Moorfields Eye Hospital, London, UK.
Department of Ophthalmology and Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary; and Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Eye (Lond). 2024 Aug;38(11):2014-2027. doi: 10.1038/s41433-024-02966-w. Epub 2024 Feb 14.
Infectious diseases affecting the eye often cause unilateral or asymmetric visual loss in children and people of working age. This group of conditions includes viral, bacterial, fungal and parasitic diseases, both common and rare presentations which, in aggregate, may account for a significant portion of the global visual burden. Diagnosis is frequently challenging even in specialist centres, and many disease presentations are highly regional. In an age of globalisation, an understanding of the various modes of transmission and the geographic distribution of infections can be instructive to clinicians. The impact of eye infections on global disability is currently not sufficiently captured in global prevalence studies on visual impairment and blindness, which focus on bilateral disease in the over-50s. Moreover, in many cases it is hard to differentiate between infectious and immune-mediated diseases. Since infectious eye diseases can be preventable and frequently affect younger people, we argue that in future prevalence studies they should be considered as a separate category, including estimates of disability-adjusted life years (DALY) as a measure of overall disease burden. Numbers of ocular infections are uniquely affected by outbreaks as well as endemic transmission, and their control frequently relies on collaborative partnerships that go well beyond the remit of ophthalmology, encompassing domains as various as vaccination, antibiotic development, individual healthcare, vector control, mass drug administration, food supplementation, environmental and food hygiene, epidemiological mapping, and many more. Moreover, the anticipated impacts of global warming, conflict, food poverty, urbanisation and environmental degradation are likely to magnify their importance. While remote telemedicine can be a useful aide in the diagnosis of these conditions in resource-poor areas, enhanced global reporting networks and artificial intelligence systems may ultimately be required for disease surveillance and monitoring.
影响眼睛的传染病常导致儿童和劳动年龄人群单侧或不对称视力丧失。这组疾病包括病毒、细菌、真菌和寄生虫疾病，既有常见的表现形式，也有罕见的表现形式，它们加在一起可能占全球视觉负担的很大一部分。即使在专科中心，诊断也常常具有挑战性，而且许多疾病表现具有高度的区域性。在全球化时代，了解各种传播方式和感染的地理分布对于临床医生来说可能具有启发性。眼部感染对全球残疾的影响在全球关于视力障碍和失明的患病率研究中目前没有得到充分体现，这些研究主要关注 50 岁以上人群的双侧疾病。此外，在许多情况下，很难区分感染性疾病和免疫介导性疾病。由于感染性眼病是可以预防的，而且经常影响年轻人，因此我们认为，在未来的患病率研究中，应将其视为一个单独的类别，包括残疾调整生命年（DALY）的估计值，作为整体疾病负担的衡量标准。眼部感染的数量受到暴发和地方性传播的影响，其控制通常依赖于超越眼科范畴的合作伙伴关系，包括疫苗接种、抗生素开发、个人医疗保健、病媒控制、大规模药物治疗、食品补充、环境卫生、流行病学制图等多个领域。此外，全球变暖、冲突、粮食贫困、城市化和环境恶化的预期影响可能会放大它们的重要性。虽然远程远程医疗可以成为资源匮乏地区这些疾病诊断的有用辅助手段，但最终可能需要增强全球报告网络和人工智能系统来进行疾病监测和监控。
