Association of spouse's vision impairment with depressive symptoms and cognitive decline in partner: A nationally representative study in China.

BACKGROUND: Although several previous studies have reported on the relationship between vision impairment and caregiver mental health, mixed results were obtained, and only one study reported the association between spousal vision impairment and partner depression. Therefore, our study aimed to examine the association between spousal vision impairment and the partner's depressive symptoms and cognitive decline. METHODS: This cross-sectional study gathered baseline data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011. A total of 10,956 couples were included in the study. Vision impairment was assessed by respondents' self-reported distance or near vision. Multivariate logistic and linear regression were conducted to evaluate the association between the spouse's vision impairment and the partner's depressive symptoms and cognitive function. RESULTS: The prevalence of partners with depressive symptoms was significantly higher among spouses with vision impairment than among those without (43.3 % vs. 32.5 %; P < 0.001), and cognitive function was significantly lower (spousal vision impairment 14.4 ± 4.5 vs. no spousal vision impairment 15.5 ± 4.6; P < 0.001). After fully adjusting for potential confounders, the partner had greater odds of depressive symptoms for spouses with vision impairment than for those without (odds ratio: 1.525; 95 % confidence interval [CI]: 1.387 to 1.677). Furthermore, spousal vision impairment was negatively associated with the partner's cognitive function (ß = -0.640; 95 % CI: -0.840 to -0.440). Sensitivity analysis was performed, and consistent results were obtained (all P < 0.05). LIMITATIONS: Visual function was assessed by self-reporting. CONCLUSIONS: A spouse's vision impairment is associated with depressive symptoms and cognitive decline in the partner. The findings imply the importance of considering the partner's mental health when managing their spouse's vision impairment.

Assessment of Causality Between Diet-Derived Antioxidants and Primary Open-Angle Glaucoma: A Mendelian Randomization Study.

Purpose: This study aimed to investigate the genetic causal relationships among diet-derived circulating antioxidants, primary open-angle glaucoma (POAG), and glaucoma-related traits using two-sample Mendelian randomization (MR). Methods: Genetic variants associated with diet-derived circulating antioxidants (retinol, ascorbate, ß-carotene, lycopene, α-tocopherol, and γ-tocopherol) were assessed as absolute and metabolic instrumental variables. POAG and glaucoma-related traits data were derived from a large, recently published genome-wide association study database; these traits included intraocular pressure (IOP), macular retinal nerve fiber layer (mRNFL) thickness, macular ganglion cell-inner plexiform layer (mGCIPL) thickness, and vertical cup-to-disc ratio (vCDR). MR analyses were performed per outcome for each exposure. Results: We found no causal association between six diet-derived antioxidants and POAG using the International Glaucoma Genetics Consortium data. For absolute antioxidants, the odds ratios (ORs) ranged from 1.011 (95% confidence interval [CI], 0.854-1.199; P = 0.895) per natural log-transformed ß-carotene to 1.052 (95% CI, 0.911-1.215; P = 0.490) for 1 µmol/L of ascorbate. For antioxidant metabolites, the OR ranged from 0.998 (95% CI, 0.801-1.244; P = 0.989) for ascorbate to 1.210 (95% CI, 0.870-1.682; P = 0.257) for γ-tocopherol, using log-transformed levels. A similar result was obtained with the FinnGen Biobank. Furthermore, our results showed no significant genetic association between six diet-derived antioxidants and glaucoma-related traits. Conclusions: Our study did not support a causal association among six diet-derived circulating antioxidants, POAG, and glaucoma-related traits. This suggests that the intake of antioxidants may not have a preventive effect on POAG and offers no protection to retinal nerve cells. Translational Relevance: This study provides valid evidence regarding the use of diet-derived antioxidants for glaucoma patients.

Quality assessment of non-mydriatic fundus photographs for glaucoma screening in primary healthcare centres: a real-world study.

BACKGROUND: This study assessed the quality distribution of non-mydriatic fundus photographs (NMFPs) in real-world glaucoma screening and analysed its influencing factors. METHODS: This cross-sectional study was conducted in primary healthcare centres in the Yinzhou District, China, from 17 March to 3 December 2021. The quality distribution of bilateral NMFPs was assessed by the Digital Reading Department of the Eye Hospital of Wenzhou Medical University. Generalised estimating equations and logistic regression models identified factors affecting image quality. RESULTS: A total of 17 232 photographs of 8616 subjects were assessed. Of these, 11.9% of images were reliable for the right eyes, while only 4.6% were reliable for the left eyes; 93.6% of images were readable in the right eyes, while 90.3% were readable in the left eyes. In adjusted models, older age was associated with decreased odds of image readability (adjusted OR (aOR)=1.07, 95% CI 1.06~1.08, p<0.001). A larger absolute value of spherical equivalent significantly decreased the odds of image readability (all p<0.001). Media opacity and worse visual acuity had a significantly lower likelihood of achieving readable NMFPs (aOR=1.52, 95% CI 1.31~1.75; aOR=1.70, 95% CI 1.42~2.02, respectively, all p<0.001). Astigmatism axes within 31°~60° and 121°~150° had lower odds of image readability (aOR=1.35, 95% CI 1.11~1.63, p<0.01) than astigmatism axes within 180°±30°. CONCLUSIONS: The image readability of NMFPs in large-scale glaucoma screening for individuals 50 years and older is comparable with relevant studies, but image reliability is unsatisfactory. Addressing the associated factors may be vital when implementing ophthalmological telemedicine in underserviced areas. TRIAL REGISTRATION NUMBER: ChiCTR2200059277.

Associations between vision impairment and multimorbidity among older Chinese adults: results from the China health and retirement longitudinal study.

BACKGROUND: Although several studies have reported the relationship between vision impairment (VI) and multimorbidity in high-income countries, this relationship has not been reported in low- and middle-income countries. This study aimed to explore the relationship between VI with multimorbidity and chronic conditions among the elderly Chinese population. METHODS: The cross-sectional analysis was applied to data from the China Health and Retirement Longitudinal Study (CHARLS) in 2018. A total of 8,108 participants ≥ 60 years old were included, and 15 chronic conditions were used in this study. Logistic regression analysis was used to analyze the relationship between VI with multimorbidity and chronic conditions. RESULTS: The prevalence of 15 chronic conditions and multimorbidity was higher among the elderly with VI than those without VI. After adjusting for demographic and socioeconomic confounders, 10 chronic conditions were associated with VI (all P < 0.05). Furthermore, positive association was observed between VI and one (odds ratio [OR]: 1.52; 95% confidence intervals [95%CI]: 1.16-2.00; P = 0.002), two (OR: 2.09; 95%CI: 1.61-2.71; P < 0.001), three (OR: 2.87; 95%CI: 2.22-3.72; P < 0.001), four (OR: 3.60; 95%CI: 2.77-4.69; P < 0.001), and five or more (OR: 5.53; 95%CI: 4.32-7.09; P < 0.001) chronic conditions, and the association increased as the number of chronic conditions (P for trend < 0.001). Sensitivity analysis stratified by gender, education, smoking status, and annual per capita household expenditure still found VI to be positively associated with multimorbidity. CONCLUSIONS: For patients older than 60 years, VI was independently associated with multimorbidity and various chronic conditions. This result has important implications for healthcare resource plans and clinical practice, for example, increased diabetes and kidney function screening for patients with VI.

Trend of glaucoma internal filtration surgeries in a tertiary hospital in China.

AIM: To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University. METHODS: A review of the medical records of inpatients who had been diagnosed with glaucoma and received anti-glaucoma surgery between January 1, 2015 and December 31, 2021 was conducted. The glaucoma diagnosis in this study included primary open angle glaucoma, primary angle-closure glaucoma, secondary glaucoma, and paediatric glaucoma. The types of surgeries were categorised as internal filtration, external filtration, and cyclodestruction surgery based on the pathway of aqueous humor outflow. The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed. RESULTS: The number of patients hospitalised for glaucoma surgery increased yearly, from 752 in 2015 to 1373 in 2021, at the Eye Hospital of Wenzhou Medical University. Regarding the patients diagnosed with primary open angle glaucoma, internal filtration surgery increased from 27.40% of the sample to 54.40% of the sample, while external filtration surgery decreased from 71.50% to 44.20% between 2015 and 2021. For paediatric glaucoma, internal filtration surgery increased from 37.50% in 2015 to 88.20% in 2021. Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma, the proportion of internal filtration surgery also showed an increase from 18.20% in 2015 to 40.90% in 2021. Meanwhile, internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00% in 2015, and showed a small increase by 2021. CONCLUSION: As surgical technology and surgical experience continue to elevate and improve, the range of glaucoma surgeries are correspondingly evolving. This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021.

The complement cascade in Alzheimer's disease: a systematic review and meta-analysis.

Genetic evidence implicates a causal role for the complement pathway in Alzheimer's disease (AD). Since studies have shown inconsistent differences in cerebrospinal fluid (CSF) and peripheral blood complement protein concentrations between AD patients and healthy elderly, this study sought to summarize the clinical data. Original peer-reviewed articles measuring CSF and/or blood concentrations of complement or complement regulator protein concentrations in AD and healthy elderly control (HC) groups were included. Of 2966 records identified, means and standard deviations from 86 studies were summarized as standardized mean differences (SMD) by random effects meta-analyses. In CSF, concentrations of clusterin (NAD/NHC = 625/577, SMD = 0.53, Z8 = 8.81, p < 0.005; I2 < 0.005%) and complement component 3 (C3; NAD/NHC = 299/522, SMD = 0.45, Z3 = 3.21, p < 0.005; I2 = 68.40%) were significantly higher in AD, but differences in C1q, C-reactive protein (CRP), serum amyloid protein (SAP), and factor H concentrations were not significant. In peripheral blood, concentrations of CRP were elevated in AD (NAD/NHC = 3404/3332, SMD = 0.44, Z43 = 3.43, p < 0.005; I2 = 93.81%), but differences between groups in C3, C4, C1-inhibitor, SAP, factor H and clusterin concentrations were not significant, and inconsistent between studies. Of 64 complement pathway proteins or regulators in the quantitative synthesis, trends in C1q, factor B, C4a, and late-stage complement pathway components (e.g. C9) in blood, C4 in CSF, and the membrane attack complex in blood and CSF, might be investigated further. The results collectively support elevated complement pathway activity in AD, which was best characterized by increased CSF clusterin concentrations and less consistently by CSF C3 concentrations. Complement activity related to an AD diagnosis was not reflected consistently by the peripheral blood proteins investigated.