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2.
Exp Eye Res ; 189: 107835, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31634478

RESUMO

Glaucoma, the leading cause of irreversible blindness worldwide, can be divided into two major types: primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG). PACG could lead to severe vision loss and has a high prevalence among Asian populations. The worldwide population affected by PACG is estimated to exceed 20 million by 2020. Recent studies have shown that there are at least eight genetic loci significantly associated with risk of PACG, possibly contributing to the phenotype by interacting with environmental factors. This review presents the progress that has been achieved in the genetics of PACG and its future perspectives. This article should be considered as a memorial article to honor Dr. R. Rand Allingham's remarkable contribution to genetic association studies in glaucoma. We are deeply saddened by the loss of Dr. Allingham, not only a huge loss for ophthalmology, but also loss of a dear friend. Looking back to his extraordinary career, Dr. Allingham devoted his whole life and passion into establishing the genetic basis of different forms of glaucoma such as open angle, angle closure, and exfoliation glaucoma. He had a special interest in analyses of populations from African ancestry, which greatly boosted the understanding of glaucoma genetics.

3.
J Glaucoma ; 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31567910

RESUMO

PRECIS: Chinese Glaucoma Study Consortium (CGSC) as the first nationwide glaucoma registry in China, we describe its design, rationale, the geographic distribution of the hospitals, and baseline patient characteristics. AIM: As a leading cause of blindness in China, glaucoma affects 2% to 4% of adults over the age of 40 and will become increasingly prevalent as the population ages. At the national level, there are few reports on the current medical practice for glaucoma patients. CGSC will be considered as the first nationwide glaucoma registry in China. Here we describe its design, rationale, the geographic distribution of the hospitals, and baseline patient characteristics. METHODS: From December 21, 2015 to September 9, 2018, CGSC recruited patients with the diagnoses of primary angle-closure suspect, primary angle-closure, primary angle-closure glaucoma, acute primary angle closure, primary open-angle glaucoma (POAG), pigmentary glaucoma (PG), and pseudoexfoliative glaucoma (PXG) from 111 hospitals covering 67 cities from 22 provinces, 4 municipalities, and 5 autonomous regions in mainland China. Clinical data were collected using an Electronic Data Capture System designed by Tongren hospital and Gauss informed Ltd. Blood samples were collected from every patient for further genetic analysis. RESULTS: Medical records of 10,892 patients were collected, of which 5762 patients have complete information. The average age of those with complete information (n=5762) was 62.05±11.26 years old, and 35.25% were males. Primary angle-closure disease, including primary angle-closure suspect/primary angle-closure/primary angle-closure glaucoma/acute primary angle closure, was predominant (4588, 79.63%), and the distribution for others is as follows: POAG (1116, 19.37%), PXG (41, 0.71%) and PG (17, 0.30%). A total of 16,684 blood samples were collected, of which 9917 (82.68%) were primary angle-closure disease, 1987 (16.57%) were POAG, 69 (0.58%) were PXG, 22 (0.18%) were PG, and 4689 were normal controls. CONCLUSIONS: The CGSC is the first national-level glaucoma registry study in China. Clinical data and blood samples will provide the opportunity to study the epidemiology of glaucoma in Chinese hospitals, to evaluate the level of medical diagnosis and treatment of glaucoma in China, and to identify the susceptibility loci for glaucoma.

4.
Chin Med J (Engl) ; 132(18): 2157-2167, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31490265

RESUMO

BACKGROUND: Handan Eye Study (HES), a large population-based cohort study in rural area of northern China, was one of the few studies focusing on the major eye diseases of rural Chinese population. The aim of this study was to introduce the design, methodology and to assess the data quality of the follow-up phase of HES. METHODS: All participants were recruited in Yongnian county of Handan city between 2012 and 2013. Main outcomes were measured by visual quality scales and ocular examinations. We performed the Chi-square test to make comparison of categorical data among groups, One-way analysis of variance and Kruskal-Wallis test was applied to make comparison of continuous data among groups, a post-hoc test was done to make further pairwise comparison. Inter-class correlation coefficients (ICCs) and Kappa coefficients were used to evaluate the consistency between different operators. Logistic regression was used to explore the influence factors of death, odds ratio (OR) and 95% confidence interval (CI) were used to estimate the effect size of each influence factor. RESULTS: The follow-up rate was 85.3%. Subjects were classified into three groups: the follow-up group (n = 5394), the loss to follow-up group (n = 929), and the dead group (n = 507), comparison of their baseline information was done. Compared with the other two groups, age of the dead group (66.52 ±â€Š10.31 years) was the oldest (Z = 651.293, P < 0.001), male proportion was the highest (59.0%) (χ = 42.351, P < 0.001), only 65.9% of the dead finished middle school education (Z = 205.354, P < 0.001). The marriage percentage, body mass index (BMI), best-corrected visual acuity (BCVA), and intra-ocular pressure of the dead group was the lowest either. Spherical equivalent error (SER) of the dead group was the highest. Besides, history of smoking, hypertension, diabetes, and heart disease were more common in the dead group. Multivariate analysis showed that age (OR = 1.901, 95% CI: 1.074-1.108), gender (OR = 0.317, 95% CI: 0.224-0.448), and BCVA (OR = 0.282, 95% CI: 0.158-0.503) were associated with death. While between the follow-up group and the loss to follow-up group, there was only difference on age, gender, BMI, systolic blood pressure and SER. The Cronbach coefficients of all scales used in the follow-up were ≥0.63 and the cumulative variances were ≥0.61, indicating good reliability and validity. The ICCs and Kappa coefficients between different operators were ≥0.69. CONCLUSIONS: HES has a high follow-up rate and a low risk of loss to follow-up bias. Age, gender, and BCVA are influence factors of death. Specifically, male subjects are at a higher risk of death than female, age is a risk factor of death while BCVA is a protective factor for death.

5.
Diabetes Res Clin Pract ; 156: 107834, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31550487

RESUMO

This meta-analysis of randomized controlled trials (RCTs) aims to investigate how to perform better interventions targeting modifiable risk factors of diabetic retinopathy (DR) to prevent and control DR in patients with type 2 diabetes by comparing different intervention types and follow-up intervals. Literature published before June 1st, 2019 were searched on Pubmed, Embase and ScienceDirect. RCTs targeting modifiable risk factors of DR (including blood glucose, blood pressure, lipid, dietary, physical activity and smoking) were selected by two reviewers and double checked for accuracy. Random effects models were estimated to calculate pooled Odds Ratios (OR). Twenty-two RCTs (n = 22,511) were included. In general, interventions targeting modifiable risk factor of DR reduced the risk of developing DR (I2 = 26.7%; OR = 0.60; 95% CI 0.45 to 0.79) and DR worsening (I2 = 0.0%; OR = 0.62; 95% CI 0.47 to 0.80; P < 0.001). Multifactorial interventions had better effect on reducing the risk of development and progression of DR in comparison with other interventions, while only blood-pressure-control interventions showed significant effect on slowing down DR worsening. Additionally, interventions with follow-up >5 years had better effect on reduction of DR development, and interventions with follow-up >2 years had better effect on reducing the risk of DR worsening.

6.
Eye (Lond) ; 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31562382

RESUMO

BACKGROUND/OBJECTIVES: To study the associations of intraocular pressure (IOP) and retinal vessel diameters: central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) with the maximum cup depth (MCD) in subjects with and without POAG. SUBJECTS/METHODS: Eligible subjects from the Handan Eye Study. All participants underwent physical and comprehensive eye examinations. Univariable and multivariable linear regression models assessed the association between MCD and other parameters. RESULTS: Four thousand one hundred and ninety-four eligible nonglaucoma and 40 POAG subjects were analyzed. On univariable analysis, deeper MCD was significantly associated with younger age, male gender, lower systolic blood pressure (BP), higher IOP, higher estimated cerebro-spinal fluid pressure (ECSFP), lower estimated trans-laminal cribrosa pressure difference (ETLCPD), longer axial length, narrower CRAE, narrower CRVE, larger disc area (DA) and a lower prevalence of hypertension and diabetes. On multivariable analysis, significant independent determinants of MCD were larger DA (P < 0.001; beta: 0.042; B: 0.20; 95% CI: 0.19, 0.22), younger age (P < 0.001; beta: -0.09; B: -0.002; 95% CI: -0.003, -0.001), higher IOP (P < 0.01; beta: 0.040; B: 0.003; 95% CI: 0.001, 0.005), and narrower CRAE (P < 0.001; beta: -0.06; B: -0.001; 95% CI: -0.001, -0.0003). On adding ECSFP and ETLCPD to the model, MCD was associated with IOP but not with estimated CSFP and TLCPD. A 1 µm decrease in CRAE or 1 mmHg increase of IOP was associated with a 1 µm increase of MCD (P < 0.001) and 3 µm increase of MCD respectively (P = 0.009). CONCLUSIONS: Narrow CRVE and higher IOP are associated with an increase in MCD.

7.
JAMA Ophthalmol ; 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31513266

RESUMO

Importance: A deep learning system (DLS) that could automatically detect glaucomatous optic neuropathy (GON) with high sensitivity and specificity could expedite screening for GON. Objective: To establish a DLS for detection of GON using retinal fundus images and glaucoma diagnosis with convoluted neural networks (GD-CNN) that has the ability to be generalized across populations. Design, Setting, and Participants: In this cross-sectional study, a DLS for the classification of GON was developed for automated classification of GON using retinal fundus images obtained from the Chinese Glaucoma Study Alliance, the Handan Eye Study, and online databases. The researchers selected 241 032 images were selected as the training dataset. The images were entered into the databases on June 9, 2009, obtained on July 11, 2018, and analyses were performed on December 15, 2018. The generalization of the DLS was tested in several validation datasets, which allowed assessment of the DLS in a clinical setting without exclusions, testing against variable image quality based on fundus photographs obtained from websites, evaluation in a population-based study that reflects a natural distribution of patients with glaucoma within the cohort and an additive dataset that has a diverse ethnic distribution. An online learning system was established to transfer the trained and validated DLS to generalize the results with fundus images from new sources. To better understand the DLS decision-making process, a prediction visualization test was performed that identified regions of the fundus images utilized by the DLS for diagnosis. Exposures: Use of a deep learning system. Main Outcomes and Measures: Area under the receiver operating characteristics curve (AUC), sensitivity and specificity for DLS with reference to professional graders. Results: From a total of 274 413 fundus images initially obtained from CGSA, 269 601 images passed initial image quality review and were graded for GON. A total of 241 032 images (definite GON 29 865 [12.4%], probable GON 11 046 [4.6%], unlikely GON 200 121 [83%]) from 68 013 patients were selected using random sampling to train the GD-CNN model. Validation and evaluation of the GD-CNN model was assessed using the remaining 28 569 images from CGSA. The AUC of the GD-CNN model in primary local validation datasets was 0.996 (95% CI, 0.995-0.998), with sensitivity of 96.2% and specificity of 97.7%. The most common reason for both false-negative and false-positive grading by GD-CNN (51 of 119 [46.3%] and 191 of 588 [32.3%]) and manual grading (50 of 113 [44.2%] and 183 of 538 [34.0%]) was pathologic or high myopia. Conclusions and Relevance: Application of GD-CNN to fundus images from different settings and varying image quality demonstrated a high sensitivity, specificity, and generalizability for detecting GON. These findings suggest that automated DLS could enhance current screening programs in a cost-effective and time-efficient manner.

8.
Br J Ophthalmol ; 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488430

RESUMO

PURPOSE: To assess changes in the position of lamina cribrosa pores (LCPs) induced by acute intraocular pressure (IOP) elevation. METHODS: A prospective observational study. Acute angle-closure suspects who underwent the 2-hour dark room prone provocative test (DRPPT) were included. At baseline and within 5 min after the DRPPT end, tonometry, fundus photography and optical coherence tomography were performed. Optic disc photos taken before and after the DRPPT were aligned and moving distance of each visible LCP was measured (LCPMD). RESULTS: 38 eyes from 27 participants (age: 52.5±10.8 years) were included. The IOP rose from 16.7±3.2 mm Hg at baseline to 23.9±4.3 mm Hg at the DRPPT end. The mean lateral LCPMD was 28.1±14.6 µm (range: 5.0-77.2 µm), which increased with higher IOP rise (p=0.01) and deeper optic cup (p=0.02) in multivariate analysis. The intralamina range and SD of the LCPMD increased with younger age (p=0.01 and p=0.02, respectively) and with wider optic cup (p=0.01 and p=0.02, respectively). The LCP movements were headed to the superior direction in 12 (33%) eyes, inferior direction in 10 (28%) eyes, temporal direction in 9 (25%) eyes, and nasal direction in 5 (14%) eyes. CONCLUSIONS: IOP rise is associated with LCP movements in the frontal plane, which are more pronounced with higher IOP rise and deeper optic cup. The intralamina variability in the IOP rise-associated LCPMD increased with younger age and wider optic cup. IOP variation-associated lateral LCP movements may be of interest to elucidate glaucomatous optic nerve damage.

9.
Ophthalmic Res ; : 1-9, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31430758

RESUMO

BACKGROUND: Myopia, especially high myopia, would cause damage in the choroid, retina and sclera, thereby leading to vision loss. Although refractive error correction can help improve visual acuity, the pathology of myopia, a global issue, remains unclear and myopia progression, as well as concomitant fundus progression, remains uncontrolled. Under such circumstances, prevention of myopia is of great significance and thus should be prioritized. OBJECTIVE: To explore whether outdoor time has positive significance for myopia prevention. SEARCH METHODS: Databases of Pubmed, Science Direct, the Cochrane Library, the Chinese National Knowledge Infrastructure and the Wanfang Database were searched. The following terms or their combinations were used: myopia, prevention, control, random, randomized, randomization, intervention, outdoor. The full search strategy was shown in the Appendix below. The databases were last searched on -October 24, 2018. SELECTION CRITERIA: Randomized controlled trials (RCTs) that participants accepted outdoor activity as an intervention measure for myopia prevention were included. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias for included studies. A fixed-effects model was applied, given that the heterogeneity among included studies was small. MAIN RESULTS: Five RCTs with 3,014 subjects were included. Subjects' age ranged from 6 to 12 years, and the follow-up duration ranged from 9 to 36 months. Spherical equivalent error (SER) of the outdoor group was larger than that of the control group, and the pooled mean difference (MD) was 0.15 (95% CI 0.06-0.23) diopter (D). The change in SER of the outdoor group was smaller than that of the control group, with a pooled MD of 0.17 (95% CI 0.16-0.18) D. New myopia cases in the outdoor group were fewer than that of the control group, and the pooled risk ratio was 0.76 (95% CI 0.67-0.87). The change in axial length of the outdoor group was smaller than that of the control group, and the pooled MD was -0.03 (95% CI -0.03 to -0.03) mm. For all analyzed outcomes, there was no heterogeneity across included studies (I2 = 0%) and there was no publication bias either. CONCLUSION: Outdoor time helps slow down the change of axial length and reduce the risk of myopia.

10.
Br J Ophthalmol ; 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462416

RESUMO

BACKGROUND: To determine the prevalence and causes of blindness and vision impairment (VI) in East Asia in 2015 and to forecast the trend to 2020. METHODS: Through a systematic literature review and meta-analysis, we estimated prevalence of blindness (presenting visual acuity <3/60 in the better eye), moderate-to-severe vision impairment (MSVI; 3/60≤presenting visual acuity <6/18), mild vision impairment (mild VI: 6/18≤presenting visual acuity <6/12) and uncorrected presbyopia for 1990, 2010, 2015 and 2020. A total of 44 population-based studies were included. RESULTS: In 2015, age-standardised prevalence of blindness, MSVI, mild VI and uncorrected presbyopia was 0.37% (80% uncertainty interval (UI) 0.12%-0.68%), 3.06% (80% UI 1.35%-5.16%) and 2.65% (80% UI 0.92%-4.91%), 32.91% (80% UI 18.72%-48.47%), respectively, in East Asia. Cataract was the leading cause of blindness (43.6%), followed by uncorrected refractive error (12.9%), glaucoma, age-related macular degeneration, corneal diseases, trachoma and diabetic retinopathy (DR). The leading cause for MSVI was uncorrected refractive error, followed by cataract, age-related macular degeneration, glaucoma, corneal disease, trachoma and DR. The burden of VI due to uncorrected refractive error, cataracts, glaucoma and DR has continued to rise over the decades reported. CONCLUSIONS: Addressing the public healthcare barriers for cataract and uncorrected refractive error can help eliminate almost 57% of all blindness cases in this region. Therefore, public healthcare efforts should be focused on effective screening and effective patient education, with access to high-quality healthcare.

11.
Artigo em Inglês | MEDLINE | ID: mdl-31283476

RESUMO

Glaucoma is one of the leading causes of irreversible vision loss. Many approaches have recently been proposed for automatic glaucoma detection based on fundus images. However, none of the existing approaches can efficiently remove high redundancy in fundus images for glaucoma detection, which may reduce the reliability and accuracy of glaucoma detection. To avoid this disadvantage, this paper proposes an attention-based convolutional neural network (CNN) for glaucoma detection, called AG-CNN. Specifically, we first establish a large-scale attention-based glaucoma (LAG) database, which includes 11,760 fundus images labeled as either positive glaucoma (4,878) or negative glaucoma (6,882). Among the 11,760 fundus images, the attention maps of 5,824 images are further obtained from ophthalmologists through a simulated eye-tracking experiment. Then, a new structure of AG-CNN is designed, including an attention prediction subnet, a pathological area localization subnet and a glaucoma classification subnet. The attention maps are predicted in the attention prediction subnet to highlight the salient regions for glaucoma detection, under a weakly supervised training manner. In contrast to other attention-based CNN methods, the features are also visualized as the localized pathological area, which are further added in our AG-CNN structure to enhance the glaucoma detection performance. Finally, the experiment results from testing over our LAG database and another public glaucoma database show that the proposed AG-CNN approach significantly advances the state-of-the-art in glaucoma detection.

13.
Graefes Arch Clin Exp Ophthalmol ; 257(7): 1435-1442, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31065848

RESUMO

PURPOSE: To investigate the safety of blue light scleral cross-linking (SXL) by evaluating changes in biological parameters in the retina and choroid in the eyes of rhesus macaques (Macaca mulatta). METHODS: Fifteen 3-year-old macaques (30 eyes) were randomly divided into three groups (n = 5). SXL was performed via riboflavin (0.5%) and blue light (460 nm) at the location of the equatorial sclera. Right eyes served as experimental eyes, and left eyes as control eyes. One quadrant of each right eye was irradiated in group A, two quadrants of each right eye and one quadrant of each left eye were irradiated in group B, and two quadrants of each right eye were irradiated in group C. Optical coherence tomography, optical coherence tomography angiography, and flash electroretinography (f-ERG) examinations were performed at baseline and 1 week, 1 month, 3 months, and 6 months after SXL. Additionally, retinal tissue alterations were detected via transmission electron microscopy at 1 week postoperatively. RESULTS: There were no significant differences between experimental eyes and control eyes in retinal thickness, vessel density of retinal superficial capillary plexus, and choroid thickness in any of the groups at any of the time points investigated (p > 0.05). Significant reductions in f-ERG parameters were detected 1 week postoperatively in the experimental eyes of groups A and C (p < 0.05), but they gradually recovered, and there was no significant difference 1 month postoperatively (p > 0.05). Ultrastructural changes were evident in the retinal layers of SXL eyes. In group B, there were no significant differences between the right and left eyes at any of the follow-up time points investigated. CONCLUSIONS: Blue light SXL can cause transient retina damage. The f-ERG parameters reductions and retinal ultrastructural changes were found at early stage, even though there were not significant changes in retinal thickness, vessel density of retinal superficial capillary plexus, and choroid thickness after blue light SXL. The long-term intraocular safety of the blue light SXL technique should be investigated further.


Assuntos
Corioide/patologia , Colágeno/farmacologia , Reagentes para Ligações Cruzadas/farmacologia , Miopia/tratamento farmacológico , Fotoquimioterapia/métodos , Retina/patologia , Riboflavina/farmacologia , Animais , Modelos Animais de Doenças , Eletrorretinografia , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Luz , Macaca mulatta , Miopia/diagnóstico , Miopia/fisiopatologia , Fármacos Fotossensibilizantes/farmacologia , Esclera , Tomografia de Coerência Óptica , Resultado do Tratamento
14.
Mol Ther ; 27(7): 1327-1338, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31129118

RESUMO

Primary open-angle glaucoma (POAG) is considered a lifelong disease characterized by optic nerve deterioration and visual field damage. Although the disease progression can usually be controlled by lowering the intraocular pressure (IOP), therapeutic effects of current approaches do not last long. Gene therapy could be a promising method for persistent treatment of the disease. Our previous study demonstrated that gene transfer of exoenzyme C3 transferase (C3) to the trabecular meshwork (TM) to inhibit Rho GTPase (Rho), the upstream signal molecule of Rho-associated kinase (ROCK), resulted in lowered IOP in normal rodent eyes. In the present study, we show that the lentiviral vector (LV)-mediated C3 expression inactivates RhoA in human TM cells by ADP ribosylation, resulting in disruption of the actin cytoskeleton and altered cell morphology. In addition, intracameral delivery of the C3 vector to monkey eyes leads to persistently lowered IOP without obvious signs of inflammation. This is the first report of using a vector to transduce the TM of an alive non-human primate with a gene that alters cellular machinery and physiology. Our results in non-human primates support that LV-mediated C3 expression in the TM may have therapeutic potential for glaucoma, the leading cause of irreversible blindness in humans.

15.
Am J Ophthalmol ; 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31078530

RESUMO

PURPOSE: To investigate the prevalence and associations of visual impairment and the spectacle use in university students in central China. DESIGN: Cross-sectional study METHODS: This study included students aged 16-26 years in China. Subjects from two universities underwent distance visual acuity (VA) assessment in both eyes using a logarithm of the minimum angle of resolution chart and refraction measurement by cycloplegic autorefraction. Blindness was defined as presenting VA <3/60 in the better eye (World Health Organization definition) and visual impairment was defined as presenting VA <6/12. RESULTS: Overall, 9710 undergraduates were enumerated, 7704 (79.3%) subjects were included in this study. The prevalence of uncorrected visual acuity <6/12 and <3/60 in the better eye were 69.9% and 0.9%, respectively. Only 77.0% (4148/5388) of subjects with uncorrected VA in the better eye of <6/12 wore glasses. When presenting VA, the prevalence of mild (VA <6/12 to 6/18), moderate (VA <6/18 to 6/60), and severe (VA <6/60 to 3/60) visual impairment was 6.3%, 12.2%, and 0.7%, respectively. Overall, 71.7% (4300/6001) of students with myopia (spherical equivalent ≤-0.5 diopters) wore spectacles. In the multiple logistic regression analysis, visual impairment was associated with female gender (p < 0.001) and lower year level of education (P = 0.006) when presenting with VA. CONCLUSIONS: This study has documented a relatively high prevalence of visual impairment and relatively low spectacle coverage existed in Chinese university students. Given the potential impact of visual impairment, target education and accessible refraction services are highly important to solve the problem.

16.
Brain Res ; 1718: 83-90, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31071304

RESUMO

Parameters derived from diffusion tensor imaging (DTI) have been found to be significantly altered in the optic tracts, optic nerves, and optic radiations in patients with primary open-angle glaucoma (POAG). In this study, DTI-derived parameters were further constructed into fiber connectivity, and we investigated anatomical fiber connectivity changes within and beyond the visual pathway in POAG patients. DTI and T1-weighted magnetic resonance images were acquired in 18 POAG patients and 26 healthy controls (HC). White matter tracts based on the Brodmann atlases (BA) were constructed using the deterministic fiber tracking method. The mean fractional anisotropy (FA), fiber number (FN), and mean fiber length (FL) were measured and then evaluated using two-sample t-tests between POAG and HC. The fiber connectivity between regions was taken as the features for classifying HC and POAG using a machine learning method known as naïve Bayesian classification. The mean FA decreased in connections between visual cortex BA17/BA18 and cortex BA23/BA25/BA35/BA36, while it increased in the connections between cortex BA3/BA7/BA9 and BA5/BA6/BA45/BA25 in POAG. Classification using fibers where a significant difference in FN had been identified produced better accuracy (ACC = 0.89) than using FA or FL (ACC = 0.77 and 0.75, respectively). The FN of individual fiber connections with higher accuracy and significant changes in POAG involved brain regions associated with vision (BA19), depression (BA10/BA46/BA25), and memory (BA29). These findings strengthen the hypothesis that POAG involves changes in anatomical connectivity within and beyond the visual pathway. Classification using the machine learning method reveals that mean FN has the potential to be used as a biomarker for detecting white matter microstructure changes in POAG.

17.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(2): 315-319, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31016950

RESUMO

There are so many biomechanical risk factors related with glaucoma and their relationship is much complex. This paper reviewed the state-of-the-art research works on glaucoma related mechanical effects. With regards to the development perspectives of studies on glaucoma biomechanics, a completely novel biomechanical evaluation factor -- Fractional Flow Reserve (FPR) for glaucoma was proposed, and developing clinical application oriented glaucoma risk assessment algorithm and application system by using the new techniques such as artificial intelligence and machine learning were suggested.


Assuntos
Glaucoma/diagnóstico , Algoritmos , Inteligência Artificial , Fenômenos Biomecânicos , Humanos , Pressão Intraocular , Aprendizado de Máquina , Medição de Risco , Fatores de Risco
18.
PLoS Negl Trop Dis ; 13(1): e0007130, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30689647

RESUMO

BACKGROUND: China used to be among the countries with a high prevalence of trachoma. At the launch of The Global Elimination of Trachoma (GET) 2020 campaign by the World Health Organization (WHO) in 1996, China was placed on the list of countries endemic for trachoma based on historical data. However, empirical observation and routinely collected eye care data were suggesting that trachoma was no longer a public health problem. To determine whether the GET 2020 goals had been met in P. R. China, we conducted a targeted assessment with national scope. METHODOLOGY/PRINCIPAL FINDING: Province assessment teams, trained in WHO Trachoma Rapid Assessment (TRA) methodology and in WHO simplified trachoma grading system, carried out assessments in 16 provinces (among them, 2 provinces conducted pilot assessment). Based on the published literature, including national and international reports, suspected trachoma-endemic areas within each province were identified. Within these areas, trachomatous inflammation- follicular (TF) assessments were carried out in at least 50 grade-one children in primary schools serving villages with the lowest socio-economic development. Trachomatous trichiasis (TT) and corneal opacity (CO) assessments were conducted among persons aged 15 and over in villages within the catchment area of the selected schools. Of 8,259 children examined in 128 primary schools in 97 suspected trachoma endemic areas, only 16 cases of conjunctivitis were graded as TF. 38 cases with TT were found among the 339,013 examined residents in villages surrounding the schools. Among these 97 suspected trachoma endemic areas in only three was the prevalence of TT more than 0.2%. CONCLUSIONS/SIGNIFICANCE: This large study suggested that trachoma was not a public health problem in 16 provinces that had been previously suspected to be endemic. These findings will facilitate planning for elimination of trachoma from PR China.


Assuntos
Doenças Endêmicas , Tracoma/diagnóstico , Tracoma/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , China/epidemiologia , Conjuntivite/diagnóstico , Conjuntivite/epidemiologia , Opacidade da Córnea/diagnóstico , Opacidade da Córnea/epidemiologia , Humanos , Lactente , Prevalência , Avaliação de Sintomas , Triquíase/diagnóstico , Triquíase/epidemiologia , Organização Mundial da Saúde
19.
Br J Ophthalmol ; 103(11): 1666-1671, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30658989

RESUMO

BACKGROUND/AIM: To quantify the impact of baseline presenting visual acuity (VA), refractive error and spectacles wear on subsequent academic performance among Chinese middle school children. METHODS: A prospective, longitudinal, school-based study on grade 7 Chinese children (age, mean±SD, 12.7±0.5 years, range=11.1-15.9) at four randomly selected middle schools in Anyang, China. Comprehensive eye examinations including cycloplegic autorefraction were performed at baseline, and information on demographic characteristics, known risk factors for myopia and spectacle wear was collected. Academic test scores for all subjects in the curriculum were obtained from the local Bureau of Education. Main outcome measure was total test scores for five subjects at the end of grade 9, adjusted for total scored at the beginning of grade 7. RESULTS: Among 2363 eligible children, 73.1% (1728/2363) had seventh grade test scores available. 93.9% (1623/1728) completed eye examinations, and 98.5% (1599/1623) of these had ninth grade test scores. Adjusting only for baseline test score, the following were significantly associated with higher ninth grade scores: younger age, male sex, less time outdoors, better baseline presenting VA, higher parental education and income and parental myopia, but refractive error and spectacle wear were not. In the full multivariate model, baseline test score (p<0.001), presenting VA (p<0.01), age (p<0.001), quality of life (p<0.05) and parental education (p<0.001) and myopia (either: p<0.05; both: p<0.05) remained significantly associated with better ninth grade scores. CONCLUSIONS: In this longitudinal study, better presenting VA, but not cycloplegic refractive error or spectacle wear, was significantly associated with subsequent academic performance.

20.
Invest Ophthalmol Vis Sci ; 59(12): 5149-5156, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30372746

RESUMO

Purpose: To evaluate spontaneous eye blink patterns and their correlations with clinical tests in dry eye disease (DED). Methods: Twenty-five DED patients and 25 healthy subjects were included in this prospective case-controlled study. Clinical evaluations included the Ocular Surface Disease Index (OSDI), lipid layer thickness (LLT), spontaneous eye blink pattern analysis, fluorescein tear film break-up time (FBUT), and so on. Eye blinks were recorded for 20 seconds with a high-speed camera. Eye blink patterns were divided into the following five phases: the eyelid closing phase (ECP), eyelid closed phase (CDP), early opening phase (EOP), late opening phase (LOP), and interblink intervals (IBI). The correlations between blink parameters and clinical tests were analyzed. Results: Compared with the control group, mean ECP, CDP, and EOP were significantly longer in DED patients (P < 0.001, P = 0.029, and P < 0.001, respectively). DED patients also had significantly shorter LOP and blink intervals (both P < 0.001) and more partial blinks as compared with control subjects (P = 0.001). FBUT was negatively correlated with ECP (r = -0.618, P=0.001) and the number of partial blinks (r = -0.413, P = 0.040). There was a positive correlation between OSDI and the number of partial blinks (r = 0.446, P = 0.026). The LLT coefficient of variation (LLT-CV) also showed a positive correlation with ECP, CDP, and LOP (P = 0.001, P = 0.050, P = 0.049, respectively). Corneal and conjunctival staining was positively correlated with ECP, CDP, and the number of blinks (r = 0.449, P = 0.024; r = 0.526, P = 0.007; r = 0.456, P = 0.022, respectively) and negatively correlated with IBI (r = -0.420, P = 0.037). Conclusions: Partial blinks, prolonged eyelid closed time and short blink intervals were the three main characteristics of DED patients' spontaneous blink patterns.

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