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Muacevic A, Adler JR. Co-existence of Age-Related Macular Degeneration and Diabetic Retinopathy in a Tertiary Referral Center in Greece. Cureus 2022; 14:e31051. [PMID: 36475145 PMCID: PMC9720086 DOI: 10.7759/cureus.31051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the co-existence of diabetic retinopathy (DR) and age-related macular degeneration (AMD), based on five-year data in a University setting. METHODS Participants in the study included 1739 patients with diabetes mellitus, who were examined in our setting from 2015 to 2019. The presence of DR and AMD was recorded while the clinical characteristics of patients were evaluated. RESULTS In our study sample, 183 out of 1739 patients with diabetes mellitus (10.5%) were diagnosed with AMD, 116 without any sign of DR, and 67 with DR. In the group of patients with DR, dry AMD was noticed mostly in patients with mild non-proliferative DR (NPDR) (11.5% dry AMD) compared to those with moderate NPDR (4.5% dry AMD), severe NPDR (4.2%) and proliferative DR (PDR) (2.4%). Similar results were found for neovascular AMD (3% in mild NPDR, 1.9% in moderate NPDR, 1% in severe NPDR, and 1.8% in PDR). There was a significant correlation between the co-existence of both diseases and the severity of DR, with AMD being less prevalent in patients with more severe DR. In patients with diabetic macular edema, dry AMD was observed in 12 (4.6%) and neovascular AMD in nine (3.4%). CONCLUSIONS The five-year prevalence of AMD in DR patients was 9% while in diabetic patients without DR it was found to be 11.5%. Therefore, the co-existence of DR and AMD is not common, suggesting that DR may be protective for AMD development.
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Yongpeng Z, Yaxing W, Jinqiong Z, Qian W, Yanni Y, Xuan Y, Jingyan Y, Wenjia Z, Ping W, Chang S, Ming Y, Yanan L, Jinyuan W, Shouling W, Shuohua C, Haiwei W, Lijian F, Qianqian W, Jingyuan Z, Zihan N, Yuning C, Ying X, Jonas JB, Wenbin W. The Association Between Diabetic Retinopathy and the Prevalence of Age-Related Macular Degeneration—The Kailuan Eye Study. Front Public Health 2022; 10:922289. [PMID: 35923972 PMCID: PMC9339787 DOI: 10.3389/fpubh.2022.922289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to investigate the prevalence of age-related macular degeneration (AMD) in patients with diabetes mellitus (DM) and diabetic retinopathy (DR) and analyze whether DR is a risk factor for AMD. This population-based epidemiological study included 14,440 people from the Kailuan Eye Study in 2016, of whom 1,618 were patients with type 2 DM aged over 50 years, and 409 had DM with DR. We analyzed whether there were differences in the prevalence of AMD between DM with DR and DM without DR, and conducted a hierarchical statistical analysis according to different stages of DR. Using variable regression analysis, we explored whether DR constituted a risk factor for AMD. In the DM population, the prevalence of wet AMD in patients with DM with and without DR was 0. 3 and 0.2%, respectively, with no significant difference (P = 0.607). Meanwhile, the prevalence of dry AMD in patients with DM with and without DR was 20.8 and 16.0%, respectively, with a significant difference. In the subgroup analysis of dry AMD, the prevalence of early, middle, and late dry AMD in DM with DR was 14.4, 5.9, and 0.5%, respectively. In DM without DR, the prevalence of early, middle, and late dry AMD was 10.5, 4.8, and 0.7%, respectively (P = 0.031). In the subgroup analysis of DR staging, statistical analysis could not be performed because of the limited number of patients with PDR. In the variable regression analysis of risk factors for dry AMD, after adjusting for age, sex, body mass index, hypertension, and dyslipidemia, DR constituted the risk factor for dry AMD. In conclusion, DM did not constitute a risk factor for AMD, and the prevalence of wet AMD and dry AMD in patients with DM and DR was higher than that in patients with DM without DR (among which dry AMD was statistically significant). Multivariate regression analysis confirmed that DR is an independent risk factor for dry AMD. Reasonable control of DM and slowing down the occurrence and development of DR may effectively reduce the prevalence of AMD in patients with DM.
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Affiliation(s)
- Zhang Yongpeng
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wang Yaxing
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhou Jinqiong
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wang Qian
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yan Yanni
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Xuan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Jingyan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhou Wenjia
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wang Ping
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shen Chang
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Ming
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luan Yanan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wang Jinyuan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wu Shouling
- Cardiology Department, Kailuan General Hospital, Tangshan, China
| | - Chen Shuohua
- Health Care Center, Kailuan Group, Tangshan, China
| | - Wang Haiwei
- Department of Ophthalmology, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Fang Lijian
- Department of Ophthalmology, Beijing Liangxiang Hospital, Capital Medical University, Beijing, China
| | - Wan Qianqian
- Department of Ophthalmology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Zhu Jingyuan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nie Zihan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chen Yuning
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xie Ying
- Department of Ophthalmology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - Wei Wenbin
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Wei Wenbin
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Jiang J, Chen Y, Zhang H, Yuan W, Zhao T, Wang N, Fan G, Zheng D, Wang Z. Association between metformin use and the risk of age-related macular degeneration in patients with type 2 diabetes: a retrospective study. BMJ Open 2022; 12:e054420. [PMID: 35473747 PMCID: PMC9045056 DOI: 10.1136/bmjopen-2021-054420] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the effect of metformin on the decreased risk of developing age-related macular degeneration (AMD) in patients with type 2 diabetes mellitus (T2DM) for ≥10 years. DESIGN A retrospective study. PARTICIPANTS Patients aged ≥50 with a diagnosis of T2DM no less than 10 years were included. METHODS Variables predisposing to AMD were reviewed; the potential confounders related to T2DM or AMD were selected from literature records; AMD and diabetic retinopathy (DR) were diagnosed by funduscopy, optical coherence tomography and/or fluorescein angiography. The subgroup analysis was performed in early and late AMD. The protective effect of metformin was evaluated in duration-response and dose-response patterns. RESULTS A total of 324 patients (115 metformin non-users and 209 users) were included in the final analysis. AMD was observed in 15.8% of metformin users and 45.2% of metformin non-users (p<0.0001). The ORs for any AMD, early AMD and late AMD present in patients with DR were 0.06 (0.02-0.20), 0.03 (0.00-0.20) and 0.17 (0.04-0.75). The serum high-density lipoprotein level was positively associated with the late AMD risk (p=0.0054). When analysed by the tertiles of cumulative duration, a similarly reduced risk was observed for the second (5-9 years) (OR: 0.24, 95% CI: 0.08 to 0.75) and third tertiles (≥10 years) (OR: 0.22, 95% CI: 0.09 to 0.52) compared with the first tertile (≤4 years). CONCLUSION Among patients with T2DM for ≥10 years, metformin users were less likely to develop any AMD and early AMD than non-users; however, the late AMD was not significantly associated with the use of metformin. Also, AMD was less prevalent in patients with DR. The prolonged metformin treatment with a high cumulative dose enhanced the protective effect against AMD. Metformin significantly reduces the AMD risk when the cumulative duration is >5 years.
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Affiliation(s)
- Jingjing Jiang
- Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Yi Chen
- Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Hongsong Zhang
- Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Wei Yuan
- Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Tong Zhao
- Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Na Wang
- Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Guohui Fan
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Dongxing Zheng
- Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Zhijun Wang
- Ophthalmology, China-Japan Friendship Hospital, Beijing, China
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Sahoo NK, Mehta MC, Rani PK, Khanna RC, Raman R, Bhattacharya J, Das AV, Murthy GVS, Narayanan R. Impact of age-related macular degeneration on diabetic retinopathy: An electronic health record based big data analysis from a tertiary eye centre in South India. Indian J Ophthalmol 2021; 69:3184-3188. [PMID: 34708768 PMCID: PMC8725103 DOI: 10.4103/ijo.ijo_1175_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To determine whether the presence of age-related macular degeneration (AMD) decreases the risk of diabetic retinopathy. Methods: This was a retrospective, case-cohort study performed in patients with a systemic diagnosis of diabetes at a tertiary health care center from May 2011 to April 2020. A total of 43,153 patients (1,024 AMD patients and 42,129 non-AMD patients) were included in the analysis. A total of 1,024 age and diabetes mellitus (DM) duration-matched controls were chosen from the non-AMD group for risk factor analysis. The severity of diabetic retinopathy was compared between the patients with AMD and the patients without AMD. Results: Out of the enrolled 43,153 diabetic patients, 26,906 were males and 16,247 were females. A total of 1,024 patients had AMD and 42,129 had no AMD. The mean age of the cohort was 58.60 ± 0.09 years. The overall prevalence of DR was noted to be 22.8% (9,825 out of 43,153 eyes). A significantly lower prevalence of diabetic retinopathy (DR) (23% in non-AMD, 11.4% in AMD, OR = −0.43, P < 0.001), non-proliferative diabetic retinopathy (NPDR) (12% in non-AMD, 8.2% in AMD, OR = −0.66, P < 0.001), and proliferative diabetic retinopathy (PDR) (11% in non-AMD, 3.2% in AMD, OR = −0.27, P < 0.001) was seen in the AMD patients. No significant difference was seen between the dry and wet AMD. On multivariate logistic regression analysis, the lower age, absence of AMD, and male gender were associated with a higher risk of PDR. Conclusion: The presence of AMD was noted to statistically reduce the risk of DR. Our results may be useful in the field of resource allocation and awareness of DR.
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Affiliation(s)
- Niroj K Sahoo
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma, Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Mehul C Mehta
- Department of Vitreo-retina, L VPrasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Padmaja K Rani
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajiv Raman
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jayanta Bhattacharya
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Department of Medicine, Center for Primary Care and Outcomes Research, Stanford University, USA
| | - Anthony V Das
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gudlavalleti V S Murthy
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Indian Institute of Public Health Hyderabad, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Raja Narayanan
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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5
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Blitzer AL, Ham SA, Colby KA, Skondra D. Association of Metformin Use With Age-Related Macular Degeneration: A Case-Control Study. JAMA Ophthalmol 2021; 139:302-309. [PMID: 33475696 PMCID: PMC7821082 DOI: 10.1001/jamaophthalmol.2020.6331] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Age-related macular degeneration (AMD), the leading cause of irreversible blindness in older adults, appears to have no effective preventive measures. The common antidiabetic drug metformin has been shown to have protective outcomes in multiple age-associated diseases and may have the potential to protect against the development of AMD. Objective To determine whether metformin use is associated with reduced odds of developing AMD. Design, Setting, and Participants This case-control study of patients from a nationwide health insurance claims database included a population-based sample of patients. Those aged 55 years and older with newly diagnosed AMD from January 2008 to December 2017 were defined as cases and matched with control participants. Data analyses were completed from June 2019 to February 2020. Exposures Dosage of metformin and exposure to other prescribed medications, as identified from outpatient drug claims. Main Outcomes and Measures Risk of developing AMD. Results A total of 312 404 affected individuals were included (181 817 women [58.2%]). After matching, 312 376 control participants were included (172 459 women [55.2%]; age range, 55 to 107 years). The case group had a slightly higher percentage of participants with diabetes (81 262 participants [26.0%]) compared with the control group (79 497 participants [25.5%]). Metformin use was associated with reduced odds of developing AMD (odds ratio [OR], 0.94 [95% CI, 0.92-0.96]). This association was dose dependent, with low to moderate doses of metformin showing the greatest potential benefit (dosages over 2 years: 1-270 g, OR, 0.91 [95% CI, 0.88-0.94]; 271-600 g, OR, 0.90 [95% CI, 0.87-0.93]; 601-1080 g, OR, 0.95 [95% CI, 0.92-0.98]). Doses of more than 1080 g of metformin over 2 years did not have reduced odds of developing AMD. Both the reduction in odds ratio and the dose-dependent response were preserved in a cohort consisting only of patients with diabetes. Metformin use was associated with a decreased OR of AMD in patients with diabetes without coexisting diabetic retinopathy (OR, 0.93 [95% CI, 0.91-0.95]) but was a risk factor in patients with diabetic retinopathy (OR, 1.07 [95% CI, 1.01-1.15]). Conclusion and Relevance In this study, metformin use was associated with reduced odds of developing AMD. This association was dose dependent, with the greatest benefit at low to moderate doses. When looking only at patients with diabetes, we saw a preservation of the dose-dependent decrease in the odds of patients developing AMD. Metformin does not appear to be protective in patients with diabetes and coexisting diabetic retinopathy. This study suggests that metformin may be useful as a preventive therapy for AMD and provides the basis for potential prospective clinical trials.
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Affiliation(s)
- Andrea L. Blitzer
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
| | - Sandra A. Ham
- Center for Health and the Social Sciences, The University of Chicago, Chicago, Illinois
| | | | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
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6
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Behboudi H, Nikkhah H, Alizadeh Y, Katibeh M, Pakbin M, Ahmadieh H, Sabbaghi H, Nourinia R, Karimi S, Behnaz N, Piryaiee G, Yaseri M, Kheiri B, Moradian S. A Population-based Study on the Prevalence and Associated Factors of Age-related Macular Degeneration in Northern Iran the Gilan Eye Study. Ophthalmic Epidemiol 2020; 27:209-218. [PMID: 31960781 DOI: 10.1080/09286586.2020.1716379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To estimate the prevalence and associated factors of AMD in an Iranian population in 2014.Methods: In this population-based cross-sectional study, a total of 2975 Iranian residents (age: ≥50 years) from the urban and rural areas of Gilan province were included. The prevalence of different grades of AMD was determined using the International Age-Related Maculopathy Epidemiological Study Group grading system.Results: Of 2975 eligible individuals, 2587 (87.0%) subjects participated and 2275 (76.5%) subjects (62.6 ± 8.8 years old) had gradable fundus photographs. Age- and sex-standardized prevalence of early and late AMD based on the 2016 Iran census were 13.2% (95% confidence interval [CI], 10.6-16.2) and 0.7% (95% CI, 0.4-1.3), respectively. In multivariate analysis, each decade increase in age was associated with the adjusted odds of any (adjusted odds ratio [AOR] = 1.31, 95% CI, 1.09-1.56; P = .0031), early (AOR = 1.27, 95% CI, 1.06-1.53; P = .012) and late AMD (AOR = 2.39, 95% CI, 1.08-5.28; P = .031). Hyperopia was identified to be less frequent in late AMD (AOR = 0.20, 95% CI, 0.04-0.80; P = .024). No significant association was found between AMD and sex, smoking, outdoor working, diabetes, hypertension, pseudophakia, hyperlipidemia and myopia.Conclusion: Gilan Eye Study demonstrated the first estimate of age-specific AMD prevalence in Iran being compatible with other WHO regions. With the expected increase in the life expectancy and aging of Iranians, the number of people affected by AMD will be increasing in future. Healthcare policy makers should be advised to provide more efficient eye care services and preventive strategies in this regard.
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Affiliation(s)
- Hassan Behboudi
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Eye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yousef Alizadeh
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Marzieh Katibeh
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mojgan Pakbin
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran.,Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Eye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Behnaz
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golbarg Piryaiee
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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7
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Lüdtke L, Jürgens C, Ittermann T, Völzke H, Tost F. Age-Related Macular Degeneration and Associated Risk Factors in the Population-Based Study of Health in Pomerania (SHIP-Trend). Med Sci Monit 2019; 25:6383-6390. [PMID: 31446436 PMCID: PMC6724561 DOI: 10.12659/msm.915493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Age-related macular degeneration (AMD) is the leading cause of visual impairment in developed countries, especially in the older population. The Study of Health in Pomerania (SHIP) is a population-based study designed to investigate risk factors and clinical disorders in the general population. In the present study, we analysed the AMD prevalence and risk factors in the north-eastern German population. Material/Methods From 2008 to 2012, we collected data among participants ages 29–79 years. The study population consisted of 4420 individuals. Non-mydriatic retinal photographs were taken of 3934 participants. AMD stages were graded according to the Rotterdam Classification System and the International Classification System. Results Photographs from 1854 participants were available for grading. The baseline examinations showed small hard drusen (<63 μm, stage 0b and 0c) were present in 10.7% of the participants (stage 0b in 7.5% and stage 0c in 3.2%). Earliest signs of AMD were detected in 28.68% (stage 0b in 7.5% and stage 1b in 21.18%). Late AMD (geographic atrophy and neovascular AMD, stages 4a and 4b) were identified in 0.43% (stage 4a in 0.16% and stage 4b 0.27%). Risk of AMD increased significantly with age and higher body mass index, waist circumference, hip circumference, and weight-waist-ratio. Smoking, sex, systolic and diastolic blood pressure, HbA1c, cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride were not associated with AMD in this study. Conclusions The prevalence of AMD increases with age and obesity-associated factors. These results must be verified in the follow-up. Data concerning the incidence of AMD will be available after the 5- and 10-year follow-ups.
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Affiliation(s)
- Lisa Lüdtke
- Department of Ophthalmology, University of Medicine, Greifswald, Germany
| | - Clemens Jürgens
- Institute of Community Medicine, University of Medicine, Greifswald, Germany
| | - Till Ittermann
- Institute of Community Medicine, University of Medicine, Greifswald, Germany
| | - Henry Völzke
- Institute of Community Medicine, University of Medicine, Greifswald, Germany.,German Center of Cardiovascular Research, University of Medicine, Greifswald, Germany
| | - Frank Tost
- Department of Ophthalmology, University of Medicine, Greifswald, Germany
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8
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Meng W, Chan BW, Ezeonwumelu C, Hébert HL, Campbell A, Soler V, Palmer CN. A genome-wide association study implicates that the TTC39C gene is associated with diabetic maculopathy with decreased visual acuity. Ophthalmic Genet 2019; 40:252-258. [PMID: 31264924 DOI: 10.1080/13816810.2019.1633549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Diabetic maculopathy is a form of diabetic retinopathy. The visual acuity of one third of patients with diabetic maculopathy will be affected. The purpose of this study was to identify genetic contributors of diabetic maculopathy with decreased visual acuity based on a genome-wide association approach using a well-defined Scottish diabetic cohort. Methods: We used linked e-health records of diabetic patients to define our cases and controls. The cases in this study were defined as type 2 diabetic patients who had ever been recorded in the linked e-health records as having maculopathy (observable or referable) in at least one eye and whose visual acuity of the eye was recorded to have decreased between the first and the last visual acuity record of that eye in the longitudinal e-health records. The controls were defined as a type 2 diabetic individual who had never been diagnosed with maculopathy or retinopathy in the linked e-health records. Anyone who had laser photocoagulation treatment was also excluded from the controls. A standard genome-wide association approach was applied. Results: Overall, we identified 469 cases and 1,374 controls within the Genetics of Diabetes Audit and Research in Tayside Scotland (GoDARTS) dataset. We found that the P value of rs9966620 in the TTC39C gene was 4.13x10-8, which reached genome-wide significance. Conclusions: We suggest that the TTC39C gene is associated with diabetic maculopathy with decreased visual acuity. This needs to be confirmed by further replication studies and functional studies.
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Affiliation(s)
- Weihua Meng
- a Division of Population Health and Genomics , Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee , Dundee , UK
| | - Brian W Chan
- a Division of Population Health and Genomics , Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee , Dundee , UK
| | - Chinenyenwa Ezeonwumelu
- a Division of Population Health and Genomics , Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee , Dundee , UK
| | - Harry L Hébert
- a Division of Population Health and Genomics , Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee , Dundee , UK
| | - Amy Campbell
- a Division of Population Health and Genomics , Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee , Dundee , UK
| | - Vencent Soler
- b Retina unit, Ophthalmology department , Hôpital Pierre Paul Riquet, CHU Toulouse, 31059 Toulouse Cedex 9; Unité "Différenciation Epithéliale et Autoimmunité Rhumatoïde", UMR 1056 Inserm - Université de Toulouse , France
| | - Colin Na Palmer
- a Division of Population Health and Genomics , Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee , Dundee , UK
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He MS, Chang FL, Lin HZ, Wu JL, Hsieh TC, Lee YC. The Association Between Diabetes and Age-Related Macular Degeneration Among the Elderly in Taiwan. Diabetes Care 2018; 41:2202-2211. [PMID: 30061321 DOI: 10.2337/dc18-0707] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/29/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between diabetes and future development of age-related macular degeneration (AMD). RESEARCH DESIGN AND METHODS Longitudinal, retrospective cohort study data for the period between 1997 and 2012 were obtained from the Longitudinal Health Insurance Database (LHID) of Taiwan. The final available 71,904 patients with diabetes and 270,213 patients without diabetes ≥50 years of age were further matched by age, sex, and Charlson comorbidity index. In the end, 54,616 study subjects in each of the diabetes and nondiabetes groups were recruited. The stratified populations of patients with diabetes with diabetic retinopathy (DR) (n = 7,119) versus those with diabetes who do not have DR (n = 7,119) and populations of patients with proliferative DR (PDR) (n = 2,134) versus those with nonproliferative DR (NPDR) (n = 2,134) were also obtained. Competing risk regression models were used to assess the adjusted hazard ratio (HR) and 99% CI. The main outcome measures were the first-ever diagnosis of AMD during the observational period. RESULTS The incidences of nonexudative AMD (HR 1.23; P = 0.108) and exudative AMD (HR 1.37; P = 0.023) were not significantly associated with cohorts of persons with diabetes compared with cohorts without diabetes. The stratified analysis showed that nonexudative AMD (HR 3.89; P = 0.001) and exudative AMD (HR 3.42; P < 0.001) were significantly correlated to diabetes with DR cohorts, compared with diabetes without DR cohorts. The incidences of nonexudative AMD (HR 0.53; P = 0.277) and exudative AMD (HR 2.27; P = 0.058) were not significantly different between PDR cohorts compared with NPDR cohorts. CONCLUSIONS This study provides large-scale, population-based evidence that diabetes with retinopathy is independently associated with an increased risk of subsequent AMD development.
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Affiliation(s)
- Ming-Shan He
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
| | - Fang-Ling Chang
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hong-Zin Lin
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jung-Lun Wu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | | | - Yuan-Chieh Lee
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan .,Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Saravia M, Zeman L, Ingolotti M, Schlaen A. The VEGF paradox: Does diabetic retinopathy protect from age related macular degeneration? Med Hypotheses 2017; 109:156-161. [DOI: 10.1016/j.mehy.2017.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/19/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
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11
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Age-related macular degeneration in a South Indian population, with and without diabetes. Eye (Lond) 2017; 31:1176-1183. [PMID: 28387762 DOI: 10.1038/eye.2017.47] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/04/2017] [Indexed: 12/29/2022] Open
Abstract
PurposeTo elucidate the prevalence and risk factors of age-related macular degeneration (AMD) in people with diabetes.MethodsOf the 5495 subjects ≥60 years of age recruited in the population-based study in south India, 4791 subjects with gradable images on 30° three-field retinal photographs were analyzed. AMD and diabetic retinopathy (DR) were graded based on the International ARM Epidemiological Study Group classification and International Clinical Diabetic Retinopathy Disease Severity Scale, respectively. All subjects underwent a detailed history, physical examination, and a comprehensive ocular examination.ResultsOf the 4791 subjects, 1256 had diabetes. In those with diabetes, 166 (13.2%) had DR: of which, 9.6% had AMD. Of those with diabetes but no DR, 15.6% had AMD. Presence of DR (OR=0.57, 95% CI: 0.33-0.99, P=0.046) was a protective factor for AMD in diabetes. When adjusted for potential confounding factors, those with AMD and diabetes were from urban areas (OR=1.65, 95% CI: 1.09-2.49, P=0.018), had raised systolic blood pressure (OR=1.02, 95% CI: 1.00-1.03, P=0.01), higher BMI (OR=1.06, 95% CI: 1.02-1.10, P=0.005), and higher serum triglycerides (OR=1.00, 95% CI: 1.00-1.01, P=0.011). A higher level of high-density lipoprotein (HDL) (OR=0.98, 95% CI: 0.96-0.99, P=0.038) was a protective factor for AMD in subjects with diabetes.ConclusionsThe presence of DR and higher serum HDL are protective factors whereas obesity and higher systolic blood pressure are risk factors for AMD in subjects with diabetes.
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Raman R, Pal SS, Ganesan S, Gella L, Vaitheeswaran K, Sharma T. The prevalence and risk factors for age-related macular degeneration in rural-urban India, Sankara Nethralaya Rural-Urban Age-related Macular degeneration study, Report No. 1. Eye (Lond) 2016; 30:688-97. [PMID: 26915746 DOI: 10.1038/eye.2016.14] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 12/08/2015] [Indexed: 11/09/2022] Open
Abstract
PurposeTo report the age- and gender-adjusted prevalence rates of early and late age-related maculopathy (ARM) and associated risk factors in rural and urban Indian population.MethodsA population-based cross-sectional study was carried out in South India between 2009 and 2011. Of the 6617 subjects ≥60 years enumerated ones, 5495 (83.04%) participated in the eye examination. A detailed history including data on demographic, socioeconomic, and ocular history was obtained. Participants underwent detailed ophthalmic evaluation including 30° 3-field photograph as per Age-Related Eye Disease Study protocol. The ARM was graded according to the International ARM Epidemiological Study Group.ResultsAge- and gender-adjusted prevalence of early ARM was 20.91% (20.86-20.94) in the rural population and 16.37% (16.32-16.42) in the urban population. Similarly, the prevalence of late ARM was 2.26% (2.24-2.29) and 2.32% (2.29-2.34) in the rural and urban population, respectively. In both rural and urban populations, risk factors that were related to both early and late ARM were age, per year increase (OR, range 1.00-1.08); middle socioeconomic status (OR, range 1.05-1.83); and smokeless tobacco (OR, range 1.11-2.21). Protective factor in both was the presence of diabetes mellitus in all ARM (OR, range 0.34-0.83). Risk factors, only in the rural arm, were female gender (OR, range 1.06-1.64), past smoker (OR, 1.14), and serum low-density lipoprotein cholesterol level (OR, 1.03).ConclusionsThe study reports smokessless tobacco as a risk factor for both early and late ARM and identified a higher prevalence of early ARM in the rural population compared with urban population.
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Affiliation(s)
- R Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, Chennai, Tamil Nadu, India
| | - S S Pal
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, Chennai, Tamil Nadu, India
| | - S Ganesan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, Chennai, Tamil Nadu, India
| | - L Gella
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, Chennai, Tamil Nadu, India.,Elite School of Optometry, Chennai, Tamil Nadu, India
| | - K Vaitheeswaran
- Department of Preventive Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - T Sharma
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, Chennai, Tamil Nadu, India
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Hyperglycemia promotes vasculogenesis in choroidal neovascularization in diabetic mice by stimulating VEGF and SDF-1 expression in retinal pigment epithelial cells. Exp Eye Res 2014; 123:87-96. [PMID: 24780853 DOI: 10.1016/j.exer.2014.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/25/2014] [Accepted: 04/18/2014] [Indexed: 01/08/2023]
Abstract
To investigate the influence of hyperglycemia on the severity of choroidal neovascularization (CNV) in diabetic mice, especially the involvement of bone marrow-derived cells (BMCs) and underlying molecular mechanisms. The mice were randomly divided into control group, diabetes group and diabetes treated with insulin group, which were laser treated to induce CNV. The CNV severity was evaluated by fundus fluorescein angiography, HE staining and choroidal flatmount. The BMCs recruitment and differentiation in CNV were examined in GFP chimeric mice by choroidal flatmount and immunofluorescence. The bone marrow-derived mesenchymal stem cells (BMSCs) recruitment and migration were tested in vivo and in vitro. VEGF and SDF-1 production in vivo and in vitro were tested by realtime PCR and ELISA. The CNV severity and expression of VEGF and SDF-1 were enhanced in DM mice compared with control mice and that insulin treatment decreased CNV severity in DM mice. The DM mice demonstrated more BMCs and bone marrow-derived mesenchymal stem cells (BMSCs) recruited and incorporated into CNV, increased ratio of BMCs expressing endothelial cell marker or macrophage marker, and up-regulated expression of VEGF and SDF-1 in CNV. Human BMSCs migration and expression of VEGF and SDF-1 in retinal pigment epithelial (RPE) cells increased when cultured under high glucose. This study suggested that hyperglycemia enhanced the expression of VEGF and SDF-1 in RPE cells, and promoted recruitment and incorporation of BMCs and affected differentiation of BMCs in CNV, which led to more severe CNV in diabetic mice.
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Ten-year incidence of age-related macular degeneration according to diabetic retinopathy classification among medicare beneficiaries. Retina 2013; 33:911-9. [PMID: 23407352 DOI: 10.1097/iae.0b013e3182831248] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the longitudinal incidence over 10 years of dry and wet age-related macular degeneration (AMD) in a U.S. sample of Medicare beneficiaries with no diabetes mellitus, diabetes mellitus without retinopathy, nonproliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). METHODS Using Medicare claims data, the 10-year incidence of dry and wet AMD from 1995 to 2005 in beneficiaries older than 69 years with newly diagnosed diabetes mellitus (n = 6,621), NPDR (n = 1,307), and PDR (n = 327) compared with each other and matched controls without diabetes for each group. RESULTS After controlling for covariates, newly diagnosed NPDR was associated with significantly increased risk of incident diagnosis of dry AMD (hazard ratio, 1.24; 95% confidence interval: 1.08-1.43) and wet AMD (hazard ratio 1.68; 95% confidence interval: 1.23-2.31). Newly diagnosed PDR was associated with significantly increased risk of wet AMD only (hazard ratio 2.15; 95% confidence interval: 1.07-4.33). Diabetes without retinopathy did not affect risk of dry or wet AMD. There was no difference in risk of wet AMD in PDR compared with NPDR. CONCLUSION Elderly individuals with NPDR or PDR may be at higher risk of AMD compared to those without diabetes mellitus or diabetic retinopathy.
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Li X, Cai Y, Wang YS, Shi YY, Hou W, Xu CS, Wang HY, Ye Z, Yao LB, Zhang J. Hyperglycaemia exacerbates choroidal neovascularisation in mice via the oxidative stress-induced activation of STAT3 signalling in RPE cells. PLoS One 2012; 7:e47600. [PMID: 23094067 PMCID: PMC3477109 DOI: 10.1371/journal.pone.0047600] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 09/18/2012] [Indexed: 12/14/2022] Open
Abstract
Choroidal neovascularisation (CNV) that occurs as a result of age-related macular degeneration (AMD) causes severe vision loss among elderly patients. The relationship between diabetes and CNV remains controversial. However, oxidative stress plays a critical role in the pathogenesis of both AMD and diabetes. In the present study, we investigated the influence of diabetes on experimentally induced CNV and on the underlying molecular mechanisms of CNV. CNV was induced via photocoagulation in the ocular fundi of mice with streptozotocin-induced diabetes. The effect of diabetes on the severity of CNV was measured. An immunofluorescence technique was used to determine the levels of oxidative DNA damage by anti-8-hydroxy-2-deoxyguanosine (8-OHdG) antibody, the protein expression of phosphorylated signal transducer and activator of transcription 3 (p-STAT3) and vascular endothelial growth factor (VEGF), in mice with CNV. The production of reactive oxygen species (ROS) in retinal pigment epithelial (RPE) cells that had been cultured under high glucose was quantitated using the 2′,7′-dichlorofluorescein diacetate (DCFH-DA) method. p-STAT3 expression was examined using Western blot analysis. RT-PCR and ELISA processes were used to detect VEGF expression. Hyperglycaemia exacerbated the development of CNV in mice. Oxidative stress levels and the expression of p-STAT3 and VEGF were highly elevated both in mice and in cultured RPE cells. Treatment with the antioxidant compound N-acetyl-cysteine (NAC) rescued the severity of CNV in diabetic mice. NAC also inhibited the overexpression of p-STAT3 and VEGF in CNV and in RPE cells. The JAK-2/STAT3 pathway inhibitor AG490 blocked VEGF expression but had no effect on the production of ROS in vitro. These results suggest that hyperglycaemia promotes the development of CNV by inducing oxidative stress, which in turn activates STAT3 signalling in RPE cells. Antioxidant supplementation helped attenuate the development of CNV. Thus, our results reveal a potential strategy for the treatment and prevention of diseases involving CNV.
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Affiliation(s)
- Xia Li
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
| | - Yan Cai
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
| | - Yu-Sheng Wang
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
- * E-mail: (YSW); (JZ)
| | - Yuan-Yuan Shi
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
| | - Wei Hou
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
| | - Chun-Sheng Xu
- State Key Laboratory of Cancer Biology, Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
| | - Hai-Yan Wang
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
| | - Zi Ye
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
| | - Li-Bo Yao
- State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
| | - Jian Zhang
- State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China
- * E-mail: (YSW); (JZ)
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Characteristics of age-related macular degeneration in patients with diabetic retinopathy. Jpn J Ophthalmol 2011; 55:235-240. [DOI: 10.1007/s10384-011-0010-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 12/08/2010] [Indexed: 11/26/2022]
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17
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Current World Literature. Curr Opin Ophthalmol 2010; 21:239-46. [DOI: 10.1097/icu.0b013e32833983a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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