ObjectivesTo assess whether patients from minority ethnic groups have different perceptions about the quality-of-life outcomes that matter most to them.DesignCross-sectional observational ...study.SettingHigh volume eye centres serving the most ethnically diverse region in the UK, recruiting from July 2021 to February 2022.Participants511 patients with primary open-angle glaucoma and the predisease state of ocular hypertension.Main outcome measuresThe main outcome was participants’ self-reported priorities for health outcomes.ResultsParticipants fell into one of four clusters with differing priorities for health outcomes, namely: (1) vision, (2) drop freedom, (3) intraocular pressure and (4) one-time treatment. Ethnicity was the strongest determinant of cluster membership after adjusting for potential confounders. Compared with white patients prioritising vision alone, the OR for black/black British patients was 7.31 (95% CI 3.43 to 15.57, p<0.001) for prioritising drop freedom; 5.95 (2.91 to 12.16, p<0.001) for intraocular pressure; and 2.99 (1.44 to 6.18, p=0.003) for one-time treatment. For Asian/Asian British patients, the OR was 3.17 (1.12 to 8.96, p=0.030) for prioritising intraocular pressure as highly as vision. Other ethnic minority groups also had higher ORs for prioritising health outcomes other than vision alone: 4.50 (1.03 to 19.63, p=0.045) for drop freedom and 5.37 (1.47 to 19.60, p=0.011) for intraocular pressure.ConclusionsEthnicity is strongly associated with differing perceptions about the health outcomes that matter. An individualised and ethnically inclusive approach is needed when selecting and evaluating treatments in clinical and research settings.
To examine early myopia-related optic disc and retinal changes in a Singapore Chinese adolescent sample without confounding ocular or systemic disease.
Population-based cross-sectional study.
...Children aged 12 to 16 years at a follow-up visit for Singapore Cohort Study of Risk Factors for Myopia.
Detailed eye examinations, including cycloplegic autorefraction and contact biometry, were performed. Retinal photographs were acquired using nonmydriatic retinal photography among children who attended follow-up examinations in 2006, and were graded for myopia-related optic disc signs and macular changes by a single experienced grader. Optic nerve head parameters were measured adjusting for camera and ocular magnification with appropriate formulae.
Optic disc changes (tilt, beta peripapillary atrophy β-PPA, and optic nerve parameters) and macular changes (staphyloma, lacquer cracks, Fuchs' spot, and chorioretinal atrophy).
Retinal photography data were available for 1227 children (median age, 14 years; range 12-16). Tilted optic discs were found in 454 subjects (37%), and were associated with myopic spherical equivalent refractions (-3.6 diopters D vs -1.3 D; P<0.0001), higher cylindrical error (0.9 vs 0.7 D; P = 0.0001) and longer axial length (24.93 vs 23.96 mm; P<0.0001). The pattern of distribution of the axes of the tilted discs and corneal curvature were similar (P = 0.4). All linear optic nerve parameters, except vertical disc diameter (P = 0.15), were significantly smaller in eyes with than without tilted discs (P <0.001) after adjusting for confounders. Apart from 20 cases, all eyes with tilted optic discs had associated β-PPA. We identified only 1 case each (0.1% prevalence) of staphyloma and lacquer cracks in this sample.
In this Asian adolescent population, tilted optic discs were highly prevalent, in contrast with the lower prevalence reported in Caucasian populations. Eyes with tilted discs tended to have smaller optic cups with smaller cup-to-disc ratios, and were associated with myopic refraction, higher astigmatism, and longer axial length. There were similar patterns of distribution between the axis of disc tilt and the axis of corneal curvature, which could have embryologic origins. In contrast with optic disc changes, myopic macular changes were rare in this age group, suggesting that these changes may develop later in life.
The authors have no proprietary or commercial interest in any of the materials discussed in this article.
To determine the prevalence of refractive errors in a multiethnic Asian population aged over 40 years and to examine secular trends and racial differences.
A total of 10,033 adults (3353 Chinese, ...3400 Indians, and 3280 Malays) participated in this study. Refractive error was determined by subjective refraction. Ocular biometric parameters were determined by partial coherence interferometry. Myopia and high myopia were defined as spherical equivalent (SE) of less than -0.5 diopters (D) and -5.0 D, respectively. Hyperopia was defined as SE of more than 0.5 D. Astigmatism was defined as cylinders less than -0.5 D.
The prevalence of myopia, high myopia, hyperopia and astigmatism in Singapore adults aged over 40 years was 38.9% (95% confidence interval CI 37.1, 40.6); 8.4% (95% CI 8.0, 8.9); 31.5% (95% 30.5, 32.5); and 58.8% (95% CI 57.8, 59.9), respectively. Compared with the Tanjong Pagar Survey 12 years ago, there was a significant increase in the prevalence of astigmatism and mean axial length (AL) in Chinese adults aged over 40 years in Singapore. Chinese were most likely to be affected by myopia, high myopia, astigmatism, and had the longest AL among the three racial groups.
The prevalence of myopia in Singapore adults is lower compared with the younger "myopia" generation in Singapore. The prevalence of astigmatism and mean AL have been increasing significantly within the past 12 years in the Chinese population. Chinese adults had higher prevalence of myopia, high myopia, astigmatism, as well as the longer AL compared with non-Chinese adults in Singapore.
Newly diagnosed open-angle glaucoma (OAG) and ocular hypertension (OHT) are habitually treated with intraocular pressure (IOP)-lowering eyedrops. Selective laser trabeculoplasty (SLT) is a safe ...alternative to drops and is rarely used as first-line treatment.
To compare health-related quality of life (HRQoL) in newly diagnosed, treatment-naive patients with OAG or OHT, treated with two treatment pathways: topical IOP-lowering medication from the outset (Medicine-1st) or primary SLT followed by topical medications as required (Laser-1st). We also compared the clinical effectiveness and cost-effectiveness of the two pathways.
A 36-month pragmatic, unmasked, multicentre randomised controlled trial.
Six collaborating specialist glaucoma clinics across the UK.
Newly diagnosed patients with OAG or OHT in one or both eyes who were aged ≥ 18 years and able to provide informed consent and read and understand English. Patients needed to qualify for treatment, be able to perform a reliable visual field (VF) test and have visual acuity of at least 6 out of 36 in the study eye. Patients with VF loss mean deviation worse than -12 dB in the better eye or -15 dB in the worse eye were excluded. Patients were also excluded if they had congenital, early childhood or secondary glaucoma or ocular comorbidities; if they had any previous ocular surgery except phacoemulsification, at least 1 year prior to recruitment or any active treatment for ophthalmic conditions; if they were pregnant; or if they were unable to use topical medical therapy or had contraindications to SLT.
SLT according to a predefined protocol compared with IOP-lowering eyedrops, as per national guidelines.
The primary outcome was HRQoL at 3 years as measured using the EuroQol-5 Dimensions, five-level version (EQ-5D-5L) questionnaire. Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness and safety.
Of the 718 patients enrolled, 356 were randomised to Laser-1st (initial SLT followed by routine medical treatment) and 362 to Medicine-1st (routine medical treatment only). A total of 652 (91%) patients returned the primary outcome questionnaire at 36 months. The EQ-5D-5L score was not significantly different between the two arms adjusted mean difference (Laser-1st - Medicine-1st) 0.01, 95% confidence interval (CI) -0.01 to 0.03;
= 0.23 at 36 months. Over 36 months, the proportion of visits at which IOP was within the target range was higher in the Laser-1st arm (93.0%, 95% CI 91.9% to 94.0%) than in the Medicine-1st arm (91.3%, 95% CI 89.9% to 92.5%), with IOP-lowering glaucoma surgery required in 0 and 11 patients, respectively. There was a 97% probability of Laser-1st being more cost-effective than Medicine-1st for the NHS, at a willingness to pay for a quality-adjusted life-year of £20,000, with a reduction in ophthalmology costs of £458 per patient (95% of bootstrap iterations between -£585 and -£345).
An unmasked design, although a limitation, was essential to capture any treatment effects on patients' perception. The EQ-5D-5L questionnaire is a generic tool used in multiple settings and may not have been the most sensitive tool to investigate HRQoL.
Compared with medication, SLT provided a stable, drop-free IOP control to 74.2% of patients for at least 3 years, with a reduced need for surgery, lower cost and comparable HRQoL. Based on the evidence, SLT seems to be the most cost-effective first-line treatment option for OAG and OHT, also providing better clinical outcomes.
Longitudinal research into the clinical efficacy of SLT as a first-line treatment will specify the long-term differences of disease progression, treatment intensity and ocular surgery rates between the two pathways.
Current Controlled Trials ISRCTN32038223.
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in
; Vol. 23, No. 31. See the NIHR Journals Library website for further project information.
PURPOSE. To determine the prevalence of amblyopia and strabismus in young Singaporean Chinese children. METHODS. Enrolled in the study were 3009 Singaporean children, aged 6 to 72 months. All ...underwent complete eye examinations and cycloplegic refraction. Visual acuity (VA) was measured with a logMAR chart when possible and the Sheridan-Gardner test when not. Strabismus was defined as any manifest tropia. Unilateral amblyopia was defined as a 2-line difference between eyes with VA < 20/30 in the worse eye and with coexisting anisometropia (> or =1.00 D for hyperopia, > or =3.00 D for myopia, and > or =1.50 D for astigmatism), strabismus, or past or present visual axis obstruction. Bilateral amblyopia was defined as VA in both eyes <20/40 (in children 48-72 months) and <20/50 (<48 months), with coexisting hyperopia > or =4.00 D, myopia < or = -6.00 D, and astigmatism > or =2.50 D, or past or present visual axis obstruction. RESULTS. The amblyopia prevalence in children aged 30 to 72 months was 1.19% (95% confidence interval CI, 0.73-1.83) with no age (P = 0.37) or sex (P = 0.22) differences. Unilateral amblyopia (0.83%) was twice as frequent as bilateral amblyopia (0.36%). The most frequent causes of amblyopia were refractive error (85%) and strabismus (15%); anisometropic astigmatism >1.50 D (42%) and isometropic astigmatism >2.50 D (29%) were frequent refractive errors. The prevalence of strabismus in children aged 6 to 72 months was 0.80% (95% CI, 0.51-1.19), with no sex (P = 0.52) or age (P = 0.08) effects. The exotropia-esotropia ratio was 7:1, with most exotropia being intermittent (63%). Of children with amblyopia, 15.0% had strabismus, whereas 12.5% of children with strabismus had amblyopia. CONCLUSIONS. The prevalence of amblyopia was similar, whereas the prevalence of strabismus was lower than in other populations.
Besides the direct economic and social burden of myopia, associated ocular complications may lead to substantial visual loss. In several population and clinic‐based cohorts, case–control and ...cross‐sectional studies, higher risks of posterior subcapsular cataract, cortical and nuclear cataract in myopic patients were reported. Patients with high myopia (spherical equivalent at least –6.0 D) are more susceptible to ocular abnormalities. The prevalent risks of glaucoma were higher in myopic adults, and risks of chorioretinal abnormalities such as retinal detachment, chorioretinal atrophy and lacquer cracks increased with severity of myopia and greater axial length. Myopic adults were more likely to have tilted, rotated, and larger discs as well as other optic disc abnormalities. Often, these studies support possible associations between myopia and specific ocular complications, but we cannot infer causality because of limitations in study methodology. The detection and treatment of possible pathological ocular complications is essential in the management of high myopia. The ocular risks associated with myopia should not be underestimated and there is a public health need to prevent the onset or progression of myopia.
To determine the prevalence of refractive error types in Singaporean Chinese children aged 6 to 72 months.
The Strabismus, Amblyopia and Refractive Error in Singaporean Children (STARS) is a ...population-based study in southwest Singapore. Door-to-door recruitment of participants was used, with disproportionate random sampling in 6-month increments. Parental questionnaires were administered. Participant eye examinations included logMAR visual acuity, cycloplegic autorefraction, and ocular biometry. Overall and age-specific prevalences of myopia (spherical equivalence SE <or= -0.50 D), high myopia (SE <or= -6.00 D), hyperopia (SE >or= +3.00 D), astigmatism (cylinder >or= +1.50 D), and anisometropia (SE difference between each eye >or=2.00 D) were calculated.
A total of 3009 children were examined (participation rate, 72.3%). Right eye (OD) cycloplegia data were available for 1375 boys and 1264 girls (mean age, 41 months). Mean OD SE was +0.69 D (SD 1.15). Overall myopia prevalence was 11.0% with no variance between the sexes (P = 0.91). The prevalence of high myopia (at least -6.00 D) was 0.2%. The prevalences of hyperopia, astigmatism, and anisometropia were 1.4%, 8.6%, and 0.6%, respectively. Most astigmatism (>95%) was with-the-rule (cylinder axes between 1 degrees and 15 degrees or 165 degrees and 180 degrees ). Myopia was present in 15.8%, 14.9%, 20.2%, 8.6%, 7.6%, and 6.4% of children aged 6 to 11, 12 to 23, 24 to 35, 36 to 47, 48 to 59, and 60 to 72 months, respectively. Prevalence increased with age for astigmatism (P < 0.001), but not for hyperopia or anisometropia (P = 0.55 and P = 0.37), respectively.
The prevalences of myopia and astigmatism in young Singaporean Chinese children are high, but that of hyperopia is low. Age effects were observed for each refractive error category, but differences between the sexes were not significant. Age-related variation in myopia prevalence may be influenced by ocular development, environment, and/or testability.
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