Prediction of myopia development among Chinese school-aged children using refraction data from electronic medical records: A retrospective, multicentre machine learning study.

BACKGROUND: Electronic medical records provide large-scale real-world clinical data for use in developing clinical decision systems. However, sophisticated methodology and analytical skills are required to handle the large-scale datasets necessary for the optimisation of prediction accuracy. Myopia is a common cause of vision loss. Current approaches to control myopia progression are effective but have significant side effects. Therefore, identifying those at greatest risk who should undergo targeted therapy is of great clinical importance. The objective of this study was to apply big data and machine learning technology to develop an algorithm that can predict the onset of high myopia, at specific future time points, among Chinese school-aged children. METHODS AND FINDINGS: Real-world clinical refraction data were derived from electronic medical record systems in 8 ophthalmic centres from January 1, 2005, to December 30, 2015. The variables of age, spherical equivalent (SE), and annual progression rate were used to develop an algorithm to predict SE and onset of high myopia (SE ≤ -6.0 dioptres) up to 10 years in the future. Random forest machine learning was used for algorithm training and validation. Electronic medical records from the Zhongshan Ophthalmic Centre (a major tertiary ophthalmic centre in China) were used as the training set. Ten-fold cross-validation and out-of-bag (OOB) methods were applied for internal validation. The remaining 7 independent datasets were used for external validation. Two population-based datasets, which had no participant overlap with the ophthalmic-centre-based datasets, were used for multi-resource validation testing. The main outcomes and measures were the area under the curve (AUC) values for predicting the onset of high myopia over 10 years and the presence of high myopia at 18 years of age. In total, 687,063 multiple visit records (≥3 records) of 129,242 individuals in the ophthalmic-centre-based electronic medical record databases and 17,113 follow-up records of 3,215 participants in population-based cohorts were included in the analysis. Our algorithm accurately predicted the presence of high myopia in internal validation (the AUC ranged from 0.903 to 0.986 for 3 years, 0.875 to 0.901 for 5 years, and 0.852 to 0.888 for 8 years), external validation (the AUC ranged from 0.874 to 0.976 for 3 years, 0.847 to 0.921 for 5 years, and 0.802 to 0.886 for 8 years), and multi-resource testing (the AUC ranged from 0.752 to 0.869 for 4 years). With respect to the prediction of high myopia development by 18 years of age, as a surrogate of high myopia in adulthood, the algorithm provided clinically acceptable accuracy over 3 years (the AUC ranged from 0.940 to 0.985), 5 years (the AUC ranged from 0.856 to 0.901), and even 8 years (the AUC ranged from 0.801 to 0.837). Meanwhile, our algorithm achieved clinically acceptable prediction of the actual refraction values at future time points, which is supported by the regressive performance and calibration curves. Although the algorithm achieved balanced and robust performance, concerns about the compromised quality of real-world clinical data and over-fitting issues should be cautiously considered. CONCLUSIONS: To our knowledge, this study, for the first time, used large-scale data collected from electronic health records to demonstrate the contribution of big data and machine learning approaches to improved prediction of myopia prognosis in Chinese school-aged children. This work provides evidence for transforming clinical practice, health policy-making, and precise individualised interventions regarding the practical control of school-aged myopia.

Construction and implications of structural equation modeling network for pediatric cataract: a data mining research of rare diseases.

BACKGROUND: The majority of rare diseases are complex diseases caused by a combination of multiple morbigenous factors. However, uncovering the complex etiology and pathogenesis of rare diseases is difficult due to limited clinical resources and conventional statistical methods. This study aims to investigate the interrelationship and the effectiveness of potential factors of pediatric cataract, for the exploration of data mining strategy in the scenarios of rare diseases. METHODS: We established a pilot rare disease specialized care center to systematically record all information and the entire treatment process of pediatric cataract patients. These clinical records contain the medical history, multiple structural indices, and comprehensive functional metrics. A two-layer structural equation model network was applied, and eight potential factors were filtered and included in the final modeling. RESULTS: Four risk factors (area, density, location, and abnormal pregnancy experience) and four beneficial factors (axis length, uncorrected visual acuity, intraocular pressure, and age at diagnosis) were identified. Quantifiable results suggested that abnormal pregnancy history may be the principle risk factor among medical history for pediatric cataracts. Moreover, axis length, density, uncorrected visual acuity and age at diagnosis served as the dominant factors and should be emphasized in regular clinical practice. CONCLUSIONS: This study proposes a generalized evidence-based pattern for rare and complex disease data mining, provides new insights and clinical implications on pediatric cataract, and promotes rare-disease research and prevention to benefit patients.

Identification of force chains in wet coal dust layer and the effect of porosity on three-body contact stiffness.

Aiming at the three-body contact problem of mechanical rough surface containing wet coal dust interface, the three-body contact model of rough surface containing wet coal dust interface is constructed by comprehensively considering the contact deformation of rough surface and contact characteristics of wet coal dust, and based on the crushing theory. By analysing the contact force, load-bearing particle size and adjacent contact angle thresholds of the wet coal dust layer, the force chain identification criterion is formulated. Finally, quantitative calculations of the force chain characteristics are performed to reveal the effect of different initial porosities on the three-body contact stiffness, which is verified experimentally. The results of the study show that the average contact force of the wet coal dust layer can be used as the force chain contact force threshold, the average particle size can be used as the force chain particle size threshold, and the force chain angle threshold is determined by the particle coordination number. As the initial porosity decreases, the number, length and stiffness of force chains in the wet coal dust layer increase significantly, and the stiffness reaches a maximum value of 2.007 × 108 pa/m at the moment of downward pressure to stabilisation, while the trend of force chain bending varies in the opposite direction, and its minimum bending degree decreases to 20°. The maximum relative error between the simulation and experimental results of three-body contact stiffness is 9.64%, which proves the accuracy of the force chain identification criterion and the quantitative calculation of three-body contact stiffness by force chain.

Differences in the prevalence of uveitis between Crohn's disease and ulcerative colitis: A systematic review and meta-analysis.

PURPOSE: Uveitis is one of the ocular manifestations of inflammatory bowel disease (IBD) that is often overlooked and has been considered a sign of severe IBD. As typical subtypes of IBD, differences exist in the prevalence of uveitis between Crohn's disease (CD) and ulcerative colitis (UC). Our study systematically assessed differences in the prevalence of uveitis between CD and UC. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. We performed a systematic review of published literature from PubMed and Embase on 30 March 2022. Two investigators independently selected studies, extracted data and evaluated methodological quality. Either a fixed- or a random-effects model was used to calculate the risk ratio (RR), odds ratio (OR) and 95% confidence interval (95% CI) depending on the heterogeneity of studies. Sensitivity analysis was used to examine the heterogeneity by removing article by article, while subgroup analysis was conducted in accordance with various regions. RESULTS: Our study included data from 14 studies encompassing 115 854 participants. The prevalence of uveitis in IBD was estimated to be 2.38% (95% CI 1.60%-3.17%). The prevalence of uveitis in CD (3.27%, 95% CI 2.15%-4.39%) was significantly higher than in UC (1.60%, 95% CI 0.93%-2.27%; RR 1.76, 95% CI 1.39-2.22, p < 0.05). In subgroup analysis, a higher incidence of CD combined with uveitis was also observed in IBD patients residing in Europe (RR 1.75, 95% CI 1.37-2.24). CONCLUSIONS: Data from 115 854 IBD patients showed that CD patients were more likely to suffer from uveitis than UC patients. Ocular manifestations in IBD, particularly CD, warrant greater attention.

An analysis of digging anchor machine stability and track wear under digging conditions.

To analyse the stability of a digging anchor machine under digging conditions, the dynamics model of the anchor machine and the interaction mechanics model between its tracks and the roadway floor are constructed with a Sandvik MB670-1 digging anchor machine in the context of the Zhang Jiamao 5-2 coal seam of the Shaanxi Coal and Chemical Industry Group. The discrete element method (DEM) and multibody dynamics (MBD) two-way coupling algorithm is used to simulate the cutting process of a full coal seam and coal rock containing gangue by using a digging anchor machine in a roadway. The changes in the cutting depth of the digging anchor machine drum, the sliding distance of the track and the stress‒strain pattern of the roadway floor are obtained. Finally, through shear slip testing, the stress distribution and deformation pattern of the roadway floor under different grouser parameters of the digging anchor machine track shoe, as well as the wear characteristics of the track shoe, are obtained. The results of this study can provide a theoretical basis for the control and reliability of the digging anchor machine and the life fatigue prediction of its tracks.

Food Additives Associated with Gut Microbiota Alterations in Inflammatory Bowel Disease: Friends or Enemies?

During the 21st century, the incidence and prevalence of inflammatory bowel disease (IBD) is rising globally. Despite the pathogenesis of IBD remaining largely unclear, the interactions between environmental exposure, host genetics and immune response contribute to the occurrence and development of this disease. Growing evidence implicates that food additives might be closely related to IBD, but the involved molecular mechanisms are still poorly understood. Food additives may be categorized as distinct types in accordance with their function and property, including artificial sweeteners, preservatives, food colorant, emulsifiers, stabilizers, thickeners and so on. Various kinds of food additives play a role in modifying the interaction between gut microbiota and intestinal inflammation. Therefore, this review comprehensively synthesizes the current evidence on the interplay between different food additives and gut microbiome alterations, and further elucidates the potential mechanisms of food additives-associated microbiota changes involved in IBD.

Anti-TNF-α agents for refractory intestinal Behçet's disease: case series and meta-analysis.

Background: Behçet's disease (BD) is a relapsing systemic immune disorder, and intestinal BD is a significant cause of mortality in patients with BD. Conventional therapeutic strategies for intestinal BD showed unsatisfactory outcomes, especially in those patients with refractory subtypes. In recent years, biologic agents have exhibited promising results in this field. While the sample sizes of existing studies were limited, the results were heterogeneous. Objectives: This study aimed to observe the efficacy of different biologics in clinical symptomatic improvement and intestinal mucosal healing. Design: This is a study including the report of case series and meta-analysis. Data sources and methods: This meta-analysis was conducted following the PRISMA guidelines. Free-text words and subject terms, including 'Behcet's Syndrome', 'Biologics', 'Tumor Necrosis Factor Antagonist', were used to systematically research the relevant studies in the electronic databases (PubMed, Web of Science, Embase, and Cochrane Library). All retrieved articles were from inception to July 2021, and the data from our institution were also included in this meta-analysis. A double arcsine transformation was performed to stabilize the variance of the original ratio. Heterogeneity was evaluated via Q-test and I 2 statistics. Random-effects or fixed-effects model was used to calculate the pooled parameters, and the results were presented as forest plots with 95% confidence intervals. Results: Twelve studies were included, but only antitumor necrosis factor alpha (anti-TNF-α) agents were prescribed as biologicals for refractory intestinal BD. The symptom improvement rates at our institution ranged from 57.1 to 81.8%, and the mucosal healing rates were from 20 to 60% in different therapeutic periods. A total of 514 patients were enrolled in the meta-analysis, and the synthesized ratios showed that 59.8% (n = 377) and 73.7% (n = 317) of patients who received maintenance therapy with anti-TNF-α agents could achieve clinical symptomatic improvement during short-term (10-14 weeks) and long-term (48-54 weeks) periods, respectively. Furthermore, 77.8% (n = 229) of patients with intestinal BD maintained therapeutic efficacy for a longer time (100 weeks). In addition, 60.9% (n = 120) of the patients achieved sustained intestinal mucosal healing during a long-term follow-up (24-52 weeks). Conclusion: Anti-TNF-α treatment is effective in treating refractory intestinal BD but more studies are required to evaluate the effects of new biologics for intestinal BD in the near future. Registration: This study has been registered on PROSPERO, the ID is CRD42022329211. Plain language summary: Anti-TNF-α agents are effective and safe in patients with intestinal Behçet's disease Behçet's disease (BD) is a disease affecting several organs including the gastrointestinal tract. Nowadays, the efficacy of existing therapy strategies is still unsatisfactory and some patients are suffering from repeated attacks of the disease. We noticed that a new kind of medicine, called antitumor necrosis factor alpha (anti-TNF-α) agents, was applied to these patients recently. The therapeutic efficacy is not convincing enough to evaluate since the number of patients receiving this new medicine was small in every individual study. Regarding this, we conducted a research to learn about the efficacy of this medicine at our own institution. Besides, we composed the results of other studies in an appropriate way. Then, we drew a conclusion on the exact efficacy of anti-TNF-α agents after the data analysis. We unveiled that the anti-TNF-α agents appeared both effective and safe in the management of intestinal BD patients when the classical therapy failed. More than half of the patients could achieve discomfort remission when they got the therapy of the new medicine at our institution. We also found that intestinal ulcers in most patients improved after they received the treatment. All in all, it offered another foothold for getting relief in these patients who were caught in this mire.

Anti -TNFα agents in preventing the postoperative recurrence of Crohn's disease: Do they still play a role in the biological era?

BACKGROUND: Approximately half of patients with Crohn's disease (CD) may inevitably receive surgical intervention as the disease progress. However, about 75% of CD patients will experience postoperative recurrence (POR). Biologics are appealing alternatives for the prevention of POR; however, it is still unclear which biological agents are more efficient. This meta-analysis aimed to investigate the efficacy of biologics for POR prevention and to compare the superiority of different biologics. METHODS: We conducted a thorough search of online databases and screened for studies on the efficacy of biologics in preventing POR (clinical, endoscopic, or histological) that were published until January 2021. The results were presented as forest plots and odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: We included 26 studies with 2,136 participants. Overall, biologics were more efficient over non-biological treatments in preventing endoscopic, severe endoscopic, and clinical POR without increasing the frequency of adverse events. Among the various types of biologics, anti-TNFα agents were better than vedolizumab in preventing endoscopic POR. Moreover, infliximab had a similar curative effect to adalimumab in preventing endoscopic, severe endoscopic, and clinical recurrence. CONCLUSION: Biologics, especially anti-TNFα agents, still play a vital role in preventing POR in the biological era.

Intestinal Fibrosis and Gut Microbiota: Clues From Other Organs.

Fibrosis is a complex and difficult to elucidate pathological process with no available therapies. Growing evidence implicates intestinal microbiota in the occurrence and development of fibrosis, and the potential mechanisms involved in different organs have been explored in several studies. In this review, we summarize the causative and preventive effects of gut microbiota on intestinal fibrosis, as well as the relationships between gut microbiota and fibrosis in other organs. Interestingly, several colonized microbes are associated with fibrosis via their structural components and metabolic products. They may also play essential roles in regulating inflammation and fibroblast activation or differentiation, which modulates extracellular matrix formation. While the relationships between intestinal fibrosis and gut microbiota remain unclear, lessons can be drawn from the effects of gut microbiota on hepatic, cardiac, nephritic, and pulmonary fibrosis. Various intestinal microbes alterations have been detected in different fibrotic organs; however, the results were heterogeneous. Mechanisms by which the intestinal microbiota regulate fibrotic processes in other organs, such as novel metabolic products or specific microbes, are also discussed. The specific microbiota associated with fibrosis in other organs could instruct future studies aiming to discover prospective mechanisms regulating intestinal fibrosis.

The associations of high academic performance with childhood ametropia prevalence and myopia development in China.

BACKGROUND: To assess associations of high academic performance with ametropia prevalence and myopia development in Chinese schoolchildren. METHODS: This multicohort observational study was performed in Guangdong, China. We first performed a cross-sectional cohort analysis of students in grades 1 to 9 from Yangjiang to evaluate the relationship between academic performance and refractive status on a yearly basis. We also performed longitudinal analyses of students in Shenzhen to evaluate the trend of academic performance with refractive changes over a period of 33 months. All refractive statuses were measured using noncycloplegic autorefractors. RESULTS: A total of 32,360 children with or without myopia were recruited in this study (mean age 10.08 years, 18,360 males and 14,000 females). Cross-sectional cohort analyses in Yangjiang showed that the prevalence of hyperopia was associated with lower academic scores in grade one, the year students entered primary school (ß=-0.04, P=0.01), whereas the prevalence of myopia was associated with higher academic scores in grade six and grade eight, the years in which students were about to take entrance examinations for junior high school or senior high school (ß=0.020, P=0.038; ß=0.041, P=0.002). Longitudinal analysis showed that in Shenzhen, faster myopia development was associated with better scores in all grades even after adjustments for BMI, outdoor activity time, screen time, reading time, and parental myopia (grade two at baseline: ß=0.026, P<0.001; grade three at baseline: ß=0.036, P=0.001; grade four at baseline: ß=0.014, P<0.001; grade five at baseline: ß=0.039, P<0.001; grade six at baseline: ß=0.04, P<0.001). CONCLUSIONS: Refractive errors correlated significantly with academic performance among schoolchildren in China. Children with high academic performance were more likely to have faster myopia development.

Real-world big data demonstrates prevalence trends and developmental patterns of myopia in China: a retrospective, multicenter study.

BACKGROUND: Myopia is a complex disease caused by a combination of multiple pathogenic factors. Prevalence trends and developmental patterns of myopia exhibit substantial variability that cannot be clearly assessed using limited sample sizes. This study aims to determine the myopia prevalence over the past 60 years and trace the myopia development in a school-aged population using medical big data. METHODS: The refraction data from electronic medical records in eight hospitals in South China were collected from January 2005 to October 2018; including patients' year of birth, refraction status, and age at the exam. All optometry tests were performed in accordance with standard procedures by qualified senior optometrists. The cross-sectional datasets (individuals with a single examination) and longitudinal datasets (individuals with multiple examinations) were analyzed respectively. SAS statistical software was used to extract and statistically analyse all target data and to identify prevalence trends and developmental patterns related to myopia. RESULTS: In total, 1,112,054 cross-sectional individual refraction records and 774,645 longitudinal records of 273,006 individuals were collected. The myopia prevalence significantly increased among individuals who were born after the 1960s and showed a steep rise until reaching a peak of 80% at the 1980s. Regarding developmental patterns, the cross-sectional data demonstrated that the myopia prevalence increased dramatically from 23.13% to 82.83% aging from 5 to 11, and the prevalence stabilized at the age of 20. The longitudinal data confirmed the results that the age of myopic onset was 7.47±1.67 years, the age of myopia stabilized at 17.14±2.61 years, and the degree of myopia stabilized at -4.35±3.81 D. CONCLUSIONS: The medical big data used in this study demonstrated prevalence trends of myopia over the past 60 years and revealed developmental patterns in the onset, progression and stability of myopia in China.

Artificial intelligence-tutoring problem-based learning in ophthalmology clerkship.

BACKGROUND: Artificial intelligence (AI) is an increasingly popular tool in medical investigations. However, AI's potential of aiding medical teaching has not been explored. This study aimed to evaluate the effectiveness of AI-tutoring problem-based-learning (PBL) in ophthalmology clerkship and to assess the student evaluations of this module. METHODS: Thirty-eight Grade-two students in ophthalmology clerkship at Sun Yat-Sen University were randomly assigned to two groups. In Group A, students learned congenital cataracts through an AI-tutoring PBL module by exploring and operating an AI diagnosis platform. In Group B, students learned congenital cataracts through traditional lecture given with the same faculty. The improvement in student performance was evaluated by comparing the pre- and post-lecture scores of a specific designed test using paired-T tests. Student evaluations of AI-tutoring PBL were measured by a 17-item questionnaire. RESULTS: The post-lecture scores were significantly higher than the pre-lecture scores in both groups (Group A: P<0.0001, Group B: P<0.0001). The improvement of group A in the part of sign and diagnosis test (Part I) was more significant than that of group B (P=0.016). However, there was no difference in the improvement in the part of treatment plan test (Part II) between two groups (P=0.556). Overall, all respondents were satisfied and agreed that AI-tutoring PBL was helpful, effective, motive and beneficial to help develop critical and creative thinking. CONCLUSIONS: The application of AI-tutoring PBL into ophthalmology clerkship improved students' performance and satisfaction. AI-tutoring PBL teaching showed advantage in promoting students' understanding of signs of diseases. The instructors play an indispensable role in AI-tutoring PBL curriculum.

Modified organized ophthalmology pre-internship in China.

BACKGROUND: Medical pre-internship plays a crucial role in medical education promoting early involvement of students in clinical setting and helping them explore potential interest of specialty. However, there is currently no specifically designed pre-internship curriculum in China. Using ophthalmology as a pilot field, we have set up a modified organized pre-internship curriculum and evaluated its effectiveness and students' feedback in this study. METHODS: In this prospective noncomparative study, 42 junior undergraduate medical students were enrolled in the organized ophthalmology pre-internship. The effects of organized pre-internship on student performance were evaluated by difference of post- to pre-lecture scores by paired t-test. The effects of baseline knowledge level and gender on performance improvement were analyzed by independent t-test. Student satisfaction comparing organized pre-internship with traditional pre-internship was measured by questionnaire. RESULTS: The difference of post- to pre-lecture scores of all participants was 6.21±2.02 (P<0.0001). The improvement in post- to pre-lecture scores of students with low knowledge level (7.08±1.85) was significantly higher than that of students with high knowledge level (4.81±1.42) (P<0.0001). Gender did not influence student performance. The responses to the questionnaire showed that most of students were more satisfied with the organized pre-internship than traditional pre-internship. CONCLUSIONS: The organized pre-internship significantly improved student performance and satisfaction. Performance improvement in students with low knowledge level was more obvious. Compared to traditional pre-internship, the organized pre-internship showed advantages in improving student performance as well as promoting learning enthusiasm. Instructors played an essential role in the organized pre-internship teaching system.

Universal artificial intelligence platform for collaborative management of cataracts.

PURPOSE: To establish and validate a universal artificial intelligence (AI) platform for collaborative management of cataracts involving multilevel clinical scenarios and explored an AI-based medical referral pattern to improve collaborative efficiency and resource coverage. METHODS: The training and validation datasets were derived from the Chinese Medical Alliance for Artificial Intelligence, covering multilevel healthcare facilities and capture modes. The datasets were labelled using a three-step strategy: (1) capture mode recognition; (2) cataract diagnosis as a normal lens, cataract or a postoperative eye and (3) detection of referable cataracts with respect to aetiology and severity. Moreover, we integrated the cataract AI agent with a real-world multilevel referral pattern involving self-monitoring at home, primary healthcare and specialised hospital services. RESULTS: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance in three-step tasks: (1) capture mode recognition (area under the curve (AUC) 99.28%-99.71%), (2) cataract diagnosis (normal lens, cataract or postoperative eye with AUCs of 99.82%, 99.96% and 99.93% for mydriatic-slit lamp mode and AUCs >99% for other capture modes) and (3) detection of referable cataracts (AUCs >91% in all tests). In the real-world tertiary referral pattern, the agent suggested 30.3% of people be 'referred', substantially increasing the ophthalmologist-to-population service ratio by 10.2-fold compared with the traditional pattern. CONCLUSIONS: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance and effective service for cataracts. The context of our AI-based medical referral pattern will be extended to other common disease conditions and resource-intensive situations.

Diagnostic Efficacy and Therapeutic Decision-making Capacity of an Artificial Intelligence Platform for Childhood Cataracts in Eye Clinics: A Multicentre Randomized Controlled Trial.

BACKGROUND: CC-Cruiser is an artificial intelligence (AI) platform developed for diagnosing childhood cataracts and providing risk stratification and treatment recommendations. The high accuracy of CC-Cruiser was previously validated using specific datasets. The objective of this study was to compare the diagnostic efficacy and treatment decision-making capacity between CC-Cruiser and ophthalmologists in real-world clinical settings. METHODS: This multicentre randomized controlled trial was performed in five ophthalmic clinics in different areas across China. Pediatric patients (aged ≤ 14 years) without a definitive diagnosis of cataracts or history of previous eye surgery were randomized (1:1) to receive a diagnosis and treatment recommendation from either CC-Cruiser or senior consultants (with over 5 years of clinical experience in pediatric ophthalmology). The experts who provided a gold standard diagnosis, and the investigators who performed slit-lamp photography and data analysis were blinded to the group assignments. The primary outcome was the diagnostic performance for childhood cataracts with reference to cataract experts' standards. The secondary outcomes included the evaluation of disease severity and treatment determination, the time required for the diagnosis, and patient satisfaction, which was determined by the mean rating. This trial is registered with ClinicalTrials.gov (NCT03240848). FINDINGS: Between August 9, 2017 and May 25, 2018, 350 participants (700 eyes) were randomly assigned for diagnosis by CC-Cruiser (350 eyes) or senior consultants (350 eyes). The accuracies of cataract diagnosis and treatment determination were 87.4% and 70.8%, respectively, for CC-Cruiser, which were significantly lower than 99.1% and 96.7%, respectively, for senior consultants (p < 0.001, OR = 0.06 [95% CI 0.02 to 0.19]; and p < 0.001, OR = 0.08 [95% CI 0.03 to 0.25], respectively). The mean time for receiving a diagnosis from CC-Cruiser was 2.79 min, which was significantly less than 8.53 min for senior consultants (p < 0.001, mean difference 5.74 [95% CI 5.43 to 6.05]). The patients were satisfied with the overall medical service quality provided by CC-Cruiser, typically with its time-saving feature in cataract diagnosis. INTERPRETATION: CC-Cruiser exhibited less accurate performance comparing to senior consultants in diagnosing childhood cataracts and making treatment decisions. However, the medical service provided by CC-Cruiser was less time-consuming and achieved a high level of patient satisfaction. CC-Cruiser has the capacity to assist human doctors in clinical practice in its current state. FUNDING: National Key R&D Program of China (2018YFC0116500) and the Key Research Plan for the National Natural Science Foundation of China in Cultivation Project (91846109).

Clinical characteristics of young adult cataract patients: a 10-year retrospective study of the Zhongshan Ophthalmic Center.

AIM: To investigate the characteristics of young adult cataract (YAC) patients over a 10-year period. METHODS: This observational study included YAC patients aged 18-49 years who were treated surgically for the first time at the Zhongshan Ophthalmic Center in China. YAC patients were analysed and compared with patients with childhood cataract (CC) in January 2005 to December 2014. RESULTS: During the 10-year period, 515 YAC patients and 2421 inpatients with CC were enrolled. Among the YAC patients, 76.76% (109/142) of unilateral patients had a corrected distance visual acuity (CDVA) better than 20/40 in the healthy eye, whereas only 20.38% (76/373) of bilateral patients had a CDVA better than 20/40 in the eye with better visual acuity. Compared with the CC group, the YAC group had a higher proportion of rural patients (40.40% vs 31.60%, p=0.001). Furthermore, the prevalence of other ocular abnormalities in YAC patients was higher than that in patients with CC (29.71% vs 17.47%, p<0.001). CONCLUSIONS: A large proportion coming from rural areas and a high prevalence of complicated ocular abnormalities may be the most salient characteristics of YAC patients. Strengthening the counselling and screening strategy for cataract and health education for young adults are required especially for those in rural areas.