Ophthalmic epidemiology最新文献

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.

Purpose: To investigate the relationship between sugar-sweetened beverages (SSBs) intake and myopia in a large population-based sample.

Methods: A cross-sectional study. Data from the population under 40 years of age were collected from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2008. Multivariable logistic regression was used to assess the association between SSB intake and myopia, with further exploration through propensity score matching (PSM). The generalized variance inflation factor (GVIF) was calculated to check for multicollinearity. Subgroup analyses examined the relationship between SSBs intake and myopia across demographic groups, while restricted cubic spline (RCS) analysis evaluated potential non-linear associations.

Results: Of 11,851 participants under 40 years of age, 3,769 had myopia. The average consumption of SSBs showed no significant difference after PSM (emmetropia group: 623.83 ± 17.99 grams/d; myopia group:605.35 ± 20.01 grams/d; p = 0.43). Multivariable logistics regression analysis showed SSBs intake was not associated with the risk of myopia before and after PSM, and multicollinearity was unlikely among all covariates. Subgroup analyses revealed no significant interactions between SSBs intake and covariates in their relationship with myopia. RCS analyses revealed no significant nonlinear associations between SSBs intake and the risk of myopia after PSM (P for non-linear = 0.2434).

Conclusion: Our study provides initial evidence that SSBs consumption may not be a risk factor for myopia in a large-scale population. Future longitudinal and experimental studies may shed more light on the relationship between dietary factors and myopia, informing public health recommendations and interventions.

Purpose: The Area Deprivation Index (ADI) is a quantitative measurement of neighborhood socioeconomic disadvantage used to identify high-risk communities. The distribution of physicians with respect to ADI can indicate decreased healthcare access in deprived neighborhoods. This study applies ADI to the distribution of ophthalmologists and demonstrates how practice patterns in the national Medicare Part D program may vary with ADI.

Methods: The Centers for Medicare and Medicaid Services Data "Medicare Part D Prescribers by Provider" data for 2021 was analyzed. Geocodio identified ADIs corresponding to the practice addresses listed in the dataset. The national rank ADIs were compared against the number of ophthalmologists. Spearman's correlation test and one-way ANOVA determined statistically significant differences in Medicare data extracted between quintiles of ADI ranks.

Results: We identified 14,668 ophthalmologists who provided care to Medicare beneficiaries. Each time ADI increased by 10, there was an average 9.4% decrease in ophthalmologists (p < 0.001). The distribution of ophthalmologists practicing throughout the United States by increasing ADI quintile are: 32%, 23%, 19%, 16%, and 9%. Providers practicing in neighborhoods in the first-ADI quintile were more likely to see Medicare beneficiaries compared to providers in the fifth-ADI quintile (p < 0.001).

Conclusion: The lack of ophthalmologists in high-ADI areas results in reduced eye care access in deprived neighborhoods. Many factors contribute to these disparities including limited access to metropolitan areas/academic institutions and fewer residency programs. Future programs and policies should focus efforts on creating an even distribution of ophthalmologists across the United States and improving access to eye care.

Purpose: To assess the efficacy of the DIGIROP-Birth algorithm in identifying infants at risk for developing retinopathy of prematurity (ROP).

Methods: In a retrospective study, we included preterm infants over 11 years, 2010-2020, meeting the inclusion criteria for the DIGIROP-Birth calculator (24 + 0/7 to 30 + 6/7 weeks of gestational age). We assessed the validity of DIGIROP-Birth using receiver-operating characteristic (ROC) curves and calculated area-under-curve (AUC), sensitivity, specificity, and positive and negative predictive values.

Results: 897 infants were included in the analysis. The median age of the first ophthalmological examination was 40 days (IQR 32-50), the median gestational age was 198 days (IQR 185-209; corresponding to 28 + 2/7 gestational weeks), median birth weight was 1000 g (IQR 790-1300). Of 897 screened children, 458 (51.1%) were diagnosed with ROP, and 34 of 897 (3.8%) required treatment.Analysis of ROP requiring treatment predicted by DIGIROP showed an AUC of 0.860 [95%-CI 0.795-0.925]. An equilibrium of sensitivity and specificity existed at a probability of 4.12%. The positive predictive value was 10.95%, and the negative predictive value was 99.36%. Independent significant peri- and postnatal risk factors were emergency cesarean section and mass blood transfusions.

Conclusions: The DIGIROP-Birth calculator showed good predictive power in our studied population, with an incidence of 3.79% for therapy-requiring ROP. Peri- and postnatal risk factors should be included in ROP screening.

Purpose: To investigate racial and ethnic inequalities in prescription of Netarsudil, one of two anti-glaucoma medications with a novel mechanism to be introduced in the past two decades, among patients with primary open-angle glaucoma.

Methods: This retrospective cohort matched study, based on electronic health records consisting of 92 million patients in the U.S, utilized Propensity Score Match, Relative Risk, Kaplan-Meier survival, and Chi-Square analysis to identify differences in rates of Netarsudil prescribing between racial and ethnic groups (non-Hispanic White, non-Hispanic Black, non-Hispanic Other Race, and Hispanic).

Results: Among the sample of patients that met Primary Open-Angle Glaucoma inclusion criteria (55,942), more White patients were prescribed Netarsudil than Black; (RR:1.24, 95% CI: 1.15-1.34) and Hispanic; (RR:1.63, 95% CI: 1.29-2.07) patients. White patients had higher prescription rates than Black patients in the Midwest (6.5% vs 4.2%; p < 0.0001) and West (11.2% vs 7.1%; p = 0.0002), higher rates than Hispanic patients in the South (4.9% vs. 2.0%; p < 0.0001) and West (11.2% vs. 7.8%; p < 0.008), but lower rates than Black patients in the Northeast (7.2% vs. 13.2%; p < 0.0001).

Conclusions: Differences in Netarsudil prescription rates within the United States exist between White and Black patients, and White and Hispanic patients. These differences exist when stratified by regions within the U.S. by varying degrees. Future studies are needed to investigate factors contributing to disparities in accessing new medications and to identify ways to eliminate such barriers to improve equity in care of glaucoma patients, especially among those historically disadvantaged.