Ophthalmic epidemiology最新文献

Purpose: Refractive errors (REs) are a significant cause of vision impairment and the second leading cause of blindness worldwide. Myopia, hyperopia, and astigmatism are the most prevalent forms. In developing regions, including India, the prevalence and impact of REs, particularly among school-aged children, is profound, affecting their academic performance and overall quality of life.

Methods: This review aimed to consolidate data from studies published post-2018 to provide updated prevalence estimates of REs among Indian school children. Following the PRISMA guidelines, a comprehensive literature search was conducted in May 2024 across four databases: Web of Science, PubMed, Scopus, and Embase. Inclusion criteria focused on cross-sectional studies from India, reporting the prevalence of REs among school-aged children.

Results: Out of 1434 studies, 43 met the inclusion criteria. The overall pooled prevalence of REs was 11% (95% CI: 0.08-0.15). The subgroup analysis showed a slight decline in prevalence post-COVID-19, from 12% to 11%. Prevalence was higher in cycloplegic studies at 12%, compared to 10% in non-cycloplegic. Myopia was the most prevalent RE at 8%, with astigmatism at 3% and hyperopia at 1%. No significant gender differences were found. The meta-regression does not indicate a statistically significant relation between the year of publication and the prevalence of RE.

Conclusion: REs, particularly myopia, pose a significant burden among Indian schoolchildren. Despite the COVID-19 pandemic, the overall prevalence of REs has remained stable. These findings emphasize the need for continued vision screening programs and targeted interventions to reduce the prevalence of uncorrected refractive errors.

Purpose: The aim of this study was to evaluate the myopia correction and its association with mental health problems among rural primary school students in China.

Methods: Using survey data from 17,950 students in 251 rural primary schools, this study examines the association between corrected myopia and mental health problems, as well as academic performance among rural students in China. Vision exams were offered to sample students, and student mental health status was measured using the Mental Health Test (MHT).

Results: The results show that 21.98% of sample students failed the vision screening for myopia. Over 65% of sample students showed some form of anxiety, with 56.86% experiencing learning anxiety and 18.71% experiencing body anxiety. The MHT score of myopic students was higher than that of students with normal vision, indicating that myopic students had worse mental health overall. Correcting myopia with eyeglasses was associated with better mental health, indicated by a lower MHT score (by 0.62 points) when controlling for covariates. Myopic students with high baseline academic performance who wore eyeglasses benefited especially from myopia correction, as they had a lower total MHT score (by 1.77 points) and lower body anxiety score (by 0.49 points, p < 0.05) than their high-performing peers with uncorrected myopia.

Conclusions: These findings suggest that future mental health prevention programs in rural China should focus on reducing the prevalence of myopia and providing eyeglasses to myopic students as potential interventions.

Purpose: To explore the relationship between myopia and green space, and the mediation effects of outdoor time.

Methods: We used large-scale, cross-sectional observational data from Shanghai, China. Participants were aged 3~20 years and underwent visual acuity and non-cycloplegic refraction in 2021. Using GIS-based data on environments surrounding participants' schools and kindergartens, we examined the association between green space (measured by NDVI) and myopia. We employed a logistic mixed-effects model to assess the impact of school-level green environments on individual myopia, reporting odds ratios (OR) and their 95% confidence intervals. Mediation analysis was conducted to explore whether outdoor activity time mediates the relationship between green environments and myopia. Additionally, we conducted age- and gender-stratified analyses and validated the robustness of the model through sensitivity analysis.

Results: Complete case sample sizes were 1,727,709 from 3,399 schools and kindergartens [899,817 (52.082%) boys; mean age 10.065 years (SD: 3.633)]. NDVI within 1000 m of schools was independently associated with lower odds of myopia (OR: 0.299, 95% CI: 0.249 ~ 0.357, p < 0.001), with 2.7% of the total effects attributed to the mediation effects of outdoor time. The effect sizes for NDVI were comparatively more protective in boys and those aged 7~12 years (OR: 0.223, 95% CI:0.156 ~ 0.319, p < 0.001). Sensitivity analysis with a 500-meter NDVI radius and alternative outcome variable of wearing glasses confirmed consistency with the previous results.

Conclusions: This study demonstrates a significant impact of green environments on myopia in children and adolescents aged 3~20 years, revealing the potential mediating effect of outdoor activities. Policymakers should consider implementing intervention measures to enhance green spaces in schools to promote eye-health-friendly environments.

Objective: To investigate associations between coffee and tea consumption with accelerated ageing indexed by retinal age gap.

Methods: The average daily coffee and tea consumption over the past year was obtained using a touchscreen questionnaire. The retinal age gap, the difference between the predicted retinal age and the chronological age, was used as the indicator of accelerated ageing. Linear regression models were applied to examine the associations of coffee and tea consumption with retinal age gap. Restricted cubic spline (RCS) model was utilized to explore potential non-linear associations between coffee and tea consumption (cups/day) with retinal age gaps.

Results: This study included 35,740 participants with a mean age of 56.8 ± 8.03 years, including 19,902 (55.7%) males. Among the participants, 7693 (21.5%) were non-coffee drinkers, and 5164 (14.4%) were non-tea drinkers. After adjusting for demographic covariates, multilinear models found that coffee consumption was not associated with retinal age gaps. However, after these adjustments, tea consumption was associated with a smaller retinal age gap (β = -0.03, 95% CI = -0.04~-0.01, p = 0.006), particularly in those who consumed > 4 cups of tea per day (β = -0.22,95% CI = -0.36~-0.08, p = 0.003). No non-linear regressions between coffee or tea with retinal age gaps were observed in RCS models (P non-linear = 0.329 for coffee, P non-linear = 0.273 for tea; respectively).

Conclusions: Our study identified a significant inverse association between tea consumption and the retinal age gap. This finding suggests that tea intake is a dietary factor linked to biological aging process indexed by retinal age gaps.

Purpose: The increasing global prevalence of high myopia, particularly in East Asia, poses a significant public health concern due to its potential for severe complications. Early detection and patient education are crucial. This study aimed to investigate KAP regarding complications of high myopia among individuals with high myopia in Chongqing, China, and to examine the impact of self-efficacy on these factors.

Methods: This study was conducted at our center from December 11, 2023, to March 31, 2024. Participants completed a KAP questionnaire designed based on relevant literature.

Results: A total of 453 participants were included in the study, with a median knowledge score of 26.00 (interquartile range: 20.00-29.00) out of 39, indicating a moderate level of knowledge. The mean attitude score was 24.08 ± 3.35 out of 30, reflecting generally positive attitudes toward high myopia management. The mean practice score was 24.04 ± 4.56 out of 35, indicating moderate adherence to recommended practices. Structural equation modeling (SEM) revealed a significant positive relationship between knowledge and attitudes (estimate: 0.274522, p < 0.001), with attitudes significantly influencing practices (estimate: 0.822825, p < 0.001). Self-efficacy also exerted a positive but weaker effect on practices (estimate: 0.021341, p = 0.023).

Conclusion: Despite moderate levels of knowledge and practice, the positive attitudes and the significant correlation between higher knowledge and better practices suggest that targeted educational interventions could further improve outcomes. This study underscores the critical role of self-efficacy in enhancing KAP related to high myopia.

Purpose: This study aimed to investigate the progression of myopia in children before and during the COVID-19 pandemic.

Methods: Online databases were searched for original studies reporting changes in the spherical equivalent refraction (SER) and axial length (AL) of children, both before and during the COVID-19 pandemic.

Results: Twelve eligible studies were identified after database search and screening. In all eligible studies, the annual changes in SER and AL were larger during the COVID-19 pandemic than during the pre-pandemic period. The pooled differences in SER and AL before and during the COVID-19 pandemic were -1.25 standard deviation (SD) and 0.27 SD, respectively. Pooled SER difference before and during the COVID-19 pandemic were -1.47 SD for cohorts with 100% children with myopia, -1.03 SD for cohorts with <100% children with myopia, -1.17 SD for cohorts from East Asia, -1.32 SD for cohorts from the other regions, -1.37 SD for younger cohorts, -1.30 SD for older cohorts, -1.79 SD for cohorts with shorter online education time, and -1.39 SD for cohorts with longer online education time.

Conclusion: Home confinement during the COVID-19 pandemic has accelerated the progression of myopia in children, especially in those with myopia or from regions other than East Asia. This systematic review protocol was registered with PROSPERO [CRD420251061387].

Purpose: To evaluate associations between social determinants of health (SDOH) and treatment rates among patients with exudative age-related macular degeneration (exAMD).

Methods: Retrospective cohort study of patients with exAMD utilizing data from the NIH All of Us Research Program. The primary outcome was annual rate of intravitreal injections abstracted from the EHR. Negative binomial regression was used to assess associations between the treatment rate and individual SDOH constructs developed from survey responses among other sociodemographic factors, adjusting for bilateral disease status and follow-up duration. An exploratory factor analysis (EFA) of all SDOH constructs was performed to identify potential latent constructs associated with the primary outcome.

Results: Among sociodemographic factors, Black individuals had significantly lower injection rates (IRR: 0.32, 95% CI: 0.13-0.79) compared to White individuals. When correcting for multiple comparisons, among the SDOH constructs, there were none that were significantly associated with treatment rate. Within the exploratory factor analysis, a factor identified by poor English proficiency, transportation difficulty, rural care access issues, worse health literacy, and provider concordance issues was associated with a significantly decreased rate of treatment (IRR: 0.73, 95% CI: 0.55-0.96), as well as a factor identified by high neighborhood disorder, high loneliness, high perceived health care and everyday discrimination, and high stress (IRR: 0.74, 95% CI: 0.60-0.92).

Conclusions: This study identifies significant racial disparities and SDOH constructs associated with exAMD treatment rates. These findings underscore the complexity of sociodemographic influences on treatment and suggest potential inequities which warrant additional study.

Purpose: The association between central serous chorioretinopathy (CSC) and cardiovascular disease (CVD) risk is debated. We aimed to investigate this link using a novel artificial intelligence (AI)-based retinal biomarker.

Methods: This retrospective study included 109 CSC patients and 1028 non-CSC controls without pre-existing CVD. A validated AI software (Dr.Noon CVD) analyzed retinal images to generate a five-year CVD risk score. We used inverse probability of treatment weighting (IPTW) to balance for age and sex, and compared scores using a weighted t-test and multivariable linear regression.

Results: After IPTW, the mean AI-derived Dr.Noon CVD score was significantly higher in the CSC group than in the control group (32.26 ± 8.09 vs. 29.87 ± 9.92; p = 0.024). In the weighted multivariable regression model, CSC was independently associated with a 2.14-point increase in the Dr.Noon CVD score (p < 0.001) after adjusting for age and gender.

Conclusion: CSC is associated with a higher AI-derived cardiovascular risk score. These findings support the concept of CSC as an ocular manifestation of systemic vascular pathology and suggest that its diagnosis warrants a broader assessment of a patient's cardiovascular health.

Purpose: To compare the patterns of association between two subtypes of open-angle glaucoma, primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG), and systemic cardiovascular, neurologic, and autoimmune conditions in a large sample.

Materials and methods: This cross-sectional study generated propensity score-matched cohorts of patients with and without the above systemic conditions, based on International Classification of Diseases (ICD) encounter diagnosis codes, using the TriNetX platform, containing data from >120 million patients. Patients were matched across age, sex, race, and ethnicity. Cohorts for autoimmune conditions were additionally matched for long-term corticosteroid use. Primary outcomes were odds of either POAG or NTG. OR threshold of significance was defined as >1.1 or <0.9 to improve signal-to-noise ratio.

Results: The only systemic conditions associated with POAG were autoimmune disorders, namely Raynaud's syndrome (OR = 1.15, 95% CI 1.08-1.23), giant cell arteritis (OR = 1.15, 95% CI 1.06-1.24), and Graves' disease (OR = 1.26, 95% CI 1.18-1.34). POAG was not associated with cardiovascular or neurologic conditions. NTG was positively associated with conditions across all three categories of systemic conditions, with stronger positive associations with each condition compared to POAG.

Conclusion: POAG was not associated with cardiovascular or neurological conditions in a very large, propensity score-matched sample, but was positively associated with certain autoimmune conditions. NTG was positively associated with conditions across multiple organ systems. These findings indicate that both glaucoma subtypes likely have multifactorial etiologies of disease, one component of which may be auto-inflammatory.