Ophthalmic epidemiology最新文献

Purpose: To investigate the genetic associations of myopia and axial length (AL) with diabetic retinopathy (DR).

Methods: We performed Mendelian randomization (MR) analyses using publicly available genome-wide association study (GWAS) summary statistics. Genetic variants were used as instrumental variables. Exposures included myopia, spherical equivalent (SE) and AL. Outcomes of interest included DR, its two subtypes including severe non-proliferative DR (NPDR) and proliferative DR (PDR), and vascular endothelial growth factor (VEGF) levels. The summary statistics for DR and its subtypes were derived from the FinnGen consortium, with over 20,000 participants involved.

Results: A genetically predicted longer AL was significantly protective of PDR (per mm increase in AL: Odds ratio [OR], 0.77; 95% confidence interval [CI], 0.60 to 0.99). There were no significant causal associations of myopia, SE and AL with any DR or severe NPDR (p > 0.05 for all). After pooling the MR results from five different data sources, we found no evidence of causal relationship between AL and VEGF levels (beta, -0.01; 95% CI, -0.08 to 0.06).

Conclusion: Our results suggest a possible causal relationship between an increased AL and a reduced risk of PDR, which may provide insights into novel strategies to prevent PDR.

Purpose: We sought to determine the prevalence of strabismus and the esotropia/exotropia ratio in Down syndrome. Wide ranges of an increased strabismus prevalence have been reported and it is unclear by how much esotropia exceeds exotropia in people with Down syndrome.

Methods: We compiled in a systematic review and meta-analysis results of over 100 studies that report the strabismus prevalence and ratio of esotropia/exotropia in cohorts of Down syndrome. We calculated the pooled global prevalence and established the geographical distribution of the strabismus prevalence and the esotropia/exotropia ratio.

Results: The ethnically-adjusted global prevalence of strabismus in Down syndrome is 30.2%. In subjects 15 years and older, the global prevalence is 53.2%, and the lifetime prevalence is 51.0%. In populations which normally have more esotropia than exotropia (e.g. Caucasians), Down syndrome subjects have a further increased bias towards esotropia. In populations which normally have more exotropia (e.g. West Africans, Asians and Hispanics), Down syndrome subjects have a significantly lower esotropia/exotropia ratio (3.21) than reported in Caucasians with Down syndrome (9.98).

Conclusion: Worldwide, about 1.81 million people with Down syndrome have strabismus: 1.42 million of them have esotropia, and 0.37 million have exotropia. Differences in the esotropia/exotropia ratio between ethnicities point to the orbital anatomy as a major contributing factor to the etiology of strabismus in Down syndrome. The narrow-set eyes (reduced orbital width) in Down syndrome favor esotropia over exotropia, especially in Caucasians, thus explaining why Down syndrome patients from different ethnicities have different prevalences of esotropia and exotropia.

Purpose: To report the incidence of treatment-requiring retinopathy of prematurity (ROP) in Greece at a national level.

Methods: Multicenter prospective cohort study of infants that required treatment for ROP at any unit in Greece between June 1^st, 2020, and May 31^st, 2021. Twelve out of the 13 invited centers contributed their data. Collected parameters included infants' demographics, ROP examination findings prior to treatment, and treatment characteristics.

Results: The overall incidence of treatment-requiring ROP (TR-ROP) was 3.8%, given the fact that 1133 live births of infants with GA <32 weeks and/or BW < 1501 g were reported during the study period. Median (range) gestational age and birth weight of treated infants were 26.9 (23.4-33.0) weeks and 850 (500-2370) g, respectively, and 55.8% were male. The most prevalent ROP severity among treated infants was type 1 ROP (70 eyes), followed by type 2 ROP (8 eyes) and aggressive ROP (6 eyes). Laser photocoagulation (69.8%) was the predominant treatment modality used vs intravitreal anti-VEGF injections (30.2%). The median postnatal age at initial treatment was 9.6 weeks (range 5.6-21.7). Re-treatment rate was 30.2% and was higher among infants treated with anti-VEGF (69.2%) vs laser (13.3%). Treatment failure was reported in one case (progression to stage 4B in one eye and stage 5 in the other), whereas ROP regressed in all other patients.

Conclusion: This is the first study to report TR-ROP incidence in Greece, treated infants' characteristics at a national level, preferred practice patterns, failure rate and recurrence rate at 6 months from initial treatment.

Purpose: This study aimed to evaluate the accuracy and readability of responses generated by ChatGPT-4o, an advanced large language model, to frequently asked patient-centered questions about keratoconus.

Methods: A cross-sectional, observational study was conducted using ChatGPT-4o to answer 30 potential questions that could be asked by patients with keratoconus. The accuracy of the responses was evaluated by two board-certified ophthalmologists and scored on a scale of 1 to 5. Readability was assessed using the Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid Grade Level (FKGL), and Flesch Reading Ease (FRE) scores. Descriptive, treatment-related, and follow-up-related questions were analyzed, and statistical comparisons between these categories were performed.

Results: The mean accuracy score for the responses was 4.48 ± 0.57 on a 5-point Likert scale. The interrater reliability, with an intraclass correlation coefficient of 0.769, indicated a strong level of agreement. Readability scores revealed a SMOG score of 15.49 ± 1.74, an FKGL score of 14.95 ± 1.95, and an FRE score of 27.41 ± 9.71, indicating that a high level of education is required to comprehend the responses. There was no significant difference in accuracy among the different question categories (p = 0.161), but readability varied significantly, with treatment-related questions being the easiest to understand.

Conclusion: ChatGPT-4o provides highly accurate responses to patient-centered questions about keratoconus, though the complexity of its language may limit accessibility for the general population. Further development is needed to enhance the readability of AI-generated medical content.

Purpose: To characterize differences in identification of diabetic retinopathy examinations using administrative claims and electronic health record data.

Methods: Adult patients ≥18 years with diabetes seen in the ophthalmology department at Johns Hopkins Hospital were included. Two methodologies were used to identify diabetic retinopathy examinations across the hospital system. First, a pre-specified set of Current Procedural Terminology (CPT) codes from administrative claims data were used. Second, natural language processing (NLP) was used to parse ophthalmology provider notes for mention of diabetic retinopathy screening or follow-up. The percentage of visits meeting each set of criteria was determined. Cohen's kappa of agreement between the two methodologies was calculated.

Results: A total of 59,538 patients and 1,926,828 office visits, of which 485,228 (25%) were in the ophthalmology department, were included. Most patients (86%) had at least one diabetic retinopathy examination identified using administrative codes, and 84% using the NLP-based methodology. Of all ophthalmology visits, administrative codes identified more diabetic retinopathy examinations compared to the NLP-based methodology (60%, versus 48%). Cohen's kappa for agreement was 0.57 (standard error 0.001, p < 0.001).

Conclusion: This study found only moderate agreement between the two methodologies for identifying diabetic retinopathy examinations. Given the imprecision of administrative codes, this suggests that prior studies reporting eye care utilization using only administrative claims may be over-estimating receipt of diabetic retinopathy examinations.

Purpose: Open Globe Injuries are one of the leading causes of preventable, trauma-related blindness. There is some literature studying the effects of demographic factors as they relate to hospital outcomes. This study characterises trends of Open Globe Injury (OGI) and hospital outcomes based on demographic information utilising the National Trauma Data Bank (NTDB).

Methods: Using Python programming software, the NTDB was queried for International Classification of Diseases 9th Revision diagnosis codes related to OGI based on the Birmingham Eye Trauma Terminology system. Descriptive statistics were calculated utilising chi-square tests, multivariable adjusted logistic regressions, and ANOVA to process adjusted odds ratio (OR) and means of comparison groups.

Results: The final analysis included 21,481 patients. Mean age of OGI was lower for Black (40.01 [40.53-41.49]), American Indian (39.08 [37.15-41.00]), and Hispanic (38.24 [37.70-38.77]) populations. OR for Black patients was lower for work-related OGI (0.36 [0.30-0.44]), but higher for drug-positive OGI (1.51 [1.35-1.69]). Black and American Indian patients had increased odds for assault-related injuries and decreased odds for accident-related injuries. Race and ethnicity had little to no effect on mortality, or discharge to home with service, ICU, or step-down unit. Mean age of fall on the same level injuries was (71.28 [70.49-72.07]); all other mechanisms of injury had a mean age < 42.

Conclusions: Our research offers a unique perspective on OGI utilising the NTDB. The trends identify at-risk populations not previously reported and suggests potential racial effects of public safety, work safety and precautions for open globe injuries.

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.