Trends in the Prevalence of Common Retinal and Optic Nerve Diseases in China: An Artificial Intelligence Based National Screening.

Purpose: Retinal and optic nerve diseases have become the primary cause of irreversible vision loss and blindness. However, there is still a lack of thorough evaluation regarding their prevalence in China. Methods: This artificial intelligence-based national screening study applied a previously developed deep learning algorithm, named the Retinal Artificial Intelligence Diagnosis System (RAIDS). De-identified personal medical records from January 2019 to December 2021 were extracted from 65 examination centers in 19 provinces of China. Crude prevalence and age-sex-adjusted prevalence were calculated by mapping to the standard population in the seventh national census. Results: In 2021, adjusted referral possible glaucoma (63.29, 95% confidence interval [CI] = 57.12-68.90 cases per 1000), epiretinal macular membrane (21.84, 95% CI = 15.64-29.22), age-related macular degeneration (13.93, 95% CI = 11.09-17.17), and diabetic retinopathy (11.33, 95% CI = 8.89-13.77) ranked the highest among 10 diseases. Female participants had significantly higher adjusted prevalence of pathologic myopia, yet a lower adjusted prevalence of diabetic retinopathy, referral possible glaucoma, and hypertensive retinopathy than male participants. From 2019 to 2021, the adjusted prevalence of retinal vein occlusion (0.99, 95% CI = 0.73-1.26 to 1.88, 95% CI = 1.42-2.44), macular hole (0.59, 95% CI = 0.41-0.82 to 1.12, 95% CI = 0.76-1.51), and hypertensive retinopathy (0.53, 95% CI = 0.40-0.67 to 0.77, 95% CI = 0.60-0.95) significantly increased. The prevalence of diabetic retinopathy in participants under 50 years old significant increased. Conclusions: Retinal and optic nerve diseases are an important public health concern in China. Further well-conceived epidemiological studies are required to validate the observed increased prevalence of diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion, and macular hole nationwide. Translational Relevance: This artificial intelligence system can be a potential tool to monitor the prevalence of major retinal and optic nerve diseases over a wide geographic area.

Aproximaciones a la epidemiología de la neuropatía óptica hereditaria de Leber en la comunidad autónoma de Madrid a través de una encuesta a los neuroftalmólogos / Approaches to the epidemiology of NOHL in the region of Madrid: Survey of neuro-ophthalmologists

Objective To estimate the epidemiology of Leber's optic neuropathy (NOHL) in the Region of Madrid. Material and methodsThe neuro-ophthalmologists who work at public hospitals of the CAM were interviewed by telephone. They were asked about the number of patients with NOHL that they had diagnosed during the time that they had been responsible for the neuro-ophthalmology department of that public hospital. The time worked and the population attended by the hospital were used to calculate the number of patient-years in follow-up by each center during the corresponding period. The basic information of each case (date of birth, mutation, and date of visual loss) was registered to avoid duplications. Results Our work estimates a global incidence of 2.34 cases for 10,000,000 inhabitants-year and a prevalence estimated from incidence of one case for each 106,682 inhabitants. This prevalence was very similar in all the studied areas and considerably lower than that reported by other studies. Conclusion This work constitutes the first approach to the epidemiology of this disease in Spain. The prevalence of NOHL in the region of Madrid is probably lower than that reported in the literature in other regions. The prevalence and the incidence were homogeneously low in the 26 studied areas. (AU)

Objetivo Estimar la epidemiología (incidencia y prevalencia) de la neuropatía óptica de Leber (NOHL) en la comunidad autónoma de Madrid (CM). Material y métodosLos neuroftalmólogos que trabajan en los hospitales públicos de la CAM fueron entrevistados telefónicamente. Se les preguntó por el número de pacientes con NOHL que habían diagnosticados durante el tiempo que han sido responsables de la consulta de neuroftalmología de ese hospital público. El tiempo trabajado y la población atendida por el hospital se utilizaron para calcular el número de habitantes-años en seguimiento por cada centro durante el periodo correspondiente y estimar la incidencia en cada área. La prevalencia estimada a partir de la incidencia (PEI) se calculó considerando que un paciente con NOHL vive unos 40 años con la enfermedad. Se registró la información básica de cada caso cuando estaba disponible (sexo, fecha de nacimiento, mutación, fecha de la pérdida visual) para evitar duplicaciones. Resultados Nuestro trabajo estima una incidencia global de 2,34 casos por cada 10.000.000 habitantes-año y una PEI de 1 caso por cada 106.682 habitantes. Esta prevalencia es inferior a la referida por otros estudios. Conclusión Este trabajo constituye la primera aproximación a la epidemiología de esta enfermedad en España. La prevalencia estimada de la NOHL en la CM es probablemente inferior a la reportada en la literatura en otras regiones. La prevalencia y la incidencia fueron homogéneamente bajas en las 26 áreas estudiadas. (AU)

[Etiologies of papilledema in Cameroonian hospitals]. / Etiologies des œdèmes papillaires en milieu hospitalier camerounais.

Introduction: papilledema refers to the swelling of the head of the optic nerve, a major sign of many local, locoregional or systemic pathologies that may involve patients' visual or vital prognosis. This condition represents a diagnostic and therapeutic emergency frequently encountered in our facilities. Therefore, it is deemed and opportune to identify the most common etiologies observed in Cameroonian hospitals. Method: we conducted a documentary and descriptive study of patients with papilledema presenting to the Ophthalmology Department of the Hospital of Instruction, Application and Reference of the Armed Forces of Yaoundé from 1st October 2013 to 31st December 2016. The variables under investigation included epidemiological data (age, sex), clinical data (functional signs, visual acuity, appearance of the papilla and associated signs according to the Hoyt and Beesten classification), complementary examinations performed (fluorescein angiography, visual field, biology, radiography, CT scan) and the etiological diagnosis. Epi-info 3.5.3 software was used for statistical analysis and the Chi-square test was performed at a 5% significance level (p < 5%). Results: during the study period, papilledema was found in 26 out of 5023 patients, reflecting a rate of 0.5%. The average age of patients was 32.7± 10.9 years, ranging from 7 to 79 years, for 13 women and 13 men. Papilledema was bilateral in 15 (57.7%) patients and unilateral in 11 (42.3%), or 41 affected eyes. The etiologies were 11 (42,3%) inflammatory optic neuropathies, 5 (19,2%) arterial hypertension, 4 (15,4%) central retinal vein occlusions, 3 (11,5%) eye contusions, 2 (7,7%) hydrocephalus and 1 case (3,9%) of cerebral malaria. Conclusion: inflammatory and vascular optic neuropathies were the most common etiologies of papilledema in our facilities.

Prevalence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in suspected papilloedema in children.

PURPOSE: Suspected papilloedema is a frequent cause of referral to paediatric ophthalmology clinics. Recent publications have described a new finding called peripapillary hyperreflective ovoid mass-like structures (PHOMS) that may cause pseudopapilloedema. We evaluated the optical coherence tomography (OCT) scans of the optic nerve in all children referred with suspected papilloedema for the presence of PHOMS and report their frequency. METHODS: The optic nerve OCT scans from children seen in our suspected papilloedema virtual clinic between August 2016 and March 2021 were evaluated for the presence of PHOMS by three assessors. A Fleiss' kappa statistic was calculated to test the agreement between the assessors for the presence of PHOMS. RESULTS: A total of 220 scans from 110 patients were evaluated during the study period. The mean patient age was 11.2 SD ± 3.4, (range 4.1-16.8). PHOMS were identified in at least one eye in 74 (67.3%) patients. Of these, 42 (56.8%) patients had bilateral and 32 (43.2%) had unilateral PHOMS. Excellent agreement between assessors for the presence of PHOMS (Fleiss' kappa 0.9865) was observed. PHOMS were common in association with other identified causes of pseudopapilloedema (81.25%) but were also common in papilloedema (66.67%) and otherwise normal discs (55.36%). CONCLUSIONS: Misdiagnosis of papilloedema can lead to unnecessary and invasive tests. PHOMS are found frequently within the paediatric population referred for suspected disc swelling. They appear to be an independent cause of pseudopapilloedema but are often seen in conjunction with true papilloedema and other causes of pseudopapilloedema.

Immune Checkpoint Inhibitors and Optic Neuropathy: A Systematic Review.

INTRODUCTION: Immune checkpoint inhibitors are a class of monoclonal antibodies that are used as a mainstay of immunotherapy for multiple solid organ malignancies. With the recent increase in popularity of these agents, immune-related adverse events including optic neuropathy are becoming more frequently reported. This review aims to explore the association between immune checkpoint inhibitors and optic neuropathy through analysis of incidence, clinical features, investigations, treatment, and patient outcomes. METHOD: A systematic search of the databases PubMed/MEDLINE, Embase, and CENTRAL was performed from inception to September 2022. Data collection and risk of bias analysis was subsequently conducted in accordance with the PRISMA guidelines. RESULTS: Eleven articles fulfilled the inclusion criteria. The results showed an increased incidence of optic neuropathy among patients receiving immune checkpoint inhibitor therapy compared to the general population. Presentation with painless reduced visual acuity and optic disc swelling was most common. Investigation findings were poorly documented. The only two patients who achieved full resolution of symptoms were treated with oral prednisolone. CONCLUSION: There is a strong association between immune checkpoint inhibitor therapy and development of optic neuropathy. Although it remains uncommon, the incidence of optic neuropathy in this population exceeds that of the general population. Future research is needed to further characterise the risk profiles of patients who are most likely to develop ICI-associated optic neuropathy, and treatment pathways for these patients.

Dysthyroid optic neuropathy: Demographics, risk factors, investigations, and management outcomes.

Purpose: To analyze the clinical presentations, risk factors, and management outcomes in patients presenting with dysthyroid optic neuropathy (DON). Methods: This is a retrospective, single-center study carried out on consecutive patients presenting with DON over a period of 4 years (2013-2016). The VISA classification was used at the first visit and subsequent follow-ups. The diagnosis was based on optic nerve function tests and imaging features. Demographic profiles, clinical features, risk factors, and management outcomes were analyzed. Results: Thirty-seven eyes of 26 patients diagnosed with DON were included in the study. A significant male preponderance was noted (20, 76.92%). Twenty patients (76.9%, P = 0.011) had hyperthyroidism, and 15 (57.69%, P = 0.02) were smokers. Decreased visual acuity was noted in 28 eyes (75.6%). Abnormal color vision and relative afferent pupillary defects were seen in 24 (64.86%) eyes, and visual field defects were seen in 30 (81.01%) eyes. The visual evoked potential (VEP) showed a reduced amplitude in 30 (96.77%, P = 0.001) of 31 eyes and delayed latency in 20 (64.51%, P = 0.0289) eyes. Twenty-six (70.27%) patients were treated with intravenous methyl prednisolone (IVMP) alone, whereas 11 (29.72%) needed surgical decompression. The overall best-corrected visual acuity improved by 0.2 l logMARunits. There was no statistically significant difference in outcome between medically and surgically treated groups. Four patients developed recurrent DON, and all of them were diabetics. Conclusion: Male gender, hyperthyroid state, and smoking are risk factors for developing DON. VEP, apical crowding, and optic nerve compression are sensitive indicators for diagnosing DON. Diabetics may have a more defiant course and are prone to develop recurrent DON.

From Scylla to Charybdis: Fixed drug combinations for tuberculosis and increased ethambutol-induced optic neuropathy in India.

Purpose: To describe the increase in prevalence of ethambutol-induced optic neuropathy (EON) in patients presenting to a single tertiary referral eye care center in India after introduction of weight-based fixed dose combinations and an increase in duration of ethambutol use from 2016 in the Revised National Tuberculosis Control Program. Methods: This was a retrospective, observational, referral hospital-based study of 156 patients with a diagnosis of EON presenting to a single tertiary referral eye care center between January 2016 and December 2019. The main outcome measure was to assess the increase in prevalence of EON cases presenting to our tertiary care institute. Results: During the 4-year study period, 156 new patients were diagnosed with EON. A total of 101 patients (64.7%) were males and 55 (35.3%) were females. The most common age group affected was 41-60 years. The significant complaint at presentation was decreased vision in all the patients. A rising trend in the number of patients diagnosed as EON was seen, with the prevalence increasing from 16 cases in 2016, 13 cases in 2017, and 31 cases in 2018 to 96 cases in 2019. Conclusion: The results of this study indicated an alarming increase in the trend of EON cases presenting to our tertiary care institute.

Association of Mood Disorders, Substance Abuse, and Anxiety Disorders in Children and Teens With Serious Structural Eye Diseases.

PURPOSE: We sought to evaluate the association between 5 eye diseases (including glaucoma, cataract, congenital optic nerve disease, congenital retinal disease, and blindness/low vision) and mental illness in a pediatric population. DESIGN: Cross-sectional study. METHODS: A de-identified commercial insurance claims database, OptumLabs Data Warehouse, between January 1, 2007, and December 31, 2018, was used. Children and teens less than 19 years of age at the time of eye diagnosis were included. Demographics and mental illness claims were compared, looking at the association of mental illness and eye disease claims. RESULTS: A total of 11,832,850 children and teens were included in this study with mean age of 8.04 ± 5.94 years at the first claim. Of the patients with at least 1 of the 5 eye diseases (n = 180,297), 30.5% had glaucoma (n = 54,954), 9.5% had cataract (n = 17,214), 21.4% had congenital optic nerve disease (n = 38,555), 26.9% had congenital retinal disease (n = 48,562), and 25.9% had blindness or low vision (n = 46,778). There was a statistically significant association, after adjusting for confounding variables, between at least 1 of the 5 eye diseases and schizophrenia disorder (OR = 1.54, 95% CI = 1.48-1.61, P < .001), anxiety disorder (OR = 1.45, 95% CI = 1.43-1.48, P < .001), depressive disorder (OR = 1.27, 95% CI = 1.25-1.29, P < .001), and bipolar disorder (OR = 1.27, 95% CI = 1.21-1.31, P < .001), but a reversed association with substance use disorder (OR = 0.88, 95% CI = 0.86-0.90, P < .001). CONCLUSIONS: We found associations between eye disease in children and teens and mental illness. Understanding these relationships may improve mental illness screening and treatment in the pediatric population.

Analysis of Variation in Incidence of Optic Disc Hemorrhage According to Seasonal and Temperature Changes.

PURPOSE: To investigate seasonal variation in optic disc hemorrhage (DH) by review of fundus photographs representative of 2 calendar years (2019 and 2020). DESIGN: Retrospective, observational trend study. METHODS: Patients who visited the Glaucoma Clinic of Seoul National University Hospital and underwent fundus photography were included. All available stereo disc photographs and red-free retinal nerve fiber layer photographs taken between January 1, 2019 and December 31, 2020 were retrospectively reviewed. The monthly incidence rate of DH was determined by reference to the photographs. Seasonal temperature information and patients' intraocular pressure (IOP) information were obtained, organized, and analyzed. RESULTS: Fundus images of 13,514 eyes were reviewed, and 454 eyes were confirmed to have DH. Poisson regression analyses revealed that as the temperature (T) increased by 1 °C, the DH risk ratio was reduced to 0.979 (95% confidence interval [CI] 0.969-0.989, P < .01). The DH incidence ratio was 1.53 (95% CI 1.23-1.91, P < .01) for the T <10 °C group relative to the T ≥20 °C group. The IOP of the patients with DH in winter was significantly higher than that measured in summer. CONCLUSION: DH is affected by temperature, and as such, shows seasonal variability. This variability is believed to be caused by temperature-related factors such as IOP or hematological factors. © 2022 Elsevier Inc. All rights reserved.

Ethambutol induced toxic optic neuropathy - A retrospective study in a tertiary eye care centre in Southern India.

INTRODUCTION: Ethambutol is an antibiotic used as a first line drug in the treatment of tuberculosis and a vision threatening side effect of EMB is ethambutol-induced optic neuropathy (EON). The aim of the study is to create awareness about the potentiality of ethambutol to cause ethambutol-induced optic neuropathy, careful monitoring of dose and patient education. MATERIALS AND METHODS: A retrospective observational study of 14 patients whose complete Anti- tubercular treatment records could be retrieved were included. Epidemiological data including age, sex, systemic illness were recorded. Duration between optic nerve toxicity , usage of ethambutol and the drug dosage were noted. Best corrected visual acuity, anterior segment examination including pupils, extraocular movements, colour vision, central fields and fundus examination were evaluated. The patients were followed up at one and three month intervals. RESULTS: Associated systemic illness was found to be a confounding factor for the development of ethambutol-induced optic neuropathy. 57% of patients had diabetes mellitus followed by hypertension (14.2%), renal disease (7.1%). The average daily dose of Ethambutol ingested was 1078.5 mg (21 mg/kg) and this high dose could have been the primary cause for development of ethambutol-induced optic neuropathy. Vision ranged from total blindness to mild visual impairment and poor recovery of vision was noted even after discontinuing ethambutol. CONCLUSION: Only a minority of patients showed improvement in visual function following discontinuation of ethambutol and the toxicity was found to be dose-dependent. Patients with comorbidities like renal impairment and diabetes mellitus appeared to be at greater risk. Ophthalmological examination before commencing treatment and periodic evaluation thereafter is mandatory.

Population-Based Incidence and Outcomes of Compressive Optic Neuropathy.

PURPOSE: Prior studies on compressive optic neuropathy (CON) have come from large tertiary centers, which may contain referral bias toward more severe or atypical disease. To our knowledge, there are no studies to determine the population-based etiologies and clinical outcomes of compressive optic neuropathy (CON). This study aims to bridge that gap using the Rochester Epidemiology Project database. DESIGN: Retrospective, population-based cohort. METHODS: Medical records of all residents living in Olmsted County, Minnesota, from January 1, 2000, through December 31, 2018, were screened for CON. Demographic and clinical information were collected before and after treatment. RESULTS: Twenty-three patients had a confirmed diagnosis of CON during our study period, which provided an overall incidence of 1.14 per 100 000 per year. Average age at onset of CON was 51 years (SD 24), and 39% were male. The most common etiologies were pituitary adenoma and meningioma. There was significant improvement in visual fields (P < .003) but not in visual acuity (P = .08) after patients underwent treatment for CON. There was also a significant relationship between the time until treatment and the degree of visual field improvement at follow-up (Pearson correlation rho = -0.58, P < .047). CONCLUSION: To our knowledge, this study provides the first population-based incidence of CON. The finding that earlier treatment leads to better visual outcomes stresses the importance of having CON on the differential diagnosis of patients with optic neuropathy.

Clinical and demographic characteristics of childhood neuro-ophthalmology diseases at a tertiary eye care center.

BACKGROUND: To evaluate the demographic, etiological, and clinical properties, as well as the treatment modalities of neuro-ophthalmological diseases in childhood. METHODS: We retrospectively analyzed the clinical data of patients younger than 18 years old who were referred to the Neuro-Ophthalmology Department of Ulucanlar Eye Hospital from 2004 to 2019. RESULTS: Of 1,910 patients who presented to the Neuro-Ophthalmology Department, 128 (6.7%) were younger than 18 years old at diagnosis, and their data were analyzed. The three most common diagnoses were congenital optic disc (OD) abnormalities in 43 (33.5%), optic neuropathies in 42 (32.8%), and idiopathic intracranial hypertension in 11 (8.5%) patients. The most frequent symptoms were as follows: decreased visual acuity in 36 (28.1%), headache in 32 (25%), and no symptoms in 19 (14.8%) patients. The best visual prognosis was associated with inflammatory optic neuritis, while hereditary and compressive optic neuropathy resulted in poor visual acuity outcomes. CONCLUSIONS: Congenital OD abnormalities and optic neuropathies are the most frequently seen disorders among children with neuro-ophthalmological diseases. Clinicians should also be aware that children without any symptoms may also have neuro-ophthalmological disorders.

Predictors of surgical intervention and visual outcome in bacterial orbital cellulitis.

ABSTRACT: This study aims to identify predictive factors associated with surgical intervention and the visual outcome of orbital cellulitis and to evaluate the treatment outcomes.A retrospective study involving 66 patients (68 eyes; 64 unilateral and 2 bilateral) diagnosed with bacterial orbital cellulitis was conducted between November 2005 and May 2019.The mean (± standard deviation) age was 42.1 (± 25.8) years (range: 15 days-86 years). Sinusitis was the most frequent predisposing factor, occurring in 25 patients (37.9%), followed by skin infection in 10 patients (15.2%), and acute dacryocystitis in 9 patients (13.6%). Subperiosteal abscesses were found in 24 eyes and orbital abscesses in 19 eyes. Surgical drainage was performed in 31 eyes. Regarding the abscess volume for surgical drainage, a cut-off of 1514 mm3 showed 71% sensitivity and 80% specificity. There was significant improvement in visual acuity (VA) and decrease in proptosis after treatment (for both, P ≤ .001). Only pre-treatment VA ≤20/200 was a significant predictor for post-treatment VA of 20/50 or worse (adjusted odds ratio: 12.0, P = .003). The presence of a relative afferent pupillary defect was the main predictor of post-treatment VA of 20/200 or worse (adjusted odds ratio: 19.0, P = .003).The most common predisposing factor for orbital cellulitis in this study was sinusitis. VA and proptosis significantly improved after treatment. We found that the abscess volume was strongly predictive of surgical intervention. Pre-treatment poor VA and the presence of relative afferent pupillary defect can predict the worst visual outcome. Hence, early detection of optic nerve dysfunction and prompt treatment could improve the visual prognosis.

Prognosis of Ocular Tuberculosis Following Long-Term Antitubercular Therapy.

Purpose: This study presents clinical features and prognosis after long-term (12-18 months) antitubercular therapy (ATT) in patients with ocular tuberculosis (OTB) in East China, an endemic area of tuberculosis. Methods: This retrospective study reviewed data from OTB patients treated at the Eye and ENT Hospital of Fudan University from 2008 to 2018. All the patients completed a minimum follow-up of 6 months after the cessation of ATT. Results: Sixty-six patients with OTB were studied. The ocular manifestations included retinal vasculitis (51.6%), choroiditis (24.2%), panuveitis (23.2%), intermediate uveitis (7.4%), scleritis (5.3%), anterior uveitis (2.1%), and optic neuropathy (1%). Except for two patients (ATT for 6 months), all other patients (64/66, 96.97%) received ATT for at least 12 months (6 patients for 12 months, 30 patients for 15 months, and 28 patients for 18 months). Treatment in conjunction with oral corticosteroids was used in 48 patients (72.7%). The average initial best-corrected visual acuity (BCVA) was 0.8 ± 0.64 (LogMAR), which improved to 0.31 ± 0.35 (LogMAR) at the last follow-up (P < 0.05). The final BCVA was significantly associated with the initial BCVA and the duration of clinical symptoms. A complete remission of uveitis was achieved in 97% of the patients. Conclusions: This study observed a favorable prognosis with long-term ATT regimens. Patients with better baseline visual acuity and a shorter duration of clinical symptoms before diagnosis had a better prognosis.

Prospective study to evaluate incidence and indicators for early detection of ethambutol toxicity.

AIMS: To evaluate incidence of toxic optic neuropathy in patients receiving ethambutol (EMB) for 6 months and to identify its early indicators. METHODS: We included 50 patients on anti-tubercular therapy (ATT) including EMB (HRE regimen) based on total body weight for 6 months. Best-corrected visual acuity (ETDRS), colour vision (Ishihara pseudo-isochromatic plates), contrast sensitivity (Pelli-Robson chart), Humphrey visual field analysis (HVF 30-2 SITA FAST), pattern visual evoked response (VER) and spectral-domain optical coherence tomography (SDOCT) for ganglion cell inner plexiform layer (GCIPL) and retinal nerve fibre layer (RNFL) analysis were assessed at baseline and at 2, 4 and 6 months after starting ATT. RESULTS: Mean age of the patients was 36.5±14.7 years with male:female ratio of 2.5:1. Mean daily dosage of EMB was 17.5±1.3 mg/kg/day. No significant change was observed in visual acuity, contrast sensitivity, color vision and mean or pattern SD on HVF at 6 months. Significant increase in VER latency of >2 SD (>125 ms) was observed in 46% eyes on follow-up indicating subclinical toxicity. Significant loss of mean RNFL (from 100.79±16.05 µm to 89.96±13.79 µm) and GCIPL thickness (from 83.1±5.60 µm to 79.85±6.45 µm) was observed at 6 months (p=0.001 for both). Patients with subclinical toxicity had significantly greater damage in temporal RNFL quadrant, supero-nasal and infero-nasal GCIPL sectors compared with others. CONCLUSION: The incidence of clinical EMB optic neuropathy was <2%, though subclinical damage in the form of increase in VER latency, and decrease in RNFL and GCIPL on OCT was seen in 46% eyes.

The occurrence of optic disc haemorrhage in primary open-angle glaucoma eyes with lower normal pressure and its relating factors.

PURPOSE: To report the occurrence probability of disc haemorrhage (DH) and risk factors for it in otherwise healthy Japanese normal-tension glaucoma (NTG) patients who had lower normal intraocular pressure (IOP) and were followed without treatment for 5 years. METHODS: A prospective observational study. Normal-tension glaucoma (NTG) patients with IOP consistently ≤15 mmHg without treatment were enrolled. The presence or absence of DH was checked semi-annually on the fundus photographs by three independent observers, while patients were followed without treatment. Cox proportional hazards model taking inter-eye correlation into consideration was adopted to identify risk factors for DH occurrence. The main outcomes were DH occurrence probability during 5-year period and its risk factors. RESULTS: One hundred seventeen eyes of 90 patients with mean age of 54.1 years, mean deviation value of -3.6 decibels and mean IOP during follow-up of 12.4 mmHg were included. Disc haemorrhage (DH) was observed at least once in 34 eyes and more than twice in 15 eyes during the follow-up. The DH occurrence probability at 5 years was 31% (95% confidence interval: 21-40%), and lower myopic refraction (HR = 1.18; p = 0.018), higher IOP during follow-up (HR = 1.35; p = 0.047) and presence of DH at baseline (HR = 4.19; p = 0.002) were its risk factors. CONCLUSION: Disc haemorrhage (DH) occurrence probability of Japanese healthy NTG patients with mean IOP of 12.4 mmHg and no systemic and/or topical treatment was 31% at 5 years. Lower myopic refraction, higher IOP and its existence at baseline were its risk factors.

Population-Based Frequency of Ophthalmic Adverse Events in Melanoma, Other Cancers, and After Immune Checkpoint Inhibitor Treatment.

PURPOSE: To examine the frequency of ophthalmic immune-related adverse events (OirAEs) in melanoma, other cancers, and after immune checkpoint inhibitor (ICI) treatment. DESIGN: Retrospective clinical cohort study. METHODS: This study identified patients diagnosed with OirAEs between January 1, 2011, and December 31, 2018, in the Kaiser Permanente Southern California electronic health records. The primary exposures of interest were prior initiation of ICIs and underlying cancer diagnosis. Risk-adjusted prevalence of OirAEs was evaluated in patients with melanoma, with nonmelanoma cancer, and without cancer. The 1-year incidence of OirAEs and recurrence of prior ophthalmic disease were identified in ICI-receiving patients with melanoma and nonmelanoma. RESULTS: Among 4,695,669 unique patients identified, 9.9% had a cancer diagnosis, of whom 2.8% had a diagnosis of melanoma. Overall prevalence for uveitis and selected neuro-ophthalmic diagnoses was 341.8/100,000 patient-years in patients with melanoma and 369.6/100,000 patient-years in patients with nonmelanoma cancer regardless of ICI treatment, compared with 142.2/100,000 patient-years in patients without cancer. A total of 2,911 unique patients received ICI therapy. Compared with patients with nonmelanoma cancer, patients with melanoma on any ICI had elevated 1-year incidence rates of uveitis (1.2% vs 0.2%; risk-adjusted odds ratio, 6.45). High 1-year recurrence rates for uveitis in ICI patients with a prior uveitis history were also observed. CONCLUSIONS: The prevalence of all OirAEs was substantially higher in patients with cancer, with ICI-related uveitis risk specifically increased in patients with melanoma compared with patients with nonmelanoma cancer. Evidence-based guidelines for ophthalmic monitoring of patients undergoing ICI treatment may require different risk stratifications based on underlying cancer diagnosis, specific ICI used, and prior history of uveitis.

Prevalence and associated factors of glaucoma in the Russian Ural Eye and Medical Study.

To assess the prevalence and associated factors of glaucoma in a Russian population. The population-based Ural Eye and Medical Study included 5899 (mean age 59.0 ± 10.7 years; range 40-94 years). Glaucomatous optic neuropathy was diagnosed using International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Among 5545 participants with assessable optic disc photographs, 246 individuals [4.4%; 95% confidence interval (CI) 3.9, 5.0] had glaucoma, with open-angle glaucoma (OAG) in 177 individuals (3.2%; 95% CI 2.7, 3.7) and angle-closure glaucoma (ACG) in 69 individuals (1.2; 95% CI 1.0, 1.5), with IOP > 21 mmHg in 79 (32.1%) patients, and with 80 (32.5%) patients on glaucoma therapy. Glaucoma prevalence increased from 3/485 (0.6%; 95% CI 0.0, 1.3) in the age group of 40-45 years to 33/165 (20.0%; 95% CI 13.8, 26.2) in the group aged 80 + years. Higher OAG prevalence correlated with older age [odds ratio (OR) 1.07; 95% CI 1.04, 1.09; P < 0.001], longer axial length (OR 1.36; 95% CI 1.17, 1.58; P < 0.001), higher intraocular pressure (IOP) (OR 1.18; 95% CI 1.13, 1.23; P < 0.001), higher stage of lens pseudoexfoliation (OR 1.26; 95% CI 1.08, 1.47; P = 0.004) and lower diastolic blood pressure (OR 0.98; 95% CI 0.96, 0.99; P = 0.035). Higher ACG prevalence correlated with older age (OR 1.07; 95% CI 1.03, 1.11; P < 0.001), narrower anterior chamber angle (OR 0.81; 95% CI 0.77, 0.86; P < 0.001), and higher IOP (OR 1.30; 95% CI 1.23, 1.38; P < 0.001). Glaucoma caused moderate to severe vision impairment (MSVI) in 9 (4.9%; 95% CI 1.8, 8.1) out of 184 individuals with MSVI (OAG, n = 7; ACG, n = 2), and blindness in one (9.1%) of 11 blind individuals. In this population from Russia, two thirds of glaucoma patients were not on therapy, and in two thirds of the glaucoma patients IOP was ≤ 21 mmHg. Otherwise, glaucoma prevalence, OAG-to-ACG ratio, and glaucoma associations did not differ markedly from Caucasian and East Asian populations.