Exploring the meaning of care among lived experiences of patients with blindness:an interpretive phenomenological study

Objective:To explore the meaning of care experienced by people with blindness in hospitals.Methods:Interpretive phenomenology along with the 6-step method of van Manen was used to conduct the study.Using purposeful sampling,15 people with legal blindness were interviewed.Thematic analysis was used to isolate the meaning of care.Results:Five themes emerged:(a)nurses in the eyes of patients with blindness;(b)negligence in the caring moments;(c)being cared for in ambiguity;(d)Uncoordinated care;and(e)Psychological discomfor t.These sub-themes were condensed into an overarching theme titled as“marginalized patients inside the stereotypical healthcare system.”Conclusions:Lived experiences of patients with blindness revealed that hospitals provide stereotypic or inappropriate care for this minority group in society.Health professionals par ticularly nurses should be skilled to provide person-centered and coordinated care for patients with blindness.

Evaluation of the etiologies and rehabilitation status of patients with blindness: A prospective observational study

Objective:Preventive measures and appropriate rehabilitation are important in reducing the social burden of blindness.This study was to evaluate the etiologies,proportions,and level of rehabilitation for patients with blindness.Materials and Methods:A prospective observational study with 1000 visually impaired patients was conducted.The data regarding age,gender,socioeconomic status(SES),etiologies,curable or incurable blindness(IB),treatments,awareness,and state of rehabilitation were collected and reviewed.Results:The ratio of curable to IB was 0.82:1.The proportion of blindness rises after 40,even while the proportion of curable blindness(CB)increases after 60.The male–female ratios were 1.25:1 and 1:1.66 in the cases of CB and IB,respectively.On the other hand,the male–female ratio for childhood blindness was 1.66:1.Cataracts(78.22%)were the most common cause of CB,whereas diabetic retinopathy(24%),corneal opacity(17.5%),and trauma(12.4%)were causes of IB.Patients with illiteracy,low SES,and female gender were more likely to develop IB.There were low enrollment rates at the blind school and poor rehabilitation,mainly because of a lack of knowledge.Conclusion:Diabetic retinopathy,corneal opacity,and trauma are the major causes of IB.IB and poor rehabilitation were more profound in women and were associated with illiteracy,low SES,and a lack of awareness.

The Cultural Paradigm of Visuality in Times of Blindness

Visuality can be generically described as the quality of the visual,that is,as the given visual field in which a subject’s attention is concentrated.In fact,the visual is intrinsically linked to human vision,and this presupposes the existence of a visible horizon from which(visual)images are given.However,this formulation presents something uncanny paradoxical because it forgets,on one hand,the broader status of the image(such as auditory and olfactory images)-seeing is not just a visual process(at least since Diderot we know it)and there are mental mechanisms in the visual constitution process that help to fabricate reality and that gestalt theory has explained-and on the other hand,the possibility of seeing beyond what is visible,after all,everything(or almost everything)that presents itself in a digital and virtual environment it can be quite ontologically suspect.Based on some of these premises,we will trace a path of analysis that leads us to the current blindness:unconditional faith in digital technology and the fragile hope of happiness in a way that rejects the reality of the visible.

Cataract blindness in Hungary

AIM:To estimate the prevalence of blindness and visual impairment resulting from cataract in the population aged≥50 y in Hungary,and to assess the cataract surgical services.METHODS:A rapid assessment of avoidable blindness(RAAB)was conducted.A total of 3523 eligible people were randomly selected and examined.Each participant underwent surgery for cataract was interviewed with regard to the year,place,and costs of the surgery.Participants with obvious cataract were asked why they had not yet undergone surgery(barriers to surgery).RESULTS:An estimated 12514 people were bilaterally blind;the visual acuity(VA)in 19293 people was<6/60,and the VA in 73962 people was<6/18 in the better eye due to cataract.An estimated 77933 eyes are blind;98067 eyes had a VA of<6/60,and an estimated 277493 eyes had a VA of<6/18 due to cataract.Almost all cataract surgeries were conducted in government hospitals.The age-and sexadjusted cataract surgical coverage with VA<3/60 in eyes was 90.0%.The rate of good visual outcome after surgery was 79.5%.Ocular comorbidity was the main cause of poor outcome(78.1%),followed by late complications(such as posterior capsule opacification)(17.2%),inadequate optical correction(3.1%),and surgical complications(1.6%).The main barrier to surgery in people with bilateral cataract and VA of<6/60 was‘need not felt’.CONCLUSION:The prevalence of visual impairment resulting from cataract is slightly higher than expected.The quality of the cataract surgical service seems adequate in Hungary.However,the number of cataract operations per year should continue to increase due to the increasing patient demands and the aging population.

Prevalence and risk factors for eye diseases, blindness, and low vision in Lhasa, Tibet

AIM: To determine the prevalence and risk factors for eye diseases, blindness, and low vision in Tibet, and to assist the development of eye disease prevention and treatment schemes.METHODS: We carried out a survey of eye diseases among a population living at high altitude. A total of 1 115 Tibetan permanent residents aged 40 years or older from the towns and villages of Qushui County, Lhasa Prefecture, Tibet Autonomous Region, participated in this study. All participants completed a detailed questio-nnaire, and underwent presenting and pinhole visual acuity tests,and a comprehensive ophthalmic examination.RESULTS: There were 187 blind eyes (8.43%), 231 eyes with low vision (10.41% ). The leading cause of visual impairment was cataract of 55.0% (101/187) blindness and of 50.2% (116/231) low vision, followed by fundus lesions of 22.9% blindness and 23.8% low vision, while only a low prevalence of glaucoma of 9.6% blindness and 1.7% low vision was observed. The analysis of 2 219 eyes showed that the most common external eye disease was pterygium (27.2%) in Tibet.CONCLUSION: The high prevalence of blindness and low vision in the Tibetan population at high altitude is a serious public health issue. There is a need to establish and maintain an appropriate effective eye care program in Tibet.

Population-based survey of prevalence,causes,and risk factors for blindness and visual impairment in an aging Chinese metropolitan population

AIM： To assess the prevalence, causes, and risk factors for blindness and visual impairment among elderly （〉60 years of age） Chinese people in a metropolitan area of Shanghai, China. METHODS： Random cluster sampling was conducted to identify participants among residents ≥60 years of age living in the Xietu Block, Xuhui District, Shanghai, China. Presenting visual acuity （PVA） and best-corrected visual acuity （BCVA） were checked by the Early Treatment Diabetic Retinopathy Study （ETDRS） visual chart. All eligible participants underwent a comprehensive eye examination. Blindness and visual impairment were defined according to World Health Organization （WHO） criteria. RESULTS： A total of 4190 persons （1688 men and 2502 women） participated in the study, and the response rate was 91.1%. Based on PVA, the prevalence of blindness was 1.1% and that of visual impairment was 7.6%. Based on BCVA, the prevalence of blindness and visual impairment decreased to 0.9% and 3.9%, respectively. Older （〉80 years of age） women, with low educational levels and smoking habits, exhibited a significantly greater chance for blindness and visual impairment than did those with high educational levels and no smoking habits （P〈0.05）. Based on PVA and BCVA, the main causes of blindness were cataract, myopic maculopathy, and age-related macular degeneration （AMD）. CONCLUSION： Our findings help to identify the population in need of intervention, to highlight the need for additional eye healthcare services in urban China.

The Association of Socioeconomic Status with the Burden of Cataract-related Blindness and the Effect of Ultraviolet Radiation Exposure: An Ecological Study

Objective To assess the association of socioeconomic status with the burden of cataract blindness in terms of year lived with disability(YLD) rates and to determine whether ultraviolet radiation(UVR) levels modify the effect of socioeconomic status on this health burden.Methods National and subnational age-standardized YLD rates associated with cataract-related blindness were derived from the Global Burden of Disease(GBD) study 2017. The human development index(HDI) from the Human Development Report was used as a measure of socioeconomic status.Estimated ground-level UVR exposure was obtained from the Ozone Monitoring Instrument(OMI)dataset of the National Aeronautics and Space Administration(NASA).Results Across 185 countries, socioeconomic status was inversely associated with the burden of cataract blindness. Countries with a very high HDI had an 84% lower age-standardized YLD rate [95%confidence interval(CI): 60%–93%, P < 0.001] than countries with a low HDI;for high-HDI countries, the proportion was 76%(95% CI: 53%–88%, P < 0.001), and for medium-HDI countries, the proportion was48%(95% CI: 15%–68%, P = 0.010;P for trend < 0.001). The interaction analysis showed that UVR exposure played an interactive role in the association between socioeconomic status and cataract blindness burden(P value for interaction = 0.047).Conclusion Long-term high-UVR exposure amplifies the association of poor socioeconomic status with the burden of cataract-related blindness. The findings emphasize the need for strengthening UVR exposure protection interventions in developing countries with high-UVR exposure.

Mayombian ethnic,vegetables low intake,insulin treatment,diabetic nephropathy and severe diabetic retinopathy are determinants of blindness in diabetic Africans

· AIM: to determine the frequency and causes of blindness in diabetic Africans. ·METHODS: The study was a cross-sectional survey carried out among known black diabetics consecutively admitted at the Teaching Hospital, University of Kinshasa, between 2005 and 2007. Examination methods included interviewer -administered structured question - naire, eye examinations (visual acuity, tonometry, funduscopy), and fasting plasma glycaemia test. ·RESULTS: Of the 227 patients examined, 15.9% had blindness. Univariate analyses showed significant association between female, severity of diabetic retinopathy, Mayombian ethnic group, use of insulin treatment, low intake of vegetables, diabetic nephropathy, open angle glaucoma and blindness in all diabetics. After logistic regression, only diabetic nephropathy, use of insulin treatment, macular oedema, Mayombian ethnic group and vegetables low intake were the independent risk factors of blindness in all diabetics. However, after logistic regression in the sub -group with diabetic retinopathy, only open angle glaucoma and proliferative diabetic retinopathy were the independent determinants of blindness.·CONCLUSION: The majority of the causes of blindness in these diabetic Africans are avoidable. It is recommended that appropriate diabetes care, nutrition education, periodic eye examination and laser photocoagulation facilities should be provided for treating diabetics in sub-Saharan Africa. ·

Unrecognized and unregistered blindness in people 70 or older in Jing'an district, Shanghai, China

AIM: To evaluate the efficacy of a registration system for the blind people and to monitor the blindness due to uncorrected refractive error and cataract in Jing’an district, Shanghai, China. ·METHODS: Five hundred and ten blind people, based on visual acuity screening in a population aged 70 or older were enrolled into the study. Four hundred and forty subjects were interviewed. The following data were collected on each patient: demographic data, number of hospital visits for eye related problems, distance visual acuity, visual fields, ophthalmic diagnoses, education and registration status. If the eligible subject was not registered as blind, the reason for non -registration was recorded. ·RESULTS: Ten point nine one percent blindness was due to cataract, 27.5% due to uncorrected refractive error, and only 61.59% met the eligible blindness criteria (uncorrected refractive error and cataract are not considered as eligible blindness). The first four leading causes of eligible blindness were age related macular degeneration (25.09% ), myopic macular degeneration (21.40%), glaucoma (18.82%) and corneal disease (8.12%). Only 68.27% eligible blind people were registered. The patients with macular degeneration and glaucoma tendednot to register. Blind people with an above primary school education were 2.59 times more likely to be registered than those who were illiterate or had only a primary school education (OR=2.59, 95%CI: 1.49-4.48, P 【0.01). Patients who had 4 or more visits to the hospital requesting eye care services in a year were 2.2 times more likely to be registered than those with less than 4 visits to the hospital (OR =2.54, 95% CI: 1.47 -4.38, P 【 0.001). The first two leading reasons of misregistration were unknowing the registration system (48% ) and unwilling to register (21%). ·CONCLUSION: Under-registration of the eligible blind people exists in the registry system. Education and the number of hospital visits for eye care services were factors associated with registration levels. Uncorrected refractive error and cataract are important causes of blindness.

Novel TRPM1 mutations in two Chinese families with early-onset high myopia, with or without complete congenital stationary night blindness

AIM：To investigate the relationship between high myopia [with or without complete congenital stationary night blindness（CSNB1）] and TRPM1 and NYX.METHODS： Two unrelated families with early-onset high myopia（eo HM） and 96 normal controls were recruited.Sanger sequencing or clone sequencing were used for mutation screening.Further analyses of the available family members and the 96 normal controls were subsequently conducted to obtain additional evidence of the pathogenicity of these variants.The initial diagnosis of the probands was eo HM.We performed a further comprehensive examination of the available family members after mutations were detected in TRPM1 or NYX. RESULTS： Two novel compound heterozygous mutations in TRPM1 were detected in the recruited families.The proband in family A with eo HM carried a c.2594 C 〉T missense mutation in exon 19 and a c.669 ＋3_669 ＋6del AAGT splicing mutation,which was co-segregated with CSNB1 in this family.A patient in family B with a compound heterozygous missense mutation（c.3262 G〉A and c.3250 T〉C） was detected.No mutations were found in NYX.These two identified compound heterozygous mutations were not found in the 96 normal controls.After further examination of the family members,the patients in family A could be diagnosed as eo HM with CSNB1.However due to the limited clinic data,the patient in family B cloud not clearly diagnosed as CSNB1.CONCLUSION： This study has expanded the mutation spectrum of TRPM1 for CSNB1 and additional studiesare needed to elucidate the association between isolated high myopia and TRPM1 and NYX.

The Prevalence of Blindness, Visual Impairment and Cataract Surgery in Tuoketuo and Shangdu Counties, Inner Mongolia, China

Aim: A population-based survey was conducted in Tuoketuo and Shangdu Counties in Inner Mongolia Autonomous Region, China, in the Autumn of 2010, to assess the prevalence and causes of blindness and visual impairment of people aged 50 years and over. Methods: Random cluster sampling was used to select 82 clusters of 50 residents in the 2 counties. Each survey team included an ophthalmologist, a nurse and a coordinator, who went to door to door in each cluster to identify eligible people. A torch, direct ophthalmoscope and portable slit lamp were used for eye examination. Visual acuity (VA) was tested for each eye of every subject. Those with VA below 6/18 in either eye were examined and causes identified. Results: The survey identified a prevalence of blindness in people aged 50+ in Tuoketuo of 1.2% (95% Confidence Interval: 0.7% - 1.7%) and in Shangdu of 1.4% (95% CI: 1.0% - 1.9%). Cataract was identified as the leading cause of blindness (BL) and severe visual impairment (SVI), and uncorrected refractive errors were the major causes of moderate visual impairment (MVI) in both counties. Over two thirds of blindness, SVI and MVI were identified as avoidable. Conclusions: The prevalence of blindness in people aged 50+ in Tuoketuo and Shangdu was low compared to other studies conducted in China [1] [2]. The prevalence of blindness of people aged 50 years and over could be reduced by up to two thirds through better eye services in the two study areas.

Prevalence and associated factors of corneal blindness in Ningxia in northwest China

AIM:To describe the prevalence and demographic characteristics of corneal blindness in an urban and rural region of Ningxia,located in the northwest part of China.METHODS:A stratified,randomized sampling procedure was employed in the study,including urban and rural area of all age group.Visual acuity,anterior segment and ocular fundus were checked.Related factor of corneal disease,including age,gender,education status,ethnic group,location and occupation,were identified according to uniform customized protocol.An eye was defined to be corneal blindness if the visual acuity was【20/400 due to a corneal disease.RESULTS:Three thousand individuals(1290 from urban area and 1710 from rural area)participated in the investigation,with a response rate of 80.380%.The prevalence of corneal blindness was 0.023%in both eyes and 0.733%in at least one eye.The blindness in at least one eye with varied causes was present in 106participants(3.533%)and in bilateral eyes in 34participants(1.133%).The corneal diseases accounted for 20.754%of blindness in at least one eye and 20.588%of bilateral blindness.The prevalence of corneal disease was higher in older and Han ethnic group,especially those who occupied in agriculture and outdoor work.People with corneal blindness were more likely to be older and lower education.Rural population were more likely to suffer from bilateral corneal blindness than the urban population in≥59-year group(χ2=6.716,P=0.019).Infectious,trauma and immune corneal disease were the three leading causes of corneal disease.Trauma cornealdisease was more likely leading to blindness in one eye.However,infectious and immune corneal diseases make more contribution to the bilateral corneal blindness.CONCLUSION:Corneal blindness is a significant burden of in Ningxia population,encompassing a variety of corneal infections and trauma;the majority of those were avoidable.Health promotion strategies and good hygienic conditions have to be developed.

Eye health is everyone's responsibility: China's first Western-style eye hospital improves in the prevention of blindness

AIM: To investigate the relationship between China's first Western-style eye hospital development and the prevention of blindness in China and determine the main factor influencing eye health today. METHODS: Data about eye health, blindness and cataract surgery rate of China from public website of World Health Organization (WHO), ORBIS International, Ministry of Health (MOH) of China, Pubmed center and Historical Archives of Zhongshan Ophthalmic Center (ZOC) were reviewed and analyzed. RESULTS: ZOC is China's first Western-style eye hospital. In 2012, the ORBIS Flying Eye Hospital has chosen ZOC once again as one of its destinations, 30 years after ORBIS expanded internationally to train eye care professionals and treat underserved patients in developing countries in 1982. During the past 30 years, cataract surgery rate and public awareness of blindness prevention were improved greatly in China, in which ZOC plays a very important role. CONCLUSION: ZOC, as China's first Western-style eye hospital,has improved in the prevention of blindness. Eye health has become everyone’s responsibility.

Corneal blindness and current major treatment concerngraft scarcity

According to World Health Organization, the global prevalence of blindness in 2010 was 39 million people, among which 4% were due to corneal opacities. Often, the sole resort for visual restoration of patients with damaged corneas is corneal transplantation. However, despite rapid developments of surgical techniques, instrumentations and immunosuppressive agents, corneal blindness remains a prevalent global health issue. This is largely due to the scarcity of good quality corneal grafts. In this review, the causes of corneal blindness, its major treatment options, and the major contributory factors of corneal graft scarcity with potential solutions are discussed.

Mayombian ethnic,vegetables low intake,insulin treatment,diabetic nephropathy and severe diabetic retinopathy are determinants of blindness in diabetic Africans

AIMTo determine the frequency and causes of blindness in diabetic Africans.

Role of Mediterranean diet, tropical vegetables rich in antioxidants, and sunlight exposure in blindness, cataract and glaucoma among African type 2 diabetics

AIM: To assess whether regular Mediterranean diet and regular intake of vegetables may reduce the risk of blindness, cataract, and glaucoma in these type 2 diabetics. · METHODS: A cross-sectional design was carried out among known black diabetics admitted at the diabetic clinics of Kinshasa, between October 2008 and March 2009. The Mediterranean-style dietary score (MSDPS) was used to characterize a Mediterranean-style dietary pattern in the study population using the Harvard semi quantitative FFQ adapted for Africa. · RESULTS: Five hundred Type 2 diabetic patients were included in this study (48% of males; 40% aged ≥60 years). There was a significant association between blindness, cataract and aging; between blindness (P <0.05), cataract (P<0.05), glaucoma (P <0.05), and physical inactivity; between blindness (P<0.05), cataract (P <0.0001), glaucoma (P <0.01) and high SES, and a very significant association between blindness (P <0.0001), cataract (P <0.0001), glaucoma (P <0.0001) and exposure to sunlight. There was also a significant association between blindness, glaucoma, and male sex. Regular intake of Mediterranean diet, Brassica Rapa, beans, Abelmoschus, Musa acuminata reduced significantly the risk of blindness, cataract and glaucoma. · CONCLUSION: Regular intake of Mediterranean diet, Brassica Rapa, beans, Abelmoschus, and Musa acuminata may significantly reduce the risk of blindness or its major causes among type 2 diabetes mellitus in Africa.

Prevalence of refraction errors and color blindness in heavy vehicle drivers

AIM: To investigate the frequency of eye disorders in heavy vehicle drivers.METHODS: A cross-sectional type study was conducted between November 2004 and September 2006 in 200 driver and 200 non-driver persons.A complete ophthalmologic examination was performed,including visual acuity,and dilated examination of the posterior segment.We used the auto refractometer for determining refractive errors.RESULTS: According to eye examination results,the prevalence of the refractive error was 21.5% and 31.3% in study and control groups respectively (P <0.05).The most common type of refraction error in the study group was myopic astigmatism (8.3%) while in the control group simple myopia (12.8%).Prevalence of dyschromatopsia in the rivers,control group and total group was 2.2%,2.8% and 2.6% respectively.CONCLUSION: A considerably high number of drivers are in lack of optimal visual acuity.Refraction errors in drivers may impair the traffic security.

Identification of a Novel Dynamic Red Blindness in Human by Event-related Brain Potentials

Dynamic color is an important carrier that takes information in some special occupations.However,up to the present,there are no available and objective tests to evaluate dynamic color processing.To investigate the characteristics of dynamic color processing,we adopted two patterns of visual stimulus called "onset-offset" which reflected static color stimuli and "sustained moving" without abrupt mode which reflected dynamic color stimuli to evoke event-related brain potentials (ERPs) in primary color amblyopia patients (abnormal group) and subjects with normal color recognition ability (normal group).ERPs were recorded by Neuroscan system.The results showed that in the normal group,ERPs in response to the dynamic red stimulus showed frontal positive amplitudes with a latency of about 180 ms,a negative peak at about 240 ms and a peak latency of the late positive potential (LPP) in a time window between 290 and 580 ms.In the abnormal group,ERPs in response to the dynamic red stimulus were fully lost and characterized by vanished amplitudes between 0 and 800 ms.No significant difference was noted in ERPs in response to the dynamic green and blue stimulus between the two groups (P】0.05).ERPs of the two groups in response to the static red,green and blue stimulus were not much different,showing a transient negative peak at about 170 ms and a peak latency of LPP in a time window between 350 and 650 ms.Our results first revealed that some subjects who were not identified as color blindness under static color recognition could not completely apperceive a sort of dynamic red stimulus by ERPs,which was called "dynamic red blindness".Furthermore,these results also indicated that low-frequency ERPs induced by "sustained moving" may be a good and new method to test dynamic color perception competence.

Frequency of Blindness Due to Zygomatic Fracture in Hazrat Fatemeh Hospital

Background: Zygomatic fracture is one of the most prevalent one among facial fractures caused by vehicle accident, motorcycle accident, fighting, fall and sport injuries. Materials & Methods: This study was a retrospective study of our patients during past 6 years. Results: We had 1277 facial fractures, of whom 9 patients had blindness. We had 193 patients with Zygomatic fracture. 98 patients had pure zygomatic fracture and other had complicated fractures. Frequency of blindness due to zygomatic fracture in a period of six years was 4.7% in all and in pure zygomatic fractures was 2.04%. Blindness was most prevalent in age group 20 - 29 years old (55.6%). The most prevalent cause of zygomatic fracture which causes blindness, was motor vehicle accident (77.8%). Blindness was more common in males (77.8%) than females (22.2%). Discussion and Conclusions: One of the most disastrous complication of zygomatic fracture is transection of optic nerve. Very careful examination of fractured bones careful examination of optic nerve and visual acuity and urgent operation and decompression of optic nerve must be performed. About 4% - 5% will have blindness purely due to fracture.

Night blindness due to vitamin A deficiency associated with resected adenocarcinoma of the pancreas

【正】Dear Sir,W e write to present a rare case of night blindness caused by vitamin A deficiency secondary to resected adenocarcinoma of the pancreas.To our knowledge this is the first reported case of this association.A 62 year-old man presented to the eye clinic with a 12mo history of worsening nyctalopia and colour perception.