Search

Purpose: To examine the distribution of intraocular pressure (IOP) in a normal population and the associations of IOP with other ocular and systemic parameters., Methods: Out of 3468 participants of the population-based cross-sectional Beijing Eye Study 2011 we selected those individuals without glaucomatous optic neuropathy. The study particpants underwent a detailed ophthalmologic and systemic examination. IOP was measured by air puff non-contact tonometry., Results: The study included 3135 eyes of 3135 participants with a mean age of 64.1 ± 9.6 years (mean ± standard deviation). The mean IOP was 14.7 ± 2.8 mmHg. The 95% percentile and 97.5% percentile of the IOP distribution decreased from 20 mmHg / 21 mmHg in individuals aged 40 to 54 years to 18 mmHg / 19 mmHg in individuals aged ≥80 years. In multivariable analysis, higher IOP was associated with the systemic parameters of younger age (P<0.001), higher blood concentration of glucose (P = 0.03) and triglycerides (P<0.001), higher diastolic blood pressure (P<0.001), higher pulse rate (P = 0.003) and higher quantity of alcohol consumption (P = 0.004), and with the ocular parameters of larger central corneal thickness (P<0.001), more myopic refractive error (P = 0.01) and steeper anterior corneal curvature radius (P = 0.006). IOP decreased significantly by 0.50 mmHg and 0.76 mmHg for each increase in age by 10 years and each increase in corneal curvature radius by 1.0 mm, respectively. The range of the mean ± 2 standard deviations of the IOP adjusted for the parameters of the multivariable model was 9.0 to 18.1 mmHg versus 9.2-20.2 mmHg for the unadjusted IOP. In the age group of 50 to 55 years, the age-adjusted IOP range (mean ± 2 standard deviations) was 9 to 18 mmHg, and in the age group of ≥75 years, it was 8 to 18 mmHg., Conclusions: IOP physiologically depends on a multitude of systemic and ocular factors including age and blood pressure. These physiological associations of the IOP may be taken into account in the definition of the normal range of the IOP., Competing Interests: Author Jost B. Jonas is a Consultant for Mundipharma Co. (Cambridge, UK) and patent holder with Biocompatibles UK Ltd. (Franham, Surrey, UK) (Title: Treatment of eye diseases using encapsulated cells encoding and secreting neuroprotective factor and / or anti-angiogenic factor; Patent number: 20120263794), and has a patent application with University of Heidelberg (Heidelberg, Germany) (Title: Agents for use in the therapeutic or prophylactic treatment of myopia or hyperopia; Europäische Patentanmeldung 15 000 771.4). This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors declare that no other competing interests exist.

Purpose: To evaluate changes in subfoveal choroidal thickness (SFCT) and peripapillary choroidal thickness (PPCT) after acute intraocular pressure (IOP) elevation provoked by a dark room prone provocative test (DRPPT)., Methods: The prospective cohort study included 114 eyes from 65 individuals who had an IOP elevation ≥2 mm Hg during the DRPPT. The participants stayed in a dark room for 2 h with the forehead placed on a desk. At baseline and within 5 min after the end of the DRPPT, tonometry and enhanced depth imaging by spectral-domain optical coherence tomography were carried out., Results: During the DRPPT, IOP increased by 10.1±10.9 mm Hg, SFCT decreased significantly (p<0.001) from 280±80 µm to 267±76 µm and PPCT decreased significantly (p<0.001) from 177±74 to 169±70 µm. In multivariate analysis, a more marked SFCT thinning was associated with higher IOP increase (p<0.001) and shallower anterior chamber depth at baseline (p=0.01). In a similar manner, a higher PPCT change was correlated with a higher IOP increase (p<0.001), and a thicker choroidal thickness at baseline (p<0.001)., Conclusions: Choroidal thickness in the subfoveal region and in the peripapillary region decreased parallel to an acute increase in IOP in individuals 2 h after a dark room test. Choroidal thickness depends on the actual IOP, which may be noted when choroidal thickness is measured., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Primary open-angle glaucoma is the most common optic neuropathy and an important cause of irreversible blindness worldwide. The optic nerve head or optic disc is divided in two parts: a central cup (without nerve fibers) surrounded by the neuroretinal rim (containing axons of the retinal ganglion cells). The International Glaucoma Genetics Consortium conducted a meta-analysis of genome-wide association studies consisting of 17,248 individuals of European ancestry and 6,841 individuals of Asian ancestry. The outcomes of the genome-wide association studies were disc area and cup area. These specific measurements describe optic nerve morphology in another way than the vertical cup-disc ratio, which is a clinically used measurement, and may shed light on new glaucoma mechanisms. We identified 10 new loci associated with disc area (CDC42BPA, F5, DIRC3, RARB, ABI3BP, DCAF4L2, ELP4, TMTC2, NR2F2, and HORMAD2) and another 10 new loci associated with cup area (DHRS3, TRIB2, EFEMP1, FLNB, FAM101, DDHD1, ASB7, KPNB1, BCAS3, and TRIOBP). The new genes participate in a number of pathways and future work is likely to identify more functions related to the pathogenesis of glaucoma., (© 2015 Wiley Periodicals, Inc.)

Elevated intraocular pressure (IOP) is an important risk factor in developing glaucoma, and variability in IOP might herald glaucomatous development or progression. We report the results of a genome-wide association study meta-analysis of 18 population cohorts from the International Glaucoma Genetics Consortium (IGGC), comprising 35,296 multi-ancestry participants for IOP. We confirm genetic association of known loci for IOP and primary open-angle glaucoma (POAG) and identify four new IOP-associated loci located on chromosome 3q25.31 within the FNDC3B gene (P = 4.19 × 10(-8) for rs6445055), two on chromosome 9 (P = 2.80 × 10(-11) for rs2472493 near ABCA1 and P = 6.39 × 10(-11) for rs8176693 within ABO) and one on chromosome 11p11.2 (best P = 1.04 × 10(-11) for rs747782). Separate meta-analyses of 4 independent POAG cohorts, totaling 4,284 cases and 95,560 controls, showed that 3 of these loci for IOP were also associated with POAG.

Glaucoma is characterized by irreversible optic nerve degeneration and is the most frequent cause of irreversible blindness worldwide. Here, the International Glaucoma Genetics Consortium conducts a meta-analysis of genome-wide association studies of vertical cup-disc ratio (VCDR), an important disease-related optic nerve parameter. In 21,094 individuals of European ancestry and 6,784 individuals of Asian ancestry, we identify 10 new loci associated with variation in VCDR. In a separate risk-score analysis of five case-control studies, Caucasians in the highest quintile have a 2.5-fold increased risk of primary open-angle glaucoma as compared with those in the lowest quintile. This study has more than doubled the known loci associated with optic disc cupping and will allow greater understanding of mechanisms involved in this common blinding condition.

Purpose: To compare the optic nerve head appearance in glaucomatous eyes before and after marked reduction of intraocular pressure (IOP)., Methods: The hospital-based observational case-series study included selected glaucoma patients for whom optic disc photographs taken before and 1 week to 5 months after surgical reduction of IOP were morphometrically examined., Results: The study included 23 eyes of 16 patients (mean age: 28.7 ± 6.0 years). Mean preoperative IOP was 31.6 ± 7.7 mmHg (22-52 mmHg), and mean IOP drop was 21.5 ± 8.4 mmHg (11-45 mmHg). The horizontal disc diameter decreased significantly (p < 0.001) after surgery, while the vertical disc diameter did not change markedly (p = 0.54). The width of the neuroretinal rim increased significantly in all disc quadrants (all p-values ≤ 0.01), optic cup depth decreased (p < 0.001), and reflectivity of the inner retinal surface increased significantly (p < 0.001). Some eyes showed a pronounced reduction in beta zone of parapapillary atrophy parallel to an increase in horizontal disc diameter, and some eyes showed an enlargement of beta zone parallel to a reduction in horizontal disc diameter., Conclusions: After marked reduction of high IOP, some eyes of young adult patients with glaucoma can show a horizontal shrinkage of the optic nerve head, in addition to a partial restoration of the neuroretinal rim and a flattening of the optic cup. In addition, beta zone of parapapillary atrophy can decrease or increase, complementarily to changes in the horizontal disc diameter. These findings may be of interest for the biomechanics of the optic nerve head and the precision of imaging techniques., (© 2013 The Authors. Acta Ophthalmologica © 2013 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To assess longitudinal changes in parapapillary atrophy in the adult population of Greater Beijing., Methods: The population-based Beijing Eye Study 2006 included 3251 subjects who had participated in the Beijing Eye Study 2001 and returned for re-examination. The mean age was 60.4 ± 10.1 years. Using optic disc photographs, we measured parapapillary atrophy which was divided into alpha zone and beta zone., Results: Overall progression rate of alpha zone was seen in 0.6 ± 0.1% (95% confidence interval (CI):0.3,0.9) of the subjects and of beta zone in 8.2 ± 0.5% (95%CI:7.2,9.1) of the subjects. In binary regression analysis, rate of progression of alpha zone was significantly associated higher age (P = 0.04) and the co-progression of zone Beta (P<0.001). Rate of progression of beta zone was significantly associated with higher age (P<0.001; odds ratio (OR):1.11;95%CI:1.10,1.14), higher intraocular pressure (P<0.001;OR:1.10;95%CI:1.05,1.14), higher myopic refractive error (P<0.001;OR:0.71; 95%CI:0.67,0.75), rural region of habitation (P = 0.002;OR: 0.58; 95%CI:0.41,0.82), presence of glaucomatous optic nerve damage (P<0.001;OR:2.89; 95%CI:1.62,5.14), co-progression of alpha zone (P<0.001;OR:7.13;95%CI:2.43,20.9), absence of arterial hypertension (P = 0.03;OR: 0.70; 95%CI:0.51,0.96), and thicker central corneal thickness (P = 0.02;OR:1.01;95%CI:1.00,1.01). Subjects with a non-glaucomatous optic nerve damage (n = 22) as compared to the remaining subjects did not vary in the progression rate of alpha zone (0.0% versus 0.6 ± 0.1%; P = 1.0) and beta zone (8.2 ± 0.5% versus 6.3 ± 0.6%;P = 1.0)., Conclusions: In adult Chinese in Greater Beijing, the 5-year progression rate of beta zone of parapapillary atrophy (seen in 8.2 ± 0.5% of subjects) was significantly correlated with higher age, rural region of habitation, absence of arterial hypertension, higher intraocular pressure, higher myopic refractive error, thicker central corneal thickness, and presence of glaucoma. It was not associated with non-glaucomatous optic nerve damage.

Purpose: To assess retinal vessel diameter in adult Chinese with and without glaucoma., Methods: The population-based, cross-sectional study included 4439 of the 5324 subjects asked to participate (response rate 83.4%), all aged 40 years or older. This study was divided into a rural part (1973 subjects [44.4%]) and an urban part (2466 subjects [55.6%]). Colour optic disc and fundus photographs were morphometrically examined for 2418 subjects. The retinal vessel diameters were measured at the optic disc border and at a distance of 2 mm to the optic disc border. The main outcome measure was the retinal vessel diameter., Results: Diameters of the retinal arteries were significantly (P < 0.001) the widest in the temporal inferior region, followed by the temporal superior region (P < 0.001), the nasal superior region (P < 0.001) and finally the nasal inferior region. Except for the nasal inferior vein, the same held true for the retinal veins. The sequence of the main four vessel trunks with respect to their diameters was not associated with age, gender or hyperopia versus myopia. The artery diameters showed a tendency to decrease in older age, while the vein diameters decreased across all age groups. Eyes with glaucomatous optic nerve damage showed significantly (P < 0.001) thinner arteries while the retinal vein diameters were not different., Conclusions: Diameters of the retinal arterioles and veins are the widest in the temporal inferior arcade, followed by the temporal superior arcade, the nasal superior arcade and finally the nasal inferior arcade. Retinal artery diameters decrease with glaucoma, and retinal vein diameters decrease with age.

Objective: To determine the predictive value of frequency-doubling threshold perimetry for glaucoma in a population-based study., Methods: The Beijing Eye Study, a population-based study on subjects 40 years or older, included an ophthalmic examination with fundus photography and frequency-doubling threshold perimetry. Glaucoma was defined by a glaucomatous optic disc appearance., Results: The study population consisted of 4349 subjects (8615 eyes). Among 207 glaucomatous eyes (2.4%), 74 (35.7%) did not show any abnormality on frequency-doubling threshold perimetry, suggesting a diagnostic sensitivity of 64.3%. In the total study population, a visual field defect was found in 905 eyes (10.5%). In 133 (14.7%) of these eyes, a glaucomatous appearance of the optic disc was detected, and 772 eyes (85.3%) had a nonglaucomatous optic disc appearance (either normal or with nonglaucomatous optic nerve damage, retinal disease, corneal disease, or cataract). For 450 eyes (49.7%) with a visual field defect, the cause of the perimetric defect was not detected., Conclusions: In a population-based study, frequency-doubling threshold perimetry has a sensitivity of about 64% to detect glaucoma. If the result is abnormal, the probability of glaucoma is about 15%. When results of frequency-doubling threshold perimetry are abnormal, the cause of the visual field defect may not be detectable in 50% of subjects.

Purpose: To evaluate whether eyes with chronic glaucoma have a larger or smaller optic disk than normal eyes., Design: Population-based, cross-sectional cohort study., Methods: The study included 4439 subjects out of 5324 subjects invited to participate with an age of 40+ years. Color optic disk photographs (45 degrees ) were morphometrically examined., Results: After exclusion of aphakic eyes, pseudophakic eyes, and highly myopic eyes, data of 3989 subjects entered the statistical analysis. The mean optic disk area did not vary significantly (P > .05) between the nonglaucomatous group (2.61 +/- 0.50 mm(2)), eyes with glaucomatous appearance of the optic disk (2.69 +/- 0.63 mm(2)), eyes with glaucomatous optic disks and visual field defects (2.66 +/- 0.70 mm(2)), and eyes with elevated intraocular pressure (2.63 +/- 0.49 mm(2))., Conclusions: In adult Chinese, optic disk size may not markedly differ between normal eyes and eyes with chronic glaucoma.

Purpose: To assess associations between the amount of physical activity and the prevalence of ocular diseases. Methods: The participants of the population‐based Beijing Eye Study underwent a detailed ophthalmological examination and an interview. Physical activity was assessed in a standardized questionnaire. Results: Out of 3468 study participants, information on their physical activity was available for 3031 (87.4%) individuals (age: 64.6 ± 9.7 years; range: 50–93 years). In multivariate analysis (regression coefficient r: 0.41), higher physical activity was associated with a lower prevalence of diabetic retinopathy [p = 0.009; standardized regression coefficient beta: −0.05; non‐standardized regression coefficient B: −15.7; 95% confidence interval (CI): −27.6, −3.90] after adjusting for younger age, rural region of habitation, lower level of education, lower blood concentrations of triglycerides and low‐density lipoproteins and higher blood concentrations of high‐density lipoproteins, higher systolic blood pressure, lower body mass index and lower depression score. Other major ocular diseases such as open‐angle glaucoma (p = 0.25), angle‐closure glaucoma (p = 0.59), nuclear cataract (p = 0.78), cortical cataract (p = 0.54), posterior subcapsular cataract (p = 0.96), retinal vein occlusions (p = 0.93) and central serous choroidopathy (p = 0.39) were not statistically associated with physical activity in that model. The association between higher physical activity and prevalence of age‐related macular degeneration (p = 0.04; β: 0.04; B: 4.87; 95% CI: 0.25, 9.50) was marginally significant. Conclusions: Higher physical activity and less sedentary lifestyle were associated with a lower prevalence of diabetic retinopathy, while the occurrence of other major ocular diseases such as any type of cataract and of glaucoma, retinal vein occlusions and central serous choroidopathy was statistically independent of physical activity or a more sedentary lifestyle. [ABSTRACT FROM AUTHOR]

Purpose: Systemic inflammation is potentially associated with ocular diseases such as late age-related macular degeneration (AMD). Using the serum concentration of high-sensitive C-reactive protein (hs-CRP) as surrogate of systemic inflammation, we examined potential associations between the serum hs-CRP concentration and the presence and degree of eye diseases. Methods: The population-based Beijing Eye Study included 3468 Chinese individuals. The study participants underwent a standardized interview and a detailed ophthalmic examination. The serum concentration of hs-CRP was determined. Results: Out of 3468 participants, 2452 (70.7%) individuals (mean age:63.4±9.4 year; range:50–91 years) had hs-CRP measurements (mean:1.96±4.07mg/L). In multivariate analysis, higher serum concentration of hs-CRP was significantly (regression coefficient r: 0.21) associated with a higher level of diabetic retinopathy (P = 0.007; standardized regression coefficient beta:0.06; non-standardized regression coefficient B:1.35; 95% confidence interval (CI):0.37,2.22) and polypoidal choroidal vasculopathy (P = 0.002;beta:0.06;B:6.22;95%CI:2.24,10.2) after adjusting for higher serum concentration of high-density lipoproteins (P<0.001;beta:-0.12;B:-1.31;95%CI:-1.77,-0.85), higher body mass index (P = 0.01;beta:0.06;B:0.06;95%CI:0.01, 0.11), lower level of education (P = 0.04;beta:-0.06;B:-0.22;95%CI:-0.42,-0.02), lower cognitive function score (P = 0.01;beta:-0.07;B:-0.08;95%CI:-0.13,-0.02). If the presences of other ocular diseases were added to the model, the presence of glaucoma (P = 0.99), open-angle glaucoma (P = 0.80), angle-closure glaucoma (P = 0.67), pseudoexfoliation (P = 0.18), nuclear cataract (P = 0.30), cortical cataract (P = 0.15), subcapsular cataract (P = 0.59), retinal vein occlusions (P = 0.33), central serous choroidopathy (P = 0.44), early stage of age-related macular degeneration (AMD) (P = 0.46), intermediate stage of AMD (P = 0.20) and late stage of AMD (P = 0.91) including geographic atrophy (P = 0.60) or neovascular AMD (P = 0.68) were not significantly associated with the serum concentration of hs-CRP. Conclusions: In Chinese aged 50+ years, higher serum concentration of hs-CRP was significantly associated with a higher level of diabetic retinopathy and higher frequency of polypoidal choroidal vasculopathy. Other major ocular disorders, namely glaucoma including open-angle glaucoma and angle-closure glaucoma, pseudoexfoliation, nuclear, cortical or subcapsular cataract, retinal vein occlusions, central serous choroidopathy, early, intermediate or late stage of AMD including geographic atrophy, were not significantly associated with hs-CRP serum concentrations. It suggests that these diseases, in contrast to diabetic retinopathy and polypoidal choroidal vasculopathy, were not associated with a major systemic inflammatory component. [ABSTRACT FROM AUTHOR]

Purpose: To assess the prevalence of depression in the general population of Beijing and its association with ocular diseases. Methods: The population-based Beijing Eye Study was conducted in a rural and an urban region of Greater Beijing. The study participants underwent a detailed ophthalmological examination and an interview including questions on the socioeconomic background. Depressive symptoms were evaluated using a Chinese depression scale adapted from Zung´s self-rated depression scale. The total score of depression symptoms was 80. Depression was defined as having a depression score >44. Results: Out of 3468 study participants, 3267 (94.2%) individuals (1419 men) with an age of 64.5±9.7 years (range: 50–93 years) participated in the interview and answered all questions on depression. The mean depression score was 25.0±5.9 (median: 23.3; range:20–64). Depression (depression score >44) was present in 66 individuals (2.0%; 95% confidence interval (CI): 1.5, 2.5), and 5 individuals (0.2%; 95%CI: 0.02,0.3) had a depression score ≥59. In multivariate regression, analysis, a higher depression score was associated (regression coefficient r2: 0.22) with a higher number of days with dry eye feeling (P<0.001; standardized regression coefficient beta: 0.09; non-standardized regression coefficient B: 0.20; 95%CI: 0.12,0.29) and shorter corneal curvature radius (P = 0.03;beta:-0.04; B:1.01; 95%CI: -1.90,-0.12), after adjusting for age, gender, region of habitation, body mass index, cognitive function score, life quality score and blood concentration of triglycerides. Adding age-related macular degeneration (P = 0.10), glaucoma (P = 0.77), diabetic retinopathy (P = 0.77), nuclear cataract (P = 0.35), cortical cataract (P = 0.58) or posterior subcapsular cataract (P = 0.28) as single parameters to the model revealed no significant correlation with the depression score. Lower best corrected visual acuity showed a marginal significant association (P = 0.05; beta: 0.04; B: 1.56; 95%CI: -0.01, 3.13). Conclusions: Dry eye feeling was the only common ocular disorder associated with an increased depression score, while the occurrence of age-related macular degeneration, any type of glaucoma, diabetic retinopathy, any type of cataract and keratoconus were not significantly associated with an increased depression score. Lower visual acuity was marginally associated. The prevalence of depression in the population aged 50+ years in Greater Beijing was 2.0% (96%CI: 1.5, 2.5). [ABSTRACT FROM AUTHOR]

Purpose To assess thickness and associations of the peripapillary choroidal layers. Methods The population-based Beijing Eye Study included 3468 participants with an age of 50+ years. Using spectral-domain optical coherence tomography, we measured the large vessel layer ( LVL) and small-to-medium vessel layer ( SMVL) of the peripapillary choroid in a circular scan with a diameter of 3.4 mm around the optic nerve head centre at eight locations equidistant (45°) to each other. The ratio of SMVL thickness to LVL thickness was calculated. Results Measurements were available for 3000 (86.5%) study participants (mean age: 64.4 ± 9.6 years; range: 50-93 years). SMVL (mean thickness: 31 ± 7 μm; range: 17-70 μm) and LVL (103 ± 48 μm; range: 9-313 μm) were thickest superiorly, followed by the temporal region, nasal region, and inferior region. Thicker SMVL was associated (regression coefficient r: 0.33) with younger age (p < 0.001; standardized regression coefficient β: −0.26), higher cognitive function (p = 0.02; β: 0.05), shorter axial length (p < 0.001; β: −0.12), thicker lens (p < 0.001; β: 0.07), smaller disc area (p < 0.001; β: −0.08), smaller parapapillary β/ γ zone (p < 0.001; β: −0.10) and lower prevalence of angle-closure glaucoma (p = 0.04; β: −0.04). Thicker LVL thickness was correlated ( r: 0.45) with younger age (p < 0.001; β: −0.34) and higher cognitive function (p = 0.01; β: 0.05), shorter axial length (p < 0.001; β: −0.09)), thicker lens (p = 0.009; β: 0.06), smaller disc area (p < 0.001; β: −0.09), smaller parapapillary alpha zone (p = 0.04; β: −0.04), smaller β/ γ zone (p < 0.001; β: −0.14) and lower prevalence of angle-closure glaucoma (p = 0.057; β: −0.04). A higher SMVL-to- LVL thickness ratio was related with older age (p < 0.001; β: 0.36), longer axial length (p < 0.001; β: 0.09), lower best-corrected visual acuity (BCVA) (p = 0.002; β: 0.07), larger optic disc area (p < 0.001; β: 0.10) and larger β/ γ zone (p < 0.001; β: 0.19). Conclusion Small-to-medium vessel layer (SMVL) and LVL, thickest superiorly and thinnest inferiorly, increased with younger age and higher cognitive function after adjusting for axial length and prevalence of angle-closure glaucoma. With older age, longer axial length, larger optic disc area and larger β zone, LVL decreased more than SMVL in thickness. The association between thicker peripapillary choroidal thickness and better cognitive function may deserve further attention. [ABSTRACT FROM AUTHOR]

Purpose: Since high myopia in the younger generation may differ etiologically from high myopia in older generations, we examined whether education-related parameters differ between high myopia in today´s school children and high pathological myopia in today´s elderly generation. Methods: The investigation included the adult populations of the population-based Beijing Eye Study (BES) (3468 adults;mean age:64.6±9.8years;range:50–93years) and Central India Eye and Medical Study (CIEMS) (4711 adults;age:49.±13.2years;range:30–100years), and the children and teenager populations of the Shandong Children Eye Study (SCES) (6026 children;age:9.7±3.3years;range:4–18years;cycloplegic refractometry), Gobi Desert Children Eye Study (1565;age:11.9±3.5years;range:6–21 years;cycloplegic refractometry), Beijing Pediatric Eye Study (681 children;age:7.7±1.6years;range:5–13 years;non-cycloplegic refractometry,calculation of axial length to corneal curvature radius ratio), Beijing Children Eye Study (15066 children;age:13.2±3.4years;range:7–18years;non-cycloplegic refractometry), Beijing High School Teenager Eye Study (4677 children;age:16.9±0.7years;range:16–18years;non-cycloplegic refractometry). Results: In the BES and CIEMS, educational level did not differ significantly between, or was significantly lower in the highly myopic group (myopic refractive error ≥6 diopters) than in the non-highly myopic group. In all non-adult study populations, higher prevalence of high myopia was significantly associated with higher degree of education related parameters such as attendance of high-level schools, and more time spent for indoors near work versus time spent outdoors. Conclusions: Comparing associations of old or genetic high myopia in adults with new or acquired high myopia in school children revealed that education-related parameters did not show a clear association with old or genetic high myopia, while in contrast, new high myopia showed strong associations with education. It confirms previous studies that the two forms of high myopia not only differed in age of onset, but also in associations with education as well. The data support the notion of two types of high myopia. Future studies may assess whether the risk of pathologic myopic maculopathy and high myopia associated open-angle glaucoma differs between both types of high myopia. [ABSTRACT FROM AUTHOR]

Purpose To examine whether the incidence of retinal vein occlusions (RVOs) is associated with estimated cerebrospinal fluid pressure (CSFP). Methods The population-based 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). Fundus photographs were examined for the new development of RVOs, differentiated into central RVOs (CRVOs) and branch RVOs (BRVOs). CSFP was calculated as CSFP [mmHg] = 0.44 × Body Mass Index [kg/m2] + 0.16 × Diastolic Blood Pressure [mmHg]−0.18 × Age[Years]. Results Incident BRVOs were detected in 50 eyes and incident CRVOs in 8 eyes. BRVOs were located at arterio-venous crossings in 39 eyes. In multivariate analysis, a higher estimated CSFP was associated with a higher incidence of CRVOs (p = 0.004; standardized coefficient beta: 0.06; regression coefficient B: 5.35; 95% confidence interval (CI):1.73, 8.96) after adjusting for urban region (p < 0.001; beta: −0.52; B: −3.93; 95% CI: −4.29, −3.57), higher educational level (p = 0.001; beta: 0.13; B: 0.44; 95% CI: 0.28, 0.60), higher blood concentrations of triglycerides (p < 0.001; beta: 0.08; B: 0.11; 95% CI: 0.05, 0.16) and higher intraocular pressure (p < 0.001; beta: 0.16; B:0.21; 95% CI: 0.16, 0.27). As a corollary, a higher incidence of RVOs as a whole, as well as a higher incidence of CRVOs combined with a higher incidence of BRVOs originating at the optic nerve head, both were significantly associated with higher estimated CSFP (p = 0.002; odds ratio (OR): 1.15; 95% CI: 1.05, 1.25; and p = 0.037; OR: 1.17; 95% CI: 1.01, 1.35, respectively) after adjusting for older age. Conclusions A higher estimated CSFP was associated with a higher incidence of RVOs originating at the optic nerve head (i.e. CRVOs, hemi-central RVOs and BRVOs originating at the optic nerve head), and vice versa, a higher incidence of RVOs was associated with a higher estimated CSFP. It suggested an influence of higher estimated CSFP on higher central retinal vein pressure. [ABSTRACT FROM AUTHOR]

Purpose To examine whether an estimated trans-lamina cribrosa pressure difference ( TLCPD) better than intraocular pressure ( IOP) correlated with markers for glaucoma. Methods The population-based Beijing Eye Study 2011 included 3468 individuals. Cerebrospinal fluid pressure ( CSFP) was calculated as CSFP [mmHg] = 0.44 × Body Mass Index [kg/m2] + 0.16 × Diastolic Blood Pressure [mmHg] − 0.18 × Age [Years] − 1.91. TLCPD was IOP- CSFP. Results In the non-glaucomatous population, mean TLCPD was 5.8 ± 4.1 mmHg and mean estimated CSFP was 8.9 ± 3.7 mmHg. IOP was higher (p = 0.008), CSFP was lower (p < 0.001), and TLCPD was (p < 0.001) higher in the glaucoma group than in the non-glaucomatous group. The intergroup difference was highest for TLCPD (2.1 mmHg) followed by CSFP (1.7 mmHg) and IOP (0.4 mmHg). Open-angle glaucoma ( OAG) was associated with higher TLCPD [p < 0.001; odds ratio ( OR): 1.14; 95% confidence intervals ( CI): 1.08, 1.19] but not with IOP (p = 0.22; OR: 0.96; 95% CI: 0.89, 1.03). In contrast, angle-closure glaucoma ( ACG) was associated with higher IOP (p = 0.03; B: 0.14; OR: 1.15; 95% CI: 1.01, 1.30) but not with TLCPD (p = 0.98), after adjustment for age and anterior chamber depth. Retinal nerve fibre layer thickness was associated with lower TLCPD (p = 0.036) but not with IOP (p = 0.96), after adjusting for gender, age, region of habitation, optic disc area and refractive error. Neuroretinal area and volume were associated with smaller TLCPD (p = 0.002, and p < 0.001, respectively), after adjusting for gender, optic disc area and refractive error, but not with IOP (p = 0.43 and p = 0.25, resp.). Conclusions In OAG, but not in ACG, calculated TLCPD versus IOP showed a better association with glaucoma presence and amount of glaucomatous optic neuropathy. It supports the notion of a potential role of low CSFP in the pathogenesis of OAG. [ABSTRACT FROM AUTHOR]

Purpose: To examine subfoveal choroidal thickness (SFCT) in eyes with glaucoma, using enhanced depth imaging spectral domain optical coherence tomography. Methods: The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range: 50–93 years). A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging for measurement of SFCT, and assessment of fundus photographs for presence of glaucoma. In addition, the group of patients with chronic angle-closure glaucoma (ACG) from the Beijing Eye Study (n = 37) was merged with a group of patients with chronic ACG from the Tongren hospital (n = 52). Results: Assessments of SFCT and glaucoma were available for 3232 (93.2%) subjects. After adjusting for age, axial length, gender, anterior chamber and lens thickness, SFCT was not significantly associated with presence of glaucoma (P = 0.08; regression coefficient B:−15.7). As a corollary, in logistic regression analysis with adjustment for age, axial length and intraocular pressure, presence of glaucoma was not significantly associated with SFCT (P = 0.20). If only open-angle glaucoma was considered, multivariate analysis revealed no significant association between SFCT and presence of open-angle glaucoma (P = 0.44). As a corollary, in logistic regression analysis, open-angle glaucoma was not significantly associated with SFCT (P = 0.91). In a similar manner if only ACG was taken into account, SFCT was not significantly associated with the presence of ACG (P = 0.27) in multivariate analysis. As a corollary in binary regression analysis, presence of ACG was not significantly associated with SFCT (P = 0.27). Conclusions: In multivariate analysis with adjustment for age, axial length, gender, anterior chamber and lens thickness, neither OAG nor ACG was associated with an abnormal SFCT. [ABSTRACT FROM AUTHOR]

Purpose To examine the relationship between major ocular diseases and mortality. Methods The population-based longitudinal study Beijing Eye Study was performed in 2001 and repeated in 2011. The participants underwent a detailed ophthalmic examination at baseline in 2001. Results Of 4439 subjects examined in 2001, 2695 (60.7%) subjects returned for the follow-up examination in 2011, while 379 (8.5%) subjects were dead and 1365 (30.8%) subjects were alive, however, did not agree to be re-examined. In multivariate regression analysis, mortality was significantly associated with the systemic parameters of older age (p < 0.001; Odds ratio ( OR): 1.07; 95% confidence interval ( CI): 1.05, 1.09), male gender (p < 0.001; OR: 0.56; 95% CI: 0.40, 0.78), lower level of education (p < 0.001; OR: 0.66; 95% CI: 0.59, 0.74) and smoking (p < 0.001; OR: 1.84; 95% CI: 1.36, 2.49) and with the ocular parameters of presence of diabetic retinopathy (p = 0.002; OR: 2.26; 95% CI: 1.34, 3.81), non-glaucomatous optic nerve damage (p = 0.001; OR: 4.90; 95% CI: 1.90, 12.7) and higher degree of nuclear cataract (p = 0.002; OR: 1.29; 95% CI: 1.10, 1.52). In that model, mortality was not significantly (all p > 0.05) associated with refractive error, cortical or subcapsular posterior cataract, intraocular pressure, best corrected visual acuity, visual field defects, prevalence of age-related macular degeneration, retinal vein occlusions, open-angle glaucoma and angle-closure glaucoma. Conclusions After adjustment for age, gender, level of education and smoking, mortality was significantly higher in subjects with diabetic retinopathy, non-glaucomatous optic nerve damage and nuclear cataract. Other major ophthalmic parameters and disorders such as hyperopia, myopia, high myopia, pterygium, age-related macular degeneration, retinal vein occlusion, glaucoma and cortical or nuclear cataract were not significantly associated with mortality in the multivariate analysis. [ABSTRACT FROM AUTHOR]

Purpose: To examine a potential association between intraocular pressure (IOP) and cerebrospinal fluid pressure (CSFP) in a population-based setting. Methods: The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range: 50–93 years). A detailed ophthalmic examination was performed. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP [mm Hg] = 0.44×Body Mass Index [kg/m2]+0.16×Diastolic Blood Pressure [mm Hg]–0.18×Age [Years]. Results: In multivariate analysis, IOP was associated with higher estimated CSFP (P<0.001; standardized correlation coefficient beta: 0.27; regression coefficient B: 0.20; 95% confidence interval (CI): 0.16, 0.24), after adjusting for thinner central corneal thickness (P<0.001; beta: 0.45; B: 0.04;95%CI: 0.04,0.04), smaller corneal curvature radius (P<0.001; beta:−0.11; B:−1.13;95%CI:−1.61,−0.64), shallower anterior chamber depth (P = 0.01; beta:−0.05; B:−0.33;95%CI:−0.59,−0.08) and longer axial length (P = 0.002; beta: 0.08; B: 0.20;95%CI: 0.08,0.32)), and after adjusting for the systemic parameters of higher pulse rate (P<0.001; beta: 0.08; B: 0.02;95%CI: 0.01,0.03), higher prevalence of arterial hypertension (P = 0.002; beta: 0.06; B: 0.32;95%CI: 0.12,0.53)), frequency of drinking alcohol (P = 0.02; beta: 0.04; B: 0.09;95%CI: 0.01,0.17), higher blood concentration of triglycerides (P = 0.001; beta: 0.06; B: 0.06;95%CI: 0.02,0.10) and cholesterol (P = 0.049; beta: 0.04; B: 0.08;95%CI: 0.00,0.17), and body mass index (P<0.001; beta:−0.13; B:−0.09;95%CI:−0.13,−0.06). In a parallel manner, estimated CSFP (mean: 10.8±3.7 mm Hg) was significantly associated with higher IOP (P<0.001; beta: 0.13; B: 0.18;95%CI: 0.13,0.23) after adjusting for rural region of habitation (P<0.001; beta:−0.37; B:−2.78;95%CI:−3.07,−2.48), higher systolic blood pressure (P<0.001; beta: 0.34; B: 0.06;95%CI: 0.05,0.07), higher pulse rate (P = 0.003; beta: 0.05; B: 0.02;95%CI: 0.01,0.03), taller body height (P<0.001; beta: 0.11; B: 0.05;95%CI: 0.03,0.07), higher blood concentration of cholesterol (P = 0.003; beta: 0.05; B: 0.17;95%CI: 0.06,0.28) and higher level of education (P = 0.003; beta: 0.09; B: 0.30;95%CI: 0.16,0.45). Conclusions: IOP was positively associated with estimated CSFP after adjusting for other ocular and systemic parameters. As a corollary, higher estimated CSFP was significantly associated with higher IOP in multivariate analysis. It fits with the notion that the arterial blood pressure, estimated CSFP and IOP are physiologically correlated with each other. [ABSTRACT FROM AUTHOR]

Anterior chamber depth (ACD) is a key anatomical risk factor for primary angle closure glaucoma (PACG). We conducted a genome-wide association study (GWAS) on ACD to discover novel genes for PACG on a total of 5,308 population-based individuals of Asian descent. Genome-wide significant association was observed at a sequence variant within ABCC5 (rs1401999; per-allele effect size = −0.045 mm, P = 8.17×10−9). This locus was associated with an increase in risk of PACG in a separate case-control study of 4,276 PACG cases and 18,801 controls (per-allele OR = 1.13 [95% CI: 1.06–1.22], P = 0.00046). The association was strengthened when a sub-group of controls with open angles were included in the analysis (per-allele OR = 1.30, P = 7.45×10−9; 3,458 cases vs. 3,831 controls). Our findings suggest that the increase in PACG risk could in part be mediated by genetic sequence variants influencing anterior chamber dimensions. [ABSTRACT FROM AUTHOR]

Purpose: To examine a potential association between snoring and glaucoma in a population-based setting. Methods: The population-based Beijing Eye Study 2011 included 3468 subjects with an age of 50+ years. The participants underwent a detailed ophthalmic examination. Glaucoma was determined according to the ophthalmoscopic appearance of the optic nerve head. Snoring assessed in an interview was graded into “severe snoring”, “moderate snoring”, and “no snoring”. Results: Data on snoring and glaucoma were available for 3146 subjects. Snoring was reported for 1787 (66.8%) subjects, with moderate snoring reported for 1384 (44.0%) subjects and severe snoring for 403 (12.8%) subjects. In multivariate analysis, prevalence of severe snoring was significantly associated with male gender (P = 0.002; regression coefficient B: 0.36; Odds ratio (OR): 1.44 (95% confidence interval (CI): 1.14, 1.81)), higher body mass index (P<0.001; B: 0.12; OR: 1.13 (95%CI: 1.09, 1.16)), higher systolic blood pressure (P<0.001; B: 0.01; OR: 1.01 (95%CI: 1.005, 1.02)), younger age (P = 0.007; B: −0.018; OR: 0.98 (95%CI: 0.97, 0.995)), and higher cognitive function (P = 0.03; B: 0.04; OR: 1.04 (95%CI: 1.004, 1.08)), however it was not significantly associated with the prevalence of open-angle glaucoma (P = 0.10; B: −0.63; OR: 0.53 (95%CI: 0.25, 1.12)). Prevalence of severe snoring was neither significantly associated with the prevalence of angle-closure glaucoma (P = 0.65), retinal vein occlusions (P = 0.24), neuroretinal rim area (P = 0.19), retinal nerve fiber layer thickness (P = 0.16) nor vertical cup/disc ratio (P = 0.64). Conclusions: Severe snoring was not significantly associated with the prevalence of open-angle glaucoma, angle-closure glaucoma or retinal vein occlusions after adjustment for age, gender, body mass index, systolic blood pressure and cognitive function score. Our population-based study did not reveal that snoring was a risk factor for glaucoma and thus did not provide a reason to assess or to treat snoring in patients with glaucoma. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to measure retinal nerve fibre layer thickness ( RNFLT) and its associated factors in a population-based setting. Methods The population-based Beijing Eye Study 2011 included 3468 individuals. The study participants underwent spectral-domain optical coherence tomography ( Spectralis®; Spectralis OCT)-assisted measurement of the RNFLT. For this study, exclusion criteria were glaucoma, pseudoexfoliation, best-corrected visual acuity of >0.5 log MAR, macular diseases, previous ocular surgery and known neurological diseases. The only inclusion criterion was an age of 50+ years. Results The inclusion criteria were fulfilled by 2548 participants. Mean RNFLT was 102 ± 11 μm. RNFLT was significantly (p < 0.001) thicker in the temporal inferior sector (153 ± 21 μm) than in the temporal superior sector (138 ± 21 μm), nasal inferior sector (118 ± 24 μm), nasal superior sector (106 ± 21 μm), temporal sector (76 ± 13 μm) and nasal sector (73 ± 15 μm). The mean intereye difference in RNFLT was 4.4 ± 6.0 μm. In multivariate analysis, thicker RNFLT was associated with younger age (p < 0.001), female gender (p < 0.001), urban region (p = 0.003), larger optic disc size (p < 0.001), larger neuroretinal rim area (p < 0.001), hyperopic refractive error (p < 0.001), larger beta zone of parapapillary atrophy (p = 0.008) and thicker subfoveal choroidal thickness (p = 0.02). RNFLT decreased by about 0.2 μm (0.2%) per year of life and by 1 μm (1%) per dioptre of myopia. Conclusion Mean RNFLT (measured by Spectralis® OCT; 102 ± 11 μm) was associated with younger age, female gender, urban region of habitation, larger optic disc, larger rim, hyperopic refractive error, larger parapapillary beta zone and thicker subfoveal choroidal thickness. Independent of age and refractive error, the RNFL was thickest temporal inferiorly and thinnest temporally and nasally. [ABSTRACT FROM AUTHOR]

Purpose: To examine potential associations between body height, cerebrospinal fluid pressure (CSFP), trans-lamina cribrosa pressure difference (TLCPD) and prevalence of open-angle glaucoma (OAG) in a population-based setting. Methods: The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range:50–93 years). A detailed ophthalmic examination was performed. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP[mmHg] = 0.44×Body Mass Index[kg/m2]+0.16×Diastolic Blood Pressure[mmHg]-0.18×Age[Years]-1.91 Results: Data of IOP and CSFP were available for 3353 (96.7%) subjects. Taller body height was associated with higher CSFP (P<0.001; standardized correlation coefficient beta:0.13; regression coefficient B:0.29; 95% confidence interval (CI):0.25,0.33) after adjusting for male gender, urban region of habitation, higher educational level, and pulse rate. If TLCPD instead of CSFP was added, taller body height was associated with lower TLCPD (P<0.001;beta:−0.10;B:−0.20;95%CI:−0.25,−0.15). Correspondingly, higher CSFP was associated with taller body height (P = 0.003;beta:0.02;B:0.01;95%CI:0.00,0.02), after adjusting for age, gender, body mass index, pulse, systolic blood pressure, and blood concentration of cholesterol. If IOP was added to the model, higher CSFP was associated with higher IOP (P<0.001;beta:0.02;B:0.02;95%CI:0.01,0.03). TLCPD was associated with lower body height (P = 0.003;beta:−0.04;B −0.02,95%CI:−0.04,−0.01) after adjusting for age, body mass index, systolic blood pressure, pulse, blood concentrations of triglycerides, axial length, central corneal thickness, corneal curvature radius, and anterior chamber depth. Adding the prevalence of OAG to the multivariate analysis revealed, that taller body height was associated with a lower OAG prevalence (P = 0.03;beta:−0.03;B:−1.20;95%CI:−2.28,−0.12) after adjusting for educational level and gender. Conclusions: Taller body height was associated with higher CSFP and lower TLCPD (and vice versa), after adjusting for systemic and ocular parameters. Parallel to the associations between a higher prevalence of glaucoma with a lower CSFP or higher TLCPD, taller body height was associated with a lower prevalence of OAG. [ABSTRACT FROM AUTHOR]

. Purpose: To examine size and frequency of parapapillary atrophy (beta zone) in patients with intrasellar or perisellar tumours and a glaucoma-like appearance of the intrapapillary optic disc region. Methods: Thirty-four Chinese subjects with intrasellar or perisellar tumours and a glaucoma-like appearance of the intrapapillary optic disc region and 129 age-matched subjects randomly selected from the population-based Beijing Eye Study were enrolled. Beta zone was measured on fundus photographs. Size and location of the tumours were assessed on neuroradiological images. Results: Beta zone was significantly more common (79 ± 7% versus 46 ± 4%; p = 0.001), and it was significantly larger in the tumour group than in the control group (circumferential extent: 135 ± 99 versus 57 ± 72; p < 0.001; relative area: 1856 ± 1923 versus 759 ± 1390; p = 0.002). The width of the intracerebral tumours was significantly associated with the circumferential extent of beta zone ( r = 0.36, p = 0.039) and with the area of beta zone ( r = 0.37, p = 0.032). Tumour width, height and depth were significantly (p = 0.001; p = 0.012; and p < 0.001, respectively) larger in the group of patients with beta zone than in the subgroup of patients without beta zone of parapapillary atrophy. Conclusions: Patients with large intrasellar or perisellar tumours and a glaucoma-like appearance of the intrapapillary region as compared with a population-based control group had a significantly larger and more frequently occurring beta zone of parapapillary atrophy. It suggests that large parasellar or suprasellar tumours can be associated with typical glaucomatous abnormalities in the parapapillary and intrapapillary region of the optic nerve head. It may give hints for the pathogenesis of glaucomatous optic neuropathy. [ABSTRACT FROM AUTHOR]

Purpose: To measure retinal nerve fiber layer (RNFL) thickness in a population-based setting. Methods: In the population-based Beijing Eye Study 2011 with 3468 individuals, RNFL thickness was measured in a subgroup of 1654 (47.7%) study participants by spectral domain optical coherence tomography (iVue SD-OCT). Results: Mean RNFL thickness was significantly (P<0.001) higher in the inferior sector (131.4±20.6 µm) than the superior sector (126.1±19.1 µm), where it was higher than in the temporal sector (79.8±12.2 µm;P<0.001), where it was higher than in the nasal sector (75.1±12.6 µm;P<0.001). In multivariate analysis, mean global RNFL thickness (103.2±12.6 µm) increased significantly with younger age (standardized correlation coefficient beta:−0.30;P<0.001), larger neuroretinal rim area (beta:0.26;P<0.001), shorter axial length (beta:−0.21;P<0.001), thicker subfoveal choroidal thickness (beta:0.15;P<0.001), larger optic disc area (beta:0.10;P<0.001), less refractive lens power (beta:0.10;P<0.001), flatter anterior cornea (beta:0.07;P = 0.01) and female gender (beta:0.05;P = 0.03). In this population with an age of 50+ years, the age-related decline in RNFL thickness was 0.5 µm per year of life or 0.36% of an original RNFL thickness of 137 µm at baseline of the study at 50 years of age. Mean global RNFL thickness decreased by 2.4 µm for each mm enlargement of axial length. Conclusions: The RNFL profile shows a double hump configuration with the thickest part in the inferior sector, followed by the superior sector, temporal sector and nasal sector. Factors influencing global RNFL thickness were younger age, larger neuroretinal rim, shorter axial length, thicker subfoveal choroid, larger optic disc, less refractive lens power, flatter anterior cornea and female gender. Beyond an age of 50+ years, RNFL decreased by about 0.3% per year of life at an age of 50+ years and by 2.4 µm per mm of axial elongation. These findings may be of interest for the knowledge of the normal anatomy of the eye and may be of help to diagnose diseases affecting the RNFL. [ABSTRACT FROM AUTHOR]

Purpose: To examine the retinal nerve fiber layer (RNFL) ophthalmoscopically, to search for localized RNFL defects, and to assess factors associated with RNFL visibility in a population-based setting. Methods: The population-based cross-sectional Beijing Eye Study 2006 included 3251 subjects. Using color fundus photographs, RNFL visibility was assessed in grades from 0 to 8 in 8 fundus sectors. Localized RNFL defects were defined as wedge-shaped defects running towards the optic disc. Results: After exclusion of subjects with optic media opacities, 2602 subjects (mean age:58.1±9.0 years) were included. RNFL visibility score was highest (P<0.001) in the temporal inferior region, followed by the temporal superior region, nasal superior region, and nasal inferior region. In multivariate analysis, higher RNFL visibility score was associated with younger age (P<0.001;standardized coefficient beta:−0.44;regression coefficient B: −0.22; 95%CI: −0.24, −0.20), female gender (P<0.001;beta:0.11;B:1.00;95%CI:0.67,1.32), higher blood concentration of low-density lipoproteins (P = 0.002;beta:0.07;B:0.34;95%CI:0.13,0.56), absence of dyslipidemia (P = 0.001;beta: −0.07;B: −0.58;95%CI: −0.93, −0.24), lower blood glucose concentration (P = 0.006;beta: −0.05;B: −0.14;95%CI: −0.24, −0.04), hyperopic refractive error (P<0.001;beta:0.15;B:0.45;95%CI:0.34,0.56), smaller optic disc size (P<0.001;beta: −0.08; B:−0.72;95% CI:−1.04, −0.40), absence of glaucomatous optic neuropathy (P<0.001;beta: −0.06;B: −2.69;95%CI:–4.18, −1.21) and absence of non-glaucomatous optic nerve damage (P = 0.001;beta: −0.06;B: −4.80;95%CI:0. −7.64, −1.96). Localized RNFL defects were detected in 96 subjects (prevalence:3.7±0.45% (95% confidence interval(CI):3.0,4.4). In multivariate analysis, prevalence of localized RNFL defects was associated with higher blood pressure (P<0.001; odds ratio (OR):1.07;95%CI:1.03,1.10), higher concentration of low-density lipoproteins (P = 0.01;OR:1.42;95%CI:1.08,1.85), higher prevalence of glaucomatous optic neuropathy (P<0.001;OR:46.8;95%CI:19.4,113) and diabetic retinopathy (P = 0.002;OR:3.20;95%CI:1.53,6.67), and lower total RNFL visibility (P<0.001;OR:0.92;95%CI:0.88,0.96). Conclusions: In Chinese aged 45+ years, a decreased RNFL visibility was associated with older age, male gender, dyslipidemia, hyperglycemia, myopia, larger optic disc, and glaucomatous or non-glaucomatous optic neuropathy. Localized RNFL defects (prevalence:3.7±0.45%) were correlated mainly with higher blood pressure, higher concentration of low-density lipoproteins, glaucomatous optic neuropathy and diabetic retinopathy. These data are helpful for the routine ophthalmoscopic examination of the RNFL. [ABSTRACT FROM AUTHOR]

. Purpose: Epigallocatechin-3-gallate (EGCG), the major polyphenol of green tea, has been suggested to reduce glutamate excitotoxicity. We therefore investigated the potentially protective effects of EGCG against N-methyl- d-aspartate (NMDA)-induced excitotoxicity in the retina. Methods: Female Wistar rats ( n = 171) were divided into a normal control group ( n = 9); saline control group with intravitreal saline injections ( n = 54); NMDA control group with an intravitreal NMDA injection and intraperitoneal saline injections ( n = 54); and NMDA study group ( n = 54) receiving an intravitreal NMDA injection plus intraperitoneal EGCG (25 mg/kg) injections. Starting at 2 days prior to the intravitreal NMDA injection, the intraperitoneal injections were performed daily for the whole study period. At 12 hr, 1, 2, 3 days, 1 and 2 weeks after the intravitreal NMDA injection, the animals were killed. We counted the neurons in the retinal ganglion cell layer (GCL) on histological sections, measured the thickness of Thy-1 immunoreactivity and assessed the expression of Thy-1 mRNA by real-time polymerase chain reaction. Results: At all time-points, GCL cell density, thickness of Thy-1 immunoreactivity and expression of Thy-1 mRNA were significantly (all p < 0.05) lower in the NMDA control group than in the NMDA study group, in which the parameters were significantly (all p < 0.05) lower than in the saline control group and the normal control group. In both groups with an intravitreal NMDA injection, GCL cell density, thickness of Thy-1 immunoreactivity and expression of Thy-1 mRNA decreased significantly with increasing follow-up time. Conclusions: Intraperitoneal application of EGCG resulted in a significantly less marked NMDA-associated loss of retinal ganglion cells. [ABSTRACT FROM AUTHOR]

Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study including 1,854 PACG cases and 9,608 controls across 5 sample collections in Asia. Replication experiments were conducted in 1,917 PACG cases and 8,943 controls collected from a further 6 sample collections. We report significant associations at three new loci: rs11024102 in PLEKHA7 (per-allele odds ratio (OR) = 1.22; P = 5.33 × 10?12), rs3753841 in COL11A1 (per-allele OR = 1.20; P = 9.22 × 10?10) and rs1015213 located between PCMTD1 and ST18 on chromosome 8q (per-allele OR = 1.50; P = 3.29 × 10?9). Our findings, accumulated across these independent worldwide collections, suggest possible mechanisms explaining the pathogenesis of PACG. [ABSTRACT FROM AUTHOR]

. Purpose: To analyze the axonal architecture of the optic nerve in patients with normal-pressure glaucoma and determine whether these parameters correlate with the disease severity. Methods: Using magnetic resonance (MRI) imaging (1.5-Tesla unit) and diffusion tensor (DT) MRI, we measured the optic nerve diameter, optic chiasm height and lateral geniculate nucleus (LGN) volume in patients with normal-pressure glaucoma and an age-matched control group. The retinal nerve fibre layer thickness (RNFL) was determined by optical coherence tomography (OCT). Results: The study included 30 patients with normal-pressure glaucoma and 30 age-matched control subjects. Optic nerve diameter (p < 0.001), optic chiasm height (p < 0.001) and LGN volume (p = 0.02) were significantly smaller in the glaucoma group than in the control group and were significantly correlated with RNFL thickness and perimetric loss. In the control group, the parameters significantly (p < 0.05) decreased with age. The DT-MRI-derived fractional anisotropy for the optic nerve was significantly lower (p < 0.001), and the DT-MRI-derived mean diffusivity (p < 0.001), radial diffusivity (λ⊥; p < 0.001) and axial diffusivity (λ||; p = 0.009) for the optic nerve were significantly higher in the glaucoma group and significantly correlated with RNFL thickness and mean perimetric defect. Conclusions: Patients with normal-pressure glaucoma show an age-adjusted reduced optic nerve diameter, optic chiasm height and LGN volume as measured by MRI, correlating with a reduced RNFL thickness and increased perimetric loss. MRI may be applied to examine the optic nerve in patients with glaucoma with opaque optic media. [ABSTRACT FROM AUTHOR]

Purpose: To assess the prevalence of glaucoma in adult Chinese. Design: Population-based study. Methods: The Beijing Eye Study in 2001 included 4439 subjects with an age of 40+ years. Glaucoma was determined using the ISGEO (International Society of Geographical and Epidemiological Ophthalmology) classification scheme. Results: Glaucoma was detected in 158 subjects (3.7%, 95% confidence interval [CI] 3.1%–4.2%), in which open-angle glaucoma (OAG), primary angle-closure glaucoma (PACG), and secondary glaucoma (SG) accounted for 2.6% (95% CI 2.1%–3.0%), 1.0% (95% CI 0.7%–1.3%), and 0.07% (95% CI 0%–0.1%), respectively. The overall glaucoma prevalence for the age groups of 40 to 49 years, 50 to 59 years, 60 to 69 years, and 70+ years was 2.2%, 2.5%, 4.4%, and 9.5%, respectively. Glaucoma prevalence increased significantly with age (P = .001), myopic refractive error (P < .001), and intraocular pressure (P < .001). The age-standardized prevalence of OAG, PACG, and SG was 2.5%, 1.0%, and 0.1%, respectively. Prevalence of glaucoma-related bilateral blindness or unilateral blindness was significantly (P = .02 and P = .03) higher in PACG than in OAG. Frequency of glaucoma-associated blindness and low vision was significantly higher in the rural area than in the urban region (6/62 vs 2/96, P = .04). Conclusions: In the adult population of Greater Beijing, glaucoma prevalence was 3.6% and increased with age, myopic refractive error, and intraocular pressure. Glaucoma prevalence of 3.6% was comparable with figures from Caucasian populations. The ratio of OAG to PACG of 2.6:1 agrees with recent other studies from East Asia. Glaucoma-related blindness and low vision occurred significantly more often in PACG than in OAG. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the normative data of anterior chamber depth (ACD) and angle width and their associations in Chinese adults. Design: Population-based study. Methods: The Beijing Eye Study 2006 included 3,251 subjects (73.3%) (aged 45+ years) out of 4,439 subjects who participated in the 2001 survey and who returned for reexamination. The subjects underwent an ophthalmologic examination including measurement of the anterior chamber dimensions by slit-lamp-based optical coherence tomography (OCT). Results: Out of the 3,251 subjects, OCT measurements were available for 2,985 subjects (91.8%). Mean ACD measured 2.42 ± 0.34 mm and the mean anterior chamber angle (ACA) was 38.3 ± 16.3 degrees. In multivariate analysis, a shallow chamber depth was significantly associated with age (P < .001), hyperopic refractive error (P < .001), female gender (P < .001), short body stature (P = .003), nuclear cataract (P = .03), central corneal thickness [CCT] (P < .001), large optic disk (P < .001), and presence of chronic angle-closure glaucoma (P < .001). Correspondingly, a narrow ACA was associated with age (P < .001), female gender (P < .001), hyperopia (P < .001), nuclear cataract (P < .001), short body stature (P = .001), large optic disk (P < .001), and angle-closure glaucoma (P < .001). Chamber depth and angle width were not associated with presence of age-related maculopathy and diabetic retinopathy. Conclusions: A shallow anterior chamber and a narrow chamber angle in Chinese adults are associated with age, female gender, hyperopia, nuclear cataract, small optic disk, short body stature, CCT, and chronic angle-closure glaucoma. These data may be helpful to explain anatomic relationships of the anterior segment of the eye, and to elucidate risk factors of angle-closure glaucoma. [Copyright &y& Elsevier]

Purpose: To determine in a population-based study whether parapapillary atrophy is associated with glaucoma. Design: Population-based cross-sectional study. Methods: The Beijing Eye Study included 4,439 of 5,324 subjects invited to participate (response rate, 83.4%). Mean age was 56.2 ± 10.6 years (range, 40 to 101 years). Color optic disk photographs (30 degrees) were examined morphometrically. Parapapillary atrophy was divided into α and β zones. Glaucomatous optic nerve atrophy was defined by a glaucomatous optic nerve head appearance. Results: After excluding highly myopic eyes, data from 4,003 (90.2%) subjects entered the statistical analysis. Glaucomatous optic nerve damage was detected in 93 (2.3%) subjects. The β zone of parapapillary atrophy as a whole and measured separately in four disk sectors was significantly larger and occurred significantly more frequently in the glaucomatous group than in the nonglaucomatous group (β zone total area, 1.21 ± 1.92 mm2 vs 0.32 ± 0.99 mm2; P < .001). In multiple regression analysis, area of β zone was significantly associated with age (P < .001), myopic refractive error (P < .001), and presence of glaucomatous optic nerve damage (P < .001), with no significant difference between chronic open-angle glaucoma (n = 72) and chronic angle-closure glaucoma (n = 21; β zone area, 1.20 ± 0.39 mm2 vs 1.19 ± 0.46 mm2; P = .69). Conclusions: In a population-based setting, the β zone of parapapillary atrophy is significantly larger and occurs more frequently in glaucomatous eyes than in normal eyes of Chinese adults, with no marked difference between chronic open-angle glaucoma and primary angle-closure glaucoma. [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]

Purpose: To determine the frequency of optic disk hemorrhages in the adult Chinese population. Design: Population-based prevalence survey. Methods: The study included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%) with an age of 40+ years. Mean age was 56.2 ± 10.6 years. Color optic disk photographs (45 degrees) were morphometrically examined. Results: Optic disk photographs were available for 8655 eyes of 4378/4439 (98.6%) subjects. Prevalence of disk hemorrhages was 107/8655 (1.24%; 95% confidence interval (CI): 1.00%, 1.47%) eyes. Occurrence of disk hemorrhages was significantly associated with glaucomatous optic nerve damage (P < .001; OR: 9.3; 95% CI: 5.6, 15.4) and age (P = .008; 95% CI: 1.01, 1.05). The occurrence of disk hemorrhages was not significantly associated with intraocular pressure (IOP) (P = .63; 95% CI: 0.97, 1.06), refractive error (P = .06; 5% CI: 0.87, 2.18), and visual field score (P = .81; 95% CI: 0.96, 1.03). Defining glaucoma as glaucomatous optic disk appearance, 20/107 (18.7%; 95% CI: 11.2%, 26.2%) disk hemorrhages were found in glaucomatous eyes. Out of 226 glaucomatous eyes, 20/226 (8.8%; 95%CI: 5.12%, 12.58%) eyes showed a disk hemorrhage. Hypertensive glaucoma eyes and normotensive glaucoma eyes did not vary considerably in frequency of disk hemorrhages (P = .44; OR: 1.82; 95% CI: 0.59, 5.68). Conclusions: Disk hemorrhages occur in a frequency of approximately 1.2% in adult Chinese. Major associated factors are glaucomatous optic neuropathy and age. Presence of a disk hemorrhage suggested glaucomatous optic nerve damage with a positive predictive value of approximately 20%. About 9% of glaucomatous eyes showed a disk hemorrhage at the time of examination. [Copyright &y& Elsevier]

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]