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Lai JY, Mclarnon P, Sheridan C, Vallabh NA. Evaluating the impact of caloric restriction, body mass index and exercise on primary open-angle glaucoma: A review. Eur J Ophthalmol 2024:11206721241274445. [PMID: 39169764 DOI: 10.1177/11206721241274445] [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: 08/23/2024]
Abstract
This literature review evaluates any possible links between primary open-angle glaucoma (POAG) and caloric restriction (CR), body mass index (BMI), and exercise, aiming to map the extent of the literature. Its primary objective is to recognise the nature and breadth of research evidence, identify possible gaps in these topics and develop future studies. The databases searched were MEDLINE (PudMed), Scopus and ScienceDirect, in April 2023 for articles published in English, with no date restriction. A total of 447 search results were retrieved. Of these, 73 were related to CR, 249 to BMI, and 125 to exercise. Records identified included systematic reviews, meta-analyses, randomised controlled trials, cohort studies and animal studies. CR has been shown to halt the degeneration of retinal ganglion cells and protect against various glaucomatous processes in animal models. Low BMI has been shown to be associated with an increased risk of POAG and a faster rate of visual field deterioration in POAG. However, the association between high BMI and POAG is not consistent. Exercise has been shown to cause mechanical, vascular, and neurobiological changes affecting the pathophysiology of POAG. The present review helps identify key characteristics and factors relating to the impacts of CR, BMI, or exercise on POAG.
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Affiliation(s)
- Jonathan Ym Lai
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Patrick Mclarnon
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Carl Sheridan
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Neeru A Vallabh
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Rajasundaram S, Segrè AV, Gill D, Woolf B, Zekavat SM, Burgess S, Khawaja AP, Zebardast N, Wiggs JL. Independent Effects of Blood Pressure on Intraocular Pressure and Retinal Ganglion Cell Degeneration: A Mendelian Randomization Study. Invest Ophthalmol Vis Sci 2024; 65:35. [PMID: 39028976 PMCID: PMC11262474 DOI: 10.1167/iovs.65.8.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/29/2024] [Indexed: 07/21/2024] Open
Abstract
Purpose To investigate the causal effect of elevated blood pressure on primary open-angle glaucoma (POAG) and POAG endophenotypes. Methods Two-sample Mendelian randomization (MR) was performed to investigate the causal effect of elevated systolic blood pressure (SBP) (N = 757,601) and diastolic blood pressure (DBP) (N = 757,601) on intraocular pressure (IOP) (N = 139,555), macular retinal nerve fiber layer (mRNFL) thickness (N = 33,129), ganglion cell complex (GCC) thickness (N = 33,129), vertical cup-to-disc ratio (VCDR) (N = 111,724), and POAG liability (Ncases = 16,677, Ncontrols = 199,580). The primary analysis was conducted using the inverse-variance weighted approach. Sensitivity analyses were performed to investigate robustness to horizontal pleiotropy, winner's curse, and collider bias. Multivariable MR was performed to investigate whether any effect of blood pressure on retinal ganglion cell degeneration was mediated through increased IOP. Results Increased genetically predicted SBP and DBP associated with an increase in IOP (0.17 mm Hg [95% CI = 0.11 to 0.24] per 10 mm Hg higher SBP, P = 5.18 × 10-7, and 0.17 mm Hg [95% CI = 0.05 to 0.28 mm Hg] per 10 mm Hg higher DBP, P = 0.004). Increased genetically predicted SBP associated with a thinner GCC (0.04 µm [95% CI = -0.07 to -0.01 µm], P = 0.018) and a thinner mRNFL (0.04 µm [95% CI = -0.07 to -0.01 µm], P = 0.004), an effect that arises independently of IOP according to our mediation analysis. Neither SBP nor DBP associated with VCDR or POAG liability. Conclusions These findings support a causal effect of elevated blood pressure on retinal ganglion cell degeneration that does not require intermediary changes in IOP. Targeted blood pressure control may help preserve vision by lowering IOP and, independently, by preventing retinal ganglion cell degeneration, including in individuals with a normal IOP.
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Affiliation(s)
- Skanda Rajasundaram
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Ayellet V. Segrè
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Ocular Genomics Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Benjamin Woolf
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Seyedeh M. Zekavat
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Anthony P. Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Ocular Genomics Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Janey L. Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Ocular Genomics Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States
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Landau Prat D, Zloto O, Kapelushnik N, Leshno A, Klang E, Sina S, Segev S, Soudry S, Ben Simon GJ. Big Data Analysis of Glaucoma Prevalence in Israel. J Glaucoma 2023; 32:962-967. [PMID: 37566879 DOI: 10.1097/ijg.0000000000002281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
PRCIS The prevalence of glaucoma in the adult population included in this study was 2.3%. Normal values of routine eye examinations are provided including age and sex variations. PURPOSE The purpose of this study was to analyze the prevalence of glaucoma in a very large database. METHODS Retrospective analysis of medical records of patients examined at the Medical Survey Institute of a tertiary care university referral center between 2001 and 2020. A natural language process (NLP) algorithm identified patients with a diagnosis of glaucoma. The main outcome measures included the prevalence and age distribution of glaucoma. The secondary outcome measures included the prevalence and distribution of visual acuity (VA), intraocular pressure (IOP), and cup-to-disc ratio (CDR). RESULTS Data were derived from 184,589 visits of 36,762 patients (mean age: 52 y, 68% males). The NLP model was highly sensitive in identifying glaucoma, achieving an accuracy of 94.98% (area under the curve=93.85%), and 633 of 27,517 patients (2.3%) were diagnosed as having glaucoma with increasing prevalence in older age. The mean VA was 20/21, IOP 14.4±2.84 mm Hg, and CDR 0.28±0.16, higher in males. The VA decreased with age, while the IOP and CDR increased with age. CONCLUSIONS The prevalence of glaucoma in the adult population included in this study was 2.3%. Normal values of routine eye examinations are provided including age and sex variations. We proved the validity and accuracy of the NLP model in identifying glaucoma.
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Affiliation(s)
- Daphna Landau Prat
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Talpiot Medical Leadership Program, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Ofira Zloto
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Talpiot Medical Leadership Program, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Noa Kapelushnik
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Ari Leshno
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Talpiot Medical Leadership Program, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Eyal Klang
- Talpiot Medical Leadership Program, Sheba Medical Center
- The Sami Sagol AI Hub, ARC Innovation Center, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Sigal Sina
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Shlomo Segev
- Institute for Medical Screening, Chaim Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | | | - Guy J Ben Simon
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Talpiot Medical Leadership Program, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
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Lee MH, Kim HK, Kim SS. Risk Factors Associated With a Large Vertical Cup-to-Disc Ratio: Korean National Health and Nutritional Examination Survey. J Glaucoma 2023; 32:221-226. [PMID: 36730126 DOI: 10.1097/ijg.0000000000002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/01/2022] [Indexed: 02/03/2023]
Abstract
PRCIS Higher intraocular pressure, higher systolic blood pressure, and higher serum aspartate transaminase to alanine aminotransaminase level were risk factors associated with a large vertical cup-to-disk ratio (vCDR). PURPOSE To identify risk factors for a large vCDR using data from the Korea National Health and Nutritional Examination Survey (2008-2012). MATERIALS AND METHODS Out of the total 29,322 participants aged 20 or older who participated in Korea National Health and Nutrition Survey (KHANES) from the year 2008 to 2012, this study was conducted on 21,780 participants, excluding 1449 of them without fundus photographs and 6093 of them with missing values. To identify the risk factors associated with a large vCDR, the participants were divided into 2 groups: ≥0.6 and <0.6. RESULTS Of the 21,780 subjects, 2357 of them had a vCDR ≥0.6 and 19,423 had a vCDR <0.6. There were significant differences in age, sex, and educational levels between the 2 groups. After adjusting age, sex, education level, and survey year by propensity score matching, in the group having vCDR ≥0.6, intraocular pressure (IOP) was high, systolic blood pressure (SBP) was high, and serum aspartate transaminase to alanine aminotransaminase level (AST/ALT ratio) was high ( P <0.001, P <0.001, and P <0.001). The results of multiple logistic regression analyses revealed that high IOP, high SBP, high myopia, and high AST/ALT ratio were risk factors for vCDR ≥0.6 ( P <0.001, P =0.006, P =0.005, P <0.001). CONCLUSIONS In this study, risk factors associated with large vCDR were analyzed. Higher IOP, higher SBP, and higher AST/ALT ratio were related to vCDR ≥0.6.
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Affiliation(s)
- Moon Hyung Lee
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan
| | - Hong Kyu Kim
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan
- Yonsei University Graduate School of Medicine
| | - Sung Soo Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
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Charng J, Alam K, Swartz G, Kugelman J, Alonso-Caneiro D, Mackey DA, Chen FK. Deep learning: applications in retinal and optic nerve diseases. Clin Exp Optom 2022:1-10. [PMID: 35999058 DOI: 10.1080/08164622.2022.2111201] [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: 10/15/2022] Open
Abstract
Deep learning (DL) represents a paradigm-shifting, burgeoning field of research with emerging clinical applications in optometry. Unlike traditional programming, which relies on human-set specific rules, DL works by exposing the algorithm to a large amount of annotated data and allowing the software to develop its own set of rules (i.e. learn) by adjusting the parameters inside the model (network) during a training process in order to complete the task on its own. One major limitation of traditional programming is that, with complex tasks, it may require an extensive set of rules to accurately complete the assignment. Additionally, traditional programming can be susceptible to human bias from programmer experience. With the dramatic increase in the amount and the complexity of clinical data, DL has been utilised to automate data analysis and thus to assist clinicians in patient management. This review will present the latest advances in DL, for managing posterior eye diseases as well as DL-based solutions for patients with vision loss.
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Affiliation(s)
- Jason Charng
- Centre of Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Australia.,Department of Optometry, School of Allied Health, University of Western Australia, Perth, Australia
| | - Khyber Alam
- Department of Optometry, School of Allied Health, University of Western Australia, Perth, Australia
| | - Gavin Swartz
- Department of Optometry, School of Allied Health, University of Western Australia, Perth, Australia
| | - Jason Kugelman
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - David Alonso-Caneiro
- Centre of Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Australia.,School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - David A Mackey
- Centre of Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Fred K Chen
- Centre of Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Ophthalmology, Royal Perth Hospital, Western Australia, Perth, Australia
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