Ophthalmic epidemiology最新文献

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.

Purpose: To assess the usability of patient education websites for refractive surgery through an analysis of readability, accountability, subjective quality, and visual accessibility.

Methods: 50 patient education websites for five refractive surgery modalities were gathered from an incognito Google search and categorized by authorship category: institutional, medical organization, or private practice. Each website was assessed for readability, accountability using the Journal of the American Medical Association (JAMA) benchmark, subjective quality using the DISCERN instrument, and visual accessibility was assessed using the Web Accessibility Evaluation Tool (WAVE).

Results: The mean reading grade across all websites was 11.02, exceeding the American Medical Association's recommended 6th-grade level (p < .001). Institutional websites were the most readable (10.32, p = 0.005) while private practice sites were the least (11.74, p = 0.015). The average JAMA score was 1.52 with no website meeting all four accountability criteria. Websites from medical organizations had significantly higher JAMA scores (1.94, p = 0.049). The average DISCERN score was 51.97 with no differences between authorship categories. Websites had an average of 87.84 visual accessibility violations.

Conclusions: Available patient education websites for refractive surgery may suffer from poor readability, quality, and visual accessibility which may limit their usability.

Purpose: This study examined global, regional, and national trends in early-onset cataract (EOC) burden from 1990 to 2021, stratified by age, sex, and socio-demographic index (SDI).

Methods: Using Global Burden of Disease 2021 data, prevalence and disability-adjusted life years (DALYs) for EOC were analyzed via Joinpoint regression to assess temporal trends.

Results: Global EOC cases surged from 5,999,808 (1990) to 10,831,058 (2021), with DALYs rising from 596,529 to 855,633. Age-standardized prevalence per 100,000 increased from 249.62 to 287.33 (AAPC = 0.461%, p < 0.001). Burden escalated with age and was consistently higher in females. Low-middle SDI regions had the highest age-standardized prevalence (416.43) and DALY rates (83.52) in 2021. Etiological shifts occurred: DALYs from air pollution declined (33.40% to 29.57%) and smoking decreased (11.68% to 9.00%), while metabolic risks like high fasting glucose (12.16% to 15.01%) and elevated BMI (12.01% to 16.05%) grew significantly.

Conclusions: EOC burden has risen markedly since 1990, driven by aging populations, female sex, metabolic risks, and socioeconomic disparities. Low-middle SDI regions face disproportionate impacts. Prioritizing prevention strategies targeting modifiable risks (air pollution, smoking, obesity, hyperglycemia) and ensuring equitable healthcare access are critical to mitigating this public health challenge.

Purpose: With the growing aging population, cataract surgeries are becoming increasingly common, placing significant pressure on hospital eye services to manage postoperative care. Co-management between ophthalmologists and optometrists offers a potential solution to enhance efficiency and care quality. This study evaluates the feasibility and safety of co-management models between ophthalmologists and optometrists for post-cataract surgery patients in different countries.

Methods: A comprehensive search was conducted across PubMed, Scopus, Web of Science, and bibliographies, up to November 26, 2024. Search terms included "shared care scheme" and "post-operative cataract surgery". Papers involving optometrists in post-cataract surgery monitoring and reporting related management outcomes were included.

Results: The ten selected studies, conducted in the United States of America (USA), England, Scotland, Ireland, and the Netherlands, showed that post-cataract co-management is feasible and safe. The results demonstrated uncompromised patient safety, positive patient satisfaction outcomes, and optometrist competency. Successful implementation was dependent on clear referrals and workflow guidelines, rigorous optometrists training, strong ophthalmologists and optometrists collaboration, and regular patients feedback. However, study heterogeneity and limited geographic scope hindered comparability and generalisability of the findings to other countries with different healthcare systems and optometric training levels.

Conclusion: Co-management of post-cataract surgery patients between ophthalmologists and optometrists has demonstrated feasibility and patient safety in some countries. However, tailoring the guidelines and adapting models to each country's specific demands and capabilities is essential for a successful implementation. Further research is needed to explore the feasibility and effectiveness of such models in different countries and healthcare systems.