Is Kidney Function Associated with Age-Related Macular Degeneration?: Findings from the Asian Eye Epidemiology Consortium.

PURPOSE: Chronic kidney disease (CKD) may elevate susceptibility to age-related macular degeneration (AMD) because of shared risk factors, pathogenic mechanisms, and genetic polymorphisms. Given the inconclusive findings in prior studies, we investigated this association using extensive datasets in the Asian Eye Epidemiology Consortium. DESIGN: Cross-sectional study. PARTICIPANTS: Fifty-one thousand two hundred fifty-three participants from 10 distinct population-based Asian studies. METHODS: Age-related macular degeneration was defined using the Wisconsin Age-Related Maculopathy Grading System, the International Age-Related Maculopathy Epidemiological Study Group Classification, or the Beckman Clinical Classification. Chronic kidney disease was defined as estimated glomerular filtration rate (eGFR) of less than 60 ml/min per 1.73 m2. A pooled analysis using individual-level participant data was performed to examine the associations between CKD and eGFR with AMD (early and late), adjusting for age, sex, hypertension, diabetes, body mass index, smoking status, total cholesterol, and study groups. MAIN OUTCOME MEASURES: Odds ratio (OR) of early and late AMD. RESULTS: Among 51 253 participants (mean age, 54.1 ± 14.5 years), 5079 had CKD (9.9%). The prevalence of early AMD was 9.0%, and that of late AMD was 0.71%. After adjusting for confounders, individuals with CKD were associated with higher odds of late AMD (OR, 1.46; 95% confidence interval [CI], 1.11-1.93; P = 0.008). Similarly, poorer kidney function (per 10-unit eGFR decrease) was associated with late AMD (OR, 1.12; 95% CI, 1.05-1.19; P = 0.001). Nevertheless, CKD and eGFR were not associated significantly with early AMD (all P ≥ 0.149). CONCLUSIONS: Pooled analysis from 10 distinct Asian population-based studies revealed that CKD and compromised kidney function are associated significantly with late AMD. This finding further underscores the importance of ocular examinations in patients with CKD. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Polyamines mediate the inhibitory effect of drought stress on nitrogen reallocation and utilization to regulate grain number in wheat.

Drought stress poses a serious threat to grain formation in wheat. Nitrogen (N) plays crucial roles in plant organ development; however, the physiological mechanisms by which drought stress affects plant N availability and mediates the formation of grains in spikes of winter wheat are still unclear. In this study, we determined that pre-reproductive drought stress significantly reduced the number of fertile florets and the number of grains formed. Transcriptome analysis demonstrated that this was related to N metabolism, and in particular, the metabolism pathways of arginine (the main precursor for synthesis of polyamine) and proline. Continuous drought stress restricted plant N accumulation and reallocation rates, and plants preferentially allocated more N to spike development. As the activities of amino acid biosynthesis enzymes and catabolic enzymes were inhibited, more free amino acids accumulated in young spikes. The expression of polyamine synthase genes was down-regulated under drought stress, whilst expression of genes encoding catabolic enzymes was enhanced, resulting in reductions in endogenous spermidine and putrescine. Treatment with exogenous spermidine optimized N allocation in young spikes and leaves, which greatly alleviated the drought-induced reduction in the number of grains per spike. Overall, our results show that pre-reproductive drought stress affects wheat grain numbers by regulating N redistribution and polyamine metabolism.

Spermidine regulates wheat grain weight at high planting density by promoting the synthesis of sucrose and starch in inferior grains.

Increasing density is an effective way to enhance wheat (Triticum aestivum L.) yield under limited cultivated areas. However, the physiological mechanisms underlying the reduction in grain weight when density increased are still unclear. Three field experiments were conducted during the 2014-2019 growing seasons to explore the physiological mechanisms by which polyamines affect grain weight formation. The results showed that when wheat planting density exceeded 450 × 104 seedlings ha-1 and 525 × 104 seedlings ha-1, wheat yield tended to decrease. Compared to moderate density (DM, 450 × 104 seedlings ha-1), the filling rate of inferior grains was reduced before 25 days after anthesis (DAA) and the active filling period was shortened by 6.4%-7.4% under high density (DH, 600 × 104 seedlings ha-1), resulting in a loss of 1000-grain weight by 5.4%-8.1%. DH significantly reduced sucrose and starch content in inferior grains at the filling stage. Meanwhile, DH inhibited the activity of key enzymes involved in polyamine synthesis [SAMDC (EC 4.1.1.50) and SpdSy (EC 2.5.1.16)] and induced the activity of ethylene (ETH) precursor synthase, resulting in a significant decrease in endogenous spermidine (Spd) content in inferior grains, but a significant increase in ETH release rate. Post-flowering application of exogenous Spd increased the accumulation of sucrose and starch in the inferior grains and positively regulated the filling and grain weight of the inferior grains, whereas exogenous ETH had a negative effect. Overall, Spd may affect wheat grain weight at high planting density by promoting the synthesis of sucrose and starch in inferior grains.

Prevalence and Pattern of Geographic Atrophy in Asia: The Asian Eye Epidemiology Consortium.

PURPOSE: Although there have been many population-based studies of age-related macular degeneration (AMD), only limited information is available in Asia on the epidemiology of geographic atrophy (GA). We aimed to determine the prevalence and patterns of GA through an analysis of multiple studies conducted within the Asian Eye Epidemiology Consortium (AEEC). DESIGN: Cross-sectional meta-analyses. PARTICIPANTS: A total of 97 213 individuals aged 40 years and older. METHODS: Data from 22 population-based studies from countries belonging to the AEEC were included. In all studies, AMD was defined on the basis of standardized grading systems. Geographic atrophy was defined as an area of pallor in the fundus with visibility of the underlying choroidal blood vessels and sharply defined borders. Random-effects meta-analysis was performed to estimate overall and age-, gender-, and region-specific pooled prevalence of GA. MAIN OUTCOME MEASURES: Prevalence of GA per 1000 persons. RESULTS: The mean age was 60.8 ± 10.0 years, and 42 673 (43.9%) were male. Overall, a total of 223 individuals (0.2%) had GA. The pooled overall prevalence of GA was 1.57 per 1000 persons (95% confidence interval [CI], 1.04-2.10), which was 3 times less than that of neovascular AMD of 5.20 per 1000 persons (95% CI, 3.97-6.43). Compared with those aged 50 to 59 years, the prevalence of GA increased from 0.34 per 1000 persons (95% CI, 0.07-0.62) to 2.90 per 1000 persons (95% CI, 1.55-4.25) in those aged ≥70 years. The GA prevalence per 1000 persons was similar between urban (2.22; 95% CI, 1.22-3.23) and rural residents (1.33; 95% CI, 0.70-1.96). Geographic atrophy was more prevalent in South Asia (based on studies from India and Nepal, 3.82 per 1000 persons; 95% CI, 1.72-5.93) compared with East Asia (based on studies from China, Korea, Hong Kong, Taiwan, and Japan, and the Singapore Chinese Eye Study, 0.76 per 1000 persons; 95% CI, 0.31-1.22, P = 0.005). CONCLUSIONS: Geographic atrophy is uncommon in Asian populations compared with those of European ancestry. Even within Asia, geographic differences in GA prevalence were seen. The findings of this meta-analysis suggest that better dissection of risk factors in the Asian population for GA may provide insights into the biological pathways that drive these late-stage manifestations, thus suggesting better targets for prevention.

Prevalence and associations of retinal vein occlusions: the Central India Eye and Medical Study.

PURPOSE: To determine the prevalence of retinal vein occlusions (RVOs) in rural central India. METHODS: The population-based Central India Eye and Medical Study was performed in rural central India and included 4,711 subjects (30 years and older). Using fundus photographs, we assessed the prevalence of branch retinal vein occlusions and central retinal vein occlusions. RESULTS: An RVO was detected in 38 eyes (0.42 ± 0.07%; 95% confidence interval: 0.29-0.56) of 35 subjects (0.76 ± 0.13%; 95% confidence interval: 0.50-1.01). Prevalence of branch retinal vein occlusions was 0.66% ± 0.12% per subject (95% confidence interval: 0.42%-0.90%) and of central retinal vein occlusions was 0.11% ± 0.05% per subject (95% confidence interval: 0.01%-0.21%). In binary logistic analysis, presence of RVOs was associated with higher age (P = 0.007), systolic blood pressure (P < 0.001), blood concentration of urea (P = 0.02), and narrower anterior chamber angle (P < 0.03). The RVO prevalence was not significantly (all Ps > 0.10) associated with body mass index; blood concentrations of glucose, cholesterol, high-density lipoproteins, and creatinine; presence of diabetes mellitus, tuberculosis and malaria; nutritional parameters; alcohol consumption; refractive error; and optic disk size. The age-specific prevalence rates of RVOs were 0.18% ± 0.13%, 0.29% ± 0.15%, 0.89% ± 0.34%, 1.07% ± 0.36%, 2.72% ± 0.85%, and 3.64% ± 2.55%, respectively, for decadal age groups. In two (5%) eyes, RVO had caused low vision (visual acuity <20/60 and ≥20/400). CONCLUSION: In the rural agrarian low-income population of Central India, RVOs were detected in 0.8% of adults, with branch retinal vein occlusions being approximately seven times more common than central retinal vein occlusions. Main associated factors were higher age, blood pressure, urea blood concentration, and narrow chamber angle. RVOs were no major reason for visual impairment.

Topical glycerine for corneal clouding during retinal laser photocoagulation for retinopathy of prematurity.

AIM: To document the use of topical glycerine to reduce corneal edema in cases of retinopathy of prematurity (ROP) undergoing laser photocoagulation (PHC). METHODS: Thirty-two eyes of 16 babies (9 males) with a mean gestational age of 30 weeks, mean gestational weight of 1242 grams underwent PHC for Type 1 (zone 1 disease) retinopathy of prematurity. All babies received a single PHC session. Twenty eyes of 10 babies received intravitreal anti-VEGF injection, 1-3 weeks before PHC session. All patients received a single drop of glycerine during the PHC session to clear the corneal clouding. All patients underwent PHC to the avascular area right up to the ora serrata. Patients were seen at one week and one month to assess the adequacy of laser PHC. RESULTS: We were able to complete the PHC for all babies in a single session without any ocular or systemic adverse events. We did not find any skip lesions at follow-up, and the second session of laser PHC was not required in any eyes. CONCLUSION: Topical glycerine is safe and effective to clear corneal clouding in eyes undergoing laser PHC for retinopathy of prematurity.

Surgical exposure for vitrectomy in retinopathy of prematurity.

Our purpose was to evaluate the efficacy of lateral canthotomy, sub-tenon anesthesia injection, and the use of modified speculum for gaining adequate surgical exposure during surgery for retinopathy of prematurity (ROP). Fourteen eyes of 10 consecutive patients undergoing microincisional vitrectomy surgery (MIVS) for stage 4 and stage 5 ROP were included. There was a significant widening of the palpebral fissure height and length using this technique. No patient developed a lens injury during the surgery. All the canthotomy incisions completely healed at a four-week follow-up visit. This is a safe and effective technique for increasing surgical exposure in cases of ROP requiring vitrectomy.

Krill's Disease: A Newer Management Option.

Purpose: To report a case of a young female who presented with scotoma in the right eye for few days. Case Report: Krill's disease or acute retinal pigment epithelitis (ARPE) is a self-limiting retinal disease with no specific treatment. Typical clinical and imaging features helped us to diagnose her with ARPE. Intravenous methylprednisolone (IVMP), which gives a rapid anti-inflammatory response, was advised. An SD-OCT scan post-injection showed a reduction in hyperreflectivity and height of lesion at day 3 and near total resolution by day 5. Conclusion: This case suggests rapid resolution of ARPE with the use of IVMP.

Integrated Microbiome and Metabolomic Analysis Reveal Responses of Rhizosphere Bacterial Communities and Root exudate Composition to Drought and Genotype in Rice (Oryza sativa L.).

BACKGROUND: As climate change events become more frequent, drought is an increasing threat to agricultural production and food security. Crop rhizosphere microbiome and root exudates are critical regulators for drought adaptation, yet our understanding on the rhizosphere bacterial communities and root exudate composition as affected by drought stress is far from complete. In this study, we performed 16S rRNA gene amplicon sequencing and widely targeted metabolomic analysis of rhizosphere soil and root exudates from two contrasting rice genotypes (Nipponbare and Luodao 998) exposed to drought stress. RESULTS: A reduction in plant phenotypes was observed under drought, and the inhibition was greater for roots than for shoots. Additionally, drought exerted a negligible effect on the alpha diversity of rhizosphere bacterial communities, but obviously altered their composition. In particular, drought led to a significant enrichment of Actinobacteria but a decrease in Firmicutes. We also found that abscisic acid in root exudates was clearly higher under drought, whereas lower jasmonic acid and L-cystine concentrations. As for plant genotypes, variations in plant traits of the drought-tolerant genotype Luodao 998 after drought were smaller than those of Nipponbare. Interestingly, drought triggered an increase in Bacillus, as well as an upregulation of most organic acids and a downregulation of all amino acids in Luodao 998. Notably, both Procrustes analysis and Mantel test demonstrated that rhizosphere microbiome and root exudate metabolomic profiles were highly correlated. A number of differentially abundant genera responded to drought and genotype, including Streptomyces, Bacillus and some members of Actinobacteria, were significantly associated with organic acid and amino acid contents in root exudates. Further soil incubation experiments showed that Streptomyces was regulated by abscisic acid and jasmonic acid under drought. CONCLUSIONS: Our results reveal that both drought and genotype drive changes in the compositions of rice rhizosphere bacterial communities and root exudates under the greenhouse condition, and that organic acid exudation and suppression of amino acid exudation to select specific rhizosphere bacterial communities may be an important strategy for rice to cope with drought. These findings have important implications for improving the adaptability of rice to drought from the perspective of plant-microbe interactions.

Lens thickness and associated factors.

BACKGROUND: To determine the normative data for lens thickness and its associated factors in a population-based study. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study included 4711 subjects (aged 30+ years). METHODS: The subjects underwent a detailed ophthalmological examination including measurement of the lens thickness by sonography. MAIN OUTCOME MEASURE: Sonographic lens thickness measurement. RESULTS: After excluding pseudophakic or aphakic eyes, lens thickness measurements were available for 9046 eyes of 4610 (97.9%) subjects with a mean age of 49.1 ± 13.2 years (range: 30-100 years) and a mean refractive error of -0.11 ± 1.77 dioptres (median, 0 dioptres; range, -21.75 to +7.75 dioptres). Mean lens thickness was 3.95 ± 0.49 mm. In multivariate analysis, a thick lens was significantly associated with higher age (P < 0.001), male gender (P < 0.001), higher body stature (P = 0.02), higher body mass index (P = 0.003), thicker central cornea (P = 0.008), shallower anterior chamber depth (P < 0.001) and hyperopic refractive error (P < 0.001). After adjustment for ocular and systemic parameters, lens thickness decreased with higher degree of nuclear cataract. CONCLUSIONS: In the rural Central Indian population, a thick lens was associated with higher age, male gender, high body stature, high body mass index, hyperopia, thick central cornea, shallow anterior chamber depth and nuclear cataract. The data may be helpful to explain anatomic relationships of the anterior segment of the eye and to elucidate risk factors of diseases associated with ocular dimensions.

Anterior chamber depth and its associations with ocular and general parameters in adults.

BACKGROUND: To investigate the normative data of anterior chamber depth and its associations in adults in rural Central India. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study included 4711 subjects aged 30+ years (response rate 80.1%). METHODS: The subjects underwent an ophthalmological examination including measurement of the anterior chamber depth by sonography. MAIN OUTCOME MEASURE: Anterior chamber depth. RESULTS: Mean anterior chamber depth was 3.22 ± 0.34 mm. In multivariate analysis, a shallow chamber depth was significantly associated with higher age (P < 0.001), female gender (P < 0.001), shorter body stature (P = 0.003), hyperopic refractive error (P < 0.001), higher lens thickness (P < 0.001) and shorter axial length (P < 0.001). CONCLUSIONS: In the rural Central Indian population, a shallow anterior chamber was associated with higher age, female gender, short body stature, hyperopia, thick lens and shorter axial length. Compared with population-based data from East Asia (China), the anterior chamber was markedly deeper in India. The data may be helpful to explain anatomic relationships of the anterior segment of the eye, to elucidate risk factors of angle-closure glaucoma and to explain ethnic differences in the prevalence of angle-closure glaucoma.

BEVACIZUMAB FOR POST VITRECTOMY CYSTOID MACULAR EDEMA IN A SILICONE OIL-FILLED EYE.

PURPOSE: To report the safety and efficacy of intravitreal bevacizumab (IVB) in a case of cystoid macular edema (CME) in a silicone oil-filled eye. METHODS: A man, aged 51 years, reported with poor visual improvement in the right eye (RE) after pars plana vitrectomy with oil injection performed 2 months back for a pseudophakic, macula-off rhegmatogenous retinal detachment. His best-corrected visual acuity in the RE was counting fingers 2 m. Fundus examination of the RE showed a silicone oil-filled eye with attached retina, and CME was confirmed on spectral-domain optical coherence tomography. He was advised to undergo IVB injection, which was given a few days later. RESULTS: One week after IVB, the central macular thickness had decreased to 437 µ m. Seven weeks later, the macular edema subsided completely with a final central macular thickness of 219 µ m. His vision improved by seven lines to 6/24 and was stable for another 2 months. He underwent removal of silicone oil after 3 months, wherein his visual acuity improved further by one line to 6/18. DISCUSSION: This case demonstrates the use IVB for CME in a silicone oil-filled eye. It was found that IVB was safe and effective in CME associated with a silicone oil-filled eye.

Coupling Effects of Nitrogen and Irrigation Levels on Growth Attributes, Nitrogen Use Efficiency, and Economics of Cotton.

Nitrogen (N) fertilization plays a pivotal role in physiomorphological attributes and yield formation of field-grown cotton (Gossypium hirsutum L.), but little is known of its interaction with irrigation levels. Therefore, this study was conducted with an objective of evaluating the impact of irrigation and nitrogen levels on growth attributes and nitrogen use efficiency of Bt cotton (Gossypium spp.) in the hot arid region. The experiment consisted of a factorial arrangement of three irrigation levels (200, 400, and 600 mm) and four nitrogen rates (0, 75, 150, and 225 kg ha-1) in a split-plot design with three replications. Nitrogen fertilization and irrigation levels influenced cotton growth attributes and yield. The highest leaf area index, dry matter accumulation, crop growth rate, and relative growth rate were achieved at 225 kg N ha-1 and irrigation level 600 mm as compared to other experimental treatments. Similarly, nitrogen uptake and content by seed, lint, and stalk and total nitrogen uptake recorded maximum at 225 kg N ha-1 and irrigation level 600 mm. Interestingly, the treatment of 600 mm of irrigation and 150 kg N ha-1 displayed significant increase in nitrogen use efficiency indices such as agronomic efficiency of nitrogen (AEN) and recovery efficiency of nitrogen (REN), while partial factor productivity of nitrogen (PFPN) and internal nitrogen use efficiency (iNUE) were significantly higher with application of 600 mm of irrigation and nitrogen application rate of 75 kg ha-1. Application of 600 mm of irrigation along with 225 kg N ha-1 resulted in significant increase in gross return, net return, and B:C ratio than any other treatment combinations. So, application of 600 mm of irrigation along with 225 kg N ha-1 could be recommended for achieving higher growth and yield, as well as profitability of Bt cotton under hot arid region and similar agroecologies.

Association between body mass index and diabetic retinopathy in Asians: the Asian Eye Epidemiology Consortium (AEEC) study.

BACKGROUND/AIMS: Obesity is a well-known risk factor for diabetes, but its association with diabetic retinopathy (DR) is inconclusive, in particular in Asians. We aimed to assess whether body mass index (BMI) is associated with the presence and severity of DR in Asian populations with diabetes. METHODS: Pooled analysis of individual-level cross-sectional data from 10 010 adults with diabetes who participated in 12 population-based studies conducted in China, India, Japan, Russia (Asian), Singapore and South Korea that were part of the Asian Eye Epidemiology Consortium (AEEC). BMI was calculated as weight in kilograms divided by height in square metres and categorised into normal (<25 kg/m2, reference), overweight (25-29.9 kg/m2) and obese (≥30 kg/m2). Any-DR (n=1669) and vision-threatening DR (VTDR, n=489) were assessed from digital retinal photographs and graded according to standard protocols. Each study was analysed separately using multivariable logistic regression models adjusted for age, sex, haemoglobin A1c%, systolic blood pressure and diabetes duration, and the estimated odds ratios (ORs) and 95% confidence interval (CIs) from all studies were then combined using random-effects models. RESULTS: In multivariable models, obesity showed a significant inverse association with any-DR (pooled OR (95% CI) =0.74 (0.59 to 0.91)) and VTDR (0.75 (0.60 to 0.93)). Similarly, in continuous analysis, BMI showed a significant inverse association with both any-DR (0.93 (0.87 to 0.99)) and VTDR (0.79 (0.68 to 0.92) per SD increase). Overweight did not show a significant association with any-DR. CONCLUSIONS: Among Asian adults with diabetes, both BMI and obesity showed an inverse association with DR. These findings warrant confirmation in further longitudinal studies.

Impact of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) GFR Estimating Equations on CKD Prevalence and Classification Among Asians.

Background: In 2021, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) validated a new equation for estimated glomerular filtration rate (eGFR). However, this new equation is not ethnic-specific, and prevalence of CKD in Asians is known to differ from other ethnicities. This study evaluates the impact of the 2009 and 2021 creatinine-based eGFR equations on the prevalence of CKD in multiple Asian cohorts. Methods: Eight population-based studies from China, India, Russia (Asian), Singapore and South Korea provided individual-level data (n = 67,233). GFR was estimated using both the 2009 CKD-EPI equation developed using creatinine, age, sex, and race (eGFRcr [2009, ASR]) and the 2021 CKD-EPI equation developed without race (eGFRcr [2021, AS]). CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 (G3-G5). Prevalence of eGFR categories was compared within each study and within subgroups of age, sex, body mass index (BMI), diabetes, and hypertension status. The extent of reclassification was examined using net reclassification improvement (NRI). Findings: Of 67,233 adults, CKD prevalence was 8.6% (n = 5800/67,233) using eGFRcr (2009, ASR) and 6.4% (n = 4307/67,233) using eGFRcr (2021, AS). With the latter, CKD prevalence was reduced across all eight studies, ranging from -7.0% (95% CI -8.5% to -5.4%) to -0.4% (-1.3% to 0.5%), and across all subgroups except those in the BMI < 18.5% subgroup. Net reclassification index (NRI) was significant at -2.33% (p < 0.001). No individuals were reclassified as a higher (more severe) eGFR category, while 1.7%-4.2% of individuals with CKD were reclassified as one eGFR category lower when eGFRcr (2021, AS) rather than eGFRcr (2009, ASR) was used. Interpretation: eGFRcr (2021, AS) consistently provided reduced CKD prevalence and higher estimation of GFR among Asian cohorts than eGFRcr (2009, ASR). Based on current risk-stratified approaches to CKD management, more patients reclassified to lower-risk GFR categories could help reduce inappropriate care and its associated adverse effects among Asian renal patients. Comparison of both equations to predict progression to renal failure or adverse outcomes using prospective studies are warranted. Funding: National Medical Research Council, Singapore.

Effective refractive error coverage in adults aged 50 years and older: estimates from population-based surveys in 61 countries.

BACKGROUND: In 2021, WHO Member States endorsed a global target of a 40-percentage-point increase in effective refractive error coverage (eREC; with a 6/12 visual acuity threshold) by 2030. This study models global and regional estimates of eREC as a baseline for the WHO initiative. METHODS: The Vision Loss Expert Group analysed data from 565 448 participants of 169 population-based eye surveys conducted since 2000 to calculate eREC (met need/[met need + undermet need + unmet need]). A binary logistic regression model was used to estimate eREC by Global Burden of Disease (GBD) Study super region among adults aged 50 years and older. FINDINGS: In 2021, distance eREC was 79·1% (95% CI 72·4-85·0) in the high-income super region; 62·1% (54·7-68·8) in north Africa and Middle East; 49·5% (45·0-54·0) in central Europe, eastern Europe, and central Asia; 40·0% (31·7-48·2) in southeast Asia, east Asia, and Oceania; 34·5% (29·4-40·0) in Latin America and the Caribbean; 9·0% (6·5-12·0) in south Asia; and 5·7% (3·1-9·0) in sub-Saharan Africa. eREC was higher in men and reduced with increasing age. Global distance eREC increased from 2000 to 2021 by 19·0%. Global near vision eREC for 2021 was 20·5% (95% CI 17·8-24·4). INTERPRETATION: Over the past 20 years, distance eREC has increased in each super region yet the WHO target will require substantial improvements in quantity and quality of refractive services in particular for near vision impairment. FUNDING: WHO, Sightsavers, The Fred Hollows Foundation, Fondation Thea, Brien Holden Vision Institute, Lions Clubs International Foundation.

Corneal refractive power and its associations with ocular and general parameters: the Central India Eye and Medical Study.

PURPOSE: To investigate the normal distribution of corneal refractive power (CRP) and its associations with other ocular and systemic parameters in the Central Indian population. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study is a population-based study performed in a rural region of Central India. The study comprised 4711 subjects aged 30+ years. METHODS: A detailed ophthalmic and medical examination was performed. Horizontal and vertical CRP were measured using a non-automatic keratometer. MAIN OUTCOME MEASURES: Corneal refractive power. RESULTS: After excluding pseudophakic or aphakic eyes, keratometric measurements were available on 9024 eyes of 4617 study participants (98.0%) with a mean age of 49.1±13.2 years (range, 30-100 years) and a mean refractive error of -0.20±1.52 diopters (D). Mean horizontal CRP was 44.60±1.68 D (mean ± standard deviation; range, 36.5-52.0 D), and vertical CRP was 44.62±1.74 D (range, 37.75-52.0 D) with no significant difference between both parameters (P=0.27). In multivariate analysis, CRP was significantly (P < 0.001) associated with the systemic parameters of increasing age (P < 0.001), lower level of education (P=0.02), and lower body height (P < 0.001), and with the ocular parameters of thinner central corneal thickness (P < 0.001), deeper anterior chamber (P < 0.001), shorter axial length (P < 0.001), and myopic refractive error (P < 0.001). The results remained unchanged if eyes with CRP ≥48 D were excluded. CONCLUSIONS: Horizontal CRP increased with higher age, lower level of education, lower body height, thinner central cornea, deeper anterior chamber, shorter axial length, and myopic refractive error. The association with age may be of importance for refractive surgery. The association of a steeper cornea with a shorter body stature and a shorter axial length parallels an association between shorter body length and shorter axial length without association with refractive error. The association among steeper cornea, shorter body length, and lower educational level complements the association between shorter body length and lower educational level. The correlation between steeper cornea and deeper anterior chamber may be explained geometrically.

Prevalence of age-related macular degeneration in rural central India: the Central India Eye and Medical Study.

PURPOSE: To evaluate the prevalence of age-related macular degeneration (AMD) in the adult population of rural central India. METHODS: The population-based Central India Eye and Medical Study was conducted in rural central India and included 4,711 subjects (aged ≥30 years). Age-related macular degeneration was defined by the international classification of the Wisconsin age-related maculopathy grading system. RESULTS: Fundus photographs were available for 4,542 subjects (96.4%). In subjects aged ≥40, ≥50, and ≥60 years, prevalence of early AMD was 6.1 ± 0.4% (95% confidence interval [CI]: 5.3-6.9%), 8.2 ± 0.6% (95% CI: 7.0-9.4%), and 8.3 ± 0.8% (95% CI: 6.8-9.9%), respectively, and that of late AMD was 0.2 ± 0.8% (95% CI: 0.1-0.4%), 0.2 ± 0.1% (95% CI: 0.1-0.4%), and 0.6 ± 0.2% (95% CI: 0.2-1.0%), respectively. The prevalence of early AMD increased from 1.3 ± 0.3% per subject in the 30-year-old to 40-year-old group, to 3.6 ± 0.5% in the 41-year-old to 50-year-old group, to 7.9 ± 0.9% in the 51-year-old to 60-year-old group, to 10.0 ± 1.1% in the 61-year-old to 70-year-old group, to 8.3 ± 0.2% in the 71-year-old to 80-year-old group, and to 8.0 ± 5.5% in the ≥81-year-old group. Age-related macular degeneration was causative for visual impairment (best-corrected visual acuity in the better eye: <20/60 and ≥20/400) in 3 of 342 subjects (0.9%) and for blindness (visual acuity <20/400) in 0 of 17 subjects. CONCLUSION: After age adjustment, AMD was found less frequently in the adult population of rural central India than in European populations. Accordingly, visual impairment because of AMD was relatively uncommon in rural central India.

Association between Body Mass Index and Chronic Kidney Disease in Asian Populations: A Participant-level Meta-Analysis.

Obesity and chronic kidney disease (CKD) are major public health problems worldwide. However, the association between body mass index (BMI) and CKD is inconclusive in Asians. In this meta-analysis, eight population-based studies, from China, India, Russia (Asian), Singapore and South Korea, provided individual-level data (n=50037). CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. BMI was analyzed both as a continuous variable and in three categories: <25kg/m2, normal; 25-29.9kg/m2, overweight; and ≥30kg/m2, obese. The association between BMI and CKD was evaluated in each study using multivariable logistic regression models and individual estimates were pooled using random-effect meta-analysis to obtain the pooled odds ratio (OR) and 95% confidence interval (CI). Associations were also evaluated in subgroups of age, gender, smoking, diabetes, and hypertension status. Of 50037 adults, 4258 (8.5%) had CKD. 13328 (26.6%) individuals were overweight while 4440 (8.9%) were obese. The prevalence of any CKD ranged from 3.5% to 29.1% across studies. In pooled analysis, both overweight and obesity were associated with increased odds of CKD, with pooled OR (95% CI) of 1.15 (1.03-1.29) and 1.23 (1.06-1.42), respectively. In subgroup analyses, significant associations between BMI and CKD were observed in adult males, non-smokers, and those with diabetes and arterial hypertension (all p<0.05). When evaluated as a continuous variable, BMI was not significantly associated with CKD. If confirmed in longitudinal studies, these results may have clinical implications in risk stratification and preventive measures, given that obesity and CKD are two major chronic diseases with substantial public health burden worldwide.

Prevalence and predictors of myopic macular degeneration among Asian adults: pooled analysis from the Asian Eye Epidemiology Consortium.

AIMS: To determine the prevalence and predictors of myopic macular degeneration (MMD) in a consortium of Asian studies. METHODS: Individual-level data from 19 885 participants from four population-based studies, and 1379 highly myopic participants (defined as axial length (AL) >26.0 mm) from three clinic-based/school-based studies of the Asian Eye Epidemiology Consortium were pooled. MMD was graded from fundus photographs following the meta-analysis for pathologic myopia classification and defined as the presence of diffuse choroidal atrophy, patchy chorioretinal atrophy, macular atrophy, with or without 'plus' lesion (lacquer crack, choroidal neovascularisation or Fuchs' spot). Area under the curve (AUC) evaluation for predictors was performed for the population-based studies. RESULTS: The prevalence of MMD was 0.4%, 0.5%, 1.5% and 5.2% among Asians in rural India, Beijing, Russia and Singapore, respectively. In the population-based studies, older age (per year; OR=1.13), female (OR=2.0), spherical equivalent (SE; per negative diopter; OR=1.7), longer AL (per mm; OR=3.1) and lower education (OR=1.9) were associated with MMD after multivariable adjustment (all p<0.001). Similarly, in the clinic-based/school-based studies, older age (OR=1.07; p<0.001), female (OR=2.1; p<0.001), longer AL (OR=2.1; p<0.001) and lower education (OR=1.7; p=0.005) were associated with MMD after multivariable adjustment. SE had the highest AUC of 0.92, followed by AL (AUC=0.87). The combination of SE, age, education and gender had a marginally higher AUC (0.94). CONCLUSION: In this pooled analysis of multiple Asian studies, older age, female, lower education, greater myopia severity and longer AL were risk factors of MMD, and myopic SE was the strongest single predictor of MMD.