. Purpose:  To estimate the prevalence of primary angle‐closure glaucoma (PACG), primary angle closure (PAC) and primary angle‐closure suspect (PACS) and associated risk factors for PACG in a rural population in Northeast China. Methods:  A population‐based survey was conducted in Bin County, Harbin, Northeast China. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. All subjects underwent a complete ophthalmic examination. Results:  A total of 4956 (86.01%) of 5762 subjects aged 40 years or older were examined. The mean intraocular pressure (IOP) of the right eyes was 14.0 mmHg. The mean vertical cup‐to‐disc ratio of the right and the left eyes was 0.31 and 0.31, respectively. The prevalence of PACG, PAC and PACS was 1.57% [95% confidence interval (CI), 1.469–1.671], 1.33% (95% CI, 1.236–1.424), and 4.68% (95% CI, 4.541–4.819), respectively. Among all PACG subjects, 42 (53.84%) had elevated IOP >21 mmHg in either eye and 37 (47.44%) had been treated by laser, surgical iridectomy or trabeculectomy. Sixty‐four subjects (82.05%) had vision impairment of varying degrees. Multivariate analysis revealed that old age, family history of PACG, constipation and IOP were significant independent risk factors. Conclusions:  Primary angle‐closure glaucoma was a disease of high prevalence in rural Northeast China. Old age, family history of PACG, constipation and IOP were significant independent risk factors for PACG.

ABSTRACT.Purpose: To investigate the prevalence and causes of distance-visual impairment and near-vision impairment in a rural Chinese population in Inner Mongolia. Methods: A population-based, cross-sectional study design was used to identify visual impairment in the Chinese aged 40 years and older living in Kailu County, Inner Mongolia. Low vision, blindness and near-visual impairment (NVI) were defined according to World Health Organization (WHO) criteria. Results: The overall prevalence of blindness and visual impairment based on the presenting visual acuity (VA) was 2.2% (95% CI: 1.8-2.6) and 9.8% (95% CI: 8.9-10.6), respectively, and was adjusted to 0.9% (95% CI: 0.6-1.2) and 4.7% (95% CI: 4.1-5.3) using best-corrected visual acuity (BCVA), respectively. Taking the presenting VA into consideration, the leading cause of visual impairment and blindness was cataract (40.3%, 40.9%), followed by uncorrected refractive error (26.6%, 28.2%). According to the BCVA, the main cause of visual impairment and blindness was cataract (48.3%, 41.3%) followed by glaucoma (19.0%, 23.9%). Among the examined subjects, 80.3% had NVI, and 51.7% had presbyopia. Major barriers reported by NVI persons without near correction were lack of money to purchase prescription glasses and poor quality of the available ones (43.2%). Conclusion: Visual impairment is a serious public health problem, and the main causes leading to visual impairment are treatable and preventable in the rural Chinese population in Inner Mongolia. Presbyopia, together with the low rate of spectacles and lack of appropriate refractive and presbyopia spectacles, is highly prevalent in rural China.

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ABSTRACT.Purpose: To investigate the prevalence and causes of visual impairment in a rural population in north-east China. Methods: A population-based study was conducted within Bin County, Harbin of north-east China. Low vision and blindness were defined using the World Health Organization categories of visual impairment. The prevalence of visual impairment was estimated, and causes were identified based on best-corrected visual acuity (BCVA) as well as presenting visual acuity (VA). Results: Out of 5764 people, 4956 (86.01%) aged older than 40 participated in the study. The prevalence of visual impairment, low vision and blindness based on presenting VA was 9.6% (BCVA, 6.6%), 7.7% (BCVA, 4.9%) and 1.9% (BCVA, 1.7%), respectively. Taking the presenting VA, cataract (44%) was the most common cause for visual impairment followed by uncorrected refractive error (24%), treatable causes of visual impairment accounted for 68% of the total cases. Cataract (59%) and glaucoma (15%) were leading causes for blindness based on presenting VA. According to BCVA, cataract was the leading cause of visual impairment and blindness (58% and 60%, respectively), followed by glaucoma (17% and 15%, respectively). The prevalence of visual impairment was higher among women than men (p < 0.0001) and increasing with age (p < 0.0001) and decreasing with increasing education level (p = 0.0075). Conclusion: Visual impairment was a serious public health problem in this rural population, with most of it easily remedied. Results highlighted the need for visual impairment prevention programs to an increasing number of elderly people, with a special emphasis on female and those with little or no education.

Purpose: To evaluate the intraocular pressure (IOP)-lowering effect of the combination of phacoemulsification with intraocular lens implantation (PEI), goniosynechialysis (GSL), and goniotomy (GT) in eyes of advanced primary angle-closure glaucoma (PACG) with cataract. Design: Multicenter observational study. Methods: We enrolled 83 eyes of 83 patients with advanced PACG who received combined PEI+GSL+GT at 8 ophthalmic institutes. Each patient was assessed before treatment and at 1, 7 days, 1, 3, 6, and 12 months postsurgery. The criteria for complete success were IOP within 6 to 18 mm Hg and at least 20% of reduction in IOP from baseline without ocular hypotensive medications or reoperation. The definition of qualified success was similar to that of complete success, except for the need for ocular hypotensive medications. The potential prognostic factors for surgical success were investigated using a multivariate logistic model. Results: All participants completed 1 year of follow-up. Complete and qualified success were achieved in 74 (89.1%) and 79 (95.2%) of 83 eyes, respectively. The mean preoperative and postsurgical IOPs were 27.4±7.3 and 14.2±2.6 mm Hg, respectively. Participants used an average of 2.0 and 0.3 types of ocular hypotensive medications before and after surgery, respectively. The chief complications included hyphema (n=9), IOP spike (n=9), and corneal edema (n=8). None of the eyes required reoperation or developed vision-threatening complications. Multivariate analysis showed that older age was associated with a higher probability of complete success (odds ratio=1.13; 95% CI: 1.02–1.25; P=0.020). Conclusions: The 1-year results of combination of PEI+GSL+GT in treating advanced PACG cases with cataract appear to be safe and effective. Further large-scale multination and multicenter studies are warranted.