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PubMed2004

Visual impairment in children born at full term from 1972 through 1989 in Finland.

OBJECTIVE: To investigate the incidence, prevalence, and causes of visual impairment in children born at full term and to determine conditions and factors associated with visual impairment. DESIGN: Retrospective, cross-sectional, population-based study. PARTICIPANTS: All visually impaired individuals from 0 to 17 years of age who were born at full term from 1972 through 1989 in Finland and recorded in the Finnish Register of Visual Impairment (n = 556) were eligible for this study. METHODS: Data in the Finnish Register of Visual Impairment relating to 556 subjects were supplemented with data from hospital records and other national registers (Register of Births, Register of Congenital Malformations, Finnish Care Register, and Finnish Cancer Register). Data relating to the children born at full term were compared with Finnish perinatal and vital statistics and with data concerning children born prematurely. The chi-square test (Mantel-Haenszel) and stepwise logistic regression analysis were used in statistical analysis of the data. MAIN OUTCOME MEASURES: Visual acuity, time of onset of visual impairment, ophthalmic diagnosis of visual impairment, systemic disease, multiple handicap, 5-minute Apgar score, prenatal disorders, perinatal disorders, disorders arising during infancy and childhood, and treatment. RESULTS: Four hundred thirty-one of the 556 individuals with visual impairment (78%) had been born at full term. Visual impairment was predominantly associated with genetic (53%) and prenatal (34%) factors. Ocular malformations (34%), retinal diseases (31%), and neuro-ophthalmologic disorders (26%) were the main ophthalmic diagnoses. Optic nerve atrophy (20%) and congenital cataract (13%) were the most common single diagnoses. The occurrence of blindness, systemic disease, and multiple handicap was 40%, 43%, and 45%, respectively. CONCLUSIONS: The incidence of visual impairment in children born at full term did not decline during the 2 decades covered by this study. The findings reflected the lack of treatment for genetic eye diseases. The results also confirmed an obvious need for further understanding of mechanisms underlying congenital anomalies of the human visual system.

Adolescent↗
PubMed2005

Refractive error and visual impairment in school-age children in Gombak District, Malaysia.

PURPOSE: To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city. DESIGN: Population-based, cross-sectional survey. PARTICIPANTS: Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households. METHODS: Random selection of geographically defined clusters was used to identify the study sample. Children in 34 clusters were enumerated through a door-to-door survey and examined in 140 schools between March and July 2003. The examination included visual acuity measurements; ocular motility evaluation; retinoscopy and autorefraction under cycloplegia; and examination of the external eye, anterior segment, media, and fundus. MAIN OUTCOME MEASURES: Distance visual acuity and cycloplegic refraction. RESULTS: The examined population was 70.3% Malay, 16.5% Chinese, 8.9% Indian, and 4.3% of other ethnicity. The prevalence of uncorrected (unaided), presenting, and best-corrected visual impairment (visual acuity < or =20/40 in the better eye) was 17.1%, 10.1%, and 1.4%, respectively. More than half of those in need of corrective spectacles were without them. In eyes with reduced vision, refractive error was the cause in 87.0%, amblyopia in 2.0%, other causes in 0.6%, and unexplained causes in 10.4%, mainly suspected amblyopia. Myopia (spherical equivalent of at least -0.50 diopter [D] in either eye) measured with retinoscopy was present in 9.8% of children 7 years of age, increasing to 34.4% in 15-year-olds; and in 10.0% and 32.5%, respectively, with autorefraction. Myopia was associated with older age, female gender, higher parental education, and Chinese ethnicity. Hyperopia (> or =2.00 D) with retinoscopy varied from 3.8% in 7-year-olds, 5.0% with autorefraction, to less than 1% by age 15, with either measurement method. Hyperopia was associated with younger age and "other" ethnicity. Astigmatism (> or =0.75 D) was present in 15.7% of children with retinoscopy and in 21.3% with autorefraction. CONCLUSIONS: Visual impairment in school-age children in urban Gombak District is overwhelmingly caused by myopia, with a particularly high prevalence among children of Chinese ethnicity. Eye health education and screening may help address the unmet need for refractive correction.

Adolescent↗
PubMed2005

14-year incidence, progression, and visual morbidity of age-related maculopathy: the Copenhagen City Eye Study.

PURPOSE: To describe the 14-year incidence of age-related maculopathy (ARM) lesions and the related visual loss. DESIGN: Population-based cohort study. PARTICIPANTS: Nine hundred forty-six residents (age range, 60-80 years) of Copenhagen participated in the study from 1986 through 1988. Excluding participants who had died since baseline, 359 persons (97.3% of survivors) were reexamined from 2000 through 2002. METHODS: Participants underwent extensive ophthalmologic examinations. Age-related maculopathy lesions were determined by grading color fundus photographs from the examinations using a modified Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOME MEASURES: Incidence of drusen type and size, pigmentary abnormalities, pure geographic atrophy, exudative ARM, visual impairment, and blindness. RESULTS: The 14-year incidences of early and late ARM were 31.5% and 14.8%, respectively. Individuals 75 to 80 years of age at baseline had significantly (P< or =0.05) higher 14-year incidences of the following lesions than those aged 60 to 64 years: medium or large drusen (> or =125 microm; 34.2% vs. 12.8%, respectively), soft drusen (45.2% vs. 21.4%), pigmentary abnormalities (31.4% vs. 17.0%), pure geographic atrophy (17.4% vs. 1.0%), and exudative ARM (23.3% vs. 5.7%). Severe drusen type, large drusen, and retinal pigmentary abnormalities at baseline were important predictors of incident late ARM. The 14-year incidences of visual impairment (<20/40 but >20/200) or legal blindness from late ARM were 6.0% and 3.4%, respectively. Late ARM caused 35.7% of all visual impairment and 66.7% of all blindness. CONCLUSIONS: There is a high incidence of ARM lesions in this elderly white population. Severe drusen type and size or a combination of drusen and pigmentary abnormalities significantly increases the risk of developing late ARM, the most frequent cause of legal blindness in this population.

Aged↗
PubMed2005

Visual acuity and the causes of visual loss in a population-based sample of 6-year-old Australian children.

PURPOSE: To describe the distribution of visual acuity and causes of visual loss in a representative sample of Australian schoolchildren. DESIGN: Population-based cross-sectional study. PARTICIPANTS: One thousand seven hundred thirty-eight predominantly 6-year old children examined during 2003 to 2004. METHODS: Logarithm of the minimum angle of resolution (logMAR) visual acuity was measured in both eyes before and after pinhole correction and with spectacles if worn. Cycloplegic autorefraction (cyclopentolate) and detailed dilated fundus examination were performed. MAIN OUTCOME MEASURES: Visual impairment was defined as any (visual acuity <20/40; <40 letters) or severe (visual acuity < or =20/200; 0-5 letters) for both better and worse eyes. Myopia was defined as spherical equivalent (SE) refraction < or =-0.50 diopters (D), and hyperopia as SE refraction > or =+2.0 D, deemed significant when > or =+3.0 D. Astigmatism was defined as cylinder > or =1.0 D and anisometropia as SE refraction difference between eyes at least 1.0 D. Amblyopia was defined as corrected visual acuity <0.3 logMAR units (<20/40; <40 letters) in the affected eye not attributable to any underlying structural abnormality of the eye or visual pathway, together with a 2-logMAR line difference between the eyes and presence of an amblyogenic risk factor. RESULTS: The mean visual acuity of this sample was 20/25 (49.3 letters). Uncorrected visual impairment was found in the better eye of 23 children (1.3%) and in the worse eye of 71 children (4.1%). The prevalence was higher in girls than boys and among children of lower socioeconomic status. Refractive error was the most frequent cause, accounting for 69.0%, followed by amblyopia (22.5%). Astigmatism was the principle refractive error causing visual impairment and was frequently uncorrected. Presenting visual impairment (using current glasses if worn) was found in the better and worse eyes of 15 children (0.9%) and 54 children (2.8%), respectively. This was mainly due to under corrected or uncorrected refractive error. CONCLUSIONS: This study has documented a relatively low prevalence of visual impairment in a population of Australian children. Uncorrected astigmatism and amblyopia were the most frequent causes.

Child↗
PubMed2005

A nationwide population-based survey on visual acuity, near vision, and self-reported visual function in the adult population in Finland.

PURPOSE: To estimate the prevalence rates of habitual visual acuity (VA) levels and visual impairment in Finland and to assess their correlation with self-reported visual function. DESIGN: Cross-sectional population-based study. PARTICIPANTS: Subjects were selected randomly from the Finnish population aged 30 years or older. Of 7979 eligible people, 7393 (93%) were interviewed, 6771 (85%) were examined, and 6663 (84%) had distance VA assessed. METHODS: Participants underwent a home interview and a comprehensive examination including measuring binocular VA for distance and for near with the participants' current spectacles, if any. MAIN OUTCOME MEASURES: The level of VA for distance and for near with current spectacle correction. The self-reported capability to read newsprint and television text and the ability to move about without being restricted by reduced vision. RESULTS: The prevalence of good to moderate VA for distance (VA> or =0.5 [> or =20/40]) measured with current spectacles was 95.9%, and 87.4% had a VA level of 0.8 (20/25) or better. The prevalence of habitual visual impairment (VA< or =0.25 [< or =20/80]) was 1.6%, and 0.5% were blind (VA<0.1 [<20/200]). The prevalence of visual impairment increased significantly with age (P<0.001), especially in the age group of 65 to 74 years and upward. There was no gender difference in VA for distance, but decreased near vision (VA< or =0.25 [< or =20/80]) was significantly more common in men than in women (P<0.01). By applying the imputated numbers of visually impaired and blind participants to the Finnish population (approximately 3 million aged 30 years or older), there were approximately 65000 (2.1%) visually impaired and 17000 (0.6%) blind adult persons in the country in 2000. The correlation between self-reported visual ability and measured visual function was moderate but statistically significant (r = 0.27-0.40; P<0.0001). The proportion of people with reading difficulties or who were unable to read newsprint has decreased 7% during the last 2 decades. CONCLUSIONS: Functional visual impairment increased with age especially in the age group of 65 to 74 years and upward and was as prevalent in women as in men. The prevalence of people with reading difficulties has decreased considerably since 1980.

Adult↗
PubMed2006

Causes of blindness and visual impairment in urban and rural areas in Beijing: the Beijing Eye Study.

OBJECTIVE: To evaluate the causes of visual impairment and blindness in adult Chinese in an urban and rural region of Beijing, China. DESIGN: Population-based prevalence survey. PARTICIPANTS: From a rural region and an urban region of Greater Beijing, 4439 of 5324 > or=40-year-old invited subjects participated in the study (response rate, 83.4%). Using the World Health Organization (WHO) standard and the United States standard, blindness was defined as best-corrected visual acuity (BCVA) in the better-seeing eye of <20/400 and of <2/20, respectively, and visual impairment was defined as best-corrected vision of <20/60 and > or =20/400, and of <20/40 and > or =2/20, respectively. METHODS: Determination of BCVA, pneumotonometry, frequency doubling perimetry, evaluation of photographs of the fundus and lens, and clinical examination. MAIN OUTCOME MEASURE: Causes of visual impairment and blindness. RESULTS: Visual acuity measurements were available for 8816 eyes of 4409 subjects (99.3%). Using the WHO standard and the U.S. standard, 49 (1.1%) subjects and 95 (2.2%) subjects, respectively, had low vision, and 13 (0.3%) subjects and 15 (0.3%) subjects, respectively, were blind by definition. Taking the whole study population, the most frequent cause of low vision/blindness was cataract (36.7%/38.5%), followed by degenerative myopia (32.7%/7.7%), glaucoma (14.3%/7.7%), corneal opacity (6.1%/15.4%), and other optic nerve damage (2.0%/7.7%). Age-related macular degeneration (AMD) (2.0%/7.7%) and diabetic retinopathy (0%/7.7%) were responsible for a minority of cases. In subjects 40 to 49 years old, the most frequent cause of low vision and blindness was degenerative myopia. In the 50- to 59-year age group, the most frequent cause was cataract, followed by degenerative myopia. In the 60- to 69-year-old subjects and the > or =70-year group, the most frequent cause of low vision and blindness was cataract, followed by degenerative myopia and glaucoma. CONCLUSIONS: The most frequent cause of low vision and blindness in adult Chinese is cataract, followed by degenerative myopia and glaucomatous optic neuropathy, with degenerative myopia dominating in younger groups and cataract dominating in elder groups. In contrast to studies in Western countries, AMD and diabetic retinopathy appear to play a minor role as a cause of visual impairment in elderly Chinese.

Adult↗
PubMed2006

Ocular trauma in a rural population of southern India: the Andhra Pradesh Eye Disease Study.

OBJECTIVE: To determine the prevalence of ocular trauma and proportion of blindness and visual impairment due to ocular trauma in a rural population of southern India. DESIGN: Population-based cross-sectional epidemiological study. PARTICIPANTS: A total of 7771 subjects of all ages, representative of the rural population of Andhra Pradesh. METHODS: The subjects underwent a detailed interview and comprehensive ocular evaluation as part of the population-based Andhra Pradesh Eye Disease Study. MAIN OUTCOME: An eye was considered to be blind due to trauma if best-corrected distance visual acuity was worse than 6/60 and the cause was attributed to ocular trauma. RESULTS: A total of 824 (10.6%) subjects gave a history of ocular trauma in either eye, including 76 (1.0%) persons reporting trauma in both eyes. The overall age- and gender-adjusted prevalence of history of eye injury in this rural population was 7.5% (95% confidence interval [CI], 7.0%-8.1%). Men were more likely to have an eye injury than women (odds ratio [OR], 2.1 [95% CI, 1.8-2.5]). After adjusting for gender and other demographic factors, ocular trauma was significantly more frequent among laborers (OR, 1.5 [95% CI, 1.2-1.7]) when compared with other occupational groups. After adjusting for gender, injury with vegetable matter such as a thorn, branch of a tree, plant secretion, etc. (n = 373 [45.3%]) was the major cause of trauma reported in this population. The majority of the eye injuries occurred at the workplace (n = 461 [55.9%]), followed by home (n = 179 [21.7%]). The majority of those affected (n = 806 [97.8%]) did not wear any eye protection at the time of trauma. A significant proportion (n = 307 [43.1%]) of subjects who sought treatment for an eye injury went to an ophthalmologist. Trauma was responsible for unilateral blindness in 39 subjects, an age- and gender-adjusted prevalence of 0.6% (95% CI, 0.4%-0.8%). CONCLUSIONS: Most ocular injuries in this rural population occurred at the workplace, suggesting the need to explore workplace strategies to minimize ocular trauma as a priority. Eye care programs targeting high-risk ocular trauma groups may need to consider ocular trauma as a priority in eye health awareness strategies to reduce blindness due to trauma.

Adolescent↗
PubMed2006

Refractive error and patterns of spectacle use in 12-year-old Australian children.

PURPOSE: To document the prevalence of visual impairment resulting from refractive error and to describe patterns of spectacle use in a representative sample of 12-year-old Australian school children. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Two thousand three hundred fifty-three predominantly 12-year-old children examined from 2004 through 2005. METHODS: Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was measured unaided and with spectacles if worn. Subjective refraction, cycloplegic autorefraction (with cyclopentolate), and detailed dilated fundus examination were performed. MAIN OUTCOME MEASURES: Myopia was defined as spherical equivalent (SE) refraction < or =-0.50 diopters (D), hyperopia as SE refraction > or =2.0 D, and astigmatism as cylinder > or =1.0 D. Uncorrected visual impairment was defined using unaided VA, and presenting visual impairment was defined using spectacle-corrected VA, if worn. Visual impairment was defined as VA <20/40 (<40 logMAR letters) for both better and worse eyes. Spectacle need was defined as uncorrected visual impairment in the better eye, improving by at least 2 lines with refraction, and undercorrection as presenting impairment in the better eye, improving by at least 2 lines with refraction. RESULTS: Uncorrected and presenting visual impairment in at least 1 eye because of refractive error was found in 10.4% and 3.7%, respectively. Spectacle use was reported by 448 children (19.0%); 204 (46.3%) had myopia, 48 (10.9%) had hyperopia, and 96 (21.8%) had astigmatism in at least 1 eye; 38.3% had no significant refractive error in either eye. Eight children were in need of spectacles and 37 children (8.3% of spectacle users) were undercorrected. Nonrefractive spectacle users were more likely to report eyestrain and headache or to have had learning difficulty at school (P<0.0001). CONCLUSIONS: This study documents a relatively low prevalence of undercorrected refractive error in a population of Australian children. Nonrefractive prescription of spectacles is common.

Adolescent↗
PubMed2006

Prevalence and correlates of children's diagnosed eye and vision conditions.

PURPOSE: Little is known about the distribution of eye and vision conditions among children and about possible disparities in the distribution of these conditions. The purpose of this report is to describe the prevalence of diagnosed eye and vision conditions among children younger than 18 years in the United States. DESIGN: Repeated population-based cross-sectional study. PARTICIPANTS: Forty-eight thousand three hundred four members of randomly selected households in the U.S. who were younger than 18 years in the years 1996 through 2001 were analyzed. METHODS: The prevalence of children with diagnosed eye and vision conditions was estimated using self-reported information from the nationally representative Medical Expenditure Panel Surveys (MEPS) for 1996 through 2001. Descriptive statistics are presented, and the associations between the likelihood of diagnosed eye and vision conditions and child and family characteristics were assessed using logistic regression analyses adjusted for the complex survey design of MEPS. MAIN OUTCOME MEASURES: Prevalence of diagnosed eye and vision conditions and measures of the association between diagnosed eye and vision conditions and child and family characteristics. RESULTS: On average, approximately 6.8% (95% confidence interval [CI], 6.4%-7.2%) of children < 18 years in the U.S. have a diagnosed eye and vision condition, ranging from 8.6% (95% CI, 7.8%-9.5%) in 1996 to 5.8% (95% CI, 5.2%-6.4%) in 2001. Excluding conjunctivitis, the 4 most common conditions were refractive disorders, potentially blinding disorders, trauma or injury, and other disorders not elsewhere classified. White children, children with more educated mothers, and children living in higher income families were more likely to have a diagnosed eye and vision condition. Hispanic children, children in very good or excellent health, and uninsured children were less likely to have any self-reported diagnosed eye and vision condition. CONCLUSIONS: This article presents a method for using MEPS to identify children younger than 18 years with eye and vision conditions. Although this method does not identify all children with eye and vision conditions, it does identify children with diagnosed eye and vision conditions. Results provide some evidence that underprivileged children may be underdiagnosed, undertreated, or both, placing them at risk for future problems.

Adolescent↗
PubMed2006

Costs of refractive correction of distance vision impairment in the United States, 1999-2002.

OBJECTIVE: Correctable vision impairment caused by refractive error is common in the United States population. We estimated the direct costs of providing eyeglasses to all Americans (age> or =12) who need refractive correction to achieve good distance vision. DESIGN: Cross-sectional study of a nationally representative sample of United States citizens. PARTICIPANTS: Participants in the 1999-2002 National Health and Nutrition Examination Survey (NHANES), age > or = 12 years. The NHANES examines a nationally representative sample of the U.S. noninstitutionalized, civilian population. METHODS: Presenting and corrected visual acuity data were obtained using an autorefractor from 13,211 (93.0%) of the 14,203 participants who visited the NHANES Mobile Examination Center in 1999 through 2002. Need for refractive correction was defined by current use of corrective lenses for distance vision, improvement to good visual acuity following autorefractor correction (using several cutpoints to define good visual acuity), or both. MAIN OUTCOME MEASURES: Estimates of direct cost for refractive correction (1 pair of complete eyeglasses and a refraction examination) were computed based on Centers for Medicare & Medicaid Services fee schedules for 2000 and also based on expenditure data from the Medical Expenditure Panel Survey. RESULTS: The NHANES results indicate that >110 million Americans could or do achieve normal vision with refractive correction. The annual direct cost of correcting distance vision impairment is at least $3.8 billion. Of this amount, $780 million represents the annual cost of providing distance vision correction for persons > age 65. CONCLUSIONS: Correctable vision impairment due to refractive error is common in the United States population. These cost estimates provide useful information for public health endeavors aimed at provision of refractive correction to those who need it.

Adolescent↗
PubMed2006

Natural history of the visual impairment of relapsing neuromyelitis optica.

PURPOSE: To describe the clinical features and natural history of the visual impairment of relapsing neuromyelitis optica. DESIGN: Prospective observational case series. PARTICIPANTS: Thirty patients of Afro-Caribbean origin with neuromyelitis optica and 47 patients with multiple sclerosis. METHODS: A complete ophthalmologic examination was performed with each ocular attack and during a remission period at least 6 months after the last attack. MAIN OUTCOME MEASURES: Incidence of unilateral and bilateral optic neuritis and incidence of unilateral and bilateral severe visual loss, defined as visual acuity (VA) < or = 20/200. RESULTS: Twenty-eight patients (93%) with neuromyelitis optica were female and 2 (7%) were male. The mean age of onset was 30+/-10.5 years. Mean disease duration was 9.5+/-5.4 years. Neuromyelitis optica first manifested by an episode of optic neuritis in 23 cases (76.6%), bilateral in 4. The average number of ocular attacks per patient was 2.7+/-1.6. Twenty-one patients (70%) showed impairment in both eyes. Median times from onset to unilateral optic neuritis, bilateral optic neuritis, mono-ocular severe visual loss, and binocular severe visual loss were 0+/-0.08, 1+/-1.6, 2+/-0.8, and 13+/-3 years, respectively. Fifteen patients (50%) experienced severe visual loss in both eyes and 6 (20%) in one eye. Severe visual loss occurred in as few as 2 attacks. CONCLUSION: This study is the largest series of relapsing neuromyelitis optica in a population of African descent. Neuromyelitis optica's visual impairment is very severe; it contrasts drastically with that typically observed in multiple sclerosis. We confirmed that the prognosis for optic neuritis in patients with neuromyelitis optica is worse than the prognosis in patients with multiple sclerosis.

Adult↗
PubMed2006

Refractive error and visual impairment in school children in rural southern China.

PURPOSE: To assess the prevalence of refractive error and visual impairment in school children in a rural area of southern China. DESIGN: Prospective cross-sectional survey. PARTICIPANTS: Two thousand four hundred children from junior high schools in Yangxi County. METHODS: Random selection of classes from the 3 junior high school grade levels was used to identify the study sample. Children from 36 classes in 13 schools were examined in April 2005. The examination included visual acuity (VA) testing; ocular motility evaluation; cycloplegic autorefraction; and examination of the external eye, anterior segment, media, and fundus. MAIN OUTCOME MEASURES: Distance VA and cycloplegic refraction. RESULTS: Among 2515 enumerated children, 2454 (97.6%) were examined. The study population consisted of the 2400 children between 13 and 17 years old. Prevalences of uncorrected, presenting, and best-corrected VA < or = 20/40 in the better eye were 27.0%, 16.6%, and 0.46%, respectively. Sixty percent of those who could achieve acuity > or =20/32 in at least one eye with best correction were without the necessary spectacles. Refractive error was the cause in 97.1% of eyes with reduced vision; amblyopia, 0.81%; other causes, 0.67%; and unexplained causes, 1.4%. Myopia (spherical equivalent, -0.50 diopters [D] or more in either eye) affected 36.8% of 13-year-olds, increasing to 53.9% of 17-year-olds. Myopia was associated with higher grade level, female gender, schooling in the county urban center, and higher parental education. Hyperopia (+2.00 D or more) affected approximately 1.0% in all age groups. Astigmatism (> or =0.75 D) was present in 25.3% of all children. CONCLUSIONS: Reduced vision because of uncorrected myopia is a public health problem among school-age children in rural China. Effective VA screening strategies are needed to eliminate this easily treated cause of visual impairment.

Adolescent↗
PubMedDate not supplied

Analysis of the National Health and Nutrition Examination Survey. Comment on "Prevalence of visual impairment in the United States", by S Vitale, MF Cotch, and RD Sperduto. JAMA 295:2158-63, 2006.

CONTEXT: The prevalence of visual impairment in the U.S. public has not been surveyed nationally in several decades. OBJECTIVE: To estimate the number of U.S. individuals aged 12 years or older who have impaired distance vision due to uncorrected refractive error. DESIGN, SETTING, AND PARTICIPANTS: The National Health and Nutrition Examination Survey (NHANES), using a multistage probability sampling design, included a vision evaluation in a mobile examination center. Visual acuity data were obtained from 13,265 of 14,203 participants (93.4%) who visited the mobile examination center in 1999-2002. Visual impairment was defined as presenting distance visual acuity of 20/50 or worse in the better-seeing eye. Visual impairment due to uncorrected refractive error was defined as (presenting) visual impairment that improved, aided by automated refraction results, to 20/40 or better in the better-seeing eye. MAIN OUTCOME MEASURES: Presenting distance visual acuity (measured with usual corrective lenses, if any) and distance visual acuity after automated refraction. RESULTS: Overall, 1,190 study participants had visual impairment (weighted prevalence, 6.4%; 95% confidence interval [CI], 6.0-6.8%), and of these, 83.3% could achieve good visual acuity with correction (95% CI, 80.9-85.8%). Extrapolating these findings to the general U.S. population, approximately 14 million individuals aged 12 years or older have visual impairment (defined as distance visual acuity of 20/50 or worse), and of these, more than 11 million individuals could have their vision improved to 20/40 or better with refractive correction. CONCLUSIONS: Visual impairment due to uncorrected refractive error is a common condition in the United States. Providing appropriate refractive correction to those individuals whose vision can be improved is an important public health endeavor with implications for safety and quality of life.

Humans↗
PubMed2002

Correctable visual impairment in an older population: the blue mountains eye study.

PURPOSE: To describe temporal changes in the characteristics of older persons with visual impairment in their better eye correctable by refraction. DESIGN: Study of two cross sections of a community 6 years apart. METHODS: The Blue Mountains Eye Study examined 3654 persons aged 49 to 97 during 1992 to 1994 (cross-section 1) and 3509 persons (2335 cohort survivors plus 1174 persons who moved to the area and age group) during 1997 to 2000 (cross-section 2). Logarithm of minimal angle of resolution visual acuity was measured before and after refraction. Correctable visual impairment was defined as visual impairment < 20/40 in the better eye before refraction that improved after refraction to no impairment (>/= 20/40). Factors associated with correctable visual impairment and persistent correctable impairment were determined. RESULTS: Cross-sections 1 and 2 had similar age-gender distributions. In cross-section 1, 7.5% of participants had correctable visual impairment, 3.6% had noncorrectable visual impairment, and 88.9% had no impairment. Corresponding rates in cross-section 2 were 5.6%, 2.7%, and 91.7%. In both cross sections, similar proportions (around 68%) of those visually impaired had correctable visual impairment and similar sociodemographic measures predicted correctable visual impairment. Cross-section 1 participants who were married, owned their home, had high job prestige, gained qualifications after high school, or were current drivers were less likely to have correctable visual impairment after controlling for age and gender. Adjusted odds for correctable visual impairment increased in those living alone, using community support services, dependent on others, with myopia, wearing distance glasses, or with low perceived health and heart disease. Histories of stroke, cancer, and diabetes were similar between groups with correctable and no visual impairment. CONCLUSION: Socioeconomic parameters, myopia, wearing distance glasses, reported health problems, and poor perceived health were associated with correctable visual impairment in this older population.

Aged↗
PubMed2003

An improved technique of eye drop self-administration for patients with limited vision.

PURPOSE: To describe a new, highly accurate, tactile technique to increase accuracy in the self-administration of eye drops. DESIGN: Interventional case series. METHODS: Ten adult patients with loss of fixation (< or = 20/400) in one eye and ten adult patients with loss of fixation in both eyes instilled one drop of artificial tears in each eye using the technique normally employed at home. The time required to instill each drop, the number of drops squeezed from the bottle, and location of the drops' landing points on the face or eye were recorded. The patients were then instructed in a new technique for instillation, guided through the procedure once, and allowed to practice until comfortable with it. All measurements were then repeated. RESULTS: In patients with loss of fixation in one eye, an additional 3.2 +/- 4.1 seconds were required to instill a drop using the new technique (P <.0001, paired t test; range, -7-18 seconds). The mean number of drops dispensed decreased by 0.1 +/- 0.6 drops (P =.60, paired t test; range, -2-1 drop). The accuracy of drop placement increased from 80.0% to 82.5% (P =.32, paired t test). In subjects with loss of fixation in both eyes, using the new technique increased the time needed to instill a drop by 3.8 +/- 3.8 seconds (P <.0001, paired t test; range, -3-13 seconds). The average number of drops dispensed decreased by 0.1 +/- 0.6 drops (P =.25, paired t test; range, -2-1 drop). The accuracy of placement increased from 63.0% to 85.0% (P =.001, paired t test). CONCLUSIONS: This technique of drop instillation may be beneficial for patients with significant visual impairment in both eyes.

Adult↗
PubMed2003

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

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

Adolescent↗