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1.
Front Endocrinol (Lausanne) ; 12: 755575, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34777252

RESUMO

Objectives: To investigate the spatial distribution of 10-year incidence of diagnosed type 2 diabetes mellitus (T2DM) and its association with obesity and physical inactivity at a reginal level breakdown. Methods: Demographic, behavioral, medical and pharmaceutical and diagnosed T2DM incidence data were collected from a cohort of 232,064 participants who were free of diabetes at enrolment in the 45 and Up Study, conducted in the state of New South Wales (NSW), Australia. We examined the geographical trend and correlation between obesity prevalence, physical inactivity rate and age-and-gender-adjusted cumulative incidence of T2DM, aggregated based on geographical regions. Result: The T2DM incidence, prevalence of obesity and physical inactivity rate at baseline were 6.32%, 20.24%, and 18.7%, respectively. The spatial variation of T2DM incidence was significant (Moran's I=0.52; p<0.01), with the lowest incidence of 2.76% in Richmond Valley-Coastal and the highest of 12.27% in Mount Druitt. T2DM incidence was significantly correlated with the prevalence of obesity (Spearman r=0.62, p<0.001), percentage of participants having five sessions of physical activities or less per week (r=0.79, p<0.001) and percentage of participants walked to work (r=-0.44, p<0.001). The geographical variations in obesity prevalence and physical inactivity rate resembled the geographical variation in the incidence of T2DM. Conclusion: The spatial distribution of T2DM incidence is significantly associated with the geographical prevalence of obesity and physical inactivity rate. Regional campaigns advocating the importance of physical activities in response to the alarming T2DM epidemic should be promoted.

2.
EClinicalMedicine ; 42: 101189, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34805812

RESUMO

Background: Although visual dysfunction is one of the most common non-motor symptoms among patients with Parkinson's disease (PD), it is not known whether visual impairment (VI) predates the onset of clinical PD. Therefore, we aim to examine the association of VI with the future development of PD in the UK Biobank Study. Methods: The UK Biobank Study is one of the largest cohort studies of health, enrolling over 500,000 participants aged 40-69 years between 2006 and 2010 across the UK. VI was defined as a habitual distance visual acuity (VA) worse than 0·3 logarithm of the minimum angle of resolution (LogMAR) in the better-seeing eye. Incident cases of PD were determined by self report data, hospital admission records or death records, whichever came first. Multivariable Cox proportional hazard regression models were used to investigate the association between VI and the risk of incident PD. Findings: A total of 117,050 participants were free of PD at the baseline assessment. During the median observation period of 5·96 (IQR: 5·77-6·23) years, PD occurred in 222 (0·19%) participants. Visually impaired participants were at a higher risk of developing PD than non-VI participants (p < 0·001). Compared with the non-VI group, the adjusted hazard ratio was 2·28 (95% CI 1·29-4·05, p = 0·005) in the VI group. These results were consistent in the sensitivity analysis, where incident PD cases diagnosed within one year after the baseline assessment were excluded. Interpretation: This cohort study found that VI was associated with an increased risk of incident PD, suggesting that VI may serve as a modifiable risk factor for prevention of future PD.

3.
Invest Ophthalmol Vis Sci ; 62(14): 19, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34797907

RESUMO

Purpose: To examine the association between adiposity by differing measures and incident cataract and identify important factors contributing to the association. Methods: Our analysis included 153,139 adults from the UK Biobank, aged 40 to 70 years at baseline (2006-2010). Cataract was ascertained using hospital inpatient, and self-reported data until the early of 2021. Anthropometric measures, body fat percentage, and glycosylated hemoglobin (HbA1c) were measured at baseline. Results: During a median follow-up of 10.9 years, 15,255 cases of incident cataract were documented. HbA1c was an important contributor to the association between obesity and incident cataract. Obesity; defined by body mass index was associated with an increased risk of cataract (hazard ratio [HR], 1.21 95% confidence interval [CI], 1.16-1.26), and this association was attenuated but remained significant after additional adjustment for HbA1c (HR, 1.05; 95% CI, 1.00-1.10). Similar results were observed for obesity defined by waist circumference or waist-to-hip ratio. Obesity defined by fat percentage was associated with an increased risk of cataract before but not after adjustment for covariates. The association between obesity defined by body mass index and incident cataract was positively significant in individuals with normal HbA1c (HR, 1.07; 95% CI, 1.02-1.13), but inversely significant in those with prediabetes (HR, 0.80; 95% CI, 0.67-0.96) or diabetes (HR, 0.74; 95% CI, 0.61-0.89). Conclusions: Anthropometric measurements are more predictive of cataract than bioelectrical impedance measures. Diabetes plays an important role in the association between obesity and incident cataract.

5.
Eye (Lond) ; 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645966

RESUMO

Myopia is a leading cause of visual impairment and has raised significant international concern in recent decades with rapidly increasing prevalence and incidence worldwide. Accurate prediction of future myopia risk could help identify high-risk children for early targeted intervention to delay myopia onset or slow myopia progression. Researchers have built and assessed various myopia prediction models based on different datasets, including baseline refraction or biometric data, lifestyle data, genetic data, and data integration. Here, we summarize all related work published in the past 30 years and provide a comprehensive review of myopia prediction methods, datasets, and performance, which could serve as a useful reference and valuable guideline for future research.

6.
Am J Ophthalmol ; 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34653355

RESUMO

PURPOSE: To compare outcomes of in-the-bag versus ciliary sulcus secondary intraocular lens (IOL) implantation for pediatric aphakia. DESIGN: Prospective interventional case series. METHODS: SETTING: institutional. PATIENT: Two hundred and two children (355 aphakic eyes) diagnosed as congenital cataracts and undergoing cataract extraction before 24 months of age. INTERVENTION: Pediatric aphakic eyes underwent either in-the-bag or ciliary sulcus secondary IOL implantation according to the amount of residual lens capsule and were followed for three years postoperatively. MAIN OUTCOME MEASURES: Adverse events (AEs), IOL tilt and decentration, best corrected visual acuity (BCVA) in operative eye. RESULTS: One hundred forty-four eyes (40.6%, 89 children) received in-the-bag IOL implantation (capsular group) and 211 (59.4%, 132 children) underwent ciliary sulcus IOL implantation (sulcus group). Kaplan-Meier curves showed that the time-dependent incidence of glaucoma-related adverse events (GRAEs) (P=0.005) and any AEs (P=0.002) were higher in the sulcus group. In-the-bag IOL implantation was a strong protective factor against GRAE (HR, 0.08, 95CI:0.01∼0.53; P=0.009) and any AEs (HR, 0.21 95CI: 0.08∼0.57; P=0.002). Clinically significant IOL decentration (>0.4mm) was more common in the sulcus group compared to the capsular group (vertical decentration: 29.8% vs. 15.7%, P=0.005; horizontal decentration: 30.3% vs. 9.35%, P<0.001). BCVA in the capsular group was better than that in the sulcus group (logarithm of the minimum angle of resolution [LogMAR] 0.56 vs. 0.67, P=0.014). CONCLUSIONS: Compared to ciliary sulcus secondary IOL implantation, in-the-bag IOL implantation reduced AEs, and yielded better IOL centration and BCVA for pediatric aphakia.

7.
Atherosclerosis ; 336: 12-22, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34607278

RESUMO

BACKGROUND AND AIMS: Adverse changes to the microcirculation play an important role in the pathogenesis of cardiovascular disease (CVD), and inflammation is a key causal mechanism. We investigated the relationship between inflammatory markers and retinal microvascular parameters. METHODS: Studies up to April 2021 were identified in Medline, Embase and PubMed with the following terms: retinal microvascular parameters, inflammatory markers, and observational studies. Correlation coefficients of inflammatory markers and retinal vascular caliber were pooled using the random-effects model. RESULTS: Of 4783 studies identified, 36 met the inclusion criteria (general population 26, patients with diseases 10). C-reactive protein (CRP) and white blood cell count (WBC) were most frequently reported. We conducted meta-analysis with 12 CRP studies (22422 participants) and six WBC studies (15209 participants), and also performed a narrative review of all studies. There was consistent evidence of a modest association between CRP and venular caliber (r = 0.09, 95%CI 0.05 to 0.12), but little evidence of an association between CRP with retinal arteriolar caliber (r = 0.00, 95%CI -0.02 to 0.02). Similarly, WBC had stronger associations with venular (r = 0.18, 95%CI 0.05 to 0.31) than arteriolar caliber (r = 0.05, 95%CI 0.01 to 0.09). Narrative review of other inflammatory markers showed consistent findings. There was little evidence of associations between inflammation markers and other microvascular parameters, fractal dimension and tortuosity. CONCLUSIONS: There was more evidence for an association of inflammation with retinal venular than with arterial caliber. The findings suggest a potential druggable mechanism contributing to microvascular damage that has been relatively overlooked in CVD pathogenesis and treatment.

8.
BMJ Open ; 11(10): e040795, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620651

RESUMO

OBJECTIVES: To investigate the association between glaucoma and 10-year mortality rate in an adult population in China. DESIGN: Population-based cohort study. SETTING: The Liwan Eye Study, China. PARTICIPANTS: 1405 baseline participants aged 50 years and older were invited to attend a 10-year follow-up examination. PRIMARY AND SECONDARY OUTCOME MEASURES: The International Society of Geographic and Epidemiologic Ophthalmology criteria was used to define glaucoma. Detailed information of mortality was confirmed using the Chinese Centre for Disease Control and Prevention. Presenting visual impairment (PVI) was defined as a presenting visual acuity of less than 20/40 in the better-seeing eye. The 10-year mortality rates were compared using the log-rank test. Cox proportional hazards regression models were used to investigate the association between glaucoma and mortality. RESULTS: A total of 1372 (97.7%) participants with available gonioscopic data were included in the analysis. Of these, 136 (9.9%), 33 (2.4%) and 21 (1.5%) participants had primary angle closure (PAC) suspect (PACS), PAC and PAC glaucoma (PACG), and 29 (2.1%) had primary open angle glaucoma (POAG). After 10 years, 306 (22.3%) participants were deceased. The 10-year mortality was significantly associated with PACG (HR, 2.15, 95% CI 1.14 to 4.04, p=0.018) but not associated with PAC (HR, 1.27, 95% CI 0.67 to 2.39, p=0.463), PACS (HR, 1.32, 95% CI 0.95 to 1.83, p=0.099) and POAG (HR, 0.74, 95% CI 0.36 to 1.49, p=0.395) when age and gender were adjusted for. This association was no longer statistically significant (HR, 1.60, 95% CI 0.70 to 3.61, p=0.263) when covariables, such as income, education, body mass index, PVI, history of diabetes and hypertension, were adjusted for. Larger vertical cup-to-disc ratio (VCDR >0.30) was only a significant risk factor in multivariable analysis (HR, 1.60, 95% CI 1.11 to 2.33, p=0.011). CONCLUSIONS: PACG was significantly associated with higher long-term mortality, but this association was likely to be confounded by other systemic risk factors. VCDR >0.3 was the only independent predictor, implying that it may be a marker of ageing and frailty.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Adulto , Distribuição por Idade , Idoso , China/epidemiologia , Estudos de Coortes , Estudos Transversais , Humanos , Pressão Intraocular , Estudos Longitudinais , Pessoa de Meia-Idade , Prevalência
9.
Br J Ophthalmol ; 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34697024

RESUMO

PURPOSE: To investigate the association of self-reported cataract surgery with all-cause and cause-specific mortality using a large-scale population-based sample. METHODS: Data from the 1999-2008 cycles of the National Health and Nutrition Examination Survey were used. A self-reported history of cataract surgery was considered a surrogate for the presence of clinically significant cataract surgery. Mortality data were ascertained from National Death Index records. Hazard ratios (HRs) and 95% confidence intervals (CIs) for survival were estimated using Cox proportional hazards regression models. RESULTS: A total of 14 918 participants were included in the analysis. During a median follow-up of 10.8 (Interquartile range, IQR, 8.25-13.7) years, 3966 (19.1%) participants died. Participants with self-reported cataract surgery were more likely to die from all causes and specific causes (vascular disease, cancer, accident, Alzheimer's disease, respiratory disease, renal disease and others) compared with those without (all Ps <0.05). The association between self-reported cataract surgery and all-cause mortality remained significant after multiple adjustments (HR=1.13; 95% CI 1.01 to 1.26). For cause-specific mortality, multivariable Cox models showed that self-reported cataract surgery predicted a 36% higher risk of vascular-related mortality (HR=1.36; 95% CI 1.01 to 1.82). The association with other specific causes of mortality did not reach statistical significance after multiple adjustments. CONCLUSIONS: This study found significant associations of self-reported cataract surgery with all-cause and vascular mortalities. Our findings provide potential insights into the pathogenic pathways underlying cataract.

10.
JAMA Ophthalmol ; 139(11): 1228-1234, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34647960

RESUMO

Importance: The conventional 2.2-mm clear corneal incision is relatively narrow compared with the sleeves of Phaco handpieces, resulting in friction at the incision site and increased risk of incision-related Descemet membrane detachment (DMD). The modified 2.2-mm incision only enlarged internal width to 3.0 mm, forming a trapezoid incision shape, which may reduce the friction of surgical instruments and decrease the risk of incisional DMD. Objective: To compare the incidence of incision-related DMD between eyes undergoing modified vs conventional 2.2-mm incision phacoemulsification for hard nuclear age-related cataract. Design, Setting, and Participants: This double-masked, parallel randomized clinical trial was conducted from July 22, 2019, to January 22, 2020, at Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. The study included patients with age-related cataract and nuclear opalescence grade of 4.0 or greater based on the Lens Opacities Classification System III. Patients were enrolled in this study according to the following inclusion criteria: (1) age between 65 to 90 years; (2) pupil size of 6 mm or greater after dilation; (3) Lens Opacities Classification System III nuclear opalescence grade of 4.0 or more; and (4) corneal endothelial cell density greater than 1500 cells/mm2. Interventions: Modified (enlarged internal width to 3.0 mm) or conventional 2.2-mm incision phacoemulsification with intraocular lens implantation. Main Outcomes and Measures: Incidence of incision-related DMD at postoperative day 1. Results: A total of 130 eyes of 130 patients were randomized into the conventional group (n = 65) or the modified group (n = 65). The mean (SD) age of participants was 74.5 (5.9) years and 74.3 (6.0) years in the conventional and modified groups, respectively. A total of 26 participants in the conventional group (40%) and 27 in the modified group (42%) were men. Compared with eyes in the conventional group, the incidence of DMD in eyes in the modified group was significantly lower at postoperative day 1 (difference, 26.15; 95% CI, 9.60-42.71; P = .003). The difference at postoperative day 7 was 16.92 (95% CI, 2.91-30.94; P = .02). The length of DMD (postoperative day 1: difference, 0.188; 95% CI, 0.075-0.301; P = .002) and maximal corneal thickness at incision site (postoperative day 1: difference, 0.032; 95% CI, 0.006-0.057; P = .02; postoperative day 7: difference, 0.019; 95% CI, 0.003-0.035; P = .02) were lower in the modified group, while visual quality parameter modulation transfer function (postoperative day 1: difference, -0.033; 95% CI, -0.064 to -0.001; P = .04) was higher. No difference was observed between the 2 groups in best-corrected visual acuity, central corneal endothelium loss, or surgically induced astigmatism at any follow-up time. There were no intraoperative complications in the 2 groups. Conclusions and Relevance: These findings suggest that modified 2.2-mm trapezoid incision phacoemulsification reduces the incidence of DMD for hard nuclear age-related cataract at postoperative day 1 and might be considered in patients at high risk of incision-related DMD, although the clinical relevance cannot be determined with certainty from this trial. Trial Registration: ClinicalTrials.gov identifier: NCT04014699.

11.
Ophthalmology ; 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34634364

RESUMO

PURPOSE: To assess baseline ocular biometric risk factors for progression from primary angle closure suspect (PACS) to primary angle closure (PAC) or acute angle closure (AAC). DESIGN: Prospective, observational study. PARTICIPANTS: Six hundred forty-three mainland Chinese with untreated PACS. METHODS: Participants underwent baseline clinical examinations, including gonioscopy, anterior segment OCT (AS-OCT) imaging, and A-scan ultrasound biometry as part of the Zhongshan Angle Closure Prevention (ZAP) Trial. Primary angle closure suspect was defined as an inability to visualize pigmented trabecular meshwork in 2 or more quadrants based on static gonioscopy. Primary angle closure was defined as development of intraocular pressure above 24 mmHg or peripheral anterior synechiae. Progression was defined as development of PAC or an AAC attack. Multivariable logistic regression models were developed to assess biometric risk factors for progression. MAIN OUTCOME MEASURES: Six-year progression from PACS to PAC or AAC. RESULTS: Six hundred forty-three untreated eyes (609 nonprogressors, 34 progressors) of 643 participants were analyzed. In a multivariable model with continuous parameters, narrower horizontal angle opening distance of 500 µm from the scleral spur (AOD500; odds ratio [OR], 1.10 per 0.01-mm decrease; P = 0.03), flatter horizontal iris curvature (IC; OR, 1.96 per 0.1-mm decrease; P = 0.01), and older age (OR, 1.11 per 1-year increase; P = 0.01) at baseline were associated significantly with progression (area under the receiver operating characteristic curve [AUC], 0.73). Smaller cumulative gonioscopy score was not associated with progression (OR, 1.03 per 1-modified Shaffer grade decrease; P = 0.85) when replacing horizontal AOD500 in the multivariable model. In a separate multivariable model with categorical parameters, participants in the lowest quartile of horizontal AOD500 (OR, 3.10; P = 0.002) and IC (OR, 2.48; P = 0.014) measurements and 59 years of age or older (OR, 2.68; P = 0.01) at baseline showed higher odds of progression (AUC, 0.72). CONCLUSIONS: Ocular biometric measurements can help to risk-stratify patients with early angle closure for more severe disease. Anterior segment OCT measurements of biometric parameters describing the angle and iris are predictive of progression from PACS to PAC or AAC, whereas gonioscopy grades are not.

12.
J Genet Genomics ; 2021 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-34520856

RESUMO

The global "myopia boom" has raised significant international concerns. Despite a higher myopia prevalence in Asia, previous large-scale genome-wide association studies (GWASs) were mostly based on European descendants. Here, we report a GWAS of spherical equivalent (SE) in 1852 Chinese Han individuals with extreme SE from Guangzhou (631 < -6D and 574 > 0D) and Wenzhou (593 < -6D and 54 > -1.75 D), followed by a replication study in two independent cohorts with totaling 3538 East Asian individuals. The discovery GWAS and meta-analysis identify three novel loci which show genome-wide significant associations with SE, including 1q25.2 FAM163A, 10p11.22 NRP1/PRAD3, and 10p11.21 ANKRD30A/MTRNR2L7, together explaining 3.34% of SE variance. 10p11.21 was successfully replicated. The allele frequencies of all three loci show significant differences between major continental groups (P < 0.001). The SE reducing (more myopic) allele of rs10913877 (1q25.2 FAM163A) demonstrates the highest frequency in East Asians and much lower frequencies in Europeans and Africans (EAS = 0.60, EUR = 0.20, AFR = 0.18). The gene-based analysis additionally identifies three novel genes associated with SE, including EI24, LHX5 and ARPP19. These results provide new insights into myopia pathogenesis, and indicate the role of genetic heterogeneity in myopia epidemiology among different ethnicities.

13.
Br J Ophthalmol ; 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518160

RESUMO

AIMS: To examine independent and interactive associations of ophthalmic and systemic conditions with incident dementia. METHODS: Our analysis included 12 364 adults aged 55-73 years from the UK Biobank cohort. Participants were assessed between 2006 and 2010 at baseline and were followed up until the early of 2021. Incident dementia was ascertained using hospital inpatient, death records and self-reported data. RESULTS: Over 1 263 513 person-years of follow-up, 2304 cases of incident dementia were documented. The multivariable-adjusted HRs (95% CI) for dementia associated with age-related macular degeneration (AMD), cataract, diabetes-related eye disease (DRED) and glaucoma at baseline were 1.26 (1.05 to 1.52), 1.11 (1.00 to 1.24), 1.61 (1.30 to 2.00) and (1.07 (0.92 to 1.25), respectively. Diabetes, heart disease, stroke and depression at baseline were all associated with an increased risk of dementia. Of the combination of AMD and a systemic condition, AMD-diabetes was associated with the highest risk for incident dementia (HR (95% CI): 2.73 (1.79 to 4.17)). Individuals with cataract and a systemic condition were 1.19-2.29 times more likely to develop dementia compared with those without cataract and systemic conditions. The corresponding number for DRED and a systemic condition was 1.50-3.24. Diabetes, hypertension, heart disease, depression and stroke newly identified during follow-up mediated the association between cataract and incident dementia as well as the association between DRED and incident dementia. CONCLUSIONS: AMD, cataract and DRED but not glaucoma are associated with an increased risk of dementia. Individuals with both ophthalmic and systemic conditions are at higher risk of dementia compared with those with an ophthalmic or systemic condition only.

14.
Am J Ophthalmol ; 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34509430

RESUMO

PURPOSE: To investigate the occurrence and risk factors of clinically significant intraocular lens (IOL) decentration and tilt in highly myopic eyes using swept-source anterior segment optical coherence tomography (SS-AS-OCT). DESIGN: Cross-sectional study. METHODS: This study included 334 participants (334 eyes) with high myopia (axial length (AL) ≥26 mm) who underwent phacoemulsification with IOL implantation. Decentration and tilt of IOL were assessed by SS-AS-OCT. Clinically significant IOL decentration and tilt was defined as decentration ≥ 0.4mm and tilt ≥7°. Routine pre- and post-operative examinations were performed, including visual acuity, refraction, biometric measurement using IOL master700, and objective visual quality evaluated by OPD-Scan III. RESULTS: Among the 334 highly myopic participants, 71 (21.3%) had clinically significant IOL decentration and 26(7.78%) had clinically significant IOL tilt. The proportion of clinically significant IOL decentration (37.1% vs 14.0%, P<0.001) and tilt (16.2% vs 3.90%, P<0.001) in those with AL ≥ 30mm was significantly higher than those of AL< 30 mm. In multivariable logistic regression model, only AL ≥ 30 mm was associated with clinically significant IOL decentration (OR=1.65, P=0.002). AL ≥ 30mm (OR=2.09, P=0.001) was independent risk factors for clinically significant IOL tilt after adjusting for confounders. AL ≥ 30.3 mm could effectively predict IOL decentration ≥ 0.6mm (area under the curve = 0.802). CONCLUSIONS: Participants with AL longer than 30mm have higher risk of clinically significant IOL decentration and tilt, thus cautious should be taken to implant multifocal or toric IOL for these patients.

15.
Int J Ophthalmol ; 14(9): 1297-1301, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34540602

RESUMO

Myopia has become a major visual disorder among school-aged children in East Asia due to its rising prevalence over the past few decades and will continue to be a leading health issue with an annual incidence as high as 20%-30%. Although various interventions have been proposed for myopia control, consensus in treatment strategies has yet to be fully developed. Atropine and orthokeratology stand out for their effectiveness in myopia progression control, but children with rapid progression of myopia require treatment with higher concentrations of atropine that are associated with increased rates of side effects, or with orthokeratology that carries risk of significant complication. Therefore, improved risk assessment for myopia onset and progression in children is critical in clinical decision-making. Besides traditional prediction models based on genetic effects and environmental exposures within populations, individualized prediction using machine learning and data based on age-specific refraction is promising. Although emerging treatments for myopia are promising and some have been incorporated into clinical practice, identifying populations who require and benefit from intervention remains the most important initial step for clinical practice.

16.
JAMA Ophthalmol ; 139(10): 1115-1121, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34529002

RESUMO

Importance: During the outbreak of COVID-19, outdoor activities were limited and digital learning increased. Concerns have arisen regarding the impact of these environmental changes on the development of myopia. Objective: To investigate changes in the development of myopia in young Chinese schoolchildren during the outbreak of COVID-19. Design, Setting, and Participants: In this observational study, 2 groups of students from 12 primary schools in Guangzhou, China, were prospectively enrolled and monitored from grade 2 to grade 3. Comparisons between the exposure and nonexposure groups were made to evaluate any association between environmental changes during the COVID-19 outbreak period and development of myopia. The exposure group received complete eye examinations in November and December 2019 and November and December 2020. The nonexposure group received examinations in November and December 2018 and November and December 2019. Main Outcomes and Measures: Changes in cycloplegic spherical equivalent refraction (SER), axial length (AL) elongation, and myopia incidence from grade 2 to grade 3. Results: Among the 2679 eligible students in grade 2 (mean [SD] age, 7.76 [0.32] years; 1422 [53.1%] male), 2114 (1060 in the nonexposure group and 1054 in the exposure group) were reexamined in grade 3. Compared with the period from November and December 2018 to November and December 2019, the shift of SER, AL elongation, and myopia incidence from grade 2 to grade 3 from November and December 2019 to November and December 2020 was 0.36 D greater (95% CI, 0.32-0.41; P < .001), 0.08 mm faster (95% CI, 0.06-0.10; P < .001), and 7.9% higher (95% CI, 5.1%-10.6%; P < .001), respectively. In grade 3 students, the prevalence of myopia increased from 13.3% (141 of 1060 students) in November and December 2019 to 20.8% (219 of 1054 students) in November and December 2020 (difference [95% CI], 7.5% [4.3-10.7]; P < .001); the proportion of children without myopia and with SER greater than -0.50 D and less than or equal to +0.50 D increased from 31.1% (286 of 919 students) to 49.0% (409 of 835 students) (difference [95% CI], 17.9% [13.3-22.4]; P < .001). Conclusions and Relevance: In this study, development of myopia increased during the COVID-19 outbreak period in young schoolchildren in China. Consequently, myopia prevalence and the proportion of children without myopia who were at risk of developing myopia increased. Future studies are needed to investigate long-term changes in myopia development after the COVID-19 pandemic.


Assuntos
COVID-19/prevenção & controle , Miopia/epidemiologia , Visão Ocular , Fatores Etários , COVID-19/epidemiologia , COVID-19/transmissão , Criança , China/epidemiologia , Humanos , Incidência , Miopia/diagnóstico , Miopia/fisiopatologia , Prevalência , Estudos Prospectivos , Recreação , Medição de Risco , Fatores de Risco , Tempo de Tela , Fatores de Tempo
17.
Ann Transl Med ; 9(13): 1077, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34422989

RESUMO

Background: To determine if tobacco smoking is a risk factor for early-onset cataracts. Methods: This was a prospective population-based cohort study. A total of 70,886 participants aged 45-55 years in the 45 and Up Study were included in our analysis. Early-onset cataracts (EOC) were defined as cataract surgeries performed before 65 years old, based on participant data linked to the Medicare Benefits Schedule (MBS). Smoking habits were assessed at baseline, based on a self-administered questionnaire. A Cox proportional hazards model was used to evaluate the association between tobacco smoking and the risk of early-onset cataracts over the follow-up period. Results: At baseline recruitment, 59.9% of study participants never smoked, 30.5% were former smokers, and 9.6% were current smokers. A total of 1,713 participants underwent cataract surgery over a mean follow-up of 625,042 person-years, with an incidence of 2.74 cases per 1,000 person-years. For current smokers, patients with EOC had longer smoking durations (P=0.019). For former smokers, patients with EOC had higher smoking intensities (P=0.001), were older at smoking commencement (P=0.011), and longer times since quitting (P=0.04). The risk of EOC was not found to be significantly different between current smokers or former smokers, compared to those who had never smoked. Both stratification and sensitivity analyses by gender, surgery year, alcohol intake, physical activity, and income yielded similar results. Conclusions: Smoking has neither a beneficial nor harmful effect on the long-term incidence of EOC.

18.
Eye (Lond) ; 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373612

RESUMO

PURPOSE: To investigate the geographic variation in the cumulative incidence of private cataract surgery (PCS) and its association with remoteness, socioeconomic, and private health insurance coverage indexes in a large Australian population. METHODS: A prospective population-based study of 266,896 Australian adults living in New South Wales (NSW) aged 45 years older and over were enrolled in the 45 and Up Study. PCS was identified using Medicare claims data. Participants were assigned to a Statistical Area Level 3 (SA3) based on residential postcode in NSW. Cumulative incidence of PCS (number of surgery per 100,000 population from 2006 to 2016) among 89 SA3s was calculated and standardized to the baseline population. Remoteness and socioeconomic deprivation was derived from Australian Bureau of Statistics (ABS). Private health insurance coverage rates were obtained from the baseline interview. RESULTS: A total of 257,237 participants with complete data were included in the current analysis. During the study period, a total of 67,707 cataract surgeries were performed among 39,744 participants. Cumulative incidence of PCS varied from 14,897 to 37,314 per 100,000 across 89 SA3s. Multivariable adjusted regression models showed that remoteness index and private health insurance coverage rates were independently associated with cumulative incidence of PCS (all P < 0.05), while no significant association between socioeconomic deprivation and cumulative incidence of PCS was observed. Collectively, these three variables explained 52.7% of the geographic variability. CONCLUSIONS: The geographical variation in the cumulative incidence of PCS calls for interventions targeted at individuals living in remote areas to reduce the burden of cataract-related vision impairment.

20.
Sci Rep ; 11(1): 15808, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34349130

RESUMO

This study investigated the diagnostic performance, feasibility, and end-user experiences of an artificial intelligence (AI)-assisted diabetic retinopathy (DR) screening model in real-world Australian healthcare settings. The study consisted of two components: (1) DR screening of patients using an AI-assisted system and (2) in-depth interviews with health professionals involved in implementing screening. Participants with type 1 or type 2 diabetes mellitus attending two endocrinology outpatient and three Aboriginal Medical Services clinics between March 2018 and May 2019 were invited to a prospective observational study. A single 45-degree (macula centred), non-stereoscopic, colour retinal image was taken of each eye from participants and were instantly screened for referable DR using a custom offline automated AI system. A total of 236 participants, including 174 from endocrinology and 62 from Aboriginal Medical Services clinics, provided informed consent and 203 (86.0%) were included in the analysis. A total of 33 consenting participants (14%) were excluded from the primary analysis due to ungradable or missing images from small pupils (n = 21, 63.6%), cataract (n = 7, 21.2%), poor fixation (n = 2, 6.1%), technical issues (n = 2, 6.1%), and corneal scarring (n = 1, 3%). The area under the curve, sensitivity, and specificity of the AI system for referable DR were 0.92, 96.9% and 87.7%, respectively. There were 51 disagreements between the reference standard and index test diagnoses, including 29 which were manually graded as ungradable, 21 false positives, and one false negative. A total of 28 participants (11.9%) were referred for follow-up based on new ocular findings, among whom, 15 (53.6%) were able to be contacted and 9 (60%) adhered to referral. Of 207 participants who completed a satisfaction questionnaire, 93.7% specified they were either satisfied or extremely satisfied, and 93.2% specified they would be likely or extremely likely to use this service again. Clinical staff involved in screening most frequently noted that the AI system was easy to use, and the real-time diagnostic report was useful. Our study indicates that AI-assisted DR screening model is accurate and well-accepted by patients and clinicians in endocrinology and indigenous healthcare settings. Future deployments of AI-assisted screening models would require consideration of downstream referral pathways.


Assuntos
Inteligência Artificial , Atenção à Saúde/normas , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Medicina Tradicional/normas , Adulto , Idoso , Austrália/epidemiologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Endocrinologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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