OBJECTIVE: To report the causes of legal blindness in the Department of Health (DOH) Eye Center among working age group patients (16-64 years old) in 2014 and compare these figures to data from 2008.

METHODS: Data were collected from the DOH Eye Center records section. The charts of new patients seen at the general ophthalmology clinic in the years 2008 and 2014 were reviewed individually. Patients between 15 and 64 years old with best corrected visual acuity (BCVA) of 20/200 (6/60) or less in the better-seeing eye were included as subjects in the study. Patients who improved to better than 20/200 (6/60) with BCVA and any medical or surgical means were excluded from the study. Patients whose visual acuity could not be assessed for any reason or with reversible causes of blindness were also excluded from the study.

RESULTS: The DOH Eye Center general ophthalmology clinic had a total of 8,941 registered patients aged 15 to 64 years old during the period January 1 to December 31, 2014. Diabetic retinopathy/maculopathy together with pathologic myopia formed the largest category of irreversible legal blindness (BCVA of 20/200 or less on the better seeing eye) with a total of 26 (18%) patients for each. Retinitis pigmentosa and macular dystrophy under the hereditary retinal disorders formed the second largest cause of legal blindness with 17 (12%) followed by glaucomatous optic neuropathy from all kinds with 15 (10%). Together, these four entities comprised more than 58% of all causes of blindness in the working age group. Optic atrophy, comprised mostly of ethambutol toxic optic neuropathies (ETON), was responsible for 14 (10%) followed by congenital disorders and corneal disorders of the eye with 7 (5%) for each. Other conditions comprised of disorders of the neural cortex; this formed 6 (4%) eligible causes of legal blindness. Uveitic causes and retinal detachment also contributed 6 (4%) each to the pool of eligible cases of legal blindness. Other conditions were endophthalmitis, central retinal artery occlusion and clinically significant macular edema which collectively contributed 6% to the pool. In comparison, the main causes of eligible legal blindness in the DOH Eye Center in 2008 were glaucoma, which accounted for 21% and was the single leading cause of blindness, followed by diabetic retinopathy (16%), retinal detachment 11%), pathologic myopia and optic atrophy (10%).

CONCLUSION: The leading causes of legal blindness in 2014 were shared between diabetic retinopathy/maculopathy and pathologic myopia. In 2008, the single leading cause of legal blindness was glaucoma from all kinds, but after 6 years, it was overtaken by diabetic retinopathy and maculopathy. The decrease in blindness caused by glaucoma may be related to increased promotion of awareness of blindness due to glaucoma. 

Human ; Male ; Female ; Middle Aged ; Adult ; Adolescent ; Diabetic Retinopathy ; Macular Edema ; Ophthalmology ; Macular Degeneration ; Optic Nerve Diseases ; Myopia ; Retinal Artery Occlusion ; Retinitis Pigmentosa

PURPOSE: To compare the multifocal electroretinography (mfERG) system to full-field ERGs obtained from patients with known retinal diseases in order to assess its clinical applicability. METHODS: Full-field ERGs, mfERG, fluorescein angiography, visual field examination were performed in normal person and in patients with retinitis pigmentosa, nonischemic central retinal vein occlusion, branch retinal vein occlusion, Vogot-Koyanagi-Harada syndrome, central serous chorioretinopathy, macular degeneration or retinal detachment. RESULTS: The dysfunctional areas measured by mfERG were well compatible to those assumed by findings of full-field ERGs. However, the results of mfERG in the retina with central serous chorioretinopathy were shown abnormal response despite of normal response of full-field ERGs. The results of mfERG in the retina with macular degeneration showed abnormal response although other findings (e.g. Full-filed ERGs, FAG, Fundus ) were normal. CONCLUSIONS: The mfERG system is useful for electroretinographic field mapping and evaluating retinal function clinically.
Central Serous Chorioretinopathy ; Electroretinography* ; Fluorescein Angiography ; Humans ; Macular Degeneration ; Retina ; Retinal Detachment ; Retinal Diseases ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Retinitis Pigmentosa ; Visual Fields

PURPOSE: To analyze the clinical course and outcomes of vitrectomy for severe vitreous hemorrhage of unknown etiology and to determine the primary cause of hemorrhage during the surgical process. METHODS: The medical records of patients who showed vitreous hemorrhage of Grade IV at their initial visit with no remarkable ophthalmologic or trauma history were reviewed retrospectively. All included patients underwent vitrectomy for severe vitreous hemorrhage for which a primary cause was not revealed before the surgery. The authors investigated the postoperative visual outcome, complications, and etiology of vitreous hemorrhage that was determined during the surgical process. We also analyzed the detailed intraoperative and postoperative funduscopic findings of patients with poor postoperative visual outcomes (BCVA < 20/200). RESULTS: Among the 50 eyes of 50 patients, the causes of vitreous hemorrhage included: branch retinal vein occlusion (48%), central retinal vein occlusion (16%), age-related macular degeneration (12%), retinal tear (8%), diabetic retinopathy (4%), rhegmatogenous retinal detachment (4%), Terson's syndrome (2%), Eales' disease (2%) and unknown causes (4%). The mean best-corrected visual acuity (BCVA) before surgery was 2.17 +/- 0.53 (log MAR) and it was recovered to 0.64 +/- 0.58 (log MAR) 6 months after the surgery (p < 0.001). The branch retinal vein occlusion showed better visual outcome than other disease entities. On funduscopic examination of the patients with poor visual outcome whose postoperative BCVA was poorer than 20/200, macular ischemia, macular degeneration, macular edema, submacular hemorrhage, tractional retinal detachment (including macular), or optic nerve atrophy were verified. CONCLUSIONS: After the vitrectomy for severe vitreous hemorrhage of unknown origin, pathologic findings of macular or irreversible optic nerve atrophy showed poor postoperative BCVA. Of all the causes of vitreous hemorrhage that were revealed after the surgery, branch retinal vein occlusion was the most common etiology of this condition and showed the most favorable visual outcome, comparatively.
Atrophy ; Diabetic Retinopathy ; Hemorrhage ; Humans ; Ischemia ; Macular Degeneration ; Macular Edema ; Medical Records ; Optic Nerve ; Retinal Detachment ; Retinal Perforations ; Retinal Vein ; Retinal Vein Occlusion ; Retrospective Studies ; Traction ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage*

PURPOSE: To investigate the clinical analysis of newly diagnosed diabetes mellitus (NDM) patients with abnormal fundus examination at the first visit. METHODS: This retrospective study utilized the first visit medical records of 15 patients (30 eyes) who were diagnosed with NDM from February 2011 to October 2016. RESULTS: Patients were divided into 3 groups: 1) diabetic retinopathy group including proliferative diabetic retinopathy (PDR) (3) and severe non-proliferative diabetic retinopathy (NPDR) (1); 2) retinal vascular disease group including central retinal vein occlusion (CRVO) (1), branch retinal vein occlusion (1), vitreous hemorrhage with CRVO (1) and macular edema (1); and 3) other retinal disease group including vitreous hemorrhage due to choroidal neovascular rupture (1), exudative age-related macular degeneration (3), central serous chorioretinopathy (2), and macular hole (1). All 3 PDR patients had latent autoimmune diabetes in adults (type 1.5 diabetes). The remaining 12 patients had type 2 diabetes. Three patients showed mild NPDR in the opposite eye and the other 9 patients did not have diabetic retinopathy in the opposite eye. Onset age, HbA1C and proteinuria were significantly different between the diabetic retinopathy group and the other retinal disease group (p = 0.006, p = 0.012 and p = 0.006, Mann-Whitney test). CONCLUSIONS: In patients with various retinal diseases, early detection of NDM could be achieved by performing fundoscopic imaging and systemic examination as well as basic ophthalmologic examination. In addition, patients with diabetic retinopathy should be treated promptly through ophthalmology and internal medicine consultation. For the retinal vascular disease and other retinal disease groups, not only treatment for ophthalmic diseases, but also education about diabetes treatment are important.
Adult ; Age of Onset ; Central Serous Chorioretinopathy ; Choroid ; Diabetes Mellitus* ; Diabetes Mellitus, Type 1 ; Diabetic Retinopathy ; Education ; Humans ; Internal Medicine ; Macular Degeneration ; Macular Edema ; Medical Records ; Ophthalmology ; Proteinuria ; Retinal Diseases ; Retinal Perforations ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Retrospective Studies ; Rupture ; Vascular Diseases ; Vitreous Hemorrhage

PURPOSE: To evaluate the causes of secondary macular hole after vitrectomy and the possibility of their prevention. METHODS: 27 patients (28 eyes) who experienced macular hole formation after vitrectomy were reviewed retrospectively. Age, sex, operation methods, duration between the vitrectomy and the secondary macular hole surgery and causes of the primary vitrectomy were recorded. Best-corrected visual acuity (BCVA) before and after primary vitrectomy; preoperative and postoperative macular findings with optical coherence tomography and fundus examination; and BCVA before and after macular hole surgery were analyzed. RESULTS: Of the 2945 eyes that had undergone vitrectomy, 28 eyes (0.96%) experienced macular hole formation. As causes of primary vitrectomy, 12 eyes had proliferative diabetic retinopathy, 6 eyes had rhegmatogenous retinal detachment, 2 eyes had branch retinal vein occlusion, 3 eyes had age-related macular degeneration and 5 eyes had trauma such as eyeball rupture or intraocular foreign body. The mean duration between primary vitrectomy and macular hole formation was 20.4 months (4 days-115 months). The estimated causes of macular hole formation included cystoid macular edema (CME) (n = 13), thinning of the macula (n = 6), thickening of internal limiting membrane or recurrence of preretinal membrane (PRM) (n = 7), recurrence of subretinal hemorrhage (n = 1) and macular damage during vitrectomy (n = 2). Final BCVA after macular hole surgery decreased in most cases compared to BCVA before macular hole formation except in 7 eyes (25%). CONCLUSIONS: Close observation of the macula after primary vitrectomy especially in eyes with continuous CME, and recurrent PRM and proper management on them including timely removal of the tangential traction force are necessary for preventing macular hole formation. In addition, surgeons should make efforts not to exert excessive tractional force on the macula to avoid iatrogenic damage during removal of the preretinal membrane.
Diabetic Retinopathy ; Foreign Bodies ; Hemorrhage ; Humans ; Macular Degeneration ; Macular Edema ; Membranes ; Methods ; Recurrence ; Retinal Detachment ; Retinal Perforations* ; Retinal Vein Occlusion ; Retrospective Studies ; Rupture ; Tomography, Optical Coherence ; Traction ; Visual Acuity ; Vitrectomy*

The branch retinal vein occlusion is the second most common retinal vascular disease after diabetic retinopathy. Complications such as macular edema, retinal neovascularization, vitreous hemorrhage, epiretinal membrane may be associated. But, the retinal detachment may occur rarely in BRVO patients. We studied the clinical features of retinal detachment associated with branch retinal vein occlusion. We reviewed the medical records of 15 retinal detachment patients associated with branch retinal vein occlusion. Mean age was 54.7 years old and 10 patients(66.7%) were female. Hypertension was associated in 13cases(86.7%). The duration between the development of BRVO and the development of retinal detachment was shorter than 4 years in all cases and shorter than 2 years in 9 cases(60.0%). Retinal break was identified in 14 cases(93.3%), among which 13 cases(92.2%) were located inside the lesion of branch vein occlusion. The epiretinal membrane was frequently combined 8 cases(53.3%). The preoperative laser photocoagulation was done in 4 cases(26.7%). The primary surgical procedures included scleral buckling in 8 cases(53.3%), pars plana vitrectomy in 6 cases(40.0%), and scleral buckling with pars plana vitrectomy in 1 case(6.7%). Three cases(20.0%) required reoperations. The postoperative complications included the progression of cataract in 6 cases(40.0%), iatrogenic retinal tear in 3 cases(20.0%), epiretinal membrane in 2 cases(13.3%), and proliferative vitreoretinopathy in 1 case(6.7%). The anatomic retinal reattachment was achieved in 14 cases(93.5%) and the visual recovery in 11 cases(73.3%).
Cataract ; Diabetic Retinopathy ; Epiretinal Membrane ; Female ; Humans ; Hypertension ; Light Coagulation ; Macular Edema ; Medical Records ; Postoperative Complications ; Retinal Detachment* ; Retinal Neovascularization ; Retinal Perforations ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Scleral Buckling ; Vascular Diseases ; Veins ; Vitrectomy ; Vitreoretinopathy, Proliferative ; Vitreous Hemorrhage

PURPOSE: To investigate postoperative visual acuities of patients who underwent vitrectomy for their dense nondiabetic vitreous hemorrhage, and in addition to assess postoperative visual results of the group who underwent early vitrectomy. METHODS: Included in the study were 52 patients (52 eyes) who had undergone vitrectomy and been followed up for longer than 4 months after surgeries. Authors investigated the underlying diseases of vitreous hemorrhage, surgical outcomes, and the rate of complications. In addition, we evaluated the results of the group who had undergone vitrectomy between 4 weeks and 6 weeks after development of hemorrhage. RESULTS: The most common cause of vitreous hemorrhage was branch retinal vein occlusion followed by macular hole, ocular trauma, central retinal vein occlusion, age related macular degeneration, Terson`s syndrome, and unknown cases. Visual acuity before operation is less than light perception to 0.3 and improved in 44 eyes (84.6%) after operation. The rate of more than 5 lines' improvement is 63.4% (33 eyes) and 51.9% (27 eyes) obtained their visual acuity of 0.5 or better. In the group which had been operated 4 to 6 weeks after the development, visual acuity improved in 100% (16 eyes). Thirteen eyes (81.2%) showed more than 5 lines' improvement of their visual acuity and 12 eyes had 0.5 or better (75.5%). The most common complication after surgeries is cataract in 5 eyes (10.8%), others were macular hole in 3 eyes (5.7%), retinal detachment in 2 eyes (3.8%), macular hole in 1 eye (6.2%). CONCLUSIONS: Pars plana vitrectomy is a good procedure to improve visual acuity for the patients who have suffered persistent visual disturbances due to non-diabetic vitreous hemorrhage. Also, early vitrectomy should be considered for early visual rehabilitation.
Cataract ; Hemorrhage ; Humans ; Macular Degeneration ; Rehabilitation ; Retinal Detachment ; Retinal Perforations ; Retinal Vein ; Retinal Vein Occlusion ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage*

PURPOSE: In this study we evaluated and analyzed the causes and prognosis of spontaneous vitreous hemorrhage except direct ocular trauma and diabetic retinopathy-induced vitreous hemorrhage confirmed after therapeutic vitrectomy. METHODS: The present study included Non-traumatic, non-diabetic vitreous hemorrhage patients who underwent vitrectomy in our hospital from March 2010 to December 2013 and were followed up for more than 1 year. Past history, preoperative visual acuity and intraocular pressure were evaluated postoperatively at 1, 3, 6 and 12 months. RESULTS: A total of 157 patients (157 eyes) were included in the study. Common causes of vitreous hemorrhage were branch retinal vein occlusion, retinal tear and age-related macular degeneration. Age-related macular degeneration and central retinal vein occlusion patients showed a poor visual prognosis. Lattice retinal degeneration or retinal tear in the opposite eye was observed in 27 patients and therefore, barrier laser was performed. CONCLUSIONS: The most common cause of spontaneous vitreous hemorrhage was retinal vein occlusion. Visual prognosis varied depending on the cause of disease, but significant vision improvement can be expected if the macula is not involved. Additionally, in some patients without evidence of retinal detachment on ultrasound, a possible retinal tear accompanied by localized retinal detachment should be considered.
Humans ; Intraocular Pressure ; Macular Degeneration ; Prognosis ; Retinal Degeneration ; Retinal Detachment ; Retinal Perforations ; Retinal Vein ; Retinal Vein Occlusion ; Ultrasonography ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage*

PURPOSE: Combined with vitreoretinal surgery, silicone oil endotamponade has become a standard technique and improved the prognosis of complex retinal diseases. To improve success rate of silicone oil endotamponade, the authors analysed complications and associated with other variables. METHODS: The authors analysed 90 cases of silicone oil endotamponade (102 eyes), all operated by one surgeon from 1995 to 2000 and followed-up over 6 months. The series consisted of proliferative diabetic retinopathy (48 eyes), complex retinal detachment (33 eyes), proliferative vitreoretinpathy (11 eyes) and ocular trauma (10 eyes). Analysed variables were preoperative visual acuity, rubeosis iridis, nuber of operations, duration of tamponade, emulsification of silicone oil, lentile status, anterior proliferative vitreoretinpathy, keratopathy, change of ocular tension, redetachment, macular degeneration and electroretinogram. RESULTS: Anatomic success was achieved in 95 of 102 eyes (93.1%) and functional success was achieved in 66 eyes (64.7%). Change of ocular tension over 10mmHg, anterior proliferative vitreoretinpathy and anatomical failure were statistically significant prognostic factors. CONCLUSIONS: Silicone oil endotamponade is an effective measure for complex retinal diseases, but its complication has always been an issue. If these complications can well be kept under the control, silicone oil endotamponade will become more widely used surgical modality.
Diabetic Retinopathy ; Endotamponade* ; Intraocular Pressure ; Lens Plant ; Macular Degeneration ; Prognosis ; Retinal Detachment ; Retinal Diseases ; Silicone Oils* ; Visual Acuity ; Vitrectomy ; Vitreoretinal Surgery

Clinical ophthalmologists consider each retinal disease as a completely unique entity. However, various retinal diseases, such as uveitis, age-related macular degeneration, diabetic retinopathy, and primary open-angle glaucoma, share a number of common pathogenetic pathways. Whether a retinal disease initiates from direct injury to the blood-retinal barrier (BRB) or a defect/injury to retinal neurons or glia that impairs the BRB secondarily, the BRB is a pivotal point in determining the prognosis as self-limiting and recovering, or developing and progressing to a clinical phenotype. The present review summarizes our current knowledge on the physiology and cellular and molecular pathology of the BRB, which underlies its pivotal role in the initiation and development of common retinal diseases.
Blood-Retinal Barrier ; Diabetic Retinopathy ; Humans ; Macular Degeneration ; Phenotype ; Retinal Diseases