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Diabetes Care Mar 2021To evaluate the association between initial diabetic retinopathy (DR) severity/risk of blindness in patients with newly diagnosed DR/good vision in the U.S.
OBJECTIVE
To evaluate the association between initial diabetic retinopathy (DR) severity/risk of blindness in patients with newly diagnosed DR/good vision in the U.S.
RESEARCH DESIGN AND METHODS
This retrospective cohort study evaluated adult patients with good vision (20/40 or better) and newly diagnosed DR between 1 January 2013 and 31 December 2017 (index date) in the American Academy of Ophthalmology's Intelligent Research in Sight (IRIS) Registry. The primary exposure of interest was DR severity at index: mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). The main outcome measure was development of sustained blindness (SB), defined as study eyes with Snellen visual acuity readings of 20/200 or worse at two separate visits ≥3 months apart that did not improve beyond 20/100.
RESULTS
Among 53,535 eligible eyes (mean follow-up 662.5 days), 678 (1.3%) eyes developed SB. Eyes with PDR at index represented 10.5% (5,629 of 53,535) of the analysis population but made up 26.5% (180 of 678) of eyes that developed SB. Kaplan-Meier analysis revealed that eyes with moderate NPDR, severe NPDR, and PDR at index were 2.6, 3.6, and 4.0 times more likely, respectively, to develop SB after 2 years of DR diagnosis versus eyes with mild DR at index. In a Cox proportional hazards model adjusted for index characteristics/development of ocular conditions during follow-up, eyes with PDR had an increased risk of developing SB versus eyes with mild NPDR at index (hazard ratio 2.26 [95% CI 2.09-2.45]).
CONCLUSIONS
In this longitudinal ophthalmologic registry population involving eyes with good vision, more advanced DR at first diagnosis was a significant risk factor for developing SB.
Topics: Adult; Blindness; Diabetes Mellitus; Diabetic Retinopathy; Humans; Retrospective Studies; Severity of Illness Index; Visual Acuity
PubMed: 33472864
DOI: 10.2337/dc20-0413 -
The Lancet. Global Health Apr 2021
Topics: Advisory Committees; Blindness; Eye Diseases; Global Burden of Disease; Global Health; Humans; Universal Health Care
PubMed: 33740398
DOI: 10.1016/S2214-109X(21)00138-8 -
The British Journal of Ophthalmology Oct 2013We aimed to evaluate age-related cataract as a contributor to blindness and visual impairment (VI) in sub-Saharan Africa (SSA). (Review)
Review
AIM
We aimed to evaluate age-related cataract as a contributor to blindness and visual impairment (VI) in sub-Saharan Africa (SSA).
METHODS
A systematic review of population-based studies published between 2000 and October 2012. Prevalence and proportions of blindness and VI due to cataract, cataract surgical coverage (CSC), per cent intraocular lens (IOL) implantation and visual outcomes of surgery in accordance with WHO criteria were ascertained.
RESULTS
Data from 17 surveys (subjects mostly aged ≥ 50-years-old) from 15 different countries in SSA were included, comprising 96 402 people. Prevalence of blindness (presenting visual acuity <3/60 in better eye) ranged from 0.1% in Uganda to 9.0% in Eritrea, and the proportion of total blindness due to cataract ranged between 21% and 67%. Cataract was the principal cause of blindness and VI in 15 and 14 studies, respectively. There was a strong positive correlation between good visual outcomes and IOL use (R=0.69, p=0.027). Considerable inter-study heterogeneity was evident in CSC and visual outcomes following surgery, and between 40% and 100% of operations had used IOL.
CONCLUSIONS
Cataract represents the principal cause of blindness and VI and should remain a priority objective for eye care in SSA. However, the prevalence of blindness and VI due to cataract was variable and may reflect differences in the availability of cataract surgical programmes and cataract incidence.
Topics: Africa South of the Sahara; Blindness; Cataract; Humans; Prevalence; Vision, Low
PubMed: 23696652
DOI: 10.1136/bjophthalmol-2013-303135 -
The British Journal of Ophthalmology Nov 2019The Rapid Assessment of Avoidable Blindness, or RAAB, is a relatively simple and low-cost survey methodology to provide data on the prevalence and causes of visual loss.... (Review)
Review
The Rapid Assessment of Avoidable Blindness, or RAAB, is a relatively simple and low-cost survey methodology to provide data on the prevalence and causes of visual loss. The aim of this article is to reflect on the achievements and challenges of RAAB, and to describe the future developments that are needed to ensure that it remains a relevant and widely used tool. To date, at least 331 RAABs have been undertaken in 79 countries, and these surveys provide an important source of information on visual loss at both the local and global level. A RAAB repository has been developed which includes the site and date of RAABs undertaken, and, where authors have agreed, the core indicators, reports or even raw data from the survey. This dataset has already been used for meta-analyses, and there are further opportunities for its use. Despite these achievements, there are core areas in which RAAB needs to be strengthened so that the full benefits of undertaking the survey can be reaped. Key developments of RAAB are underway, and will include greater use of mobile technologies using a cloud-based platform to enable both digital data collection, real-time survey reviews, reporting and analysis, and a greater emphasis on using the data for planning.
Topics: Aged; Blindness; Cataract Extraction; Corneal Diseases; Health Surveys; Humans; Middle Aged; Prevalence; Refractive Errors; Time Factors; Vision Screening
PubMed: 31266777
DOI: 10.1136/bjophthalmol-2019-314015 -
BMJ (Clinical Research Ed.) Nov 2015
Topics: Amputation, Surgical; Blindness; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Lower Extremity; Male
PubMed: 26561339
DOI: 10.1136/bmj.h5643 -
Acta Ophthalmologica Feb 2017
Topics: Blindness; Glaucoma; Global Health; Humans; Intraocular Pressure; Terminal Care
PubMed: 28102642
DOI: 10.1111/aos.12933 -
British Medical Journal (Clinical... Oct 1982
Topics: Blindness; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Time Factors
PubMed: 6812749
DOI: 10.1136/bmj.285.6348.1066 -
Bulletin of the World Health... 1999
Topics: Blindness; Cataract; Global Health; Humans; Trachoma; World Health Organization
PubMed: 10427928
DOI: No ID Found -
BMJ Open Jun 2023This study provides an estimate of the annual cost of blindness and moderate to severe visual impairment (MSVI) among people with diabetes aged 40 years and above in...
OBJECTIVES
This study provides an estimate of the annual cost of blindness and moderate to severe visual impairment (MSVI) among people with diabetes aged 40 years and above in India in the year 2019.
DESIGN
A cost of illness study.
SETTING
India.
PARTICIPANTS
People with diabetes aged 40 years and above in India in the year 2019.
PRIMARY AND SECONDARY OUTCOME MEASURES
Estimates are provided for the total costs of screening for most common vision-threatening eye conditions, treatment of these conditions, economic activity lost by these people and their family carers whose ability to work is affected, and loss of quality of life experienced by people with diabetes and blindness or MSVI.
RESULTS
It is estimated that for people with diabetes aged 40 years or above, annual screening followed by eye examination where required would cost around 42.3 billion Indian rupees (INR) (4230 crores) per year; treating sight problems around 2.87 billion INR (287 crores) per year if 20% of those needing treatment receive it; and lost economic activity around 472 billion INR (47 200 crores). Moreover, 2.86 million (0.286 crores) quality-adjusted life years (QALYs) are lost annually due to blindness and MSVI. The estimate of lost production is highly sensitive to the proportion of people with MSVI able to work and how their output compares with that of a person with no visual impairment.
CONCLUSIONS
This is the first study to estimate the cost of blindness and MSVI for people aged 40 years and over with diabetes in India. The annual cost to the Indian economy is substantial. This cost will be expected to fall if a successful screening and treatment plan is introduced in India. Further work is suggested using more robust data, when available, to estimate the loss of productivity and loss of QALYs, as this would be worthwhile.
Topics: Humans; Adult; Middle Aged; Quality of Life; Prevalence; Blindness; Vision, Low; Diabetes Mellitus; India
PubMed: 37355259
DOI: 10.1136/bmjopen-2022-063390 -
Indian Journal of Ophthalmology Jun 2022Currently, there are an estimated 4.95 million blind persons and 70 million vision impaired persons in India, out of which 0.24 million are blind children. Early...
PURPOSE
Currently, there are an estimated 4.95 million blind persons and 70 million vision impaired persons in India, out of which 0.24 million are blind children. Early detection and treatment of the leading causes of blindness such as cataract are important in reducing the prevalence of blindness and vision impairment. There are significant developments in the field of blindness prevention, management, and control since the "Vision 2020: The right to sight" initiative. Very few studies have analyzed the cost of blindness at the population level. This study was undertaken to update the information on the economic burden of blindness and visual impairment in India based on the prevalence of blindness in India. We used secondary and publicly available data and a few assumptions for our estimations.
METHODS
We used gross national income (GNI), disability weights, and loss of productivity metrics to calculate the economic burden of blindness and vision impairment based on the "cost of illness" methodology.
RESULTS
The estimated net loss of GNI due to blindness in India is INR 845 billion (Int$ 38.4 billion), with a per capita loss of GNI per blind person of INR 170,624 (Int$ 7,756). The cumulative loss of GNI due to avoidable blindness in India is INR 11,778.6 billion (Int$ 535 billion). The cumulative loss of GNI due to blindness increased almost three times in the past two decades. The potential loss of productivity due to vision impairment is INR 646 billion (Int$ 29.4 billion).
CONCLUSION
These estimates provide adequate information for budgetary allocation and will help advocate the need for accelerated adoption of all four strategies of integrated people-centered eye care (IPCEC). Early detection and treatment of blindness, especially among children, is very important in reducing the economic burden; thus, there is a need for integrating primary eye care horizontally with all levels of primary healthcare.
Topics: Blindness; Child; Cost of Illness; Financial Stress; Humans; India; Vision, Low
PubMed: 35648000
DOI: 10.4103/ijo.IJO_2804_21