Blindness in iraq: leading causes, target patients, and barriers to treatment

Predictors of glaucoma knowledge and its risk factors among Jordanian patients with primary open angle glaucoma at a tertiary teaching hospital: A cross-sectional survey

PURPOSE OF STUDY

To assess and compare glaucoma knowledge between Jordanian patients with glaucoma and non-glaucoma ophthalmic patients.

METHODS

A cross-sectional survey was developed after an extensive literature search to investigate glaucoma-related knowledge among participants with glaucoma visiting the Jordan University Hospital clinics from October 2021 to February 2022. Responses were compared to a sample of ophthalmic participants with eye conditions other than glaucoma visiting the ophthalmology clinics at the same time frame.

RESULTS

A total of 256 participants filled out the survey, of which 53.1% were diagnosed with glaucoma while 46.9% had ophthalmic conditions other than glaucoma. Our sample of participants is characterized by a mean age of 52.2 ± 17.8 years and a male-to-female ratio of 1.04:1. Overall, participants with glaucoma were more aware of their disease than participants with other ophthalmic conditions. Compared to their ophthalmic non-glaucoma counterparts, those diagnosed with glaucoma face significantly more daily life difficulties due to their ophthalmic disease (p <0.001). Results of the independent sample t-test demonstrate that participants with glaucoma have significantly higher knowledge scores (p <0.001) and were able to recognize more glaucoma symptoms than their non-glaucoma counterparts (p = 0.002). Similarly, those with a positive family history of glaucoma displayed higher knowledge (p = 0.005). Multivariate linear regression demonstrates that family history of glaucoma, higher symptom recognition score, reliance on ophthalmologists, and the internet for glaucoma-related information are positive predictors of higher knowledge scores.

CONCLUSION

We have demonstrated that both glaucoma and non-glaucoma ophthalmic patients display average levels of glaucoma knowledge. Raising awareness through various interventions may improve the lifestyles of patients with glaucoma and alleviate the economic burden associated with treating the disease.

A Review of Advancements and Evidence Gaps in Diabetic Retinopathy Screening Models

Diabetic retinopathy (DR) is a microvascular complication of diabetes with a prevalence of ~35%, and is one of the leading causes of visual impairment in people of working age in most developed countries. The earliest stage of DR, non-proliferative DR (NPDR), may progress to sight-threatening DR (STDR). Thus, early detection of DR and active regular screening of patients with diabetes are necessary for earlier intervention to prevent sight loss. While some countries offer systematic DR screening, most nations are reliant on opportunistic screening or do not offer any screening owing to limited healthcare resources and infrastructure. Currently, retinal imaging approaches for DR screening include those with and without mydriasis, imaging in single or multiple fields, and the use of conventional or ultra-wide-field imaging. Advances in telescreening and automated detection facilitate screening in previously hard-to-reach communities. Despite the heterogeneity in approaches to fit local needs, an evidence base must be created for each model to inform practice. In this review, we appraise different aspects of DR screening, including technological advances, identify evidence gaps, and propose several studies to improve DR screening globally, with a view to identifying patients with moderate-to-severe NPDR who would benefit if a convenient treatment option to delay progression to STDR became available.

New treatments for diabetic macular edema

This work comprehensively reviews the latest treatment options for diabetic macular edema (DME) used in its management and presents further work on the topic. Diabetic retinopathy is an important and increasingly prevalent cause of preventable blindness worldwide. To meet this increasing burden there has recently been a proliferation of pharmacological therapies being used in clinical practice. A variety of medical treatment options now exist for DME. These include non-steroidal anti-inflammatory drugs such as nepafenac, as well as intravitreal steroids like triamcinolone (kenalog). Long-term results up to 7 years after commencing treatment are presented for triamcinolone. Studies are reviewed on the use of dexamethasone (ozurdex) and fluocinolone (Retisert and Iluvien implants) including the FAME studies. A variety of anti-vascular endothelial growth factor (anti-VEGF) agents used in DME are considered in detail including ranibizumab (lucentis) and the RESTORE, RIDE, RISE and Diabetic Retinopathy Clinical Research Network (DRCR.net) studies. Bevacizumab (avastin) and pegaptinib (macugen) are also considered. The use of aflibercept (eylea) is reviewed including the significance of the DA VINCI, VISTA-DME, VIVID-DME and the DRCR.net studies which have recently suggested potentially greater efficacy when treating DME for aflibercept in patients with more severely reduced visual acuity at baseline. Evidence for the anti-VEGF agent bevasiranib is also considered. Studies of anti-tumour necrosis factor agents like infliximab are reviewed. So are studies of other agents targeting inflammation including minocycline, rapamycin (sirolimus) and protein kinase C inhibitors such as midostaurin and ruboxistaurin. The protein kinase C β inhibitor Diabetic Macular Edema Study is considered. Other agents which have been suggested for DME are discussed including cyclo-oxygenase-2 inhibitors like celecoxib, phospholipase A2 inhibitors, recombinant erythropoietin, and monoclonal anti-interleukin antibodies such as canakinumab. The management of DME in a variety of clinical scenarios is also discussed - in newly diagnosed DME, refractory DME including after macular laser, and postoperatively after intraocular surgery. Results of long-term intravitreal triamcinolone for DME administered up to seven years after commencing treatment are considered in the context of the niche roles available for such agents in modern management of DME. This is alongside more widely used treatments available to the practitioner such as anti-VEGF agents like aflibercept (Eylea) and ranibizumab (Lucentis) which at present are the mainstay of pharmacological treatment of DME.

Pattern of uveitis at a referral center in Iraq

PURPOSE

To determine the etiologies of uveitis and the causes of visual loss in uveitis patients at a referral center in Baghdad, Iraq.

PATIENTS AND METHODS

A 4-year prospective study was performed at the uveitis clinic at Ibn Al-Haetham teaching eye hospital in Baghdad, Iraq. Referral cases of active uveitis were included. A complete ophthalmic examination was performed in all cases. If clinical picture did not indicate a specific etiology, patients were sent for a routine set of tests while ancillary tests were conducted when indicated.

RESULTS

Out of 318 patients included in this study, 236 patients (74.2%) had bilateral uveitis, and 212 patients (66.7%) had non-granulomatous uveitis. Posterior uveitis was recorded in 123 cases (38.7%) followed by panuveitis in 97 cases (30.5%), anterior uveitis in 78 cases (24.5%), and intermediate uveitis in 20 cases (6.3%). A diagnosis was established in 210 cases (66%) while etiology could not be determined in the remaining 108 cases (34%). Most common infectious causes were toxoplasmosis (13.8%) and presumed ocular tuberculosis (11.4%) while most common non-infectious causes were Vogt-Koyanagi-Harada disease (12.3%), Behηet's disease (8.2%), and pars planitis (5.7%). Out of 49 eyes with irreversible blindness, macular degenerations, or scars (46.9%) and optic nerve atrophy (34.7%) were the most important causes.

CONCLUSION

At this referral center, toxoplasmosis and presumed ocular tuberculosis were the most common infectious causes of uveitis while Vogt-Koyanagi-Harada disease, Behηet's disease, and pars planitis were, in that order, the most common non-infectious causes. Macular degenerations or scars and optic nerve atrophy were the most important causes of irreversible blindness.