Open-angle glaucoma and diabetes. The Blue Mountains eye study Australia
Paul Mitchell MD, Wayne Smith BMed, B Math MPH, Tien Chey BSc, Mapp Stat, Paul R Healey BMedSci MBBS
Purpose: The authors explore the relationship between diabetes and open-angle glaucoma in a defined older Australian population.
Methods: Three thousand six hundred and fifty-four people, 49 to 96 years of age, living west of Sydney, underwent a detailed eye examination. This included automated perimetry, stereo optic disc photographs, and applanation tonometry; in addition, fasting plasma glucose levels were ascertained. Glaucoma was diagnosed if matching visual field and optic disc cupping were present, without reference to intraocular pressure (IOP) level. Ocular hypertension (OH) was diagnosed if IOP in either eye was ³22 mm and glaucomatous disc and visual field changes were absent.
Results: Glaucoma prevalence was increased in people with diabetes, diagnosed from history or elevated fasting plasma glucose level (5.5%), compared with those without diabetes (2.8%; age-gender adjusted odds ratio [OR] 2.12, 95% confidence intervals [C1] 1.18-3.79). Ocular hypertension was also more common in people with diabetes (6.7%), compared with those without diabetes (3.5%; OR 1.86, C1 1.09-3.20). Diabetes was present in 13.0% of people with glaucoma, compared with 6.9% of those without glaucoma. This increase was highest for previously diagnosed glaucoma cases (16.7%; OR 2.82, C1 1.35-5.87). However, in 67% of such cases, glaucoma was diagnosed before the diabetes. For those not receiving glaucoma treatment, IOP was consistently slightly higher in people with diabetes, with the age-gender adjusted mean IOP 0.6 mm higher.
Conclusion: The significant and consistent association between diabetes and glaucoma found in our study, which appeared independent of the effect of diabetes on IOP, suggests that there is a real association between these two diseases.
Published courtesy of: Ophthalmology 1997; 104: 712-8
Correspondence to: Dr Paul Mitchell, Department of Ophthalmology, University of Sydney, Hawkesbury Road, Westmead, NSW, AUSTRALIA 2145
Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome
Parul Desai, Caroline J MacEwen, Paul Baines, Darwin C Minassian
Aims: To provide epidemiological data on the current burden of serious eye injuries utilising the hospital eye service, to inform the planning and provision of eye health care and safety strategies for the prevention of ocular injuries.
Methods: A prospective observational study was carried out of all patients with ocular trauma admitted to hospitals in Scotland, under the care of a consultant ophthalmologist, during a one-year period. The population of Scotland represented the population at risk of injury. Visual outcome (Snellen visual acuity in the injured eye) was measured at the time of final discharge from ophthalmic care and at follow up.
Results: All ophthalmic departments in Scotland participated and a total of 415 residents of Scotland were admitted. The one-year cumulative incidence of ocular trauma necessitating admission to hospital is estimated to be 8.14 per 100 000 population (95% CI 7.38 to 8.97). Some 13.2% (n = 26/197) of patients discharged from follow up had a poor visual outcome with a visual acuity less than 6/12 in the injured eye. Some 10.7% (21/197) of patients at this time had a blinding outcome in the injured eye (visual acuity less than 6/60). No patient was registered blind or partially sighted during the study period. The home was the single most frequent place for blinding injuries to occur (52%, n = 11/21), followed by the workplace (24%, n = 5/21). The one year cumulative incidence of blinding outcome from serious ocular trauma is estimated to be 0.41 per 100 000 population per year (95% CI 0.26 to 0.64).
Conclusion: The current burden of serious ocular trauma presenting to the hospital eye service has been quantified from this population based study, and for the first time, a direct estimate of the incidence of the subsequent blinding outcome from these injuries has been provided. Ocular trauma remains an important cause of avoidable and, predominantly, monocular visual morbidity (visual impairment and blindness), with over half of the blinding injuries now occurring in the home. Health education and safety strategies should now consider targeting the home for the prevention of serious eye injuries in addition to the traditional work, sports, and leisure environments and their related activities.
Published courtesy of: Br J Ophthalmol 1996; 80: 592-6
Correspondence to: Dr Parul Desai, Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, LONDON, WC1E 7HT
News and notices in Comm Eye Health Vol. 10 No. 24 1997 –
- Book review. Eye care in the field: a manual for health professionals
- Book review. Appropriate technology in ophthalmology
- FLYING TULIPS
- International Society for Geographical & Epidemiological Ophthalmology (ISGEO) Congress
- Standard List of Medicines, Equipment, Instruments and Optical Supplies for District Level Eye Care Services