Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 526
Filtrar
1.
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.

2.
J Hypertens ; 38(2): 266-273, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31584520

RESUMO

BACKGROUND: The retinal microvasculature provides a window to the cerebral vasculature and enables examination of changes in retinal caliber that may mimic those occurring in cerebrovascular disease. The association of central arterial stiffness and retinal vessel caliber in a population sample is not fully understood. METHODS: In 1706 older adults (mean age 76.3, 58.1% women) from the population-based Atherosclerosis Risk in Communities Study, we examined the cross-sectional association of central arterial stiffness [carotid-femoral pulse wave velocity (cfPWV)] with retinal vessel calibers [central retinal arteriolar equivalent (CRAE) and central retinal vein equivalent (CRVE)]. We estimated the association of cfPWV with CRAE narrowing (<25th percentile) and CRVE widening (>75th percentile) after adjustment for age, sex, race-field center, BMI, smoking, and type 2 diabetes. We tested for effect modification by sex, hypertension, and type 2 diabetes. RESULTS: Carotid-femoral PWV (m/s) was not associated with the odds of CRAE narrowing [odds ratio (OR): 0.99; 95% CI: 0.95-1.03]. The association of cfPWV with CRVE widening was stronger in those without hypertension (OR: 1.10; 95% CI: 1.01-1.20) versus those with hypertension (OR: 1.01 95% CI: 0.96-1.05) and slightly stronger in those with type 2 diabetes (OR: 1.07; 95% CI: 1.00-1.14) versus without type 2 diabetes (OR: 1.01; 95% CI: 0.96-1.06). CONCLUSIONS: In older adults, cfPWV was associated with wider retinal venular caliber, particularly in individuals without hypertension. Central arterial stiffening may be associated with cerebral microvascular changes, as exhibited in its retinal vasculature component.

3.
Asia Pac J Ophthalmol (Phila) ; 8(6): 448-456, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789647

RESUMO

Diabetic retinopathy (DR), a major cause of blindness in working-age adults, is emerging as a major public health issue worldwide, in particular in low- and middle-income countries (LMIC). Traditionally, the management of DR has been on tertiary-level treatment (eg, laser, anti-VEGF injections and surgery) in specialized settings by highly trained ophthalmologists on individual patients. To win the war on DR, a paradigm shift in strategic focus and resources must be made from such tertiary treatment toward primary and secondary prevention, which are broader, more impactful, and cost-effective for the larger population. These include improving education and awareness of risk of DR among people initially diagnosed with diabetes, promoting behavioral modifications such as physical activity and medication adherence for improving glycemic and blood pressure control, setting up systematic screening programs for DR to detect the onset or progression of the disease, and implementing cost-effective, evidence-based policies and guidelines for managing DR. Additionally, there is a need to leverage on novel technology including the application of digital big data to predict people at risk of diabetes and DR, the use of wearable devices and smart phone apps, behavioral techniques including social media for self-management of diabetes, and telemedicine-based DR screening incorporating artificial intelligence (AI) to broaden access to screening in all settings. To turn the tide on the war on DR, we must reframe DR not only as a specific condition that can be managed by ophthalmologists, but fundamentally, as a preventable condition by shifting the weight of strategies from tertiary to secondary and primary battlegrounds.

5.
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.

6.
Am J Ophthalmol ; 206: 48-73, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31095951

RESUMO

PURPOSE: To describe the pattern and risk factor traits associated with visual loss (defined as either visual impairment [VI] or blindness) in a multiethnic Asian cohort of Malay, Indian, and Chinese individuals living in Singapore. METHODS: A total of 10 020 participants from the Singapore Epidemiology of Eye Diseases Study were examined between 2004 and 2011. All underwent standardized examinations. VI (visual acuity <20/40 to ≥20/200) and blindness (visual acuity <20/200) were defined based on the US definition, better-seeing eye. Singapore Population Census 2010 was used to calculate age-standardized prevalence. Multiple logistic regression analysis was performed to determine the independent and joint risk factors associated with visual loss. RESULTS: Malay individuals had higher age-standardized prevalence of best-corrected and presenting VI (5.4% and 19.9%, respectively) than Indian (3.6% and 18.0%) and Chinese individuals (3.3% and 17.2%). Cataract was the main cause for presenting and best-corrected blindness; cataract and diabetic retinopathy were the top causes for best-corrected VI, consistently observed across the 3 ethnic groups. Older age, female sex, lower socioeconomic status, diabetes, systemic comorbidities, and cognitive impairment were independently associated with increased risk of best-corrected visual loss (all P ≤ .027). Individuals aged ≥60 years with diabetes were 12.7 times (95% confidence interval, 8.39-19.23) likely to have best-corrected visual loss, compared with younger, nondiabetic individuals. Lower income and education explained 58.1% and 23.2% of best-corrected visual loss in this population, respectively. CONCLUSION: In this urban multiethnic Asian population, we identified common traits associated with visual loss across Malay, Indian, and Chinese individuals. These results will be useful for the planning and designing of eye health services and strategies for Asia's rapidly developing populations living in urban communities. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

7.
Prog Retin Eye Res ; 72: 100759, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31048019

RESUMO

The advent of computer graphic processing units, improvement in mathematical models and availability of big data has allowed artificial intelligence (AI) using machine learning (ML) and deep learning (DL) techniques to achieve robust performance for broad applications in social-media, the internet of things, the automotive industry and healthcare. DL systems in particular provide improved capability in image, speech and motion recognition as well as in natural language processing. In medicine, significant progress of AI and DL systems has been demonstrated in image-centric specialties such as radiology, dermatology, pathology and ophthalmology. New studies, including pre-registered prospective clinical trials, have shown DL systems are accurate and effective in detecting diabetic retinopathy (DR), glaucoma, age-related macular degeneration (AMD), retinopathy of prematurity, refractive error and in identifying cardiovascular risk factors and diseases, from digital fundus photographs. There is also increasing attention on the use of AI and DL systems in identifying disease features, progression and treatment response for retinal diseases such as neovascular AMD and diabetic macular edema using optical coherence tomography (OCT). Additionally, the application of ML to visual fields may be useful in detecting glaucoma progression. There are limited studies that incorporate clinical data including electronic health records, in AL and DL algorithms, and no prospective studies to demonstrate that AI and DL algorithms can predict the development of clinical eye disease. This article describes global eye disease burden, unmet needs and common conditions of public health importance for which AI and DL systems may be applicable. Technical and clinical aspects to build a DL system to address those needs, and the potential challenges for clinical adoption are discussed. AI, ML and DL will likely play a crucial role in clinical ophthalmology practice, with implications for screening, diagnosis and follow up of the major causes of vision impairment in the setting of ageing populations globally.

8.
Br J Ophthalmol ; 103(12): 1777-1783, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31000510

RESUMO

AIM: To determine the association between dementia and age-related macular degeneration (AMD) using meta-analysis. METHODS: We searched in the MEDLINE, EMBASE, Web of Knowledge, PsycInfo and Cochrane database of systematic reviews for studies published from March 1959 to March 2018. We included cross-sectional, case-control and cohort studies that evaluated the association of dementia/Alzheimer's disease (AD) with AMD (as outcome) and the association of AMD with dementia/AD (as outcome). Studies that compared cognitive functions between AMD and controls were also included. The summary outcomes, namely odds ratio (OR), relative risk, mean differences and corresponding 95% CIs, were estimated using random effects models. We performed sensitivity analysis based on study quality and individual study effect to control for potential biases. RESULTS: Among 2159 citation records, we identified 21 studies consisting of 7 876 499 study subjects for meta-analysis. Patients with dementia (padjusted≤0.017, OR≥1.24, I2≤9%) or AD (p=0.001, ORunadjusted=2.22, I2=50%) were at risk for AMD, particularly for late AMD (padjusted<0.001, OR=1.37, I2=0). AMD was also significantly associated with increased risk of AD/cognitive impairment (padjusted=0.037, OR=2.42, I2=38%). Moreover, patients with AMD had poorer cognitive functions when compared with controls, including Mini-Mental State Examination (p<0.001, I2≤79%) and Trail Making Test A (p<0.001, I2=0). Sensitivity analysis and Egger's test indicated our results were less likely biased. CONCLUSIONS: A significant association between dementia/AD and AMD calls for greater clinical awareness. The cost-effectiveness of routine screening for the other condition in patients with primary diagnosis of dementia/AD or AMD requires further study.

9.
PLoS One ; 14(3): e0210625, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30870422

RESUMO

INTRODUCTION: Half of all hypertensive individuals have inadequately-controlled BP because monitoring methods are ineffective. This single centre study examined consecutive subjects undergoing 24 hour BP measurements for clinic and ambulatory BP levels, and for end-organ damage (retinal microvascular abnormalities and left ventricular hypertrophy, LVH, > 1.1 cm). Retinal images were graded for microvascular retinopathy (Wong and Mitchell classification), and vessel calibre using a semiautomated method. Features were compared using chi-squared, Fisher's exact or the student's t test. METHODS: One hundred and thirty-one individuals (59 male, 45.0%, mean age 61.7 ± 14.5 years) were studied. Ninety-nine (76.2%) had a clinic BP ≥ 140/90 mm Hg, 84 (64.6%) had a mean awake systolic BP ≥ 135 mm Hg, 100 (76.9%) had a mean sleeping systolic BP ≥ 120 mm Hg, and 100 (76.2%) had abnormal nocturnal BP dipping patterns. Sixty-nine individuals had undergone echocardiography and 23 (33.3%) had LVH. RESULTS: All participants had a mild (88.5%) or moderate (11.5%) microvascular retinopathy. Moderate microvascular retinopathy was found in 86.7% of those with a mean awake systolic BP ≥135 mm Hg (p = 0.058) but was not associated with other abnormal BP measurements, abnormal dipping patterns or LVH. However retinal arteriole calibre was reduced in subjects with a mean 24 hour awake systolic BP ≥ 135 mm Hg (p = 0.05). Retinal arteriole calibre was smaller in subjects with LVH (128.1 ± 13.5 µm compared with 137.6 ± 14.1 µm in normals, p = 0.014). Venular calibre was also less in subjects with LVH (185.4 ± 24.6 µm compared with 203.0 ± 27.2 µm in normals, p = 0.016). Arteriole narrowing predicted an increased risk of LVH (AUC 0.69, 95%CI 0.55 to 0.83) that was comparable with 24 hour systolic BP ≥130 mm Hg (AUC 0.68, 95%CI 0.53 to 0.82) and mean awake systolic BP ≥135 mm Hg (AUC 0.68, 95%CI 0.54 to 0.83). CONCLUSIONS: This study suggests that retinal arteriole narrowing may be equally accurate in predicting LVH as any clinic or ambulatory BP measurement. The convenience and accuracy of microvascular calibre measurement mean that it should be investigated further for a role in routine hypertension assessment and monitoring.


Assuntos
Determinação da Pressão Arterial/métodos , Hipertensão/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Vasos Retinianos/anormalidades , Idoso , Assistência Ambulatorial , Monitorização Ambulatorial da Pressão Arterial , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/etiologia , Masculino , Pessoa de Meia-Idade , Vasos Retinianos/diagnóstico por imagem
10.
Schizophr Res ; 2019 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-30837202

RESUMO

Cannabis appears to have vascular effects that may have implications for cerebrovascular function, but no studies have directly visualized the microvasculature in living cannabis users. The current study used retinal imaging, a tool taken from ophthalmology, to visualize the small retinal microvessels in cannabis users. We compared retinal arteriolar (small arteries) and venular (small veins) diameters in 55 frequent cannabis users and 51 comparison individuals with a mean age of 19.25 years (SD = 2.43). Results indicated that mean arteriolar diameter was statistically significantly wider for cannabis users (M = 157.98, SE = 1.42) than for comparison individuals (M = 153.56, SE = 1.46; F(1,103) = 4.67, p = .033), even after controlling for a variety of covariates and after excluding from analyses cannabis users who had used cannabis in the past 24 h. There was no statistically significant difference in retinal venular diameter between cannabis users and comparison individuals. Findings suggest that frequent cannabis use is associated with wider retinal arterioles, which might represent a residual vasodilatory effect of recent cannabis use or impaired autoregulation resulting from chronic cannabis use. Retinal imaging is a non-invasive, cost-effective tool for visualizing the microvasculature in living individuals and can be combined, in future research, with neuroimaging and other measures of retinal vascular function to better understand the acute and longer-term effects of cannabis use on the microvasculature.

12.
JAMA Netw Open ; 2(3): e191540, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30924904

RESUMO

Importance: The association of diabetic microvascular complications such as diabetic retinopathy (DR) and diabetic kidney disease (DKD) with mortality in populations is not clear. Objective: To examine the association of DR and DKD separately and jointly with all-cause and cardiovascular disease (CVD) mortality in a multiethnic Asian population. Design, Setting, and Participants: A population-based cohort study was conducted including 2964 adults between the ages of 40 and 80 years with diabetes who participated in the Singapore Epidemiology of Eye Diseases study (baseline, 2004-2011). Data analysis was performed from January to May 2018. Exposures: Diabetic retinopathy ascertained from retinal photographs and DKD from estimated glomerular filtration rate. Main Outcomes and Measures: All-cause and CVD mortality obtained by linkage with the National Registry of Births and Deaths until May 2017. Results: Of the 2964 adults (mean [SD] age, 61.8 [10.0] years; 1464 [49.4%] female; 592 Chinese, 1052 Malay, and 1320 Indian), 29.9% of the participants had DR, while 20.7% had DKD. Over a median (interquartile range) follow-up of 8.8 (7.2-11.0) years, 610 deaths occurred (20.6%), of which 267 (9.0%) were due to CVD. In separate models, the multivariable hazard ratios for all-cause and CVD mortality were 1.54 (95% CI, 1.24-1.91) and 1.74 (95% CI, 1.27-2.40), respectively, for DR and 2.04 (95% CI, 1.64-2.56) and 2.29 (95% CI, 1.64-3.19), respectively, for DKD. In models including both DR and DKD, the subgroup with DKD alone (27.1% and 12.6%) followed by DR alone (6.5% and 5.2%) contributed substantially to the excess risk of all-cause and CVD mortality. Compared with those with no DR and DKD, the hazard ratios of all-cause and CVD mortality were 1.89 (95% CI, 1.40-2.57) and 2.26 (95% CI, 1.42-3.61), respectively, for DKD alone and 1.38 (95% CI, 1.03-1.86) and 1.64 (95% CI, 1.06-2.56), respectively, for DR alone. Hazard ratios for all-cause and CVD mortality were 2.76 (95% CI, 2.05-3.72) and 3.41 (95% CI, 2.19-5.32), respectively, for those with both DKD and DR. The relative excess risk associated with the interaction was 0.49 (95% CI, -0.29 to 1.27; P = .20) for all-cause mortality and 0.51 (95% CI, -0.83 to 1.85; P = .50) for CVD mortality. Conclusions and Relevance: These results suggest that risks of all-cause and CVD mortality were significantly higher in those with DKD and DR, but DKD was more strongly associated with excess risk. The findings underscore the importance of early identification and close monitoring and management of patients with DR and DKD to reduce the risk of death.


Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Nefropatias Diabéticas/complicações , Retinopatia Diabética/complicações , Idoso , Ásia/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Neurology ; 2019 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-30651383

RESUMO

OBJECTIVE: To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. METHODS: We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n = 20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. RESULTS: The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 × 10-8; and LINC00539/ZDHHC20, p = 5.82 × 10-9. Both have been associated with blood pressure (BP)-related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p [BI] = 9.38 × 10-25; p [SSBI] = 5.23 × 10-14 for hypertension), smoking (p [BI] = 4.4 × 10-10; p [SSBI] = 1.2 × 10-4), diabetes (p [BI] = 1.7 × 10-8; p [SSBI] = 2.8 × 10-3), previous cardiovascular disease (p [BI] = 1.0 × 10-18; p [SSBI] = 2.3 × 10-7), stroke (p [BI] = 3.9 × 10-69; p [SSBI] = 3.2 × 10-24), and MRI-defined white matter hyperintensity burden (p [BI] = 1.43 × 10-157; p [SSBI] = 3.16 × 10-106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p ≤ 0.0022), without indication of directional pleiotropy. CONCLUSION: In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significant modifiable, causal risk factor for BI.

14.
Pulm Circ ; 9(1): 2045894018819781, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30622700

RESUMO

Retinal vessel diameters have been associated with left ventricular morphology and function but their relationship with the right ventricle (RV) has not been studied. We hypothesized that wider retinal venules and narrower retinal arterioles are associated with RV morphology and function. RV end-diastolic mass (RVEDM), end-diastolic volume (RVEDV), end-systolic volume (RVESV), stroke volume (RVSV), and ejection fraction (RVEF) were assessed using cardiac magnetic resonance imaging (MRI) scans of 4204 participants without clinical cardiovascular disease at the baseline examination; retinal photography was obtained at the second examination. Mean diameters of retinal arterioles and venules were measured and summarized as central retinal vein and artery equivalents ("veins" and "arteries," respectively). After adjusting for covariates, wider veins were associated with greater RVEDM and RVEDV in women (P = 0.04 and P = 0.02, respectively), whereas there was an inverse association with RVEDV in men (P = 0.02). In both sexes, narrower arteries were associated with lower RVEDM (P < 0.001 in women and P = 0.002 in men) and smaller RVEDV (P < 0.001 in women and P = 0.04 in men) in adjusted models. Narrower arteries were also associated with lower RVEF in men but this was of borderline significance after adjusting for the LVEF (P = 0.08). Wider retinal venular diameter was associated with sex-specific changes in RVEDM and RVEDV in adults without clinical cardiovascular disease. Narrower retinal arteriolar diameter was associated with significantly lower RVEDM and smaller RVEDV in both sexes.

15.
Retina ; 39(9): 1655-1663, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29927796

RESUMO

PURPOSE: To assess the ability of optical coherence tomography (OCT) alone and in combination with OCT angiography (OCTA) to differentiate polypoidal choroidal vasculopathy (PCV) from neovascular age-related macular degeneration, as compared to fluorescein angiography and indocyanine green angiography. METHODS: This is a cross-sectional study. All participants had a standardized history, clinical examination including measurement of best-corrected visual acuity, slit-lamp biomicroscopy, and indirect fundus examination, and underwent standardized imaging (color photography, fluorescein and indocyanine green angiography, OCT, and OCTA) after predefined protocols. We used a 2-step approach (Step 1: spectral domain OCT; Step 2: addition of OCTA) combining structural OCT and OCTA to differentiate 50 treatment-naive eyes with PCV, choroidal neovascularization, and retinal angiomatous proliferation and compared with the diagnosis based on fluorescein angiography and indocyanine green angiography. Spectral domain OCT signs used to diagnose PCV included presence of two out of three of any retinal pigment epithelium detachment (pigment epithelial detachment/double-layer sign), notched or narrow-peaked pigment epithelial detachment, or round subretinal pigment epithelium structure. Optical coherence tomography angiography signs used to diagnose PCV included presence of a localized subretinal pigment epithelium hyperflow signal in the cross-sectional OCTA and/or presence of a focal hyperflow sign in en face OCTA based on outer retina slab. RESULTS: Based on fluorescein angiography and indocyanine green angiography, the diagnosis was choroidal neovascularization in 24 eyes, PCV in 23 eyes, and retinal angiomatous proliferation in 3 eyes. Based on spectral domain OCT signs, PCV was diagnosed in 19/23 (82.6%) eyes; however, specificity of OCT was only 51.9%. Cross-sectional OCTA showed a diffuse hyperflow signal in all 24 (100.0%) eyes with choroidal neovascularization, whereas a localized subretinal pigment epithelium hyperflow signal was detected in 19/23 (82.6%) eyes with PCV. En face OCTA only detected a nodular hyperflow signal in 10/23 eyes (43.5%) with PCV. Combination of OCT and OCTA achieved 82.6% sensitivity and 100.0% specificity for differentiating PCV from choroidal neovascularization/retinal angiomatous proliferation. CONCLUSION: Cross-sectional OCTA is more sensitive than en face OCTA in detecting flow signal in polyps. Combination of structural OCT and OCTA can be used to screen for PCV with a high level of sensitivity and specificity.

16.
Lancet Diabetes Endocrinol ; 7(2): 140-149, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30005958

RESUMO

Diabetic retinopathy is a leading cause of vision impairment and blindness. We systematically reviewed studies published from Jan 1, 1980, to Jan 7, 2018, assessed the methodological quality, and described variations in incidence of diabetic retinopathy by region with a focus on population-based studies that were conducted after 2000 (n=8, including two unpublished studies). Of these eight studies, five were from Asia, and one each from the North America, Caribbean, and sub-Saharan Africa. The annual incidence of diabetic retinopathy ranged from 2·2% to 12·7% and progression from 3·4% to 12·3%. Progression to proliferative diabetic retinopathy was higher in individuals with mild disease compared with those with no disease at baseline. Our Review suggests that more high-quality population-based studies capturing data on the incidence and progression of diabetic retinopathy with stratification by age and sex are needed to consolidate the evidence base. Our data is useful for conceptualisation and development of major public health strategies such as screening programmes for diabetic retinopathy.

17.
Ophthalmology ; 126(4): 497-510, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30114417

RESUMO

TOPIC: OCT is a noninvasive tool to measure specific retinal layers in the eye. The relationship of retinal spectral-domain (SD) OCT measurements with Alzheimer's disease (AD) and mild cognitive impairment (MCI) remains unclear. Hence, we conducted a systematic review and meta-analysis to examine the SD OCT measurements in AD and MCI. CLINICAL RELEVANCE: Current methods of diagnosing early AD are expensive and invasive. Retinal measurements of SD OCT, which are noninvasive, technically simple, and inexpensive, are potential biomarkers of AD. METHODS: We conducted a literature search in PubMed and Excerpta Medica Database to identify studies published before December 31, 2017, that assessed the associations between AD, MCI, and measurements of SD OCT: ganglion cell-inner plexiform layer (GC-IPL), ganglion cell complex (GCC), macular volume, and choroidal thickness, in addition to retinal nerve fiber layer (RNFL) and macular thickness. We used a random-effects model to examine these relationships. We also conducted meta-regression and assessed heterogeneity, publication bias, and study quality. RESULTS: We identified 30 eligible studies, involving 1257 AD patients, 305 MCI patients, and 1460 controls, all of which were cross-sectional studies. In terms of the macular structure, AD patients showed significant differences in GC-IPL thickness (standardized mean difference [SMD], -0.46; 95% confidence interval [CI], -0.80 to -0.11; I2 = 71%), GCC thickness (SMD, -0.84; 95% CI, -1.10 to -0.57; I2 = 0%), macular volume (SMD, -0.58; 95% CI, -1.03 to -0.14; I2 = 80%), and macular thickness of all inner and outer sectors (SMD range, -0.52 to -0.74; all P < 0.001) when compared with controls. Peripapillary RNFL thickness (SMD, -0.67; 95% CI, -0.95 to -0.38; I2 = 89%) and choroidal thickness (SMD range, -0.88 to -1.03; all P < 0.001) also were thinner in AD patients. CONCLUSIONS: Our results confirmed the associations between retinal measurements of SD OCT and AD, highlighting the potential usefulness of SD OCT measurements as biomarkers of AD.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Doenças Retinianas/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Biomarcadores , Estudos Transversais , Humanos , Fibras Nervosas/patologia , Tamanho do Órgão , Retina/diagnóstico por imagem , Células Ganglionares da Retina/patologia
19.
Curr Opin Neurol ; 32(1): 82-91, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30566412

RESUMO

PURPOSE OF REVIEW: To summarize the current findings on clinical retinal diseases and retinal imaging changes with dementia, focusing on Alzheimer's disease. RECENT FINDINGS: Studies observed that clinical retinal diseases such as age-related macular degeneration, open-angle glaucoma and diabetic retinopathy are related to dementia, but the associations are not entirely consistent. In terms of the retinal neuronal structure, multiple retinal neuronal layers are significantly thinner in Alzheimer's disease dementia, such as the parapapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL). Recent studies further demonstrated that macular GC-IPL and macular RNFL are also significantly thinner in the preclinical stage of Alzheimer's disease. A thinner RNFL is also associated with a significantly increased risk of developing both cognitive decline and Alzheimer's disease dementia. In addition, studies consistently showed that retinal vascular changes are associated with poorer cognitive performance, as well as prevalent and incident Alzheimer's disease dementia. SUMMARY: The current findings support the concept that changes in the retina, particular in retinal neuronal structure and vasculature, can reflect the status of cerebral neuronal structure and vasculature, highlighting the potential role of retinal changes as biomarkers of dementia.


Assuntos
Demência/diagnóstico , Retina/diagnóstico por imagem , Neurônios Retinianos/patologia , Biomarcadores , Demência/diagnóstico por imagem , Demência/patologia , Humanos , Retina/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica
20.
Br J Ophthalmol ; 103(7): 871-877, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30409914

RESUMO

BACKGROUND: To assess prevalence and causes of vision loss in Central and South Asia. METHODS: A systematic review of medical literature assessed the prevalence of blindness (presenting visual acuity<3/60 in the better eye), moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60) and mild vision impairment (MVI; presenting visual acuity <6/12 and ≥6/18) in Central and South Asia for 1990, 2010, 2015 and 2020. RESULTS: In Central and South Asia combined, age-standardised prevalences of blindness, MSVI and MVI in 2015 were for men and women aged 50+years, 3.72% (80% uncertainty interval (UI): 1.39-6.75) and 4.00% (80% UI: 1.41-7.39), 16.33% (80% UI: 8.55-25.47) and 17.65% (80% UI: 9.00-27.62), 11.70% (80% UI: 4.70-20.32) and 12.25% (80% UI:4.86-21.30), respectively, with a significant decrease in the study period for both gender. In South Asia in 2015, 11.76 million individuals (32.65% of the global blindness figure) were blind and 61.19 million individuals (28.3% of the global total) had MSVI. From 1990 to 2015, cataract (accounting for 36.58% of all cases with blindness in 2015) was the most common cause of blindness, followed by undercorrected refractive error (36.43%), glaucoma (5.81%), age-related macular degeneration (2.44%), corneal diseases (2.43%), diabetic retinopathy (0.16%) and trachoma (0.04%). For MSVI in South Asia 2015, most common causes were undercorrected refractive error (accounting for 66.39% of all cases with MSVI), followed by cataract (23.62%), age-related macular degeneration (1.31%) and glaucoma (1.09%). CONCLUSIONS: One-third of the global blind resided in South Asia in 2015, although the age-standardised prevalence of blindness and MSVI decreased significantly between 1990 and 2015.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA