Objective. Determine prevalence of blindness and visual impairment in adults aged ≥ 50 years in P... more Objective. Determine prevalence of blindness and visual impairment in adults aged ≥ 50 years in Panama, identify their main causes, and characterize eye health services. Methods. Cross-sectional population study using standard Rapid Assessment of Avoidable Blindness methodology. Fifty people aged ≥ 50 years were selected from each of 84 clusters chosen through representative random sampling of the entire country. Visual acuity was assessed using a Snellen chart; lens and posterior pole status were assessed by direct ophthalmoscopy. Cataract surgery coverage was calculated and its quality assessed, along with causes of visual acuity < 20/60 and barriers to access to surgical treatment. Results. A total of 4 125 people were examined (98.2% of the calculated sample). Age- and sex-adjusted prevalence of blindness was 3.0% (95% CI: 2.3–3.6). The main cause of blindness was cataract (66.4%), followed by glaucoma (10.2%). Cataract (69.2%) was the main cause of severe visual impairment a...
Revista panamericana de salud pública = Pan American journal of public health, 2015
To review data on functional low vision (FLV) (low vision-visual acuity (VA) < 6/18 (<20/60... more To review data on functional low vision (FLV) (low vision-visual acuity (VA) < 6/18 (<20/60) to > perception of light (PL+) in the better eye-that is untreatable and uncorrectable) in adults aged 50 years or older from published population-based surveys from 15 countries in Latin America and the Caribbean. Data from 15 cross-sectional, population-based surveys on blindness and visual impairment (10 national and five subnational) covering 55 643 people > 50 years old in 15 countries from 2003 to 2013 were reanalyzed to extract statistics on FLV. Eleven of the studies used the rapid assessment of avoidable blindness (RAAB) method and four used the rapid assessment of cataract surgical services (RACSS) method. For the 10 national surveys, age-and sex-specific prevalence of FLV was extrapolated against the corresponding population to estimate the total number of people > 50 years old with FLV. Age- and sex-adjusted prevalence of FLV in people > 50 years old ranged from...
A prevalence survey for active trachoma in children aged under 10 years and trichiasis in women a... more A prevalence survey for active trachoma in children aged under 10 years and trichiasis in women aged 40 years and older was carried out in four districts in the Sololá region in Guatemala, which is suspected of still having a trachoma problem. Population-based surveys were undertaken in three districts, within 15 randomly selected communities in each district. In addition, in a fourth district that borders the third district chosen, we surveyed the small northern sub-district, by randomly selecting three communities in each community, 100 children aged under 10 years were randomly selected, and all females over 40 years. Five survey teams were trained and standardized. Trachoma was graded using the World Health Organization simplified grading scheme and ocular swabs were taken in cases of clinical follicular or inflammatory trachoma. Prevalence estimates were calculated at district and sub-district level. Trachoma rates at district level varied from 0-5.1%. There were only two sub-d...
In the last decade, health indicators in Latin America and the Caribbean reflect advances. The pe... more In the last decade, health indicators in Latin America and the Caribbean reflect advances. The per capita public expenditure on health care has increased in many countries. Despite these improvements, it is estimated that for every million population in Latin America and the Caribbean, 5,000 are blind and 20,000 are visually impaired; at least 66% of the blindness is attributable to treatable conditions such as cataract. The cataract surgery rate in the region remains low as compared to the industrialized countries, although it is higher than many other regions of the world. The availability of eye care services varies from country to country within the region, and the number of ophthalmologists per million population in the richest countries may be nine times more than in the poorest. Access, defined as the distance between the consumer and the services, is problematic in countries with isolated areas in the rainforest or high mountains, poor road systems, or lack of public transportation. Affordability is an important issue that limits utilization of services by the poorest segments of the population in nearly all countries in Latin America and the Caribbean.
Revista panamericana de salud pública = Pan American journal of public health, 2015
To conduct a comparative analysis of social inequalities in eye health and eye health care and ge... more To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. Overall prevalence of blindness in people 50 years old...
Revista panamericana de salud pública = Pan American journal of public health, 2015
Determine the prevalence of blindness and avoidable visual impairment in Argentina, its causes, t... more Determine the prevalence of blindness and avoidable visual impairment in Argentina, its causes, the coverage of cataract surgery, and the barriers that hinder access to these services. Cross-sectional population study conducted between May and November 2013 using the standard methodology for rapid assessment of avoidable blindness (RAAB), with a random cluster sampling of 50 people aged 50 years or more, -representative of the entire country. Participants' visual acuity (VA) was measured and the lens and posterior pole were examined by direct ophthalmoscopy. An assessment was made of the causes of having VA < 20/60, the coverage and quality of cataract surgery, and the barriers to accessing treatment. 3 770 people were assessed (92.0% of the projected number). The prevalence of blindness was 0.7% (confidence interval of 95%: 0.4-1.0%). Unoperated cataract was the main cause of blindness and severe visual impairment (44.0% and 71.1%, respectively), while the main cause of mode...
Revista panamericana de salud pública = Pan American journal of public health, 2014
To investigate and describe the prevalence and causes of blindness and moderate and severe visual... more To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay. All individuals aged ≥ 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction. Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) ...
Revista panamericana de salud pública = Pan American journal of public health, 2014
To estimate the prevalence of blindness and visual impairment among adults in Peru and to determi... more To estimate the prevalence of blindness and visual impairment among adults in Peru and to determine their causes, to evaluate the coverage and quality of the cataract surgical services and to investigate the barriers that inhibit access to these services. A cross-sectional population study with two-stage random cluster sampling of individuals of ≥ 50 years old, representative of the entire country, using the standard methodology of the Rapid Assessment of Avoidable Blindness. Visual acuity was assessed and the condition of the lens and posterior pole examined by direct ophthalmoscopy. Cataract surgical coverage was calculated. Its quality, as well as the causes of visual acuity < 20/60 and the barriers to accessing surgical treatment were assessed. A total of 4 849 people were examined. Blindness prevalence was 2.0% (confidence interval of 95%: 1.5-2.5%). The main causes of blindness were cataract (58.0%), glaucoma (13.7%) and age-related macular degeneration (11.5%). Uncorrected...
Revista panamericana de salud pública = Pan American journal of public health, 2014
To examine the prevalence of blindness, visual impairment, and related eye diseases and condition... more To examine the prevalence of blindness, visual impairment, and related eye diseases and conditions among adults in El Salvador, and to explore socioeconomic inequalities in their prevalence by education level and occupational status, stratified by sex. Based upon the Rapid Assessment of Avoidable Blindness (RAAB) methodology, this nationwide sample comprised 3 800 participants (3 399 examined) ≥ 50 years old from 76 randomly selected clusters of 50 persons each. The prevalence of blindness, visual impairment and related eye diseases and conditions, including uncorrected refractive error (URE), was calculated for categories of education level and occupational status. Multiple logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and stratified by sex. Age-adjusted prevalence was 2.4% (95% CI: 2.2-2.6) for blindness (men: 2.8% (95% CI: 2.5-3.1); women: 2.2% (95% CI: 1.9-2.5)) and 11.8% (95% CI: 11.6-12.0) for moderate visual impairmen...
Revista panamericana de salud pública = Pan American journal of public health, 2014
Determine prevalence of blindness and visual impairment in adults aged > 50 years in Panama, i... more Determine prevalence of blindness and visual impairment in adults aged > 50 years in Panama, identify their main causes, and characterize eye health services. Cross-sectional population study using standard Rapid Assessment of Avoidable Blindness methodology. Fifty people aged > 50 years were selected from each of 84 clusters chosen through representative random sampling of the entire country. Visual acuity was assessed using a Snellen chart; lens and posterior pole status were assessed by direct ophthalmoscopy. Cataract surgery coverage was calculated and its quality assessed, along with causes of visual acuity < 20/60 and barriers to access to surgical treatment. A total of 4 125 people were examined (98.2% of the calculated sample). Age- and sex-adjusted prevalence of blindness was 3.0% (95% CI: 2.3-3.6). The main cause of blindness was cataract (66.4%), followed by glaucoma (10.2%). Cataract (69.2%) was the main cause of severe visual impairment and uncorrected refracti...
Revista panamericana de salud pública = Pan American journal of public health, 2014
To determine the prevalence of blindness and visual impairment in Honduras, its causes and the re... more To determine the prevalence of blindness and visual impairment in Honduras, its causes and the response by the health services to growing demand. A cross-sectional population study was conducted between June and December 2013 using the standard methodology of the Rapid Assessment of Avoidable Blindness. A random sample survey was done in 63 clusters of 50 individuals aged ≥ 50, representative of the country as a whole. Visual acuity (VA) was assessed using a Snellen eye chart, and the condition of the lens and posterior pole was examined by direct ophthalmoscopy. Cataract surgical coverage was calculated and an assessment made of its quality, the causes of VA < 20/60 and the barriers to accessing surgical treatment. A total of 2 999 people were examined (95.2% of the forecast total). Blindness prevalence was 1.9% (confidence interval of 95%: 1.4-2.4%) and 82.2% of these cases were avoidable. The main causes of blindness were unoperated cataracts (59.2%) and glaucoma (21.1%). Unco...
We report the clinicopathologic features of an eye with occult choroidal neovascularization assoc... more We report the clinicopathologic features of an eye with occult choroidal neovascularization associated with age-related macular degeneration. Ophthalmoscopic findings at presentation included subretinal fluid and lipid. We noted angiographic staining of irregularly elevated areas of retinal pigment epithelium. In the late phase of the angiogram, fluorescein leakage at the level of the outer retina was observed that did not correspond to well-demarcated areas of hyperfluorescence in earlier phases. The patient was randomized to treatment in a pilot trial comparing the effects of grid laser treatment with the effects of no treatment for occult choroidal neovascularization. Three weeks after treatment, some of the subretinal fluid had cleared and vision improved. The patient died 6 weeks after laser treatment. Histopathologic study disclosed a subretinal pigment epithelial fibrovascular membrane. Neovascularization originated from the choroid.
... Marıa Catalina Ramırez Irene Bengo Riccardo Mereu Astrid Ximena Bejarano R. JuanCamil... more ... Marıa Catalina Ramırez Irene Bengo Riccardo Mereu Astrid Ximena Bejarano R. JuanCamilo Silva ... for the introduction of youth development of Mambasa and Politecnico di Milano, considering factors ... Moreover Leonel Riano, community leader says that '' All the work of ...
We review what is known in each country of the Latin American region in regard to blindness and v... more We review what is known in each country of the Latin American region in regard to blindness and visual impairment and make some comparisons to Hispanic populations in the United States. Prevalence of blindness varied from 1.1% in Argentina to 4.1% in Guatemala in people 50 years of age and older, with the major cause being cataract. Diabetic retinopathy and
Clinicopathologic studies of eyes lead to a better understanding of the nature of the ophthalmosc... more Clinicopathologic studies of eyes lead to a better understanding of the nature of the ophthalmoscopic and fluorescein angiographic features of drusen. A study was conducted to provide clinicopathologic correlation of drusen and present a classification of drusen based on clinical and histopathologic features. The macular areas of three eyes from two patients were serially sectioned and studied, and features were depicted in a two-dimensional map and compared with clinical findings. All three tyes had large drusen (&gt; 63 microns) with soft morphologic characteristics (poorly demarcated borders) documented on fundus photographs. In both eyes from one patient, these large drusen corresponded to areas of focal retinal pigment epithelium hypopigmentation overlying Bruch&#39;s membrane, which was diffusely thickened throughout the macula. Similar findings were noted in another eye from a second patient, and additionally, where there was relatively marked fluorescein staining of large drusen on the late phase of an angiogram, the pathologic correlation demonstrated detachment of the thickened inner aspect of Bruch&#39;s membrane from the remainder of Bruch&#39;s membrane. Focal hyperpigmentation corresponded to areas of hypertrophy of the retinal pigment epithelium and to clusters of pigmented cells in the subretinal space and outer nuclear area. Diffuse thickening of the inner aspect of Bruch&#39;s membrane is associated with retinal pigment epithelial hypopigmentation, focal atrophy, and soft (large) drusen formation.
To collect cataract surgery rates data in 19 Latin American countries over a 4-year period as dat... more To collect cataract surgery rates data in 19 Latin American countries over a 4-year period as data published to date have been limited. Cataract surgery rates were obtained from National Society of Ophthalmology, National VISION 2020/Prevention of Blindness Committee and Ministry of Health representatives for each country for 2005 to 2008. Economic (gross national income per capita) and other data were collected from publicly available databases. Linear and power correlations between gross national incomes and cataract surgery rates were calculated. Over the study period, most countries increased their cataract surgery rates, with the largest increases observed for Venezuela (186%), Nicaragua (183%), Costa Rica (100%), Uruguay (97%), and Peru (88%). Mean cataract surgery rates for 2005, 2006, 2007, and 2008 for the ensemble of countries were 1545, 1684, 1660, and 1822 per million population, respectively, with a growth over the study period of 17.9%, concurrent with an increase of 57 million (11.5%) in the population. A good correlation between cataract surgery rate and gross national income per capita was found (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Although progress is being made in the region, the cataract surgery rates represent only one parameter. When they are examined in the context of cataract surgical coverage it is clear that substantial proportions of bilaterally blind persons are still not receiving surgery.
To present results of a rapid assessment on visual impairment due to cataract and on cataract sur... more To present results of a rapid assessment on visual impairment due to cataract and on cataract surgical services in the Northwestern districts of Buenos Aires, Argentina. These results will enable health managers to plan effective interventions in this area in line with VISION 2020. One hundred fifteen clusters of 40 persons of 50 years and older in each cluster (4600 eligible persons) were selected by systematic sampling from the Northwestern districts of Buenos Aires, Argentina. This area consists of 10 districts with a total population of 2,716,573 (2001 census), from whom 4302 persons were examined (coverage 93.5%). The visual acuity was measured with a tumbling E-chart and the lens status with distant direct ophthalmoscopy. Cataract is the major cause of bilateral blindness (54.2%). The age and sex adjusted prevalence of bilateral cataract blindness (presenting VA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 20/400) in people of 50 years and older was 0.5% (95% CI: 0.4-0.8%), an estimated number of 2,985 persons. The cataract surgical coverage at this level was 70% for males and 78% for females. The prevalence of bilateral cataract and VA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 20/200 in persons of 50 years and older was 0.8% (95% CI: 0.6-1.1), an estimated 4,705 persons. In this last group, the surgical coverage was 66% (persons) and 57% (eyes). Of all operated eyes, 10% could not see 20/200. &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Cannot afford&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (32%), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;unaware of cataract&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (21%) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;contraindication for surgery&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (18%) were mentioned most as reason why surgery had not been done. The cataract problem is getting under control in this area. Coverage indicators are fairly high, and the outcome data better than in other studies. The cataract surgical rate could be raised further by awareness campaigns and by making cataract surgery more affordable.
Objective. Determine prevalence of blindness and visual impairment in adults aged ≥ 50 years in P... more Objective. Determine prevalence of blindness and visual impairment in adults aged ≥ 50 years in Panama, identify their main causes, and characterize eye health services. Methods. Cross-sectional population study using standard Rapid Assessment of Avoidable Blindness methodology. Fifty people aged ≥ 50 years were selected from each of 84 clusters chosen through representative random sampling of the entire country. Visual acuity was assessed using a Snellen chart; lens and posterior pole status were assessed by direct ophthalmoscopy. Cataract surgery coverage was calculated and its quality assessed, along with causes of visual acuity < 20/60 and barriers to access to surgical treatment. Results. A total of 4 125 people were examined (98.2% of the calculated sample). Age- and sex-adjusted prevalence of blindness was 3.0% (95% CI: 2.3–3.6). The main cause of blindness was cataract (66.4%), followed by glaucoma (10.2%). Cataract (69.2%) was the main cause of severe visual impairment a...
Revista panamericana de salud pública = Pan American journal of public health, 2015
To review data on functional low vision (FLV) (low vision-visual acuity (VA) < 6/18 (<20/60... more To review data on functional low vision (FLV) (low vision-visual acuity (VA) < 6/18 (<20/60) to > perception of light (PL+) in the better eye-that is untreatable and uncorrectable) in adults aged 50 years or older from published population-based surveys from 15 countries in Latin America and the Caribbean. Data from 15 cross-sectional, population-based surveys on blindness and visual impairment (10 national and five subnational) covering 55 643 people > 50 years old in 15 countries from 2003 to 2013 were reanalyzed to extract statistics on FLV. Eleven of the studies used the rapid assessment of avoidable blindness (RAAB) method and four used the rapid assessment of cataract surgical services (RACSS) method. For the 10 national surveys, age-and sex-specific prevalence of FLV was extrapolated against the corresponding population to estimate the total number of people > 50 years old with FLV. Age- and sex-adjusted prevalence of FLV in people > 50 years old ranged from...
A prevalence survey for active trachoma in children aged under 10 years and trichiasis in women a... more A prevalence survey for active trachoma in children aged under 10 years and trichiasis in women aged 40 years and older was carried out in four districts in the Sololá region in Guatemala, which is suspected of still having a trachoma problem. Population-based surveys were undertaken in three districts, within 15 randomly selected communities in each district. In addition, in a fourth district that borders the third district chosen, we surveyed the small northern sub-district, by randomly selecting three communities in each community, 100 children aged under 10 years were randomly selected, and all females over 40 years. Five survey teams were trained and standardized. Trachoma was graded using the World Health Organization simplified grading scheme and ocular swabs were taken in cases of clinical follicular or inflammatory trachoma. Prevalence estimates were calculated at district and sub-district level. Trachoma rates at district level varied from 0-5.1%. There were only two sub-d...
In the last decade, health indicators in Latin America and the Caribbean reflect advances. The pe... more In the last decade, health indicators in Latin America and the Caribbean reflect advances. The per capita public expenditure on health care has increased in many countries. Despite these improvements, it is estimated that for every million population in Latin America and the Caribbean, 5,000 are blind and 20,000 are visually impaired; at least 66% of the blindness is attributable to treatable conditions such as cataract. The cataract surgery rate in the region remains low as compared to the industrialized countries, although it is higher than many other regions of the world. The availability of eye care services varies from country to country within the region, and the number of ophthalmologists per million population in the richest countries may be nine times more than in the poorest. Access, defined as the distance between the consumer and the services, is problematic in countries with isolated areas in the rainforest or high mountains, poor road systems, or lack of public transportation. Affordability is an important issue that limits utilization of services by the poorest segments of the population in nearly all countries in Latin America and the Caribbean.
Revista panamericana de salud pública = Pan American journal of public health, 2015
To conduct a comparative analysis of social inequalities in eye health and eye health care and ge... more To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. Overall prevalence of blindness in people 50 years old...
Revista panamericana de salud pública = Pan American journal of public health, 2015
Determine the prevalence of blindness and avoidable visual impairment in Argentina, its causes, t... more Determine the prevalence of blindness and avoidable visual impairment in Argentina, its causes, the coverage of cataract surgery, and the barriers that hinder access to these services. Cross-sectional population study conducted between May and November 2013 using the standard methodology for rapid assessment of avoidable blindness (RAAB), with a random cluster sampling of 50 people aged 50 years or more, -representative of the entire country. Participants' visual acuity (VA) was measured and the lens and posterior pole were examined by direct ophthalmoscopy. An assessment was made of the causes of having VA < 20/60, the coverage and quality of cataract surgery, and the barriers to accessing treatment. 3 770 people were assessed (92.0% of the projected number). The prevalence of blindness was 0.7% (confidence interval of 95%: 0.4-1.0%). Unoperated cataract was the main cause of blindness and severe visual impairment (44.0% and 71.1%, respectively), while the main cause of mode...
Revista panamericana de salud pública = Pan American journal of public health, 2014
To investigate and describe the prevalence and causes of blindness and moderate and severe visual... more To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay. All individuals aged ≥ 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction. Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) ...
Revista panamericana de salud pública = Pan American journal of public health, 2014
To estimate the prevalence of blindness and visual impairment among adults in Peru and to determi... more To estimate the prevalence of blindness and visual impairment among adults in Peru and to determine their causes, to evaluate the coverage and quality of the cataract surgical services and to investigate the barriers that inhibit access to these services. A cross-sectional population study with two-stage random cluster sampling of individuals of ≥ 50 years old, representative of the entire country, using the standard methodology of the Rapid Assessment of Avoidable Blindness. Visual acuity was assessed and the condition of the lens and posterior pole examined by direct ophthalmoscopy. Cataract surgical coverage was calculated. Its quality, as well as the causes of visual acuity < 20/60 and the barriers to accessing surgical treatment were assessed. A total of 4 849 people were examined. Blindness prevalence was 2.0% (confidence interval of 95%: 1.5-2.5%). The main causes of blindness were cataract (58.0%), glaucoma (13.7%) and age-related macular degeneration (11.5%). Uncorrected...
Revista panamericana de salud pública = Pan American journal of public health, 2014
To examine the prevalence of blindness, visual impairment, and related eye diseases and condition... more To examine the prevalence of blindness, visual impairment, and related eye diseases and conditions among adults in El Salvador, and to explore socioeconomic inequalities in their prevalence by education level and occupational status, stratified by sex. Based upon the Rapid Assessment of Avoidable Blindness (RAAB) methodology, this nationwide sample comprised 3 800 participants (3 399 examined) ≥ 50 years old from 76 randomly selected clusters of 50 persons each. The prevalence of blindness, visual impairment and related eye diseases and conditions, including uncorrected refractive error (URE), was calculated for categories of education level and occupational status. Multiple logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and stratified by sex. Age-adjusted prevalence was 2.4% (95% CI: 2.2-2.6) for blindness (men: 2.8% (95% CI: 2.5-3.1); women: 2.2% (95% CI: 1.9-2.5)) and 11.8% (95% CI: 11.6-12.0) for moderate visual impairmen...
Revista panamericana de salud pública = Pan American journal of public health, 2014
Determine prevalence of blindness and visual impairment in adults aged > 50 years in Panama, i... more Determine prevalence of blindness and visual impairment in adults aged > 50 years in Panama, identify their main causes, and characterize eye health services. Cross-sectional population study using standard Rapid Assessment of Avoidable Blindness methodology. Fifty people aged > 50 years were selected from each of 84 clusters chosen through representative random sampling of the entire country. Visual acuity was assessed using a Snellen chart; lens and posterior pole status were assessed by direct ophthalmoscopy. Cataract surgery coverage was calculated and its quality assessed, along with causes of visual acuity < 20/60 and barriers to access to surgical treatment. A total of 4 125 people were examined (98.2% of the calculated sample). Age- and sex-adjusted prevalence of blindness was 3.0% (95% CI: 2.3-3.6). The main cause of blindness was cataract (66.4%), followed by glaucoma (10.2%). Cataract (69.2%) was the main cause of severe visual impairment and uncorrected refracti...
Revista panamericana de salud pública = Pan American journal of public health, 2014
To determine the prevalence of blindness and visual impairment in Honduras, its causes and the re... more To determine the prevalence of blindness and visual impairment in Honduras, its causes and the response by the health services to growing demand. A cross-sectional population study was conducted between June and December 2013 using the standard methodology of the Rapid Assessment of Avoidable Blindness. A random sample survey was done in 63 clusters of 50 individuals aged ≥ 50, representative of the country as a whole. Visual acuity (VA) was assessed using a Snellen eye chart, and the condition of the lens and posterior pole was examined by direct ophthalmoscopy. Cataract surgical coverage was calculated and an assessment made of its quality, the causes of VA < 20/60 and the barriers to accessing surgical treatment. A total of 2 999 people were examined (95.2% of the forecast total). Blindness prevalence was 1.9% (confidence interval of 95%: 1.4-2.4%) and 82.2% of these cases were avoidable. The main causes of blindness were unoperated cataracts (59.2%) and glaucoma (21.1%). Unco...
We report the clinicopathologic features of an eye with occult choroidal neovascularization assoc... more We report the clinicopathologic features of an eye with occult choroidal neovascularization associated with age-related macular degeneration. Ophthalmoscopic findings at presentation included subretinal fluid and lipid. We noted angiographic staining of irregularly elevated areas of retinal pigment epithelium. In the late phase of the angiogram, fluorescein leakage at the level of the outer retina was observed that did not correspond to well-demarcated areas of hyperfluorescence in earlier phases. The patient was randomized to treatment in a pilot trial comparing the effects of grid laser treatment with the effects of no treatment for occult choroidal neovascularization. Three weeks after treatment, some of the subretinal fluid had cleared and vision improved. The patient died 6 weeks after laser treatment. Histopathologic study disclosed a subretinal pigment epithelial fibrovascular membrane. Neovascularization originated from the choroid.
... Marıa Catalina Ramırez Irene Bengo Riccardo Mereu Astrid Ximena Bejarano R. JuanCamil... more ... Marıa Catalina Ramırez Irene Bengo Riccardo Mereu Astrid Ximena Bejarano R. JuanCamilo Silva ... for the introduction of youth development of Mambasa and Politecnico di Milano, considering factors ... Moreover Leonel Riano, community leader says that '' All the work of ...
We review what is known in each country of the Latin American region in regard to blindness and v... more We review what is known in each country of the Latin American region in regard to blindness and visual impairment and make some comparisons to Hispanic populations in the United States. Prevalence of blindness varied from 1.1% in Argentina to 4.1% in Guatemala in people 50 years of age and older, with the major cause being cataract. Diabetic retinopathy and
Clinicopathologic studies of eyes lead to a better understanding of the nature of the ophthalmosc... more Clinicopathologic studies of eyes lead to a better understanding of the nature of the ophthalmoscopic and fluorescein angiographic features of drusen. A study was conducted to provide clinicopathologic correlation of drusen and present a classification of drusen based on clinical and histopathologic features. The macular areas of three eyes from two patients were serially sectioned and studied, and features were depicted in a two-dimensional map and compared with clinical findings. All three tyes had large drusen (&gt; 63 microns) with soft morphologic characteristics (poorly demarcated borders) documented on fundus photographs. In both eyes from one patient, these large drusen corresponded to areas of focal retinal pigment epithelium hypopigmentation overlying Bruch&#39;s membrane, which was diffusely thickened throughout the macula. Similar findings were noted in another eye from a second patient, and additionally, where there was relatively marked fluorescein staining of large drusen on the late phase of an angiogram, the pathologic correlation demonstrated detachment of the thickened inner aspect of Bruch&#39;s membrane from the remainder of Bruch&#39;s membrane. Focal hyperpigmentation corresponded to areas of hypertrophy of the retinal pigment epithelium and to clusters of pigmented cells in the subretinal space and outer nuclear area. Diffuse thickening of the inner aspect of Bruch&#39;s membrane is associated with retinal pigment epithelial hypopigmentation, focal atrophy, and soft (large) drusen formation.
To collect cataract surgery rates data in 19 Latin American countries over a 4-year period as dat... more To collect cataract surgery rates data in 19 Latin American countries over a 4-year period as data published to date have been limited. Cataract surgery rates were obtained from National Society of Ophthalmology, National VISION 2020/Prevention of Blindness Committee and Ministry of Health representatives for each country for 2005 to 2008. Economic (gross national income per capita) and other data were collected from publicly available databases. Linear and power correlations between gross national incomes and cataract surgery rates were calculated. Over the study period, most countries increased their cataract surgery rates, with the largest increases observed for Venezuela (186%), Nicaragua (183%), Costa Rica (100%), Uruguay (97%), and Peru (88%). Mean cataract surgery rates for 2005, 2006, 2007, and 2008 for the ensemble of countries were 1545, 1684, 1660, and 1822 per million population, respectively, with a growth over the study period of 17.9%, concurrent with an increase of 57 million (11.5%) in the population. A good correlation between cataract surgery rate and gross national income per capita was found (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Although progress is being made in the region, the cataract surgery rates represent only one parameter. When they are examined in the context of cataract surgical coverage it is clear that substantial proportions of bilaterally blind persons are still not receiving surgery.
To present results of a rapid assessment on visual impairment due to cataract and on cataract sur... more To present results of a rapid assessment on visual impairment due to cataract and on cataract surgical services in the Northwestern districts of Buenos Aires, Argentina. These results will enable health managers to plan effective interventions in this area in line with VISION 2020. One hundred fifteen clusters of 40 persons of 50 years and older in each cluster (4600 eligible persons) were selected by systematic sampling from the Northwestern districts of Buenos Aires, Argentina. This area consists of 10 districts with a total population of 2,716,573 (2001 census), from whom 4302 persons were examined (coverage 93.5%). The visual acuity was measured with a tumbling E-chart and the lens status with distant direct ophthalmoscopy. Cataract is the major cause of bilateral blindness (54.2%). The age and sex adjusted prevalence of bilateral cataract blindness (presenting VA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 20/400) in people of 50 years and older was 0.5% (95% CI: 0.4-0.8%), an estimated number of 2,985 persons. The cataract surgical coverage at this level was 70% for males and 78% for females. The prevalence of bilateral cataract and VA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 20/200 in persons of 50 years and older was 0.8% (95% CI: 0.6-1.1), an estimated 4,705 persons. In this last group, the surgical coverage was 66% (persons) and 57% (eyes). Of all operated eyes, 10% could not see 20/200. &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Cannot afford&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (32%), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;unaware of cataract&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (21%) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;contraindication for surgery&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (18%) were mentioned most as reason why surgery had not been done. The cataract problem is getting under control in this area. Coverage indicators are fairly high, and the outcome data better than in other studies. The cataract surgical rate could be raised further by awareness campaigns and by making cataract surgery more affordable.
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