Ophthalmic epidemiology最新文献

Purpose: To assess the efficacy of the DIGIROP-Birth algorithm in identifying infants at risk for developing retinopathy of prematurity (ROP).

Methods: In a retrospective study, we included preterm infants over 11 years, 2010-2020, meeting the inclusion criteria for the DIGIROP-Birth calculator (24 + 0/7 to 30 + 6/7 weeks of gestational age). We assessed the validity of DIGIROP-Birth using receiver-operating characteristic (ROC) curves and calculated area-under-curve (AUC), sensitivity, specificity, and positive and negative predictive values.

Results: 897 infants were included in the analysis. The median age of the first ophthalmological examination was 40 days (IQR 32-50), the median gestational age was 198 days (IQR 185-209; corresponding to 28 + 2/7 gestational weeks), median birth weight was 1000 g (IQR 790-1300). Of 897 screened children, 458 (51.1%) were diagnosed with ROP, and 34 of 897 (3.8%) required treatment.Analysis of ROP requiring treatment predicted by DIGIROP showed an AUC of 0.860 [95%-CI 0.795-0.925]. An equilibrium of sensitivity and specificity existed at a probability of 4.12%. The positive predictive value was 10.95%, and the negative predictive value was 99.36%. Independent significant peri- and postnatal risk factors were emergency cesarean section and mass blood transfusions.

Conclusions: The DIGIROP-Birth calculator showed good predictive power in our studied population, with an incidence of 3.79% for therapy-requiring ROP. Peri- and postnatal risk factors should be included in ROP screening.

Purpose: To identify factors that are associated with no-shows and cancellations in a glaucoma clinic.

Methods: Retrospective observational study of patients seen at a glaucoma clinic over a two-year period (6/2017-5/2019). Demographics and clinic information were recorded from the electronic medical record. A total of 36,810 visits from 7,383 patients were studied. Weather data was collected from the National Centers for Environmental Information. Distance analysis was calculated utilizing Bing Maps application programming interface (API) on Microsoft Excel. Visits were divided into three groups based on appointment status: kept, cancelled, and no-show.

Results: Bivariate analysis found a statistically significant difference in various factors amongst patients based on appointment status. Patients <15 miles from clinic had a higher rate of no-show, but a lower rate of cancellations compared to those farther (p < 0.0001) Using multivariable logistic regression, the following factors were associated with the likelihood of patient cancellation: average snowfall (Odds Ratio = 1.37); presence of storm event (OR = 1.12), new visit (OR = 1.82), follow-up appointments (OR = 1.90), and travel distance > 15 miles (OR = 1.11). The following factors were associated with patient no-show: resident clinic (OR = 1.79), new visit (OR = 2.24), follow-up appointments (OR = 2.18), age (OR = 0.99), average snowfall (OR = 1.27), presence of storm event (OR = 1.41), average windspeed (OR = 0.98), and travel distance > 15 miles (OR = 0.67).

Conclusion: Patient age, gender, travel distance, appointment type, and weather were all significantly associated with rates of patient cancellations and no-shows. These risk factors could lead to interventions to improve appointment adherence and patient retention. Weather is an under-analyzed factor in patient follow-up rates that warrants further investigation.

Purpose: To assess the feasibility, implementation, and patient experience of autonomous artificial intelligence-based diabetic retinopathy detection models.

Methods: This was a prospective cohort study where consenting adult participants previously diagnosed with diabetes were screened for diabetic retinopathy using retinal imaging with autonomous artificial intelligence (AI) interpretation at their routine primary care appointment from December 2022 through October 2023 in Thunder Bay, Ontario. Demographic (age, sex, race) and clinical (type and duration of diabetes, last reported eye exam) data were collected using a data collection form. A 5-point Likert scale questionnaire was completed by participants to assess patient experience following the AI exam.

Results: Among the 202 participants (38.6% women) with a mean age of 70.8 ± 11.7 years included in the study and screened by AI, the exam was successfully completed by 93.6% (n = 189), with only 1.5% (n = 3) requiring dilating eyedrops. The most common reason for an unsuccessful exam was small pupils with patient refusal for dilating eyedrops (n = 4). Among the participants with successful eye exams, 22.2% (n = 42) had referable diabetic retinopathy detected and were referred to see an ophthalmologist; 32/42 (76.0%) of these attended their ophthalmologist appointment. A total of 184 participants completed the satisfaction questionnaire; the mean score (out of 5) for satisfaction with the addition of an eye exam to their primary care visit was 4.8 ± 0.6.

Conclusion: Screening for diabetic retinopathy using autonomous artificial intelligence in a primary care setting is feasible and acceptable. This approach has significant advantages for both physicians and patients while achieving very high patient satisfaction.

Purpose: Visual field loss poses a high personal cost to those affected, significantly impacting activities of daily living, including driving. However, there is conflicting evidence on the association between visual field loss and crash risk. This study examined the association between severity and location of binocular visual field loss and motor vehicle crashes in older adults aged 50+, using linked population data over a 29-year study period.

Methods: Using a database of visual field tests obtained from ophthalmologists in Western Australia (WA) between 1990 and 2019, deficits in field sensitivity were identified and classified into three severities across five regions. This was linked to other government administrative databases including crash data.

Results: Of 31,296 people, 4,307 (13.76%) older drivers were involved in 5,537 vehicle crashes. Binocular visual field loss (regardless of severity and location) significantly increased the odds of a crash by 84% (OR 1.84; 95% CI 1.71-1.97). Severe visual field loss significantly increased the odds of a crash by 98% in the upper left quadrant (OR 1.98; 95% CI 1.70-2.06), 97% in the lower left (OR 1.97; CI 1.80-2.16), 89% in the lower right (OR 1.89; CI 1.72-2.06) and 95% in the upper right quadrant (OR 1.95; CI 1.78-2.14).

Conclusion: The large population-based study provided robust estimates on the degree of severity and specific locations of visual field loss that threaten safe driving and objective evidence on the usefulness of linking large customised ophthalmic databases to crash records for developing 'fitness to drive' guidelines for older drivers.

Purpose: Diabetic eye disease, namely diabetic retinopathy (DR), remains a leading cause of preventable blindness worldwide. Research has shown that treatment for diabetes and eye care was disrupted during the pandemic - with disparities between urban and rural populations being unknown. Thus, we aimed to assess the prevalence of reported rates of DR and dilated fundus exams from 2017 to 2021.

Methods: We performed a cross-sectional analysis using data from the Behavioral Risk Factor Surveillance System (BRFSS). Among US residents with diabetes, we calculated the rates of DR and annual dilated fundus exams - overall and by metropolitan statistical area (MSA) - measuring differences using X² tests.

Results: In 2017, the rate of DR was 19.78% among US residents reporting diabetes, which increased to the highest rate in 2018 at 22.19% before dropping to the lowest rates in 2019 and 2020 (18.44%). These annual changes were statistically significant (p < .001), but we found no significant differences by MSA status. Each year, nearly ⅔ of all individuals reported receiving dilated fundus examinations which peaked in 2019 at 71.5%. These annual deviations, as well as deviations by MSA were statistically significant (p < .001).

Conclusion: Although populations outside of an MSA experienced an increase in dilated fundus examinations, the national prevalence of DR continues to rise. Further research into sociodemographic and cultural factors influencing diabetic eye disease and access to ophthalmic care will be crucial for the prevention of DR and improving vision outcomes.

Purpose: To investigate the relationships between vision-related functional impairment (VFI) with sociodemographic and healthcare access factors in a representative sample of the United States population.

Methods: Data from the 2017 National Health Interview Survey (NHIS) were used. The NHIS involves responses from the U.S. civilian, non-institutionalized population aged 18 years or older. It provides self-reported data on demographic characteristics, socioeconomic factors, health status, and healthcare access. NHIS participants who responded to at least one of our target questions about VFI were included in the study. VFI was defined for participants based on their 'yes' or 'no' responses to target questions about experiencing a VFI. Data analysis was performed through univariable and multivariable logistic regression.

Results: Overall, 26,711 participants were included, of which 6926 (25.9%) participants reported experiencing a VFI. In univariable analysis, there were greater odds of VFI among females (OR: 1.16, 95% CI: 1.07-1.26, p < 0.001), and participants with less than a high school degree compared to those with an advanced degree (OR: 1.17, 95% CI: 1.02-1.33, p = 0.02). Among economic and healthcare access factors, greater odds of VFI was associated with public health insurance versus private coverage (OR: 1.19, 95% CI: 1.07-1.32, p = 0.001), having delayed medical care due to costs (OR: 1.86, 95% CI: 1.86-2.10, p < 0.001), and being unemployed (OR: 1.39, 95% CI: 1.26-1.53, p < 0.001). Participants whose incomes were lower than the poverty threshold (OR: 1.54, 95% CI: 1.32-1.80, p < 0.001) had higher odds of VFI than those with income >5× poverty threshold.

Conclusions: Several demographic and economic factors are associated with VFI in a representative sample of the U.S. population. These results highlight the importance of addressing social and economic factors that are associated with the development of VFI.

Purpose: We aim to report the frequency and distribution of corneal transplantation, by age, sex, and state/territory, in Australia over a > 25-year period from 1994 to 2022, including during COVID-19 lockdowns.

Methods: Using data from Medicare, Australia's Government-funded health insurance scheme, we retrospectively analysed corneal transplants performed from January 1994 to December 2022.

Results: From 1994 to 2022, there were 27,536 corneal transplantation services processed by Medicare. Transplants tended to be more common in males in younger age groups (67.7% male in 15-24-year-olds), and in females in older age groups (59.2% female in 75-84-year-olds). Most transplants were performed in New South Wales (9,438 services, 34.3%), Queensland (7,722, 28.0%), and Victoria (5,209, 18.9%). Annual corneal transplantation rates in Australia tended to decrease from 1994 to 2006 (lowest rate during study period), falling by 31%, and then increased by 81%, from 2006 to 2022 (end of study period). Annual repeat corneal transplantation rates (i.e. second and subsequent transplants) increased from 2004 to 2022, rising 301%. During Australia's nationwide 2020 COVID-19 lockdown (from March to April), monthly transplantation rates decreased by 31%.

Conclusion: We performed a longitudinal analysis of corneal transplantation in Australia using a comprehensive, routinely collected, population-based data source. Prior studies examining corneal transplantation have interrogated data from the Australian Corneal Graft Registry, which relies on voluntary reporting. Corneal transplantation rates have increased during the last 15 years, likely as new corneal transplant techniques have evolved, with increasing demand for corneal donation and eye banking services.

Purpose: To report the design of FLuorometholone as Adjunctive MEdical therapy for TT surgery (FLAME) trial.

Design: Parallel design, double-masked, placebo-controlled clinical trial with 1:1 randomization to fluorometholone 0.1% eye drops twice daily or placebo twice daily for 4 weeks in eyes undergoing trachomatous trichiasis (TT) surgery for assessing the efficacy, safety, and cost-effectiveness of fluorometholone 0.1% in preventing recurrent postoperative trichiasis (PTT).

Methods: Up to 2500 eligible persons with trachomatous trichiasis undergoing lid rotation surgery were enrolled in the Jimma zone, Ethiopia. Participants, surgeons, study field staff, and study supervisors leading operational aspects of the trial are masked to treatment assignment. Randomization is stratified by the surgeon and is simultaneously stratified by the district. Study visits (in addition to programmatic follow-ups) are at the baseline/enrollment, at four-week post-enrollment, and after 6 months and 1 year. The primary outcome is cumulative one-year PTT incidence, defined as: ≥1 lashes touching the globe, evidence of epilation, and/or repeat TT surgery. Secondary postoperative outcomes include the number of trichiatic lashes, location (touching the cornea or not), evidence of post-operative epilation, entropion, changes in corneal opacity, IOP elevation, need for cataract surgery, visual acuity change from the baseline, eyelid contour abnormality, granuloma, eyelid closure defect, and the occurrence of adverse events. Health economic analyses center on calculating the incremental cost per case of PTT avoided by fluorometholone treatment.

Conclusion: The FLAME Trial is designed to provide evidence of the efficacy, safety, and cost-effectiveness of adjunctive topical peri-/postoperative fluorometholone 0.1% therapy with trichiasis surgery, which is hypothesized to reduce the risk of recurrent trichiasis while being acceptably safe.

Clinical trial registration: https://www.clinicaltrials.gov/study/NCT04149210.

Purpose: To estimate the prevalence of vision loss for 2020 in South and Central Asia and analyze trends since 1990.

Methods: In a systematic literature review, we estimated the prevalence of blindness, visual impairment (VI) and presbyopia-related VI in 1990,2000,2010, and 2020.

Results: The study included 103 population-based studies. In South/Central Asia combined, age-standardized prevalence of blindness, moderate-to-severe VI (MSVI), moderate VI, severe VI, mild VI and presbyopia-related VI for all ages was 0.65% (95% uncertainty interval (UI):0.56/0.74), 5.06 (4.55/5.59), 4.40 (3.91/4.94), 0.65 (0.57/0.74), 3.21 (2.89/3.56), and 8.77 (6.37/11.48), respectively, with higher values for women than men. From 2000 to 2020, changes in age-standardized prevalence in South Asia were -36.85 (-36.94/-36.76), -7.01 (-7.13/-6.90), -5.86 (-5.99/-5.73), -13.96 (-14.09/-13.82), -9.55 (-9.66/-9.44), and -8.62 (-8.93/-8.31), respectively for men, and -38.50 (-38.59/-38.40), -10.12 (-10.22/-10.01), -9.23(-9.36/-9.10), -14.86 (-14.99/-14.73), -9.44 (-9.56/-9.33), and -7.78 (-8.09/-7.48), respectively for women. From 2000/2020, the changes in age-standardized prevalence figures in Central Asia were -21.44 (-21.58/-21.30), -2.75 (-2.87/-2.64), -2.17 (-2.30/-2.04), -7.12 (-7.26/-6.99), -5.36 (-5.48/-5.25), and -3.67(-4.02/-3.32), respectively for men, and -21.13 (-21.27/-20.99), -2.70 (-2.81/-2.58), -2.18 (-2.30/-2.05), -6.93 (-7.07/-6.80), -5.03 (-5.14/-4.91), and -2.65 (-3.00/-2.30), respectively, for women. In 2020, 11.94 million (9.98-14.07) and 0.30 million (0.24-0.36) individuals were blind, and 96.22 million (84.12-110.27) and 2.95 million (2.52-3.43) had MSVI in South Asia and Central Asia, respectively.

Conclusions: Despite a higher decrease between 2000 and 2020, the age-standardized prevalence of blindness and MSVI were higher in South Asia than in Central Asia in 2020. The number of people affected increased due to population growth and improved longevity.

Purpose: Several studies suggest that myopia is more frequently observed in first-born compared to later-born children. However, it is unknown whether the prevalence of myopia in alpha birth order differs between only-children and first-borns with siblings.

Methods: In this post-hoc study, we analyzed weighted data from the nationwide, representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) and assessed the relationship between birth order and the prevalence of refractive anomalies in study participants aged 11-17 years (n = 3,429).

Results: Our results showed that there was a significantly higher percentage of self-reported myopia in only-children as compared to first-borns with siblings (34.5% vs 28.2%, p = 0.001). A logistic regression model with myopia as dependent variable and only-child status as independent variable adjusted to age, sex, body-mass index, socioeconomic and migration status confirmed that only-child status was independently and positively associated with myopia (odds ratio = 1.396, 95%-confidence interval = 1.166-1.671, p < 0.001). However, no such relationship was found for hyperopia (p = 0.203).

Conclusions: Myopia, but not hyperopia, was significantly and positively related to only-child status, irrespective of confounders as age, sex, body-mass index, as well as socioeconomic and migration status. Further research is needed to decipher the pathophysiological mechanisms underlying this relationship.