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1.
N Engl J Med ; 382(18): 1687-1695, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32286748

RESUMO

BACKGROUND: Nonophthalmologist physicians do not confidently perform direct ophthalmoscopy. The use of artificial intelligence to detect papilledema and other optic-disk abnormalities from fundus photographs has not been well studied. METHODS: We trained, validated, and externally tested a deep-learning system to classify optic disks as being normal or having papilledema or other abnormalities from 15,846 retrospectively collected ocular fundus photographs that had been obtained with pharmacologic pupillary dilation and various digital cameras in persons from multiple ethnic populations. Of these photographs, 14,341 from 19 sites in 11 countries were used for training and validation, and 1505 photographs from 5 other sites were used for external testing. Performance at classifying the optic-disk appearance was evaluated by calculating the area under the receiver-operating-characteristic curve (AUC), sensitivity, and specificity, as compared with a reference standard of clinical diagnoses by neuro-ophthalmologists. RESULTS: The training and validation data sets from 6779 patients included 14,341 photographs: 9156 of normal disks, 2148 of disks with papilledema, and 3037 of disks with other abnormalities. The percentage classified as being normal ranged across sites from 9.8 to 100%; the percentage classified as having papilledema ranged across sites from zero to 59.5%. In the validation set, the system discriminated disks with papilledema from normal disks and disks with nonpapilledema abnormalities with an AUC of 0.99 (95% confidence interval [CI], 0.98 to 0.99) and normal from abnormal disks with an AUC of 0.99 (95% CI, 0.99 to 0.99). In the external-testing data set of 1505 photographs, the system had an AUC for the detection of papilledema of 0.96 (95% CI, 0.95 to 0.97), a sensitivity of 96.4% (95% CI, 93.9 to 98.3), and a specificity of 84.7% (95% CI, 82.3 to 87.1). CONCLUSIONS: A deep-learning system using fundus photographs with pharmacologically dilated pupils differentiated among optic disks with papilledema, normal disks, and disks with nonpapilledema abnormalities. (Funded by the Singapore National Medical Research Council and the SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Program.).


Assuntos
Aprendizado Profundo , Fundo de Olho , Redes Neurais de Computação , Oftalmoscopia/métodos , Papiledema/diagnóstico , Fotografação , Retina/diagnóstico por imagem , Algoritmos , Área Sob a Curva , Conjuntos de Dados como Assunto , Diagnóstico Diferencial , Humanos , Valor Preditivo dos Testes , Curva ROC , Retina/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade
2.
Ophthalmology ; 2020 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-32344073

RESUMO

OBJECTIVE: Although there have been many population-based studies of age-related macular degeneration (AMD) only limited information is available in Asia on the epidemiology of geographic atrophy (GA). We aimed to determine the prevalence and patterns of GA through an analysis of multiple studies conducted within the Asian Eye Epidemiology Consortium (AEEC). DESIGN: Cross-sectional meta-analyses. PARTICIPANTS: A total of 97,213 individuals aged 40 years and older. METHODS: Data from 22 population-based studies from countries belonging to the AEEC were included. In all studies, AMD was defined based on standardized grading systems. GA was defined as an area of pallor in the fundus with visibility of the underlying choroidal blood vessels and sharply defined borders. Random-effects meta-analysis was performed to estimate overall, age-, gender-, and region-specific pooled prevalence of GA. MAIN OUTCOME MEASURES: Prevalence of GA per 1000 persons RESULTS: The mean age was 60.8 ±10.8 years, 42,673 (43.9%) were males. Overall, a total of 223 (0.2%) individuals had GA. The pooled overall prevalence of GA was 1.57 per 1000 persons (95% Confidence Interval [CI], 1.04-2.10), which was three times less than that of neovascular AMD of 5.20 per 1000 persons (95% CI, 3.97-6.43). Compared to those aged 50-59 years, the prevalence of GA rose from 0.34 per 1,000 persons (95% CI, 0.07-0.62) to 2.94 per 1,000 persons (95% CI, 1.60-4.29) in those aged ≥70 years. The GA prevalence per 1000 persons was similar between urban (2.22 [95% CI, 1.23-3.23]) and rural residents (1.55 [95% CI, 0.87-2.23]). GA was more prevalent in South Asia (based on studies from India and Nepal, 3.78 per 1,000 persons; 95% CI, 1.67-5.89), compared to East Asia (based on studies from China, Korea, and Japan, 0.76 per 1000 persons; 95% CI, 0.31-1.22, P=0.006). CONCLUSIONS: GA is uncommon in Asian populations compared to those of European ancestry. Even within Asia geographical differences in GA prevalence were seen. The findings of this meta-analysis suggest that better dissection of risk factors in the Asian population for GA, and it may provide insights into the biological pathways that drive these late-stage manifestations, thus suggesting better targets for prevention.

3.
Invest Ophthalmol Vis Sci ; 61(4): 27, 2020 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-32315378

RESUMO

Purpose: To study the effect of changing heart rate on the ocular pulse and the dynamic biomechanical behavior of the optic nerve head (ONH) using a comprehensive mathematical model. Methods: In a finite element model of a healthy eye, a biphasic choroid consisted of a solid phase with connective tissues and a fluid phase with blood, and the lamina cribrosa (LC) was viscoelastic as characterized by a stress-relaxation test. We applied arterial pressures at 18 ocular entry sites (posterior ciliary arteries), and venous pressures at four exit sites (vortex veins). In the model, the heart rate was varied from 60 to 120 bpm (increment: 20 bpm). We assessed the ocular pulse amplitude (OPA), pulse volume, ONH deformations, and the dynamic modulus of the LC at different heart rates. Results: With an increasing heart rate, the OPA decreased by 0.04 mm Hg for every 10 bpm increase in heart rate. The ocular pulse volume decreased linearly by 0.13 µL for every 10 bpm increase in heart rate. The storage modulus and the loss modulus of the LC increased by 0.014 and 0.04 MPa, respectively, for every 10 bpm increase in heart rate. Conclusions: In our model, the OPA, pulse volume, and ONH deformations decreased with an increasing heart rate, whereas the LC became stiffer. The effects of blood pressure/heart rate changes on ONH stiffening may be of interest for glaucoma pathology.

4.
Br J Ophthalmol ; 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32229517

RESUMO

BACKGROUND: This study aimed to assess the prevalence and causes of vision loss in sub-Saharan Africa (SSA) in 2015, compared with prior years, and to estimate expected values for 2020. METHODS: A systematic review and meta-analysis assessed the prevalence of blindness (presenting distance visual acuity <3/60 in the better eye), moderate and severe vision impairment (MSVI; presenting distance visual acuity <6/18 but ≥3/60) and mild vision impairment (MVI; presenting distance visual acuity <6/12 and ≥6/18), and also near vision impairment (

6.
Inj Prev ; 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111726

RESUMO

INTRODUCTION: Falls in older aged adults are an important public health problem. Insight into differences in fall-related injury rates between countries can serve as important input for identifying and evaluating prevention strategies. The objectives of this study were to compare Global Burden of Disease (GBD) 2017 estimates on incidence, mortality and disability-adjusted life years (DALYs) due to fall-related injury in older adults across 22 countries in the Western European region and to examine changes over a 28-year period. METHODS: We performed a secondary database descriptive study using the GBD 2017 results on age-standardised fall-related injury in older adults aged 70 years and older in 22 countries from 1990 to 2017. RESULTS: In 2017, in the Western European region, 13 840 per 100 000 (uncertainty interval (UI) 11 837-16 113) older adults sought medical treatment for fall-related injury, ranging from 7594 per 100 000 (UI 6326-9032) in Greece to 19 796 per 100 000 (UI 15 536-24 233) in Norway. Since 1990, fall-related injury DALY rates showed little change for the whole region, but patterns varied widely between countries. Some countries (eg, Belgium and Netherlands) have lost their favourable positions due to an increasing fall-related injury burden of disease since 1990. CONCLUSIONS: From 1990 to 2017, there was considerable variation in fall-related injury incidence, mortality, DALY rates and its composites in the 22 countries in the Western European region. It may be useful to assess which fall prevention measures have been taken in countries that showed continuous low or decreasing incidence, death and DALY rates despite ageing of the population.

7.
Acta Ophthalmol ; 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32190987

RESUMO

PURPOSE: Since histomorphometric descriptions of posterior scleral staphylomas, although forming a major part of myopic maculopathy, have been scarce so far, we histomorphometrically examined scleral staphylomas in enucleated human eyes. METHODS: Using light microscopy, we histomorphometrically examined sagittal histological sections of human globes enucleated due to malignant choroidal melanomas or secondary angle-closure glaucoma. RESULTS: Out of 246 globes included into the study, posterior scleral staphylomas were detected in 10 eyes (mean length: 31.4 ± 3.0 mm; range: 28.0-37.0 mm). In the staphylomatous region in the study group as compared with the corresponding region of a control group adjusted for age and axial length, scleral thickness was significantly lower (109 ± 25 µm versus 319 ± 161 µm; p = 0.001). The study group in the staphylomatous region as compared to the highly myopic control group in the corresponding region did not differ significantly in retinal pigment epithelium (RPE) cell density (19.6 ± 4.9 cells/300 µm versus 21.1 ± 5.7 cells/300 µm; p = 0.84) and RPE height (8.2 ± 2.8 µm versus 6.1 ± 2.5 µm; p = 0.13), Bruch's membrane (BM) thickness (3.5 ± 1.3 µm versus 4.2 ± 2.3 µm; p = 0.40) and choriocapillaris thickness (5.3 ± 2.8 µm versus 4.4 ± 2.8 µm; p = 0.49) and density (164 ± 99 µm versus 226 ± 38 µm; p = 0.13). All staphylomatous regions showed a localized BM defect. CONCLUSIONS: Marked scleral thinning and spatially correlated BM defects histologically characterized myopic scleral staphylomas, while thickness and density of the choriocapillaris and RPE and BM thickness did not differ significantly between staphylomatous versus non-staphylomatous eyes in the respective regions. These findings support the notion that a locally reduced scleral resistance against a backward pushing BM led to a local scleral outpouching. The outpouching-associated increase in curvature length may stretch BM with the sequel of a localized BM rupture.

8.
Artigo em Inglês | MEDLINE | ID: mdl-32209585

RESUMO

OBJECTIVE: Hemoglobin A1c (HbA1c) accuracy is important for diabetes diagnosis and estimation of overall glycemia. The G6PD-Asahi variant which causes glucose-6-phosphate dehydrogenase (G6PD) deficiency has been shown to lower HbA1c independently of glycemia in African ancestry populations. As different G6PD variants occur in Asian ancestry, we sought to identify Asian-specific G6PD variants associated with HbA1c. RESEARCH DESIGN AND METHODS: In eight Asian population-based cohorts, we performed imputation on the X chromosome using the 1000 Genomes reference panel and tested for association with HbA1c (10 005 East Asians and 2051 South Asians). Results were meta-analyzed across studies. We compared the proportion of individuals classified as having diabetes/pre-diabetes by fasting glucose ≥100 mg/dL or HbA1c ≥5.7% units among carriers and non-carriers of HbA1c-associated variants. RESULTS: The strongest association was a missense variant (G6PD-Canton, rs72554665, minor allele frequency=2.2%, effect in men=-0.76% unit, 95% CI -0.88 to -0.64, p=1.25×10-27, n=2844). Conditional analyses identified a secondary distinct signal, missense variant (G6PD-Kaiping, rs72554664, minor allele frequency=1.6%, effect in men=-1.12 % unit, 95% CI -1.32 to -0.92, p=3.12×10-15, pconditional_Canton=7.57×10-11). Adjusting for glucose did not attenuate their effects. The proportion of individuals with fasting glucose ≥100 mg/dL did not differ by carrier status of G6PD-Canton (p=0.21). Whereas the proportion of individuals with HbA1c ≥5.7% units was lower in carriers (5%) compared with non-carriers of G6PD-Canton (30%, p=0.03). CONCLUSIONS: We identified two G6PD variants in East Asian men associated with non-glycemic lowering of HbA1c. Carriers of these variants are more likely to be underdiagnosed for diabetes or pre-diabetes than non-carriers if screened by HbA1c without confirmation by direct glucose measurements.

9.
Sci Rep ; 10(1): 5159, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32198480

RESUMO

To assess differences between secondary high myopia (SHM) due to congenital glaucoma and primary high myopia (PHM) and non-highly myopic eyes (NHM) in the relationships between axial length and Bruch's membrane (BM) thickness and retinal pigment epithelium (RPE) density. The histomorphometric study included human globes enucleated for reasons such as malignant uveal melanoma, end-stage painful secondary angle-closure glaucoma and congenital glaucoma. BM thickness and RPE cell density were measured upon light microscopy. The investigation included 122 eyes (mean axial length: 26.7 ± 3.7 mm; range: 20.0-37.0 mm): 7 eyes with SHM (axial length: 33.7 ± 2.1 mm; range: 31.0-37.0 mm), 56 eyes with PHM (mean axial length: 29.1 ± 2.4 mm; range: 26.0-36.0 mm) and 59 eyes in the NHM-group (axial length: 23.5 ± 1.3 mm; range: 20.0-25.5 mm). In the SHM group, longer axial length was associated with lower RPE cell density at the posterior pole (standardized regression coefficient beta: 0.92; non- standardized regression coefficient B: -2.76; 95% confidence interval (CI): -4.41, -1.10;P = 0.01), at the midpoint posterior pole/equator (beta: -0.87; B: -3.60; 95% CI: -6.48, -0.73;P = 0.03), and at the equator (beta: -0.88; B: -0.95; 95% CI: -1.68, -0.23; P = 0.02), but not at the ora serrata (P = 0.88). In the PHM-group and NHM group, RPE cell density at the posterior pole (P = 0.08) and ora serrata (P = 0.88) was statistically independent of axial length, while at the midpoint posterior pole/equator (P = 0.01) and equator (P < 0.001), RPE cell density decreased with longer axis. BM thickness in the SHM group decreased with longer axial length at the posterior pole (beta: -0.93;B: -0.29; 95% CI: -0.39, -0.14; P = 0.003), midpoint posterior pole/equator (beta: -0.79; B: -0.22; 95% CI: -0.42, -0.02; P = 0.035) and equator (beta: -0.84; B: -0.21; 95% CI: -0.37, -0.06; P = 0.017), while in the PHM-group and NHM-group, BM thickness at any ocular region was not statistically significantly correlated with axial length (all P > 0.05). In the SHM-group, but not in the PHM-group or NHM-group (P = 0.98), lower BM thickness was associated with lower RPE cell density (beta: 0.93; B: 0.09; 95% CI: 0.04, 0.14; P = 0.007), while in the eyes without congenital glaucoma the relationship was not statistically significant. In SHM in contrast to PHM, BM thickness and RPE cell density decrease in a parallel manner with longer axial length. The findings fit with the notion of BM being a primary driver in the process of axial elongation in PHM as compared to SHM.

10.
JAMA Netw Open ; 3(3): e200567, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32142129

RESUMO

Importance: Although myopic maculopathy has become a major cause of vision impairment worldwide, few data from Russia and Central Asia on the prevalence of myopic maculopathy have been available. Objective: To assess the prevalence of myopic maculopathy and its associations with ocular and systemic parameters in a population in Russia. Design, Setting, and Participants: The Ural Eye and Medical Study, a population-based case-control study, was conducted in rural and urban areas in Bashkortostan, Russia, from October 26, 2015, to July 4, 2017. Data analysis was performed from September 13 to September 15, 2019. The Ural Eye and Medical Study included 5899 of 7328 eligible individuals (80.5%) aged 40 years or older. Exposures: A detailed ocular and systemic examination included fundus photography and optic coherence tomography for the assessment of myopic maculopathy. Main Outcomes and Measures: Prevalence of myopic maculopathy. Results: The present investigation included 5794 of the 5899 eligible individuals (98.2%; 3277 [56.6%] women; mean [SD] age, 58.9 [10.7] years) with available information about myopic maculopathy. Mean (SD) axial length was 23.3 (1.1) mm (range, 19.78-32.87 mm). Prevalence of any myopic maculopathy was 1.3% (95% CI, 1.0%-1.6%); myopic maculopathy stage 2, 0.8% (95% CI, 0.6%-10.0%); stage 3, 0.2% (95% CI, 0.1%-0.4%); and stage 4, 0.2% (95% CI, 0.1%-0.4%). The prevalence of moderate to severe vision impairment and blindness was 29.8% (14 of 47 participants; 95% CI, 16.2%-43.3%) in stage 2 myopic maculopathy, 57.1% (8 of 14 participants; 95% CI, 27.5%-86.8%) in stage 3, and 100% (13 of 13 participants; 95% CI, 100%-100%) in stage 4. In multivariable analysis, a higher myopic maculopathy prevalence was associated with longer axial length (odds ratio [OR], 4.54; 95% CI, 3.48-5.92; P < .001), older age (OR, 1.04; 95% CI, 1.01-1.07; P = .03), and thinner peripapillary retinal nerve fiber layer thickness (OR, 0.96; 95% CI, 0.95-0.98; P < .001). After exclusion of glaucomatous eyes, the association between myopic maculopathy prevalence and thinner retinal nerve fiber layer remained significant (OR, 0.96; 95% CI, 0.95-0.98; P < .001). Myopic maculopathy prevalence was not significantly associated with sex; region of habitation; level of education; ethnicity; prevalence of arterial hypertension, chronic obstructive pulmonary disease, chronic kidney disease, diabetes, and inflammatory liver disease; hearing loss; depression score; or anxiety score. Conclusions and Relevance: In this ethnically mixed population from Russia, myopic maculopathy prevalence was mainly associated with elongated axial length and thinner peripapillary retinal nerve fiber layer, but was not associated with any major internal medical disease, level of education, ethnicity, or sex. Higher myopic maculopathy stage was associated with vision impairment and blindness. In addition to a known association between high axial myopia and glaucoma, myopic maculopathy may be associated with nonglaucomatous optic neuropathy.

11.
BMC Musculoskelet Disord ; 21(1): 64, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32007098

RESUMO

BACKGROUND: Back pain and neck pain are leading causes of the burden of disease worldwide, while information about their prevalence in Russia is missing. METHODS: The population-based Ural Eye and Medical Study was conducted in a rural and urban region in Bashkortostan/Russia. As part of a detailed systematic examination, we assessed the prevalence of low back pain, thoracic spine pain and neck pain in an interview with standardized questions in 5397 study participants (mean age:58.6 ± 10.6 years;range:40-94 years). RESULTS: The mean prevalence of low back pain, thoracic spine pain and neck pain was 2912/5397 (54.0%;95% confidence interval (CI):52.6,55.3), 1271/5397 (23.6%;95%CI:22.4,24.7), and 1570/5397 (29.1%;95%CI:27.9,30.3), respectively. A higher prevalence of low back pain was associated with females (P = 0.04;odds ratio (OR):1.14;95%CI:1.004,1.30), younger age (P < 0.001;OR:0.99;95%CI:0.98,0.99), higher body mass index (P = 0.002;OR:1.02;95%CI:1.01,1.03), lower frequency of vigorous activities during leisure time (P = 0.001;OR:0.79;95%CI:0.69,0.90), more time spent sitting and reclining (P = 0.03;OR:1.00;95%CI:1.00,1.00), higher serum concentration of high-density lipoproteins (P = 0.004;OR:1.10;95%CI:1.03,1.18), higher prothrombin index (P = 0.003;OR:1.01;95%CI:1.003,1.01), higher prevalence of a history of cardiovascular disease (P = 0.004;OR:1.23;95%CI:1.07,1.42), falls (P < 0.004;OR:1.71;95%CI:1.45,2.00), bone fractures (P = 0.01;OR:1.18;95% CI:1.03,1.34), unconsciousness (P < 0.001;OR:1.78;95%CI:1.40,2.25), osteoarthritis (P < 0.001;OR:2.76;95%CI:2.34,3.26), iron-deficiency anemia (P < 0.001;OR:1.87;95%CI:1.41,2.50), and thyroid disorder (P = 0.004;OR:1.37;95%CI:1.10,1.70), fewer days of vegetable intake (P < 0.001;OR:0.89;95%CI:0.85,0.93), smaller amounts of salt intake (P = 0.008;OR:0.97;95%CI:0.94,0.99), higher anxiety score (P < 0.001;OR:1.05;95%CI:1.03,1.06), and in women, history of menopause (P = 0.02;OR:1.36;95%CI:1.05,1.75). The prevalence of thoracic spine pain and neck pain showed similar associations. CONCLUSIONS: In a Russian population, the prevalence of low back pain, thoracic spine pain and neck pain (54.0, 23.6 and 29.1%, respectively) were correlated with parameters such as the female sex, younger age, higher body mass index, higher anxiety score, higher prevalence of a history of cardiovascular disease, lower frequency of vigorous activities and more time spent sitting or reclining. These data may be of interest for assessing the burden of back and neck pain in Russia as part of the global burden of disease.

13.
J Glaucoma ; 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32097258

RESUMO

PRéCIS:: After a short-term IOP elevation, the central retinal vein caliber may be widened at lower IOP rise levels, while be compressed at higher IOP rise values. PURPOSE: To investigate changes in the calibers of the central retinal vein (CRVT) and artery (CRAT) trunk during a short-term elevation of IOP. METHODS: A prospective observational study. Acute primary angle-closure suspects underwent a dark room prone provocative test (DRPPT) for two hours. Before and at the end of the test, tonometry, swept-source optical coherence tomography, and non-mydriatic fundus photography were performed. The calibers of the CRVT and CRAT were measured on the fundus photos taken at baseline and at the end of the DRPPT. RESULTS: The study included 101 eyes (61 individuals; mean age:54.8±9.3▒y; range:30-70▒y) which showed an increase in IOP by 9.6±9.0▒mmHg (range:2.3-46.7▒mmHg). From baseline to the end of the DRPPT, the mean CRVT caliber increased from 101.8±25.9▒µm to 107.7±26.6▒µm (P<0.001), while the CRAT caliber did not differ significantly (110.3±24.2▒µm vs. 109.7±21.5▒µm; P=0.54) during the test. The CRVT widening was larger in the subgroup with IOP rise of <6▒mmHg than in the subgroup with an IOP rise of 6-15▒mmHg, while in the subgroup with an IOP rise of >15▒mmHg the CRVT caliber did not change significantly (P=0.20) during the test. CONCLUSIONS: A physiologic short-term IOP rise at lower levels of IOP elevation led to a widening of the CRVT, while at higher IOP values, the further IOP-rise may have compressed the retinal vein. Due to higher intraluminal pressure values, the retinal artery diameters were not affected by the IOP-rise.

14.
BMC Ophthalmol ; 20(1): 49, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050936

RESUMO

BACKGROUND: Diagnosis and follow-up of retinal diseases may be improved if the thickness of the various retinal layers, in addition to the total retinal thickness, is taken into account. Here we measured the thickness of the macular retinal layers in a population-based study group to assess the normative values and their associations. METHODS: Using spectral-domain optical coherence tomographic images (Spectralis®, wavelength: 870 nm; Heidelberg Engineering Co, Heidelberg, Germany), we measured the thickness of the macular retinal layers in participants of the population-based Beijing Eye Study without ocular diseases and without systematic diseases, such as arterial hypertension, hyperlipidemia, diabetes mellitus, cardiovascular diseases, previous myocardial infarction, cerebral trauma and stroke. Segmentation and measurement of the retinal layers was performed automatically in each of the horizontal scans. RESULTS: The study included 384 subjects (mean age:60.0 ± 8.0 years). The mean thickness of the whole retina, outer plexiform layer, outer nuclear layer,retinal pigment epithelium, inner retinal layer and photoreceptor layer was 259.8 ± 18.9 µm, 19.4 ± 3.9 µm, 93.4 ± 9.6 µm, 17.6 ± 1.9 µm, 169.8 ± 18.6 µm, and 90.0 ± 4.2 µm, respectively. In multivariable analysis, the thickness of the foveola and of all retinal layers in the foveal, parafoveal and perifoveal region decreased with older age (all P < 0.05), except for the thickness of the parafoveal outer plexiform layer which increased with age. Men as compared to women had higher thickness measurements of the photoreceptor layer and outer nuclear layer in all areas, and of all layers between the retinal nerve fiber layer and inner nuclear layer in the parafoveal area (all P < 0.05). The associations between the macular retinal layers thickness and axial length were not consistent. The inner plexiform layer was thicker, and the ganglion cell layer and inner nuclear layer were thinner, in the temporal areas than in the nasal areas, CONCLUSIONS: The associations between decreasing thickness of most retinal layers with older age and the correlation of a higher thickness of some retinal layers with male gender may clinically be taken into account.

15.
Br J Ophthalmol ; 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959588

RESUMO

AIM: To comprehensively examine the association between kidney function and primary open angle glaucoma (POAG) in a large consortium of multiple Asian population-based studies. METHODS: 28 925 participants (57 340 eyes) from 9 population-based studies (from China, Hong Kong, India, Korea, Russia, Singapore) of the Asian Eye Epidemiology Consortium were included. Across all studies, POAG was defined based on the International Society of Geographical and Epidemiological Ophthalmology criteria. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine. Chronic kidney disease (CKD) was defined as eGFR<60 mL/min/1.73 m2. Eye-specific data were pooled from each study. Multivariable regression analysis with generalised estimating equation models was performed to evaluate the associations between kidney function with POAG and intraocular pressure (IOP). RESULTS: After adjusting for age, gender, study group, hypertension, diabetes, hyperlipidaemia, body mass index, smoking status and IOP, lower eGFR (per 10 mL/min/1.73 m2 decrease) was not significantly associated with POAG (OR=1.01; p=0.77). Presence of CKD was also not significantly associated with POAG (OR=1.01; p=0.739). Furthermore, lower eGFR and presence of CKD were not associated with IOP (all p≥0.12), However, in the subgroup of combined Korean and Chinese individuals, significant associations between lower eGFR (OR=1.09; 95% CI 1.00 to 1.18; p=0.048) and severe kidney function decline (<45 mL/min/1.73 m2; OR=2.57; 95% CI 1.34 to 4.93; p=0.004) with POAG, were observed. CONCLUSION: In this large pooled-analysis of multiple Asian population-based studies, our findings suggest that the association between CKD and POAG may only be present in East Asians specifically but not in the overall Asian population. Further evaluation in Japanese population is warranted to confirm this observation.

16.
Graefes Arch Clin Exp Ophthalmol ; 258(3): 513-520, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31897704

RESUMO

PURPOSE: To investigate microvascular abnormalities in diabetic patients without conventional clinical signs of diabetic retinopathy (DR). METHODS: In this cross-sectional observational cohort study, the study group included randomly chosen participants of a community-based cohort with diabetes type 2 without DR, and the control group consisted of non-diabetic individuals from a population-based study. All participants underwent optical coherence tomographic angiography (OCTA). RESULTS: Upon OCTA, 118 (40.4%) eyes of the study group (n = 292 eyes) showed microvascular abnormalities including foveal avascular zone erosion (95 (32.5%) eyes), non-perfusion areas in the superficial and deep retinal layers (39 (13.4%) eyes and 19 (6.5%) eyes, respectively), and microaneurysms in the superficial and deep retinal layers (22 (7.5%) eyes and 31 (10.6%) eyes, resp.). None of these abnormalities was detected in the control group (n = 80). The study group showed a lower vessel density in the superficial retinal vascular layer in all regions except for the foveal region (P < 0.001), and higher vessel density in the parafoveal region in the deep retinal vascular layer (P = 0.01). Higher diabetes prevalence was associated with lower superficial retinal vascular density (P = 0.005) in multivariable analysis. A lower radial peripapillary capillary flow density was correlated (regression coefficient r, 0.62) with higher fasting blood concentration of glucose (P < 0.001) in multivariable analysis. CONCLUSIONS: OCTA revealed microvascular abnormalities in 40% of eyes of diabetic patients without ophthalmoscopically detectable diabetic fundus changes in a community-based population. The early stage of DR may be re-defined upon OCTA.

17.
Retina ; 40(2): 225-232, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31972791

RESUMO

PURPOSE: To assess and compare clinical features of a ridge-shaped macula (defined as macular elevation only in one meridian across the fovea) in individuals younger than 20 years with those of a dome-shaped macula (DSM) in patients aged 20+ years. METHODS: The retrospective observational case series study included 185 highly myopic eyes of 100 consecutive patients younger than 20 years, who were compared with highly myopic patients with DSMs, aged 20+ years and examined in previous studies. RESULTS: Seventeen (9.2%) eyes of the highly myopic young patients showed macular elevations all of which ran only in the horizontal direction across the vertical optical coherence tomographic section fulfilled the definition of a ridge and did not show any staphylomas or any macular Bruch membrane defects. By contrast, in the older patients with DSMs, the DSMs were significantly higher and had a narrower base than the ridges in the young patients, and showed macular Bruch membrane defects in their vicinity, with the axial length being significantly longer, the myopic maculopathy more severe, and the subfoveal choroid thinner. CONCLUSION: Macular elevations detected in children and adolescents are usually ridge-shaped maculas and do not have the characteristics of DSMs. In comparison with DSMs, ridge-shaped maculas do not show a spatial association with macular Bruch membrane defects or posterior staphylomas and have a wider basis and smoother elevation slope. As a hypothesis, ridge-shaped maculas may be due to a folding of Bruch membrane at the posterior pole, potentially caused by an asymmetrical enlargement of Bruch membrane in the equatorial region.

18.
Nat Genet ; 52(2): 160-166, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31959993

RESUMO

Glaucoma, a disease characterized by progressive optic nerve degeneration, can be prevented through timely diagnosis and treatment. We characterize optic nerve photographs of 67,040 UK Biobank participants and use a multitrait genetic model to identify risk loci for glaucoma. A glaucoma polygenic risk score (PRS) enables effective risk stratification in unselected glaucoma cases and modifies penetrance of the MYOC variant encoding p.Gln368Ter, the most common glaucoma-associated myocilin variant. In the unselected glaucoma population, individuals in the top PRS decile reach an absolute risk for glaucoma 10 years earlier than the bottom decile and are at 15-fold increased risk of developing advanced glaucoma (top 10% versus remaining 90%, odds ratio = 4.20). The PRS predicts glaucoma progression in prospectively monitored, early manifest glaucoma cases (P = 0.004) and surgical intervention in advanced disease (P = 3.6 × 10-6). This glaucoma PRS will facilitate the development of a personalized approach for earlier treatment of high-risk individuals, with less intensive monitoring and treatment being possible for lower-risk groups.


Assuntos
Glaucoma/genética , Polimorfismo de Nucleotídeo Único , Austrália , Estudos de Casos e Controles , Proteínas do Citoesqueleto/genética , Progressão da Doença , Proteínas do Olho/genética , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Glaucoma/etiologia , Glaucoma/cirurgia , Glicoproteínas/genética , Humanos , Pressão Intraocular/genética , Herança Multifatorial , Razão de Chances , Nervo Óptico/fisiologia , Penetrância , Trabeculectomia/efeitos adversos , Reino Unido , Estados Unidos
19.
Retina ; 40(3): 456-460, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30586350

RESUMO

PURPOSE: To report on a progressing ridge-shaped macula parallel to Bruch membrane defects and a macular suprachoroidal cavitation. METHOD: Single case report. RESULT: The right eye of a 54-year-old man with an axial length of 30.96 mm showed 2 extrafoveal Bruch membrane defects with a partial herniation of the retina into the choroidal space and an ophthalmoscopically yellowish area inferior to one of the Bruch membrane defects. Optical coherence tomography revealed a horizontal transfoveal ridge of the sclera, Bruch membrane, and macula and a deepening of the suprachoroidal space, corresponding to the ophthalmoscopically detectable yellowish area and fulfilling the criteria of a macular suprachoroidal cavitation. After a follow-up of 10 years, the height of the ridge increased parallel to a further deepening of the macular suprachoroidal cavitation and an increase in axial length by 0.67 mm. CONCLUSION: The findings support the notion of a progression of a ridge-shaped macula parallel to a further deepening of a macular suprachoroidal cavitation in an axially elongating eye.

20.
Retina ; 40(3): 399-411, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31259808

RESUMO

PURPOSE: To estimate prevalence, associated factors, and time trends of myopia in Chinese children and adolescents. METHODS: We searched PubMed, EMBASE, and Web of Science for studies examining the prevalence of myopia in children and adolescents aged 3 years to 19 years in China before October 2018. We pooled the prevalence and associated factors for myopia and estimated time trends. RESULTS: In 22 eligible studies including 192,569 individuals, the pooled prevalence (95% confidence interval [CI]) of myopia and high myopia in the study period from 1998 to 2016 was 37.7% (95% CI: 23.5-52.0%) and 3.1% (95% CI: 1.2-5.0%), respectively, with higher odds for girls than boys (myopia: odds ratio: 1.29; 95% CI: 1.14-1.46; P < 0.001; high myopia: odds ratio: 1.37; 95% CI: 1.05-1.78; P = 0.02) and with higher prevalences for urban areas than rural regions (myopia: 48.8% [95% CI: 32.3-65.3] vs. 31.9% [95% CI: 20.4-43.3; P < 0.001]). The pooled prevalence of myopia and high myopia increased from 4.7% (95% CI: 2.5-6.9) and 0.2% (95% CI: 0.0-0.5), respectively, in <7-years-olds to 56.2% (95% CI: 29.8-82.5) and 15.1% (95% CI: 6.4-23.8), respectively, in 16- to 18-year-olds. Myopic refractive error increased with older age (P < 0.001), female gender (P < 0.001), and study year (P = 0.003). Studies performed after 2013 showed a prevalence of myopia and high myopia in the 16- to 18-year-olds of 84.8% (95% CI: 84.4-85.2%) and 19.3% (95% CI: 18.6-20.2%), respectively. Assuming a further linear relationship with the study year, myopia prevalence in 2050 among children and adolescents aged 3 years to 19 years would be estimated to be about 84%. CONCLUSION: The marked rise in high myopia prevalence among adolescents in China may be of importance for high myopia as risk factor for irreversible vision loss in Chinese adults in the future.

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