Ophthalmic epidemiology最新文献

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.

Purpose: To determine the incidence rates, risk factors, and economic burden of orbital and preseptal cellulitis in the United States (US).

Methods: This retrospective longitudinal study was completed using data from the US Nationwide Emergency Department Sample dataset. An estimated 732,105 emergency department (ED) visits with a primary or secondary diagnosis of orbital and preseptal cellulitis from 2006 to 2018 were included. Incidence rates, descriptive statistics, and risk factors were calculated using linear and multivariate logistic regression models.

Results: The incidence rates of preseptal cellulitis increased from 6.2 in 2006 to 19.2 per 100,000 US population in 2018. In contrast, orbital cellulitis incidence rates have been decreasing from 6.1 to 2.8 per 100,000 US population from 2006 to 2018, respectively. Young adults (ages 21-44) comprise a majority of patients with either preseptal or orbital cellulitis (31.7%; 95% CI, 30.5-33.0%). Hypertension (11.8%, 12.9%), tobacco use (11.2%, 9.6%), and sinusitis (9.2%, 4.3%) were the most commonly associated diagnoses for orbital and preseptal cellulitis, respectively. Only 27.6% of patients with orbital cellulitis were admitted with 64.7% of patients routinely discharged. The inflation-adjusted ED charges for patients with orbital and preseptal cellulitis from 2006 to 2018 totalled over $997 million.

Conclusion: Orbital and preseptal cellulitis are costly infections in the US with increasing incidence rates for preseptal cellulitis. High rates of routine discharge from the ED for orbital cellulitis may represent a knowledge gap amongst providers and an opportunity to improve care. Identifying individuals at risk for infection is key for diagnosis and appropriate triage of care.

Purpose: Diabetic eye disease, namely diabetic retinopathy (DR), remains a leading cause of preventable blindness worldwide. Research has shown that treatment for diabetes and eye care was disrupted during the pandemic - with disparities between urban and rural populations being unknown. Thus, we aimed to assess the prevalence of reported rates of DR and dilated fundus exams from 2017 to 2021.

Methods: We performed a cross-sectional analysis using data from the Behavioral Risk Factor Surveillance System (BRFSS). Among US residents with diabetes, we calculated the rates of DR and annual dilated fundus exams - overall and by metropolitan statistical area (MSA) - measuring differences using X² tests.

Results: In 2017, the rate of DR was 19.78% among US residents reporting diabetes, which increased to the highest rate in 2018 at 22.19% before dropping to the lowest rates in 2019 and 2020 (18.44%). These annual changes were statistically significant (p < .001), but we found no significant differences by MSA status. Each year, nearly ⅔ of all individuals reported receiving dilated fundus examinations which peaked in 2019 at 71.5%. These annual deviations, as well as deviations by MSA were statistically significant (p < .001).

Conclusion: Although populations outside of an MSA experienced an increase in dilated fundus examinations, the national prevalence of DR continues to rise. Further research into sociodemographic and cultural factors influencing diabetic eye disease and access to ophthalmic care will be crucial for the prevention of DR and improving vision outcomes.

Purpose: To assess the feasibility, implementation, and patient experience of autonomous artificial intelligence-based diabetic retinopathy detection models.

Methods: This was a prospective cohort study where consenting adult participants previously diagnosed with diabetes were screened for diabetic retinopathy using retinal imaging with autonomous artificial intelligence (AI) interpretation at their routine primary care appointment from December 2022 through October 2023 in Thunder Bay, Ontario. Demographic (age, sex, race) and clinical (type and duration of diabetes, last reported eye exam) data were collected using a data collection form. A 5-point Likert scale questionnaire was completed by participants to assess patient experience following the AI exam.

Results: Among the 202 participants (38.6% women) with a mean age of 70.8 ± 11.7 years included in the study and screened by AI, the exam was successfully completed by 93.6% (n = 189), with only 1.5% (n = 3) requiring dilating eyedrops. The most common reason for an unsuccessful exam was small pupils with patient refusal for dilating eyedrops (n = 4). Among the participants with successful eye exams, 22.2% (n = 42) had referable diabetic retinopathy detected and were referred to see an ophthalmologist; 32/42 (76.0%) of these attended their ophthalmologist appointment. A total of 184 participants completed the satisfaction questionnaire; the mean score (out of 5) for satisfaction with the addition of an eye exam to their primary care visit was 4.8 ± 0.6.

Conclusion: Screening for diabetic retinopathy using autonomous artificial intelligence in a primary care setting is feasible and acceptable. This approach has significant advantages for both physicians and patients while achieving very high patient satisfaction.

Purpose: Visual field loss poses a high personal cost to those affected, significantly impacting activities of daily living, including driving. However, there is conflicting evidence on the association between visual field loss and crash risk. This study examined the association between severity and location of binocular visual field loss and motor vehicle crashes in older adults aged 50+, using linked population data over a 29-year study period.

Methods: Using a database of visual field tests obtained from ophthalmologists in Western Australia (WA) between 1990 and 2019, deficits in field sensitivity were identified and classified into three severities across five regions. This was linked to other government administrative databases including crash data.

Results: Of 31,296 people, 4,307 (13.76%) older drivers were involved in 5,537 vehicle crashes. Binocular visual field loss (regardless of severity and location) significantly increased the odds of a crash by 84% (OR 1.84; 95% CI 1.71-1.97). Severe visual field loss significantly increased the odds of a crash by 98% in the upper left quadrant (OR 1.98; 95% CI 1.70-2.06), 97% in the lower left (OR 1.97; CI 1.80-2.16), 89% in the lower right (OR 1.89; CI 1.72-2.06) and 95% in the upper right quadrant (OR 1.95; CI 1.78-2.14).

Conclusion: The large population-based study provided robust estimates on the degree of severity and specific locations of visual field loss that threaten safe driving and objective evidence on the usefulness of linking large customised ophthalmic databases to crash records for developing 'fitness to drive' guidelines for older drivers.

Purpose: To explore the genetic links between obesity, glycemic traits and retinal vein occlusion (RVO).

Methods: Summary-level statistics for obesity and glycemic traits were extracted from publicly available genome-wide association studies (GWAS) of European participants in the IEU Open GWAS database. Genetic associations with clinically diagnosed RVO were obtained from the FinnGenresearch project (372 cases and 182,573 controls). Two-sample Mendelian randomization (MR) and multivariate MR (MVMR) analysis were performed to determine the total effect and direct effect, respectively.

Results: After adjustment for the false discovery rate (FDR), the primary inverse-variance-weighted (IVW) methods indicated that the odds ratios of RVO increased with per 1-standard deviation increased in body mass index (BMI) (OR = 1.94, 95% CI: 1.23-3.08,p-FDR = 0.025), waist circumference (OR = 2.4, 95% CI: 1.36-4.24, p-FDR = 0.019), fasting glucose (OR = 5.01, 95% CI: 2-12.55, p-FDR = 0.0067) and two-hour glucose (OR = 3.17, 95% CI: 1.63-6.18,p-FDR = 0.0067). Higher whole-body fat-free mass (OR = 0.45, 95% CI: 0.26-0.8,p-FDR = 0.025) is a potential protective factor for RVO. In addition, the results of MVMR showed that BMI, whole-body fat-free mass, fasting glucose and two-hour glucose were independent factors that had a direct impact on the onset of RVO.

Conclusions: Our comprehensive MR analysis suggested significant genetic associations between BMI, whole-body fat-free mass, fasting glucose, two-hour glucose and RVO. This study highlighted the importance of weight, blood glucose management and physical activity for primary prevention and control of RVO.

Purpose: To determine the prevalence of retinal vascular anomalies in the general population in Germany and to analyse potential associations with ocular and systemic factors.

Methods: The Gutenberg Health Study is a population-based cohort study, including 15,010 participants aged 35-74 years. We performed fundus photographs of the macula and the optic disc. Vascular anomalies of the retina were graded. The prevalence was computed. We conducted multivariable logistic regression analysis including generalized estimating equations to assess associated factors.

Results: We included 12,956 participants (mean age 55.0 ± 11.1 years; 49.8% female). Retinal arterial tortuosity (RAT) was present in 5.9% in at least one eye and in 3.7% in both eyes. Systolic (OR = 1.01, p = 0.0039) and diastolic (OR = 0.98, p = 0.0039) arterial blood pressure, low-density lipoproteins (LDL) levels (OR = 1.0, p = 0.036), and spherical equivalent (OR = 1.06, p < 0.0001) were associated with RAT. Birth weight (OR = 0.97, p < 0.0001) and age (OR = 0.85, p = 0.0004) were inversely associated, while high-density lipoproteins (HDL), body mass index, and smoking were not associated with RAT. Temporal cilioretinal arteries (CRA) were prevalent in at least one eye in 40.2% and in 9.2% in both eyes. Spherical equivalent was associated with the prevalence of CRA (OR = 1.03 per dpt, p = 0.0006). Branch-building CRA had a prevalence of 0.5% in at least one eye.

Conclusion: This study describes prevalence of retinal vascular anomalies for the first time in a German population. CRA were positively associated with spherical equivalent and thus might be protective for myopia. RAT was associated with cardiovascular risk factors and with lower birth weight.

Purpose: To investigate whether there is a direct, age-independent association between telomere length and visual acuity decline in a large community-based cohort study.

Methods: Participants older than 40 with linked leukocyte telomere length (LTL) were enrolled in NHANES. LTL was assayed using qPCR from the participants' blood samples. Best corrected visual acuity (BCVA) of the better-seeing eye was analyzed, with visual impairment (VI) defined as the BCVA of 20/40 or worse. LTL was grouped into quartiles, and its association with BCVA and VI was evaluated after adjusting for covariates.

Results: Among the 4,480 enrolled participants, the weighted means of age, BCVA, and telomere length were 56.1 ± 11.9 years, 0.05 ± 0.08 logMAR, and 5,662 ± 36 base pairs, respectively. The proportion of VI was 2.6%. After adjusting for covariates including sex, ethnicity, education, family poverty income ratio, general health status, hypertension, diabetes, smoking, and body mass index, BCVA was significantly worse in participants with shorter LTL, with a significant trend (p = 0.002). However, after further adjusting for age, the association between LTL and BCVA was no longer significant, without a trend (p = 0.640). No significant association or trend between LTL and VI was found in the stepwise logistic model.

Conclusions: No age-independent association between LTL and BCVA was found. Our study indicates LTL may not serve as a biomarker for age-related visual acuity decline.

Purpose: We aim to report the frequency and distribution of corneal transplantation, by age, sex, and state/territory, in Australia over a > 25-year period from 1994 to 2022, including during COVID-19 lockdowns.

Methods: Using data from Medicare, Australia's Government-funded health insurance scheme, we retrospectively analysed corneal transplants performed from January 1994 to December 2022.

Results: From 1994 to 2022, there were 27,536 corneal transplantation services processed by Medicare. Transplants tended to be more common in males in younger age groups (67.7% male in 15-24-year-olds), and in females in older age groups (59.2% female in 75-84-year-olds). Most transplants were performed in New South Wales (9,438 services, 34.3%), Queensland (7,722, 28.0%), and Victoria (5,209, 18.9%). Annual corneal transplantation rates in Australia tended to decrease from 1994 to 2006 (lowest rate during study period), falling by 31%, and then increased by 81%, from 2006 to 2022 (end of study period). Annual repeat corneal transplantation rates (i.e. second and subsequent transplants) increased from 2004 to 2022, rising 301%. During Australia's nationwide 2020 COVID-19 lockdown (from March to April), monthly transplantation rates decreased by 31%.

Conclusion: We performed a longitudinal analysis of corneal transplantation in Australia using a comprehensive, routinely collected, population-based data source. Prior studies examining corneal transplantation have interrogated data from the Australian Corneal Graft Registry, which relies on voluntary reporting. Corneal transplantation rates have increased during the last 15 years, likely as new corneal transplant techniques have evolved, with increasing demand for corneal donation and eye banking services.

Purpose: To evaluate the incidence, refractive error (RE) association, and distribution of atraumatic rhegmatogenous retinal detachment (RRD) in U.S. military service members (SMs).

Methods: This study used data from the Military Health System (MHS) M2 database to identify active U.S. military and National Guard SMs diagnosed with RRD from 2017 to 2022. The RE in diopters (D) was manually extracted from available medical charts for 518 eyes. The annual incidence rate of RRD was calculated overall and evaluated in terms of age, gender, and RE. A multivariate Poisson regression model was used to estimate the relative risk (RR) for RRD with RE.

Results: From 2017 to 2022, 1,537 SMs were diagnosed with RRD and 1,243,189 were diagnosed with RE. One thousand two hundred seventy-five SMs had both diagnoses: RRD and RE. The overall incidence rate of RRD over the 6-year study was 16.3 per 100,000 people (16.4 and 15.9 for males and females, respectively). In all study groups, the incidence of RRD increased with age. SMs with RE had an overall 25-fold increased risk for RRD compared to SMs without RE. RE was present in 83.0% of cases of RRD. Myopia accounted for 93.3% of cases for eyes with detailed refractive data.

Conclusion: The incidence of RRD in U.S. SMs is comparable to other studies and is similar among male and female SMs. RE is present in most cases of RRD in SMs, with the most common type being low to moderate amounts of myopia.