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Purpose To measure the central corneal thickness (CCT) using anterior segment optical coherence tomography (AS-OCT) in older adults with and without pterygium from the Brazilian Amazon Region Eye Survey (BARES). Methods BARES is a population-based epidemiological cross-sectional study conducted in Parintins city. Participants were residents ≥45 years of age identified through a door-to-door interview. Eligible participants were invited for a comprehensive eye exam. Pterygium occurrence and severity were assessed by ophthalmologists through slit-lamp examination considering its location (nasal or/and temporal) and severity (lesion with extension Results A total of 671 subjects, 533 (79.4%) with pterygium in at least one eye and 138 (20.6%) without pterygium in either eye, were examined. The mean CCT evaluated by multiple linear regression and adjusted for demographic variables and pterygium severity was 521 ± 34 μm (median = 521; range = 304–665). Decreased CCT was significantly associated with age and pterygium severity. Individuals aged 65–74 years had CCT 7 μm thinner than those aged 45–54 years ( p = 0.044), individuals aged 75 years and older had CCT 15 μm thinner than those aged 45–54 years ( p = 0.001), and eyes with severe pterygium had CCT 33 μm thinner than eyes without pterygium ( p Conclusions The CCT analysis in this population-based sample shows that a thinner cornea is associated with pterygium severity and older age.

Purpose To investigate the prevalence and causes of near vision impairment (NVI) in a population of older adults from the Brazilian Amazon Region. Design Population-based cross-sectional study. Methods Cluster sampling was used in randomly selecting subjects 45 years of age and older from urban and rural areas of Parintins city, Brazil. Participants underwent ophthalmic examination, including uncorrected (UCNVA), presenting (PNVA), and best-corrected near visual acuity (BCNVA) from each eye; biomicroscopy; funduscopy; and subjective refraction, including testing with additional lenses for near vision optical correction. A principal cause for NVI was assigned by the ophthalmologist and presbyopia was defined as UCNVA ≤ 20/40 changing to > 20/40 with BCNVA. Free-of-charge glasses were provided for those in need. Results A total of 2384 subjects were enumerated and 2025 had reliable NVA measurements from both eyes. The prevalence of NVI in the better-seeing eye was 96.5% with UCNVA, decreasing to 81.1% with PNVA and to 20.5% with BCNVA. Presbyopia was the principal cause of NVI in 71.8%, followed by cataract (16.5%) and pterygium (2.5%), and was associated with younger age and high schooling. Glasses for near vision were prescribed and provided to 1414 (69.8%) participants. Conclusions A high prevalence of NVI was detected even in those wearing glasses for near. Prescription and provision of low-cost reading glasses should be considered by Brazilian health authorities to address this easily and promptly correctable form of vision impairment.

Morning Glory Syndrome is a very rare condition. It is characterized by an enlarged and funnel-shaped optic disc excavated and is associated with other craniofacial anomalies such as hypertelorism, cleft lip, cleft palate, and basal encephalocele. CaseReport. A case of a 30 year-old man who came for neurosurgical evaluation after a magnetic resonance imaging (MRI) scan that showed spheno-ethmoidal encephalocele is reported. Conclusions. There is a high association between basal encephalocele,midface abnormalities and Morning Glory Syndrome. A neurosurgical, ophtalmological and endocrinological evaluation must always be done. The patients present with ophtalmic signs and/or strabismus or poor vision. An image study should always be performed to delineate the extent of the lesion and a complete hormone screening should be carried out to exclude pituitary deficiency.

PURPOSE To investigate cataract surgery prevalence, complications, visual outcomes, and coverage in a population of older adults from the Brazilian Amazon region. DESIGN Population-based cross-sectional study. METHODS Individuals ≥45 years of age from urban and rural areas of Parintins City, Brazil, were identified by cluster random sampling. Participants underwent ophthalmic examination, including uncorrected visual acuity, acuity with presenting correction (APC), and best-corrected visual acuity (BCVA) from each eye. In those with previous cataract surgery, surgical technique and complications including its contribution to vision impairment were noted. The association of surgical complications and surgical coverage with sociodemographic variables was assessed by multiple logistic regression. RESULTS A total of 2,384 persons were determined to be eligible, and 2,041 (85.6%) were examined. Overall, prevalence of cataract surgery was 8.6%, with 11.3% urban and 5.0% rural. Surgical complications were associated with males, older age, and urban residency and were found in 60.4%, with posterior capsule opacification in 29.6% and posterior capsule rupture in 16.3%. Among the 270 eyes having cataract surgery, APC ≥20/32 was found in 44.4%, APC 20/40 to 20/63 in 20.8%, APC

Purpose: To determine the prevalence and causes of visual impairment and blindness in adults aged 45 years and older from Parintins, Brazilian Amazon Region. Methods: A random cluster sampling method was used to identify subjects 45 years of age and older from urban and rural census sectors of Parintins city, Amazonas State, from March 2014 to May 2015. Participants underwent a detailed ocular examination, including presenting (PVA) and best corrected visual acuity (BCVA). The main cause of PVA

AimsTo determine prevalence of pterygium, its role as main cause of unilateral and bilateral visual impairment and blindness and its impact on refractive errors from adults living in a high ultraviolet exposure area in the Brazilian Amazon Region.MethodsCluster sampling was used in randomly selecting subjects ≥45 years of age from urban and rural areas of Parintins city. Eligible subjects were enumerated through a door-to-door household survey and invited for an eye exam including refraction. Pterygium was assessed considering location (nasal, temporal or both) and size (ResultsA total of 2384 persons were enumerated and 2041 (85.6%) were examined. Prevalence of pterygium was 58.8% (95% CI 53.8% to 63.7%) and associated with male gender (OR=1.63; 95% CI 1.37 to 1.94; p=0.001), while higher education was a protective factor (OR=0.63; 95% CI 0.44 to 0.92; p=0.018). Older age and rural residence were associated with pterygium ≥3 mm reaching or not pupillary margin, while higher education was a protective factor for pterygium ≥3 mm reaching pupillary margin. Prevalence of pterygium as cause of visual impairment and blindness was 14.3% and 3.9%, respectively. Significantly higher hyperopic refractive errors were found in eyes with pterygium ≥3 mm reaching or not pupillary margin.ConclusionsPterygium was highly prevalent and the second cause of visual impairment and blindness after provision of refractive correction. Risk factors for pterygium were male gender, advanced age, lower education and rural residency. Strategies to provide pterygium early detection and proper management should be considered by healthcare authorities in this population.

Conselho Nacional de Desenvolvimento Cientifico e Tecnologico - CNPq, Brasilia, Brasil, Programa Ciencia sem Fronteiras Fundacao de Amparo a Pesquisa do Estado de Sao Paulo, FAPESP, Sao Paulo, Brasil SightFirst Program - Lions Club International Foundation Older adults living in remote areas with limited access to health services are at higher risk to develop visual impairment and blindness. We conducted a population-based survey to determine the vision status in subjects 45 years of age and older from urban and rural areas of Parintins city, Brazilian Amazon Region. Participants underwent ophthalmic examination, including uncorrected (UCVA), presenting (PVA) and best-corrected visual acuity (BCVA). Vision status was described as lines of visual acuity (VA) impairment and lines of VA improvement from UCVA to BCVA and from PVA to BCVA in the better-seeing eye. A total of 2384 subjects were enumerated, 2041 (85.6%) were examined, with reliable VA measurements obtained from 2025 participants. Vision status in lines of VA impairment was (mean +/- standard deviation): 3.44 +/- 3.53 for UCVA, 2.85 +/- 3.52 for PVA and 1.50 +/- 3.51 for BCVA. Female gender, older age and lower education were associated with >= 6 lines of UCVA impairment. Lines of improvement >= 3 was found in 626 (30.9%) participants and associated with female gender and rural residency. In conclusion, a third of participants could have at least three lines of VA improvement with proper refraction. Strategies to improve access to eye care and affordable glasses are needed. Univ Fed Sao Paulo UNIFESP, Escola Paulista Med, Dept Oftalmol & Ciencias Visuais, Sao Paulo, SP, Brazil Univ Sao Paulo, Fac Med Ribeirao Preto, Dept Oftalmol Otorrinolaringol & Cirurgia Cabeca, Ribeirao Preto, SP, Brazil Univ La Frontera, Dept Salud Publ, Temuco, Chile Univ Fed UFPA, Fac Med, Belem, PA, Brazil Univ Fed Minas Gerais, Fac Med, Dept Oftalmol & Otorrinolaringol, Belo Horizonte, MG, Brazil Univ Fed Amazonas UFAM, Fac Med, Dept Cirurgia, Div Oftalmol, Manaus, Amazonas, Brazil Univ Fed Sao Paulo UNIFESP, Escola Paulista Med, Dept Oftalmol & Ciencias Visuais, Sao Paulo, SP, Brazil CNPq: 402120/2012-4 FAPESP: 2013/16397-7 Lions Club International Foundation: 1758 Web of Science

To evaluate the efficacy and safety of a novel lutein-based dye for the anterior capsulorhexis during phacoemulsification in cataract surgery in humans.Twenty-five eyes from 25 patients were operated by 25 different surgeons who performed continuous circular capsulorhexis (CCC) guided by a lutein-based dye (Phacodyne™) during cataract surgery by phacoemulsification. A questionnaire assessed the surgeon’s opinion regarding the efficacy of the dye. Follow-up examinations were performed at 1, 7, and 30 days post-surgery. Eyes were evaluated by full ophthalmic examination, corneal topography/pachymetry, and corneal endothelial cell count.As revealed by the answers to the questionnaire, the dye facilitated the CCC procedure in all eyes. Baseline nuclear cataract classification (according to the Lens Opacities Classification System III; LOCS III) was 3.24 (± 1.12). Preoperative BCVA (logMAR) was 0.89 ± 0.59 and improved to 0.23 ± 0.22 on day 30 after surgery. The intraocular pressure (IOP) remained stable and the inflammatory reaction subsided in all cases within the first 7 days after surgery. The pre-operative values of corneal pachymetry and IOP were similar to those found on follow-up day 30. Loss in endothelial cell number was similar to earlier reports.Phacodyne™ was efficient when used for anterior capsulorhexis during cataract surgery by phacoemulsification and

Objectives To characterise and confirm the presence of Mansonella ozzardi microfilariae in the cornea by biomicroscopy and corneal confocal microscopy. Design Cross-sectional study. Settings Clinical practice study in patients from rural communities in Coari city on the Solimoes river, Amazonas state, Brazil. Participants The eyes of 212 consecutive volunteer patients were examined using a flash light and their blood checked for the presence of microfilariae by an expert microscopist. Patients with suspicious corneal lesions (characterised as nummular keratitis) were submitted to biomicroscopy, fundoscopy and corneal confocal microscopy evaluation (CCME). In two patients, a biopsy of the limbal conjunctiva adjacent to the nummular keratitis was carried out and blood collected from the surgical wound for microfilariae investigation by thick blood film examination. Primary and secondary outcome measures Positive correlation between corneal biomicroscopic and confocal lesions and M ozzardi microfilaremia. Results Of the 212 patients, 56 (26.4%) were positive for microfilaremia. 22 patients with nummular keratitis identified under flash light examination underwent biomicroscopy and CCME. Corneal lesions were positively correlated to microfilaremia (p=0.0001). At biomicroscopy, lesions were classified as quiescent or active. At CCME, lesions were categorised as circular or filiform. The associations between corneal lesions, CCME findings and microfilaremia are shown. Conclusions We describe M ozzardi microfilariae in the cornea and the associated eye pathology. Further studies using ocular tissue PCR and other imaging techniques would be helpful.