Assuntos
População Negra/estatística & dados numéricos , Cegueira/etnologia , Países em Desenvolvimento/estatística & dados numéricos , Oftalmopatias/etnologia , Baixa Visão/etnologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Cegueira/etiologia , Criança , Pré-Escolar , Oftalmopatias/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Suriname/epidemiologia , Baixa Visão/etiologia , Adulto JovemRESUMO
OBJECTIVE: To describe the 9-year incidence of visual impairment and primary causes of blindness among black participants of the Barbados Eye Studies (BES). DESIGN: Population-based prospective cohort study. PARTICIPANTS: The BES followed a nationally representative cohort selected by simple random sampling, aged 40 to 84 years at baseline, with reexaminations after 4 years (Barbados Incidence Study of Eye Diseases [BISED]) and 9 years (BISED II). BISED II included 2793 (81%) of those eligible. METHODS: Cumulative 9-year incidence rates were estimated by the Product-Limit approach. The study was reviewed and approved by the institutional review boards of collaborating institutions. MAIN OUTCOME MEASURES: Best-corrected visual acuity (VA) was assessed by the Ferris-Bailey chart, following a modified Early Treatment of Diabetic Retinopathy Study protocol. Low vision and blindness were defined by World Health Organization (WHO) criteria as VA <6/18 to 6/120, and <6/120, respectively, in the better eye, and by U.S. criteria as VA < or =20/40 and < or =20/200, respectively. Vision loss was defined as a decrease of 15 letters or more read correctly in the better eye between baseline and follow-up examinations. RESULTS: The 9-year incidence was 1.0% and 2.1% for blindness and 6.0% and 9.0% for low vision, by WHO and U.S. criteria, respectively. Older age at baseline was associated with higher incidence of low vision and blindness, reaching 23.0% (95% confidence interval [CI], 18.8-28.0) and 4.3% (95% CI, 2.7-6.9) at age 70 years or more, based on WHO criteria. The primary causes of incident bilateral blindness (U.S. criteria) in 126 eyes were age-related cataract (48.3%), open-angle glaucoma (OAG) (14.3%), combined cataract and OAG (6.3%), diabetic retinopathy (8.7%), and optic atrophy (7.1%). Age-related macular degeneration (2.4%) rarely caused blindness. CONCLUSIONS: Incident visual impairment is exceedingly high in this population. Cataract, OAG, and diabetic retinopathy remain the major causes of blindness, underpinning the clinical and public health significance of these conditions in this and similar populations.
Assuntos
População Negra , Cegueira/etnologia , Baixa Visão/etnologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Barbados/epidemiologia , Cegueira/etiologia , Oftalmopatias/complicações , Oftalmopatias/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição por Sexo , Baixa Visão/etiologia , Acuidade Visual , Organização Mundial da SaúdeRESUMO
OBJECTIVE: To describe the 4-year incidence of visual impairment and causes of blindness among black participants of the Barbados Eye Studies. DESIGN: Population-based incidence study. SETTING AND PARTICIPANTS: The Barbados Incidence Study of Eye Diseases (BISED) followed the cohort of the Barbados Eye Study (BES), a prevalence study based on a simple random sample of Barbadians 40 to 84 years of age. BISED included 3193 black participants from the original cohort (85% of those eligible). MAIN OUTCOME MEASURES: Best-corrected visual acuity (Ferris-Bailey chart) at baseline and follow-up was measured according to a modified Early Treatment of Diabetic Retinopathy Study protocol. By use of World Health Organization (WHO) criteria, low vision and blindness for an individual were defined as visual acuity (VA) <6/18 to 6/120 and <6/120, respectively, in the better eye. By commonly used US criteria, low vision and blindness were defined as VA < or = 20/40 and < or = 20/200, respectively. Vision loss was defined as a doubling of the visual angle (i.e., decrease of 15 letters or more read correctly between baseline and follow-up examinations). Progression was defined as vision loss among those with low vision at baseline. RESULTS: On the basis of WHO criteria, the overall 4-year incidence was 3.6% (95% confidence interval [CI], 3.0%-4.4%) for low vision and 0.6% (95% CI, 0.4%-1.0%) for blindness. Incidence rates were higher using US criteria: 5.3% (95 % CI, 4.5%-6.2%) and 1.5% (95% CI, 1.1%-2.0%), respectively, reaching 21.5% and 7.3% for persons aged 70 years or older at baseline. One tenth of the cohort had vision loss, and 28.6% of those with low vision progressed. About one half of incident blindness was due to age-related cataract. Nearly one fifth was caused by open-angle glaucoma (OAG) alone or combined with cataract, and approximately 10% was caused by diabetic retinopathy (DR). CONCLUSIONS: The incidence of visual impairment was high in this Afro-Caribbean population, particularly in older age groups, indicating the public health significance of visual loss for this and similar black populations. Cataract, OAG, and DR were among the leading causes of incident blindness, paralleling their high prevalence in this population.
Assuntos
População Negra , Cegueira/etnologia , Baixa Visão/etnologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Barbados/epidemiologia , Cegueira/etiologia , Oftalmopatias/complicações , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Baixa Visão/etiologia , Acuidade Visual , Organização Mundial da SaúdeRESUMO
Objetivo: Comparar as características demográficas, idade e sexo, bem como diagnóstico e conduta entre pacientes idosos, atendidos em um Serviço de Baixa Visão do Sistema Único de Saúde e um serviço na rede privada, além de verificar a eficácia da conduta nos dois serviços. Local: Fundação Altino Ventura (FAV) e Hospital de Olhos de Pernambuco (HOPE). Método: Realizou-se um estudo comparativo entre um serviço público e um privado, onde se pesquisaram prontuários de pacientes com baixa visão, na faixa etária de 60 anos ou mais, atendidos num período de dois anos pelo mesmo examinador. Compararam-se os dados sobre sexo, idade, motivo de procura ao serviço de baixa visão, diagnóstico, acuidade visual com e sem auxílio e recurso óptico indicado. Resultados: Encontrou-se um aumento significativo da idade dos pacientes atendidos no serviço privado em relação ao público. Houve predomínio do sexo masculino no serviço público, em relação ao privado. O diagnóstico mais freqüente no serviço público foi o glaucoma, no serviço privado, a degeneração macular relacionada a idade. O principal motivo de procura por ambos os serviços de baixa visão foi o desejo de retorno à leitura. Prescreveu-se, como auxílio para perto, principalmente, lentes esferoprismáticas, no serviço privado; e lentes asféricas, no público. A acuidade visual com auxílio para perto foi maior ou igual a 1,00 M em 21 (88,6 por cento) pacientes do serviço público e 29 (82,8 por cento) pacientes do privado. Conclusão: Conclui-se que apesar das diferenças encontradas entre os pacientes atendidos nos dois serviços pesquisados, o objetivo final de melhora da acuidade visual com o auxílio para perto foi atingido em ambos os grupos.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Baixa Visão/etnologia , Saúde do Idoso , Baixa Visão , Idoso de 80 Anos ou mais , Acuidade VisualRESUMO
OBJECTIVE: To determine the prevalence and causes of low vision and blindness in a predominantly black population. DESIGN: Population-based prevalence study of a simple random sample of Barbados-born citizens aged 40 to 84 years. PARTICIPANTS: Four thousand seven hundred nine persons (84% participation). METHODS: The standardized protocol included best-corrected visual acuity (with a Ferris-Bailey chart), automated perimetry, lens gradings (LOCS II), and an interview. Participants with visual acuity of worse than 20/30, other positive findings, and a 10% sample also had an ophthalmologic examination that evaluated the cause and extent of vision loss (resulting from that cause), if any. MAIN OUTCOME MEASURES: Low vision and blindness were defined as visual acuity in the better eye between 6/18 and 6/120 and visual acuity worse than 6/120, respectively (World Health Organization [WHO] criteria). RESULTS: Of the 4631 participants with complete examinations, 4314 (93%) reported their race as black, 184 (4%) reported their race as mixed (black and white), and 133 (3%) reported their race as white or other. Low vision was found in 5.9% of the black, 2.7% of the mixed, and 3.0% of white or other participants. Bilateral blindness was similar for black and mixed race participants (1.7% and 1.6%, respectively) and was not found in whites. Among black and mixed participants, the prevalence of low vision increased with age (from 0.3% at 40-49 years to 26.8% at 80 years or older). The prevalence of blindness was higher (P < 0.001) for men than women at each age group (0.5% versus 0.3% at ages 40-49 and 10.9% versus 7.3% at 80 years or more). Sixty percent of blindness was due to open-angle glaucoma and age-related cataract, each accounting for more than one fourth of cases. Other major causes were optic atrophy or neuropathy and macular and other retinal diseases. Few cases of blindness were due to diabetic retinopathy (1.4%), and none were due to age-related macular degeneration. CONCLUSIONS: Using the WHO criteria, prevalence of visual impairment was high in this African-origin population, particularly at older ages. Most blindness was due to open-angle glaucoma and cataract, with open-angle glaucoma causing a higher proportion of blindness than previously reported. The increased prevalence of blindness in men may be due to the increased male prevalence of glaucoma in this population and warrants further investigation. Results underline the need for blindness prevention programs, with emphasis on effective treatment of age-related cataract and enhancing strategies for early detection and treatment of open-angle glaucoma.
Assuntos
População Negra , Cegueira/etnologia , Catarata/etnologia , Glaucoma de Ângulo Aberto/etnologia , Baixa Visão/etnologia , População Branca , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Barbados/epidemiologia , Cegueira/etiologia , Catarata/complicações , Feminino , Glaucoma de Ângulo Aberto/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Baixa Visão/etiologia , Acuidade VisualRESUMO
PURPOSE: To assess and compare uncorrected binocular distance visual impairment rates in U.S. Hispanic children and adolescents. METHODS: Data from the Hispanic Health and Nutrition Examination Survey, 1982-1984, were analyzed for 6-19 year-old Cuban-Americans (n = 317), Mexican-Americans (n = 2519), and Puerto Ricans (n = 988). Visual acuity was assessed using Sloan Letters or Landolt Rings. RESULTS: Prevalence rates of uncorrected binocular distance visual impairment (20/30 or worse) were 15.5%, 14.9%, and 23.6% for Cuban-Americans, Mexican-Americans, and Puerto Ricans, respectively. After adjusting for age and gender, the differences between Puerto Ricans and both Cuban-Americans and Mexican-Americans were significant (p < 0.05). Children 6-12 years of age had lower visual impairment rates than 13-19 year-old adolescents. Girls had higher age-adjusted visual impairment rates than boys; these gender differences were statistically significant among Mexican-Americans (OR = 1.6, 95% CI = 1.1, 2.2) and Puerto Ricans (OR = 1.7, 95% CI = 1.2, 2.4). CONCLUSIONS: Among Hispanics, Puerto Rican children and adolescents have the highest prevalence rate of uncorrected binocular distance visual impairment; older age and female gender are associated with higher rates of uncorrected visual impairment.