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1.
J Cereb Blood Flow Metab ; : 271678X21990980, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33530830

RESUMO

To determine whether white matter network disruption mediates the association between MRI markers of cerebrovascular disease (CeVD) and cognitive impairment. Participants (n = 253, aged ≥60 years) from the Epidemiology of Dementia in Singapore study underwent neuropsychological assessments and MRI. CeVD markers were defined as lacunes, white matter hyperintensities (WMH), microbleeds, cortical microinfarcts, cortical infarcts and intracranial stenosis (ICS). White matter microstructure damage was measured as fractional anisotropy and mean diffusivity by tract based spatial statistics from diffusion tensor imaging. Cognitive function was summarized as domain-specific Z-scores.Lacunar counts, WMH volume and ICS were associated with worse performance in executive function, attention, language, verbal and visual memory. These three CeVD markers were also associated with white matter microstructural damage in the projection, commissural, association, and limbic fibers. Path analyses showed that lacunar counts, higher WMH volume and ICS were associated with executive and verbal memory impairment via white matter disruption in commissural fibers whereas impairment in the attention, visual memory and language were mediated through projection fibers.Our study shows that the abnormalities in white matter connectivity may underlie the relationship between CeVD and cognition. Further longitudinal studies are needed to understand the cause-effect relationship between CeVD, white matter damage and cognition.

2.
Br J Ophthalmol ; 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33589436

RESUMO

PURPOSE: To evaluate the effect of signal strength (SS) on optical coherence tomography (OCT) parameters, and devise an algorithm to adjust the effect, when acceptable SS cannot be obtained. METHODS: 5085 individuals (9582 eyes), aged ≥40 years from the Singapore Epidemiology of Eye Diseases population-based study were included. Everyone underwent a standardised ocular examination and imaging with Cirrus HD-OCT. Effect of SS was evaluated using multiple structural breaks linear mixed-effect models. Expected change for increment in SS between 4 and 10 for individual parameter was calculated. Subsequently we devised and evaluated an algorithm to adjust OCT parameters to higher SS. RESULTS: Average retinal nerve fibre layer (RNFL) thickness showed shift of 4.11 µm from SS of 5 to 6. Above 6, it increased by 1.72 and 3.35 µm to 7 and 8; and by 1.09 µm (per unit increase) above 8 SS. Average ganglion cell-inner plexiform layer (GCIPL) thickness shifted 5.15 µm from SS of 5 to 6. Above 6, increased by 0.94 µm from 7 to 8; and by 0.16 µm (per unit increase) above 8 SS. When compared with reference in an independent test set, the algorithm produced less systemic bias. Algorithm-adjusted average RNFL was 0.549 µm thinner than the reference, while the unadjusted one was 2.841 µm thinner (p<0.001). Algorithm-adjusted and unadjusted average GCIPL was 1.102 µm and 2.228 µm thinner (p<0.001). CONCLUSIONS: OCT parameters can be adjusted for poor SS using an algorithm. This can potentially assist in diagnosis and monitoring of glaucoma when scans with acceptable SS cannot be acquired from patients in clinics.

3.
Ophthalmol Retina ; 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33610832

RESUMO

PURPOSE: To determine whether eyes with pathologic myopia can be identified and whether each type of myopic maculopathy lesion in fundus photographs can be diagnosed by deep learning (DL) algorithms. DESIGN: A DL algorithm was developed to recognize myopic maculopathy features and to automatically categorize the myopic maculopathy. SUBJECTS: We examined 7020 fundus images from 4432 highly myopic eyes obtained from the Advanced Clinical Center for Myopia. METHODS: DL algorithms were developed to recognize the key features of myopic maculopathy with 5176 fundus images of 2588 highly myopic eyes. These algorithms were also used to develop a META-PM categorizing system (META-PM CS) by adding a specific processing layer. Models and system were evaluated by 1844 fundus images of 1844 highly myopic eyes. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, the sensitivity, and specificity were used to determine the performance of each DL algorithm. The rate of correct predictions was used to determine the performance of the META-PM CS. MAIN OUTCOME MEASURES: Four trained DL models were able to recognize the lesions of myopic maculopathy accurately with high sensitivity and specificity. The META-PM CS also had a high accuracy and was qualified to be used in a semi-automated way during screening for myopic maculopathy in highly myopic eyes. RESULTS: The sensitivity of the DL models was 84.44% for diffuse atrophy, 87.22% for patchy atrophy, 85.10% for macular atrophy, and 37.07% for choroidal neovascularization, and the AUC values with 95% CI of 0.970 (0.966-0.974), 0.978 (0.967-0.987), 0.982 (0.971-0.994) and 0.881 (0.854-0.902), respectively. The rate of total correct predictions from META-PM CS was 87.53%, with rates of 90.18%, 95.28%, 97.50%, and 91.14% respectively for each type of lesion. The META-PM CS had an overall rate of 92.08% in detecting pathologic myopia correctly which was defined as having myopic maculopathy equal to or more serious than diffuse atrophy. CONCLUSIONS: The novel DL models and systems can achieve high sensitivity and specificity in identifying the different types of lesions of myopic maculopathy. These results will assist in the screening for pathologic myopia and subsequent protection of patients against low vision and blindness caused by myopic maculopathy.

4.
Br J Ophthalmol ; 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622697

RESUMO

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

5.
JMIR Public Health Surveill ; 7(2): e24445, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33605883

RESUMO

BACKGROUND: The COVID-19 pandemic has led to urgent calls for the adoption of telehealth solutions. However, public interest and demand for telehealth during the pandemic remain unknown. OBJECTIVE: We used an infodemiological approach to estimate the worldwide demand for telehealth services during COVID-19, focusing on the 50 most affected countries and comparing the demand for such services with the level of information and communications technology (ICT) infrastructure available. METHODS: We used Google Trends, the Baidu Index (China), and Yandex Keyword Statistics (Russia) to extract data on worldwide and individual countries' telehealth-related internet searches from January 1 to July 7, 2020, presented as relative search volumes (RSV; range 0-100). Daily COVID-19 cases and deaths were retrieved from the World Health Organization. Individual countries' ICT infrastructure profiles were retrieved from the World Economic Forum Report. RESULTS: Across the 50 countries, the mean RSV was 18.5 (SD 23.2), and the mean ICT index was 62.1 (SD 15.0). An overall spike in worldwide telehealth-related RSVs was observed from March 11, 2020 (RSV peaked to 76.0), which then tailed off in June-July 2020 (mean RSV for the period was 25.8), but remained higher than pre-March RSVs (mean 7.29). By country, 42 (84%) manifested increased RSVs over the evaluation period, with the highest observed in Canada (RSV=100) and the United States (RSV=96). When evaluating associations between RSV and the ICT index, both the United States and Canada demonstrated high RSVs and ICT scores (≥70.3). In contrast, European countries had relatively lower RSVs (range 3.4-19.5) despite high ICT index scores (mean 70.3). Several Latin American (Brazil, Chile, Colombia) and South Asian (India, Bangladesh, Pakistan) countries demonstrated relatively higher RSVs (range 13.8-73.3) but low ICT index scores (mean 44.6), indicating that the telehealth demand outstrips the current ICT infrastructure. CONCLUSIONS: There is generally increased interest and demand for telehealth services across the 50 countries most affected by COVID-19, highlighting the need to scale up telehealth capabilities, during and beyond the pandemic.

6.
Sci Rep ; 11(1): 501, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436813

RESUMO

We evaluated the 6-year incidence and risk factors of pterygium in a multi-ethnic Asian population. Participants who attended the baseline visit of the Singapore Epidemiology of Eye Diseases Study (year 2004-2011) and returned six years later, were included in this study. Pterygium was diagnosed based on anterior segment photographs. Incident pterygium was defined as presence of pterygium at 6-year follow-up in either eye, among individuals without pterygium at baseline. Multivariable logistic regression models were used to determine factors associated with incident pterygium, adjusting for baseline age, gender, ethnicity, body mass index, occupation type, educational level, income status, smoking, alcohol consumption, presence of hypertension, diabetes and hyperlipidemia. The overall age-adjusted 6-year incidence of pterygium was 1.2% (95% confidence interval [CI] 1.0-1.6%); with Chinese (1.9%; 95% CI 1.4%-2.5%) having the highest incidence rate followed by Malays (1.4%; 95% CI 0.9%-2.1%) and Indians (0.3%; 95% CI 0.3-0.7%). In multivariable analysis, Chinese (compared with Indians; odds ratio [OR] = 4.21; 95% CI 2.12-9.35) and Malays (OR 3.22; 95% CI 1.52-7.45), male (OR 2.13; 95% CI 1.26-3.63), outdoor occupation (OR 2.33; 95% CI 1.16-4.38), and smoking (OR 0.41; 95% CI 0.16-0.87) were significantly associated with incident pterygium. Findings from this multi-ethnic Asian population provide useful information in identifying at-risk individuals for pterygium.

7.
Br J Ophthalmol ; 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468492

RESUMO

PURPOSE: We described the 6-year incidence and changes of retinopathy, and their associated risk factors in a multi-ethnic Asian population without diabetes. METHODS: We included 4374 participants with non-diabetes from a population-based cohort, the Singapore Epidemiology of Eye Disease Study, with gradable retinal photographs at baseline and 6-year follow-up visit. Retinopathy was assessed according to the modified Airlie House classification system. RESULTS: Over the 6-year period, the cumulative rates were 2.5% (106/4279) for retinopathy incidence, 1.0% (1/95) for retinopathy progression and 68.4% (65/95) for retinopathy regression. In multivariable analysis, higher diastolic blood pressure (DBP) (risk ratio (RR)=1.02; 95% CI: 1.00 to 1.04; per 10 mm Hg increase in DBP) and wider retinal arteriolar calibre (RR=1.36; 95% CI: 1.13 to 1.63; per SD increase in central retinal artery equivalent) were associated with higher risk of incident retinopathy, while higher level of high-density lipoprotein (HDL) was associated with lower risk of incident retinopathy (RR=0.56; 95% CI: 0.32 to 0.99; per mmol/L increase in HDL). Compared with Chinese, Malays were more likely to have retinopathy regression (RR=1.63; 95% CI: 1.20 to 2.22), while overweight (RR=0.47; 95% CI: 0.26 to 0.84) and higher glycosylated haemoglobin (HbA1c) level (RR=0.58; 95% CI: 0.37 to 0.93; per per cent increase in HbA1c) were associated with lower likelihood of retinopathy regression. CONCLUSION: Risk of developing retinopathy in Asians without diabetes is generally low. However, regression of retinopathy over time is common, suggesting that these retinopathy signs may reflect subclinical reversible microvascular dysfunction. Several metabolic risk factors are associated with incidence or regression of retinopathy, suggesting that good metabolic control may still be important in the management of non-diabetic retinopathy.

8.
Age Ageing ; 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33480974

RESUMO

BACKGROUND: The relationship between self-reported visual disability and cognitive impairment in older individuals is unclear. OBJECTIVE: To determine the relationship of vision-specific functioning (VSF), vision-specific mobility (VSM) and visual acuity (VA) with clinically assessed cognitive impairment in the Epidemiology of Dementia in Singapore study. DESIGN: Cross-sectional. SETTING: Population-based. SUBJECTS: Eight hundred and seventy-four adults aged ≥60 years at higher risk of possible cognitive impairment by the Abbreviated Mental Test and progressive forgetfulness question. METHODS: VSF and VSM were measured using Rasch-transformed continuous scores of two Impact of Vision Impairment questionnaire domains. Cognitive impairment was objectively determined using detailed neuropsychological testing and defined as no cognitive impairment (NCI), mild cognitive impairment-no dementia (CIND), moderate CIND only and moderate CIND or dementia. Associations were assessed using multinomial logistic regression models. RESULTS: Of the 874 participants (49.0% males, mean age (SD) 65.5 (7.0) years), 277, 281 and 316 had NCI, mild CIND and moderate CIND or dementia, respectively. Compared to NCI, the odds of moderate CIND, and moderate CIND or dementia increased for every SD worsening in VSF (OR: 1.44, 95% CI 1.14-1.82, and OR: 1.52, 95%CI 1.19-1.94, respectively) and VSM (OR: 1.42, 95%CI 1.11-1.81, and OR: 1.50, 95%CI 1.15-1.95). Similarly, the odds of mild CIND (OR: 1.62, 95%CI 1.19-2.22), moderate CIND (OR: 1.93, 95%CI 1.45-2.58), and moderate CIND or dementia (OR: 2.25, 95%CI 1.62-3.11) increased significantly with every SD worsening of VA. CONCLUSIONS: Our results emphasise the importance of interventions to prevent vision loss and improve quality of life to reduce likelihood of age-related cognitive decline.

10.
J Nurs Scholarsh ; 53(1): 87-95, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33316153

RESUMO

PURPOSE: The purpose of this study was to explore what motivates family members to visit a relative with dementia who has been transferred to a nursing home in Taiwan. DESIGN AND METHODS: Data were collected for this qualitative descriptive study using audiotaped, semi-structured, in-depth, face-to-face interviews. A total of 20 family members of elderly nursing home residents participated in the study. Nursing home residents were from four nursing homes in Taiwan and had been diagnosed with probable or possible dementia by a psychiatrist or neurologist. Transcribed audiotaped interviews were analyzed using thematic analysis. FINDINGS: Most family members were the children of the residents (n =17, 85%). The theme describing the core motivation for family members' visits to nursing home residents was "to maintain the unforgotten family affection." This motivation comprised four relevant categories: hoping to slow degeneration, providing a congruous environment, honoring filial and karmic duty, and ensuring the quality of care. CONCLUSIONS: Motivations for Taiwanese family members' visits to nursing home residents with dementia were similar to those in Western cultures. However, "hoping to slow degeneration" and "providing a congruous environment" were unique categories. CLINICAL RELEVANCE: Nurses and policymakers could use these findings to design interventions that might increase holistic care for both family members and nursing home residents with dementia. Providing programming focused on family members' unique priorities could address swallowing difficulties, management of dementia symptoms, nutritional needs, and selection of residents' roommates. These programs could improve the quality of family members' visits as well as the quality of staff-family relationships.

11.
Br J Ophthalmol ; 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33257306

RESUMO

AIMS: To evaluate the normative profiles for neuroretinal rim area (RA) in a multiethnic Asian population. METHODS: Subjects were recruited from the Singapore Epidemiology of Eye Diseases (2009-2015) study and underwent standardised examinations. RA measurements were performed using Cirrus high-definition optical coherence tomography (Carl Zeiss Meditec). Multivariable linear regression with generalised estimating equation model was used to evaluate the associations between demographic, systemic and ocular factors with RA. RESULTS: A total of 9394 eyes from 5116 subjects (1724 Chinese, 1463 Malay, 1929 Indian) were included in the final analysis. The mean (±SD) of RA was 1.28 (±0.23) mm2 for Chinese, 1.33 (±0.26) mm2 for Malays, and 1.23 (±0.23) mm2 for Indians. The 5th percentile value for RA was 0.94 mm2 for Chinese, 0.96 mm2 for Malay, and 0.89 mm2 for Indian. In multivariable analysis, following adjustment for age, gender, body mass index, diabetes mellitus, hyperlipidaemia, history of cataract surgery, axial length, intraocular pressure (IOP) and disc area, Indian eyes have smaller RA when compared with Malays (ß=-0.074; 95% CI -0.090 to -0.058; p<0.001) and Chinese (ß=-0.035; 95% CI -0.051 to -0.019; p<0.001), respectively. Additionally, older age (per decade, ß=-0.022), male gender (ß=-0.031), longer axial length (per mm, ß=-0.025), spherical equivalent (per negative dioptre, ß=-0.005), higher IOP (per mm Hg, ß=-0.009) were associated with smaller RA (all p≤0.004). CONCLUSION: In this multiethnic population-based study, we observed significantly smaller RA in Indian eyes, compared with Chinese and Malays. This indicates the need of a more refined ethnic-specific RA normative databases among Asians.

12.
Biomed Opt Express ; 11(11): 6356-6378, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33282495

RESUMO

Recently proposed deep learning (DL) algorithms for the segmentation of optical coherence tomography (OCT) images to quantify the morphological changes to the optic nerve head (ONH) tissues during glaucoma have limited clinical adoption due to their device specific nature and the difficulty in preparing manual segmentations (training data). We propose a DL-based 3D segmentation framework that is easily translatable across OCT devices in a label-free manner (i.e. without the need to manually re-segment data for each device). Specifically, we developed 2 sets of DL networks: the 'enhancer' (enhance OCT image quality and harmonize image characteristics from 3 devices) and the 'ONH-Net' (3D segmentation of 6 ONH tissues). We found that only when the 'enhancer' was used to preprocess the OCT images, the 'ONH-Net' trained on any of the 3 devices successfully segmented ONH tissues from the other two unseen devices with high performance (Dice coefficients > 0.92). We demonstrate that is possible to automatically segment OCT images from new devices without ever needing manual segmentation data from them.

13.
Aging Dis ; 11(6): 1444-1458, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33269099

RESUMO

To describe the rationale, design and methodology of a geographically-representative and population-based study investigating the epidemiology, impact, personal and economic burden of age-related eye diseases, declining visual and other sensory systems in Asians aged >60 years in Singapore.PIONEER (The PopulatION HEalth and Eye Disease PRofilE in Elderly Singaporeans Study) is currently a cross-sectional study targeting 3152 Chinese, Malay and Indian adults who are Singapore citizens or permanent residents aged 60 years and older living across Singapore. The study is intended to be longitudinal, with several waves of data planned to be collected in the future. The sampling frame consisted of 7000 names derived from age, gender and ethnicity-stratified random sampling of individuals >60 years. Selected individuals were invited via letters, home visits, and telephone calls for a clinical assessment at the Singapore Eye Research Institute. Individuals with limited mobility were examined in a custom-designed mobile eye clinic. Questionnaires were subsequently administered at participants' homes by trained interviewers in their preferred language. A total of 3,299 participants (from East, West, North and South Singapore) were approached from December 2017 to November 2019. Of these, 953 (28.5%) were deemed ineligible. Out of 2,346 eligible participants, 904 (38.5%) refused, and 1,442 (61.5%) attended our clinical testing protocol, giving an initial response rate of 61.5%. Of these, 1,170 (81%) were cognitively able to complete the questionnaire assessment. The mean age±SD of our participants was 73.8±8.6 years; n=798 (55.3%) were female; and 828 (57.4%) were of Chinese ethnicity. The findings from this study will allow a deeper understanding of the risk factors and impact of aging in Asian populations, particularly in relation to the visual function and other functional system.

14.
Lancet Digit Health ; 2(10): e526-e536, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33328047

RESUMO

BACKGROUND: The application of deep learning to retinal photographs has yielded promising results in predicting age, sex, blood pressure, and haematological parameters. However, the broader applicability of retinal photograph-based deep learning for predicting other systemic biomarkers and the generalisability of this approach to various populations remains unexplored. METHODS: With use of 236 257 retinal photographs from seven diverse Asian and European cohorts (two health screening centres in South Korea, the Beijing Eye Study, three cohorts in the Singapore Epidemiology of Eye Diseases study, and the UK Biobank), we evaluated the capacities of 47 deep-learning algorithms to predict 47 systemic biomarkers as outcome variables, including demographic factors (age and sex); body composition measurements; blood pressure; haematological parameters; lipid profiles; biochemical measures; biomarkers related to liver function, thyroid function, kidney function, and inflammation; and diabetes. The standard neural network architecture of VGG16 was adopted for model development. FINDINGS: In addition to previously reported systemic biomarkers, we showed quantification of body composition indices (muscle mass, height, and bodyweight) and creatinine from retinal photographs. Body muscle mass could be predicted with an R2 of 0·52 (95% CI 0·51-0·53) in the internal test set, and of 0·33 (0·30-0·35) in one external test set with muscle mass measurement available. The R2 value for the prediction of height was 0·42 (0·40-0·43), of bodyweight was 0·36 (0·34-0·37), and of creatinine was 0·38 (0·37-0·40) in the internal test set. However, the performances were poorer in external test sets (with the lowest performance in the European cohort), with R2 values ranging between 0·08 and 0·28 for height, 0·04 and 0·19 for bodyweight, and 0·01 and 0·26 for creatinine. Of the 47 systemic biomarkers, 37 could not be predicted well from retinal photographs via deep learning (R2≤0·14 across all external test sets). INTERPRETATION: Our work provides new insights into the potential use of retinal photographs to predict systemic biomarkers, including body composition indices and serum creatinine, using deep learning in populations with a similar ethnic background. Further evaluations are warranted to validate these findings and evaluate the clinical utility of these algorithms. FUNDING: Agency for Science, Technology, and Research and National Medical Research Council, Singapore; Korea Institute for Advancement of Technology.


Assuntos
Algoritmos , Composição Corporal , Creatinina/sangue , Aprendizado Profundo , Processamento de Imagem Assistida por Computador/métodos , Modelos Biológicos , Retina , Área Sob a Curva , Ásia , Pequim , Biomarcadores , Grupos Étnicos , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos , Redes Neurais de Computação , Fotografação , Curva ROC , República da Coreia , Singapura , Reino Unido
15.
Lancet Digit Health ; 2(6): e295-e302, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-33328123

RESUMO

BACKGROUND: Screening for chronic kidney disease is a challenge in community and primary care settings, even in high-income countries. We developed an artificial intelligence deep learning algorithm (DLA) to detect chronic kidney disease from retinal images, which could add to existing chronic kidney disease screening strategies. METHODS: We used data from three population-based, multiethnic, cross-sectional studies in Singapore and China. The Singapore Epidemiology of Eye Diseases study (SEED, patients aged ≥40 years) was used to develop (5188 patients) and validate (1297 patients) the DLA. External testing was done on two independent datasets: the Singapore Prospective Study Program (SP2, 3735 patients aged ≥25 years) and the Beijing Eye Study (BES, 1538 patients aged ≥40 years). Chronic kidney disease was defined as estimated glomerular filtration rate less than 60 mL/min per 1·73m2. Three models were trained: 1) image DLA; 2) risk factors (RF) including age, sex, ethnicity, diabetes, and hypertension; and 3) hybrid DLA combining image and RF. Model performances were evaluated using the area under the receiver operating characteristic curve (AUC). FINDINGS: In the SEED validation dataset, the AUC was 0·911 for image DLA (95% CI 0·886 -0·936), 0·916 for RF (0·891-0·941), and 0·938 for hybrid DLA (0·917-0·959). Corresponding estimates in the SP2 testing dataset were 0·733 for image DLA (95% CI 0·696-0·770), 0·829 for RF (0·797-0·861), and 0·810 for hybrid DLA (0·776-0·844); and in the BES testing dataset estimates were 0·835 for image DLA (0·767-0·903), 0·887 for RF (0·828-0·946), and 0·858 for hybrid DLA (0·794-0·922). AUC estimates were similar in subgroups of people with diabetes (image DLA 0·889 [95% CI 0·850-0·928], RF 0·899 [0·862-0·936], hybrid 0·925 [0·893-0·957]) and hypertension (image DLA 0·889 [95% CI 0·860-0·918], RF 0·889 [0·860-0·918], hybrid 0·918 [0·893-0·943]). INTERPRETATION: A retinal image DLA shows good performance for estimating chronic kidney disease, underlying the feasibility of using retinal photography as an adjunctive or opportunistic screening tool for chronic kidney disease in community populations. FUNDING: National Medical Research Council, Singapore.


Assuntos
Aprendizado Profundo , Oftalmopatias/complicações , Interpretação de Imagem Assistida por Computador/métodos , Fotografação/métodos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Algoritmos , China , Estudos Transversais , Oftalmopatias/diagnóstico , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Singapura
16.
Ophthalmology ; 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33333104

RESUMO

TOPIC: Visual impairment (VI) and cognitive impairment (CIM) are prevalent age-related conditions that impose substantial burden on the society. While the bidirectional association of VI and CIM has been hypothesized, findings have been equivocal. Hence, we conduct a systematic review and meta-analysis to examine the bidirectional relationship between VI and CIM. CLINICAL RELEVANCE: 60% risk of CIM has not been well-elucidated in the literature. A bidirectional relationship between CIM and VI may provide opportunities for developing public health strategies for early detection and management of risk factors for both VI and CIM in older people. METHODS: Pubmed, Embase and Cochrane Central registers were systematically searched for observational studies, published from inception until 6 April 2020, in adults aged ≥ 40 years reporting objectively measured VI, and CIM assessment using clinically validated cognitive screening tests or diagnostic evaluation. Meta-analyses on cross-sectional and longitudinal associations between VI and CIM outcomes (any CIM assessed using screening tests, and clinically diagnosed dementia) were examined. Random effect models were used to generate pooled odds ratios (OR), and 95% confidence interval (CI). Publication bias and heterogeneity were examined using Egger's test, meta-regression, and trim-and-fill methods. RESULTS: Forty studies were included (N=47,913,570). Meta-analyses confirmed that persons with VI were more likely to have CIM, with significantly higher odds [OR (95%CI)] of: (i) any CIM [cross-sectional: 2.38 (1.84-3.07); longitudinal: 1.66 (1.46-1.89)], and (ii) clinically diagnosed dementia [(cross-sectional: 2.43 (1.48-4.01); longitudinal: 2.09 (1.37-3.21)], compared to persons without VI. Significant heterogeneity was partially explained by differences in age, sex and follow-up duration. There was also some evidence that individuals with CIM, relative to cognitively intact persons, were more likely to have VI, with most papers (8/9, 89%) reporting significantly positive associations, however meta-analyses on this association could not be conducted due to insufficient data. CONCLUSIONS: Overall, our work suggests that VI is a risk factor of CIM while further work is needed to confirm the association of CIM as a risk factor for VI. Strategies for early detection and management of both visual and cognitive impairment in older people may minimize individual clinical and public health consequences.

17.
Br J Ophthalmol ; 2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334817

RESUMO

AIMS: To compare the shape of the anterior surface of the peripapillary sclera (PPS) between glaucoma and healthy subjects. METHODS: 88 primary open angle glaucoma (POAG), 98 primary angle closure glaucoma (PACG) and 372 age-matched and gender-matched healthy controls were recruited in this study. The optic nerve head of one randomly selected eye of each subject was imaged with spectral domain optical coherence tomography. The shape of the PPS was measured through an angle defined between a line parallel to the nasal anterior PPS boundary and one parallel to the temporal side. A negative value indicated that the PPS followed an inverted v-shaped configuration (peak pointing towards the vitreous), whereas a positive value indicated that it followed a v-shaped configuration. RESULTS: The mean PPS angle in normal controls (4.56±5.99°) was significantly smaller than that in POAG (6.60±6.37°, p=0.011) and PACG (7.90±6.87°, p<0.001). The v-shaped PPS was significantly associated with older age (ß=1.79, p<0.001), poorer best-corrected visual acuity (ß=3.31, p=0.047), central corneal thickness (ß=-0.28, p=0.001), peripapillary choroidal thickness (ß=-0.21, p<0.001) and presence of POAG (ß=1.94, p<0.009) and PACG (ß=2.96, p<0.001). The v-shaped configuration of the PPS significantly increased by 1.46° (p=0.001) in healthy controls for every 10-year increase in age, but not in glaucoma groups. CONCLUSIONS: The v-shaped configuration of the PPS was more pronounced in glaucoma eyes than in healthy eyes. This posterior bowing of the PPS may have an impact on the biomechanical environment of the optic nerve head.

18.
J Telemed Telecare ; : 1357633X20972004, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33197365

RESUMO

INTRODUCTION: The worldwide coronavirus disease 2019 pandemic re-emphasises the importance of Internet videoconferencing in supporting interactions between nursing home residents and their family and friends. However, there is a scarcity of comparative studies on how modalities of conferencing programs impact health outcomes. The purpose of this study was to compare laptop-based with smartphone-based videoconferencing programs on nursing home residents' perceptions of loneliness, depressive symptoms and social support. METHODS: This retrospective secondary analysis used data from two previous studies on the effectiveness of videoconferencing programs (laptop-based and smartphone-based) to improve outcomes of loneliness, depressive symptoms and social support (type and source) among nursing home residents. Generalised estimating equations compared differences from baseline measures with measures at 1 and 3 months between the two groups with and without adjusting for the effects of confounding variables. RESULTS: With the exception of age, there were no differences in demographics between participants in the laptop and smartphone groups. Neither changes from baseline in mean scores for loneliness nor depressive symptoms differed between groups. However, changes in mean scores from baseline between groups were significantly greater in the smartphone-based group compared with the laptop-based group for three types of social support: informational and appraisal at 1 and 3 months; and emotional at 3 months. Changes from baseline in mean scores for social support from friends (at 1 and 3 months) and other sources (at 3 months) were also significantly greater for the smartphone group compared with the laptop group. DISCUSSION: The two modalities of videoconferencing did not differ in effects on depressive symptoms or loneliness. However, smartphones had a greater effect on the type and source of social support compared with laptops. Whether the small screen of a smartphone reduces users' anxiety and allows them to talk more on screen is worth studying.

19.
Sci Rep ; 10(1): 19222, 2020 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-33154407

RESUMO

Microcirculatory insufficiency has been hypothesized in glaucoma pathogenesis. There is a scarcity of data to comprehensively examine the changes in retinal microvasculature and its role in normal tension glaucoma (NTG). We conducted a cross-sectional case-control study and included 168 eyes from 100 NTG patients and 68 healthy subjects. Quantitative retinal arteriolar and venular metrics were measured from retinal photographs using a computer-assisted program. Radial peripapillary capillary network was imaged with OCT-A and quantitative capillary metrics (circumpapillary vessel density (cpVD) and circumpapillary fractal dimension (cpFD)) were measured with a customized MATLAB program. We found that NTG was associated with decreased arteriolar and venular tortuosity, arteriolar branching angle, cpVD and cpFD. Decreased venular caliber, arteriolar and venular branching angles, cpVD and cpFD were associated with thinner average RNFL thickness. Decreased arteriolar and venular branching angles, cpVD and cpFD were also associated with worse standard automated perimetry measurements (mean deviation and visual field index). Compared with retinal arteriolar and venular metrics, regression models based on OCT-A capillary metrics consistently showed stronger associations with NTG and structural and functional measurements in NTG. We concluded that NTG eyes showed generalized microvascular attenuations, in which OCT-A capillary metrics attenuations were more prominent and strongly associated with NTG.

20.
Br J Ophthalmol ; 2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33208351

RESUMO

AIMS: To use machine learning (ML) to determine the relative contributions of modifiable and non-modifiable clinical, metabolic, genetic, lifestyle and socioeconomic factors on the risk of major eye diseases. METHODS: We conducted analyses in a cross-sectional multi-ethnic population-based study (n=10 033 participants) and determined a range of modifiable and non-modifiable risk factors of common eye diseases, including diabetic retinopathy (DR), non-diabetic-related retinopathy (NDR); early and late age-related macular degeneration (AMD); nuclear, cortical and posterior subcapsular (PSC) cataract; and primary open-angle (POAG) and primary angle-closure glaucoma (PACG). Risk factors included individual characteristics, metabolic profiles, genetic background, lifestyle patterns and socioeconomic status (n~100 risk factors). We used gradient boosting machine to estimate the relative influence (RI) of each risk factor. RESULTS: Among the range of risk factors studied, the highest contributions were duration of diabetes for DR (RI=22.1%), and alcohol consumption for NDR (RI=6.4%). For early and late AMD, genetic background (RI~20%) and age (RI~15%) contributed the most. Axial length was the main risk factor of PSC (RI=30.8%). For PACG, socioeconomic factor (mainly educational level) had the highest influence (20%). POAG was the disease with the highest contribution of modifiable risk factors (cumulative RI~35%), followed by PACG (cumulative RI ~30%), retinopathy (cumulative RI between 20% and 30%) and late AMD (cumulative RI ~20%). CONCLUSION: This study illustrates the utility of ML in identifying factors with the highest contributions. Risk factors possibly amenable to interventions were intraocular pressure (IOP) and Body Mass Index (BMI) for glaucoma, alcohol consumption for NDR and levels of HbA1c for DR.

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