| 1. |
- Baptista, Antonio M. G., et al.
(författare)
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Causes of Vision Impairment in Portugal : A hospital based study
- 2015
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Ingår i: Investigative Ophthalmology and Visual Science. - 0146-0404 .- 1552-5783. ; 56:7
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Causes of vision impairment (VI) are influenced by factors such as race or socio-economic circumstances. Because of this collecting national information is important for planning reduction of vision loss. The aim of this study was to determine causes of vision impairment in a population visiting ophthalmology departments in public hospitals in Portugal.Methods This study was designed according with the guidelines of the Vancouver Economic Burden of Vision Loss Group (IOVS, 2010, V51/4/1801). Recommendations are to collect hospital data during 1 year to determine causes of VI. We selected four public hospitals that are expected to have over 120-140K appointments per year. Files are analysed weekly to detect patients with vision impairment. Inclusion criteria are: visual acuity with the current refractive correction equal or less than 0.5 (20/40) in the better-seeing eye and/or a visual field of less than 20 degrees. Patients were selected by trained hospital staff (medics and orthoptists) and inserted in a database. Diagnoses were classified according the ICD9. Data collected included fundamental demographic information, main diagnosis, secondary diagnosis and comorbidities.Results We have now 2462 patients selected that correspond to 4 to 33 weeks of data collection. The number of weeks is variable because we did not start all hospitals simultaneously. From the current number of cases detected, 58% are female, 1.9% are under 20, 8.2% are between 20 and 50 and 89.9% are 50 years or older. The leading causes of vision impairment among these patients are diabetic retinopathy (DR), cataract (C), glaucoma (GC) and age-related macular degeneration (AMD). Using the North American definition of VI the proportions are 26.8% for DR, 25.5% for C, 10.4% for GC and 8.2% for AMD. The remaining causes of VI have percentages below 5% and in total they correspond to approximately 29% of the cases detected.Conclusions Our results show that the most common causes of vision impairment are eye diseases related with systemic conditions and aging of the population. Vision impairment was relatively low under the age of 20 and the causes were mostly inherited diseases. Numbers reported now will be more accurate at the end of the study but they already highlight the importance of targeting conditions such as diabetes.
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| 2. |
- Carneiro de Freitas, Rui, et al.
(författare)
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Prevalence of Visual Impairment in Portugal : study design and initial results
- 2015
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Ingår i: Investigative Ophthalmology and Visual Science. - 0146-0404 .- 1552-5783. ; 56:7
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Information about the prevalence of visual impairment is fundamental to define policies that deal with vision loss. The aim of this study is to determine the prevalence of visual impairment (VI) in the population looking for eye care in public hospitals in Portugal.Methods We designed an observation, cross-sectional prospective study (Prevalence and Costs of Visual Impairment in Portugal: PC-VIP study) to investigate the prevalence of VI in patients attending outpatient appointments in four public hospitals in Portugal. Hospital selected provide from general eye care (3-6 ophthalmologists) to high-specialized eye care (40+ ophthalmologists) that in total have between 120-140K hospital appointments per year. Files of patients are analysed weekly to detect patients with VI. Inclusion criteria were: visual acuity equal or worse than 0.5 (USA definition 20/40) in the better eye and/or a visual field of less than 20deg. Cases are selected by trained hospital staff and inserted in a database. Data collected included demographic information, acuity from both eyes, qualitative information about visual field (good, reduced, requires investigation), main diagnosis, secondary diagnosis and comorbidities. Diagnoses were classified according with ICD9.Results We have now detected 2462 cases of VI that correspond to 4 to 33 weeks of data collection. The number of weeks is variable because collection did not start simultaneously in all sites. From the number of cases detected, 58% were female, 1.9% were under 20y, 8.2% were between 20y and 50y and 89.9% were ≥50y. The mean prevalence of visual impairment was 13.6% (SD=5.6) using the USA definition and it was 7.0%(SD=4.1) using the WHO definition (acuity equal or worse than 0.3 or ~20/63). With a methodology that controls for demographics the lowest and highest estimates were calculated. Considering the USA definition, the prevalence in the general population would be in the range 0.4 -0.4% (age<40y) and 0.8-2.4% (age>=40y). Considering WHO definition, it would be 0.2-0.5% (age<40y) and 0.4-1.0% (age>=40y).Conclusions A hospital-based study can provide effective estimates of the prevalence of visual impairment in a population. Estimates for the country are in agreement with the expected results that can be deducted from neighbour countries and self-reported visual impairment in census 2001.
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| 3. |
- Hernández-Moreno, Laura, et al.
(författare)
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The Portuguese version of the activity inventory
- 2015
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Ingår i: Investigative Ophthalmology and Visual Science. - 0146-0404 .- 1552-5783. ; 56:7
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To characterize interventions needed by the population with visual impairment or to assess interventions in vision rehabilitation validated and standardized instruments used in different cultural contexts are necessary. The aim of this work was to characterize the functional status of a sample of people with visual impairment with the Portuguese version of the activity inventory (AI)Methods: A group of participants in the study Prevalence and Costs of Visual Impairment in Portugal (PC-VIP) was recruit to face-to-face interviews and the activity inventory was administered. The AI examines 50 goals split between three objectives: social functioning, recreation and daily living. Goals rated ‘not important’ were skipped, but for all other goals the participant was asked to rate its difficulty on a five point scale ranging from ‘not difficult’ to ‘impossible without help’. The difficulty responses were Rasch analysed (Winsteps v3.81.0) to produce a continuous measure of visual ability (AI score). Additional information about distance and near visual acuity (ETDRS scale), contrast sensitivity (MARS test) and critical print size (MNREAD test) was collected.Results: A total of 94 persons participated in this study. Some participants were not able to read or recognize letters due to their poor vision or poor literacy and were excluded from further analysis. Data reported here are from 62 participants, median age 63y (range=12-85) and the most common cause of visual impairment were retinal diseases. Mean presenting acuity in the better eye was 0.93logMAR (SD=0.5). The mean difficulty (item measure) in the AI was -0.33 logits (SD=0.96). The most difficult items were "sew or do needlework", "read the newspaper", "drive" and the easiest items were "provide care for a pet", "eat your meals", "use the restroom in a public place". The mean ability score (person measures) was 1.11 logits (SD=2.04). The ability measures in the AI were correlated with distance visual acuity (r=-0.57, p<.001), near visual acuity (r=-0.66, p<0.001), contrast sensitivity (r=0.62, p<.001) and critical print size (r=-0.60, p<.001).Conclusions: Our results indicate that the AI scores in a sample of people Portuguese people with visual impairment were in line with what has been found in other cultural contexts. The visual ability measured by the AI was correlated with visual function assessed by different visual tests, which shows that this instrument can be used with confidence.
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| 4. |
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| 5. |
- Macedo, António Filipe, et al.
(författare)
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Anti-saccades in early stages of multiple sclerosis
- 2015
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Ingår i: Investigative Ophthalmology and Visual Science. - 0146-0404 .- 1552-5783. ; 56:7
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Eye movements disability is common finding in multiple sclerosis (MS) but the exact stage at which changes are visible is not clear. The aim of study was to assess if anti-saccade (AS) planning and execution are altered at early stages of the disease.Methods: A total of 48 participants with MS selected by a neurologist (JJC) at Hospital de Braga and 52 controls participated in this study. Inclusion criteria: relapsing-remitting course, EDSS≤3, 1 month or more without MS crisis, and normal or corrected visual acuity. Exclusion criteria (MS and Control): cognitive impairment, traumatic brain injury or stroke. The mean age in the MS group was 37y and 33y in the control group. Eye movements were monitored using a binocular infrared eyetracker running at 250Hz(RED250, SMI Gmb Germany), precision <0.4deg, stimuli were presented in a 22 monitor (Dell P2210). Code for running the experiment and data analysis was written using the Matlab (Mathworks Inc). Participants were seated in a room dim light at 74cm from the monitor and head movements were minimized by a headband. The task was to fixate, after a variable period between steady fixation and the stimulus of 1250ms or 1600ms, participants looked as quickly as possible for the opposite direction where the target (a 30x30mm cross) was presented (anti-saccade movement). Each subject performed 40 trails.Results: The main results were the proportion of the directional errors (wherein the participant voluntarily looked for the wrong side), and latencies for: i) anti-saccades, ii) pro-saccades (movement in the same direction of the stimulus) and iii) correction (reaction time that the participant takes from the error fixation until to start the movement). The mean number of errors was 28%(SD=19) in MS group and 16%(SD=11) in the control group, mean difference 12%, t(74)=3.83, p<.001. Anti-saccades latency was 330msec (SD=61) in the MS group and 294ms(SD=59) in the control group, mean difference 36ms, F(1,98)=10.99, p<.05. The mean of the correction latency value was 178ms(SD=111) in the MS group and 129ms(SD=107) in the control group with a mean difference of 49ms, F(1,98)=6, p<.05. No statistically significant differences were found in accuracy and pro-saccade latency between groups.Conclusions: This study shows that anti-saccades latency and errors are increased at early stages of multiple sclerosis. Anti-saccades might be a sensitive tool to assess functional status in people with this condition.
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| 6. |
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| 7. |
- Macedo, António Filipe, et al.
(författare)
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Investigating unstable fixation in patients with macular disease
- 2011
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Ingår i: Investigative Ophthalmology and Visual Science. - : Association for Research in Vision and Ophthalmology (ARVO). - 0146-0404 .- 1552-5783. ; 52:3, s. 1275-1280
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Tidskriftsartikel (refereegranskat)abstract
- Purpose.: To assess the effect on visual acuity of compensating fixation instability by controlling retinal image motion in people with macular disease.Methods.: Ten patients with macular disease participated in this study. Crowded and noncrowded visual acuity were measured using an eye tracking system to compensate for fixation instability. Four conditions, corresponding to four levels of retinal image motion, were tested: no compensation (normal motion), partial compensation (reduced motion), total compensation (no motion), and overcompensation (increased motion). Fixation stability and the number of preferred retinal loci were also measured.Results.: Modulating retinal image motion had the same effect on crowded and noncrowded visual acuity (P = 0.601). When fixation instability was overcompensated, acuity worsened by 0.1 logMAR units (P < 0.001) compared with baseline (no compensation) and remained equal to baseline for all other conditions.Conclusions.: In people with macular disease, retinal image motion caused by fixation instability does not reduce either crowded or noncrowded visual acuity. Acuity declines when fixation instability is overcompensated, showing limited tolerance to increased retinal image motion. The results provide evidence that fixation instability does not improve visual acuity and may be a consequence of poor oculomotor control.
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| 8. |
- Macedo, António Filipe, et al.
(författare)
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Smartphones in visual impairment
- 2014
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Ingår i: Investigative Ophthalmology and Visual Science. - 0146-0404 .- 1552-5783. ; 55:13
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Tidskriftsartikel (refereegranskat)abstract
- Purpose We have previously shown that electronic devices can be used by people with relatively low visual acuity and contrast sensitivity. The aim of this study was to determine if people with visual impairment use smartphones to compensate their visual deficits.Methods An online survey was advertised to people with visual impairment using personal contacts, social media and online discussion groups. This survey was administered in two languages: English and Portuguese. The first author is fluent in both languages and ensured accurate translation. The questionnaire was designed to collect basic demographic information and self-reported cause of visual impairment. Participants were asked to specify whether they used smartphones, and if so which operating system they used, what they used the device for, and which accessibility functions they used.Results In total 131 responses were obtained: 75 to the English and 56 to the Portuguese survey. 93% of the respondents were younger than 64 years and 25% had no perception of light. From the total number of 131 respondents, 101 used smartphone. Of these, 57% used an Apple OS, 22% used Android and 15% used Symbian. 98% of smartphone users made phone calls with their device and sending text messages was reported by 93%. Internet navigation was used by 84%, photo capabilities were used by 53% to help them to see and by 73% for other purposes. 80% also used apps on their device. Speech navigation was used by 67% of respondents, ability to enlarge print was used by 58% and a large screen was important to 40%. Font type and contrast changes were less commonly used. Only 14% received information about these devices from a vision care professional. Other sources included online search, recommendations from friends or blind associations.Conclusions Smartphones are widely used by people with visual impairment. The current accessibility features such as speech navigation and large print allow people with visual impairment to use of these devices not only as phones but also as an electronic low vision aid.
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| 9. |
- Macedo, António Filipe, et al.
(författare)
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Temporal Processing in the Peripheral Retina
- 2012
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Ingår i: Investigative Ophthalmology and Visual Science. - 0146-0404 .- 1552-5783. ; 53:14
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: There is an increasing number of reports in the literature about the possible influence of the peripheral refraction in myopia development. The aim of this work was to determine whether the peripheral refractive differences lead to changes in visual performance. We used a forced choice procedure to assess the speed and accuracy (visual processing) of people with and without myopia at detecting the direction of a Gabor patch presented at different retinal locations. Methods: Visual processing was measured twice in random order at 6 retinal locations: 10, 20 and 30 degrees eccentricity at the temporal and at the nasal retina. We tested the dominant eye of 8 adults (aged 19 to 33 years) with moderate myopia (spherical equivalent ranging from -4.25 to -2.00 D) and 8 age-matched adults without myopia (spherical equivalent from -0.63 to 0.75 D). Participants’ task was to report via bottom press whether the Gabor patch, with suprathreshold contrast and spatial frequency, was tilted 30º to the right or to the left. The target was preceded by a 50 msec duration cue, exposed for variable periods of 10, 30, 60, 90 and 140 msec, selected in random order, and followed by a noise mask until response was given. For each block, processing time was determined using the method of constant stimuli based in 400 trials per retinal location (80 trials per exposure). Threshold was defined as the exposure time yielding 75% of correct responses; results were analysed using linear mixed models (SPSS, v18). Results: The mean processing time in the group with myopia was 73 msec and in the group without myopia was 66 msec; the difference between groups was not statistically significant (p = 0.087). There was a statistically significant difference between the nasal and temporal retina, mean difference was 13 msec (p = 0.002) with smaller processing time in the nasal retina. Conclusions: For the type of paradigm used in this study, there was no difference in processing time of the peripheral retina between people with and people without myopia. Despite extensive reports in the literature about different refraction patterns in this study we found evidences that this does not translate into functional changes.
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| 10. |
- Marques, Ana Patricia, et al.
(författare)
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Emergence of intravitreal injections in a National Health System : 2002-2012
- 2014
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Ingår i: Investigative Ophthalmology and Visual Science. - 0146-0404 .- 1552-5783. ; 55:13
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Intravitreal injections of antivascular endothelial growth factor (anti-VEGF) are an innovative procedure with well-proven benefits to preserve vision in certain eye conditions. The aim of this study was to examine the diffusion of this treatment in the Portuguese National Health System.Methods We used a database of all in-patient and day cases stays from all Portuguese public hospitals during period 2002-2012. We selected cases based on four procedures, ICD-9-CM codes: 1414, 1475, 1479, 149. Given that these procedures are not specific for intravitreal injections it is likely that our results captured cases that are not anti-VEGF injections. Because we were only interested in the diffusion of new anti-VEGF treatments we included years 2002-2005 as baseline because during that period drugs anti-VEGF were not licenced. We calculated absolute values, yearly rates of episodes and rates of patients treated per 100,000 habitants.Results Our final sample included 98,408 episodes, 52% performed in men. The total number of episodes increased from 1,815 in 2002 to 25,106 in 2012 (mean annual increase of 32%). These values corresponded to an increase in ratios per 100,000 from 17.4 to 238.77. The highest increase was observed between 2007 and 2009 with an increase of 337%. The number of treated patients was six times higher in 2012 with 11,937 treated compared with 1,561 in 2002 (mean annual increase of 24%). The highest increase was also observed between 2006 and 2009. In 2012, 86.2% of the procedures were performed as day cases, representing an increase of 78.3% as compared to 2002. The percentage of patients older than 60 years increased from 60% in 2002 to 80% in 2012. Five diagnoses (See Figure: wet AMD, diabetic macular oedema, oedema of the retina, retinal neovascularization and non-specific AMD) were associated with 73% of these procedures in 2012, in contrast with only 16% in 2002.Conclusions The number of procedures grew exponentially since anti-VGEF treatments were approved. The aging of the population and the expected growth in conditions such as diabetes and AMD are likely to increase the demand for these procedures in years to come. These factors are likely to impose tremendous challenges to health services. That will happen not only due to the price of the procedures but also for number of physicians and other staff needed in Ophthalmology departments. View
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