Primary open-angle glaucoma: clinical update

Health insurance enrollment and vision health in rural China: an epidemiological survey

Background

Vision health is an important aspect of health worldwide. Visual impairment (VI) is associated with poor quality of life and is usually more prevalent in rural areas. To help rural populations obtain vision care, health insurance policies have emerged throughout the world. However, some existing literatures show that health insurance enrollment’s impact on the overall physical health of rural population has been minimal. Focusing on vision health among adults in rural China, our study aims to investigates the impact of health insurance on vision health, heterogeneity of the effect, and the moderating effect of health insurance enrollment on the impact of chronic physical diseases and basic eye diseases on vision health.

Methods

Primary data were collected through a nation-wide epidemiological survey of vision health conducted in rural China in 2018, with a sample size of 28,787 used in our statistical analysis. Instrumental variables regression and Heckman selection models were conducted to examine the impact of health insurance enrollment and reimbursement ratio adults’ vision health outcomes. Subsample regressions by sex, age, education level, and whether with eye diseases were further conducted to explore the heterogeneity in our results. We then examined whether health insurance enrollment moderates the impact of chronic physical diseases and basic eye diseases on vision health through the method of introducing interaction terms.

Results

Participating in health insurance reduced the probability of VI by 2.15 %. The reimbursement rate increasing by 1 % point may reduce the probability of worsening VI by 6.12 %. Men (-0.0235, P = 0.0002) benefit more from insurance enrollment than women (-0.0201, P = 0.0082) with respect to vision health. From the young adult group to the oldest group, the marginal effect of health insurance increased from − 0.0068 (P = 0.0394) to -0.0753 (P < 0.0001). The marginal effect on VI was most significant in people with lower education levels and weakened with increased education levels. People with basic eye diseases (-0.0496, P = 0.0033) benefit more from participating insurance than the people without basic eye diseases (-0.0196, P = 0.0001) with respect to vision health. The moderating effects of health insurance enrollment on the impacts of cerebral infarction (-0.1225, P < 0.0001), diabetes (-0.0398, P = 0.0245), hyperlipidemia (-0.1364, P = 0.0271), mental illness (-0.1873, P = 0.0010), glaucoma (-0.1369, P = 0.0073), diabetic retinopathy (-0.1560, P = 0.0043), and retinal vein obstruction (-0.2018, P = 0.0155) on vision health were significantly negative.

Conclusions

The results suggest that participation in health insurance and higher health insurance reimbursement ratios reduced the risk of VI in the sampled adults. Health insurance has the most significant effect in in vulnerable groups. Heath insurance enrollment moderates the impacts of several chronic physical and basic eye conditions on vision health. Our findings have potential implications for reforming health insurance policies to improve vision health conditions in rural areas of developing countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06754-0.

Aqueous humor interleukin-6 levels in primary open-angle glaucoma (POAG): A systematic review and meta-analysis

OBJECTIVE

To determine the change in aqueous humor interleukin-6 (IL-6) levels among primary open-angle glaucoma (GPAA) patients.

METHODS

Studies that investigated IL-6 level in the aqueous humor in GPAA patients using the detección methods of enzyme-linked immunosorbent assay (ELISA) y multiplex bead immunoassay were retrieved. A meta-analysis was performed a determine the overall change in IL-6 of GPAA patients compared a controls.

RESULTS

A total of 14 studies were selected. Analysis combining the results of studies using both detección approaches did not show any changes in the level of IL-6 in GPAA (SMD=-0,07, 95%IC -0,73 - 0,59, P=0,83), possibly due a the heterogeneity of ELISA data. Since multiplex bead immunoassay is more sensitive than convenciónal ELISA in detecting antibodies, further isolated analysis of multiplex bead immunoassay results revealed that GPAA patients had a lower level of IL-6 in the aqueous humor compared a controls (SMD=-0,40, 95%IC -0,70 - 0,09, P=0,01). Moreover, a sensitivity test also confirmed that no alteracións of results were observed in all pooled studies y pooled studies from multiplex bead immunoassay, suggesting the stabilities of our synthetic results.

CONCLUSION

Because of its robustness, the pooled data from multiplex bead immunoassay was used a draw a conclusion in this study, showing that the reducción of IL-6 levels in aqueous humor was observed in patients with GPAA. Further studies are still warranted a confirm our findings.

The association of estrogen-signaling pathways and susceptibility to open-angle glaucoma

Background

Glaucoma is a complex multivariate disorder characterized by retinal ganglion cell (RGC) loss and optic nerve degeneration. Evidence suggests the role of estradiol (E2) and the etiology of glaucoma. Therefore, this present study evaluates the association between estrogen-signaling pathways and the risk of open-angle glaucoma (OAG).

Results

Meta-analysis was performed from available studies that investigated intraocular pressure (IOP) in patients treated with or without hormone replacement therapy (HRT) and studies that evaluated the associations between estrogen receptor (ER) polymorphisms and the risk of OAG. The pooled result showed that HRT had a positive effect in lowering IOP. Moreover, ERβ polymorphisms showed a significant association with the risk of OAG.

Conclusion

This report supports the notion that estrogen-signaling pathways play a pivotal role in the development of OAG.