Volume 50 · Issue 03 · 2014

Action plan for the prevention of avoidable blindness and visual impairment for 2014-2019 endorsed by 66th World Health Assembly is an important document for promoting the global prevention of blindness.This action plan summarized the experiences and lessons in the global prevention of avoidable blindness and visual impairment from 2009 to 2013,raised the global goal for the prevention of blindness-the reduction in prevalence of avoidable visual impairment by 25 ％ by 2019 from the baseline of 2010,set up the monitoring indicators for realizing the global goal.This document can be served as a roadmap to consolidate joint efforts aimed at working towards universal eye health in the world.This action plan must give a deep and important impact on the prevention of blindness in China.We should implement the action plan for the prevention of avoidable blindness and visual impairment for 2014-2019 to push forward sustaining development of the prevention of blindness in China.

Cataract is the first blinding eye disease in the world and China.However,due to various reasons,cataract surgery rate (CSR) in China is much lower than in developed countries and even some developing countries.Properly and standardized training of cataract surgery for ophthalmologists from primary hospital and young eye doctors is one of the key point to improve CSR.For above,we had explored actively to establish an appropriate and suitable training model of cataract surgery.Ophthalmologist in primary hospital can provide high quality medical services to cataract patients in accordance with their own conditions after training and promote the sustainable development of blindness prevention work.

Objective To investigate the prevalence of blindness and moderate and severe visual impairment among adults aged 50 years or above in Yangxi County of Guangdong Province,China.Methods It was a population-based cross-section study.Geographically defined cluster sampling was used in randomly selecting 5 531 individuals aged 50 years or above in Yangxi County from September 2006 to January 2007.The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out.All participants were enumerated using village registers foliowed by door-to-door visits.Eligible individuals were invited to receive visual acuity measurement and eye examination.Statistical analyses were performed using Stata/SE Statistical Software,release 9.0.Chi-square test was used to investigate the association of age,gender and education with presenting and best corrected visual acuity.Results Five thousands five hundreds and thirty-one individuals were enumerated and 4 589 persons were examined,the response rate was 82.97％.Based on the criteria of World Health Organization visual impairment classification in 1973,the prevalence of blindness and moderate and severe visual impairment defined as best corrected visual acuity was 2.38％ (109/4 589) and 9.44％ (433/4 589) respectively.The prevalence of blindness and moderate and severe visual impairment defined as presenting visual acuity was 2.68％ (123/4 589) and 18.15％ (833/4 589) respectively.The prevalence of blindness and moderate and severe visual impairment was higher in aged (trend x2 =1 239.34,P ＜ 0.0l),female (x2 =37.88,P ＜0.01) and illiterate(trend x2 =235.11,P ＜ 0.01) persons.Cataract was the first leading cause of blindness and visual impairment.Conclusions The prevalence of blindness and moderate and severe visual impairment is higher among older adults aged 50 years or above in Yangxi County.Cataract remains as the first leading cause of blindness and visual impairment.

In order to use the terminology and its abbreviations in this field more conveniently and concisely, this journal specifically publishes some foreign language abbreviations which are well-known and recognized. Authors can directly use the following abbreviations in the abstract and text without giving their full names when writing articles. For unpublished terms, please write the full Chinese name when it first appears, and write the full foreign name and its abbreviation in parentheses, such as tumor necrosis factor (TNF).

Objective To investigate the prevalence of blindness and moderate and severe visual impairment among adults aged 50 years or above in Shuangcheng City of Heilongjiang Provicne,China.Methods It was a population-based cross-section study.Geographically defined cluster sampling was used in randomly selecting 5 841 individuals aged 50 years or above in 28 basic smaple units in Shuangcheng City from September to December 2006.The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out.All participants were enumerated through village registers followed door-to-door visits.Eligible individuals were invited to receive visual acuity measurement and eye examination.Statistical analyses were performed using Stata/SE Statistical Software,release 9.0.Chi-square test was used to investigate the association of age,gender and education with presenting and best corrected visual acuity.Results Five thousands four hundreds and eighty-one individuals were enumerated and 5 047 persons were examined,the response rate was 92.08％.Based on the criteria of World Health Organization visual impairment classification in 1973,the prevalence of blindness and moderate and severe visual impairment defined as best corrected visual acuity was 1.72％ (87/5 047)and 4.69％ (237/5 047) respectively.The prevalence of blindness and moderate and severe visual impairment defined as presenting visual acuity was 1.90％ (96/5 047) and 7.23％ (365/5 047) respectively.The prevalence of blindness and moderate and severe visual impairment was higher in aged (trend x2 =674.44,P ＜ 0.01),female (x2 =39.61,P ＜ 0.01) and illiterate (trend x2 =142.82,P ＜ 0.01) persons.Cataract (52.70％) was still the first leading cause of blindness and visual impairment.The percentage of the retinal diseases,including age-related macular degeration,high myopic retinopathy and diabetic retinopathy was 11.31％ among the eyes with blindness and moderate and severe visual impairment.Un-corrected refractive error (13.38％) also was the main cause of visual impairment.Conclusions The prevalence of blindness and moderate and severe visual impairment in Shuangcheng City is relatively higher in China Nine Province Survey.Cataract,retinal diseases and uncorrected refractive error are the main causes of the blindness and moderate and severe visual impairment.

It is co-sponsored by Ophthalmology Branch of Shanghai Medical Association, Ophthalmology Branch of National Ten Provincial Medical Associations, Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, College of Optometry of Wenzhou Medical University and China International Science and Technology Conference Center of China Association for Science and Technology; The 14th International Conference on Ophthalmology and Optometry jointly organized by Eye, Ear, Nose and Throat Hospital affiliated to Fudan University, China International Science and Technology Conference Center and Shanghai Ruiou Exhibition Service Co., Ltd. will be held at Shanghai Transnational Procurement Exhibition Center (No.35 Zhongjiang Road, Putuo District, Shanghai) from March 27th to 30th, 2014.

Objective To investigate the risk factors of cataract among people aged 50 years and above in Funing county of Jiangsu province.Methods Case-control study.All of 1 488 cataract cases were selected from cataract patients' database and 1 821 subjects without visual impairment were recruited as controls from Funing county who were examined between June 2010 and May 2011.Unconditional logistic regression was used to analyze possible risk factors of cataract such as socioeconomic status,lifestyles,history of chronic disease,and history of exposure to sunlight.Results The univariate analysis results showed that the risk of cataract on-set was higher with aging.Odds ratios (ORs) for people aged 60 to ＜70 years,70 to ＜ 80 years,and ≥80 years were 6.88,87.66,and 416.19 respectively with statistical significance comparing to people aged 60 years and below.Female had 12％ higher risk of getting cataract than male(OR =1.24,P =0.003).Compared with the illiterate,the ORs with educational background of elementary school,junior high school,and high school and above were 0.44 (P ＜ 0.01),0.42 (P ＜ 0.01) and 0.09 (P ＜ 0.01) respectively.The risk of cataract in farmers,smokers,people with high blood pressureor diabetes were significantly high with OR of 3.13 (P ＜ 0.01),1.23 (P =0.003),1.44 and 1.92 (P ＜ 0.01),respectively.Long time exposure to sunlight increased cataract risk.The ORs of sunlight exposure during 3 to ＜4 hours,4 to ＜ 6 hours and ≥ 6 hours were 2.09 (P ＜ 0.01),2.89 (P ＜ 0.01),and 6.52 (P ＜ 0.01) respectively comparing to exposure less than 3 hours per day.Marital status and alcohol drinking were not associated with cataract (P ＞ 0.05).Multiple logistic regression analysis showed that the risk factors of cataract were the age (comparing the age of 50 to ＜60 years,the OR values of 60 to ＜70 years,70 to ＜80 years and ≥80years were 6.83,132.39,868.68 respectively with P ＜ 0.01),the gender(OR =2.29 for females,P ＜0.01),sunlight exposure(the OR for 3 to ＜ 4 hours exposure,4 to ＜ 6 hours exposure and ≥6 hours exposure were 2.88,5.99 and 13.28 respectively comparing to people with less than 3 hour exposure per day),smoking(OR =1.87,P =0.019) and diabetes(OR =1.31,P =0.029).Education was a protective factor with OR of 0.64,0.41 and 0.31 (P ＜ 0.01) for elementary school,junior high school and high school respectively.Conclusion Senior people,female,low level of education,smoking,history of diabetes and long time exposure to sunlight are risk factors of cataract among elderly people aged 50 years and above in Funing country.

With the approval of Ophthalmology Branch of Chinese Medical Association, the 14th National Academic Conference on Corneal and Ocular Surface Diseases and the 6th National Academic Conference on Corneal Refraction will be held in Shanghai from April 24 to 27, 2014. The Keratology Group of Ophthalmology Branch of Chinese Medical Association and the organizer of the conference-Eye, Ear, Nose and Throat Hospital affiliated to Fudan University sincerely invite domestic and foreign ophthalmologists, colleagues and ophthalmology business people to attend.

Objective To survey popularity and clinical characteristics of retinopathy of prematurity (ROP) in Xi'an area in infants with birth weight over 2 000 g.Methods Retrospective case-series study.ROP screening data of 1 866 infants was collected and reviewed from Department of Ophthalmology,Xijing Hospital from January 2008 to December 2012.One thousand eight hundreds and sixty-six cases (3 732 eyes) with 1 166 males and 700 females were examined.Their gestation age was (34 ± 4)weeks (24-46 weeks),and birth weight was (2 106 ± 743)g (730-4 900 g).All the related information about infants accepted examinations was screened,inquired and recorded carefully,such as gestation age,birth weight,continuous inhalation of oxygen and respirator applied records.Whether they had asphyxia,hypoxic-ischemic encephalopathy,acute respiratory distress syndrome,pneumonia,jaundice,anemia,congenital heart disease was also recorded.Moreover the physical situations of maternity including gestational hypertension,premature rupture of amniotic fluid,placenta abruption and placenta previa were also assessed.Percentiles (P90 and P95) of birth weight in ROP infants were calculated.Birth weight over 2 000 g in ROP patients was identified as high birth weight,whereas birth weight less than 2 000 g was confirmed as low birth weight.Clinical characteristics were compared in the two groups.T-test,Chi-square test,and Fisher's exact test were used for this study.Results In all the infants examined,243 cases were screened out as ROP patients with different stages.The positive rate was 13.0％.Among them,96 cases needed to be treated which was 39.5％.They were severer than pre-threshold Type Ⅰ.P90 and P95 of birth weight percentiles of these ROP infants were 2 060 g and 2 240 g.If birth weight less than 2 000 g was coufirmed as screen guideline,9.9％ patients might be excluded.There were 24 ROP infants whose birth weight were over 2 000 g with gestation age of (33 ±3)weeks(28-40 weeks),and with birth weight of (2 411 ± 354)g (2 100-3 300 g).Six of them needed to be treated,which was 6.3％.Compared with ROP infants with low birth weight,they had almost same stages and risk factors.Conclusions High birth weight ROP infants occupies some proportions in Xi'an area.They has no special characteristics or severity compared with low birth weight ones.

The Chinese Journal of Ophthalmology was founded on October 113, 1950. It was sponsored by the Chinese Medical Association and edited by the Editorial Committee of the Chinese Journal of Ophthalmology. The editorial committee is composed of nearly 100 well-known ophthalmologists in China. The current editor-in-chief Zhao Kanxing and the editorial director Huang Yibin. The main readers of this journal are ophthalmologists across the country, and it is publicly distributed at home and abroad. China Standard Issue Number: ISSN0412-4081, CN11-2142/R; Postal code: 2-60; National map code: M93. "Chinese Journal of Ophthalmology" has always implemented the principles and policies of the Party and the state on health work, implemented the principle of combining theory with practice, popularization and improvement, and reported the major progress and innovative achievements of clinical and scientific research in ophthalmology in China.

Objective To evaluate the vision-related quality of life in patients with exudative agerelated macular degeneration (AMD).Methods Retrospective case-series study.One hundred and twentytwo patients with exudative AMD who were treated in Beijing Tongren Eye Center from July 2007 to July 2008 were invited to participate in this study.Vision-related quality of life was evaluated by the 25-item National Eye Institute Visual Functioning Questionnaire.Statistical analysis was performed using t test for data which were normal distribution and using Wilcoxon rank sum test for data which were abnormal distribution.Results Eighty-seven cases were fully completed and included in the final analysis within the 122 questionnaires.The total score of the questionnaire was 57.2 ± 18.4,excluded driving item.The lowest scoring item was near activities with mean score of 30.8 ± 22.3.There was statistically significant difference in mental health between male (52.9 ± 26.3) and female (40.8 ± 26.0) (w =1 175,P ＜ 0.05).Except for the general health and ocular pain,patients with binocular involvement showed statistically significant lower scores than those with monocular involvement in all other subscales (P ＜ 0.05).The two age groups (patients ＜ 65 vs.≥65 years old) in binocular involvement group showed statistically significant difference only in the subscale of social activities (56.6±22.2 vs.42.3 ±30.2) (w=97,P=0.013).Conclusions This study suggests that exudative AMD damaged patients' near activities seriously.Female patients tends to have lower scores than male in mental health.The score of patients with binocular involvement is lower than that of patients with monocular involvement.Age has significant effects on the social activities of those patients with binocular involvement.

Objective To evaluate the effect of endoscopy assisted pars plana vitrectomy for severe ocular trauma with no light perception.Methods A retrospective case-series study.Medical records of 6 eyes of 6 patients undergoing endoscopy assisted vitrectomy for severe ocular trauma with no light perception from December 2006 to August 2009 were studied.Four patients were male and 2 patients were female.Their age ranged from 6 to 67 years old with an mean age of 38 years.History of trauma,visual acuity prior to vitrectomy and at final follow-up,bacterial culture results and surgical approaches were recorded.Results Visual acuity prior to vitrectomy was no light perception in all the 6 patients with a mean intraocular pressure of 3 mmHg(1 mmHg =0.133 kPa).All the patients had diffuse corneal edema along with opacities caused by corneal perforation from trauma in 3 patients,blood staining of cornea in 2 patients and endophthalmitis in 1 patient.B-scan ultrasound echography carried out before surgery showing that all the patients had retinal detachment.Three patients' vitreous samples were sent for bacterial culture.Bacillus cereus,S.epidermidis and Aeromonas Hydrophila were identified respectively.Patients were followed up for 18 to 36 months.Postoperatively,5 of the patients' visual acuity was better than light perception,ranging from light perception to 0.04.The retina was reattached in 4 patients.Conclusion Endoscopy assisted vitrectomy is a safe and effective option for the treatment of severe traumatic eye with no light perception.

The 2nd National Neuroophthalmology Conference (CNOS), the 2nd Cross-Strait Neuroophthalmology Forum (CNOF) and the 3rd National Neuroophthalmology Backbone Training Course of Ophthalmology Branch of Chinese Medical Association were held in Dalian from July 25 to 29, 2013. At the opening ceremony of this conference, the Neuroophthalmology Group of Ophthalmology Branch of Chinese Medical Association was formally established with the approval of Chinese Medical Association.

A 10-year-old male twin came to the Department of Ophthalmology of Peking Union Medical College Hospital on August 11, 2011 due to progressive decrease in visual acuity in both eyes, night blindness, gradual drooping of both upper eyelids for 4 years, bilateral deafness, tremor of both upper limbs and walking weakness for 1 year. Two patients suffered from the disease at the same time, and their manifestations were almost exactly the same, among which the younger brother was slightly deaf. No one else in the family had similar symptoms. Because of the deafness, the patient had difficulty in language communication, he relied on writing to communicate. Ophthalmological examination: the visual acuity of the older brother in his right eye was 0.15, 0.25 in his left eye, and the intraocular pressure in his right eye was 9 mmHg (1 mmHg =0.133 kPa), and that in his left eye was 12 mmHg; The visual acuity of the younger brother's right eye was 0.3, the visual acuity of the left eye was 0.1, and the intraocular pressure could not cooperate with the detection. Both upper eyelids were drooping (Figure 1), covering the upper 1/2 of the pupil, the eye position was right, and the movement in all directions was limited; Bilateral pupils are equal in size, with direct and indirect reflection of light; There was no abnormality in the anterior segment of the eye, and the lens was transparent.Fundus examination of two patients (Figure 2): the optic papillary boundary was clear and slightly yellow.The retinal blood vessels were thin, the posterior pole retina was dark in color, the retina was generally thinned, and large choroidal blood vessels were visible.

With the development and improvement of clinical diagnosis technology, the role of all kinds of ophthalmology clinical pictures in disease diagnosis has been paid more and more attention. In order to encourage clinical accumulation of relevant data, promote experience exchange, improve clinical diagnosis and treatment technology, provide a new platform for academic exchange for readers, and at the same time enrich the content and form of this journal to better serve the majority of ophthalmologists, this journal continued to open the "Picture Essence" column in 2014. The submitted pictures can be arranged according to the type of case or diagnostic technique, with relevant instructions,

The patient, a 62-year-old man, was seen in Henan Ophthalmology Research Institute on August 18, 2008 due to swelling of his right eye for more than half a year and exophthalmos for 3 months. The patient had retinal detachment in his right eye 4 years ago and lost sight. Three years ago, due to right eye pain and neovascular glaucoma in his right eye, he was given laser iridectomy in his right eye, and the symptoms were relieved. Ophthalmological examination: Visual acuity: no light sensation in the right eye, 0.5 in the left eye. The right eyelid was swollen, and a round mass about 2 cm in diameter could be palpable above the temporal portion of the right eyeball, which was dark in color and tightly adhered to the eyeball. The cornea of the right eye was edema and turbid, with a large amount of endothelial pigmentation, disappearance of the anterior chamber, iris atrophy, pupil membrane closure, disappearance of light reflex, and invisibility of the posterior segment of the eye. The intraocular pressure measured by the finger was T +2, the eyeball rotation was poor, the right eyeball moved downward, and there was no abnormality in the left eye (Figure 1).

The patient was a 19-year-old male. He went to Beijing Tongren Eye Center on February 1, 2013 because of blurred vision in his right eye for 2 months, a tumor in his right eye for 1 month, and occasional eye swelling. The patient went to the ophthalmology department of another hospital 2 weeks ago and was diagnosed with "iris mass in his right eye and amblyopia in his left eye", but no further treatment was performed. The patient had amblyopia in his left eye since childhood, and denied the history of ocular trauma and ocular surgery, ocular medication, systemic disease and systemic surgery (including amniocentesis during fetus). Ocular examination: visual acuity: right eye 0.7, left eye 0.2. BCVA: right eye 0.7, left eye 0.2. Non-contact intraocular pressure: right eye 24.0 mmHg (1 mmHg =0.133 kPa), left eye 15.9 mmHg.

A 66-year-old female, Uygur nationality, came to the Department of Ophthalmology of Occupational Disease Hospital of Xinjiang Uygur Autonomous Region for 5 years of visual loss in her right eye, 2 years of loss of vision, and half a year of eye swelling and eye pain. She had a history of diabetes mellitus for 18 years. Ocular examination showed that the visual acuity was light sensing in the right eye and 0.2 in the left eye, the intraocular pressure in the right eye was 60~70 mmHg (1 mmHg =0.133 kPa), the cornea was foggy and opaque, a large number of new blood vessels could be seen on the surface of the iris, the pupil was extensively adhered posteriorly, the lens density was significantly increased (Quintessence Picture 1), and the fundus was invisible.

The patient was a 23-year-old male who went to Guangzhou Aier Eye Hospital because of visual acuity decrease in his left eye and visual object deformation. The patient was in good health and had no history of systemic disease or trauma. Ocular examination showed that the visual acuity was 1.5 in the right eye and 0.2 in the left eye, and the intraocular pressure was 13 mmHg (1 mmHg =0.133 kPa) in the left eye and 14 mmHg in the left eye. No abnormalities were found in the anterior segment of the left eye, and the essence picture 1 was seen in the left fundus of the eye. No abnormalities were found in the examination of the right eye. Ultra-high-speed scanning was performed by Fourier domain OCT. The conventional 6 mm ×6 mm pattern showed retinoschisis and neuroepithelial detachment, but the foveal defect was not found (essence picture 2). In the 9 mm ×12 mm wide scan mode, the fovea slightly temporal below the optic head is shown in the color fundus image, and its center corresponds to the optical dark area where the optic head structure is broken in the OCT image, and communicates with the vitreous cavity. This is the defect of the optic head fovea (essence picture 3). In essence picture 4, there is a hole in the outer layer of the macular neuroepithelium, and the split cavity of the neuroepithelium communicates with the serous detachment cavity of the neuroepithelium. Clinical diagnosis: congenital fovea of the optic head with myelin nerve fibers in the left eye.

In order to comply with the development trend of network and digitalization of journals and provide high-quality services for authors and readers, the Journal of Chinese Medical Association has developed a remote manuscript management system. The system is designed according to the business requirements of manuscript processing process, editing and processing specification, manuscript review system and management specification of Chinese Medical Association series magazines. It adopts advanced database and network technology, and has strong data processing and analysis ability. The remote manuscript management system will assist authors, editors, reviewers, editorial boards,

A 49-year-old woman came to Xiamen Eye Center for treatment due to blurred vision in her right eye and dark shadows in front of her eyes for 2 months. She had undergone hemorrhoid surgery in another hospital 2 years ago (details unknown). The patient was depressed, anxious, often insomnia and tears. He denied that she and her family had a history of mental illnesses. Eye examination: No obvious abnormalities were found in the left eye. The naked visual acuity of the right eye was 0.1, the corrected visual acuity was 0.4 (+3.00 DS), and no obvious abnormalities were found in the anterior segment of the eye. Fundus macular edema, retinal folds, and no obvious abnormalities in the peripheral part (Quintessential Picture 1); The results of fundus angiography are shown in essence picture 2; the results of OCT are shown in essence picture 3. Clinical diagnosis: central serous chorioretinopathy with extensive serous pigment epithelial detachment in the right eye.

It is now well recognized that vitreomacular adhesion (VMA) plays an important role in the pathogenesis of various retinopathy.Traction released through pars plana vitrectomy was used before,but it is limited by some problems such as incomplete vitreoretinal separation,vitreous remnant and other operative complications.While another new method-Pharmacologic Vitreolysis provided us a new method for persistent pathologic VMA treatment.This review aims to introduce the vitreous molecular structure,principles of posterior vitreous detachment and progression of pharmacologic vitreolysis method study.

In order to enable national ophthalmologists and other related doctors to have a deeper understanding of the marginal discipline of orbital disease and further promote the development of this discipline, the 7th National Orbital Disease Diagnosis and Treatment and the First National Orbital Fracture Surgical Skills and Progress Study Class sponsored by the Institute of Orbital Diseases of Armed Police General Hospital and co-organized by the Institute of Ophthalmology of Shenyang Fourth Hospital will be held in Shenyang from August 7 to 10H, 2014. National Category I continuing education credits (10 points) are awarded upon graduation. At that time, related diseases such as orbital tumors, periorbital plastic surgery and orbital fracture treatment progress will be discussed. At the same time, doctors in ophthalmology, neurosurgery, otolaryngology and maxillofacial surgery are welcome to register for the conference.

With the continuous development of ophthalmology and translational medicine, more and more ophthalmologists pay attention to multi-center clinical trials. However, quite a few people are still unclear about why and how to organize and design multi-center clinical trials. If there are problems in the organization and design of multi-center clinical trials, then even if the trials are carried out, they will not get reliable and credible conclusions, but will lead to misleading.

In May 2013, the 66th World Health Assembly (WHA) signed WHA Resolution 66.4 "Towards Universal Eye Health: Global Action Plan 2014-2019". The Global Action Plan aims to support and expand the efforts of World Health Organization (WHO) member states and secretariats and international partners to further improve eye Health. It is expected that the Global Action Plan 2014-2019 will provide a roadmap for consolidating global joint efforts towards universal eye Health.

The International Retina Summit Forum (IRS) 2013, jointly organized by Aier College of Ophthalmology of Central South University, Department of Ophthalmology and Visual Sciences of The Chinese University of Hong Kong and Chinese Journal of Ophthalmology, was held in Shenzhen, Guangdong Province from October 18 to 20, 2013. The theme of the forum was the application of new technologies in clinical diagnosis and treatment of fundus, diagnosis and treatment of difficult diseases and the most cutting-edge basic research, and explored new challenges in the field of fundus.