Long-term impact of dry eye symptoms on vision-related quality of life after phacoemulsification surgery.

PURPOSE: To observe the long-term changes in dry eye symptoms and vision-related quality of life in age-related cataract patients after phacoemulsification. METHODS: A total of 101 cataract patients after phacoemulsification combined with IOL implantation (Ph-IOL) in one eye were enrolled. Visual acuity, tear film breakup time (BUT), and Schirmer test 1 (ST1) were measured before and 1, 3, and 6 months after surgery. Ocular Surface Disease Index (OSDI) scores were used to evaluate the severity of dry eye symptoms. Utility values were assessed by the time trade-off (TTO), standard gamble for death (SGD), standard gamble for blindness (SGB) and rating scale (RS). RESULTS: The average LogMAR visual acuity in the operated eye was 1.35 ± 0.50 and increased rapidly after Ph-IOL, approaching a peak at 3 months (0.26 ± 0.15). The BUT and ST1 results decreased abruptly 1 month after surgery and gradually recovered until 6 months. OSDI scores increased significantly after surgery and gradually decreased until 6 months. Utility values evaluated by TTO, SGD, SGB and RS before surgery were 0.67 ± 0.19, 0.75 ± 0.15, 0.67 ± 0.20 and 0.2 ± 0.18, respectively, and increased to 0.91 ± 0.06, 0.98 ± 0.04, 0.92 ± 0.52 and 0.91 ± 0.06, 6 months after. Utility values measured with TTO, SGB or RS correlated significantly (P < 0.05) with visual acuity and OSDI scores pre- and postoperatively. CONCLUSIONS: Dry eye symptoms persist more than 3 months after Ph-IOL. Utility values were negatively influenced by dry eye symptoms.

Refractive versus diffractive multifocal intraocular lenses in cataract surgery: a meta-analysis of randomized controlled trials.

METHODS: Data sources, including PubMed, Medline, Embase, and the Cochrane Controlled Trials Register, were used to identify potentially relevant randomized controlled trials. Eight qualified studies incorporating 1,242 eyes of 621 patients were analyzed using Rev- Manager version 5.2 software (The Cochrane Collaboration, Oxford, England). The primary measures included uncorrected distance, intermediate, and near visual acuity. Reading ability, spectacle independence, and occurrence of photic phenomena were also addressed. RESULTS: The refractive MIOL group exhibited better uncorrected distance visual acuity than the diffractive MIOL group (weighted mean difference [WMD] = -0.04, 95% confidence interval [CI]: -0.06 to -0.02, P < .01). However, the diffractive MIOL group performed better than the refractive MIOL group in uncorrected near visual acuity, reading acuity, reading speed, smallest print size, spectacle independence, halo, and glare rate (WMD = 0.13, 95% CI: 0.10 to 0.17, P < .01; WMD = 0.14, 95% CI: 0.08 to 0.19, P < .01; WMD = -24.14, 95% CI: -43.56 to -4.72, P = .01; WMD = 0.56, 95% CI: 0.43 to 0.69, P < .01; WMD = 0.56, 95% CI: 0.45 to 0.70, P < .01; WMD = 1.50, 95% CI: 1.16 to 1.93, P = .002; WMD = 1.39, 95% CI: 1.10 to 1.75, P = .006, respectively). There was no significant difference between the two groups in uncorrected intermediate visual acuity (WMD = -0.04, 95% CI: -0.09 to 0.00, P = .05). CONCLUSIONS: Refractive MIOLs can provide better distance vision, whereas diffractive MIOLs provide better near vision, reading ability, and equivalent intermediate vision, reduce unwanted photic phenomena, and allow greater spectacle independence.

The control effect of orthokeratology on axial length elongation in Chinese children with myopia.

BACKGROUND: To retrospectively compare axial elongation in children with different degrees of myopia wearing spectacles and undergoing ortho-k treatment. METHODS: The medical records of 128 patients who were fitted with spectacles or orthokeratology (ortho-k) lenses in our clinic between 2008 and 2009 were reviewed. Ortho-k group comprised 65 subjects and 63 subjects wearing spectacles were included in the control group. Subjects were also divided into low-myopia, moderate-myopia and high-myopia groups, based on the basic spherical equivalent refractive error. Axial length periodically measured over 2-year of lens wear and changes in axial length were compared between treatment groups and between subgroups with different degrees of myopia. RESULTS: The control group exhibited more changes in axial length than the ortho-k group at both 12 months (0.39 ± 0.21 mm vs 0.16 ± 0.17 mm, p <0.001) and 24 months (0.70 ± 0.35 mm vs 0.34 ± 0.29 mm, p <0.001). Axial length elongation was estimated to be slower by about 51% in the ortho-k group. Similar results were found for the subgroups (49%, 59% and 46% reductions, respectively). In the group with low and moderate myopia, the annual increases in axial length were significantly different between the ortho-k and control groups during both the first ( Low myopia: 0.19 ± 0.17 mm vs 0.40 ± 0.18 mm, p = 0.001; Moderate myopia: 0.14 ± 0.18 mm vs 0.45 ± 0.22 mm, p <0.001) and second ( Low myopia: 0.18 ± 0.14 mm vs 0.32 ± 0.19 mm, p = 0.012; Moderate myopia: 0.18 ± 0.16 mm vs 0.34 ± 0.30 mm, p = 0.030) years. In the high myopia groups, significant differences were only found between the ortho-k and control groups during the first year (0.16 ± 0.18 mm vs 0.34 ± 0.22 mm, p = 0.004). The 2-year axial elongation was significantly associated with initial age (p <0.001) and treatment (p <0.001), but not with gender, initial refractive error, initial axial length, initial corneal curvature. CONCLUSIONS: This 2-year study indicates that ortho-k contact lens wear is effective for reducing myopia progression in children with low, moderate and high myopia.

TCERG1L hypermethylation is a risk factor of diabetic retinopathy in Chinese children with type 1 diabetes.

AIM: To identify the differential methylation sites (DMS) and their according genes associated with diabetic retinopathy (DR) development in type 1 diabetes (T1DM) children. METHODS: This study consists of two surveys. A total of 40 T1DM children was included in the first survey. Because no participant has DR, retina thinning was used as a surrogate indicator for DR. The lowest 25% participants with the thinnest macular retinal thickness were included into the case group, and the others were controls. The DNA methylation status was assessed by the Illumina methylation 850K array BeadChip assay, and compared between the case and control groups. Four DMS with a potential role in diabetes were identified. The second survey included 27 T1DM children, among which four had DR. The methylation patterns of the four DMS identified by 850K were compared between participants with and without DR by pyrosequencing. RESULTS: In the first survey, the 850K array revealed 751 sites significantly and differentially methylated in the case group comparing with the controls (|Δß|>0.1 and Adj.P<0.05), and 328 of these were identified with a significance of Adj.P<0.01. Among these, 319 CpG sites were hypermethylated and 432 were hypomethylated in the case group relative to the controls. Pyrosequencing revealed that the transcription elongation regulator 1 like (TCERG1L, cg07684215) gene was hypermethylated in the four T1DM children with DR (P=0.018), which was consistent with the result from the first survey. The methylation status of the other three DMS (cg26389052, cg25192647, and cg05413694) showed no difference (all P>0.05) between participants with and without DR. CONCLUSION: The hypermethylation of the TCERG1L gene is a risk factor for DR development in Chinese children with T1DM.

[Analysis of cataract surgical rate and its influencing factors in Shanghai, China].

OBJECTIVE: To explore the cataract surgical rate (CSR) of Shanghai from 2006 to 2012 and examine its influencing factors. METHODS: As of 2003, a cataract surgery registration form had been filled by physicians after every cataract surgery in Shanghai. The local eye disease prevention team then entered the relevant information into the Shanghai Cataract Operations Database. Based upon this database, CSR of Shanghai was calculated. And the number of cataract surgeries was compared between Shanghai urban and suburban districts as well as among different medical institutions. RESULTS: The overall CSR in Shanghai increased from 1741 in 2006 to 2313 in 2012. In 2012, CSR in urban districts reached 6013 while it stood at 460 and 584 in inner and outer suburb districts respectively. The number of hospitals performing cataract surgery in urban districts was much more than that in suburbs. And the average number of cataract surgeries per hospital per year in suburbs was only one third of that (748 cases) in urban areas. The number of cataract surgeries at in private hospitals increased rapidly during the past 7 years. The number of 1921 cases was nearly twice as many as that at tertiary hospitals in 2012. Phacoemulsification surgery was the most popular surgical choice for cataract removal, accounting for 98.40% of total cataract surgeries in 2012. CONCLUSION: Until 2012, CSR in Shanghai dropped below the target of World Health Organization (WHO). A low level of CSR in suburbs is a major influencing factor for the overall level of CSR in Shanghai.

[Correlation of retinal sensitivity, visual acuity and central macular thickness in different types of diabetic macular edema].

OBJECTIVE: To detect the correlation of retinal sensitivity, visual acuity and central macular thickness in patients with different types of diabetic macular edema (DME), macular function were evaluated by measuring the sensitivity, fixation pattern of the macular was examined by fundus-related microperimetry, then analyzed and compared the results with best-corrected visual acuity (BCVA) and foveal retinal thickness measured by optical coherence tomography (OCT). METHODS: A retrospective case-series study. In a prospective, observational case series study, 52 consecutive patients (83 eyes) with diabetic macular edema were included.Sex, age,BMI, education, type of DM, duration, treatment, laboratory examinations, history of cardiovascular disease, hypertension, hyperlipidemia, diabetic nephropathy, and cigarette use were documented.Logarithm of the minimum angle of resolution (logMAR) BCVA was evaluated using the international vision test chart.Foveal thickness was measured by OCT. Mean retinal sensitivities, fixation stability and position was investigated with microperimetry. Variables related with BCVA, foveal thickness and mean retinal sensitivities were analyzed in different types of DME patients using one-way ANOVA or Kruskal-Wallis test. As for fixation, Fisher exact test was chosen. Pearson Correlation analysis was performed to evaluate the association between these variables. Spearman correlation analysis was used for ordinal data. The correlation between retinal sensitivities and all the variables examined were analyzed under multiple regression analysis. RESULTS: Eighty-three eyes were included in this study. Forty-seven eyes (56.63%) were graded as focal DME, 20 eyes (24.10%) as diffuse DME, 5 eyes (6.02%) as ischemic DME and 11 eyes (13.25%) as proliferative DME. Comparison between different types of DME patients showed statistically significant difference in mean logMAR BCVA (F = 12.737, P < 0.01) , mean OCT foveal thickness (H = 31.504, P < 0.01) , mean central retinal sensitivities (F = 14.760, P < 0.01) , and patterns of fixation, which were also statistically correlated (χ(2)= 23.47, 21.01; P < 0.01). It was a positive correlation between OCT foveal thickness and logMAR BCVA in patients with focal, diffuse and ischemic DME (r = 0.56, -0.62; P < 0.01) , but not with proliferative DME (r = 0.43, P = 0.19) .While central retinal sensitivities were also negative correlation between OCT foveal thickness and logMAR BCVA (r = -0.62, -0.68; P < 0.01) . Multiple regression analysis showed that central retinal sensitivity was inversely correlated with LogMAR and retinal thickness (t = -5.52, -4.24; P < 0.01). CONCLUSIONS: There are statistically significant difference in macular morphology and vision function between different types of DME patients. The progression of DME are expressed gradually from focal, diffuse to ischemic type. DME could be fully evaluated by measuring macular sensitivity, fixation pattern with microperimetry as well as macular thickness measurement with OCT and visual acuity determination comprehensively.

Suppression of cAMP/PKA/CREB signaling ameliorates retinal injury in diabetic retinopathy.

The blood-retinal barrier (BRB), homeostasis, neuronal integrity, and metabolic processes are all directly influenced by Müller cells, the most important retinal glial cells. We isolated primary Müller cells from Sprague-Dawley (SD) neonatal rats and treated them with glucose at varying doses. CCK-8 was used to quantify cellular viability, and a TUNEL assay was performed to detect cell apoptosis. ELISA, immunofluorescence, and western blotting were used to assess cAMP/PKA/CREB signaling, Kir4.1, AQP4, GFAP, and VEGF levels, respectively. H&E staining was used to examine histopathological alterations in diabetic retinopathy (DR)-affected retinal tissue in rats. As glucose concentration increases, gliosis of Müller cells became apparent, as evidenced by a decline in cell activity, an increase in apoptosis, downregulation of Kir4.1 level, and overexpression of GFAP, AQP4, and VEGF. Treatments with low, intermediate, and high glucose levels led to aberrant activation of cAMP/PKA/CREB signaling. Interestingly, blocking cAMP and PKA reduced high glucose-induced Müller cell damage and gliosis by a significant amount. Further in vivo results suggested that cAMP or PKA inhibition significantly improved edema, bleeding, and retinal disorders. Our findings showed that high glucose exacerbated Müller cell damage and gliosis via a mechanism involving cAMP/PKA/CREB signaling.

Changes and related factors of blood CCN1 levels in diabetic patients.

Objective: To study the differences in blood cellular communication network factor 1 (CCN1) levels between patients with diabetes mellitus (DM) and healthy individuals and to explore the relationship between CCN1 and diabetic retinopathy (DR). Methods: Plasma CCN1 levels were detected using ELISA in 50 healthy controls, 74 patients with diabetes without diabetic retinopathy (DM group), and 69 patients with diabetic retinopathy (DR group). Correlations between CCN1 levels and age, body mass index, mean arterial pressure, hemoglobin A1c, and other factors were analyzed. The relationship between CCN1 expression and DR was explored using logistic regression after adjusting for confounding factors. Blood mRNA sequencing analysis was performed for all subjects, and the molecular changes that may be related to CCN1 were explored. The retinal vasculature of streptozotocin-induced diabetic rats was examined using fundus fluorescein angiography; in addition, retinal protein expression was examined using western blotting. Results: Plasma CCN1 levels in patients with DR were significantly higher than in the control and DM groups; however, no significant differences were observed between healthy controls and patients with DM. CCN1 levels negatively correlated with body mass index and positively correlated with the duration of diabetes and urea levels. It was observed that high (OR 4.72, 95% CI: 1.10-20.25) and very high (OR 8.54, 95% CI: 2.00-36.51) levels of CCN1 were risk factors for DR. Blood mRNA sequencing analysis revealed that CCN1-related pathways were significantly altered in the DR group. The expression of hypoxia-, oxidative stress-, and dephosphorylation-related proteins were elevated, while that of tight junction proteins were reduced in the retinas of diabetic rats. Conclusion: Blood CCN1 levels are significantly elevated in patients with DR. High and very high levels of plasma CCN1 are risk factors for DR. Blood CCN1 level may be a potential biomarker for diagnosis of DR. The effects of CCN1 on DR may be related to hypoxia, oxidative stress, and dephosphorylation.

PEDF in diabetic retinopathy: a protective effect of oxidative stress.

Diabetic retinopathy (DR) is a major cause of blindness in working age adults, and oxidative stress plays a vital role in the pathogenesis of DR. Pigment-epithelium-derived factor (PEDF), a multifunctional protein, has shown to inhibit the development of DR by accumulating evidence. This paper highlights the current understanding of probable mechanism about how PEDF blocks the deterioration of DR through its antioxidative properties and application prospects of PEDF as a novel therapeutic target in DR. Gene therapy of PEDF is becoming more and more acceptable and will widely be applied to the actual treatment in the near future.

Photopic pupil size change in myopic orthokeratology and its influence on axial length elongation.

AIM: To explore the photopic pupil size behavior in myopic children undergoing overnight orthokeratology (ortho-k) over 1-year period and its effects on the axial elongation. METHODS: A total of 202 Chinese myopic children were enrolled in this prospective clinical trial. Ninety-five subjects in ortho-k group and eighty-eight subjects in spectacle group completed the 1-year study. Axial length (AL) was measured before enrollment and every 6mo after the start of ortho-k. The photopic pupil diameter (PPD) was determined using the Pentacam AXL and measured in an examination room with lighting of 300-310 Lx. Stepwise multiple linear regression analysis was used to identify variables contribution to axial elongation. RESULTS: Compared with spectacle group, the average 1-year axial elongation was significantly slower in the ortho-k group (0.25±0.27 vs 0.44±0.23 mm, P<0.0001). In ortho-k group, PPDs significantly decreased from 4.21±0.62 mm to 3.94±0.53 mm after 1mo of lens wear (P=0.001, Bonferroni correction) and the change lasts for 3-month visit. No significantly change during the other follow-up visits was found (P>0.05, Bonferroni correction). The 4.81 mm PPD may be a possible cutoff point in the ortho-k group. Subjects with PPD below or equal to 4.81 mm tended to have smaller axial elongation compared to subjects with PPD above 4.81 mm after 1-year period (t=-3.09, P=0.003). In ortho-k group, univariate analyses indicated that those with older age, greater degree of myopia, longer AL, smaller baseline PPD (PPDbaseline) experienced a smaller change in AL. In multivariate analyses, older age, greater AL and smaller PPDbaseline were associated with smaller increases in AL. In spectacle group, PPD tended to be stable (P>0.05, Bonferroni correction) and did not affect axial growth. CONCLUSION: PPDs experience significantly decreases at 1-month and 3-month ortho-k treatment. Children with smaller PPD tend to experience slower axial elongation and may benefit more from ortho-k.

[The major problem and countermeasures of recent meta-analysis manuscripts in Chinese journals].

The present paper concerns on some distinct shortcomings of recent eye diseases related meta-analysis manuscripts in Chinese literatures, then discusses the following important-aspects in meta-analysis procedures: addressing the purpose properly, providing a precise title, collecting relative literatures comprehensively, assessing the quality of enrolled studies systematically, evaluating the result of test for heterogeneity correctly, choosing the outcome indicators and effect indexes accurately, analyzing sensitivity, and correlating the statistical and clinical significance of the results in an objective manner, et al. The reporting format is suggested to follow the MOOSE guidelines and QUOROM statement.

[Practising appropriate vision check scheme in eye diseases mass screening works].

Vision check is the first step of mass screening works of most blinding diseases. In recent China, the primary childhood vision check is mainly conducted by hygiene teachers in educational institutions, following the Chinese traditional poor vision classification system, which is based on uncorrected distance visual acuity. However, this classification system does not meet childhood vision developmental mechanism, and may lead to massive unnecessary repetitive screening, diagnosis and treatment of corrected ametropia. In some Chinese communities and villages, the vision check is still based on uncorrected distance visual acuity during eye diseases mass screening procedures in adults. The critical point of preschool children vision impairment screening is then suggested to follow novel Chinese amblyopia diagnostic criteria. Combination of uncorrected, presenting and corrected visual acuity indexes may be used for children' vision check. Collaboration of children health care workers, pediatric ophthalmologists and optometrists in children eye diseases screening projects should be realized as soon as possible. In the adult population, presenting vision is suggested to be used in vision impairment screening works, and appropriate vision check scheme should be adopted in specific eye diseases screening works.

[Appraisal of meta-analysis manuscripts on eye diseases published in Chinese journals with QUOROM statement and MOOSE guidelines].

OBJECTIVE: To assess the standardization of meta-analyses reports on eye diseases published in Chinese journals in recent ten years. METHODS: Meta-analyses manuscripts on eye diseases published in Chinese-language journals from January 2000 to September 2010 were retrieved through the following databases: Wanfang Data, VIP Information, CNKI and Chinese Bio-medicine Database, along with manual database search. The manuscripts translated from foreign-language meta-analyses reports or repetitive publications were excluded. All enrolled manuscripts were then analyzed item by item according to the checklist of QUOROM statement and MOOSE guidelines. RESULTS: 50 manuscripts were finally enrolled into the present quality appraisal study, including 32 meta-analyses manuscripts of randomized control trail (RCT) studies and the other 18 meta-analyses manuscripts of observational studies. Out of the 32 manuscripts evaluated with QUOROM statement, only 8 (25.0%) manuscripts included flow chat describing the process of selection, 18 (56.3%) manuscripts included sensitivity analyses and 9 (28.1%) included bias evaluation part. Out of the 18 manuscripts evaluated with MOOSE guidelines, only 6 (33.3%) included comprehensive relative literatures search strategy, 4 (22.2%) included sensitivity analyses and 8 (44.4%) included bias evaluation section. CONCLUSION: The standardization of meta-analyses reports on eye diseases published in Chinese journals needs to be improved.

[A prevalence investigation of blindness and vision impairment in 2009 in older adults of Dachang Blocks of Baoshan District, Shanghai, China].

OBJECTIVE: To investigate the prevalence of blindness and low vision and the leading causes of blindness in residents aged≥60 years in Dachang Blocks of Baoshan District, Shanghai, China. METHODS: A cross-sectional study was carried out by Shanghai Eye Disease Prevention & Treatment Center and the Center for Disease Control and Prevention in Baoshan District of Shanghai from October to December in 2009. Randomly cluster sampling was used to identify the adults aged≥60 years who had lived in Dachang Blocks of Baoshan District, Shanghai for more than 10 years. Presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) based on autorefraction and subjective refraction were measured separately in each eye. External eye, anterior segment and ocular fundus were examined by the ophthalmologist using slit lamp-microscopes direct ophthalmoscopy and non-mydriatic digital camera. And the leading causes of visual impairment were assured. The Chi square test was used between the groups of rate comparison. RESULTS: Of 5199 enumerated subjects≥60 years of age, 87.42% (4545/5199) were examined. All subjects were urban population who were originally changed from the rural population in nearly 10 years. In this population, with best-corrected visual acuity, 30 persons were diagnosed as blindness, 145 persons were diagnosed as low vision. The prevalence of blindness and low vision were 0.67%, 3.19%, respectively. Low vision was associated with female gender. It was statistically significant difference (χ2=4.88, P<0.05). The leading causes of blindness were cataract, macular degeneration, ocular absence or atrophy, glaucoma, and diabetic retinopathy or corneal diseases. With presenting visual acuity, 39 persons were diagnosed as blindness, 401 persons were diagnosed as low vision. The prevalence of blindness and low vision were 0.86%, 8.82%, respectively. Blindness and low vision were associated with older age. The prevalence of blindness and low vision increased rapidly in aged 75 years or older people. The leading causes of blindness were cataract, uncorrected refractive error, macular degeneration, ocular absence or atrophy, glaucoma. Low vision was associated with female gender. It had statistically significant difference (χ2=13.345, P<0.01). CONCLUSIONS: In rapidly urbanized and aging community of Shanghai, cataract, uncorrected refractive error, macular degeneration were the leading causes of blindness with presenting visual acuity. The prevalence of low vision in females was higher than that of males which had statistically significant difference. These kinds of residents needed more targeted eye health education and services.

Prevalence and risk factors of diabetic retinopathy in patients with type 2 diabetes in Shanghai.

AIM: To investigate the prevalence of diabetic retinopathy (DR) in residents of Shanghai and analyze the risk factors of DR. METHODS: This study involved 7233 patients with diabetes in 2016. The demographic data of the participants were collected using a questionnaire survey. Physical examination, laboratory tests, and ophthalmological examinations were conducted. Two professional ophthalmologists diagnosed and graded DR by fundus examination and then combined the results with fundus images. The unconditional multivariate Logistic regression analysis was used to determine the risk factors. RESULTS: In total, 6978 patients with type 2 diabetes in Shanghai with a mean age of 68.33±8.40y were recruited, including 2975 males (42.6%) and 4003 females (57.4%). Overall, 1184 patients were diagnosed with DR, with a prevalence rate of 16.97%. Regression analysis showed that duration of diabetes (OR 1.061, 95%CI 1.049-1.073), high systolic blood pressure (SBP; OR 1.071, 95%CI 1.037-1.106), increased glycosylated hemoglobin level (OR 1.234, 95%CI 1.162-1.311), high blood glucose level (OR 1.061, 95%CI 1.023-1.099), increased neutrophil-to-lymphocyte ratio (NLR; OR 1.132, 95%CI 1.053-1.217) and mean platelet volume (MPV; OR 1.077, 95%CI 1.016-1.142) were risk factors of DR. Conversely, hematocrit (HCT; OR 0.971, 95%CI 0.954-0.988) and mean corpuscular volume (MCV; OR 0.980, 95%CI 0.965-0.994) were protective factors. CONCLUSION: The prevalence rate of DR in Shanghai is 16.97%. The duration of diabetes, high SBP, increased glycosylated hemoglobin, NLR, and MPV were determined as risk factors of DR.

[The application study of community-based tele-screening system for diabetic retinopathy in Beixinjing Blocks, Shanghai].

OBJECTIVE: To design the community-based tele-screening system for diabetic retinopathy and evaluate the feasibility of it. METHODS: Cross-sectional study. The tele-screening system was based on non-mydriatic digital eye fundus camara photography and computer network technology. 109 type 2 diabetes mellitus residents were randomly selected for system evaluation, which included: (1) The consistency of the far visual acuity examined by an ophthalmologist and a trained inspector, evaluated by paired t-sample test; the consistency of diagnosis of diabetic retinopathy by tele-screening system and traditional screening method by ophthalmoscope, slit-lamp bimicroscope combined with non-contact lens after pupil dilation, evaluated by kappa value and intraclass coefficient correlation. (2) The proper compression ratio of the fundus photographs transferring through the internet, evaluated by intraclass coefficient correlation. (3) The working time for the tele-screening on the residents, comparing with the traditional screening method. RESULTS: The visual acuities of the 218 eyes in 109 residents examined by an ophthalmologist were < 0.05 in 13 eyes, between 0.05 and 0.3 in 61 eyes, > or = 0.3 in 144 eyes. No significant difference was found between the vision acuity given by different examiner (t = -0.572, P = 0.568). 52 eyes were diagnosed as DR by traditional screening method, while 51 eyes were diagnosed as DR by the tele-screening method, so in DR diagnosis, high consistency were found with kappa value as 0.885, 95%CI 0.807 to 0.963, and in DR degree diagnosis with ICC value as 0.91, 95%CI 0.85 to 0.94. The most compression ratio of fundus photographs was as low as 15% (526 x 350). It took 5 to 7 minutes for the tele-screening system to examining and giving diagnosis of a diabetes mellitus resident, a little bit sooner than traditional screening method. CONCLUSIONS: This community-based tele-screening system can meet the requirements of mass screening for diabetic retinopathy.

Recent Epidemiology Study Data of Myopia.

Myopia, a pandemic refractive error, is affecting more and more people. The progression of myopia could cause numerously serious complications, even leading to blindness. This review summarizes the epidemiological studies on myopia after 2018 and analyzes the risk factors associated with myopia. The prevalence of myopia varies in different regions, age, and observation time. East Asia has been gripped by an unprecedented rise in myopia, and other parts of the world have also seen an increase. The prevalence of myopia in children continues to rise and aggravates with age. The prevalence of high myopia has also increased along with myopia. Racial dependence and family aggregation can be seen frequently in myopia patients. Increased outdoor activities are proven to be protective factors for myopia, as near-distance work and higher education levels affect in the opposite. The impact of gender or urbanization on myopia is controversial. The relationship between nutrition, digital screens, Kawasaki disease, pregnant women smoking during pregnancy, and myopia is still not clear for lack of sufficient evidence. Understanding the various factors that affect myopia helps to clarify the mechanism of myopia formation and also to formulate reasonable prevention and control measures of myopia to protect people's health, especially for adolescents.

[Some aspects in planning and conducting a Chinese vision-related quality of life study].

The present paper concerns on some shortcoming of the planning and conducting steps in recent Chinese vision-related quality of life (VRQoL) studies, addresses the main application of VRQoL, introduces two instruments, these are questionnaire and utility value for VRQoL evaluation, the standard strategies for introducing or self-making questionnaire, and the principals of the conducting work.

[A prevalence survey of blindness and visual impairment in adults aged equal or more than 60 years in Beixinjing blocks of Shanghai, China].

OBJECTIVE: To investigate the prevalence rate of blindness and low vision and the leading cause of blindness in residents aged > or = 60 years in Beixinjing blocks, Shanghai. METHODS: A cross-sectional study was carried out by Shanghai First People's Hospital, affiliated Shanghai Jiaotong University and Shanghai Beixinjing Community hospital from November 2007 to April 2008. Randomly cluster sampling method was used, and all the individuals aged > or = 60 years in 8 communities from Beixinjing blocks, Shanghai was enrolled in this study. The pinhole visual acuity and presenting visual acuity were measured separately in each eye. External eye, anterior segment and ocular fundus were examined by the ophthalmologist using slit lamp-microscopes, direct ophthalmoscopy and non-mydriatic digital camara. Assigned ophthalmologic doctors assured the leading blind causes of every blind person. The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out. RESULTS: 3851 individuals were examined, and the response rate was 92.73%. According to WHO diagnostic criteria: 29 persons were diagnosed as blindness, 11 male (37.93%) and 18 female (62.07%). 104 persons were diagnosed as low vision, 37 male (35.58%) and 67 female (64.42%). The prevalence rates of blindness and low vision were 0.75% and 2.70%. The leading causes of blindness were macular degeneration, cataract, corneal diseases, and retinal detachment. According to presenting vision diagnostic criteria: 61 persons were diagnosed as severe binocular blindness, 20 male (32.79%) and 41 female (67.21%). 66 persons were diagnosed as slight binocular blindness, 27 male (40.91%) and 39 female (59.09%). 276 persons were diagnosed as monocular blindness, 120 male (43.48%) and 156 female (56.52%). The prevalence of severe binocular blindness, slight binocular blindness and monocular blindness was 1.58%, 1.71% and 7.17%, respectively. The leading causes of blindness were macular degeneration, cataract, ametropia and corneal diseases. CONCLUSION: The leading cause of blindness was macular degeneration. The prevalence of degenerative retinopathy in this area is on the rise.

[Epidemiologic study of conjunctivochalasis in populations equal or over 60 years old in Caoyangxincun community of Shanghai, China].

OBJECTIVE: To investigate the prevalence and relative factors of conjunctivochalasis among people over 60 years old in Caoyangxincun community of Shanghai. METHODS: A cross-sectional study based on local residents in this community was carried out from September 2008 to October 2008. Cluster sampling was used in randomly selecting individuals aged > or = 60 years. Slit-lamp ophthalmoscope was used for eye examination and diagnosis. The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out. A database was set using SPSS 10.0 software, Chi-square test was used for data analysis. RESULTS: 2110 residents took part in this study, with the response rate 94.85%. 930 cases (1762 eyes) were confirmed as conjunctivochalasis, so the prevalence rate is 44.08%. The prevalence of conjunctivochalasis was increasing with age (chi(2) = 10.44, P < 0.01). 556 cases (943 eyes) were confirmed as degree I, 246 cases (647 eyes) as degree II, 120 cases (162 eyes) as degree III and the rest 8 cases (10 eyes) as degree IV. Several symptoms, such as blurred vision, asthenopia and eye pain were more frequent in patient group than in the normal ones (chi(2) value was 15.44, 20.54 and 19.74, respectively, P < 0.01). In the disease eyes, the conjunctiva usually piled up on the nasal and temporal side (944 eyes, 53.58%), the location of inferior lid margin was usually above corneal limbus (2589 eyes, 61.35%) and inferior lid margin entropion and introversion were always found (7.04% and 6.63%). Abnormal lacrimal river was found in 87.23% of the diseased eyes, more than the non-conjunctivochalasis eyes (chi(2) = 1615.81, P < 0.01). CONCLUSIONS: Conjunctivochalasis is a common eye disease in aged population, with obvious signs and symptoms of ocular surface and lacrimal river impairment. In the local residents, most patients were classified as minimal or moderate degree. The location of inferior lid margin and the tension of inferior lid may be related factor of conjunctivochalasis.