[Handicap related to blindness]. / Handicap lié à la cécité.

Handicap related to blindness. The interest of vision professionals in visual impairment is recent, dating back to the early 1990s. This interest led to the creation in 1996 of the French society for low-vision patients, ARIBa. The epidemiological figures remain unclear, but the number of people in France with visual disabilities is around one million, together with the major public health concern of age-related macular degeneration and the risk of dependence of the elderly in activities of daily living. This is a major medical and social, but also economic concern. Other causes of visual impairment remain numerous, despite advances in the means of prevention and medical or surgical treatment. Moreover, the investment in basic and clinical research raises high expectations for the decades to come. It should be noted that despite the development of rehabilitation facilities, in which the French school for low-vision patients has particularly been active, the territorial network of rehabilitation responses to visual impairment remains extremely inadequate and unequal.

Handicap lié à la cécité. L'intérêt des professionnels de la vision pour la déficience visuelle est récent, il date du début des années 1990. Cet intérêt s'est concrétisé en 1996 par la création de la Société francophone de basse vision ARIBa. Les chiffres épidémiologiques restent imprécis, mais le nombre de personnes en situation de handicap d'origine visuelle tourne autour du million, avec en filigrane le problème majeur de santé publique de la dégénérescence maculaire liée à l'âge et le risque de dépendance des personnes âgées. Il s'agit là d'une problématique médicale mais également sociale et économique majeure. Les autres causes de déficiences visuelles sont encore nombreuses, malgré les progrès des moyens de prévention et de traitement médical ou chirurgical. Enfin, les grands axes de la recherche fondamentale et clinique permettent de grands espoirs pour les décennies à venir. Notons pour terminer que, malgré le développement de moyens de rééducation où l'école française de basse vision s'est particulièrement distinguée, le maillage territorial des réponses de réadaptation à la déficience visuelle reste extrêmement insuffisant et inégalitaire.

Patient characteristics and treatment of neovascular age-related macular degeneration in France: the LUEUR1 observational study.

BACKGROUND: Age-related macular degeneration is the primary cause of blindness in developed countries. Current treatments of this degenerative disease mainly include laser, photodynamic therapy with verteporfin and administration of anti-vascular endothelial growth factors. The LUEUR (LUcentis® En Utilisation Réelle) study is composed of a cross-sectional part (LUEUR1), which examined the current management of wet AMD in France, and a follow-up part (LUEUR2), which will assess the development of patients treated for wet AMD over 4 years. Here we describe the results of LUEUR1. METHODS: Patients with wet AMD were enrolled during a routine medical examination in LUEUR1, a cross-sectional, observational, prospective, multicentre study. Investigators recorded patient demographics, visual acuity, characteristics of wet AMD lesions, date of AMD diagnosis, comorbidities, previous treatments, treatments prescribed at inclusion, and low vision rehabilitation. RESULTS: A total of 72 investigators recruited 1,019 patients with wet AMD, corresponding to 1,405 eyes affected by the disease. The mean age of patients was 78.7 ± 7.3 years. Most were female (62.3%) and non-smokers (66.9%). The mean visual acuity was 49.12 ± 24.18 Early Treatment Diabetic Retinopathy Study letters. Most eyes showed occult (52.8%) and subfoveal (84.6%) choroidal neovascularisation. Bilateral wet AMD affected 37.9% of patients. The median time since diagnosis was 12 months. Ranibizumab-based therapy (67.3%) and photodynamic therapy (29.8%) were the most frequent previous treatments. Prior to inclusion, 5.6% of patients had low vision rehabilitation. When a treatment was prescribed on the day of inclusion, it was most often ranibizumab (89.0% of all treatments at inclusion). CONCLUSIONS: The results of this study illustrate the impact of anti-vascular endothelial growth factor therapies on the treatment of wet AMD in a real-life context. Specifically, ranibizumab-based therapy appears to have largely replaced laser photocoagulation and verteporfin-based photodynamic therapy.

Ophthalmic regional anesthesia: medial canthus episcleral (sub-tenon) single injection block.

BACKGROUND: The purpose of this study was to evaluate the efficacy and safety of episcleral single-injection anesthesia in a large number of patients. METHODS: Over a period of 5 yr, in four institutions, anesthesiologists involved in this prospective study completed a standardized form to evaluate single-injection medial canthus high-volume episcleral anesthesia. The success rate of the block was rated according to an akinesia score. The study parameters included demographic data, surgical procedure, and anesthetic management. All patients were followed up at least until postoperative day 1, and all complications, pain, and discomfort were noted. Statistical analysis was done to assess the risk factors for complications. RESULTS: A total of 2,031 patients were included in the study. The most frequent surgical procedures performed were phacoemulsification and posterior chamber artificial lens implantation (91.0%). A total of 66 complications (3.3%) occurred in 60 patients. One patient had a retrobulbar hemorrhage, and 59 had one or two more minor incidents or pain/discomfort with the procedure. The complications consisted of subconjunctival hematoma (1.3%), ocular hypertonia (0.4%), and chemosis (0.30%). Statistical analysis revealed that inexperience in the technique represented a risk factor for complications. CONCLUSIONS: This is the first survey of a large experience in episcleral single-injection anesthesia, a form of anesthesia that does not preclude sharp-needle complications and does require training. Only one complication occurred among 2,031 patients; however, a larger number of patients is needed to definitively evaluate the safety of episcleral single-injection anesthesia.