Investigation on the Attitude of Middle School Students with Depression in the City Toward Professional Psychological Help-Seeking.

Background: Many middle school students are depressed due to pressure from family, study, life, and communication. With the increasing depression of middle school students, professional psychological counseling institutions have also become more numerous. Therefore, students need to be guided to correctly recognize difficulties and seek professional psychological assistance. Aim: We aimed to investigate the depression status of middle school students in the city and analyze their attitude towards professional psychological help-seeking. Methods: A total of 2485 students from two classes of each grade from six middle schools in the city were randomly selected as the research objects. They were subjected to answer the general questionnaire and professional psychological help-seeking attitude questionnaire to analyze their depression status, psychological help-seeking status, and attitude towards professional psychological help-seeking. Results: 2485 questionnaires were distributed, and 2205 valid questionnaires were returned. A total of 791 (35.9%) of students had depressive symptoms. The detection rate and depression scores in girls were significantly higher than in boys, and the detection rate in junior high school students in the city was notably higher than in high school students and students from rural areas (P<0.05). Only 31 (3.9%) middle school students with depressive symptoms have sought professional psychological help. The scores of self-cognition, stigma tolerance, interpersonal openness, and trust scores of middle school students with depressive symptoms in help-seeking attitude were significantly lower than those of normal students, while self-stigma scores were significantly higher in those with depressive symptoms (P<0.001). Conclusion: Middle school students in the city with depression have a poor attitude towards professional psychological help-seeking. Educators should positively and correctly guide depressed middle school students to seek professional psychological assistance when they need help.

The Association between Cholesterol Levels and Severity of Normal Tension Glaucoma.

Purpose: To evaluate the serum lipid levels, including total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) of patients with normal tension glaucoma (NTG) and to investigate the relationship between serum HDL levels and the severity of NTG. Methods: In this cross-sectional, case-control study, 282 NTG subjects and 202 control subjects were enrolled from the outpatient clinic of the Department of Ophthalmology at Taichung Veterans General Hospital in central Taiwan from 2015 to 2021. Fasting cholesterol, HDL, and LDL levels were evaluated using a biochemical analyzer (ARCHITECT c16000). Glaucoma severity was classified by visual field test as mild (mean deviation [MD] ≥ -6.0dB), moderate (-12dB ≤ MD < -6 dB), and severe (MD < -12dB), based on the mean deviation. Results: HDL levels were significantly lower in the NTG group compared with the control subjects (47 ± 18mg/dl versus 53 ± 18mg/dl; p = 0.03). There were no statistically significant differences in total cholesterol or LDL levels between the NTG and control subjects (total cholesterol levels: 194 ± 39mg/dl versus 190 ± 32mg/dl; p > 0.05; LDL levels: 113 ± 30mg/dl versus 110 ± 29mg/dl; p > 0.05). The mean serum HDL levels were lowest in the severe group (41 ± 11mg/dl) followed by the moderate (45 ± 16mg/dl) and mild (50 ± 15mg/dl) groups, with significant differences among the three groups (p = 0.02). The multivariate regression analysis revealed a statistically significant negative correlation between HDL and vertical cup-to-disc ratio (VCDR; B =-0.16, p = 0.03) among all NTG patients and a positive correlation between HDL and retinal nerve fiber layer (RNFL; r = 0.34, p = 0.03) among all NTG patients. Conclusions: A significantly lower serum HDL concentration was found in the NTG patients, which was negatively associated with disease severity. The findings warrant further study to elucidate the role of these phenomena in the pathogenesis of glaucoma.

Effect of Muller's muscle-conjunctival resection on the upper eyelid crease position in Asian eyelids: a retrospective cohort study.

PURPOSE: Investigating the effect of Muller's muscle-conjunctival resection (MMCR) on the eyelid crease position. METHODS: This retrospective study included patients with unilateral acquired blepharoptosis who underwent MMCR during October 2018-December 2021. The following factors were recorded: preoperative, after phenylephrine, postoperative marginal reflex distance1 (MRD1) and tarsal platform show (TPS) of bilateral eyelids. The primary outcome was to measure the change in TPS and evaluate the factors associated with post-operative TPS. The secondary outcomes included exploring the rate of MRD1 and TPS symmetry after the operation. RESULTS: Forty patients were included in the final analysis. The mean MRD1 of the ptotic eye was 1.28 ± 0.78 mm, 2.79 ± 0.66 mm and 3.20 ± 0.67 mm before, after phenylephrine and after the operation, respectively. The mean TPS of the ptotic eye was 5.90 ± 1.86 mm, 3.96 ± 1.49 mm and 2.79 ± 1.63 mm before, after phenylephrine and after the operation, respectively. Changes in mean TPS after the phenylephrine test and post-operation were statistically significant (p < 0.001). The linear regression model revealed that the absolute change in TPS after phenylephrine drop and absolute change in MRD1 post-operation were significantly correlated with the absolute change in TPS post-operation. Besides, the ratio of symmetry in MRD1 and TPS was greatly improved post-operation (82.5% and 70.0% respectively). CONCLUSION: MMCR is an effective surgical method for ptosis correction as it can not only correct the eyelid crease position but also narrow the wide TPS. This method is particularly beneficial to patients with both mild to moderate ptosis and an asymmetric crease height.

Corvis Biomechanical Factor Facilitates the Detection of Primary Angle Closure Glaucoma.

Purpose: To characterize the corneal biomechanical properties of primary angle closure glaucoma (PACG) and to investigate the diagnostic performance of combining corneal biomechanical parameters and anterior segment parameters in detecting PACG. Methods: This retrospective cross-sectional study evaluated 79 and 81 eyes of normal controls and patients with PACG, respectively. Corvis Biomechanical Factor (CBiF) and anterior chamber volume (ACV) were measured using the Corvis ST and Pentacam, respectively. We performed multivariable logistic regression, adjusted for age, sex, central corneal thickness, intraocular pressure, and ACV to evaluate the effect of CBiF on PACG. The area under the receiver operating curve (AUC) was calculated to compare the diagnostic performance of ACV, CBiF, and ACV-CBiF combination for detecting PACG. Results: The median CBiF of the control and PACG groups was 6.61 (interquartile range [IQR], 6.39-6.88) and 6.20 (IQR, 5.93-6.48), respectively (P < 0.001). A lower CBiF, suggestive of decreased corneal biomechanical stability, increased the odds of PACG (odds ratio, 0.029; 95% confidence interval [CI], 0.003-0.266; P = 0.002) in the multivariable logistic regression model. The ACV-CBiF combination yielded the highest AUC (0.934; 95% CI, 0.882-0.968) compared with ACV alone (0.878; 95% CI, 0.823-0.928). The ACV-CBiF combination had significantly higher discriminatory ability than that of ACV alone (DeLong test, P = 0.004). Conclusions: Lower CBiF and ACV may act as independent predictors for PACG. Combining ACV and CBiF may enhance detection of PACG. Translational Relevance: The combination of corneal biomechanical parameters and anterior segment parameters enhances the detection of PACG.

Association between HSPA5 Promoter Polymorphisms and a Reduced Risk of Normal Tension Glaucoma.

INTRODUCTION: In normal tension glaucoma (NTG), factors other than elevated intraocular pressure (IOP) are likely to play a role in the pathogenesis of optic neuropathy. The potential similarities between Alzheimer's disease (AD) and NTG in cellular apoptosis leading to neurodegeneration have been shown in recent studies. Heat Shock Protein family A member 5 (HSPA5) promoter polymorphisms have been reported to be associated with a risk of AD. The purpose of our study was to investigate the role of HSPA5 promoter polymorphisms in NTG patients. METHODS: A total of 222 patients with NTG, along with 236 normal controls were enrolled in this study. Genomic DNA was amplified through a polymerase chain reaction (PCR) and identified for the polymorphic HSPA5 (-415 and -370) by Xmn1 and BstY1 restriction digestion, respectively. PCR fragments with potential polymorphic HSPA5 (-180) were subjected to sequence-analyses by a Hex-labeled primer. Genotypes for both NTG patients and control groups were compared for statistically significant differences. RESULTS: Polymorphisms (-415) G/A and (-180) del/G were completely linked in our population. The genotype and allele frequency distribution at the -415 G/A and -180 del/G sites showed a significant difference between the NTG cases and controls. The genotype frequency of HSPA5 (-415) AA/(-180) GG and the allele frequency of HSPA5 (-415) A/(-180) G were significantly lower (p = 0.04 and p = 0.01, respectively) in the NTG patients when compared with those in the control group. There was no significant difference in genotype or allele frequency distribution of the HSPA5 (-370) C/T between the NTG and control groups. There was a reduced risk of NTG associated with the carriers for the HSPA5 (-415) A/(-180) G allele compared with that in the control population (p = 0.01). CONCLUSION: HSPA5 (-415) A and (-180) G allele polymorphisms may be protective factors in the development of NTG.

The Clinical Influence after Implementation of Convolutional Neural Network-Based Software for Diabetic Retinopathy Detection in the Primary Care Setting.

Deep learning-based software is developed to assist physicians in terms of diagnosis; however, its clinical application is still under investigation. We integrated deep-learning-based software for diabetic retinopathy (DR) grading into the clinical workflow of an endocrinology department where endocrinologists grade for retinal images and evaluated the influence of its implementation. A total of 1432 images from 716 patients and 1400 images from 700 patients were collected before and after implementation, respectively. Using the grading by ophthalmologists as the reference standard, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to detect referable DR (RDR) were 0.91 (0.87-0.96), 0.90 (0.87-0.92), and 0.90 (0.87-0.93) at the image level; and 0.91 (0.81-0.97), 0.84 (0.80-0.87), and 0.87 (0.83-0.91) at the patient level. The monthly RDR rate dropped from 55.1% to 43.0% after implementation. The monthly percentage of finishing grading within the allotted time increased from 66.8% to 77.6%. There was a wide range of agreement values between the software and endocrinologists after implementation (kappa values of 0.17-0.65). In conclusion, we observed the clinical influence of deep-learning-based software on graders without the retinal subspecialty. However, the validation using images from local datasets is recommended before clinical implementation.

Tuning of Two-Dimensional Plasmon-Exciton Coupling in Full Parameter Space: A Polaritonic Non-Hermitian System.

Non-Hermitian photonic systems with gains and/or losses have recently emerged as a powerful approach for topology-protected optical transport and novel device applications. To date, most of these systems employ coupled optical systems of diffraction-limited dielectric waveguides or microcavities, which exchange energy spatially or temporally. Here, we introduce a diffraction-unlimited approach using a plasmon-exciton coupling (polariton) system with tunable plasmonic resonance (energy and line width) and coupling strength. By designing a chirped silver nanogroove cavity array and coupling a single tungsten disulfide monolayer with a large contrast in resonance line width, we show the tuning capability through energy level anticrossing and plasmon-exciton hybridization (line width crossover), as well as spontaneous symmetry breaking across the exceptional point at zero detuning. This two-dimensional hybrid material system can be applied as a scalable and integratable platform for non-Hermitian photonics, featuring seamless integration of two-dimensional materials, broadband tuning, and operation at room temperature.

Phonon renormalization in reconstructed MoS2 moiré superlattices.

In moiré crystals formed by stacking van der Waals materials, surprisingly diverse correlated electronic phases and optical properties can be realized by a subtle change in the twist angle. Here, we discover that phonon spectra are also renormalized in MoS2 twisted bilayers, adding an insight to moiré physics. Over a range of small twist angles, the phonon spectra evolve rapidly owing to ultra-strong coupling between different phonon modes and atomic reconstructions of the moiré pattern. We develop a low-energy continuum model for phonons that overcomes the outstanding challenge of calculating the properties of large moiré supercells and successfully captures the essential experimental observations. Remarkably, simple optical spectroscopy experiments can provide information on strain and lattice distortions in moiré crystals with nanometre-size supercells. The model promotes a comprehensive and unified understanding of the structural, optical and electronic properties of moiré superlattices.

Engineering Giant Rabi Splitting via Strong Coupling between Localized and Propagating Plasmon Modes on Metal Surface Lattices: Observation of √N Scaling Rule.

We present a strong coupling system realized by coupling the localized surface plasmon mode in individual silver nanogrooves and propagating surface plasmon modes launched by periodic nanogroove arrays with varied periodicities on a continuous silver medium. When the propagating modes are in resonance with the localized mode, we observe a √N scaling of Rabi splitting energy, where N is the number of propagating modes coupled to the localized mode. Here, we confirm a giant Rabi splitting on the order of 450-660 meV (N = 2) in the visible spectral range, and the corresponding coupling strength is 160-235 meV. In some of the strong coupling cases studied by us, the coupling strength is about 10% of the mode energy, reaching the ultrastrong coupling regime.

Moiré potential impedes interlayer exciton diffusion in van der Waals heterostructures.

The properties of van der Waals heterostructures are drastically altered by a tunable moiré superlattice arising from periodically varying atomic alignment between the layers. Exciton diffusion represents an important channel of energy transport in transition metal dichalcogenides (TMDs). While early studies performed on TMD heterobilayers suggested that carriers and excitons exhibit long diffusion, a rich variety of scenarios can exist. In a moiré crystal with a large supercell and deep potential, interlayer excitons may be completely localized. As the moiré period reduces at a larger twist angle, excitons can tunnel between supercells and diffuse over a longer lifetime. The diffusion should be the longest in commensurate heterostructures where the moiré superlattice is completely absent. Here, we experimentally demonstrate the rich phenomena of interlayer exciton diffusion in WSe2/MoSe2 heterostructures by comparing several samples prepared with chemical vapor deposition and mechanical stacking with accurately controlled twist angles.

Unveiling defect-mediated carrier dynamics in monolayer semiconductors by spatiotemporal microwave imaging.

The optoelectronic properties of atomically thin transition-metal dichalcogenides are strongly correlated with the presence of defects in the materials, which are not necessarily detrimental for certain applications. For instance, defects can lead to an enhanced photoconduction, a complicated process involving charge generation and recombination in the time domain and carrier transport in the spatial domain. Here, we report the simultaneous spatial and temporal photoconductivity imaging in two types of WS2 monolayers by laser-illuminated microwave impedance microscopy. The diffusion length and carrier lifetime were directly extracted from the spatial profile and temporal relaxation of microwave signals, respectively. Time-resolved experiments indicate that the critical process for photoexcited carriers is the escape of holes from trap states, which prolongs the apparent lifetime of mobile electrons in the conduction band. As a result, counterintuitively, the long-lived photoconductivity signal is higher in chemical-vapor deposited (CVD) samples than exfoliated monolayers due to the presence of traps that inhibits recombination. Our work reveals the intrinsic time and length scales of electrical response to photoexcitation in van der Waals materials, which is essential for their applications in optoelectronic devices.

The building of social resilience in Sichuan after the Wenchuan earthquake: A perspective of the socio-government interactions.

In November 2007, China implemented its Emergency Response Law to ensure national unified leadership and collaboration when responding to emergencies. In recent years, China's main focuses for enhancing disaster management have included emergency preparation, emergency management, and legal system mechanisms. However, its well-designed management system faced a great challenge during the Wenchuan earthquake in 2008. By examining the literature on the development of disaster management, we realized that enhancing self-organization in communities can effectively resolve problems caused by collective actions and strengthen resilience to disasters. In the decade since the Wenchuan earthquake, the literature has focused more on empowering communities during disaster management in China. However, literature on the compatibility of social resilience and the government-dominant model in China is still scant. This study investigates China's current disaster management system design; specifically, it identifies ways and methods for counteracting any conflicts between disaster management under social synergies and China's emergency management system. It further explores what factors facilitate the balance between social synergies and the emergency management system if the two concepts were fused together. Using case studies, in-depth interviews, and a focus group in the field of public administration, this study collected qualitative data to understand the changes in China's disaster management system since the Wenchuan earthquake as well as provide recommendations for future reform.

The association of dry eye syndrome and psychiatric disorders: a nationwide population-based cohort study.

BACKGROUND: Several previous studies reported a greater prevalence of dry eye syndrome (DES) among patients with psychiatric diseases. The aim of this study is to investigate the prevalence and risk factors of DES in patients with psychiatric disorders (PD) using nationwide population-based data in Taiwan. METHODS: This population-based cohort study retrospectively identified patients with PD from 1997 to 2011. Patients with both PD and DES served as the DES cohort, and PD patients without DES comprised the non-DES cohort. PD was defined as a diagnosis of PD (ICD-9-CM 290-319) made by psychiatrists only, with at least three consecutive outpatient visits or at least one inpatient visit. DES was defined as a diagnosis of DES (ICD-9-CM 375.15) and a prescription for an eye lubricant (anatomical therapeutic chemical code, ATC code: S01XA). The main outcome measures were the prevalence of DES in these patients and associated risk factors. RESULTS: A total of 75,650 patients with PD (3665 in the DES cohort and 71,985 in the non-DES cohort) were included in the final analysis. The majority of patients in the DES group were women (72.6%), compared the non-DES group (57.8%). The mean age of patients in the DES cohort was 62.2 ± 14.9, which was significantly older than those in the non-DES group (50.9 ± 17.5). The patients with DES had a significantly greater likelihood of having dementia, bipolar disorder, depression, and neurotic disorders. Conditional regression analyses revealed that patients with dry eye disease were more likely to have schizophrenia (OR = 1.34), bipolar disorder (OR = 1.9), depression (OR = 1.54), and neurotic disorders (OR = 1.62). In addition, patients with DES were more likely to use 1st generation anti-psychotics (OR = 1.28) and had a lower risk of using 2nd generation anti-psychotics (OR = 0.64). CONCLUSION: The study demonstrated that among PD patients, DES is highly prevalence in certain subtypes of PD, such as depression, bipolar disorder, and neurotic disorders, after adjusting for the comorbidities.

Association between Metformin and a Lower Risk of Age-Related Macular Degeneration in Patients with Type 2 Diabetes.

PURPOSE: This population-based, retrospective cohort study was to investigate whether metformin is associated with a lower risk of subsequent age-related macular degeneration (AMD) in patients with type 2 diabetes. METHODS: Using the Taiwan National Health Insurance Research Database from 2001 to 2013, 68205 subjects with type 2 diabetes were enrolled in the study cohort. Among them, 45524 were metformin users and 22681 were nonusers. The metformin and nonmetformin groups were followed until the end of 2013. Cox regression analyses were used to estimate hazard ratios (HRs) for AMD development associated with metformin use. Confounders included for adjustment were age, sex, and comorbidities (hypertension, hyperlipidemia, coronary artery disease, obesity, diabetic retinopathy, chronic kidney disease, and insulin treatment). Furthermore, propensity score (PS) matching method was used to choose the matched sample, and PS-adjusted Cox regression was performed. Finally, how HRs changed according to metformin treatment duration and dose was also evaluated in the metformin group. RESULTS: After adjusting for confounders, the metformin group had a significantly lower risk of AMD (adjusted HR = 0.54; 95% confidence interval [CI], 0.50-0.58). In the PS-matched sample, the significance remained (adjusted HR = 0.57; 95% CI, 0.52-0.63). In the metformin group, the adjusted HRs for the second (1.5-4 years) and third (≥4 years) tertiles of metformin treatment duration were 0.52 and 0.14, respectively, compared with the first tertile (<1.5 years). We also found significant trends of lower HRs (all p-value for trend <0.05) with increasing total and average doses. CONCLUSIONS: Among patients with type 2 diabetes, those who use metformin are at a significantly lower risk of developing AMD relative to individuals who do not use metformin. Also, the trend of a significantly lower AMD risk was found with a higher dose of metformin.

Clinical Characteristics, Intraoperative Findings, and Surgical Outcomes of Canalicular Laceration Repair with Monocanalicular Stent in Asia.

PURPOSE: To report the epidemiological and clinical data as well as surgical outcomes of canalicular lacerations with Mini-Monoka insertion at a tertiary center in Taiwan and to discuss differences in traumatic pattern, pathogenesis, and surgical outcomes between Taiwan and other countries. METHODS: From 2009 to 2018, all 48 patients who underwent canalicular laceration repair with Mini-Monoka stent at a tertiary center in Taiwan were retrospectively analyzed. Demographic and clinical data and surgical outcomes were recorded. RESULTS: The mean age of the 48 patients was 38 years. Single lower canaliculus was involved in 37 (77.1%) patients, upper canaliculus in 10 (20.8%) patients, and both in 1 (2.1%) patient. The most common etiology was motorcycle accident (41.7%), and all traffic accident injuries accounted for 68.75% of cases. Subgroup classification revealed 64.6% of patients (n=31) were categorized in the deep laceration group, and lower anatomical and functional outcomes were noted in deep laceration. The mean follow-up time was 14.5 months. Overall, the anatomical success rate was 87.5%, and the functional success rate was 91.7% after stent removal. CONCLUSION: Canalicular laceration caused by traffic accidents occurred with a relatively high frequency in Taiwan. Affected patients tended to be middle-aged, and deep laceration accounted for 64.6% of patients. These were contributed by the avulsive eyelid injury mechanism caused by traffic accidents. Furthermore, the deeper lacerated site was located, and the lower anatomical and functional success rates were observed. Early repair after trauma with Mini-Monoka stents achieved good eyelid position (100%) as well as good anatomical (87.5%) and functional (91.7%) success without serious complication.

Epitaxial Growth of Optically Thick, Single Crystalline Silver Films for Plasmonics.

Single crystalline Ag films on dielectric substrates have received tremendous attention recently due to their technological potentials as low loss plasmonic materials. Two different growth approaches have been used to produce single crystalline Ag films previously. One approach is based on repetitive cycles of a two-step process (low temperature deposition followed by RT annealing) using molecular beam epitaxy (MBE), which is extremely time-consuming due to the need for repeat growth cycles. Another approach is based on rapid e-beam deposition which is capable of growing thick single crystalline Ag films (>300 nm) but lacks the precision in thickness control of thin epitaxial films. Here, we report a universal approach to grow atomically smooth epitaxial Ag films by eliminating the repetitive cycles used in the previous two-step MBE method while maintaining the precise thickness control from a few monolayers to the optically thick regime, thus overcoming the limitations of the two aforementioned methods. In addition, we develop an in situ growth of aluminum oxide as the capping layer to protect the epitaxial Ag films. The quality of the epitaxial Ag films was evaluated using a variety of techniques, and the superior optical performance of the films is demonstrated by measuring the propagation length of surface plasmon polaritons (∼80 µm at 632 nm) as well as their capability to support a plasmonic nanolaser in infrared incorporating an InGaAsP quantum well as the gain media.

Suppression of GeO x interfacial layer and enhancement of the electrical performance of the high-K gate stack by the atomic-layer-deposited AlN buffer layer on Ge metal-oxide-semiconductor devices.

For high-performance nanoscale Ge-based transistors, one important point of focus is interfacial germanium oxide (GeO x ), which is thermodynamically unstable and easily desorbed. In this study, an atomic-layer-deposited AlN buffer layer was introduced between the crystalline ZrO2 high-K gate dielectrics and epitaxial Ge, in order to reduce the formation of interfacial GeO x . The results of X-ray photoelectron spectroscopy and high-resolution transmission electron microscopy demonstrate that the AlN buffer layer suppressed the formation of interfacial GeO x . Hence, significant enhancement of the electrical characteristics of Ge metal-oxide-semiconductor (MOS) capacitors was achieved with a two-orders-of-magnitude reduction in the gate leakage current, a 34% enhancement of the MOS capacitance, and a lower interfacial state density. The results indicate that the AlN buffer layer is effective in providing a high-quality interface to improve the electrical performance of advanced Ge MOS devices.

Low threshold room-temperature UV surface plasmon polariton lasers with ZnO nanowires on single-crystal aluminum films with Al2O3 interlayers.

ZnO is one of the most promising optical gain media and allows lasing in ZnO nanowires at room temperature. Plasmonic lasers are potentially useful in applications in biosensing, photonic circuits, and high-capacity signal processing. In this work, we combine ZnO nanowires and single-crystalline aluminum films to fabricate Fabry-Perot type surface plasmon polariton (SPP) lasers to overcome the diffraction limit of conventional optics. High quality ZnO nanowires were synthesized by a vapor phase transport process via catalyzed growth. The ZnO nanowires were placed on a single-crystalline Al film grown by molecular beam epitaxy with an interlayer Al2O3 deposited by atomic layer deposition. The plasmonic laser is of metal-oxide-semiconductor (MOS) structure, compatible with silicon device processing. An optimal thickness of atomic layer deposited Al2O3 layer can lead to a low lasing threshold, 6.27 MW cm-2, which is 3 times and 12 times lower than that of previous reports for ZnO/Al and Zno/Al2O3/Al plasmonic lasers, respectively, owing to low materials loss. Both the thickness and quality of insulating layers were found to critically influence the lasing threshold of the SPP nanolasers in the subwavelength regime. The simulation results also manifest the importance of the quality of the dielectric interlayer.

Association between normal tension glaucoma and the risk of Alzheimer's disease: a nationwide population-based cohort study in Taiwan.

OBJECTIVES: To investigate a possible association between normal tension glaucoma (NTG) and an increased risk of developing Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING: NTG group and the comparison group were retrieved from the whole population of the Taiwan National Health Insurance Research Database from 1 January 2001 to 31 December 2013. PARTICIPANTS: A total of 15 317 subjects with NTG were enrolled in the NTG group, and 61 268 age-matched and gender-matched subjects without glaucoma were enrolled in the comparison group. PRIMARY AND SECONDARY OUTCOME MEASURES: Kaplan-Meier curves were generated to compare the cumulative hazard of AD between the two groups. A multivariable Cox regression analysis was used to estimate the adjusted hazard ratios (HRs) of AD, adjusted for diabetes, hypertension, hyperlipidaemia, coronary artery disease and stroke. Furthermore, risk factors for developing AD among the NTG group were investigated. RESULTS: The mean age of the cohort was 62.1±12.5 years. Patients with NTG had significantly higher proportions of diabetes, hypertension, hyperlipidaemia, coronary artery disease and stroke than the comparisons. Patients with NTG had a significantly higher cumulative hazard for AD than the comparisons (p<0.0001). In the multivariable Cox regression after adjustment for confounders, the NTG group had a significantly higher risk of AD (adjusted HR 1.52; 95% CI 1.41 to 1.63). Moreover, in the NTG group, when we compared the effects of different types of glaucoma eye drops, none of the eye drops used were significant risk factors or protective factors for AD. CONCLUSIONS: People with NTG are at a significantly greater risk of developing AD compared with individuals without glaucoma. Among patients with NTG, none of the glaucoma eye drops used significantly changed the risk of subsequent AD.