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IMPROVED TREATMENT IS KEY IN MALAYSIA

The prevalence of blindness in Malaysia is 0.29%, with cataract the leading cause, according to results from the first ever Malaysian National Eye Survey (

). From a sample obtained by a stratified two stage cluster strategy, Zainal et al interviewed and examined 18 027 respondents. The age adjusted prevalence of blindness was 0.29% while that of low vision was 2.44%. Thirty nine per cent of blindness was caused by cataract, while uncorrected refractive error accounted for 48% of low vision. As these are both highly treatable, improvements in the provision of eye care would have a significant impact on the burden of visual impairment in Malaysia.

ELDERLY INDEPENDENCE AFFECTED

Undercorrected refractive error is a common condition in older people with a significant impact on their independent living. A population based survey explored several demographic, social, and eye related variables that are associated with the condition (

). The researchers measured visual acuity and checked for refractive errors in 3654 Australians. They found that undercorrected refractive error was present in 814 people, and that factors such as increasing age, hyperopia, social disadvantage, and isolation were associated with a higher prevalence of the condition. The findings suggest the need to target education and eye care services.

ROLE OF HYPERTENSION CLARIFIED

It is well known that retinal microvascular changes are associated with hypertension but whether these changes reflect current or longstanding raised blood pressure was not clear. A recent study has found that some changes actually reflect blood pressure at the time of retinal photography while others represent cumulative arteriolar damage from longstanding hypertension (

). Additionally, the results showed that patients with untreated or poorly controlled hypertension are more liable to have retinal microvascular abnormalities.

NO TOWN VERSUS COUNTRY DIFFERENCE IN INDIA

There is no major difference in the prevalence of diabetic retinopathy among self reported diabetics in a rural compared with an urban setting. The Pallakad Eye Disease survey in India sampled 5666 people over 50 years old (

). The prevalence of diabetic retinopathy was 26.8% compared with that in a nearby urban population of 22.4%. They also found a comparatively low prevalence in the population sampled (1.3%) of diabetic retinopathy and blindness as a consequence (0.03%). Because of the projected increase in the number of people with diabetes in India from 19 to 57 million between 1995 and 2025, the existing pattern of blindness may change. Preventive strategies in India have to evolve to ensure that blindness as a consequence of retinopathy does not become a public health problem.

OMAN CAN DO BETTER

A study revealed that 1.1% of the indigenous Omani population was blind. Prevalence of blindness in some regions of Oman, such as the capital Muscat, is in line with industrial countries (0.3%–0.5%) while in others it is at the level of developing countries (over 1.5%) (

). Blindness in women (1.4%) was nearly twice that of men (0.8%). Prevalence increased significantly with age: 93% of those found to be blind were over age 40. The study found that most causes of blindness were largely preventable or treatable. Unoperated cataract and corneal opacities accounted for over 60% of cases. The authors conclude that while blindness rates have been decreasing over the years more needs to be done to improve preventative measures and uptake of treatment, especially by women.

PUBLIC HEALTH KNOWLEDGE NEEDS IMPROVEMENT

An improvement in public health awareness may help to prevent blindness attributable to common eye ailments. The research involving the Hong Kong Chinese population aimed to assess the individual knowledge and awareness about common eye problems like cataract, glaucoma, and age related macular degeneration (

). The researchers studied causes of adult visual loss and public awareness about common ocular diseases, by eye examinations and interviews in a randomly selected group of people aged 40 and above. The research showed only 22.9% of the study people could properly describe the symptoms of cataract and just 40% of them knew that surgery is the best treatment option for the disease. The researchers recommended implementation of public health awareness programmes to fight preventable blindness.

TURKMENISTAN—CATARACT BLINDNESS ON THE BRINK OF ELIMINATION

Turkmenistan boasts a respectably low prevalence of bilateral cataract blindness—the leading cause of all blindness (54%). The adjusted prevalence of the condition in the country is less than a quarter of predicted (

). While surgical coverage is good (75% bilateral cataract blindness being operated on) the authors call for a re-evaluation of guidelines for patients access to surgery. If each surgeon could increase from 71 to 285 operations a year, Turkmenistan could be brought into line with guidelines for the complete elimination of avoidable blindness. This may be achieved by lowering the intake criteria for surgery from VA <3/60 to VA <6/60. Education plans will complement efforts, with the main barrier to surgery being the attitude “old age, no need for surgery”.

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