underwent infrared subthreshold (no intraoperative visible endpoint) grid laser treatment. Best–corrected visual acuity with ETDRS charts, foveal thickness measured by optical coherence tomography, fluorescein angiography, and intraocular pressure were evaluated at baseline and at each follow–up examination. Main outcome measures were the changes of at least 2 lines of visual acuity and the foveal thickness reduction of at least 25% from the baseline values. The follow–up ranged from 8 to 12 months (mean: 8,9 months). Results: At the end of the follow–up an improvement of at least 2 lines of best–corrected visual acuity was registered in 9 eyes (82%). Foveal thickness improved in 9 eyes (82%), with an overall change from a mean initial value of 479µ to a mean final value of 259µ. Four eyes (36%) developed an intraocular pressure rise over 22 mmHg requiring glaucoma therapy. No patient revealed cataract progression. Conclusions: Combined therapy of IVT and subthreshold grid laser treatment with infrared micropulse 810 nm diode laser is an effective treatment in improving visual function in patients affected by macular edema associated with BRVO.

Purpose: To evaluate the effectiveness of subthreshold grid laser therapy with infrared micropulse 810 nm diode laser in the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). Methods: In a prospective, randomized clinical trial, thirty–six patients with macular edema secondary to BRVO were randomized either to infrared subthreshold (no intraoperative visible endpoint) grid laser treatment, or to conventional threshold (visible endpoint) grid laser treatment with 647 nm krypton laser. The primary outcome measure was the number of eyes that gained at least 10 letters (approximately 2 or more lines of visual acuity gain) at the 12– and 24–month examinations in the two groups. Results: By the month–12 visit, an improvement of at least 2 lines of visual acuity was registered in 59% and 58% of patients treated using infrared subthreshold grid and using krypton laser, respectively. A gain of at least 2 lines of visual acuity was registered in 64% and 58% of patients treated using infrared subthreshold grid and using krypton laser, respectively, by the month–24 examination. Interestingly, no clinically or angiographically visible sign of the administered laser spots was detectable after subthreshold grid laser treatment. Conclusions: Subthreshold infrared micropulsed grid laser treatment is as effective as krypton grid laser treatment in improving visual acuity in patients affected by macular edema secondary to BRVO.

Purpose: To evaluate the precision of the IcareONE rebound tonometer, which was developed for self-measuring intraocular pressure (IOP) and to compare IcareONE measurement with Goldmann applanation tonometry (GAT). Methods: Twenty-four healthy eyes and 81 glaucomatous eyes were enrolled. IOP measurements (three times per session) with IcareONE were made in a random order by an ophthalmologist (Icare(O)) and by the subject (Icare(S)). Intraclass correlation coefficients (CCs), kappa values and mean values of IOP were compared among the two types of Icare recordings and GAT. Bland–Altman analysis was used to assess agreement between methods. Multiple regression analysis was performed to identify the subject factors that influenced the discordant measurements between IcareONE and GAT. Results: The mean value of Icare(O) and Icare(S) measurements was 13.5 ± 5.2 and 13.5 ± 5.4 mmHg, respectively, neither of which was significantly different from GAT (13.8 ± 4.4). The intrarater CC of Icare(O) and Icare(S) was 0.968 and 0.885, respectively. The intermethod CC and weighted kappa between Icare(O) and Icare(S) were 0.907 and 0.684, respectively. All pairwise correlations between the two types of IOP measurement showed coefficients of determination >0.8. Bland–Altman analysis did not show any proportional biases. Multiple regression analysis revealed that the differences between GAT and Icare(O) or Icare(S) were positively correlated with central corneal thickness (CCT) and negatively correlated with age. Conclusions: Intraocular pressure measurements with IcareONE by a physician and by the subject showed excellent agreement with GAT measurements; IcareONE measurements between a physician and the subject had high intrarater reliability, and good agreement thicker CCT led IcareONE measurement to overestimate IOP, while higher age caused it to underestimate IOP compared with GAT.

BACKGROUND: The aim was to describe the morphology and localisation of crystals in a case of Bietti's crystalline corneo-retinal dystrophy (BCD) by means of spectral domain optical coherence tomography (SD-OCT) and in vivo confocal microscopy (IVCM).METHODS: Clinical examination, SD-OCT and IVCM evaluation of a 35-year-old woman with BCD.RESULTS: Optical coherence tomography examination of the macular region revealed multiple crystals in the retinal pigment epithelium (RPE)-choriocapillaris, some crystals within the full thickness of the neurosensory retina and less numerous crystals in the choroid. Crystals were present peripherally in areas of retinal atrophy, predominantly in the choroid and to a lesser extent in the RPE-choriocapillaris and the neuroepithelium. In vivo confocal microscopy showed multiple crystals of varying morphology in the peripheral and paralimbal cornea, mainly located in the anterior stroma over 360°.CONCLUSIONS: SD-OCT provided greater precision in the localisation of crystals, found mainly in the choroid and RPE-choriocapillaris rather than the neuroepithelium. In vivo confocal microscopy revealed a higher number of crystals compared to those visible using conventional slitlamp biomicroscopy and showed a different crystal morphology.

Purpose: to evaluate the fluorescein and indocyanine green angiographic characteristics of recurrent choroidal neovascularization (R-CNV)in age-related macular degeneration (AMD). Method: a prospective investigation performed on 107 consecutive patients with exudative AMD and CNV not involving the foveal avascular zone was conducted. Laser treatment was ICGA-guided. In each patient, best corrected visual acuity (BCVA) on ETDRS charts was measured. FA and ICGA were performed in the same session the day before treatment and later repeated 3 weeks and 2, 3, 4, 6, 9, 12 months after photocoagulation. In eyes with questionable angiographic features for R-CNV at 3-week control, examinations were repeated each week till the pattern was defined. Result: at 1 year from photocoagulation, R-CNV occurred in 53 (49.5%) eyes, with classic features in 14 (26.4%) eyes, and occult in 39 (73.6%) on FA. At the 3-week follow-up visit, 49 (45.8%) eyes showed leakage beyond margins of laser scar on FA, whereas on ICGA hot spots appeared in 23 (21.5%) eyes, marginally in 21 cases and centrally in 2. One week later, in 5 of these eyes leakage persisted on FA and marginal hot spots on ICGA with subfoveal location were still detectable. Additional FA and ICGA performed at 5 weeks revealed lesion enlargement in all 5 eyes, leading to persistent CNV diagnosis. ICGA highlighted 3 patterns of R-CNV: Focal R-CNV (39 eyes, 73.6% of all R-CNV), a single dot-like hyperfluorescence along photocoagulated area margin, already detectable in early phases; Anular R-CNV (10 eyes, 18.8%), a hyperfluorescent, irregulary-shaped lesion, partially or completely encircling treated area, detectable in intermediate and late phases; Plaque R-CNV (4 eyes, 7.5%), a hyperfluorescent lesion greater than 1 disc diameter, expanding sectorially from the border of the treated area, and visible during intermediate and late phases. At the time of R-CNV onset, focal pattern had the BCVA among the three patterns whereas the final mean values are similar in the three groups. Conclusion: R-CNV resulted to be ill-defined in 73.6% of eyes, highlighting the role of ICGA in defining R-CNV site and extension. Only after disappearance of temporary hot spots on ICGA, that occurred at 4-week control, a precise distinction between them and real persistent CNV can be made. Three main patterns of R-CNV on ICGA were identified. Focal R-CNV has the best visual acuity at the onset time, probably due to smaller size, and anular R-CNV the worst, but at follow-up end mean BCVA is similar in the 3 patterns. Focal and plaque R-CNV lose an avarage of about 3 lines, whereas anular R-CNV retains its BCVA nearly unmodified.

Age-related macular degeneration (AMD) is an irreversible pathology that is the principal cause of serious loss of central vision and legal blindness among people over 60 years of age. There are two forms of AMD: the dry, or atrophic form, and the wet, neovascular form. The latter is less frequent but is the cause of approximately 80–90% of cases of serious loss of vision in a short time period. Early diagnosis is therefore essential to permit intervention as promptly as possible. Currently, the most effective therapy for neovascular AMD uses the new class of anti-VEGF drugs, and ranibizumab is today’s ‘gold standard’ for this treatment. The Progetto LUCE (LUCE Project) consists of an advisory board of retinal disease specialists in Lombardy, Italy, whose task is to propose a consensus for the diagnosis, treatment and follow-up of neovascular AMD patients treated with ranibizumab on the basis of a review of the scientific evidence and Italian national health service regulations and the clinical experience of the advisory board members.

Purpose To compare the effects of subthreshold laser treatment (STLT) with threshold laser treatment (TLT) in patients affected by symptomatic retinal arterial macroaneurism (RAM). Methods The trial was registered at Clinicaltrail.gov (number NCT01301326 ). Patients affected by symptomatic RAM, characterized by exudative manifestations involving the fovea and best corrected visual acuity (BCVA) worse than 20/80 Snellen equivalent, were recruited. Patients were randomly assigned to STLT or TLT and regularly followed up for 12 months. Primary outcome measures: Changes in central point thickness (CPT) at the end of the follow-up. Secondary outcome measures: Changes in mean BCVA at the end of the follow-up, and identification of post-laser alterations. Results In this single centre, randomized, clinical trial, 12 patients were randomized to STLT and 13 to TLT. CPT at baseline was 332μm and 341μm, changing to 249μm and 226μm at the 12-month examination, in STLT and TLT, respectively, with a statistically significant difference (p