Quantitative assessment of changes in anterior segment morphology after argon laser peripheral iridoplasty: findings from the EARL study group.

IMPORTANCE: Argon laser peripheral iridoplasty (ALPI) could be effective in widening residual angle closure following laser peripheral iridotomy (LPI). BACKGROUND: We investigated changes in angle parameters following ALPI and its safety profile in this study. DESIGN: Retrospective, observational case series. PARTICIPANTS: The records from a single centre, of 36 patients (60 eyes) who underwent ALPI, for residual angle closure following LPI, were reviewed. METHODS: We analysed anterior chamber parameters in anterior segment optical coherence tomography (ASOCT) images using customized software pre- and post-ALPI. Paired t-test was used to compare changes. MAIN OUTCOME MEASURES: ASOCT parameters analysed included angle opening distance (AOD 500 and 750), trabecular iris surface area (TISA 500 and 750), anterior chamber width (ACW), anterior chamber volume (ACV), angle recess area (ARA), anterior chamber area (ACA), anterior chamber depth (ACD) and lens vault (LV). RESULTS: There was a mean increase in AOD 500 (0.05 vs. 0.16 mm, P < 0.001), AOD 750 (0.15 vs. 0.27 mm, P < 0.001), TISA 500 (0.010 vs. 0.038 mm2 , P < 0.001), TISA 750 (0.039 vs. 0.102 mm2 , P < 0.001), ACV (89.76 vs. 102.25 mm3 , P = 0.01), ARA 500 (0.015 vs. 0.033 mm2 , P < 0.001) and ARA 750 (0.044 vs. 0.088 mm2 , P < 0.001). There was no significant change in ACW, ACD, ACA and LV. Mean intraocular pressure (IOP) decreased post-ALPI (17.2 vs. 15.7 mmHg, P = 0.002). The mean follow-up duration was 2.1 years (range 0.5-5 years). CONCLUSIONS AND RELEVANCE: ALPI results in changes to the angle morphology and lowered IOP in eyes with residual angle closure. Our findings suggest a possible role for ALPI in eyes with residual angle closure following peripheral iridotomy.

Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis.

BACKGROUND: Numerous population-based studies of age-related macular degeneration have been reported around the world, with the results of some studies suggesting racial or ethnic differences in disease prevalence. Integrating these resources to provide summarised data to establish worldwide prevalence and to project the number of people with age-related macular degeneration from 2020 to 2040 would be a useful guide for global strategies. METHODS: We did a systematic literature review to identify all population-based studies of age-related macular degeneration published before May, 2013. Only studies using retinal photographs and standardised grading classifications (the Wisconsin age-related maculopathy grading system, the international classification for age-related macular degeneration, or the Rotterdam staging system) were included. Hierarchical Bayesian approaches were used to estimate the pooled prevalence, the 95% credible intervals (CrI), and to examine the difference in prevalence by ethnicity (European, African, Hispanic, Asian) and region (Africa, Asia, Europe, Latin America and the Caribbean, North America, and Oceania). UN World Population Prospects were used to project the number of people affected in 2014 and 2040. Bayes factor was calculated as a measure of statistical evidence, with a score above three indicating substantial evidence. FINDINGS: Analysis of 129,664 individuals (aged 30-97 years), with 12,727 cases from 39 studies, showed the pooled prevalence (mapped to an age range of 45-85 years) of early, late, and any age-related macular degeneration to be 8.01% (95% CrI 3.98-15.49), 0.37% (0.18-0.77), and 8.69% (4.26-17.40), respectively. We found a higher prevalence of early and any age-related macular degeneration in Europeans than in Asians (early: 11.2% vs 6.8%, Bayes factor 3.9; any: 12.3% vs 7.4%, Bayes factor 4.3), and early, late, and any age-related macular degeneration to be more prevalent in Europeans than in Africans (early: 11.2% vs 7.1%, Bayes factor 12.2; late: 0.5% vs 0.3%, 3.7; any: 12.3% vs 7.5%, 31.3). There was no difference in prevalence between Asians and Africans (all Bayes factors <1). Europeans had a higher prevalence of geographic atrophy subtype (1.11%, 95% CrI 0.53-2.08) than Africans (0.14%, 0.04-0.45), Asians (0.21%, 0.04-0.87), and Hispanics (0.16%, 0.05-0.46). Between geographical regions, cases of early and any age-related macular degeneration were less prevalent in Asia than in Europe and North America (early: 6.3% vs 14.3% and 12.8% [Bayes factor 2.3 and 7.6]; any: 6.9% vs 18.3% and 14.3% [3.0 and 3.8]). No significant gender effect was noted in prevalence (Bayes factor <1.0). The projected number of people with age-related macular degeneration in 2020 is 196 million (95% CrI 140-261), increasing to 288 million in 2040 (205-399). INTERPRETATION: These estimates indicate the substantial global burden of age-related macular degeneration. Summarised data provide information for understanding the effect of the condition and provide data towards designing eye-care strategies and health services around the world. FUNDING: National Medical Research Council, Singapore.

Racial differences in retinal vessel geometric characteristics: a multiethnic study in healthy Asians.

PURPOSE: To investigate potential racial/ethnic differences in retinal vascular geometric parameters in a multiethnic Asian population (Chinese, Malay, and Indian) free of clinical diseases. METHODS: A series of retinal vascular parameters were measured from retinal photographs using a computer-assisted program following a standardized protocol. Healthy participants were defined as nonsmokers, the absence of diabetes mellitus, uncontrolled hypertension, obesity, stroke, heart disease, glaucoma, and retinopathy. RESULTS: THERE WERE SIGNIFICANT DIFFERENCES IN MEASUREMENTS OF RETINAL VASCULAR CALIBER, TORTUOSITY, AND FRACTAL DIMENSION AMONG THE THREE ETHNIC GROUPS. IN MULTIPLE LINEAR REGRESSION MODEL CONTROLLING FOR AGE, SEX, BODY MASS INDEX, SYSTOLIC BLOOD PRESSURE, CHOLESTEROL, AND GLUCOSE LEVELS, INDIANS HAD THE LARGEST ARTERIOLAR AND VENULAR CALIBERS (ARTERIOLES [SE]: 158.94 µm [1.00]; venules: 228.26 µm [1.53]), followed by Malays (arterioles: 138.31 µm [0.74]; venules: 204.26 µm [1.13]), and then Chinese (arterioles: 131.20 µm [0.84]; venules: 195.09 µm [1.28]). Chinese had the largest arteriolar and venular tortuosity (arterioles [× $${10}^{5}$$]: 7.20 [0.08] VENULES [ $${10}^{5}$$]: 9.09 [0.10]), and venular fractal dimension (1.244 [0.003]). There were no statistically significant differences in other retinal vascular parameters after correcting multiple comparisons by the method of modified false discovery rate. CONCLUSIONS: We found that among ethnic groups composed of healthy Chinese, Malay, and Indians, there were statistically significant differences in several retinal parameters. There exist racial influences in retinal vascular parameters and other yet unknown or unmeasured environmental factor or lifestyle habits and genetic variations not related to race that may also contribute to these differences.

Cataract conversion assessment using lens opacity classification system III and Wisconsin cataract grading system.

PURPOSE: To propose a general conversion approximation algorithm and illustrate its application to two cataract classification systems, the Lens Opacity Classification System III (LOCS III) and Wisconsin Cataract Grading System (Wisconsin system). METHODS: Lens opacity of 3265 participants (78.7% response rate) aged 40 to 80 years from the Singapore Malay Eye study were assessed both clinically during slit-lamp examination using LOCS III, and via slit-lamp and retro-illumination photographic grading using the Wisconsin system. Collapsed contingency tables were used to convert between the LOCS III and Wisconsin System. RESULTS: The conversion between the two cataract classification systems is affected by the direction of transformation. The conversion algorithm was validated and explained with an application example. CONCLUSIONS: An approximate conversion algorithm for any two cataract grading systems was proposed and applied to the LOCS III and Wisconsin system. These findings provide general ways to pool and compare cataract prevalence using different grading systems in epidemiological studies.