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A. Chabi, D. Johnson; Vitamin A Deficiency Detection . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5571.
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Vitamin A deficiency (VAD) is the most preventable cause of blindness in the world. Causes of VAD include malnutrition, malabsorption, and impaired metabolism due to liver disease. Often thought of as a problem of developing countries, it has been shown to be a potential public health issue in the United States as well. Night blindness is cited as the most common and earliest symptom of VAD; other findings include conjunctival xerosis, Bitot's spots, corneal xerosis, corneal ulcerations, and keratomalacia. The purpose of the study was to examine the most common presentations of patients with VAD at a university hospital.
A retrospective review was conducted of the coding data of all patients tested for Vitamin A deficiency at University Hospital Medical Center in San Antonio Texas from 1/1/00 through 1/1/05. Serum retinol concentrations of <0.30mg/L were interpreted as indicating inadequate vitamin A status. Medical diagnoses, including any ophthalmic diagnoses, of all the patients tested were recorded.
Five hundred and thirty Vitamin A tests were conducted over the 5 year period; 470 of the results showed VAD and were attributable to 103 patients. 51.5% of the patients were female. The mean age was 49.08 yrs with ages ranging from 1 to 77 years old. The most common diagnosis codes associated with Vitamin A level testing were GI disorders. The most common diagnosis code associated with findings of VAD was liver cirrhosis. The most common ophthalmic codes associated with Vitamin A level testing were tear film insufficiency, keratitis sicca, and corneal ulcers. Only 14.6% of the patients who were found to have VAD received ophthalmic exams at our center over the course of the 5 years.
We found that only a low percentage of patients with VAD where referred for ophthalmic evaluation. Based on the insurance information, we would expect that the majority of the ophthalmology referrals would have been to our center. Among the most common ophthalmic codes in patients with VAD were tear film insufficiency, keratitis sicca, and corneal ulcers. Given that a high proportion of patients with VAD were not referred to ophthalmology, heightened awareness of this trend by the ophthalmology community is important to increase testing and identification of VAD.
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