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Subhi Y, Potapenko I, Hajari JN, la Cour M. Prognostic modelling of number of patients with retinal vein occlusion in anti-VEGF therapy. Acta Ophthalmol 2024; 102:318-325. [PMID: 37278225 DOI: 10.1111/aos.15721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/21/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of the study was to evaluate temporal changes in age- and sex-stratified incidence rates of retinal vein occlusion (RVO) commenced in anti-vascular endothelial growth factor (anti-VEGF) treatment, proportion of patients remaining in active anti-VEGF therapy over time, and to develop a forecasting model for future number of patients with RVO in active anti-VEGF therapy. METHODS This was a registry-based study of patients with RVO in the Capital Region of Denmark from commenced in anti-VEGF therapy from 1 January 2007 to 30 June 2022. Census data were extracted from Statistics Denmark for incidence rate analyses and forecasting data of future demographics. RESULTS A total of 2641 patients with RVO were commenced in anti-VEGF therapy, of which 2192 were later discontinued. Number of patients rose dramatically during the first years of introduction of anti-VEGF therapy, after which growth was slower and followed the demographic changes. Trend analyses revealed that the COVID-19 epidemics impacted with fewer referrals and more aggressive discontinuation practices. Annual incidence of RVO in 2012-2021 was 13.1 per 100 000 (95% CI: 12.6-13.6 per 100 000). Proportion of patients with RVO remaining in active anti-VEGF treatment was 55.0%, 40.1%, 30.8% and 12.1% after Years 1, 2, 3 and 8, respectively. According to our forecast, number of patients with RVO in active anti-VEGF therapy will grow slowly but continually at least until year 2035. CONCLUSION Our study reports incidence rates and provides prognostic modelling of number of patients with RVO in anti-VEGF therapy.
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Affiliation(s)
- Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ivan Potapenko
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Javad N Hajari
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Schuster AK, Leisle L, Picker N, Bubendorfer-Vorwerk H, Lewis P, Hahn P, Wasem J, Finger RP. Epidemiology of Diagnosed Age-related Macular Degeneration in Germany: An Evaluation of the Prevalence Using AOK PLUS Claims Data. Ophthalmol Ther 2024; 13:1025-1039. [PMID: 38386186 PMCID: PMC10912065 DOI: 10.1007/s40123-024-00901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Epidemiologic data on age-related macular degeneration (AMD) are mainly based on cohort studies, including both diagnosed and undiagnosed cases. Using health claims data allows estimating epidemiological data of diagnosed subjects with AMD within the health care system using diagnosis codes from a regional claims database (AOK PLUS) to estimate the prevalence and incidence of non-exudative and exudative AMD in Germany. METHODS Patients with AMD were identified among AOK PLUS insured patients based on at least two outpatient, ophthalmologic or one inpatient H35.3 diagnoses for the years 2012 to 2021. Patients without continuous observation in a calendar year were excluded. Prevalence was assessed, and 1-year cumulative incidence was determined by the number of newly diagnosed patients divided by the number of individuals at risk. For 2020 and 2021, the AMD stage was assessed by diagnostic subcodes for non-exudative and exudative AMD, respectively. For 2012 to 2019, patient numbers were estimated based on the average proportions of non-exudative AMD and exudative AMD, respectively, in 2020 and 2021. Incidence and prevalence numbers were then extrapolated to Germany. RESULTS Between 2012 to 2021, the prevalence of diagnosed AMD cases remained relatively stable among approximately 3.27 million AOK PLUS insured persons, ranging from 0.96% (minimum in 2021) to 1.31% (maximum in 2014) for non-exudative AMD, about twice as high as for exudative AMD (min-max: 0.53-0.72%). The age- and sex-adjusted projections amounted to 644,153 diagnosed non-exudative and 367,086 diagnosed German patients with exudative AMDs in 2021. The 1-year cumulative incidence for non-exudative and exudative AMD, respectively, ranged from 122,427-142,932 to 46,092-86,785 newly diagnosed cases. CONCLUSION The number of diagnosed cases with AMD in Germany has increased slightly over the past decade. For the first time, patient counts with non-exudative and exudative AMD were approximated for Germany based on a representative, large-scale database study.
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Affiliation(s)
- Alexander K Schuster
- Department of Ophthalmology, University Medical Center Mainz, Geb. 101, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Lilia Leisle
- Real World and Advanced Analytics, Ingress-Health HWM GmbH, A Cytel Company, Wismar/Berlin, Germany
| | - Nils Picker
- Real World and Advanced Analytics, Ingress-Health HWM GmbH, A Cytel Company, Wismar/Berlin, Germany
| | | | - Philip Lewis
- Value, Access and Policy DACH, Apellis Germany GmbH, München, Germany
| | - Philipp Hahn
- Institut für Pharmakoökonomie und Arzneimittellogistik e.V, Wismar, Germany
| | - Jürgen Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Claessen H, Kvitkina T, Narres M, Bertram B, Icks A. Decline in Blindness in Persons Up to Age 65 and the Associated Lost Years of Gainful Employment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:198-199. [PMID: 38666675 PMCID: PMC11079808 DOI: 10.3238/arztebl.m2023.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 05/12/2024]
Affiliation(s)
- Heiner Claessen
- Both authors share joint first authorship
- Institute for Health Services Research and Health Economics, German Diabetes Centre, German Center for Diabetes Research
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf
- German Center for Diabetes Research (DZD), München-Neuherberg
| | - Tatjana Kvitkina
- Both authors share joint first authorship
- Institute for Health Services Research and Health Economics, German Diabetes Centre, German Center for Diabetes Research
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf
- German Center for Diabetes Research (DZD), München-Neuherberg
| | - Maria Narres
- Institute for Health Services Research and Health Economics, German Diabetes Centre, German Center for Diabetes Research
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf
- German Center for Diabetes Research (DZD), München-Neuherberg
| | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Centre, German Center for Diabetes Research
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf
- German Center for Diabetes Research (DZD), München-Neuherberg
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Schuster AK. [Healthcare research in glaucoma]. DIE OPHTHALMOLOGIE 2023; 120:1086-1087. [PMID: 37921909 DOI: 10.1007/s00347-023-01944-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 11/05/2023]
Affiliation(s)
- Alexander K Schuster
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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Bek T, Bech BH. Visual acuity and causes of central visual loss in the adult Danish population 2020-2022. Results from the FORSYN study. Acta Ophthalmol 2023. [PMID: 36726309 DOI: 10.1111/aos.15641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Knowledge of visual health in the population is necessary for designing and implementing measures to handle visual handicap. The purpose of the FORSYN (Forekomst af synshandicap og synshjaelpemidler i Danmark) project was to study visual health in the Danish population 2020-2022 after implementation of the recent advances in the management of choroidal and retinal vascular disease. The present study reports visual acuity and causes of central visual loss from this study. METHODS A population-representative sample of 10 350 citizens living within 40 kilometres from Aarhus University Hospital were invited to answer a questionnaire about quality of life related to vision, measurement of visual acuity and a non-mydriatic examination of the eyes. The data were corrected for selection bias on the basis of demographic and socioeconomic factors so that the results could be projected to represent the adult Danish population. RESULTS Population-adjusted visual acuity in ETDRS letters (mean ± SD) differed significantly (p < 0.0001) among the worse eye (84.1 ± 0.25), the better eye (88.4 ± 0.11) and binocularly (89.2 ± 0.15). Social blindness affected 0.22% (95% CI: 0.14%-0.33%) of the population and was in none of the studied persons due to exudative age-related macular degeneration (AMD) or diabetic retinopathy. The most frequent causes of visual loss were atrophic AMD, neuro-ophthalmic disorders and other chorioretinal diseases. CONCLUSIONS Recent advances in the therapy of chorioretinal vascular diseases have been paralleled with a reduction in central vision loss secondary to exudative AMD and diabetic retinopathy in Denmark. The demographic development can be expected to increase the demand for treatments of vision-threatening diseases that mainly affect older persons.
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Affiliation(s)
- Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, University of Aarhus, Aarhus C, Denmark
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Ramos PL, Santana R, Marques AP, Sousa I, Rocha-Sousa A, Macedo AF. Cross-sectional study investigating the prevalence and causes of vision impairment in Northwest Portugal using capture-recapture. BMJ Open 2022; 12:e056995. [PMID: 36691224 PMCID: PMC9462125 DOI: 10.1136/bmjopen-2021-056995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 07/06/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The aim of this study was to estimate the prevalence and causes of vision impairment (VI) in Portugal. SETTING Information about people with VI was obtained from primary care centres, blind association (ACAPO) and from hospitals (the PCVIP study) in the Northwest of Portugal during a period spanning years 2014-2015. Causes of VI were obtained from hospitals. PARTICIPANTS Administrative and medical records of people with visual acuity in the better seeing eye of 0.5 decimal (0.30logMAR) or worse and/or visual field less than 20° were investigated. Capture-recapture with log-linear models was applied to estimate the number of individuals missing from lists of cases obtained from available sources. PRIMARY AND SECONDARY OUTCOME MEASURES Log-linear models were used to estimate the crude prevalence and the category specific prevalence of VI. RESULTS Crude prevalence of VI was 1.97% (95% CI 1.56% to 2.54%), and standardised prevalence was 1% (95% CI 0.78% to 1.27%). The age-specific prevalence was 3.27% (95% CI 2.36% to 4.90%), older than 64 years, 0.64% (95% CI 0.49% to 0.88%), aged 25-64 years, and 0.07% (95% CI 0.045% to 0.13%), aged less than 25 years. The female-to-male ratio was 1.3, that is, higher prevalence among females. The five leading causes of VI were diabetic retinopathy, cataract, age-related macular degeneration, glaucoma and disorders of the globe. CONCLUSIONS The prevalence of VI in Portugal was within the expected range and in line with other European countries. A significant number of cases of VI might be due to preventable cases and, therefore, a reduction of the prevalence of VI in Portugal seems possible. Women and old people were more likely to have VI and, therefore, these groups require extra attention. Future studies are necessary to characterise temporal changes in prevalence of VI in Portugal.
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Affiliation(s)
- Pedro Lima Ramos
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Low Vision and Visual Rehabilitation Lab, Department and Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal
| | - Rui Santana
- Escola Nacional Saude Publica, Comprehensive Health Research Centre Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Patricia Marques
- Escola Nacional Saude Publica, Comprehensive Health Research Centre Universidade Nova de Lisboa, Lisboa, Portugal
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ines Sousa
- Department of Mathematics and Applications and Center of Molecular and Environmental Biology, School of Sciences, University of Minho, Braga, Portugal
| | - Amandio Rocha-Sousa
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Antonio Filipe Macedo
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Low Vision and Visual Rehabilitation Lab, Department and Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal
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Schaub F, Mele B, Gass P, Ader M, Helbig H, Lagrèze WA, Schlötzer-Schrehardt U, Ueffing M, Cursiefen C. [Scientific performance of ophthalmological research institutions in Germany 2018-2020 : Studies, publications, third-party funding and more-The research map of the German Ophthalmological Society (DOG)]. DIE OPHTHALMOLOGIE 2022; 119:582-590. [PMID: 35925367 DOI: 10.1007/s00347-022-01653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 03/31/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The German Ophthalmological Society (DOG) regularly records the scientific activities of ophthalmological research institutions in Germany. OBJECTIVE With this publication the DOG wants to make the performance of scientific ophthalmology in Germany transparent and increase the options for future research cooperation with facilities of research institutions. METHODS Systematic survey of German research centers in ophthalmology. RESULTS The current research map records the data from 41 German research centers for the reporting period 2018-2020. Compared to previous editions of the research map, there has been a significant increase in scientific activity. The number of studies reported rose to 496. The number of government funded research projects (n = 121) and projects funded by foundations (n = 108) also increased. Furthermore, the number of scientific publications has almost doubled: while 1919 were published in the period from 2012 to 2014 and 2305 in the period from 2015 to 2017, there were 4215 in the current reporting period. The map also reports on a continuous increase in the number of young scientists in ophthalmology. CONCLUSION The research map demonstrates the performance of German scientific ophthalmology. At the same time, the need for research in ophthalmology remains high because many diseases that affect the eyes are not yet or not yet completely curable.
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Affiliation(s)
- Friederike Schaub
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
| | - Birgit Mele
- Deutsche Ophthalmologische Gesellschaft e. V. (DOG), München, Deutschland
| | - Philip Gass
- Deutsche Ophthalmologische Gesellschaft e. V. (DOG), München, Deutschland
| | - Marius Ader
- Arbeitskreis Forschung der DOG (AK DOG-Forschung)
- Center for Regenerative Therapies Dresden (CRTD), Technische Universität Dresden, Dresden, Deutschland
| | - Horst Helbig
- Arbeitskreis Forschung der DOG (AK DOG-Forschung)
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Wolf A Lagrèze
- Arbeitskreis Forschung der DOG (AK DOG-Forschung)
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Ursula Schlötzer-Schrehardt
- Arbeitskreis Forschung der DOG (AK DOG-Forschung)
- Universitätsklinikum Erlangen, Augenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Marius Ueffing
- Arbeitskreis Forschung der DOG (AK DOG-Forschung)
- Universitätsklinikum Tübingen, Forschungsinstitut für Augenheilkunde, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Claus Cursiefen
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland
- Arbeitskreis Forschung der DOG (AK DOG-Forschung)
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Nestler S, Kreft D, Doblhammer G, Guthoff RF, Frech S. Progression to severe visual impairment and blindness in POAG patients: pace and risk factors—a cohort study using German health claims data. BMJ Open Ophthalmol 2022; 7:e000838. [PMID: 35136840 PMCID: PMC8804656 DOI: 10.1136/bmjophth-2021-000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Glaucoma is a leading cause of severe visual impairment and blindness (SVI/B) worldwide. Hence, it is of utmost importance to explore relevant risk factors and study the pace of progression to SVI/B. Methods and analysis We used a random sample of 250 000 persons from administrative individual-level health records of the Allgemeine Ortskrankenkassen between 2004 and 2015. We identified 3535 primary open-angle glaucoma (POAG) patients aged 55 and older and followed them for up to 10 years. Monocular and binocular SVI/B were defined by the ICD-10 classifications H54.0 and H54.4. Ophthalmological and chronic disease risk factors were analysed by applying a multivariable Cox proportional hazard model. Results The risk of SVI/B in POAG patients was significantly increased by the presence of specific additional eye diseases such as secondary glaucoma (HR: 3.08, p<0.001), retinal vascular occlusion (HR: 3.00, p<0.001) or age-related macular degeneration (AMD) (HR: 2.26, p<0.001). The risk was highest in the first 2 years after the POAG diagnosis and significantly decreased after the fifth year (HR: 0.36, p=0.002). Ocular injuries, other ocular diseases, non-ophthalmological comorbidities, and age and sex had no significant influence (p>0.05). Conclusion Although progression to SVI/B is relatively rare in POAG patients in Germany, one must be aware of additional risk factors, such as secondary glaucoma, retinal vascular occlusion and AMD. Regular ophthalmological examinations help prevent the progression of SVI/B, especially in the first years after the POAG diagnosis. Specific, targeted, and timely treatments for the other eye diseases could help prevent or delay SVI/B.
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Affiliation(s)
- Sophia Nestler
- Institute for Sociology and Demography, University of Rostock, Rostock, Germany
| | - Daniel Kreft
- Institute for Sociology and Demography, University of Rostock, Rostock, Germany
- German Centre for Neurodegenerative Diseases, Bonn, Germany
| | - Gabriele Doblhammer
- Institute for Sociology and Demography, University of Rostock, Rostock, Germany
- German Centre for Neurodegenerative Diseases, Bonn, Germany
| | - Rudolf F Guthoff
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Stefanie Frech
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
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Anti-VEGF therapies for age-related macular degeneration: a powerful tactical gear or a blunt weapon? The choice is ours. Graefes Arch Clin Exp Ophthalmol 2021; 259:3561-3567. [PMID: 34669026 PMCID: PMC8526354 DOI: 10.1007/s00417-021-05451-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose Blindness and vision loss are still frequent disabilities associated with a relevant impact on health care and quality of life, and a high economic burden. Supranational programs established by the World Health Organization (WHO), International Agency for the Prevention of Blindness (IAPB), and World Health Assembly (WHA) aim at reducing avoidable visual impairment. Age-related macular degeneration (AMD), diabetic retinopathy (DR), and other retinal diseases are well known causes of visual disability. Since more than a decade, intravitreal agents are available for the treatment of these diseases. The aim of this study is to review whether pharmacotherapy with anti-vascular endothelial growth factor (VEGF) drugs has led to a decrease in the prevalence of blindness with emphasis on AMD and different countries. A brief analysis of other factors correlated to changes in the rate of blindness is also presented. Methods PubMed and Scopus web platforms were used to identify relevant studies on epidemiology of blindness and vision impairment, the influence of intravitreal therapies, and the existence of different vision care models. Additional data and material was searched in web internet accessed by the web browser Firefox. Results Age-standardized prevalence of blindness secondary to AMD has started to decline as testified by a number of studies in different countries. This is due to the adoption of anti-VEGF therapy and its adequate management. The frequency of treatment and regimens applied are indirect signs of successful treatment. Local rules and regulations may represent an obstacle. Conclusions This review shows that by implementing existing health care systems and dispensing adequate therapies in the field of retinal diseases, the prevalence of blindness due to these conditions can decline.
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Incidence, individual, and macro level risk factors of severe binocular visual impairment and blindness in persons aged 50 and older. PLoS One 2021; 16:e0251018. [PMID: 33939749 PMCID: PMC8092648 DOI: 10.1371/journal.pone.0251018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aims to estimate the incidence of severe binocular vision impairment and blindness (SVI/B) and to identify eye diseases and regional risk factors of persons with SVI/B at ages 50 years and older. METHODS We designed an observational cohort study based on longitudinal, multifactorial, and administrative information of a random sample of 250,000 persons at ages 50+. All individuals were included in the process-produced health claims register of the Allgemeine Ortskrankenkasse in 2004, and were followed until 2015. We analyzed ten selected eye diseases and regional characteristics as risk factors for SVI/B using Cox models, adjusting for demographic characteristics and multi-morbidity. RESULTS The age-standardized incidence was 79 new diagnoses of SVI/B per 100,000 person-years (95%-CI: 76-82); 77 for males (72-82) and 81 for females (77-85). By adjusting for multiple factors, the model revealed and confirmed that individuals who were very old (Hazard ratio90+: 6.67; 3.59-12.71), male (1.18; 1.01-1.38), had multi-morbidities (three+ diseases: 3.36; 2.51-4.49), or had diabetes (1.26; 1.07-1.49) had an increased risk of SVI/B. Compared to persons without the particular eye disease (all p<0.001), persons diagnosed with secondary glaucoma had a multiple-adjusted 4.66 times (3.17-6.85) higher risk, those with retinal vascular occlusion had a 4.51 times (3.27-6.23) higher risk, and those with angle-closure glaucoma had a 4.22 times (2.60-6.85) higher risk. Population density was not a risk factor, while persons living in wealthier regions had 0.75 times (p=0.003) to 0.70 times (p<0.001) the risk of SVI/B than persons in the least wealthy regions of Germany. CONCLUSION The study revealed and confirmed some profound risk factors of SVI/B at both the individual and the macro level. The sizes of the effects of the characteristics of the living context were smaller than those of the individual characteristics, especially for some severe eye diseases. While urbanity and access to health services had no effect, regional economic wealth was a risk factor for SVI/B. Future health care measures and advice by physicians should take these dimensions of inequalities in SVI/B into account.
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