Comparison of visual outcomes in adult patients with different types of developmental cataracts after toric multifocal intraocular lenses implantation.

PURPOSE:  To analyze and compare the visual performance and patient satisfaction following the implantation of toric multifocal intraocular lenses (TMIOLs) in adult patients with different types of developmental cataracts (DC) accompanied by corneal astigmatism (CA). METHODS:  This is a prospective observational cohort study. Patients diagnosed with DC aged 18-30 years were divided into three groups according to the anatomic location of the lens opacity: cortical, nuclear, and posterior subcapsular (PSC) groups, and implanted with TMIOLs. Visual acuity (VA), postoperative refractive astigmatism (RA), intraocular lens (IOL) rotation, high-order aberrations (HOAs), modulation transfer function (MTF) curve, and Strehl ratio were compared. The functional vision and incidence of photic phenomena were surveyed using questionnaires. RESULTS:  Fifty-five eyes of 37 patients were enrolled and completed a 1-year follow-up. The mean CA was 2.06 ± 0.79 D preoperatively, and the mean RA was 0.29 ± 0.30 D 3-month postoperatively. The IOL rotation was 2.48° ± 1.89°, with no deviation > 10°. At 12 months, mean uncorrected distance VA improved from 0.93 ± 0.41 preoperatively to 0.08 ± 0.08 logarithm of the minimum angle of resolution (logMAR), mean uncorrected near VA increased from 0.45 ± 0.30 preoperatively to 0.12 ± 0.11 logMAR, and mean uncorrected intermediate VA was 0.14 ± 0.08 logMAR. The cortical and nuclear groups displayed better improvements in uncorrected near and intermediate VA than that in the PSC group. Similar results were observed in the 3-month defocus curves, HOAs, MTF curve, halo incidence, and near vision satisfaction. CONCLUSION: In adult patients with DC accompanied by CA, TMIOLs implantation achieved good postoperative visual outcomes and significantly reduced glasses dependency. Patients with cortical or nuclear lens opacity showed better whole-course VA and quality of vision, while patients with PSC opacity showed unsatisfactory near vision and suffered more photic phenomena.

Optical Quality and Intraocular Scattering in the Diabetic Eye without Diabetic Retinopathy.

SIGNIFICANCE: This study suggests that despite having comparable best-corrected visual acuity and normal fundus appearance, objective measurements of optical quality showed that patients with diabetes but without overt retinopathy may have impaired visual function. Screening using the Optical Quality Analysis System might help identify those patients. PURPOSE: Visual impairments are common in diabetes, but the status of the problem is unclear before the development of diabetic retinopathy. The aim of this pilot study was to investigate the optical quality and intraocular scattering in the diabetic eye without diabetic retinopathy. METHODS: Twenty-seven patients with diabetes without diabetic retinopathy were enrolled. Twenty-seven age- and sex-matched healthy volunteers served as a control group. Optical quality parameters included modulation transfer function cutoff frequency, Strehl (two-dimensional) ratio, and Optical Quality Analysis System values at 100, 20, and 9 contrast levels. The objective scatter index was assessed using the Optical Quality Analysis System. Correlations were analyzed between the modulation transfer function cutoff, Strehl ratio, objective scatter index, and Optical Quality Analysis System value, and the age of the patient and the duration of diabetes mellitus. RESULTS: The diabetic group exhibited lower modulation transfer function cutoff, Strehl ratio, and Optical Quality Analysis System values at 100, 20, and 9% contrast levels and higher objective scatter index than did the controls (all, P < .01). There were no associations between the optical quality parameters and age or the duration of diabetes mellitus in the diabetic participants (all, P > .05). Moderate associations were found between all parameters obtained from the Optical Quality Analysis System and age in the control group (all, P < .01). CONCLUSIONS: This pilot study suggests that optical quality was reduced, and intraocular scattering increased in the diabetic eye without diabetic retinopathy compared with controls.

Myopic Laser Corneal Refractive Surgery Reduces Interdevice Agreement in the Measurement of Anterior Corneal Curvature.

OBJECTIVES: To investigate interdevice differences and agreement in the measurement of anterior corneal curvature obtained by different technologies after laser corneal refractive surgery. METHODS: The prospective study comprised 109 eyes of 109 consecutive patients who had undergone laser-assisted in situ keratomileusis (LASIK). Preoperative and postoperative corneal parameters were measured by Scheimpflug imaging (Pentacam), Placido-slit-scanning (Orbscan) and auto-keratometry (IOLMaster). Preoperative and postoperative anterior corneal curvatures (K readings) were compared between devices. Interdevice agreement was evaluated by Bland-Altman analysis. RESULTS: Preoperatively, the difference of K reading for Pentacam-IOLMaster (0.04±0.20 D) was not statistically significant (P=0.059). The differences between Pentacam-Orbscan and Orbscan-IOLMaster were 0.20±0.34 D (P<0.001) and -0.17±0.29 D (P<0.001), respectively. After surgery, no difference was found for Pentacam-Orbscan (-0.05±0.38, P=0.136). The differences between Pentacam-IOLMaster and Orbscan-IOLMaster were 0.13±0.29 D (P<0.001) and 0.19±0.34 D (P<0.001). Preoperative interdevice agreement (95% limit of agreement [LOA]) between Pentacam and Orbscan, Pentacam and IOLMaster, and Orbscan and IOLMaster were 1.31 D, 0.79 D and 1.14 D, respectively. The 95% LOAs decreased to 1.47 D, 1.14 D, and 1.34 D after refractive surgery. CONCLUSION: Corneal refractive surgery changed the preoperative and postoperative interdevice differences in corneal curvature measurements and reduced interdevice agreement, indicating that the devices are not interchangeable.

Mathematical Method for Analysis of the Refractive Outcome after Toric Intraocular Lens Implantation.

PURPOSE: We aimed to develop a self-designed software programmed with a mathematical method that analyzes the refractive outcome after toric intraocular lens (IOL) implantation, taking the axis misalignment of the toric IOL into consideration. METHODS: A mathematical method that can analyze the refractive outcome after toric IOL implantation was devised. Compared with the conventional method, which performs the analysis based on precise alignment of the IOL, optional meridian orientations of the toric IOL were taken into account in this method. Self-designed computer software was developed using the mathematical method. RESULTS: Relatively high accordance was achieved between the mathematical analysis and the actual postoperative outcome. The mean predicted spherical power was 0.37 ± 0.74 dpt, and the mean measured spherical power was 0.37 ± 0.71 dpt (paired t test, p = 0.98). The mean predicted cylindrical power was -1.35 ± 0.86 dpt, and the mean measured cylindrical power was -1.42 ± 0.85 dpt (p = 0.27). The mean predicted change in the astigmatic axis was 33.7 ± 11.8°, and the mean measured parameter was 32.5 ± 15.4° (p = 0.49). CONCLUSIONS: The advantage of the present mathematical method is that the postoperative refractive outcome can be analyzed under IOL misalignment.

Design and baseline characteristics of a population-based study of eye disease in southern Chinese people: the Dongguan Eye Study.

BACKGROUND: To describe the study design, methodology and baseline characteristics of the Dongguan Eye Study. DESIGN: Population-based, cross-sectional study PARTICIPANTS: A total of 8952 rural-dwelling residents aged 40 years or older in Hengli, Dongguan. METHODS: The Dongguan Eye Study was conducted from September 2011 to February 2012. The interview covered demographic data, socio-economic status and health- and vision-related quality of life. Physical measurements included height, weight, waist and hip circumference, heart rate and blood pressure. Laboratory tests included fasting blood glucose, haemoglobin A1c, oral glucose tolerance, serum total cholesterol, triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, serum creatinine, blood urea nitrogen and uric acid. Ophthalmic examinations included visual acuity and autorefraction testing, intraocular pressure measurement, slit-lamp examination, ocular biometry, gonioscopy, fundus photography, retinal nerve fibre layer imaging and visual field testing. MAIN OUTCOME MEASURES: Prevalence and risk factors for visual impairment, blindness, eye diseases and their associations with systemic medical indicators or health-related lifestyles, as well as epidemiological data on diabetic subjects. Methodology, response rates and baseline characteristics are presented. RESULTS: Of the 11 357 individuals eligible for the Dongguan Eye Study, 8952 (78.82%) subjects participated. All participants were self-identified Han Chinese. The average age was 54.0 years, 59.9% were female, 48.4% were farmers and 77.2% had elementary or junior middle school educational levels. The average body mass index and waist-hip ratio were 24.6 ± 3.9 kg/m(2) and 0.9 ± 0.2. CONCLUSIONS: Data from the Dongguan Eye Study provide information concerning the prevalence, risk factors and impacts of eye diseases in rural residents undergoing urbanization in southern China.

Programmed Death 1 (PD-1) is involved in the development of proliferative diabetic retinopathy by mediating activation-induced apoptosis.

PURPOSE: Recent studies revealed that immunological mechanisms play a prominent role in the pathogenesis of proliferative diabetic retinopathy (PDR). Given the importance of the immune response in PDR and the significance of the programmed death 1 (PD-1) pathway as an immune regulatory pathway, the aim of this study is to determine the expression and functional characteristics of the PD-1 pathway in peripheral blood lymphocytes from patients with PDR. METHODS: Peripheral blood lymphocytes were obtained from patients with PDR, age-matched patients with diabetes mellitus and no diabetic retinopathy (DM-NDR), and controls. The mRNA expression of PD-1 and its ligands were determined using real-time PCR. The frequencies of PD-1 and its ligands, activation-induced apoptosis, IFN-γ, and IL-4 were determined by flow cytometry. RESULTS: The PD-1 mRNA expression markedly decreased, while the frequency of PD-1(+) cells increased in the PDR group compared with the DM-NDR and control groups. The expression of PD-ligand 1 (PD-L1) mRNA and PD-L1(+) cells in the PDR group was lower than that in the other two groups. In the PDR group, the frequency of Annexin V(+)PI(-) and Annexin V(+)PI(-)PD-1(+) cells increased, while the frequency of Annexin V(+)PI(-)PD-L1(+) cells decreased. Although their expression was upregulated, the ratio of PD-1(+) IFN-γ(+) to PD-1(+)IL-4(+) cells in the PDR group was not significantly different to that in the DM-NDR and control groups. CONCLUSIONS: These results suggest that PD-1 is involved in the development of PDR by mediating activation-induced apoptosis.

Visual outcomes and patient satisfaction after implantations of three types of presbyopia-correcting intraocular lenses that have undergone corneal refractive surgery.

This prospective, non-randomized, comparative study aimed to compare the visual outcomes and patient satisfaction after implantations of three presbyopia-correcting intraocular lenses (IOLs) after myopic refractive surgery. It was conducted from January 2020 to December 2021 in Shanghai Heping Eye Hospital. Patients were divided into three groups based on the type of IOL implanted. The visual acuity, refractive stability, high-order aberrations, objective visual quality, spectacle independence, and visual function index 14 questionnaire scores of the three groups were compared. This study included 78 eyes of 39 patients: 26 eyes with 839MP, 26 eyes with MF30, and 26 eyes with ZXR00. Uncorrected distance visual acuity improved significantly for all three groups. For a pupil diameter of 4.0 mm, the spherical aberrations of the three groups were 0.33 ± 0.16 µ, 0.50 ± 0.08 µ, and 0.39 ± 0.10 µ, respectively. The spectacle independence for distance vision was over 90% in each group; for near vision, it was only 25% for the ZXR00 group. All three types of presbyopia-correcting IOLs improved visual quality in post-LASIK or PRK patients. However, the high incidence of photic phenomena after presbyopia-correcting IOL implantation in patients who have undergone myopic LASIK should not be neglected.

mTOR regulates TGF-ß2-induced epithelial-mesenchymal transition in cultured human lens epithelial cells.

BACKGROUND: Post-cataract surgery fibrosis in the lens capsule is caused by epithelial to mesenchymal transition (EMT) of the lens epithelium. Mammalian target of rapamycin (mTOR) has been demonstrated to be a key regulator of EMT. The aim of this study was to investigate the role of mTOR in transforming growth factor ß2 (TGF-ß2)-induced EMT in human lens epithelial cells (HLECs). METHODS: Human lens epithelial B-3 (HLEB-3) cells were cultured with 10 ng/ml TGF-ß2 for different periods of time. The expression of E-cadherin, connexin 43, fibronectin and α-smooth muscle actin (α-SMA), and activation of mTOR were determined by Western blots. Cell migration was assessed by wound healing assay. An inhibition test was performed using two kinds of mTOR inhibitors. RESULTS: E-cadherin and connexin 43 expressions were suppressed, whereas fibronectin and α-SMA expressions were increased in HLEB-3 cells after treatment with TGF-ß2. mTOR was activated during the TGF-ß2-induced EMT in a time-dependent manner. Rapamycin or Ku-0063794 with 100 nM was able to inhibit the phosphorylation of mTOR and impaired EMT induced by TGF-ß2. Cell motility enhanced by TGF-ß2 for 24 h was attenuated by both rapamycin and Ku-0063794. CONCLUSIONS: mTOR is activated during TGF-ß2-induced EMT in HLECs, suggesting that it is involved in the regulation of TGF-ß2-induced EMT and may contribute to the development of posterior capsule opacification.

Comparison of astigmatism correction and visual outcomes in mix-and-match implantations of trifocal intraocular lenses with femtosecond laser-assisted arcuate keratotomy and contralateral bifocal Toric intraocular lenses.

Introduction: Astigmatism reduces the postoperative visual performance after non-toric intraocular lenses (IOLs) implantation, and limits the use of refractive IOLs in cataract surgery. The purpose of this study was to compare the efficacy in astigmatism correction and the postoperative visual outcomes between the implantation of a trifocal IOL with femtosecond laser-assisted arcuate keratotomy (FSAK) in one eye and a bifocal toric IOL (TIOL) in the other, in patients with cataract and moderate astigmatism. Methods: This prospective observational paired-eye study enrolled patients with cataract and corneal astigmatism (CA) between 0.75 and 2.25 D in both eyes. The patients underwent a mix-and-match treatment comprising trifocal IOL implantation with FSAK and bifocal TIOL implantation. We compared the visual acuity (VA) at all distances, defocus curve, postoperative refractive astigmatism (RfA), CA, high-order aberrations, modulation transfer function (MTF) curve, and Strehl ratio between the two eye groups. Results: In total, 41 patients (82 eyes) were enrolled and completed a 6-month follow-up. The 1- and 3-month uncorrected distance VA and 3-month uncorrected near VA were greater in eyes with bifocal TIOLs than with trifocal IOLs and FSAK (p = 0.036, 0.010, and 0.030, respectively), whereas the latter had greater uncorrected intermediate VA at every visit and greater VA in the intermediate range of defocus curve (at -1.50 and - 2.00 D) than the eyes with bifocal TIOLs. The postoperative RA of the eyes with trifocal IOL and FSAK was significantly higher than that of the bifocal TIOL-implanted eyes at the 3- and 6-month follow-ups. Discussion: Both FSAK and TIOL implantation effectively reduce pre-existing moderate astigmatism in patients with cataract. The eyes with bifocal TIOLs had more stable long-term astigmatism correction, whereas those with trifocal IOLs and FSAK had better intermediate VA. Therefore, a mix-and-match implantation of trifocal IOL with FSAK and contralateral bifocal TIOL could achieve effective astigmatism correction and provide an overall optimal VA.

Effect of postoperative residual astigmatism on visual outcomes after trifocal intraocular lens implantation.

Purpose: The aim of this study was to evaluate the effect of residual astigmatism on postoperative visual outcomes after trifocal intraocular lens implantation. Methods: In this prospective observational study, we divided 156 eyes into two groups according to postoperative astigmatism measured by subjective optometry and followed them up for 3 months. Visual acuity, modulation transfer function (MTF) curves, Strehl ratio (SR), Visual Function Index-14 scores, and photic phenomena were compared. Results: Linear regression analysis revealed a weak correlation between residual astigmatism and uncorrected distance visual acuity (UDVA) (r = 0.190, P = 0.016) at 3 months and a significant between-group difference at 1- and 3-month postoperative UDVA (P = 0.038, P = 0.018, respectively). MTF curve values and SR (MTF-10 total, MTF-10 cornea, MTF-30 total, MTF-30 cornea, SR Total, and SR cornea) were significantly worse (P < 0.001), and the Visual Function Index-14 scores were lower in the 0.5 < astigmatism ≤ 1.25 D group (P < 0.05) than in the astigmatism ≤ 0.5 D group. No significant differences were found in the frequency, severity, and bothersomeness of photic phenomena (P > 0.05). Conclusion: Postoperative residual astigmatism affects the UDVA of the trifocal intraocular lens-implanted eyes. Although we found no significant differences in uncorrected intermediate and near visual acuity, both objective and subjective visual quality were affected, suggesting the need for surgical planning when the anticipated postoperative astigmatism is >0.5 D.

Binocular Visual Outcomes Comparison of Two Trifocal Intraocular Lenses in High-Myopic Cataract Patients: A 1-Year Multicenter Study.

PURPOSE: To compare the postoperative visual outcomes and quality of vision obtained with 2 types of diffractive trifocal intraocular lenses (IOLs) in patients with highly myopic cataracts. DESIGN: Prospective, multicenter, randomized controlled trial. METHODS: Patients with high-myopic cataracts were randomized to binocular implantation of either the TFNT00 (n = 27) or the 839 MP (n = 28) trifocal IOLs at 3 surgery centers in China and were followed up for 1 year. Postoperative uncorrected distance, uncorrected intermediate, and uncorrected near visual acuity, and best-corrected distance visual acuity were measured. The defocus curve, high-order aberrations, modulation transfer function curve, Strehl ratio, and reading ability were compared between both groups. The functional vision and incidence of photic phenomena were surveyed using questionnaires. RESULTS: Visual acuity at all ranges of vision was significantly improved in both groups. The TFNT00 group showed superior uncorrected intermediate visual acuity to that in the 839 MP group (P = .013). Reading ability at 40 and 60 cm was similar in both groups (P ≥ .05), whereas the preferred reading distances for near and intermediate were significantly different. The TFNT00 group had a significantly higher mean Visual Function Index 14 score, lower incidence of photic phenomena, and less posterior capsular opacity than the 839 MP group. CONCLUSION: Bilateral implantation of both types of trifocal IOLs in patients with high-myopic cataracts provided good whole-course visual restoration, although recognition of fine Chinese characters remained impeded. As compared with 839 MP IOL, TFNT00 IOL resulted in greater patient satisfaction in intermediate activities, with a lower photic phenomena incidence.

Comparison of Visual Outcomes and Quality of Life in Patients with High Myopic Cataract after Implantation of AT LISA Tri 839MP and LS-313 MF30 Intraocular Lenses.

Purpose: To investigate the benefits of multifocal lens in patients with high myopic cataract and compare the clinical effects between AT LISA tri 839MP and MPlus LS-313 MF30 intraocular lenses (IOLs) in high myopic eyes. Methods: This retrospective cohort study analyzed 60 eyes with axial length >26 mm in 40 patients. Thirty eyes were implanted with MF30, and the remaining 30 eyes were implanted with 839MP. Postoperative uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCDVA), uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA), defocus curve, modulation transfer function (MTF) curve, Strehl ratio (SR), and complications were compared between the two groups. Results: All vision outcomes were significantly improved in both groups (p < 0.05). There was no significant between-group difference in UDVA at 1 and 3 months postoperatively (p > 0.05). However, UIVA and UNVA were significantly better in the 839MP group (p < 0.05). The VF-14 score, especially for near vision quality, was significantly higher in the MF30 group (2.2 ± 0.9 vs. 0.8 ± 0.7; p ≤ 0.001). The SR of both groups significantly increased postoperatively (p < 0.05). All the 3-month MTF curve values (MTF 10 total, MTF 10 internal, MTF 30 total, and MTF 30 internal) were significantly better in the 839MP group (p < 0.05). Meanwhile, all the high-order aberration values (coma, spherical aberration, and trefoil) were significantly greater in the MF30 group (p < 0.05). Conclusion: Multifocal IOL implantation achieves good quality of distance, intermediate, and near vision in patients with high myopia, improving their quality of life. Both 839MP and MF30 IOLs can provide good distance vision, but 839MP performs better in near and intermediate vision. However, for some patients with an extra-long optic axis, MF30 may be a good choice because of its wider range of degrees.

High HDL-C and high LDL-C are risk factors of pterygium in a population-based cross-sectional study in Southern China: the Dongguan Eye Study.

OBJECTIVES: To investigate the relationship between serum lipids and pterygium in a large-scale rural population aged 40 years or older from Southern China. STUDY DESIGN: The Dongguan Eye Study was a cross-sectional population-based study from September 2011 to February 2012. SETTING: The area was set in the rural area of Dongguan, Southern China. PARTICIPANTS: Adult rural population aged 40 or older. METHODS: Participants underwent physical, haematological and ophthalmic examinations. PRIMARY AND SECONDARY OUTCOME MEASURES: The frequency and risk factors of pterygium. RESULTS: A total of 11 357 participants were eligible for inclusion and 8952 (78.8%) participants were enrolled for the systemic and ophthalmic examinations. The prevalence of pterygium was 17.3% after adjusting the sex and age distribution, 22.0% in participants with hypercholesterolaemia (total cholesterol ≥6.22 mmol/L (240 mg/dL)) and 21.8% in those with low-density lipoprotein-cholesterol (LDL-C) ≥4.14 mmol/L (160 mg/dL), respectively. After adjusting for multiple confounding factors, higher level of high-density lipoprotein-cholesterol (HDL-C) (OR: 1.23, 95% CI: 1.06 to 1.41) and LDL-C (OR: 1.13, 95% CI: 1.06 to 1.20) were positively associated with the risk of pterygium. The ORs for HDL-C or LDL-C with pterygium were significantly greater in participants aged 40-49 years than those aged 50 years or above (P for interaction <0.001). Furthermore, increased HDL-C showed greater association with pterygium in normal body mass index (BMI) group compared with overweight group (P for interaction=0.002). CONCLUSION: Increased HDL-C and LDL-C are risk factors of pterygium, especially in people <50 years or those with normal BMI level. Strict control of HDL-C and LDL-C may be a new prevention method in reducing the risk of pterygium.

Extracellular vesicles secreted from mesenchymal stem cells exert anti-apoptotic and anti-inflammatory effects via transmitting microRNA-18b in rats with diabetic retinopathy.

Diabetic retinopathy (DR) is a major cause of visual deficits and blindness in the working-age population and inflammatory response is a key event during DR. In this study, we investigated the anti-inflammatory properties of small extracellular vesicles (sEVs) derived from human umbilical cord mesenchymal stem cells (hUCMSCs) in a diabetic rat model and human retinal microvascular endothelial cells. After development of DR in rats subjected to diabetes induction with streptozotocin (STZ), the DR rats were treated with different concentrations of hUCMSC-sEVs. Our results showed that the treatment of the retinas of DR rats with hUCMSC-sEVs not only reduced the level of vascular leakage in the retinas of rats but also decreased the retinal thickness as well as the associated inflammation. Further, our in vitro evidences suggest that hUCMSC-sEVs repress high glucose (HG)-induced cell inflammation and apoptosis. Subsequently, we analyzed the differentially expressed microRNAs (miRNAs) in the hUCMSC-sEVs by microarray and performed in silico studies to predict the target mRNA of miR-18b. Our findings also revealed that the expression of miR-18b was significantly elevated in the retina of diabetic rats after sEV treatment. In addition, miR-18b was found to target mitogen-activated protein kinase kinase kinase 1 (MAP3K1), thereby inhibiting NF-κB p65 phosphorylation to alleviate DR. Overall, this study highlights the potential of hUCMSCs-sEVs as biomaterials for anti-inflammatory and anti-apoptotic effects in DR by transferring miR-18b.

Usefulness of Machine Learning for Identification of Referable Diabetic Retinopathy in a Large-Scale Population-Based Study.

Purpose: To development and validation of machine learning-based classifiers based on simple non-ocular metrics for detecting referable diabetic retinopathy (RDR) in a large-scale Chinese population-based survey. Methods: The 1,418 patients with diabetes mellitus from 8,952 rural residents screened in the population-based Dongguan Eye Study were used for model development and validation. Eight algorithms [extreme gradient boosting (XGBoost), random forest, naïve Bayes, k-nearest neighbor (KNN), AdaBoost, Light GBM, artificial neural network (ANN), and logistic regression] were used for modeling to detect RDR in individuals with diabetes. The area under the receiver operating characteristic curve (AUC) and their 95% confidential interval (95% CI) were estimated using five-fold cross-validation as well as an 80:20 ratio of training and validation. Results: The 10 most important features in machine learning models were duration of diabetes, HbA1c, systolic blood pressure, triglyceride, body mass index, serum creatine, age, educational level, duration of hypertension, and income level. Based on these top 10 variables, the XGBoost model achieved the best discriminative performance, with an AUC of 0.816 (95%CI: 0.812, 0.820). The AUCs for logistic regression, AdaBoost, naïve Bayes, and Random forest were 0.766 (95%CI: 0.756, 0.776), 0.754 (95%CI: 0.744, 0.764), 0.753 (95%CI: 0.743, 0.763), and 0.705 (95%CI: 0.697, 0.713), respectively. Conclusions: A machine learning-based classifier that used 10 easily obtained non-ocular variables was able to effectively detect RDR patients. The importance scores of the variables provide insight to prevent the occurrence of RDR. Screening RDR with machine learning provides a useful complementary tool for clinical practice in resource-poor areas with limited ophthalmic infrastructure.

An Optical Coherence Tomography-Based Deep Learning Algorithm for Visual Acuity Prediction of Highly Myopic Eyes After Cataract Surgery.

BACKGROUND: Due to complicated and variable fundus status of highly myopic eyes, their visual benefit from cataract surgery remains hard to be determined preoperatively. We therefore aimed to develop an optical coherence tomography (OCT)-based deep learning algorithms to predict the postoperative visual acuity of highly myopic eyes after cataract surgery. MATERIALS AND METHODS: The internal dataset consisted of 1,415 highly myopic eyes having cataract surgeries in our hospital. Another external dataset consisted of 161 highly myopic eyes from Heping Eye Hospital. Preoperative macular OCT images were set as the only feature. The best corrected visual acuity (BCVA) at 4 weeks after surgery was set as the ground truth. Five different deep learning algorithms, namely ResNet-18, ResNet-34, ResNet-50, ResNet-101, and Inception-v3, were used to develop the model aiming at predicting the postoperative BCVA, and an ensemble learning was further developed. The model was further evaluated in the internal and external test datasets. RESULTS: The ensemble learning showed the lowest mean absolute error (MAE) of 0.1566 logMAR and the lowest root mean square error (RMSE) of 0.2433 logMAR in the validation dataset. Promising outcomes in the internal and external test datasets were revealed with MAEs of 0.1524 and 0.1602 logMAR and RMSEs of 0.2612 and 0.2020 logMAR, respectively. Considerable sensitivity and precision were achieved in the BCVA < 0.30 logMAR group, with 90.32 and 75.34% in the internal test dataset and 81.75 and 89.60% in the external test dataset, respectively. The percentages of the prediction errors within ± 0.30 logMAR were 89.01% in the internal and 88.82% in the external test dataset. CONCLUSION: Promising prediction outcomes of postoperative BCVA were achieved by the novel OCT-trained deep learning model, which will be helpful for the surgical planning of highly myopic cataract patients.

Linkage analysis and mutation screening of the rhodopsin gene in a Chinese Bai family with autosomal dominant retinitis pigmentosa.

Autosomal dominant retinitis pigmentosa (adRP) is a common form of RP worldwide. Although rhodopsin (RHO) is the most frequently reported adRP gene in many populations, it has not been detected in patients from the Bai nationality, one of the minority ethnic groups of southwest China. In this study, we used linkage analysis and mutation screening to identify the RHO gene in a Chinese Bai family with adRP. We found that in all affected members of the Bai family, the maximum two-point logarithm of odds score obtained was 3.61 and 4.52 at a recombination fraction (θ) of zero, with markers D3S3606 and D3S1292, respectively. Haplotype analysis showed cosegregation at the 1-c region harboring the RHO gene between the two markers with the disease. Direct sequencing of RHO revealed a c.1040C>T (p.Pro347leu) mutation in exon 5, which was supported by the reaction of the restriction enzyme. Two nonpathogenic single-nucleotide polymorphisms, rs7984 and rs2269736, were found in exon 1. To the best of our knowledge, this is the first genetic analysis of a Chinese Bai family with adRP, and a known missense RHO mutation (p.Pro347leu) is responsible for it.

[Analysis of corneal asphericity in patients after phacoemulsification].

OBJECTIVE: To investigate the distribution of corneal Q-value in the age-related cataract patients and aspherical features of cornea before and after the phacoemulsification (PHACO). METHODS: Thirty-nine eyes of 30 age-related cataract patients in our department were included. Transparent cornea incision at the temporal cornea was applied for patients with cornea astigmatism < 1.00 D and transparent cornea incision at the maximum curvature meridian for patients with cornea astigmatism > or = 1.00 D in PHACO. All patients were followed up to 3 months, corneal Q-value, corneal curvature, astigmatism were examined before and after PHACO, distribution of corneal Q-value and their correlation factors were analyzed. RESULTS: The mean corneal Q-value before and after the PHACO was -0.07 +/- 0.22 and -0.11 +/- 0.16, respectively. There was no statistical difference between the corneal Q-values before and after surgery (t = 1.14, P = 0.26). The mean of corneal curvature before and after the PHACO was (44.6 +/- 1.92) D and (44.70 +/- 1.47) D, respectively. There was no statistical difference between corneal curvature before and after the operation (t = -0.69, P = 0.50). The corneal Q-value was negatively co-related with corneal curvature before the surgery (r = -0.46, P = 0.003). The mean astigmatism power before and after the HACO was (0.67 +/- 0.43) D and (0.66 +/- 0.42) D, respectively. There was no statistical difference between astigmatism power before and after the surgery (t = -0.24, P = 0.82). There was no relationship between the corneal Q-value and astigmatism power before surgery (r = -0.24, P = 0.14). CONCLUSIONS: The corneal Q-value of aged patients is in normal distribution, is negative in the majority, and showed a negative relationship with corneal curvature. There is no statistical difference between the corneal Q-value, corneal curvature, and astigmatism power before and after PHACO surgery.

Prevalence and risk factors for diabetic retinopathy in a cross-sectional population-based study from rural southern China: Dongguan Eye Study.

RESEARCH QUESTION: The current population-based study aimed to investigate the prevalence of diabetic retinopathy (DR) and risk factors among residents over 40 years old in the rural area of Dongguan, southern China. STUDY DESIGN: The Dongguan Eye Study was a population-based study from September 2011 to February 2012. SETTING: The area was set in the rural area of Dongguan, southern China. PARTICIPANTS: Adult rural population aged 40 or older. INTERVENTION: Participants underwent haematological, physical, ophthalmic examinations and completed a questionnaire regarding lifestyles and systemic medical conditions. PRIMARY AND SECONDARY OUTCOME MEASURES: The frequency and risk factors of visual impairment and the major vision-threatening eye diseases. RESULTS: Of the 8952 Han Chinese, 1500 were diagnosed with type 2 diabetes mellitus (T2DM) with an average age of 59.5±11.1 years, and 1310 participants with fundus photography results were analysed. Standardised prevalence rate of DR was 18.2% for all patients with diabetes, 32.8% for the patients with previously diagnosed diabetes and 12.6% for newly diagnosed patients with T2DM. The prevalence rate of male DR was significantly higher than that of female DR (23.0% vs 14.1%, p<0.001). No significant difference was found in age-specific prevalence of DR. In diabetic patients, the prevalence rates of vision-threatening diabetic retinopathy, diabetic macular oedema and clinically significant macular oedema were 2.5%, 2.8% and 0.9%, respectively. Male gender, higher education level, longer duration of diabetes mellitus (DM), higher systolic blood pressure and glycosylated haemoglobin were independent risk factors for DR development in patients with diabetes. CONCLUSION: A relatively lower prevalence of DR was found among the participants with T2DM in residents over 40 years in the rural area of southern China. Thus, an ophthalmic examination is recommended, especially for individuals with DM and DR risk factors. There is a need to increase awareness and education on DM and DR, especially in subjects with DR risk factors to reduce the incidence of DR and macular oedema.

Intraocular Pressure in General and Diabetic Populations From Southern China: the Dongguan Eye Study.

Purpose: To investigate the distribution and risk factors for intraocular pressure (IOP) among general and diabetic populations in Southern China. Methods: The study participants aged 40 years or older were enrolled from the Dongguan Eye Study, a population-based cross-sectional study from September 2011 to February 2012. Systemic and ophthalmic examinations were performed, and diabetes status was screened based on the American Diabetes Association diagnostic criteria (2010). IOP was measured by a noncontact tonometer per standardized protocol. Regression analyses were used to assess the association between potential risk factors and IOP. Results: A total of 2112 subjects were included with a median age of 55 years. IOP for general population showed a near normal distribution with an average of 15.58 ± 3.27 mm Hg. Multiple regression analyses revealed that higher IOP was significantly correlated with younger age, higher body mass index (BMI), shorter height, higher blood pressure (BP), higher fasting blood glucose (FBG), higher low-density lipoprotein cholesterol (LDL-C), lower high-density lipoprotein cholesterol (HDL-C), and thicker central corneal thickness (CCT). There was no association between diabetes status and IOP after adjusting for possible confounders. IOP for diabetic participants showed a right-skewed distribution. Risk factors for IOP elevation in diabetes included female, younger age, higher BP, higher LDL-C, lower HDL-C, and thicker CCT. Conclusions: The present study identifies risk factors for elevated IOP in general and diabetic populations. Younger age and lower HDL-C, as well as higher BP, LDL-C, and CCT were significant factors contributing to higher IOP, especially in the female diabetic population.