Ophthalmic epidemiology最新文献

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.

Purpose: There is limited cost-effectiveness evidence of primary eye health strategies in low-and-middle-income countries, despite their importance for addressing vision loss. This study examines fixed and mobile primary eye health services in Guatemala to identify which delivers greatest cost-effectiveness.

Methods: Using financial records of a large eye health provider, we conduct a retrospective micro-costing and economic modelling analysis of five primary eye health approaches. We report total costs, case finding cost-effectiveness, and incremental cost-effectiveness ratios (ICERs) for each strategy from a provider perspective over the period 2019-2021. Probabilistic sensitivity analysis is conducted.

Results: Permanent facilities require $71.7 and $116.8 (2023 USD) to diagnose a case of refractive error and cataract respectively, and convert the patient to treatment. Case finding costs per treatment initiated for mobile approaches range from $7.7 to $21.6 per case of refractive error, and $13.3-$14.9 per case of cataract. Health outpost screening has an ICER of $245 per DALY averted (95% CI: 160-362). The ICER of community screening is $233 per DALY averted (95% CI: 134-316). The remaining strategies are dominated.

Conclusion: Mobile approaches are substantially more cost-effective at case finding, due to the increased utilization of resources made possible by a mobile operating model. When considering both case finding and downstream treatment costs, community and health outpost screening dominate other strategies. The results point to the need for careful analysis of costs and outcomes along the entire continuum-of-care to appropriately inform planners of primary eye health networks in low-and-middle-income countries.

Purpose: To review the efficacy of dichoptic and monocular strategies for treating monocular amblyopia, and to examine the factors that determine the degree of recovery from amblyopia.

Methods: Mean and individual participant data (IPD) from studies that used either monocular or dichoptic training methods to treat monocular amblyopic patients were analyzed. A mixed-effects model was used to analyze influential factors. Studies were searched using PubMed, OVID, Cochrane library, and EBM reviews.

Results: The mean improvements in visual acuity (VA) for dichoptic and monocular training were 0.153 logMAR and 0.162 logMAR, respectively. In the dichoptic training subgroup, the mean VA improvements were 0.201 logMAR, and 0.145 logMAR for strabismic and anisometropic amblyopia, respectively. In the monocular training subgroup, the mean VA improvements were 0.171 logMAR, and 0.143 logMAR for strabismic and anisometropic amblyopia, respectively. The mean improvements in stereopsis of dichoptic training and monocular training were 1.201 octaves and 1.661 octaves, respectively. Baseline visual acuity of the amblyopic eye and training duration were significant factors influencing visual gains. We found no significant impacts of age, astigmatism, and baseline stereopsis on visual acuity and stereopsis outcomes.

Conclusions: This IPD meta-analysis provides evidence that both monocular and dichoptic training yield different visual acuity outcomes in treating unilateral amblyopia. Subgroup analysis suggests that strabismic amblyopia may respond differently to dichoptic training. Baseline visual acuity of the amblyopic eye and training duration are significant factors influencing visual gains. We believe that a more personalized training program could help restore binocularity in patients with monocular amblyopia.

Objective: To screen influencing factors of dry eye and evaluate a new diagnosis and treatment model combining tertiary hospitals with community health management.

Methods: A total of 500 community residents from two Chinese hospitals between January - September, 2023 were included. Dry eye was diagnosed based on the presence of typical symptoms, an OSDI score > 13, a tear film break-up time (BUT) < 10 seconds, and/or a Schirmer I test (SIT) result < 10 mm/5 min, following the 2020 Chinese Dry Eye Expert Consensus. Diagnosed patients were randomized into a management group (community health management) and a control group (self-management). Both received standardized hospital treatment for six months. Disease cognition, symptom improvement, psychological state, eye comfort, satisfaction, and quality of life were compared.

Results: Dry eye prevalence was 26.40% (132/500). Univariate analysis identified age, sex, drug use, connective tissue disease, laser corneal surgery, vitamin A deficiency, hepatitis C, mite infection, anxiety, depression, sleep disorder, and diabetes as influencing factors (p < 0.05). After six months, the management group showed better disease cognition, improved BUT and SIT, and lower OSDI scores than the control group (p < 0.05). SAS and SDS scores were lower, and VAS scores were reduced, while GQLI and management satisfaction were higher (p < 0.05).

Conclusion: Factors such as drug use, laser surgery, vitamin A deficiency, hepatitis C, mite infection, and psychological and metabolic conditions influence dry eye. A combined hospital-community management model improves symptoms, psychological well-being, disease awareness, quality of life, and treatment satisfaction.

Purpose: The study aimed to compare corneal topographic and specular microscopic parameters before and after vaccination with activated (Pfizer -BioNTech (BNT162b2)) SARS-CoV-2 mRNA vaccine.

Methods: 128 eyes of 64 patients were evaluated in this prospective study. The time interval between pre and post-vaccination examinations was nearly two and a half months (75.6 ± 4.5 days).The topographic evaluation was made with Sirius corneal topography (Sirius, CSO Inc, Florence, Italy) and specular microscopy was made with Tomey EM-4000 specular microscopy (Tomey GmbH, Japan). All patients underwent detailed ophthalmologic examination including best-corrected visual acuity assessment (BCVA), measurement of intraocular pressure (IOP), anterior segment evaluation with biomicroscopy, and dilated fundus examination.

Results: The significant change in the topographic evaluation was the post-vaccine (542.0 (534.25-548.0)) increase in central corneal thickness compared to pre-vaccine values (528.0 (520.25-537.75) (p = 0.001). The endothelial cell density (ECD) was 2597 (2550.0-2646.50) before vaccination and 2378.0 (2299.0-2419.0) at least two months after vaccination (p < 0.001). The median mean coefficient of variation (CV) value was 39.0(38.0-42.0) before vaccination measurements and 42 (40-44) after vaccination measurements (p < 0.001). The mean hexagonality was 50.0 (48.25-52.0) before vaccination and 48(46-49) after vaccination (p < 0.001).The median central corneal thickness (CCT) value was 533(526-538) before vaccination and 548 (543.50-556) after vaccination (p < 0.001).

Conclusion: Changes in corneal endothelium occur in the short term after two-doses of the Pfizer-BioNTech (BNT162b2) COVID-19 mRNA vaccine. Hence the endothelium should be closely monitored in those with a low endothelial count or who have had a corneal graft.