RESUMEN
BACKGROUND: Myopia or nearsightedness is a type of refractive error. It causes people to see near objects clearly but distant objects as blurred. Good vision can be obtained if the refractive error is corrected properly but, where this is not possible, impaired vision will remain. The remaining myopia imposes a considerable personal and societal burden. In addition, the progression of myopia is more likely to be accompanied by other ocular diseases such as cataract, glaucoma and retinal detachment. Myopia has emerged as a significant global public health problem in recent years. The World Health Organization (WHO) reported uncorrected or undercorrected myopia to be a major cause of visual impairment worldwide. From both an individual and social perspective, it is important to prevent the onset of myopia and slow down its progression. Observational studies have shown that children who spend more time outdoors have a lower incidence of myopia. Several other non-Cochrane systematic reviews have focused on the association between increasing children's outdoor activity time and the prevention of myopia. However, none of these systematic reviews were limited to randomised controlled trials (RCTs), as they included all types of study designs, including observational studies and non-RCTs, in addition to RCTs. OBJECTIVES: To assess the effects of interventions to increase outdoor time on the incidence and progression of myopia in children. SEARCH METHODS: We searched CENTRAL, MEDLINE Ovid, Embase Ovid, ISRCTN registry, ClinicalTrials.gov, and the WHO ICTRP with no language restrictions. The databases were last searched on 24 June 2022. SELECTION CRITERIA: We included RCTs and cluster-RCTs in which interventions were performed to increase the outdoor time for children with the aim of preventing the incidence and progression of myopia. DATA COLLECTION AND ANALYSIS: We employed the standard methods recommended by Cochrane and assessed the certainty of the evidence using GRADE. We considered the following outcome measures: mean change in refractive error from baseline, incidence of myopia, mean change in the axial length from baseline, mean change in unaided distance visual acuity from baseline, quality of life and adverse event. MAIN RESULTS: We included five RCTs in this review, four of which were cluster-RCTs. The total number of participants was 10,733. The included participants were primary school children, most of whom were in first or second grade (aged six to nine years). Four cluster-RCTs involved school-based interventions to encourage children to spend more time outdoors. The interventions included classroom time outdoors, routine for spending recess outdoors, motivational tools for spending time outdoors, and encouragement through electronic information tools. The intervention groups had less change in refractive errors in the direction of myopia; however, 95% confidence intervals (CIs) included no benefit or both benefit and harm at years one and three, and differences at year two included both clinically important and unimportant benefits (at 1 year: mean difference (MD) 0.08 dioptres (D), 95% CI -0.01 to 0.17; 4 studies, 1656 participants; low-certainty evidence; at 2 years: MD 0.13 D, 95% CI 0.06 to 0.19; 4 studies, 2454 participants; moderate-certainty evidence; at 3 years: MD 0.17 D, 95% CI -0.17 to 0.51; 1 study, 729 participants; low-certainty evidence). Our protocol defined a difference of 0.1 D in the change in refractive error as clinically important. At one year, the difference was less than 0.1 D, but at two and three years it was more than 0.1 D. The incidence of myopia was lower in the intervention groups compared to the control groups, but 95% CIs included no change or clinically unimportant benefits (at 1 year: 7.1% with intervention versus 9.5% with control; risk ratio (RR), 0.82, 95% CI 0.56 to 1.19; 3 studies, 1265 participants; low-certainty evidence; at 2 years: 22.5% with intervention versus 26.7% with control; RR 0.84, 95% CI 0.72 to 0.98; 3 studies, 2104 participants; moderate-certainty evidence; at 3 years: 30.5% with intervention versus 39.8% with control; RR 0.77, 95% CI 0.59 to 1.01; 1 study, 394 participants; moderate-certainty evidence). Our protocol defined a difference of 3% in the incidence of myopia as clinically important. At one year, the difference was 2.4%, but there were clinically important differences between the two groups at two (4.2%) and three years (9.3%). The intervention groups had smaller changes in axial lengths in the direction of myopia than the control groups; however, 95% CIs included no benefit or both benefit and harm at years one and three (at 1 year: MD -0.04 mm, 95% CI -0.09 to 0; 3 studies, 1666 participants; low-certainty evidence; at 2 years: MD -0.04 mm, 95% CI -0.07 to -0.01; 3 studies, 2479 participants; moderate-certainty evidence; at 3 years: MD -0.03 mm, 95% CI -0.13 to 0.07; 1 study, 763 participants; moderate-certainty evidence). No included studies reported changes in unaided distance visual acuity and quality of life. No adverse events were reported. AUTHORS' CONCLUSIONS: The intervention methods varied from adopting outdoor activities as part of school lessons to providing information and motivation for encouraging outdoor activities. The results of this review suggest that long-term interventions to increase the time spent outdoors may potentially reduce the development of myopia in children. However, although the interventions may also suppress the progression of myopia, the low certainty of evidence makes it difficult to draw conclusions. Further research needs to be accumulated and reviewed.
Asunto(s)
Progresión de la Enfermedad , Miopía , Humanos , Miopía/prevención & control , Miopía/epidemiología , Niño , Incidencia , Factores de Tiempo , Actividades Recreativas , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
This retrospective observational study aimed to investigate the difference in 4-year outcomes of ranibizumab or aflibercept therapy for macular neovascularization (MNV) with high myopia between pathologic myopia (PM) and non-PM. This study was conducted at Kyoto University Hospital and included consecutive treatment-naïve eyes with active myopic MNV, in which a single intravitreal ranibizumab or aflibercept injection was administered, followed by a pro re nata (PRN) regimen for 4 years. Based on the META-PM study classification, eyes were assigned to the non-PM and PM groups. This study analyzed 118 eyes of 118 patients (non-PM group, 19 eyes; PM group, 99 eyes). Baseline, 1-year, and 2-year best-corrected visual acuity (BCVA) were significantly better in the non-PM group (P = 0.02, 0.01, and 0.02, respectively); however, the 3-year and 4-year BCVA were not. The 4-year BCVA course was similar in both groups. However, the total number of injections over 4 years was significantly higher in the non-PM than in the PM group (4.6 ± 2.6 vs. 2.9 ± 2.6, P = 0.001). Four-year BCVA significantly correlated only with baseline BCVA in both non-PM (P = 0.047, ß = 0.46) and PM groups (P < 0.001, ß = 0.59). In conclusion, over the 4-year observation period, the BCVA course after anti-VEGF therapy for myopic MNV was similar in the eyes with non-PM and those with PM; however, more additional injections in a PRN regimen were required in the eyes with non-PM compared to those with PM. Thus, more frequent and careful follow-up is required for the eyes with non-PM compared with those with PM to maintain long-term BCVA.
Asunto(s)
Inhibidores de la Angiogénesis , Miopía Degenerativa , Ranibizumab , Receptores de Factores de Crecimiento Endotelial Vascular , Proteínas Recombinantes de Fusión , Factor A de Crecimiento Endotelial Vascular , Agudeza Visual , Humanos , Masculino , Femenino , Ranibizumab/administración & dosificación , Ranibizumab/uso terapéutico , Proteínas Recombinantes de Fusión/administración & dosificación , Proteínas Recombinantes de Fusión/uso terapéutico , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Anciano , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Estudios Retrospectivos , Resultado del Tratamiento , Persona de Mediana Edad , Miopía Degenerativa/tratamiento farmacológico , Miopía Degenerativa/complicaciones , Inhibidores de la Angiogénesis/uso terapéutico , Inhibidores de la Angiogénesis/administración & dosificación , Inyecciones Intravítreas , Neovascularización Coroidal/tratamiento farmacológico , Neovascularización Coroidal/patología , Neovascularización Retiniana/tratamiento farmacológico , Neovascularización Retiniana/patologíaRESUMEN
Purpose: To evaluate the efficacy and safety of faricimab injections for treatment-naïve neovascular age-related macular degeneration (nvAMD) patients, including subtypes and pachychoroid phenotypes, and identify predictive factors for visual outcomes. Methods: nvAMD patients were prospectively recruited, receiving three monthly faricimab (6 mg) injections. Best-corrected visual acuity (BCVA) two months after the last injection (month 4) was compared between subtypes, and between pachychoroid neovasculopathy (PNV) and non-PNV eyes. Regression analysis determined factors influencing month 4 BCVA. Results: The study involved 23 patients (12 typical AMD [tAMD], 10 polypoidal choroidal vasculopathy [PCV], 1 retinal angiomatous proliferation [RAP]). Eleven exhibited PNV phenotype. Significant BCVA (P = 4.9 × 10-4) and central retinal thickness (CRT) (P = 1.3 × 10-5) improvements were observed post-faricimab treatment. The therapy demonstrated favourable results for both tAMD and PCV eyes, and non-PNV and PNV eyes. Faricimab achieved dry macula in 77.3% of eyes, with subretinal fluid resolution in most cases, although intraretinal fluid (IRF) often persisted. Multivariable analysis identified external limiting membrane (ELM) presence and IRF as BCVA contributors at month 4. Conclusion: Faricimab demonstrated significant effectiveness and safety in treatment-naïve nvAMD patients, particularly for PCV and PNV eyes. ELM presence and IRF is predictive of visual outcomes.
RESUMEN
BACKGROUND: The morphology and content of stratum corneum (SC) cells provide information on the physiological condition of the skin. Although the morphological and biochemical properties of the SC are known, no method is available to fully access and interpret this information. This study aimed to develop a method to comprehensively decode the physiological information of the skin, based on the SC. Therefore, we established a novel image analysis technique based on artificial intelligence (AI) and multivariate analysis to predict skin conditions. MATERIALS AND METHODS: SC samples were collected from participants, imaged, and annotated. Nine biomarkers were measured in the samples using enzyme-linked immunosorbent assay. The data were then used to teach machine-learning models to recognize individual SC cell regions and estimate the levels of the nine biomarkers from the images. Skin physiological indicators (e.g., skin barrier function, facial analysis, and questionnaires) were measured or obtained from the participants. Multivariate analysis, including biomarker levels ââand structural parameters of the SC as variables, was used to estimate these physiological indicators. RESULTS: We established two machine-learning models. The accuracy of recognition was assessed according to the average intersection over union (0.613), precision (0.953), recall (0.640), and F-value (0.766). The predicted biomarker levels significantly correlated with the measured levels. Skin physiological indicators and questionnaire answers were predicted with strong correlations and correct answer rates. CONCLUSION: Various physiological skin conditions can be predicted from images of the SC using AI models and multivariate analysis. Our method is expected to be useful for dermatological treatment optimization.
Asunto(s)
Inteligencia Artificial , Piel , Humanos , Piel/diagnóstico por imagen , Epidermis , Aprendizaje Automático , BiomarcadoresRESUMEN
PURPOSE: To investigate the prevalence and incidence of strabismus in the Japanese population by age group and to estimate the subtype proportions. DESIGN: A nationwide population-based cohort study. METHODS: This study investigated the number of cases with previous and new diagnoses of strabismus by age group between 2009 and 2020 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan, which includes almost all (≥95%) medical claims data. We calculated the strabismus prevalence and 1-year incidence in 2019 and analyzed the proportion of each strabismus subtype. RESULTS: The strabismus prevalence was 2.154% (2 709 207/125 708 000; 95% CI, 2.152%-2.157%). It showed a bimodal distribution, with a high proportion in school and old ages (especially ≥75 years). Exotropia, esotropia, and cyclovertical strabismus proportions were 67.3%, 26.0%, and 6.7%, respectively. Cyclovertical strabismus was uncommon in patients aged ≤18 years (1.4%) and more common (10.2%) in those aged >18 years. The strabismus incidence in 2019 was 321 per 100 000 person-years (403 093/125 708 000; 95% CI, 320-322). The annual incidence proportion of cyclovertical strabismus as opposed to whole strabismus subtypes in patients aged >18 years (13.1%) was higher than that in those aged ≤18 years (1.4%). CONCLUSIONS: This is the first nationwide population-based cohort study to demonstrate strabismus's overall prevalence and incidence. The high prevalence of cyclovertical strabismus in adults compared with children may suggest that cyclovertical strabismus is a primarily age-related strabismus. The high prevalence of exotropia may indicate a genetic difference between Japanese and other ethnicities.
RESUMEN
This study aimed to analyze the trends and factors influencing the number of ophthalmic surgeries in Japan using the open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan published by the Ministry of Health, Labour and Welfare. We calculated the number of cataract, glaucoma, and vitreoretinal surgeries, categorized by sex, age, and surgical type, for the fiscal years (FY) 2014 to 2020. The number of cataract surgeries remained stable at approximately 1.45 million cases from FY 2014 to 2018, increased to nearly 1.6 million cases in FY 2019, and decreased to 1.45 million cases in FY 2020. Among glaucoma surgeries, surgical treatments were increased 1.8 times over 7 years, from 33,000 to 60,000 cases. Laser treatment remained steady at around 55,000 cases from FY 2014 to 2017 and then increased to approximately 60,000 cases. The number of vitreoretinal surgeries was increased 1.2 times from FY 2014 to 2019, from 120,000 to 140,000, and decreased to 130,000 by FY 2020. Trends in ophthalmic surgeries over the past 7 years may be influenced by population aging, minimally invasive surgery, and the coronavirus disease pandemic. These findings have implications on surgical decision-making and resource allocation.
Asunto(s)
Extracción de Catarata , Catarata , Glaucoma , Humanos , Anciano , Japón/epidemiología , Seguro de SaludRESUMEN
Though vascular endothelial growth factors (VEGF) and other proangiogenic factors, such as angiopoietins (Ang), may be involved in the development of neovascular age-related macular degeneration (nvAMD), only drugs that inhibit the VEGF family are available for the treatment. The newly approved anti-VEGF drug faricimab, which also inhibits Ang-2, is expected to be effective in patients with AMD refractory to conventional anti-VEGF drugs. Therefore, we prospectively investigated the efficacy of faricimab in the treatment of aflibercept-refractory nvAMD. Patients with nvAMD who had been treated with aflibercept in the last year and required bimonthly injections were recruited. 25 eyes showed persistent exudative changes immediately before the faricimab injection (baseline). In these 25 eyes, switching to faricimab did not change visual acuity or central retinal thickness 2 months after the injection; however, 56% of eyes showed reduction or complete absorption of fluid. Notably, 25% of the eyes that showed dry macula at month 2 had no fluid recurrence for up to 4 months. These results indicate that faricimab could benefit some patients with aflibercept-refractory nvAMD.
Asunto(s)
Degeneración Macular , Degeneración Macular Húmeda , Humanos , Ranibizumab , Factor A de Crecimiento Endotelial Vascular , Resultado del Tratamiento , Estudios de Seguimiento , Tomografía de Coherencia Óptica/métodos , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Degeneración Macular/tratamiento farmacológico , Inyecciones Intravítreas , Inhibidores de la Angiogénesis/uso terapéutico , Degeneración Macular Húmeda/tratamiento farmacológicoRESUMEN
PURPOSE: To investigate factors associated with 3-month or 1-year best-corrected visual acuity (BCVA) after vitrectomy with subretinal tissue plasminogen activator injection for submacular hemorrhage (SMH) and to identify the predictors of early displacement. METHODS: This prospective cohort study included consecutive eyes with SMH complicating neovascular age-related macular degeneration or retinal macroaneurysm that underwent vitrectomy with subretinal tissue plasminogen activator injection and were followed up for at least 3 months. Parameters that correlated with 3-month BCVA, 1-year BCVA, and 2-week displacement grade (0-3) were identified. RESULTS: Twenty-nine eyes of 29 patients (73.1 ± 8.4 years; neovascular age-related macular degeneration, 25 eyes) were included. Logarithm of the minimum angle of resolution BCVA improved 3 months after the surgery (baseline, 0.76 [20/115] ± 0.35; 3-month, 0.51 [20/65] ± 0.32; P = 0.006). In multivariable analyses, 1-year logarithm of the minimum angle of resolution BCVA correlated with age ( P = 0.007, ß = 0.39) and SMH recurrence within 1 year after surgery ( P < 0.001, ß = 0.65). Two-week displacement grade correlated with the contrast-to-noise ratio of SMH ( P = 0.001, ß = -0.54). Macular hole occurred in three eyes (10%) with small SMH size and was closed in all eyes via additional vitrectomy with an inverted internal limiting membrane flap technique. CONCLUSION: The recurrence of SMH negatively affected the 1-year visual outcome after vitrectomy with subretinal tissue plasminogen activator injection for SMH. The contrast-to-noise ratio was a useful predictor of early SMH displacement, but not of 1-year BCVA. Further research is necessary to determine the optimal treatment to prevent SMH recurrence.
Asunto(s)
Degeneración Macular , Activador de Tejido Plasminógeno , Humanos , Lactante , Fibrinolíticos/uso terapéutico , Vitrectomía/métodos , Estudios Prospectivos , Resultado del Tratamiento , Estudios de Seguimiento , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/cirugía , Hemorragia Retiniana/complicaciones , Degeneración Macular/complicaciones , Estudios RetrospectivosRESUMEN
PURPOSE: To investigate the 10-year visual outcome and chorioretinal atrophy after a single intravitreal ranibizumab injection followed by a pro re nata regimen for myopic macular neovascularization in pathologic myopia, and to identify the factors associated with 10-year best-corrected visual acuity (BCVA). METHODS: This retrospective observational study evaluated 26 consecutive treatment-naïve eyes (26 patients) with myopic macular neovascularization in pathologic myopia who underwent a single intravitreal ranibizumab followed by a pro re nata regimen of intravitreal ranibizumab and/or intravitreal aflibercept injection and observed over 10 years. We assessed changes in BCVA and morphological parameters, including the META-PM Study category as a chorioretinal atrophy index. RESULTS: The logarithm of the minimum angle of resolution BCVA changed from 0.36 (Snellen, 20/45) ± 0.39 to 0.39 (20/49) ± 0.36 over 10 years of observation. Compared to baseline, 1-year BCVA improved ( P = 0.002), whereas 2 to 10-year BCVA was not significantly different. Total injection frequency was 3.8 ± 2.6. In none of the eyes, 10-year BCVA was 20/200 or less. Ten-year BCVA correlated with baseline BCVA ( P = 0.01, r = 0.47). The META-PM Study category progressed in 60% of eyes. There were no drug-induced complications. CONCLUSION: Best-corrected visual acuity in eyes with myopic macular neovascularization in pathologic myopia was maintained for 10 years after a single intravitreal ranibizumab followed by a pro re nata regimen without drug-induced complications. The META-PM Study category progressed in 60% of eyes, especially those with older baseline age. Early diagnosis and treatment of myopic macular neovascularization are essential to maintain good long-term BCVA.
Asunto(s)
Neovascularización Coroidal , Miopía , Humanos , Inhibidores de la Angiogénesis/efectos adversos , Atrofia/tratamiento farmacológico , Neovascularización Coroidal/diagnóstico , Neovascularización Coroidal/tratamiento farmacológico , Neovascularización Coroidal/etiología , Estudios de Seguimiento , Fondo de Ojo , Inyecciones Intravítreas , Miopía/complicaciones , Ranibizumab/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Factor A de Crecimiento Endotelial VascularRESUMEN
PURPOSE: To investigate the genetic architecture of age-related macular degeneration (AMD) in a Japanese population. DESIGN: Genome-wide association study (GWAS). PARTICIPANTS: Three thousand seven hundred seventy-two patients with AMD and 16 770 control participants from the Japanese population were enrolled in the association analyses. METHODS: We conducted a meta-analysis of 2 independent GWASs that included a total of 2663 patients with AMD and 9471 control participants using the imputation reference panel for genotype imputation specified for the Japanese population (n = 3541). A replication study was performed using an independent set of 1109 patients with AMD and 7299 control participants. MAIN OUTCOME MEASURES: Associations of genetic variants with AMD. RESULTS: A meta-analysis of the 2 GWASs identified 6 loci significantly associated with AMD (P < 5.0 × 10-8). Of these loci, 4 were known to be associated with AMD (CFH, C2/FB, TNFRSF10A, and ARMS2), and 2 were novel (rs4147157 near WBP1L and rs76228488 near GATA5). The newly identified associations were confirmed in a replication study (P < 0.01). After the meta-analysis of all datasets, we observed strong associations in these loci (P = 1.88 × 10-12 and P = 1.35 × 10-9 for meta-analysis for rs4147157 and rs76228488, respectively). When we looked up the associations in the reported central serous chorioretinopathy (CSC) GWAS conducted in the Japanese population, both loci were associated significantly with CSC (P = 4.86 × 10-3 and P = 4.28 × 10-3 for rs4147157 and rs76228488, respectively). We performed a genetic colocalization analysis for these loci and estimated that the posterior probabilities of shared causal variants between AMD and CSC were 0.39 and 0.60 for WBP1L and GATA5, respectively. Genetic correlation analysis focusing on the epidemiologically suggested clinical risk factors implicated shared polygenic architecture between AMD and smoking cessation (rg [the measure of genetic correlation] = -0.33; P = 0.01; false discovery rate, 0.099). CONCLUSIONS: Our findings imply shared genetic components conferring the risk of both AMD and CSC. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Asunto(s)
Coriorretinopatía Serosa Central , Degeneración Macular , Humanos , Estudio de Asociación del Genoma Completo , Predisposición Genética a la Enfermedad , Coriorretinopatía Serosa Central/diagnóstico , Coriorretinopatía Serosa Central/genética , Degeneración Macular/genética , Genotipo , Polimorfismo de Nucleótido Simple , Sitios GenéticosRESUMEN
Purpose: To elucidate the incidence and treatment pattern of active exudative age-related macular degeneration (AMD). Design: A population-based cohort study conducted using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), a national claims database managed by the Japanese Ministry of Health, Labour, and Welfare (MHLW). Participants: The entire Japanese population aged 40 years or older (76 million people). Methods: With the permission of the MHLW, we accessed the complete NDB dataset and identified patients with newly diagnosed active exudative AMD between 2011 and 2018. The incidence of active exudative AMD was categorized by age and sex per year between 2011 and 2018; moreover, details regarding first-line therapy and number of anti-vascular endothelial growth factor (VEGF) injections per elapsed year since initial treatment were obtained and changes in treatment pattern were investigated. Main Outcome Measures: Incidence rate of active exudative AMD. Results: During the specified 8-year period, 246 064 incident cases of active exudative AMD were identified; 61.4% of these patients were men. The overall incidence rate was 40.66 per 100 000 person-years (95% confidence interval [CI], 40.49-40.82) in the general population aged 40 years or older, 53.22 (95% CI, 52.95-53.49) in men, and 29.78 (95% CI, 29.60-29.98) in women. Mean age of onset was lower in men than in women (72.51 ± 10.50 years vs. 73.90 ± 10.46 years). Among patients with newly diagnosed active exudative AMD, 92.9% received anti-VEGF injections for initial treatments, whereas 1.8% underwent combination therapy with photodynamic therapy. The number of anti-VEGF injections in the first year (0-12 months), second year (13-24 months), and third year (25-36 months) after the initial injection was 3.66 ± 2.30, 1.39 ± 2.20, and 1.23 ± 2.19, respectively. Patients who received fewer injections in the first year received fewer injections in subsequent years and vice versa. Conclusions: This is a relatively large population-based study on the detailed epidemiology and actual treatment patterns of active exudative AMD in clinical practice. Our results can be a fundamental information source to ensure healthy eyes and promote well-being for all at all ages.
RESUMEN
PURPOSE: To investigate the effectiveness of screening and subsequent intervention for age-related macular degeneration (AMD) in Japan. STUDY DESIGN: Best-case-scenario analysis using a Markov model. METHODS: The clinical effectiveness and cost-effectiveness of screening for AMD were assessed by calculating the reduction proportion of blindness and the incremental cost-effectiveness ratio (ICER). The Markov model simulation began at screening at the age of 40 years and ended at screening at the age of 90 years. The first-eye and second-eye combined model assumed annual state-transition probabilities in the development and treatment of AMD. Data on prevalence, morbidity, transition probability, utility value, and treatment costs were obtained from previously published reports. Sensitivity analysis was performed to assess the influence of the parameters. RESULTS: In the base-case analysis, screening for AMD every 5 years, beginning at age 40 years and ending at age 74 years (reflecting the screening ages of the current Japanese legal "Specific Health Checkups") showed a decrease of 40.7% in the total number of blind patients. The screening program reduced the number of blind people more than did the additional AREDS/AREDS2 formula supplement intake. However, the ICER of screening versus no screening was ¥9,846,411/QALY, which was beyond what people were willing to pay (WTP) in Japan. Sensitivity analysis revealed that neither OCT nor AI improved the ICER, but the scenario in which the prevalence of smoking decreased by 30% improved the ICER (¥4,655,601/QALY) to the level under the WTP. CONCLUSIONS: Ophthalmologic screening for AMD is highly effective in reducing blindness but is not cost-effective, as demonstrated by a Markov model based on real-world evidence from Japan.
Asunto(s)
Degeneración Macular , Tomografía de Coherencia Óptica , Adulto , Anciano , Anciano de 80 o más Años , Inteligencia Artificial , Análisis Costo-Beneficio , Humanos , Japón/epidemiología , Degeneración Macular/diagnóstico , Degeneración Macular/epidemiología , Cadenas de MarkovRESUMEN
PURPOSE: To investigate the association between the use of topical ß-blockers and subsequent asthma attacks in glaucoma patients with asthma. METHODS: This was a retrospective longitudinal cohort study using an administrative claims database. All patients aged 20 years or older who were registered in the health insurance claims database updated and managed by JMDC Inc. (Tokyo, Japan). Patients who were newly prescribed eye drops for glaucoma treatment were identified between 2011 and 2017. The patients with glaucoma were divided into two groups: ß-blocker users and non-ß-blocker users, based on the presence of a ß-blocker in the prescribed eye drops. We investigated whether the incidence of asthma attacks in patients with previously treated asthma differed between the two groups. RESULTS: We categorized 17,666 patients in the ß-blocker-user group and 12,609 patients in the non-ß-blocker-user group. A total of 580 patients in the ß-blocker group (3.28%) and 847 in the non-ß-blocker group (6.72%) underwent asthma treatment before the prescription of anti-glaucoma eye drops (P < 0.001). Furthermore, 94 patients in the ß-blocker-user group (0.53%) and 278 in the non-ß-blocker user group (2.20%) were undergoing current treatment for asthma (P < 0.001). The adjusted hazard ratios of asthma attacks were 0.73 (95% confidence interval, 0.46-1.16, P = 0.18) in patients with a history of asthma treatment and 1.22 (95% confidence interval, 0.56-2.70, P = 0.62) in patients with current asthma treatment, compared to the non-ß-blocker-user group. CONCLUSION: Our results clarified that several patients with asthma were prescribed topical ß-blockers for glaucoma treatment. However, asthma attacks may not be significantly attributed to topical ß-blockers, even in glaucoma patients under current asthma treatment. The administration of topical ß-blockers to asthma patients could be a treatment option in the absence of other treatment options, if adequate informed consent is obtained. Further studies are needed to draw a firm conclusion on this clinical question.
Asunto(s)
Asma , Glaucoma , Administración Tópica , Antagonistas Adrenérgicos beta/efectos adversos , Asma/diagnóstico , Asma/tratamiento farmacológico , Asma/epidemiología , Estudios de Cohortes , Glaucoma/diagnóstico , Glaucoma/tratamiento farmacológico , Glaucoma/epidemiología , Humanos , Estudios Longitudinales , Estudios RetrospectivosRESUMEN
AIMS: The aim of this study was to elucidate the epidemiological background of central serous chorioretinopathy (CSC), including its incidence and treatment pattern. METHODS: This was a population-based longitudinal cohort study using a nationwide health insurance claims database of the Japan Ministry of Health, Labour and Welfare (MHLW). As Japan employs universal health coverage, the database covers more than 95% of claims issued in Japan. We accessed all data stored in the database with permission from the MHLW. We traced all individuals aged 30 years or older and identified individuals with new onset of CSC between January 2011 and December 2018. CSC cases were categorised by age and sex for each year, and incidence rate was calculated. We also identified major treatments for CSC to elucidate the initial treatment pattern. RESULTS: During the 8-year period, 247 930 incidences of CSC were identified, among which 75.9% were men. The crude incidence rate (per 100 000 person-years) in the general population aged 30 years or older was 34.0 (95% CI 33.9 to 34.2), in men was 54.2 (95% CI 53.9 to 54.4) and in women was 15.7 (95% CI 15.5 to 15.8). The mean age of onset was lower in men than in women (50.5±12.5 years vs 54.7±13.5 years). Most of the patients with newly diagnosed CSC (86.8%) did not receive major treatment. CONCLUSIONS: The current study provides the nationwide population-based evidence to clarify the detailed epidemiology of CSC. These results could help to understand the pathogenesis and mechanisms of CSC in the future.
Asunto(s)
Coriorretinopatía Serosa Central , Masculino , Humanos , Femenino , Adulto , Persona de Mediana Edad , Coriorretinopatía Serosa Central/diagnóstico , Coriorretinopatía Serosa Central/epidemiología , Coriorretinopatía Serosa Central/patología , Incidencia , Estudios de Cohortes , Japón/epidemiología , Estudios Longitudinales , Estudios Retrospectivos , Angiografía con Fluoresceína/métodos , Tomografía de Coherencia Óptica/métodos , Coroides/patologíaRESUMEN
Optical coherence tomography angiography (OCTA) is a new technique for non-invasive imaging of blood vessels, allowing combined evaluation of both deep and surface vessels. The purpose of this study was to evaluate the post-trabeculectomy longitudinal changes in complete avascular area (CAA) of filtering blebs using anterior segment (AS-) OCTA and their association with surgical outcomes. This study included 57 eyes of 53 patients who had undergone trabeculectomy with mitomycin C. AS-OCTA images of filtering bleb were acquired at 3 and 6 months after trabeculectomy, and at 1 month in possible cases. CAAs, regions where complete blood flow was not depicted in AS-OCTA images, were evaluated for their presence, extent, and change over time. CAAs were detected in 37 eyes (65%) and 33 eyes (58%) at 3 and 6 months postoperatively, respectively. The extent of CAAs reduced over time after surgery in most cases. No parameters related to CAAs were significantly associated with surgical success (i.e., intraocular pressure (IOP) ≤ 12 mmHg and IOP reduction > 20% without medication). In conclusion, although it is difficult to predict surgical success by CAA itself, AS-OCTA may be useful for the objective evaluation of the vascularity of filtering blebs.
Asunto(s)
Glaucoma/cirugía , Mitomicina/administración & dosificación , Tomografía de Coherencia Óptica/métodos , Trabeculectomía/métodos , Adulto , Anciano , Angiografía por Tomografía Computarizada , Femenino , Glaucoma/diagnóstico por imagen , Humanos , Presión Intraocular , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mitomicina/farmacología , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: Investigations of morphological changes in photoreceptors in Behçet's disease (BD) using adaptive optics scanning light ophthalmoscope (AOSLO) are lacking. The authors aimed to evaluate macular cone density and regularity in BD patients with or without a history of uveitis with good visual acuity (VA). PATIENTS AND METHODS: The authors included 16 patients (29 eyes) with BD and 12 healthy volunteers (12 eyes) as controls. All subjects had VA of 20/20 or higher. Subjects underwent AOSLO to evaluate the photoreceptor status including cone density (numbers/mm2) and proportion of hexagonal Voronoi domains. RESULTS: Hyporeflective patches that were not detected in color fundus photograph or optical coherence tomography were observed by AOSLO in BD patients both with and without past uveitis history; these were not detected in the control group. Cone density was significantly reduced in BD patients with a history of uveitis compared to controls (P = .002). The proportion of hexagonal Voronoi domains was significantly reduced in BD eyes both with and without history of uveitis relative to controls (P < .001). CONCLUSION: Macular photoreceptor damage was observed in BD patients with and without a history of uveitis. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:218-225.].
Asunto(s)
Síndrome de Behçet , Síndrome de Behçet/diagnóstico , Angiografía con Fluoresceína , Humanos , Oftalmoscopios , Células Fotorreceptoras Retinianas Conos , Agudeza VisualRESUMEN
PURPOSE: To evaluate the efficacy of the claims'-based definition of age-related macular degeneration (AMD) in detecting clinically-diagnosed AMD. STUDY DESIGN: A validation study using cross-sectional data. METHODS: Seven hundred clinically-diagnosed AMD patients and seven hundred non-AMD individuals were randomly selected from patients at the Kyoto University Hospital's ophthalmology outpatient clinic between January 2011 and December 2017. We evaluated the sensitivity, specificity, and positive/negative likelihood ratio of eight different claims'-based definitions of AMD for detecting clinically-diagnosed AMD. These definitions consist of the diagnosis name (AMD) in combination with (1) fluorescent fundus angiography, and/or (2) treatment of AMD, and (3) the exclusion of patients who had a diagnosis of central serous chorioretinopathy (CSC) or myopic choroidal neovascularization. RESULTS: Defining by the diagnosis name AMD in the claims' data showed the highest accuracy (sensitivity 94.9%, specificity 92.6%, accuracy 93.7%). Combining the diagnosis name AMD with fluorescence fundus angiography and/or anti-vascular endothelial growth factor (anti VEGF) treatment increased the specificity at the expense of sensitivity. Notably, the combination with AMD treatment achieved a specificity of 98.3%. CONCLUSION: The current validation study elucidated the high accuracy of the disease name (AMD) in the claims' data for identifying clinically-diagnosed AMD at a single university hospital. Although drawing wider conclusions may be limited, the results of this study contribute to creating real-world evidence in ophthalmology, based on the National Database of Health Insurance Claims in Japan.
Asunto(s)
Neovascularización Coroidal , Degeneración Macular , Estudios Transversales , Hospitales , Humanos , Japón/epidemiología , Degeneración Macular/diagnóstico , Degeneración Macular/epidemiologíaRESUMEN
PURPOSE: To assess the characteristics of glaucoma patients who received systemic or topical steroid treatment. METHODS: Patients who received steroid treatment were selected from a total of 4256 patients at our tertiary referral center of glaucoma management between August 2011 and October 2017. Clinical characteristics of the subjects were extracted from clinical records. To evaluate the factors influencing highest intraocular pressure during observation (max-IOP) or mean deviations (MDs) of visual field at the first and last visits, univariate and multivariate regression analyses were performed using a generalized estimating equation. RESULTS: Three hundred and eighty-two eyes of 196 patients were included in this study. The most frequent disease as the reason for steroid treatment was atopic dermatitis (58 eyes) followed by autoimmune diseases. The patients with atopic dermatitis were significantly younger (38.0 ± 11.2 years old, p < 0.001) and had lower MD (- 9.3 ± 9.1 dB at first visit, p = 0.01; - 10.6 ± 9.2 dB at last visit, p = 0.004) than those with other diseases. In multivariate regression analysis, age and MD at first visit, max-IOP, and atopic dermatitis were correlated with MD at last visit. CONCLUSIONS: The results of the present study suggest that patients with atopic dermatitis carry the risk of irreversible visual field loss even in youth. For earlier detection of high intraocular pressure, reinforcement of ophthalmological screening in management of atopic dermatitis should be recommended.
Asunto(s)
Dermatitis Atópica , Glaucoma , Adolescente , Niño , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/epidemiología , Glaucoma/diagnóstico , Glaucoma/tratamiento farmacológico , Glaucoma/epidemiología , Humanos , Presión Intraocular , Estudios Retrospectivos , Factores de Riesgo , Esteroides , Campos VisualesRESUMEN
AIMS: The latest evidence in the incidence of central retinal artery occlusion (CRAO) is needed to support the development of novel treatments as orphan drugs. However, up-to-date information on the incidence of CRAO in the ageing or aged population is limited. We aimed to investigate the nationwide epidemiological and clinical characteristics of CRAO in Japan, using nationwide health insurance claims data. METHODS: We analysed a total of 16 069 762 claims data in the sampling dataset of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), which is the nationwide health insurance claims database of 127 million whole Japanese individuals. CRAO was identified using the International Classification of Diseases 10th edition diagnostic code H34.1. The crude incidence rates and age-standardised incidence rates of CRAO, according to the standard age-structure population of the WHO, were calculated. RESULTS: The crude incidence rate of CRAO in Japan was 5.84 (95% CI, 5.71 to 5.97) per 100 000 person-years. With respect to the sex-related incidence, the rate was higher 1.40 times in men than in women (6.85 (95% CI, 6.65 to 7.06) vs 4.88 (95% CI, 4.71 to 5.05), p<0.001). The age-standardised incidence rate was 2.53 (95% CI, 2.29 to 2.76) per 100 000 person-years. CONCLUSIONS: The crude incidence rate of CRAO was higher in Japan than in other countries, as reported previously, reflecting the Japanese population structure as a super-aged society. These findings can be helpful for the development of appropriate healthcare policies to address the increasing incidence of CRAO with the ageing population.
Asunto(s)
Oclusión de la Arteria Retiniana , Anciano , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Seguro de Salud , Japón/epidemiología , Masculino , Oclusión de la Arteria Retiniana/epidemiologíaRESUMEN
Purpose: Patients with Behcet's disease frequently have abnormal focal outer plexiform layer (OPL) bumps, which compress the inner nuclear layer. This study investigates the clinical relevance of these OPL elevations in Behcet's disease patients. Methods: Thirty-one consecutive patients (59 eyes) with Behcet's disease in remission and with available optical coherence tomography (OCT) images were included. The number of OPL bumps was counted using spectral-domain OCT images. The relationships between the number of bumps and visual acuity (VA), retinal thickness, choroidal thickness, disease duration, number of prior ocular attacks, and photoreceptor layer status (including external limiting membrane [ELM] and ellipsoid zone [EZ] continuity) were examined. Results: Eyes with more severe EZ or ELM disruptions had lower VA, more ocular attacks, and thinner retinas. Additionally, EZ line and ELM line status were significantly correlated with the number of OPL elevations. Eyes with OPL elevations had poorer VA, longer disease duration, more ocular attacks, and thinner retinas than those without OPL elevations. Additionally, the number of OPL elevations was strongly correlated with the number of ocular attacks in eyes with a preserved photoreceptor layer (R = 0.720, P < 0.0001). Conclusions: The number of OPL elevations was associated with the number of prior ocular attacks in eyes with preserved photoreceptor layers. Therefore, OPL elevations may be a marker of prior posterior ocular attacks, which is important when determining how best to manage Behcet's uveitis.