Regina Lukács

Diabetes and diabetic retinopathy in people aged 50 years and older in Hungary

Background/aims The purpose of this study was to estimate the prevalence of diabetes mellitus (DM) and diabetic retinopathy (DR) in the population aged 50 years and older in Hungary, and to assess the coverage of diabetic eye care services. Methods In total, 105 clusters of 35 people aged 50 years or older were randomly selected. The standardised rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) was used. Participants were classified as having DM if they were known to have DM or if their random blood glucose level was ≥200 mg/dL. Dilated fundus examination and Scottish DR grading were performed. Results In total, 3523 (95.9%) out of 3675 eligible subjects were examined. And 705 (20.0%) out of 3523 had known (661) or newly diagnosed DM (44). Twenty per cent of participants with known DM had a blood glucose level ≥200 mg/dL, and 27.4% had never had an ophthalmological examination for DR. Prevalence of DR and/or maculopathy was 20.7% and prevalence of sight-threatening DR (STDR) was 4.3% in one or both eyes among participants with DM. Conclusions Prevalence of DM was in line with findings of other RAAB+DRM surveys and slightly lower than the unpublished earlier age-matched Hungarian estimate. Prevalence of DR was slightly lower than expected. The prevalence of STDR was low in people aged 50 years and older in Hungary compared with the results of other RAAB with DRM surveys. DR screening coverage was low. To prevent severe complications of DM and possible concomitant visual loss, the coverage of ophthalmic examinations in patients with DM should be increased.

Cukorbetegség és retinopathia diabetica regionális egyenlőtlenségei Magyarországon az 50 éves és idősebb korú lakosság körében

Absztrakt: Bevezetes: A cukorbetegseg az egyik leggyakoribb oka a vaksagnak az 50 eves vagy idősebb koru lakossag koreben. Celkitűzes: Tanulmanyunk celja a cukorbetegseg es a retinopathia diabetica (RD) prevalenciajanak meghatarozasa, illetve a cukorbetegek szemeszeti ellatasa lefedettsegenek vizsgalata hazank kulonboző reszein. Modszer: Szazot lakokorzetben, osszesen 3675, 50 eves vagy idősebb koru szemelyt vontunk be a vizsgalatba. A standardizalt rapid assessment of avoidable blindness (RAAB) + diabetic retinopathy module (DRM) segitsegevel vizsgaltuk a resztvevőket, majd a Nyugat-, Kozep- es Kelet-Magyarorszag kozotti kulonbsegeket. Eredmenyek: A cukorbetegseg prevalenciaja Kelet-Magyarorszagon (20,9%) magasabb volt, mint Nyugat- (19,5%) es Kozep-Magyarorszagon (19,5%). Az RD prevalenciaja Nyugat-Magyarorszagon (24,1%) magasabb volt, mint Kozep- (17,8%) es Kelet-Magyarorszagon (19,6%). A kozep-magyarorszagi resztvevők kozott volt a legkisebb azon paciensek aranya (19,1%), akik meg sohasem vettek reszt...INTRODUCTION Diabetes mellitus (DM) is one of the main causes of blindness among persons aged 50 years and older. AIM The purpose of our survey was to estimate the prevalence of DM and diabetic retinopathy (DR), as well as to assess the coverage of diabetic eye care services in different regions of Hungary. METHOD In 105 clusters, 3675 people aged 50 years and older were included in the survey. The standardized rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) was used to examine the participants. Thereafter, differences between West-, Middle- and East-Hungary were analysed. RESULTS Prevalence of DM was higher in East-Hungary (20.9%), than in West- (19.5%) and in Middle-Hungary (19.5%). Prevalence od DR was higher in West-Hungary (24.1%), than in Middle- (17.8%) and in East-Hungary (19.6%). Proportion of participants who never had a fundus examination for DR was the lowest in Middle-Hungary (19.1%). CONCLUSIONS Primary care should be strenghten mainly in country settlements or telemedical eye screening program should be started to decrease the prevalence of diabetic eye complications. Orv. Hetil., 2017, 158(10), 362-367.

Visual impairment and blindness in Hungary

The aim of this study was to estimate the prevalence and causes of blindness, severe visual impairment (SVI), moderate visual impairment (MVI), and early visual impairment (EVI) and its causes in an established market economy of Europe.

Feasibility of the rapid assessment of avoidable blindness with diabetic retinopathy module (RAAB+DR) in industrialised countries: challenges and lessons learned in Hungary

ABSTRACT Purpose: To present experiences gained during the planning, implementation, and practical performance of the rapid assessment of avoidable blindness with diabetic retinopathy module (RAAB+DR) in an established market economy. Methods: A total of 3523 people aged 50 years or older were examined at their homes in 105 randomly selected clusters in Hungary. During the 4-month-long field work, five teams visited the clusters. Each team was composed of a senior ophthalmic resident or eye specialist, a nurse, an assistant, a driver, and a local guide. The local guides were found through local mayors of the towns or villages or other local leaders. Results: Of all 105 clusters, 41% were completed in 1 day and 59% required a longer stay. The shortest daily examination time was 3.5 hours and the longest was 10 hours. Altogether, 7.6% of the enumeration areas needed revisit, mainly due to insufficient preparatory work and absence of the subjects. The best local guides were the local government workers, health visitors, and general practitioner (GP) nurses. Refusal of pupillary dilatation was relatively high and varied greatly among the study groups (7.7–43.8%). Conclusion: The performance of a RAAB+DR study in a well-industrialised country is difficult, but may be successful. The most critical factor for success is an excellent local guide who is able to achieve participation of the people. The results of the RAAB are a solid basis for the development of a national programme for universal eye health and to prepare active media campaigns.

Patológiás myopia talaján kialakult érújdonképződés intravitrealis ranibizumabkezelése

INTRODUCTION Pathological myopia is one of the leading causes of vision loss worldwide, especially among young people of working age. Choroidal neovascularization is one of the most important cause of visual impairment in pathological myopia. AIM To evaluate the efficacy of intravitreal ranibizumab for the treatment of myopic choroidal neovascularization. METHOD In this retrospective analysis 14 eyes of 14 patients (mean age: 61 ± 17 years) with myopic choroidal neovascularization were treated with intravitreal ranibizumab as needed. Best-corrected visual acuity, thickness of choroidal neovascularization lesion and the number of injections were assessed. RESULTS The mean visual acuity changed from 55.8 ± 19.3 letters to 64.8 + 15.5 at 12 months (p = 0.0414), and 62.6 ± 16.3 during follow-up time (p = 0.2896). Mean follow-up time was 19.7 ± 23.9 months, average number of injections was 2.8 ± 2.1. Visual acuity declined in four patients despite the treatment. CONCLUSIONS Intravitreal ranibizumab is an effective therapy in pathological myopia. Some patients experience deterioration of visual acuity despite of treatment. Orv. Hetil., 2017, 158(15), 579-586.Absztrakt: Bevezetes: A patologias myopia vilagszerte a latasvesztes egyik meghatarozo oka, jelentős reszben a meg aktiv, dolgozo korosztalyt erintve. Az egyik jelentős, latast veszelyeztető komplikacio patologias myopiaban a chorioidea-neovascularisatio. Celkitűzes: A patologias myopia talajan kialakult subfovealis erujdonkepződesek intravitrealis ranibizumabkezelese eredmenyessegenek vizsgalata. Modszer: Retrospektiv analizisunk soran 14 beteg (eletkor: 61 ± 17 ev) 14 szemen patologias rovidlatas talajan kialakult subfovealis erujdonkepződeseket kezeltunk intravitrealis ranibizumabbal, szukseg szerinti adagolasi moddal. Vizsgaltuk a legjobb korrigalt tavoli latoelesseg, a chorioidea-neovascularisatios laesio magassaganak valtozasat es a beadott injekciok szamat. Eredmenyek: A legjobb korrigalt latoelesseg a kiindulasi 55,8 ± 19,3 betűről az első ev vegere 64,8 ± 15,5 betűre (p = 0,0414), a kovetesi idő vegere 62,6 ± 16,3 betűre (p = 0,2896) javult. Az atlagos kovetesi idő 19,7 ± 23,9 honap, az atlagos i...

[Long-term treatment with intravitreal ranibizumab for exudative age-related macular degeneration].

INTRODUCTION The results of intravitreal ranibizumab treatment for exsudative age-related macular degeneration have been favourable until this time. AIM To evaluate the two-year functional and anatomic results of intravitreal ranibizumab treatment. METHOD 46 patients (age: 75 ± 9.1 years) were included in a prospective single center study. Treatment regimen was the following: monthly 0.5 mg ranibizumab was administered in the first 3 months, and later as required (pro re nata). The change of best corrected visual acuity and central retinal thickness was followed. RESULTS The visus change at the end of the follow-up time was not statistically significant compared to baseline (p = 0.760) and the at the end of the first year (p = 0.154). Central retinal thickness decreased significantly compared to baseline (p = 0.000001), but the change was not statistically significant compared to the end of the first year (p = 0.875). CONCLUSIONS Patients with neovascular macular degeneration treated with intravitreal ranibizumab using pro re nata regimen have stable visus for long term, and the exsudation could be reduced efficiently.

Long term intravitreal ranibizumab treatment for exsudative age-related macular degeneration

INTRODUCTION The results of intravitreal ranibizumab treatment for exsudative age-related macular degeneration have been favourable until this time. AIM To evaluate the two-year functional and anatomic results of intravitreal ranibizumab treatment. METHOD 46 patients (age: 75 ± 9.1 years) were included in a prospective single center study. Treatment regimen was the following: monthly 0.5 mg ranibizumab was administered in the first 3 months, and later as required (pro re nata). The change of best corrected visual acuity and central retinal thickness was followed. RESULTS The visus change at the end of the follow-up time was not statistically significant compared to baseline (p = 0.760) and the at the end of the first year (p = 0.154). Central retinal thickness decreased significantly compared to baseline (p = 0.000001), but the change was not statistically significant compared to the end of the first year (p = 0.875). CONCLUSIONS Patients with neovascular macular degeneration treated with intravitreal ranibizumab using pro re nata regimen have stable visus for long term, and the exsudation could be reduced efficiently.

Hosszú távú intravitrealis ranibizumabkezelés exsudativ idoskori maculadegenerációban

INTRODUCTION The results of intravitreal ranibizumab treatment for exsudative age-related macular degeneration have been favourable until this time. AIM To evaluate the two-year functional and anatomic results of intravitreal ranibizumab treatment. METHOD 46 patients (age: 75 ± 9.1 years) were included in a prospective single center study. Treatment regimen was the following: monthly 0.5 mg ranibizumab was administered in the first 3 months, and later as required (pro re nata). The change of best corrected visual acuity and central retinal thickness was followed. RESULTS The visus change at the end of the follow-up time was not statistically significant compared to baseline (p = 0.760) and the at the end of the first year (p = 0.154). Central retinal thickness decreased significantly compared to baseline (p = 0.000001), but the change was not statistically significant compared to the end of the first year (p = 0.875). CONCLUSIONS Patients with neovascular macular degeneration treated with intravitreal ranibizumab using pro re nata regimen have stable visus for long term, and the exsudation could be reduced efficiently.