JAMA ophthalmology最新文献

Importance: The incidence of retinopathy of prematurity (ROP) has been increasing in the US since 2003. Understanding the progression of and racial disparities in ROP incidence in California can provide a contrasting perspective that may guide future research and practice in the management and prevention of ROP.

Objective: To describe how the screening and incidence of ROP among very preterm infants in California changed from January 1, 2012, to December 31, 2021.

Design, setting, and participants: This study used a cohort of very preterm infants (defined as infants born prior to 32 weeks' gestational age or weighing less than 1500 g) admitted to 60 neonatal intensive care units across California from January 1, 2012, to December 31, 2021. Among this cohort, several factors were examined, including (1) the clinical and sociodemographic covariates of the population with and without ROP, (2) trends in screening for ROP, and (3) the incidence of ROP in total and by race and ethnicity. Data analysis was performed in April 2024.

Exposures: Race and ethnicity and other birthing parental and infant descriptive characteristics.

Main outcomes and measures: Incidence rates of ROP and severe ROP. The primary measures were rates of ROP screening and incidence rates of ROP and severe ROP. Time trends in the risk of ROP and severe ROP were estimated using robust Poisson regression models.

Results: In this cohort of 39 269 very preterm infants (<32 weeks' gestational age) eligible for ROP screening, the mean (SD) infant gestational age was 28.6 (2.6) weeks. The mean (SD) birth weight was 1075 (274) g, and 48.6% of infants were female. The birthing parents of the population were 12.6% Asian, 13.3% Black, 44.9% Hispanic White or Hispanic other race, 0.7% Native American/Alaskan, 24.7% non-Hispanic White, and 1.0% Pacific Islander. From January 1, 2012, to December 31, 2021, in California, ROP screening rates remained steady at 95% or greater for eligible infants less than 30 weeks of gestational age for all race and ethnic subgroups. In this study cohort among all very preterm infants (<32 weeks' gestational age), the incidence of ROP decreased from 31% in 2012 to 29% in 2021. Incidence rates of ROP among Asian and Hispanic individuals decreased the most quickly compared to other racial and ethnic groups, narrowing disparities.

Conclusions and relevance: In this cohort study, in contrast to increasing national trends, the total incidence of and racial and ethnic disparities in ROP incidence remained steady or decreased from 2012 to 2021 in California.

Importance: Selective laser trabeculoplasty (SLT) is becoming the recommended first choice in the treatment of open-angle glaucoma (OAG). However, whether repeat SLT can be recommended regardless of initial response remains controversial.

Objective: To assess the potential of OAG and ocular hypertension (OHT) undergoing repeat laser to respond favorably to SLT, termed responsiveness to SLT.

Design, setting, and participants: This post hoc analysis of the Laser in Glaucoma and Ocular Hypertension Trial in China (LiGHT China) was conducted from March 2015 to April 2023 in Zhongshan Ophthalmic Center. Of 1376 newly diagnosed OAG and OHT eyes of 771 adults in the original trial, 180 eyes of 105 participants were included in the present study, which underwent initial and repeat SLT as primary treatments.

Exposures: Standard SLT was the primary treatment. Repeat SLT was the first choice of treatment escalation regardless of initial response. IOP reduction after SLT and the duration of effect were analyzed. The maximum reduction in IOP within 2 years after initial SLT and repeat SLT was used to identify potential nonresponsiveness.

Main outcomes and measures: IOP reduction 2 months after SLT.

Results: A total of 180 eyes from 105 Chinese participants (mean [SD] age, 45.6 [14.5] years; 58 [55.2%] male and 47 [44.8%] female) underwent repeat SLT. Initial SLT and repeat SLT were both associated with a reduction in IOP (mean, 4.5 mm Hg; 95% CI, 3.9 to 5.1; P < .001 and mean, 3.3 mm Hg; 95% CI, 2.7 to 3.8; P < .001, respectively). The mean (SD) IOP after repeat SLT was 15.8 (3.4) mm Hg, similar to 16.0 (4.0) mm Hg after initial SLT (difference, -0.4mm Hg; 95% CI, -1.0 to 0.3; P = .24). Duration of effect after repeat SLT was longer than after initial SLT (1043 days vs 419 days; hazard ratio, 0.38; 95% CI, 0.29 to 0.50; P < .001). IOP reduction after initial SLT was uncorrelated with that after repeat SLT, and 153 eyes (85.0%) responded favorably to SLT at least once. A subset of 27 eyes (15.0%) was identified as potentially nonresponsive and found distinctive with older age (mean [SD], 54.1 [12.5] years vs 44.2 [14.2] years; difference, 10.5 years; 95% CI, 2.9 to 18.1; P = .009), higher proportion of female participants (difference, 27.5%; 95% CI, 3.6 to 51.5; P = .03), and lower baseline IOP (difference, -3.2 mm Hg; 95% CI, -5.2 to -1.3; P = .001).

Conclusions and relevance: These post hoc analyses showed that most cases of OAG and OHT were highly responsive to SLT and support the consideration of repeat SLT regardless of initial response, while individuals who are nonresponsive to this treatment may have specific features.