Ophthalmic epidemiology最新文献

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.

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.