Ophthalmic epidemiology最新文献

Purpose: Observational studies have suggested a link between coronavirus disease 2019 (COVID-19) and increased risk for primary angle-closure glaucoma (PACG). However, these studies may be influenced by bias. We explored the potential causal relationship between host susceptibility to COVID-19 and its severity, and the risk for developing PACG.

Methods: Summary statistics for COVID-19 susceptibility and severity were obtained from the COVID-19 Host Genetics Initiative and utilized as exposure data. Single nucleotide polymorphisms linked to PACG were sourced from the FinnGen project and the VA Million Veteran Program as outcomes. We employed the inverse-variance weighted (IVW) method to investigate the causal relationships between COVID-19 and PACG. A thorough sensitivity analysis was performed to assess the robustness of the identified associations.

Results: Hospitalized COVID-19 showed a significant association with an increased risk for PACG, both in the FinnGen project (odds ratio [OR] = 1.22; 95% confidence interval [CI] = 1.07-1.40; p = 0.003) and the VA Million Veteran Program (OR = 1.08; 95% CI = 1.01-1.16; p = 0.021). Confirmed very severe respiratory COVID-19 was also significantly linked to PACG risk in the FinnGen sample (OR = 1.15; 95% CI = 1.04-1.27; p = 0.006). However, no such association was found in COVID-19 susceptibility in either PACG sample.

Conclusion: Our findings suggest a potential link between severe COVID-19 and increased risk for PACG. This underscores the importance of early screening and proper management of glaucoma in individuals with severe COVID-19.

Purpose: It is difficult to explain the complications of surgery to patients. Care has to be taken to convey the facts clearly and objectively while expressing concern for their wellbeing. This study compared responses from surgeons with responses from a large language model (LLM)-based chatbot.

Methods: We presented 10 common scenarios of cataract surgery complications to seven senior surgeons and a chatbot. The responses were graded by two independent graders for comprehension, readability, and complexity of language using previously validated indices. The responses were analyzed for accuracy and completeness. Honesty and empathy were graded for both groups. Scores were averaged and tabulated.

Results: The readability scores for the surgeons (10.64) were significantly less complex than the chatbot (12.54) (p < 0.001). The responses from the surgeons were shorter, whereas the chatbot tended to give more detailed answers. The average accuracy and completeness score of chatbot-generated conversations was 2.36 (0.55), which was similar to the surgeons' score of 2.58 (0.36) (p = 0.164). The responses from the chatbot were more generalized, lacking specific alternative measures. While empathy scores were higher for surgeons (1.81 vs. 1.20, p = 0.041), honesty scores showed no significant difference.

Conclusions: The LLM-based chatbot gave a detailed description of the complication but was less specific about the alternative measures. The surgeons had a more in-depth understanding of the situation. The chatbot showed complete honesty but scored less for empathy. With more training using complex real-world scenarios and specialized ophthalmologic data, the chatbots could be used to assist the surgeons in counselling patients for postoperative complications.

Purpose: Early detection of visual disorders in children and related factors is important to minimize future problems in academic performance and social life. The present study aimed to determine the prevalence of vision problems among school-entering children, and their association with socio-demographic characteristics.

Methods: A population-based cross-sectional study was conducted in Qazvin province between June and November 2023. The research participants were school-entering children and their parents recruited using random quota multi-stage sampling. Data were collected by interviewing parents including demographic characteristics, children's vision status, family history of vision problems, and daily hours of using the internet and/or playing videogames by children. Data were analyzed using multivariate multi-nominal logistic regression.

Results: A total of 5141 parents of school-entering children participated. The prevalence of wearing glasses and suspected visual impairment was 2.2% and 6.7%, respectively. The odds of using eyeglasses among boys was 38% lower than among girls (p = 0.014). The odds of using eyeglasses was 3.5 times higher if there was a history of vision disorders in other children in the family (p < 0.001) and 90% more likely if there was a history of vision disorders among the parents (p = 0.002). The odds of using eyeglasses increased 5% with each unit increase in children's BMI. The odds of suspected vision problems increased by 39% and 3% with each year of age of the child and their mother (p = 0.001 and p = 0.034 respectively). The odds of suspected visual problems was 90% higher among urban vs. rural children (p < 0.001) and 58% higher if there was a history of vision disorders among other children in the family (p = 0.029).

Conclusion: The present study identified socio-demographic predictors of having vision disorder among school-entering children based on information provided by their parents. Although vision health screening is carried out as part of the health assessment program for children upon entering school in Iran, high-risk individuals should not to postpone their children's vision examinations until they enter school and should have eye examinations at a younger age.

Purpose: This study analyzes trends in glaucoma surgical management at the Eye & ENT Hospital of Fudan University over a 10-year period (2013-2023), focusing on the evolution of surgical practices and the adoption of new techniques.

Methods: A retrospective observational study was conducted using medical records of patients diagnosed with glaucoma who underwent surgery between January 1, 2013, and December 31, 2023. Data were analyzed using the Cochrane-Armitage trend test.

Results: A total of 13,092 glaucoma surgeries were performed, increasing from 736 in 2013 to 2,451 in 2023. Primary angle-closure glaucoma (PACG) accounted for 71.00% (9247/13092) of cases. Patients were predominantly aged 40-64 (43.56%) and 65+ (41.12%), with 56.60% female and 43.40% male. Internal filtration surgeries dropped between 2013-2015 but rose from 2.95% (26/880) in 2015 to 7.87% (193/2451) in 2023. External filtration surgeries declined from 82.47% (607/736) to 26.56% (651/2451). Phacoemulsification combined with goniosynechialysis (Phaco+GSL) increased from 7.61% (56/736) to 65.36% (1602/2451), while cyclodestruction procedures remained stable (0.54% to 0.20%). In congenital glaucoma (CG), ab interno trabeculotomy rose to 52.74% (77/146) by 2023. External filtration for primary open-angle glaucoma (POAG) decreased from 98.54% (135/137) to 74.82% (312/417), while Phaco+GSL for PACG increased from 11.43% (56/490) to 84.36% (1591/1886). Among glaucoma drainage devices (GDDs), Ahmed Glaucoma Valve usage declined from 94.25% (246/261) to 61.66% (193/313), while the Ex-Press device was phased out, and XEN Gel Stent (MIGS) usage rose to 38.34% (120/313).

Conclusion: Glaucoma surgical management at the Eye & ENT Hospital of Fudan University has evolved significantly over the past decade, with a notable shift towards minimally invasive procedures and personalized treatment strategies.

Purpose: Although the associations between cardiovascular diseases and cerebrovascular diseases with visual impairment have been documented, the relationship between cardio-cerebrovascular disease (CCVD) and visual impairment remains unclear. Thus, we aimed to investigate the association between visual impairment and the risk of CCVD among older adults in South Korea.

Methods: This study included 20,398 individuals registered in the Korean National Health Insurance Service-Elderly Cohort between 2005 and 2019. Propensity score matching (1:1) was used to identify pairs of individuals with and without visual impairment from the national disability registry. Cox proportional hazards regression models were used to analyze the associations between CCVD-related variables and visual impairment.

Results: The primary outcome was the occurrence of CCVD. Compared to individuals without visual impairment, those with visual impairment had a higher risk of CCVD. The prevalence of CCVD was higher in patients with visual impairment, regardless of the severity of impairment. The risk of CCVD was highest during the first 12 and 24 months following the diagnosis of visual impairment.

Conclusions: Older individuals with visual impairment are at an increased risk of CCVD, regardless of the degree of impairment. Hence, novel approaches to CCVD care are required for these individuals.

Purpose: Vision is one of the most important functions needed for safer driving. We aim to investigate the usefulness of eyeglasses in improving self-reported on-the-job road safety outcomes among commercial drivers.

Methods: A before and after assessment study was conducted among commercial truck-drivers to explore their vision problems and the usefulness of eyeglasses in improving self-reported on-the-job road safety outcomes. Truck-drivers underwent vision examination and if their monocular distance visual acuity was ≤6/9, then refraction was conducted. A total of 9,857 commercial vehicle drivers completed screening. A convenience sample of 385 drivers with distance vision refractive error underwent a baseline interview and 173 drivers completed the follow-up survey after receiving eyeglasses to rate the level of difficulty in eight specific driving tasks.

Results: A high proportion of commercial vehicle drivers had uncorrected distance vision refractive error (17.7%). Commercial drivers (Range 49.1-74.0%) reported improvements in difficulty with glare, driving at night, identifying moving objects, judging distance and speed and driving in bad weather following the receipt of eyeglasses. In multivariate logistical regression models, drivers not meeting the Indian national visual acuity standard at baseline (presenting visual acuity ≤6/18) were nearly four times as likely to experience improvement in 4-8 visual difficulties (Odds ratio 3.69, 95% CI 1.13-12.0) compared to having no improvement in driving difficulties after receiving glasses.

Conclusion: The prevalence of readily correctable refractive errors was high in this cohort of commercial drivers from across India and corrective glasses may reduce commercial drivers' driving difficulties significantly.

Purpose: Primary eye care (PEC) model aims to facilitate right-siting of care for patients with stable and non-complex conditions by upskilling optometrists. However, there is 1) a lack of examination on PEC's quality of care (measured as degree of agreement in plan of care between upskilled optometrists and ophthalmologists) and 2) no comprehensive real-world evaluation on operational viability and stakeholders' perception of the community-based PEC model. Holistic evaluation is important as in-depth understanding of stakeholders' experience in implementation will be key to ensure the long-term sustainability and scalability of this PEC model. This study aims to examine the quality of care provided at PEC as well as the contextual factors, strategies, and processes that influence implementation, sustainability, and scalability of PEC.

Methods: This study will adopt a mixed-method sequential explanatory design, guided by the Practical, Robust Implementation and Sustainability Model framework. First, the quality of care will be assessed by examining the degree of agreement between PEC optometrists and ophthalmologists on patients' plan of care. Second, qualitative research design will be employed to understand the experiences of patients and healthcare professionals. In-depth interviews will be conducted with patients and focused group discussions will be conducted with healthcare professionals. Integration of quantitative and qualitative data will be achieved by employing the building and merging approach.

Conclusion: This study will identify areas that could be improved to increase PEC's operational efficiency and enhance its service utilisation. Importantly, key lessons and strategies derived from these evaluations will help to facilitate future nationwide implementation of PEC.

Purpose: To examine trends and disparities in vision screening among U.S. school-aged children prior to and during the COVID-19 pandemic.

Methods: This study used nationally representative data on children aged 6-17 years residing in U.S. households from the 2016, 2017, and 2021-2023 survey years of the National Survey of Children's Health.  A child was defined as having had their vision screened if their caregiver reported that in the past 2 years the child had their vision tested (2016 and 2017) or that they visited an eye doctor or received vision screening from a provider other than an eye doctor (2021-2023).  Descriptive statistics and linear regression models were used to examine trends in the prevalence of vision screening and to assess whether the association between vision screening and sociodemographic and contextual variables changed over time.

Results: The weighted prevalence of vision screening in the past 2 years for U.S. school-aged children was 84.6% in 2016, 84.9% in 2017, 77.8% in 2021, 79.7% in 2022 and 79.6% in 2023. In regression models, lower household income, lower parental education, lack of health insurance, a primary household language other than English, not having a usual source of health care, and living in a state without vision screening requirements were associated with a significantly lower likelihood of vision screening. Screening disparities increased over time for children whose primary household language was not English or who were uninsured.

Conclusion: Public health interventions should be considered to reduce widening disparities in vision screening among U.S. school-age children.

Purpose: A knowledge gap persists regarding the utilization of corneal transplant surgery among enrollees in Affordable Care Act (ACA) plans and the factors influencing associated costs and complications post-ACA implementation. This study investigates the demographics, costs, and complications of cornea transplant for patients insured under the ACA from 2015 to 2019.

Methods: A novel claims dataset of Affordable Care Act (ACA) marketplace plan subscribers was utilized. Multivariable logistic and linear regression models were used to assess demographics, cost, and complication rates of corneal transplant using demographic/clinical data and insurance plan type.

Results: Among 26,997,610 enrollees, 0.005% (n = 1266) underwent cornea transplant. About 32.9% (n = 416) of patients experienced a postoperative complication, the most common being corneal transplant failure (15.6%) and infectious keratitis (11.5%). Insurance plan type was not associated with rate of postoperative complications (p = 0.87). Patients with different plan types incurred significantly different out-of-pocket (OOP) cost (p < 0.001), with patients on Silver cost-sharing reduction plans paying the lowest ($4).

Conclusion: This study is the first to assess the demographics, costs, and complications of corneal transplant patients within the ACA population. Our findings suggest that patients with higher cost-sharing subsidies experience lower OOP costs and may be more inclined to pursue corneal transplant than those on lower actuarial value plans.

Purpose: To examine the burden of blindness caused by refraction disorders (BCRD) in China over the past 30 years by year, age, and sex, and to estimate future projections.

Methods: Data from the Global Burden of Diseases (GBD) 2019 database were used to analyze the number of cases and age-standardized prevalence rates (ASPRs) of BCRD in China from 1990 to 2019. We focused on changes over time using estimated annual percentage changes (EAPCs). In addition, we performed the Nordpred analysis and the Bayesian Age-Period-Cohort (BAPC) model with integrated nested Laplace approximations to predict the BCRD burden from 2020 to 2034.

Results: The number of prevalent cases due to BCRD increased from 750,956.7 (95% uncertainty interval [UI] 636,381.24-872,040.62) in 1990 to 1,145,881.76 (95% UI 931,966.43-1,342,338.18) in 2019. The ASPRs of BCRD showed a decreasing trend, with EAPCs of -0.58 (95% confidence interval [CI] -0.81-0.36). The older and female populations had a higher BCRD burden. The number of prevalent cases due to BCRD is projected to continue to increase from 1.33 million in 2020 to 1.86 million in 2034. The ASPR also showed an increasing trend over the next 15 years.

Conclusion: Over the past three decades, the prevalence of BCRD in China has improved in both sexes and will continue to increase in the next 15 years. This study highlights the importance of prevention of BCRD, especially for women and the elderly.