[Visual impairment and blindness in Icelanders aged 50 years and older - the Reykjavík Eye Study]. / Sjónskerding og blinda Reykvíkinga 50 ára og eldri. Reykjavíkuraugnrannsóknin.

INTRODUCTION: The purpose of this study was to examine the cause-specific prevalence and 5-year incidence of visual impairment and blindness among middle-aged and older citizens of Reykjavík. MATERIAL AND METHODS: A random sample of 1045 persons aged 50 years or older underwent a detailed eye examination in 1996 and 846 of the survivors participated in a follow-up examination in 2001. Visual impairment was defined according to World Health Organization definitions as a best-corrected visual acuity of <6/18 but no worse than 3/60, or visual field of ≥5° and <10° around a fixation point in the better eye. Best-corrected visual acuity of <3/60 in the better eye was defined as blindness. The causes of visual impairment or blindness were determined for all eyes with visual loss. RESULTS: The prevalence of bilateral visual impairment and blindness was 1.0% (95% CI 0.4-1.6) and 0.6% (95% CI 0.1-1.0), respectively and the 5-year incidence was 1.1% (95% CI 0.4-1.8) and 0.4% (95% CI 0.0-0.8), respectively. The prevalence of visual impairment among 60-69 year old participants was 0.6%, but among those aged 80 years or older the prevalence was 7.9%. The major cause of bilateral visual impairment and blindness both at baseline and follow-up was age-related macular degeneration. Cataract accounted for less severe visual loss. The two most common causes of unilateral visual impairment at baseline were amblyopia and cataract. Cataract was the main cause of unilateral visual impairment at 5-year follow-up. CONCLUSION: Prevalence and 5-year incidence of both uni- and bilateral visual impairment and blindness increases with age. Age-related macular degeneration was the leading cause of severe visual loss in this population of middle-aged and older Icelanders.

Five-year incidence of visual impairment and blindness in older Icelanders: the Reykjavik Eye Study.

PURPOSE: This study examined age, sex and cause-specific 5-year incidence of visual impairment and blindness in a middle-aged and elderly Icelandic population. METHODS: The study cohort consisted of a population-based, random sample of citizens aged > or = 50 years. Of 1379 eligible subjects, 1045 underwent a baseline examination in 1996; 846 of the 958 survivors (88.2%) underwent a 5-year follow-up examination in 2001. All participants underwent an extensive ophthalmological examination including best corrected visual acuity (BCVA) using a Snellen chart. We used World Health Organization (WHO) criteria, which define visual impairment as BCVA in the better eye of < 6/18 and > or = 3/60 and blindness as BCVA in the better eye of < 3/60. We also used US criteria, which consider BCVA of < 6/12 and > 6/60 in the better eye to represent visual impairment and BCVA of < or = 6/60 in the better eye to represent blindness. The causes of incident visual loss in either eye were determined. Deterioration or improvement in vision were defined as a loss or gain of > or = 2 Snellen lines. RESULTS: According to WHO criteria, 5-year incidence of bilateral visual impairment and blindness were 1.07% (95% confidence interval [CI] 0.37-1.76) and 0.35% (95% CI 0.00-0.76), respectively. Using US criteria, equivalent incidence of bilateral visual impairment and blindness were 3.49% (95% CI 2.24-4.74) and 0.95% (95% CI 0.29-1.60), respectively. Age-related macular degeneration and cataract were the major causes of incident visual impairment and blindness. CONCLUSIONS: Incidences of visual impairment and blindness increased significantly with age. Age-related macular degeneration, present in 75% of affected persons, was the most common cause of 5-year incident legal blindness in this middle-aged and elderly Icelandic population.

Prevalence and causes of visual impairment and blindness in Icelanders aged 50 years and older: the Reykjavik Eye Study.

PURPOSE: This study aimed to study the prevalences and causes of visual impairment and blindness in an Icelandic adult population. METHODS: The Reykjavik Eye Study includes a random sample of citizens of Reykjavik aged > or = 50 years, with an equal proportion (6.4%) for each year of birth and each sex. A total of 1045 persons were examined, representing a response rate of 75.8%. All participants underwent an extensive ophthalmological examination using a standard protocol. We used World Health Organization (WHO) definitions for bilateral visual impairment (best corrected visual acuity [VA] < 6/18 or visual field of > or = 5 degrees and < 10 degrees around the fixation point in the better eye) and blindness (VA < 3/60 or visual field < 5 degrees in the better eye). We also used US criteria, which define bilateral visual impairment as present if VA is < 6/12 and blindness as present if VA is < or = 6/60 (both in the better eye). The causes of visual loss were determined for all participants found to be visually impaired in one or both eyes. RESULTS: The prevalences of bilateral visual impairment and blindness were 0.96% (95% confidence interval [CI] 0.37-1.55) and 0.57% (95% CI 0.12-1.03), respectively, using the WHO criteria, and 2.01% (95% CI 1.16-2.86) and 0.77% (95% CI 0.24-1.29), respectively, using the US criteria. The prevalence rates were 4.40% and 5.45% for unilateral visual impairment and 1.72% and 3.06% for unilateral blindness, using the WHO and US criteria, respectively. Age-related macular degeneration (AMD) was the major cause of bilateral visual loss, whereas the most common causes of unilateral visual loss were, in this order, amblyopia, cataract and glaucoma. CONCLUSIONS: Prevalence of visual loss increases with age. The leading cause of bilateral visual impairment and blindness was AMD, accounting for more than half of all cases, and cases of geographic atrophy outnumbered those of exudative AMD by two to one.

[Macular oedema and intravitreal triamcinolone injections]. / Sjónhimnubjúgur og barksterasprautun augna.

PURPOSE: To evaluate the efficacy of intravitreal triamcinolone injections for macular oedema in Iceland 2004-2006. METHODS: We reviewed hospital records of 28 patients who underwent intravitreal injection with triamcinolone acetonide 2004-2006. Most patients were treated with 8 mg of triamcinolone acetonide. Patients were categorized according to the cause of macular oedema (diabetes (n=10), phacoemulsification (n=7), branch retinal vein occlusion (BRVO) (n=7) and uveitis (n=4)). Best corrected visual acuity was determined before treatment and 1, 3 and 6 months postoperatively. Intraocular pressure and foveal thickness were measured before and after treatment. RESULTS: Visual acuity improved in 4 patients with diabetic macular oedema while 5 had unchanged vision. The effect lasted 6 months in 8 out of 9 cases. Seven were treated for macular oedema after phacoemulsification. Two had improved visual acuity after the injection and 5 had unchanged eye sight. The effect lasted for 6 months in every case except for one who lost vision. Out of 7 who were treated for macular oedema after BRVO, 3 had improved visual acuity and 4 remained unchanged for 6 months. Four patients with uveitis got triamcinolone injections and a month after treatment 2 had better vision and 2 had unchanged visual acuity. The effect lasted for 6 months in all cases but one. In the diabetes and BRVO groups OCT showed a significant reduction of foveal thickness. In 4 cases intraocular pressure increased, all of them were successfully treated with topical treatment. CONCLUSION: Intravitreal triamcinolone improves visual acuity in about 40% of patients with macular oedema, about 10% lose vision and about 50% remain unchanged. OCT reveal improved anatomic results with significant reduction of foveal thickness and macular oedema. No serious complications were noted.