To evaluate anterior chamber biometric factors associated with the degree of angle widening and intraocular pressure (IOP) reduction after phacoemulsification.
University of California, San ...Francisco, California, USA.
Case series.
Anterior chamber parameters obtained by anterior segment coherence tomography were compared preoperatively and 3 months postoperatively. Measurements included the angle opening distance 500 μm anterior to the scleral spur (AOD500), trabecular-iris space area 500 μm from the scleral spur (TISA500), iris curvature (I-Curv), anterior chamber angle (ACA), trabecular-iris space area, anterior chamber volume, anterior chamber width, and lens vault (LV).
The study enrolled 73 eyes. The mean patient age was 77.45 years ± 7.84 (SD); 65.75% of patients were women. From preoperatively to 3 months postoperatively, the mean AOD500 increased significantly (0.254 ± 0.105 to 0.433 ± 0.108 mm) and the mean IOP decreased significantly (14.97 ± 3.35 to 12.62 ± 3.37 mm Hg) (P<.001). The reduction in IOP was correlated with the increase in AOD500 (r = 0.240, P=.041) and preoperative LV (r = 0.235, P=.045). After adjusting for related factors, AOD500 widening was positively correlated with LV (β = 0.458, P=.044) and I-Curv (β = 0.235, P=.043) and negatively correlated with preoperative TISA500 (β = -0.269, P=.025) and ACA (β = -0.919, P=.027).
Surgically induced AOD widening was significantly correlated with anterior chamber biometric factors. Preoperative LV appears to be a significant factor in angle widening and IOP reduction after phacoemulsification.
To describe variations in anterior chamber width (ACW) and investigate its association with the presence of narrow angles.
Cross-sectional study.
We recruited 2047 subjects aged 50 years or more from ...a community polyclinic and 111 subjects with primary angle closure (PAC) or primary angle closure glaucoma (PACG) from an eye hospital in Singapore.
All participants underwent gonioscopy, anterior chamber depth (ACD) and axial length (AL) measurement (IOLMaster; Carl Zeiss, Jena, Germany), and anterior-segment optical coherence tomography (AS-OCT, Visante, Carl Zeiss Meditec, Dublin, CA). Customized software was used to measure the ACW, defined as the distance between the scleral spurs in the horizontal (nasal-temporal) axis of AS-OCT scans. An eye was deemed to have narrow angles if the posterior trabecular meshwork was not visible for at least 180 degrees on non-indentation gonioscopy with the eye in the primary position.
Anterior chamber width and narrow angles.
Data on 1465 community-based subjects were available for analysis. Anterior chamber width was significantly smaller in women compared with men (11.70 mm vs. 11.81 mm, respectively, P<0.001) and decreased significantly with age (P for trend <0.001). Significant predictors of smaller ACW were lower educational level, lower body mass index, shorter AL, shallower ACD, and Chinese race. Of the 1465 subjects, 315 (21.5%) had narrow angles on gonioscopy. Mean ACW was smaller in eyes with narrow angles compared with those without narrow angles (11.60 mm vs. 11.80 mm, P<0.001). The age- and gender-adjusted odds ratio for the highest quartile compared with the lower 3 quartiles of ACW with the presence of narrow angles was 3.4 (95% confidence interval, 2.3-5.0; P for trend <0.001). Hospital-based subjects with PAC/PACG had even smaller ACW than community subjects with narrow angles (11.33 mm vs. 11.60 mm, P<0.001).
In this cross-sectional study, ACW was smaller in women, Chinese persons, and older persons, and was associated with narrow angles in 2 different study populations. These data suggest that a smaller ACW may represent a novel risk indicator for angle closure.
Fault problems associated with submarine cables caused by variations in their burial depth are becoming increasingly prominent. To address the difficulty of detecting the burial depth of submarine ...cables and trends in its variation, a prediction model for submarine cable burial depth was proposed which considers the dynamic characteristics of thermal resistance. First, a parallel thermal circuit model of a three-core submarine cable was established, and a formula for calculating the submarine cable’s burial depth was derived based on a formula for calculating the submarine cable’s core temperature. Then, the calculation result was corrected by considering the dynamic characteristics of the thermal resistance of the submarine cable’s structural materials. On this basis, feature vectors associated with the seabed cable burial depth calculation data and time nodes were mined by a convolutional neural network and used as the input parameters of a long short-term memory network for optimization and training, and a prediction model for trends in seabed cable burial depth variation was obtained. Finally, an example analysis was carried out based on the actual electrical parameter data of submarine cables buried by an offshore oil and gas platform. The results showed that the prediction model for trends in variations in the burial depth of submarine cables based on the CNN-LSTM neural network can achieve high prediction accuracy and prediction efficiency.
Abstract
It is unclear regarding associations of dietary patterns with a wide range of chronic diseases and which dietary score is more predictive of major chronic diseases. Using the UK Biobank, we ...examine associations of four individual healthy dietary scores with the risk of 48 individual chronic diseases. Higher Alternate Mediterranean Diet score is associated with a lower risk of 32 (all 8 cardiometabolic disorders, 3 out of 10 types of cancers, 7 out of 10 psychological/neurological disorders, 5 out of 6 digestive disorders, and 9 out of 14 other chronic diseases). Alternate Healthy Eating Index-2010 and Healthful Plant-based Diet Index are inversely associated with the risk of 29 and 23 individual chronic diseases, respectively. A higher Anti-Empirical Dietary Inflammatory Index is associated with a lower risk of 14 individual chronic diseases and a higher incidence of two diseases. Our findings support dietary guidelines for the prevention of most chronic diseases.
Orthokeratology (Ortho-K) works to reshape cornea and is the only non-surgical way to enable vision without corrective aids. However, its effect is only temporary, and successful stabilization ...requires ongoing Ortho-K wear to maintain the reshaping effect. Corneal crosslinking (CXL) is a commonly-used technique in clinical practice to stabilize corneal shape in keratoconic eyes. However, whether or not CXL can stabilize corneal shape after Ortho-K in normal cornea has not been reported. Therefore, this proof-of-concept study using 2 rhesus monkeys aimed to determine the efficacy of the combined procedure. One monkey wore Ortho-K bilaterally for 24 hours, and the other from 6 pm to 8 am for 7 days. The left eyes of both monkeys underwent CXL after Ortho-K while the contralateral eye served as control. Results showed a gradual regression of corneal shape in all eyes with or without CXL. However, eyes underwent CXL regressed more slowly than the control eyes. The control eyes and the CXL treatment eye in the 7-day Ortho-K monkey regressed completely at last, while the CXL treatment eye in the 24 h Ortho-K monkey maintained a corneal flattening of -1.48 D 27 days after procedure. These findings suggest CXL can slow the regression of Ortho-K for a short duration, but cannot sustain its effect according to the current protocol.
Retinal structural abnormalities have been found to serve as biomarkers for cardiovascular disease (CVD). However, the association between retinal nerve fiber layer (RNFL) thickness and the incidence ...of CVD events remains inconclusive, and relevant longitudinal studies are lacking. Therefore, we aimed to examine this link in two prospective cohort studies.
A total of 25,563 participants from UK Biobank who were initially free of CVD were included in the current study. Another 635 participants without retinopathy at baseline from the Chinese Guangzhou Diabetes Eye Study (GDES) were adopted as the validation set. Measurements of RNFL thickness in the macular (UK Biobank) and peripapillary (GDES) regions were obtained from optical coherence tomography (OCT). Adjusted hazard ratios (HRs), odd ratios (ORs), and 95% confidence intervals (CI) were calculated to quantify CVD risk.
Over a median follow-up period of 7.67 years, 1281 (5.01%) participants in UK Biobank developed CVD events. Each 5-μm decrease in macular RNFL thickness was associated with an 8% increase in incident CVD risk (HR = 1.08, 95% CI: 1.01-1.17, p = 0.033). Compared with participants in the highest tertile of RNFL thickness, the risk of incident CVD was significantly increased in participants in the lowest thickness tertile (HR = 1.18, 95% CI: 1.01-1.38, p = 0.036). In GDES, 29 (4.57%) patients developed CVD events within 3 years. Lower average peripapillary RNFL thickness was also associated with a higher CVD risk (OR = 1.35, 95% CI: 1.11-1.65, p = 0.003). The additive net reclassification improvement (NRI) was 21.8%, and the absolute NRI was 2.0% by addition of RNFL thickness over the Framingham risk score. Of 29 patients with incident CVD, 7 were correctly reclassified to a higher risk category while 1 was reclassified to a lower category, and 21 high risk patients were not reclassified.
RNFL thinning was independently associated with increased incident cardiovascular risk and improved reclassification capability, indicating RNFL thickness derived from the non-invasive OCT as a potential retinal fingerprint for CVD event across ethnicities and health conditions.
ISRCTN 15853192.
Artificial intelligence has rapidly evolved from the experimental phase to the implementation phase in many image-driven clinical disciplines, including ophthalmology. A combination of the increasing ...availability of large datasets and computing power with revolutionary progress in deep learning has created unprecedented opportunities for major breakthrough improvements in the performance and accuracy of automated diagnoses that primarily focus on image recognition and feature detection. Such an automated disease classification would significantly improve the accessibility, efficiency, and cost-effectiveness of eye care systems where it is less dependent on human input, potentially enabling diagnosis to be cheaper, quicker, and more consistent. Although this technology will have a profound impact on clinical flow and practice patterns sooner or later, translating such a technology into clinical practice is challenging and requires similar levels of accountability and effectiveness as any new medication or medical device due to the potential problems of bias, and ethical, medical, and legal issues that might arise. The objective of this review is to summarize the opportunities and challenges of this transition and to facilitate the integration of artificial intelligence (AI) into routine clinical practice based on our best understanding and experience in this area.
Plasma metabolomic profile is disturbed in dementia patients, but previous studies have discordant conclusions.
Circulating metabolomic data of 110,655 people in the UK Biobank study were measured ...with nuclear magnetic resonance technique, and incident dementia records were obtained from national health registers. The associations between plasma metabolites and dementia were estimated using Cox proportional hazard models. The 10-fold cross-validation elastic net regression models selected metabolites that predicted incident dementia, and a 10-year prediction model for dementia was constructed by multivariable logistic regression. The predictive values of the conventional risk model, the metabolites model, and the combined model were discriminated by comparison of area under the receiver operating characteristic curves (AUCs). Net reclassification improvement (NRI) was used to estimate the change of reclassification ability when adding metabolites into the conventional prediction model.
Amongst 110,655 participants, the mean (standard deviation) age was 56.5 (8.1) years, and 51 186 (46.3%) were male. A total of 1439 (13.0%) developed dementia during a median follow-up of 12.2 years (interquartile range: 11.5-12.9 years). A total of 38 metabolites, including lipids and lipoproteins, ketone bodies, glycolysis-related metabolites, and amino acids, were found to be significantly associated with incident dementia. Adding selected metabolites (n=24) to the conventional dementia risk prediction model significantly improved the prediction for incident dementia (AUC: 0.824 versus 0.817, p =0.042) and reclassification ability (NRI = 4.97%, P = 0.009) for identifying high risk groups.
Our analysis identified various metabolomic biomarkers which were significantly associated with incident dementia. Metabolomic profiles also provided opportunities for dementia risk reclassification. These findings may help explain the biological mechanisms underlying dementia and improve dementia prediction.
Abstract Purpose To evaluate the anterior segment biometric changes measured by anterior segment optical coherence tomography (AS-OCT) in acute primary angle closure (APAC) after laser peripheral ...iridotomy (LPI). Design Prospective interventional study. Methods In this clinic-based study, 52 eyes of 52 patients with resolved APAC attack who underwent LPI were enrolled. Subjects underwent complete ophthalmic examination and AS-OCT imaging before and 6 weeks after LPI. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness (IT), iris area, iris curvature, lens vault (LV), anterior vault, angle opening distance (AOD 500, AOD750), and trabecular iris space area (TISA500, TISA750) were measured in qualified images using the Zhongshan Angle Assessment Program and compared before and after LPI. A linear mixed model analysis was performed for potential predictors of change in AOD750. Main outcome measure was change in AOD750 after LPI. Results The mean age of participants was 60.7±9.2 years. Mean angle width (Shaffer grade) changed from 0.25 ± 0.34 at baseline to 1.22 ± 0.86 after LPI (P<0.001). However, 25 (48.0%) nasal angles and 28 (53%) temporal angles had iridotrabecular contact after LPI. All angle parameters (AOD500, AOD750, TISA500, TISA750; p≤0.03), ACD (p=0.001), and ACA (p<0.001) increased significantly after LPI. Iris curvature and LV were reduced (P=0.01 for both) after LPI, but there was no significant change in IT and iris area. After multivariate analysis, pre-LPI AOD750 was the only factor associated with change in AOD750 (β=-0.992, p=0.02). Exaggerated LV, defined as LV greater than one third of the anterior vault (sum of LV and ACD), was present in 61.5% of the cases (32 eyes). The extent of change in angle parameters was not significantly different between groups with and without exaggerated LV after LPI. Conclusion This study confirms that LPI results in a significant increase in the angle width, ACD, and ACA as well as flattening of the iris in APAC eyes. The extent of angle deepening is inversely related to baseline angle width. The lens shifts posteriorly after resolution of attack especially in those with greater lens vault.
We aimed to evaluate the impacts of metabolomic body mass index (metBMI) phenotypes on the risks of cardiovascular and ocular diseases outcomes.
This study included cohorts in UK and Guangzhou, ...China. By leveraging the serum metabolome and BMI data from UK Biobank, this study developed and validated a metBMI prediction model using a ridge regression model among 89,830 participants based on 249 metabolites. Five obesity phenotypes were obtained by metBMI and actual BMI (actBMI): normal weight (NW, metBMI of 18.5-24.9 kg/m
), overweight (OW, metBMI of 25-29.9 kg/m
), obesity (OB, metBMI ≥ 30 kg/m
), overestimated (OE, metBMI-actBMI > 5 kg/m
), and underestimated (UE, metBMI-actBMI < - 5 kg/m
). Additional participants from the Guangzhou Diabetes Eye Study (GDES) were included for validating the hypothesis. Outcomes included all-cause and cardiovascular (CVD)-cause mortality, as well as incident CVD (coronary heart disease, heart failure, myocardial infarction MI, and stroke) and age-related eye diseases (age-related macular degeneration AMD, cataracts, glaucoma, and diabetic retinopathy DR).
In the UKB, although OE group had lower actBMI than NW group, the OE group had a significantly higher risk of all-cause mortality than those in NW prediction group (HR, 1.68; 95% CI 1.16-2.43). Similarly, the OE group had a 1.7-3.6-fold higher risk than their NW counterparts for cardiovascular mortality, heart failure, myocardial infarction, and coronary heart disease (all P < 0.05). In addition, risk of age-related macular denegation (HR, 1.96; 95% CI 1.02-3.77) was significantly higher in OE group. In the contrast, UE and OB groups showed similar risks of mortality and of cardiovascular and age-related eye diseases (all P > 0.05), though the UE group had significantly higher actBMI than OB group. In the GDES cohort, we further confirmed the potential of metabolic BMI (metBMI) fingerprints for risk stratification of cardiovascular diseases using a different metabolomic approach.
Gaps of metBMI and actBMI identified novel metabolic subtypes, which exhibit distinctive cardiovascular and ocular risk profiles. The groups carrying obesity-related metabolites were at higher risk of mortality and morbidity than those with normal health metabolites. Metabolomics allowed for leveraging the future of diagnosis and management of 'healthily obese' and 'unhealthily lean' individuals.
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