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Xu Y, Mao Y, Lin X, Gao Z, Ruan X. Trend and projection of the prevalence and burden of near vision loss in China and globally from 1990 to 2030: A Bayesian age-period-cohort modeling study. J Glob Health 2024; 14:04119. [PMID: 39091200 PMCID: PMC11294904 DOI: 10.7189/jogh.14.04119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Background Few studies have investigated near vision loss (NVL) in China. To address this gap, we aimed to explore trends in the prevalence and disease burden of NVL from 1990 to 2019 and to predict trends over the next decade. Methods Using data from the Global Burden of Disease 2019 study, we calculated the age-standardised prevalence rate (ASPR), age-specific disability-adjusted life years (DALYs), and annual percentage change (EAPC) in China and different regions. We then used the Bayesian age-period-cohort (BAPC) predictive model to predict the prevalence trends from 2020 to 2030 in both contexts. Results At the global level, ASPRs increased from 5613.27 in 1990 to 5937.81 per 100 000 population in 2019, with an EAPC of 0.06. The ASPR in China specifically decreased from 7538.14 in 1990 to 7392.86 per 100 000 population in 2019 (EAPC = -0.02). The age-standardised DALY rate was higher in women than in men, both globally and in China. The NVL burden was relatively higher in low-income regions, low sociodemographic index regions, and the South-East Asia Region compared to other regions. The predictive model indicated that the ASR trend for NVL slowly increased at a global level after 2020, yet decreased in China. Conclusions Despite a decline in the age-standardised prevalence of NVL in China over the next decade, the current burden remains substantial. To alleviate this burden, decision-makers should adopt inclusive approaches by involving all stakeholders.
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Affiliation(s)
- Yanxin Xu
- Department of Ophthalmology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yan Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xuming Lin
- Department of Ophthalmology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Zongyin Gao
- Department of Ophthalmology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Xiaoting Ruan
- Department of Ophthalmology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
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Ibukun FA, Ugalahi MO, Bekibele CO. Unilateral visual impairment and blindness in school children - prevalence and aetiology in Saki-East LGA of Oyo State, Nigeria. Eye (Lond) 2024; 38:2117-2123. [PMID: 38448733 PMCID: PMC11269637 DOI: 10.1038/s41433-024-02960-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE This study determined the prevalence and aetiology of unilateral visual impairment (VI) and blindness and its associated factors in school children. METHODS We conducted a multistage, cross-sectional study in primary and secondary schools of Saki-East Local Government Area of Oyo State, Nigeria. Unilateral VI was defined as presenting visual acuity (PVA) worse than +0.3 LogMAR (6/12) and unilateral blindness as PVA worse than +1.3 LogMAR (3/60) in the worse eye. Detailed ocular examinations were performed for students with unilateral VI, and Logistic regression analysis was performed to explore associations with independent variables. RESULTS The mean age of participants was 11 ± 3.2 years. Thirty-six (0.98%) of 3671 children had unilateral VI, and fifteen children had unilateral blindness (0.41%), giving a combined prevalence of 1.39 ± 0.5%. History of ocular trauma was reported by 14 (27.5%) participants with unilateral VI and blindness. In addition, those with a history of ocular trauma were 6.5 times more likely to be blind or have a severe VI (95% CI 1.5-2.8) than those without a history of ocular trauma. Uncorrected refractive error was the major cause of unilateral VI in 26 (51%) participants, while traumatic cataract was the main cause of unilateral blindness seen in 5 (9.8%) participants, none of whom had a previous eye examination. CONCLUSION Fourteen per thousand school children had unilateral VI in this study; the major causes were refractive error and cataract, which are treatable. Ocular trauma was a significant risk factor for unilateral VI and blindness.
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Affiliation(s)
- Folahan Adesola Ibukun
- Department of Ophthalmology, University College Hospital, Queen Elizabeth Road, Oritamefa, Ibadan, Oyo State, Nigeria.
| | - Mary Ogbenyi Ugalahi
- College of Medicine, University of Ibadan and Department of Ophthalmology, University College Hospital, Queen Elizabeth Road, Oritamefa, Ibadan, Oyo State, Nigeria
| | - Charles Obu Bekibele
- College of Medicine, University of Ibadan and Department of Ophthalmology, University College Hospital, Queen Elizabeth Road, Oritamefa, Ibadan, Oyo State, Nigeria
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Akosman S, Tran E, Rosenberg S, Pakhchanian H, Raiker R, Belyea DA. Patient Demand for Ophthalmologists in the United States: A Google Trends Analysis. Ophthalmic Epidemiol 2024; 31:349-355. [PMID: 37885262 DOI: 10.1080/09286586.2023.2273508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To study geographic patterns in ophthalmologist supply and patient demand for services in the United States. METHODS Google Trends data for the keywords "ophthalmology" and "ophthalmologist" between 2004 and 2019 were queried and normalized to determine relative search volumes (RSV) for each United States state. Ophthalmologist density was calculated by dividing the number of practicing ophthalmologists by the State Census Bureau population estimates. RSV values were divided by ophthalmologist density and normalized to calculate the relative demand index (RDI) for each state. The number of accredited ophthalmology programs per state was acquired through the Accreditation Council for Graduate Medical Education. RESULTS Ophthalmologist concentration was highly heterogeneous across the country. The states with the highest concentration of ophthalmologist per 10,000 people were Washington, DC (1.42), Maryland (0.94), Massachusetts (0.87), and New York (0.86), while the lowest were Wyoming (0.19), Idaho (0.36), New Mexico (0.38), and Nevada (0.39). RSVs ranged from 36 (Alaska and North Dakota) to 100 (Michigan). The highest RDI was found in South Dakota (100), Delaware (84), Michigan (66), and Arizona (56). The lowest RDI was in Washington, DC (0), Hawaii (7), Oregon (8), and Montana (14). The highest number of ophthalmology residency programs were in New York (18), Texas (9), and California (9), whereas 12 states lacked residency programs altogether. CONCLUSIONS In this study, we found a wide range in the geographic distribution of ophthalmologists and residency programs in the United States. States with the highest relative demand index may represent areas most at risk of unmet medical needs.
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Affiliation(s)
- Sinan Akosman
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Elizabeth Tran
- College of Computer, Mathematical, and Natural Sciences, University of Maryland, College Park, MD, USA
| | - Sedona Rosenberg
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Haig Pakhchanian
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rahul Raiker
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, WV, USA
| | - David A Belyea
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Ahn SJ. Real-World Research on Retinal Diseases Using Health Claims Database: A Narrative Review. Diagnostics (Basel) 2024; 14:1568. [PMID: 39061705 PMCID: PMC11276298 DOI: 10.3390/diagnostics14141568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Real-world data (RWD) has emerged as a crucial component in understanding and improving patient outcomes across various medical conditions, including retinal diseases. Health claims databases, generated from healthcare reimbursement claims, offer a comprehensive source of RWD, providing insights into patient outcomes, healthcare utilization, and treatment effectiveness. However, the use of these databases for research also presents unique challenges. This narrative review explores the role of real-world research on retinal diseases using health claims databases, highlighting their advantages, limitations, and potential contributions to advancing our understanding and management of the diseases. The review examines the applications of health claims databases in retinal disease research, including epidemiological studies, comparative effectiveness and safety analyses, economic burden assessments, and evaluations of patient outcomes and quality of care. Previous findings demonstrate the value of these databases in generating prevalence and incidence estimates, identifying risk factors and predictors, evaluating treatment effectiveness and safety, and understanding healthcare utilization patterns and costs associated with retinal diseases. Despite their strengths, health claims databases face challenges related to data limitations, biases, privacy concerns, and methodological issues. Accordingly, the review also explores future directions and opportunities, including advancements in data collection and analysis, integration with electronic health records, collaborative research networks and consortia, and the evolving regulatory landscape. These developments are expected to enhance the utility of health claims databases for retinal disease research, resulting in more comprehensive and impactful findings across diverse retinal disorders and robust real-world insights from a large population.
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Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
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Elbedwehy AM, Wu J, Na HK, Baek A, Jung H, Kwon IH, Lee SW, Kim JH, Lee TG. ROS-responsive charge reversal mesoporous silica nanoparticles as promising drug delivery system for neovascular retinal diseases. J Control Release 2024; 373:224-239. [PMID: 39002796 DOI: 10.1016/j.jconrel.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
Intravitreal injection of biodegradable implant drug carriers shows promise in reducing the injection frequency for neovascular retinal diseases. However, current intravitreal ocular devices have limitations in adjusting drug release rates for individual patients, thereby affecting treatment effectiveness. Accordingly, we developed mesoporous silica nanoparticles (MSNs) featuring a surface that reverse its charge in response to reactive oxygen species (ROS) for efficient delivery of humanin peptide (HN) to retinal epithelial cells (ARPE-19). The MSN core, designed with a pore size of 2.8 nm, ensures a high HN loading capacity 64.4% (w/w). We fine-tuned the external surface of the MSNs by incorporating 20% Acetyl-L-arginine (Ar) to create a partial positive charge, while 80% conjugated thioketal (TK) methoxy polyethylene glycol (mPEG) act as ROS gatekeeper. Ex vivo experiments using bovine eyes revealed the immobilization of Ar-MSNs-TK-PEG (mean zeta potential: 2 mV) in the negatively charged vitreous. However, oxidative stress reversed the surface charge to -25 mV by mPEG loss, facilitating the diffusion of the nanoparticles impeded with HN. In vitro studies showed that ARPE-19 cells effectively internalize HN-loaded Ar-MSNs-TK, subsequently releasing the peptide, which offered protection against oxidative stress-induced apoptosis, as evidenced by reduced TUNEL and caspase3 activation. The inhibition of retinal neovascularization was further validated in an in vivo oxygen-induced retinopathy (OIR) mouse model.
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Affiliation(s)
- Ahmed M Elbedwehy
- Department of Nano Science, Korea National University of Science and Technology (UST), Daejeon 34113, Republic of Korea; Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea; Nanotechnology Center, Mansoura University, Mansoura 35516, Egypt
| | - Jun Wu
- Fight Against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Hee-Kyung Na
- Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea
| | - Ahruem Baek
- Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea
| | - Haejin Jung
- Flow Cytometry Core Facility of Research Solution Center, Institute of Basic Science, Daejeon 34126, Republic of Korea
| | - Ik Hwan Kwon
- Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea
| | - Sang Won Lee
- Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea
| | - Jeong Hun Kim
- Fight Against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul 03080, Republic of Korea; Global Excellence Center for Gene & Cell Therapy (GEC-GCT), Seoul National University Hospital, Seoul 03080, Republic of Korea; Institute of Reproductive Medicine and Population, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
| | - Tae Geol Lee
- Department of Nano Science, Korea National University of Science and Technology (UST), Daejeon 34113, Republic of Korea; Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea.
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Swaminathan SS, Medeiros FA, Gedde SJ. Impact of Social Vulnerability Index on the Development of Severe Visual Impairment or Blindness From Glaucoma. Am J Ophthalmol 2024; 267:172-181. [PMID: 38971319 DOI: 10.1016/j.ajo.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE To evaluate whether geocoded social risk factor data predict the development of severe visual impairment or blindness due to glaucoma during follow-up using a large electronic health record (EHR) database. DESIGN Cohort study. METHODS Patients diagnosed with open-angle glaucoma (OAG) at a tertiary care institution. All eyes had glaucomatous visual field defects at baseline. Sociodemographic and ocular data were extracted from the EHR, including age, gender, self-reported race and ethnicity, insurance status, OAG type, prior glaucoma laser or surgery, baseline disease severity using Hodapp-Anderson-Parrish criteria, mean intraocular pressure (IOP) during follow-up, and central corneal thickness. Social vulnerability index (SVIndex) data at the census tract level were obtained using geocoded patient residences. Mixed-effects Cox proportional hazard models were completed to assess for the development of severe visual impairment or blindness during follow-up, defined as BCVA ≤ 20/200 at least at the last two clinic visits or standard automated perimetry (SAP) mean deviation (MD) ≤ -22dB confirmed on two tests. RESULTS A total of 4,046 eyes from 2,826 patients met inclusion criteria and were followed for an average of 4.3 ± 2.2 years. Severe visual impairment or blindness developed in 79 eyes (2.0%) from 76 patients (2.7%) after an average of 3.4 ± 1.8 years, leading to an incidence rate of severe visual impairment or blindness of 0.5% per year. Older age (adjusted hazards ratio [HR] 1.36 per decade, P = .007), residence in areas with higher SVIndex (HR 1.56 per 25% increase, P < .001), higher IOP during follow-up (HR 3.01 per 5 mmHg increase, P < .001), and moderate or severe glaucoma at baseline (HR 7.31 and 26.87, P < .001) were risk factors for developing severe visual impairment or blindness. Concordance index of the model was 0.88. Socioeconomic, minority status/language, and housing type/transportation SVIndex themes were key contributors to developing severe visual impairment or blindness. CONCLUSIONS Risk factors for developing glaucoma-related severe visual impairment or blindness included older age, elevated IOP during follow-up, moderate or severe disease at baseline, and residence in areas associated with greater social vulnerability. In addition to ocular risk factors, geocoded EHR data regarding social risk factors could help identify patients at high risk of developing glaucoma-related visual impairment.
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Affiliation(s)
- Swarup S Swaminathan
- From the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (S.S.S., F.A.M., S.J.G.), Miami, Florida, USA.
| | - Felipe A Medeiros
- From the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (S.S.S., F.A.M., S.J.G.), Miami, Florida, USA
| | - Steven J Gedde
- From the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (S.S.S., F.A.M., S.J.G.), Miami, Florida, USA
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Zakrajsek AD, Foulkes S, Nagel N, Neurohr F, Nauman EA. Biomechanical Considerations of Refreshable Braille and Tactile Graphics Toward Equitable Access: A Review. J Biomech Eng 2024; 146:060907. [PMID: 38421346 DOI: 10.1115/1.4064964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
This review highlights the biomechanical foundations of braille and tactile graphic discrimination within the context of design innovations in information access for the blind and low-vision community. Braille discrimination is a complex and poorly understood process that necessitates the coordination of motor control, mechanotransduction, and cognitive-linguistic processing. Despite substantial technological advances and multiple design attempts over the last fifty years, a low-cost, high-fidelity refreshable braille and tactile graphics display has yet to be delivered. Consequently, the blind and low-vision communities are left with limited options for information access. This is amplified by the rapid adoption of graphical user interfaces for human-computer interaction, a move that the blind and low vision community were effectively excluded from. Text-to-speech screen readers lack the ability to convey the nuances necessary for science, technology, engineering, arts, and math education and offer limited privacy for the user. Printed braille and tactile graphics are effective modalities but are time and resource-intensive, difficult to access, and lack real-time rendering. Single- and multiline refreshable braille devices either lack functionality or are extremely cost-prohibitive. Early computational models of mechanotransduction through complex digital skin tissue and the kinematics of the braille reading finger are explored as insight into device design specifications. A use-centered, convergence approach for future designs is discussed in which the design space is defined by both the end-user requirements and the available technology.
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Affiliation(s)
- Anne D Zakrajsek
- Department of Biomedical Engineering, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45221
| | - Samuel Foulkes
- Clovernook Center for the Blind and Visually Impaired, 7000 Hamilton Avenue, Cincinnati, OH 45231
| | - Nicole Nagel
- School of Biomedical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, IN 47907
| | - Fred Neurohr
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, OH 45229
| | - Eric A Nauman
- Department of Biomedical Engineering, University of Cincinnati, 2901 Woodside Dr., Cincinnati, OH 45221
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Hindle J, Williams A, Kim Y, Kim D, Patil K, Khatkar P, Osgood Q, Nelson C, Routenberg DA, Howard M, Liotta LA, Kashanchi F, Branscome H. hTERT-Immortalized Mesenchymal Stem Cell-Derived Extracellular Vesicles: Large-Scale Manufacturing, Cargo Profiling, and Functional Effects in Retinal Epithelial Cells. Cells 2024; 13:861. [PMID: 38786083 PMCID: PMC11120263 DOI: 10.3390/cells13100861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
As the economic burden associated with vision loss and ocular damage continues to rise, there is a need to explore novel treatment strategies. Extracellular vesicles (EVs) are enriched with various biological cargo, and there is abundant literature supporting the reparative and immunomodulatory properties of stem cell EVs across a broad range of pathologies. However, one area that requires further attention is the reparative effects of stem cell EVs in the context of ocular damage. Additionally, most of the literature focuses on EVs isolated from primary stem cells; the use of EVs isolated from human telomerase reverse transcriptase (hTERT)-immortalized stem cells has not been thoroughly examined. Using our large-scale EV-manufacturing platform, we reproducibly manufactured EVs from hTERT-immortalized mesenchymal stem cells (MSCs) and employed various methods to characterize and profile their associated cargo. We also utilized well-established cell-based assays to compare the effects of these EVs on both healthy and damaged retinal pigment epithelial cells. To the best of our knowledge, this is the first study to establish proof of concept for reproducible, large-scale manufacturing of hTERT-immortalized MSC EVs and to investigate their potential reparative properties against damaged retinal cells. The results from our studies confirm that hTERT-immortalized MSC EVs exert reparative effects in vitro that are similar to those observed in primary MSC EVs. Therefore, hTERT-immortalized MSCs may represent a more consistent and reproducible platform than primary MSCs for generating EVs with therapeutic potential.
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Affiliation(s)
| | - Anastasia Williams
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA 20110, USA (K.P.)
| | - Yuriy Kim
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA 20110, USA (K.P.)
| | | | - Kajal Patil
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA 20110, USA (K.P.)
| | - Pooja Khatkar
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA 20110, USA (K.P.)
| | | | - Collin Nelson
- Meso Scale Diagnostics, L.L.C., Rockville, MD 20850, USA (D.A.R.)
| | | | - Marissa Howard
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA 20110, USA
| | - Lance A. Liotta
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA 20110, USA
| | - Fatah Kashanchi
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA 20110, USA (K.P.)
| | - Heather Branscome
- ATCC, Manassas, VA 20110, USA
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA 20110, USA (K.P.)
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Becker S, L'Ecuyer Z, Jones BW, Zouache MA, McDonnell FS, Vinberg F. Modeling complex age-related eye disease. Prog Retin Eye Res 2024; 100:101247. [PMID: 38365085 PMCID: PMC11268458 DOI: 10.1016/j.preteyeres.2024.101247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/18/2024]
Abstract
Modeling complex eye diseases like age-related macular degeneration (AMD) and glaucoma poses significant challenges, since these conditions depend highly on age-related changes that occur over several decades, with many contributing factors remaining unknown. Although both diseases exhibit a relatively high heritability of >50%, a large proportion of individuals carrying AMD- or glaucoma-associated genetic risk variants will never develop these diseases. Furthermore, several environmental and lifestyle factors contribute to and modulate the pathogenesis and progression of AMD and glaucoma. Several strategies replicate the impact of genetic risk variants, pathobiological pathways and environmental and lifestyle factors in AMD and glaucoma in mice and other species. In this review we will primarily discuss the most commonly available mouse models, which have and will likely continue to improve our understanding of the pathobiology of age-related eye diseases. Uncertainties persist whether small animal models can truly recapitulate disease progression and vision loss in patients, raising doubts regarding their usefulness when testing novel gene or drug therapies. We will elaborate on concerns that relate to shorter lifespan, body size and allometries, lack of macula and a true lamina cribrosa, as well as absence and sequence disparities of certain genes and differences in their chromosomal location in mice. Since biological, rather than chronological, age likely predisposes an organism for both glaucoma and AMD, more rapidly aging organisms like small rodents may open up possibilities that will make research of these diseases more timely and financially feasible. On the other hand, due to the above-mentioned anatomical and physiological features, as well as pharmacokinetic and -dynamic differences small animal models are not ideal to study the natural progression of vision loss or the efficacy and safety of novel therapies. In this context, we will also discuss the advantages and pitfalls of alternative models that include larger species, such as non-human primates and rabbits, patient-derived retinal organoids, and human organ donor eyes.
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Affiliation(s)
- Silke Becker
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Zia L'Ecuyer
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Bryan W Jones
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Moussa A Zouache
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Fiona S McDonnell
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Frans Vinberg
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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Laspro M, Thys E, Chaya B, Rodriguez ED, Kimberly LL. First-in-Human Whole-Eye Transplantation: Ensuring an Ethical Approach to Surgical Innovation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:59-73. [PMID: 38181210 DOI: 10.1080/15265161.2023.2296407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
As innovations in the field of vascular composite allotransplantation (VCA) progress, whole-eye transplantation (WET) is poised to transition from non-human mammalian models to living human recipients. Present treatment options for vision loss are generally considered suboptimal, and attendant concerns ranging from aesthetics and prosthesis maintenance to social stigma may be mitigated by WET. Potential benefits to WET recipients may also include partial vision restoration, psychosocial benefits related to identity and social integration, improvements in physical comfort and function, and reduced surgical risk associated with a biologic eye compared to a prosthesis. Perioperative and postoperative risks of WET are expected to be comparable to those of facial transplantation (FT), and may be similarly mitigated by immunosuppressive protocols, adequate psychosocial support, and a thorough selection process for both the recipient and donor. To minimize the risks associated with immunosuppressive medications, the first attempts in human recipients will likely be performed in conjunction with a FT. If first-in-human attempts at combined FT-WET prove successful and the biologic eye survives, this opens the door for further advancement in the field of vision restoration by means of a viable surgical option. This analysis integrates recent innovations in WET research with the existing discourse on the ethics of surgical innovation and offers preliminary guidance to VCA programs considering undertaking WET in human recipients.
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Affiliation(s)
| | - Erika Thys
- University of Nevada Reno School of Medicine
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11
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Hasanah A, Kharisma B, Remi SS, Adam AM, Siregar AYM. Food diversity: its relation to children's health and consequent economic burden. BMC Public Health 2024; 24:1155. [PMID: 38658917 PMCID: PMC11044496 DOI: 10.1186/s12889-024-18530-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND This study investigates the impact of low food diversity on the health status of children using the Dietary Diversity Score (DDS) and Dietary Serving Score (DSS) in a sub-district with the highest percentage of poor households. The economic burden of low food diversity was observed by analysing the cost of illness in the children with low food diversity. METHODS Data from 329 children were collected. We determined the impact of DDS and DSS and other factors on the health status of children aged 2-14 years, using a probit model. The cost of illness (e.g., typhus, stomach ulcers, coughs, flu, and fever) due to low food diversity was calculated from medical registration fees, medical action costs, transportation costs, and other costs. RESULTS The results shows that a 1% point increase in DDS or DSS potentially decreases children's health complaints by 10% and 8%, respectively. Given the current 26% prevalence of health complaints among children with low DDS, the annual economic burden reaches US$75.72 per child per household. In addition, the current 41% prevalence of children with low DDS resulted in an annual cost to the government of US$153.45 per child. CONCLUSIONS The effect of inadequate dietary diversity on children's health is potentially high and contributes to the economic burden on households and the government.
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Affiliation(s)
- Alfiah Hasanah
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia.
| | - Bayu Kharisma
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Sutyastie S Remi
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Asep Muhammad Adam
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Adiatma Y M Siregar
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
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Yin J, Jiang B, Zhao T, Guo X, Tan Y, Wang Y. Trends in the global burden of vision loss among the older adults from 1990 to 2019. Front Public Health 2024; 12:1324141. [PMID: 38638474 PMCID: PMC11025641 DOI: 10.3389/fpubh.2024.1324141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Purpose To quantify the global impact of vision impairment in individuals aged 65 years and older between 1990 and 2019, segmented by disease, age, and sociodemographic index (SDI). Methods Using the Global Burden of Diseases 2019 (GBD 2019) dataset, a retrospective demographic evaluation was undertaken to ascertain the magnitude of vision loss over this period. Metrics evaluated included case numbers, prevalence rates per 100,000 individuals, and shifts in prevalence rates via average annual percentage changes (AAPCs) and years lived with disability (YLDs). Results From 1990 to 2019, vision impairment rates for individuals aged 65 years and older increased from 40,027.0 (95% UI: 32,232.9-49,945.1) to 40,965.8 (95% UI: 32,911-51,358.3, AAPC: 0.11). YLDs associated with vision loss saw a significant decrease, moving from 1713.5 (95% UI: 1216.2-2339.7) to 1579.1 (95% UI: 1108.3-2168.9, AAPC: -0.12). Gender-based evaluation showed males had lower global prevalence and YLD rates compared to females. Cataracts and near vision impairment were the major factors, raising prevalence by 6.95 and 2.11%, respectively. Cataract prevalence in high-middle SDI regions and near vision deficits in high SDI regions significantly influenced YLDs variation between 1990 and 2019. Conclusion Over the past three decades, there has been a significant decrease in the vision impairment burden in individuals aged 65 and older worldwide. However, disparities continue, based on disease type, regional SDI, and age brackets. Enhancing eye care services, both in scope and quality, is crucial for reducing the global vision impairment burden among the older adults.
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Affiliation(s)
- Jiayang Yin
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Postdoctoral Station of Clinical Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bing Jiang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tantai Zhao
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaojian Guo
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Tan
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Postdoctoral Station of Clinical Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanbing Wang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Hatcher JB, Lin G, Moran CP, Al Awamlh SAH, Sulieman L, Morales NG, Berkowitz ST, Patel S, Lindsey J. Effects of Cost Sharing on Ophthalmic Care Utilization in the Affordable Care Act Marketplace. Ophthalmic Epidemiol 2024; 31:159-168. [PMID: 37042706 DOI: 10.1080/09286586.2023.2199849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/01/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE To determine the distribution and quantity of ophthalmic care consumed on Affordable Care Act (ACA) plans, the demographics of the population utilizing these services, and the relationship between ACA insurance coverage plan tier, cost sharing, and total cost of ophthalmic care consumed. METHODS This cross-sectional study analyzed ACA individual and small group market claims data from the Wakely Affordable Care Act (WACA) 2018 dataset, which contains detailed claims, enrollment, and premium data from Edge Servers for 3.9 million individual and small group market lives. We identified all enrollees with ophthalmology-specific billing, procedure, and national drug codes. We then analyzed the claims by plan type and calculated the total cost and out-of-pocket (OOP) cost. RESULTS Among 3.9 million enrollees in the WACA 2018 dataset, 538,169 (13.7%) had claims related to ophthalmology procedures, medications, and/or diagnoses. A total of $203 million was generated in ophthalmology-related claims, with $54 million in general services, $42 million in medications, $20 million in diagnostics and imaging, and $86 million in procedures. Average annual OOP costs were $116 per member, or 30.9% of the total cost, and were lowest for members with platinum plans (16% OOP) and income-driven cost sharing reduction (ICSR) subsidies (17% OOP). Despite stable ocular disease distribution across plan types, beneficiaries with silver ICSR subsidies consumed more total care than any other plan, higher than platinum plan enrollees and almost 1.5× the cost of bronze plan enrollees. CONCLUSIONS Ophthalmic care for enrollees on ACA plans generated substantial costs in 2018. Plans with higher OOP cost sharing may result in lower utilization of ophthalmic care.
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Affiliation(s)
- Jeremy B Hatcher
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George Lin
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Cullen P Moran
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Lina Sulieman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Sean T Berkowitz
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shriji Patel
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Lindsey
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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14
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Muma S, Naidoo KS, Hansraj R. Estimation of the lost productivity to the GDP and the national cost of correcting visual impairment from refractive error in Kenya. PLoS One 2024; 19:e0300799. [PMID: 38527046 PMCID: PMC10962815 DOI: 10.1371/journal.pone.0300799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND In developing countries such as Kenya, minimal attention has been directed towards population based studies on uncorrected refractive error (URE). However, the absence of population based studies, warrants utilization of other avenues to showcase to the stakeholders in eye health the worth of addressing URE. Hence this study estimated the lost productivity to the Gross Domestic Product (GDP) as a result of URE and the national cost required to address visual impairment from URE in Kenya. METHODS The lost productivity to the GDP for the population aged 16-60 years was calculated. Thereafter the productivity loss of the caregivers of severe visual impaired individuals was computed as a product of the average annual productivity for each caregiver and a 5% productivity loss due to visual impairment. The productivity benefit of correcting refractive error was estimated based on the minimum wage for individuals aged between 16-60 years with URE. Estimation of the national cost of addressing URE was based on spectacle provision cost, cost of training functional clinical refractionists and the cost of establishing vision centres. A cost benefit analysis was undertaken based on the national cost estimates and a factor of 3.5 times. RESULTS The estimated lost productivity to the GDP due to URE in in Kenya is approximately US$ 671,455,575 -US$ 1,044,486,450 annually for population aged between 16-60 years. The productivity loss of caregivers for the severe visually impaired is approximately US$ 13,882,899 annually. Approximately US$ 246,750,000 is required to provide corrective devices, US$ 413,280- US$ 108,262,300 to train clinical refractionists and US$ 39,800,000 to establish vision centres. The productivity benefit of correcting visual impairment is approximately US$ 41,126,400 annually. Finally, a cost benefit analysis showed a return of US$ 378,918,050 for human resources, US$ 863,625,000 for corrective devices and US$ 139,300,000 for establishment of vision centres. CONCLUSION The magnitude of productivity loss due to URE in Kenya is significant warranting prioritization of refractive error services by the government and all stakeholders since any investment directed towards addressing URE has the potential to contribute a positive return.
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Affiliation(s)
- Shadrack Muma
- Department of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kovin Shunmugam Naidoo
- Department of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- OneSight EssilorLuxottica Foundation, Paris, France
| | - Rekha Hansraj
- Department of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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15
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Zhao C, Ding Q, Yang Z. Burdens and trends of blindness and vision loss among those aged 55 years and older: A systematic analysis for the Global Burden of Disease Study 2019. Eur J Ophthalmol 2024:11206721241238878. [PMID: 38454852 DOI: 10.1177/11206721241238878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE To systematically analysis the burden and trends of blindness and vision loss for those aged ≥55 years from 1990 to 2019 and to predict trends over the next few years. METHODS The data were extracted from the Global Burden of Disease Study (GBD) 2019. Trends from 1990 to 2019 were calculated using average annual percentage change (AAPC) by joinpoint regression analysis. Bayesian age-period-cohort (BAPC) models were used to predict future trends. RESULTS In 2019, the global prevalence of blindness and vision loss was 471.1 million with 15.9 million disability-adjusted life-years (DALYs) for those aged ≥55 years. These numbers will reach 640.3 million cases and 18.9 million DALYs in 2030. The prevalence rate (per 100,000 population) increased from 32,137.8 (95% uncertainty interval [UI], 26,307.9-39,246.3) in 1990 to 33,509 (95% UI, 27,435.5-40,996.2) in 2019, with an AAPC of 0.143 (95% confidence interval [CI], 0.125-0.161; P < 0.001). The DALY rate (per 100,000 population) decreased from 632.9 (95% UI, 447.7-870.9) in 1990 to 579.3 (95% UI, 405.2-803.4) in 2019, with an AAPC of -0.293 (95% CI, -0.323-[-]0.263). Although the prevalence rates of cataracts, age-related macular degeneration, glaucoma, and near vision loss showed increasing trends from 1990 to 2019, the DALY rates indicated a downward trend for all blindness-causing diseases. The burden is heavier for women and in low Socio-demographic Index (SDI) regions. CONCLUSIONS Despite a decline from 2001 to 2019, the burden of blindness and vision loss, measured by prevalence and DALYs, continues to rise after adjusting for population growth and aging. Blindness and vision loss are significant public health burdens, especially for women and in low-SDI regions.
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Affiliation(s)
- Congling Zhao
- Aier eye hospital, Jinan university, Guangzhou, Guangdong Province, China
| | - Qiang Ding
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhikuan Yang
- Aier eye hospital, Jinan university, Guangzhou, Guangdong Province, China
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Tran MT, Gonzalez VV, Mead-Harvey C, Shen JF. Insights Into Eye Care Accessibility: Geospatial Distribution of Eye Care Providers and Socioeconomic Factors by ZIP Code. Transl Vis Sci Technol 2024; 13:21. [PMID: 38530303 PMCID: PMC10981161 DOI: 10.1167/tvst.13.3.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose In the United States, the ZIP Code has long been used to collect geospatial data revealing disparities in social determinants of health. This cross-sectional study examines the distribution of eye care access in association with local socioeconomic factors at a ZIP Code level. Methods Data from the 2020 Centers of Medicare and Medicaid Services and American Community Survey were used to examine locations of 47,949 providers (17,631 ophthalmologists and 30,318 optometrists) and corresponding local socioeconomic variables (education, employment, and income). Multivariable zero-inflated negative binomial regression was used to model eye care provider count per capita in each ZIP Code area with socioeconomic factors as independent covariates. Results For every 1% increase in percentage of population over 25 years with a bachelor's degree or higher, the expected number of providers increases by 4.4% (incidence rate ratio [IRR] = 1.044; 95% confidence interval [CI], 1.041-1.046; P < 0.001). For every 1% increase in percentage unemployment, the expected number of providers decreases by 2.7% (IRR = 0.973; 95% CI, 0.964-0.983; P < 0.001). However, for every $1000 increase in median household income, the expected number of providers decreases by 1.6% (IRR = 0.984; 95% CI, 0.983-0.986; P < 0.001). Conclusions Disparities in access exist in areas of lower employment and educational attainment, as both have positive correlations with eye care provider access. Conversely, areas of greater median household income have lower access to providers. Translational Relevance This research contributes to a greater field studying social determinants of health and may inform public health strategies on allocation of providers to improve equitable access to vision care.
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Affiliation(s)
- Meagan T. Tran
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | | | - Joanne F. Shen
- Mayo Clinic Department of Ophthalmology, Scottsdale, AZ, USA
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Rein DB, Herring-Nathan ER. Vision Need Profiles for the City of Richmond, Virginia: A Pilot Application of Calibration Methods to Vision Surveillance. OPHTHALMOLOGY SCIENCE 2024; 4:100429. [PMID: 38187127 PMCID: PMC10767496 DOI: 10.1016/j.xops.2023.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024]
Abstract
Purpose People with vision problems (VPs) have different needs based on their age, economic resources, housing type, neighborhood, and other disabilities. We used calibration methods to create synthetic data to estimate census tract-level community need profiles (CNPs) for the city of Richmond, Virginia. Design Cross-sectional secondary data analysis. Subjects Anonymized respondents to the 2015 to 2019 American Community Survey (ACS). Methods We used calibration methods to transform the ACS 5-year tabular (2015-2019) and Public Use Microdata estimates into a synthetic data set of person-level records in each census tract, and subset the data to persons who answered yes to the question "Are you blind or do you have serious difficulty seeing even when wearing glasses?" To identify individual need profiles (INPs), we applied divisive clustering to 17 variables measuring individual demographics, nonvision disability status, socioeconomic status (SES), housing, and access and independence. We labeled tracts with CNP names based on their predominant INPs and performed sensitivity analyses. We mapped the CNPs and overlayed information on the number of people with VP, the National Walkability Index, and an uncertainty measure based on our sensitivity analysis. Main Outcome Measures Individual need profiles and CNPs. Results Compared with people without VP, people with VP exhibited higher rates of disabilities, having low incomes, living alone, and lacking access to the internet or private home vehicles. Among people with VP, we identified 7 INP clusters which we mapped into 6 CNPs: (1) seniors (≥ age 65); (2) low SES younger; (3) low SES older; (4) mixed SES; (5) higher SES; and (6) adults and children in group quarters. Three CNPs had lower-than-average walkability. Community need profile assignments were somewhat sensitive to calibration variables, with 18 tracts changing assignments in 1 sensitivity analysis, and 4 tracts changing assignments in ≥ 2 sensitivity analyses. Conclusions This pilot project illustrates the feasibility of using ACS data to better understand the support and service needs of people with VP at the census tract level. However, a subset of categorical CNP assignments were sensitive to variable selection leading to uncertainty in CNP assignment in certain tracts. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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18
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Shah SN, Zhou S, Sanvicente C, Burkemper B, Apolo G, Li C, Li S, Liu L, Lum F, Moghimi S, Xu B. Prevalence and Risk Factors of Blindness Among Primary Angle Closure Glaucoma Patients in the United States: An IRIS Registry Analysis. Am J Ophthalmol 2024; 259:131-140. [PMID: 37944688 PMCID: PMC10922147 DOI: 10.1016/j.ajo.2023.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States. DESIGN Retrospective cross-sectional study. METHODS Eligible patients from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry had newly diagnosed PACG, defined as: 1) observable during a 24-month lookback period from index date of PACG diagnosis; 2) no history of eye drops, laser, or cataract surgery unless preceded by a diagnosis of anatomical narrow angle (ANA); and 3) no history of glaucoma surgery. Logistic regression models were developed to identify risk factors for any (one or both eyes) or bilateral (both eyes) blindness (visual acuity ≤20/200) at first diagnosis of PACG. RESULTS Among 43,901 eligible patients, overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (odds ratios [ORs] 1.42 and 1.21, respectively; P < .001) and bilateral (ORs 2.04 and 1.53, respectively; P < .001) blindness compared with non-Hispanic White patients adjusted for ocular comorbidities. Age <50 or >80 years, male sex, Medicaid or Medicare insurance product, and Southern or Western practice region also conferred a higher risk of blindness (OR > 1.28; P ≤ .01). CONCLUSIONS Blindness affects 1 of 9 patients with newly diagnosed PACG in the IRIS Registry. Black and Hispanic patients and Medicaid and Medicare recipients are at significantly higher risk. These findings highlight the severe ocular morbidity among patients with PACG and the need for improved disease awareness and detection methods.
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Affiliation(s)
- Sona N Shah
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Sarah Zhou
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Carina Sanvicente
- Harvey & Bernice Jones Eye Institute (C.S.), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bruce Burkemper
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Galo Apolo
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Charles Li
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Siying Li
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Lynn Liu
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Flora Lum
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center (S.M.), Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Benjamin Xu
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA.
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Ng QX, Ong C, Yaow CYL, Chan HW, Thumboo J, Wang Y, Koh GCH. Cost-of-illness studies of inherited retinal diseases: a systematic review. Orphanet J Rare Dis 2024; 19:93. [PMID: 38424595 PMCID: PMC10905859 DOI: 10.1186/s13023-024-03099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND While health care and societal costs are routinely modelled for most diseases, there is a paucity of comprehensive data and cost-of-illness (COI) studies for inherited retinal diseases (IRDs). This lack of data can lead to underfunding or misallocation of resources. A comprehensive understanding of the COI of IRDs would assist governmental and healthcare leaders in determining optimal resource allocation, prioritizing funding for research, treatment, and support services for these patients. METHODS Following PRISMA guidelines, a literature search was conducted using Medline, EMBASE and Cochrane databases, from database inception up to 30 Jun 2023, to identify COI studies related to IRD. Original studies in English, primarily including patients with IRDs, and whose main study objective was the estimation of the costs of IRDs and had sufficiently detailed methodology to assess study quality were eligible for inclusion. To enable comparison across countries and studies, all annual costs were standardized to US dollars, adjusted for inflation to reflect their current value and recalculated on a "per patient" basis wherever possible. The review protocol was registered in PROSPERO (registration number CRD42023452986). RESULTS A total of nine studies were included in the final stage of systematic review and they consistently demonstrated a significant disease burden associated with IRDs. In Singapore, the mean total cost per patient was roughly US$6926/year. In Japan, the mean total cost per patient was US$20,833/year. In the UK, the mean total cost per patient with IRD ranged from US$21,658 to US$36,549/year. In contrast, in the US, the mean total per-patient costs for IRDs ranged from about US$33,017 to US$186,051 per year. In Canada, these mean total per-patient costs varied between US$16,470 and US$275,045/year. Non-health costs constituted the overwhelming majority of costs as compared to healthcare costs; 87-98% of the total costs were due to non-health costs, which could be attributed to diminished quality of life, poverty, and increased informal caregiving needs for affected individuals. CONCLUSION IRDs impose a disproportionate societal burden outside health systems. It is vital for continued funding into IRD research, and governments should incorporate societal costs in the evaluation of cost-effectiveness for forthcoming IRD interventions, including genomic testing and targeted therapies.
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Affiliation(s)
- Qin Xiang Ng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore.
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Clyve Yu Leon Yaow
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hwei Wuen Chan
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Julian Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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20
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Andersson RBÅ, Pelino C, Monaco WA, Bunin G. Prevalence Rates of Diabetic Retinopathy and Undiagnosed Diabetes Among Delaware Nursing Home and Assisted Living Facility Residents. Gerontol Geriatr Med 2024; 10:23337214241260938. [PMID: 39091995 PMCID: PMC11292678 DOI: 10.1177/23337214241260938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/25/2024] [Accepted: 05/19/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives: To determine the prevalence of diabetic retinopathy and undiagnosed diabetes among Delaware nursing home and assisted care facility residents. Methods: This cross-sectional study involved the statistical analysis of comprehensive eye examination records of 2,063 nursing home residents residing in 18 facilities and 4 assisted living facilities in Delaware from 2005 to 2009. Descriptive statistical analyses were conducted to identify the rates of retinal dot and blot hemorrhages and existing systemic diabetes diagnoses. Results: The mean age of nursing home and assisted care facility residents was 77 years (range 9-104), and 64.4% were over the age of 80. Most residents were female (61.1%) and white (72.5%). 3.6% of the 2,063 nursing home residents had blot or dot hemorrhages in one or both eyes. 32.8% had a type 1 or type 2 diabetes diagnosis. Of the ones with a positive dot and blot hemorrhage finding, 56.8% had a diagnosis of diabetes, and 43.2% did not. Discussion: There was a high prevalence of dot and blot hemorrhages without a systemic diagnosis of diabetes, indicating a need for regular eye care among residents.
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Purola PKM, Taipale J, Väätäinen S, Harju M, Koskinen SVP, Uusitalo HMT. Price tag of glaucoma care is minor compared with the total direct and indirect costs of glaucoma: Results from nationwide survey and register data. PLoS One 2023; 18:e0295523. [PMID: 38117760 PMCID: PMC10732367 DOI: 10.1371/journal.pone.0295523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND The estimations of the economic burden of glaucoma have focused on comparing different treatment modalities; hence, the total direct and indirect costs of glaucoma at population level are not well known. OBJECTIVE To estimate the direct and indirect costs of glaucoma and its treatment in Finland. METHODS Economic and glaucoma data were collected from the cross-sectional nationwide Health 2000 health examination survey linked to multiple national registers, which allowed a 13-year follow-up between 1999-2011 among survey participants. Direct costs covered eye- and non-eye-related hospitalizations and outpatient visits, outpatient health care services, and travel costs among participants aged 30 years or older, adjusted for age and sex. Indirect costs covered premature retirement and productivity losses among participants aged 30-64 years. Glaucoma patients (n = 192) were compared with non-glaucomatous population (n = 6,952). RESULTS The annual additional total direct costs were EUR 2,660/glaucoma patient, EUR 1,769/glaucoma patient with medication, and EUR 3,979/operated glaucoma patient compared with persons without glaucoma. The respective additional total indirect costs were EUR 4,288, EUR 3,246, and EUR 12,902 per year. In total, the additional annual direct and indirect expenditures associated with glaucoma in Finland were EUR 202 million (0.86% of total expenditures of health care) and EUR 71 million (0.03% of the Finnish gross domestic product) arising mainly from non-eye-related hospitalizations and productivity losses, respectively. CONCLUSION Glaucoma is associated with an increased health care consumption mainly due to non-eye-related health care, which can be explained by the vision loss as well as increased number of co-morbidities among glaucoma patients. Therefore, glaucoma constitutes a major economic burden for the health care system and society, highlighting the importance of early glaucoma interventions. The difference in direct and indirect costs between glaucoma treatment groups is explained by the uneven distribution of co-morbidities.
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Affiliation(s)
- Petri K. M. Purola
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
| | - Joonas Taipale
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Mika Harju
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo V. P. Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hannu M. T. Uusitalo
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
- Tays Eye Center, Tampere University Hospital, Tampere, Finland
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Lee IK, Xie R, Luz-Madrigal A, Min S, Zhu J, Jin J, Edwards KL, Phillips MJ, Ludwig AL, Gamm DM, Gong S, Ma Z. Micromolded honeycomb scaffold design to support the generation of a bilayered RPE and photoreceptor cell construct. Bioact Mater 2023; 30:142-153. [PMID: 37575875 PMCID: PMC10415596 DOI: 10.1016/j.bioactmat.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/27/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
Age-related macular degeneration (AMD) causes blindness due to loss of retinal pigment epithelium (RPE) and photoreceptors (PRs), which comprise the two outermost layers of the retina. Given the small size of the macula and the importance of direct contact between RPE and PRs, the use of scaffolds for targeted reconstruction of the outer retina in later stage AMD and other macular dystrophies is particularly attractive. We developed microfabricated, honeycomb-patterned, biodegradable poly(glycerol sebacate) (PGS) scaffolds to deliver organized, adjacent layers of RPE and PRs to the subretinal space. Furthermore, an optimized process was developed to photocure PGS, shortening scaffold production time from days to minutes. The resulting scaffolds robustly supported the seeding of human pluripotent stem cell-derived RPE and PRs, either separately or as a dual cell-layered construct. These advanced, economical, and versatile scaffolds can accelerate retinal cell transplantation efforts and benefit patients with AMD and other retinal degenerative diseases.
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Affiliation(s)
- In-Kyu Lee
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Ruosen Xie
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Agustin Luz-Madrigal
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Department of Comparative Biomedical Sciences, University of Wisconsin–Madison, Madison, WI, 53706, USA
| | - Seunghwan Min
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Jingcheng Zhu
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Jiahe Jin
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | | | - M. Joseph Phillips
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Allison L. Ludwig
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - David M. Gamm
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53705, USA
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Department of Comparative Biomedical Sciences, University of Wisconsin–Madison, Madison, WI, 53706, USA
| | - Shaoqin Gong
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Zhenqiang Ma
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Department of Engineering Physics, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Grainger Institute for Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
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Kerschensteiner D. Losing, preserving, and restoring vision from neurodegeneration in the eye. Curr Biol 2023; 33:R1019-R1036. [PMID: 37816323 PMCID: PMC10575673 DOI: 10.1016/j.cub.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
The retina is a part of the brain that sits at the back of the eye, looking out onto the world. The first neurons of the retina are the rod and cone photoreceptors, which convert changes in photon flux into electrical signals that are the basis of vision. Rods and cones are frequent targets of heritable neurodegenerative diseases that cause visual impairment, including blindness, in millions of people worldwide. This review summarizes the diverse genetic causes of inherited retinal degenerations (IRDs) and their convergence onto common pathogenic mechanisms of vision loss. Currently, there are few effective treatments for IRDs, but recent advances in disparate areas of biology and technology (e.g., genome editing, viral engineering, 3D organoids, optogenetics, semiconductor arrays) discussed here enable promising efforts to preserve and restore vision in IRD patients with implications for neurodegeneration in less approachable brain areas.
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Affiliation(s)
- Daniel Kerschensteiner
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Purola P, Koskinen S, Uusitalo H. Nationwide and regional trends in distance and near visual acuities during 2000-2017 in Finland. Acta Ophthalmol 2023. [PMID: 37772430 DOI: 10.1111/aos.15784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/30/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE To evaluate time trends in distance and near vision at the national and regional levels during 2000-2017 in Finland. METHODS We used three cross-sectional, nationwide health examination surveys representing the Finnish adult population aged 30 years or older in 2000, 2011 and 2017. Bilateral, habitual distance and near visual acuity (VA) were measured in all three surveys. RESULTS The prevalence of good distance vision (VA ≥ 1.0) increased from 76.7% to 81.3% during 2000-2017 while the prevalence of weak or worse distance vision (VA ≤ 0.5) decreased from 7.6% to 3.7%. The improvements were largest among those aged 85 years and older: the prevalence of distance VA ≤ 0.5 decreased from 71.8% to 28.3%. Near vision showed improvement to a lesser extent in the total population; nevertheless, among those aged 85 years and older the prevalence of weak or worse near vision (VA ≤ 0.5) decreased from 62.3% to 27.1%. A similar positive time trend was observed in all main regions of Finland, and differences between urban and rural regions were small. CONCLUSION During the past two decades, the overall vision level has improved among the adult population. This is explained mostly by a positive shift from lower to higher vision levels among older age groups, indicating that people live longer with good or adequate vision. This positive trend showed remarkable similarity throughout different regions in Finland, highlighting the importance of equal and accessible eye care throughout the country.
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Affiliation(s)
- Petri Purola
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Uusitalo
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
- Tays Eye Center, Tampere University Hospital, Tampere, Finland
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25
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Patel SH, Lamba DA. Factors Affecting Stem Cell-Based Regenerative Approaches in Retinal Degeneration. Annu Rev Vis Sci 2023; 9:155-175. [PMID: 37713278 DOI: 10.1146/annurev-vision-120222-012817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Inherited and age-associated vision loss is often associated with degeneration of the cells of the retina, the light-sensitive layer at the back of the eye. The mammalian retina, being a postmitotic neural tissue, does not have the capacity to repair itself through endogenous regeneration. There has been considerable excitement for the development of cell replacement approaches since the isolation and development of culture methods for human pluripotent stem cells, as well as the generation of induced pluripotent stem cells. This has now been combined with novel three-dimensional organoid culture systems that closely mimic human retinal development in vitro. In this review, we cover the current state of the field, with emphasis on the cell delivery challenges, role of the recipient immunological microenvironment, and challenges related to connectivity between transplanted cells and host circuitry both locally and centrally to the different areas of the brain.
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Affiliation(s)
- Sachin H Patel
- Department of Ophthalmology, University of California, San Francisco, California, USA;
| | - Deepak A Lamba
- Department of Ophthalmology, University of California, San Francisco, California, USA;
- Eli and Edythe Broad Center of Regeneration Medicine & Stem Cell Research, University of California, San Francisco, California, USA
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Almazroa A, Almatar H, Alduhayan R, Albalawi M, Alghamdi M, Alhoshan S, Alamri S, Alkanhal N, Alsiwat YJ, Alrabiah S, Aldrgham M, AlSaleh AA, Alsanad HA, Alsomaie B. The Patients' Perspective for the Impact of Late Detection of Ocular Diseases on Quality of Life: A Cross-Sectional Study. CLINICAL OPTOMETRY 2023; 15:191-204. [PMID: 37719025 PMCID: PMC10503557 DOI: 10.2147/opto.s422451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
Background Late detection of ocular diseases negatively affects patients' quality of life (QoL), encompassing health status, psychological, financial, and social aspects. However, the early detection of eye conditions leads to rapid intervention and avoiding complications, thus preserving the QoL. This study assessed the impact of ocular diseases late detection on patients' QoL at multi-eye clinics based on questionnaire responses. Methods We developed an original Arabic-English questionnaire to assess the QoL of patients with ocular diseases referred from primary and secondary healthcare centers to tertiary hospitals. It covered preliminary data, patient perspectives on having lately detected ocular disease and treatment costs, and the impact of late detection on finances, social life, psychology, health status, and awareness of current initiatives. Logistic regression analysis was used to explore the associations between patient perspectives on having ocular diseases detected at a late stage and its impact on different domains. Multivariate logistic regression was applied with impact types of health status, psychological, financial, and social (dependent variables) and age, income levels, and hospital type (independent variables). Results Three hundred and eighty-eight responded, with 50% experiencing psychological effects, 27% health issues, 23% social impacts, and 23% financial burdens. Two hundred seventeen patients (56%) reported having ocular condition detected in late stage. Logistic regression analysis showed positive association with health status, social well-being, and financial effects (p < 0.05). Multivariate analysis revealed pronounced effects in patients ≤ 50 years, with income \< 5000 SAR, and those visiting private clinics (p < 0.05). The social impact was greater in patients visiting private hospitals. Ninety percent of all patients emphasized the importance of increasing awareness for better QoL. Conclusion Significant associations were found between the late detection of eye diseases and their impact on QoL. Therefore, early detection and increasing patients' awareness of ocular diseases and treatment are essential.
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Affiliation(s)
- Ahmed Almazroa
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hessa Almatar
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reema Alduhayan
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Maram Albalawi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mansour Alghamdi
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Saja Alhoshan
- Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Suhailah Alamri
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Norah Alkanhal
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yara J Alsiwat
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saad Alrabiah
- Department of Ophthalmology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Aldrgham
- Department of Ophthalmology, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint AbdulRahman University, Riyadh, Saudi Arabia
| | | | - Hessa Abdulrahman Alsanad
- Department of Social Planning, College of Social Work, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Barrak Alsomaie
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Sood S, Sanchez V, Heilenbach N, Al-Aswad LA. Cost-effectiveness of Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects. Ophthalmol Glaucoma 2023; 6:332-341. [PMID: 37212626 DOI: 10.1016/j.ogla.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/10/2022] [Accepted: 10/21/2022] [Indexed: 05/23/2023]
Abstract
PURPOSE To investigate the cost-effectiveness (CE) of prophylactic laser peripheral iridotomy (LPI) in primary angle-closure (PAC) suspects (PACSs). DESIGN Cost-effectiveness analysis utilizing Markov models. SUBJECTS Patients with narrow angles (PACSs). METHODS Progression from PACSs through 4 states (PAC, PAC glaucoma, blindness, and death) was simulated using Markov cycles. The cohort entered at 50 years and received either LPI or no treatment. Transition probabilities were calculated from published models, and risk reduction of LPI was calculated from the Zhongshan Angle Closure Prevention trial. We estimated costs of Medicare rates, and previously published utility values were used to calculate quality-adjusted life year (QALY). Incremental CE ratios (ICER) were evaluated at $50 000. Probabilistic sensitivity analyses (PSAs) addressed uncertainty. MAIN OUTCOME MEASURES Total cost, QALY, and ICER. RESULTS Over 2 years, the ICER for the LPI cohort was > $50 000. At 6 years, the LPI cohort was less expensive with more accrued QALY. In PSA, the LPI arm was cost-effective in 24.65% of iterations over 2 years and 92.69% over 6 years. The most sensitive parameters were probability of progressing to PAC and cost and number of annual office visits. CONCLUSIONS By 6 years, prophylactic LPI was cost-effective. The rate of progressing to PAC and differing practice patterns most impacted CE. With uncertainty of management of narrow angles, cost may be a decision management tool for providers. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Shefali Sood
- Department of Ophthalmology, Georgetown University School of Medicine, Washington, District of Columbia
| | - Victor Sanchez
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York, New York
| | - Noah Heilenbach
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York, New York
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Wittenborn JS, Lee AY, Lundeen EA, Lamuda P, Saaddine J, Su GL, Lu R, Damani A, Zawadzki JS, Froines CP, Shen JZ, Kung TPH, Yanagihara RT, Maring M, Takahashi MM, Blazes M, Rein DB. Validity of Administrative Claims and Electronic Health Registry Data From a Single Practice for Eye Health Surveillance. JAMA Ophthalmol 2023; 141:534-541. [PMID: 37140901 PMCID: PMC10160993 DOI: 10.1001/jamaophthalmol.2023.1263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/06/2023] [Indexed: 05/05/2023]
Abstract
Importance Diagnostic information from administrative claims and electronic health record (EHR) data may serve as an important resource for surveillance of vision and eye health, but the accuracy and validity of these sources are unknown. Objective To estimate the accuracy of diagnosis codes in administrative claims and EHRs compared to retrospective medical record review. Design, Setting, and Participants This cross-sectional study compared the presence and prevalence of eye disorders based on diagnostic codes in EHR and claims records vs clinical medical record review at University of Washington-affiliated ophthalmology or optometry clinics from May 2018 to April 2020. Patients 16 years and older with an eye examination in the previous 2 years were included, oversampled for diagnosed major eye diseases and visual acuity loss. Exposures Patients were assigned to vision and eye health condition categories based on diagnosis codes present in their billing claims history and EHR using the diagnostic case definitions of the US Centers for Disease Control and Prevention Vision and Eye Health Surveillance System (VEHSS) as well as clinical assessment based on retrospective medical record review. Main Outcome and Measures Accuracy was measured as area under the receiver operating characteristic curve (AUC) of claims and EHR-based diagnostic coding vs retrospective review of clinical assessments and treatment plans. Results Among 669 participants (mean [range] age, 66.1 [16-99] years; 357 [53.4%] female), identification of diseases in billing claims and EHR data using VEHSS case definitions was accurate for diabetic retinopathy (claims AUC, 0.94; 95% CI, 0.91-0.98; EHR AUC, 0.97; 95% CI, 0.95-0.99), glaucoma (claims AUC, 0.90; 95% CI, 0.88-0.93; EHR AUC, 0.93; 95% CI, 0.90-0.95), age-related macular degeneration (claims AUC, 0.87; 95% CI, 0.83-0.92; EHR AUC, 0.96; 95% CI, 0.94-0.98), and cataracts (claims AUC, 0.82; 95% CI, 0.79-0.86; EHR AUC, 0.91; 95% CI, 0.89-0.93). However, several condition categories showed low validity with AUCs below 0.7, including diagnosed disorders of refraction and accommodation (claims AUC, 0.54; 95% CI, 0.49-0.60; EHR AUC, 0.61; 95% CI, 0.56-0.67), diagnosed blindness and low vision (claims AUC, 0.56; 95% CI, 0.53-0.58; EHR AUC, 0.57; 95% CI, 0.54-0.59), and orbital and external diseases (claims AUC, 0.63; 95% CI, 0.57-0.69; EHR AUC, 0.65; 95% CI, 0.59-0.70). Conclusion and Relevance In this cross-sectional study of current and recent ophthalmology patients with high rates of eye disorders and vision loss, identification of major vision-threatening eye disorders based on diagnosis codes in claims and EHR records was accurate. However, vision loss, refractive error, and other broadly defined or lower-risk disorder categories were less accurately identified by diagnosis codes in claims and EHR data.
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Affiliation(s)
- John S. Wittenborn
- Public Health Analytics Program, National Opinion Research Center at the University of Chicago, Chicago, Illinois
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle
| | - Elizabeth A. Lundeen
- Division of Diabetes Translation, Vision Health Initiative, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Phoebe Lamuda
- Public Health Analytics Program, National Opinion Research Center at the University of Chicago, Chicago, Illinois
| | - Jinan Saaddine
- Division of Diabetes Translation, Vision Health Initiative, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Grace L. Su
- Department of Ophthalmology, University of Washington, Seattle
| | - Randy Lu
- Department of Ophthalmology, University of Washington, Seattle
| | - Aashka Damani
- Department of Ophthalmology, University of Washington, Seattle
| | | | | | - Jolie Z. Shen
- Department of Ophthalmology, University of Washington, Seattle
| | - Timothy-Paul H. Kung
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo
| | | | - Morgan Maring
- Department of Ophthalmology, University of Washington, Seattle
| | | | - Marian Blazes
- Department of Ophthalmology, University of Washington, Seattle
| | - David B. Rein
- Public Health Analytics Program, National Opinion Research Center at the University of Chicago, Chicago, Illinois
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Annadanam A, Hicks PM, Lu MC, Pawar M, Kochar P, Selvaraj S, Kuppuraj D, Rathod C, Muppala RS, Gaur S, Krishnan A, Sumithra SR, Woodward MA, Prajna NV. The effect of social determinants of health on severity of microbial keratitis presentation at a tertiary eye care hospital in Southern India. Indian J Ophthalmol 2023; 71:2448-2454. [PMID: 37322658 PMCID: PMC10417972 DOI: 10.4103/ijo.ijo_331_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Understanding the association between social determinants of health (SDoHs) and microbial keratitis (MK) can inform underlying risk for patients and identify risk factors associated with worse disease, such as presenting visual acuity (VA) and time to initial presentation. Methods This was a cross-sectional study was conducted with patients presenting with MK to the cornea clinic at a tertiary care hospital in Madurai, India. Patient demographics, SDoH survey responses, geographic pollution, and clinical features at presentation were collected. Descriptive statistics, univariate analysis, multi-variable linear regression models, and Poisson regression models were utilized. Results There were 51 patients evaluated. The mean age was 51.2 years (SD = 13.3); 33.3% were female and 55% did not visit a vision center (VC) prior to presenting to the clinic. The median presenting logarithm of the minimum angle of resolution (logMAR) VA was 1.1 [Snellen 20/240, inter-quartile range (IQR) = 20/80 to 20/4000]. The median time to presentation was 7 days (IQR = 4.5 to 10). The average particulate matter 2.5 (PM2.5) concentration, a measure of air pollution, for the districts from which the patients traveled was 24.3 μg/m3 (SD = 1.6). Age- and sex-adjusted linear regression and Poisson regression results showed that higher levels of PM2.5 were associated with 0.28 worse presenting logMAR VA (Snellen 2.8 lines, P = 0.002). Patients who did not visit a VC had a 100% longer time to presentation compared to those who did (incidence rate ratio = 2.0, 95% confidence interval = 1.3-3.0, P = 0.001). Conclusion Patient SDoH and environmental exposures can impact MK presentation. Understanding SDoH is important for public health and policy implications to mitigate eye health disparities in India.
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Affiliation(s)
- Anvesh Annadanam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Mercy Pawar
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Prabhleen Kochar
- Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Suvitha Selvaraj
- Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Dhanya Kuppuraj
- Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Chetan Rathod
- Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Rekha Sravya Muppala
- Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Smriti Gaur
- Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Abinaya Krishnan
- Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - SR Sumithra
- Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
| | - N Venkatesh Prajna
- Department of Cornea & Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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30
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Watanabe K, Aouadj C, Hiratsuka Y, Yamamoto S, Murakami A. Quality of Life and Economic Impacts of Retinitis Pigmentosa on Japanese Patients: A Non-interventional Cross-sectional Study. Adv Ther 2023; 40:2375-2393. [PMID: 36947329 PMCID: PMC10032244 DOI: 10.1007/s12325-023-02446-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/26/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Retinitis pigmentosa (RP) is an inherited progressive disease, characterized by a loss of photoreceptors, and is the second leading cause of visual impairment in Japan. RP is currently incurable and can result in complete blindness, with affected patients typically experiencing a gradual loss of light sensitivity, visual field, and visual acuity. Identification of any unmet medical needs of patients with this condition requires an understanding of the impacts of RP; in this study, we surveyed Japanese patients with RP to investigate the quality of life and economic impacts of visual impairment. METHODS This non-interventional, cross-sectional study surveyed Japanese patients with RP. Economic impact was measured using an original questionnaire that assessed out-of-pocket cost (e.g., vision aids and medical services), salary gap with the general public, and the cost of depression and anxiety. Worker productivity was assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI). Quality of life was evaluated using the Health Utilities Index Mark 3 (HUI3), the National Eye Institute Visual Function Questionnaire-25 (VFQ-25), and the 5-level EQ-5D version (EQ-5D-5L). The primary outcome was direct and indirect costs of visual impairment or blindness during the lifetime of patients with RP. RESULTS Among 122 surveyed patients with RP, the estimated annual cost per patient was 218,520 yen (2176 USD), and the estimated lifetime cost per patient was 18,523,909 yen (184,501 USD). Additional robustness testing increased the estimated annual cost and lifetime cost per patient to 783,176 yen (7801 USD) and 66,389,827 yen (661,253 USD), respectively. In working patients, work productivity loss was 26.2% per person and impairment of daily activities was 31.6% per person. The mean VFQ-25, HUI3, and EQ-5D-5L scores were 42.0, 0.393, and 0.833, respectively. CONCLUSION RP imposed a heavy economic burden and negative quality of life impacts in Japanese patients.
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Affiliation(s)
- Katsuhiko Watanabe
- Ophthalmology Medical Franchise Department, Novartis Pharma K.K., Toranomon Hills Mori Tower 23-1, Toranomon 1-chome Minato-ku, Tokyo, 105-6333, Japan.
| | | | - Yoshimune Hiratsuka
- Department of Ophthalmology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | | | - Akira Murakami
- Department of Ophthalmology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Mong MA. Vitamin K and the Visual System-A Narrative Review. Nutrients 2023; 15:nu15081948. [PMID: 37111170 PMCID: PMC10143727 DOI: 10.3390/nu15081948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
Vitamin K occupies a unique and often obscured place among its fellow fat-soluble vitamins. Evidence is mounting, however, that vitamin K (VK) may play an important role in the visual system apart from the hepatic carboxylation of hemostatic-related proteins. However, to our knowledge, no review covering the topic has appeared in the medical literature. Recent studies have confirmed that matrix Gla protein (MGP), a vitamin K-dependent protein (VKDP), is essential for the regulation of intraocular pressure in mice. The PREDIMED (Prevención con Dieta Mediterránea) study, a randomized trial involving 5860 adults at risk for cardiovascular disease, demonstrated a 29% reduction in the risk of cataract surgery in participants with the highest tertile of dietary vitamin K1 (PK) intake compared with those with the lowest tertile. However, the specific requirements of the eye and visual system (EVS) for VK, and what might constitute an optimized VK status, is currently unknown and largely unexplored. It is, therefore, the intention of this narrative review to provide an introduction concerning VK and the visual system, review ocular VK biology, and provide some historical context for recent discoveries. Potential opportunities and gaps in current research efforts will be touched upon in the hope of raising awareness and encouraging continued VK-related investigations in this important and highly specialized sensory system.
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Affiliation(s)
- Michael A Mong
- Department of Ophthalmology, Veteran Affairs North Texas Health Care Medical Center, Dallas, TX 75216, USA
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Zhu A, Tailor P, Verma R, Zhang I, Schott B, Ye C, Szirth B, Habiel M, Khouri AS. Implementation of deep learning artificial intelligence in vision-threatening disease screenings for an underserved community during COVID-19. J Telemed Telecare 2023:1357633X231158832. [PMID: 36908254 PMCID: PMC10014445 DOI: 10.1177/1357633x231158832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Age-related macular degeneration, diabetic retinopathy, and glaucoma are vision-threatening diseases that are leading causes of vision loss. Many studies have validated deep learning artificial intelligence for image-based diagnosis of vision-threatening diseases. Our study prospectively investigated deep learning artificial intelligence applications in student-run non-mydriatic screenings for an underserved, primarily Hispanic community during COVID-19. METHODS Five supervised student-run community screenings were held in West New York, New Jersey. Participants underwent non-mydriatic 45-degree retinal imaging by medical students. Images were uploaded to a cloud-based deep learning artificial intelligence for vision-threatening disease referral. An on-site tele-ophthalmology grader and remote clinical ophthalmologist graded images, with adjudication by a senior ophthalmologist to establish the gold standard diagnosis, which was used to assess the performance of deep learning artificial intelligence. RESULTS A total of 385 eyes from 195 screening participants were included (mean age 52.43 ± 14.5 years, 40.0% female). A total of 48 participants were referred for at least one vision-threatening disease. Deep learning artificial intelligence marked 150/385 (38.9%) eyes as ungradable, compared to 10/385 (2.6%) ungradable as per the human gold standard (p < 0.001). Deep learning artificial intelligence had 63.2% sensitivity, 94.5% specificity, 32.0% positive predictive value, and 98.4% negative predictive value in vision-threatening disease referrals. Deep learning artificial intelligence successfully referred all 4 eyes with multiple vision-threatening diseases. Deep learning artificial intelligence graded images (35.6 ± 13.3 s) faster than the tele-ophthalmology grader (129 ± 41.0) and clinical ophthalmologist (68 ± 21.9, p < 0.001). DISCUSSION Deep learning artificial intelligence can increase the efficiency and accessibility of vision-threatening disease screenings, particularly in underserved communities. Deep learning artificial intelligence should be adaptable to different environments. Consideration should be given to how deep learning artificial intelligence can best be utilized in a real-world application, whether in computer-aided or autonomous diagnosis.
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Affiliation(s)
- Aretha Zhu
- 537707Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Priya Tailor
- 537707Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rashika Verma
- 537707Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Isis Zhang
- 537707Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Brian Schott
- 537707Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Catherine Ye
- 537707Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Bernard Szirth
- 537707Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Miriam Habiel
- 537707Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Albert S Khouri
- 537707Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
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Wittenborn J, Lee A, Lundeen EA, Lamuda P, Saaddine J, Su GL, Lu R, Damani A, Zawadzki JS, Froines CP, Shen JZ, Kung TPH, Yanagihara RT, Maring M, Takahashi MM, Blazes M, Rein DB. Comparing Telephone Survey Responses to Best-Corrected Visual Acuity to Estimate the Accuracy of Identifying Vision Loss: Validation Study. JMIR Public Health Surveill 2023; 9:e44552. [PMID: 36881468 PMCID: PMC10031446 DOI: 10.2196/44552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/13/2022] [Accepted: 01/06/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Self-reported questions on blindness and vision problems are collected in many national surveys. Recently released surveillance estimates on the prevalence of vision loss used self-reported data to predict variation in the prevalence of objectively measured acuity loss among population groups for whom examination data are not available. However, the validity of self-reported measures to predict prevalence and disparities in visual acuity has not been established. OBJECTIVE This study aimed to estimate the diagnostic accuracy of self-reported vision loss measures compared to best-corrected visual acuity (BCVA), inform the design and selection of questions for future data collection, and identify the concordance between self-reported vision and measured acuity at the population level to support ongoing surveillance efforts. METHODS We calculated accuracy and correlation between self-reported visual function versus BCVA at the individual and population level among patients from the University of Washington ophthalmology or optometry clinics with a prior eye examination, randomly oversampled for visual acuity loss or diagnosed eye diseases. Self-reported visual function was collected via telephone survey. BCVA was determined based on retrospective chart review. Diagnostic accuracy of questions at the person level was measured based on the area under the receiver operator curve (AUC), whereas population-level accuracy was determined based on correlation. RESULTS The survey question, "Are you blind or do you have serious difficulty seeing, even when wearing glasses?" had the highest accuracy for identifying patients with blindness (BCVA ≤20/200; AUC=0.797). The highest accuracy for detecting any vision loss (BCVA <20/40) was achieved by responses of "fair," "poor," or "very poor" to the question, "At the present time, would you say your eyesight, with glasses or contact lenses if you wear them, is excellent, good, fair, poor, or very poor" (AUC=0.716). At the population level, the relative relationship between prevalence based on survey questions and BCVA remained stable for most demographic groups, with the only exceptions being groups with small sample sizes, and these differences were generally not significant. CONCLUSIONS Although survey questions are not considered to be sufficiently accurate to be used as a diagnostic test at the individual level, we did find relatively high levels of accuracy for some questions. At the population level, we found that the relative prevalence of the 2 most accurate survey questions were highly correlated with the prevalence of measured visual acuity loss among nearly all demographic groups. The results of this study suggest that self-reported vision questions fielded in national surveys are likely to yield an accurate and stable signal of vision loss across different population groups, although the actual measure of prevalence from these questions is not directly analogous to that of BCVA.
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Affiliation(s)
- John Wittenborn
- Public Health Analytics, National Opinion Research Center at the University of Chicago, Chicago, IL, United States
| | - Aaron Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | | | - Phoebe Lamuda
- Public Health Analytics, National Opinion Research Center at the University of Chicago, Chicago, IL, United States
| | - Jinan Saaddine
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Grace L Su
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Randy Lu
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Aashka Damani
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Jonathan S Zawadzki
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Colin P Froines
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Jolie Z Shen
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Timothy-Paul H Kung
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Ryan T Yanagihara
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Morgan Maring
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Melissa M Takahashi
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Marian Blazes
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - David B Rein
- Public Health Analytics, National Opinion Research Center at the University of Chicago, Chicago, IL, United States
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Lopez JB, Chan L, Saifee M, Seitzman GD, Yung M, Chan MF. Characterization of Infectious Keratitis in Opioid Users in a County Hospital Setting. CORNEA OPEN 2023; 2:e0010. [PMID: 37637189 PMCID: PMC10449330 DOI: 10.1097/coa.0000000000000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Purpose To determine risk factors and clinical course of corneal ulcers in the setting of opioid use. Methods A retrospective cohort study was performed of patients presenting with bacterial or fungal keratitis at a county hospital from 2010-2021. Subjects were separated into three groups: opioid drug users (heroin, methadone, fentanyl), non-opioid drug users, and non-drug users. 24 opioid users, 77 non-opioid drug users, and 38 non-drug users were included in the study. Chi-square and t-tests were used to compare hospitalization for corneal ulcer treatment; length of hospitalization; loss to follow-up; final best corrected visual acuity (BCVA); medication noncompliance; time to ulcer resolution; and visual disability (defined either by the legal limit for driving in California or the federal limit for blindness). Results Opioid users had higher rates of unemployment (p=0.002), homelessness (p=0.018), and psychiatric conditions (p=0.024) compared with non-opioid and non-drug users. They had more severe presentations, with worse initial BCVA of the affected eye (p=0.003), larger ulcer size (p=0.023), and higher rates of individuals below the legal vision thresholds for driving (p=0.009) and blindness (p=0.033) at initial presentation. Opioid use was associated with increased rate of hospitalization (p<0.001), higher fortified antibiotic use (p=0.009), worse final BCVA of the affected eye (p=0.020), and increased rates of BCVA worse than the legal vision thresholds for driving (p=0.043) and blindness (p<0.001) on final presentation. Conclusions Infectious keratitis associated with opioid use is associated with more severe presentations and poorer outcomes, including higher rates of visual disability.
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Affiliation(s)
- Jacqueline B. Lopez
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
| | - Lawrence Chan
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
| | - Murtaza Saifee
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
| | - Gerami D. Seitzman
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California,
San Francisco, San Francisco, CA, USA
| | - Madeline Yung
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma
Center, Department of Ophthalmology, San Francisco, CA, USA
| | - Matilda F. Chan
- University of California, San Francisco, Department of
Ophthalmology, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California,
San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma
Center, Department of Ophthalmology, San Francisco, CA, USA
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35
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Topical Review: Teaching Serious News Delivery in Eye Care. Optom Vis Sci 2023; 100:127-133. [PMID: 36728608 DOI: 10.1097/opx.0000000000001983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SIGNIFICANCE Eye doctors regularly convey serious illness news to their patients. There is an evolving understanding of how medical educators can effectively teach this vital communication skill during real-time patient care. This article proposes teaching strategies to improve clinical optometric education related to serious illness conversations.Effectively conveying serious illness news is an essential skill in optometry practice. Established protocols can help optometrists navigate these nuanced, emotional, and complex conversations with patients, yet protocols for teaching this skill in eye care settings have not been described. Clinical educators need discrete strategies for making such pivotal communication skills learnable in an environment where patient care, teaching priorities, and limited resources are regularly juggled. Despite the importance of this competency, limited study has focused on teaching optometry learners to deliver serious eye news. In this article, we explore the importance of optometry talk, serious news delivery tools, and considerations for optometric educators teaching serious news delivery. We then adapt specific strategies from medical education to help optometry educators teach serious news delivery in clinical settings.
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Killeen OJ, De Lott LB, Zhou Y, Hu M, Rein D, Reed N, Swenor BK, Ehrlich JR. Population Prevalence of Vision Impairment in US Adults 71 Years and Older: The National Health and Aging Trends Study. JAMA Ophthalmol 2023; 141:197-204. [PMID: 36633858 PMCID: PMC9857701 DOI: 10.1001/jamaophthalmol.2022.5840] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023]
Abstract
Importance Existing estimates of the prevalence of vision impairment (VI) in the United States are based on self-reported survey data or measures of visual function that are at least 14 years old. Older adults are at high risk for VI and blindness. There is a need for up-to-date, objectively measured, national epidemiological estimates. Objective To present updated national epidemiological estimates of VI and blindness in older US adults based on objective visual function testing. Design, Setting, and Participants This survey study presents a secondary data analysis of the 2021 National Health and Aging Trends Study (NHATS), a population-based, nationally representative panel study of Medicare beneficiaries 65 years and older. NHATS includes community-dwelling older adults or their proxies who complete in-person interviews; annual follow-up interviews are conducted regardless of residential status. Round 11 NHATS data were collected from June to November 2021, and data were analyzed in August 2022. Interventions In 2021, NHATS incorporated tablet-based tests of distance and near visual acuity and contrast sensitivity with habitual correction. Main Outcomes and Measures National prevalence of impairment in presenting distance visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), presenting near visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), and contrast sensitivity (>1 SD below the sample mean). Prevalence estimates stratified by age and socioeconomic and demographic data were calculated. Results In the 2021 round 11 NHATS sample, there were 3817 respondents. After excluding respondents who did not complete the sample person interview (n = 429) and those with missing vision data (n = 362), there were 3026 participants. Of these, 29.5% (95% CI, 27.3%-31.8%) were 71 to 74 years old, and 55.2% (95% CI, 52.8%-57.6%) were female respondents. The prevalence of VI in US adults 71 years and older was 27.8% (95% CI, 25.5%-30.1%). Distance and near visual acuity and contrast sensitivity impairments were prevalent in 10.3% (95% CI, 8.9%-11.7%), 22.3% (95% CI, 20.3%-24.3%), and 10.0% (95% CI, 8.5%-11.4%), respectively. Older age, less education, and lower income were associated with all types of VI. A higher prevalence of near visual acuity and contrast sensitivity impairments was associated with non-White race and Hispanic ethnicity. Conclusions and Relevance More than 1 in 4 US adults 71 years and older had VI in 2021, higher than prior estimates. Differences in the prevalence of VI by socioeconomic and demographic factors were observed. These data could inform public health planning.
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Affiliation(s)
- Olivia J. Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Mengyao Hu
- Institute for Social Research, University of Michigan, Ann Arbor
| | - David Rein
- National Opinion Research Center, University of Chicago, Chicago, Illinois
| | - Nicholas Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bonnielin K. Swenor
- Johns Hopkins University School of Nursing, Baltimore, Maryland
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
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Roth S, Moss HE, Vajaranant TS, Sweitzer B. Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery. Anesthesiology 2022; 137:620-643. [PMID: 36179149 PMCID: PMC9588701 DOI: 10.1097/aln.0000000000004338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors reviewed perioperative ocular complications and implications of ocular diseases during nonocular surgeries. Exposure keratopathy, the most common perioperative eye injury, is preventable. Ischemic optic neuropathy, the leading cause of perioperative blindness, has well-defined risk factors. The incidence of ischemic optic neuropathy after spine fusion, but not cardiac surgery, has been decreasing. Central retinal artery occlusion during spine fusion surgery can be prevented by protecting eyes from compression. Perioperative acute angle closure glaucoma is a vision-threatening emergency that can be successfully treated by rapid reduction of elevated intraocular pressure. Differential diagnoses of visual dysfunction in the perioperative period and treatments are detailed. Although glaucoma is increasingly prevalent and often questions arise concerning perioperative anesthetic management, evidence-based recommendations to guide safe anesthesia care in patients with glaucoma are currently lacking. Patients with low vision present challenges to the anesthesia provider that are becoming more common as the population ages.
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Affiliation(s)
- Steven Roth
- Department of Anesthesiology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Heather E Moss
- Departments of Ophthalmology and Neurology & Neurologic Sciences, Stanford University, Palo Alto, California
| | - Thasarat Sutabutr Vajaranant
- Department of Ophthalmology and Visual Science, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - BobbieJean Sweitzer
- University of Virginia, Charlottesville, Virginia; Perioperative Medicine, Inova Health System, Falls Church, Virginia
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Moos WH, Faller DV, Glavas IP, Harpp DN, Kamperi N, Kanara I, Kodukula K, Mavrakis AN, Pernokas J, Pernokas M, Pinkert CA, Powers WR, Sampani K, Steliou K, Tamvakopoulos C, Vavvas DG, Zamboni RJ, Chen X. Treatment and prevention of pathological mitochondrial dysfunction in retinal degeneration and in photoreceptor injury. Biochem Pharmacol 2022; 203:115168. [PMID: 35835206 DOI: 10.1016/j.bcp.2022.115168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
Pathological deterioration of mitochondrial function is increasingly linked with multiple degenerative illnesses as a mediator of a wide range of neurologic and age-related chronic diseases, including those of genetic origin. Several of these diseases are rare, typically defined in the United States as an illness affecting fewer than 200,000 people in the U.S. population, or about one in 1600 individuals. Vision impairment due to mitochondrial dysfunction in the eye is a prominent feature evident in numerous primary mitochondrial diseases and is common to the pathophysiology of many of the familiar ophthalmic disorders, including age-related macular degeneration, diabetic retinopathy, glaucoma and retinopathy of prematurity - a collection of syndromes, diseases and disorders with significant unmet medical needs. Focusing on metabolic mitochondrial pathway mechanisms, including the possible roles of cuproptosis and ferroptosis in retinal mitochondrial dysfunction, we shed light on the potential of α-lipoyl-L-carnitine in treating eye diseases. α-Lipoyl-L-carnitine is a bioavailable mitochondria-targeting lipoic acid prodrug that has shown potential in protecting against retinal degeneration and photoreceptor cell loss in ophthalmic indications.
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Affiliation(s)
- Walter H Moos
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA.
| | - Douglas V Faller
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Cancer Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Ioannis P Glavas
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - David N Harpp
- Department of Chemistry, McGill University, Montreal, QC, Canada
| | - Natalia Kamperi
- Center for Clinical, Experimental Surgery and Translational Research Pharmacology-Pharmacotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | | | | | - Anastasios N Mavrakis
- Department of Medicine, Tufts University School of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
| | - Julie Pernokas
- Advanced Dental Associates of New England, Woburn, MA, USA
| | - Mark Pernokas
- Advanced Dental Associates of New England, Woburn, MA, USA
| | - Carl A Pinkert
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Whitney R Powers
- Department of Health Sciences, Boston University, Boston, MA, USA; Department of Anatomy, Boston University School of Medicine, Boston, MA, USA
| | - Konstantina Sampani
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Kosta Steliou
- Cancer Research Center, Boston University School of Medicine, Boston, MA, USA; PhenoMatriX, Inc., Natick, MA, USA
| | - Constantin Tamvakopoulos
- Center for Clinical, Experimental Surgery and Translational Research Pharmacology-Pharmacotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Demetrios G Vavvas
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Robert J Zamboni
- Department of Chemistry, McGill University, Montreal, QC, Canada
| | - Xiaohong Chen
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China.
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Coleman AL, McLeod SD. Screening for Impaired Visual Acuity in Older Adults. JAMA 2022; 327:2090-2091. [PMID: 35608845 DOI: 10.1001/jama.2022.6688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anne L Coleman
- Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Stephen D McLeod
- Department of Ophthalmology, School of Medicine, University of California, San Francisco
- Francis I. Proctor Foundation, University of California, San Francisco
- American Academy of Ophthalmology, San Francisco, California
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40
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Van Gelder RN, Chiang MF, Dyer MA, Greenwell TN, Levin LA, Wong RO, Svendsen CN. Regenerative and restorative medicine for eye disease. Nat Med 2022; 28:1149-1156. [PMID: 35715505 PMCID: PMC10718186 DOI: 10.1038/s41591-022-01862-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/06/2022] [Indexed: 12/11/2022]
Abstract
Causes of blindness differ across the globe; in higher-income countries, most blindness results from the degeneration of specific classes of cells in the retina, including retinal pigment epithelium (RPE), photoreceptors, and retinal ganglion cells. Advances over the past decade in retinal regenerative medicine have allowed each of these cell types to be produced ex vivo from progenitor stem cells. Here, we review progress in applying these technologies to cell replacement - with the goal of vision restoration in degenerative disease. We discuss the landscape of human clinical trials for RPE transplantation and advanced preclinical studies for other cell types. We also review progress toward in situ repair of retinal degeneration using endogenous progenitor cells. Finally, we provide a high-level overview of progress toward prosthetic ocular vision restoration, including advanced photovoltaic devices, opsin-based gene therapy, and small-molecule photoswitches. Progress in each of these domains is at or near the human clinical-trial stage, bringing the audacious goal of vision restoration within sight.
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Affiliation(s)
- Russell N Van Gelder
- Karalis-Johnson Retina Center, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA, USA.
- Department of Biological Structure, University of Washington School of Medicine, Seattle, WA, USA.
- Department of Pathology and Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, USA.
- Roger and Angie Karalis Johnson Retina Center, University of Washington School of Medicine, Seattle, WA, USA.
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Dyer
- Department of Developmental Neurobiology, St. Jude's Research Hospital, Memphis, TN, USA
| | - Thomas N Greenwell
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leonard A Levin
- Department of Ophthalmology and Visual Sciences, McGill University, Montreal, Quebec, Canada
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Rachel O Wong
- Karalis-Johnson Retina Center, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Biological Structure, University of Washington School of Medicine, Seattle, WA, USA
| | - Clive N Svendsen
- Board of Governors Regenerative Medicine Institute, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Eckert KA, Lansingh VC, Carter MJ, Frick KD. Update of a Simple Model to Calculate the Annual Global Productivity Loss Due to Blindness and Moderate and Severe Vision Impairment. Ophthalmic Epidemiol 2022; 30:1-9. [PMID: 35610969 DOI: 10.1080/09286586.2022.2072899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To develop a simple but more precise model to calculate potential annual productivity losses due to blindness and moderate and severe vision impairment (MSVI) at the national, regional, and global level. METHODS Productivity loss was defined as the loss of minimum wage/Gross National Income per capita (GNI) incurred by people aged 50-64 years with blindness or MSVI, who were not able to work or worked with reduced earnings in 2020. We developed a global list of minimum wage data from on-line sources. All other model data were sourced from international, standardised, and open-access databases. For blindness, the total productivity loss (not working) incurred by 64%-90% of the affected population was summed up with partial productivity loss, defined as 10%-36% of the affected population earning one-third of that of the sighted population. For MSVI, the total productivity loss for 30%-55% of the affected population was summed with the partial productivity loss, defined as 45%-70% of the affected population having 35% reduced earnings. The costs of blindness and MSVI were summed to obtain the cost of combined vision loss. RESULTS The global cost of vision loss based on minimum wage was US$160-US$216.32 billion for 2020. The global cost of vision loss using GNI was US$449.36-US$584.66 billion. CONCLUSIONS A parsimonious model that considers minimum wage and GNI potentially lost due to blindness and MSVI can be used for eye care programming planning and advocacy at the national, regional, and global level.
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Affiliation(s)
| | - Van C Lansingh
- Department of Research, Instituto Mexicano de Oftalmología, Queretaro, Mexico
- Chief Medical Office, Help Me See, Jersey City, New Jersey, USAUSA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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