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Purpose To investigate changes in the optic nerve head morphology after acute intraocular pressure (IOP) elevation during a dark room prone provocative test (DRPPT). Design Prospective cohort study. Participants Acute primary angle-closure (APAC) suspects underwent DRPPT. Methods Study participants stayed in a dark room for 2 hours with the forehead placed on a desk. At baseline and within 5 minutes after DRPPT, tonometry and enhanced depth imaging by spectral-domain optical coherence tomography (SD OCT) were performed. Main Outcome Measures Changes in 3-dimensional optic nerve head topography. Results The study included 114 eyes of 65 participants with a mean age of 58.3±8.7 years and a mean IOP elevation of 10.1±10.9 mmHg during DRPPT. When all eyes were included, the mean value of most optic disc parameters did not change significantly, except for a decrease in the temporal minimal rim width ( P = 0.005). By including only eyes with an IOP increase greater than 15 mmHg, the mean value of cup width ( P = 0.001) and cup depth ( P = 0.002) increased, whereas the lamina cribrosa (LC) thickness ( P = 0.035), temporal minimal rim width ( P = 0.001), and nasal minimal rim width ( P < 0.001) decreased. The LC depth and Bruch's membrane opening (BMO) did not differ between the baseline and the end of DRPPT. An IOP increase was significantly associated with widening ( P < 0.001; r = 0.46) and deepening ( P < 0.001; r = 0.52) of the optic cup, thinning of the LC ( P = 0.003; r = −0.35), temporal minimal rim width ( P < 0.001; r = −0.34), and nasal minimal rim width ( P < 0.001; r = −0.35). Conclusions Angle-closure suspect eyes showed a widening and deepening of the optic cup, decrease in neuroretinal rim width, and thinning of the LC after a darkness-induced IOP increase of >15 mmHg. The diameter of the BMO and position of the anterior LC surface remained unchanged. This suggests that a short-term IOP increase leads to a condensation of neuroretinal rim, prelaminar tissue, and LC, without major changes in the optic disc size and position of the anterior LC surface. [ABSTRACT FROM AUTHOR]

Purpose: To examine subfoveal choroidal thickness (SFCT) in patients with diabetes mellitus and patients with diabetic retinopathy. Design: Population-based, cross-sectional study. Participants: The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range, 50–93 years). Methods: A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (OCT) with enhanced depth imaging for measurement of SFCT and fundus photography for the assessment of diabetic retinopathy. Main Outcome Measures: Subfoveal choroidal thickness. Results: Fasting blood samples, fundus photographs, and choroidal OCT images were available for 2041 subjects (58.8%), with 246 subjects (12.1±0.7%) fulfilling the diagnosis of diabetes mellitus and 23 subjects having diabetic retinopathy. Mean SFCT did not differ significantly between patients with diabetes mellitus and nondiabetic subjects (266±108 vs. 261±103 μm; P = 0.43) nor between patients with diabetic retinopathy and subjects without retinopathy (249±86 vs. 262±104 μm; P = 0.56). After adjustment for age, sex, axial length, lens thickness, anterior chamber depth, corneal curvature radius, and best-corrected visual acuity, SFCT was associated with a higher glycosylated hemoglobin (HbA1c) value (P<0.001; regression coefficient B, 8.18; 95% confidence interval [CI], 4.02–12.3); standardized coefficient β, 0.08) or with the presence of diabetes mellitus (P = 0.001; B, 21.3; 95% CI, 9.12–33.5) but not with presence of diabetic retinopathy (P = 0.61) or stage of diabetic retinopathy (P = 0.14). As a corollary, after adjusting for age, region of habitation, body mass index, systolic and diastolic blood pressure, and level of education, diabetes mellitus was associated with a thicker SFCT (P<0.001). In contrast, neither presence of diabetic retinopathy (P = 0.61) nor stage of diabetic retinopathy (P = 0.09) were associated significantly with SFCT after adjusting for body mass index, diastolic and systolic blood pressure, and level of education and after adjusting for blood glucose concentrations, HbA1c value, diagnosis of diabetes mellitus, and systolic and diastolic blood pressure, respectively. Conclusions: Patients with diabetes mellitus had a slightly, but statistically significantly, thicker subfoveal choroid, whereas presence and stage of diabetic retinopathy were not associated additionally with an abnormal SFCT. Whereas diabetes mellitus as a systemic disease leads to a slight thickening of the choroid, diabetic retinopathy as an ocular disorder was not associated with choroidal thickness abnormalities after adjusting for the presence of diabetes mellitus. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of pseudoexfoliation syndrome (PEX) and its associations in a population-based setting. Design: Population-based, cross-sectional cohort study. Participants: Of 4403 eligible subjects with an age of ≥50 years, 3468 individuals (78.8%) participated in the Beijing Eye Study 2011 (mean age, 64.6±9.8 years; range, 50–93 years). Methods: All study participants underwent a detailed ophthalmologic examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp-based biomicroscopy. Main Outcome Measures: Prevalence and associations of PEX. Results: Slit-lamp examination results were available for 3022 study participants (87.1%). Definite pseudoexfoliation was observed in 72 of the 3022 subjects, with a prevalence of 2.38% (95% confidence interval [CI], 1.84–2.93). Suspected PEX was detected in 104 of the subjects (3.44%; 95% CI, 2.8–4.1). The overall prevalence of PEX (definite and suspected) was 176 of 3022 or 5.82% (95% CI, 4.99–6.66). In 80 subjects (45.5%), PEX was detected in both eyes, whereas it was detected only in the right eye in 42 subjects (23.9%) and only in the left eye in 54 (30.7%). The prevalence of PEX increased from 1.1% in among those 50 to 54 years old, to 3.5%, 5.7%, and 11.8% among those 60 to 64 years, 70 to 74 years, and ≥80 years, respectively. In multivariate analysis, presence of PEX was significantly associated with older age (P<0.001; odds ratio [OR], 1.08; 95% CI, 1.04–1.10), shorter axial length (P = 0.03; OR, 0.82; 95% CI, 0.68,0.98), and shallower anterior chamber (P = 0.03; OR, 0.59; 95% CI, 0.36–0.95). We found that PEX was not associated (all P>0.05) with sex, diabetes mellitus, blood pressure, psychological depression, smoking, dyslipidemia, body mass index, central corneal thickness, corneal diameter, optic nerve head measurements, choroidal thickness, retinal vessel diameters, early age-related macular degeneration, or retinal vein occlusion. Conclusions: In a North Chinese population aged ≥50 years, the prevalence of definite PEX was 2.38% (95% CI, 1.84–2.93), suspect PEX was 3.4% (95% CI, 2.8–4.1) and overall PEX was 5.82% (95% CI, 4.99–6.66). We found PEX to be associated with older age, shorter axial length, and shallower anterior chamber. The relationship between PEX and glaucomatous optic neuropathy remained inconclusive among our population. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Objective: To assess the 10-year incidence of retinal vein occlusions (RVOs) and associated factors in adult Chinese subjects. Design: Population-based, longitudinal study. Participants: The Beijing Eye Study, which included 4439 subjects (age: 40+ years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). Methods: The study participants underwent a detailed ophthalmic examination. Fundus photographs were examined for the new development of RVOs, differentiated into branch RVOs (BRVOs) and central RVOs (CRVOs). Main Outcome Measures: Incidence of RVOs. Results: Incident RVOs were detected in 51 eyes (49 subjects) with an incidence of 1.9±0.1 per 100 persons and 1.0±0.1 per 100 eyes. Incidence of BRVO was 1.6±0.1 per 100 subjects (43 subjects [88% of patients with RVO]; 44 eyes), and incidence of CRVO was 0.3±0.1 per 100 persons. Of 61 patients with an RVO in 2001 and 25 subjects reexamined in 2011, at least 4 subjects (7%) developed a second RVO. Incident BRVOs were located more often in the superior temporal quadrant and inferior temporal quadrant (32% and 34%, respectively) than in the superior nasal quadrant and inferior nasal quadrant (21% and 14%, respectively). In 35 eyes (80% of the BRVO eyes), the BRVO was located at an arteriovenous crossing. At the crossing sites, arterioles were found superficial to venules in 28 eyes (64% of the BRVO eyes). Macular edema was detected in 18 (37%) of all RVO eyes, including 13 (30%) of BRVO eyes. In multivariate logistic analysis, incident RVOs were associated with higher systolic blood pressure (P = 0.01; odds ratio [OR], 1.04), hypertension (P = 0.03; OR, 4.62), lower cognitive function score (P = 0.007; OR, 0.88), blood concentration of cholesterol ≥5.72 mmol/L (P = 0.007; OR, 3.29), and status after cerebral infarction/hemorrhage (P = 0.02; OR, 1.19). Incident RVOs were not significantly related to the intake of aspirin (P=0.37). Conclusions: The 10-year incidence of RVOs in Greater Beijing (1.9±0.1 per 100 persons) was similar to that in other studies on Caucasian populations. The 10-year incidence of RVOs was related to the known risk factors of arterial hypertension, hypercholesterolemia, and status after cerebral infarction/hemorrhage, as well as with a lower cognitive function score. Incident BRVO was approximately 6 times more frequent than incident CRVO. Macular edema was detected in approximately 30% of BRVO eyes. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To study subfoveal choroidal thickness (SFCT) in adult Chinese subjects and its correlation with ocular biometric parameters, refractive error, and age. Design: Population-based longitudinal study. Participants: The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range, 50–93 years). Methods: A detailed ophthalmic examination was performed, including spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging for measurement of SFCT. Main Outcome Measures: Subfoveal choroidal thickness. Results: The SFCT measurements were available for 3233 subjects (93.2%). Mean SFCT was 253.8±107.4 μm (range, 8–854 μm). In multivariate analysis, SFCT increased with younger age (P<0.001; correlation coefficient r = 4.12; beta coefficient = 0.37), shorter axial length (P<0.001; r = 44.7; beta coefficient = 0.46), male gender (P<0.001; r = 28.5; beta coefficient = −0.13), deeper anterior chamber depth (P<0.001; r = 39.3; beta coefficient = 0.13), thicker lens (P<0.001; r = 26.8; beta coefficient = 0.08), flatter cornea (P<0.001; r = 46.0; beta coefficient = 0.11), and better best-corrected visual acuity (BCVA) (logarithm of minimal angle of resolution; P = 0.001; r = 48.4; beta coefficient = 0.06). In multivariate analysis, SFCT was not significantly associated with blood pressure, ocular perfusion pressure, intraocular pressure, cigarette smoking, alcohol consumption, serum concentrations of lipids and glucose, diabetes mellitus, and arterial hypertension. In the myopic refractive error range of more than −1 diopter (D), SFCT decreased by 15 μm (95% confidence interval [CI], 11.9–18.5) for every increase in myopic refractive error of 1 D, or by 32 μm (95% CI, 37.1–26.0) for every increase in axial length of 1 mm. For each year increase in age, the SFCT decreased by 4.1 μm (95% CI, 4.6–3.7) (multivariate analysis). Conclusions: Subfoveal choroidal thickness with a mean of 254±107 μm in elderly subjects with a mean age of 65 years decreased with age (4 μm per year of age) and myopia (15 μm per diopter [D] of myopia). It was also associated with male gender and the ocular biometric parameters of a deeper anterior chamber and thicker lens. The association between SFCT and BCVA indicates a functional aspect of SFCT. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To describe the 5-year incidence of retinal microvascular abnormalities and analyze their associations with arterial hypertension in nondiabetic elderly Chinese subjects in urban and rural Beijing in a follow-up of the original Beijing Eye Study 2001. Design: Population-based study. Participants: The Beijing Eye Study 2006 included 3251 subjects who had participated in the Beijing Eye Study 2001 and returned for reexamination. Methods: By using fundus photographs, we determined the 5-year incidence and change (progression or regression) of retinal microvascular abnormalities, including focal narrowing (FN) of retinal arterioles, arteriovenous nicking (AVN), and retinopathy. Arterial hypertension was graded as controlled treated arterial hypertension, uncontrolled treated arterial hypertension, and untreated arterial hypertension. Main Outcome Measures: Incidence of retinal microvascular abnormalities. Results: After excluding patients with diabetes mellitus or any retinal or optic nerve disease, 2058 subjects (1409 women [68.5%]) were included in the study. The mean age of subjects was 53.8±9.5 years, and the mean refractive error was −0.24±2.04 diopters. The 5-year accumulated incidence of FN, AVN, and retinopathy was 4.1%, 1.4%, and 3.3%, respectively. Adjusted for age, gender, and region of habitation, the 5-year incidence of FN, AVN, and retinopathy increased 1.58 times (95% confidence interval [CI], 1.24–2.00; P<0.001), 1.55 times (95% CI, 1.04–2.32; P = 0.03), and 1.46 times (95% CI, 1.12–1.91; P = 0.005), respectively, for every 10 mmHg increase in mean arterial blood pressure. After adjusting for age, gender, and region of habitation, the rate of regression of FN decreased by 28% with every increase in the grade of the arterial hypertension classification. Correspondingly, the rate of regression of FN was significantly higher in the group with controlled arterial hypertension (44.4%) than in the uncontrolled (22.6%) and untreated (11.5%) groups (P = 0.01). Conclusions: Arterial hypertension was strongly associated with the incidence and longitudinal change of retinal microvascular abnormalities in nondiabetic subjects. Better control of arterial hypertension was correlated with a decreased incidence of retinal microvascular abnormalities and an increased rate of regression of FN. This suggests that retinal FN as potentially the first step of retinal microvascular abnormalities is reversible if arterial hypertension is controlled. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To examine the incidence of age-related macular degeneration (AMD) and its associated factors in an adult Chinese population. Design: Population-based study. Participants: The Beijing Eye Study, which included 4439 subjects (age ≥40 years) in 2001, was repeated in 2006 with 3251 (73.2%) subjects participating. Methods: Fundus photographs were graded using the International Age-related Maculopathy Epidemiological Study Group grading system. Main Outcome Measures: Incidence of AMD. Results: Gradable slides were available on 3049 (93.9%) subjects who participated in the survey of 2001 and again in 2006. The incidence of early, late, and neovascular AMD per eye was 2.6% (95% confidence interval [CI], 2.2–3.0), 0.1% (95% CI, 0.00–0.2), and 0.1% (95% CI, 0.00–0.2), respectively. The incidence of early, late, and neovascular AMD per person was 4.2±0.4% (95% CI, 3.5–5.0), 0.1±0.1% (95% CI, 0.0–0.2), and 0.1±0.1% (95% CI, 0.0–0.2), respectively. By multivariate analysis, incident early AMD was associated significantly with greater age at baseline (P = 0.01; odds ratio [OR], 1.03; 95% CI, 1.01–1.06), smaller optic disc size (P = 0.007; OR, 0.50; 95% CI, 0.30–0.83), smaller scleral spur distance (P = 0.04; OR, 0.59; 95% CI, 0.36–0.98), and hyperopic refractive error (P = 0.057; OR, 1.15; 95% CI, 1.00–1.33), with the latter being significant only marginally. It was not associated with the systemic parameters of gender, body height, body mass index, region of habitation, level of education, profession, smoking, arterial blood pressure, diabetes mellitus, fasting blood concentrations of glucose, triglycerides, high-density or low-density lipoproteins; or the ocular parameters of intraocular pressure, retinal arterial and vein diameters, retinal microvascular abnormalities, amount of nuclear cataract, cortical cataract or subcapsular cataract, pseudophakia, glaucoma, nonglaucomatous optic neuropathy, retinal vein occlusions, size of the beta zone of parapapillary atrophy, or progression of the zone of atrophy during the follow-up from 2001 to 2006. Conclusions: Hyperopia, short interscleral spur distance, and small optic disc size were, beside older age, the main factors associated with incident early AMD. This may point to a small globe size, potentially in relation to a firmly attached vitreous, playing a role in early incident AMD. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. [Copyright &y& Elsevier]

Purpose: The Beijing Eye Public Health Care Project was designed to screen all elderly subjects (age 55–85 years) of the rural region of Greater Beijing. It was developed as a preparatory step for a telemedicine-based public health care system in ophthalmology in China. Design: Population-based public health care project. Participants: Elderly subjects (age 55–85 years) of the rural region of Greater Beijing. Methods: Project participants were visited, interviewed, and examined by 2500 high school graduates trained as ophthalmic technicians. If visual acuity was <0.30, subjects were referred to primary health care centers where ocular photographs were taken. Using telemedicine, the photographs were transmitted to a reading center and causes for visual impairment were diagnosed. Main Outcome Measures: Practicability of a mass screening system in ophthalmology; prevalence of visual impairment and causes for it. Results: Out of 692 323 eligible inhabitants, 562 788 (81.3%) subjects participated. Visual impairment in ≥1 eye was detected in 54 155 (9.62%) subjects, and among them, 30 164 (5.36%) subjects had bilateral visual impairment. Ocular fundus photographs were taken for 37 281 subjects. Cause for visual impairment was cataract in 19 163 (3.41%) of all screened subjects, glaucoma in 1606 (0.29%) subjects, diabetic retinopathy in 905 (0.16%) subjects, other macular diseases in 2700 (0.48%) subjects, pterygium in 1381 (0.25%) subjects, and corneal leukoma in 283 (0.05%) subjects. For 5853 (1.04%) subjects, a diagnosis of premature or mature cataract was made showing the urgent need of cataract surgery. After cataract surgery, visual acuity was ≥0.30 in 1464 (91.7%) of 1596 postoperatively reexamined subjects. Conclusions: Using a telemedicine approach, the Beijing Eye Public Health Care Project developed, applied and tested an infrastructure for ophthalmic mass screening of >500 000 elderly inhabitants with a response rate of >80%. Beside cataract, retinal diseases including diabetic retinopathy and glaucoma were major causes for visual impairment. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To describe the cumulative 5-year incidence of visual impairment and blindness in adult Chinese in greater Beijing. Design: Population-based study. Participants: The Beijing Eye Study 2006 included 3251 subjects who had participated in the Beijing Eye Study 2001 and returned for re-examination. Methods: Using the World Health Organization (WHO) definition, low vision and blindness were defined as best corrected visual acutiy (BCVA) <20/60 to 20/400 and as BCVA <20/400 in the better-seeing eye, respectively. Using the United States standard, low vision and blindness were defined as BCVA <20/40 to 20/200 and as BCVA <20/200 in the better-seeing eye, respectively. Main Outcome Measures: Incidence of low vision and blindness. Results: Visual acuity measurements were available for 3249 (99.9%) participants. Using WHO and United States definitions, the incidences of low vision and blindness were 0.5±0.1% (mean±standard error) and 0.1±0.04%, and 1.1±0.2% and 0.1±0.04%, respectively. In multivariate analysis, incidence of BCVA visual impairment or blindness increased significantly with greater age (P = 0.01), but was not associated with gender, region, or level of education. Causes of BCVA visual impairment or blindness were cataract (39%), glaucoma (17%), and degenerative myopia (11%). Using the WHO and the United States criteria, incidences of low vision and blindness based on presenting visual acuity, were 1.7±0.2% and 0.1±0.06%, and 3.8±0.3% and 0.2±0.08%, respectively. Incidence of visual impairment or blindness (presenting visual acuity, WHO definition) increased significantly with higher age (P<0.001) and less education (P = 0.018) and was greater in women (P = 0.015). The major cause of presenting VA visual impairment or blindness was undercorrected refractive error (76%). Conclusions: In adult Chinese in greater Beijing, the 5-year cumulative incidence of BCVA visual impairment or blindness was 0.6±0.1% (BCVA in better-seeing eye, <20/60) or 1.7±0.2% (presenting VA in better-seeing eye, <20/60), which increased significantly with age. Measured as presenting VA, this also was associated with female gender and rural region. The major cause (76%) of decreased presenting VA was undercorrected refractive error, followed by cataract. Treating undercorrection of refractive error may be the easiest and most efficient method to improve vision in this community. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Purpose: To estimate the 5-year incidence of cataract and cataract surgery in an adult Chinese population. Design: Population-based study. Participants: The Beijing Eye Study 2006 included 3251 (73.2%) subjects (≥45 years) of 4439 subjects who participated in the 2001 survey and returned for re-examination. Methods: Nuclear, cortical, and posterior subcapsular lens opacities were assessed based on standardized slit-lamp–based photographs and retroilluminated photographs of the lens using a modification of the grading score of the Age-Related Eye Disease Study. Main Outcome Measures: Incidence of any type of cataract and of cataract surgery. Results: The 5-year incidence of nuclear cataract was 5.98% (95% confidence intervals [CI], 5.96%–6.00%), that of cortical cataract was 11.14% (95% CI, 11.12%–11.17%), that of posterior subcapsular cataract was 5.47% (95% CI, 5.45%–5.48%), and that of cataract surgery was 2.01% (95% CI, 2.00%–2.02%). The incidence of any cataract (16.82%; 95% CI, 16.79%–16.86%) was significantly associated with higher age (P<0.001) and female gender (P<0.001). It was not significantly associated with the area of habitation (P = 0.78), smoking (P = 0.95), or alcohol consumption (P = 0.12). Differentiation into the 3 cataract types revealed that the incidence of nuclear cataract additionally was associated with rural region (P<0.001) and smoking (P<0.001). The incidence of cortical cataract additionally was associated with nonsmoking (P = 0.02). The incidence of cataract surgery was significantly (P<0.001) associated with age only. Conclusions: As in white persons, the age-adjusted incidence of all types of cataract types increased with age and it was associated with female gender. When compared with data in the literature, the incidence rates of all cataract types did not vary markedly between Chinese in greater Beijing and white persons. In contrast, the incidence of cataract surgery was considerably lower in this Chinese population. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Purpose: To determine the prevalence and progression of myopic retinopathy in Chinese adults. Design: Population-based cross-sectional study. Participants: The Beijing Eye Study 2001 included 4439 subjects of 5324 individuals who were invited to participate (response rate, 83.4%); the eligibility criterion was an age of 40+ years. The study was repeated in 2006, with 3251 subjects (73.2%) participating. Methods: The participants underwent a detailed eye examination, including fundus photography. Myopic retinopathy was defined by posterior staphylomata, lacquer cracks, Fuchs'' spot of the macula, and myopic chorioretinal atrophy at the posterior pole. Parapapillary atrophy was assessed separately. Main Outcome Measures: Prevalence of myopic retinopathy and its change during a follow-up of 5 years. Results: After exclusion of pseudophakic or aphakic eyes, and eyes without assessable fundus photographs, 4319 subjects (97.3%) were included in the present study. Myopic retinopathy was present in 198 eyes (2.3%±0.2%; 95% confidence interval [CI], 2.0–2.6) of 132 participants (3.1%). Myopic retinopathy was significantly associated with higher age (P<0.001), worse best-corrected visual acuity (P<0.001), deeper anterior chamber (P = 0.04), larger optic disc (P<0.001), less age-related macular degeneration (P = 0.02; odds ratio [OR] 0.90), and greater prevalence of open-angle glaucoma (P<0.001; OR 4.42). Myopic retinopathy was not associated significantly (P>0.20) with body height and weight, gender, rural versus urban region of residence, level of education, intraocular pressure, or central corneal thickness. The prevalence of myopic retinopathy increased significantly (P<0.001) with increasing myopic refractive error, from 3.8% in eyes with a myopic refractive error of < −4.0 diopters to 89.6% in eyes with a myopic refractive error of at least −10.0 diopters. At the 5-year follow-up examination, enlargement of the chorioretinal atrophy at the posterior fundus was observed in 9% of the eyes. Conclusions: Myopic retinopathy was present in 3.1% of subjects aged 40+ years who resided in the Greater Beijing area. Myopic retinopathy was associated with increased age, worse best-corrected visual acuity, deeper anterior chamber, larger optic disc, less age-related macular degeneration, and higher prevalence of open-angle glaucoma. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Purpose: To assess the relationship of hypertension with major eye diseases and other ocular parameters. Design: Population-based study. Participants: The Beijing Eye Study is a population-based study that included 4439 Chinese subjects examined at the baseline examination in 2001; there was a follow-up examination in 2006, in which 3251 subjects participated, of whom 3222 had blood pressure measurements. Methods: All participants underwent an ophthalmic examination, anthropometric measurements, and blood pressure measurement. Hypertension was defined as a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, and/or self-reported current treatment for hypertension with antihypertensive medication. Main Outcome Measures: Blood pressure and ocular parameters, including intraocular pressure and prevalence of major ophthalmic diseases. Results: Mean age of participants in the present study was 60.4±10.0 years. Hypertension was present in 1500 (46.6%) of the 3222 subjects who had their blood pressure measured. In multiple regression analysis, hypertension was associated with higher intraocular pressure (β = 0.39; 95% confidence interval [CI], 0.12–0.66; P = 0.005), focal arteriolar narrowing (odds ratio [OR], 1.78; 95% CI, 1.34–2.36; P<0.001), arteriovenous nicking (OR, 1.50; 95% CI, 1.11–2.04; P = 0.009), generalized retinal arteriolar narrowing (OR, 1.65; 95% CI, 1.30–2.09; P<0.001), retinal vein occlusions (OR, 2.86; 95% CI, 1.21–6.80; P = 0.02), and diabetic retinopathy (OR, 1.90; 95% CI, 1.08–3.31; P = 0.02). Hypertension was not significantly associated with the prevalence of open-angle glaucoma (P = 0.19), angle-closure glaucoma (P = 0.15), age-related macular degeneration (AMD) (P = 0.73), nuclear cataract (P = 0.88), posterior subcapsular cataract (P = 0.30), cortical cataract (P = 0.10), or area of alpha zone (P = 0.05) or beta zone of parapapillary atrophy (P = 0.95). Conclusions: In Chinese persons, while controlling for other systemic parameters, hypertension was associated with increased intraocular pressure, retinal microvascular abnormalities, and prevalence of retinal vein occlusion and diabetic retinopathy. Hypertension was not associated significantly with AMD, age-related cataract, or glaucoma. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Objective: To examine the associations between alcohol consumption and ocular diseases in the adult population of mainland China. Design: Population-based study. Participants: The Beijing Eye Study, performed in 2001, included 4439 subjects (age 40+ years) of 5324 individuals invited to participate (response rate 83.4%). The study was conducted in both a rural region (1973 subjects) and an urban region of Greater Beijing (2466 subjects). Methods: All participants underwent an interview, including questions about alcohol consumption and a detailed ophthalmic examination, including photography of the cornea, lens, and fundus. Main Outcome Measures: Consumption of alcohol and systemic and ophthalmic parameters. Results: Information on alcohol consumption was obtained on 4141 subjects (93.3%), of whom 549 (13.3%) reported they consumed beer or wine. In multivariate analysis, alcohol consumption was significantly associated with the systemic parameters of lower age (P = 0.001), male gender (P<0.001), rural region (P<0.001), lower level of education (P = 0.01), and smoking (P<0.001). Alcohol consumption was not a significant risk factor for the prevalences of age-related macular degeneration (P = 0.24), open-angle glaucoma (P = 0.51), angle-closure glaucoma (P = 0.75), diabetic retinopathy (P = 0.35), retinal vein occlusion (P = 0.39), pterygium (P = 0.08), trachoma (P = 0.053), epiretinal membrane (P = 0.09), non-glaucomatous optic nerve atrophy (P = 0.55), dry eye (P = 0.86), cortical cataract (P = 0.67), subcapsular posterior cataract (P = 0.62), or nuclear cataract (P = 0.76), or with the ocular parameters of refractive error (P = 0.99), intraocular pressure (P = 0.19), retinal artery diameters (temporal inferior: P = 0.60), retinal vein diameters (temporal inferior: P = 0.41), or size of alpha zone and beta zone of parapapillary atrophy (P = 0.68). Conclusions: When adjusted for the systemic parameters of age, gender, rural/urban region, level of education, and smoking, self-reported moderate consumption of alcohol does not have a significant effect on the prevalence of major ocular diseases or the physiologic parameters of intraocular pressure and refractive error. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To determine the prevalence of cataract surgery and the postoperative visual outcome in the adult Chinese population living in rural and urban regions of Greater Beijing. Design: Population-based study. Participants: The Beijing Eye Study 2006 included 3251 subjects (73.3%) (aged 45+ years) of 4439 subjects who participated in the 2001 survey and returned for reexamination. Methods: The prevalence of surgical pseudophakia/aphakia was assessed, and postoperative visual acuity and reasons for decreased postoperative vision were examined. Visual impairment was defined by a presenting visual acuity (PVA) <6/18 or a best-corrected visual acuity (BCVA) <6/18. Main Outcome Measures: Prevalence of cataract surgery, lens status, and causes of visual impairment. Results: Of the 3215 (98.9% of 3251) subjects for whom data on the lens status were available, 92 (41 male, 133 eyes) had undergone cataract surgery in 1 or both eyes (prevalence rate, 2.86%; 95% confidence interval [CI], 2.28–3.44). In multivariate analysis, this rate was statistically associated with higher age (P<0.001), presence of angle-closure glaucoma (P = 0.02), and higher level of hemorrhagic retinopathy (P<0.001). The prevalence of postoperative visual impairment was 27/133 (20.3%), as defined by a PVA <6/18, and 14/133 or 10.5%, as defined by a BCVA <6/18. Aphakia (odds ratio [OR], 6.71; P = 0.02) and rural residence (OR, 4.05; P = 0.01) were significantly associated with postoperative visual impairment. The most common causes of postoperative visual impairment were uncorrected refractive error followed by hemorrhagic retinopathy and posterior capsule opacification. By comparing 2001 with 2006, the rate of cataract surgery increased, and the rate of postoperative visual impairment decreased significantly (P = 0.049). Conclusions: In the adult population of Greater Beijing, approximately 3% of the population aged 45+ years underwent cataract surgery, the prevalence of which was associated with age, angle-closure glaucoma, and hemorrhagic retinopathy. One of 10 subjects who underwent cataract surgery had a BCVA visual of less than 6/18, and 1 of 5 subjects had a PVA of less than 6/18. Low postoperative visual acuity was associated with rural region, undercorrection of refractive error, and hemorrhagic retinopathy. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Objective: To examine the relationship between mortality and major ocular diseases. Design: Population-based study. Participants: At baseline in 2001, the Beijing Eye Study examined 4439 subjects with an age of 40 years or more. The mean age was 56.2±10.6 years (range, 40–101 years). In 2006, all study participants were invited for a follow-up examination. Methods: The participants underwent a detailed ophthalmic examination and answered questions regarding their socioeconomic background. Rate of mortality was determined in the follow-up survey of 2006. Main Outcome Measures: Factors associated with mortality. Results: Of the 4439 subjects examined in the 2001, 3251 (73.2%) subjects returned for the follow-up examination, whereas 143 (3.2%) subjects had died and 1045 (23.5%) subjects were alive but did not agree to be reexamined. In binary logistic regression analysis, mortality was significantly associated with the systemic parameters of higher age (P<0.001; odds ratio [OR], 1.07), male gender (P = 0.01; OR, 0.55), lower level of education (P<0.001; OR, 0.65), smoking status (P = 0.023; OR, 1.25), and with the ocular parameters of level of diabetic-like retinopathy (P = 0.036; OR, 1.02), presence of angle-closure glaucoma (P = 0.013; OR, 3.74), and presence of nonglaucomatous optic nerve damage (P = 0.027; OR, 3.41). Presence of retinal vein occlusions was associated marginally with mortality (P = 0.059; OR, 2.59). Mortality was not significantly associated with best-corrected visual acuity (P = 0.14) in multivariate analysis, nor with age-related macular degeneration, open-angle glaucoma, trachoma, any type of cataract, visual field defects, intraocular pressure, or refractive error. Conclusions: If socioeconomic parameters, age, gender, and smoking status were taken into account, ocular parameters associated with an increased mortality were diabetic-like retinopathy, angle-closure glaucoma, and nonglaucomatous optic nerve damage. Retinal vein occlusions were marginally associated. Other major ocular disorders such as any form of cataract, open-angle glaucoma, age-related macular degeneration, trachoma, pterygia, and high myopia or high hyperopia were not significantly related to mortality. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Objective: To evaluate whether marked myopia, compared with moderate myopia and low myopia, is associated with a higher prevalence of glaucomatous optic nerve damage. Design: Population-based cross-sectional study. Participants: Four thousand four hundred thirty-nine of 5324 subjects 40 years or older were invited to participate (response rate, 83.4%). The group was stratified according to refractive error into high myopia (myopia > −8 diopters [D]), marked myopia (<−6 to −8 D), moderate myopia (<−3 to −6 D), low myopia (<−0.5 to −3 D), emmetropia (−0.5 to + <2 D), and hyperopia (>+ 2 D) subgroups. Methods: Morphologic assessment of optic disc monoscopic photographs. Main Outcome Measures: Morphologic optic disc parameters and intraocular pressure (IOP). Results: For 4319 (97.3%) subjects (8484 eyes), optic disc photographs were evaluated. Prevalence of glaucomatous optic nerve atrophy as defined by the glaucomatous optic nerve head appearance did not vary significantly (P = 0.77; odds ratio [OR], 1.2; 95% confidence interval [CI], 0.38–3.81) between the highly myopic group and the group with marked myopia. In both refractive groups combined, glaucoma frequency seemed to be higher (P = 0.075; OR, 2.28; 95% CI, 0.99–5.25) higher than in the group with moderate myopia; it was significantly (P = 0.001; OR, 3.5; 95% CI, 1.71–7.25) higher than in the group with low myopia; significantly (P<0.001; OR, 7.56; 95% CI, 3.98–14.35) higher than in the group with emmetropia; and significantly (P = 0.005; OR, 4.23; 95% CI, 1.57–11.45) higher than in the group with hyperopia. Glaucoma frequency did not vary significantly between the hyperopic group and the emmetropic group (P = 0.17), the group with low myopia (P = 0.83), and the group with moderate myopia (P = 0.32). Intraocular pressure did not vary significantly (P>0.10) between any of the subgroups. Similar results were obtained for the frequency of glaucoma defined as glaucomatous optic disc appearance and visual field defects. In binary logistic regression analysis, presence of glaucoma was significantly associated with the myopic refractive error (P<0.001), age (P<0.001), and IOP (P<0.001). Conclusions: Marked to high myopia with a myopic refractive error exceeding −6 D may be a risk factor associated with glaucomatous optic neuropathy. [Copyright &y& Elsevier]

Objective: To evaluate factors associated with high myopia (defined as a myopic refractive error exceeding −8 diopters) in a population-based study. Design: Population-based prevalence study. Participants: The Beijing Eye Study included 4439 participants from among 5324 individuals from a rural area and an urban region of Greater Beijing, ≥40 years old and invited to participate (response rate, 83.4%). Methods: Interview and detailed ophthalmic examination. Main Outcome Measures: Refractive error, microvascular retinal abnormalities, optic disc morphometry, amount of cataract, and age-related macular changes. Results: Fundus photographs and data for refractive error were available for 4319 participants (97.3%; 8484 eyes). In binary logistic regression analysis, prevalence of high myopia was significantly associated with low best-corrected visual acuity (P<0.001; 95% confidence interval [CI], 0.15–0.40), large optic disc size (P<0.001; 95% CI, 1.64–2.25), large size of β zone (P = 0.31; 95% CI, 1.45–1.75) and α zone of peripapillary atrophy (P<0.001; 95% CI, 1.20–1.58), and lower macular drusen count (P = 0.020; 95% CI, 0.81–0.98). The highly myopic group had a smaller mean size of macular drusen (P = 0.03; 95% CI, 0.02–0.26) and a smaller area covered by drusen (P = 0.01; 95% CI, 0.03–0.22). In the highly myopic group, the predominant drusen type was significantly (P = 0.01; 95% CI, 0.05–0.41) more often the hard distinct drusen type than the soft drusen type, and visual field defects were significantly more common (P<0.001; odds ratio [OR], 24.0; 95% CI, 13.9–41.4) and larger (P<0.001; 95% CI, −1.67 to −1.13). The frequencies of early macular degeneration (P = 0.03; OR, 3.0; 95% CI, 1.21–7.51) and late macular degeneration (P<0.001; OR, 6.33) were significantly lower in the highly myopic group than in the non–highly myopic group. High myopia was not significantly associated with gender (P = 0.18; 95% CI, 0.76–1.05), focal arteriolar thinning (P>0.35), arteriolar sheathing (P>0.45), arteriovenous crossing abnormalities (P>0.20), self-reported diagnosis of diabetes mellitus (P = 0.54; OR, 1.36; 95% CI, 0.48–3.80), or arterial hypertension (P = 0.34; OR, 0.66; 95% CI, 0.32–1.34). Conclusions: In the adult Chinese population, high myopia is associated with a lower number, smaller, size and less advanced type of macular drusen, a larger optic nerve head, and decreased best-corrected visual acuity. The risk of early and late macular degeneration was lower for highly myopic participants than for non–highly myopic participants. [Copyright &y& Elsevier]

Objective: To assess retinal vascular abnormalities, including focal and generalized arteriolar narrowing, arteriovenous nicking, and arteriolar sheathing, in adult Chinese in rural and urban Beijing, and their associations with self-reported diagnosis of cardiovascular and cerebrovascular diseases. Design: Population-based cross-sectional cohort study. Participants: The study included 4439 subjects out of 5324 subjects invited to participate (response rate, 83.4%) with an age of ≥40 years. It was divided into a rural part (n = 1973 [44.4%]) and an urban part (n = 2466 [55.6%]). Mean age was 56.2±10.6 years (range, 40–101 years). Methods: Color optic disc photographs were morphometrically examined. One eye of each participant was randomly selected. Generalized and focal arteriolar narrowing, arteriovenous nicking (arteriovenous crossing abnormalities), and arteriolar sheathing were assessed. Self-reported histories of cardiovascular and cerebrovascular diseases and habits of smoking and alcohol drinking were obtained from questionnaires. Main Outcome Measures: Frequency of generalized and focal arteriolar narrowing, arteriovenous nicking, and arteriolar sheathing. Results: Optic disc photographs were available for 4228 (95.2%) subjects. Focal arteriolar narrowing was found in 6.3%, arteriovenous nicking in 6.6%, arteriolar sheathing in 4.8%, and generalized narrowing in 4.3% of the subjects. Abnormalities were more common in the temporal quadrant; they were rare in the inferior nasal quadrant. Frequencies and severities of all retinal microvascular abnormalities examined increased with age (P<0.05). The microvascular abnormalities were detected more frequently in the rural population than in the urban population (P<0.05). After controlling for age, gender, area, and habit of drinking alcohol, generalized arteriolar narrowing (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.64, 4.22), focal arteriolar narrowing (OR, 1.51; 95% CI, 1.00, 2.29), and arteriolar sheathing (OR, 1.71; 95% CI, 1.08, 2.71) were significantly associated with the self-reported diagnosis of arterial hypertension. The microvascular abnormalities were not significantly associated with the self-reported diagnosis of coronary heart disease or stroke. Conclusions: Retinal vascular abnormalities in adult Chinese increase with age and are more commonly found in people living in rural areas. Retinal vascular abnormalities are associated with the self-reported diagnosis of arterial hypertension, and are not related to self-reported diagnosis of coronary heart disease or previous cerebrovascular events such as stroke. [Copyright &y& Elsevier]

Objective: To determine the prevalence of lens opacities in the elderly Chinese population in an urban and a rural region of Beijing. Design: Population-based cross-sectional study. Participants: The study included 4439 subjects of 5324 subjects invited to participate (response rate, 83.4%). The subjects were divided into a rural part (1973 subjects [44.4%]) and an urban part (2466 subjects [55.6%]). The study was limited to participants age 40 and older, and the mean age was 56.2±10.6 years (range, 40–101 years). Methods: Nuclear, cortical, and posterior subcapsular lens opacities were assessed based on standardized slit-lamp photographs of the lens using a modification of the grading score of the Age-related Eye Disease Study (AREDS). Main Outcome Measures: Grading score of the AREDS. Results: Lens data were provided for 4378 subjects (98.6%) of 4439 persons examined, which consisted of 8724 eyes. Prevalence of any cataract surgery was 1.3% (95% confidence interval [CI]: 1.0–1.7), which was statistically independent of gender (P = 0.51; odds ratio [OR]: 0.86; 95% CI: 1.00–1.34), rural area versus urban region (P = 0.25), and level of education (P = 0.84). Prevalence of any nuclear lens opacity was 82.0% (95% CI: 80.8–83.2); prevalence of any cortical lens opacity was 10.3% (95% CI: 9.4–11.3); and prevalence of any posterior subcapsular opacity was 4.3% (95% CI: 3.7–4.9). If grade 2 of nuclear lens opacity was considered to be normal, prevalence of nuclear cataract was 50.3% (95% CI: 48.8–51.8), and the overall prevalence of any cataract was 53.1% (95% CI: 51.6–54.6), increasing from 6.5% (95% CI: 5.2–7.8) in those subjects 40 to 49 years of age to 52.3% (95% CI: 47.4–55.3) in those who were 50 to 59 years of age, and to 97.8% (95% CI: 96.4–99.2) in those 70 years and older (P<0.001). Frequencies of any cortical cataract and any subcapsular posterior cataract were 10.3% (95% CI: 9.4–11.3) and 4.3% (95% CI: 3.7–4.9), respectively. Conclusions: Cataracts are common among adult Chinese residents in Beijing, with age as the most important associated factor. In view of the relatively low rate of cataract surgery performed so far, one may expect a marked increase in the number of cataract surgeries to meet the visual needs of the growing elderly population in China. [Copyright &y& Elsevier]

Purpose: To evaluate refractive error and its demographic associations in an urban and rural population in northern China. Design: Epidemiological study. Participants: The Beijing Eye Study is a population-based cohort study in northern China including 4439 subjects. Excluding pseudophakic and aphakic patients, the present study involved 4319 subjects. It was divided into a rural part (1905 [44.1%] subjects) and an urban part (2414 [55.9%] subjects). Mean age was 55.85±10.33 years (range, 40–90). Methods: Standardized ophthalmologic examination. For statistical analysis, the spherical equivalent was converted to binary variables, and logistic regression was used to investigate the association with continuous or categorical independent variables. Main Outcome Measure: Refractive error. Results: Mean refractive error measured −0.33±2.22 diopters (D) (range, −20.88 to +7.88). Myopia of >−0.50 D, −1.0 D, >−6.0 D, and >−8 D, respectively, occurred in 22.9% (95% confidence interval [CI], 21.7–24.2), 16.9% (95% CI, 15.8–18.0), 2.6% (95% CI, 2.2–3.1), and 1.5% (95% CI, 1.1–1.9) of the subjects, respectively. Myopic refractive error was associated significantly with younger age (P<0.001), urban region (vs. rural region) (P<0.001), higher educational background (P<0.001), higher degree of nuclear cataract (P<0.001), decreasing uncorrected visual acuity (UCVA) (P<0.001), decreasing best-corrected visual acuity (BCVA) (P<0.001), and female gender (P<0.001). Prevalence of high myopia (myopic refractive error >−8 D) was associated with age (P<0.001), female gender (P = 0.020), urban region (P = 0.023), and lower BCVA (P<0.001). Mean anisometropia was 1.09±2.03 D (median, 0.38; range, 0–22.0). Prevalence of anisometropia of ≥1 D was associated significantly with age (P<0.001), refractive error (P<0.001), BCVA (P<0.001), and region (P<0.001). Mean astigmatic error measured 0.62±0.90 D (median, 0.25; range, 0–7.50). Astigmatism of ≥1 D was associated significantly with age (P<0.001), lower UCVA (P = 0.003), lower BCVA (P<0.001), urban area (P<0.001), and degree of cortical cataract (P = 0.027). Conclusions: As in other population-based studies on Chinese, myopia was more prevalent in younger subjects. Myopia was associated with urban region, educational background, female gender, decreasing visual acuity, and nuclear cataract. If longitudinal studies confirm the association of refractive error with age, refractive surgery may achieve emmetropia only for a limited time. [Copyright &y& Elsevier]

Purpose To examine the prevalence of fundus tessellation and its associated factors. Design Population-based study. Participants The Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range, 50–93 years). Methods Participants underwent a comprehensive ophthalmic examination. By using 45° color fundus photographs of the macula and optic disc, fundus tessellation, defined as variation in the visibility of the large choroidal vessels, was differentiated into 3 grades. Main Outcome Measures Fundus tessellation. Results Assessment of fundus tessellation was available for 3442 individuals (99.6%) or 6789 eyes (98.6%). In multivariate analysis, a higher degree of fundus tessellation (mean, 0.84±0.79) was associated with older age ( P < 0.001; standardized correlation coefficient beta, 0.14), male sex ( P < 0.001; beta, −0.08), lower body mass index ( P = 0.04; beta, 0.03), worse best-corrected visual acuity ( P < 0.001; beta, 0.05), thinner subfoveal choroidal thickness ( P < 0.001; beta, −0.51), longer axial length ( P < 0.001; beta, 0.11), larger parapapillary beta zone ( P < 0.001; beta, 0.08), lower prevalence of intermediate age-related macular degeneration (AMD) ( P = 0.02; beta, −0.04), and lower prevalence of late AMD ( P = 0.007; beta, −0.04). If parapapillary beta zone was dropped, higher glaucoma prevalence ( P = 0.003) was associated with a higher degree of fundus tessellation. Prevalence of diabetes mellitus and retinal vein occlusions, mean blood pressure, and intraocular pressure were not ( P > 0.10) associated with fundus tessellation. In a reverse manner, thinner subfoveal choroidal thickness was associated with a higher degree of fundus tessellation ( P < 0.001; beta, −0.49) in the multivariate analysis. Subfoveal choroidal thickness decreased from 322±90 μm (95% confidence interval [CI], 317–327) in eyes without fundus tessellation to 229±80 μm in eyes with grade 1, to 122±52 μm in eyes with grade 2, and to 81±37 μm in eyes with grade 3 of fundus tessellation. Conclusions Fundus tessellation is a surrogate for choroidal thinness and may be a clinical sign for a leptochoroid. After adjusting for ocular and systemic parameters, fundus tessellation also is associated with a larger parapapillary beta zone and higher glaucoma prevalence, and a lower prevalence of intermediate and late AMD. Its association with lower visual acuity warrants further investigation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the causes of visual impairment and blindness in adult Chinese in an urban and rural region of Beijing, China. Design: Population-based prevalence survey. Participants: From a rural region and an urban region of Greater Beijing, 4439 of 5324 ≥40-year-old invited subjects participated in the study (response rate, 83.4%). Using the World Health Organization (WHO) standard and the United States standard, blindness was defined as best-corrected visual acuity (BCVA) in the better-seeing eye of <20/400 and of <2/20, respectively, and visual impairment was defined as best-corrected vision of <20/60 and ≥20/400, and of <20/40 and ≥2/20, respectively. Methods: Determination of BCVA, pneumotonometry, frequency doubling perimetry, evaluation of photographs of the fundus and lens, and clinical examination. Main Outcome Measure: Causes of visual impairment and blindness. Results: Visual acuity measurements were available for 8816 eyes of 4409 subjects (99.3%). Using the WHO standard and the U.S. standard, 49 (1.1%) subjects and 95 (2.2%) subjects, respectively, had low vision, and 13 (0.3%) subjects and 15 (0.3%) subjects, respectively, were blind by definition. Taking the whole study population, the most frequent cause of low vision/blindness was cataract (36.7%/38.5%), followed by degenerative myopia (32.7%/7.7%), glaucoma (14.3%/7.7%), corneal opacity (6.1%/15.4%), and other optic nerve damage (2.0%/7.7%). Age-related macular degeneration (AMD) (2.0%/7.7%) and diabetic retinopathy (0%/7.7%) were responsible for a minority of cases. In subjects 40 to 49 years old, the most frequent cause of low vision and blindness was degenerative myopia. In the 50- to 59-year age group, the most frequent cause was cataract, followed by degenerative myopia. In the 60- to 69-year-old subjects and the ≥70-year group, the most frequent cause of low vision and blindness was cataract, followed by degenerative myopia and glaucoma. Conclusions: The most frequent cause of low vision and blindness in adult Chinese is cataract, followed by degenerative myopia and glaucomatous optic neuropathy, with degenerative myopia dominating in younger groups and cataract dominating in elder groups. In contrast to studies in Western countries, AMD and diabetic retinopathy appear to play a minor role as a cause of visual impairment in elderly Chinese. [Copyright &y& Elsevier]

Purpose: To examine the features of myopia-related optical coherence tomography (OCT) findings in a population-based setting. Design: Population-based study. Participants: The Beijing Eye Study 2011 included 3468 subjects with an age of 50 years or more. Methods: The participants underwent a detailed ophthalmic examination including OCT with enhanced depth imaging of the macula. Main Outcome Measures: Optical coherence tomography features of the macula in highly myopic eyes defined by a refractive error of −6 diopters or less or an axial length of 26.5 mm or more. Results: Readable OCT images were available for 6530 eyes (94.5%) of 3278 participants. The most common change in the macula was maculoschisis (0.8±0.1%), followed by incomplete posterior vitreous detachment (0.7±0.1%), disruption of the photoreceptor inner segment/outer segment interface (0.6±0.1%), epiretinal membranes (0.6±0.1%), macular defects in Bruch's membrane (0.3±0.1%), clumping of the retinal pigment epithelium (0.2±0.1%), vitreofoveal adhesion (0.2±0.1%), and macular holes in 2 eyes (0.1±0.1%). Prevalence of any myopic maculopathy per eye was 112 of 6530, or 1.71±0.16% (95% confidence interval [CI], 1.40–2.03). After adjustment for longer axial length (P<0.001; odds ratio [OR], 2.68; 95% CI, 1.97–3.64) and myopic refractive error (P<0.001; OR, 0.63; 95% CI, 0.55–0.73), presence of any myopic maculopathy was not significantly associated with any systemic variables (all P≥0.05), including biochemical blood examination and ocular parameters. Best-corrected visual acuity was associated significantly with the absence of a disruption of the photoreceptor inner segment/outer segment interface (P<0.001), epiretinal membranes (P<0.001), and macular holes (P<0.001) after adjustment for age and cylindrical refractive error. Conclusions: Based on OCT examination, the most common macular change in highly myopic eyes was maculoschisis, followed by incomplete posterior vitreous detachment, disruption of the photoreceptor inner segment/outer segment interface, epiretinal membranes, macular defects in Bruch's membrane, clumping of the retinal pigment epithelium, vitreofoveal adhesion, and macular holes. The most important macular changes with a negative effect on best-corrected visual acuity were a disruption of the photoreceptor inner segment/outer segment interface and epiretinal membranes. [ABSTRACT FROM AUTHOR]

Objective: To assess associations among outdoor activity, ocular biometric parameters, and myopia among grade 1 and grade 4 primary students in Beijing. Design: School-based, cross-sectional study. Participants: A total of 382 grade 1 and 299 grade 4 children participated in the study. Methods: The children underwent a comprehensive eye examination, including ocular biometry by optical low-coherence reflectometry and noncycloplegic refractometry. Parents and children participated in a detailed interview, including questions on time spent indoors and outdoors. Main Outcome Measures: Factors associated with myopia. Results: The study included 681 children, with 382 (56.1%) students from grade 1 (mean age, 6.3±0.5 years; range, 5–8 years) and 299 students from grade 4 (mean age, 9.4±0.7 years; range, 8–13 years); 370 students (54.3%) lived in the urban region. The mean daily time spent outdoors was 1.6±0.8 hours (range, 0.5–5.1 hours). In multivariate analysis, axial length was significantly associated with older age (P<0.001; standardized β coefficient, 0.28), taller body height (P = 0.001; β, 0.18), maternal myopia (P = 0.03; β, 0.09), and urban region of habitation (P<0.001; β, −0.21), or alternatively to the region of habitation, with less time spent outdoors (P = 0.001; β, −0.16) and more time spent indoors studying (P = 0.02; β, 0.10). The axial length-to-corneal curvature radius ratio was associated with older age, urban region of habitation, maternal and paternal myopia, and paternal level of education. Presence of myopia (defined as refractive error ≤−1 diopters in the right eye) was associated with older age (P<0.001; odds ratio [OR], 1.45; 95% confidence interval [CI], 1.24–1.69), maternal myopia (P<0.001; OR, 2.99; 95% CI, 1.94–5.35), and urban region of habitation (P<0.001; OR, 0.17; 95% CI, 0.11–0.26), or alternatively to the region of habitation, with less time spent outdoors (P<0.001; OR, 0.32; 95% CI, 0.21–0.48) and more time spent indoors studying (P<0.001; OR, 1.38; 95% CI, 1.09–1.75). Conclusions: Less outdoor activity, more indoor studying, older age, maternal myopia, and urban region of habitation were associated with longer ocular axial length and myopia in grade 1 and grade 4 primary school children in Greater Beijing. Remaining outdoors more (e.g., during school) may reduce the high prevalence of myopia in the young generation in Beijing. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose To investigate the progression pattern of myopic maculopathy and associated factors in a population-based study. Design Population-based longitudinal study. Participants The Beijing Eye Study including 4439 participants in 2001 was repeated in 2011, with 2695 individuals (66.4%) being re-examined in 2011. Methods The study participants underwent detailed ophthalmic and general examinations. Using fundus photographs obtained in 2001 and 2011, we assessed the progression of myopic maculopathy in highly myopic eyes with a refractive error ≥−6 diopters in 2001. Myopic maculopathy was differentiated into tessellated fundus (category 1), diffuse chorioretinal atrophy (category 2), patchy chorioretinal atrophy (category 3), and macular atrophy (category 4), with lacquer cracks and choroidal neovascularization as additional plus signs. Main Outcome Measures Progression pattern of myopic maculopathy. Results Of 110 highly myopic eyes (70 individuals) at baseline, 39 eyes (35.5%) showed progression observed in 15 of 79 eyes (19%) with tessellated fundus at baseline, in 17 of 24 eyes (71%) with diffuse chorioretinal atrophy, in all 6 eyes with patchy chorioretinal atrophy, and the 1 eye with macular atrophy. Lacquer cracks detected in 2 eyes in 2001 developed into a small patchy atrophy (1 eye) or widened during the follow-up (1 eye). Five eyes demonstrated new lacquer cracks. In binary regression analysis, progression of myopic maculopathy was associated with longer axial length ( P < 0.001; odds ratio [OR], 7.13; 95% confidence interval [CI], 2.49–20.4), older age ( P = 0.001; OR, 1.25; 95% CI, 1.10–1.42), higher prevalence of staphylomas ( P = 0.03; OR, 24.3; 95% CI, 2.89–204), smaller parapapillary γ-zone in 2011 ( P = 0.01; OR, 0.61; 95% CI, 0.41–0.91), and female gender ( P = 0.04; OR, 9.78; 95% CI, 1.06–90.6). Conclusions The 10-year progression rate of myopic maculopathy in this elderly Chinese population was 35.5%, increasing from 15 of 79 eyes (19%) in category 1 of myopic maculopathy at baseline to 17 of 24 eyes (71%) in category 2 and 6 of 6 eyes (100%) in category 3. Risk factors for myopic maculopathy progression were longer axial length, pre-existing staphylomata, smaller parapapillary γ-zone, older age, and female gender. [ABSTRACT FROM AUTHOR]

Purpose To assess changes in the peripapillary retinal pigment epithelium (RPE) in association with an acute intraocular pressure (IOP) elevation provoked by a dark room prone provocative test (DRPPT). Design Prospective, comparative clinical observational study. Participants Nineteen study group eyes (14 individuals) and 26 control eyes (21 patients). Methods Individuals with normal optic nerve heads (ONHs) underwent a DRPPT in a standardized manner. They were stratified into a study group with an IOP rise of more than 15 mmHg at the end of the DRPPT and a control group with an IOP rise between 2 and 4 mmHg. Before and at the end of the test, the ONH was imaged by spectral-domain optical coherence tomography (OCT). Main Outcome Measures Morphologic features of the RPE at the peripapillary end of Bruch's membrane. Results After a mean IOP rise by 32.1±9.5 mmHg (range, 17–47 mmHg), 18 (95%) eyes in the study group showed a folding or a centrifugal sliding, or both, of the end of the RPE layer on the peripapillary Bruch's membrane. The RPE changes were located most often at the temporal pole of the ONH (16 eyes [89%]), followed by the nasal pole (2 eyes [11%]). The RPE changes were not detected at the inferior or superior disc poles. Some eyes with marked RPE changes showed corresponding changes in peripapillary β zone on infrared ONH photographs. In 7 eyes of 7 participants with OCT images obtained on the day after the PRPPT, the RPE end moved back to the end of peripapillary Bruch's membrane. The single eye of the study group without exhibiting IOP rise–associated RPE changes showed an interdigitation zone line indistinguishable from Bruch's membrane line on OCT images. None of the control eyes showed RPE changes. The difference in frequency of RPE changes between study and control groups was significant ( P < 0.001). Conclusions Eyes with an acute rise in IOP (>15 mmHg) showed a folding and centrifugal sliding of the peripapillary RPE and, after IOP reduction, centripetal RPE movement. These observations may be of interest to elucidate the pathogenesis of peripapillary atrophy in glaucoma. [ABSTRACT FROM AUTHOR]