Epidemiologic Analysis of Asteroid Hyalosis and Associations: The Gutenberg Health Study

Asteroid Hyalosis: An Update on Prevalence, Risk Factors, Emerging Clinical Impact and Management Strategies

Asteroid hyalosis (AH) is a benign clinical entity characterized by the presence of multiple refractile spherical calcium and phospholipids within the vitreous body. First described by Benson in 1894, this entity has been well documented in the clinical literature and is named due to the resemblance of asteroid bodies on clinical examination to a starry night sky. Today, a growing body of epidemiologic data estimates the global prevalence of asteroid hyalosis to be around 1%, and there is a strong established association between AH and older age. While pathophysiology remains unclear, a variety of systemic and ocular risk factors for AH have recently been suggested in the literature and may provide insight into possible mechanisms for asteroid body (AB) development. As vision is rarely affected, clinical management is focused on differentiation of asteroid hyalosis from mimicking conditions, evaluation of the underlying retina for other pathology and consideration of vitrectomy in rare cases with visual impairment. Taking into account the recent technologic advances in large-scale medical databases, improving imaging modalities, and the popularity of telemedicine, this review summarizes the growing body of literature of AH epidemiology and pathophysiology and provides updates on the clinical diagnosis and management of AH.

Prevalence and associations of asteroid hyalosis: the Beijing Eye Study

Background

To determine the prevalence and associations of asteroid hyalosis (AH) in a Chinese population-based cohort.

Methods

The retrospective, cross-sectional, population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6 ± 9.8 years (range: 50–93 years). Participants underwent detailed ophthalmic examinations including fundus photographs for diagnosis of AH. Data on systemic and ocular factors were collected for all participants according to the standardized protocol. Multiple linear regression and multivariate Logistic regression analysis were performed.

Results

Fundus photographs were gradable in 3419 subjects. AH was detected in 63 (0.9%, 95% CI: 0.7%, 1.1%) eyes of 53 (1.6%, 95% CI: 1.1%, 2.0%) subjects. AH was bilateral in 18.9%. Mean age of all subjects with AH was 69.2 ± 9.5 years (median, 71.0 years; range, 51–91 years), mean spherical equivalent was 0.63 ± 1.53D (median, 0.75 D; range, -4.12 to 4.00D). In multivariate analysis, prevalence of AH was associated with elder age (P = 0.014, OR 1.057), thicker lens (P = 0.032, OR 3.887), higher spherical equivalent (P = 0.017, OR 1.396).

Conclusions

In adult Chinese in Beijing, the prevalence of AH was 0.9% for eyes or 1.6% for subjects. AH was associated with elder age, thicker lens, and higher spherical equivalent. It was not associated with diabetes or other systemic indicators.

Spotlight on Asteroid Hyalosis: A Clinical Perspective

Asteroid hyalosis is a benign degenerative condition of the vitreous that is often asymptomatic. Our purpose with this narrative review is to provide a current overview of asteroid hyalosis from a clinical perspective. We review the epidemiology and risk factors, the clinical diagnosis and differential diagnoses, clinical challenges in eyes with asteroid hyalosis, and the treatment of asteroid hyalosis. Many clinical questions remain unanswered, and the current evidence to guide clinical practice is largely based on anecdotal evidence and clinical experience. More studies on asteroid hyalosis from a clinical perspective are warranted.