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George R, Asokan R, Vijaya L. Association of metformin use among diabetics and the incidence of primary open-angle glaucoma - The Chennai Eye Disease Incidence Study. Indian J Ophthalmol 2021; 69:3336-3338. [PMID: 34708800 PMCID: PMC8725087 DOI: 10.4103/ijo.ijo_1486_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Studies have reported the usage of metformin being associated with the reduced risk of progression of glaucoma. The current study aims to determine the association of metformin usage among subjects with diabetes mellitus and the six-year incidence of primary open-angle glaucoma (POAG). Methods In this prospective cohort study, subjects who did not have glaucoma at the baseline and had a follow-up after a six-year interval were included. Details such as medical and drug history, applanation tonometry, gonioscopy, pachymetry, optic disc evaluation, and automated perimetry were collected. Incident POAG was defined as subjects who do not have glaucoma at baseline and developed glaucoma as classified International Society of Geographical and Epidemiological Ophthalmology Classification at the follow-up. The association between the subjects who were on metformin for treatment of diabetes mellitus and development of incident POAG was assessed. Results Among the 4302 eligible participants, 128 (3%) had incident POAG. There were 905 (21.0%) subjects who had diabetes mellitus of which 142 (15.7%) were using metformin. Of the subjects with POAG, 92 (71.9%) were nondiabetics and 36 were diabetics (28.1%). Among the diabetics, the incidence of POAG among those on metformin was 5.6% (8 participants) and those not on metformin was 3.6% (28 participants). There was no difference in the incidence of POAG in subjects with diabetes mellitus, with and without metformin use (P = 0.25). Logistic regression showed no association of metformin use with the incidence of POAG (OR: 1.33, 95 CI: 0.58-3.04, P = 0.49) after adjusting for age, gender, and place of residence. Conclusion The current study did not find any association between the effects of metformin on the incidence of POAG.
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Affiliation(s)
- Ronnie George
- Glaucoma Services, Medical Research Foundation, Chennai, Tamilnadu, India
| | - Rashima Asokan
- Glaucoma Services, Medical Research Foundation, Chennai, Tamilnadu, India
| | - Lingam Vijaya
- Glaucoma Services, Medical Research Foundation, Chennai, Tamilnadu, India
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Majithia S, Tham YC, Chee ML, Nusinovici S, Teo CL, Chee ML, Thakur S, Soh ZD, Kumari N, Lamoureux E, Sabanayagam C, Wong TY, Cheng CY. Cohort Profile: The Singapore Epidemiology of Eye Diseases study (SEED). Int J Epidemiol 2021; 50:41-52. [PMID: 33393587 DOI: 10.1093/ije/dyaa238] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Shivani Majithia
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yih-Chung Tham
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Miao-Li Chee
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Simon Nusinovici
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Cong Ling Teo
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Miao-Ling Chee
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Sahil Thakur
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Zhi Da Soh
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Neelam Kumari
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Khoo Teck Puat Hospital, Singapore
| | - Ecosse Lamoureux
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Charumathi Sabanayagam
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Tien-Yin Wong
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Ramesh SV, George R, Raju P, Sachi D, Sunil G, Vijaya L. Perimetric severity in hospital‐based and population‐based glaucoma patients. Clin Exp Optom 2021; 93:349-53. [DOI: 10.1111/j.1444-0938.2010.00505.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- S Ve Ramesh
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
E‐mail:
| | - Ronnie George
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
E‐mail:
| | - Prema Raju
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
E‐mail:
| | - Devi Sachi
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
E‐mail:
| | - Gt Sunil
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
E‐mail:
| | - Lingam Vijaya
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
E‐mail:
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Choudhari NS, George R, Asokan R, Khanna R, Vijaya L, Garudadri CS. Combination of Simple Diagnostic Tests to Detect Primary Angle Closure Disease in a Resource-constrained Region. Ophthalmic Epidemiol 2019; 26:430-438. [PMID: 31389761 DOI: 10.1080/09286586.2019.1650380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To report on diagnostic accuracy of van Herick (vH) technique performed by a vision technician (VT) as well as on efficacy of a combination of vH technique and central anterior chamber depth (ACD) in detection of primary angle closure disease.Methods: Data was obtained from two cohorts; rural clinic setting (n = 111), and rural population-based research setting (n = 888). Van Herick grading was performed by a VT in first cohort and a glaucoma specialist in second cohort. A reference standard four-mirror gonioscopy was performed by a glaucoma specialist in both cohorts. We did preferential sampling. Cut-off levels for vH technique and central ACD were grade 2 and 25th percentile value, respectively. Data from one eye per participant was analyzed.Results: Three hundred and forty (34%) eyes were gonioscopically occludable. Area under receiver operating characteristic curve (95% confidence interval) for vH test was 0.83 (0.76, 0.9) and 0.81 (0.78, 0.84) in first and second cohorts, respectively. Simultaneous testing achieved sensitivity of 87.8% while sequential testing achieved specificity of 99.3%. Negative predictive value* of simultaneous testing was 98.3% compared to 96.6% of vH technique while positive predictive value* of sequential testing was 86% compared to 49.3% of vH technique. (*at 10% prevalence of gonioscopically occludable angle)Conclusions: Diagnostic accuracy of vH grading was similar when performed by a VT and a glaucoma specialist. While test combination was effective to rule in, vH technique may suffice to rule out the disease. Implications of these findings for resource-constrained regions are discussed.
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Affiliation(s)
- Nikhil S Choudhari
- V S T Glaucoma Centre, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India.,Edward and Soona Brown Eye Centre, L V Prasad Eye Institute, Sattenapalle, India
| | - Ronnie George
- Smt. Jadhavbai Nathamal Singhvee Department of Glaucoma, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Rashima Asokan
- Smt. Jadhavbai Nathamal Singhvee Department of Glaucoma, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Rohit Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Lingam Vijaya
- Smt. Jadhavbai Nathamal Singhvee Department of Glaucoma, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Bassi ST, George R, Sen S, Asokan R, Lingam V. Prevalence of the optic disc anomalies in the adult South Indian population. Br J Ophthalmol 2018; 103:94-98. [DOI: 10.1136/bjophthalmol-2017-311566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/13/2018] [Accepted: 03/04/2018] [Indexed: 11/04/2022]
Abstract
PurposeTo determine the prevalence of congenitally abnormal disc (all anomalies) in an adult population in southern India.MethodsSubjects aged ≥40 years (n=6013) underwent a complete ophthalmic examination. Optic disc anomalies were diagnosed according to the definitions given in the article.ResultsOptic disc anomalies were found in 81 eyes of 66 (1.1%, 95% CIs 0.00834 to 0.01361) patients. The prevalence of each anomaly in the descending order was peripapillary myelinated nerve fibre (0.28%), epipapillary glial tissue on the optic disc (0.28%), peripapillary vascular loops (0.16%), tilted disc (0.09%), optic disc coloboma (0.08%), optic nerve hypoplasia (0.04%), optic disc pit (0.04%), optic disc pigmentation (0.03%), optic nerve head drusen (0.03%), Bergmeister’s papilla (0.03%), optic disc pit and coloboma (0.01%).ConclusionsThe prevalence of optic disc anomalies is 1.1% in the adult South Indian population.
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The Prevalence of Pseudoexfoliation and the Long-term Changes in Eyes With Pseudoexfoliation in a South Indian Population. J Glaucoma 2017; 25:e596-602. [PMID: 25950660 DOI: 10.1097/ijg.0000000000000276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the prevalence, long-term changes and associated factors for pseudoexfoliation (PEX) in a population aged 40 years and above from rural and urban south India. MATERIALS AND METHODS At baseline (the Chennai Glaucoma Study), 7774 subjects were examined. After 6 years, as a part of the incidence study, 133 of the 290 subjects diagnosed with PEX at baseline were reexamined for long-term changes. Participants had detailed examination at base hospital. RESULTS At baseline PEX was noted in 290 [3.73%, 95% confidence interval (CI), 3.3-4.2] subjects. It was associated with glaucoma in 24 (8.3%), ocular hypertension (OHT) in 21 (7.2%), and occludable angles in 24 (8.3%) subjects. The age-adjusted and sex-adjusted prevalence was 3.41% (95% CI, 3.39-3.43). Increasing age was a significant associated factor. Using the 40- to 49-year age group as a reference, the odds ratio increased from 8.4 (95% CI, 4.1-17.1) for the 50- to 59-year age group to 51.2 (95% CI, 25.8-101.6) for the 70 years and above age group. Other associated factors were rural residence (P<0.001), higher intraocular pressure (P<0.001), cataract (P<0.001), being underweight (P=0.01), manual labor (P=0.03), and aphakia (P<0.001). Of the 133 subjects reexamined, 8 (6.0%) subjects developed glaucoma and all had OHT at baseline. Rates of cataract surgery were (P<0.001) higher in subjects with PEX. CONCLUSION Prevalence of PEX was higher in rural population and baseline OHT was a significant factor for conversion to glaucoma.
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Vijaya L, Asokan R, Panday M, George R. Is prophylactic laser peripheral iridotomy for primary angle closure suspects a risk factor for cataract progression? The Chennai Eye Disease Incidence Study. Br J Ophthalmol 2016; 101:665-670. [PMID: 27485723 DOI: 10.1136/bjophthalmol-2016-308733] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/16/2016] [Accepted: 07/11/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND To report the risk of cataract progression among primary angle closure suspects (PACS) 6 years after they underwent laser peripheral iridotomy (LPI). METHODS In the Chennai Eye Disease Incidence Study, 6 years after their baseline evaluation, 4421 subjects were examined again. As part of a detailed evaluation cataract was graded using the Lens Opacities Classification System II; progression was defined as change of cataract by two or more grades or history of cataract surgery in the 6-year period. Only bilaterally phakic subjects with less than N2 or C2 or P2 cataract at baseline with no history of any form of glaucoma, primary angle closure and pseudoexfoliation were included. RESULTS There were 3205 eligible subjects. Of these, 190 had undergone LPI for PACS. In comparison to the study population, they were significantly older (p<0.001), female (p=0.008), urban residents (p=0.001) and patients with hypertension (p<0.001). During the intervening period, 53 subjects had undergone cataract surgery. The cataract progression rate was significantly greater (OR 1.7, 95% CI 1.3 to 2.4, p<0.001) in those who had undergone LPI. For the study population the baseline risk factors for progression of cataract were age (p<0.001), female gender (p=0.01), diabetes (p<0.001) and LPI (p<0.001). Diabetes and female gender were significant risk factors for nuclear and cortical cataract progression; LPI was a risk factor only for cortical cataract (OR 1.6, 95% CI 1.1 to 2.3, p=0.007). CONCLUSIONS There was significant cataract progression in 6 years following LPI for PACS.
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Affiliation(s)
- Lingam Vijaya
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rashima Asokan
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.,Elite School of Optometry, Chennai, Tamil Nadu, India.,Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | - Manish Panday
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ronnie George
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Panday M, George R, Asokan R, Ve Ramesh S, Velumuri L, Choudhari NS, Boddupalli SD, Sunil GT, Vijaya L. Six-year incidence of visually significant age-related cataract: the Chennai eye disease incidence study. Clin Exp Ophthalmol 2015; 44:114-20. [PMID: 26290386 DOI: 10.1111/ceo.12636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 07/30/2015] [Accepted: 08/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study is to report the 6-year incidence of age-related cataract in a population-based study. DESIGN The design used is a population-based cohort study. PARTICIPANTS A cohort of 2484 phakic subjects, aged 40 years and above at baseline, from a south Indian population was included in the study. METHODS Bilateral phakics with visual acuity of 6/12 or better and cataract less than N2, C2 and P2 on the Lens Opacities Classification System II at baseline were included. Subjects with glaucoma and corneal or retinal diseases were excluded. Incident visually significant cataract was defined as visual acuity of less than 6/18 with a corresponding one grade or greater change in Lens Opacities Classification System II or history of having undergone cataract surgery with evidence of pseudophakia or aphakia at the 6-year follow-up. MAIN OUTCOME MEASURES Six-year incidence of visually significant cataract and associated risk factors data were collected. RESULTS Incident visually significant cataract at 6 years was seen in 158 subjects (6.36%, 95% CI: 5.40-7.32, phakics:pseudophakics/aphakics 70:88). Incidence was higher in the rural cohort as compared with the urban cohort (P < 0.001). Incidence increased with age and was highest in the ≥70 years age group (odds ratio (OR):31.23, 95% CI: 15.20-64.16, P < 0.001). Other associated risk factors included illiteracy (OR 1.75, 95% CI: 1.17-2.61, P = 0.007) and smoking (OR 1.77, 95% CI: 1.08-2.88, P = 0.02). CONCLUSIONS A significant proportion of the population developed visually significant age-related cataract at 6 years. Incident visually significant cataract was significantly greater for the rural cohort between 50 and 69 years old.
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Affiliation(s)
- Manish Panday
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Ronnie George
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Rashima Asokan
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India.,Elite School of Optometry, Chennai, India
| | - Satyamangalam Ve Ramesh
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India.,Elite School of Optometry, Chennai, India
| | - Lokapavani Velumuri
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India.,Elite School of Optometry, Chennai, India
| | - Nikhil S Choudhari
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Sachi Devi Boddupalli
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Govindan T Sunil
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Lingam Vijaya
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Vijaya L, George R, Asokan R, Velumuri L, Ramesh SV. Prevalence and causes of low vision and blindness in an urban population: The Chennai Glaucoma Study. Indian J Ophthalmol 2015; 62:477-81. [PMID: 23619490 PMCID: PMC4064227 DOI: 10.4103/0301-4738.111186] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aim: To evaluate the prevalence and causes of low vision and blindness in an urban south Indian population. Settings and Design: Population-based cross-sectional study. Exactly 3850 subjects aged 40 years and above from Chennai city were examined at a dedicated facility in the base hospital. Materials and Methods: All subjects had a complete ophthalmic examination that included best-corrected visual acuity. Low vision and blindness were defined using World Health Organization (WHO) criteria. The influence of age, gender, literacy, and occupation was assessed using multiple logistic regression. Statistical Analysis: Chi-square test, t-test, and multivariate analysis were used. Results: Of the 4800 enumerated subjects, 3850 subjects (1710 males, 2140 females) were examined (response rate, 80.2%). The prevalence of blindness was 0.85% (95% CI 0.6–1.1%) and was positively associated with age and illiteracy. Cataract was the leading cause (57.6%) and glaucoma was the second cause (16.7%) for blindness. The prevalence of low vision was 2.9% (95% CI 2.4–3.4%) and visual impairment (blindness + low vision) was 3.8% (95% CI 3.2–4.4%). The primary causes for low vision were refractive errors (68%) and cataract (22%). Conclusions: In this urban population based study, cataract was the leading cause for blindness and refractive error was the main reason for low vision.
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Affiliation(s)
- Lingam Vijaya
- Department of Glaucoma Project, Chennai Glaucoma Study, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Vijaya L, Asokan R, Panday M, Choudhari NS, Ve Ramesh S, Velumuri L, George R. Six-Year Incidence and Baseline Risk Factors for Pseudoexfoliation in a South Indian Population. Ophthalmology 2015; 122:1158-64. [DOI: 10.1016/j.ophtha.2015.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/21/2015] [Accepted: 02/05/2015] [Indexed: 10/23/2022] Open
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Philomenadin FS, Asokan R, N V, George R, Lingam V, Sarangapani S. Genetic association of SNPs near ATOH7, CARD10, CDKN2B, CDC7 and SIX1/SIX6 with the endophenotypes of primary open angle glaucoma in Indian population. PLoS One 2015; 10:e0119703. [PMID: 25798827 PMCID: PMC4370747 DOI: 10.1371/journal.pone.0119703] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 01/15/2015] [Indexed: 11/18/2022] Open
Abstract
Primary open angle glaucoma (POAG) belonging to a group of optic neuropathies, result from interaction between genetic and environmental factors. Study of associations with quantitative traits (QTs) is one of the successful strategies to understand the complex genetics of POAG. The current study attempts to explore the association of variations near/in genes like ATOH7, SIX1/SIX6 complex, CDKN2B, CARD10, and CDC7 with POAG and its QTs including vertical cup to disc ratio (VCDR), central corneal thickness (CCT), intra ocular pressure (IOP), and axial length (AL). Case-control study design was carried out in a sample size of 97 POAG cases and 371 controls from South India. Model-based (additive, recessive, dominant) association of the genotypes and their interaction was carried out between cases and controls using chi-square, linear and logistic regression methods. Nominal significance (P<0.05) was observed for QTs like i) VCDR with SNPs rs1900004 (ATOH7); rs1192415 (CDC7); rs10483727 (SIX1/SIX6), rs9607469 (CARD10); ii) CCT with rs1192415; iii) IOP with rs1900004 and iv) AL with rs1900004 and rs1063192 (CDKN2B). We were able to replicate previously known interactions between ATOH7-SIX6 and SIX6-CDKN2B along with few novel interactions between ATOH7—CDC7 and SIX6 with genes including CARD10 and CDC7. In summary, our results suggest that a probable interaction among the candidate genes for QTs, play a major role in determining the individual’s susceptibility to POAG.
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Affiliation(s)
- Ferdinamarie Sharmila Philomenadin
- SNONGC Department of Genetics and Molecular biology, Vision Research foundation, Sankara Nethralaya, Chennai, India
- PhD Scholar, Birla Institute of Technology & Science (BITS), Pilani, 333 031, Rajasthan, India
| | - Rashima Asokan
- Chennai Glaucoma Study, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Viswanathan N
- Biostatistician, Department of Preventive Ophthalmology, Medical research foundation, Sankara Nethralaya, Chennai, India
| | - Ronnie George
- Chennai Glaucoma Study, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Vijaya Lingam
- Chennai Glaucoma Study, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Sripriya Sarangapani
- SNONGC Department of Genetics and Molecular biology, Vision Research foundation, Sankara Nethralaya, Chennai, India
- * E-mail:
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Panday M, George R, Asokan R, Ramesh SV, Velumuri L, Choudhari NS, Boddupalli SD, Sunil GT, Vijaya L. Six-year incidence of ocular hypertension in a South Indian population: the Chennai eye disease incidence study. Br J Ophthalmol 2014; 99:604-8. [PMID: 25388449 DOI: 10.1136/bjophthalmol-2014-305714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/21/2014] [Indexed: 11/04/2022]
Abstract
AIMS To report the 6-year incidence and risk factors for ocular hypertension (OHT) in a population-based study in southern India. METHODS 6 years after baseline evaluation, 56.9% subjects (participants:non-participants, 4421:3353) were re-examined at the base hospital. Incident OHT was defined as an intraocular pressure above the 97.5th centile for the population with no evidence of glaucoma in the 2852 phakic subjects, 40 years or older. Subjects with trauma, laser or incisional surgery at baseline or follow-up were excluded (total exclusions: 1569). RESULTS Incidence of OHT at 6 years was 62/2852 subjects (2.17% (95% CI 1.64% to 2.71%, men:women, 36:26)). Incidence was higher in the rural cohort as compared with the urban cohort (80.6% vs 19.4%, p<0.001). A higher baseline intraocular pressure (with increasing OR: 16-18 mm Hg (OR 4.0, 95% CI 2.1 to 7.9), 19-21 mm Hg (OR 11.4, 95% CI 5.7 to 22.9), 22-24 mm Hg (OR 42.6, 95% CI 11.0 to 164.8, in the urban cohort)) and increasing age (50-59 years (OR 1.9, 95% CI 1.1 to 3.3), 70 years and above (OR 3.6, 95% CI 1.2 to 10.6)) were significantly associated risk factors for incident OHT. CONCLUSIONS A significant proportion of this normal population converted to OHT. A higher incidence of conversion was seen in the rural population.
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Affiliation(s)
- Manish Panday
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Ronnie George
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Rashima Asokan
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India Elite School of Optometry, Chennai, India
| | - Satyamangalam Ve Ramesh
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India Elite School of Optometry, Chennai, India
| | - Lokapavani Velumuri
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India Elite School of Optometry, Chennai, India
| | - Nikhil S Choudhari
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Sachi Devi Boddupalli
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Govindan T Sunil
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Lingam Vijaya
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Choudhari NS, George R, Sathyamangalam RV, Raju P, Asokan R, Velumuri L, Vijaya L. Long-term change in central corneal thickness from a glaucoma perspective. Indian J Ophthalmol 2014; 61:580-4. [PMID: 24145562 PMCID: PMC3853455 DOI: 10.4103/0301-4738.119338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To investigate the longitudinal change in central corneal thickness (CCT) over 3 years in patients with glaucoma. MATERIALS AND METHODS The Chennai Glaucoma Follow-up Study, an offshoot of the Chennai Glaucoma Study, was designed to evaluate the progression of glaucoma. A cohort of participants in the Chennai Glaucoma Study that were suffering from glaucoma or were at a higher risk for glaucoma underwent comprehensive ophthalmic evaluation at the base hospital at 6-month intervals during the years 2004 to 2007. The CCT (average of 10 readings) was measured between 11 am and 1 pm on any given day using an ultrasonic pachymeter. Patients with a history of ocular surgery, corneal disease and usage of topical carbonic anhydrase inhibitor were excluded. No patient was a contact lens wearer. RESULTS One hundred and ninety-six patients (84 male, 112 female) met the inclusion criteria. We analyzed data from the right eye. The mean age of the patients was 59.97 ± 9.06 years. Fifty-nine (30.1%) of the patients were diabetic. The mean change in CCT (CCT at first patient visit--CCT at last patient visit) was 3.46 ± 7.63 μm. The mean change in CCT was 0.75 μm per year (R² = 0.00). Age, gender, intraocular pressure at the first patient visit and diabetic status had no significant influence on the magnitude of change in CCT. CONCLUSION A carefully obtained CCT reading by a trained examiner need not be repeated for at least 3 years as long as the ocular and systemic factors known to affect the measurement of CCT are constant.
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Affiliation(s)
- Nikhil S Choudhari
- Department of Glaucoma project, Chennai Glaucoma Study, Vision Research Foundation, Sankara Nethralaya, 18, College Road, Chennai 600006, India
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Predictors for incidence of primary open-angle glaucoma in a South Indian population: the Chennai eye disease incidence study. Ophthalmology 2014; 121:1370-6. [PMID: 24650554 DOI: 10.1016/j.ophtha.2014.01.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the 6-year incidence of primary open-angle glaucoma (POAG) and its associated predictors. DESIGN Population-based cohort study. PARTICIPANTS A total of 4316 subjects without POAG at baseline who were 40 years of age and older from a south Indian population. METHODS Participants were examined at baseline and after a 6-year interval. Detailed ophthalmic examination included applanation tonometry, gonioscopy, pachymetry, optic disc evaluation, and automated perimetry. Glaucoma was defined using the International Society of Geographical and Epidemiological Ophthalmology Classification. Multivariable logistic regression was performed to identify the baseline risk factors that could predict the incident POAG. MAIN OUTCOME MEASURES Six-year incidence of POAG and its associated risk factors. RESULTS In 6 years, incident POAG developed in 129 subjects (2.9%; 95% confidence interval [CI], 2.4-3.4; male-to-female ratio, 65:64). Baseline age was a risk factor. In reference to the group 40 to 49 years of age, the incidence increased from 2.3 (95% CI, 1.4-3.7) for the group 50 to 59 years of age to 3.5 (95% CI, 2.2-5.7) for the group 60 to 69 years of age (P<0.001). Other baseline risk predictors were urban residence (odds ratio [OR], 1.6; 95% CI, 1.1-2.2; P = 0.01), higher intraocular pressure (IOP; OR, 2.0; 95% CI, 1.5-2.6 per 10 mmHg; P<0.001), myopia (OR, 1.7; 95%, CI, 1.1-2.5; P<0.001), and axial length (OR, 1.5; 95% CI, 1.0-2.2 per millimeter; P = 0.03). Thinner corneas with higher IOP at baseline had the highest incidence of POAG. In 80% of the urban population and 100% of the rural population, incident glaucoma was previously undetected. CONCLUSIONS A significant proportion of this population demonstrated incident POAG. The baseline risk factors could help in identifying those at highest risk of disease.
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Vijaya L, Asokan R, Panday M, Choudhari NS, Ramesh SV, Velumuri L, Boddupalli SD, Sunil GT, George R. Six-year incidence of angle-closure disease in a South Indian population: the Chennai Eye Disease Incidence Study. Am J Ophthalmol 2013; 156:1308-1315.e2. [PMID: 24075428 DOI: 10.1016/j.ajo.2013.07.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 07/03/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To estimate the 6-year incidence of primary angle-closure (PAC) disease among adult population aged 40 years and older from rural and urban south India. DESIGN Population-based longitudinal study. METHODS A complete ophthalmologic examination, including applanation tonometry, gonioscopy, biometry, stereoscopic fundus examination, and automated perimetry was performed at both baseline and at the 6-year follow up at base hospital. Incident PAC disease was defined as the development of PAC disease during the 6-year follow-up in phakic subjects without PAC disease at baseline. Diagnosis was made using the International Society Geographical and Epidemiological Ophthalmology classification. RESULTS The data were analyzed for 3350 subjects (mean age, 56.4 ± 8.9 years; 1547 males, 1803 females) for a diagnosis of PAC disease at baseline and at follow-up examinations. The incidence of PAC disease was identified in 134 subjects (6-year incidence rate, 4.0%; 95% confidence interval (CI), 3.3-4.7). Among the 134 subjects, 88 subjects (2.6%, 95% CI, 2.1-3.2) were primary angle-closure suspects; 37 subjects (1.1%, 95% CI, 0.7-1.5) had primary angle closure, and 9 subjects (0.3%, 95% CI, 0.1-0.4) had primary angle-closure glaucoma. There was an inverse relationship between the incidence of PAC disease and the cataract surgery rates. Significant risk factors for PAC disease on logistic regressions were higher intraocular pressure, increased lens thickness, shorter axial length, shallow anterior chamber depth, anteriorly positioned lens, and hyperopia. CONCLUSIONS The average incidence of PAC disease per year was 0.7%. All biometric parameters were found to be strong predictors for the incidence of PAC disease.
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Thapa SS, Paudyal I, Khanal S, Twyana SN, Paudyal G, Gurung R, Ruit S, van Rens GH. A Population-based Survey of the Prevalence and Types of Glaucoma in Nepal: The Bhaktapur Glaucoma Study. Ophthalmology 2012; 119:759-64. [DOI: 10.1016/j.ophtha.2011.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 09/27/2011] [Accepted: 10/14/2011] [Indexed: 10/14/2022] Open
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Asokan R, Venkatasubbu RS, Velumuri L, Lingam V, George R. Prevalence and associated factors for pterygium and pinguecula in a South Indian population. Ophthalmic Physiol Opt 2011; 32:39-44. [DOI: 10.1111/j.1475-1313.2011.00882.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arvind H, George R, Raju P, Ve RS, Mani B, Kannan P, Vijaya L. Optic Disc Dimensions and Cup-Disc Ratios among Healthy South Indians: The Chennai Glaucoma Study. Ophthalmic Epidemiol 2011; 18:189-97. [DOI: 10.3109/09286586.2011.602502] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Can intraocular pressure asymmetry indicate undiagnosed primary glaucoma? The Chennai Glaucoma Study. J Glaucoma 2011; 22:31-5. [PMID: 21878819 DOI: 10.1097/ijg.0b013e31822af25f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM : To investigate the association of intraocular pressure (IOP) asymmetry with undiagnosed primary glaucoma in rural and urban populations of south India. METHODS Chennai Glaucoma Study is a population-based cross-sectional study. The participants were adults, 40 years or older. The prevalence of primary glaucoma was defined using International Society of Geographical and Epidemiological Ophthalmology classification. IOP asymmetry was diagnosed when the difference in IOP between 2 eyes was >3 mm Hg. Analysis included only bilaterally phakic subjects. We excluded subjects with known glaucoma, secondary glaucoma, pseudoexfoliation, ocular trauma, and ocular surgery. RESULTS Of 6310 subjects, 3052 (48.4%) were rural residents. The mean age was 52 (standard deviation: 9.5) years. The prevalence of IOP asymmetry increased steadily with increasing patient age. The prevalence of undiagnosed primary glaucoma was 3.4% (95% confidence interval, 2.9-3.8). Undiagnosed primary glaucoma was 3 times more common in subjects with IOP asymmetry than without (odds ratio 3.08, 95% confidence interval, 2.1-4.3). The specificity of IOP asymmetry in detecting undiagnosed primary glaucoma was 92%. CONCLUSIONS IOP asymmetry of >3 mm Hg has limited accuracy for the detection of undiagnosed primary glaucoma. The criterion should be combined with other indicators of glaucoma to build the pretest probability of the disease.
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Thapa SS, Rana PP, Twayana SN, Shrestha MK, Paudel I, Paudyal G, Gurung R, Ruit S, Hewitt AW, Craig JE, van Rens G. Rationale, methods and baseline demographics of the Bhaktapur Glaucoma Study. Clin Exp Ophthalmol 2010; 39:126-34. [DOI: 10.1111/j.1442-9071.2010.02429.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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George R, Arvind H, Baskaran M, Ramesh SV, Raju P, Vijaya L. The Chennai glaucoma study: prevalence and risk factors for glaucoma in cataract operated eyes in urban Chennai. Indian J Ophthalmol 2010; 58:243-5. [PMID: 20413933 PMCID: PMC2886261 DOI: 10.4103/0301-4738.62655] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We report the prevalence and risk factors for glaucoma among aphakes and pseudophakes in 3850 subjects who participated in a population-based study in urban south India. The subjects underwent an ophthalmic examination including applanation tonometry, gonioscopy, optic disc evaluation and frequency doubling perimetry. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Thirty eight, 15 aphakes and 23 pseudophakes (0.99% of 3850 subjects) of the 406 persons who had undergone cataract surgery were diagnosed with glaucoma. Aphakes/pseudophakes were at higher risk of glaucoma as compared to the phakic population (Odds Ratio: 2.71, 95% CI: 1. 94, 3.38, p=0.001). On multivariate analysis, older age and higher intra ocular pressure were risk factors for glaucoma. Blindness attributable to glaucoma was detected in 20% of aphakic and 4.3% of pseudophakic eyes. Glaucoma was a significant cause of morbidity in those who had undergone cataract surgery in this urban population.
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Affiliation(s)
- Ronnie George
- Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Vijaya L, George R, Rashima A, Raju P, Arvind H, Baskaran M, Ve RS. Outcomes of cataract surgery in a rural and urban south Indian population. Indian J Ophthalmol 2010; 58:223-8. [PMID: 20413926 PMCID: PMC2886254 DOI: 10.4103/0301-4738.62648] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: To assess the visual outcome after cataract surgery in a south Indian population. Materials and Methods: Population-based cross-sectional study of subjects aged 40 years or more. Three thousand nine hundred and twenty-four rural subjects from 27 contiguous villages and 3850 urban subjects from five randomly selected divisions were studied. All subjects underwent a comprehensive ophthalmic examination that included visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, and dilated retinal examination. Statistical Analysis: Chi square test, t test and multivariate analysis were used. Results: Five hundred and twenty-eight (216 males, 312 females, 781 eyes) rural subjects (13.5%, 95% confidence interval (CI) 12.4% to 14.6%) and 406 (197 males, 209 females, 604 eyes) urban subjects (10.5%, 95% CI 9.6-11.5%) had undergone cataract surgery. Outcome of cataract surgery was defined based on visual acuity. Using best-corrected visual acuity for classification, the single most important cause for visual impairment was cystoid macular edema in the aphakic group and posterior capsule opacification in the pseudophakic group. Aphakia (visual acuity of <20/60 to ≤20/400 - odds ratio (OR) 1.8; 95% CI 1.3 to 2.6%, visual acuity of <20/400 - OR 6.2; 95% 4.0 to 9.8%), rural residence (visual acuity of <20/60 to ≤20/400 - OR 3.2; 95% CI 2.2 to 4.5% and visual acuity of <20/400 - OR OR 3.5; 95% CI 2.3 to 5.5%) were associated with visual impairment. The urban cataract-operated population had significantly more pseudophakics (P < 0.001), men (P = 0.02) and literates (P < 0.001). In the rural group the prevalence of cataract surgery (13.5% vs. 10.5%, P < 0.001) and number of people that had undergone cataract surgery within three years prior to examination (P < 0.001) were significantly greater. In 30% of rural and 16% of urban subjects uncorrected refraction was the cause of visual impairment. Conclusions: Surgery-related complications were major causes for visual acuity of <20/60.
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Affiliation(s)
- Lingam Vijaya
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Vijaya L, George R, Arvind H, Ve Ramesh S, Baskaran M, Raju P, Asokan R, Velumuri L. Central corneal thickness in adult South Indians: the Chennai Glaucoma Study. Ophthalmology 2010; 117:700-4. [PMID: 20079536 DOI: 10.1016/j.ophtha.2009.09.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 08/27/2009] [Accepted: 09/16/2009] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To evaluate the characteristics of central corneal thickness (CCT) and its association with age, gender, and intraocular pressure in rural and urban South Indian populations. DESIGN Population-based cross-sectional study. PARTICIPANTS Seven thousand seven hundred seventy-four subjects (rural-to-urban ratio, 3924:3850) aged 40 years and older were examined at a dedicated facility in the base hospital. INTERVENTION All subjects underwent a complete ophthalmic examination that included CCT measurements with an ultrasonic pachymeter and applanation tonometry. MAIN OUTCOME MEASURES Central corneal thickness. RESULTS Of the 7774 subjects examined, 974 had undergone cataract surgery and were excluded. The remaining 6800 were bilaterally phakic, of which 46 were excluded (17 glaucoma subjects receiving treatment, 12 with corneal pathologic features and 17 with incomplete data) and 6754 subjects data were analyzed. The mean CCT for the population was 511.4+/-33.5 microm, and CCT in males (515.6+/-33.8 microm) was significantly (P = 0.0001) greater than females (508.0+/-32.8 microm). The CCT was significantly greater (by 18 microm) in the urban population and decreased with age in both genders (P<0.0001). The decrease per decade was 4.34 microm (95% confidence interval [CI], 3.24-5.44) in the rural population and 2.41 microm (95% CI, 1.25-3.53) in the urban population. A 100-microm increase in CCT was associated with a 1.96-mmHg increase in intraocular pressure in the rural population, versus 2.45 mmHg for every 100 microm in the urban population. CONCLUSIONS In this population-based study, females and subjects living in a rural area had thinner corneas. A negative association with age and a positive association with intraocular pressure were seen. These findings will have implications in the diagnosis and management of glaucoma in this population. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Lingam Vijaya
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India.
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Sathyamangalam RV, Paul PG, George R, Baskaran M, Hemamalini A, Madan RV, Augustian J, Prema R, Lingam V. Determinants of glaucoma awareness and knowledge in urban Chennai. Indian J Ophthalmol 2009; 57:355-60. [PMID: 19700873 PMCID: PMC2804123 DOI: 10.4103/0301-4738.55073] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: To assess the awareness and knowledge levels about glaucoma and its determinants in an urban population of Chennai in south India. Materials and Methods: Chennai glaucoma study (CGS) was a population based prevalence study to estimate the prevalence of glaucoma in a rural and urban south Indian population. A total of 3850 subjects aged 40 years or above participated in the urban arm of CGS. A systematic random sample of 1926 (50.0%) subjects completed a questionnaire that assesses their awareness and knowledge level of glaucoma. Respondents “having heard of glaucoma” even before they were contacted/recruited for the study were defined as “aware” and respondents having some understanding of the eye disease were defined as “knowledgeable”. Results: Overall 13.5% were aware of glaucoma, the age-gender adjusted rate for awareness was 13.3% (95% CI: 11.57 to 15.03). Two clinicians graded knowledge on glaucoma, based on the subject's knowledge of risk factors, definitions and treatment aspects of glaucoma. Overall 8.7% had some knowledge about glaucoma. Among those who had knowledge 0.5% had good knowledge about glaucoma, 4% had fair knowledge and 4.2% had poor knowledge. We observed a very good agreement between the clinicians in grading knowledge (k =0.92). Determinants of glaucoma awareness and knowledge were higher levels of education, females, age, religion and family history of glaucoma. Conclusion: Awareness and knowledge about glaucoma was very low among the urban population of Chennai. We have found that younger subjects and men were less aware of glaucoma. Subjects with lower levels of education were less aware and knew less about glaucoma than their counterparts. The study findings stress the need for health education for effective prevention of blindness due to glaucoma.
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Sen P, Bhargava A, George R, Ramesh SV, Hemamalini A, Prema R, Kumaramanickavel G, Vijaya L. Prevalence of Retinitis Pigmentosa in South Indian Population Aged Above 40 Years. Ophthalmic Epidemiol 2009; 15:279-81. [DOI: 10.1080/09286580802105814] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Prema R, George R, Sathyamangalam Ve R, Hemamalini A, Baskaran M, Kumaramanickavel G, Catherine M, Vijaya L. Comparison of refractive errors and factors associated with spectacle use in a rural and urban South Indian population. Indian J Ophthalmol 2009; 56:139-44. [PMID: 18292625 PMCID: PMC2636078 DOI: 10.4103/0301-4738.39119] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To compare the prevalence of refractive errors and factors associated with spectacle use in a rural and urban south Indian population. MATERIALS AND METHODS Four thousand eight hundred subjects (age> 39 years) each from rural and urban Tamil Nadu were enumerated for a population-based study. All participants underwent a complete ophthalmic evaluation including best-corrected visual acuity (BCVA), objective and subjective refraction. Out of 3924 rural responders 63.91% and out of 3850 urban responders 81.64% were phakic in the right eye with BCVA of 20/40 or better and were included in the study. Association of spectacle use and refractive errors with different parameters were analysed using logistic regression. STATISTICAL ANALYSIS Chi square, t test, Chi square for trend and Pearson's correlation coefficient were used for analysis. RESULTS Spectacle use was significantly higher and positively associated with literacy and employment in the urban population. The age and gender-adjusted prevalence of emmetropia, myopia of spherical equivalent (SE) < or =-0.50 diopter sphere (DS), high myopia (SE < or =-5.00DS), hyperopia (SE> 0.50DS) and astigmatism < or = 0.50 diopter cylinder (DC) were 46.8%, 31.0%, 4.3%, 17.9% and 60.4% respectively in the rural population and 29.0%, 17.6%, 1.5%, 51.9%, 59.1% respectively in the urban population. The prevalence of emmetropia decreased with age ( p p = 0.001) and were associated with nuclear sclerosis ( p = 0.001) in both populations. Hyperopia was commoner among women than men ( p = 0.001); was positively associated with diabetes mellitus ( p = 0.008) in the rural population and negatively with nuclear sclerosis ( p = 0.001) in both populations. CONCLUSION Spectacle use was found to be significantly lower in the rural population. The pattern of refractive errors was significantly different between both populations.
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Affiliation(s)
- Raju Prema
- Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Vijaya L, George R, Arvind H, Baskaran M, Ve Ramesh S, Raju P, Kumaramanickavel G, McCarty C. Prevalence of Primary Angle-Closure Disease in an Urban South Indian Population and Comparison with a Rural Population. Ophthalmology 2008; 115:655-660.e1. [PMID: 17869343 DOI: 10.1016/j.ophtha.2007.05.034] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 05/18/2007] [Accepted: 05/18/2007] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To determine the prevalence of primary angle-closure glaucoma (PACG), primary angle closure (PAC), and PAC suspect (PACS) in an urban population, and to compare prevalence and associated risk factors with a rural population. DESIGN Population-based cross-sectional study. PARTICIPANTS Four thousand eight hundred subjects 40 years or older were selected from Chennai city using multistage random cluster sampling. INTERVENTION All subjects had a complete ophthalmic examination that included logarithm of the minimum angle of resolution visual acuity, applanation tonometry, gonioscopy, grading of lens opacities, dilated fundus examination, optic disc photography, and visual fields. MAIN OUTCOME MEASURES Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology classification. RESULTS Three thousand eight hundred fifty (80.2%) responded; 34 subjects (17 female, 17 male) had PACG (0.88%; 95% confidence interval [CI], 0.60-1.16). The mean intraocular pressure (IOP) was 26.0+/-14.9 mmHg. Five subjects (14.7%) had been previously diagnosed to have glaucoma, 1 of whom had undergone glaucoma surgery and 2 of whom had been diagnosed to have open-angle glaucoma. Two subjects (5.9%) were bilaterally and 3 subjects (8.8%) were unilaterally blind. One hundred six subjects (2.75%; 95% CI, 2.01-3.49) were diagnosed to have PAC (62 female, 44 male). Thirty-nine subjects (36.8%) had presenting IOP > 24 mmHg, 83 (78.3%) had peripheral anterior synechiae, and 16 (15.1%) had both. Two hundred seventy-eight subjects (7.24%; 95% CI, 6.38-8.02) had PACS (183 female, 95 male). Prevalences of PACG and PACS were similar in the urban and rural populations. Primary angle closure prevalence was higher in the urban population (P<0.0001). Primary angle closure and PACG were positively associated with increasing age and IOP in both populations and were more common in rural women (odds ratio [OR], 4.3; 95% CI, 2.2-8.3). Association with hyperopia was seen only in the urban population (OR, 2.0; 95% CI, 1.4-2.8). CONCLUSIONS Prevalences of PACG and PACS were similar in the rural and urban populations; PAC was more common in the urban population. In both groups, the disease was asymptomatic. Poor detection rates were probably due to lack of gonioscopy as a routine part of an eye examination.
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Affiliation(s)
- Lingam Vijaya
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India.
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Sen P, Bhargava A, Vijaya L, George R. Prevalence of idiopathic macular hole in adult rural and urban south Indian population. Clin Exp Ophthalmol 2008; 36:257-60. [PMID: 18412595 DOI: 10.1111/j.1442-9071.2008.01715.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Parveen Sen
- Bhagwan Mahavir Vitreo-Retinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Vijaya L, George R, Baskaran M, Arvind H, Raju P, Ramesh SV, Kumaramanickavel G, McCarty C. Prevalence of Primary Open-angle Glaucoma in an Urban South Indian Population and Comparison with a Rural Population. Ophthalmology 2008; 115:648-654.e1. [PMID: 17664010 DOI: 10.1016/j.ophtha.2007.04.062] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2006] [Revised: 04/08/2007] [Accepted: 04/17/2007] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and risk factors of primary open-angle glaucoma (POAG) in an urban population and compare the same with that of our published rural population data in southern India. DESIGN Population-based cross-sectional study. PARTICIPANTS Four thousand eight hundred subjects 40 years or older were selected using a multistage random cluster sampling procedure in Chennai city. INTERVENTION Three thousand eight hundred fifty (80.2%) subjects underwent a complete ophthalmic examination, including applanation tonometry, gonioscopy, pachymetry, optic disc photography, and automated perimetry. MAIN OUTCOME MEASURES Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology Classification. RESULTS The distribution of intraocular pressure (IOP) and vertical cup-to-disc ratio (VCDR) was obtained from the right eye of the 2532 subjects with normal suprathreshold visual fields. Mean IOP was 16.17+/-3.74 mmHg (97.5th and 99.5th percentiles, 24 mmHg and 30 mmHg). The mean VCDR was 0.43+/-0.17 (97.5th and 99.5th percentiles, 0.7 and 0.8). One hundred thirty-five (64 men, 71 women) subjects had POAG (3.51%; 95% confidence interval [CI], 3.04-4.0). Primary open-angle glaucoma subjects (58.4+/-11.3 years) were older (P<0.0001) than the study population (54.8+/-10.6 years). One hundred twenty-seven (94%) subjects were diagnosed to have POAG for the first time. Two subjects (1.5%) were bilaterally blind, and 3 (3.3%) were unilaterally blind due to POAG. The urban population prevalence was more than that of the rural population (1.62%; 95% CI, 1.4%-1.8%; P<0.0001). In both populations, increasing IOP (per millimeter of mercury) and older age were associated with the disease. There was no association with gender, myopia, systemic hypertension, diabetes, or central corneal thickness. CONCLUSIONS The prevalence of POAG in a > or =40-year-old south Indian urban population was 3.51%, higher than that of the rural population. The prevalence increased with age, and >90% were not aware of the disease.
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Affiliation(s)
- Lingam Vijaya
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, Chennai, India.
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Arvind H, George R, Raju P, Ramesh SV, Mani B, Kannan P, Vijaya L. Agreement between clinical estimates and planimetric measures of vertical cup:disc ratio. Clin Exp Ophthalmol 2008; 35:881-2. [PMID: 18173427 DOI: 10.1111/j.1442-9071.2007.01642.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sripriya S, George R, Arvind H, Baskaran M, Raju P, Ramesh SV, Karthiyayini T, Vijaya L, Kumaramanickavel G. Transforming growth factor beta-1 -509C>T polymorphism in Indian patients with primary open angle glaucoma. Mol Diagn Ther 2007; 11:151-4. [PMID: 17570736 DOI: 10.1007/bf03256236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Extracellular matrix (ECM) accumulation in the trabecular meshwork tissues of glaucoma patients has been demonstrated as one of the factors that contribute to glaucoma pathology. Transforming growth factor-beta (TGFbeta) has its fundamental function in regulating the ECM molecules and has been implicated in glaucoma pathology. In this study, the association of the TGFB1-509C>T single nucleotide polymorphism (SNP) with primary open angle glaucoma (POAG) in patients from India is analyzed. METHODS One-hundred and six POAG patients and 104 controls were selected after comprehensive ophthalmic examinations. TGFB1 alleles were typed by restriction enzyme digestion with the isoschizomer Eco81I of Bsu36I, whose site is altered by the -509C>T SNP, and statistically analyzed for any significant association. Two clinical variables, vertical cup disc ratio (CDR) and intraocular pressure (IOP), were compared at diagnosis by the Mann-Whitney test for any significant association with the polymorphism. RESULTS Statistical analysis between the two groups did not suggest any significant difference in the distribution of allele and genotype frequencies. The Mann-Whitney test did not show any significant p value for the clinical parameters IOP (p = 0.29 and 0.59) and CDR (p = 0.26 and 0.17). CONCLUSIONS The current study shows that the TGFB1-509C>T polymorphism might not be associated with POAG. Analysis of the other polymorphisms in the regulatory region of the TGFB1 gene could give a better understanding of the role of TGFbeta in POAG pathogenesis.
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Affiliation(s)
- Sarangapani Sripriya
- SNONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Ramesh SV, George R, Soni PM, Palaniappan L, Raju P, Paul PG, Ramsathish S, Vijaya L. Population norms for frequency doubling perimetry with uncorrected refractive error. Optom Vis Sci 2007; 84:496-504. [PMID: 17568319 DOI: 10.1097/opx.0b013e31806db55e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To compare the effect of uncorrected refractive error on threshold estimation using frequency doubling perimetry (FDP) full-threshold N-30 with emmetropia among normal subjects. METHODS One thousand two hundred ninety-nine subjects were enrolled from the Chennai Glaucoma Study, a population-based glaucoma prevalence study. Subjects underwent a comprehensive eye examination including the FDP full-threshold N-30 test. Normal subjects (with spherical equivalent refractive errors within +/-7 D) with no other ocular pathology were stratified into six groups based on the degree of myopia and hyperopia and compared with age-matched emmetropic controls. A subset of 22 subjects with higher refractive errors was assessed for within-subject effect on FDP parameters. The following FDP parameters were compared: mean deviation, pattern standard deviation, central threshold (CT), mean sensitivity (MS), paracentral points (PA), and peripheral threshold. RESULTS The one-way analysis of variance between all refractive error groups and emmetropes showed no statistically significant difference for the mean deviation (p = 0.1002) and pattern standard deviation (p = 0.4789). FDP parameters did not show a statistically significant difference for between and within-group comparisons. The variability of FDP sensitivity (derived from the 95% confidence interval range) as a proportion of the threshold range of the instrument was 31, 41, 46, and 41% for CT, MS, PA, and peripheral sensitivity, respectively, without spectacle correction and 29, 34, 36, and 35% for CT, MS, PA, and peripheral sensitivity, respectively, with correction. The mean CT, PA, and peripheral sensitivity show a decreasing trend from central to periphery in all the refractive error groups and a similar trend was noted in the emmetropic controls. CONCLUSION Between-subject (uncorrected ammetropes and age-matched emmetropes) and within-subject comparisons showed no statistically significant differences in any of the FDP parameters or in the contrast sensitivity estimates between the central and peripheral test locations. This finding is likely due to the high within-subject variability of FDP.
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Affiliation(s)
- Sathyamangalam Ve Ramesh
- Glaucoma Project, Vision Research Foundation, Sankara Nethralaya, 18 College Road, Chennai 600006, India
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Raju P, George R, Ve Ramesh S, Arvind H, Baskaran M, Vijaya L. Influence of tobacco use on cataract development. Br J Ophthalmol 2006; 90:1374-7. [PMID: 16837540 PMCID: PMC1857475 DOI: 10.1136/bjo.2006.097295] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To study the influence of tobacco use on cataract formation in a rural South Indian population. METHODS 3924 subjects from the Chennai Glaucoma Study conducted in rural south India underwent a comprehensive eye examination, including Lens Opacities Classification System II grading. Information on tobacco use, type of tobacco (smoking and smokeless), duration and quantity of use was collected. RESULTS 1705 (male:female (M:F) 1106:599) people used tobacco and were significantly older (mean (standard deviation (SD)) age 55.80 (10.64) years) than non-users (52.23 (10.51); p<0.001). 731 (M:F 730:1) people smoked, 900 (M:F 302:598) used smokeless tobacco, and 74 (M:F, 74:0) used tobacco in both forms. The unadjusted and adjusted (age and sex) odds ratio (OR) for a positive history of tobacco use and cataract was 1.72 (95% confidence interval (CI) 1.51 to 1.96) and 1.39 (95% CI 1.15 to 1.68), respectively. The unadjusted OR for smokers and smokeless tobacco users was 1.04 (95% CI 0.88 to 1.23) and 2.74 (95% CI 2.31 to 3.26), respectively. The adjusted OR was 1.19 (95% CI 0.89 to 1.59) and 1.54 (95% CI 1.22 to 1.95), respectively. No significant association was noted between smoking and any particular type of cataract. Smokeless tobacco use was found to be significantly associated with nuclear cataract even after adjusting for age and sex (OR 1.67, p = 0.067, 95% CI 1.16 to 2.39). CONCLUSION Tobacco use was significantly associated with cataract. Smoking was not found to be significantly associated with cataract formation; however, smokeless tobacco use was more strongly associated with cataract.
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Affiliation(s)
- P Raju
- Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, India 600006
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Vijaya L, George R, Arvind H, Baskaran M, Raju P, Ramesh SV, Paul PG, Kumaramanickavel G, McCarty C. Prevalence and causes of blindness in the rural population of the Chennai Glaucoma Study. Br J Ophthalmol 2006; 90:407-10. [PMID: 16547314 PMCID: PMC1857022 DOI: 10.1136/bjo.2005.081406] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2005] [Indexed: 10/24/2022]
Abstract
AIM To study the prevalence and causes of blindness in a rural south Indian population. METHODS 3924/4800 enumerated (81.75%) subjects, aged 40 years or more from rural Tamil Nadu, underwent comprehensive ophthalmic examination-visual acuity, refraction, intraocular pressure, gonioscopy, cataract grading (LOCS II), retinal examination, and SITA Standard where indicated. Blindness was defined using WHO criteria as best corrected visual acuity of less than 3/60 and/or visual field of less than 10 degrees in the better eye. The influence of age, sex, literacy, and occupation was assessed using multiple logistic regression. RESULTS 753 subjects (19.2%; 321 males, 432 females) presented with a visual acuity of <3/60; 132 subjects (3.36%, 95% CI: 2.80 to 3.93) were diagnosed to be blind. Cataract was responsible in 74.62% of eyes; glaucoma, cystoid macular oedema, optic atrophy, and corneal scars accounted for 3.79% each. Bilateral causes of blindness were cataract (78.63%), glaucoma (4.29%), optic atrophy (3.42%), cystoid macular oedema, and corneal scars (2.56% each). In 19 eyes (7.2%) the blindness was probably related to cataract surgery. Blindness was positively associated with increasing age (p<0.0001). CONCLUSION 3.36% of the studied rural population was bilaterally blind, with cataract being the single most important cause.
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Affiliation(s)
- L Vijaya
- Vision Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, India 600 006.
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Paul PP, George RJ, Arvind H, Raj M, Ramesh SV, Sriram P, Kumaramanickavel G, McCarthy C, Vijaya L. A comparison of participants and non-participants in the Chennai Glaucoma Study-rural population. Ophthalmic Epidemiol 2005; 12:125-35. [PMID: 16028345 DOI: 10.1080/09286580590932798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To study whether the difference in the demographic characteristics of participants and non participants could result in biased prevalence estimates and associations. AIM To compare the non-participant and participant characteristics, and to ascertain if non-response bias is present in the rural population of the Chennai Glaucoma Study (CGS). METHODS Rural participants and non-participants were compared with regard to socio-demographic variables (age, gender, religion, mother tongue, literacy and employment). RESULTS 4800 subjects aged 40 years or over were enumerated, 82% (3934: 45% male and 55% female) responded. Gender did not influence participation (adjusted OR-1.11, CI: .91-1.36). Subjects in the 70-79 year age group were more likely to respond (OR-1.76; CI-1.31-2.38). Hindus had a higher participation rate than Christians or Muslims (adjusted OR-2.63, CI: 1.80-3.84). The other predictors of participation were illiteracy (adjusted OR-1.44, CI: 1.22-1.70), unemployment (OR-1.28, CI: 1.04-1.58), place of residence (main villages) (OR-6.66, 95% CI: 4.6-9.64). CONCLUSION Based on our study findings, it does not seem likely that participation bias will affect the study results.
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Affiliation(s)
- Pradeep P Paul
- Glaucoma Projectm, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Arvind H, George R, Raju P, Ramesh SV, Baskaran M, Paul PG, McCarty C, Vijaya L. Glaucoma in aphakia and pseudophakia in the Chennai Glaucoma Study. Br J Ophthalmol 2005; 89:699-703. [PMID: 15923505 PMCID: PMC1772656 DOI: 10.1136/bjo.2004.056234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To determine the prevalence of glaucoma among aphakes and pseudophakes in a rural population of southern India. METHODS 3924 subjects aged 40 years or above underwent complete ophthalmic examination. Glaucoma in aphakia/pseudophakia was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria in aphakic/pseudophakic people. RESULTS 54 subjects (37 aphakes, 17 pseudophakes) (1.38% of 3924 subjects, 11.2% of 482 aphakes/pseudophakes) had glaucoma in aphakia/pseudophakia. Aphakia, age, intraocular pressure (IOP), pseudoexfoliation, and peripheral anterior synechiae greater than or equal to 180 degrees of the angle were risk factors for glaucoma on univariate analysis. On multivariate analysis, IOP and aphakia were independent risk factors for glaucoma. 39 people (72.22%) with glaucoma had normal IOP at presentation. None of the people with glaucoma were aware of the disease. Blindness in one or both eyes was seen in 12 subjects (10 unilateral and two bilateral)-that is, 22.22% of people with glaucoma in aphakia/pseudophakia. CONCLUSIONS Glaucoma is an important cause of ocular morbidity among aphakes and pseudophakes in this rural population of south India. This glaucoma, responsible for unilateral or bilateral blindness in 22.2% of those affected, was entirely undetected in this study population.
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Affiliation(s)
- H Arvind
- Medical Research Foundation, Vision Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, India-600 006
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