Ophthalmic epidemiology最新文献

Purpose: To evaluate the efficacy of repeated low-level red-light (RLRL) therapy for myopia control in children and adolescents with myopic anisometropia.

Methods: Between January 2022 and October 2023, a total of 52 participants diagnosed with myopic anisometropia were enrolled in the study. The participants underwent RLRL therapy, administered via a device emitting red light at a wavelength of 650 nm. Each participant received the treatment for a duration of one year and underwent examinations at baseline, 3-, 6-, and 12-months. The follow-up period concluded by October 2024.

Results: More myopic eye refers to the eye with a higher (more negative) spherical equivalent (SE) value as measured by refractive examination, the contralateral eye is the less myopic eye. Cycloplegic spherical equivalence refraction (SER) of more myopia eyes changed from -4.47 ± 2.37D to -4.40 ± 2.37D (p = 0.005). However, SER of less myopic eyes between baseline and 12-month showed no significant difference (-2.59 ± 2.15D versus -2.50 ± 2.14D, p = 0.061). Axial length (AL) of more myopic eyes decreased more (25.42 ± 1.29 mm versus 25.17 ± 1.21 mm, p < 0.001), while less myopic eyes shortened from 24.62 ± 1.13 mm to 24.45 ± 1.08 mm (p < 0.001). In more myopic eyes, the change of AL showed relationship to initial AL (p = 0.046) and SER status (p = 0.023). No other correlation was found among sex, age, and change of AL or SER.

Conclusions: RLRL therapy has emerged as a promising therapeutic approach for addressing myopia anisometropia. Notably, eyes with greater degrees of myopia exhibit more pronounced benefits, including AL shortening and reversal of SER progression.

Purpose: Trachoma is endemic in Australia, affecting remote Indigenous communities in northern, central and western Australia. The World Health Organization (WHO) defines a key requirement of elimination as a public health problem being the prevalence of active trachoma (characterised as trachomatis inflammation - follicular) below 5% in children aged 1-9 years. In Australia, screening is based in school settings and focuses on children aged 5-9 years. There is international evidence that active trachoma may be more common in children under five, meaning true Australian prevalence may be under-estimated.

Methods: In 2018, jurisdictions screened children aged 1-4 years in 64 at-risk communities in addition to usual screening of children aged 5-9 years. Active trachoma was assessed by trained graders according to WHO simplified grading criteria. Logistic regression using a mixed effect model was used to compare age groups.

Results: In total, 2907 children were screened for trachoma, with observed active trachoma prevalence 7.2% and 6.9% in children aged 5-9 years and 1-4 years, respectively. No evidence of association between age group and trachoma prevalence was found overall [OR = 1.29 (95% CI: 0.93-1.79)] and when analyses were restricted by geographic location or to communities meeting screening coverage thresholds.

Conclusion: There was no evidence of higher active trachoma prevalence in children aged 1-4 years. These findings support the use of prevalence in children aged 5-9 years in assessing one of the key indicators of elimination of trachoma as a public health problem in the Australian context.

Purpose: Optic disc hemorrhages (DH) are one of the hallmark signs of primary open-angle glaucoma (POAG). However, due to the scarcity of longitudinal reports, the influence of baseline DH on the progression of POAG and its subtype, normal tension glaucoma (NTG), remains unclear. We conducted a systematic review with meta-analysis to determine the association of baseline DH with progression of POAG and NTG.

Methods: PubMed, Embase, Cochrane, SCOPUS, and Web of Science were searched from inception till July 1, 2025. POAG and NTG progressions were defined based on functional or structural changes. Following the PRISMA guidelines and a PROSPERO-registered protocol (CRD42021292572), two authors selected observational studies reporting glaucomatous progression in patients aged 18 years and above. We performed random-effects meta-analysis to estimate the pooled odds ratio (OR) for the association between baseline DH and progression of POAG and NTG. Additionally, we also performed a qualitative analysis for data on the location of DH and its association with visual field deterioration.

Results: We included 22 papers comprising seven prospective cohort studies and 15 retrospective cohort studies. Baseline DH was associated with the progression of POAG (OR = 4.51; 95% CI (confidence interval) = 3.24 to 6.26; I2 = 44.2%) and NTG (OR = 5.15; 95% CI = 3.72-7.14; I2 = 29%). DH were most commonly observed inferotemporally, with a topological association between the location of DH and the site of visual field deterioration.

Conclusion: DH is an important predictor for POAG progression, particularly for NTG. The presence of baseline DH in POAG patients may warrant closer monitoring of retinal nerve fibre layer thinning and visual field loss.

Purpose: The purpose of the current study was to update the prevalence of blindness and visual impairment (VI) in North Africa and the Middle East (NAME) region and to address the current status of its trends in 2020.

Methods: We performed a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We assessed the prevalence of blindness, moderate and severe VI (MSVI), severe VI, moderate VI, mild VI, and presbyopia in NAME region in 2020.

Results: In NAME region in 2020, the age-standardised prevalence per 1000, for all ages and sexes, was 0.70 (0.59-0.80) for blindness, 4.31 (3.91-4.72) for MSVI, 0.54 (0.47-0.60) for severe VI, 3.77 (3.38-4.18) for moderate VI, 2.68 (2.42-2.97) for mild VI, and 3.21 (2.29-4.35) for presbyopia. The all-ages and ≥50 year's age-standardised prevalence were higher in females than in males for all categories of vision impairment. In 2020, 3.09 (2.51-3.75) million people were blind, 21.83 (18.97-24.97) million had MSVI, 2.53 (2.11-3.03) million had severe VI, and 19.30 (16.57-22.27) million had moderate VI. Between 2000 and 2020, age-standardised prevalence of blindness and other categories of visual impairment decreased in all ages and among adults over than 50 years.

Conclusion: Although the absolute numbers of people with blindness and MSVI have increased between 1990 and 2020 in NAME region, the overall prevalence and the age standardized prevalence in those aged 50+ years have decreased significantly for the same period.

Purpose: To investigate the relationships between vision-related functional impairment (VFI) with sociodemographic and healthcare access factors in a representative sample of the United States population.

Methods: Data from the 2017 National Health Interview Survey (NHIS) were used. The NHIS involves responses from the U.S. civilian, non-institutionalized population aged 18 years or older. It provides self-reported data on demographic characteristics, socioeconomic factors, health status, and healthcare access. NHIS participants who responded to at least one of our target questions about VFI were included in the study. VFI was defined for participants based on their 'yes' or 'no' responses to target questions about experiencing a VFI. Data analysis was performed through univariable and multivariable logistic regression.

Results: Overall, 26,711 participants were included, of which 6926 (25.9%) participants reported experiencing a VFI. In univariable analysis, there were greater odds of VFI among females (OR: 1.16, 95% CI: 1.07-1.26, p < 0.001), and participants with less than a high school degree compared to those with an advanced degree (OR: 1.17, 95% CI: 1.02-1.33, p = 0.02). Among economic and healthcare access factors, greater odds of VFI was associated with public health insurance versus private coverage (OR: 1.19, 95% CI: 1.07-1.32, p = 0.001), having delayed medical care due to costs (OR: 1.86, 95% CI: 1.86-2.10, p < 0.001), and being unemployed (OR: 1.39, 95% CI: 1.26-1.53, p < 0.001). Participants whose incomes were lower than the poverty threshold (OR: 1.54, 95% CI: 1.32-1.80, p < 0.001) had higher odds of VFI than those with income >5× poverty threshold.

Conclusions: Several demographic and economic factors are associated with VFI in a representative sample of the U.S. population. These results highlight the importance of addressing social and economic factors that are associated with the development of VFI.

Purpose: Identifying barriers experienced by individuals with vision difficulty (VD) in accessing healthcare is crucial to inform public health policies to provide equitable healthcare. We examined the association between VD with healthcare access measures in the United States (U.S.).

Methods: We used data on 1,258,919 participants surveyed from the 2019, 2020, and 2021 cycles of the Behavioral Risk Factor Surveillance System (BRFSS), a national telephone-based survey of U.S. adults ≥ 18 years. The following outcome of healthcare access were examined: no healthcare coverage, no healthcare provider, >1 year since last checkup, inability to afford healthcare. VD was self-reported blindness/serious difficulty seeing even when wearing glasses. Survey-weighted, multivariable logistic regression models were used to examine the relationship between VD and the outcomes of interest, adjusting for confounders.

Results: Of the 1,258,919 participants surveyed from 2019 to 2021, 5.1% reported having VD. Adjusted models showed that adults with VD had greater odds of having no healthcare coverage (OR = 1.14, 95% CI = 1.04-1.24), no provider (OR = 1.12; 95% CI = 1.05-1.20), a health checkup > 1 year ago (OR = 1.12; 95% CI = 1.04-1.21), and of being unable to afford care (OR = 1.62, 95% CI = 1.52-1.73).

Conclusion: Adults reporting VD faced more barriers accessing healthcare. These disparities could be explained by a differential distribution of social determinants of health, lack of accessibility of medical facilities and communication barriers. Policies aimed at strengthening provisions around accessibility of healthcare facilities might result in increased access to healthcare for this population.

Purpose: To estimate the prevalence of vision loss for 2020 in high-income countries (HICs) and Central/Eastern Europe and analyse evolving trends since 1990.

Methods: Based on a systematic review of medical literature, prevalence of blindness, moderate and severe vision impairment (MSVI), mild vision impairment (VI), moderate VI and presbyopia were estimated for 1990, 2000, 2010, and 2020.

Results: The study included 68 population-based studies. In the whole study region, the age-standardized prevalence (all ages) of blindness, MSVI, moderate VI, severe VI, mild VI, and presbyopia-related VI was 0.17% (95% CI:0.15-0.19), 2.27% (2.05-2.49), 2.06% (1.84-2.29), 0.21% (0.18-0.23), 1.79% (1.62-1.99), and 2.61% (1.88-3.48) respectively, with slightly higher rates for women than men. The prevalence rates were higher in Central/Eastern Europe than in the HIC, and lower than the global rates. Stratified between Australasia, high-income Asia Pacific region, high-income North America, Western Europe, Central Europe, and Eastern Europe, the age-standardized prevalence of blindness changed between 2000 and 2020 for men aged 50+ years by -7.95% (-8.11/-7.78), -14.51% (-14.64/-14.38), +13.18% (+13.00/+13.36), -12.07% (-12.23/-11.91), -14.39% (-14.54/-14.23), and -23.59% (-23.72/-23.46), respectively, without significant sex-related differences. Highest increase was in high-income North America (+13.18% (+13.00/+13.36)) and most marked reduction in Eastern Europe (-23.59% (-23.72/-23.46)). Estimated blind individuals were stratified as follows: Australasia, 68,866 (54,913-84,527), high-income Asia Pacific region, 535,124 (439,912-640,330), high-income North America, 711,990 (575,977-867,402), Western Europe, 1,533,752 (1,218,371-1,898,343), Central Europe, 327,352 (264,513-398,083) and Eastern Europe, 789,618 (663,130-923,121).

Conclusions: Age-standardized prevalence of blindness and MSVI have further decreased in HIC and Eastern/Central Europe (except for high-income North America with an increase).

Purpose: This study analyzes the prevalence, causes, and distribution of blindness and moderate-to-severe vision impairment (MSVI) in the Middle East and North Africa (MENA) using the Global Burden of Disease (GBD) 2019 dataset.

Methods: The GBD 2019 dataset was used to analyze vision impairment across 21 countries in MENA according to the Snellen chart classification (moderate vision impairment with presenting visual acuity worse than 6/18, severe impairment worse than 6/60, blindness worse than 3/60). Age-standardized prevalence and regional variations were compared to global averages. An exponential linear regression model was used to forecast MSVI and blindness in the year 2050.

Results: As of 2019, approximately 37.2 million people in MENA experienced blindness or vision loss. Although the age-standardized prevalence of vision impairment and blindness in MENA decreased from 1990 to 2019 due to improvements in healthcare, the absolute number has almost doubled (18.58 million in 1990 to 37.19 million in 2019) due to population growth and aging. Between 1990 to 2019, the population aged 70 and older in MENA grew from 7.2 million to over 19.2 million. Lastly, our predictions indicate an 86% increase in the number of individuals with vision loss by 2050.

Conclusion: The largest causes of moderate vision loss were refractive errors and cataracts, respectively, while the major causes of blindness were cataracts and glaucoma, respectively. The projection of increased vision impairment by 2050 underscores the urgent need for policy changes and efficient resource distribution to improve healthcare access and interventions.

Purpose: To report the prevalence, causes, and risk factors for unilateral visual impairment (UVI) among the elderly population (≥60 years) in Telangana, India.

Methods: A population-based, cross-sectional study was conducted in four districts of Telangana. Trained teams conducted eye examinations. Distance visual acuity (VA) was assessed using a Snellen chart with a tumbling E optotypes at 6 m. Anterior eye examination and non-mydriatic fundus imaging were performed for all participants. UVI was defined as presenting VA worse than 6/18 in one eye and VA better than or equal to 6/18 in the other eye. Multivariable analysis was performed to assess the factors associated with UVI.

Results: Of 2,447 participants aged ≥60 years were included in the analysis, 1,285 (52.5%) were women, and 1,786 (73%) had no formal education. In total, 525 (21.5%) participants were from Adilabad, 602 (24.6%) from Mahbubnagar, 610 (24.9%) from Khammam, and 710 (29%) from Warangal districts. The mean (standard deviation) age of the participants was 66.6 (±6.3) years. The prevalence of UVI was 34.9% (95% CI: 33.0-36.9; n = 856). Cataract (48.5%; n = 415) was the leading cause of UVI, followed by uncorrected refractive error (33.1%; n = 284). The multivariate analysis showed higher odds of UVI in the older age group and among those residing in the Khammam and Warangal districts.

Conclusion: Over a third of the elderly population in Telangana had UVI. Eight out of 10 cases of UVI could be addressed by providing spectacles and cataract surgery at primary and secondary levels of eye care, respectively.

Aim: To determine the prevalence and trends in vision impairment in South-East Asia and Oceania over the past 30 years.

Methods: We conducted a systematic review of medical literature and employed hierarchical models to estimate the prevalence of vision impairment (VI) in 2020 in South-East Asia and Oceania in those 50 + years of age. We estimated the prevalence (with 95% uncertainty intervals [UIs]) of mild VI (presenting visual acuity between ≥6/18 and <6/12), moderate and severe VI (MSVI) (presenting visual acuity less than 6/18 to 3/60), and blindness (presenting visual acuity less than 3/60 or less than 10° visual field around central fixation); we also estimated the prevalence of vision impairment due to uncorrected presbyopia (presenting near vision less than N6 or N8 at 40 cm where best-corrected distance visual acuity is ≥6/12).

Results: The prevalence of blindness in men and women in South-East Asia in 2020 was 3.05% (UI 2.58-3.49%) and 4.18% (UI 3.58-4.82%), respectively, with an age-standardised reduction of 32% for both sexes since 1990. The prevalence of MSVI in men and women in South-East Asia was 14.92% (UI 13.59-16.31%) and 15.77% (UI 14.41-17.19%), respectively, with an age-standardised reduction of 6.4% for men and 5.1% for women since 1990. The prevalence of blindness in men and women in Oceania was 1.74% (UI 1.43-2.04%) and 2.22% (1.84-2.61%), respectively, with an age-standardised reduction of 18% for both sexes. The prevalence of MSVI in men and women in Oceania in 2020 was 16.77% (14.78-18.79%) and 17.78% (15.82-19.92%), respectively, with an age-standardised reduction of 5.4% for men and 7.2% for women since 1990.

Conclusions: Although there has been a significant reduction in the prevalence of blindness in both South-East Asia and Oceania since 1990, the rates of mild to moderate visual impairment have only seen modest reductions. Furthermore, the absolute number blind in these regions increased from approximately 4.1 million in 1990 to 6.0 million in 2020.