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Zhu A, Tailor P, Verma R, Zhang I, Schott B, Ye C, Szirth B, Habiel M, Khouri AS. Implementation of deep learning artificial intelligence in vision-threatening disease screenings for an underserved community during COVID-19. J Telemed Telecare 2024; 30:1590-1597. [PMID: 36908254 PMCID: PMC10014445 DOI: 10.1177/1357633x231158832] [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: 09/24/2022] [Accepted: 02/05/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Age-related macular degeneration, diabetic retinopathy, and glaucoma are vision-threatening diseases that are leading causes of vision loss. Many studies have validated deep learning artificial intelligence for image-based diagnosis of vision-threatening diseases. Our study prospectively investigated deep learning artificial intelligence applications in student-run non-mydriatic screenings for an underserved, primarily Hispanic community during COVID-19. METHODS Five supervised student-run community screenings were held in West New York, New Jersey. Participants underwent non-mydriatic 45-degree retinal imaging by medical students. Images were uploaded to a cloud-based deep learning artificial intelligence for vision-threatening disease referral. An on-site tele-ophthalmology grader and remote clinical ophthalmologist graded images, with adjudication by a senior ophthalmologist to establish the gold standard diagnosis, which was used to assess the performance of deep learning artificial intelligence. RESULTS A total of 385 eyes from 195 screening participants were included (mean age 52.43 ± 14.5 years, 40.0% female). A total of 48 participants were referred for at least one vision-threatening disease. Deep learning artificial intelligence marked 150/385 (38.9%) eyes as ungradable, compared to 10/385 (2.6%) ungradable as per the human gold standard (p < 0.001). Deep learning artificial intelligence had 63.2% sensitivity, 94.5% specificity, 32.0% positive predictive value, and 98.4% negative predictive value in vision-threatening disease referrals. Deep learning artificial intelligence successfully referred all 4 eyes with multiple vision-threatening diseases. Deep learning artificial intelligence graded images (35.6 ± 13.3 s) faster than the tele-ophthalmology grader (129 ± 41.0) and clinical ophthalmologist (68 ± 21.9, p < 0.001). DISCUSSION Deep learning artificial intelligence can increase the efficiency and accessibility of vision-threatening disease screenings, particularly in underserved communities. Deep learning artificial intelligence should be adaptable to different environments. Consideration should be given to how deep learning artificial intelligence can best be utilized in a real-world application, whether in computer-aided or autonomous diagnosis.
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Affiliation(s)
- Aretha Zhu
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Priya Tailor
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rashika Verma
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Isis Zhang
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Brian Schott
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Catherine Ye
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Bernard Szirth
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Miriam Habiel
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Albert S Khouri
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
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Liu Q, Celis-Morales C, Sattar N, Welsh P. Association of glycaemic control with intraocular pressure in a large general population: Results from the UK Biobank. Diabetes Obes Metab 2024; 26:5192-5201. [PMID: 39157858 DOI: 10.1111/dom.15865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 08/20/2024]
Abstract
AIM To evaluate the association of glycated haemoglobin (HbA1c) and serum glucose with intraocular pressure (IOP) in a large UK general population. MATERIALS AND METHODS Participants were selected from the UK Biobank, excluding those with eye conditions that may affect IOP. IOP was measured using an ocular response analyser. Goldmann-correlated IOP (IOPg) and corneal-compensated IOP (IOPcc) were outcomes of interest, and ocular hypertension was defined as left-eye IOPg or IOPcc > 21 mmHg. HbA1c and random (non-fasting) serum glucose were the exposures of interest. Multivariate restricted cubic spline models, as well as linear regression, were applied to explore the associations of interest. RESULTS Among 68 806 participants (46.5% male), the mean age was 56.7 years. The mean (standard deviation) for IOPg was 15.7 (3.6) mmHg and 15.9 (3.6) mmHg for IOPcc. Occular hypertension was prevalent in 8055 participants (11.7%) and 4178 participants (6.1%) had diabetes. Those with diabetes had higher IOP and a higher prevalence of ocular hypertension. After adjustment for demographic and clinical variables, HbA1c was positively associated with IOP in participants with diabetes, but not in those without diabetes. For every 10-mmol/mol increase in HbA1c, IOPg increased by 0.20 mmHg (95% confidence interval [CI] 0.12, 0.28) and IOPcc by 0.15 mmHg (95% CI 0.07, 0.23); the odds of ocular hypertension was increased by 6% (95% CI 1.00, 1.13) in participants with diabetes. A borderline positive association between serum glucose and IOP was found only in participants without diabetes. CONCLUSIONS Impaired glycaemic control was associated with elevated IOP and a possible risk of ocular hypertension among participants with diabetes but of normal ocular health.
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Affiliation(s)
- Qiaoling Liu
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Human Performance Lab, Education, Physical Activity and Health Research Unit, University Católica del Maule, Talca, Chile
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Yuan Y, Ji S, Song Y, Che Z, Xiao L, Tang S, Xiao J. Global trends in diabetic eye disease research from 2012 to 2021. Neural Regen Res 2024; 19:2310-2320. [PMID: 38488565 PMCID: PMC11034595 DOI: 10.4103/1673-5374.391303] [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: 05/17/2023] [Revised: 08/22/2023] [Accepted: 10/07/2023] [Indexed: 04/24/2024] Open
Abstract
JOURNAL/nrgr/04.03/01300535-202410000-00032/figure1/v/2024-02-06T055622Z/r/image-tiff Diabetic eye disease refers to a group of eye complications that occur in diabetic patients and include diabetic retinopathy, diabetic macular edema, diabetic cataracts, and diabetic glaucoma. However, the global epidemiology of these conditions has not been well characterized. In this study, we collected information on diabetic eye disease-related research grants from seven representative countries--the United States, China, Japan, the United Kingdom, Spain, Germany, and France--by searching for all global diabetic eye disease journal articles in the Web of Science and PubMed databases, all global registered clinical trials in the ClinicalTrials database, and new drugs approved by the United States, China, Japan, and EU agencies from 2012 to 2021. During this time period, diabetic retinopathy accounted for the vast majority (89.53%) of the 2288 government research grants that were funded to investigate diabetic eye disease, followed by diabetic macular edema (9.27%). The United States granted the most research funding for diabetic eye disease out of the seven countries assessed. The research objectives of grants focusing on diabetic retinopathy and diabetic macular edema differed by country. Additionally, the United States was dominant in terms of research output, publishing 17.53% of global papers about diabetic eye disease and receiving 22.58% of total citations. The United States and the United Kingdom led international collaborations in research into diabetic eye disease. Of the 415 clinical trials that we identified, diabetic macular edema was the major disease that was targeted for drug development (58.19%). Approximately half of the trials (49.13%) pertained to angiogenesis. However, few drugs were approved for ophthalmic (40 out of 1830; 2.19%) and diabetic eye disease (3 out of 1830; 0.02%) applications. Our findings show that basic and translational research related to diabetic eye disease in the past decade has not been highly active, and has yielded few new treatment methods and newly approved drugs.
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Affiliation(s)
- Yuan Yuan
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Shangli Ji
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China
- Aier Eye Institute, Changsha, Hunan Province, China
| | - Yali Song
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Zhaodi Che
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Lu Xiao
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Shibo Tang
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China
- Aier Eye Institute, Changsha, Hunan Province, China
| | - Jia Xiao
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China
- Aier Eye Institute, Changsha, Hunan Province, China
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
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Giloyan A, Khachadourian V, Hakobyan V, Kirakosyan L, Petrosyan V, Harutyunyan T. Migraine headache and other risk factors associated with glaucoma among the adult population living in Armenia: a case-control study. Int Ophthalmol 2024; 44:188. [PMID: 38647698 DOI: 10.1007/s10792-024-03145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This study aimed to assess the association between migraine headache and glaucoma among the adult population living in Armenia. METHODS This case-control study recruited 145 cases with glaucoma and 250 controls without glaucoma and other ocular disorders except refractive error from Optomed Canada Diagnostic Eye Center in Armenia. A structured questionnaire contained questions on socio-demographics, family history of glaucoma and stroke, ocular health, smoking, migraine, and obstructive sleep apnea. The Migraine Screening Questionnaire assessed possible migraine and the Berlin Questionnaire measured obstructive sleep apnea. RESULTS The mean ages of cases and controls were 63.3 (SD = 12.3) and 39.5 (SD = 13.5), respectively. Females comprised 62.8% of cases and 69.1% of controls. A total of 17.8% of cases and 19.0% of controls had possible migraine. In the adjusted analysis older age (OR 1.17; 95% CI 1.12; 1.23), average/lower than average socio-economic status (OR 5.27; 95% CI 1.30; 21.3), and family history of glaucoma (OR 4.25; 95% CI 1.51; 11.9) were associated with high-tension glaucoma. CONCLUSION Timely case detection of glaucoma among those with average/low socio-economic status and those with family history of glaucoma could prevent further progression of the disease. Further studies to explore the relationship between migraine headache and specific types of glaucoma may be worthwhile.
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Affiliation(s)
- Aida Giloyan
- American University of Armenia, Yerevan, Armenia.
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Ye ST, Shang XW, Huang Y, Zhu S, Zhu ZT, Zhang XL, Wang W, Tang SL, Ge ZY, Yang XH, He MG. Association of age at diagnosis of diabetes with subsequent risk of age-related ocular diseases and vision acuity. World J Diabetes 2024; 15:697-711. [PMID: 38680694 PMCID: PMC11045417 DOI: 10.4239/wjd.v15.i4.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/19/2023] [Accepted: 02/27/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The importance of age on the development of ocular conditions has been reported by numerous studies. Diabetes may have different associations with different stages of ocular conditions, and the duration of diabetes may affect the development of diabetic eye disease. While there is a dose-response relationship between the age at diagnosis of diabetes and the risk of cardiovascular disease and mortality, whether the age at diagnosis of diabetes is associated with incident ocular conditions remains to be explored. It is unclear which types of diabetes are more predictive of ocular conditions. AIM To examine associations between the age of diabetes diagnosis and the incidence of cataract, glaucoma, age-related macular degeneration (AMD), and vision acuity. METHODS Our analysis was using the UK Biobank. The cohort included 8709 diabetic participants and 17418 controls for ocular condition analysis, and 6689 diabetic participants and 13378 controls for vision analysis. Ocular diseases were identified using inpatient records until January 2021. Vision acuity was assessed using a chart. RESULTS During a median follow-up of 11.0 years, 3874, 665, and 616 new cases of cataract, glaucoma, and AMD, respectively, were identified. A stronger association between diabetes and incident ocular conditions was observed where diabetes was diagnosed at a younger age. Individuals with type 2 diabetes (T2D) diagnosed at < 45 years [HR (95%CI): 2.71 (1.49-4.93)], 45-49 years [2.57 (1.17-5.65)], 50-54 years [1.85 (1.13-3.04)], or 50-59 years of age [1.53 (1.00-2.34)] had a higher risk of AMD independent of glycated haemoglobin. T2D diagnosed < 45 years [HR (95%CI): 2.18 (1.71-2.79)], 45-49 years [1.54 (1.19-2.01)], 50-54 years [1.60 (1.31-1.96)], or 55-59 years of age [1.21 (1.02-1.43)] was associated with an increased cataract risk. T2D diagnosed < 45 years of age only was associated with an increased risk of glaucoma [HR (95%CI): 1.76 (1.00-3.12)]. HRs (95%CIs) for AMD, cataract, and glaucoma associated with type 1 diabetes (T1D) were 4.12 (1.99-8.53), 2.95 (2.17-4.02), and 2.40 (1.09-5.31), respectively. In multivariable-adjusted analysis, individuals with T2D diagnosed < 45 years of age [β 95%CI: 0.025 (0.009,0.040)] had a larger increase in LogMAR. The β (95%CI) for LogMAR associated with T1D was 0.044 (0.014, 0.073). CONCLUSION The younger age at the diagnosis of diabetes is associated with a larger relative risk of incident ocular diseases and greater vision loss.
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Affiliation(s)
- Si-Ting Ye
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Xian-Wen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Yu Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Susan Zhu
- Austin Hospital, University of Melbourne, Melbourne 3084, Victoria, Australia
| | - Zhuo-Ting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Xue-Li Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Shu-Lin Tang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Zong-Yuan Ge
- Monash e-Research Center, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Center, Monash University, Melbourne 3080, Victoria, Australia
| | - Xiao-Hong Yang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Ming-Guang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, Melbourne 3002, Victoria, Australia
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Choe E, Poleon S, Thomas T, Racette L. The association between perceived cause of glaucoma and illness perceptions. Front Med (Lausanne) 2024; 11:1363732. [PMID: 38638934 PMCID: PMC11024309 DOI: 10.3389/fmed.2024.1363732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Purpose The perceived cause of disease is an important factor that has been linked with treatment outcomes but has not been fully assessed in primary open-angle glaucoma (POAG). This study assessed the accuracy of patients' perceived cause of POAG and identified associations between accuracy, illness perceptions, medication adherence, and quality of life (QoL). Methods The Brief Illness Perception Questionnaire (BIPQ) was used to assess illness perceptions and asked patients to rank the three most important causes of their disease in order of importance. POAG risk factors recognized by the American Academy of Ophthalmology were used to code responses as accurate or inaccurate based on the following three methods: (1) coding any reported cause, regardless of rank, (2) coding only the first-ranked cause, and (3) coding and weighting all reported causes. Medication adherence was measured electronically. QoL was measured using the Glaucoma Quality of Life questionnaire. Mann-Whitney U test was used to detect differences in illness perceptions, medication adherence, and QoL between accuracy groups. Results A total of 97 patients identified a cause of their POAG and were included in this analysis. A higher proportion of patients reported an accurate cause (86.6% using method 1, 78.4% using method 2, and 79.4% using method 3; all p < 0.001). Mean medication adherence was 86.0% ± 17.8 and was similar across accuracy groups (all p > 0.05). Using method 2 (p = 0.045) and method 3 (p = 0.028), patients who reported an accurate cause of their POAG believed that their illness would last for a longer time compared to patients who reported an inaccurate cause. Method 3 also revealed that patients who reported an accurate cause of their POAG had lower perceived understanding of their illness (p = 0.048) compared to patients who reported an inaccurate cause. There were no differences in QoL between accuracy groups (all p > 0.05). Conclusion This study highlights the association between perceived cause of POAG and illness perceptions related to knowledge level and POAG duration. Future studies should assess associations between perceived cause of disease and other critical dimensions of illness perception.
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Affiliation(s)
| | | | | | - Lyne Racette
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Okruszko MA, Szabłowski M, Zarzecki M, Michnowska-Kobylińska M, Lisowski Ł, Łapińska M, Stachurska Z, Szpakowicz A, Kamiński KA, Konopińska J. Inflammation and Neurodegeneration in Glaucoma: Isolated Eye Disease or a Part of a Systemic Disorder? - Serum Proteomic Analysis. J Inflamm Res 2024; 17:1021-1037. [PMID: 38370463 PMCID: PMC10874189 DOI: 10.2147/jir.s434989] [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] [Received: 09/24/2023] [Accepted: 01/23/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Glaucoma is the most common optic neuropathy and the leading cause of irreversible blindness worldwide, which affects 3.54% of the population aged 40-80 years. Despite numerous published studies, some aspects of glaucoma pathogenesis, serum biomarkers, and their potential link with other diseases remain unclear. Recent articles have proposed that autoimmune, oxidative stress and inflammation may be involved in the pathogenesis of glaucoma. Methods We investigated the serum expression of 92 inflammatory and neurotrophic factors in glaucoma patients. The study group consisted of 26 glaucoma patients and 192 healthy subjects based on digital fundography. Results Patients with glaucoma had significantly lower serum expression of IL-2Rβ, TWEAK, CX3CL1, CD6, CD5, LAP TGF-beta1, LIF-R, TRAIL, NT-3, and CCL23 and significantly higher expression of IL-22Rα1. Conclusion Our results indicate that patients with glaucoma tend to have lower levels of neuroprotective proteins and higher levels of neuroinflammatory proteins, similar to those observed in psychiatric, neurodegenerative and autoimmune diseases, indicating a potential link between these conditions and glaucoma pathogenesis.
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Affiliation(s)
| | - Maciej Szabłowski
- Department of Ophthalmology, Medical University of Bialystok, Białystok, 15-089, Poland
| | - Mateusz Zarzecki
- Department of Ophthalmology, Medical University of Bialystok, Białystok, 15-089, Poland
| | | | - Łukasz Lisowski
- Department of Ophthalmology, Medical University of Bialystok, Białystok, 15-089, Poland
| | - Magda Łapińska
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Zofia Stachurska
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Anna Szpakowicz
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Karol Adam Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Bialystok, Białystok, 15-089, Poland
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Sun MT, Pershing S, Goldberg JL, Wang SY. Impact of Type 2 diabetes mellitus and insulin use on progression to glaucoma surgery in primary open angle glaucoma. Eye (Lond) 2024; 38:558-564. [PMID: 37740048 PMCID: PMC10858255 DOI: 10.1038/s41433-023-02734-2] [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: 02/09/2023] [Revised: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE To investigate outcomes of primary open-angle glaucoma (POAG) patients with and without type 2 diabetes mellitus (T2DM). METHODS Retrospective observational study using U.S. nationwide healthcare insurance claims database. Patients ≥40 years old with at least one HbA1c within one year of POAG diagnosis were included. Diabetic factors associated with POAG progression requiring glaucoma surgery were evaluated using multivariable Cox proportional hazards regression models adjusted for demographic, diabetic and glaucoma factors. T2DM diagnosis and use of either oral hypoglycaemic agents or insulin therapy were assessed in association with POAG progression requiring glaucoma surgery. RESULTS 104,515 POAG patients were included, of which 70,315 (67%) had T2DM. The mean age was 68.9 years (Standard deviation 9.2) and 55% were female. Of those with T2DM, 93% were taking medication (65,468); 95% (62,412) taking oral hypoglycaemic agents, and 34% (22,028) were on insulin. In multivariable analyses, patients with T2DM had a higher hazard of requiring glaucoma surgery (Hazard ratio, HR 1.15, 95% CI 1.09-1.21, p < 0.001). Higher mean HbA1c was also a significant predictor of progression requiring glaucoma surgery (HR 1.02, 95% CI 1.01-1.03, p < 0.001). When evaluating only patients who were taking antidiabetic medication, after adjusting for confounders, insulin use was associated with a 1.20 higher hazard of requiring glaucoma surgery compared to oral hypoglycaemic agents (95% CI 1.14-1.27, p < 0.001), but when stratified by HbA1c, this effect was only significant for those with HbA1c > 7.5%. CONCLUSIONS Higher baseline HbA1c, particularly in patients taking insulin may be associated with higher rates of glaucoma surgery in POAG.
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Affiliation(s)
- Michelle T Sun
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Suzann Pershing
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jeffrey L Goldberg
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sophia Y Wang
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
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Al-Manjoumi AM, Filimban MA, Bantan MS, Abualhamayel HA, Youldash OA. Prevalence of Risk Factors Among Patients With Glaucoma in Jeddah, Saudi Arabia. Cureus 2023; 15:e37689. [PMID: 37206536 PMCID: PMC10191456 DOI: 10.7759/cureus.37689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Objective The objective of this study is to estimate the prevalence of risk factors among patients with glaucoma in Jeddah, Saudi Arabia. Methods This cross-sectional study was conducted on 215 patients diagnosed with glaucoma in the period between March 2022 and August 2022 at King Abdulaziz University Hospital, in Jeddah, Saudi Arabia. We used the participants' medical records and contacted the patients to collect information on sociodemographic characteristics and known risk factors of glaucoma. Results Among the 215 patients with glaucoma, 142 (66.0%) patients had open-angle glaucoma, 15 (7.0%) patients had closed-angle glaucoma, and 58 (27.0%) patients had congenital glaucoma. Among the patients with open-angle glaucoma, 122 (85.9%) patients were aged > 40 years, and 99 (69.7%) patients had myopia. Among the patients with closed-angle glaucoma, 13 (86.7%) patients had hyperopia and 10 (66.7%) patients were aged > 60 years. Among the patients with congenital glaucoma, 21 (36.2%) patients had a family history of congenital glaucoma and 28 (48.3%) patients had consanguine parents. Conclusion The prevalence of advanced age, hyperopia, and consanguine parents was the highest among patients with open-angle glaucoma, closed-angle glaucoma, and congenital glaucoma, respectively. These findings could inform public health policies among practitioners involved in ophthalmological care.
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Affiliation(s)
| | - Majed A Filimban
- General Practice, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Mohammed S Bantan
- General Practice, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Omar A Youldash
- General Practice, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Luebke J. Individualized Treatment for Glaucoma Patients with Diabetes mellitus. Klin Monbl Augenheilkd 2023; 240:142-146. [PMID: 36634690 DOI: 10.1055/a-1961-7186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Glaucoma and diabetes mellitus are two common chronic diseases in Europe and worldwide which require intensive therapy. Various pathophysiological mechanisms have been discussed which favour the development of glaucoma, especially in the presence of diabetes mellitus. Medicinal and surgical adjustment of intraocular pressure is associated with some limitations in patients with diabetes mellitus, for example, filtering interventions show lower success rates than in non-diabetic glaucoma patients. Besides pure ophthalmological endocrinological therapy, the psychological burden of two chronic diseases should also be considered and included in the individual therapy plan.
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Affiliation(s)
- Jan Luebke
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
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Zhao QF, Hirneiss C. Does Diabetes Influence Adherence in Glaucoma Patients? Klin Monbl Augenheilkd 2023; 240:136-141. [PMID: 36351553 DOI: 10.1055/a-1975-2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With chronic diseases, patient adherence plays a crucial role in delaying disease progression and in determining the success of therapy. Problems arise not only from low medication adherence, but also non-adherence to recommended follow-up examinations. Obtaining an accurate estimate of adherence is difficult, especially in glaucoma patients, due to the fact that most antihypertensive drugs are administered in the form of eye drops. There is great variability in the published adherence values for glaucoma patients. Most studies report an average medication adherence of approximately 70%, with around 50% of patients having good adherence (at least 80% of medication administered as planned). Furthermore, 6.8 - 31.4% of the eye drops do not end up in the patient's eye, which means there is even less active ingredient to achieve a therapeutic effect. Glaucoma patients also show low persistence and adherence to follow-up appointments. Since diabetes increases the risk for POAG and secondary glaucoma and given that diabetics have particularly low adherence, the question arose whether a diabetes diagnosis is associated with reduced adherence in glaucoma patients. Previous studies found no significant association between diabetes and reduced adherence in glaucoma patients, although a significant impact of elevated HbA1c on adherence in glaucoma patients was found in one study. However, this connection still needs to be examined more closely in studies with larger samples.
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Affiliation(s)
- Qifan Felix Zhao
- Glaukomsprechstunde, Augenklinik und Poliklinik des Klinikums der Universität München, München, Deutschland
| | - Christoph Hirneiss
- Glaukomsprechstunde, Augenklinik und Poliklinik des Klinikums der Universität München, München, Deutschland
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12
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Kim MH, Lim SH. Matrix Metalloproteinases and Glaucoma. Biomolecules 2022; 12:biom12101368. [PMID: 36291577 PMCID: PMC9599265 DOI: 10.3390/biom12101368] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Matrix metalloproteinases (MMPs) are enzymes that decompose extracellular matrix (ECM) proteins. MMPs are thought to play important roles in cellular processes, such as cell proliferation, differentiation, angiogenesis, migration, apoptosis, and host defense. MMPs are distributed in almost all intraocular tissues and are involved in physiological and pathological mechanisms of the eye. MMPs are also associated with glaucoma, a progressive neurodegenerative disease of the eyes. MMP activity affects intraocular pressure control and apoptosis of retinal ganglion cells, which are the pathological mechanisms of glaucoma. It also affects the risk of glaucoma development based on genetic pleomorphism. In addition, MMPs may affect the treatment outcomes of glaucoma, including the success rate of surgical treatment and side effects on the ocular surface due to glaucoma medications. This review discusses the various relationships between MMP and glaucoma.
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Affiliation(s)
- Moo Hyun Kim
- Department of Ophthalmology, Daegu Premier Eye Center, Suseong-ro 197, Suseong-Gu, Daegu 42153, Korea
| | - Su-Ho Lim
- Department of Ophthalmology, Daegu Veterans Health Service Medical Center, 60 Wolgok-Ro, Dalseo-Gu, Daegu 42835, Korea
- Correspondence: ; Tel.: +82-53-630-7572
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13
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Dada T, Verma S, Gagrani M, Bhartiya S, Chauhan N, Satpute K, Sharma N. Ocular and Systemic Factors Associated with Glaucoma. J Curr Glaucoma Pract 2022; 16:179-191. [PMID: 36793269 PMCID: PMC9905876 DOI: 10.5005/jp-journals-10078-1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/14/2022] [Indexed: 01/25/2023] Open
Abstract
Glaucoma is one of the leading causes of irreversible blindness in the world. Although numerous factors have been implicated in the pathogenesis of glaucoma, the main focus of management still remains lowering the intraocular pressure (IOP) by medical or surgical therapy. However, a major challenge is that many glaucoma patients continue to progress despite good control of IOP. In this regard, the importance of other coexisting factors that may contribute to disease progression needs to be explored. Ophthalmologists need to be aware of ocular risk factors and the impact of systemic diseases and their medications, along with lifestyle modifications on the course of glaucomatous optic neuropathy and adopt a holistic approach in treating the eye as well as the patient to alleviate the suffering from glaucoma in a comprehensive manner. How to cite this article Dada T, Verma S, Gagrani M, et al. Ocular and Systemic Factors associated with Glaucoma. J Curr Glaucoma Pract 2022;16(3):179-191.
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Affiliation(s)
- Tanuj Dada
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saurabh Verma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Meghal Gagrani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shibal Bhartiya
- Senior consultant, Department of Opthalmology, fortis memorial research institute, Gurugram, Haryana, India
| | - Nidhi Chauhan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kanchan Satpute
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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14
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Tan Y, Zhu W, Zou Y, Zhang B, Yu Y, Li W, Jin G, Liu Z. Hotspots and trends in ophthalmology in recent 5 years: Bibliometric analysis in 2017–2021. Front Med (Lausanne) 2022; 9:988133. [PMID: 36091704 PMCID: PMC9462464 DOI: 10.3389/fmed.2022.988133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to investigate the hotspots and research trends of ophthalmology research. Method Ophthalmology research literature published between 2017 and 2021 was obtained in the Web of Science Core Collection database. The bibliometric analysis and network visualization were performed with the VOSviewer and CiteSpace. Publication-related information, including publication volume, citation counts, countries, journals, keywords, subject categories, and publication time, was analyzed. Results A total of 10,469 included ophthalmology publications had been cited a total of 7,995 times during the past 5 years. The top countries and journals for the number of publications were the United States and the Ophthalmology. The top 25 global high-impact documents had been identified using the citation ranking. Keyword co-occurrence analysis showed that the hotspots in ophthalmology research were epidemiological characteristics and treatment modalities of ocular diseases, artificial intelligence and fundus imaging technology, COVID-19-related telemedicine, and screening and prevention of ocular diseases. Keyword burst analysis revealed that “neural network,” “pharmacokinetics,” “geographic atrophy,” “implementation,” “variability,” “adverse events,” “automated detection,” and “retinal images” were the research trends of research in the field of ophthalmology through 2021. The analysis of the subject categories demonstrated the close cooperation relationships that existed between different subject categories, and collaborations with non-ophthalmology-related subject categories were increasing over time in the field of ophthalmology research. Conclusions The hotspots in ophthalmology research were epidemiology, prevention, screening, and treatment of ocular diseases, as well as artificial intelligence and fundus imaging technology and telemedicine. Research trends in ophthalmology research were artificial intelligence, drug development, and fundus diseases. Knowledge from non-ophthalmology fields is likely to be more involved in ophthalmology research.
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Affiliation(s)
- Yuan Tan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Weining Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Yingshi Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Bowen Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Yinglin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- *Correspondence: Guangming Jin
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Zhenzhen Liu
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Khalili AF, Razzaghi S, Motlagh BF, Faramarzi E, Zeinalzadeh AH. Prevalence of Primary Open-Angle Glaucoma and its Relationship with Smoking in the Population of the Azar Cohort: A Cross-Sectional Study. Middle East Afr J Ophthalmol 2022; 29:109-115. [PMID: 37408718 PMCID: PMC10319078 DOI: 10.4103/meajo.meajo_101_22] [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: 04/19/2022] [Revised: 11/24/2022] [Accepted: 03/13/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE The purpose is to determine the prevalence of primary open-angle glaucoma (POAG) and study the relationship of smoking and other potential risk factors with POAG. METHODS This is a cross-sectional study based on the Azar cohort databases (including the eye cohort study) in Iran, including 11,208 participants aged 35-70 years. According to the questionnaire, participants were divided into five groups in terms of smoking. Ophthalmologic examinations were performed in two steps. The first step was performed by an optometrist, and all referred participants underwent a complete ophthalmological examination in the second step, then after POAG cases were diagnosed using Criteria of the International Society of Geographic and Epidemiological Ophthalmology. RESULTS Of the participants, 4992 (44.5%) were male and 6216 (55.5%) were female, with a mean age of 50.1 ± 9.27 years. The prevalence of POAG in our study population was 1%, which included 58 (1.2%) males and 58 (0.9%) females. There was no significant difference between the two groups in terms of the prevalence of different smoking categories in both genders. There was a statistically significant difference between the two groups in both genders in terms of diabetes mellitus (DM) after adjusting for age and there was a statistically significant difference between the two groups in the male population in terms of triglycerides ≥150 mg/dl. CONCLUSION Findings of this study indicated that there is no association between cigarette smoking in different doses and a history of smoking with POAG. Other factors, such as aging and underlying diseases, including DM and hypertriglyceridemia, have a statistically significant association with POAG.
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Affiliation(s)
- Ali F. Khalili
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahryar Razzaghi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad F. Motlagh
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali H. Zeinalzadeh
- Social Determinants of Health Research Center, Geriatric Medicine Fellowship, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Meida NS, Purwanto B, Wasita B, Indrakila S, Soetrisno S, Poncorini E, Cilmiaty R. Effects of Ethanol Extract of Propolis on Repair Optic Nerve Damage in a Rat Model for Diabetes Mellitus (Study of MDA, CRP, Caspase-3, and TGF-β Expression and Histopathological Changes on Optic Nerve Damage). Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose
Hyperglycemia in diabetes increases oxidative stress in the body. It causes optic nerve damage and risk of glaucoma. In this study, we evaluated and analyzed the effect of propolis ethanol extract on repair of optic nerve damage in a rat model for Diabetes Mellitus.
Study Design
Laboratory experimental using the posttest only control group design was used in this study.
Methods
A total of 28 male Wistar rat were randomly divided into the following four groups namely control (K1), diabetes mellitus (K2), diabetes mellitus with propolis treatment (100 mg/kg) (P1) and diabetes mellitus with propolis treatment (200 mg/kg) (P2). Statistical analysis used ANOVA and Kruskal Wallis with a significance of p < 0.05.
Results
The results showed that Gunung Lawu propolis significantly reduced serum glucose levels, malondialdehyde levels and C-reactive protein levels (p<0.01). Furthermore, propolis extract significantly decreased caspase-3 expression and TGF-β expression (p<0.05) in the optic nerve. Propolis can significantly repair optic nerve damage (optic nerve necrosis, thinning of the retinal nerve fiber layer and retinal ganglion cell apoptosis (p < 0.01).
Conclusion
The final results showed that most of the beneficial effects of propolis were mediated by the reduction of blood glucose levels in diabetic rat.
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Potential for Prebiotic Stabilized Cornus mas L. Lyophilized Extract in the Prophylaxis of Diabetes Mellitus in Streptozotocin Diabetic Rats. Antioxidants (Basel) 2022; 11:antiox11020380. [PMID: 35204262 PMCID: PMC8868578 DOI: 10.3390/antiox11020380] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/16/2022] Open
Abstract
As a systemic disease, diabetes mellitus (DM) is characterized by the disruption of many glucose metabolic pathways. Therefore, it seems critical to study new therapies to support treatment to develop therapeutic systems that can operate across a broad metabolic spectrum. The current state of knowledge indicates an essential role of the gut microbiota in the development and course of the disease. Cornus mas fruits have demonstrated a rich biological activity profile and potential for application in the treatment of DM. As part of a preliminary analysis, the activity of four cultivars of Cornus mas fruits was analyzed. The cultivar Wydubieckij was selected as having the highest activity in in vitro conditions for further prebiotic system preparation. The study aimed to develop a unique therapeutic system based, first of all, on the mechanism of α-glucosidase inhibition and the antioxidant effect resulting from the activity of the plant extract used, combined with the prebiotic effect of inulin. The obtained system was characterized in vitro in terms of antioxidant activity and enzyme inhibition capacity, and was then tested on diabetic rats. The study was coupled with an analysis of changes in the intestinal microflora. The system of prebiotic stabilized Cornus mas L. lyophilized extract with inulin offers valuable support for the prophylaxis and treatment of DM.
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Sadiq M, Ali M, . A, Ahmad W, Azam Khan M, Akhtar F. A Cross-Sectional Study on Socioeconomic Status of Glaucoma Patients and Prescription Burden of Antiglaucoma Drugs in Pakistan. INT J PHARMACOL 2022. [DOI: 10.3923/ijp.2022.207.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Direev AO, Munts IV, Mazurenko ES, Shapkina MY, Ryabikov AN, Bobak M, Malyutina SK. Associations of cardiovascular diseases and type 2 diabetes with ophthalmic diseases in a population sample over 55 years old. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To study associations of cardiovascular diseases and type 2 diabetes (T2D) with ophthalmic diseases in a population sample of men and women from middle to old age (Novosibirsk).Material and methods. The population cohort was initially studied in 2003-2005 (n=9360, 45-69 years old, Novosibirsk, the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) project). At the second survey (2015-2017) in a random subsample (n=1011), the following ophthalmic diseases were identified: hypertensive retinopathy (HR), diabetic retinopathy (DR), cataract, glaucoma, age-related macular degeneration (AMD), optic disc abnormalities, etc.Results. The prevalence of HR signs in persons with and without hypertension (HTN) was 81 and 46%, respectively (p<0,001). This association persisted regardless of other factors (odds ratio, 2,27 (95% confidence interval: 1,78-4,17). The prevalence of AMD, cataract and DR increased in HTN, but associations were largely explained by metabolic factors in multivariate models. People with T2D more often than without T2D had signs of DR (9,3 vs 0,4%, p<0,001), AMD (22 vs 17%, p=0,042) and glaucoma (14 vs 7%, p=0,001). Associations of T2D with DR and glaucoma persisted regardless of other factors. Individuals with carotid atherosclerosis (CA) were 1,6 times more likely to have HR than those without CA when adjusted for sex, age, and smoking (p=0,013).Conclusion. In the surveyed population sample of mainly elderly people, a number of associations between cardiometabolic and common ophthalmic diseases were revealed. The identified comorbidities may have important therapeutic and prophylactic applications in an aging population.
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Affiliation(s)
- A. O. Direev
- Novosibirsk State Medical University;
Research Institute of Internal and Preventive Medicine, Federal Research Center Institute of Cytology and Genetics
| | | | - E. S. Mazurenko
- Research Institute of Internal and Preventive Medicine, Federal Research Center Institute of Cytology and Genetics
| | | | - A. N. Ryabikov
- Novosibirsk State Medical University;
Research Institute of Internal and Preventive Medicine, Federal Research Center Institute of Cytology and Genetics
| | | | - S. K. Malyutina
- Novosibirsk State Medical University;
Research Institute of Internal and Preventive Medicine, Federal Research Center Institute of Cytology and Genetics
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Air Pollutant Particles, PM 2.5, Exposure and Glaucoma in Patients with Diabetes: A National Population-Based Nested Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189939. [PMID: 34574858 PMCID: PMC8471364 DOI: 10.3390/ijerph18189939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 12/31/2022]
Abstract
The global prevalence of diabetes mellitus (DM) has reached 20%. Air pollutants with a particle size of less than 2.5 μm (PM2.5) are a globally recognized risk factor for diabetes and glaucoma. We examined whether the risk of glaucoma would decrease or increase when patients with DM were exposed to different PM2.5 concentrations. Data were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan and the Air Quality Monitoring Network between 2008 and 2013. This nested case-control study involved 197 DM patients with glaucoma and 788 DM patients without glaucoma. Cases and controls were matched (1:4) by gender, age (±5 years), and index date (±6 months), and their data were entered in a logistic regression model adjusted for gender, age, urbanization level, income level, and comorbidities. The odds ratio (OR) of glaucoma at PM2.5 exposure concentration in the fourth quartile (Q4) compared with in the first quartile (Q1) was 1.7 (95% CI: 1.084-2.764). For glaucoma risk, the OR was 1.013 (95% CI: 1.006-1.020) at a PM2.5 exposure concentration in Q1, 1.004 (95% CI: 1.001-1.007) in the third quartile (Q3), and 1.003 (95% CI: 1.001-1.004) in Q4. In the subgroup analysis of patients living in non-emerging towns and non-agricultural towns, the OR for glaucoma in Q4 compared with in Q1 was 2.1 (95% CI: 1.229-3.406) and 1.8 (95% CI: 1.091-2.803), respectively (p trend = 0.001 and 0.011). For patients without migraine, the OR for glaucoma was 1.7 (95% CI: 1.074-2.782; p = 0.006). These results demonstrate that, for patients with DM, PM2.5 increased the risk of glaucoma and PM2.5 was an independent risk factor for glaucoma in patients with DM.
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Li W, Pan J, Wei M, Lv Z, Chen S, Qin Y, Li N. Nonocular Influencing Factors for Primary Glaucoma: An Umbrella Review of Meta-Analysis. Ophthalmic Res 2021; 64:938-950. [PMID: 34517373 DOI: 10.1159/000519247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/22/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Glaucoma is the main cause of irreversible blindness worldwide. Still, little is known about nonocular risk factors. We use an umbrella review to examine the meta-analytic evidence of the correlation between nonocular factors and glaucoma. METHOD We searched PubMed and Embase databases up to July 24, 2020. Eligible meta-analyses (MAs) included cohort, case-control, and randomized controlled study designs. Two authors independently extracted the data and evaluated the methodological quality of the MAs. AMSTAR 2 was used to assess the methodological quality of each included MA. RESULTS This umbrella review contains 22 MAs with 22 unique nonocular factors in total. We identified 11 factors that increase the risk of glaucoma: hyperlipidemia, nocturnal dip in blood pressure, infection with Helicobacter pylori, myopia, obstructive sleep apnea syndrome, corneal properties, diabetes, hypertension, hypothyroidism, migraine, and plasma homocysteine. We identified 3 factors that reduce the risk of glaucoma: dietary intake of vitamin A, dietary intake of vitamin C, and short-term statin use. We identified 8 factors that had no association with glaucoma: dietary intake of vitamin B, dietary intake of vitamin E, cigarette smoking, Alzheimer's disease, serum folic acid, serum vitamin B6, serum vitamin B12, and serum vitamin D. CONCLUSIONS In this umbrella review of MAs, evidence was found for associations of various nonocular factors with glaucoma to different degrees. However, risk factors were only mildly associated, suggesting low impact of systemic risk factors. Additional higher quality studies are needed to provide robust evidence.
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Affiliation(s)
- Wenman Li
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China,
| | - Jiaxing Pan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Maoling Wei
- The Center for Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiqing Lv
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Sijie Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Qin
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Ni Li
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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22
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Li Y, Mitchell W, Elze T, Zebardast N. Association Between Diabetes, Diabetic Retinopathy, and Glaucoma. Curr Diab Rep 2021; 21:38. [PMID: 34495413 DOI: 10.1007/s11892-021-01404-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The strength of the relationship between diabetes, diabetic retinopathy (DR), and glaucoma remains controversial. We review evidence supporting and refuting this association and explore mechanistic pathological and treatment relationships linking these diseases. RECENT FINDINGS While studies have shown diabetes/DR may increase the risk for glaucoma, this remains inconsistently demonstrated. Diabetes/DR may contribute toward glaucomatous optic neuropathy indirectly (either by increasing intraocular pressure or vasculopathy) or through direct damage to the optic nerve. However, certain elements of diabetes may slow glaucoma progression, and diabetic treatment may concurrently be beneficial in glaucoma management. Diabetes plays a significant role in poor outcomes after glaucoma surgery. While the relationship between diabetes/DR and glaucoma remains controversial, multiple mechanistic links connecting pathophysiology and management of diabetes, DR, and glaucoma have been made. However, a deeper understanding of the causes of disease association is needed.
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Affiliation(s)
- Yangjiani Li
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, 02114, USA
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, 510060, China
| | - William Mitchell
- Department of Ophthalmology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Ophthalmology, Royal Victorian Eye and Ear, Melbourne, VIC, 3002, Australia
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, 02114, USA
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.
- Department of Ophthalmology, Harvard Medical School, Boston, MA, 02115, USA.
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Associations of new-onset atrial fibrillation and severe visual impairment in type 2 diabetes: A multicenter nationwide study. World J Cardiol 2021. [DOI: 10.4330/wjc.v13.i8.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Kaewput W, Thongprayoon C, Rangsin R, Bathini T, Mao MA, Cheungpasitporn W. Associations of new-onset atrial fibrillation and severe visual impairment in type 2 diabetes: A multicenter nationwide study. World J Cardiol 2021; 13:372-380. [PMID: 34589172 PMCID: PMC8436677 DOI: 10.4330/wjc.v13.i8.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/20/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many studies have demonstrated an association between type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF). However, the potential independent contributions of T2DM and AF to the prevalence of visual impairment have not been evaluated.
AIM To determine whether such an association between T2DM and incident AF with visual impairment exists, and if so, the prevalence and magnitude of this association.
METHODS We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study had evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. T2DM patients were categorized into two groups: patients without and with incident AF. T2DM patients without AF were selected as the reference group. The association between incident AF and visual impairment among T2DM patients was assessed using multivariate logistic regression.
RESULTS A total of 27281 T2DM patients with available eye examination data were included in this analysis. The mean age was 60.7 ± 10.5 years, and 31.2% were male. The incident AF was 0.2%. The prevalence of severe visual impairment in all T2DM patients, T2DM patients without AF, and T2DM patients with incident AF were 1.4%, 1.4%, and 6.3%, respectively. T2DM patients with incident AF were associated with an increased OR of 3.89 (95%CI: 1.17-13.38) for severe visual impairment compared with T2DM patients without AF.
CONCLUSION T2DM patients with incident AF were independently associated with increased severe visual impairment. Therefore, early eye screening should be provided for these high-risk individuals.
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Affiliation(s)
- Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, United States
| | - Michael A Mao
- Department of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
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Dennyson Savariraj A, Salih A, Alam F, Elsherif M, AlQattan B, Khan AA, Yetisen AK, Butt H. Ophthalmic Sensors and Drug Delivery. ACS Sens 2021; 6:2046-2076. [PMID: 34043907 PMCID: PMC8294612 DOI: 10.1021/acssensors.1c00370] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022]
Abstract
Advances in multifunctional materials and technologies have allowed contact lenses to serve as wearable devices for continuous monitoring of physiological parameters and delivering drugs for ocular diseases. Since the tear fluids comprise a library of biomarkers, direct measurement of different parameters such as concentration of glucose, urea, proteins, nitrite, and chloride ions, intraocular pressure (IOP), corneal temperature, and pH can be carried out non-invasively using contact lens sensors. Microfluidic contact lens sensor based colorimetric sensing and liquid control mechanisms enable the wearers to perform self-examinations at home using smartphones. Furthermore, drug-laden contact lenses have emerged as delivery platforms using a low dosage of drugs with extended residence time and increased ocular bioavailability. This review provides an overview of contact lenses for ocular diagnostics and drug delivery applications. The designs, working principles, and sensing mechanisms of sensors and drug delivery systems are reviewed. The potential applications of contact lenses in point-of-care diagnostics and personalized medicine, along with the significance of integrating multiplexed sensing units together with drug delivery systems, have also been discussed.
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Affiliation(s)
| | - Ahmed Salih
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Fahad Alam
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mohamed Elsherif
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Bader AlQattan
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Ammar A. Khan
- Department
of Chemical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Ali K. Yetisen
- Department
of Physics, Lahore University of Management
Sciences, Lahore Cantonment 54792, Lahore, Pakistan
| | - Haider Butt
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
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Alqahtani SM, Bakarman MA, Almanjoumi A, Alzahrani SH. Awareness and knowledge about glaucoma among patients visiting the screening clinic in Jeddah Eye Hospital, Saudi Arabia. Int J Ophthalmol 2021; 14:887-895. [PMID: 34150545 DOI: 10.18240/ijo.2021.06.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To explore levels and determinants of awareness and knowledge about glaucoma among patients. METHODS This was a cross-sectional study that included adult patients from October to the end of December 2018. A semi-structured questionnaire was designed by the researchers to measure the levels of awareness and knowledge about 18 basic information about glaucoma. The sheet was divided into 4 domains: types of glaucoma, risk factors, clinical features, and management. A knowledge score (KS, range=0-18) was calculated, with higher scores indicating higher levels. RESULTS A total of 383 patients responded to the questionnaire, 61.9% males, mean±SD age was 38.5±12.94 years old, and 61.6% had a university degree or higher. Of them, 6.3% and 23.2% reported personal and family history of glaucoma, respectively. The most frequently reported source of information about glaucoma was another person with glaucoma (28.2%), followed by physicians (24.8%) and TV (19.6%). Knowledge by item ranged from 3.1% to 82.5% correctness rate, while KS showed mean=5.91 and median=5; and reliability testing of the knowledge scale showed Cronbach's alpha=0.782. Higher KS were found among respondents with higher educational level (P=0.036), diabetes history (P=0.025), and personal (P<0.001) and family (P<0.001) history of glaucoma. CONCLUSION This study reveals low awareness and knowledge levels about glaucoma among the attendees of a local eye care hospital, where several misconceptions about disease risk factors, clinical features, and management are identified.
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Affiliation(s)
| | - Marwan A Bakarman
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdul Aziz University, Jeddah 21589, Saudi Arabia
| | - Ahmed Almanjoumi
- Ophthalmology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 22234, Saudi Arabia
| | - Sami H Alzahrani
- Family Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah 22431, Saudi Arabia
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[Assessment of risk factors for the occurrence of open angle glaucoma : Guidelines of the German Ophthalmological Society and the Professional Association of Ophthalmologists in Germany]. Ophthalmologe 2021; 118:1-14. [PMID: 32705323 DOI: 10.1007/s00347-020-01169-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Dascalu AM, Stana D, Nicolae VA, Cirstoveanu C, Vancea G, Serban D, Socea B. Association between vascular comorbidity and glaucoma progression: A four-year observational study. Exp Ther Med 2021; 21:283. [PMID: 33603890 PMCID: PMC7851678 DOI: 10.3892/etm.2021.9714] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022] Open
Abstract
Glaucoma, one of the significant causes of blindness worldwide, is a chronic optic neuropathy, characterized by progressive loss of retinal ganglion cells and specific perimetric defects. This study aimed to assess the association between the risk of glaucoma progression and different systemic vascular abnormalities. A 4-year prospective study was carried out on 204 patients diagnosed with open-angle glaucoma. Associated systemic vascular pathology was documented in 102 cases. Progression was encountered in 57 (55.9%) patients with vascular comorbidities and only in 10 (9.8%) patients with no associated vascular diseases (OR 13.81, P<0.01). The vascular risk factors associated with glaucoma progression in the study group were diastolic hypotension (OR 5.444, P=0.027), ischemic cardiac disease (OR 5.826; P<0.01), peripheral vasospasm (OR 3.108, P=0.042) and arterial hypertension (OR 2.593, P=0.05). Diabetes was not significantly correlated with progression in the study group, but only patients without diabetic retinopathy were included. This study highlights that systemic comorbidities associated with endothelial lesions, atherosclerosis and hypoperfusion can lead to damage to the retinal nerve fiber layer and the underlying conjunctive tissue.
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Affiliation(s)
- Ana Maria Dascalu
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Daniela Stana
- Department of Ophthalmology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Vanesa Andrada Nicolae
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Catalin Cirstoveanu
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Geta Vancea
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Omidtabrizi A, Ghavami V, Shafiee M, Bayani R, Banaee T. Long-Term Intraocular Pressure Changes after Pars Plana Vitrectomy: An 8-Year Study. J Curr Ophthalmol 2021; 32:335-342. [PMID: 33553834 PMCID: PMC7861093 DOI: 10.4103/joco.joco_85_20] [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] [Received: 03/10/2020] [Revised: 06/23/2020] [Accepted: 07/11/2020] [Indexed: 11/05/2022] Open
Abstract
Purpose: To investigate the long-term changes of intraocular pressure (IOP) after pars plana vitrectomy (PPV). Methods: This was a retrospective historical cohort study. Patients with a history of vitrectomy in one eye by a single surgeon were enrolled. IOP of the operated eye was compared to the fellow eye. Previous scleral buckling, IOP rise due to surgical/anatomic complications, silicone oil (SO) emulsification, and contralateral ocular hypertension/glaucoma at recruitment were exclusion criteria. “Significant IOP rise” (>6.0 mmHg) and development of open angle glaucoma (OAG) were the main outcome measures. Results: Two hundred and twenty-five eyes were included. Mean and median follow-up duration were 20.6 and 9.0 months, respectively. Mean baseline IOP and mean final IOP were 13.53 ± 3.75 mmHg and 16.52 ± 6.95 mmHg, respectively (P < 0.001). Forty-three patients developed “significant IOP rise” with no statistically significant relation to the indication of vitrectomy, the postoperative lens status, and number of vitrectomies (P = 0.410, P = 0.900, and P = 0.160, respectively). SO injection raised the probability of IOP rise in the long-term (P = 0.028). OAG occurred in 17 patients (7.5%) with no association to SO tamponade (P = 0.840). “Significant IOP rise” and OAG occurred in 3 and 1 control eyes, respectively, significantly lower than the rates in study eyes (P < 0.001). Conclusion: Mean IOP slightly rose in the long-term after PPV. SO tamponade was associated with IOP rise in the long-term but not with the incidence of OAG. Both IOP rise and OAG were more probable after vitrectomy.
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Affiliation(s)
- Arash Omidtabrizi
- Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Ghavami
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Shafiee
- Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Bayani
- Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Touka Banaee
- Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch at Galveston, TX, USA
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Baccaglini L, Kusi Appiah A, Ray M, Yu F. Variability in preventive care practices among US adults with diabetes mellitus. BMJ Open Diabetes Res Care 2021; 9:9/1/e001861. [PMID: 33468499 PMCID: PMC7817787 DOI: 10.1136/bmjdrc-2020-001861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/30/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Patients with diabetes are advised to follow standard medical care including daily blood glucose and foot checks, eye examinations with pupil dilation, and cholesterol checks to prevent diabetes-related complications. It is unclear how these practices currently vary across different US population subgroups. The objective of this study was to assess variation in overall and individual diabetes care practices and identify specific factors associated with differences in these practices in a representative sample of US diabetic adults. RESEARCH DESIGN AND METHODS Cross-sectional data were from the 2017 Behavioral Risk Factor Surveillance System. Survey logistic regression was used to account for the complex sampling design. RESULTS Among 30 780 eligible participants, 8957 (equivalent to 28% of the target population) followed all four diabetes care practices. Insulin-dependent participants had higher adjusted odds (adjusted OR=2.95; 95% CI 2.62 to 3.31) of following all four diabetic care practices compared with those who did not. Cost-related variables (having healthcare coverage and/or a personal doctor) were positively associated with diabetes care practices, with the strongest association observed for adherence to more costly practices (annual eye examination and cholesterol check) versus less costly ones (daily blood glucose check, daily foot check). CONCLUSIONS Our findings suggest the need for diabetes care practice-specific and population subgroup-specific public health interventions to encourage early adherence to diabetic care practices and reduce complications.
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Affiliation(s)
- Lorena Baccaglini
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Adams Kusi Appiah
- Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mahua Ray
- Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Fang Yu
- Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
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31
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Grzybowski A, Och M, Kanclerz P, Leffler C, De Moraes CG. Primary Open Angle Glaucoma and Vascular Risk Factors: A Review of Population Based Studies from 1990 to 2019. J Clin Med 2020; 9:E761. [PMID: 32168880 PMCID: PMC7141380 DOI: 10.3390/jcm9030761] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 12/17/2022] Open
Abstract
Glaucoma is one of the leading causes of blindness worldwide, and as the proportion of those over age 40 increases, so will the prevalence of glaucoma. The pathogenesis of primary open angle glaucoma (POAG) is unclear and multiple ocular risk factors have been proposed, including intraocular pressure, ocular perfusion pressure, ocular blood flow, myopia, central corneal thickness, and optic disc hemorrhages. The purpose of this review was to analyze the association between systemic vascular risk factors (including hypertension, diabetes, age, and migraine) and POAG, based on major epidemiological studies. Reports presenting the association between POAG and systemic vascular risk factors included a total of over 50,000 patients. Several epidemiological studies confirmed the importance of vascular risk factors, particularly hypertension and blood pressure dipping, in the pathogenesis and progression of glaucomatous optic neuropathy. We found that diabetes mellitus is associated with elevated intraocular pressure, but has no clear association with POAG. No significant correlation between migraine and POAG was found, however, the definition of migraine varied between studies.
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Affiliation(s)
- Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61-285 Poznan, Poland
| | - Mariusz Och
- Department of Ophthalmology, The Voivodal Specialistic Hospital in Olsztyn, 10-561 Olsztyn, Poland;
| | - Piotr Kanclerz
- Department of Ophthalmology, Hygeia Clinic, 80-286 Gdańsk, Poland;
| | - Christopher Leffler
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, Virginia, VA 23284, USA;
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY 10032, USA;
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Nahomi RB, Nam MH, Rankenberg J, Rakete S, Houck JA, Johnson GC, Stankowska DL, Pantcheva MB, MacLean PS, Nagaraj RH. Kynurenic Acid Protects Against Ischemia/Reperfusion-Induced Retinal Ganglion Cell Death in Mice. Int J Mol Sci 2020; 21:ijms21051795. [PMID: 32151061 PMCID: PMC7084183 DOI: 10.3390/ijms21051795] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/21/2020] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Glaucoma is an optic neuropathy and involves the progressive degeneration of retinal ganglion cells (RGCs), which leads to blindness in patients. We investigated the role of the neuroprotective kynurenic acid (KYNA) in RGC death against retinal ischemia/reperfusion (I/R) injury. Methods: We injected KYNA intravenously or intravitreally to mice. We generated a knockout mouse strain of kynurenine 3-monooxygenase (KMO), an enzyme in the kynurenine pathway that produces neurotoxic 3-hydroxykynurenine. To test the effect of mild hyperglycemia on RGC protection, we used streptozotocin (STZ) induced diabetic mice. Retinal I/R injury was induced by increasing intraocular pressure for 60 min followed by reperfusion and RGC numbers were counted in the retinal flat mounts. Results: Intravenous or intravitreal administration of KYNA protected RGCs against I/R injury. The I/R injury caused a greater loss of RGCs in wild type than in KMO knockout mice. KMO knockout mice had mildly higher levels of fasting blood glucose than wild type mice. Diabetic mice showed significantly lower loss of RGCs when compared with non-diabetic mice subjected to I/R injury. Conclusion: Together, our study suggests that the absence of KMO protects RGCs against I/R injury, through mechanisms that likely involve higher levels of KYNA and glucose.
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Affiliation(s)
- Rooban B. Nahomi
- Sue Anschutz-Rodgers Eye Center and Department of Ophthalmology, University of Colorado, Aurora, CO 80045, USA; (M.-H.N.); (J.R.); (S.R.); (M.B.P.)
- Correspondence: (R.B.N.); (R.H.N.); Tel.: +1-303-724-8824 (R.H.N.)
| | - Mi-Hyun Nam
- Sue Anschutz-Rodgers Eye Center and Department of Ophthalmology, University of Colorado, Aurora, CO 80045, USA; (M.-H.N.); (J.R.); (S.R.); (M.B.P.)
| | - Johanna Rankenberg
- Sue Anschutz-Rodgers Eye Center and Department of Ophthalmology, University of Colorado, Aurora, CO 80045, USA; (M.-H.N.); (J.R.); (S.R.); (M.B.P.)
| | - Stefan Rakete
- Sue Anschutz-Rodgers Eye Center and Department of Ophthalmology, University of Colorado, Aurora, CO 80045, USA; (M.-H.N.); (J.R.); (S.R.); (M.B.P.)
| | - Julie A. Houck
- Division of Endocrinology, Metabolism and Diabetes, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (J.A.H.); (G.C.J.); (P.S.M.)
| | - Ginger C. Johnson
- Division of Endocrinology, Metabolism and Diabetes, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (J.A.H.); (G.C.J.); (P.S.M.)
| | - Dorota L. Stankowska
- Department of Pharmacology and Neuroscience, North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Mina B. Pantcheva
- Sue Anschutz-Rodgers Eye Center and Department of Ophthalmology, University of Colorado, Aurora, CO 80045, USA; (M.-H.N.); (J.R.); (S.R.); (M.B.P.)
| | - Paul S. MacLean
- Division of Endocrinology, Metabolism and Diabetes, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (J.A.H.); (G.C.J.); (P.S.M.)
| | - Ram H. Nagaraj
- Sue Anschutz-Rodgers Eye Center and Department of Ophthalmology, University of Colorado, Aurora, CO 80045, USA; (M.-H.N.); (J.R.); (S.R.); (M.B.P.)
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA
- Correspondence: (R.B.N.); (R.H.N.); Tel.: +1-303-724-8824 (R.H.N.)
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Behera UC, Bhattacharjee H, Das T, Gilbert C, Murthy GVS, Rajalakshmi R, Pant HB. Spectrum of Eye Disease in Diabetes (SPEED) in India: A prospective facility-based study. Report # 4. Glaucoma in people with type 2 diabetes mellitus. Indian J Ophthalmol 2020; 68:S32-S36. [PMID: 31937726 PMCID: PMC7001170 DOI: 10.4103/ijo.ijo_1948_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/23/2019] [Accepted: 11/29/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose To estimate the proportion of people with type 2 diabetes mellitus (T2DM) and glaucoma in a facility-based cross-sectional observational study in India. Methods All people received a comprehensive eye examination. Glaucoma-specific examinations included applanation tonometry, optic disc and cup evaluation, and stereo biomicroscopy in all people; gonioscopy and visual field testing in glaucoma suspects. The International Society of Geographic and Epidemiologic Ophthalmology guidelines were used to diagnose and classify glaucoma. Results The study recruited 11,182 people (average age: 58.2 ± 10.6; range 39-96 years). Glaucoma was diagnosed in 4.9% (n = 547) people. About 76.8% (n = 420) of those with glaucoma had bilateral disease, and 98.7% (n = 540) were >40 years. Among people with bilateral disease, 94.5% (n = 397) had primary glaucoma - open angle in 59.3% (n = 228) and angle closure in 40.2% (n = 169). Diabetes duration was ≤10 years in 71.5% (n = 300) people. On linear regression, the following were associated with glaucoma: advancing age [compared with < 40 years age group; odds ratio [OR] in 50-60 year age group: 1.36 [95% confidence interval (CI): 1.01-1.8], P < 0.035); >60 years age group (OR: 2.05, 95% CI: 1.57-2.67; P < 0.001), and diabetic neuropathy (OR: 2.62, 95% CI: 1.35-5.10, P < 0.003). Glycemic control did not have significant association (P = 0.425). Conclusion Presence of glaucoma in people with T2DM in this cohort was similar to the general population prevalence studies in India. Glaucoma was invariably bilateral. A comprehensive eye examination in people age 40 years and older with diabetes and/or glaucoma is beneficial.
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Affiliation(s)
- Umesh C Behera
- Retina Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Taraprasad Das
- Retina Vitreous Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - G V S Murthy
- Department of Clinical Research, Indian School of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - R Rajalakshmi
- Department of Ophthalmology, Dr Mohan's Diabetes Foundation, Chennai, Tamil Nadu, India
| | - Hira B Pant
- Department of Clinical Research, Indian School of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
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Killeen AL, Brock KM, Dancho JF, Walters JL. Remote Temperature Monitoring in Patients With Visual Impairment Due to Diabetes Mellitus: A Proposed Improvement to Current Standard of Care for Prevention of Diabetic Foot Ulcers. J Diabetes Sci Technol 2020; 14:37-45. [PMID: 31122064 PMCID: PMC7189171 DOI: 10.1177/1932296819848769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Two debilitating sequelae of diabetes are foot ulcerations and vision impairing conditions including retinopathy, open-angle glaucoma, and cataracts. Current standard of care recommends daily visual screening of feet. Despite willingness, many patients are impeded by visual impairment. We investigate whether once-daily remote temperature monitoring can improve self-screening for patients at risk for diabetic foot complications. METHODS We followed four male veterans with diabetes mellitus, peripheral neuropathy, impaired visual acuity, and at least one other diabetes-related visual impairment in a high-risk podiatry clinic. Patients received a telemedicine remote temperature monitoring mat and instructed on proper daily use. Each patient developed a "hotspot," defined as a 1.75°C localized temperature difference between matched pedal locations, which resulted in telephone triage outreach. RESULTS In three cases, outreach resulted in a sooner appointment where patients were found to have a relevant outcome at the hotspot. Patients in cases 1-3 had University of Texas (UT) 1A ulcerations. The patient in case 4 had inflammation from trauma. All patients had refractive errors plus another vision impairing condition that potentially delayed identification of lesions. Patients in cases 1 and 2 have cataracts, patients in cases 2 and 3 have retinopathy, and patient in case 4 has glaucoma. CONCLUSIONS As an adjunct to daily preventative diabetic self-care, once-daily remote temperature monitoring technology can augment self-screening to prompt necessary outreach and treatment and potentially prevent costly and debilitating diabetic foot complications. This case series serves as a pilot study for real-world application of thermometry, where further large-scale research is needed.
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Affiliation(s)
- Amanda L. Killeen
- Department of Surgery, Podiatry Section,
Southern Arizona Veteran Affairs Health Care System, Tucson, AZ, USA
| | | | - James F. Dancho
- Department of Surgery, Podiatry Section,
Southern Arizona Veteran Affairs Health Care System, Tucson, AZ, USA
| | - Jodi L. Walters
- Department of Surgery, Podiatry Section,
Southern Arizona Veteran Affairs Health Care System, Tucson, AZ, USA
- Jodi L. Walters, DPM, Diplomate, ABFAS,
Southern Arizona VA Health Care System, 3601 S 6th Ave, Tucson, AZ 85723, USA.
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Laville V, Kang JH, Cousins CC, Iglesias AI, Nagy R, Cooke Bailey JN, Igo RP, Song YE, Chasman DI, Christen WG, Kraft P, Rosner BA, Hu F, Wilson JF, Gharahkhani P, Hewitt AW, Mackey DA, Hysi PG, Hammond CJ, vanDuijn CM, Haines JL, Vitart V, Fingert JH, Hauser MA, Aschard H, Wiggs JL, Khawaja AP, MacGregor S, Pasquale LR. Genetic Correlations Between Diabetes and Glaucoma: An Analysis of Continuous and Dichotomous Phenotypes. Am J Ophthalmol 2019; 206:245-255. [PMID: 31121135 PMCID: PMC6864262 DOI: 10.1016/j.ajo.2019.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE A genetic correlation is the proportion of phenotypic variance between traits that is shared on a genetic basis. Here we explore genetic correlations between diabetes- and glaucoma-related traits. DESIGN Cross-sectional study. METHODS We assembled genome-wide association study summary statistics from European-derived participants regarding diabetes-related traits like fasting blood sugar (FBS) and type 2 diabetes (T2D) and glaucoma-related traits (intraocular pressure [IOP], central corneal thickness [CCT], corneal hysteresis [CH], corneal resistance factor [CRF], cup-to-disc ratio [CDR], and primary open-angle glaucoma [POAG]). We included data from the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database, the UK Biobank, and the International Glaucoma Genetics Consortium. We calculated genetic correlation (rg) between traits using linkage disequilibrium score regression. We also calculated genetic correlations between IOP, CCT, and select diabetes-related traits based on individual level phenotype data in 2 Northern European population-based samples using pedigree information and Sequential Oligogenic Linkage Analysis Routines. RESULTS Overall, there was little rg between diabetes- and glaucoma-related traits. Specifically, we found a nonsignificant negative correlation between T2D and POAG (rg = -0.14; P = .16). Using Sequential Oligogenic Linkage Analysis Routines, the genetic correlations between measured IOP, CCT, FBS, fasting insulin, and hemoglobin A1c were null. In contrast, genetic correlations between IOP and POAG (rg ≥ 0.45; P ≤ 3.0 × 10-4) and between CDR and POAG were high (rg = 0.57; P = 2.8 × 10-10). However, genetic correlations between corneal properties (CCT, CRF, and CH) and POAG were low (rg range -0.18 to 0.11) and nonsignificant (P ≥ .07). CONCLUSION These analyses suggest that there is limited genetic correlation between diabetes- and glaucoma-related traits.
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Affiliation(s)
- Vincent Laville
- Department of Computational Biology, Institut Pasteur, Paris, France
| | - Jae H Kang
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Clara C Cousins
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Adriana I Iglesias
- Departments of Ophthalmology and Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Réka Nagy
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jessica N Cooke Bailey
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Robert P Igo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yeunjoo E Song
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William G Christen
- Division of Preventive Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank Hu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - James F Wilson
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Puya Gharahkhani
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Pirro G Hysi
- Department of Twin Research and Genetic Epidemiology, King's College London, United Kingdom
| | - Christopher J Hammond
- Department of Twin Research and Genetic Epidemiology, King's College London, United Kingdom
| | - Cornelia M vanDuijn
- Departments of Ophthalmology and Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jonathan L Haines
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Veronique Vitart
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - John H Fingert
- Department of Ophthalmology and Visual Science, University of Iowa, Iowa City, Iowa, USA
| | - Michael A Hauser
- Departments of Ophthalmology and Medicine, Duke University, Durham, North Carolina, USA
| | - Hugues Aschard
- Department of Computational Biology, Institut Pasteur, Paris, France; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Janey L Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony P Khawaja
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Louis R Pasquale
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Kreft D, Doblhammer G, Guthoff RF, Frech S. Prevalence, incidence, and risk factors of primary open-angle glaucoma - a cohort study based on longitudinal data from a German public health insurance. BMC Public Health 2019; 19:851. [PMID: 31262269 PMCID: PMC6604230 DOI: 10.1186/s12889-019-6935-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 05/02/2019] [Indexed: 01/15/2023] Open
Abstract
Background This study estimates the prevalence and incidence rates of primary open -angle glaucoma (POAG) as well as risk factors based on a dataset from the largest German health insurance company. Methods A random sample of 250,000 persons at age 50+ of the Allgemeine Ortskrankenkasse (AOK) from 2010 to 2013 was used. Selected risk factors of POAG incidence were analyzed using multivariate Cox proportional hazard models. Results The age-standardized prevalence of POAG at age 50+ in 2010 was 2.79% (95%-CI: 2.72–2.85%). The age-standardized total incidence rate was 0.38 (0.36–0.39) per 100 person-years. Sex differences were significant for total prevalence and total incidence rates, with higher prevalence and incidence rates for women compared to men. The Cox model revealed a strong age effect, a significantly 19% higher incidence for women (p ≤ 0.001), injuries of the eye and orbit (175%, p ≤ 0.001), degeneration of iris and ciliary body (155%, p = 0.022), myopia (155%, p ≤ 0.001), retinal vascular occlusions (134%, p ≤ 0.001), hypertension (13%, p ≤ 0.001) and diabetes mellitus (23%, p ≤ 0.001). Conclusion Health claims data are an important data source for estimating POAG occurrence and help overcome the problems of small sample sizes. These results may help to understand the causal pathways of POAG and to develop intervention strategies to increase the awareness of patients and physicians with the aim of reducing POAG incidence. Electronic supplementary material The online version of this article (10.1186/s12889-019-6935-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Kreft
- Institute for Sociology and Demography, University of Rostock, Ulmenstrasse 69, 18057, Rostock, Germany. .,Rostock Center for the Study of Demographic Change, Konrad-Zuse-Str. 1, 18057, Rostock, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Sigmund-Freud-Straße 27, 53105, Bonn, Germany.
| | - G Doblhammer
- Institute for Sociology and Demography, University of Rostock, Ulmenstrasse 69, 18057, Rostock, Germany.,Rostock Center for the Study of Demographic Change, Konrad-Zuse-Str. 1, 18057, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Sigmund-Freud-Straße 27, 53105, Bonn, Germany
| | - R F Guthoff
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany
| | - S Frech
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany
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Ghoraba HH, Leila M, Elgouhary SM, Elgemai EEM, Abdelfattah HM, Ghoraba HH, Heikal MA. Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries. Clin Ophthalmol 2018; 12:2383-2391. [PMID: 30538421 PMCID: PMC6263217 DOI: 10.2147/opth.s185274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the safety of high-dose intravitreal triamcinolone acetonide (IVTA) as affordable low-cost alternative to anti-vascular endothelial growth factor (anti-vascular endothelial growth factor [anti-VEGF] agents) in lower-middle-income countries. Patients and methods This was a retrospective interventional non-comparative case series. The study recruited patients who received 20 mg IVTA for treating various retinal and optic nerve diseases over the past 5 years. Main outcome measure was assessment of complications secondary to high-dose IVTA. The crosstabs procedure was used to display the interaction between the variables tested. The ANOVA test was used to analyze the differences among group means. Results The study included 207 eyes of 168 patients. The main indication for high-dose IVTA were diabetic macular edema 64%, and macular edema secondary to retinal vein occlusion 19%. The mean follow-up period post-injection was 22 months. Mean number of injections was 1.3. Cataract developed in 54% of eyes. Glaucoma developed in 18.5% of eyes. Glaucoma surgery for intractable glaucoma attributed to high-dose IVTA was needed in 1% of eyes. Endophthalmitis and retinal detachment developed in one patient each. Conclusion High-dose IVTA is a safe and cost-effective alternative to anti-VEGF agents. Cataract formation and intraocular pressure rise do not pose major adverse effects when weighed against the risk of vision loss due to inability to afford anti-VEGF treatment.
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Affiliation(s)
- Hammouda Hamdy Ghoraba
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt.,Department of Retina, Magrabi Eye Hospital, Tanta, Egypt
| | - Mahmoud Leila
- Retina Department, Research Institute of Ophthalmology, Giza, Egypt,
| | | | - Emad Eldin Mohamed Elgemai
- Department of Retina, Magrabi Eye Hospital, Tanta, Egypt.,Department of Ophthalmology, Damanhour Teaching Hospital, Damanhour, Egypt
| | - Haithem Mamon Abdelfattah
- Department of Retina, Magrabi Eye Hospital, Tanta, Egypt.,Department of Ophthalmology, Banha Teaching Hospital, Banha, Egypt
| | | | - Mohamed Amin Heikal
- Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt
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Muc R, Saracen A, Grabska-Liberek I. Associations of Diabetic Retinopathy with Retinal Neurodegeneration on the Background of Diabetes Mellitus. Overview of Recent Medical Studies with an Assessment of the Impact on Healthcare systems. Open Med (Wars) 2018; 13:130-136. [PMID: 29675479 PMCID: PMC5906647 DOI: 10.1515/med-2018-0008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 02/27/2018] [Indexed: 11/24/2022] Open
Abstract
Diabetes Mellitus (DM) is one of the biggest healthcare and financial problems worldwide. The disease is strongly associated with microvascular and macrovascular complications, causing co-existing diseases like Diabetic Retinopathy, Diabetic Neuropathy and Diabetic Nephropathy. Annual healthcare expenditures for diabetes treatment and complications prevention cost 727 billion USD in year 2017. Diabetes Mellitus, Diabetic Retinopathy and Diabetic Retinal Neuropathy are closely related diseases - originating from incorrectly controlled glycemia, blood pressure and lipid levels in the course of increasing resistance of the body tissues to insulin. Irrespectively of thorough programs for Diabetes Mellitus prevention and treatment, Diabetic Retinopathy management requires targeted treatment strategies for both microvasculopathy and retinal neurodegeneration, to delay disease severity course and risk of blindness. The study and conclusions in this article are based on web-available data and officially published articles related to the diabetes mellitus and associated diseases - Diabetic Retinopathy and Diabetic Retinal Neuropathy. The articles have been reviewed and analyzed to assess mutual relations between the discussed diseases.
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Affiliation(s)
- Rafał Muc
- Faculty of Health Sciences and Physical Education, K. Pulaski University of Technology and Humanities in Radom, Radom, Poland
| | - Agnieszka Saracen
- Faculty of Health Sciences and Physical Education, K. Pulaski University of Technology and Humanities in Radom, Radom, Poland
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