Ophthalmic epidemiology最新文献

Purpose: With the expansion of neonatal care in sub-Saharan Africa (SSA), an increasing number of premature babies are at risk to develop retinopathy of prematurity (ROP). Previous studies have quantified the cost-effectiveness of addressing ROP in middle-income countries, but few have focused on SSA. This study estimates the cost of a national program for ROP screening and anti-VEGF injection treatment in Rwanda compared to the status quo.

Methods: Medical cost data were collected from King Faisal Hospital in Rwanda (July 2022). Societal burden of vision loss included lost productivity and quality-adjusted life years (QALYs). Published data on epidemiology and natural history of ROP were used to estimate burden and sequelae of ROP in Rwanda. Cost of a national program for screening and treating a one-year birth cohort was compared to the status quo using a decision analysis model.

Results: Cost of ROP screening and treatment was $738 per infant. The estimated equipment cost necessary for the startup of a national program was $58,667. We projected that a national program could avert 257 cases of blindness in the cohort and increase QALYs compared to the status quo. Screening and treatment for ROP would save an estimated $270,000 for the birth cohort from reductions in lost productivity.

Conclusion: The cost of screening and anti-VEGF treatment for ROP is substantially less than the indirect cost of vision loss due to ROP. Allocating additional funding towards expansion of ROP screening and treatment is cost-saving from a societal perspective compared to current practice.

Purpose: To compare the outcomes of ophthalmic surgical emergencies during shelter-in-place (SIP) order with the corresponding period in 2019.

Methods: This retrospective cohort study compared patients presenting to the Bascom Palmer Eye Institute (BPEI) emergency department (ED) who underwent urgent surgery during the SIP period (March 23-May 17, 2020), compared to the same weeks in 2019 (non-SIP). Main outcome measures included symptom-to-ED time, ED-to-surgical decision time, surgical decision-to-operating room (OR) time, ED-to-OR time, and postoperative follow-up time. Secondary outcome measures included travel distance, visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medications.

Results: Seventy-six and 148 patients presented with ophthalmic surgical emergencies in the SIP and non-SIP study periods, respectively. Retinal detachment (RD), acute glaucoma, and open globe injury were the most common diagnoses in both periods. Symptom-to-ED and surgical decision-to-OR times were shorter during the SIP period. SIP patients had comparable preoperative VA but worse postoperative VA compared to non-SIP patients. During the SIP period, RD patients experienced postoperative VA reduction rather than improvement (+0.09 vs. -0.23 logMAR, p = 0.03); glaucoma patients were less likely to reach surgical decision within 24 h (OR 0.16 [95% CI 0.03-0.95]); and globe injuries had longer ED-to-surgical decision time and ED-to-OR time compared to the non-SIP period. Other outcomes were similar between both study periods.

Conclusion: There was reduced volume of ophthalmic surgical emergencies and worse postoperative vision during SIP compared to the non-SIP period, despite shorter symptom-to-ED and surgical decision-to-OR times suggesting minimal delays in seeking or receiving care.

Purpose: Artificial intelligence (AI) has gained significant attention in ophthalmology. This paper reviews, classifies, and summarizes the research literature in this field and aims to provide readers with a detailed understanding of the current status and future directions, laying a solid foundation for further research and decision-making.

Methods: Literature was retrieved from the Web of Science database. Bibliometric analysis was performed using VOSviewer, CiteSpace, and the R package Bibliometrix.

Results: The study included 3,377 publications from 4,035 institutions in 98 countries. China and the United States had the most publications. Sun Yat-sen University is a leading institution. Translational Vision Science & Technology"published the most articles, while "Ophthalmology" had the most co-citations. Among 13,145 researchers, Ting DSW had the most publications and citations. Keywords included "Deep learning," "Diabetic retinopathy," "Machine learning," and others.

Conclusion: The study highlights the promising prospects of AI in ophthalmology. Automated eye disease screening, particularly its core technology of retinal image segmentation and recognition, has become a research hotspot. AI is also expanding to complex areas like surgical assistance, predictive models. Multimodal AI, Generative Adversarial Networks, and ChatGPT have driven further technological innovation. However, implementing AI in ophthalmology also faces many challenges, including technical, regulatory, and ethical issues, and others. As these challenges are overcome, we anticipate more innovative applications, paving the way for more effective and safer eye disease treatments.

Purpose: To assess the efficacy and safety of repeated low-level red-light (RLRL) therapy in controlling myopia progression among multi-ethnic school-aged children. This report focuses on interim three-month data analysis.

Methods: A multi-ethnic, parallel controlled randomized trial. Thirty-four children aged 8-13 years with myopia were enrolled. Participants were randomly assigned to the RLRL group (n = 17) or the single-vision spectacles (SVS) control group (n = 17). RLRL therapy was administered twice daily on weekdays for three-minute sessions, while the SVS group continued routine activities. Assessments were scheduled at baseline and follow-up visits at one, three, six and 12 months, with compliance monitoring and safety assessments throughout. Respectively the primary outcome and a key secondary outcome are axial length (AL) change and cycloplegic spherical equivalent (SE) change.

Results: A total of 32 (94.1%) participated in the three-month follow-up visit. The RLRL group demonstrated a significant shortening in AL ( - 0.06   ±   0.05 mm) compared to the SVS group (0.02   ±   0.06 mm, p < 0.001). Similarly, the RLRL group demonstrated a reversal in SE (0.23   ±   0.18 D), whereas the SVS group exhibited a smaller increase (0.04   ±   0.43 D). No severe adverse events were reported in either of the groups.

Conclusions: The three-month interim analysis shows that RLRL therapy effectively controls myopia progression among multi-ethnic children without safety concerns, suggesting its potential as a globally applicable solution for myopia control.

Purpose: Previous studies have shown a conflicting association between body mass index and myopia. This study aimed to analyze the possible association between Body Mass Index (BMI) and myopia in the observational design and genetic evidence.Methods: In the observational investigation, 5,710 participants (12-25 years) from the 2001-2006 National Health and Nutrition Examination Survey (NHANES) were included. Weighted logistic regression models, restricted cubic spline (RCS) and stratified analysis were conducted in the NHANES. A two-sample Mendelian Randomization (MR) study using Genome-Wide Association Studies (GWAS) summary statistics and GWAS catalog was performed. The inverse-variance weighted (IVW) method was used as the main analysis method, and the sensitivity analysis was performed to detect pleiotropy and heterogeneity bias.Results: In the fully adjusted model, individuals with obesity had a higher risk of myopia [OR = 1.253, 95% CI= (1.049, 1.496), p = 0.014] and mild and moderate myopia [OR = 1.305, 95% CI= (1.094, 1.558), p = 0.004]. BMI was correlated with refractive spherical equivalent and showed a linear relationship (P for nonlinearity = 0.468, p = 0.002,β=-0.016). In males, obesity had an association with myopia, while there was no statistical significance in females. In the subgroup with an education level of < 9th Grade, obesity and myopia exhibited consistent results. Two-sample MR showed that obesity had no statistically significant with myopia and refractive error.Conclusions: This study suggests that the associations between BMI and the risk of myopia differ based on gender and education levels in an observational study, while there are no associations in genetic evidence.

Purpose: Prompted by the clinical concern that limited healthcare resources allocation affects physicians' research productivity, this study examines the association between bibliometric indices of ophthalmologic research and national economic indicators in Organisation for Economic Co-operation and Development (OECD) countries.

Methods: The Scimago Journal and Country rank source was searched for research productivity data in ophthalmology among OECD countries between 1996 and 2019. Bibliometric indices included: documents number, number and percent of citable documents, citations number, citations per document, and H-index. The updated economic indicators of each country (gross domestic product [GDP] per capita, health spending as percent of GDP (health expenditure), gross domestic expenditure on research, and development as percent of GDP [GERD]) were collected from the World Bank and the OECD websites. Correlation between economic and bibliometric metrics and multivariate linear regression analyses were performed.

Results: Among 267,444 documents analyzed, correlation analysis found a strong correlation between health expenditure and H index (r = 0.711, p < 0.001); a moderate correlation between health expenditure and documents number (r = 0.589, p < 0.001), number of citable document (r = 0.593, p < 0.001) and citations number (r = 0.673, p < 0.001); and a moderate correlation between GERD and H index (r = 0.564, p < 0.001). Multivariate regression analysis controlling for economic factors, population and language showed the independent association of these parameters with bibliometric indices.

Conclusions: This study demonstrates a positive correlation between bibliometric indicators of ophthalmology research and economic factors, particularly health expenditure, among the OECD countries. Our results suggest an advantage of domestic investment in health to expand academic productivity in the field of ophthalmology.

Purpose: This study investigated the relationship between near work hours and myopia in Korean adults.

Methods: We used data from the 2021 Korean National Health and Nutrition Examination Survey. Associations between near work time, physical activity, and myopia were assessed using chi-square tests and multiple logistic regression analyses.

Results: The overall prevalence of myopia was 60.2% in adults aged 19-59 years. The prevalence of myopia was 46.2% for individuals who used smart devices for less than one hour per day, while it was 68.0% for those who used smart devices for more than four hours. In the multiple logistic regression analysis, the odds ratio (OR) for myopia was significantly higher among individuals using smart devices for 3 hours (OR = 1.55, 95% CI = 1.08-2.23) or more than 4 hours (OR = 1.75, 95% CI = 1.27-2.42), compared to users with less than 1 hour of usage. Regarding sitting time, the OR for myopia was significantly higher in individuals who sat for more than 12 hours (OR = 1.66, 95% CI = 1.05-2.61) compared to those who sat less than 4 hours.

Conclusion: This study found that near work and sitting times were positively associated with myopia. Given the high prevalence of myopia and its implications for serious eye diseases, it is essential to implement measures to manage myopia. Considering the increased near work hours resulting from the COVID-19 pandemic, it is necessary to adopt supplementary measures, such as ensuring sufficient rest time for the eyes and adjusting the brightness of lights, to improve eye health.

Purposes: To determine the relationship between carotid artery stenosis (CAS) and the development of open-angle glaucoma (OAG) in the Taiwanese population.

Methods: This retrospective cohort study was conducted using Chang Gung Research Database. Cox-proportional hazards model was applied to calculate the hazard ratio for OAG between CAS and the control cohort.

Results: Among 19,590 CAS patients, 17,238 had mild CAS (<50%), 1,895 had moderate CAS (50-69%), and 457 had severe CAS (≥70%). The CAS cohort had a higher proportion of several comorbidities. After adjusting for comorbidities, no significant difference in OAG development was found between CAS and control cohorts. Matching for key comorbidities, no significant differences in OAG incidence were found between matched cohorts (P = .869). Subdividing the matched CAS cohort by stenosis severity: mild (<50%), moderate (50-69%), and severe (≥70%), a statistically significantly lower OAG risk was observed in patients with mild CAS stenosis (HR: 1.12, 95% CI = 1.03-1.21, P = .006). Kaplan-Meier analysis revealed reduced OAG incidence in CAS patients who underwent surgical intervention, compared to the control cohort (P <.001). Subgroup analysis revealed that patients in the mild CAS stenosis group, those who underwent surgical intervention exhibited a reduced OAG risk (HR: 0.29, 95% CI = 0.15-0.58, P = .001).

Conclusions: No statistically significant differences in OAG risk were observed between patients with CAS and the control cohort. The severity of CAS appears to influence OAG risk, with surgical intervention potentially offering protective effects, particularly in patients with mild CAS stenosis (<50%), suggesting that enhanced ocular perfusion post-surgery may act as a protective factor against OAG development.

Purpose: To elicit associations between vision difficulties and physical or psychosocial challenges in children in the United States.

Methods: Children aged 2-17 years old from the 2021 National Health Interview Survey with data pertaining to vision difficulty were included in our retrospective, population-based analysis. Our primary aim was investigating physical and psychosocial challenges as predictors of vision difficulty. Logistic regression models were performed on Stata version 17.0 (StataCorp LLC, College Station, Texas). Analyses were accompanied by an odds ratio (OR) and 95% confidence interval (CI).

Results: A total of 7,373 children had data pertaining to their level of vision difficulty and were included in our sample. In our multivariable analysis, children with a good/fair (OR = 1.84, 95% CI = [1.31, 2.60], p < 0.01), or poor (OR = 5.08, 95% CI = [1.61, 16.04], p < 0.01) general health status had higher odds of vision difficulty relative to children with an excellent/very good health status. Furthermore, children with difficulties hearing (OR = 8.67, 95% CI = [5.25, 14.31], p < 0.01), communicating (OR = 1.96, 95% CI = [1.18, 3.25], p < 0.01), learning (OR = 1.93, 95% CI = [1.27, 2.93], p < 0.01), and making friends (OR = 1.94, 95% CI = [1.12, 3.36], p = 0.02) had higher odds of vision difficulty. Nonetheless, the following factors were only predictors of vision difficulty in our univariable analysis: requiring equipment for mobility (p < 0.01), experiencing anxiety (p < 0.01), and experiencing depression (p < 0.01).

Conclusion: Several factors pertaining to physical and psychosocial challenges in children are associated with vision difficulty. Future research should further explore potential causal links between vision difficulty and physical or psychosocial factors to aid in coordinating public health efforts dedicated to vision health equity.

Purpose: Racial and ethnic minorities have a higher prevalence of diabetic retinopathy (DR) and present at advanced stages of disease. In an urban hospital population, we investigated microvascular differences in optical coherence tomography angiography (OCTA) between racial/ethnic groups while adjusting for socioeconomic status (SES).

Methods: 3 × 3 mm² macular OCTA scans were obtained for analysis of foveal avascular zone (FAZ) area, FAZ perimeter as well as superficial (SCP) and deep capillary plexus (DCP) vessel density (VD), vessel length density (VLD), and adjusted flow index (AFI). SES was measured using the Area Deprivation Index. Multivariable regression models were used to adjust estimates for relevant confounders.

Results: 217 non-diabetic and 1,809 diabetic patients were included in the study, consisting of 42.2% Hispanic, 24.9% non-Hispanic (NH) Asian, 6.8% NH Black, 9.7% NH White and 16.3% Other patients. NH White was used as the reference group. Hispanic, NH Asian, and NH Black patients had significantly greater FAZ areas and FAZ perimeters, and lower DCP VD and VLD, among both non-diabetic and diabetic patients (Benjamini-Hochberg adjusted P-values <0.05). The addition of SES scores in the models did not modify any regressions significantly.

Conclusions: In patients with and without diabetes, racial and ethnic minorities have significant retinal microvasculature differences when compared to NH White patients, regardless of SES. These differences are pronounced in DCP and may predispose racial/ethnic minorities to worse outcomes in DR, thus widening disparities in ophthalmic care.