Epidemiology Studies Of Blindness And Visual Impairment Among Adults,Major Eye Diseases In Diabetic Population In Shanghai

Part ⅠEpidemiology studies of blindness and visual impairment among adults in Shanghai1.Prevalence and causes of blindness and moderate and severe visual impairment among adults aged 50 years or above in Shanghaibjective:To access the Prevalence of blindness and moderate and severe visual impairment among adults aged 50 years or above in Shanghai,China.Methods:It was a population-based cross-section study.Geographically defined cluster sampling was used in 5949 and 5586 randomly selected individuals aged≥50 years in 20 clusters in the Baoshan and Xuhui district from July to November 2014 respectively.The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out.All participants were enumerated through village registers followed door to door visits.Eligible individuals were invited to receive visual acuity measurement and eye examination.Statistical analyses were performed using SPSS V19.0 Statistical package(IBM Corp.Armonk,New York,USA).Chi-square test was used to investigate the association of age,gender,education and area with presenting and best corrected visual acuity.Multiple logistic regressions were used to investigate the association of age,gender,education,and area with best-corrected visual impairment and blindness.Results:Totally 13374 individuals were recruited and 11543 persons were examined.The response rate was 86.31%.Based on the criteria of World Health Organization visual impairment classification,58 persons were diagnosed as blindness,781 persons were diagnosed as moderate and severe visual impairment defined as presenting visual acuity.The prevalence of blindness and moderate and severe visual impairment were 0.50%and 6.77%respectively.Thirty-six persons were diagnosed as blindness,229 persons were diagnosed as moderate and severe visual impairment defined as best corrected visual acuity.The prevalence of blindness and moderate and severe visual impairment were 0.31%and 1.99%respectively.The prevalence of blindness and moderate and severe visual impairment was higher in aged(OR=1.117,95%CI:l.103-1.131,P<0.001)and female persons(OR=1.697,95%Cl:1.297-2.221,P<0.001),and was lower in urban persons(OR=0.733,95%CI:0.568-0.945,P=0.017).Cataract was still the major cause of blindness and visual impairment.The macular degeneration was the leading cause of blindness.Un-corrected refractive error also was the main cause of visual impairment.Conclusions:The prevalence of blindness and moderate and severe visual impairment has been decreasing among older adults aged 50 years or above in Shanghai.The leading cause of blindness and visual impairment is macular degeneration and cataract respectively.2.Prevalence and surgery status of cataract among adults aged 50 years or above in ShanghaiObjective:To assess the prevalence of cataract,the outcomes of cataract surgery,the rate of cataract surgical coverage,and the rate of cataract blindness social burden.Methods:Cluster sampling was used in 5949 and 5586 randomly selected individuals aged≥50 years in the Baoshan and Xuhui district of Shanghai from July to November 2014 respectively.All individuals were received visual acuity and eye examination,including the evaluation of lens status and cataract surgical status by slit lamp biomicroscopy.Data bank was established by Epi-info Software.Statistical analyses were performed using SPSS V19.0 Statistical package(IBM Corp.Armonk,New York,USA).A binary logistic regression analysis was employed to analyze the prevalence of cataract,cataract surgical coverage rate,cataract blindness social burden rate and outcomes of surgery among different ages,sex,educational background and area.Results:In 11535 individuals,1827 cases of cataract were found,the prevalence of cataract was 15.83%among adults aged 50 or above.The prevalence of cataract was higher in the aged,female persons(P<0.01).In 1015 eyes with cataract surgery,21 eyes(2.10%)and 835 eyes(82.27%)were performed by the modern extra-capsular surgery and phacoemusification respectively.The rate of intraocular lens implantation was 97.64%.Post-operative presenting and best-corrected visual acuity more than 0.7 was 37.39%and 65.48%of operated eyes respectively.The main causes of the post-operated eyes with worse visual acuity were macular degeneration,diabetic retinopathy and glaucoma.In the cataract with BCVA<0.1 and BCVA<0.3,the cataract surgical coverage rate was 94.83%and 76.84%,and the cataract blindness social burden rate was 3.52%and 4.83%respectively.The cataract blindness social burden rate was higher in the aged,female persons(P<0.01).Conclusions:Although the cataract surgical coverage rate is high in Shanghai,but still is lower in the aged,female persons.Part ⅡEpidemiology studies of major eye diseases in diabetic population in Shanghai1.Prevalence,causes and risk factors of moderate and severe visual impairment and blindness in type 2 diabetes residentsObjective:To determine the prevalence,causes and risk factors of visual impairment and blindness among type 2 diabetes adult residents in Xinjing community,Shanghai,China.Methods:A population-based,cross-sectional survey among 2,216 Han adult residents with type 2 diabetes was conducted between October 2014 and January 2015.Random cluster sampling was used to enroll diabetic residents based on the local Chronic Diseases Prevention&Control System data.The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out.Eligible participants underwent a comprehensive eye examination,including the best corrected visual acuity(BCVA)test using the logarithm of the minimum angle resolution charts.Moderate and severe visual impairment was defined as BCVA<20/63 to>20/400,and blindness was defined as BCVA<20/400 in the better eye following the Modified World Health Organization(WHO)definitions.The primary causes of visual impairment and blindness were determined.Binary logistic regression analysis was used to determine the related factors of blindness and moderate and severe visual impairment.Results:2582 individuals were enumerated and 2216 persons were examined,therefore the response rate was 85.8%.The prevalence of moderate and severe visual impairment was 5.2%and that of blindness was 0.7%.BCVA<20/63 in the better eye was associated with older age,female gender,earlier onset diabetes and a lower spherical equivalent(SE)in the better eye.The predominant cause of moderate and severe visual impairment was cataracts(66.3%),followed by diabetic retinopathy(11.5%)and macular degeneration(9.4%).Cataracts were the leading cause of blindness(55.2%);macular degeneration(30%)and eyeball atrophy(6.7%)were the second and third leading causes of blindness,respectively.Conclusion:Moderate and severe visual impairment and blindness are important public health problems in Chinese patients with type 2 diabetes.Extensive screening,periodic follow-up and early treatment of cataracts and retinal complications are strongly commended to.reduce the rate of visual impairment.2.Prevalence and risk factors for diabetic retinopathy in residents with type 2 diabetesObjective:To determine the prevalence and risk factors of diabetic retinopathy(DR)among type 2 diabetes adult residents in Beixinjing community,Shanghai,China.Methods:A population-based,cross-sectional survey among 2,216 Han adult residents with type 2 diabetes was conducted between October 2014 and January 2015.Eligible participants underwent a standardized interview,a comprehensive eye examination and blood biochemical examination.Retinal photographs obtained after pupil dilation were graded for the presence and severity of DR according to the International Clinical Diabetic Retinopathy and Diabetic Macular Edema Disease Severity Scales.Results:The overall prevalence of DR was 31.8%(95%confidence interval,22.7%-41.05%).The prevalence of proliferative DR,macular edema,and vision-threatening retinopathy was 1.2%,4.6%,and 4.8%,respectively.In multiple logistic regression,any retinopathy were associated with higher hemoglobin HbAlc(odds ratio[OR],1.38;95%CI,1.28-1.48,per%increase),higher creatinine Cr(OR,1.01;95%CI,1.00-1.01,per μmol/L increase),higher mean arterial pressure(OR,1.01,95%CI,1.00-1.02,permmHg increase),older(OR,1.03;95%CI,1.01-1.05,per year increase),younger onset age(OR,0.93;95%CI,0.92-0.95,per year increase)and axial length less than or equal to 26mm(OR,0.42;95%CI,0.25-0.68).Conclusions:Our study reports a high prevalence of DR among adults 40 years and older with Type 2 diabetes in Shanghai.There is a pressing need for appropriate screening and management of diabetes and its complications in Shanghai.