Ophthalmic epidemiology最新文献

Purpose: To assess burden of blindness and visual impairment (VI) in Sub-Saharan Africa (SSA) as of 2020, the planned end point of the Vision 2020 program.

Methods: A systematic review and meta-analysis assessed burden, in the better eye, of blindness (presenting distance visual acuity, VA < 3/60), moderate and severe vision impairment (MSVI; VA < 6/18 but ≥ 3/60) and mild vision impairment (VA < 6/12 and ≥ 6/18); and also functional presbyopia (

Results: In 2020, an estimated 5,083,000 people (95%Uncertainty Interval, UI, 4,474,000-5,696,000) in SSA were bilaterally blind; 20442,000 more (95%UI 18,568,000-22,430,000) had MSVI. The age-standardized prevalence of blindness in SSA is the highest for any GBD super-region, nearly double the world average (0.99%, 95%UI, 0.85-1.12; vs 0.52%, 95% UI, 0.46-0.59 respectively). The Western (4.15%) and Eastern (3.79%) SSA sub-regions had the highest age-standardized prevalence of blindness for the 50+ age group amongst SSA sub-regions. Improvement in age-specific prevalence since 2000 was less than the Vision 2020 target (-25%) for all subcategories of VI; improvement in blindness was the only category close to the goal (about 80-100% of goal across SSA sub-regions).

Conclusions: The SSA age-specific prevalence of VI has generally improved since 2000, especially for blindness. However, the number of VI cases has increased with population growth and aging, and Vision 2020 targets were not met. Because most causes of VI require individual-level clinical care, large increases in training and eye care delivery systems development/financing are critical areas of focus.

Purpose: In the UK, people are certified as severely sight impaired (SSI) or sight impaired (SI) according to Government guidelines. Certification ensures people with visual impairments can access adequate support and benefits. Certification of visual impairment data has been collected and analysed in Northern Ireland by a team and full continuous data is available from 2014 to 2023.Methods: Data from certification forms was collected, entered into an Excel spreadsheet, and 10% was validated by the certification of visual impairment team. This data was collated, cleaned and analysed using IBM SPSS (version 27) for frequency, mean, median and interquartile ranges.Results: Results show that over a 10-year period (2014-2023) the number of certifications in Northern Ireland has increased to a point where they are aligned with figures from other regions of the United Kingdom (UK). Results show that more people are certified as SSI than SI in Northern Ireland (NI) which is in contrast to figures reported in England and Wales. More females are certified than males in NI. Similarly to England and Wales, the most common cause of certification of visual impairment in adults in NI is Age-Related Macular Degeneration, accounting for around 50% of certifications annually. The second most common cause is glaucoma followed by diabetic eye disease (DED). In working age adults, DED is the leading cause of certification.Conclusion: The results from 10 years of certification data in NI show common themes with other high-income countries, including increased certification, particularly among females, and the most common causes of certification remain AMD, glaucoma and DED.

Purpose: To assess the impact of social determinants of health (SDoH) and clinical factors on visual impairment (VI) at initial presentation to academic centers in cataract patients.

Methods: Multi-institutional cross-sectional study. We identified patients aged ≥40 years with cataract diagnosis using ICD-9 and ICD-10 codes from the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Data Repository. Best-recorded vision (BRV) at initial presentation, demographics, Charlson comorbidity index (CCI), cigarette smoking status, and Distressed Community Index (DCI) were recorded. BRV in the better eye was used to categorize VI as none/mild (BRV ≥20/40), moderate (20/40 < BRV < 20/200), and severe (BRV ≤ 20/200). Logistic regression models were used to assess the impact of clinical and sociodemographic factors on moderate and severe VI.

Results: Among 137,847 patients with a mean (SD) age of 67.4 (9.1), 58.6% (N = 77,425) were White, 22.5% (N = 29,725) were Black, and 8.8% (N = 11,562) were Hispanic/Latino. Adjusted logistic regression revealed Black patients (OR: 1.16; CI: 1.11-1.22), Native American patients (OR: 1.45; CI: 1.18-1.78), non-English speaking patients (OR: 1.79; CI: 1.69-1.91), and current smokers (OR: 1.29; CI: 1.22-1.37) had higher odds of severe VI. Higher DCI quintiles (more economically distressed) were associated with severe VI compared with the 1st (Prosperous) quintile: 2nd (OR 1.22; 95% CI 1.16-1.27), 3rd (OR 1.45; 95% CI 1.38-1.52), 4th (OR 1.56; 95% CI 1.47-1.64), and 5th (OR 1.36; 95% CI 1.29-1.44) quintiles.

Conclusions: This is one of the largest studies examining the impact of DCI on cataract related VI, highlighting the need for interventions to improve access to healthcare and prevent VI in these communities.

Purpose: To investigate current trends in corneal transplantation in South Korea by integrating data from the Korean Ophthalmological Society (KOS) and Eversight Eye Bank, focusing on surgical preferences, donor demographics, and evolving practices between 2021 and 2023.

Methods: This retrospective epidemiological study reviewed data from annual KOS surveys of government-registered transplantation centers and records from the Eversight Eye Bank. Surgical categories included penetrating keratoplasty (PKP), anterior lamellar keratoplasty (ALK), Descemet's stripping automated endothelial keratoplasty (DSAEK), Descemet's membrane endothelial keratoplasty (DMEK), and keratolimbal allograft (KLA). Variables collected included types of surgery, donor demographics, sources of donor corneas, time from death to corneal preservation, and endothelial cell density (ECD). For endothelial keratoplasty (EK), additional graft-specific parameters were collected, including graft diameter, thickness, preloading status, and loading materials.

Results: A total of 2636 corneal transplantations were identified. While PKP remained most commonly performed procedure (49.5% in 2023), the proportion of EK steadily increased. DMEK nearly doubled from 8.4% in 2021 to 15.2% in 2023. The proportion of imported donor tissue rose, reaching 74.5% by 2023. Donor age was significantly higher for DMEK (60.9 ± 6.0 years) than for PKP (48.0 ± 14.1 years) or DSAEK (50.7 ± 12.9 years). There was a clear trend toward greater use of preloaded grafts, smaller diameters, and novel loading techniques.

Conclusion: Corneal transplantation in South Korea is shifting toward EK, especially DMEK, driven by limited domestic donations and changes in surgical preferences. These findings highlight the importance of enhancing local donation systems and maintaining robust data infrastructure to guide policy and clinical decision-making.

Purpose: To quantify the global burden of glaucoma in adults aged 55 and older from 1990 to 2021 and project trends through 2036, providing evidence to guide future prevention and management strategies.

Methods: Using data from the Global Burden of Disease (GBD) 2021 study, we evaluated the burden of glaucoma via case counts, age-standardized prevalence, disability-adjusted life years (DALYs) rate, and annual percentage change. Cluster analysis identified key risk factors and temporal patterns, while Bayesian age-period-cohort (BAPC) models were applied to forecast future trends.

Results: Globally, the number of glaucoma cases in adults aged ≥55 rose from 3.97 million (95% uncertainty interval [UI]: 3.39-4.67 million) in 1990 to 7.42 million (95% UI: 6.37-8.74 million) in 2021. However, both age-standardized prevalence and DALYs rates declined, with average annual percentage changes of -0.83% (95% UI: -0.85 to -0.80) and -1.26% (95% UI: -1.22 to -1.00), respectively. The burden was higher in older males and inversely correlated with the Sociodemographic Index (SDI). BAPC projections suggest a continued decline in global prevalence among older adults through 2036.

Conclusion: While global age-standardized prevalence and DALYs rates for glaucoma have declined since 1990, the absolute number of cases continues to rise. Targeted interventions should prioritize high-risk groups and underserved regions, particularly older men and low SDI regions, respectively.

Purpose: Ocular trauma is a leading cause of visual impairment, with work-related incidents representing a substantial yet preventable portion. Using nationwide data from regional trauma centers, this study compared work-related and non-work-related ocular trauma cases to identify injury mechanisms and high-risk groups of vision loss.

Methods: This retrospective cross-sectional study compared work-related and non-work-related ocular injuries in adults, excluding superficial cases, from the Korea Trauma Data Bank (2017-2023). Diagnostic codes were categorized into three risks of vision loss tiers using a modified Delphi expert consensus. Risk factors for vision loss and surgical intervention were identified via multivariable logistic regression.

Results: This study analyzed 10,272 adults with ocular trauma. Work-related trauma comprised 24.0% (N = 2,470) of cases, which were predominantly males (96.4%) aged 40-64 years (64.0%). Non-work-related trauma (N = 7,802) was more prevalent among females (25.0%) aged 65 years or older (30.6%). In the work-related group, non-Korean individuals had a significantly higher risk of vision loss (adjusted Odds Ratio [aOR] 1.73; 95% confidence interval [CI] 1.20-2.50). Cutting or piercing injuries and burns were the strongest predictors of vision loss in both groups, especially the work-related trauma group (aOR 74.73, 95% CI 33.37-167.36).

Conclusions: Cutting or piercing accidents and burns were identified as high-risk accident types for vision loss, highlighting the need for strengthened safety measures to prevent these hazardous events. There was an elevated risk for work-related trauma among non-Korean individuals, as well as for non-work-related trauma among older adults, highlighting the need for targeted safety policies and training.

Purpose: Integrated delivery networks (IDNs) enhance care for patients with diabetes by improving communication between specialists who perform eye examinations and primary care providers (PCPs). In this study, we aimed to identify factors associated with receiving eye care outside of an IDN and evaluate how leakage affects coordinated diabetes management.

Methods: The study included 1,139 patients aged 18-75 with diabetes who received primary care in an IDN and had health insurance coverage provided by an accountable care organization (ACO). Claims data were reviewed to determine the rate at which completed eye examinations were communicated to PCPs. Patient demographic and biometric factors were analyzed using logistic regression to investigate their association with completion of an eye examination out-of-network.

Results: A total of 772 patients completed eye examinations, 37% elected to do so out of network. Patients who received out-of-network eye care were less likely to have good glycemic control (A1c < 8.0%: 70.4% vs. 79.2%, p = 0.008), more likely to have poor glycemic control (A1c > 9.0%: 14.3% vs. 8.0%, p = 0.009), and had fewer documented diabetes-related complications (diabetic retinopathy: 7.7% vs. 17.3%, p < 0.001). Whereas all eye examinations completed within network were available through the electronic health record (EHR), fewer than three-quarters of eye examinations completed outside network were communicated back to PCPs (100% vs. 74%, p < 0.001).

Conclusion: Ophthalmologists practicing outside of IDNs need to strengthen communication of eye examination results, particularly for patients at risk of complications from poorly-controlled diabetes.

Purpose: Cataracts are a leading cause of blindness treatable with surgery. The purpose of this retrospective study was to investigate the association between cataract surgery and race/ethnicity, socioeconomic status, healthcare access, and other factors related to social determinants of health.

Methods: A total of 37,204 participants with at least one cataract diagnosis were included in this study from the All of Us Research Program using electronic health records and self-reported surveys. Kaplan-Meier and Cox models assessed risk factors for cataract surgery, while summary statistics showed surgery rates by age, race, and gender. The primary outcome was cataract surgery, identified by Current Procedural Terminology (CPT) codes.

Results: Of the included participants, 19.8% (N = 7,363) underwent cataract surgery. The overall cataract surgery rate for this cohort was 30.6 per 1000 person-years and was significantly higher for persons who were 70-79 years old (58.5 per 100 persons-years), male (31.8 per 1000 person-years), or Hispanic (39.0 per 100 person-years). Non-Hispanic Black participants had the lowest cataract surgery rate (24.4 per 1000 person-years). Cox models demonstrated an increased hazard of undergoing cataract surgery among Hispanic participants (adjusted HR 1.31; 95% CI [1.21, 1.42]) compared to non-Hispanic White participants. A decreased hazard for undergoing cataract surgery was observed for non-Hispanic Black participants (adjusted HR 0.88, 95% CI [0.81,0.95]) compared to non-Hispanic White participants.

Conclusions: Age, race/ethnicity, and sex were significantly associated with time from cataract diagnosis to first cataract surgery. These findings highlight barriers and disparities in cataract surgery, emphasizing the need for interventions to promote health equity.

Purpose: This study investigated the epidemiology of motor vehicle accident (MVA) related eye injuries presenting to the United States (US) emergency departments (EDs) from 2000 to 2020.

Methods: The National Electronic Injury Surveillance System - All Injury Program (NEISS-AIP) gathers information from 66 participating US EDs for nonfatal injuries. We queried NEISS-AIP for MVA-related eye injuries from 2000 to 2020, and collected data on diagnosis, mechanism of injury, and patient demographics. Non-ocular injuries were collected from 2018 to 2020. We extrapolated national estimates using the NEISS-AIP weighting system. Rates/10,000 people and 10,000 licensed drivers were calculated using annual US Census and US Department of Transportation data. Case review and analysis was conducted in January 2024.

Results: From 2000 to 2020, an estimated 224,231 (95% confidence interval [CI] 215,247-233,217) MVA-associated eye injuries presented to US EDs. The rate of injuries declined during this period (0.34/10,000 people - 0.27/10,000 people). Males accounted for 62.8% of injuries; most patients were White (47.7%, rate of 5.6/10,000 people), or Black/African American (17.8%, rate of 10/10,000 people). The highest rate of injury per population occurred in American Indian/Alaska Natives (11.3/10,000 people). The highest rates of ED visits were for ages 20-24 years (30,030 cases, CI: [26,791-33,269], rate of 13.5/10,000 people). The leading ocular diagnoses were contusions/abrasions (59.3%). Most patients were treated and discharged (93.9%). Between 2018 and 2020, the leading systemic injury was contusions/abrasions (26%) to the face (estimated 4026, CI: [2942-5110]).

Conclusion: Rates for MVA-related eye injuries decreased from 2000 to 2020. Vulnerable populations including adolescents and American Indian/Alaska Natives remain at increased risk for MVA-related eye injuries.

Purpose: Dietary intake of nutrients seems to play a role in the prevention of age-related macular degeneration (AMD). It may be worthwhile to identify certain nutrients that are highly related to AMD when consumed in small amounts. This study aims to evaluate the association between nutritional intake and risk of AMD.Methods: A population-based cross-sectional study analyzed data from the Korean National Health and Nutrition Examination Survey (KNHANES) between 2010 and 2011, involving 6,471 participants aged 40 years or older. The presence and severity of AMD were graded using fundus photography. Multivariable regression analysis was employed to assess the association between dietary intake and AMD risk.Results: The prevalence of AMD among 6,471 participants was 8.9% (576 cases), comprising 8.2% (531) with early AMD and 0.7% (45) with late AMD. Multivariable-adjusted analyses revealed that, among obese individuals (body mass index ≥25), men with AMD had significantly lower intakes of fiber, ash, calcium, potassium, thiamin, and vitamin C compared to those without AMD (all p < 0.05). In obese women, AMD showed a significant association with lower intakes of protein, vitamin A, and carotene (all p < 0.05).Conclusions: An insufficient intake of certain nutrients was associated with an increased likelihood of AMD in obese individuals. Larger prospective cohort studies are needed to investigate the relationship between specific nutrients and the risk of AMD.