Rupert Richard Alexander Bourne

Purpose: To investigate global and regional risk factors for blindness and vision impairment pertaining to all geographical locations between 1990 and 2020. Methods: (1) Twenty-four covariates were selected with a potential link to vision impairment from the Global Burden of Disease Study (GBD) Covariates database as predictive factors. (2) From these, the linear association was investigated, with crude and age-standardised prevalence estimates of blindness and distance and near vision impairment in 2020 by using data for the whole population, sex and 5-year age groups, and by stratifying severity through mild, moderate, severe and total impairment. (3) Analysis investigated whether percentage rates of change in risk factors were associated with rates of change in prevalence in 1990–2020. Results: For adults (50+ years), for crude and age-standardised vision loss prevalence estimates for the year 2020, a significant negative association of smoking prevalence was found initially for all persons and for each sex, which appears to be due to ecological confounding and became a positive association using more granular regional and age group data. Maternal care and immunisation, sanitation proportion, Health Access and Quality Index and Socio-demographic Index were other significant age-standardised negative associations. Ophthalmologists/million population had a weak but significant protective effect, and positive associations were found for pollution (outdoor and indoor), stronger for greater vision impairment severities. Years in education per capita were weakly, negatively associated with vision loss prevalence, yet zero education proportion had a stronger but positive association for both sexes. Conclusions: This study confirmed associations at population level globally, which appear to be stable over decades. In addition, the study quantified the contribution of epidemiologically-based risk factors to vision loss at a GBD super-regional level, which is novel. This opens useful avenues for targeted intervention by policymakers. For example, reduction in sex inequity in blindness rates over 30 years has been positively associated with reducing overall prevalence of blindness.

Objective: The aim of this study was to report results of a survey on the diagnostics, progression monitoring, and treatment of glaucoma in myopic eyes and identify future research priorities. Methods: We conducted a survey among the members of the European Glaucoma Society to explore their perspectives on the most critical questions regarding glaucoma in myopic eyes. We asked participants to compose critical questions about glaucoma diagnostics, progression monitoring, nonsurgical, and surgical management in myopic eyes. We used large language models to identify the most frequently recurring themes in the questions and human evaluation to validate and calculate responses for each theme. Results: A total of 251 participants out of 1045 responded, of whom 98% were glaucoma specialists, and 86% glaucoma surgeons. We received 581 questions on diagnostics, 470 on progression monitoring, 453 on nonsurgical treatment, and 483 on surgical treatment of glaucoma in myopic eyes. The top themes for diagnostics and progression monitoring were differentiating glaucomatous changes and progression from myopic changes and progression, role and reliability of ocular coherence tomography, and visual field testing and interpretation in myopic eyes. For treatment, the leading themes were choice of surgical procedure, effectiveness of different medications, and effectiveness of selective laser trabeculoplasty in the treatment of glaucoma in myopic eyes. Conclusions: The survey showed that there are knowledge gaps regarding diagnostics, monitoring, and treatment of glaucoma in myopic eyes among glaucoma experts. We recommend that the most frequently recurring themes of this survey are prioritised in future research in this area.

Background/aims Many countries provide social support to patients with severe sight impairment (blindness). In the UK, these benefits require a certificate of visual impairment (CVI) which requires referral by a consultant ophthalmologist. Many eligible patients do not receive a CVI due to personal choice or lack of consideration or communication by their doctor. This study investigated the frequency and reasons for missed certification in glaucoma. Methods A retrospective cross-sectional survey was undertaken of all patients with glaucoma attending a tertiary referral clinic over a 12-month period. Semi-automated screening using objective visual acuity and perimetry parameters was facilitated by a web application, GFDC (Glaucoma Field Defect Classifier). CVI-eligible patients’ records were analysed to determine the reasons for missed registration, including incorrect screening classification. Results Of 5620 individual patients consulted, 919 were classified as sight impaired, and 64 were classified as severely sight impaired (blind). Of the patients classified as blind, 7 (11%) were misclassified, and 36 (56%) were on the CVI register already. 21 of 57 eligible patients with glaucoma-induced blindness (37%) were unregistered. Reasons for missed registration included administrative failure (23.8%), lack of consent (9.5%), reversible visual impairment (19.0%), frailty and comorbidity (71.4%), and mental health diagnoses (38.1%). Conclusion A semi-automated algorithm can be used to screen large numbers of patients for CVI eligibility due to blindness. Many eligible patients are not registered, with risk factors including frailty, comorbidity and reversible causes of visual impairment. This algorithm could be used to prompt ophthalmologists to consider registration or used as an alternative referral mechanism. Screening for CVI-eligible patients with an objective algorithm may ameliorate the inequity associated with subjective and variable decision-making.

Objectives: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by diabetic retinopathy and their proportion of the total number of vision-impaired individuals. Methods: Data from population-based studies on eye diseases between 1980 to 2018 were compiled. Meta-regression models were performed to estimate the prevalence of blindness (presenting visual acuity <3/60) and moderate or severe vision impairment (MSVI; <6/18 to ≥3/60) attributed to DR. The estimates, with 95% uncertainty intervals [UIs], were stratified by age, sex, year, and region. Results: In 2020, 1.07 million (95% UI: 0.76, 1.51) people were blind due to DR, with nearly 3.28 million (95% UI: 2.41, 4.34) experiencing MSVI. The GBD super-regions with the highest percentage of all DR-related blindness and MSVI were Latin America and the Caribbean (6.95% [95% UI: 5.08, 9.51]) and North Africa and the Middle East (2.12% [95% UI: 1.55, 2.79]), respectively. Between 2000 and 2020, changes in DR-related blindness and MSVI were greater among females than males, predominantly in the super-regions of South Asia (blindness) and Southeast Asia, East Asia, and Oceania (MSVI). Conclusions: Given the rapid global rise in diabetes and increased life expectancy, DR is anticipated to persist as a significant public health challenge. The findings emphasise the need for gender-specific interventions and region-specific DR healthcare policies to mitigate disparities and prevent avoidable blindness. This study contributes to the expanding body of literature on the burden of DR, highlighting the need for increased global attention and investment in this research area.

Objectives: To validate and update the 2013 James Lind Alliance (JLA) Sight Loss and Vision Priority Setting Partnership (PSP)’s research priorities for Ophthalmology, as part of the UK Clinical Eye Research Strategy. Methods: Twelve ophthalmology research themes were identified from the JLA report. They were allocated to five Clinical Study Groups of diverse stakeholders who reviewed the top 10 research priorities for each theme. Using an online survey (April 2021-February 2023), respondents were invited to complete one or more of nine subspecialty surveys. Respondents indicated which of the research questions they considered important and subsequently ranked them. Results: In total, 2240 people responded to the survey (mean age, 59.3 years), from across the UK. 68.1% were female. 68.2% were patients, 22.3% healthcare professionals or vision researchers, 7.1% carers, and 2.1% were charity support workers. Highest ranked questions by subspecialty: Cataract (prevention), Cornea (improving microbial keratitis treatment), Optometric (impact of integration of ophthalmic primary and secondary care via community optometric care pathways), Refractive (factors influencing development and/or progression of refractive error), Childhood onset (improving early detection of visual disorders), Glaucoma (effective and improved treatments), Neuro-ophthalmology (improvements in prevention, diagnosis and treatment of neurodegeneration affecting vision), Retina (improving prevention, diagnosis and treatment of dry age-related macular degeneration), Uveitis (effective treatments for ocular and orbital inflammatory diseases). Conclusions: A decade after the initial PSP, the results refocus the most important research questions for each subspecialty, and prime targeted research proposals within Ophthalmology, a chronically underfunded specialty given the substantial burden of disability caused by eye disease.