Visual impairment and eye care among older adults - five States, 2005.

Blindness and visual impairment are among the 10 most common causes of disability in the United States and are associated with shorter life expectancy and lower quality of life. Previously, state-specific prevalences of visual impairment and eye disease were estimated from national prevalences. However, in 2005, five states (Iowa, Louisiana, Ohio, Tennessee, and Texas) provided state-specific estimates by using the new CDC Behavioral Risk Factor Surveillance System (BRFSS) vision module. CDC analyzed data from the module to determine the self-reported prevalence of visual impairment, eye disease, eye injury, and lack of eye-care insurance and eye examination among persons aged >or=50 years in each of these five states and among certain sociodemographic populations overall. This report describes the results of that analysis, which indicated variation in disease prevalence and use of eye care among individual states and also among racial/ethnic populations and age groups within the five states combined. The variability among state data suggests that statespecific surveillance of visual impairment and eye care and investigation by states to identify influencing factors might lead to creation of vision programs better suited to individual state needs.

Diabetes, impaired fasting glucose, and elevated HbA1c in U.S. adolescents: the Third National Health and Nutrition Examination Survey.

OBJECTIVE: Using population-based data, we estimated the prevalence of diabetes, impaired fasting glucose, and elevated HbA1c (>6%) levels in U.S. adolescents. RESEARCH DESIGN AND METHODS: The Third National Health and Nutrition Examination Survey (1988-1994) examined a representative sample of the U.S. population, which included 2,867 adolescents aged 12-19 years who had serum glucose measured. RESULTS: A total of 13 adolescents in the sample were considered to have diabetes; 9 reported using insulin, 2 reported using oral agents only, and 2 did not report any treatment but had high glucose levels (> or = 11.1 mmol/l regardless of length of fast or > or = 7.0 mmol/l after an 8-h fast). Four of these cases (31% of the sample with diabetes) were considered to have type 2 diabetes. The estimated prevalence of diabetes (all types) per 100 adolescents ages 12-19 years was 0.41% (95% confidence interval 0-0.86). The prevalence of impaired fasting glucose (> or = 6.1 mmol/l) among adolescents without diabetes who had fasted for at least 8 h was 1.76% (0.02-3.50). The prevalence of elevated HbA1c (>6%) was 0.39% (0.04-0.74). CONCLUSIONS: National data reflect the presence of type 2 diabetes in U.S. adolescents, but the survey sample size was not large enough to obtain precise prevalence estimates because of the relatively low prevalence.

Prevalence of self-rated visual impairment among adults with diabetes.

OBJECTIVES: This study estimated the prevalence of self-rated visual impairment among US adults with diabetes and identified correlates of such impairment. METHODS: Self-reported data from the 1995 Behavioral Risk Factor Surveillance System survey of adults 18 years and older with diabetes were analyzed. Correlates of visual impairment were examined by multiple logistic regression analysis. RESULTS: The prevalence of self-rated visual impairment was 24.8% (95% confidence interval [CI] = 22.3%, 27.3%). Among insulin users, multivariable-adjusted odds ratios were 4.9 (95% CI = 2.6, 9.2) for those who had not completed high school and 1.8 (95% CI = 1.0, 2.8) for those who had completed high school compared with those with higher levels of education. Comparable estimates of odds ratios for nonusers of insulin were 2.2 (95% CI = 1.4, 3.4) and 1.3 (95% CI = 0.9, 2.0), respectively. Among nonusers, the adjusted odds for minority adults were 2.4 (95% CI = 1.0, 3.7) times the odds for non-Hispanic Whites. CONCLUSIONS: By these data, 1.6 million US adults with diabetes reported having some degree of visual impairment. Future research on the specific causes of visual impairment may help in estimating the avoidable public health burden.

Screening for diabetic retinopathy: the utility of nonmydriatic retinal photography in Egyptian adults.

Although regular screening for diabetic retinopathy with ophthalmoscopy or retinal photography is widely recommended in the United States and Europe, few reports of its use in developing countries are available. We compared the performance of screening by retinal photography with that of indirect ophthalmoscopy by using data from a population-based survey of diabetes and its complications in Egypt. During that project, 427 persons with diabetes underwent an eye examination and fundus photography with a non-mydriatic camera through a dilated pupil. Data from the examinations of the right eye of each patient are presented. Ninety-two (22%) of the 427 retinal photographs were ungradable; in 58 eyes (63%), this was due to media opacity (42 eyes with cataract, 3 with corneal opacity, and 13 with both). Agreement between retinal photography and indirect ophthalmoscopy was poor (kappa = 0.33; 95% CI = 0.27-0.39) and primarily due to the large number of eyes (n = 79) with ungradable photographs that could be graded by ophthalmoscopy. None of these eyes was judged by ophthalmoscopy to have sight-threatening retinopathy. Fifty-four photographs were diagnosed with greater retinopathy than found on ophthalmoscopy. Retinal photography with the nonmydriatic camera through a dilated pupil is a useful method to screen for diabetic retinopathy in most adults in Egypt. However, such screening strategies have limited use in older persons and in persons with corneal disease or cataract.