Effect of Primary Intravitreal Bevacizumab Injection on Stage 3 Retinopathy of Prematurity with Plus Signs

PURPOSE: To evaluate the efficacy and safety of primary intravitreal bevacizumab injection in stage 3 retinopathy of prematurity with plus signs. METHODS: We reviewed retrospectively the medical records of 30 eyes of 16 patients diagnosed with stage 3 retinopathy of prematurity with plus signs treated with primary intravitreal bevacizumab injection between March 1, 2011 and February 28, 2013 and followed up for at least 9 months. RESULTS: Mean gestational age was 26 + 4 weeks +/- 11 days and mean birth weight was 822 +/- 251.4 g. The locations of disease were zone II in 24 eyes and zone III in 6 eyes. Intravitreal bevacizumab injection was performed after the mean 1.3 +/- 1 day after plus signs were detected. Mean postconceptional age at treatment was 38 + 2 weeks +/- 16 days. Mean follow-up period was 16.6 +/- 6.9 months. Plus signs started to regress after the mean 4.6 +/- 2.3 days after injection and completely regressed after the mean 24.3 +/- 12.4 days. Cataract extraction was performed in 1 eye due to a cataract that appeared not associated with the injection procedure, but was regarded as a treatment failure. There were no local or systemic complications. CONCLUSIONS: Primary intravitreal bevacizumab injection in stage 3 retinopathy of prematurity with plus signs demonstrated excellent short-term efficacy and safety.

Current Status and Future Expectations of Cataract Surgery in Korea: KNHANES IV

PURPOSE: To identify socio-demographic factors in cataract surgery in Korea and expect future effect of the bundle of service system. METHODS: We analyzed the number of people undergoing cataract surgery and associated factors such as surgery ratio, region, age, income, and insurance status of 28,980 patients older than 40 years using data from the fifth Korea National Health and Nutrition Examination Survey 2008-2012 (KNHANES). RESULTS: Among total population in 2012, 47.5% of elderly aged 80 years and older have received cataract surgery. According to region in patients older than 40, Jeollanam-do showed the highest proportion of patients undergoing cataract surgery, at 12%, Daejeon showed the lowest proportion of 3.6%, and Seoul showed 6.8%. Regional analysis was also performed by analyzing the number of cataract patients per ophthalmologist. Jeollanam-do showed the highest with 40,115 patients per ophthalmologist, and Seoul showed the least with 1,094 patients per ophthalmologist. The sociodemographic factors such as education or income, were not associated with cataract surgery after adjusting for age and regional difference. On the other hand, subjects with medicaid were associated with 1.6-fold (95% confidence interval, 1.3-2.0) higher rate of cataract surgery than subjects with national health insurance. CONCLUSIONS: Regional disparity was found in the cataract surgery rate and surgery rate per an ophthalmologists, whereas sociodemographic factors were not significant in receiving benefits of cataract surgery. Before the amount of bundled payment is changing, down-leveling of quality of care and deepening of disparities among health care provider should be considered.

Current Status and Future Expectations of Cataract Surgery in Korea: KNHANES IV

PURPOSE: To identify socio-demographic factors in cataract surgery in Korea and expect future effect of the bundle of service system. METHODS: We analyzed the number of people undergoing cataract surgery and associated factors such as surgery ratio, region, age, income, and insurance status of 28,980 patients older than 40 years using data from the fifth Korea National Health and Nutrition Examination Survey 2008-2012 (KNHANES). RESULTS: Among total population in 2012, 47.5% of elderly aged 80 years and older have received cataract surgery. According to region in patients older than 40, Jeollanam-do showed the highest proportion of patients undergoing cataract surgery, at 12%, Daejeon showed the lowest proportion of 3.6%, and Seoul showed 6.8%. Regional analysis was also performed by analyzing the number of cataract patients per ophthalmologist. Jeollanam-do showed the highest with 40,115 patients per ophthalmologist, and Seoul showed the least with 1,094 patients per ophthalmologist. The sociodemographic factors such as education or income, were not associated with cataract surgery after adjusting for age and regional difference. On the other hand, subjects with medicaid were associated with 1.6-fold (95% confidence interval, 1.3-2.0) higher rate of cataract surgery than subjects with national health insurance. CONCLUSIONS: Regional disparity was found in the cataract surgery rate and surgery rate per an ophthalmologists, whereas sociodemographic factors were not significant in receiving benefits of cataract surgery. Before the amount of bundled payment is changing, down-leveling of quality of care and deepening of disparities among health care provider should be considered.

Visual Acuity and Quality of Life: KNHANES IV

PURPOSE: To evaluate the health-related quality of life (QOL) in Koreans according to visual acuity. METHODS: The fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) is a nationwide survey. The present study included 11,022 Koreans who completed the KNHANES IV. The relation of visual acuity and QOL was verified, and EuroQoL 5D (EQ-5D) was identified using the adjusted mean based on linear regression analysis. RESULTS: As visual acuity decreased, QOL decreased. QOL in mobility, usual activities, and pain/discomfort were affected by the vision gradient, while self-care and anxiety/depression were less influenced by the vision gradient. In particular, QOL in usual activities was significantly affected by the visual gradient. Subjects with a visual acuity of 1.6-3.0 were less likely to have a low QOL in usual activities compared to subjects with a visual acuity of 0.0-0.5 as a reference group (adjusted Odds Ratio = 23.6, 95% CI, 4.8-115.5). QOL in usual activities was statistically low in subjects older than 65 years of age, with low household monthly income, low education, and living without a spouse. CONCLUSIONS: As visual acuity decreased, QOL in the aspect of mobility, usual activities, and pain/discomfort decreased severely, which resulted from activity limitation. Considering that the risk group with increasing age, low income, low education, and living without a spouse had lower QOL, the most important is to increase activity, which can induce the improvement of QOL in Koreans who have low visual acuity and related risk factors is.

Epidemiological Survey Regarding Cataract Awareness in Korea: KNHANES IV

PURPOSE: To identify cataract awareness in the Korean population. METHODS: The present study included 3,662 subjects who were diagnosed with a cataract by ophthalmic examination out of 11,058 subjects in the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). Among the 3,662 participants, 944 were aware that they already had a cataract. The socio-demographic disparities in cataract awareness were identified using multivariate analysis. RESULTS: The mean age of the study population was 65.6 years (standard deviation, 0.2). The awareness calculated based on total weighted population was 24.6% in people over 19 years of age (95% confidence interval, 22.5-26.6%). In multivariate logistic analysis, subjects with higher income, living in a rural area, having a spouse, and binge alcohol use were less likely to be aware of their cataract. In multivariate linear regression analysis after adjusting for confounding factors, there were statistically significant differences of mean in age and monthly house income. Deajeon (11%), and Gwangju (16%) were the lower ranked regions for cataract awareness in Korea. CONCLUSIONS: The cataract awareness in Korea was lower than in other developed countries. Public education and strategies to improve cataract awareness in susceptible people are necessary. More effort is needed to improve cataract awareness based on the Korean society's acceptance of ophthalmologists as in other countries.

Factors Associated with Diabetic Retinopathy and Nephropathy Screening in Korea: The Third and Fourth Korea National Health and Nutrition Examination Survey (KNHANES III and IV)

This cross-sectional study was done to identify and determine the socio-demographic and health-related factors associated with diabetic retinopathy and nephropathy screening in Korea. Participants included 2,660 adults, aged 40 or older, with diabetes. Of the 2,660 adults, 998 (37%) and 1,226 (46.1%) had received a diabetic retinopathy and a nephropathy screening within one year, respectively. Regarding retinopathy, subjects older than 65, living in urban areas, with high educational levels, and with self-reported "unhealthy" status were likely to receive annual screening. Subjects living in urban areas, with higher educational levels, with self-reported "fair" or "unhealthy" status, and with 1 to 2 co-morbidities were likely to receive annual nephropathy screening. The Korea Composite Stock Price Index (KOSPI) continued to rise until 2007 when it started to decline over the subsequent years, following the same curve as the diabetic retinopathy and nephropathy screening rates during that time. Together with the financial matter, lack of patient education proved to be a hindrance to diabetes-related screening. The relatively low screening rates in Korea compared to the Western countries are likely to be due to the difference in the health system, economic situations and national demographics.

Disparities of Socio-Demographic Factors between Visually Disabled People and Other Disabled People: KNHANES III

PURPOSE: To identify the disparities of socio-demographic factors between visually disabled people and other people with disabilities. METHODS: The fourth Korea National Health and Nutrition Examination Survey (KNHANES III) is a nationwide survey. The present study included 25,125 people who completed the KNHANES III. For analysis, the participants were divided into 3 groups: subjects without disabilities, subjects with disabilities but without visual disabilities, and subjects with visual disabilities. The gender, age, monthly house income, occupation, education, residential area, and health insurance were investigated. Multivariate logistic regression analysis was used to determine the most differentiating factor. RESULTS: Visually disabled people were proportionally older (40 to 64 years), were male, living in a non-metropolitan area except Seoul/Pusan/Gyunggi compared to other disabled people and also had a higher proportion of the above factors, as well as lower education compared to non-disabled people. CONCLUSIONS: Socio-demographic factors showed disparities in visually disabled people and people with other disabilities. Ophthalmologists should understand these disparities and be involved in establishing policies to reduce the disparities. Ophthalmologists also need to provide holistic and comprehensive medical care using the Blindness is Preventable! Korea Foundation for the Prevention of Blindness, consultation with social work teams in hospitals and other institutions, as well as evaluating the visual impairment.

Disparities of Socio-Demographic Factors between Visually Disabled People and Other Disabled People: KNHANES III

PURPOSE: To identify the disparities of socio-demographic factors between visually disabled people and other people with disabilities. METHODS: The fourth Korea National Health and Nutrition Examination Survey (KNHANES III) is a nationwide survey. The present study included 25,125 people who completed the KNHANES III. For analysis, the participants were divided into 3 groups: subjects without disabilities, subjects with disabilities but without visual disabilities, and subjects with visual disabilities. The gender, age, monthly house income, occupation, education, residential area, and health insurance were investigated. Multivariate logistic regression analysis was used to determine the most differentiating factor. RESULTS: Visually disabled people were proportionally older (40 to 64 years), were male, living in a non-metropolitan area except Seoul/Pusan/Gyunggi compared to other disabled people and also had a higher proportion of the above factors, as well as lower education compared to non-disabled people. CONCLUSIONS: Socio-demographic factors showed disparities in visually disabled people and people with other disabilities. Ophthalmologists should understand these disparities and be involved in establishing policies to reduce the disparities. Ophthalmologists also need to provide holistic and comprehensive medical care using the Blindness is Preventable! Korea Foundation for the Prevention of Blindness, consultation with social work teams in hospitals and other institutions, as well as evaluating the visual impairment.