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      Prevalence and Causes of Visual Impairment and Blindness in Central Iran; The Yazd Eye Study

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          Abstract

          Purpose:

          To determine the prevalence and causes of blindness and visual impairment (VI) in Yazd, central Iran.

          Methods:

          This population-based, cross-sectional study was performed on adults aged 40–80 years, residing in Yazd district, in 2010–2011. Eligible subjects were selected using cluster random sampling. Each participant underwent an interview and complete ophthalmologic examination. Blindness and VI were defined as best-corrected visual acuity (VA) <3/60 and < 6/18 in the better eye, respectively.

          Results:

          Out of 2,320 eligible individuals, 2,098 participated in the study (90.4% response rate), of whom, 2,023 subjects completed all evaluations. The standardized prevalence of blindness and VI were 0.7% (95% confidence interval [CI], 0.3–1.0%) and 4.4% (95% CI, 3.3–5.4%), respectively which was significantly associated with older age (odd ratio [OR] = 3.2, 95% CI: 1.9–5.2 and OR = 3.1, 95% CI: 2.3–4.2, respectively) and female sex (OR = 3.6, 95% CI: 1.1–12.3 and OR = 1.7, 95% CI: 1.2–2.5, respectively). The proportion of avoidable causes of blindness and VI were 92.9% (95% CI: 80.0-100.0%) and 76.6% (95% CI: 69.2-85.0%), respectively. Major causes of blindness were diabetic retinopathy (50.0%), glaucoma (21.4%) and cataracts (14.3%) whereas main causes of VI were cataracts (41.5%), diabetic retinopathy (17.0%) and age-related macular degeneration (13.8%).

          Conclusions:

          Diabetic retinopathy, glaucoma, cataract and age-related macular degeneration were the leading causes of blindness and VI in Yazd, most of which are avoidable. Planning for prevention of blindness is highly recommended to decrease the proportion of avoidable blindness.

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          Most cited references38

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          Global data on visual impairment in the year 2002.

          This paper presents estimates of the prevalence of visual impairment and its causes in 2002, based on the best available evidence derived from recent studies. Estimates were determined from data on low vision and blindness as defined in the International statistical classification of diseases, injuries and causes of death, 10th revision. The number of people with visual impairment worldwide in 2002 was in excess of 161 million, of whom about 37 million were blind. The burden of visual impairment is not distributed uniformly throughout the world: the least developed regions carry the largest share. Visual impairment is also unequally distributed across age groups, being largely confined to adults 50 years of age and older. A distribution imbalance is also found with regard to gender throughout the world: females have a significantly higher risk of having visual impairment than males. Notwithstanding the progress in surgical intervention that has been made in many countries over the last few decades, cataract remains the leading cause of visual impairment in all regions of the world, except in the most developed countries. Other major causes of visual impairment are, in order of importance, glaucoma, age-related macular degeneration, diabetic retinopathy and trachoma.
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            Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group.

            (1991)
            The modified Airlie House classification of diabetic retinopathy has been extended for use in the Early Treatment Diabetic Retinopathy Study (ETDRS). The revised classification provides additional steps in the grading scale for some characteristics, separates other characteristics previously combined, expands the section on macular edema, and adds several characteristics not previously graded. The classification is described and illustrated and its reproducibility between graders is assessed by calculating percentages of agreement and kappa statistics for duplicate gradings of baseline color nonsimultaneous stereoscopic fundus photographs. For retinal hemorrhages and/or microaneurysms, hard exudates, new vessels, fibrous proliferations, and macular edema, agreement was substantial (weighted kappa, 0.61 to 0.80). For soft exudates, intraretinal microvascular abnormalities, and venous beading, agreement was moderate (weighted kappa, 0.41 to 0.60). A double grading system, with adjudication of disagreements of two or more steps between duplicate gradings, led to some improvement in reproducibility for most characteristics.
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              An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group.

              A common detection and classification system is needed for epidemiologic studies of age-related maculopathy (ARM). Such a grading scheme for ARM is described in this paper. ARM is defined as a degenerative disorder in persons > or = 50 years of age characterized on grading of color fundus transparencies by the presence of the following abnormalities in the macular area: soft drusen > or = 63 microns, hyperpigmentation and/or hypopigmentation of the retinal pigment epithelium (RPE), RPE and associated neurosensory detachment, (peri)retinal hemorrhages, geographic atrophy of the RPE, or (peri)retinal fibrous scarring in the absence of other retinal (vascular) disorders. Visual acuity is not used to define the presence of ARM. Early ARM is defined as the presence of drusen and RPE pigmentary abnormalities described above; late ARM is similar to age-related macular degeneration (AMD) and includes dry AMD (geographic atrophy of the RPE in the absence of neovascular AMD) or neovascular AMD (RPE detachment, hemorrhages, and/or scars as described above). Methods to take and grade fundus transparencies are described.
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                Author and article information

                Journal
                J Ophthalmic Vis Res
                J Ophthalmic Vis Res
                JOVR
                Journal of Ophthalmic & Vision Research
                Medknow Publications & Media Pvt Ltd (India )
                2008-2010
                2008-322X
                Jul-Sep 2015
                : 10
                : 3
                : 279-285
                Affiliations
                [1 ] Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [2 ] Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [3 ] Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
                [4 ] Department of Ophtalmology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
                Author notes
                Correspondence to: Mojgan Pakbin. Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, No 23, Paidarfard Street., Boostan 9 Street., Pasdaran Avenue, Tehran, 16666, Iran. E-mail: mpopto@ 123456yahoo.com
                Article
                JOVR-10-279
                10.4103/2008-322X.170362
                4687262
                26730314
                dee0014e-f7f8-4269-a86d-9a0021382f86
                Copyright: © 2015 Journal of Ophthalmic and Vision Research

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 06 July 2014
                : 26 October 2014
                Categories
                Original Article

                Ophthalmology & Optometry
                blindness,community health planning,iran,prevalence
                Ophthalmology & Optometry
                blindness, community health planning, iran, prevalence

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