Ophthalmic epidemiology最新文献

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.

Purpose: To report eye disease detection referral rates for in-office eye care across the Screening and Intervention for Glaucoma and eye Health through Telemedicine (SIGHT) Studies conducted in Alabama (AL-SIGHT), Michigan (MI-SIGHT), and New York City (NYC-SIGHT).

Methods: Individuals age ≥40 years who completed eye health screenings in federally qualified health centers, a free clinic, and affordable housing developments were included in the analysis. Visual acuity, intraocular pressure (IOP), and fundus photography were conducted across all sites and detection of eye diseases and referral rates are reported. Two-sample t-test and chi-square test (or Fisher's exact test) were used to compare continuous and categorical variables, respectively, between those referred and not referred.

Results: Of the 838 participants screened in AL-SIGHT, 2970 in MI-SIGHT, and 708 in NYC-SIGHT, referral rates for in-office eye care were 47.3%, 42.8%, and 66.1% respectively. Detection rates of glaucoma and glaucoma suspect in AL-SIGHT were 18.6%, MI-SIGHT were 24%, and NYC-SIGHT were 26.7%. Among those referred there were significantly more participants who identified as Black race, had high school or less education, were single/divorced/separated/widowed, retired or unable to work/disabled, insured with Medicare, or reported having diabetes, hypertension, or glaucoma (p < 0.05).

Conclusion: The SIGHT Studies provide evidence that reaching underserved individuals at high-risk for eye diseases and providing telehealth-based eye health screenings in trusted community-based settings, led to high rates of eye disease detection and referral for in-office eye care.

Purpose: To investigate the key features of electronic device use in the AACE (acute acquired concomitant esotropia) population and compare them with those in normal and other strabismus populations, while further exploring the pathogenesis of AACE.

Methods: A case-control study was conducted on patients admitted to the strabismus department of our hospital from March 2023 to March 2024. The cohort comprised 48 acute acquired concomitant esotropia (AACE) patients, 55 intermittent exotropia (IXT) patients, and 48 healthy controls. Their refractive status and strabismus histories were documented. Additionally, a multiple logistic regression analysis was performed using a questionnaire on electronic device usage to identify the risk factors for AACE.

Results: Regardless of adjustments, patients in the AACE group used digital devices for 7.74 ± 4.33 hours per day, significantly longer than those in the IXT and normal groups (p < 0.001). Multivariate logistic regression analysis revealed that long-term use of electronic devices was a risk factor for AACE (OR, 1.28; 95% CI, 1.09,1.49; p < 0.001). Among the 48 patients with AACE, 29 (63.04%) engaged in near-vision tasks without refractive correction, which was significantly higher than in the other two groups, and the difference was statistically significant (p = 0.005).

Conclusion: Prolonged and excessive use of electronics serves as a risk factor for acute acquired concomitant esotropia. This finding provides valuable information for clinicians on how to prevent AACE in daily life, such as minimizing electronic device use and wearing prescription glasses when engaging in near-vision tasks.

Purpose: To evaluate the efficacy and safety of repeated low-level red-light (RLRL) therapy in combination with orthokeratology (OK) for controlling myopia in Spanish children.

Methods: A single-site, randomized, parallel-group, single-blinded clinical trial. Twenty-six children aged 8-15 years with myopia between -0.75 to -6.75 D were enrolled. Participants were randomly assigned to either the RLRL combined with OK (RCO) group (n = 11) or the OK-only group (n = 15). The OK group wore OK lenses for at least 8 hours per night, while the RCO group received additional daily RLRL therapy, administered twice daily for 3 minutes per session five days per week. Follow-up visits were conducted at 1, 3, 6, and 12 months, with compliance and safety monitoring. The primary outcome measure was axial length (AL) change.

Results: All 26 children completed the 6-month follow-up visit. After 6 months, the adjusted mean AL change was -0.057 mm (95% CI, -0.078 to -0.037 mm) in RCO group, and 0.041 mm (95% CI, 0.029 to 0.054 mm) in OK group. In RCO group, 5 children (45.5%) achieved clinically significant axial shortening (defined as AL change ≤ -0.05 mm). The adjusted mean macular thickness change was 0.664 µm (95% CI, 0.468 to 0.859 µm) in RCO group, and 0.077 µm (95% CI, -0.048 to 0.203 µm) in OK group. No severe adverse events or significant corneal findings were observed.

Conclusions: The six-month interim analysis indicates that combining RLRL therapy with OK effectively controls myopia progression in Spanish children, with no severe adverse effects. Long-term follow-up is ongoing.

Purpose: To perform a systematic review and meta-analysis assessing the diversity and representation of diabetic retinopathy (DR) patients in clinical trials conducted in the United States from January 1, 2018, to December 31, 2023.

Methods: A comprehensive search strategy was conducted on May 28th, 2024 using MEDLINE (PubMed) and Embase (Elsevier) to identify relevant clinical trials. Inclusion criteria included trials published between January 1, 2018 and December 31, 2023, focusing on interventions for DR that were conducted in the United States. Screening and data extraction were independently performed by three reviewers.

Results: Eleven clinical trials met the inclusion criteria and were analyzed for participant representation based on sex, age, and race/ethnicity. Sex representation was rated as good in 9 of the 11 studies. However, age representation was rarely reported (only 1/11 studies) and race/ethnicity representation was poor in 6 of the 11 studies. The findings highlight significant underrepresentation of Asian and Black populations.

Conclusion: This study reveals substantial disparities in the demographic representation within DR clinical trials in the United States, emphasizing the critical need for improved inclusion strategies. Enhancing diversity in these trials is essential for producing research findings that are more applicable to the broader population affected by DR, ultimately contributing to more equitable healthcare outcomes and advancing the effectiveness of treatments across diverse demographic groups.

Purpose: To identify factors that are associated with no-shows and cancellations in a glaucoma clinic.

Methods: Retrospective observational study of patients seen at a glaucoma clinic over a two-year period (6/2017-5/2019). Demographics and clinic information were recorded from the electronic medical record. A total of 36,810 visits from 7,383 patients were studied. Weather data was collected from the National Centers for Environmental Information. Distance analysis was calculated utilizing Bing Maps application programming interface (API) on Microsoft Excel. Visits were divided into three groups based on appointment status: kept, cancelled, and no-show.

Results: Bivariate analysis found a statistically significant difference in various factors amongst patients based on appointment status. Patients <15 miles from clinic had a higher rate of no-show, but a lower rate of cancellations compared to those farther (p < 0.0001) Using multivariable logistic regression, the following factors were associated with the likelihood of patient cancellation: average snowfall (Odds Ratio = 1.37); presence of storm event (OR = 1.12), new visit (OR = 1.82), follow-up appointments (OR = 1.90), and travel distance > 15 miles (OR = 1.11). The following factors were associated with patient no-show: resident clinic (OR = 1.79), new visit (OR = 2.24), follow-up appointments (OR = 2.18), age (OR = 0.99), average snowfall (OR = 1.27), presence of storm event (OR = 1.41), average windspeed (OR = 0.98), and travel distance > 15 miles (OR = 0.67).

Conclusion: Patient age, gender, travel distance, appointment type, and weather were all significantly associated with rates of patient cancellations and no-shows. These risk factors could lead to interventions to improve appointment adherence and patient retention. Weather is an under-analyzed factor in patient follow-up rates that warrants further investigation.

Purpose: Previous studies have assessed the impact of air pollution on myopia from the individual level, while none of them have explored the role of air pollution in visual health disparities between different regions from the area level. This ecological study aimed to investigate the impact of ambient air pollution on reduced visual acuity (VA).

Methods: The data were derived from the Chinese National Survey on Students' Constitution and Health (CNSSCH) conducted in 2014 and 2019, which involved 261,833 and 267,106 students respectively. The participants were 7-22 years old randomly selected from 30 mainland provinces in China. Locally weighted scatterplot smoothing (LOESS) regression models and fixed-effects panel regression models were used to explore the associations of provincial-level prevalence of reduced VA with air quality index (AQI), fine particulate matter ;(PM2.5), PM10, sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2) and ozone (O3) concentrations.

Results: There were nearly linear positive dose-response relationships between AQI, air pollutant concentrations and the prevalence of reduced VA. After adjusting for covariates, an interquartile range increase in PM2.5 exposure was significantly associated with a 5.0% (95% confidence interval, 0.7%-9.3%) increase in the prevalence of reduced VA, whereas no significant associations were observed between AQI, the other five pollutants and the prevalence of reduced VA.

Conclusion: Regions with more polluted air tend to have a higher prevalence of reduced VA. Exposure to PM2.5 might be an important risk factor for myopia among children and adolescents.