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van der Heide FCT, Khawaja A, Berendschot TTJM, Littlejohns TJ, Kuźma E, Luben R, Patel PJ, Foster PJ, Bertelsen G, von Hanno T, Johnsen B, Schirmer H, Rebouças SCL, Grasset L, Delcourt C, Helmer C, Stehouwer CDA. Associations of inner retinal layers with risk of incident dementia: An individual participant data analysis of four prospective cohort studies. Alzheimers Dement 2024; 20:211-220. [PMID: 37551793 PMCID: PMC10914314 DOI: 10.1002/alz.13167] [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: 02/27/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Our main objective was to investigate whether retinal neurodegeneration, estimated from lower thickness of inner retinal layers, was associated with incident all-cause dementia and Alzheimer's disease (AD). METHODS We performed an individual participant data meta-analysis using unpublished data from four prospective cohort studies with a total of 69,955 participants (n = 1087 cases of incident all-cause dementia; n = 520 cases incident AD; follow-up time median [interquartile range] 11.3 [8.8-11.5] years). RESULTS General baseline characteristics of the study population were mean (standard deviation) age, 58.1 (8.8) years; 47% women. After adjustment, lower baseline macular retinal nerve fiber layer thickness was significantly associated with a 10% and 11% higher incidence of all-cause dementia and AD, respectively. Lower baseline macular ganglion cell-inner plexiform layer thickness was not significantly associated with these outcomes. DISCUSSION These findings suggest that retinal neurodegeneration precedes the onset of clinical dementia. Retinal imaging tools may be informative biomarkers for the study of the early pathophysiology of dementia.
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Affiliation(s)
- Frank C. T. van der Heide
- CARIM School for Cardiovascular DiseasesMaastricht University (UM), 6229 ERMaastrichtthe Netherlands
- Department of Internal MedicineMaastricht University Medical Center+ (MUMC+)Maastrichtthe Netherlands
- University Eye Clinic Maastricht, MUMC+Maastrichtthe Netherlands
- Université de ParisInserm U1153Epidemiology of Ageing and Neurodegenerative DiseasesParisFrance
| | - Anthony Khawaja
- NIHR Biomedical Research CentreMoorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
| | | | | | - Elżbieta Kuźma
- Albertinen‐Haus Centre for Geriatrics and GerontologyUniversity of HamburgHamburgGermany
| | - Robert Luben
- NIHR Biomedical Research CentreMoorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
- MRC Epidemiology UnitCambridgeUK
| | - Praveen J. Patel
- NIHR Biomedical Research CentreMoorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
| | - Paul J. Foster
- NIHR Biomedical Research CentreMoorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
| | - The Maastricht Study Consortium
- CARIM School for Cardiovascular DiseasesMaastricht University (UM), 6229 ERMaastrichtthe Netherlands
- Department of Internal MedicineMaastricht University Medical Center+ (MUMC+)Maastrichtthe Netherlands
- University Eye Clinic Maastricht, MUMC+Maastrichtthe Netherlands
- CAPHRI Care and Public Health Research InstituteFaculty of HealthMedicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of EpidemiologyMaastricht UniversityMaastrichtthe Netherlands
- Department of Psychiatry and Neuropsychology and MHeNs School for Mental Health and NeuroscienceFaculty of HealthMedicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Heart and Vascular CentreMaastricht University Medical Centre +Maastrichtthe Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI)Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Geir Bertelsen
- Department of OphthalmologyUniversity Hospital of North NorwayTromsøNorway
- Department of Community MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Therese von Hanno
- Department of OphthalmologyNordland Hospital TrustBodøNorway
- Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Bente Johnsen
- Department of Community MedicineUiT The Arctic University of NorwayTromsøNorway
- Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Department of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Henrik Schirmer
- Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Institute of Clinical MedicineUniversity of OsloLørenskogNorway
- Department of CardiologyAkershus University HospitalLørenskogNorway
| | - Sara C. L. Rebouças
- University of BordeauxInserm, Bordeaux Population Health Research Center, UMR U1219BordeauxFrance
| | - Leslie Grasset
- University of BordeauxInserm, Bordeaux Population Health Research Center, UMR U1219BordeauxFrance
| | - Cécile Delcourt
- University of BordeauxInserm, Bordeaux Population Health Research Center, UMR U1219BordeauxFrance
| | - Catherine Helmer
- University of BordeauxInserm, Bordeaux Population Health Research Center, UMR U1219BordeauxFrance
| | | | | | - Coen D. A. Stehouwer
- CARIM School for Cardiovascular DiseasesMaastricht University (UM), 6229 ERMaastrichtthe Netherlands
- Department of Internal MedicineMaastricht University Medical Center+ (MUMC+)Maastrichtthe Netherlands
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Medin H, Dalby M, Kure ISH, Karabeg M, Drolsum L, Kristianslund O. Intraocular Inflammation in Eyes Operated for Late In-the-bag intraOcular lens dislocatioN (LION): A Randomized Clinical Trial. Am J Ophthalmol 2022; 238:66-74. [PMID: 34995522 DOI: 10.1016/j.ajo.2021.12.019] [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: 11/01/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the intraocular inflammation after 2 surgical approaches for late in-the-bag intraocular lens (IOL) dislocation. DESIGN Prospective, randomized, parallel-group clinical trial. METHODS We randomly assigned 100 patients (100 eyes) referred to Oslo University Hospital (tertiary referral center) with late in-the-bag IOL dislocation into IOL repositioning by scleral suturing (n=49) or IOL exchange with retropupillary fixation of an iris-claw lens (n=51). Patients were examined before surgery and 2 weeks, 6 weeks, and 6 months after surgery. The main outcome measure was anterior chamber laser flare, measured with a laser flare meter as photon counts per millisecond (pc/ms). RESULTS Two weeks following surgery, median flare values were 28.9 pc/ms (range, 7.9-140) in the repositioning group and 31.6 pc/ms (range, 9.8-92.3) in the exchange group (P = .83). Flare levels were still elevated after 6 weeks with no difference between the groups (P = .93), whereas it decreased to baseline levels after 6 months. Six weeks following surgery, the central retinal thickness was similar (P = .97); cystoid macular edema (CME) was found in 4 and 5 patients, respectively (P = .85); and the mean best corrected visual acuity was 0.17 (95% CI 0.09, 0.25) and 0.21 (95% CI 0.09, 0.32) logarithm of the minimum angle of resolution, respectively (P = .61). CONCLUSIONS This study revealed similar levels of intraocular inflammation following IOL repositioning and IOL exchange. There was no significant difference regarding risk of CME and visual outcome. The prolonged elevation in postoperative flare indicates a possible requirement for an extended anti-inflammatory treatment period after these operations.
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Affiliation(s)
- Helle Medin
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway.
| | - Marius Dalby
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.)
| | | | - Mia Karabeg
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway
| | - Liv Drolsum
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway
| | - Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway
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Kristianslund O, Dalby M, Drolsum L. Late in-the-bag intraocular lens dislocation. J Cataract Refract Surg 2021; 47:942-954. [PMID: 33750091 DOI: 10.1097/j.jcrs.0000000000000605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Abstract
This review aimed to evaluate the cumulative incidence, patient characteristics, predisposing conditions, and treatment outcomes for late in-the-bag intraocular lens (IOL) dislocation. Literature searches in PubMed (MEDLINE), Embase, and Cochrane Library Central database identified 1 randomized clinical trial, 1 prospective case series, 2 prospective cohort studies, and 36 retrospective studies of this condition, which showed that the cumulative incidence was 0.5% to 3%, it occurred on average 6 to 12 years after cataract surgery, and mean patient age was 65 to 85 years. Pseudoexfoliation syndrome, myopia, and previous vitreoretinal surgery were the most common predisposing conditions. Studies indicated that IOL repositioning and IOL exchange provided similar visual outcomes and were equally safe. The long-term visual outcome seemed satisfactory. However, the quality of evidence regarding treatment was in general quite low. More studies of late in-the-bag IOL dislocation are needed, and in particular, different surgical techniques should be included in high-quality clinical trials.
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Affiliation(s)
- Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital, Oslo Norway (Kristianslund, Dalby, Drolsum); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Kristianslund, Dalby, Drolsum)
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Chen W, Fu J, Meng Z, Li L, Su H, Dai W, Yao Y. Lhasa childhood eye study: the rationale, methodology, and baseline data of a 5 year follow-up of school-based cohort study in the Tibetan plateau region of Southwest China. BMC Ophthalmol 2020; 20:250. [PMID: 32571250 PMCID: PMC7310065 DOI: 10.1186/s12886-020-01522-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022] Open
Abstract
Background Tibetan Plateau is a highland area with special geographical location, time zone, and ethnic composition. We herein report the rationale, methodology and baseline data of the school-based childhood cohort study named Lhasa Childhood Eye Study (LCES), with the primary objective to pursue a comprehensive understanding on the longitudinal trends of refractive error as well as other ocular diseases and to address the differences between Tibetan Plateau and other parts of the world. Methods Grade one students from primary schools in Lhasa were cluster randomly selected. They were examined and would be conducted with follow-up annually for 5 years. The examination procedures for LCES consisted of standardized ocular, systematic examinations, and questionnaires, identical to the Anyang Childhood Eye Study (ACES) conducted in central China. Results One thousand nine hundred two Grade one students eligible for the LCES, 1856 (97.58%) participated in the study, with a mean age of 6.83 ± 0.46 years (range 5.89–10.32 years), and the proportions of male to be 53.02%. 1762 (94.93%) of the 1856 participants in the baseline exam were Tibetans. 1837 (98.98%) of the students examined had cycloplegic autorefraction performed. The numbers of hyperopia, emmetropia, myopia, and high myopia were 127 (6.91%), 1639 (89.22%), 71 (3.86%) and 3 (0.16%) respectively. Compared with ACES, students from LCES baseline had a younger age (p < 0.001), lower cycloplegic spherical equivalent (p < 0.001), similar myopia prevalence (p = 0.886), lower hyperopia prevalence (p < 0.001), and a higher emmetropia prevalence (p < 0.001). Conclusions LCES was a school-based cohort study in Tibetan Plateau with a high baseline response rate. A higher emmetropic trend was found in LCES compared with ACES. Continuous documentation of this cohort might potentially provide useful reference information for the areas of China which was previously not well studied. Trial registration The study has finished the clinical registration on Chinese Clinical Trial Registry. (ChiCTR1900026693).
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Affiliation(s)
- Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China.
| | - Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Han Su
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Wei Dai
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Yao Yao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
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Effect of age and refractive error on quick contrast sensitivity function in Chinese adults: a pilot study. Eye (Lond) 2020; 35:966-972. [PMID: 32518399 DOI: 10.1038/s41433-020-1009-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the potential effect of age and refractive error on visual acuity (VA) performance and quick contrast sensitivity function (qCSF) in normal Chinese adults. METHOD Ninety-two subjects with normal best corrected distance VA (BCDVA) were enrolled in this pilot study. Measurements included BCDVA, best corrected near VA (BCNVA), unaided VA (UNVA), habitual spectacle-corrected near VA (SCNVA) and qCSF. For analyses, subjects were categorized into three age groups (20~40 years, 41~60 year and >60 years) and four refractive groups (hyperopia, emmetropia, myopia and high myopia). Relationships between age, refractive error, types of VA and qCSF were tested using simple and multiple linear regressions analyses. RESULT Mean age and refractive error of the study participants were 44.04 ± 12.68 years and -1.86 ± 2.91D, respectively. Among the stratified age groups, a hyperopic shift of refraction (-3.24 ± 2.88D vs. -1.24 ± 2.64D vs. 0.39 ± 1.42D, respectively; P < 0.001) and a reduction in BCNVA (P = 0.014), SCNVA (P < 0.001) and cut-off spatial frequency (SF) (P = 0.032) were found with increasing age. Among the four refractive groups, the SCNVA and cut-off SF of hyperopia were worse compared to the other refractive statuses (all P < 0.05). Age was significantly associated with cut-off SF (standardized β = -0.29, P = 0.005) after adjustment for SER, gender and all types of VA. CONCLUSION For normal Chinese adults with normal BCDVA, age was the main factor associated with CSF, which may be independent of refractive error.
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Dalby M, Kristianslund O, Drolsum L. Long-Term Outcomes after Surgery for Late In-The-Bag Intraocular Lens Dislocation: A Randomized Clinical Trial. Am J Ophthalmol 2019; 207:184-194. [PMID: 31194950 DOI: 10.1016/j.ajo.2019.05.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the long-term efficacy and safety of 2 operation methods for late in-the-bag intraocular lens (IOL) dislocation. DESIGN Prospective, randomized, parallel group surgical clinical trial. METHODS During a 3-year period, 104 patients (104 eyes) were assigned one group for IOL repositioning by scleral suturing (n = 54) or one group for IOL exchange by retropupillary fixation of an iris claw IOL (n = 50). A single surgeon performed all operations using an anterior approach. Patients were examined before surgery and at 6 months and 1 and 2 years after surgery. The present study included the 66 patients (63%) who completed the 2-year follow-up, and the main outcaome measurement was corrected distance visual acuity (CDVA) 2 years after surgery. RESULTS After 2 years, the mean CDVA was 0.20 ± 0.29 logarithm of the minimum angle of resolution (logMAR) units (range, -0.18 to 1.10) in the repositioning group and 0.22 ± 0.30 logMAR (range, -0.10 to 1.22) in the exchange group (P = .69). A CDVA of 20/40 or better was achieved by 76% of all patients. Four eyes (12%) had cystoid macular edema in the repositioning group compared with 5 eyes (15%) in the exchange group. Two eyes underwent redislocation (1 in each group). There were no cases of endophthalmitis or retinal detachment. CONCLUSIONS There were no significant differences between the visual acuity using IOL repositioning and that using IOL exchange 2 years after surgery. The two methods were equally efficient and safe from a long-term perspective and are both considered acceptable treatments.
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Stoor K, Karvonen E, Liinamaa J, Saarela V. Evaluating refraction and visual acuity with the Nidek autorefractometer AR-360A in a randomized population-based screening study. Acta Ophthalmol 2018; 96:384-389. [PMID: 29193822 DOI: 10.1111/aos.13636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/01/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The evaluation of visual acuity (VA) and refraction in the Northern Finland Birth Cohort Eye study was performed using the Nidek AR-360A autorefractometer. The accuracy of the method for this population-based screening study was assessed. METHODS Measurements of the refractive error were obtained from the right eyes of 1238 subjects (mean age 47), first objectively with the AR-360A and then subjectively by an optometrist. Agreement with the subjective refraction was calculated for sphere, cylinder, mean spherical equivalent (MSE), cylindrical vectors J45 and J0 and presbyopic correction (add). Visual acuity (VA) was measured using an ETDRS chart and the autorefractometer. RESULTS The refractive error measured with the AR-360A was higher than the subjective refraction performed by the optometrist for sphere (0.007 D ± 0.24 D p = 0.30) and also for cylinder (-0.16 D ± 0.20 D p < 0.0005). The bias between the measurements of MSE, J45 and J0 was low: -0.07 D ± 0.22 D (p = 0.002), 0.01 D ± 0.43 D (p = 0.25) and -0.01 D ± 0.42 D (p = 0.43), respectively. The amount of add measured by the autorefractometer was higher than the subjective 0.35 D ± 0.29 D (p < 0.0005). There was a statistically significant correlation between VA (p < 0.0005) and the difference between the subjective and objective refraction. In 99.2% of the measurements, visual values were within one decimal line of each other. CONCLUSION The Nidek AR-360A autorefractometer is an accurate tool for determining the refraction and VA in a clinical screening trial.
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Affiliation(s)
- Katri Stoor
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Elina Karvonen
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Johanna Liinamaa
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Ville Saarela
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
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Delcourt C, Le Goff M, von Hanno T, Mirshahi A, Khawaja AP, Verhoeven VJM, Hogg RE, Anastosopoulos E, Cachulo ML, Höhn R, Wolfram C, Bron A, Miotto S, Carrière I, Colijn JM, Buitendijk GHS, Evans J, Nitsch D, Founti P, Yip JLY, Pfeiffer N, Creuzot-Garcher C, Silva R, Piermarocchi S, Topouzis F, Bertelsen G, Foster PJ, Fletcher A, Klaver CCW, Korobelnik JF. The Decreasing Prevalence of Nonrefractive Visual Impairment in Older Europeans: A Meta-analysis of Published and Unpublished Data. Ophthalmology 2018; 125:1149-1159. [PMID: 29548645 DOI: 10.1016/j.ophtha.2018.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/20/2017] [Accepted: 02/05/2018] [Indexed: 01/02/2023] Open
Abstract
TOPIC To estimate the prevalence of nonrefractive visual impairment and blindness in European persons 55 years of age and older. CLINICAL RELEVANCE Few visual impairment and blindness prevalence estimates are available for the European population. In addition, many of the data collected in European population-based studies currently are unpublished and have not been included in previous estimates. METHODS Fourteen European population-based studies participating in the European Eye Epidemiology Consortium (n = 70 723) were included. Each study provided nonrefractive visual impairment and blindness prevalence estimates stratified by age (10-year strata) and gender. Nonrefractive visual impairment and blindness were defined as best-corrected visual acuity worse than 20/60 and 20/400 in the better eye, respectively. Using random effects meta-analysis, prevalence rates were estimated according to age, gender, geographical area, and period (1991-2006 and 2007-2012). Because no data were available for Central and Eastern Europe, population projections for numbers of affected people were estimated using Eurostat population estimates for European high-income countries in 2000 and 2010. RESULTS The age-standardized prevalence of nonrefractive visual impairment in people 55 years of age or older decreased from 2.22% (95% confidence interval [CI], 1.34-3.10) from 1991 through 2006 to 0.92% (95% CI, 0.42-1.42) from 2007 through 2012. It strongly increased with age in both periods (up to 15.69% and 4.39% in participants 85 years of age or older from 1991 through 2006 and from 2007 through 2012, respectively). Age-standardized prevalence of visual impairment tended to be higher in women than men from 1991 through 2006 (2.67% vs. 1.88%), but not from 2007 through 2012 (0.87% vs. 0.88%). No differences were observed between northern, western, and southern regions of Europe. The projected numbers of affected older inhabitants in European high-income countries decreased from 2.5 million affected individuals in 2000 to 1.2 million in 2010. Of those, 584 000 were blind in 2000, in comparison with 170 000 who were blind in 2010. CONCLUSIONS Despite the increase in the European older population, our study indicated that the number of visually impaired people has decreased in European high-income countries in the last 20 years. This may be the result of major improvements in eye care and prevention, the decreasing prevalence of eye diseases, or both.
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Affiliation(s)
- Cécile Delcourt
- Bordeaux Population Health Research Center, Team LEHA, Unité Mixte de Recherche (UMR) 1219, INSERM, Université de Bordeaux, Bordeaux, France.
| | - Mélanie Le Goff
- Bordeaux Population Health Research Center, Team LEHA, Unité Mixte de Recherche (UMR) 1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Therese von Hanno
- UiT, The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, Nordland Hospital, Bodø, Norway
| | - Alireza Mirshahi
- Dardenne Eye Clinic, Bonn-Bad Godesberg, Bonn, Germany; Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Anthony P Khawaja
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Virginie J M Verhoeven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ruth E Hogg
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Maria Luz Cachulo
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - René Höhn
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany; Department of Ophthalmology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Christian Wolfram
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Alain Bron
- Department of Ophthalmology, Eye and Nutrition Research Group, University Hospital, Dijon, France
| | - Stefania Miotto
- Department of Ophthalmology, Camposampiero Hospital, Camposiero, Italy
| | - Isabelle Carrière
- U1061, Inserm, Montpellier, France; Université de Montpellier, Montpellier, France
| | - Johanna M Colijn
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gabriëlle H S Buitendijk
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jennifer Evans
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Dorothea Nitsch
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Panayiota Founti
- Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Jennifer L Y Yip
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom; London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | | | - Rufino Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; Faculty of Medicine, Institute for Biomedical Imaging and Life Sciences (IBILI), University of Coimbra, Coimbra, Portugal
| | | | - Fotis Topouzis
- Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Geir Bertelsen
- Department of Ophthalmology, Nordland Hospital, Bodø, Norway; University Hospital of North Norway, Tromsø, Norway
| | - Paul J Foster
- Integrative Epidemiology, University College London Institute of Ophthalmology, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Astrid Fletcher
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jean-François Korobelnik
- Bordeaux Population Health Research Center, Team LEHA, Unité Mixte de Recherche (UMR) 1219, INSERM, Université de Bordeaux, Bordeaux, France; Service d'Ophtalmologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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von Hanno T, Lade AC, Mathiesen EB, Peto T, Njølstad I, Bertelsen G. Macular thickness in healthy eyes of adults (N = 4508) and relation to sex, age and refraction: the Tromsø Eye Study (2007-2008). Acta Ophthalmol 2017; 95:262-269. [PMID: 27989016 PMCID: PMC5412929 DOI: 10.1111/aos.13337] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/17/2016] [Indexed: 12/26/2022]
Abstract
Purpose To provide sex‐stratified normative data on retinal thickness and study the relationship with sex, age and refractive status. Methods Population‐based study including 2617 women and 1891 men, aged 38–87 (mean 61 ± 8) years, without diabetes, glaucoma and retinal diseases, and spherical equivalent refraction (SER) within ±6 dioptres. Retinal thickness was measured with optical coherence tomography (spectral domain Cirrus HD‐OCT). Results Women had thinner retina than men. Retinal thickness was significantly associated with refraction, where mean change in retinal thickness per 1 D increase in SER was −1.3 (0.2) μm in the fovea, 0.7 (0.1) μm in the pericentral ring and 1.4 (0.1) μm in the peripheral ring. In the fovea, there was a non‐monotonic curved relationship between retinal thickness and age in both sexes with a maximum at about 60 years (p < 0.001). In the pericentral ring, the mean reduction in retinal thickness per 10‐year increase was 2.7 (0.3) μm in women and 4.0 (0.4) μm in men and corresponding results in the peripheral ring were 2.3 (0.3) μm in women and 2.6 (0.4) μm in men. In both regions, there was evidence for a nonlinear pattern with an increased rate of change with higher age. There was a significant interaction between sex and age for retinal thickness of the pericentral ring (p = 0.041). Conclusion Women had thinner retina than men, and thickness varied with refractive status. Retinal thickness was associated with age in all macular regions, and the rate of change in retinal thickness varied at different ages.
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Affiliation(s)
- Therese von Hanno
- Brain and Circulation Research Group; Department of Clinical Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
- Department of Ophthalmology; Nordland Hospital; Bodø Norway
| | - Anette C. Lade
- Department of Rehabilitation; University Hospital of North Norway; Tromsø Norway
| | - Ellisiv B. Mathiesen
- Brain and Circulation Research Group; Department of Clinical Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
- Department of Neurology; University Hospital of North Norway; Tromsø Norway
| | - Tunde Peto
- Centre of Public Health; Queen's University; Belfast UK
| | - Inger Njølstad
- Research Group of Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - Geir Bertelsen
- Research Group of Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
- Department of Ophthalmology and Neurosurgery; University Hospital of North Norway; Tromsø Norway
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Zocher MT, Rozema JJ, Oertel N, Dawczynski J, Wiedemann P, Rauscher FG. Biometry and visual function of a healthy cohort in Leipzig, Germany. BMC Ophthalmol 2016; 16:79. [PMID: 27268271 PMCID: PMC4895813 DOI: 10.1186/s12886-016-0232-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/05/2016] [Indexed: 11/23/2022] Open
Abstract
Background Cross-sectional survey of ocular biometry and visual function in healthy eyes across the life span of a German population aged 20 to 69 years (n = 218). Subject number in percent per age category reflected the percentage within the respective age band of the population of Leipzig, Germany. Methods Measurements obtained: subjective and objective refraction, best-corrected visual acuity, accommodation, contrast sensitivity, topography and pachymetry with Scheimpflug camera, axial length with non-contact partial coherence interferometry, and spectral-domain optical coherence tomography of the retina. Pearson correlation coefficients with corresponding p-values were given to present interrelationships between stature, biometric and refractive parameters or their associations with age. Two-sample T-tests were used to calculate gender differences. The area under the logarithmic contrast sensitivity function (AULCSF) was calculated for the analysis of contrast sensitivity as a single figure across a range of spatial frequencies. Results The results of axial length (AL), anterior chamber depth (ACD) and anterior chamber volume (ACV) differed as a function of the age of the participants (rho (p value): AL −0.19 (0.006), ACD −0.56 (< 0.001), ACV-0.52 (< 0.001)). Longer eyes had deeper ACD (AL:ACD 0.62 (< 0.001), greater ACV (AL:ACV 0.65 (< 0.001) and steeper corneal radii (AL:R1ant; R2ant; R1post; R2post 0.40; 0.35; 0.36; 0.36 (all with (< 0.001)). Spherical equivalent was associated with age (towards hyperopia: 0.34 (< 0.001)), AL (−0.66 (< 0.001)), ACD (−0.52 (< 0.001)) and ACV (−0.46 (< 0.001)). Accommodation was found lower for older subjects (negative association with age, r = −0.82 (< 0.001)) and contrast sensitivity presented with smaller values for older ages (AULCSF −0.38, (< 0.001)), no change of retinal thickness with age. 58 % of the study cohort presented with a change of refractive correction above ±0.50 D in one or both eyes (64 % of these were habitual spectacle wearers), need for improvement was present in the young age-group and for older subjects with increasing age. Conclusion Biometrical data of healthy German eyes, stratified by age, gender and refractive status, enabled cross-comparison of all parameters, providing an important reference database for future patient-based research and specific in-depth investigations of biometric data in epidemiological research. Trial registration ClinicalTrials.gov # NCT01173614 July 28, 2010
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Affiliation(s)
- Maria Teresa Zocher
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany
| | - Jos J Rozema
- Department of Ophthalmology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Department of Medicine and Health Science, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Nicole Oertel
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany
| | - Jens Dawczynski
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany
| | - Peter Wiedemann
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany
| | - Franziska G Rauscher
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany.
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12
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Høeg TB, Ellervik C, Buch H, La Cour M, Klemp K, Kvetny J, Erngaard D, Moldow B. Danish Rural Eye Study: Epidemiology of Adult Visual Impairment. Ophthalmic Epidemiol 2016; 23:53-62. [PMID: 26825126 DOI: 10.3109/09286586.2015.1066396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the frequency and causes of visual impairment (VI) in a select population of Danish adults. METHODS A total of 3843 adults aged 20-94 years from the Danish General Suburban Population Study (GESUS) were included in the population-based, cross-sectional ophthalmological study, Danish Rural Eye Study (DRES). All DRES participants received a comprehensive general health examination preceding their eye examination, including measurement of best-corrected visual acuity (BCVA) for each eye, bilateral 45° retinal fundus photographs and further ophthalmological examination where indicated. RESULTS Overall, 3826 of 3843 participants (99.6%) had bilateral visual acuity measurements. The overall frequency of VI (BCVA <20/40 in the better-seeing eye) was 0.4% (95% confidence interval, CI, 0.2-0.7%; n = 15) among all DRES participants, 0.6% (95% CI 0.3-1.0%; n = 15) among participants >50 years and 3.7% (95% CI 2.1-6.5%; n = 11) in participants >80 years. The primary causes of VI in the better-seeing eye were age-related macular degeneration (AMD) in 46.7% (7/15) and cataract in 26.7% (4/15). A total of 43.3% (n = 115) of participants >80 years were pseudophakic in one or both eyes. The frequency of diabetes (HbA1c ≥ 48 mmol/mol or self-reported diagnosis) was 5.9% (n = 227), including 1.3% (n = 51) newly diagnosed in the GESUS. Of participants determined to have VI due to exudative AMD, 50% had received anti-vascular endothelial growth factor (VEGF) treatment. CONCLUSION We report a relatively low frequency of VI among Danish adults over 59 years of age compared with that observed 10-15 years ago, which is both consistent with other recent Scandinavian studies and reflective of our relatively healthy and mobile population sample.
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Affiliation(s)
- Tracy Beth Høeg
- a Department of Ophthalmology , University of Copenhagen, Næstved Hospital , Næstved , Denmark.,b Faculty of Health Sciences , University of Copenhagen , Denmark
| | - Christina Ellervik
- b Faculty of Health Sciences , University of Copenhagen , Denmark.,c Department of General Population Study , Nykøbing Falster Hospital , Denmark
| | - Helena Buch
- d Department of Ophthalmology , Capital Region Eye Clinic , Glostrup , Denmark.,e Department of Ophthalmology , Rigshospitalet, National University Hospital , Copenhagen , Denmark.,f Copenhagen Eye and Strabismus Clinic, Copenhagen Private Hospital , Copenhagen , Denmark
| | - Morten La Cour
- b Faculty of Health Sciences , University of Copenhagen , Denmark.,d Department of Ophthalmology , Capital Region Eye Clinic , Glostrup , Denmark
| | - Kristian Klemp
- e Department of Ophthalmology , Rigshospitalet, National University Hospital , Copenhagen , Denmark
| | - Jan Kvetny
- g Department of Internal Medicine , Næstved Hospital, Næstved , Denmark.,h Institute of Regional Health Services, University of Southern Denmark , Odense , Denmark
| | - Ditte Erngaard
- a Department of Ophthalmology , University of Copenhagen, Næstved Hospital , Næstved , Denmark
| | - Birgitte Moldow
- a Department of Ophthalmology , University of Copenhagen, Næstved Hospital , Næstved , Denmark
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13
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Eriksen BO, Løchen ML, Arntzen KA, Bertelsen G, Winther Eilertsen BA, von Hanno T, Herder M, Jenssen TG, Mathisen UD, Melsom T, Njølstad I, Solbu MD, Mathiesen EB. Estimated and Measured GFR Associate Differently with Retinal Vasculopathy in the General Population. Nephron Clin Pract 2015; 131:175-84. [PMID: 26426198 DOI: 10.1159/000441092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/11/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND/AIMS Estimated glomerular filtration rate (eGFR) is used extensively in epidemiological research. Validations of eGFR have demonstrated acceptable performance, but the dependence of creatinine and cystatin C on non-GFR factors could confound associations with disease. Few studies have investigated this issue in direct comparison with measured GFR (mGFR). We compared the associations between eGFR and mGFR and retinal vasculopathy, a marker of systemic microvasculopathy. METHODS Iohexol clearance and retinal photography were examined in the Renal Iohexol Clearance Survey in Tromsø 6, which consists of a representative sample of middle-aged persons from the general population. A total of 1,553 persons without self-reported kidney disease, cardiovascular disease or diabetes were investigated. Three eGFR equations based on creatinine and/or cystatin C from the Chronic Kidney Disease Epidemiology Collaboration were studied. Differences between eGFR and mGFR were analyzed with seemingly unrelated regression methods. RESULTS mGFR in the lowest quartile was associated with an increased multivariable-adjusted odds ratio of retinopathy (OR 1.86, 95% CI 1.16-2.97), but not with retinal artery or vein diameters. eGFR based on cystatin C (eGFRcys) was consistently biased relative to mGFR in its associations with retinal vessel diameters across different models. eGFR based on creatinine (eGFRcrea) and eGFR based on both creatinine and cystatin C were also biased in several of these models (p < 0.05). For retinopathy, the differences between the 3 eGFR and mGFR measurements were not statistically significant. CONCLUSIONS Low mGFR is associated with retinopathy in the general population. eGFR based on creatinine and/or cystatin C are not valid substitutes for mGFR in studies of the relationship between the retina and kidney function in healthy persons.
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Affiliation(s)
- Bjørn Odvar Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsx00F8;, Norway
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Morgan IG, Iribarren R, Fotouhi A, Grzybowski A. Cycloplegic refraction is the gold standard for epidemiological studies. Acta Ophthalmol 2015; 93:581-5. [PMID: 25597549 DOI: 10.1111/aos.12642] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/24/2014] [Indexed: 11/26/2022]
Abstract
Many studies on children have shown that lack of cycloplegia is associated with slight overestimation of myopia and marked errors in estimates of the prevalence of emmetropia and hyperopia. Non-cycloplegic refraction is particularly problematic for studies of associations with risk factors. The consensus around the importance of cycloplegia in children left undefined at what age, if any, cycloplegia became unnecessary. It was often implicitly assumed that cycloplegia is not necessary beyond childhood or early adulthood, and thus, the protocol for the classical studies of refraction in older adults did not include cycloplegia. Now that population studies of refractive error are beginning to fill the gap between schoolchildren and older adults, whether cycloplegia is required for measuring refractive error in this age range, needs to be defined. Data from the Tehran Eye Study show that, without cycloplegia, there are errors in the estimation of myopia, emmetropia and hyperopia in the age range 20-50, just as in children. Similar results have been reported in an analysis of data from the Beaver Dam Offspring Eye Study. If the only important outcome measure of a particular study is the prevalence of myopia, then cycloplegia may not be crucial in some cases. But, without cycloplegia, measurements of other refractive categories as well as spherical equivalent are unreliable. In summary, the current evidence suggests that cycloplegic refraction should be considered as the gold standard for epidemiological studies of refraction, not only in children, but in adults up to the age of 50.
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Affiliation(s)
- Ian G. Morgan
- Research School of Biological Science; Australian National University; Canberra ACT Australia
- Division of Preventive Ophthalmology and State Key Laboratory in Ophthalmology; Zhongshan Ophthalmic Center; Sun Yat-sen University; Guangzhou China
| | - Rafael Iribarren
- Department of Ophthalmology; San Luis Medical Center; Buenos Aires Argentina
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics; School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | - Andrzej Grzybowski
- Department of Ophthalmology; Poznan City Hospital; Poznan Poland
- Chair of Ophthalmology; University of Warmia and Mazury; Olsztyn Poland
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MacGillivray TJ, Cameron JR, Zhang Q, El-Medany A, Mulholland C, Sheng Z, Dhillon B, Doubal FN, Foster PJ, Trucco E, Sudlow C. Suitability of UK Biobank Retinal Images for Automatic Analysis of Morphometric Properties of the Vasculature. PLoS One 2015; 10:e0127914. [PMID: 26000792 PMCID: PMC4441470 DOI: 10.1371/journal.pone.0127914] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/20/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose To assess the suitability of retinal images held in the UK Biobank - the largest retinal data repository in a prospective population-based cohort - for computer assisted vascular morphometry, generating measures that are commonly investigated as candidate biomarkers of systemic disease. Methods Non-mydriatic fundus images from both eyes of 2,690 participants - people with a self-reported history of myocardial infarction (n=1,345) and a matched control group (n=1,345) - were analysed using VAMPIRE software. These images were drawn from those of 68,554 UK Biobank participants who underwent retinal imaging at recruitment. Four operators were trained in the use of the software to measure retinal vascular tortuosity and bifurcation geometry. Results Total operator time was approximately 360 hours (4 minutes per image). 2,252 (84%) of participants had at least one image of sufficient quality for the software to process, i.e. there was sufficient detection of retinal vessels in the image by the software to attempt the measurement of the target parameters. 1,604 (60%) of participants had an image of at least one eye that was adequately analysed by the software, i.e. the measurement protocol was successfully completed. Increasing age was associated with a reduced proportion of images that could be processed (p=0.0004) and analysed (p<0.0001). Cases exhibited more acute arteriolar branching angles (p=0.02) as well as lower arteriolar and venular tortuosity (p<0.0001). Conclusions A proportion of the retinal images in UK Biobank are of insufficient quality for automated analysis. However, the large size of the UK Biobank means that tens of thousands of images are available and suitable for computational analysis. Parametric information measured from the retinas of participants with suspected cardiovascular disease was significantly different to that measured from a matched control group.
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Affiliation(s)
- Thomas J MacGillivray
- VAMPIRE project, Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Clinical Research Facility, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - James R. Cameron
- The Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Qiuli Zhang
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Ahmed El-Medany
- Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Carl Mulholland
- Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Ziyan Sheng
- Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Bal Dhillon
- VAMPIRE project, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Fergus N. Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul J. Foster
- National Institute for Health Research, Biomedical Research Centre at Moorfields Eye Hospital & University College London Institute of Ophthalmology, London, United Kingdom
| | - Emmanuel Trucco
- VAMPIRE project, School of Computing, University of Dundee, Dundee, United Kingdom
| | - Cathie Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Höhn R, Kottler U, Peto T, Blettner M, Münzel T, Blankenberg S, Lackner KJ, Beutel M, Wild PS, Pfeiffer N. The ophthalmic branch of the Gutenberg Health Study: study design, cohort profile and self-reported diseases. PLoS One 2015; 10:e0120476. [PMID: 25775251 PMCID: PMC4361691 DOI: 10.1371/journal.pone.0120476] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/22/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose This paper describes the study design, methodology, cohort profile and self-reported diseases in the ophthalmological branch of the Gutenberg Health Study (GHS). Methods The GHS is an ongoing, prospective, interdisciplinary, single-center, population-based cohort study in Germany. The main goals of the ophthalmological section are to assess the prevalence and incidence of ocular diseases and to explore risk factors, genetic determinants and associations with systemic diseases and conditions. The eye examination at baseline included a medical history, self-reported eye diseases, visual acuity, refractive errors, intraocular pressure, visual field, pachymetry, keratometry, fundus photography and tear sampling. The 5-year follow-up visit additionally encompassed optical coherence tomography, anterior segment imaging and optical biometry. The general examination included anthropometry; blood pressure measurement; carotid artery ultrasound; electrocardiogram; echocardiography; spirometry; cognitive tests; questionnaires; assessment of mental conditions; and DNA, RNA, blood and urine sampling. Results Of 15,010 participants (aged 35-74 years at the time of inclusion), ocular data are available for 14,700 subjects (97.9%). The mean visual acuity (standard deviation), mean spherical equivalent, median decimal visual acuity, and mean intraocular pressure were 0.08 (0.17) logMar, -0.42 (2.43) diopters, 0.9 and 14.24 (2.79) mm Hg, respectively. The frequencies of self-reported strabismus, glaucoma, surgery for retinal detachment and retinal vascular occlusions were 2.7%, 2.3%, 0.2% and 0.4%, respectively. Conclusions The GHS is the most extensive dataset of ophthalmic diseases and conditions and their risk factors in Germany and one of the largest cohorts worldwide. This dataset will provide new insight in the epidemiology of ophthalmic diseases and related medical specialties.
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Affiliation(s)
- René Höhn
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
- Klinik Pallas, Olten, Switzerland
- * E-mail:
| | - Ulrike Kottler
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Tunde Peto
- NIHR Biomedical Research Center at Moorfields Eye Hospital, NHS Foundation Trust, and UCL Institute of Ophthalmology, London, United Kingdom
| | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Preventive Cardiology and Preventive Medicine / Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl J. Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine / Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
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Erke MG, Bertelsen G, Peto T, Sjølie AK, Lindekleiv H, Njølstad I. Cardiovascular risk factors associated with age-related macular degeneration: the Tromsø Study. Acta Ophthalmol 2014; 92:662-9. [PMID: 24460653 DOI: 10.1111/aos.12346] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/10/2013] [Indexed: 01/05/2023]
Abstract
PURPOSE To examine associations between cardiovascular risk factors and age-related macular degeneration (AMD). METHODS A population-based, cross-sectional study of Caucasians aged 65-87 years was conducted in Norway in 2007/2008. Retinal photographs were graded for AMD. Multivariable logistic regression analyses were performed based on questionnaires addressing habits of smoking, alcohol consumption, physical activity, health and medication; and physical examination comprising anthropometric measurements, blood pressure and blood sampling. Cardiovascular disease status was obtained from a validated end-point registry. RESULTS Gradable photographs were available for 2631 participants, of whom 92 (3.5%) subjects had late AMD. In the multivariable analysis of late AMD, significant interactions were found between sex and the variables age, triglyceride level, use of lipid-lowering drugs and physical exercise. Current daily smoking was significantly related to late AMD in both sexes (odds ratio (OR) 4.06, 95% confidence interval (CI) 1.69-9.76 and OR 3.59, 95% CI 1.17-11.04, women and men, respectively) compared with never smokers. Higher number of pack years was associated with the presence of large drusen (>125 μm) (OR 1.04, 95% CI 1.01-1.09 per 5 years). Higher systolic blood pressure (OR 1.06, 95% CI 1.01-1.12 per 5 mmHg), overweight (OR 2.87, 95% CI 1.13-7.29) and obesity (OR 2.92, 95% CI 1.06-8.03), physical exercise duration (OR 0.41, 95% 0.18-0.96 for 30 min or more compared with less) and frequency (OR 0.46, 95% CI 0.23-0.92 for weekly or more often compared to less) were associated with late AMD in women only. CONCLUSIONS Smoking was strongly associated with AMD, in line with results from other populations. Also, late AMD was related to higher systolic blood pressure, physical inactivity, overweight and obesity in women.
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Affiliation(s)
- Maja G Erke
- Department of Ophthalmology and Neurosurgery; University Hospital of North Norway; Tromsø Norway
- Research Group of Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
| | - Geir Bertelsen
- Department of Ophthalmology and Neurosurgery; University Hospital of North Norway; Tromsø Norway
- Research Group of Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; Head of Reading Centre; London UK
| | - Anne K Sjølie
- Department of Ophthalmology; Odense University Hospital; Odense Denmark
- Brain and Circulation Research Group; Department of Clinical Medicine, Faculty of Health Sciences; University of Tromsø; Tromsø Norway
| | - Haakon Lindekleiv
- Research Group of Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
| | - Inger Njølstad
- Research Group of Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
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von Hanno T, Sjølie AK, Mathiesen EB. Retinal vascular calibre and response to light exposure and serial imaging. Acta Ophthalmol 2014; 92:444-8. [PMID: 23826913 PMCID: PMC4329411 DOI: 10.1111/aos.12213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose To investigate whether retinal vessel calibre measurements on optical retinal photography are affected by light and dark exposure prior to photography and whether the vessel calibre changes during an imaging sequence of several images. Methods Digital optical retinal photographs were obtained from 32 healthy adults in two separate image sequences of six images during 1 min; one sequence with 10 min of dark exposure and one with 10 min of light exposure prior to imaging. Retinal arteriolar and venular calibres were measured computer-assisted and summarized as central retinal artery and vein equivalents (CRAE and CRVE). Outcome measures were difference in calibres after prior light versus prior dark exposure and difference in calibre during each of the two imaging sequences. Results CRVE was wider with prior light exposure (2.7%, p = 0.0001), comparing the first image in each image sequence. Within each sequence, there was a venular dilatation from first to last image, both with prior light exposure (1.7%, p = 0.0003) and prior dark exposure (3.1%, p < 0.0001), with the change less pronounced with prior light exposure (p = 0.0164). CRAE showed no significant change in either outcome. Conclusions Retinal venular calibre was wider with light exposure prior to imaging and increased slightly during the imaging sequences, less pronounced after prior light than dark exposure. Measurement error due to these effects will probably be reduced by avoiding dark prior to imaging, and a possible bias effect of endothelial dysfunction may possibly be reduced by measuring calibre on an image taken early in the image sequence.
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Affiliation(s)
- Therese von Hanno
- Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Department of Ophthalmology, Nordland Hospital, Bodø, Norway
| | - Anne Katrin Sjølie
- Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Ellisiv B. Mathiesen
- Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Department of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø, Norway
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Abstract
PURPOSE Anisometropia shows an exponential increase in prevalence with increasing age based on cross-sectional studies. The purpose of this study was to evaluate longitudinal changes in anisometropia in all refractive components in older observers and to assess the influence of early cataract development. METHODS Refractive error was assessed at two time points separated by approximately 12 years in 118 older observers (aged 67.1 and 79.3 years at the two test times). Anisometropia defined as greater than or equal to 1.00 D was calculated for all refractive components. The subjects had intact ocular lenses in both eyes throughout the study. Lens evaluations were performed at the second test using the Lens Opacities Classification System III. RESULTS All refractive components approximately doubled in prevalence of anisometropia. Spherical equivalent anisometropia changed from 16.1 to 32.2%. Similar changes were found for spherical error (17 to 38.1%), primary astigmatism (7.6 to 17.8%), and oblique astigmatism (14.4 to 29.7%). Many who did not have anisometropia at the first visit subsequently developed anisometropia (e.g., 26.3% for spherical error and 22.9% for oblique cylinder). The onset of anisometropia occurred at all ages within the studied age range, with no particular preference for any one age. A small number lost anisometropia over time. Individual comparisons of refractive error changes in the two eyes in combination with nuclear lens changes showed that early changes in nuclear sclerosis in the two eyes could account for a large proportion of anisometropia (~40%), but unequal hyperopic shift in the spherical component in the two eyes was the primary cause of the anisometropia. CONCLUSIONS Anisometropia is at least 10 times more common in the elderly than in children, and anisometropia develops in all refractive components in the oldest observers. Clinicians need to be aware of this common condition that could lead to binocular vision problems and potentially cause falls in the elderly.
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Wolfram C, Höhn R, Kottler U, Wild P, Blettner M, Bühren J, Pfeiffer N, Mirshahi A. Prevalence of refractive errors in the European adult population: the Gutenberg Health Study (GHS). Br J Ophthalmol 2014; 98:857-61. [DOI: 10.1136/bjophthalmol-2013-304228] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lindekleiv H, Erke MG, Bertelsen G, Peto T, Arntzen KA, Schirmer H, Wilsgaard T, Mathiesen EB, Njølstad I. Cognitive function, drusen, and age-related macular degeneration: a cross-sectional study. Eye (Lond) 2013; 27:1281-7. [PMID: 23970030 DOI: 10.1038/eye.2013.181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 07/20/2013] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To examine the cross-sectional relationship between drusen, late age-related macular degeneration (AMD), and cognitive function. METHODS; We included 2149 stroke-free participants from the population-based Tromsø Study in Norway. Retinal photographs were graded for presence of drusen and AMD. Cognitive function was assessed using the verbal memory test (short verbal memory), digit-symbol coding test (processing speed), and the tapping test (psychomotor tempo). We assessed the relationship between drusen, late AMD, and cognitive test scores, adjusted for potential confounders. RESULTS Late AMD was associated with decreased performance in the verbal memory test (standardized β=-0.23, 95% confidence interval (CI): -0.51 to -0.01). Intermediate and large drusen were associated with decreased performance in the digit-symbol coding test (standardized β=-0.14 and -0.19, 95% CIs: -0.23 to -0.05 and -0.29 to -0.09, respectively). Participants with large drusen were more likely to have test scores in the lowest quartile of the digit-symbol coding test (odds ratio (OR)=1.9, 95% CI: 1.1-3.5) and the tapping test (OR=1.6, 95% CI: 1.0-2.6), but not in the verbal memory test (OR=1.0, 95% CI: 0.6-1.6). CONCLUSIONS The findings suggest a relationship between drusen deposition and reduced cognitive function. Although the relationships between drusen, late AMD, and the cognitive test results varied in strength and significance across the types of cognitive test, and may partly have been caused by residual confounding, it is not unlikely that a genuine but weaker relationship exists between drusen deposition and cognitive decline.
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Affiliation(s)
- H Lindekleiv
- Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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