Perfil de población con baja visión que asiste a la unidad de baja visión y rehabilitación visual en un hospital clínico de Chile / Low vision population assisting a unit of low vision and visual rehabilitation in a clinical hospital from Chile

El objetivo de este trabajo fue caracterizar epidemiológica y sociodemográficamente a las personas atendidas en la Unidad de Baja Visión y Rehabilitación Visual del Hospital Clínico de la Universidad de Chile. El método utilizado fue un estudio descriptivo, transversal y retrospectivo de los registros clínicos de las personas atendidas en la Unidad, entre marzo de 2015 a octubre de 2016. Para el análisis se utilizó el software MS Excel, calculando las frecuencias relativas y medidas de posición central y dispersión. En los resultados se observaron un mayor número de pacientes de sexo femenino (55,5%), y adultos mayores de 60 años o más (53,3%). El 73,3% de los pacientes pertenecieron al sistema de salud público y un 35,6% poseían menos de 8 años de estudio. El 80 % de las personas atendidas se encuentra en edad laboral, de éstos un 63,9% se encontraban laboralmente inactivos. Las enfermedades oftalmológicas con mayor frecuencia correspondieron a las enfermedades genéticas del ojo (22,2%) y la degeneración macular relacionada con la edad (17,8%). Un 57,8% de los pacientes presentó alguna patología sistémica asociada a baja visión. Sólo un 6,0% recibió rehabilitación visual anteriormente. Se concluyó que la mayor prevalencia de enfermedades oculares asociadas al envejecimiento como la degeneración macular relacionada con la edad y enfermedades genéticas del ojo, sumado a las características sociodemográficas y en particular a que un 94% de los pacientes no habían tenido acceso a rehabilitación visual, constituyen un perfil que desafía al desarrollo de medidas de salud pública que resguarden la prevención, acceso y rehabilitación, siendo la formación de equipos multidisciplinarios especialistas una necesidad imperiosa.

This work aimed to do a characterization, epidemiological and socio demographical, to the people attended in a Low Vision and Rehabilitation Unit from a Clinical Hospital of the Universidad de Chile. A descriptive, transversal and retrospective method was used for the clinical registers of the people attended in the Unit, between March 2015 to October 2016. For the analysis, a MS Excel software was used, calculating the relative and measured frequencies of central position and dispersion. In the results, a greater number of feminine patients (55. 5%) were observed, and seniors of 60 years or more (53.3%). 73.3% of the patients belonging to the Public Health Care System and 35.6% had less than 8 years of studies. The 80% of attended patients were in working age, from this 63,9% were unemployed. The ophthalmological diseases with more frequency belonged to eye genetic diseases (22.2%) and macular degeneration related to age (17.8%). 57.8% of the patients presented a systematic pathology associated with low vision. Just 6.0% received previous visual rehabilitation. We concluded that the greater prevalence of ocular diseases associated to aging such as macular degeneration related to age and eye genetic diseases added to the sociodemographic features and particularly a 94% of the patients did not have access to visual rehabilitation, represent a profile that challenges the development public health care measures that safeguard the prevention, access, and rehabilitation, being an imperative need the making of specialist multidisciplinary teams.

Prevalência de fatores predisponentes de baixa visual em uma população de jovens do Colégio Universitário Geraldo Reis em Niterói - RJ / Prevalence of predisposing factors of low visual acuity in a youth population of the Geraldo Reis University College in Niterói - RJ

Resumo Objetivo: Determinar a prevalência de fatores predisponentes de baixa acuidade visual entre os alunos do Colégio Universitário Geraldo Reis em Niterói-RJ. Métodos: Trata-se de um estudo observacional transversal realizados em duas etapas. A primeira realizou-se a medida da acuidade visual dos alunos voluntários que aderiram ao termo de assentimento. Na segunda etapa foram selecionados aqueles alunos cuja acuidade visual não ultrapassaram 0,8 em pelo menos um dos olhos ou que apresentaram diferença de acuidade visual entre os olhos de duas linhas ou mais na tabela de Snellen, sendo encaminhados para avaliação oftalmológica completa no Serviço de Oftalmologia do Hospital Universitário Antônio Pedro / Universidade Federal Fluminense. Resultados: Do total de 325 alunos matriculados, 134 (41,2%) participaram da primeira etapa do estudo e, destes, apenas 39 (29%) apresentaram baixa visão. Dos 39 alunos selecionados para a segunda etapa do estudo, apenas 14 (36%) se voluntariaram a prosseguir para avaliação oftalmológica completa, tendo as ametropias (57,14%), a ambliopia (21,42%) e o estrabismo (14,28%) como as principais causas de baixa visual identificadas. Conclusão: A prevalência de baixa visão(low vision=baixa visão tem definição, não se chama baixa visual) para essa comunidade foi de 29% e as principais causas identificadas foram as ametropias, as ambliopias e o estrabismo. Campanhas de conscientização e os problemas de adesão aos programas de triagem devem ser considerados em novos estudos.

Abstract Purpose: To determine the prevalence of predisposing factors of low visual acuity among the students of the Geraldo Reis University College in Niterói-RJ. Methods: This was a cross-sectional observational study during which the visual acuity of the volunteer students who adhered to the assent term was measured. Those students whose visual acuity did not exceed 0.8 in at least one eye or who presented a difference between the eyes of two lines or more in the Snellen table were selected for the next stage of the study and were referred for complete ophthalmologic evaluation in the Service of Ophthalmology of the Antônio Pedro University Hospital / Fluminense Federal University. Results: Of the total of 325 students enrolled, 134 (41.2%) participated in the first stage of the study and of these, only 39 (29%) presented visual impairment. Of the 39 students selected for the second phase of the study, only 14 (36%) volunteered to proceed for a complete ophthalmologic evaluation, with ametropias (57.14%), amblyopia (21.42%) and strabismus (14, 28%) as the main causes of visual impairment identified. Conclusion: The prevalence of visual impairment for this community was 29% and the main causes identified were ametropias, amblyopia and strabismus. Awareness campaigns and problems of adherence to screening programs should be considered in new studies.

Estudo das causas de cegueira e baixa de visão em uma escola para deficientes visuais na cidade de Bauru / The study of the causes of blindness and low vision in a school for visual disabilities in Bauru city

RESUMO Objetivo: Analisar as causas de cegueira dos alunos do Lar Escola Santa Luzia Para Cegos no município de Bauru, Estado de São Paulo. ambém avaliamos e discutimos o grau de inserção social dos alunos e a facilidade de acesso à saúde e locomoção dos deficientes visuais. Métodos: Foi realizado estudo prospectivo, qualitativo e quantitativo com todos os 66 alunos do Lar Escola "Santa Luzia" Para Cegos no município de Bauru. Cada pessoa com deficiência visual respondeu a questionários sobre diversos temas e foi submetido a um exame oftalmológico que constou de: anamnese, refração e acuidade visual corrigida (AV), biomicroscopia, tonometria e exame de fundo de olho. Resultados: Do total de 66 alunos da escola, 44 participaram do estudo e 22 não quiseram ou não puderam comparecer à consulta oftalmológica. 56,81% (25) do total de participantes eram homens e 43,19% (19) mulheres. Os desafios dos alunos deste estudo compreendem basicamente a locomoção com maior autonomia, além de maiores recursos disponíveis em informática e braile. As causas mais frequentes de deficiência visual no presente estudo, em ordem crescente de prevalência foram: atrofia óptica, meningite, retinocoroidite por toxoplasmose, neurite óptica, DMRI, retinopatia da prematuridade, descolamento tracional de retina, hidrocefalia, tumor ocular, glaucoma congênito, uveíte, glaucoma, retinose pigmentar, descolamento de retina regmatogênica e trauma ocular. Conclusão: Medidas governamentais e o apoio da sociedade no sentido de uma intervenção de maneira eficaz e transformadora e de valores sociais solidários em prol da pessoa com deficiência visual são imprescindíveis para a inclusão social.

ABSTRACT Objective: To analyze the causes of blindness among students of the Lar Escola Santa Luzia Para Cegos in the city of Bauru, State of São Paulo. We also evaluated and discussed the degrees of social insertion of the students and the access to health and locomotion of the visually impaired. Methods: A prospective, qualitative and quantitative study was performed with all 66 students of the Lar Escola Santa Luzia para Cegos in the city of Bauru. Each person with visual impairment answered several questionnaires on various subjects and underwent an ophthalmologic examination consisting of: anamnesis, refraction and corrected visual acuity (VA), biomicroscopy, tonometry and fundus examination. Results: Out of the total of 66 students in the school, 44 participated in the study and 22 did not want or could not attend the ophthalmological visit. 56.81% (25) of the total participants were men and 43.19% (19) women. The students' challenges in this study basically include locomotion with greater autonomy, as well as greater resources available in computer science and Braille. The most frequent causes of visual impairment in the present study, in increasing order of prevalence were: optic atrophy, meningitis, toxoplasmosis retinocoriditis, optic neuritis, AMD, retinopathy of prematurity, tractional retinal detachment, hydrocephalus, ocular tumor, congenital glaucoma, uveitis, glaucoma, pigmentary retinitis, regmatogenic retinal detachment and ocular trauma. Conclusion: Government measures and the support of the society for effective and transformative intervention and solidarity-based social values for the visually impaired are essential for social inclusion.

Evaluación oftalmológica en niños derivados a un proyecto de rehabilitación en baja visión de un organismo de apoyo social / Ophthalmological evaluation in children referred to a low-vision rehabilitation project of a social assistance agency

INTRODUCCIÓN: Un niño con baja visión (BV) rehabilitado puede tener una educación integral. Objetivo: Estudiar el perfil de los escolares derivados para evaluación a un Proyecto de Rehabilitación en un organismo de apoyo social. PACIENTES Y MÉTODO: Estudio transversal descriptivo de beneficiarios evaluados entre septiembre 2015 y septiembre 2016 en JUNAEB. Se consideró diagnóstico de derivación, agudeza visual monocular (AV) con corrección óptica para lejos (cartillas Feinbloom) y cerca (cartillas Zeiss). Se clasificaron según AV y perimetría. Se consideró éxito de tratamiento lograr AV > 0,4 para le jos y/o cerca con ayuda óptica. RESULTADOS: Se evaluaron 278 escolares. 153 (55%) fueron hombres, 121(43,5%) entre 10 a 14 años. Catarata congénita bilateral, distrofias retinales, alta miopía, atrofia óptica y nistagmus congénito fueron las patologías más frecuentes. 224 (80,6%) se habilitaron con ayudas. 85 (37,9%) presentaron BV moderada y 63 (28,6%) BV severa. 122 (54,5%) presentaban perimetría normal, 68 (30,4%) campo visual (CV) tubular, 19 (8,5%) defecto sectorial del CV y 15 (6,7%) compromiso central del CV. 198 (88,4%) escolares lograron éxito visual de lejos y todos lograron éxito visual de cerca. 48 (17,2%) escolares no pudieron ser rehabilitados, estando asocia dos a una afección neuroftalmológica (41,7%), alto error refractivo (16,6%) o glaucoma congénito (10,4%). 6 (2,2%) casos mejoraron su AV con nueva corrección óptica. CONCLUSIÓN: El éxito obtenido demuestra la necesidad de habilitar visualmente a escolares con BV. Nuestro desafío es mantener este programa y educar al oftalmólogo prestador para una derivación oportuna.

INTRODUCTION: A low-vision (LV) rehabilitated child can receive comprehensive education. OBJECTIVE: To study the profile of school children referred for evaluation to a rehabilitation project in a social assistance agency. PATIENTS AND METHODS and Method: Descriptive cross-sectional study of beneficiaries evaluated between September 2015 and September 2016 in the National Board of School Assistan ce and Scholarships (JUNAEB). The referral diagnosis, monocular visual acuity (VA) with optical correction at far (Feinbloom chart) and close (Zeiss chart) distances were considered. They were classified according to VA and perimetry. Treatment success was considered if VA reaches > 0.4 at far and/or close distances with optical devices. RESULTS: 278 students were assessed. 153 (55%) were men, 121 (43.5%) between the ages of 10 to 14. Bilateral congenital cataract, retinal dystrophies, high myopia, optic atrophy, and congenital nystagmus were the most frequent pathologies. 224 students (80.6%) received optical devices. 85 (37.9%) presented moderate LV and 63 (28.6%) severe LV; 122 (54.5%) presented normal perimetry, 68 (30.4%) tubular Visual Field (VF), 19 (8.5%) sectoral VF defects, and 15 (6.7%) central scotoma. 198 (88.4%) students achieved visual success at a far distance and all achieved visual success at a near distance. 48 (17.2%) students could not be rehabilitated due to a neuro-ophthalmological condition (41.7%), high refractive error (16.6%) or congenital glauco ma (10.4%).Six (2.2%) cases improved VA with a new optical correction. CONCLUSION: This success demonstrates the need to provide low vision aids to schoolchildren with LV. Our challenge is to maintain this program and to educate ophthalmologist for timely referral.

Magnitude of visual impairment, blindness and causes in the southwest region of São Paulo state, Brazil / Importância da deficiência visual, cegueira e causas na região sudoeste do estado de São Paulo, Brasil

ABSTRACT Purposes: The purpose of this study was to evaluate the magnitude and determinants of bilateral blindness and visual impairment (VI) in the southwest region of São Paulo State, Brazil. Methods: This cross-sectional study conducted during 2013 and 2014 targeted people of all ages in 10 districts in the southwest region of São Paulo State, Brazil. Ophthalmologists in a mobile unit measured visual acuity and examined eyes. Visual acuity was categorized according to the World Health Organization sex-adjusted rates with 95% confidence intervals (CI) were calculated. Number of blindness and visually impaired was projected for the entire study area. Results: We examined 2,306 participants. The age- and sex-adjusted frequency of bilateral blindness was 0.26% (95% CI: 0.1-0.4). Females (0.35%) and patients 350 years old (0.58%) had higher rate of blindness compared with males and younger individuals. The rate of severe VI was 9.1% (95% CI: 8.8-10.6) and was higher among males (11.6%) and those 350 years (12.3%). There could be 880 people with bilateral SVI in the study area. Bilateral severe VI was attributed to cataracts in 63% and was attributed to refractive error in 18%. Conclusion: Visual impairment and blindness in the study population was low and mainly due to cataract and refractive errors. Initiatives should be addressed by health care services to further reduce avoidable blindness in the region.

RESUMO Objetivos: O objetivo deste estudo foi avaliar a mag­nitude e determinantes da cegueira bilateral e deficiência visual (DV) na região sudoeste do estado de São Paulo, Brasil. Métodos: Trata-se de um estudo transversal do qual participaram pessoas de todas as idades, habitantes de 10 distritos da região sudoeste do estado de São Paulo - Brasil, nos anos de 2013-2014. Oftalmologistas avaliaram a acuidade visual e realizaram exame oftalmológico usando uma unidade móvel. A acuidade visual foi categorizada seguindo os critérios da Organização Mundial de Saúde. Foi calculada a taxa ajustada por idade-sexo e o intervalo de confiança de 95% para estimar o número de cegos e deficientes visuais na população. Resultados: Foram examinadas 2.306 pessoas. A frequência de cegueira bilateral ajustada por idade e sexo foi de 0,26% (95% CI: 0,1-0,4). Mulheres (0,35%) e indivíduos 350 anos (0,58%) foram os que tiveram maior taxa de cegueira. A taxa de deficiência visual grave foi de 9,1% (95% CI: 8,8-10,6), ocorrendo mais em homens (11,6%), com idade 350 anos (12,3%). Estimativas indicaram existência de 880 pessoas com deficiência visual grave bilateral na região. Catarata (63%) e erros refrativos (18%) foram as prin­cipais causas de deficiência visual grave. Conclusão: Deficiência visual grave e cegueira na região estudada foram baixas, sendo as causas mais frequentes a catarata e os erros de refração. Os serviços de saúde precisam implementar iniciativas para reduzir as causas evitáveis de cegueira na região.

Causes of low vision in patients referred to the Low Vision Service in a Reference Center of Ophthalmology / Causas de baixa visão em pacientes encaminhados ao Serviço de Visão Subnormal em um Centro de Referência em Oftalmologia

Abstract Purpose: To identify the prevalence of the most common diseases diagnosed in the Low Vision Service (LVS) Methods: Seven hundred and thirteen patient's clinical records were evaluated. The best corrected visual acuity (BCVA) in the better eye was collected. All of the diagnosed diseases related to visual impairment were identified and classified. A total of 220 patients (36.6%) fulfilled the concept of low vision (group 1), and 381 patients (63.39%) presented legal blindness (groups 2, 3, 4 and 5), according to the WHO Study Group on the Prevention of Blindness (Geneva, l972). Results: The most prevalent disorder was the group of Retinal Inherited Distrophies (n=124; 20.63%). Following the first group were Ocular toxoplasmosis with chorioretinal scars (118 cases, representing a prevalence of 19.63%), Myopic Maculopathy (38-6.32%), Age related Macular Degeneration (AMD) (36 cases, representing a prevalence of 6%). Conclusion: Planning and implementing preventive actions in ophthalmology requires appropriate comprehension about regional clinical problems. Social support, and a proper partnership between educational and health systems, are important to improve visual outcomes in patients diagnosed with low vision and legal blindness.

Resumo Objetivo: identificar a prevalência dos distúrbios mais comuns em pacientes do Serviço de Visão Subnormal do Centro de Referência de Oftalmologia (CEROF - UFG). Método: Foram avaliados 713 registros de pacientes, t odos apresentavam erros refrativos corrigidos. Coletaram-se dois elementos: melhor acuidade visual corrigida (MAVC) no melhor olho e o diagnóstico da doença oftalmológica responsável pela deficiência visual. Todos os grupos etários foram incluídos, sem distinção entre sexo ou raça. Resultados: As doenças mais prevalentes foram distrofias retinianas hereditárias (124 pacientes; 20,63%), cicatrizes coriorretinianas por toxoplasmose (118-19,63%), maculopatia miópica (38-6,32%), Degeneração macular relacionada à idade (DMRI) (36-6%). 220 pacientes (36,6%) preencheram critério de baixa visão (grupo 1), e 381 (63,39%) apresentaram definição de cegueira legal (grupos 2, 3, 4 e 5) recomendada pelo Grupo de Estudos para a Prevenção da Cegueira WHO (Genebra, l972). Conclusão: Estudos nacionais mostram resultados semelhantes sobre cicatrizes coriorretinianas. Estudos epidemiológicos mostram maior prevalência de DMRI, provavelmente porque as clínicas oftalmológicas primárias falham no encaminhamento destes pacientes. A proporção de cegueira relacionada à ROP nos países desenvolvidos é maior, possivelmente porque não há plano de ação público oferecendo acompanhamento oftalmológico adequado para essas crianças. Não havia número significativo de pacientes com glaucoma congênito no departamento, o que pode se relacionar com as condições socioeconômicas e saúde no Brasil. Ações preventivas em oftalmologia necessitam de conhecimento científico de problemas oftalmológicos regionais aplicados à realidade, que será foco de tal ação. Um suporte social, incluindo parceria entre escola, família e sistema público de saúde, seria importante para gerar benefícios para a população.

Avaliação do perfil socioeconômico, formação profissional e estado de saúde de pessoas com deficiência visual / Evaluation of socioeconomic profile, professional training and health status of people with visual impairment

Resumo Objetivo: Verificar os aspectos socioeconômicos, a formação profissional, o nível de escolaridade e o estado de saúde de pessoas com deficiência visual. Métodos: Estudo transversal e descritivo com participação de 33 pessoas com deficiência visual, atendidas em uma Instituição Especializada para essa deficiência na cidade de Uberaba-MG, sendo 16 com baixa visão e 17 cegos. Avaliou-se os aspectos socioeconômicos por meio do instrumento Critério de Classificação Econômica Brasil (CCEB), a formação profissional e o estado de saúde foi verificado com o preenchimento de um formulário estruturado. Resultados: A faixa etária foi de 47,3 anos (± 17,2 anos), com prevalência do sexo feminino (57,5%) e da raça branca (51,5%). Em relação à formação profissional, 50% dos indivíduos com baixa visão e 52,9% com cegueira são aposentados; e a escolaridade foi de 8 anos de estudo para ambos os grupos. No estado de saúde 31,2% dos participantes com baixa visão apresentaram retinose pigmentar, e 23,5% dos participantes com cegueira apresentaram glaucoma. Em ambos grupos a maioria dos indivíduos não possuía nenhum tipo de comorbidade associado. De acordo com CCEB para o grupo baixa visão, a média da pontuação total foi de 18,4 pontos e para o grupo de cegos foi de 18,1; culminando na classificação C1 do nível socioeconômico. Conclusão: O perfil das pessoas do estudo demonstrou situações razoáveis de escolaridade, presença de indivíduos brancos e solteiros com idade economicamente ativa, com benefício de aposentadoria e classe econômica baixa.

Abstract Objective: To verify the socioeconomic aspects, the professional formation, the educational level and the state of health of people with visual deficiency. Methods: This is a cross-sectional and descriptive study with the participation of 33 people with visual impairment attended at a Specialized Institution for this deficiency in the city of Uberaba-MG, 16 with low vision and 17 with blindness. Socioeconomic aspects were evaluated through the Brazilian Economic Classification Criteria (CCEB), professional training and health status were verified by completing a structured form. Results: The age group was 47.3 years (± 17.2 years), with a prevalence of female (57.5%) and white (51.5%). In relation to professional training, 50% of the individuals with low vision and 52.9% with blindness are retired people; and schooling was 8 years of study for both groups. In the health condition 31.2% of the participants of low vision presented retinitis pigmentosa, and 23.5% of participants with blindness had glaucoma. In both groups, most individuals did not have any associated comorbidities. According to CCEB for the low vision group, the mean of the total score was 18.4 points and for the blind group was 18.1; culminating in the C1 classification of the socioeconomic level. Conclusion: The profile of the people in the study showed reasonable situations of schooling, presence of white and single individuals with economically active age, with retirement benefits and low economic class.

Causes of visual impairment and blindness in children at Instituto Benjamin Constant Blind School, Rio de Janeiro / Causas de baixa visão e cegueira infantil na Escola para cegos do Instituto Benjamin Constant, Rio de Janeiro

Abstract Objective: To determine the main causes of visual impairment and blindness in children enrolled at Instituto Benjamin Constant blind school (IBC) in 2013, to aid in planning for the prevention and management of avoidable causes of blindness. Methods: Study design: cross-sectional observational study. Data was collected from medical records of students attending IBC in 2013. Causes of blindness were classified according to WHO/PBL examination record. Data were analyzed for those children aged less than 16 years using Stata 9 program. Results: Among 355 students attending IBC in 2013, 253 (73%) were included in this study. Of these children, 190 (75%) were blind and 63 (25%) visually impaired. The major anatomical site of visual loss was retina (42%), followed by lesions of the globe (22%), optic nerve lesions (13.8%), central nervous system (8.8%) and cataract/pseudophakia/aphakia (8.8%). The etiology was unknown in 41.9% and neonatal factors accounted for 30,9% of cases. Forty-eight percent of cases were potentially avoidable. Retinopathy of prematurity (ROP) was the main cause of blindness and with microphthalmia, optic nerve atrophy, cataract and glaucoma accounted for more than 50% of cases. Conclusion: Provision and improvement of ROP, cataract and glaucoma screening and treatment and programs could prevent avoidable visual impairment and blindness.

Resumo Objetivo: Determinar as causas de cegueira e deficiência visual nas crianças matriculadas na Escola do Instituto Benjamin Constant (IBC) em 2013, para contribuir na elaboração de estratégias de controle e prevenção de causas evitáveis de cegueira. Métodos: Desenho de estudo: observacional do tipo transversal. Os dados foram coletados através dos prontuários dos alunos matriculados na Escola em 2013. As causas de cegueira foram classificadas de acordo com os registros de exames elaborados pela OMS/IAPB. Os dados foram analisados, em crianças com idade abaixo de 16 anos, usando o Programa Stata9. Resultados: Entre 355 alunos matriculados no IBC em 2013, 253 (73%) foram incluídos nesse estudo. Dessas crianças, 190 (75%) eram cegas e 63 (25%), deficientes visuais. O principal sítio anatômico, responsável pela perda visual, encontrado foi a retina (42%), seguido de lesões do globo ocular (22%), lesões no nervo óptico (13,8%), cegueira de origem no sistema nervoso central (8,8%) e catarata/pseudofácico/afácico (8.8%). A etiologia foi desconhecida em 41,9% e fatores neonatais corresponderam a 30,9% dos casos. Quarenta e oito porcento dos casos foram potencialmente evitáveis. Retinopatia da prematuridade (ROP) foi a principal causa de cegueira e microftalmia, atrofia do nervo óptico, catarata e glaucoma contaram com mais de 50% dos casos. Conclusão: A oferta e melhoria de programas de triagem e tratamento do ROP, catarata e glaucoma podem prevenir os casos de deficiência visual e cegueira evitáveis.

As principais causas de cegueira e baixa visão em escola para deficientes visuais / The main causes of blindness and low vision in school for blind

RESUMO Objetivo: Identificar e analisar as principais causas de cegueira e baixa visão em escola para deficientes visuais. Métodos: Foram revisados 165 prontuários de alunos portadores de deficiência visual em instituição especializada no ensino de cegos, atendidos no período de agosto de 2013 a maio de 2014. As variáveis analisadas foram: idade, gênero, acuidade visual, diagnóstico principal e secundário, tratamento, recursos ópticos prescritos e prognóstico. Resultados: Dos 165 alunos avaliados, 91 alunos (55%) são legalmente cegos e apenas 74 (45%) dos alunos são enquadrados como baixa visão. As principais causas identificadas foram: retinopatia da prematuridade (21%), atrofia de nervo óptico (18%), glaucoma congênito (16%), distrofias retinianas (11%) e neoplasias (8%). As causas de baixa visão foram: catarata congênita (18%), glaucoma congênito (15%) e cicatriz de retinocoroidite (12%). As causas de cegueira evitáveis (preveníveis ou tratáveis) no estudo perfizeram um total de 52%. Conclusão: As principais causas de cegueira e baixa visão nos alunos do Instituto Benjamin Constant são por doenças evitáveis.

ABSTRACT Objective: Identify and analyze the main causes of blindness and low vision in school for blind. Methods: One hundred sixty-five medical records of visually impaired students were reviewed in an institution specialized in teaching the blind, treated between august 2013 and may 2014. The variables analyzed were age, sex, visual acuity, primary and secondary diagnoses, treatment, optical prescription features and prognosis. Results: 165 students were evaluated, 91 students (55%) are legally blind and only 74 (45%) of the students are classified as low vision. The main causes of blindness were: retinopathy of prematurity (21%), optic nerve atrophy (18%), congenital glaucoma (16%), retinal dystrophy (11%) and cancer (8%). The causes of low vision were: congenital cataract (18%), congenital glaucoma (15%) and retinochoroidal scarring (12%). Conclusions: The main causes of blindness and low vision in the Benjamin Constant Institute are from preventable diseases.

Avaliação oftalmológica de crianças de escolas públicas de Belo Horizonte/MG: um panorama acerca da baixa acuidade visual / Ophthalmologic screening of children of public schools in Belo Horizonte/MG: an overview about the visual impairment in children

Objetivo:Descrever e analisar a prevalência de baixa acuidade visual e suas causas em estudantes do ensino público de Belo Horizonte/MG.Métodos:Estudo transversal de 1452 escolares de 5 a 19 anos, do ensino público de Belo Horizonte/MG, triados e atendidos entre 2011 e 2014.Resultados:Da amostra total, 150 pacientes (10,33%) apresentaram baixa acuidade visual à triagem, recebendo encaminhamento para atendimento oftalmológico. Quarenta (26,66%) foram encaminhados e compareceram à consulta, onde 29 (72,5%) apresentaram indicação de correção visual. O astigmatismo miópico simples e composto foram os diagnósticos mais relacionados à prescrição de óculos.Conclusão:O estudo mostrou que a prevalência de baixa acuidade visual na população estudada foi compatível com demais programas semelhantes. Em contrapartida, a taxa de abstenção foi maior do que o esperado, evidenciando a importância da criação de medidas preventivas e informativas quanto à importância do cuidado com a saúde ocular.

Objective:To describe and analyze the prevalence of visual impairment and its causes in public school students in Belo Horizonte/MG.Methods:Cross-sectional study of 1.452 public school children from 5 to 19 years old, in Belo Horizonte/MG, screened and evaluated between 2011 and 2014.Results:Of the total sample, 150 patients (10,33%) had low visual acuity at the screening, and were referred to an ophthalmologist to further examination. Forty (26%) of the referred patients presented at the ambulatory, where 29 (72,5%) of these showed indication of visual correction. Simple and compound myopic astigmatism were the most frequent diagnoses associated with prescription glasses.Conclusion:The study showed that the prevalence of visual impairment in this population were consistent with other similar programs. By contrast, the abstention rate was much higher than the expectation, showing the importance of preventive and informative actions about the eye health care.

Caracterización clinicoepidemiológica de la baja visión en el adulto mayor y su rehabilitación visual / Clinical and epidemiolotical characterization of the low vision in the older adult and their visual rehabilitation

OBJETIVO: caracterizar clínica y epidemiológicamente a los pacientes con diagnóstico de baja visión, así como su rehabilitación. MÉTODOS: se realizó un estudio descriptivo, prospectivo, en 628 pacientes atendidos en el Servicio de Baja Visión en el período de 2011 a 2012 en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Se recogieron los datos generales, los antecedentes generales y oculares, el defecto refractivo, la causa de la baja visión, la motivación, la ayuda óptica y la evaluación de la rehabilitación visual. La información obtenida se plasmó en una base de datos; posteriormente se procesaron y analizaron para dar salida a los objetivos del estudio. RESULTADOS: predominaron el sexo femenino, la raza blanca y el grupo de edad entre 70 y 79 años. La mayor parte de los pacientes no presentaron enfermedad sistémica y sí estuvo presente en la mayoría de los pacientes con predominio del glaucoma, lo que constituyó la primera causa ocular de discapacidad visual en estos. La ayuda óptica estuvo en correspondencia con la motivación expresada por ellos, donde la principal fue la lectoescritura. En la mayoría de los casos se logró una adecuada rehabilitación. CONCLUSIONES: en los casos de baja visión, la rehabilitación presenta relación estadística con el sexo, los antecedentes patológicos generales, la motivación y la ayuda óptica, algunas sin explicación clínica.

OBJECTIVE: with the objective of characterizing clinical epidemically to the patients with diagnostic of low vision as well as its rehabilitation. METHODS: was carried out a descriptive study, prospective in 628 patients assisted in the service of Low Vision in the period from the 2011 to the 2012 in the ICO "Ramón Pando Ferrer". the general data were picked up, the general and ocular antecedents, refractive defect, causes of the drop vision, motivation, helps optics and evaluation of the visual rehabilitation. The obtained Information was captured in a database, later on they were processed and they analyzed to give exit to the objectives of the study. RESULTS: it prevailed the feminine sex, the white race and the age group between 70 and 79 years. Most of the patients didn't present systemic illness. I didn't seize in the ocular pathological antecedents that it was present in most of the patients with prevalence of the glaucoma, constituting the first ocular cause of visual discapacidad in these. The optic help was in correspondence with the motivationexpressed by the same ones, where the lecture-write was the main one, in most of the cases an appropriate rehabilitation was achieved. CONCLUSIONS: the rehabilitation was evaluated meeting statistical relationship with the sex, the general pathological antecedents, the motivation and the optic help, some without clinical explanation.

Discapacidad visual; otra forma de verla / Visual impairment; another way of see it

La discapacidad visual es un problema de salud pública que afecta a más de doscientos ochenta y cinco millones de personas alrededor del mundo, dentro de los cuales doscientos cuarenta y seis millones sufren baja visión y treinta y nueve millones ceguera primaria. Es una entidad altamente relacionada con las condiciones socioeconómicas y las posibilidades de acceder a los servicios de salud, esto explica que entre el 80 y el 90 por ciento de las personas con alteraciones visuales sean de países en vía de desarrollo, principalmente en zonas rurales. Una infinidad de casos de ceguera y baja visión son consecuencia de eventos prevenibles, entre los cuales sobresalen los defectos refractivos no corregidos tales como astigmatismo, miopía, hipermetropía y presbicia. Es por esto que la discapacidad visual se ha convertido en una prioridad para múltiples entidades a nivel mundial, que buscan disminuir la presentación de ceguera prevenible a través de una simple corrección visual bien diagnosticada...

Visual impairment is a public health problem that affects more than two hundred eighty-five million people around the world, among them two hundred forty-six million suffer low vision and thirty-nine million primary blindness. It is highly related to socio-economic conditions and the possibilities to access to health services, explained that between 80 and 90 percent of persons with visual impairments from countries developing, mainly in rural areas. An infinite number of cases of blindness and low vision are the result of events preventable, among which stand out the uncorrected refractive errors such as myopia, hyperopia, astigmatism and presbyopia. It is for this reason that visual impairment has become a priority for many organizations around the world, seeking to reduce the presentation of preventable blindness through a simple visual correction well diagnosed...

Blindness and severe visual impairment in pupils at schools for the blind in burundi

To determine the causes of childhood blindness and severe visual impairment in pupils attending schools for the blind in Burundi in order to assist planning for services in the country. All pupils attending three schools for the blind in Burundi were examined. A modified WHO/PBL eye examination record form for children with blindness and low vision was used to record the findings. Data was analyzed for those who became blind or severely visually impaired before the age of 16 years. Overall, 117 pupils who became visually impaired before 16 years of age were examined. Of these, 109 [93.2%] were blind or severely visually impaired. The major anatomical cause of blindness or severe visual impairment was cornea pathology/phthisis [23.9%], followed by lens pathology [18.3%], uveal lesions [14.7%] and optic nerve lesions [11.9%]. In the majority of pupils with blindness or severe visual impairment, the underlying etiology of visual loss was unknown [74.3%]. More than half of the pupils with lens related blindness had not had surgery; among those who had surgery, outcomes were generally poor. The causes identified indicate the importance of continuing preventive public health strategies, as well as the development of specialist pediatric ophthalmic services in the management of childhood blindness in Burundi. The geographic distribution of pupils at the schools for the blind indicates a need for community-based programs to identify and refer children in need of services

Prevalence and causes of blindness in an urban area of Paraguay / Prevalência e causas de cegueira em uma população urbana do Paraguai

PURPOSE: To determine the prevalence and causes of blindness in Piribebuy, Paraguay. METHODS: A population based study was conducted from September to November 2007 in Piribebuy, Paraguay. Based on the city map, seven clusters were randomly selected, containing 22 to 36 squares (423 to 578 houses) each, where all subjects > 40 years old who agreed to participate were included in the study. Presenting vision acuity (VA) was obtained for each eye, with 'E' Snellen charts 6 meters far from the patient with appropriate light. Eyes with VA<20/60 were also tested with the pinhole. Objective and subjective refraction was performed, followed by examination of anterior segment under the slit-lamp, Goldmann applanation tonometry, and pupil dilatation with 0.5% tropicamide plus 0.5% phenylephrine, followed by evaluation of the posterior pole. Best corrected visual acuity was used to classify the patients as follows: blindness was defined as visual acuity of the better eye <20/400, low vision as 20/400

OBJETIVO: Determinar a prevalência e causas de cegueira em Piribebuy, Paraguay. MÉTODOS: Um estudo populational foi conduzido de setembro a novembro de 2007 em Piribebuy, Paraguay. Baseado no mapa da cidade, sete agrupamentos foramaleatoriamente selecionados, contendo 22 a 36 quarteirões (423 a 578 casas) cada, onde todos os indivíduos > 40 anos de idade, que concordaram em participar, foram incluídos no estudo. A acuidade visual (AV) conforme apresentada foi obtida para cada olho, com Tabela de Snellen a 6 metros do paciente, com luz apropriada. Olhos com AV<20/60 também foram testados com orifício estenopeico. Refrações objetiva e subjetiva foram realizadas, seguido de avaliação da câmara anterior sob lâmpada de fenda, tonometria de aplanação de Goldmann e dilatação pupilar com tropicamida a 0.5% e fenilefrina a 0.5%, seguido de avaliação do polo posterior. A melhor acuidade visual corrigida foi usada para classificar os pacientes nos seguintes grupos: cegueira foi definida como acuidade visual do melhor olho <20/400, baixa visão como 20/400

Screening for visual impairment: Outcome among schoolchildren in a rural area of Delhi.

Background: Uncorrected refractive errors are the main cause of vision impairment in school-aged children. The current study focuses on the effectiveness of school eye screening in correcting refractive errors. Objectives: 1. To study the magnitude of visual impairment among school children. 2. To assess the compliance of students for refraction testing, procurement and use of spectacles. Materials and Methods: An intervention study was conducted in schools of the north- west district of Delhi, in the rural field practice area of a medical college. Students studying in five government schools in the field practice area were chosen as the study subjects. Results: Out of 1123 students enrolled, 1075 (95.7%) students were screened for refractive errors. Low vision (visual acuity < 20/60) in the better eye was observed in 31 (2.9%) children and blindness (visual acuity <20/200) in 10 (0.9%) children. Compliance with referral for refraction was very low as only 51 (41.5%) out of 123 students could be tested for refraction. Out of 48 students, 34 (70.8%) procured spectacles from family resources but its regular use was found among only 10 (29.4%) students. The poor compliance among students stems out of various myths and perceptions regarding use of spectacles prevalent in the community. Conclusion: Refractive error is an important cause of avoidable blindness among rural school children. Behavior change communication among rural masses by spreading awareness about eye health and conducting operational research at school and community level to involve parent's teachers associations and senior students to motivate students for use of spectacles may improve utilization of existing eye health services in rural areas.

Causes of Visual Impairment among Patients Referred to a Visual Rehabilitation Clinic in Iran

PURPOSE: Epidemiologic evaluation and investigating the causes of visual impairment in any society is a matter of concern and has a direct effect on the country's health care planning. In this study we describe causes of low vision and blindness in Iranian patients referred to rehabilitation clinics for taking vision aids. METHODS: In this cross-sectional study, visual acuity was classified based on best-corrected visual acuity in the better eye according to the World Health Organization definition (blindness, visual acuity [VA] < 20 / 400; severe visual impairment, VA < 20 / 200-20 / 400; mild to moderate visual impairment, VA < 20 / 60-20 / 200). The causes of blindness and low vision were determined using the 10th version of International Classification of Diseases based on the main cause in both eyes. To describe data, we used mean +/- SD and frequency. RESULTS: The study included 432 patients, 65% male, with a mean age of 43.6 +/- 25.5 years (range, 3 to 92 years). Mild to moderate visual impairment, severe visual impairment and blindness were present in 122 (28.8%), 196 (46.4%) and 105 (24.8%) of the patients, respectively. The main causes of visual impairment were retinal and choroidal diseases (74.5%), optic nerve and optic tract diseases (9.8%), vitreous and globe disorders (5.3%), congenital cataract (3.1%), and glaucoma (2.6%). The distribution pattern of the causes was similar in all age subgroups. CONCLUSIONS: Diseases of the retina and choroid are the main cause of visual impairment among patients referred to an academic visual rehabilitation clinic in Iran.

Prognostic factors for vision outcome after surgical repair of open globe injuries.

Purpose: To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries. Materials and Methods: The study was carried out at a tertiary referral eye care center in Central India. In this retrospective study, case records of 669 patients with open globe injuries were analyzed. Different preoperative variables were correlated with the final visual outcome. Exclusion criteria were patients with less than four months follow up, previous ocular surgery, presence of intraocular foreign body or endophthalmitis at the time of presentation. Using statistical tests, the prognostic factors for vision outcome following surgical repair of open globe injuries were studied. Results: Based on the Spearman's Rho correlation analysis, following factors were found to be significantly associated with the final visual acuity at univariate level: age (P<0.001), preoperative visual acuity (P=0.045), mode of injury (P=0.001), and time lag between the injury and surgery (P=0.003). None of the other clinical factors have statistically significant correlation with final visual acuity. On multivariate analysis using binary logistic regression, only age, mode of injury and the time lag between injury and surgery achieved statistically significant results. Conclusion: In the current study, elapsed time between the injury and surgery, age of the patient, preoperative visual acuity and mode of injury were found to be adversely affecting the final visual outcome. Recognizing these factors prior to surgical intervention or intraoperatively can help the surgeon in evidence-based counseling of the trauma victim and family.

Serviço de visão subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC): análise dos pacientes atendidos no 1º ano do departamento (2004) / Low vision service at the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC): analysis of the patients examined on the first year of the department (2004)

Objetivo: Traçar o perfil dos pacientes portadores de baixa visão atendidos no serviço de visão subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC). Métodos: Realizou-se um estudo transversal no qual foram revisados 82 prontuários de pacientes com baixa visão, atendidos pelo Serviço Único de Saúde (SUS) no primeiro ano do departamento de Visão Subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira em 2004. Os dados analisados foram: sexo, faixa etária, etiologia, acuidade visual inicial e final (pós-refração) para longe e perto, com e sem auxílio óptico e recurso óptico indicado. Resultados: Dos 82 pacientes avaliados, 11 (13,4 por cento) foram excluídos do trabalho por não apresentarem visão subnormal. Dos 71 pacientes restantes, 32 (45 por cento) eram menores de 20 anos. Quanto ao sexo, não houve diferença estatisticamente significante (51 por cento eram mulheres e 49 por cento eram homens). A etiologia mais frequente em crianças e adolescentes foi o glaucoma congênito (15,6 por cento). Em pacientes de 20 a 39 anos prevaleceu a toxoplasmose ocular (21,1 por cento). Entre os pacientes de 40 a 59 anos, a retinose pigmentar foi a patologia mais frequente (19 por cento). Nos idosos, o glaucoma foi a patologia mais encontrada (40 por cento). Trinta e três pacientes (40,2 por cento) tinham acuidade visual entre 20/60 e 20/160. O sistema telescópico foi o único auxílio óptico indicado para longe (44 por cento) e os óculos foram os mais indicados para perto (54,5 por cento). Conclusão: Existe uma alta prevalência de baixa visão em crianças e adolescentes em países em desenvolvimento como o Brasil. Desta forma o oftalmologista precisa criar programas preventivos, melhorar as condições de atendimento e atentar para o diagnóstico precoce e o tratamento destes pacientes.

Purpose: To outline low vision (LV) patients profile of the low vision department of the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC). Methods: Transversal study of 82 medical charts from the low vision service at the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira of the first year of the department - 2004, considering age, gender, etiology, distance and near visual acuity with and without optical aids and prescription assistance. Results: Of the 82 available patients, 11 (13.4 percent) were excluded of the study because they did not present low vision. Of the 71 patients, 32 (45 percent) were younger than 20 years old. Regarding the gender, there was not a significant difference (51 percent female and 49 percent male). The most frequent etiology in infants and adolescents was congenital glaucoma and in patients aged between 20-39 years was ocular toxoplasmosis (21.1 percent). In patients with 40-59 years old, pigmentary retinosis was the most frequently pathology (19 percent). In elderly people it was glaucoma (49 percent). Thirty-three patients (40.2 percent) had visual acuity between 20/60 and 20/160. The telescopic system was the only optical aid indicated for distance (44 percent) and glasses were the most indicated for near (54.5 percent). Conclusion: There is a high prevalence of low vision in infants and adolescents that live in developing countries like Brazil. Therefore, ophthalmologists need to be aware to promote early diagnosis and treatment to these patients, creating preventive programs and better assistance conditions.

Inclusão social do deficiente visual: experiência e resultados de Assis / Social inclusion for visually impaired: experience and results from Assis

OBJETIVOS: Traçar o perfil do usuário da Sala de Recursos para Deficiente Visual na cidade de Assis - SP, avaliar a porcentagem de deficientes visuais empregados e comparar o emprego com idade, gênero, tipo de deficiência e doença causadora da deficiência, entre dois períodos: de 1984 a 1996 e de 1997 a 2009. MÉTODOS: Foi realizado estudo retrospectivo dos prontuários médicos e da ficha escolar dos portadores de deficiência visual que frequentaram a Sala de Recursos para Deficiente Visual, no período de 1984 a 2009 na cidade de Assis - SP, divididos em dois períodos de 1984 a 1996 (G1) e de 1997 a 2009 (G2). Analisaram-se dados demográficos, a doença que provocou a baixa visão, o tipo de deficiência visual (cegueira ou baixa visão), escolaridade, recursos ópticos, frequência à Sala de Recursos para Deficiente Visual e taxa de emprego. Foi feita associação da taxa de emprego com: idade, gênero, raça/cor, tipo de deficiência e doença nos dois diferentes períodos. RESULTADOS: Foram encontrados 149 deficientes visuais sendo: 61,07 por cento homens, 38,9 por cento mulheres, 82,5 por cento brancos e 17,4 por cento não brancos e a mediana da idade foi de 18 anos. Dos 149 deficientes visuais, 63,75 por cento eram portadores de baixa visão e 36,24 por cento portadores de cegueira. As principais doenças que levaram à deficiência visual dos 149 pacientes foram em ordem decrescente: retinocoroidite por toxoplasmose (17,40 por cento), atrofia óptica congênita (12,10 por cento), alta hipermetropia (8,72 por cento), retinose pigmentar e alta miopia (6,71 por cento cada uma) e glaucoma congênito e catarata congênita (6,04 por cento cada uma). A frequência à Sala de Recursos para Deficiente Visual foi boa em mais de 50 por cento dos pacientes. Estavam trabalhando regularmente 44,7 por cento e 12,3 por cento dos maiores de 14 anos respectivamente nos períodos de 1984 - 1996 e de 1997 - 2009. Não houve diferença entre os dois períodos quanto às características...

PURPOSES: To establish the visually impaired resource class users profile in the city of Assis - SP, to estimate the visually impaired employment percentage and to compare employment rate with age, gender, deficiency type and causing disease between two periods:1984 - 1996 and 1997 - 2009. METHODS: Retrospective review of both medical and school records from visually impaired individuals attending visually impaired resource class in Assis - SP between 1984 and 2009. This time period was divided into two intervals: 1984 - 1996 (G1) and 1997 - 2009 (G2). Collected data included demographic features and diseases, type of visual impairment (blindness or low vision), education, optic aids, attendance to visually impaired resource class and employment rate. Employment rate was associated with age, gender, type of visual impaiment and causing disease between both study time intervals. RESULTS: A total of 149 visually impaired individuals were identified - 61.07 percent male, 38.9 percent female, 82.5 percent white, and 17.4 percent non-white. Mean age was 18 years. Of the 149 visually impaired, 63.75 percent had low vision and 36.24 percent were blind. In decreasing order, the more frequent conditions leading to visual impairment were toxoplasmosis retinochoroiditis (17.40 percent), congenital optic atrophy (9.39 percent), high hyperopia (8.72 percent), pigmentary retinosis and high myopia (with 6.71 percent each) and congenital glaucoma and congenital cataract (with 6.04 percent each). Attendance to visually impaired resource class was good by over 50 percent of the patients. Of the individuals >14 years-old, 44.7 percent and 12.3 percent were regularly employed during 1984 - 1996 and 1997 - 2009 periods, respectively. Employment rate only correlated with age (individuals with higher mean age were most frequently employed) and there was not correlation with demographic characteristics, deficiency type and causing diseases...

Visual impairment in the hearing impaired students.

Background: Ocular problems are more common in children with hearing problems than in normal children. Neglected visual impairment could aggravate educational and social disability. Aim: To detect and treat visual impairment, if any, in hearing-impaired children. Setting and Design: Observational, clinical case series of hearing-impaired children in schools providing special education. Materials and Methods: Hearing-impaired children in selected schools underwent detailed visual acuity testing, refraction, external ocular examination and fundoscopy. Ocular motility testing was also performed. Teachers were sensitized and trained to help in the assessment of visual acuity using Snellen's E charts. Refractive errors and squint were treated as per standard practice. Statistical Analysis: Excel software was used for data entry and SSPS for analysis. Results: The study involved 901 hearing-impaired students between four and 21 years of age, from 14 special education schools. A quarter of them (216/901, 24%) had ocular problems. Refractive errors were the most common morbidity 167(18.5%), but only 10 children were using appropriate spectacle correction at presentation. Fifty children had visual acuity less than 20/80 at presentation; after providing refractive correction, this number reduced to three children, all of whom were provided low-vision aids. Other common conditions included strabismus in 12 (1.3%) children, and retinal pigmentary dystrophy in five (0.6%) children. Conclusion: Ocular problems are common in hearing-impaired children. Screening for ocular problems should be made mandatory in hearing-impaired children, as they use their visual sense to compensate for the poor auditory sense.