Timur R. Gilmanshin

Objective. To assess the medical, social and demographic status of patients with diabetic retinopathy (DR) in real clinical practice and to form a sportsman of a patient with this pathology of the organ of vision. Material and methods. A survey of 314 patients with DR was conducted in the adult outpatient consultative department of the Ufa Research Institute of Eye Diseases. Results. The most typical portrait of a patient with DR receiving medical care in a polyclinic in the Republic of Bashkortostan includes the following characteristics: age from 61 to 70 years (in 34,9% of cases), female gender (68,79%), residence in regional centers and other cities of the Republic of Bashkortostan (excluding Ufa) (in 61,14% of cases), secondary specialized education (56,69%), being on a permanent pension benefit (73,89%), being married (53,50%), assessment of their monthly income level as low (38,22%). Regarding the clinical status, patients with DR had predominantly bilateral damage to the organ of vision (89,81%), non-proliferative and pre-proliferative forms of the disease (43,93% and 42,99%, respectively), the duration of the disease was from 3 to 5 years (32,48%), the presence of concomitant pathology of the organ of vision in the form of cataracts (60,8%), and, in addition to diabetes mellitus, suffering, in most cases, from cardiovascular pathology (54,78%). Conclusion. The results of the study allowed us to form a clinical and anamnesitic image of a patient with stable diabetes and others. The study of the medical and social aspects of this patient population is a very important aspect in the clinical practice for a better understanding of the needs and capabilities of people with this complex chronic pathology, both in terms of drug therapy, medical supervision and other areas of the patient's lifestyle related to health. Keywords: Diabetes mellitus, diabetic retinopathy, medical and social characteristics of the patient, patient portr ait

Purpose. To analyze the prevalence of blindness and vision impairment due to age-related macular degeneration. Material and methods. In the period from 2015 to 2017, cross-sectional clinical and population study Ural eye and Medical Study (UEMS) were conducted at the Ufa Research Institute. Results. Among individuals with moderate to severe vision impairment, late stage of age-related macular degeneration was the cause of vision impairment in 14 respondents (7.7%; 95% CI: 3.8–11.6), among whom geographic atrophy was noted in 7 (3.8%; 95% CI: 1.0–6.7) people. Among individuals suffering from blindness, AMD as the main cause of vision loss was identified in 2 respondents (18.2%; 95% CI: 3.2–52.2). The proportion of individuals has moderate to severe vision impairment due to age-related macular degeneration in the study population was 0.24% (95% CI: 0.14–0.41), The proportion of people who became blind due to age-related macular degeneration was 0.03% (95% CI: 0.01–0.14). Conclusion. In the population of the Southern Urals, the prevalence of moderate and severe visual impairment due to age-related macular degeneration was 0.24% (95% CI: 0.14–0.41), blindness – 0.03% (95% CI: 0.01–0.14). The data obtained are comparable with those among the regions of the world and the world population as a whole. Key words: clinical and population studies, age-related macular degeneration, vision impairment, blidness

Purpose. To study and assess medication adherence in patients with primary glaucoma with regard to the main clinical and demographic parameters. Material and methods. The study was conducted on the basis of Ufa Eye Research Institute by random sampling of individuals with primary glaucoma from June to September 2024. Data from a sociological survey of 244 respondents using a modified Morisky – Green questionnaire were used in the work. Statistical analysis of the data was performed using IBM SPSS Statistic. Results and discussion. We found that the percentage of non-adherent patients was the highest and estimated at 58.2%, the share of adherent patients was the lowest – 5.7%, and 36.1% of patients were insufficiently adherent. Among the non-adherent patients, there were no statistically significant differences both between men and women (men – 65.0%, women – 51.7%, p=0.11), and between Ufa residents, people living in district centers or towns of Bashkortostan, and rural residents (51.7%, 60.0%, and 64.7%, respectively, p=0.06). However, the share of non-compliant patients with primary glaucoma stage I was 41.2%, with stage II – 60.9%, with stage III – 60.0%, with stage IV – 63.6% (p=0.3). Conclusion. Our data show that the majority of glaucoma patients have low medication adherence. Enhancing patient compliance remains an urgent public health problem, and developing the necessary strategies will increase the efficacy of medical care and improve the quality of life in glaucoma. Key words: medication adherence, compliance, glaucoma, quality of life

Purpose. To develop a program for predicting the resistance of diabetic macular edema based on its morphofunctional characteristics, providing the ability to diagnose the type of DME and formulate a further effective treatment plan for the patient. Material and methods. To implement this task, 448 patients (448 eyes) with newly diagnosed DME and compensated type 2 diabetes were examined, the duration of which was 11.5±3.5 years. The average age of the patients was 64.3±4.9 years. The number of women is 230 (51,3%), men – 218 (48,7%). A complete ophthalmological examination was carried out, including additional research methods such as spectral optical coherence tomography of the macular area of the operated eye. Patients resistant to loading doses of anti-VEGF drugs (brolucizumab, ranibizumab, aflibercept) were switched to intravitreal administration of a dexamethasone-containing implant. The observation period was 6 months after the last injection. Results. As a result of the study, a clinical working classification of DME was developed. According to the proposed classification, DME was divided into non-resistant and resistant. The latter, in turn, includes low-resistant (to loading injections of an anti-VEGF drug, but with a good response to 1 injection of an implant with dexamethasone) and highly resistant (both to loading injections of an anti-VEGF drug and to a single injection of an implant with dexamethasone). Based on the data obtained, a formula was derived for calculating the resistance classification coefficient, on the basis of which a computer program was developed that determines the type of edema according to the classification we developed after entering the data. Conclusion. The developed clinical classification of DME resistance makes it possible to make a decision on choosing the most effective drug for initial therapy based on the morphofunctional characteristics of the retina of a particular patient. The proposed program for predicting the resistance of diabetic macular edema to intravitreal pharmacotherapy based on its morpho-functional characteristics can be used by outpatient ophthalmologists to assess the type of diabetic macular edema, which will allow drawing up a further plan for effective treatment of the patient. Key words: diabetic macular edema, treatment, prediction of resistance, intravitreal pharmacotherapy, computer program, classification of diabetic macular edema

Purpose. To analyze the prevalence of glaucoma in Bashkortostan depending on the stage of the disease, gender and settlement features of the respondents. Material and methods. 5899 individuals (including glaucoma by optic nerve head morphology changes — 5458) took part in this population-based analytical cross-sectional study; of them 3400 rural and 2499 urban people. The study procedure involved the evaluation of 683 criteria for each person, 293 of them related to the respondents’ questionnaire answers and general somatic examination, 355 referred to ophthalmic examination and 35 to laboratory tests. For glaucoma detection we applied the classification of Jonas J.B. et al. (1988), based on optic nerve head morphology changes. Eye exams included measuring BCVA and uncorrected visual acuity, autorefractometry, bimicroscopy, A-scans (axial length, depth of anterior chamber, lens thickness), non-contact tonometry tests, ophthalmoscopy, corneal kertotopography, fundus photography, static perimetry, OCT. Results. Glaucoma was detected in 561 out of 10 961 examined eyes (5458 people). Its prevalence in age groups was significantly different. The highest prevalence was noted in group of 85–89 years (24.2 %) and it significantly exceeded the rates in other age groups (1.4–12.7 %). Stage I glaucoma was detected in 58.1 %, Stage II in 20.1 %. Stage III in 11.4 %. Stage IV — 8.2 % and Stage V in 2.1 %. The prevalence of glaucoma in the Southern Urals among 40+ made up 5.2 % (open-angle glaucoma — 3.8 %, angle-closure glaucoma — 1.5 %), with a predominance among men and a significant (2.2-fold) prevalence among urban people. In total, the index of glaucoma prevalence was 1.5-fold higher than the average world index (3.5 %), there was a tendency to its increase with age. The highest correlation of glaucoma is associated with such factors as increased IOP, age, city residence and elongated axial length. Conclusion. The relatively high prevalence of glaucoma in the Ural region (5.3 %), which was revealed during the population-based study, may indicate not only the impact of hereditary or cultural factor on glaucoma development, but also some features and problems of ophthalmic care provision in this region. The question demands further investigation and taking certain measures. It is natural that the results obtained are of great importance for the development of glaucoma monitoring and the improvement of pathology prevention in the region. Keywords: glaucoma, epidemiological characteristcs

Age-related macular degeneration is one of the most common causes of visual impairment and blindness worldwide. As the population ages, AMD is becoming an increasingly significant and frequent disease. The pathogenesis of this process remains not fully elucidated and is more related to genetic factors and environmental influences. This article highlights data on the prevalence and risk factors of AMD according to the results of global population studies. The prevalence of AMD according to the data of the only population study in Russia, the Ural Eye and Medical Study (UEMS), in which 5899 urban and rural residents of the Republic of Bashkortostan aged 40 years and older participated, was 10.5%, which was lower than the same indicator in Western Europe (12.3 %), and higher than in East Asia (7.4 %) and Africa (7.5 %). Risk factors for AMD development according to the UEMS are older age, rural region of residence, shorter eye axial length and lower prevalence of diabetes. Keywords: age-related macular degeneration, population study, prevalence, risk factors

Intrоduction. Various biometric indicators of the eyeball in certain categories of the population continue to be the subject of research and discussion among specialists. At the same time, the information provided by different authors regarding the normal values of the length of the axial length of the eye is quite contradictory, while the norm indicators in certain population groups and subgroups are of great value. This fact was the reason for the present study. Material and methods. Between 2017 and 2020 The Ufa Eye Research Institute conducted a descriptive and analytical population study Ural Very Old Study (UVOS), in which 1526 participants took part. Results. The axial length of the eyeball in the population of the Republic of Bashkortostan (RB) aged 85 years and older is, on average, 23.11±1.08 mm. The conducted multivariate linear regression analysis showed the most statistically significant association of axial length (cumulative coefficient of determination R² =0.70) with factors such as height (p<0.001), level of education (p=0.002), refractive power of the cornea (p<0.001), spherical refractive error (p<0.001). Conclusion. The morphometric and correlation features of the length of the anterior-posterior axis of the eyeball revealed in the UVOS study determine the presence of regional specificity of the anatomical and nosological characteristics of the organ of vision in the population of the Republic of Bashkortostan aged 85 and older. Key words: axial length, population study, year 85 and older

Background: Back pain and neck pain are leading causes of the burden of disease worldwide, while information about their prevalence in Russia is missing.Methods: The population-based Ural Eye and Medical Study was conducted in a rural and urban region in Bashkortostan/Russia. As part of a detailed systematic examination, we assessed the prevalence of low back pain, thoracic spine pain and neck pain in an interview with standardized questions in 5397 study participants (mean age:58.6 ± 10.6 years;range:40–94 years).Results: The mean prevalence of low back pain, thoracic spine pain and neck pain was 2912/5397 (54.0%;95% confidence interval (CI):52.6,55.3), 1271/5397 (23.6%;95%CI:22.4,24.7), and 1570/5397 (29.1%;95%CI:27.9,30.3), respectively. A higher prevalence of low back pain was associated with females (P = 0.04;odds ratio (OR):1.14;95%CI:1.004,1.30), younger age (P < 0.001;OR:0.99;95%CI:0.98,0.99), higher body mass index (P = 0.002;OR:1.02;95%CI:1.01,1.03), lower frequency of vigorous activities during leisure time (P = 0.001;OR:0.79;95%CI:0.69,0.90), more time spent sitting and reclining (P = 0.03;OR:1.00;95%CI:1.00,1.00), higher serum concentration of high-density lipoproteins (P = 0.004;OR:1.10;95%CI:1.03,1.18), higher prothrombin index (P = 0.003;OR:1.01;95%CI:1.003,1.01), higher prevalence of a history of cardiovascular disease (P = 0.004;OR:1.23;95%CI:1.07,1.42), falls (P < 0.004;OR:1.71;95%CI:1.45,2.00), bone fractures (P = 0.01;OR:1.18;95% CI:1.03,1.34), unconsciousness (P < 0.001;OR:1.78;95%CI:1.40,2.25), osteoarthritis (P < 0.001;OR:2.76;95%CI:2.34,3.26), iron-deficiency anemia (P < 0.001;OR:1.87;95%CI:1.41,2.50), and thyroid disorder (P = 0.004;OR:1.37;95%CI:1.10,1.70), fewer days of vegetable intake (P < 0.001;OR:0.89;95%CI:0.85,0.93), smaller amounts of salt intake (P = 0.008;OR:0.97;95%CI:0.94,0.99), higher anxiety score (P < 0.001;OR:1.05;95%CI:1.03,1.06), and in women, history of menopause (P = 0.02;OR:1.36;95%CI:1.05,1.75). The prevalence of thoracic spine pain and neck pain showed similar associations.Conclusions: In a Russian population, the prevalence of low back pain, thoracic spine pain and neck pain (54.0, 23.6 and 29.1%, respectively) were correlated with parameters such as the female sex, younger age, higher body mass index, higher anxiety score, higher prevalence of a history of cardiovascular disease, lower frequency of vigorous activities and more time spent sitting or reclining. These data may be of interest for assessing the burden of back and neck pain in Russia as part of the global burden of disease.

Aim. To study of the prevalence of diabetes and diabetic retinopathy in the Republic of Bashkortostan among people over 40 years of age, depending on the stage of the disease, gender and the nature of the settlement of the respondents. Materials and methods. A population-based study “Ural Eye and Medical Study” on the basis of the Ufa Research Institute of Eye Diseases covered 5899 people, of whom 2581 (43.7 %) were men, 3318 (52.3 %) were women. There were 2501 (42.3 %) urban residents, 3398 (59.7 %) rural residents. Statistical data analysis was performed using the IBM SPSS Statistic application package.Results. According to the study, diabetes was observed in 687 people, among them – 221 (32.2 %) men, 466 (67.8 %) women; urban residents – 378 (55.0 %) people, rural – 309 (45.0 %) people. The prevalence of diabetes is 11.6 %. Diabetic retinopathy was observed in 102 people (27 men – 26.5 %, and 75 women – 73.5 %), urban residents – 60 (58.8 %), rural – 42 (41.2 %). The prevalence of diabetic retinopathy among the entire study population was 2.1 %, or 14.8 % in the diabetic population. Conclusions. The prevalence of diabetes in the Republic of Bashkortostan according to the results of the Ural Eye and Medical Study was 11.6 % among people over 40 years old. The prevalence of diabetic retinopathy in the general population of the republic was 2.1 %, and in the population with diabetes it was 14.8 %, which is, in general, less than the global average.

Although anemia is one of the leading causes of the global burden of disease, information about its prevalence in Russia is mostly missing. We therefore assessed its prevalence and associated factors in a Russian population. The population-based Ural Eye and Medical Study included 5899 (80.5%) out of 7328 eligible individuals (mean age:59.0 ± 10.7 years;range:40–94 years) who underwent a standardized interview and detailed general examination. The definition of anemia was based on the hemoglobin concentration (definition #1:hemoglobin concentration < 140 g/L in men,< 130 g/L in women; definition #2:hemoglobin concentration < 130 g/L in men,< 120 g/L in women [World Health Organization definition]). Higher hemoglobin concentration (mean:142.6 ± 14.8 g/L; range:80-171 g/L) was associated (multivariable analysis) with male gender (P < 0.001; standardized regression coefficient beta:-0.20), higher waist-hip circumference ratio (P < 0.001;beta:0.05), higher prevalence of car ownership (P < 0.001;beta:0.05), higher blood concentrations of bilirubin (P < 0.001;beta:0.05) and triglycerides (P < 0.001;beta:0.06), lower erythrocyte sedimentation rate (P < 0.001;beta:-0.32), and shorter blood clotting time (P < 0.001;beta:-0.39). Using definition #1 and #2, anemia was detected in 1385 individuals (23.6%;95% confidence interval CI)CI:22.5,24.7) and in 453 individuals (7.7%;95%CI:7.0,8.4), respectively. Prevalence of moderate anemia (hemoglobin concenttration:110 g/L-80 g/L), detected in 165 individuals (2.8%;95%CI:2.4,3.2), increased with younger age (P = 0.008;odds ratio (OR):0.98;95%CI:0.96,0.99), female gender (P < 0.001;OR:2.52;95%CI:1.47,4.33), higher erythrocyte sedimentation rate (P < 0.001;OR:1.08;95%CI:1.06,1.09), longer blood clotting time (P < 0.001;OR:8.56;95%CI:5.68,12.9), and marginally significantly, with a lower waist-hip circumference ratio (P = 0.058;OR:0.13;95%CI:0.02,1.07). In women, it was significantly (P < 0.001) higher before menopause (8.8%;95%CI:6.4,11.1) than after menopause (3.5%;95%CI:2.8,4.3). In this Russian population as compared to populations from countries with a similar socio-demographic index, anemia prevalence was relatively low. As in other populations, higher anemia prevalence was strongly and inversely associated with menopause, and to a minor degree, with lower waist-hip circumference ratio and lower socio-economic background.