Cost-effectiveness and cost-utility of a digital technology-driven hierarchical healthcare screening pattern in China.

Utilization of digital technologies for cataract screening in primary care is a potential solution for addressing the dilemma between the growing aging population and unequally distributed resources. Here, we propose a digital technology-driven hierarchical screening (DH screening) pattern implemented in China to promote the equity and accessibility of healthcare. It consists of home-based mobile artificial intelligence (AI) screening, community-based AI diagnosis, and referral to hospitals. We utilize decision-analytic Markov models to evaluate the cost-effectiveness and cost-utility of different cataract screening strategies (no screening, telescreening, AI screening and DH screening). A simulated cohort of 100,000 individuals from age 50 is built through a total of 30 1-year Markov cycles. The primary outcomes are incremental cost-effectiveness ratio and incremental cost-utility ratio. The results show that DH screening dominates no screening, telescreening and AI screening in urban and rural China. Annual DH screening emerges as the most economically effective strategy with 341 (338 to 344) and 1326 (1312 to 1340) years of blindness avoided compared with telescreening, and 37 (35 to 39) and 140 (131 to 148) years compared with AI screening in urban and rural settings, respectively. The findings remain robust across all sensitivity analyses conducted. Here, we report that DH screening is cost-effective in urban and rural China, and the annual screening proves to be the most cost-effective option, providing an economic rationale for policymakers promoting public eye health in low- and middle-income countries.

Skills assessment after a grape-based microsurgical course for ophthalmology residents: randomised controlled trial.

AIMS: To introduce and assess a course using grapes as training models for ophthalmology residents to acquire basic microsurgical skills. METHODS: Ophthalmology residents who were novices at microsurgery were included. Participants were randomised into a 1:1 ratio to a 4-hour training programme based on fruit models (group A) or virtual reality (VR) modulator and silicone suture pads (group B), respectively. Before and after training, questionnaires were designed to measure their self-confidence with ophthalmic operations and with their coming role as surgical assistants. After training, each participant provided their interest in further studying microsurgery and was assessed for their general competence of ophthalmic microsurgery on porcine eyes. RESULTS: Eighty-three participants were included, with 42 ones in group A and 41 ones in group B. After training, participants in group A performed better in the uniformities of the suture span (p<0.05), suture thickness (p<0.05) and tissue protection (p<0.05) during the corneal suturing assessment. The overall scores of corneal suturing and circular capsulorhexis in the porcine eye in group A were comparable to those in group B (p=0.26 and 0.87, respectively). Group A showed a more positive attitude to withstand the training for more than 4 hours (p<0.001), as well as a higher willingness to receive more times of the training in the future (p<0.001). CONCLUSIONS: Training models based on grapes are equal to VR simulators and silicon suture pads to provide solid training tasks for ophthalmology residents to master basic microsurgical skills, and might have advantages in lower economic cost, and easy availability. TRIAL REGISTRATION NUMBER: ChiCTR2000040439.

Single-cell RNA cap and tail sequencing (scRCAT-seq) reveals subtype-specific isoforms differing in transcript demarcation.

The differences in transcription start sites (TSS) and transcription end sites (TES) among gene isoforms can affect the stability, localization, and translation efficiency of mRNA. Gene isoforms allow a single gene diverse functions across different cell types, and isoform dynamics allow different functions over time. However, methods to efficiently identify and quantify RNA isoforms genome-wide in single cells are still lacking. Here, we introduce single cell RNA Cap And Tail sequencing (scRCAT-seq), a method to demarcate the boundaries of isoforms based on short-read sequencing, with higher efficiency and lower cost than existing long-read sequencing methods. In conjunction with machine learning algorithms, scRCAT-seq demarcates RNA transcripts with unprecedented accuracy. We identified hundreds of previously uncharacterized transcripts and thousands of alternative transcripts for known genes, revealed cell-type specific isoforms for various cell types across different species, and generated a cell atlas of isoform dynamics during the development of retinal cones.

Patient-centred and economic effectiveness of a decision aid for patients with age-related cataract in China: study protocol of a randomised controlled trial.

INTRODUCTION: The need for cataract surgery is on the rise due to our ageing population and high demands for greater visual functioning. Although the majority of patients want to participate in a shared decision-making process, no decision aid has been available to improve the quality of decision. The present study aims to determine whether a decision aid increases informed decision about cataract surgery. METHODS AND ANALYSIS: A parallel randomised controlled trial (772 participants) will be conducted. The decision aid will be implemented among patients with any age-related cataract in Yuexiu District, which is socioeconomically representative of a major metropolitan region in Southern China. Participants will be randomly assigned to receive either a patient decision aid or a traditional booklet, and they will complete three surveys: (1) baseline assessment before the intervention (time point (T)1), 2 weeks (T2) and 1 year (T3) after the intervention. The control group receives a traditional booklet with standard general information developed by the National Eye Institute to help patients understand cataract, whereas the intervention group receives a patient decision aid that includes not only the standard general information, but also the quantitative risk information on the possible outcomes of cataract surgery as well as value clarification exercise. The primary study outcome is the informed decision, the percentage of patients who have adequate knowledge and demonstrate consistency between attitudes and intentions. Secondary outcomes include perceived importance of cataract surgery benefits/harms, decision conflict and confidence, anticipated regret and booklet utilisation and acceptability at 2 weeks, and surgical rates and a cost-utility estimate of the decision aid at 1 year. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ethics Committee of Zhongshan Ophthalmic Center (reference number: 2019KYPJ090). Results will be published in peer-reviewed journals and presented at scientific meetings for academic audiences. TRIAL REGISTRATION NUMBER: NCT03992807.

Patient participation in free cataract surgery: a cross-sectional study of the low-income elderly in urban China.

OBJECTIVES: To explore the characteristics of the low-income elderly who underwent free cataract surgery and to determine the degree of patient satisfaction with the free cataract surgery programme in urban China. METHODS: A free cataract surgery management workflow was designed as a poverty relief project in Guangzhou. In this study, participants who underwent free cataract surgery between January and August 2014 received a telephone interview based on a structured questionnaire. Data were collected on patient demographics, resources, health conditions, reasons for undergoing the free surgery and overall evaluation of the free cataract surgery programme. RESULTS: Among the 833 participants, the mean surgical age was 76.85±7.46 years (95% CI 76.34 to 77.36), and the male to female ratio was 385:448. The majority (94.31%, 746/791) of patients resided in the main urban districts. Patients underwent surgery 61.08±60.15 months (95% CI 56.17 to 66.00) after becoming aware of the cataract, although 66.83% of them reported that their daily lives were influenced by cataracts. Only 21.5% of the respondents underwent physical examinations that included regular eye screening, and only 6.30% were highly educated patients. Financial problems were the primary reason cited by patients for participating in the free surgery programme. Those patients with a monthly family income of 1000-2999¥ (US$161-482) per capita constituted the largest patient population. The free clinics in the parks and the free cataract surgery were highly rated (9.46 and 9.11 of 10 points) by the beneficiaries. CONCLUSIONS: The telephone survey revealed a high level of patient satisfaction regarding the free cataract surgery programme. Most of the patients who participated in the programme resided in major urban districts and had poor health awareness and a low level of education. The information provided by this study is crucial for improving and expanding the management of free cataract surgery programmes. TRIAL REGISTRATION NUMBER: NCT02633865; Post-results.

[Comparative assessment of individualized multifocal intraocular lens implantation].

OBJECTIVE: To evaluate the visual quality after combined implantation of refractive and diffractive multifocal intraocular lens (MIOLs) in both eyes (CustomMatch pattern). METHODS: Prospective, nonrandomized study. Zhongshan Ophthalmic Center, Sun yat-sen university, P.R. China. Age-related cataract patients, selected according to the inclusion criteria and divided into MIOL group and monofocal intraocular lens (SIOL) group, received phacoemulsification and were implanted with combined a ReZoom NXG1 IOL in the dominant eye and a Tecnis ZM900 IOL in the fellow eye or bilateral Sensar AR40e IOLs. Monocular and binocular testing one month after surgery included uncorrected and best-spectacle corrected visual acuity at far, intermediate and near distances under 100 cd/m(2) and 6 cd/m(2), reading visual acuity and reading speed, defocus curve, and subjective vision-related quality of life using questionnaire. RESULTS: Under 100 cd/m(2) and 6 cd/m(2), binocular mean uncorrected visual acuity at 500 cm in MIOL group was logMAR 0.013 +/- 0.149 and logMAR 0.163 +/- 0.220 and binocular mean best-spectacle corrected visual acuity was logMAR -0.027 +/- 0.092 and logMAR 0.109 +/- 0.175 respectively. The mean refraction spherical equivalent for best distance corrected visual acuity was (-0.18 +/- 0.85) D and (-0.32 +/- 0.90) D respectively. Under 100 cd/m(2), better uncorrected visual acuity (decimal 0.63) at 40 cm, 63 cm and 100 cm was achieved in MIOL group. Under 6 cd/m(2), the uncorrected visual acuities in MIOL group at 40 cm and 63 cm distance were significantly higher than those in SIOL group although there were no statistically difference at 100 cm. Uncorrected reading visual acuity and reading speed in MIOL group were better than those in SIOL group, while the results in reading ability were similar when MIOL group without correction compared with SIOL group with correction. The depth of focus was 5.5 diopter in MIOL group. No patient in both groups wore glasses for distance and 70% patients in MIOL group did not need to wear glasses for intermediate and near distances after surgery. CONCLUSION: CustomMatch pattern could provide a satisfactory vision at a full range of near, intermediate and far distance and improve the life quality to a certain extent.

[Comparative assessment of visual quality after combined implantation of multifocal intraocular lens].

OBJECTIVE: To evaluate the visual quality after combined implantation of refractive and diffractive multifocal intraocular lenses (IOL) in both eyes. METHODS: Prospective, nonrandomized study. Age-related cataract patients were divided into multifocal IOL group (MIOL group) and monofocal IOL group (SIOL group) and received phacoemulsification. In MIOL group, a ReZoom NXG1 IOL and a Tecnis Z M900 IOL were implanted into the dominant eye and the fellow eye, respectively. In SIOL group, Sensar AR40e IOLs were implanted into both eyes. Monocular or binocular test was performed one month after surgery, including wavefront aberration, contrast sensitivity with or without glare and near stereoacuity. RESULTS: The root mean square of spherical aberration at pupil diameter of 5 mm was 0.058 +/- 0.159 microm in NXG1 eyes and 0.005 +/- 0.169 microm in ZM900 eyes, both of them were significantly lower than 0.408 +/- 0.160 microm achieved in AR40e eyes (F = 11.734; P = 0.001, 0.000). There was no significant difference in the total ocular aberration, contrast sensitivity and high-order aberration among eyes with these different IOLs. The uncorrected near stereoacuity in MIOL group was (45.60 +/- 35.04) seconds of arc, which was significantly better than (110.00 +/- 41.23) seconds of arc achieved in SIOL group (F = 2.923; P = 0.010). CONCLUSION: Combined implantation of multifocal ReZoom NXG1 IOL and Tecnis ZM900 IOL provides a good visual quality with reduced spherical aberration and satisfactory near stereoacuity.