Helena Buch

Prevalence and causes of visual impairment according to World Health Organization and United States criteria in an aged, urban Scandinavian population: The Copenhagen City Eye Study

PURPOSE To evaluate the prevalence and causes of visual impairment in an epidemiologic study of aged, urban individuals in Denmark. DESIGN Cross-sectional study. PARTICIPANTS The study population consisted of 1000 randomly selected residents aged 60 to 80 years in Copenhagen, Denmark. Of 976 eligible persons, 946 (96.9%) could be examined. Information about best-corrected visual acuity (VA) was obtained from 944 cooperative persons (96.7%). METHODS Data from the Copenhagen City Eye Study were used to assess the cause-specific prevalence of visual impairment as defined by the World Health Organization (WHO) (VA worse than 20/60-20/400 in the better eye) and the criteria used most commonly in the United States (VA worse than 20/40 but better than 20/200 in the better eye). Eligible subjects underwent an extensive ophthalmologic examination at The National University Hospital of Denmark. MAIN OUTCOME MEASURES Best-corrected VA and primary causes of visual impairment. RESULTS The prevalence of low vision according to the WHO definition ranged from 2.6% in subjects aged 70 to 74 years to 4.8% in subjects 75 to 80 years of age, with an age-adjusted relative prevalence of 1.58%. Using the U.S. definition, the overall age-adjusted prevalence of visual impairment was 2.9%. The causes of visual impairment according to the WHO criteria were age-related macular degeneration (AMD) (44.4%), cataract (33.3%), glaucoma in combination with cataract (11.1%), myopic macular degeneration (5.6%), and diabetic retinopathy (5.6%). However, according to the U.S. criteria, cataract was the most frequent primary cause (50.0%) and AMD was the second most frequent primary cause (34.4%) of visual impairment. Furthermore, using the U.S. criteria diabetic retinopathy was revealed as equally important as AMD and cataract as a cause of visual impairment among persons aged 65 to 69 years (33.3%). CONCLUSIONS Increasing age was an independent predictor of visual impairment. Cataract and AMD were the leading causes. Adequate implementation of surgery to treat cataract could reduce visual impairment by 33.3% according to the WHO criteria and by 50% according to the U.S. criteria.

Danish Rural Eye Study: the association of preschool vision screening with the prevalence of amblyopia

To determine the prevalence of amblyopia in Denmark before and after the initiation of the Danish national preschool vision screening programme.

Acute acquired comitant esotropia of childhood: a classification based on 48 children

To identify characteristics of pediatric patients who develop acute acquired comitant esotropia (AACE) with and without intracranial disease.

Danish Rural Eye Study: Epidemiology of Adult Visual Impairment

ABSTRACT Purpose: To examine the frequency and causes of visual impairment (VI) in a select population of Danish adults. Methods: A total of 3843 adults aged 20–94 years from the Danish General Suburban Population Study (GESUS) were included in the population-based, cross-sectional ophthalmological study, Danish Rural Eye Study (DRES). All DRES participants received a comprehensive general health examination preceding their eye examination, including measurement of best-corrected visual acuity (BCVA) for each eye, bilateral 45° retinal fundus photographs and further ophthalmological examination where indicated. Results: Overall, 3826 of 3843 participants (99.6%) had bilateral visual acuity measurements. The overall frequency of VI (BCVA <20/40 in the better-seeing eye) was 0.4% (95% confidence interval, CI, 0.2–0.7%; n = 15) among all DRES participants, 0.6% (95% CI 0.3–1.0%; n = 15) among participants >50 years and 3.7% (95% CI 2.1–6.5%; n = 11) in participants >80 years. The primary causes of VI in the better-seeing eye were age-related macular degeneration (AMD) in 46.7% (7/15) and cataract in 26.7% (4/15). A total of 43.3% (n = 115) of participants >80 years were pseudophakic in one or both eyes. The frequency of diabetes (HbA1c ≥48 mmol/mol or self-reported diagnosis) was 5.9% (n = 227), including 1.3% (n = 51) newly diagnosed in the GESUS. Of participants determined to have VI due to exudative AMD, 50% had received anti-vascular endothelial growth factor (VEGF) treatment. Conclusion: We report a relatively low frequency of VI among Danish adults over 59 years of age compared with that observed 10–15 years ago, which is both consistent with other recent Scandinavian studies and reflective of our relatively healthy and mobile population sample.

Keratopathy and pachymetric changes after photorefractive keratectomy and vitrectomy with silicone oil injection

We present a man who, after bilateral excimer laser photorefractive keratectomy (PRK) for high myopia in the right eye, had repeated retinal detachment surgery with lensectomy and injection of silicone oil. Visual acuity fluctuated in accordance with significant central corneal thickness diurnal variation. The case illustrates the possibility of PRK as a predisposing factor for keratopathy after retinal detachment surgery with silicone injection in an aphakic eye.

An evaluation of fundus photography and fundus autofluorescence in the diagnosis of cuticular drusen

Purpose To examine non-mydriatic fundus photography (FP) and fundus autofluorescence (FAF) as alternative non-invasive imaging modalities to fluorescein angiography (FA) in the detection of cuticular drusen (CD). Methods Among 2953 adults from the Danish Rural Eye Study (DRES) with gradable FP, three study groups were selected: (1) All those with suspected CD without age-related macular degeneration (AMD) on FP, (2) all those with suspected CD with AMD on FP and (3) a randomly selected group with early AMD. Groups 1, 2 and 3 underwent FA and FAF and group 4 underwent FAF only as part of DRES CD substudy. Main outcome measures included percentage of correct positive and correct negative diagnoses, Cohens κ and prevalence-adjusted and bias-adjusted κ (PABAK) coefficients of test and grader reliability. Results CD was correctly identified on FP 88.9% of the time and correctly identified as not being present 83.3% of the time. CD was correctly identified on FAF 62.0% of the time and correctly identified as not being present 100.0% of the time. Compared with FA, FP has a PABAK of 0.75 (0.60 to 1.5) and FAF a PABAK of 0.44 (0.23 to 0.95). Conclusions FP is a promising, non-invasive substitute for FA in the diagnosis of CD. FAF was less reliable than FP to detect CD.

THE ASSOCIATION BETWEEN CUTICULAR DRUSEN AND KIDNEY FUNCTION: A Population-Based Case-Control Study.

Purpose: To determine the association between cuticular drusen (CD) and kidney function. Design: observational case-control study. Methods: Setting: Population-based. Patients or Study Population: 53 participants with (CD) and 53 age- and sex-matched controls, selected from the Danish Rural Eye Study. Cuticular drusen participants were diagnosed using fluorescein angiography and controls were excluded if the patients were suspected of having CD on fundus photography or did not have an available estimated glomerular filtration rate. Main Outcome Measures: creatinine and estimated glomerular filtration rate. Results: The mean estimated glomerular filtration rate of those with CD was 73.3 mL·min·1.73 m−2 (95% confidence interval [CI]: 70.0–76.6) and 73.4 mL·minute−1·1.73 m−2 (95% CI: 69.5–77.3) in controls. The difference was not significant (P: 0.970). The mean creatinine among those with CD was 72.8 &mgr;mol/L (69.3–76.4) and 73.5 &mgr;mol/L (95% CI: 69.3–77.6) among controls. The difference was not significant (P = 0.820). Conclusion: The authors did not find an association between a (CD) diagnosis and decreased kidney function at a population level.