The Burden of Macular Diseases in Central and Eastern Europe-Implications for Healthcare Systems.

BACKGROUND: Despite the significant impact of retinal diseases such as wet age-related macular degeneration (wAMD) and diabetic macular edema (DME), there is a limited understanding of how these conditions are managed in Central and Eastern Europe (CEE). OBJECTIVES: To provide a comprehensive overview of the clinical and economic burden of wAMD and DME in CEE and the status quo associated with their management. METHODS: A narrative literature review was undertaken to identify existing data on wAMD and DME, including epidemiology, economic burden, clinical guidelines, and available and reimbursed treatments. Data were collected from relevant sources such as PubMed, ophthalmology associations, national statistical offices, and government agency websites; practical viewpoints were provided by local ophthalmologists and healthcare economics experts in CEE. RESULTS: Epidemiological data on wAMD and DME are limited in CEE, and intercountry comparison is difficult because of differences in data collection methodologies. There are effective treatment options for wAMD and DME, and international guidelines advocate the use of intravitreal anti-vascular endothelial growth factor injections as first-line therapy. Local expert organizations broadly support these recommendations; nevertheless, no clinical practice guidelines exist on the treatment of wAMD and DME in CEE. Access to and reimbursement of anti-vascular endothelial growth factor agents vary significantly in the region and, as a result, many patients remain untreated or inadequately treated. CONCLUSIONS: There is an urgent need for the creation of a wAMD/DME treatment program in CEE to ensure that patients have timely access to the most appropriate treatments.

Amblyopia screening in Bulgaria.

PURPOSE: To determine the prevalence of amblyopia and the average age at first ophthalmological examination of school-aged children from northwestern Bulgaria. METHODS: Visual acuity testing, stereopsis, orthoptics, ocular motility, non-cycloplegic refraction, direct ophthalmoscopy, and external ocular inspection were performed. Cycloplegic refraction and indirect ophthalmoscopy were done as necessary. A total of 2,054 children (1,020 girls and 1,034 boys) were divided into three age groups: 6 to 8 years (803 children), 8 to 10 years (719 children), and 10 to 12 years (530 children). RESULTS: A total of 1,861 children (90.6%) received their first examination: 754 (93.9%) aged 6 to 8 years, 638 (88.7%) aged 8 to 10 years, and 469 (88.2%) aged 10 to 12 years. Amblyopia was detected in 88 children (4.3%): 42 (5.2%) aged 6 to 8 years, 27 (3.8%) aged 8 to 10 years, and 19 (3.6%) aged 10 to 12 years. The first group had higher prevalence compared to countries with well-developed screening programs. Refractive errors were detected in 403 children (19.7%): 125 (15.6%) aged 6 to 8 years, 146 (20.3%) aged 8 to 10 years, and 132 (24.8%) aged 10 to 12 years. The estimated prevalence increases with age. Strabismus was detected in 24 children (1.2%): 8 (1.0%) aged 6 to 8 years, 7 (1.0%) aged 8 to 10 years, and 9 (1.7%) aged 10 to 12 years. CONCLUSIONS: The lack of screening programs in Bulgaria is the main reason for late diagnosis of amblyopia. The "Do Good "project provided eye examination of school-aged children aged 6 to 12 years, when amblyopia is curable. This model could be used in establishing a Bulgarian national screening program.