To examine annual changes in refraction and ocular components around the onset of myopia in Chinese children.
Longitudinal study.
Twins aged 7 to 15 years in 2006 from the Guangzhou Twin Registry.
...Participants underwent eye examinations annually from 2006 to 2010. Years were defined (+1 or -1) relative to the examination at which the onset of myopia was first identified.
Annual change in spherical equivalent refraction (SER) and ocular biometry.
Children who were not myopic at the first examination and myopic in at least 1 subsequent examination from 2006 to 2010 were included in the analysis. Annual change in SER increased slowly from 4 years before the first detection of myopia to 2 years before myopia onset (-0.25 to -0.4 diopter D). The rate of progression was the highest during the year of onset (-0.92 D). After the first detection of myopia, the rate of progression decreased to -0.71 D in the following year and kept decreasing. Annual change in axial length showed a similar, but inverse, shape to that of SER. Annual change in lens power did not change significantly around the onset of myopia.
Before the onset of myopia, axial elongation and progression accelerate. After a myopic refraction is established, axial elongation and progression decrease. We suggest that the increases before myopia may be due to increased intensity of study and decreased time outdoors. In contrast, the rapid slowing after the onset of myopia may represent an inhibitory effect of myopic defocus on eye growth.
To investigate the association of lens parameters-specifically, lens vault (LV), lens thickness (LT), and lens position (LP)-with angle closure.
Prospective, comparative study.
One hundred two ...Chinese subjects with angle closure (consisting of primary angle closure, primary angle-closure glaucoma, and previous acute primary angle closure) attending a glaucoma clinic and 176 normal Chinese subjects with open angles and no evidence of glaucoma recruited from an ongoing population-based cross-sectional study.
All participants underwent gonioscopy and anterior-segment optical coherence tomography (AS OCT; Carl Zeiss Meditec, Dublin, CA). Customized software was used to measure LV, defined as the perpendicular distance between the anterior pole of the crystalline lens and the horizontal line joining the 2 scleral spurs, on horizontal AS OCT scans. A-scan biometry (US-800; Nidek Co, Ltd, Tokyo, Japan) was used to measures LT and to calculate LP (defined as anterior chamber depth ACD +1/2 LT) and relative LP (RLP; defined as LP/axial length AL).
Lens parameters and angle closure.
Significant differences between angle-closure and normal eyes were found for LV (901±265 vs. 316±272 μm; P<0.001), LT (4.20±0.92 vs. 3.90±0.73 mm; P = 0.01), LT-to-AL ratio (0.18±0.04 vs. 0.16±0.03; P<0.001), ACD (2.66±0.37 vs. 2.95±0.37 mm; P<0.001), and AL (22.86±0.93 vs. 23.92±1.37 mm; P<0.001), but no significant differences were found for LP (4.76±0.51 vs. 4.90±0.54 mm; P = 0.34) or RLP (0.21±0.02 vs. 0.20±0.02; P = 0.14). After adjusting for age, gender, ACD, LT, and RLP, increased LV was associated significantly with angle closure (odds ratio OR, 48.1; 95% confidence interval CI, 12.8-181.3, comparing lowest to highest quartile), but no association was found for LT (OR, 1.78; 95% CI, 0.76-4.16), LP (OR, 1.94; 95% CI, 0.59-6.31), or RLP (OR, 2.08; 95% CI, 0.66-6.57). There was low correlation between LV and LT (Pearson's correlation coefficient PCC, 0.17), between LV and RLP (PCC, 0.08), or between LV and LP (PCC, 0.2).
Eyes with angle closure have thicker lenses with greater LV compared with normal eyes. The LV, which represents the anterior portion of the lens, is a novel parameter independently associated with angle closure after adjusting for age, gender, ACD, and LT.
To estimate the age-, gender-, and ethnicity-specific prevalence of amblyopia in children aged 5 to 15 years using data from the multi-country Refractive Error Study in Children (RESC).
...Population-based, cross-sectional study.
Among 46 260 children aged 5 to 15 years who were enumerated from 8 sites in the RESC study, 39 551 had a detailed ocular examination and a reliable visual acuity (VA) measurement in 1 or both eyes. Information on ethnicity was available for 39 321 of these participants. This study focused on findings from the 39 321 children.
The examination included VA measurements, evaluation of ocular alignment and refractive error under cycloplegia, and examination of the external eye, anterior segment, media, and fundus.
The proportion of children aged 5 to 15 years with amblyopia in different ethnic cohorts. Amblyopia was defined as best-corrected visual acuity (BCVA) of ≤20/40 in either eye, with tropia, anisometropia (≥2 spherical equivalent diopters D), or hyperopia (≥+6 spherical equivalent D), after excluding children with fundus or anterior segment abnormalities.
The overall prevalence of amblyopia was 0.74% (95% confidence interval, 0.64-0.83) with significant (P < 0.001) variation across ethnic groups: 1.43% in Hispanic, 0.93% in Chinese, 0.62% in Indian, 0.52% in Malay, 0.35% in Nepali, and 0.28% in African children. Amblyopia was not associated with age or gender. The most common cause of amblyopia was anisometropia.
In this study, the prevalence of amblyopia varied with ethnicity and was highest in Hispanic children and lowest in African children. Most cases were unilateral and developed before the age of 5 years. The impact of changes of definitions on prevalence estimates is discussed.
The purpose of this study is to evaluate the feasibility and patient acceptability of a novel artificial intelligence (AI)-based diabetic retinopathy (DR) screening model within endocrinology ...outpatient settings. Adults with diabetes were recruited from two urban endocrinology outpatient clinics and single-field, non-mydriatic fundus photographs were taken and graded for referable DR ( ≥ pre-proliferative DR). Each participant underwent; (1) automated screening model; where a deep learning algorithm (DLA) provided real-time reporting of results; and (2) manual model where retinal images were transferred to a retinal grading centre and manual grading outcomes were distributed to the patient within 2 weeks of assessment. Participants completed a questionnaire on the day of examination and 1-month following assessment to determine overall satisfaction and the preferred model of care. In total, 96 participants were screened for DR and the mean assessment time for automated screening was 6.9 minutes. Ninety-six percent of participants reported that they were either satisfied or very satisfied with the automated screening model and 78% reported that they preferred the automated model over manual. The sensitivity and specificity of the DLA for correct referral was 92.3% and 93.7%, respectively. AI-based DR screening in endocrinology outpatient settings appears to be feasible and well accepted by patients.
ObjectiveThis study was to aggregate the prevalence and risks of epiretinal membranes (ERMs) and determine the possible causes of the varied estimates.DesignSystematic review and meta-analysis.Data ...sourcesThe search strategy was designed prospectively. We searched PubMed, Embase and Web of Science databases from inception to July 2016. Reference lists of the included literatures were reviewed as well.Study selectionSurveys published in English language from any population were included if they had a population-based design and reported the prevalence of ERM from retinal photography with or without optical coherence tomography. Eligibility and quality evaluation was conducted independently by two investigators.Data extractionThe literature search generated 2144 records, and 13 population-based studies comprising 49 697 subjects were finally included. The prevalence of ERM and the ORs of potential risk factors (age, sex, myopia, hypertension and so on) were extracted.ResultsThe pooled age-standardised prevalence estimates of earlier ERM (cellophane macular reflex (CMR)), advanced ERM (preretinal macular fibrosis (PMF)) and any ERM were 6.5% (95% CI 4.2% to 8.9%), 2.6% (95% CI 1.8% to 3.4%) and 9.1% (95% CI 6.0% to 12.2%), respectively. In the subgroup analysis, race and photography modality contributed to the variation in the prevalence estimates of PMF, while the WHO regions and image reading methods were associated with the varied prevalence of CMR and any ERM. Meta-analysis showed that only greater age and female significantly conferred a higher risk of ERMs.ConclusionsOur findings suggest that ERMs are relatively common among aged population. Race, image taking and reading methodology may play important roles in influencing the large variability of ERM prevalence estimates.
We aimed to examine whether meal patterns, as well as energy intake from three main meals and snacks, were associated with incident hypertension.
We included 12 995 participants aged 18-59 years from ...the China Health and Nutrition Survey in the final analysis. Dietary intake was assessed using weighing methods in combination with 24-h food records. Cox proportional hazards regression models were used to examine the association of meal patterns, and energy intake from different meals with incident hypertension.
During a mean follow-up of 11.2 years, 4766 new hypertension cases were documented. Four meal patterns were derived according to energy intake: balanced, breakfast dominant, lunch dominant, and dinner dominant patterns. Dinner dominant meal pattern was associated with a lower risk of incident hypertension hazard ratio (95% confidence interval): 0.90 (0.84-0.98) compared with the balanced meal pattern. Breakfast energy intake was positively, but dinner energy intake was inversely associated with incident hypertension. The positive association between breakfast energy intake and incident hypertension was observed in rural residents only 1.22 (1.07-1.41) for rural residents, 0.98 (0.82-1.18) for urban residents; P interaction = 0.0348. A positive association between energy intake from lunch and incident hypertension was observed in the urban residents only.
Dinner dominant meal pattern was associated with a lower risk of hypertension compared with the balanced meal pattern in Chinese adults. A relatively small breakfast and large dinner may help to prevent or delay the development of hypertension, especially in urban residents.
The prevalence of myopia increases with both age and grade for children attending school. The current study aimed to distinguish the effects of aging and grade on myopia.
Grade 1 students (706 at ...baseline in 2009, mean age 6.56 ± 0.29 years, range 6.00 to 6.99 years old, 55.5% boys) were followed up until 2012. Cycloplegic spherical equivalent (SE) was measured annually.
The sample in a grade was divided into three 4-month age blocks according to their birth month. Within each grade, there were no significant differences in SE between age blocks (all P > 0.05), despite an age range of one year. More myopic SE was observed in the youngest block of grade 2 compared to the oldest block of grade 1 (difference, -0.36 ± 0.08 D; P < 0.001), although age of the two blocks only differed by four months. Similarly, more myopic SE were found in the youngest block in grade 3 than the oldest block in grade 2 (differences, -0.50 ± 0.10 D; P < 0.001) and in the youngest block in grade 4 than the oldest block in grade 3 (differences, -0.82 ± 0.14 D; P < 0.001).
Exposure to schooling, rather than age, appears to be the major driver of refractive development, at least in the early years of schooling. Interventions during this period, involving reductions in educational pressure and increased time outdoors may have major effects on the subsequent development of myopia.
Myopia (near-sightedness) is an important public health issue. Spending more time outdoors can prevent myopia but the long-term association between this exposure and myopia has not been well ...characterised. We investigated the relationship between time spent outdoors in childhood, adolescence and young adulthood and risk of myopia in young adulthood. The Kidskin Young Adult Myopia Study (KYAMS) was a follow-up of the Kidskin Study, a sun exposure-intervention study of 1776 children aged 6-12 years. Myopia status was assessed in 303 (17.6%) KYAMS participants (aged 25-30 years) and several subjective and objective measures of time spent outdoors were collected in childhood (8-12 years) and adulthood. Index measures of total, childhood and recent time spent outdoors were developed using confirmatory factor analysis. Logistic regression was used to assess the association between a 0.1-unit change in the time outdoor indices and risk of myopia after adjusting for sex, education, outdoor occupation, parental myopia, parental education, ancestry and Kidskin Study intervention group. Spending more time outdoors during childhood was associated with reduced risk of myopia in young adulthood (multivariable odds ratio OR 0.82, 95% confidence interval CI 0.69, 0.98). Spending more time outdoors in later adolescence and young adulthood was associated with reduced risk of late-onset myopia (≥ 15 years of age, multivariable OR 0.79, 95% CI 0.64, 0.98). Spending more time outdoors in both childhood and adolescence was associated with less myopia in young adulthood.
Purpose
To explore the association between age‐related cataract and 10‐year mortality in an adult population in urban China.
Methods
A total of 1405 participants aged 50 years or older were examined ...at baseline in the Guangzhou Liwan Eye Study. All participants were invited to attend a 10‐year follow‐up visit. Cataract cases were defined as either having visible lens opacity confirmed with direct ophthalmoscope under pupil dilation or previous history of cataract surgery. Visual impairment (VI) was defined as a visual acuity of 20/40 or worse in the better‐seeing eye with habitual correction if worn. Body mass index (BMI) was based on anthropometric data. A brief questionnaire regarding family income, educational attainment and medical history of systemic disease was administered. Mortality rates were compared using the log‐rank test and Cox proportional hazards regression models.
Results
Among 1405 participants examined at baseline, 957 participants (68.1%) had visible lens opacity or history of cataract surgery. After 10 years, 320 (22.8%) participants died. The 10‐year mortality rate was significantly higher in participants with cataract than in those without (30.1% versus 7.14%, log‐rank p < 0.05). After adjusting for age, gender, family income, educational attainment, BMI, history of diabetes and hypertension and presence of VI, presence of cataract predicted a nearly threefold increase in the risk of mortality (HR, 2.99; 95% CI, 1.89–4.71).
Conclusions
Our findings that age‐related cataract is a predictor for poorer survival compared to those without may imply that cataract is a biomarker of ageing and frailty.
To examine the association of physical activities (PA) with diabetic retinopathy (DR) progression based on a 10-year follow-up of a large cohort of working-aged diabetic populations in Australia.
...Nine thousand and eighteen working-aged diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5-14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through the Medicare Benefits Schedule, which was available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence.
In the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend = 0.002; medium vs. low, hazard ratio (HR) = 0.78, 95% Confidence Interval (CI): 0.61-0.98; high vs. low, HR = 0.61, 95%CI: 0.36-0.84. In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC.
Higher PA level was independently associated with a lower risk of DR progression among working-aged diabetic populations in this large cohort study.
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