Alfred Sommer's research while affiliated with Johns Hopkins Bloomberg School of Public Health and other places

Publications (139)

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Purpose: To describe the characteristics of the patient population included in the 2016 IRIS® Registry (Intelligent Research in Sight) database for analytic aims. Design: Description of a clinical data registry. Participants: The 2016 IRIS Registry database consists of 17 363 018 unique patients from 7200 United States-based ophthalmologists i...
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During its first century, the Johns Hopkins University Bloomberg School of Public Health has been home to several faculty members who have played leading roles in defining and expanding the field and science of epidemiology. They have done so by training leaders in the field, creating new methods and applications, and making relevant discoveries in...
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A recent, sophisticated granular analysis of climate change in the United States related to burning fossil fuels indicates a high likelihood of dramatic increases in temperature, wet-bulb temperature, and precipitation, which will dramatically impact the health and well-being of many Americans, particularly the young, the elderly, and the poor and...
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Aberrant dark adaptation is common to many ocular diseases and pathophysiological conditions, including vitamin A deficiency, cardiopulmonary diseases, and hypoxia. Scotopic vision and pupillary responsiveness have typically been measured using subjective, time-consuming methods. Existing techniques are particularly challenging for use in developin...
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Global blindness exacts an enormous financial and social cost on developing countries. Reducing the prevalence of blindness globally requires a set of strategies that are different from those typically used in developed countries. This was the subject of the 2013 Knapp symposium at the American Ophthalmological Society Annual Meeting, and this arti...
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Within 20 years of its discovery 100 years ago, vitamin A was recognized as critical to normal eyes, growth, and survival. Clinical interest subsequently contracted to its importance in preventing xerophthalmia, until this ophthalmologist stumbled, quite accidently, on its role in fighting life-threatening infections. Repeated, large-scale randomiz...
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Those seeking breakthrough discoveries in ophthalmology and vision, like those working to bring the benefits of such discoveries and modern ophthalmic care to poor people around the globe, are not doing it for the recognition or the money. Still, recognition and monetary awards, particularly those that advance their work, do not hurt. The António C...
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The clinical importance of vitamin A as an essential nutrient has become increasingly clear. Adequate vitamin A is required for normal organogenesis, immune competence, tissue differentiation, and the visual cycle. Deficiency, which is widespread throughout the developing world, is responsible for a million or more instances of unnecessary death an...
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A little more than a decade ago, Foster1,2 provided a simple metric for estimating the number of cataract operations required to prevent needless blindness and vision impairment from cataract in any given population, the cataract surgical rate (CSR): the number of cataract operations needed to be performed per million population per year. This was...
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To determine whether vitamin A supplementation administered in the preschool years can lower the risk of hearing loss in adolescence and adulthood. Follow-up study of adolescents and young adults who, as preschool aged children in 1989, were enrolled into a cluster randomised, double blinded, placebo controlled trial of vitamin A supplementation. S...
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This annual, always anticipated edition of the Archives is titled “Worldwide,” not “International.” Seemingly subtle differences in nomenclature sometimes denote marked differences in perspective. Too frequently, “international” has come to connote “second class,” something that would not, ordinarily, make the grade. Not so here. “Worldwide” makes...
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Let me begin with a simple, declarative conclusion: ocular hypertension and low-/normal-tension glaucoma are not clinical entities. They are meaningless statistical constructs that have done more to confuse the diagnosis and management of primary open-angle glaucoma (POAG) than they ever did to enhance it. It is time these terms were put to permane...
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A large number of animal studies and human observational studies suggest a positive relationship between vitamin A status and lung function. Depletion of vitamin A from the diet of pregnant female rats is associated with abnormalities in lung development of offspring, an effect that can be prevented by supplementation with vitamin A in early, but n...
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Vitamin A is important in regulating early lung development and alveolar formation. Maternal vitamin A status may be an important determinant of embryonic alveolar formation, and vitamin A deficiency in a mother during pregnancy could have lasting adverse effects on the lung health of her offspring. We tested this hypothesis by examining the long-t...
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For those of us of a certain age, conventional wisdom stated that elevated intraocular pressure (IOP) caused glaucoma, and lowering IOP was the only effective way to prevent and treat it. We knew this because every textbook claimed it was so, and observational and anecdotal reports heralded the association. Inconveniently, a few nonophthalmologists...
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Vitamin A deficiency has a plethora of clinical manifestations, ranging from xerophthalmia (practically pathognomonic) to disturbances in growth and susceptibility to severe infection (far more protean). Like other classical vitamin deficiency states (scurvy, rickets), some of the signs and symptoms of xerophthalmia were recognized long ago. Report...
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We assessed the effect of supplementing newborns with 50000 IU of vitamin A on all-cause infant mortality through 24 weeks of age. This was a community-based, double-masked, cluster-randomized, placebo-controlled trial conducted in 19 unions in rural northwest Bangladesh. The study was nested into and balanced across treatment arms of an ongoing pl...
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JAMAComparison of Annual and Biannual Mass Antibiotic Administration for Elimination of Infectious TrachomaMuluken Melese, MD, MPH; Wondu Alemayehu, MD, MPH; Takele Lakew, MD, MPH; Elizabeth Yi, MPH; Jenafir House, MPH, MSW; Jaya D. Chidambaram, MBBS; Zhaoxia Zhou, BA; Vicky Cevallos, MT; Kathryn Ray, MA; Kevin Cyrus Hong, BA; Travis C. Porco, PhD,...
Article
My ophthalmologic career might well have ended before it truly began. In an editorial prepared as a second-year resident, I decried the sorry state of clinical research (citing the shortcomings of published articles by leading academics) and called for the rigorous application of epidemiologic and statistical principles.1 Fortunately, those cited w...
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Several outside reviewers of this solicited editorial considered “managed care,” which I had failed to mention, a major barrier to eye care services. From a global perspective, the vast majority of people with whom we share this planet would be delighted to have eye care services that could be “managed.”“Access” of any type requires trained, qualif...
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New England Journal of MedicineMass Treatment With Single-Dose Azithromycin for TrachomaAnthony W. Solomon, MB, BS, PhD; Martin J. Holland, PhD; Neal D. E. Alexander, PhD; Patrick A. Massae, DCEH; Aura Aguirre, PhD; Angels Natividad-Sancho, MSc; Sandra Molina, MSc; Salesia Safari, MD; John F. Shao, MD, PhD; Paul Courtright, DrPH; Rosanna W. Peeling...
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Today's vision preservation and blindness prevention enterprise canbe traced to the founding of the International Agency for Prevention of Blindnessand the World Health Organization's Blindness Prevention Program in the late1970s. In many ways, it anticipated the larger global health agenda withinwhich it now resides and with which it increasingly...
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We previously reported that maternal micronutrient supplementation in rural Nepal decreased low birth weight by approximately 15%. We examined the effect of daily maternal micronutrient supplementation on fetal loss and infant mortality. The study was a double-blind, cluster-randomized, controlled trial among 4926 pregnant women and their 4130 infa...
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WHEN id A MANN1 compiled her classic monograph, she sought to describe geoethnic variations in ocular disease, in part to recognize differing medical needs but also to stimulate interest in their underlying causality.When we designed the Baltimore Eye Survey, 2,3 we selected equal numbers of black and white subjects to identify racial variations in...
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To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women. Double blind cluster randomised controlled trial. Rural community in south eastern Nepal. 4926 pregnant women and 4130 live born infants. 426 communities were randomised to five regimens in which pregnant women rece...
Article
Comprehensive recommendations for the assessment and control of vitamin A deficiency (VAD) were rigorously reviewed and revised by a working group and presented for discussion at the XX International Vitamin A Consultative Group meeting in Hanoi, Vietnam. These recommendations include standardized definitions of VAD and VAD disorders. VAD is define...
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Editor—Did the recent campaign to distribute vitamin A in Assam, India, cause an epidemic of illness or hysteria? The public health science underlying vitamin A prophylaxis and the reports that emerged after the same-day dosing of some 2.5 million preschool children point to hysteria. Firstly, did vitamin A kill a child the day after dosing, and u...
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The impact of visual loss has profound implications for the person affected and society as a whole. The majority of blind people live in developing countries, and generally, their blindness could have been avoided or cured. Given the current predictions that the number of blind people worldwide will roughly double by the year 2020, it is clear that...
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Night blindness due to vitamin A deficiency is common during pregnancy among women in Nepal. The authors assessed the risk of maternal death during and after a pregnancy with night blindness among women participating in a cluster-randomized, placebo-controlled vitamin A and beta-carotene supplementation trial in Nepal from July 1994 to September 19...
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The effect of vitamin A supplementation on the survival of infants aged <6 mo is unclear. Because most infant deaths occur in the first few month of life, maternal supplementation may improve infant survival. The objective was to assess the effect of maternal vitamin A or beta-carotene supplementation on fetal loss and survival of infants <6 mo of...
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The relations among hyporetinolemia, acute phase proteins, and vitamin A status in children are unclear. The objective was to examine the relations between acute phase proteins and plasma retinol concentrations in children with and without clinical vitamin A deficiency (Bitot spots and night blindness). The study was a nonconcurrent analysis of acu...
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To determine if eyes with larger optic disc area are more likely to have open-angle glaucoma or to have glaucoma at lower intraocular pressure (IOP). Data were collected from a population-based sample of adults residing in East Baltimore, consisting of demographic information, ocular examinations, automated and static/kinetic visual field tests, IO...
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To describe the sources of tension within the health care system and methods for pursuing their solution. Presentation of observations pertinent to patient, provider, and payer perspectives relevant to the cost, delivery, and quality of care and their impact on health. Societal forces, not just wealth, are major determinants of both health and the...
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To assess the impact on mortality related to pregnancy of supplementing women of reproductive age each week with a recommended dietary allowance of vitamin A, either preformed or as beta carotene. Double blind, cluster randomised, placebo controlled field trial. Rural southeast central plains of Nepal (Sarlahi district). 44 646 married women, of wh...
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Abstract Objective: To assess the impact on mortality related to pregnancy of supplementing women of reproductive age each week with a recommended dietary allowance of vitamin A, either preformed or as βcarotene. Design: Double blind, cluster randomised, placebo controlled field trial. Setting: Rural southeast central plains of Nepal (Sarlahi distr...
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The transition from research to the applications of its results is a difficult one. Several stages must be passed through before a discovery can be put to practical use. The development of the current standards for vitamin A is a good example of both a successful and a difficult transition. The importance of the public media and of international or...
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Inconsistencies have been observed in the impact of vitamin A (VA) supplementation on early child growth. To help clarify this issue, a cohort of 3377 rural Nepalese, nonxerophthalmic children 12-60 mo of age were randomized by ward to receive vitamin A [60,000 microg retinol equivalents (RE)] or placebo-control (300 RE) supplementation once every...
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It has been little more than a decade since the initial observation of the dose dependent relation between the severity of vitamin A deficiency and childhood mortality,1 quickly followed by the publication of a controlled trial in which children of preschool age, randomised to receive large doses of vitamin A every six months, died at only two thir...
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The authors estimated the prevalence and rates of progressive visual field loss in glaucoma patients followed annually for a median of 6.3 years. Linear regression was used to estimate rates of progression of mean deviation, corrected pattern standard deviation (CPSD), clusters of locations based on the Glaucoma Hemifield Test (GHT), and location s...
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To evaluate the potential value of obtaining follow-up stereoscopic photographs on glaucoma suspects in identifying progressive optic nerve damage. Nineteen sets of stereoscopic optic disc photographs, reflecting one eye from each of 19 patients at two time points, were selected from the records of subjects enrolled in the Glaucoma Screening Study....
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Whereas population-based data on the causes of bilateral blindness have been reported, little information is available on the distribution of causes of central vision loss less severe than the criteria used to define legal blindness. This visual impairment is responsible for a high proportion of eye care service use and results in important reducti...
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To estimate the rate of visual field loss in persons with open-angle glaucoma. The visual field data obtained by Goldmann perimetry from 151 persons with open-angle glaucoma from the Baltimore Eye Survey were graded on a nine-level severity scale. Approximately one half of these persons had previously diagnosed glaucoma and were being treated. Usin...
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To study the incidence of acute angle-closure glaucoma secondary to pupillary dilation and to identify screening methods for detecting angles at risk of occlusion. We studied 5,308 respondents to the Baltimore Eye Survey, a cross-sectional, population-based survey conducted in a multiracial urban community. We measured incidence of acute angle-clos...
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Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.
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To examine different definitions of incident visual field loss among patients with elevated intraocular pressure and varying numbers of abnormal glaucoma hemifield test results over an average of 6 years of follow-up. A cohort of patients with annual C-30-2 Humphrey visual fields were followed for a minimum of 5 years. Three different definitions o...
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To determine whether vitamin A supplementation at birth could reduce infant morbidity and mortality. We conducted a placebo-controlled trial among 2067 Indonesian neonates who received either 52 micromol (50,000 IU) orally administered vitamin A or placebo on the first day of life. Infants were followed up at 1 year to determine the impact of this...
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We read with interest the report of the Barbados Eye Study1 in which Leske and associates reportedly failed to identify blood pressure (BP) as a "risk factor" for primary open-angle glaucoma (POAG). While there were many differences between their study and the Baltimore Eye Survey (which included 2500 African-Americans aged 40 years and older), the...
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Vitamin A deficiency is a major public health problem among preschool-aged children in many developing countries. In Bangladesh, a national nutritional surveillance system was initiated in 1990 to monitor 1) the occurrence of vitamin A deficiency by history of night blindness and 2) the routine coverage of national twice-yearly prophylactic vitamin...
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The prevalence of night blindness during pregnancy and lactation was assessed in a sample of 426 women living in the rural terai of Nepal. These women were also examined for ocular signs of vitamin A deficiency. Among 241 lactating women, 16.2% reported experiencing night blindness at some time during the pregnancy that produced the infant they wer...
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As a response to the inability to provide vital information during the floods of 1987 and 1988 a nutrition surveillance system (the NSP) was established. This is a collaborative effort that involves international and indigenous non-governmental organizations and the government of Bangladesh. The NSP has demonstrated an ability to provide regular an...
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To identify preoperative patient characteristics associated with a lack of improvement on one or more measures 4 months after cataract surgery. The authors collected preoperative and 4-month postoperative information on 552 patients undergoing first-eye cataract surgery from the practices of 72 ophthalmologists in three cities. The principal outcom...
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Although the prevalence of blindness and visual impairment increases with age, most surveys of ocular disease do not include nursing home residents. We conducted a population-based prevalence survey of persons 40 years of age or older residing in nursing homes in the Baltimore area. Of 738 eligible subjects in 30 nursing homes, 499 (67.6 percent) p...
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The association of diabetes with primary-open angle glaucoma (POAG) has been controversial and often confused by varying definitions of both diabetes and POAG. The purpose of this study is to evaluate this association in a population-based sample of subjects from the Baltimore Eye Survey. A stratified sample of residents in 16 cluster areas of east...
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To determine if automated perimetry detects visual field defects before manual Goldmann perimetry. Subjects with ocular hypertension without field loss on detailed manual perimetry were followed prospectively with annual automated and manual perimetry. Subjects with field loss on manual perimetry were age-matched post hoc to subjects who did not ha...
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A randomized controlled clinical trial was conducted to determine the relative protection afforded by two large doses of vitamin A against subclinical vitamin A deficiency among 345 preschool children. At baseline, children either had or were at high risk of developing non-corneal xerophthalmia. Vitamin A status was assessed by the relative dose re...
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Background: Although ophthalmologists have long recognized that visual acuity alone is an inadequate measure of visual impairment, the need for and outcomes of cataract surgery historically have been assessed in terms of visual acuity. Purpose: To examine the relation among different cataract surgery outcome measures, including a 14-item instrument...
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To examine associations between surgical technique, patient and surgeon characteristics, and clinical outcomes of cataract surgery. Seventy-five ophthalmologists were recruited from three cities based on a sampling scheme stratified by surgeon-reported annual volume of cataract surgery. Seven hundred seventy-two patients undergoing first eye catara...
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The degree to which diarrheal disease clustered within households and within villages among preschool age children was examined using data from four population-based prevalence surveys undertaken in Malawi, Zambia, Indonesia, and Nepal over the past decade. The design effect for each cluster survey was calculated using the diarrhea prevalence, the...
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The clustering of xerophthalmia within households and villages was estimated among preschool age children using data from studies conducted in Malawi, Zambia, Indonesia and Nepal over the past decade. Paitwise odds ratiw (OR) were used to measure the magnitude of clustering. This OR measures the risk of xerophthalmia for a preschool child given tha...
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Purpose: The authors studied 57,103 randomly selected Medicare beneficiaries who underwent extracapsular cataract extraction in 1986 or 1987 to determine the possible association between performance of neodymium (Nd):YAG laser capsulotomy and the risk of subsequent retinal break or detachment. Methods: Cases of cataract surgery were identified from...
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A randomized, double-masked, placebo-controlled, clinical trial of 236 preschool children, age 3–6, in West Java, Indonesia, was carried out to assess the impact of vitamin A supplementation on hematological indicators of iron metabolism and nutritional status. Clinically normal children (n=118) were matched by age and sex with xerophthalmic childr...
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A randomized, double-masked, placebo-controlled clinical trial was conducted with 236 preschool children, age 3-6 y, in Indonesia to assess immune status in mild vitamin A deficiency. The immune response to tetanus immunization was used as a measure of immune competence. Clinically normal children (n = 118) and children with mild xerophthalmia (n =...
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From annual examinations of 813 ocular hypertensive eyes, the authors compared optic disc and nerve fiber layer photographs in 2 age-matched subgroups: 37 eyes that converted to abnormal visual field tests at the end of a 5-year period and 37 control eyes that retained normal field tests. Disc change was detected in only 7 of 37 (19%) converters to...
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The effect of test duration on fixation losses, and false-positive and false-negative catch trial responses was examined in 361 eyes of 203 ocular hypertensive patients. These were recorded at 5-min intervals during automated perimetric testing with the Humphrey field analyzer's C-30-2 program. There was no statistically significant change in the d...
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Bilateral blindness unrelated to simple refractive error is twice as prevalent among blacks as among whites, although the difference narrows among the elderly. The reasons for this race- and age-related pattern are uncertain. A randomly selected, stratified, multistage cluster sample of 2395 blacks and 2913 whites 40 years of age and older in East...
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• The Baltimore Eye Survey is a population-based study of ocular disorders conducted in East Baltimore, Md, designed to determine the prevalence and severity of vision loss and ocular disease and their relationships to socioeconomic and other risk factors. This survey comprised 5300 subjects (2911 whites and 2389 blacks). Visual impairment was asso...

Citations

... Similar results were noted in many studies. 5,12,[15][16][17][18]26,[28][29][30][31][32][33] Medical conditions pregnancy induced hypertension (PIH) and GDM, life style factors smoking(active and passive) and tobacco chewing were associated with LBW babies. Similar results were obtained in other studies too. ...
... On the other hand, fluctuations in IOP might depend on a common humoral background of IOP and ABP control [12]. As hypertension induces atherosclerosis and impairs vascular autoregulation, some authors propose that it negatively affects blood supply to the optic nerve [13]. The latter hypothesis may explain observations of a higher prevalence of glaucoma in patients with systemic hypertension, irrespective of an ABP and IOP relationship [9]. ...
... Also, when diagnosing glaucoma damage in patients who are being followed due to ocular hypertension, it is necessary to confirm findings at several consecutive visits to avoid a very large percentage of false-positive diagnoses. [21][22][23] It is often stated that in order to be absolutely sure of a glaucoma diagnosis, it is necessary to document progression. 24,25 This is indeed a suitable way of avoiding false-positive diagnoses, which result in unnecessary treatment and reduction of quality of life. ...
... In hypoxic individuals the dim light also cooperates to the eye fl exibility. During the World War II the fi ghter pilots face diffi culties with their vision while fl ying at high altitude and hills [10]. Dark adaptation and oxygen defi ciency have very close association to each other. ...