PURPOSE:To characterize diabetic retinopathy (DR) severity and predominantly peripheral lesion (PPL) status among patients with diabetes mellitus (DM) imaged using ultrawide-field (UWF) photography at a tertiary center in Egypt following introduction of the first national UWF camera and certified reading center. METHODS:This prospective, cross-sectional study included all patients imaged from Feb2022 to Jan2025. UWF images were graded using the ETDRS severity scale, and PPLs were evaluated on non-steered color images. Demographic and clinical variables, including DM duration, treatment, HbA1c, age, and age of onset, were collected. Temporal trends in DR severity, PPL prevalence, and patient characteristics were assessed using linear regression and generalized estimating equation models. RESULTS:A total of 61,095 eyes from 26,170 patients were imaged; 47.5% had DM. Among 29,828 diabetic eyes, 34.9% had no DR; 17.2%, 10.8%, and 6.5% had mild, moderate, and severe NPDR; and 25.0% had PDR. The proportion of eyes with no DR increased significantly over time, while moderate NPDR and PDR declined (all p < 0.001). Vision-threatening DR decreased from 53.8% to 39.2%, and more-than-mild retinopathy declined from 61.0% to 42.0% (both p < 0.001). Mean HbA1c and diabetes duration decreased, while age and age of onset increased. Mean HbA1c decreased, while age, DM duration, and age of onset increased. PPL prevalence increased during the initial year, followed by stabilization in mild NPDR and decreases in moderate and severe NPDR. CONCLUSION:Implementation of UWF imaging and certified grading was followed by a shift toward imaging patients with earlier DR and reduced fluorescein angiography use. UWF deployment may facilitate earlier DR detection and triage in resource-limited settings.
PURPOSE:To assess methodological biases in studies reporting racial and ethnic differences in retinopathy of prematurity (ROP). METHODS:Systematic review of peer-reviewed studies published between 2014 and 2024 that reported on ROP outcome measures by race, ethnicity, or social determinants of health (SDOH). Three reviewers independently assessed each observation for selection and collider bias using definitions derived from perinatal epidemiology literature. Findings were also compared using a structured comparative synthesis between studies with and without identified methodological bias. RESULTS:A structured PubMed search identified 78 articles; 13 met inclusion criteria, with one study contributing two distinct analytical approaches, yielding 14 total observations. Survivorship bias was identified in 6 of 14 observations (42.9%), primarily due to the exclusion of infants who died prior to ROP screening. Potential collider bias was most common, found in 9 of 14 observations (64.3%), and was introduced through adjustment or stratification by gestational age and/or birthweight. Three studies did not exhibit either assessed biases. Among studies with identified bias, 8 of 10 observations reported lower ROP risk among Black versus White infants, whereas 3 of 4 observations without identified bias reported higher ROP risk or incidence among Black infants. CONCLUSION:Methodological biases in ROP studies investigating race or ethnicity are prevalent. Adjustment for gestational age or birthweight may introduce spurious race-ROP associations and contribute to paradoxical findings. Further exploration of the impact of SDOH on disease outcomes may reduce the misattribution of race as a biological risk factor and improve the interpretation of ROP disparities.
PURPOSE:To investigate the independent and interactive associations of high myopia (HM) and glucose metabolism status with subfoveal choroidal thickness (SFCT) in a nationwide, population-based study. METHODS:This cross-sectional study analyzed data from the Korea National Health and Nutrition Examination Survey 2019-2021. Participants were classified into a HM group (axial length [AL] >26.0 mm) and a control group (AL < 24.5 mm). Glucose metabolism status was categorized as normal, prediabetes, or diabetes mellitus (DM). Survey-weighted linear regression analyses were performed to identify independent determinants of SFCT. Interaction terms between HM and glucose metabolism status were additionally included to assess potential synergistic effects. RESULTS:A total of 9,132 participants were included, of whom 1,118 (12.2%) were classified as HM. The distribution of glucose metabolism status differed significantly across groups (p < 0.001), with a higher prevalence of prediabetes and DM in the control group (46.4% vs. 34.3% and 15.4% vs. 10.1%, respectively). HM was associated with a substantial decrease in SFCT (β = -107.25, p < 0.001), whereas prediabetes was associated with an increase in SFCT (β = 5.58, p = 0.015) after full adjustment for potential confounders. DM showed no significant association with SFCT (p = 0.705). No significant interaction was observed between HM and glucose metabolism status, indicating additive rather than synergistic effects. These findings were consistent across sensitivity analyses. CONCLUSION:In this nationwide, population-based study, prediabetes was associated with increased SFCT independent of HM. The absence of an association between DM and SFCT suggests that DM may exert opposing, stage-dependent effects on SFCT according to disease severity.
PURPOSE:As the eye disease burden is increasing, the allocation of eye care resources plays an important role in the sustainable development of eye care services. This study is to investigate the allocation and trend of eye care resources from 2013 to 2019 in Shanghai, China. METHODS:This study was composed of multiple cross-sectional surveys conducted in 2013, 2015, 2017, and 2019, in Shanghai, China. Institutions, doctors, technicians, and nurses were selected for describing eye care resources. The Lorenz curve, Gini coefficient, and Theil index were applied to assess the equity of eye care resource allocation. Trend analyses were applied to assess the temporal change. RESULTS:From 2013 to 2019, the total of eye care institutions increased a few, from 319 to 333, and the number of doctors and technicians almost doubled, but the number of nurses remained around 900. Institutions, doctors, technicians, and nurses were all concentrated heavily in the urban regions of Shanghai and the suburban regions have the lower density of institutions (ranging from 0.25 to 0.73 per 10,000 persons) and doctors (ranging from 1.35 to 2.01 per 10,000 persons). The contributions of total inequity for each indicator are different. For institutions and doctors, the major variations were from the differences between urban and suburban regions (more than 50%). For technicians, the inter-variation between urban and suburban regions contributed nearly 40% of the total inequity. But for nurses, the intra-variations in urban and suburban districts contributed to the major inequity (almost 80%). Given the temporal change of the Theil index, the inter-variations between urban and suburban regions among doctors decreased from 67.4% to 50.0% (P for trend 0.023), and the intra-variations in suburban districts among technicians also decreased from 35.0% to 27.3% (P for trend 0.022). GDP per capita and subway density were both associated with the allocation of eye care resoureces in Shanghai. CONCLUSIONS:The eye care resources were continuously more concentrated in the urban regions in Shanghai. The number of ophthalmologists in Shanghai is sufficient, but there is a shortage of auxiliary technicians and nurses. Future health policies should pay more attention to balancing the allocation of eye care resources and increasing the number of auxiliary technicians and nurses.
PURPOSE:Diabetic retinopathy remains a leading cause of blindness in the United States. Autonomous artificial intelligence (AI) systems for screening have received US Food and Drug Administration authorization, and a dedicated Medicare billing code for autonomous point-of-care retinal screening was introduced in 2021. This study aimed to characterize observed utilization, billing National Provider Identifier (NPI) uptake, provider-type distribution, and geographic spread of autonomous AI screening in Medicare from 2021 to 2023. METHODS:This study performed a retrospective descriptive analysis of the 2021-2023 Medicare Physician & Other Practitioners-by Provider and Service public-use files. Current Procedural Terminology (CPT) 92229 was the primary focus, with CPT 92227 and 92228 included as contextual comparators. RESULTS:Autonomous AI screening increased nearly tenfold, from 143 services in 2021 to 1,427 in 2023. Unique billing NPIs increased from 5 to 39. Optometry accounted for 57.7% of services, followed by family practice (13.9%), endocrinology (12.5%), and internal medicine (11.9%). The number of states with observed use increased from 3 to 16, and urban providers accounted for 96.6% of observed services. In 2023, observed use corresponded to approximately 15.3 services per 100,000 Medicare beneficiaries identified as having diabetes using fee-for-service claims. Estimated Medicare payments captured in the file increased from $3,538 to $42,889. CONCLUSION:Autonomous AI screening showed rapid early growth in Medicare Part B after introduction of code 92229, with expansion across billing NPIs, provider types, and states. Absolute use nonetheless remained small, indicating early billing uptake rather than meaningful population penetration.
PURPOSE:Beyond conventional vascular risk factors, we investigated whether baseline smoking exposure - a modifiable behavioral risk factor - is longitudinally associated with incident branch retinal vein occlusion (BRVO). METHODS:We analyzed 40,513 individuals (aged ≥40 years) undergoing serial health screenings (2011-2022). Incident BRVO was defined as new retinal hemorrhages in previously normal fundi, confirmed by masked specialists. Hypertension, diabetes, dyslipidemia, and decreased kidney function were defined by conventional criteria. Overweight/obesity was defined as BMI ≥ 23 kg/m2 or waist circumference ≥ 90 cm (men)/≥85 cm (women), and fatty liver by radiologist-confirmed ultrasonography. Smoking was classified as ever versus never. Variables with a log-rank p < 0.20 were entered into a multivariable Cox proportional hazards model. RESULTS:During a median follow-up of 5.2 years, 58 participants developed BRVO (0.14% of the cohort; 10-year Kaplan-Meier cumulative incidence, 0.30%). In multivariable analysis, age (HR, 1.05; 95% CI, 1.01-1.09), hypertension (HR, 2.27; 95% CI, 1.30-3.96), overweight/obesity (HR, 2.83; 95% CI, 1.39-5.75), and ever smoking (HR, 2.63; 95% CI, 1.20-5.79) were independently associated with incident BRVO. CONCLUSION:In this longitudinal health-screening cohort, baseline ever smoking was independently associated with incident BRVO after adjustment for conventional vascular risk factors. These findings suggest that smoking, a modifiable exposure, may contribute to BRVO risk beyond established determinants, although the small number of events warrants cautious interpretation and confirmation in larger, multicenter studies.
PURPOSE:This study aimed to assess factors associated with pediatric keratoconus in a large, population-based cohort. METHODS:This retrospective population-based nested case-control study utilized data from "Clalit" healthcare provider, Israel's largest. The records of patients diagnosed with keratoconus before age 18 between 2005 and 2020 were reviewed. Demographic data, socioeconomic status, smoking habits, and the presence of systemic conditions that may be linked with keratoconus were collected and analyzed. Univariable and multivariable conditional logistic regression were employed to identify the factors associated with the development of keratoconus. RESULTS:Overall, 1953 pediatric keratoconus patients with a mean age of 14.2 years of which 60.8% were male were included. There were 19,530 age-matched healthy subjects in the control group. In multivariable analysis, male gender (OR = 1.54, p < 0.001), asthma (OR = 1.41, p < 0.001), intellectual disability (OR = 2.39, p < 0.001), atopic dermatitis (OR = 1.39, p < 0.001), and allergy (OR = 1.28, p < 0.001) were significantly associated with pediatric keratoconus. Smoking (OR = 0.73, p = 0.007), middle socioeconomic status (SES) (OR = 0.71, p = 0.001), and high SES (OR = 0.57, p = 0.001) were inversely associated with pediatric keratoconus. Diabetes mellitus showed no significant association with keratoconus risk (OR = 1.01, 95% CI: 0.40-2.58, p = 0.982). CONCLUSION:Male gender, asthma, intellectual disability, allergy, and atopic dermatitis were linked with increased risk, while smoking, middle SES, and high SES were inversely associated with pediatric keratoconus. These findings provide valuable insights into possible areas of focus for early detection and preventative interventions in high-risk populations.
PURPOSE:To investigate whether the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) can predict the progression of intermediate age-related macular degeneration (iAMD) to advanced non-neovascular (NNV) or neovascular (NV). METHODS:380 patients aged 55-99 years with iAMD in one or both eyes and no evidence of geographic atrophy (GA) or NV AMD in either eye were enrolled (2014-2023 into the University of Colorado AMD registry) with follow-up through November 2024. AMD classification and progression were based on multimodal imaging review by two vitreoretinal surgeons. Baseline visual acuity (LogMAR) and VFQ-25 scores were collected at enrollment. Cox proportional hazards models assessed time to progression. Kaplan-Meier analysis evaluated significant VFQ-25 subscales. RESULTS:Among 380 iAMD participants (mean age 76.1 years, 95.8% white), 131 (34.5%) progressed to advanced AMD over a median 32-month follow up (SD- 27). Worse baseline LogMAR in both the better- (HR: 6.39, 95% CI: 1.57-26; p = 0.001) and worse- (HR: 2.64, 95% CI: 1.26-5.55; p = 0.010) seeing eyes predicted progression. Lower baseline VFQ-25 general vision (HR: 0.84 per 10-point increase, 95% CI: 0.74-0.95, p = 0.006) and distance activities scores (HR: 0.89 per 10-point increase, 95% CI: 0.80-0.98, p = 0.019) predicted progression during follow-up. In multivariable analysis adjusting for age and LogMAR for both eyes, this remained significant for general vision (HR: 0.85, 95% CI:0.75-0.98, p = 0.022). Kaplan-Meier analysis showed faster progression for patients with baseline general vision and distance activity subscores below 85 (p = 0.013 and p = 0.011, respectively). CONCLUSION:Lower NEI-VFQ-25 general vision subscale scores independently predicted progression to advanced AMD.
PURPOSE:To investigate how race and other social determinants of health (SDOH) influence prehospital opioid administration for open globe injuries (OGIs) in the United States. METHODS:We analyzed emergency medical service activations for OGIs in the National Emergency Medical Services Information System (NEMSIS) database from 2017-2021, excluding cancellations and cases without patient contact. Demographics, maximum reported pain scores, and administered medications were recorded. Multivariate logistic regression adjusted for pain score was used to identify factors associated with increased likelihood of opioid administration. RESULTS:Among 53,589 OGI cases, females were less likely than males to receive opioids (OR 0.71). Non-White patients were less likely than White patients to receive opioids (African Americans OR 0.37; Hispanics OR 0.83). Urban patients were less likely than suburban patients (OR 0.63), and patients in the Midwest (OR 0.75), Northeast (OR 0.24), and South (OR 0.77) were less likely than those in the West. Cases between 11 pm-7 am were less likely to involve opioid use (OR 0.62). Emergent cases (OR 1.85) and patients aged 66-75 (OR 1.41) were more likely to receive opioids. CONCLUSION:Significant racial, regional, and gender disparities exist in prehospital opioid use for OGIs. Addressing bias, diversifying the workforce, and implementing clearer guidelines may promote equitable pain management in ocular trauma.
PURPOSE:Sun exposure has important effects on human health, including risk of myopia (short-sightedness). We examined the association between outdoor time in the sun and myopia in 16,543 Australian-born adult participants of the 45 and Up study (aged 58-99 years). METHODS:At the baseline survey (2005-2009), participants of the 45 and Up study self-reported history of skin cancer and outdoor, sun exposure and sedentary behaviours. At the Health Compass Survey follow-up (2022), participants additionally self-reported their history of myopia. Associations were analysed using multivariable logistic regression. RESULTS:The prevalence of self-reported myopia was 53.1%, likely representing an over-estimate. Higher prevalence of self-reported myopia was associated with self-identifying as female (odds ratio [OR]=1.26, 95% confidence interval [CI]: 1.17, 1.35, p < 0.001), being younger (OR = 1.45, 95% CI: 1.19, 1.79, p < 0.001 for age 55-64 years vs age 85+ years), exercising less (OR = 1.04, 95% CI: 1.00, 1.09, p = 0.04), spending less time outdoors in the sun (OR = 1.05, 95% CI: 1.03, 1.08, p < 0.001) spending more time sitting (OR = 1.02, 95% CI: 1.01, 1.04, p < 0.001) and having lower propensity to tan (OR = 1.19, 95% CI: 1.06, 1.35, p = 0.005 for Never tan vs Get very tanned after sun exposure). CONCLUSIONS:In adulthood, higher time spent outdoors was associated with lower prevalence of self-reported myopia. This may indicate that outdoor behaviours in adulthood reflect those in childhood, when myopia develops. However, caution interpreting these findings is warranted due to the cross-sectional design, potential misclassification of myopia and temporal gap (13-17 years) between self-reporting of outdoor time and myopia status.
PURPOSE:To determine whether the clinical characteristics of IRD patients are associated with the positive molecular diagnosis. METHODS:This multi-center cross-sectional study analyzed 492 IRD patients in Taiwan enrolled between January 2018 and May 2022. Patients with clinical IRD suspicion aged between 0 and 96 years with no previous genetic diagnosis were enrolled. RESULTS:Among the 492 patients recruited, 274 (55.7%) received a molecular diagnosis. The mean age at first visit was 49.5 years, and 245 patients (49.8%) were male. Positive genetic results were observed in 67 of 72 patients (93.1%) with onset age < 10 years, compared with 18 of 28 (64.3%) in those with onset age ≥ 50 years. Positive results were also more common in patients with a positive IRD family history, 136 of 162 (84.0%), compared with those without a family history, 138 of 179 (77.1%). In addition, patients with a previous genetic diagnosis in one family member had a higher diagnostic yield. In univariate analysis, male sex (OR 1.83; p < .01), age of onset 0-9 years (OR 3.00; p < .01), a positive IRD family history (OR 4.18; p < .05), and a previous genetic diagnosis in one family member (OR 4.24; p < .001) were associated with higher odds of a positive result. For worse-seeing-eye BCVA, diagnostic yield ranged from 68.6% in patients with normal vision to 87.5% in those with moderate visual impairment and 85.1% in those with no light perception. In the multivariate model, only worse-seeing-eye logMAR BCVA > 2.0 remained independently associated with positive testing (OR 4.80; p < .001). No negative predictors of panel-based molecular diagnosis were identified. CONCLUSION:We discovered key patient-level demographic and clinical factors associated with increased odds of obtaining a molecular diagnosis. This study supports further evaluations of clinical characteristics that can improve the cost-benefit of panel-based genetic testing for IRD, paving the way for efficient genetic diagnostics and identifying high-risk panel-undiagnosable patients to pursue more advanced sequencing platforms.
PURPOSE:To analyze the diagnosis of eye-related emergency department (ED) visits in South Korea and to investigate the national burden of eye-related visits in the ED and their trends over time. METHODS:Data were obtained from the National Emergency Department Information System in South Korea between 2014 and 2022. A total of 74,714,270 ED visits were analyzed. Eye-related ED visits were identified using diagnosis codes at the time of discharge from ED. Temporal trends in annual ED visits were analyzed. Eye-related ED visits were categorized into three groups based on the emergent categories (emergent, unlikely-emergent, and indeterminate). RESULTS:During the 9-year study period, eye-related ED visits accounted for 1,356,169 (1.82%) visits. Total ED visits significantly decreased in 2020 due to the COVID-19 pandemic, with a partial recovery by 2022 to 85% of 2019 levels. The number of eye-related ED visits similarly decreased in 2020, but it continued to decline until 2022, with its proportion dropping from 2.08% in 2014 to 1.58% in 2022 (rate: -0.0547%/year, 95% confidence interval: [-0.0723, -0.0371], p < 0.001). The SIR of total ED visits declined by 6.12% from 2014 to 2022. Among the eye-related ED visits, there were emergent (19.7%), unlikely-emergent (13.2%), and indeterminate (67.1%) cases. CONCLUSIONS:Eye-related ED visits in South Korea decreased over the 9-year study period and the proportion of emergent cases increased. The steady decline in eye-related ED visits, along with an increase in emergent cases, may have implications for the allocation of ED resources in the field of ophthalmology.
PURPOSE:Demyelinating disease has been associated with dry eye syndrome (DES). Current studies are limited by sample size and confounding autoimmune disorders. Neuromyelitis optica spectrum disorder (NMOSD) has not been associated with DES in a large-scale study to date. METHODS:This retrospective case-control study utilized data from the NIH's All of Us Research Database. Cases were patients with DES. Controls were identified with exact matching by birth year (±2 years), sex, race, and ethnicity. Patients with certain confounding diseases, including Sjögren's disease, were excluded. Patients with NMOSD and MS were identified, and aquaporin-4 (AQP4) testing was utilized to reclassify patients as NMOSD. Primary analysis was adjusted for exposure to DES-associated medications. A supplementary cross-sectional analysis was completed to evaluate the association in an unmatched cohort. RESULTS:Cases (n = 25,789) and controls (n = 102,954) were successfully matched. After AQP4-based reclassification and exclusions, 1,065 MS patients (338 cases, 727 controls) and 36 NMOSD patients were analyzed for association with DES. MS was significantly associated with DES adjusted OR 1.61 (95% CI 1.41-1.85). Preliminary analysis also demonstrated NMOSD is associated with DES adjusted OR 3.43 (95% CI 1.74-6.77). Supplementary cross-sectional analysis supported these associations. CONCLUSIONS:Both MS and NMOSD are significantly associated with DES, however the NMOSD effect size should be cautiously interpreted given the modest sample size. These findings represent the first moderate-scale epidemiological evidence linking NMOSD to DES. Our results support increased clinical awareness for DES in demyelinating disease patients. However, effect size validation is necessary in future, prospective studies.
PURPOSE:To examine changes in macular ganglion cell layer (GCL) thickness over five years in a community-based birth cohort of children without ophthalmic disease. METHODS:This prospective study included 660 children without ophthalmic disease from the Copenhagen Child Cohort 2000 Eye Study. Optical coherence tomography (OCT) scans were analyzed for seven macular GCL thickness and volume measurements. Associations with age, sex, axial length, and OCT signal strength were evaluated. Additionally, GCL thickness was measured in eyes with optic disc drusen (ODD; n = 16) and compared with non-ODD eyes. RESULTS:From around age 11 to 16, macular GCL thickness in boys increased by approximately 1.6%, with statistical significance in six of seven predefined measurements. In girls, GCL thickness was stable or slightly decreased (-0.4%), with significance in four of seven measurements. Baseline axial length (AL) differed significantly between sexes (23.47/22.89 mm in boys/girls, p < 0.0001), as did axial growth between visits (ΔAL, 0.19/0.42 mm in boys/girls, p < 0.0001). No consistent associations were found between AL and GCL thickness or longitudinal changes thereof. After adjusting for potential confounders, four of seven GCL measurements increased significantly with age in boys, while no age-related changes were observed in girls. No significant differences were found in baseline GCL thickness or longitudinal change in GCL between eyes with or without ODD. CONCLUSIONS:GCL thickness remained relatively stable between ages 11 and 16, with small but statistically significant differences between sexes.
PURPOSE:To describe the study design and inter-observer agreement of study instruments for the impact of cataract surgery on the psychological well-being and economy (SCOPE) study, which aims to i) investigate the economic impact of cataract surgery among adults aged 40 and older in rural south India and ii) evaluate the effects of cataract surgery on visual function, dementia, mental health, and falls. METHODS:Participants aged ≥ 40 years with best-corrected distance visual acuity (BCVA) of <6/12 in both eyes and with bilateral, operable cataract will be enrolled. Both the groups (with and without cataract surgery) will be followed up at 3 and 12 months to assess the effect of cataract surgery on household and individual income after adjustment for age, gender, education, visual function, cognition, mental health, and fear of falls. To assess inter-rater reliability, continuous variables such as logarithmic minimum angle of resolution (logMAR) visual acuity (VA) values were categorized into visual impairment (VI) categories, and Cohen's Kappa was computed for all categorical measures, including logMAR VA, lens opacity, and all interview questionnaires. RESULTS:Cohen's Kappa values for inter-rater agreement for logMAR VA, lens opacity, patient health questionnaire, Hindi Mental State Examination and Indian Visual Function Questionnaire were 0.655 (95%CI:0.558-0.792) to 0.939 (95%CI: 0.874-0.967); 0.700 (95%CI:0.547-0.742) to 0.938 (95%CI:0.871-0.969); 0.594 (95%CI:0.510-0.664) to 0.789 (95%CI:0.692-0.866); 0.846 (95%CI:0.812-0.859) to 0.872 (95%CI:0.849-0.932); and 0.507 (95%CI:0.430-0.585) to 0.507 (95%CI:0.404-0.607) respectively. CONCLUSION:All questionnaires demonstrated reliability. SCOPE provides insights into the psychological, economic, and societal impacts of cataract surgery to inform healthcare policy and improve older adults' well-being.
PURPOSE:To estimate the prevalence and severity of myopia progression among adult undergraduates during their college years, providing a foundation for larger-scale stratified surveys. METHODS:An online survey targeting Chinese adult undergraduates was conducted via WeChat. The original questionnaire collected data on current refractive status, myopia progression information, family history and lifestyle habits. Non-myopic individuals and those with other ocular diseases were excluded. RESULTS:By June 2024, 996 responses were collected, with 922 included after exclusions. Participants were mostly from Hubei (23.9%), Shanghai (18.2%) and Tianjin (15.8%), majoring in Engineering and Architecture (19.0%), Literature (15.7%) and Medicine (15.2%). The average age was 21.9 ± 1.2 years, and the mean spherical power (SPH) was -3.84 ± 1.80D (left eye) and -4.06 ± 1.81D (right eye). Myopia progression was reported by 56.3% of participants, with the fastest progression during the third year (40.3%) and the second year (28.7%). The fastest annual change of SPH was 0-0.25D (49.5%), followed by 0.25-0.50D (28.5%), 0.50-0.75D (11.0%) and over 0.75D (3.5%). The willingness to adopt myopia control measures was substantial, with 66.3% of participants expressing a preference for specially designed frame glasses. Logistic regression indicated that higher baseline SPH, younger age, and greater stress were associated with myopia progression during college years. CONCLUSION:Myopia progression is common among Chinese adult undergraduates, particularly during their second and third years. Students experiencing myopia progression show a strong willingness to adopt myopia control interventions. Myopia progression during college years is associated with age, baseline spherical power and academic stress.
Purpose: To evaluate long-term trends of refractive error-related blindness in Chinese children and adolescents (1990-2021) and project future trajectories to 2035, assessing impacts of COVID-19 and socioeconomic development. Methods: Retrospective and predictive analysis using Global Burden of Disease (GBD) 2021 data. Primary outcomes were age-specific prevalence and DALY rates in youth (<20 years). Secondary outcomes included age-standardized rates, EAPCs, decomposition components, and projections via BAPC and ARIMA models. Results: Refractive error-related blindness affected 26.97 million individuals in China (1990-2021), including nearly 3 million youth. Primary outcomes showed consistent increases in age-specific prevalence (0-14 years: +15.0%; 15-19 years: +16.8%). Secondary analyses revealed declining age-standardized rates (ASPR EAPC: -0.18%), with population aging as the dominant driver (83.4-93.0%). During COVID-19, adolescent prevalence declined sharply (-10.61%). ARIMA projections suggest a turning point, with youth prevalence expected to decline by 30.5-36.3% by 2036. Global analysis revealed >10-fold variation in adolescent burden across countries. Conclusion: Despite declining age-standardized rates, rising youth prevalence demands targeted interventions. Encouraging projections suggest delayed policy impacts, while COVID-19 disruptions highlight health system vulnerabilities. Prioritizing early screening and adolescent-focused strategies remains critical.
PURPOSE:To explore the Surveillance, Epidemiology, and End Results Program (SEER) database in a longitudinal study to determine the factors associated with the risk of death in ocular melanoma. METHODS:Patients with a primary diagnosis of ocular melanoma from the SEER database between 1975 and 2022 were included. Chi-square analysis and independent samples t test were performed. The Kaplan-Meier estimate was also run to determine survival months' variability by primary site. RESULTS:The 2,917 included patients were categorized as "died of ocular melanoma" or "alive or dead of other causes." Age was higher in patients who died from ocular melanoma (60.7 years ±12) compared to those alive or dead of another cause (57.9 years ±13.5; p < 0.001; OR 0.984; 0.977, 0.992; p < 0.001). The primary site of melanoma was also statistically significantly different between groups; conjunctiva (81.7%) and cornea (81.3%) had the highest survival rate, while the lacrimal gland and an overlapping lesion of the eye and adnexa had the highest mortality rates (100% and 73%, respectively; p < 0.001). Survival analysis with Kaplan-Meier estimate showed lacrimal gland and overlapping lesions of eye and adnexa differed in mean months of survival after diagnosis (54 months and 100.8 months, respectively) compared to conjunctiva and ciliary body (264.5 months and 237.5 months, respectively; p < 0.001). CONCLUSION:Age and primary site were associated with mortality from ocular melanoma. Overlapping lesions of the eye and adnexa, unspecified ocular site, and choroid were associated with the highest mortality risk from this melanoma.
PURPOSE:Age-related eye conditions, including cataract, glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and dry eye disease (DED), are prevalent and have been linked to mental health disorders, though findings are mixed. This study systematically examines associations between these ocular diseases and mental health conditions using a large real-world dataset. METHODS:A retrospective cohort study was conducted using the Global TriNetX database. Five cohorts (aged ≥ 40 years) with diagnoses of cataract, glaucoma, AMD, DR, and DED were propensity score matched 1:1 with controls without these eye diseases based on demographic and clinical covariates. Outcome measures were the incidence of mood, anxiety, and psychotic disorders, identified using ICD-10 codes. Hazard ratios (HRs) and 95% confidence intervals (95% CI) from the Cox proportional hazards models were used to assess associations. RESULTS:Study included patients with cataract (N = 121,060), glaucoma (N = 122,663), AMD (N = 39,915), DR (n = 43,495), DED (n = 148,221), and their median follow-up ranging 1263-2191 days. Cataracts, glaucoma, DR, and DED were each associated with mildly increased risks of mood (HR range: 1.05-1.10), anxiety (HR range: 1.04-1.12), and psychotic disorders (HR range: 1.18-1.36). When accompanied by visual impairment, risks were higher: mood (HR range: 1.22-1.57), anxiety (HR range: 1.16-1.32), and psychotic disorders (HR range: 1.54-2.15). CONCLUSION:Age-related ocular diseases, particularly when presented with vision impairment, are independently associated with elevated risks of mental health disorders. These findings underscore the need for integrated ophthalmic-psychiatric care and early intervention before vision loss to address the complex needs of affected patients.
