Prevalence and causes of registered blindness in the largest federal state of Germany

Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127 Bonn, Germany.
The British journal of ophthalmology (Impact Factor: 2.81). 03/2011; 95(8):1061-7. DOI: 10.1136/bjo.2010.194712
Source: PubMed

ABSTRACT As no current estimates for the prevalence and causes of blindness in Germany are available, the database of Germany's largest welfare institution (covering 9.5 million people in the federal state of Northrhine) assessing eligibility for an allowance payable to blind people was used to investigate the prevalence and the specific causes of blindness and visual impairment.
Data from a representative sample of 5100 cases out of 20 365 cases were extracted, entered into an electronic database and statistically analysed. Blindness and severe vision impairment were defined as visual acuity equal to or below 20/1000 and 20/400, respectively, in the better-seeing eye.
The mean age of the overall sample was 72±22 years and the mean visual acuity of the better seeing eye was 20/800. The prevalence of blindness and severe vision impairment in Northrhine was estimated to be 47.91 per 25,000 [corrected] persons. Most registered visual impairment was due to age-related macular degeneration (AMD; 41%), followed by glaucoma (15%) and diabetic eye disease (10%). Sixty-five per cent of registered blind people were women, 56% of them over the age of 80 years. Registered children and teenagers had the relative worst visual acuity (hand movement) and patients with retinal dystrophies had the relative best visual acuity (20/200) within the whole cohort (p<0.001). Standardised prevalence of blindness and severe visual impairment for Germany is estimated to be 44.4/100.000 (57.94 for women and 30.78 for men).
Prevalence of blindness and severe vision impairment for Germany compare well to other European countries. AMD is the most prevalent cause of registered blindness and severe vision impairment, and prevalence in women is higher. Generally, prevalence increases with age. Provision of support and welfare services need to be organised accordingly.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Staatliche Schule für Blinde und Sehbehinderte in Ilvesheim wird seit 1868 von der Universitätsaugenklinik Heidelberg betreut. Frühere Untersuchungen über die Ursachen der Sehbehinderung haben bis 1981 die Entwicklung der Medizin und der Augenheilkunde mit einer deutlichen Abnahme entzündlicher Hornhauterkrankungen und später von Schülern mit kongenitaler Katarakt und Glaukom widergespiegelt. Ziel dieser Studie war die Erhebung der entsprechenden aktuellen Daten und der Vergleich mit früheren Zahlen.Von 268 der 278 Schüler, die die Schlossschule Ilvesheim im Zeitraum von 2000 bis 2008 besuchten, waren die augenärztlichen Befunde sowie Angaben zu weiteren Gesundheitseinschränkungen vorhanden. Diese wurden hinsichtlich der Ausprägung der Sehbehinderung und der zugrunde liegenden Erkrankung ausgewertet und mit den früheren Untersuchungen verglichen.Von den 268 Schülern waren 83 Frühgeborene (31%); 130 Blinde und 51 hochgradig Sehbehinderte besuchten die Schule. Unter den 82 blinden, hochgradig sehbehinderten oder sehbehinderten Frühgeborenen waren 69 (84,2%) mehrfach behindert. Bei 142 Schülern lag neben der Sehbehinderung eine Lernbehinderung, geistige oder/und körperliche Behinderung vor. Häufigste Ursache war eine Optikusatrophie (mit 36,2 bzw. 37,3% bei blinden bzw. hochgradig sehbehinderten Schülern. Der Anteil an erblichen Netzhauterkrankungen ist gegenüber der Erhebung von 1981 mit 24,6% bei den blinden Schülern etwas höher, er beträgt bei den hochgradig Sehbehinderten 15,7% und bei den Sehbehinderten 17,1%. Eine Frühgeborenenretinopathie bestand bei rund 20% der hochgradig sehbehinderten und blinden Schüler.Entsprechend den in den letzten Jahrzehnten erheblich verbesserten medizinischen Möglichkeiten der perinatalen Versorgung ist der Anteil an ehemals frühgeborenen Schülern deutlich angestiegen. Hierbei handelt es sich überwiegend um mehrfach behinderte Kinder, die eine umfassende Betreuung benötigen. Obwohl der Anteil blinder Schüler aufgrund der zunehmenden Tendenz einer Beschulung in Regelschulen bei Fehlen weiterer Behinderungen deutlich rückläufig ist, hat der relative Anteil an Schülern mit erblichen Netzhauterkrankungen in den letzten 40 Jahren leicht zugenommen.
    Der Ophthalmologe 01/2013; 110(4). DOI:10.1007/s00347-012-2708-7 · 0.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose. The etiology of neovascular age-related macular degeneration (nAMD) cannot be completely explained by identified environmental risk factors or single-locus gene variants. This study was to explore the potential interactions among gene variants on nAMD in Chinese population. Methods. 43 SNPs located in different genes were genotyped in 932 Chinese individuals (464 nAMD patients and 468 controls). We explored the potential interactions among gene variants using generalized multifactor dimensionality reduction (GMDR) algorithm and the method to measure the departure from the additivity model. Results. The joint effect that involved CFH rs1061170 and HTRA1 rs3793917 was shown statistically significant (P < 0.001) with the highest cross-validation consistency (10/10) and the best testing balanced accuracy (64.50%). In addition, based on the method to measure the departure from the additivity model, the synergy index (S) was 2.63 (1.09-6.38) and the attributable proportion due to interaction (AP) was 55.7% (21.4%-89.9%), which suggested that a common pathway may exist for these genes for nAMD. Those who carried CC for rs3793917 and TC/CC for rs1061170 were at the highest risk of nAMD (OR: 9.76, 95% CI: 4.65-20.51). Conclusions. Evidence that the joint effect that involved CFH and ARMS2/HTRA1 may contribute to the risk of neovascular AMD in Chinese population was obtained.
    Journal of Ophthalmology 01/2015; 2015:821918. DOI:10.1155/2015/821918 · 1.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To determine the safety and efficacy of low-voltage, external-beam, stereotactic radiotherapy (SRT) for patients with neovascular age-related macular degeneration (AMD). Design Randomized, double-masked, sham-controlled, multicenter, clinical trial. Participants A total of 230 participants with neovascular AMD who received ≥3 ranibizumab or bevacizumab injections within the preceding year and requiring treatment at enrollment. Methods Participants received 16 Gray, 24 Gray, or sham SRT. All arms received pro re nata (PRN) ranibizumab for 12 months, with PRN bevacizumab or ranibizumab thereafter. Main Outcome Measures Mean number of PRN injections; best-corrected visual acuity (BCVA); loss of <15 Early Treatment of Diabetic Retinopathy Study letters; change in optical coherence tomography central subfield thickness; and change in angiographic total lesion area and choroidal neovascularization (CNV) area. Results At year 2, the 16 and 24 Gray arms received fewer PRN treatments compared with sham (mean 4.5, P = 0.008; mean 5.4, P = 0.09; and mean 6.6, respectively). Change in mean BCVA was −10.0, −7.5, and −6.7 letters for the 16 Gray, 24 Gray, and sham arms, respectively, with 46 (68%), 51 (75%), and 58 participants (79%), respectively, losing <15 letters. Mean central subfield thickness decreased by 67.0 μm, 55.4 μm, and 33.3 μm, respectively. Mean total active lesion area increased by 1.0, 4.2, and 2.7 mm2, respectively. Mean CNV area decreased by 0.1 mm2 in all groups. An independent reading center detected microvascular abnormalities in 6 control eyes and 29 SRT eyes, of which 18 were attributed to radiation; however, only 2 of these possibly affected vision. An exploratory subgroup analysis found that lesions with a greatest linear dimension ≤4 mm (the size of the treatment zone) and a macular volume greater than the median (7.4 mm³) were more responsive to SRT, with 3.9 PRN injections versus 7.1 in comparable sham-treated participants (P = 0.001) and mean BCVA 4.4 letters superior to sham (P = 0.24). Conclusions A single dose of SRT significantly reduces intravitreal injections over 2 years. Radiation can induce microvascular change, but in only 1% of eyes does this possibly affect vision. The best response occurs when AMD lesions fit within the treatment zone and they are actively leaking.
    Ophthalmology 09/2014; 122(1). DOI:10.1016/j.ophtha.2014.07.043 · 6.17 Impact Factor