To describe the prevalence of retinal vascular signs and their association with cardiovascular risk factors in a Japanese population.
Population-based cross-sectional study.
Adult persons aged 35 ...years or older from Funagata, Yamagata Prefecture, Japan (n = 1481).
The Funagata Study is a Japanese population-based study of persons aged 35 years or older, and included 1961 nondiabetic participants (53.3% of 3676 eligible subjects). A nonmydriatic retinal photograph was taken of 1 eye to assess retinal microvascular signs. Retinal arteriolar wall signs (focal arteriolar narrowing, arteriovenous nicking, enhanced arteriolar wall reflex) and retinopathy were assessed in 1481 participants without diabetes (40.3% of eligible persons) using a standardized protocol. Using a computer-assisted method, retinal vessel diameters were measured in 921 participants with gradable retinal image (25.1% of eligible persons).
Prevalence of retinal microvascular signs and their association with cardiovascular risk factors.
Moderate or severe focal arteriolar narrowing, arteriovenous nicking, enhanced arteriolar wall reflex, and retinopathy were found in 8.3%, 15.2%, 18.7%, and 9.0%, respectively, of the study population. Mean (+/-standard error) values for retinal arteriolar diameter were 178.6+/-21.0 mum, and mean values (+/-standard error) for venular diameter were 214.9+/-20.6 mum. Older persons were more likely to have retinal arteriolar wall signs, retinopathy, and narrower retinal vessel diameters. After adjusting for multiple factors, each 10-mmHg increase in mean arterial blood pressure was associated with a 20% to 40% increased likelihood of retinal arteriolar signs and a 2.8-mum reduction in arteriolar diameter. Retinopathy was associated with higher body mass index and both impaired glucose tolerance and impaired fasting glucose.
In nondiabetic Japanese adults, retinal arteriolar wall signs were associated with older age and increased blood pressure, whereas retinopathy was associated with older age, higher body mass index, impaired glucose tolerance, and impaired fasting glucose. These findings are comparable with data from white populations.
Abstract
Purpose: To examine the association of reproductive factors and major eye diseases, including glaucoma, age-related macular degeneration (AMD), diabetic retinopathy and cataract, in Asian ...women.
Methods: The Singapore Malay Eye Study is a population-based cross-sectional epidemiological study which examined 3280 persons (78.7% response) of Malay ethnicity aged 40-80 years; 1704 were female. Information on reproductive factors and use of hormone replacement therapy (HRT) was collected using an interviewer-administered questionnaire. Glaucoma was defined according to the International Society for Geographical and Epidemiological Ophthalmology criteria. Retinal photographs were graded for AMD following the Wisconsin grading system, and diabetic retinopathy according to the modified Airlie House classification system. Cataract was graded according to the Lens Opacity Classification System III.
Results: A total of 1176 women reported having experienced menopause by the time of the study with 1073 (91%) having a natural menopause, 88 (7.5%) a hysterectomy and 9 (0.8%) due to other reasons; HRT was used by 70 (6%) women. Women whose age at menopause was 52 years were 3.5 times more likely to have glaucoma (95% confidence interval, CI, 1.23-9.98, p value = 0.02) than those whose age at menopause was 53 years. Age of menopause was not associated with AMD (age-adjusted odds ratio, OR, 1.22, 95% CI 0.65-2.31), diabetic retinopathy (age-adjusted OR 1.01, 95% CI 0.66-1.54) or cataract (age-adjusted OR 1.38, 95% CI 0.95-2.00). Use of HRT was not associated with any of these eye diseases.
Conclusion: Women who had menopause at a younger age were more likely to have glaucoma. This association needs to be confirmed in other studies.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Thicker or thinner central corneas may lead to either overestimation or underestimation of intraocular pressure, which is the most important causal and treatable risk factor for glaucoma. However, ...the findings on the associations between diabetes, random glucose, and glycated hemoglobin A1c (HbA1c) with central corneal thickness (CCT) are conflicting.
To evaluate the associations between diabetes, random glucose, and HbA1c with CCT in a multiethnic Asian population.
Cross-sectional analysis of the Singapore Epidemiology of Eye Diseases (SEED) Study conducted from 2004 to 2011. A total of 10 033 Chinese, Malay, and Indian individuals 40 years or older residing in Singapore were recruited. Participants with incomplete information on diabetes status (448 participants), prior refractive or cataract surgery (1940 eyes), and corneal edema or dystrophy (29 eyes) were excluded. A meta-analysis was conducted to estimate the overall association of diabetes with CCT.
Standardized clinical examinations and interviewer-administered questionnaire to collect information about demographic, systemic, and ocular factors.
Measurement of CCT using ultrasound pachymetry.
A total of 8846 adults (mean SD age, 57.9 9.9 years; 4447 women 50.3%) (17 201 eyes) were included in the final analyses. The CCT profile was similar among participants with and without diabetes (mean SD CCT, 545.3 33.7 μm vs 544.8 33.9 μm; P = .39). Following adjustments of age, sex, ethnicity, corneal curvature, axial length, and body mass index, CCT was a mean (SD) of 4.9 (0.8) μm (95% CI, 3.3-6.5 μm) thicker in patients with diabetes than those without diabetes. Multivariable analyses also showed that thicker CCT was associated with higher random glucose (per 10 mg/dL to convert to mmol/L, multiply by 0.0555, β = 0.3; 95% CI, 0.2-0.4) and higher HbA1c (per percentage, β = 1.5; 95% CI, 1.0-2.1) (all P < .001). These associations were significant in the subgroup with diabetes but not in the subgroup without diabetes. A meta-analysis including 12 previous population- and clinical-based studies showed that CCT was 12.8 μm (95% CI, 8.2-17.5 μm) thicker in eyes of patients with diabetes.
These findings suggest that diabetes and hyperglycemia were associated with thicker CCT. This study provides useful information on the interpretation of intraocular pressure in patients with diabetes.
To examine the relationship between corneal biomechanical properties and retinal vascular caliber in Singaporean children in a cross-sectional study of 257 healthy subjects from the Singapore Cohort ...Study of Risk Factors for Myopia.
Corneal hysteresis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), and corneal compensated intraocular pressure (IOP(CC)) were measured with a patented dynamic bi-directional applanation device. Digital retinal photography was performed, and retinal vascular caliber was measured with custom software. The central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were calculated, representing the average arteriolar and venular calibers. Spherical equivalent (SE) refraction, axial length, height, weight, and mean arterial blood pressure (MABP) were measured.
Mean values of this study were as follows: age of study subjects, 13.97 +/- 0.90 years; CH, 11.80 +/- 1.55 mm Hg; CRF, 11.83 +/- 1.72 mm Hg; CCT, 578.76 +/- 34.47 microm; IOP(CC), 15.12 +/- 2.84 mm Hg; CRAE, 151.70 +/- 15.54 microm; CRVE, 227.51 +/- 22.82 microm. After controlling for age, sex, ethnicity, body mass index, father's educational level, MABP, IOP, and SE, there was a significant increase in CRAE by 1.40 microm (95% CI: 0.17-2.61; P = 0.03) for every 1.55 mm Hg increase in CH and by 1.68 microm (95% CI: 0.21-3.15; P = 0.03) for every 1.72 mm Hg increase in CRF. There were no significant associations between CRVE and CH, CRF, CCT, or IOP.
Lower CH and CRF are associated with narrower retinal arterioles in Singaporean children.
To evaluate the relationships in Singapore school children between optic nerve head parameters and retinal nerve fiber layer thickness images by using the Heidelberg Retinal Tomograph (HRT; ...Heidelberg Engineering, Heidelberg, Germany) and determining optic disc tilt and refractive error.
This was a cross-sectional study involving 316 children 11 and 12 years of age (163 girls and 153 boys) selected randomly from one of the three schools in the Singapore Cohort study of Myopia. A total of 13 optic disc parameters were obtained from HRT images acquired before cycloplegia. Refractive errors were measured by cycloplegic autorefraction. The presence of optic disc tilt or otherwise was determined by two independent assessors using stereoscopic viewing of retinal photographs.
Of the 316 children, 142 had tilted discs. The tilting of optic discs was associated with a smaller disc, rim or cup area measurements, cup-to-disc area ratios, cup volumes or cup depths, but with a larger measured rim volume, rim-to-disc area ratios, height variation of the contour, retinal nerve fiber layer thicknesses or volumes, and a more negative cup shape measure (all P < 0.001). Decreased maximum cup depths were significantly associated with longer axial lengths (P < 0.001), but were not associated with spherical equivalent (P = 0.693). These associations remained only in children without tilted discs, but were no longer significant in those with tilted discs. Other HRT parameters were not associated with axial lengths or myopic status.
Optic nerve head parameters and retinal nerve fiber layer thickness measured by the current HRT algorithms are strongly influenced by the tilting of the optic nerve head, but not by refractive errors or axial length.
Abstract Objective To examine the reliability of inexperienced observers in plotting optic disc contours on Heidelberg retinal tomography images before and after training. Design Observational study. ...Participants One hundred eyes that were randomly selected from the Singapore Indian Eye Study. Methods Both eyes of subjects were imaged with Heidelberg Retina Tomograph 3 (HRT-3; Heidelberg Engineering, Heidelberg, Germany). Optic disc contours were plotted on the same images by 2 new observers on 2 separate occasions, before and after 2-hour standardized training on the skills and tools available to accurately identify and delineate optic disc contours. These plottings were compared with an experienced, trained glaucoma expert (gold standard). Agreement and variability were analyzed by interclass correlation tests and Bland–Altman plots. Results A total of 182 images (18 excluded because of poor quality) from 89 Indian subjects were included. The mean age was 53.27 ± 7.25 years and 54.8% were male. There was moderate-to-high agreement between pretraining (both new observers) and experienced observer’s results (interclass correlation values range, 0.76–0.99). The interclass correlation improved for all the HRT-3 parameters after the 2 new observers were adequately trained. Comparing the interclass correlation values before and after training, the differences for mean retinal nerve fibre layer thickness for Observer 1 and all the HRT-3 parameters for Observer 2 were statistically significant. Conclusions This study shows that it is easy to train a new inexperienced observer to plot optic disc contours on HRT images, which translates into improved and acceptable interobserver variability and agreement.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Purpose To examine the relationship between refractive error and optic disc topographic parameters and retinal nerve fiber layer (RNFL) thickness. Design Population-based cross-sectional study. ...Methods All 3280 (78.7% response rate) persons of Asian Malay ethnicity 40 to 80 years of age underwent a standardized interview, ocular examinations, and optic disc imaging with the Heidelberg Retina Tomography II (HRT; Heidelberg Engineering). Associations between spherical equivalent (SE) and HRT parameters were evaluated by partial correlation analysis. Results There were 2457 (74.9%) right eyes with good-quality HRT images for analyses. When compared with emmetropic eyes, highly myopic eyes (SE < −6.0 diopters) had greater disc area, rim area, rim volume, whereas hyperopic eyes (SE > 0.5 diopters) had significantly smaller disc area, rim area, and cross-sectional RNFL area (all P < .005). In partial correlation after adjustment for age, sex, body mass index, intraocular pressure, and optic disc area, increase of SE (toward hyperopia) was related significantly with greater cup area (partial correlation coefficient, r = 0.058; P = .004) and cup-to-disc area ratio ( r = 0.058; P = .004) and with smaller optic disc area ( r = −0.058; P = .004), rim area ( r = 0.058; P = .004), and rim volume ( r = −0.091; P < .001). Conclusions This population-based study shows that refractive error is significantly (but weakly) associated with HRT parameters of disc area, cup area, rim area, cup-to-disc area ratio, and rim volume. The clinical significance of these associations need to be determined in further studies.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
To evaluate the association of genetic variants at chromosomes 8p21 and 4q12 with the risk of developing AMD and its two main subtypes, choroidal neovascular membrane (CNV) and polypoidal choroidal ...vasculopathy (PCV), in Asian populations.
The study population comprised 2360 patients with neovascular AMD (1013 typical AMD-CNV and 1282 PCV), and 3598 controls from four independent cohorts, two of Japanese (n = 4859) and two of Chinese (n = 1099) ethnicity. We performed a meta-analysis in case-control studies of two reported single nucleotide polymorphisms (SNPs) (rs13278062 at TNFRSF10A-LOC389641 on 8p21 and rs1713985 at REST-C4orf14-POLR2B-IGFBP7 on 4q12) by using logistic regression analysis adjusted for age and sex. Subgroup analysis by CNV and PCV subtypes were performed to evaluate the significance of these two variants.
The reported association between rs13278062 at 8p21 and neovascular AMD was replicated in this population (P = 1.12 × 10(-4), odds ratio OR = 0.79, 95% confidence interval CI = 0.70-0.89). However, there was no association of rs1713985 at 4q12 with neovascular AMD, or its two subtypes, typical AMD-CNV and PCV (all P > 0.05). The study sample size had a statistical power of greater than 99% to detect an association of a risk allele with AMD with an OR of 1.30, as reported in the original study of rs1713985 and AMD.
The present results did not replicate the reported association between rs1713985 at 4q12 and neovascular AMD. However, we confirmed the association between rs13278062 at 8p21 and neovascular AMD in Asian populations.
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