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Bikbov MM, Kazakbaeva GM, Iakupova EM, Fakhretdinova AA, Gilmanshin TR, Panda-Jonas S, Jonas JB. Prevalence of age-related macular degeneration and retinal pseudodrusen in an elderly population. The ural very old study. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06644-1. [PMID: 39297887 DOI: 10.1007/s00417-024-06644-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/05/2024] [Accepted: 09/11/2024] [Indexed: 09/21/2024] Open
Abstract
PURPOSE To assess the prevalence of age-related macular degeneration (AMD) and reticular pseudodrusen (RPD) in very old individuals. METHODS The population-based Ural Very Old Study consisted of 1526 (81.1%) out of 1882 eligible individuals aged 85 + years. All individuals living in the study regions and having an age of 85 + years were eligible for the study. The presence of AMD and RPDs was assessed on color fundus photographs, red-free fundus images, and optical coherence tomographic images. RESULTS The study included 932 (61.1% of 1526) individuals (age:88.6 ± 2.7 years) with available fundus images. Prevalence of any, early, intermediate and late AMD was 439/932 (47.1%; 95%CI:44.0,50.0), 126/932 (13.5%; 95% CI:11.0,16.0), 185/932 (19.8%; 95% CI:17.3,22.3) and 128/932 (13.7%; 95% CI:11.7,15.7), respectively. Neovascular AMD was present in 63 eyes (6.8%;95%CI:5.3,8.3) and geographic atrophy in 65 eyes (7.0%;95%CI:5.0,9.0). Higher prevalence of any AMD and late AMD was significantly correlated with urban region of habitation (OR:3.34; 95% CI:2.37,4.71; P < 0.001), and with older age (OR:1.12; 95% CI:1.04,1.19; P = 0.001), female sex (OR:1.63; 95%CI:1.02,2.60; P = 0.04), and urban region of habitation (OR:2.89; 95% CI:1.59,5.26; P < 0.001), respectively. RPDs (assessed in 889 (58.3%) study participants) were present in 220/889 participants (24.7%; 95%CI:21.7,27.7). Higher RPD prevalence was associated (multivariable analysis) with higher serum concentration of the rheumatoid factor (OR:1.15; 95% CI:1.04,1.28; P = 0.008), shorter axial length (OR:0.84;95%CI:0.71,0.00;P = 0.04), and higher degree of nuclear cataract (OR:1.06; 95% CI:1.01,1.12; P = 0.02). AMD was the main cause for vision impairment in 230 (24.7%) participants, for moderate-to-severe vision impairment in 75 (8.0%; 95% CI: 6.4, 10.0) individuals, and for blindness in 15 (1.6%; 95%CI: 0.8, 2.5) persons respectively. CONCLUSIONS In this ethnically mixed, very old population, AMD prevalence (any AMD:47.1%;late AMD:13.7%) was statistically independent of most systemic and ocular parameters. Higher RPD prevalence correlated with shorter axial length. KEY MESSAGES What is known The prevalence of age-related macular degeneration (AMD) has been explored in many studies and societies. Information is missing about its prevalence and associations in very old individuals. The same holds true for reticular pseudodrusen of the macula. What is new In an ethnically mixed, very old population in Bashkortostan / Russia, the prevalence of AMD (any AMD: 47.1%; late AMD:13.7%) was statistically independent of most systemic and ocular parameters. Higher prevalence of reticular pseudodrusen correlated with shorter axial length.
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Affiliation(s)
- Mukharram M Bikbov
- Ufa Eye Research Institute of Bashkir State Medical University, Ufa, Russia.
| | | | - Ellina M Iakupova
- Ufa Eye Research Institute of Bashkir State Medical University, Ufa, Russia
| | | | - Timur R Gilmanshin
- Ufa Eye Research Institute of Bashkir State Medical University, Ufa, Russia
| | - Songhomitra Panda-Jonas
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
- Privatpraxis Prof Jonas Und Dr Panda-Jonas, Heidelberg, Germany
| | - Jost B Jonas
- Privatpraxis Prof Jonas Und Dr Panda-Jonas, Heidelberg, Germany.
- Rothschild Foundation Hospital, Institut Français de Myopie, Paris, France.
- Singapore Eye Research Institute, Singapore, Singapore.
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Beijing Visual Science and Translational Eye Research Institute, Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Bejing, China.
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Jonas JB, Bikbov MM, Kazakbaeva GM, Wang YX, Xu J, Nangia V, Nangia PV, Panda-Jonas S. Positive and Negative Associations of Myopia with Ocular Diseases in Population-Based Studies. Ophthalmology 2024:S0161-6420(24)00414-7. [PMID: 38971323 DOI: 10.1016/j.ophtha.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024] Open
Abstract
PURPOSE Prevalence of myopia and vision impairment due to myopic macular degeneration and myopia-related optic neuropathies have markedly increased worldwide. We evaluated whether myopia is associated with other ocular disorders. DESIGN Population-based studies conducted in Russia, China, and India. PARTICIPANTS The Russian Ural Eye and Medical Study (UEMS) and the Beijing Eye Study (BES) included 5899 individuals and 4439 individuals (all aged 40+ years), respectively, and the Central India Eye and Medical Study (CIEMS) consisted of 4711 individuals aged 30+ years. The studies were conducted in rural and urban regions in Bashkortostan/Russia, Nagpur/India, and Beijing/China. METHODS The participants underwent a series of ophthalmological and general medical examinations. MAIN OUTCOME MEASURES Axial length as a surrogate for myopia and prevalence of diabetic retinopathy (DR), age-related macular degeneration (AMD), angle-closure glaucoma (ACG), and open-angle glaucoma (OAG). RESULTS In the UEMS, DR prevalence (odds ratio [OR], 0.73), AMD prevalence (OR, 0.85), and ACG prevalence (OR, 0.72) decreased, and OAG prevalence (OR, 1.65) increased with longer axial length in multivariable analyses. In the CIEMS, lower AMD prevalence (OR, 0.81) and lower ACG prevalence (OR, 0.55), and higher OAG prevalence (OR, 1.45) were associated with longer axial length. Diabetic retinopathy prevalence (0.33%) was too low for statistical analysis in the CIEMS. In the BES, prevalence (OR, 0.64) and 10-year incidence of DR (OR, 0.48) and prevalence (OR, 0.83) and 5-year incidence of AMD (OR, 0.996) decreased, and prevalence (OR, 1.35) and 10-year incidence of OAG (OR, 1.40) increased with longer axial length. In all 3 studies, the association between higher OAG prevalence and longer axial length was nonlinear with a slight increase for the moderate myopia range and a steep increase in the highly myopic range. CONCLUSIONS Myopia is associated with a lower prevalence of DR, AMD, and ACG and a lower incidence of DR and AMD, whereas high myopia more than moderate myopia is associated with a higher prevalence and incidence of OAG. Future studies may assess whether in myopia (in particular, in moderate myopia), the myopia-related advantages, that is, lower prevalence of DR, AMD, and ACG, may outweigh the increased risks for OAG and other myopia-related disorders. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Jost B Jonas
- Institut Français de Myopie, Hôpital Fondation Adolphe de Rothschild, Paris, France; Singapore Eye Research Institute, Singapore; Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany.
| | | | | | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | | | - Songhomitra Panda-Jonas
- Institut Français de Myopie, Hôpital Fondation Adolphe de Rothschild, Paris, France; Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
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Tsui JC, Brucker AJ, Kim BJ, Kolomeyer AM. COMBINED RHEGMATOGENOUS RETINAL AND CHOROIDAL DETACHMENT: A Systematic Review. Retina 2023; 43:1226-1239. [PMID: 36893435 DOI: 10.1097/iae.0000000000003770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE To review the literature on eyes with concurrent rhegmatogenous retinal and choroidal detachment (RRD-CD). METHODS Several databases were searched for "rhegmatogenous retinal detachment" and "choroidal detachment" through October 2022. All English language primary literature was reviewed. RESULTS Studies demonstrated that eyes with RRD-CD were very uncommon and had diminished baseline visual acuity (VA) and intraocular pressure (IOP) compared with eyes with RRD only. Although no randomized trials have been performed, pars plana vitrectomy with or without scleral buckle (SB) have reported higher surgical success rates than SB alone. Reattachment rates were affected by age, IOP, adjuvant steroids, and grade of proliferative vitreoretinopathy. CONCLUSION Low IOP and poor initial VA are salient features of eyes with RRD-CD. Steroids can be useful adjuvants administered safely using several routes including periocular and intravitreal injection. PPV ± SB may result in best surgical outcomes.
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Affiliation(s)
- Jonathan C Tsui
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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Differentiating drusen and drusenoid deposits subtypes on multimodal imaging and risk of advanced age-related macular degeneration. Jpn J Ophthalmol 2023; 67:1-13. [PMID: 36477878 DOI: 10.1007/s10384-022-00943-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/10/2022] [Indexed: 12/12/2022]
Abstract
Drusen are extracellular material considered a precursor lesion to advanced age-related macular degeneration (AMD), located either on the retinal pigment epithelium (RPE) or the sub-RPE; they contain various proteins associated with inflammation and lipids. Previous studies suggest that the lifecycle of drusen varies depending on drusen type and size. In general, conventional drusen grow and aggregate/coalesce in the first stage, and in the second stage, they regress with or without showing RPE atrophy. The risk of advanced AMD also varies depending on the drusen and drusenoid deposit types' along with their size and RPE abnormalities. In eyes with macular neovascularization (MNV), specific drusen/drusenoid deposits are closely associated with the MNV subtype. Recently, pachychoroid-associated drusen (pachydrusen) were proposed and clinical findings regarding this entity have been accumulating, as more attention is focused on drusen as well as pachychoroid diseases. With the advance in imaging modalities, various modalities can show specific characteristics depending on drusen types. To assess the risk of advanced AMD, it is essential for physicians to have accurate clinical knowledge about each druse/drusenoid lesion and correctly evaluate its imaging characteristics using multimodal imaging. This review summarizes the latest clinical knowledge about each druse/drusenoid lesions and documents their imaging characteristics on multimodal imaging, allowing clinicians to better manage patients and stratify the risk of developing advanced AMD. The most representative cases are illustrated, which can be helpful in the differential diagnosis of drusen and drusenoid deposits.
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Bikbov MM, Kazakbaeva GM, Fakhretdinova AA, Tuliakova AM, Rakhimova EM, Panda-Jonas S, Gilemzianova LI, Garipova LA, Khakimov DA, Jonas JB. Myopic axial elongation in school children and the COVID-19 lockdown in Russia: The Ural Children Myopia Study. PLoS One 2023; 18:e0279020. [PMID: 36696436 PMCID: PMC9876376 DOI: 10.1371/journal.pone.0279020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/17/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To explore an influence of the COVID-19-related lockdown on ocular axial elongation in school children in Russia. METHODS The participants of the school-based Ufa Children Myopia Study in Ufa/Russia underwent, at baseline in 2019/2020 before the COVID-19 outbreak and after a COVID-19-related lockdown, a detailed interview and ophthalmological examination including laser interferometric biometry for axial length measurement. RESULTS The study included 461 children (age:10.7±2.1 years;range:6.8-16.9 years). The mean follow-up was 1.41±0.33 years. Mean axial length at baseline was 23.96±0.95mm and 23.94±0.95mm in the right and left eyes, respectively. During the study period, annual axial elongation (right/left eyes) was 0.19±0.17mm/0.19±0.22mm. Before the COVID-19 lockdown, the age-dependent coefficient for axial length (ADCAL) for the right/left eyes was 0.21mm (95%CI:0.17,0.25)/0.20mm (95%CI:0.16,0.24). In children younger than 9.6 years (n = 157), annual axial elongation (right eyes) during the study period was larger than the ADCAL before the COVID-19 outbreak (0.29 mm (95%:0.00,0.66) versus 0.21 mm (95%CI:0.02,0.41)). In the groups aged 9.6 to 11.4 years (n = 148) and aged >11.4 years (n = 156), annual axial elongation during the study period was comparable to the ADCAL before the COVID-19 outbreak (0.18mm (95%CI:-0.07,0.46) versus 0.22mm (95%CI:-0.05,0.48), and (0.09mm (95%CI:-0.15,0.34) versus 0.14mm (95%CI:0.00,0.28), respectively). In children aged ≤9 years at study end, axial length at study end was 0.20 mm larger than axial length at baseline in the participants aged ≤9 years at baseline. Larger axial elongation during the study period was associated (multivariable analysis) with younger age (beta:-0.62;P<0.001), female sex (beta:0.21;P<0.001), longer study period (beta:0.22;P<0.001), and longer axial length at baseline (beta:0.28;P<0.001), and marginally, with less time spent outdoors (beta:-0.07;P = 0.06). CONCLUSIONS The COVID-19-related lockdown in the Russian city of Ufa was associated with a relatively minor increase in axial elongation, detected only in children aged <9.6 years.
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Affiliation(s)
| | | | | | | | | | - Songhomitra Panda-Jonas
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
| | | | | | | | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- * E-mail: (JBJ); (MMB)
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Abstract
BACKGROUND Cataracts and age-related macular degeneration (AMD) are common causes of decreased vision and blindness in individuals over age 50. Although surgery is the most effective treatment for cataracts, it may accelerate the progression of AMD, so this study further evaluated the influence of cataract surgery for AMD through a systematic review and meta-analysis. METHODS The Cochrane Systematic Evaluation method was adopted, and computer searches were conducted for the China Knowledge Network, Wanfang, Vipul, SinoMed, PubMed, SpringerLink, Clinicalkey, Medline, Cochrane Library, Web of Science, OVID, and Embase databases of cohort studies on the impact of cataract surgery on AMD, with search timeframes up to May 2022. Meta-analysis was performed using Stata/12.0. RESULTS A total of 8 cohort studies were included in the study. The results showed that the relative risk (RR) of AMD progression after cataract surgery was not significantly different, RR 1.194 [95% credibility interval (CI) 0.897-1.591]; the risk remained increased more than 5 years after surgery, RR 1.372 (95% CI 1.062-1.772). CONCLUSION There is still a significant positive correlation between cataract surgery and increase the risk of worsening of AMD progression, and faster progression of early-to-late AMD found in cataract surgery with longer follow-up of patients.
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Affiliation(s)
- Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Sichuan, PR China
- * Correspondence: Zhaoyan Chen, Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China (e-mail: )
| | - Ya Zeng
- Department of Pharmacy, West China Hospital, Sichuan University, Sichuan, PR China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Sichuan, PR China
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Bikbov MM, Kazakbaeva GM, Rakhimova EM, Rusakova IA, Gilmanshin TR, Zainullin RM, Panda‐Jonas S, Fakhretdinova AA, Tuliakova AM, Safiullina KR, Bolshakova NI, Gizzatov AV, Ponomarev IP, Jonas JB. Prevalence and determinants of reticular pseudodrusen in the Russian Ural Eye and Medical Study. Acta Ophthalmol 2022; 100:e1701-e1707. [PMID: 35343644 DOI: 10.1111/aos.15145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the prevalence of reticular pseudodrusen (RPD) and their determinants. METHODS The Population-based Ural Eye and Medical Study conducted in Bashkortostan/Russia included 5899 participants aged 40+ years. Presence of RPDs was assessed on conventional colour fundus photographs, red-free fundus images and optical coherence tomographic images. RESULTS The study included 4914 (83.3%) individuals (mean age: 58.5 ± 10.5 years; range: 40-94 years). Using two age limits (>55 years and 40+ years) for the definitions of RPD and AMD (age-related macular degeneration), RPD prevalence was 186/4914 (3.8%; 95% confidence interval (CI): 3.3, 4.3) and 246/4914 (5.0%, 95% CI: 4.4, 5.6), respectively, and the prevalence of any AMD without RPD was 182/4914 (3.7%: 95% CI: 3.2, 4.2) and 224/4914 (4.6%; 95% CI: 4.0, 5.1) respectively. Within the subgroup of early AMD, intermediate AMD and late AMD, RPD prevalence (age limit: 40+ years) was 55.1% (95% CI: 49.5, 60.8), 42.9% (95% CI: 33.8, 51.9) and 33.3% (95% CI: 16.4, 50.3) respectively. In multivariable analysis, higher RPD prevalence (age limit 40+ years) was associated with higher age (odds ratio (OR): 1.08; 95% CI: 1.07, 1.10; p < 0.001), rural region of habitation (OR: 3.81; 95% CI: 2.76, 5.24; p < 0.001) and lower percentage of lymphocytes on leukocyte counts (OR: 0.95; 95% CI: 0.93, 0.97; p < 0.001). Higher prevalence of any AMD without RPD was associated with urban region (OR: 1.58; 95% CI: 1.18, 2.11; p = 0.002), lower diabetes prevalence (OR: 0.55; 95% CI: 0.33, 0.90; p = 0.02) and shorter axial length (OR: 0.85; 95% CI: 0.74, 0.98; p = 0.03), after adjusting for age. CONCLUSIONS Reticular pseudodrusen (mean prevalence: 3.8% (age limit >55 years); 5.0% (age limit 40+ years)) differs from AMD without RPD in its association with urban region (AMD without RPD: rural region), lower lymphocyte percentage (AMD without RPD: no association) and a lack of associations with axial length (AMD without RPD: shorter axial length) and with diabetes prevalence (AMD without RPD: lower diabetes prevalence).
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Affiliation(s)
| | | | | | | | | | | | - Songhomitra Panda‐Jonas
- Privatpraxis Prof Jonas und Dr Panda‐Jonas Heidelberg Germany
- Department of Ophthalmology University Hospital Heidelberg Heidelberg Germany
| | | | | | | | | | | | | | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim Heidelberg University Mannheim Germany
- Institute of Molecular and Clinical Ophthalmology Basel Basel Switzerland
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Peripheral Monocyte Count and Age-Related Macular Degeneration. The Tongren Health Care Study. Am J Ophthalmol 2021; 227:143-153. [PMID: 33737032 DOI: 10.1016/j.ajo.2021.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To assess potential associations between the prevalence of age-related macular degeneration (AMD) and systemic parameters in a Chinese population. DESIGN Cross-sectional study. METHODS The Tongren Health Care Study included individuals attending regular health care check-up examinations in the Beijing Tongren Hospital from 2017 to 2019. Detailed medical examinations and ophthalmic examinations were applied, including fundus photography. AMD was evaluated according to the Beckman Initiative guidelines. RESULTS The study included 7,719 participants (mean age: 60.5 ± 8.1 years; range: 50-97 years). The prevalence of any, early, intermediate, and late AMD was 1,607 of 7,719 (20.8%; 95% confidence interval [CI]: 20.1%, 21.9%), 832 of 7,719 (10.8%; 95% CI: 10.1%, 11.5%), 733 of 7,719 (9.5%; 95% CI: 8.9%, 10.2%), and 42 of 7,719 (0.50%; 95% CI: 0.40%, 0.70%), respectively. In multivariate analysis, the prevalence of any AMD increased with higher blood monocyte count (odds ratio [OR]:3.49; 95% CI: 2.26, 5.38; P < .001), after adjusting for older age (OR: 1.06; 95% CI: 1.05, 1.07; P < .001), higher serum concentration of calcium (OR: 2.52; 95% CI: 1.32, 4.84; P = .005), high-density lipoproteins (OR: 1.39; 95% CI: 1.19, 1.61; P < .001), and lower lipoprotein a (OR: 0.99; 95% CI: 0.98, 0.99; P = .02). Similar findings were obtained for the prevalence of intermediate and late AMD combined. The association between higher monocyte count and higher AMD prevalence showed the highest odds ratio for the age group of 50-59 years (any AMD: OR: 4.35, P < .001; intermediate and late AMD: OR: 6.14, P < .001). Individuals with a monocyte count of ≥0.5 × 109/L as compared to participants with a monocyte of 0.1-0.4 × 109/L had a 1.45-fold increased risk for any AMD (OR: 1.45; 95% CI: 1.27, 1.64; P < .001) and 1.58 fold increase risk for intermediate/late AMD (OR: 1.58; 95% CI: 1.33, 1.87; P < .001). CONCLUSION A higher prevalence of early AMD, intermediate AMD, late AMD, and any AMD was associated with a higher peripheral monocyte count. In agreement with previous studies, the observation suggests monocytes playing a role in the pathogenesis of AMD.
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Bikbov MM, Khalimov TA, Cerrada-Gimenez M, Ragauskas S, Kalesnykas G, Jonas JB. Compatibility of intravitreally applied epidermal growth factor and amphiregulin. Int Ophthalmol 2021; 41:2053-2063. [PMID: 33713254 PMCID: PMC8172503 DOI: 10.1007/s10792-021-01761-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/07/2021] [Indexed: 12/01/2022]
Abstract
Introduction To examine the compatibility of intravitreally injected epidermal growth factor (EGF) and amphiregulin as EGF family member. Methods Four rabbits (age: 4 months; body weight: 2.5 kg) received three intravitreal injections of EGF (100 ng) uniocularly in monthly intervals and underwent ocular photography, tonometry, biometry, and optical coherence tomography. After sacrificing the rabbits, the globes were histomorphometrically examined. In a second study part, eyes of 22 guinea pigs (age: 2–3 weeks) received two intravitreal administrations of amphiregulin (10 ng) or phosphate buffered solution (PBS) in 10-day interval, or were left untouched. Ten days after the second injection, the guinea pigs were sacrificed, the enucleated eyes underwent histological and immune-histological examinations. Results The rabbit eyes with EGF injections versus the contralateral untouched eyes did not show significant differences in intraocular pressure (7.5 ± 2.4 mmHg vs. 6.8 ± 2.2 mmHg; P = 0.66), retinal thickness (158 ± 5 µm vs. 158 ± 3 µm; P = 1.0), cell counts in the retinal ganglion cell layer (3.3 ± 1.7 cells/150 µm vs. 3.0 ± 1.4 cells/150 µm; P = 0.83), inner nuclear layer (46.4 ± 23.2 cells/150 µm vs. 39.6 ± 6.4 cells/150 µm; P = 0.61), and outer nuclear layer (215 ± 108 cells/150 µm vs. 202 ± 47 cells/150 µm; P = 0.83), or any apoptotic retinal cells. The guinea pig eyes injected with amphiregulin versus eyes with PBS injections did not differ (P = 0.72) in the degree of microglial activation, and both groups did not differ from untouched eyes in number of apoptotic retinal cells and retinal gliosis. Conclusions Intravitreal applications of EGF (100 ng) in rabbits nor intravitreal applications of amphiregulin (10 ng) in guinea pigs led to intraocular specific inflammation or any observed intraocular destructive effect. The findings support the notion of a compatibility of intraocular applied EGF and amphiregulin.
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Affiliation(s)
| | | | | | | | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Universitäts-Augenklinik, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany.
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Kolomeyer AM, Smith E, Daniel E, Ying GS, Pan W, Pistilli M, Grunwald J, Maguire MG, Kim BJ. BETA-PERIPAPILLARY ATROPHY AND GEOGRAPHIC ATROPHY IN THE COMPARISON OF AGE-RELATED MACULAR DEGENERATION TREATMENTS TRIALS. Retina 2021; 41:125-134. [PMID: 32383840 PMCID: PMC7641972 DOI: 10.1097/iae.0000000000002825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To determine associations between beta-peripapillary atrophy (B-PPA) and incidence and growth of geographic atrophy (GA) in eyes treated with anti-vascular endothelial growth factor agents in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). METHODS We included 245 cases with incident GA and 245 controls matched by baseline demographics and characteristics associated with development of GA in the CATT. Baseline color images were graded for the type of B-PPA, defined as presence of hypopigmentation with visible choroidal vessels and sclera that is adjacent to the optic disk. Beta-peripapillary atrophy was further classified as scleral ring, sclera, sclera/choroidal blood vessels, or combination. Areas of each type of B-PPA and the circumferential extent of B-PPA were measured. RESULTS Beta-peripapillary atrophy was present in 58% of eyes developing GA and in 52% without GA (P = 0.17). The greater circumferential extent of sclera/choroidal blood vessels B-PPA in relation to the optic disk was associated with incident GA (P = 0.02) and the GA size at first observation (P = 0.047). Beta-peripapillary atrophy was not associated with GA growth rates (P>0.05). Patients without B-PPA had a higher number of GA-associated risk alleles of ARMS2 (P = 0.0003) and HTRA1 (P = 0.001). CONCLUSION The extent of sclera/choroidal blood vessel B-PPA was associated with the GA incidence and size but not with the growth rate in eyes treated for neovascular age-related macular degeneration. Beta-peripapillary atrophy and GA may share some common pathophysiologic pathways unrelated to the GA-associated risk alleles evaluated.
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Affiliation(s)
- Anton M Kolomeyer
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eli Smith
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ebenezer Daniel
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei Pan
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Max Pistilli
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan Grunwald
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maureen G Maguire
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin J Kim
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Does Cataract Surgery Improve the Progression of Age-Related Macular Degeneration? A Meta-Analysis. J Ophthalmol 2020; 2020:7863987. [PMID: 33062316 PMCID: PMC7537699 DOI: 10.1155/2020/7863987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose Cataract and age-related macular degeneration (AMD) are the common causes of blindness in the elderly. Although cataract surgery is the most effective treatment for cataract, some clinicians suspect that such interventions may accelerate the progression of AMD. Therefore, we carried out this meta-analysis to focus on demonstrating the effectiveness and safety of cataract surgery in eyes with AMD. Methods We performed a systematic literature search in the PubMed, EMBASE, and Cochrane Library databases, and the electronic databases were last searched in January 2019. We planned to include cohort trials of eyes affected by both cataract and AMD in which cataract surgery would be compared to no surgery. Two reviewers independently evaluated the search results against the inclusion and exclusion criteria. 8 trials were included for this meta-analysis. Results We used the Stata/12.0 to integrate the data that was extracted from the articles. Eight cohort trials with data from different study populations were included. In random effects model, the relative risk (RR) for the progression of AMD is 1.194 (95% CI 0.897–1.591). As for those grouped according to the follow-up year, the RR for longer than five years was 1.372 (95% CI 1.062–1.772). Conclusion We could draw out such a conclusion that there is still a positive correlation between cataract surgery and the progression of AMD, especially for the Asians. However, based on the current results, it is not possible to draw conclusions from existing studies on the impact of cataract surgery on early AMD development.
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12
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Prevalence and Associated Factors of Age-Related Macular Degeneration in a Russian Population: The Ural Eye and Medical Study. Am J Ophthalmol 2020; 210:146-157. [PMID: 31606441 DOI: 10.1016/j.ajo.2019.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess the prevalence of age-related macular degeneration (AMD) in a Russian population. DESIGN Population-based prevalence assessment. METHODS The Ural Eye and Medical Study was conducted in a rural and urban area in the Russian republic of Bashkortostan. The study included 5,899 participants aged 40+ years old. AMD, defined according to the Beckman Initiative for Macular Research, was assessed by fundus photographs and optical coherence tomographic images of 4,932 (83.6%) participants. RESULTS The prevalence of any AMD, early AMD, intermediate AMD, or late AMD, geographic atrophy, and neovascular AMD were 18.2% (95% confidence interval [CI], 16.8-19.6), 11.6% (95% CI, 10.4-12.8), 5.0% (95% CI, 4.2-5.8), 1.6% (95% CI, 1.1-2.0), 0.7% (95% CI, 0.4-1.0) and 0.9% (95% CI, 0.6-1.3), respectively, for individuals >55 years old. Applying an age limit of 40+ years for the AMD definition, prevalence of any AMD, early AMD, intermediate AMD, late AMD, geographic atrophy and neovascular AMD were 14.1% (95% CI, 13.1-15.1), 9.4% (95% CI, 8.6-10.2), 3.8% (95% CI, 3.2-4.3), 1.0% (95% CI, 0.7-1.2), 0.4% (95% CI, 0.2-0.6) and 0.5% (95% CI, 0.3-0.7), respectively, for individuals aged 40+ years. Higher AMD prevalence was correlated with older age (odds ratio [OR], 1.15; 95% CI, 1.13-1.16; P < 0.001), rural region (OR, 1.69; 95% CI, 1.32-2.17; P < 0.001), lower diabetes prevalence (OR, 0.56; 95% CI, 0.38-0.82; P = 0.003), and shorter axial length (OR, 0.89; 95% CI, 0.79-0.99; P = 0.04). AMD prevalence was not significantly (all P ≥ 0.20) correlated with any systemic parameter examined, except for lower prevalence of diabetes. CONCLUSIONS In this typical, ethnically mixed, urban and rural population from Russia, a higher prevalence for AMD was associated mainly with older age, rural region of habitation, shorter axial length, and lower prevalence of diabetes mellitus. The AMD prevalence was lower than in Europeans and higher than in East Asians.
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13
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Wang Q, Wang YX, Wu SL, Chen SH, Yan YN, Yang MC, Yang JY, Zhou WJ, Chan SY, Zhang XH, Yang X, Lei YH, Qin SQ, Chen MX, Jonas JB, Wei WB. Ocular Axial Length and Diabetic Retinopathy: The Kailuan Eye Study. Invest Ophthalmol Vis Sci 2019; 60:3689-3695. [PMID: 31469896 DOI: 10.1167/iovs.19-27531] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the role of ocular axial length as an ocular parameter for the prevalence and severity of diabetic retinopathy (DR). Methods The cross-sectional Kailuan Diabetic Retinopathy Study included patients with diabetes who participated in the community-based longitudinal Kailuan Study and who had undergone ocular fundus photography. The fundus photographs were graded using the Early Treatment of Diabetic Retinopathy Study criteria. Results The study included 1096 patients with diabetes (mean age: 60.8 ± 9.4 years; axial length: 23.37 ± 0.92 mm). In binary regression analysis, a higher DR prevalence was associated with shorter axial length (P = 0.007; odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.70, 0.95) after adjusting for longer known duration of diabetes (P = 0.02; OR: 1.13; 95%CI: 1.02, 1.24) and higher fasting blood glucose concentration (P < 0.001; OR: 1.38; 95%CI: 1.26, 1.52). A more severe DR stage was associated (regression coefficient r: 0.46) with shorter ocular axial length (P = 0.047; standardized regression coefficient β: -0.06) after adjusting for higher fasting blood glucose (P < 0.001; β: 0.41) and longer known duration of diabetes (P = 0.045; β: 0.07). Longer axial length was associated with a lower DR prevalence (P = 0.003; β: -0.10) after adjusting for younger age (P < 0.001), male sex (P < 0.001), higher body mass index (P = 0.016), and lower fasting blood glucose concentration (P = 0.036). Conclusions After adjusting for systemic risk factors, DR prevalence decreased by 19% (95%CI: 5, 30) for each millimeter increase in axial length. With longer axial length being a surrogate for axial myopia, the marked increase in myopia prevalence worldwide may lead to a relative decrease in the prevalence and incidence of DR in future.
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Affiliation(s)
- Qian Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shou Ling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | | | - Yan Ni Yan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Mo Chi Yang
- Department of Ophthalmology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Jing Yan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Wen Jia Zhou
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Szy Yann Chan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Xiao Hui Zhang
- Physical Examination Center, Linxi Hospital of Kailuan General Hospital, Tangshan, China
| | - Xuan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Ya Hui Lei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Shu Qi Qin
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Meng Xi Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
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14
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Wong CW, Yanagi Y, Tsai ASH, Shihabuddeen WA, Cheung N, Lee SY, Jonas JB, Cheung CMG. Correlation of axial length and myopic macular degeneration to levels of molecular factors in the aqueous. Sci Rep 2019; 9:15708. [PMID: 31673022 PMCID: PMC6823508 DOI: 10.1038/s41598-019-52156-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
Abstract
To elucidate the molecular processes associated with the development of myopic macular degeneration (MMD), we measured the intraocular concentrations of molecular factors in emmetropic and myopic eyes. This is a retrospective clinic-based case-control study that included eyes undergoing routine cataract surgery whereby aqueous humour samples were obtained. We measured the concentrations of pigment epithelium derived factor(PEDF), matrix metalloproteinase 2(MMP-2), tissue inhibitor of metalloproteinase(TIMP-2), vascular endothelial growth factor isoform A(VEGF-A), interleukin 8(IL-8), interleukin 6(IL-6), C-reactive protein(CRP), angiopoietin 2(Ang2), and amphiregulin. 38 eyes (axial length (AL): 22.4–32.4 mm), including 12 highly myopic (HM) eyes (AL ≥ 26.5 mm) without MMD and 12 HM eyes with MMD but without neovascularization were included. Eyes with MMD were found to have significantly lower VEGF-A levels (p = 0.007) and higher MMP-2 levels (p = 0.02) than control eyes after adjusting for age and gender. MMP-2 levels correlated positively (r = 0.58, p = 0.002), while VEGF-A levels correlated negatively with longer axial length (r = −0.75, p < 0.001). Both the concentrations of VEGF-A (P = 0.25) and MMP-2 (P = 0.69) were not significantly associated with MMD after adjusting for AL. These findings suggest that the predominant mechanism underlying the development of non-neovascular MMD may be axial elongation, driven in part by MMP-2 related mechanisms.
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Affiliation(s)
- Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yasuo Yanagi
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Andrew Shih Hsiang Tsai
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Mannheim, Germany
| | | | - Ning Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Mannheim, Germany
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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15
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Dietary Patterns and Age-Related Macular Degeneration in Korea: The Korea National Health and Nutrition Examination Survey 2010-2011. Sci Rep 2019; 9:8200. [PMID: 31160668 PMCID: PMC6546709 DOI: 10.1038/s41598-019-44632-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/08/2019] [Indexed: 12/23/2022] Open
Abstract
This study was performed to reveal dietary patterns and age-related macular degeneration risk association in general Korean population. A retrospective cross-sectional database analysis using the data collected from January 2010 to December 2011 at a Korea nationwide survey was conducted. The present analysis was performed from December 2016 to November 2017. Detailed grading with fundus photographs was performed by observers blinded to the patient characteristics. The current study focused on subjects forty year and older who had fundus photographs that is assessable from at least one eye (7,899 participants). Participants were excluded if they reported extreme energy intake (142 participants) or if they were likely to have changed dietary behavior (1,171 participants), or with missing data (n = 764). After exclusion, 5,843 participants data were analyzed in the current study. As the result, 6.8% of the participants exhibited early stages of age-related macular degeneration and 0.6% exhibited late stages. Furthermore, relatively more frequent fish consumption was associated reduced odds of early age-related macular degeneration when comparing the third quartile with the first quartile groups, however, relatively more frequent legume consumption was associated with reduced odds of late age-related macular degeneration when comparing the third quartile with the first quartile groups. In conclusion, the current study insists that the diet pattern rich in fish and legume might have protective effect against age-related macular degeneration in Korean population.
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16
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Wang YX, Wei WB, Xu L, Jonas JB. Physical activity and eye diseases. The Beijing Eye Study. Acta Ophthalmol 2019; 97:325-331. [PMID: 30338672 DOI: 10.1111/aos.13962] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/26/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess associations between the amount of physical activity and the prevalence of ocular diseases. METHODS The participants of the population-based Beijing Eye Study underwent a detailed ophthalmological examination and an interview. Physical activity was assessed in a standardized questionnaire. RESULTS Out of 3468 study participants, information on their physical activity was available for 3031 (87.4%) individuals (age: 64.6 ± 9.7 years; range: 50-93 years). In multivariate analysis (regression coefficient r: 0.41), higher physical activity was associated with a lower prevalence of diabetic retinopathy [p = 0.009; standardized regression coefficient beta: -0.05; non-standardized regression coefficient B: -15.7; 95% confidence interval (CI): -27.6, -3.90] after adjusting for younger age, rural region of habitation, lower level of education, lower blood concentrations of triglycerides and low-density lipoproteins and higher blood concentrations of high-density lipoproteins, higher systolic blood pressure, lower body mass index and lower depression score. Other major ocular diseases such as open-angle glaucoma (p = 0.25), angle-closure glaucoma (p = 0.59), nuclear cataract (p = 0.78), cortical cataract (p = 0.54), posterior subcapsular cataract (p = 0.96), retinal vein occlusions (p = 0.93) and central serous choroidopathy (p = 0.39) were not statistically associated with physical activity in that model. The association between higher physical activity and prevalence of age-related macular degeneration (p = 0.04; β: 0.04; B: 4.87; 95% CI: 0.25, 9.50) was marginally significant. CONCLUSIONS Higher physical activity and less sedentary lifestyle were associated with a lower prevalence of diabetic retinopathy, while the occurrence of other major ocular diseases such as any type of cataract and of glaucoma, retinal vein occlusions and central serous choroidopathy was statistically independent of physical activity or a more sedentary lifestyle.
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Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
- Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
| | - Wen Bin Wei
- Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
| | - Liang Xu
- Beijing Institute of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
- Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
| | - Jost B. Jonas
- Beijing Institute of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
- Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
- Department of Ophthalmology Medical Faculty Mannheim of the Ruprecht‐Karls‐University Mannheim Germany
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17
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Bikbov MM, Kazakbaeva GM, Gilmanshin TR, Zainullin RM, Arslangareeva II, Salavatova VF, Bikbova GM, Panda-Jonas S, Nikitin NA, Zaynetdinov AF, Nuriev IF, Khikmatullin RI, Uzianbaeva YV, Yakupova DF, Aminev SK, Jonas JB. Axial length and its associations in a Russian population: The Ural Eye and Medical Study. PLoS One 2019; 14:e0211186. [PMID: 30707718 PMCID: PMC6358075 DOI: 10.1371/journal.pone.0211186] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/04/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess the normal distribution of axial length and its associations in a population of Russia. Methods The population-based Ural Eye and Medical Study included 5,899 (80.5%) individuals out of 7328 eligible individuals aged 40+ years. The participants underwent an ocular and systemic examination. Axial length was measured sonographically (Ultra-compact A/B/P ultrasound system, Quantel Medical, Cournon d'Auvergne, France). Results Biometric data were available for 5707 (96.7%) individuals with a mean age of 58.8±10.6 years (range:40–94 years; 25%, 50%, 75% quartile: 51.0, 58.0, 66.0 years, respectively). Mean axial length was 23.30±1.10 mm (range: 19.02–32.87mm; 95% confidence interval (CI): 21.36–25.89; 25%, 50%, 75% quartile: 22.65mm, 23.23mm, 23.88mm, resp.). Prevalences of moderate myopia (axial length:24.5-<26.5mm) and high myopia (axial length >26.5mm) were 555/5707 (8.7%;95%CI:9.0,10.5) and 78/5707 (1.4%;95%CI:1.1,1.7), respectively. Longer axial length (mean:23.30±1.10mm) was associated (correlation coefficient r2:0.70) with older age (P<0.001;standardized regression coefficient beta:0.14), taller body height (P<0.001;beta:0.07), higher level of education (P<0.001;beta:0.04), higher intraocular pressure (P<0.001;beta:0.03), more myopic spherical refractive error (P<0.001;beta:-0.55), lower corneal refractive power (P<0.001;beta:-0.44), deeper anterior chamber depth (P<0.001;beta:0.20), wider anterior chamber angle (P<0.001;beta:0.05), thinner peripapillary retinal nerve fiber layer thickness (P<0.001;beta:-0.04), higher degree of macular fundus tessellation (P<0.001;beta:0.08), lower prevalence of epiretinal membranes (P = 0.01;beta-0.02) and pseudoexfoliation (P = 0.007;beta:-0.02) and higher prevalence of myopic maculopathy (P<0.001;beta:0.08). In that model, prevalence of age-related macular degeneration (any type: P = 0.84; early type: P = 0.46), diabetic retinopathy (P = 0.16), and region of habitation (P = 0.27) were not significantly associated with axial length. Conclusions Mean axial length in this typically multi-ethnic Russian study population was comparable with values from populations in Singapore and Beijing. In contrast to previous studies, axial length was not significantly related with the prevalences of age-related macular degeneration and diabetic retinopathy or region of habitation.
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Affiliation(s)
- Mukharram M. Bikbov
- Ufa Eye Research Institute, Ufa, Bashkortostan, Russia
- * E-mail: (MMB); (JBJ)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
- * E-mail: (MMB); (JBJ)
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18
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Gürbüz Yurtseven Ö, Aksoy S, Karatay Arsan A, Buyru Özkurt Y, Kökçen HK. Evaluation of the Relationship Between Age-related Macular Degeneration and Refractive Error, Socio-demographic Features, and Biochemical Variables in a Turkish Population. Turk J Ophthalmol 2018; 48:238-244. [PMID: 30405945 PMCID: PMC6216530 DOI: 10.4274/tjo.97254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/09/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To investigate the relationship between age-related macular degeneration (AMD) and refractive error and axial length, as well as the socio-demographic characteristics and biochemical variables that may affect this relationship. MATERIALS AND METHODS A total of 196 eyes of 98 patients over 50 years of age who were diagnosed with AMD at our clinic were included in this cross-sectional study. Early and late AMD findings were categorized according to the age-related eye disease study grading scale. Objective refractive error was measured by autorefractometer, confirmed by subjective examination, and spherical equivalent was calculated. Refractive errors of -0.50 D to 0.50 D were classified as emmetropia, <-0.50 D as myopia, and >0.50 D as hyperopia. Axial length was measured by ultrasonic biometry and values ≤23.00 mm were classified as short, >23.00 and <24.00 mm as normal, and ≥24.00 mm as long axial length. Demographic, systemic, and biochemical parameters of all patients were also investigated. RESULTS Hypermetropic refractive error and shorter axial length were significantly more common than the other groups (p<0.01). No differences were observed between early and late stage groups in terms of refractive error and axial length. Patients with myopia had significantly lower values for total cholesterol, triglyceride, fasting blood glucose, and proportion of smokers. Rates of oral nutritional supplement use and fish consumption were significantly higher in the early AMD group. The most common comorbidity among the AMD patients in our study was essential hypertension. CONCLUSION Hyperopic refractive error and shorter axial length were found to be associated with AMD. Longitudinal studies including larger patient numbers are needed to elucidate the causal and temporal relationship between hyperopic refractive error and AMD.
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Affiliation(s)
| | - Sibel Aksoy
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Aysu Karatay Arsan
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Yelda Buyru Özkurt
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
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19
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Using spectral-domain optical coherence tomography to evaluate the type and thickness of interdigitation zone band in adult Chinese. Sci Rep 2018; 8:12253. [PMID: 30115984 PMCID: PMC6095864 DOI: 10.1038/s41598-018-30848-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/07/2018] [Indexed: 11/21/2022] Open
Abstract
To study types and thickness of interdigitation zone band in adult Chinese subjects, we conducted a cross-sectional study. The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6 ± 9.8 years. 263 people (263eyes) with a mean age of 64.8 years were randomly selected cases without macular diseases included in the study. A detailed ophthalmic examination was performed including SD-OCT for measurement of the thickness of interdigitation zone band. There are two types of interdigitation zone band; the type1 which can distinguish RPE–BM complex in 170 eyes; and the Type 2 which the two layers merged involved 93 eyes. In type1, the mean thickness of the interdigitation zone band was significantly thicker in the foveal center (16.46 ± 2.92 μm), then nasal macular region (16.19 ± 2.69 μm), temporal macular region (15.73 ± 2.68 . μm), superior region (15.72 ± 2.70 μm), and inferior macular region (14.84 ± 2.63 μm) (P all < 0.05). And the mean thickness of the interdigitation zone band in the foveal center associated with the subfoveal choroidal thickness (P = 0.025) and level of education (P = 0.033). The increase in the thickness of the interdigitation zone band may play a role in the pathophysiologic features of various age-related ocular conditions.
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The relationship between scleral staphyloma and choroidal thinning in highly myopic eyes: The Beijing Eye Study. Sci Rep 2017; 7:9825. [PMID: 28852194 PMCID: PMC5575118 DOI: 10.1038/s41598-017-10660-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/14/2017] [Indexed: 11/08/2022] Open
Abstract
Based on the Beijing Eye Study 2011, a detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging for measurement of subfoveal choroidal thickness (SFCT) and relative height of posterior scleral staphyloma. OCT images were obtained in 103 highly myopic eyes (≤-6.00 diopters) and 227 normal eyes. The mean SFCT in highly myopic eyes was 110.6 ± 85.2 μm (range, 3 to 395 μm). The SFCT of high myopia without posterior scleral staphyloma(55 eyes) was 157.79 ± 85.18 μm, which was significantly greater than that (54.94 ± 49.96 μm) of high myopia with posterior scleral staphyloma (48 eyes) (P < 0.001). In multivariate analysis, posterior scleral staphyloma was the most important factor of choroidal thinning in high myopia (F = 22.63; P < 0.001), then age (F = 19.14; P < 0.001), axial length (F = 17.37; P < 0.001) and gender (F = 17.31; P < 0.001). The SFCT in highly myopic eyes is very thin and undergoes further thinning with increasing age and axial length (refractive error). Posterior staphyloma formation was a key factor in choroidal thinning in highly myopic eyes and to be a good indicator for risk management of choroidal thinning. Abnormalities of the choroid may play a role in the pathogenesis of myopic degeneration.
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21
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Zhang K, Zhong Q, Chen S, Guo C, Xu Y, Liu Y, Sun W, Yan Y, Zhao P. An epidemiological investigation of age-related macular degeneration in aged population in China: the Hainan study. Int Ophthalmol 2017; 38:1659-1667. [PMID: 28688024 PMCID: PMC6061009 DOI: 10.1007/s10792-017-0639-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/27/2017] [Indexed: 11/29/2022]
Abstract
Purpose The aim of this study was to investigate the prevalence of age-related macular degeneration (AMD) and the risk factors in the residents aged ≥50 years in Hainan Province. Methods Random sampling was carried out in four separated cities in Hainan Province in 2015. All the subjects accomplished the standard questionnaire and ocular examinations. The diagnosis of AMD was performed based on the criteria proposed by Beckman Initiative for Macular Research Classification Committee. Results Three hundred and fifty-seven subjects (15.6%) were diagnosed with AMD, including 267 (11.7%) of early AMD, 64 (2.80%) of intermediate AMD and 24 (1.1%) of late AMD, respectively. The factors associated with the prevalence of AMD included age, educational level, smoking, outdoor activities and diet. The prevalence of AMD increased with age, lower educational level, smoking or less outdoor activities. The prevalence of AMD in those with a diet of meat or eggs was higher compared with a diet of vegetables or fish. The prevalence of early, intermediate and late AMD in the aged population in Hainan Province was 11.7, 2.8 and 1.1%, respectively. Conclusions Age and smoking were the risk factors for AMD, while the educational level and outdoor activities were the protective factors. Early AMD mostly occurred in those aged 50–59 years and 60–69 years, while intermediate and late AMD occurred in 70–79 years and older than 80 years.
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Affiliation(s)
- Kaiyan Zhang
- Department of Ophthalmology, Hainan Provincial People's Hospital, Haikou, 570311, China.
| | - Qionglei Zhong
- Department of Ophthalmology, Hainan Provincial People's Hospital, Haikou, 570311, China
| | - Siying Chen
- Department of Ophthalmology, Hainan Provincial People's Hospital, Haikou, 570311, China
| | - Chuanxian Guo
- Department of Ophthalmology, Hainan Provincial People's Hospital, Haikou, 570311, China
| | - Yan Xu
- Department of Ophthalmology, Hainan Provincial People's Hospital, Haikou, 570311, China
| | - Yang Liu
- Department of Ophthalmology, Hainan Provincial People's Hospital, Haikou, 570311, China
| | - Wen Sun
- Department of Ophthalmology, Hainan Provincial People's Hospital, Haikou, 570311, China
| | - Yijie Yan
- Department of Ophthalmology, Hainan Provincial People's Hospital, Haikou, 570311, China
| | - Puning Zhao
- Department of Ophthalmology, Hainan Provincial People's Hospital, Haikou, 570311, China
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Rim TH, Cheng CY, Kim DW, Kim SS, Wong TY. A nationwide cohort study of cigarette smoking and risk of neovascular age-related macular degeneration in East Asian men. Br J Ophthalmol 2017; 101:1367-1373. [PMID: 28292774 DOI: 10.1136/bjophthalmol-2016-309952] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/14/2017] [Accepted: 02/07/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Few longitudinal studies have evaluated the relationship between cigarette smoking and risk of neovascular age-related macular degeneration (AMD) among Asian populations. This study aimed to prospectively evaluate the association between cigarette smoking and risk of neovascular AMD among Korean men. METHODS Men between the ages of 45 and 79 years included in the Korea National Health Insurance Service database from 2002 through 2013. We compared hazard ratios (HR) for neovascular AMD between 64 560 past/current and 64 560 never smokers by 1:1 propensity-matched analysis and 85 267 past/current and 72 347 never smokers by unmatched cohort and propensity-adjusted analysis. RESULTS The risk of neovascular AMD among past/current smokers was 50% higher than that among never smokers (propensity-adjusted whole cohort analysis: HR, 1.48; 95% CI 1.22 to 1.79; propensity-matched analysis: HR, 1.50; 95% CI 1.22 to 1.84), with the risk more pronounced among current than past smokers (current vs past smokers: propensity-adjusted whole cohort analysis, HR, 1.66; 95% CI 1.35 to 2.04 vs HR, 1.15, 95% CI 0.87 to 1.52; propensity-matched analysis, HR, 1.65; 95% CI 1.32 to 2.05 vs HR, 1.21; 95% CI 0.90 to 1.63). Duration of smoking and daily cigarette consumption was associated with the incidence of neovascular AMD in a dose-dependent manner (p<0.001 for trend). CONCLUSIONS Cigarette smoking is associated with a strong risk of neovascular AMD among Korean men. These data highlight the public health impact of smoking on blindness in Asia.
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Affiliation(s)
- Tyler Hyungtaek Rim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.,Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea
| | - Ching-Yu Cheng
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dong Wook Kim
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Healthcare Big Data Based Knowledge Integration System Research Center, Yonsei University College of Medicine, Seoul, Korea.,Institute of Convergence Science, Yonsei University College of Medicine, Seoul, Korea
| | - Tien Y Wong
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Li Y, You QS, Wei WB, Xu J, Chen CX, Wang YX, Xu L, Jonas JB. Prevalence and associations of central serous chorioretinopathy in elderly Chinese. The Beijing Eye Study 2011. Acta Ophthalmol 2016; 94:386-90. [PMID: 26928876 DOI: 10.1111/aos.12891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 08/23/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the prevalence and associations of central serous chorioretinopathy (CSC) in elderly Chinese. METHODS The population-based cross-sectional Beijing Eye Study 2011 included 3468 individuals (age: 64.6 ± 9.8 years; range: 50-93 years), who underwent enhanced depth imaging of spectral-domain optical coherence tomography (SD-OCT). CSC was defined as serous detachment of the retina in the macular region without signs of haemorrhages or signs of polypoidal choroidal vasculopathy, exudative age-related macular degeneration or other retinal vascular disorders, both on fundus photographs and on optical coherence tomography (OCT) images. RESULTS Central serous chorioretinopathy was diagnosed in 10 eyes (prevalence rate: 0.15 ± 0.05%; 95% confidence interval (CI):0.06%, 0.25%) of 10 subjects (prevalence rate: 0.31 ± 0.10%; 95% CI: 0.12%, 0.50%). In five subjects, CSC was located foveally, and in five subjects, CSC was located extrafoveally. All subjects affected by foveal CSC were men, and three of the five individuals with extrafoveal CSC were men. In univariate analysis, subjects with CSC were significantly younger than the remaining study participants, and foveal CSC showed a significant (p = 0.02) predilection for men. After adjusting for age and gender, individuals with foveal CSC (383 ± 112 μm versus 270 ± 47 μm; p = 0.02) and the whole group of subjects with CSC had a significantly thicker subfoveal choroid. In a parallel manner, eyes contralateral to eyes with foveal CSC showed a significantly thicker subfoveal choroid than the age-adjusted control group (413 ± 74 μm versus 270 ± 47 μm; p = 0.001). CONCLUSIONS In Chinese aged 50+ years, the prevalence of CSC was 0.14% per subject. The choroid in the CSC affected eyes and in the contralateral unaffected eyes was significantly thicker than in an age- and gender-adjusted control population-based group.
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Affiliation(s)
- Yang Li
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Wen Bin Wei
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Jie Xu
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Chang Xi Chen
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Liang Xu
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Jost B. Jonas
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; Medical Faculty Mannheim of the Ruprecht-Karls-University; Heidelberg Germany
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Lin SC, Singh K, Chao DL, Lin SC. Refractive Error and the Risk of Age-Related Macular Degeneration in the South Korean Population. Asia Pac J Ophthalmol (Phila) 2016; 5:115-21. [PMID: 26914445 DOI: 10.1097/apo.0000000000000169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We investigated the association between refractive error and the prevalence of age-related macular degeneration (AMD) in a population-based study. DESIGN This was a cross-sectional study. METHODS Right eyes were included from 14,067 participants aged 40 years and older with gradable fundus photographs and refraction data from the fourth and the fifth Korea National Health and Nutrition Examination Survey 2008 to 2011. Early and late AMD was graded based on the International Age-Related Maculopathy Epidemiological Study Group grading system. Autorefraction data were collected to calculate spherical equivalent refraction in diopters (D) and classified into 4 groups: hyperopia (≥1.0 D), emmetropia (-0.99 to 0.99 D), mild myopia (-1.0 to -2.99 D), and moderate to high myopia (≤-3.0 D). RESULTS After adjustment for potential confounders, each diopter increase in spherical equivalent was associated with a 16% [odds ratio (OR), 1.16; 95% confidence interval (CI), 1.08-1.25] and 18% (OR, 1.18; 95% CI, 1.10-1.27) increased risk of any (early + late) and early AMD, respectively. Mild and moderate to high myopia were associated with lower odds of any and early AMD compared with hyperopia (any AMD: OR, 0.62; 95% CI, 0.4-0.95 for mild myopia; OR, 0.41; 95% CI, 0.21-0.81 for moderate to high myopia; early AMD: OR, 0.63; 95% CI, 0.4-0.99 for mild myopia; OR, 0.36; 95% CI, 0.16-0.77 for moderate to high myopia group). There was no association between refractive status and the likelihood of late AMD (P = 0.91). CONCLUSIONS Myopia is associated with lower odds of any and early AMD, but not with late AMD in the South Korean population.
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Affiliation(s)
- Shuai-Chun Lin
- From the *Department of Ophthalmology, University of California, San Francisco, San Francisco, CA; †National Yang-Ming University, Taipei, Taiwan; and ‡Department of Ophthalmology, Stanford University, Stanford, CA
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Jonas JB, Wang N, Wang YX, You QS, Yang D, Xie X, Xu L. Incident retinal vein occlusions and estimated cerebrospinal fluid pressure. The Beijing Eye Study. Acta Ophthalmol 2015; 93:e522-6. [PMID: 25996958 DOI: 10.1111/aos.12575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 09/22/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE To examine whether the incidence of retinal vein occlusions (RVOs) is associated with estimated cerebrospinal fluid pressure (CSFP). METHODS The population-based Beijing Eye Study, which included 4439 subjects (age: 40 + years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). Fundus photographs were examined for the new development of RVOs, differentiated into central RVOs (CRVOs) and branch RVOs (BRVOs). CSFP was calculated as CSFP [mmHg] = 0.44 × Body Mass Index [kg/m(2) ] + 0.16 × Diastolic Blood Pressure [mmHg]-0.18 × Age[Years]. RESULTS Incident BRVOs were detected in 50 eyes and incident CRVOs in 8 eyes. BRVOs were located at arterio-venous crossings in 39 eyes. In multivariate analysis, a higher estimated CSFP was associated with a higher incidence of CRVOs (p = 0.004; standardized coefficient beta: 0.06; regression coefficient B: 5.35; 95% confidence interval (CI):1.73, 8.96) after adjusting for urban region (p < 0.001; beta: -0.52; B: -3.93; 95% CI: -4.29, -3.57), higher educational level (p = 0.001; beta: 0.13; B: 0.44; 95% CI: 0.28, 0.60), higher blood concentrations of triglycerides (p < 0.001; beta: 0.08; B: 0.11; 95% CI: 0.05, 0.16) and higher intraocular pressure (p < 0.001; beta: 0.16; B:0.21; 95% CI: 0.16, 0.27). As a corollary, a higher incidence of RVOs as a whole, as well as a higher incidence of CRVOs combined with a higher incidence of BRVOs originating at the optic nerve head, both were significantly associated with higher estimated CSFP (p = 0.002; odds ratio (OR): 1.15; 95% CI: 1.05, 1.25; and p = 0.037; OR: 1.17; 95% CI: 1.01, 1.35, respectively) after adjusting for older age. CONCLUSIONS A higher estimated CSFP was associated with a higher incidence of RVOs originating at the optic nerve head (i.e. CRVOs, hemi-central RVOs and BRVOs originating at the optic nerve head), and vice versa, a higher incidence of RVOs was associated with a higher estimated CSFP. It suggested an influence of higher estimated CSFP on higher central retinal vein pressure.
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Affiliation(s)
- Jost B. Jonas
- Beijing Ophthalmology and Visual Science Key Lab; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg; Heidelberg Germany
| | - Ningli Wang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Ya Xing Wang
- Beijing Ophthalmology and Visual Science Key Lab; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Qi Sheng You
- Beijing Ophthalmology and Visual Science Key Lab; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Diya Yang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Xiaobin Xie
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Eye Hospital of China Academy of Chinese Medical Sciences; Beijing China
| | - Liang Xu
- Beijing Ophthalmology and Visual Science Key Lab; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
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Jonas JB, Xu L, Xu J, Wei WB, Wang YX. Prevalence of Diabetic Retinopathy and Vision Loss in the Beijing Eye Study: the Potential Role of the Cerebrospinal Fluid Pressure. Curr Diab Rep 2015; 15:71. [PMID: 26275444 DOI: 10.1007/s11892-015-0649-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the Beijing Eye Study, a population-based study carried out in 2001, 2006, and 2011, prevalence of diabetic retinopathy (DR) was 2.9 ± 0.3 % (95 % confidence interval 2.3, 3.5) per individual in 2011. Correspondingly, only 1.1 % of blindness and 0.8 % of visual impairment were caused by DR in East Asia. As in other populations, prevalence, severity, and 10-year incidence of DR were associated with higher levels of HbA1c, higher blood glucose concentration, longer known duration of diabetes, lower educational level, and higher blood pressure. Interestingly, the presence, severity, and 10-year incidence of DR were additionally correlated with higher estimated cerebrospinal fluid pressure and shorter ocular length. Higher cerebrospinal fluid pressure may lead to higher retinal vein pressure and subsequently higher retinal capillary blood pressure increasing fluid and blood extravasation. Shorter axial length or hyperopia may be associated with higher intraocular concentration of cytokines. Aging of the society, improvements in medical infrastructure, and lifestyle changes may profoundly increase prevalence of, and burden by, DR in China in the future.
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Affiliation(s)
- Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, China, 100730,
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Jonas RA, Wang YX, Yang H, Li JJ, Xu L, Panda-Jonas S, Jonas JB. Optic Disc-Fovea Distance, Axial Length and Parapapillary Zones. The Beijing Eye Study 2011. PLoS One 2015; 10:e0138701. [PMID: 26390438 PMCID: PMC4577126 DOI: 10.1371/journal.pone.0138701] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/02/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose To measure the distance between the optic disc center and the fovea (DFD) and to assess its associations. Methods The population-based cross-sectional Beijing Eye Study 2011 included 3468 individuals aged 50+ years. The DFD was measured on fundus photographs. Results Readable fundus photographs were available for 2836 (81.8%) individuals. Mean DFD was 4.76 ± 0.34mm (median: 4.74 mm; range: 3.76–6.53mm). In multivariate analysis, longer DFD was associated with longer axial length (P<0.001; standardized correlation coefficient beta: 0.62), higher prevalence of axially high myopia (P<0.001; beta:0.06), shallower anterior chamber depth (P<0.001; beta:-0.18), thinner lens thickness (P = 0.004; beta: -0.06), smaller optic disc-fovea angle (P = 0.02; beta: -0.04), larger parapapillary alpha zone (P = 0.008; beta: 0.05), larger parapapillary beta/gamma zone (P<0.001; beta: 0.11), larger optic disc area (P<0.001; beta: 0.08), lower degree of cortical cataract (P = 0.002; beta: -0.08), and lower prevalence of age-related macular degeneration (P = 0.001; beta: -0.06). Bruch´s membrane opening-fovea distance (DFD minus disc radius minus parapapillary beta/gamma zone width) in non-glaucomatous eyes was not significantly (P = 0.60) related with axial length in emmetropic or axially myopic eyes (axial length ≥23.5 mm), while it increased significantly (P<0.001; r: 0.32) with longer axial length in eyes with an axial length of <23.5mm. Ratio of mean DFD to disc diameter was 2.65 ± 0.30. If the ratio of disc-fovea distance to disc diameter was considered constant and if the individual disc diameter was calculated as the individual disc-fovea distance divided by the constant factor of 2.65, the resulting calculated disc diameter differed from the directly measured disc diameter by 0.16 ±0.13 mm (median: 0.13 mm, range: 0.00–0.89 mm) or 8.9 ± 7.3% (median: 7.4%; range: 0.00–70%) of the measured disc diameter. Conclusions DFD (mean: 4.76mm) increases with longer axial length, larger parapapillary alpha zone and parapapillary beta/gamma zone, and larger disc area. The axial elongation associated increase in DFD was due to an enlargement of parapapillary beta/gamma zone while the Bruch’s membrane opening-fovea distance did not enlarge with longer axial length. This finding may be of interest for the process of emmetropization and myopization. Due to its variability, the disc-fovea distance has only limited clinical value as a relative size unit for structures at the posterior pole.
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Affiliation(s)
- Rahul Arvo Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- * E-mail:
| | - Hua Yang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Jian Jun Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Songhomitra Panda-Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Jost Bruno Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
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Abstract
BACKGROUND To examine the intravitreal concentration of vascular endothelial growth factor (VEGF) in dependence of the axial length in eyes without intraocular neovascularization. METHODS The concentrations of VEGF in vitreous samples and blood samples of patients undergoing pars plana vitrectomy for treatment of idiopathic macular holes or epiretinal membranes were examined using enzyme-linked immunosorbent assay. Axial length was determined by biometry. RESULTS The study included 34 patients with macular holes (n = 21) or epiretinal membranes (n = 13) with a mean age of 62.4 ± 10.5 years (range: 35-76 years) and a mean axial length of 24.1 ± 1.8 mm (range: 21.0-29.1 mm). The intravitreal VEGF concentration (mean: 71.0 ± 63.2 pg/mL) was significantly (P < 0.001) lower than the VEGF concentration in the blood (830 ± 585 pg/mL). Both parameters were significantly associated with each other (P = 0.04; correlation coefficient r = 0.35). The intravitreal VEGF concentration was not significantly associated with gender (P = 0.25) or age (P = 0.48). A higher intravitreal VEGF concentration was significantly associated with a shorter axial length (P = 0.025; r = -0.39) or a higher hyperopic refractive error (P = 0.04; r = 0.35). Neither plasma concentration of VEGF nor the ratio of plasma VEGF concentrations to intravitreal VEGF concentration was significantly associated with axial length (P = 0.89 and P = 0.22, respectively) or with refractive error (P = 0.89 and P = 0.26, respectively). CONCLUSION Intravitreal VEGF concentration decreased with increasing axial length. It suggests a diluting effect in eyes with larger intraocular volume and/or a faster turnover rate of VEGF in axially myopic eyes with vitreous liquefaction.
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Zhu D, Yang DY, Guo YY, Zheng YF, Li JL, Wang B, Tao Y, Jonas JB. Intracameral interleukin 1β, 6, 8, 10, 12p, tumor necrosis factor α and vascular endothelial growth factor and axial length in patients with cataract. PLoS One 2015; 10:e0117777. [PMID: 25679504 PMCID: PMC4332662 DOI: 10.1371/journal.pone.0117777] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 12/31/2014] [Indexed: 11/24/2022] Open
Abstract
Objective To assess associations between the aqueous humour concentration of interleukin IL-1β, IL-6, IL-8, IL-10 and IL-12p, tumor necrosis factor α (TNF-α) and vascular endothelial growth factor (VEGF) and axial length in eyes with cataract. Methods The hospital-based investigation included patients who underwent cataract surgery between March 2014 and April 2014. Using aqueous humour collected at the start of cataract surgery, the interleukins IL-1β, IL-6, IL-8, IL-10 and IL-12p, TNF-α and VEGF were examined using a cytometric bead array. Axial length was determined by partial coherence laser interferometry (IOL Master). Results The study included 33 patients with cataract (33 eyes) with a mean age of 69.2±10.8 years (range:50–87 years) and a mean axial length of 24.7±1.9 mm (range:22.6–31.5 mm). Lower aqueous concentration of VEGF was significantly associated with longer axial length (VEGF concentration (pg/mL) = -5.12 x Axial Length (mm) + 163; correlation coefficient r = -0.41; P<0.001) and more myopic refractive error (VEGF concentration (pg/mL) = 1.27xspherical equivalent (diopters)+44.8; r = 0.383; P = 0.002). The aqueous concentrations of all other substances were not significantly (all P>0.10) associated with axial length or refractive error. Conclusions Higher intravitreal concentrations of VEGF were measured in eyes with a longer axial length, while the intraocular concentrations of IL-1β, IL-6, IL-8, IL-10, IL-12p and TNF-α were not correlated with axial length. The lower concentration of VEGF in axially elongated eyes may be one of the reasons for the lower prevalence of age-related macular degeneration and diabetic retinopathy in myopic eyes.
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Affiliation(s)
- Dan Zhu
- Department of Ophthalmology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Da-Yong Yang
- Department of Ophthalmology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Yuan-Yuan Guo
- Department of Ophthalmology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Yan-Fei Zheng
- Department of Ophthalmology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Jun-Lian Li
- Department of Ophthalmology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Bin Wang
- Department of Ophthalmology, People’s Hospital, Peking University, Beijing, China
| | - Yong Tao
- Department of Ophthalmology, People’s Hospital, Peking University, Beijing, China
- * E-mail:
| | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Germany
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Jonas JB, Wang NL, Wang YX, You QS, Xie XB, Yang DY, Xu L. Estimated trans-lamina cribrosa pressure difference versus intraocular pressure as biomarker for open-angle glaucoma. The Beijing Eye Study 2011. Acta Ophthalmol 2015; 93:e7-e13. [PMID: 24961652 DOI: 10.1111/aos.12480] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 05/17/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine whether an estimated trans-lamina cribrosa pressure difference (TLCPD) better than intraocular pressure (IOP) correlated with markers for glaucoma. METHODS The population-based Beijing Eye Study 2011 included 3468 individuals. Cerebrospinal fluid pressure (CSFP) was calculated as CSFP [mmHg] = 0.44 × Body Mass Index [kg/m(2) ] + 0.16 × Diastolic Blood Pressure [mmHg] - 0.18 × Age [Years] - 1.91. TLCPD was IOP-CSFP. RESULTS In the non-glaucomatous population, mean TLCPD was 5.8 ± 4.1 mmHg and mean estimated CSFP was 8.9 ± 3.7 mmHg. IOP was higher (p = 0.008), CSFP was lower (p < 0.001), and TLCPD was (p < 0.001) higher in the glaucoma group than in the non-glaucomatous group. The intergroup difference was highest for TLCPD (2.1 mmHg) followed by CSFP (1.7 mmHg) and IOP (0.4 mmHg). Open-angle glaucoma (OAG) was associated with higher TLCPD [p < 0.001; odds ratio (OR): 1.14; 95% confidence intervals (CI): 1.08, 1.19] but not with IOP (p = 0.22; OR: 0.96; 95% CI: 0.89, 1.03). In contrast, angle-closure glaucoma (ACG) was associated with higher IOP (p = 0.03; B: 0.14; OR: 1.15; 95% CI: 1.01, 1.30) but not with TLCPD (p = 0.98), after adjustment for age and anterior chamber depth. Retinal nerve fibre layer thickness was associated with lower TLCPD (p = 0.036) but not with IOP (p = 0.96), after adjusting for gender, age, region of habitation, optic disc area and refractive error. Neuroretinal area and volume were associated with smaller TLCPD (p = 0.002, and p < 0.001, respectively), after adjusting for gender, optic disc area and refractive error, but not with IOP (p = 0.43 and p = 0.25, resp.). CONCLUSIONS In OAG, but not in ACG, calculated TLCPD versus IOP showed a better association with glaucoma presence and amount of glaucomatous optic neuropathy. It supports the notion of a potential role of low CSFP in the pathogenesis of OAG.
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Affiliation(s)
- Jost B. Jonas
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg; Mannheim Germany
| | - Ning Li Wang
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Beijing Ophthalmology and Visual Sciences Key Laboratory; Capital Medical University; Beijing China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Xiao Bin Xie
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Beijing Ophthalmology and Visual Sciences Key Laboratory; Capital Medical University; Beijing China
| | - Di Ya Yang
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Beijing Ophthalmology and Visual Sciences Key Laboratory; Capital Medical University; Beijing China
| | - Liang Xu
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
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Xu J, Xu L, Wang YX, You QS, Jonas JB, Wei WB. Ten-year cumulative incidence of diabetic retinopathy. The Beijing Eye Study 2001/2011. PLoS One 2014; 9:e111320. [PMID: 25347072 PMCID: PMC4210166 DOI: 10.1371/journal.pone.0111320] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the cumulative 10-year incidence of diabetic retinopathy (DR) and its associated factors in a population living in Greater Beijing. METHODS The population-based longitudinal Beijing Eye Study, which included 4439 subjects (age in 2001: 40+years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). The study participants underwent a detailed ophthalmic examination. Fundus photographs were examined for the new development of DR. RESULTS After excluding individuals with DR at baseline (n = 87) or no sufficient fundus photographs in 2011 (n = 6), the study included 2602 subjects with a mean age of 64.6±9.7 years (median: 64.0 years; range: 50 to 93 years). In the 10-year period, 109 subjects (39 men) developed new DR with an incidence of 4.2% (95% confidence interval (CI): 3.45,5.03). In multiple logistic regression analysis, incident DR was significantly associated with higher HbA1c value (P<0.001; Odds Ratio (OR): 1.73; 95% Confidence Interval (CI): 1.35,2.21), longer duration of diabetes mellitus (P<0.001; OR: 1.16; 95% CI: 1.10,1.22), higher serum concentration of creatinine (P = 0.02; OR: 1.01; 95% CI: 1.002,1.022), lower educational level (P = 0.049; OR: 0.74; 95% CI: 0.55,0.99), higher estimated cerebrospinal fluid pressure (P = 0.038; OR: 1.10; 95% CI: 1.01,1.22), and shorter axial length (P<0.001; OR: 0.48; 95% CI: 0.33,0.71). CONCLUSIONS The cumulative 10-year incidence (mean: 4.2%) of DR in a North Chinese population was significantly associated with a higher HbA1c value, longer known duration of diabetes mellitus, higher estimated CSFP and shorter axial length (P<0.001). Shorter axial length (or hyperopia) and, potentially, higher CSFP may be additional risk factors to be taken into account when counseling and treating patients with diabetes mellitus.
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Affiliation(s)
- Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Jonas JB, Holbach L, Panda-Jonas S. Bruch's membrane thickness in high myopia. Acta Ophthalmol 2014; 92:e470-4. [PMID: 24612938 DOI: 10.1111/aos.12372] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/29/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To measure the thickness of Bruch's membrane (BM) and assess its associations with axial length. METHODS Using a light microscope, we measured the thickness of Bruch's membrane, choroid and sclera on horizontal anterior-posterior histological sections of enucleated human globes. RESULTS The study included 54 eyes (42 with glaucomatous optic nerve damage; 23 globes with axial length ≥26.5 mm) with a mean axial length of 26.6 ± 3.3 mm (range: 21.0-34.0 mm). In the non-highly myopic eyes, BM was significantly thicker at the pars plana region (6.6 ± 1.1 μm) than at the equator (4.1 ± 1.5 μm; p < 0.001), the midpoint between equator and posterior pole (4.1 ± 1.5 μm; p < 0.001), the parapapillary region (4.5 ± 1.0 μm; p = 0.006) or the posterior pole (4.4 ± 1.7 μm; p = 0.001). At any measurement location at or behind the ora serrata, BM thickness did not differ significantly (all p ≥ 0.40) between the non-glaucomatous non-highly myopic group and the glaucomatous non-highly myopic group, or between the non-highly myopic group and the highly myopic group. BM thickness at any location was not significantly (all p > 0.45) related to axial length. The ratio of scleral thickness to BM thickness and the ratio of choroidal thickness to BM thickness significantly decreased with longer axial length for measurements taken behind the equator. CONCLUSIONS BM is physiologically thickest in the pars plana, with no major thickness differences between locations at or behind the ora serrata. In contrast to choroidal and scleral thickness, BM thickness is not significantly related to axial length. Axially elongated eyes have a normal BM thickness, despite a thinned choroid and sclera.
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Affiliation(s)
- Jost B. Jonas
- Department of Ophthalmology; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Leonard Holbach
- Department of Ophthalmology; Friedrich-Alexander University Erlangen-Nürnberg; Erlangen Germany
| | - Songhomitra Panda-Jonas
- Department of Ophthalmology; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
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Wang YX, Zhang JS, You QS, Xu L, Jonas JB. Ocular diseases and 10-year mortality: the Beijing Eye Study 2001/2011. Acta Ophthalmol 2014; 92:e424-8. [PMID: 24612916 DOI: 10.1111/aos.12370] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the relationship between major ocular diseases and mortality. METHODS The population-based longitudinal study Beijing Eye Study was performed in 2001 and repeated in 2011. The participants underwent a detailed ophthalmic examination at baseline in 2001. RESULTS Of 4439 subjects examined in 2001, 2695 (60.7%) subjects returned for the follow-up examination in 2011, while 379 (8.5%) subjects were dead and 1365 (30.8%) subjects were alive, however, did not agree to be re-examined. In multivariate regression analysis, mortality was significantly associated with the systemic parameters of older age (p < 0.001; Odds ratio (OR): 1.07; 95% confidence interval (CI): 1.05, 1.09), male gender (p < 0.001; OR: 0.56; 95% CI: 0.40, 0.78), lower level of education (p < 0.001; OR: 0.66; 95% CI: 0.59, 0.74) and smoking (p < 0.001; OR: 1.84; 95% CI: 1.36, 2.49) and with the ocular parameters of presence of diabetic retinopathy (p = 0.002; OR: 2.26; 95% CI: 1.34, 3.81), non-glaucomatous optic nerve damage (p = 0.001; OR: 4.90; 95% CI: 1.90, 12.7) and higher degree of nuclear cataract (p = 0.002; OR: 1.29; 95% CI: 1.10, 1.52). In that model, mortality was not significantly (all p > 0.05) associated with refractive error, cortical or subcapsular posterior cataract, intraocular pressure, best corrected visual acuity, visual field defects, prevalence of age-related macular degeneration, retinal vein occlusions, open-angle glaucoma and angle-closure glaucoma. CONCLUSIONS After adjustment for age, gender, level of education and smoking, mortality was significantly higher in subjects with diabetic retinopathy, non-glaucomatous optic nerve damage and nuclear cataract. Other major ophthalmic parameters and disorders such as hyperopia, myopia, high myopia, pterygium, age-related macular degeneration, retinal vein occlusion, glaucoma and cortical or nuclear cataract were not significantly associated with mortality in the multivariate analysis.
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Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital University of Medical Science; Beijing China
| | - Jing Shang Zhang
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital University of Medical Science; Beijing China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital University of Medical Science; Beijing China
| | - Liang Xu
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital University of Medical Science; Beijing China
| | - Jost B. Jonas
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital University of Medical Science; Beijing China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg; Mannheim Germany
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Jonas JB, Wang N, Wang S, Wang YX, You QS, Yang D, Wei WB, Xu L. Retinal vessel diameter and estimated cerebrospinal fluid pressure in arterial hypertension: the Beijing Eye Study. Am J Hypertens 2014; 27:1170-8. [PMID: 24632393 DOI: 10.1093/ajh/hpu037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertensive retinal microvascular abnormalities include an increased retinal vein-to-artery diameter ratio. Because central retinal vein pressure depends on cerebrospinal fluid pressure (CSFP), we examined whether the retinal vein-to-artery diameter ratio and other retinal hypertensive signs are associated with CSFP. METHODS Participants of the population-based Beijing Eye Study (n = 1,574 subjects) underwent measurement of the temporal inferior and superior retinal artery and vein diameter. CSFP was calculated as 0.44 × body mass index (kg/m(2)) + 0.16 × diastolic blood pressure (mm Hg) - 0.18 × age (years) - 1.91. RESULTS Larger retinal vein diameters and higher vein-to-artery diameter ratios were significantly associated with higher estimated CSFP (P = 0.001) in multivariable analysis. In contrast, temporal inferior retinal arterial diameter was marginally associated (P = 0.03) with estimated CSFP, and temporal superior artery diameter was not significantly associated (P = 0.10) with estimated CSFP; other microvascular abnormalities, such as arteriovenous crossing signs, were also not significantly associated with estimated CSFP. In a reverse manner, higher estimated CSFP as a dependent variable in the multivariable analysis was associated with wider retinal veins and higher vein-to-artery diameter ratio. In the same model, estimated CSFP was not significantly correlated with retinal artery diameters or other retinal microvascular abnormalities. Correspondingly, arterial hypertension was associated with retinal microvascular abnormalities such as arteriovenous crossing signs (P = 0.003), thinner temporal retinal arteries (P < 0.001), higher CSFP (P < 0.001), and wider retinal veins (P = 0.001) or, as a corollary, with a higher vein-to-artery diameter ratio in multivariable analysis. CONCLUSIONS Wider retinal vein diameters are associated with higher estimated CSFP and vice versa. In arterial hypertension, an increased retinal vein-to-artery diameter ratio depends on elevated CSFP, which is correlated with blood pressure.
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Affiliation(s)
- Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Shuang Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Diya Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China;
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Intraocular pressure and estimated cerebrospinal fluid pressure. The Beijing Eye Study 2011. PLoS One 2014; 9:e104267. [PMID: 25105777 PMCID: PMC4126772 DOI: 10.1371/journal.pone.0104267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/03/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To examine a potential association between intraocular pressure (IOP) and cerebrospinal fluid pressure (CSFP) in a population-based setting. METHODS The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range: 50-93 years). A detailed ophthalmic examination was performed. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP [mm Hg] = 0.44×Body Mass Index [kg/m2]+0.16×Diastolic Blood Pressure [mm Hg]-0.18×Age [Years]. RESULTS In multivariate analysis, IOP was associated with higher estimated CSFP (P<0.001; standardized correlation coefficient beta: 0.27; regression coefficient B: 0.20; 95% confidence interval (CI): 0.16, 0.24), after adjusting for thinner central corneal thickness (P<0.001; beta: 0.45; B: 0.04;95%CI: 0.04,0.04), smaller corneal curvature radius (P<0.001; beta:-0.11; B:-1.13;95%CI:-1.61,-0.64), shallower anterior chamber depth (P = 0.01; beta:-0.05; B:-0.33;95%CI:-0.59,-0.08) and longer axial length (P = 0.002; beta: 0.08; B: 0.20;95%CI: 0.08,0.32)), and after adjusting for the systemic parameters of higher pulse rate (P<0.001; beta: 0.08; B: 0.02;95%CI: 0.01,0.03), higher prevalence of arterial hypertension (P = 0.002; beta: 0.06; B: 0.32;95%CI: 0.12,0.53)), frequency of drinking alcohol (P = 0.02; beta: 0.04; B: 0.09;95%CI: 0.01,0.17), higher blood concentration of triglycerides (P = 0.001; beta: 0.06; B: 0.06;95%CI: 0.02,0.10) and cholesterol (P = 0.049; beta: 0.04; B: 0.08;95%CI: 0.00,0.17), and body mass index (P<0.001; beta:-0.13; B:-0.09;95%CI:-0.13,-0.06). In a parallel manner, estimated CSFP (mean: 10.8±3.7 mm Hg) was significantly associated with higher IOP (P<0.001; beta: 0.13; B: 0.18;95%CI: 0.13,0.23) after adjusting for rural region of habitation (P<0.001; beta:-0.37; B:-2.78;95%CI:-3.07,-2.48), higher systolic blood pressure (P<0.001; beta: 0.34; B: 0.06;95%CI: 0.05,0.07), higher pulse rate (P = 0.003; beta: 0.05; B: 0.02;95%CI: 0.01,0.03), taller body height (P<0.001; beta: 0.11; B: 0.05;95%CI: 0.03,0.07), higher blood concentration of cholesterol (P = 0.003; beta: 0.05; B: 0.17;95%CI: 0.06,0.28) and higher level of education (P = 0.003; beta: 0.09; B: 0.30;95%CI: 0.16,0.45). CONCLUSIONS IOP was positively associated with estimated CSFP after adjusting for other ocular and systemic parameters. As a corollary, higher estimated CSFP was significantly associated with higher IOP in multivariate analysis. It fits with the notion that the arterial blood pressure, estimated CSFP and IOP are physiologically correlated with each other.
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Sharma HE, Mathewson PA, Lane M, Shah P, Glover N, Palmer H, Haque MS, Denniston AK, Tsaloumas MD. The role of social deprivation in severe neovascular age-related macular degeneration. Br J Ophthalmol 2014; 98:1625-8. [PMID: 24997180 DOI: 10.1136/bjophthalmol-2014-304959] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Advances in therapy have improved outcomes for patients with neovascular age-related macular degeneration (nAMD). Prompt access to treatment is a priority and may be used as a key performance indicator. In this study, we investigate how social deprivation may impact on access to services, treatment and visual impairment registration. METHODS Patients were identified retrospectively through the Certificate of Visual Impairment system for the University Hospitals Birmingham Medical Retina service. The Index of Multiple Deprivation (IMD) 2007 score was calculated for each patient. The impact of deprivation, age, gender and ethnicity on key stages in the care pathway was assessed. RESULTS 120 patients were identified. Patients with greater social deprivation were under-represented, had worse visual acuity at first presentation (correlation of the better-seeing eye with IMD 0.225 (p=0.013)) and had sight-impairment registration earlier (correlation -0.246; p=0.007). Deprivation did not affect time to first appointment, and was not associated with a higher rate of non-attendance. CONCLUSIONS The late presentation and under-representation of patients with greater social deprivation is a serious concern. Our study strongly suggests that this vulnerable group is encountering barriers in accessing treatment in nAMD, and that these occur prior to entry into the Hospital Eye Service.
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Affiliation(s)
- Hannah E Sharma
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Priscilla A Mathewson
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Lane
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Shah
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Nicholas Glover
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Palmer
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Sayeed Haque
- Department of Primary Care and Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marie D Tsaloumas
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Jonas JB, Wang N, Wang YX, You QS, Yang D, Xu L. Ocular hypertension: general characteristics and estimated cerebrospinal fluid pressure. The Beijing Eye Study 2011. PLoS One 2014; 9:e100533. [PMID: 24988292 PMCID: PMC4079553 DOI: 10.1371/journal.pone.0100533] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/23/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine characteristics of ocular hypertensive subjects and potential associations with estimated cerebrospinal fluid pressure (estCSFP). Methods The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years. Ocular hypertension was defined as intraocular pressure (IOP) >21 mmHg, normal optic nerve head appearance and normal retinal nerve fiber layer thickness. IOP was corrected for its dependence on central corneal thickness (CCT) and corneal curvature radius. Estimated CSFP was calculated as CSFP [mmHg] = 0.44×Body Mass Index [kg/m2]+0.16×Diastolic Blood Pressure [mmHg]−0.18×Age [Years]−1.91. Estimated trans-lamina cribrosa pressure difference (estTLCPD) was IOP–estCSFP. Results EstCSFP (10.5±3.6 mmHg versus 9.0±3.7 mmHg; P = 0.003) and estTLCPD (12.0±4.4 mmHg versus 5.4±3.8 mmHg; P<0.001) were higher in the ocular hypertensive group than in the normotensive group. In binary regression analysis, ocular hypertension was associated with increased estCSFP (P = 0.03; odds ratio (OR): 1.08; 95% confidence interval (CI): 1.01, 1.17) after adjusting for prevalence of arterial hypertension (P = 0.07; OR: 1.79; 95%CI: 0.96, 3.34), retinal nerve fiber layer thickness (P = 0.03; OR: 0.97; 95%CI: 0.95, 0.997) and blood glucose concentration (P = 0.006; OR: 1.17; 95%CI: 1.04, 1.30). Conclusions Ocular hypertensive subjects (with IOP correction for CCT and corneal curvature) as compared to ocular normotensive subjects had a significantly higher estCSFP in univariate analysis and in multivariate analysis. Despite of a higher estCSFP, estTLCPD was still markedly higher in ocular hypertensive eyes than in ocular normotensive eyes.
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Affiliation(s)
- Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Diya Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- * E-mail:
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Huang EJC, Wu SH, Lai CH, Kuo CN, Wu PL, Chen CL, Chen CY, King YC, Wu PC. Prevalence and risk factors for age-related macular degeneration in the elderly Chinese population in south-western Taiwan: the Puzih eye study. Eye (Lond) 2014; 28:705-14. [PMID: 24625378 PMCID: PMC4058619 DOI: 10.1038/eye.2014.55] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 02/07/2014] [Indexed: 01/30/2023] Open
Abstract
AIM This study aimed to ascertain the prevalence of and the risk factors associated with early and late age-related macular degeneration (AMD) among Chinese individuals aged ≥65 years residing in Puzih, Taiwan. METHODS This population-based cross-sectional study graded digital colour photographs of the ocular fundus of 673 individuals using the Wisconsin Age-Related Maculopathy Grading System. We compared the characteristics of individuals with early and late AMD using χ(2)-analyses and described risk factors for early and late AMD using odds ratios and 95% confidence intervals. RESULTS Individuals with late AMD were significantly older and more likely to have hypertension. Further, their sunlight exposure time was longer than that of those with early AMD, only drusen, or no AMD lesions (P<0.01). A history of hyperlipidaemia for >10 years was a significant risk factor for early AMD, while old age, hypertension for >10 years, and exposure to sunlight for >8 h per day were associated with late AMD. CONCLUSIONS The prevalence rate of early AMD in the present study was 15.0%, which is similar to that reported for Caucasians and Japanese included in the European Eye Study and the Hisayama Study, respectively. The late AMD prevalence rate of 7.3% found among our study participants was comparable to that reported by the Greenland Inuit Eye Study and Reykjavik Study, but considerably lower than that reported for Caucasians, indicating that late AMD might be less prevalent among Asians than Caucasians.
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Affiliation(s)
- E J-C Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital- Chiayi, Chiayi, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - S-H Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital- Chiayi, Chiayi, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - C-H Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital- Chiayi, Chiayi, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - C-N Kuo
- Department of Ophthalmology, Chang Gung Memorial Hospital- Chiayi, Chiayi, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - P-L Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital- Chiayi, Chiayi, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - C-L Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital- Chiayi, Chiayi, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - C-Y Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital- Chiayi, Chiayi, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Y-C King
- Department of Ophthalmology, Chang Gung Memorial Hospital- Chiayi, Chiayi, Taiwan
| | - P-C Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital- Chiayi, Chiayi, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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Jonas JB, Wang N, Xu J, Wang YX, You QS, Yang D, Xie XB, Xu L. Diabetic retinopathy and estimated cerebrospinal fluid pressure. The Beijing Eye Study 2011. PLoS One 2014; 9:e96273. [PMID: 24789334 PMCID: PMC4006875 DOI: 10.1371/journal.pone.0096273] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 03/28/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose The cerebrospinal fluid pressure (CSFP) is a major determinant of central retinal vein pressure and thus of retinal capillary pressure. We tested the hypothesis whether prevalence and severity of diabetic retinopathy are associated with CSFP. Methods The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years. A detailed ophthalmic examination was performed including fundus photography for the assessment of diabetic retinopathy according. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP[mmHg] = 0.44xBody Mass Index[kg/m2]+0.16 Diastolic Blood Pressure[mmHg]–0.18xAge[Years]−1.91. Results In binary regression analysis, presence of diabetic retinopathy was significantly associated with higher levels of HbA1c (P<0.001; regression coefficient B:0.25; odds ratio (OR):1.28; 95% confidence interval (CI):1.15,1.43), higher blood concentration of glucose (P<0.001; B:0.40;OR:1.49;95%CI:1.36,1.63), longer known duration of diabetes mellitus (P<0.001; B:0.14;OR:1.15; 95%CI:1.11,1.19), higher systolic blood pressure (P<0.001; B:0.03;OR:1.03;95%CI:1.02,1.04), lower diastolic blood pressure (P<0.001; B:−0.06;OR:0.94;95%CI:0.91,0.97), and higher CSFP (P = 0.002; B:0.13;OR:1.14;95%CI:1.05,1.24). Severity of diabetic retinopathy was significantly associated with higher HbA1c value (P<0.001; standardized coefficient beta: 0.19; correlation coefficient B: 0.07;95%CI:0.05,0.08), higher blood concentration of glucose (P<0.001; beta:0.18;B:0.04;95%CI:0.04,0.05), longer known duration of diabetes mellitus (P<0.001; beta:0.20;B:0.03;95%CI:0.02,0.03), lower level of education (P = 0.001; beta:−0.05;B:−0.02;95%CI:−0.03,−0.01), lower diastolic blood pressure (P = 0.002; beta:−0.08;B:−0.001;95%CI:−0.004,−0.001), higher systolic blood pressure (P = 0.006; beta:0.06;B:0.001;95%CI:0.000,0.001), and higher CSFP (P = 0.006; beta:0.06;B:0.006;95%CI:0.002,0.010). Conclusions Higher prevalence and severity of diabetic retinopathy were associated with higher estimated CSFP after adjusting for systemic parameters. Higher CSFP through a higher retinal vein pressure may lead to more marked retinal venous congestion and vascular leakage in diabetic retinae.
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Affiliation(s)
- Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
- * E-mail: (LX); (JBJ)
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Diya Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiao Bin Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- * E-mail: (LX); (JBJ)
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Li Y, Wang J, Zhong X, Tian Z, Wu P, Zhao W, Jin C. Refractive error and risk of early or late age-related macular degeneration: a systematic review and meta-analysis. PLoS One 2014; 9:e90897. [PMID: 24603619 PMCID: PMC3946285 DOI: 10.1371/journal.pone.0090897] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/05/2014] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To summarize relevant evidence investigating the associations between refractive error and age-related macular degeneration (AMD). DESIGN Systematic review and meta-analysis. METHODS We searched Medline, Web of Science, and Cochrane databases as well as the reference lists of retrieved articles to identify studies that met the inclusion criteria. Extracted data were combined using a random-effects meta-analysis. Studies that were pertinent to our topic but did not meet the criteria for quantitative analysis were reported in a systematic review instead. MAIN OUTCOME MEASURES Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between refractive error (hyperopia, myopia, per-diopter increase in spherical equivalent [SE] toward hyperopia, per-millimeter increase in axial length [AL]) and AMD (early and late, prevalent and incident). RESULTS Fourteen studies comprising over 5800 patients were eligible. Significant associations were found between hyperopia, myopia, per-diopter increase in SE, per-millimeter increase in AL, and prevalent early AMD. The pooled ORs and 95% CIs were 1.13 (1.06-1.20), 0.75 (0.56-0.94), 1.10 (1.07-1.14), and 0.79 (0.73-0.85), respectively. The per-diopter increase in SE was also significantly associated with early AMD incidence (OR, 1.06; 95% CI, 1.02-1.10). However, no significant association was found between hyperopia or myopia and early AMD incidence. Furthermore, neither prevalent nor incident late AMD was associated with refractive error. Considerable heterogeneity was found among studies investigating the association between myopia and prevalent early AMD (P = 0.001, I2 = 72.2%). Geographic location might play a role; the heterogeneity became non-significant after stratifying these studies into Asian and non-Asian subgroups. CONCLUSION Refractive error is associated with early AMD but not with late AMD. More large-scale longitudinal studies are needed to further investigate such associations.
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Affiliation(s)
- Ying Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - JiWen Wang
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - XiaoJing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhen Tian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Peipei Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenbo Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Body height, estimated cerebrospinal fluid pressure and open-angle glaucoma. The Beijing Eye Study 2011. PLoS One 2014; 9:e86678. [PMID: 24489767 PMCID: PMC3906067 DOI: 10.1371/journal.pone.0086678] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022] Open
Abstract
Purpose To examine potential associations between body height, cerebrospinal fluid pressure (CSFP), trans-lamina cribrosa pressure difference (TLCPD) and prevalence of open-angle glaucoma (OAG) in a population-based setting. Methods The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range:50–93 years). A detailed ophthalmic examination was performed. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP[mmHg] = 0.44×Body Mass Index[kg/m2]+0.16×Diastolic Blood Pressure[mmHg]-0.18×Age[Years]-1.91 Results Data of IOP and CSFP were available for 3353 (96.7%) subjects. Taller body height was associated with higher CSFP (P<0.001; standardized correlation coefficient beta:0.13; regression coefficient B:0.29; 95% confidence interval (CI):0.25,0.33) after adjusting for male gender, urban region of habitation, higher educational level, and pulse rate. If TLCPD instead of CSFP was added, taller body height was associated with lower TLCPD (P<0.001;beta:−0.10;B:−0.20;95%CI:−0.25,−0.15). Correspondingly, higher CSFP was associated with taller body height (P = 0.003;beta:0.02;B:0.01;95%CI:0.00,0.02), after adjusting for age, gender, body mass index, pulse, systolic blood pressure, and blood concentration of cholesterol. If IOP was added to the model, higher CSFP was associated with higher IOP (P<0.001;beta:0.02;B:0.02;95%CI:0.01,0.03). TLCPD was associated with lower body height (P = 0.003;beta:−0.04;B −0.02,95%CI:−0.04,−0.01) after adjusting for age, body mass index, systolic blood pressure, pulse, blood concentrations of triglycerides, axial length, central corneal thickness, corneal curvature radius, and anterior chamber depth. Adding the prevalence of OAG to the multivariate analysis revealed, that taller body height was associated with a lower OAG prevalence (P = 0.03;beta:−0.03;B:−1.20;95%CI:−2.28,−0.12) after adjusting for educational level and gender. Conclusions Taller body height was associated with higher CSFP and lower TLCPD (and vice versa), after adjusting for systemic and ocular parameters. Parallel to the associations between a higher prevalence of glaucoma with a lower CSFP or higher TLCPD, taller body height was associated with a lower prevalence of OAG.
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Nidhi B, Mamatha BS, Padmaprabhu CA, Pallavi P, Vallikannan B. Dietary and lifestyle risk factors associated with age-related macular degeneration: a hospital based study. Indian J Ophthalmol 2013; 61:722-7. [PMID: 24178404 PMCID: PMC3917390 DOI: 10.4103/0301-4738.120218] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/24/2013] [Indexed: 11/25/2022] Open
Abstract
AIM To establish the frequency, associations and risk factors for age-related macular degeneration (AMD) in hospital population of South India. MATERIALS AND METHODS In this cross-sectional hospital based study, 3549 subjects (2090 men and 1459 women) above 45 years of age were screened randomly for AMD. Participants underwent ocular evaluation and were interviewed for lifestyle variables and dietary intake of carotenoids by structured food frequency questionnaire. AMD was defined according to the international classifications and grading system. RESULTS Either form of AMD was detected in 77 (2.2%) participants. Of which, early and late AMD was present in 63 (1.8%) and 14 (0.4%) subjects, respectively. Binary logistic analysis showed that the incidence of AMD was significantly higher with increasing age (Odds ratio [OR] 1.17; 95% CI 1.13-1.22) and diabetes (OR 3.97; 95% CI 2.11-7.46). However, AMD was significant among heavy cigarette smokers (OR 5.58; 95% CI 0.88-7.51) and alcoholics (OR 4.85; 95% CI 2.45-12.22). Dietary lutein/zeaxanthin (L/Z) and β-carotene intake were associated (P < 0.001) with the reduction in risk for AMD, with an OR of 0.38 and 0.65, respectively. CONCLUSIONS Higher dietary intake of carotenoids, especially L/Z, was associated with lower risk for AMD. Risk of AMD is higher with increasing age and was prevalent among subjects with diabetes. Cessation of smoking and alcohol may reduce the risk of AMD in this population.
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Affiliation(s)
- Bhatiwada Nidhi
- Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, CSIR, Mysore, Karnataka, India
| | - Bangera Sheshappa Mamatha
- Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, CSIR, Mysore, Karnataka, India
| | | | - Prabhu Pallavi
- Department of Ophthalmology, Sushrutha Eye Hospital, Mysore, Karnataka, India
| | - Baskaran Vallikannan
- Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, CSIR, Mysore, Karnataka, India
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You QS, Xu L, Wang YX, Yang H, Ma K, Li JJ, Zhang L, Jonas JB. Pseudoexfoliation: normative data and associations: the Beijing eye study 2011. Ophthalmology 2013; 120:1551-8. [PMID: 23622877 DOI: 10.1016/j.ophtha.2013.01.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/06/2013] [Accepted: 01/11/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To assess the prevalence of pseudoexfoliation syndrome (PEX) and its associations in a population-based setting. DESIGN Population-based, cross-sectional cohort study. PARTICIPANTS Of 4403 eligible subjects with an age of ≥ 50 years, 3468 individuals (78.8%) participated in the Beijing Eye Study 2011 (mean age, 64.6 ± 9.8 years; range, 50-93 years). METHODS All study participants underwent a detailed ophthalmologic examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp-based biomicroscopy. MAIN OUTCOME MEASURES Prevalence and associations of PEX. RESULTS Slit-lamp examination results were available for 3022 study participants (87.1%). Definite pseudoexfoliation was observed in 72 of the 3022 subjects, with a prevalence of 2.38% (95% confidence interval [CI], 1.84-2.93). Suspected PEX was detected in 104 of the subjects (3.44%; 95% CI, 2.8-4.1). The overall prevalence of PEX (definite and suspected) was 176 of 3022 or 5.82% (95% CI, 4.99-6.66). In 80 subjects (45.5%), PEX was detected in both eyes, whereas it was detected only in the right eye in 42 subjects (23.9%) and only in the left eye in 54 (30.7%). The prevalence of PEX increased from 1.1% in among those 50 to 54 years old, to 3.5%, 5.7%, and 11.8% among those 60 to 64 years, 70 to 74 years, and ≥ 80 years, respectively. In multivariate analysis, presence of PEX was significantly associated with older age (P<0.001; odds ratio [OR], 1.08; 95% CI, 1.04-1.10), shorter axial length (P = 0.03; OR, 0.82; 95% CI, 0.68,0.98), and shallower anterior chamber (P = 0.03; OR, 0.59; 95% CI, 0.36-0.95). We found that PEX was not associated (all P>0.05) with sex, diabetes mellitus, blood pressure, psychological depression, smoking, dyslipidemia, body mass index, central corneal thickness, corneal diameter, optic nerve head measurements, choroidal thickness, retinal vessel diameters, early age-related macular degeneration, or retinal vein occlusion. CONCLUSIONS In a North Chinese population aged ≥ 50 years, the prevalence of definite PEX was 2.38% (95% CI, 1.84-2.93), suspect PEX was 3.4% (95% CI, 2.8-4.1) and overall PEX was 5.82% (95% CI, 4.99-6.66). We found PEX to be associated with older age, shorter axial length, and shallower anterior chamber. The relationship between PEX and glaucomatous optic neuropathy remained inconclusive among our population. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing, China
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Zhou JQ, Xu L, Wang S, Wang YX, You QS, Tu Y, Yang H, Jonas JB. The 10-Year Incidence and Risk Factors of Retinal Vein Occlusion. Ophthalmology 2013; 120:803-8. [DOI: 10.1016/j.ophtha.2012.09.033] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 08/21/2012] [Accepted: 09/19/2012] [Indexed: 12/21/2022] Open
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Gemmy Cheung CM, Li X, Cheng CY, Zheng Y, Mitchell P, Wang JJ, Jonas JB, Nangia V, Wong TY. Prevalence and risk factors for age-related macular degeneration in Indians: a comparative study in Singapore and India. Am J Ophthalmol 2013; 155:764-73, 773.e1-3. [PMID: 23246273 DOI: 10.1016/j.ajo.2012.10.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/12/2012] [Accepted: 10/16/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare the prevalence and risk factors for age-related macular degeneration (AMD) in 2 Indian populations, 1 living in urban Singapore and 1 in rural central India. DESIGN Population-based, cross-sectional studies of Indians aged 40+ years. METHODS Our analysis included 3337 Singapore-residing participants and 3422 India-residing participants. All participants underwent comprehensive systemic and ocular examinations and retinal photography. AMD was graded from retinal photographs according to the Wisconsin Age-Related Maculopathy Grading System. Systemic and ocular risk factors were assessed for association with AMD. RESULTS Singapore-residing participants were older (mean age 57.8 years vs 53.8 years) and, after adjusting for age and sex, were more likely to have previous cataract surgery, higher body mass index, hypertension, diabetes, previous myocardial infarction, higher cholesterol, and lower creatinine levels, but less likely to be current smokers, than India-residing participants. The age-standardized prevalence of early and late AMD was 4.45% and 0.34%, respectively, in Singapore and 5.80% and 0.16%, respectively, in India. Shorter axial length was associated with early AMD in both Singapore and India, whereas previous cataract surgery, higher body mass index, hypertension, and lower cholesterol were associated with early AMD in Singapore but not in India. CONCLUSION The prevalence of AMD was similar among Indian adults living in urban Singapore and rural India, despite differences in cardiovascular risk factor profile and demographics.
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Shao L, Xu L, You QS, Wang YX, Chen CX, Yang H, Zhou JQ, Jonas JB, Wei WB. Prevalence and associations of incomplete posterior vitreous detachment in adult Chinese: the Beijing Eye Study. PLoS One 2013; 8:e58498. [PMID: 23544043 PMCID: PMC3609755 DOI: 10.1371/journal.pone.0058498] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 02/05/2013] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To determine prevalence and associations of incomplete posterior vitreous detachment (PVD). METHODS The population-based cross-sectional Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range: 50-93 years). A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (SD-OCT). Incomplete PVD was differentiated into type 1 (shallow PVD with circular perifoveal vitreous attachment), type 2 (PVD reaching fovea but not foveola), type 3 (shallow PVD with pinpoint vitreous attachment at the foveola), and type 4 (PVD completely detached from the macula, attached to the optic disc). RESULTS An incomplete PVD was detected in 3948 eyes (prevalence: 60.5±0.6%; 95% Confidence Interval (CI): 59.3%,61.7%) of 2198 subjects (67.1±0.8%;95%CI: 65.6%,68.7%). Type 1 PVD was seen in 3090 (78.3%) eyes, type 2 PVD in 504 (12.8%) eyes, type 3 PVD in 70 (1.8%) eyes, and type 4 PVD in 284 (7.2%) eyes. Prevalence of incomplete PVD was associated with younger age (P<0.001;OR:0.91), male gender (P<0.001;OR:0.64), rural region of habitation (P<0.001;OR:0.49), larger corneal diameter (P = 0.04;OR:0.91), better best corrected visual acuity (P = 0.02;OR:0.41), and hyperopic refractive error (P<0.001;OR:1.15). The type of incomplete PVD was associated with higher age (P<0.001), urban region of habitation (P<0.001), myopic refractive error (P = 0.001), thinner cornea (P = 0.005), and better best corrected visual acuity (P = 0.056). CONCLUSIONS In adult Chinese in Greater Beijing, prevalence of an incomplete PVD (detected in 67.1% subjects) was associated with younger age, male gender, rural region of habitation, larger corneal diameter, better best corrected visual acuity and hyperopic refractive error.
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Affiliation(s)
- Lei Shao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chang Xi Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hua Yang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jin Qiong Zhou
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Miller JW. Age-related macular degeneration revisited--piecing the puzzle: the LXIX Edward Jackson memorial lecture. Am J Ophthalmol 2013; 155:1-35.e13. [PMID: 23245386 DOI: 10.1016/j.ajo.2012.10.018] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/19/2012] [Accepted: 10/23/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To present the current understanding of age-related macular degeneration (AMD) pathogenesis, based on clinical evidence, epidemiologic data, histopathologic examination, and genetic data; to provide an update on current and emerging therapies; and to propose an integrated model of the pathogenesis of AMD. DESIGN Review of published clinical and experimental studies. METHODS Analysis and synthesis of clinical and experimental data. RESULTS We are closer to a complete understanding of the pathogenesis of AMD, having progressed from clinical observations to epidemiologic observations and clinical pathologic correlation. More recently, modern genetic and genomic studies have facilitated the exploration of molecular pathways. It seems that AMD is a complex disease that results from the interaction of genetic susceptibility with aging and environmental factors. Disease progression also seems to be driven by a combination of genetic and environmental factors. CONCLUSIONS Therapies based on pathophysiologic features have changed the paradigm for treating neovascular AMD. With improved understanding of the underlying genetic susceptibility, we can identify targets to halt early disease and to prevent progression and vision loss.
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