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As the population ages, promoting good health maintenance practices has become an important strategy in many health systems. Regular general health checks detect common diseases and empower older adults to monitor their physical health. Yet the service uptake rate is low. Previous reviews have identified intervention methods to improve the uptake rate, but the overall effectiveness of these interventions remains unclear. This review aims to determine the overall effectiveness of the interventions used to improve general health check uptake and identify the behavior change techniques used in these interventions. Literature searches were conducted in four electronic databases in August 2020 and updated in May 2021. Six randomized controlled trials were included in this review. Seven intervention types were identified, including enhanced invitation letters, telephone invitation, question-behavior-effect questionnaire, financial incentive, leaflet, pre-notification, and SMS reminder. Overall, the interventions are effective, with an odds ratio of 1.21, and a 95% confidence interval between 1.09–1.33. Fifteen behavior change techniques were identified using the Behaviour Change Technique Taxonomy (v1). The findings suggest that the current interventions implemented in invitation methods are effective in improving the general health check uptake rate, but there are still opportunities to further improve the uptake rate by considering other intervention types. Future studies could consider how other intervention types could be implemented alone or with the enhanced invitation methods to maximize the service uptake rate. The systematic review protocol is registered on PROSPERO (ref: CRD42021221041).

Background Visual decline is inevitable in older adults. Utilizing preventive vision care can mitigate major risk factors, yet the uptake rate remains suboptimal globally. Barriers to seek preventive eye care were identified in the literature. However, the understanding of these barriers was limited by the quantitative approach, hindering the opportunity to suggest specific strategies to improve service uptake. This qualitative aimed to identify the factors influencing the decision-making process of older adults to use preventive vision care. Methods This was a qualitative study guided by the grounded theory approach. Purposive sampling was used to recruit the subjects. Semi-structured interviews were conducted with 25 community-dwelling adults aged 65 years or above in Hong Kong. Data were transcribed and constant comparison techniques were used for data analysis. Results The core theme revealed a decision-making process of being difficult in “prioritising and fitting preventive vision care into the existing health service utilization” for older people when deciding the utilization of preventive vision care. Five sub-themes were identified to explain the low preventive vision care utilization. Specifically, in absence of past preventive vision care utilization experience, most rely on other “previous health service utilization” to guide their judgment. “Low perceived preventive vision care needs” were due to perceived low disruption of symptoms in daily practices and lack of social cues. “Low perceived self-efficacy of service utilization” was due to limited information on service availability, limited social support, limited health literacy, and financial concerns. Unfulfilled “service expectation” also lowered their motivation to use preventive vision care. Discussion This study found that multiple factors influenced the decision-making process and reduced the motivation of subjects to use preventive vision care. Future interventions could exploit the benefit of social influences on the identified factors so that preventive vision care can smoothly fit into the ongoing healthcare use. Adopting a longitudinal qualitative perspective would enrich understanding the reasons for not using preventive vision care.

Understanding the impact of a health care voucher scheme and service access barriers could facilitate optometry service promotion to the older population.A voucher is one strategy to improve the utilisation of the different health care services available in the private sector. This study aims to explore how a health care voucher system for older people impacts utilisation of optometry services from the perspective of service users and service providers.People aged 65 years or above were recruited to fill in a structured questionnaire studying the usage characteristics and access barriers of optometry services and the health care voucher. Views from the optometrists about the voucher scheme were collected by questionnaire.A total of 1156 valid questionnaires from eligible voucher users was collected. Results showed that 53.7% (621/1156) of participants had used optometry services within the past 2 years. Lack of familiarity with services provided, professional fees, and prices of spectacles were the main barriers to using optometry services. Of those participants who had used the voucher for optometry services previously, 80.4% (284/353) had an eye examination in the past 2 years. Among 389 optometrists who participated in the study, over 80% agreed that the voucher scheme improved awareness of major eye conditions and access to prescription spectacles when necessary.The health care voucher for older people improved access to optometry services. Access could be further improved by increasing price transparency of professional services and prescription spectacles. Responses from optometry service providers supported the view that the voucher scheme improved access to, and utilisation of, preventive care services.

Background Financial incentive is increasingly used as a mean to promote preventive care utilization (PCU), but the current Elderly Health Care Voucher Scheme (EHCVS) in Hong Kong is ineffective for encouraging PCU. Objective To explore the older people's barriers to PCU and their views on financial incentive, including EHCVS, for improving private PCU. Design and setting Focus-group discussions were conducted in community elderly centres located in five districts of Hong Kong. Participants Community-dwelling older people aged 60 years or above. Results Lack of understanding about preventive care and low awareness of the need for preventive care were key factors for the low motivation for PCU. Uncertainty over the level of service fee charged and concerns over service quality hindered the choice of using the private service providers under the current EHCVS. Financial incentives specific for preventive care services were thought to be cues to actions and guides for service promotion. However, some flexibility in service coverage and a set time limit of the financial incentives were preferred to accommodate individual needs. Conclusions Apart from promoting knowledge of preventive care, official monitoring for service fee and quality is important for empowering older people to choose private service providers for preventive care. Financial incentives for preventive care services should be more specific to cue service promotion and uptake of preventive care while maintaining flexibility to accommodate individual needs. Patient or public contribution Participants were recruited using purposive sampling with the coordination of community elderly centres. Data were analysed using thematic coding.

Myopia is the commonest eye disorder in the world. High myopes are predisposed to ocular pathologies. The vasoactive intestinal peptide receptor 2 (VIPR2) gene was identified as a myopia susceptibility locus by our group and another group. We continued to fine-map this locus. A case-control study was performed in 4 sequential stages with a total of 941 highly myopic subjects and 846 control subjects, all unrelated Chinese. Stage 1 experimentally genotyped 64.4% of the entire cohort for 152 single-nucleotide polymorphisms (SNPs) and Stage 2 the remaining subjects for 21 SNPs. Stage 3 combined the genotypes for 21 SNPs for the entire cohort, and identified one group of high-risk haplotypes and one group of protective haplotypes significantly associated with high myopia. Stage 4 imputed genotypes for variants in the VIPR2 region and identified two independent groups of variants: one group with high-risk minor alleles and another with protective minor alleles. Variants within each group were generally in strong linkage disequilibrium among themselves while high-risk variants were in linkage equilibrium with protective variants. Therefore, the VIPR2 locus seems to contain variants with opposite effects. This is the first study that has examined the genetic architecture of a myopia susceptibility locus in detail.

ObjectiveThis study was conducted to evaluate the real-world effectiveness and potential cost-effectiveness of a community-based vision care programme for the ageing population aged 60 years or above.MethodsData from a total of 8899 subjects participating in a community based comprehensive vision care programme from 2015 to 2019 were extracted and analyzed to evaluate the effectiveness of the programme in terms of the prevalence of visual impairment (VI), the change in the prevalence of VI after refractive error correction, and the types of ocular disorders detected. VI was defined by a) visual acuity (VA) worse than 6/18 in any eye (worse eye) and b) VA worse than 6/18 in the better eye. The cost-effectiveness from the funder’s perspective was also estimated in terms of cost per VI avoided from such a programme.ResultsThe study found that referenced to VA of the worse eye, the prevalence of VI was 39.1% (3482/8899, 95% CI: 38.1%-40.1%) based on presenting VA and reduced to 13.8% (1227/8899, 95% CI: 13.1%-14.5%) based on best-corrected VA. Referenced to the VA in the better eye, the prevalence of VI was 17.3% (1539/8899, 95% CI: 16.5%-18.1%) based on presenting VA and decreased to 4.2% (373/8899, 95% CI: 3.8%-4.6%) after best-corrected VA. Uncorrected refractive error was the major cause of presenting VI. From the funder’s perspective, the cost per VI case prevented was HK$1921 based on VA in the worse eye and HK$3715 based on the better eye.ConclusionA community-based programme was effective to detect the VI and reduced a relative 65% to 76% VI after refractive error correction for the community-dwelling ageing population. The ageing population can benefit from regular comprehensive vision care.

PURPOSE To evaluate the influence of 2.2 mm clear corneal incision (CCI) features in surgically induced astigmatism (SIA) and higher-order aberrations (HOAs) after cataract surgery. METHODS Right eyes of 92 subjects receiving 2.2 mm incision cataract surgery were involved. A total of 38 eyes were categorized as the intact incision group, and 54 eyes were the defective incision group. Pre- and postoperative (1 month and 6 months) corneal astigmatism and HOAs on anterior and posterior corneal surfaces, corneal volume, and corneal thickness (CT) were measured using Pentacam. The CCI features including incision length (IL), incision angles, distance from incision to central cornea (Dis-En/Ex), and CT at incision site were quantified using AS-OCT. RESULTS The defective incision group showed shorter IL and larger incision angles [false discovery rate (FDR) - p

Purpose The SARS‐CoV‐2 RNA has been detected in tears and conjunctival samples from infected individuals. Conjunctivitis is also reported in a small number of cases. We evaluated ocular symptoms and ocular tropism of SARS‐CoV‐2 in a group of patients with COVID‐19. Method Fifty‐six patients infected with SARS‐CoV‐2 were recruited as subjects. Relevant medical histories were obtained from the electronic medical record system. Ocular history and ocular symptoms data were obtained by communicating directly with the subjects. The Ocular Surface Disease Index (OSDI) and Salisbury Eye Evaluation Questionnaire (SEEQ) were used to assess the anterior ocular surface condition before and after the onset of disease. Results Patients classified as severe COVID‐19 cases were more likely to have hypertension compared to mild cases (p = 0.035). Of the 56 subjects, thirteen patients (23%) were infected in Wuhan, 32 patients (57%) were community‐infected, 10 patients (18%) were unknown origin, 1 (2%) was a physician likely infected by a confirmed patient. Three patients wore face mask with precaution when contacting the confirmed patients. Fifteen (27%) had aggravated ocular symptoms, of which 6 (11%) had prodromal ocular symptoms before disease onset. The differences in mean scores of OSDI questionnaire and SEEQ between before and after onset of COVID‐19 were all significant (p

ObjectiveTo study how a non-targeted publicly-funded health care voucher system for the elderly impact on access to optometry services from the perspective of service users and service providersDesignCross-sectional studySetting19 elderly community centersParticipants1176 people, aged 65 years or above, and 389 optometristsPrimary and secondary outcome measuresUsage characteristics of optometry services by eligible service users of the voucher schemePerspectives of eligible service users on access barriers to optometry servicesPerspectives of service providers on voucher schemeResultsIn total, 1156 valid questionnaires were collected from a cohort of eligible service users. Results showed that 53.7% of subjects had used optometry services within the past 2 years, while 22% had not used optometry services before. Lack of familiarity with services provided, professional fees and prices of prescription spectacles were the main barriers to using optometry services. Of those subjects who had used the voucher for optometry service before, 80.4% had eye examination in the past 2 years, versus 64.1% among subjects who had not use health care voucher on the optometry service. “Insufficient voucher value” was a commonly quoted reason for not using the health care vouchers for optometry services. Over 80% of optometrists agreed that the voucher scheme improved the awareness of major eye conditions and enabled the elderly to have prescription spectacles when necessary.ConclusionThe health care voucher for the elderly improved access to optometry services. Access could be improved further by promoting awareness optometry services, location of service providers, price transparency of professional services and prescription spectacles. Responses from optometry services providers are supportive of the view that the voucher scheme improved access to and utilization of preventive care services.Article SummaryStrengths and limitations of this study-High representativeness of community dwelling older population in Hong Kong.-The mixed method approach provided a more in-depth investigation of the population.-One limitation is the generalizability of the results with older people who are members in the community centers.

Background: Coronavirus disease 2019 (COVID-19) is a highly infectious disease transmitted human-to-human by the coronavirus SARS-CoV-2 The SARS-CoV-2 RNA has

To evaluate the risk factors associated with contamination of lens cases in a group of orthokeratology (ortho-k) lens wearers.Ortho-k patients attending the Contact Lens Clinic of the Hospital were required to complete a checklist about their routine daily care and handling of lens cases. Their cases were then collected for analysis. Contamination was evaluated by determining the optical density (OD) of crystal violet stained biofilm present in the cases. OD values were divided into three groups, lower, middle, and upper tertiles, and associations between risk factors were determined by multivariate analysis.A total of 194 subjects were recruited. Twenty-five subjects used cylindrical lens cases (CC), 98 flat cases with ridges (FCR), and 71 flat cases without ridges (FC). FCRs were the most heavily contaminated and CC showed least contamination (FCR FC, OR 2.16, CI 1.11-4.18, p = 0.023; FCRCC, OR 8.86, CI 2.97-26.44, p0.001; FC CC, OR 2.33, CI 1.35-12.45, p = 0.013). Replacing lens cases monthly significantly reduced the risk of high contamination (OR 0.013, CI 0.06-0.30, p 0.001), compared to those used for three months. Cases that were not rinsed (OR 3.44, CI 1.50-7.86, p = 0.003) or rinsed by other methods (OR 4.07, CI 1.67-9.92, p = 0.002) had significantly more contamination, compared to those rinsed with multipurpose solution. Lens cases, which were not dried (OR 11.36, CI 2.06-62.93, p = 0.005) or air-dried (OR 8.71, CI 1.16-65.56, p = 0.036), showed more contamination compared to those wiped with tissue daily.Case design (cylindrical), monthly replacement, daily rinsing with MPS, and wiping with tissue daily can effectively reduce biofilm formation in contact lens cases.

Background Genome-wide association studies (GWAS) is a major method for studying the genetics of complex diseases. Finding all sequence variants to explain fully the aetiology of a disease is difficult because of their small effect sizes. To better explain disease mechanisms, pathway analysis is used to consolidate the effects of multiple variants, and hence increase the power of the study. While pathway analysis has previously been performed within GWAS only, it can now be extended to examining rare variants, other “-omics” and interaction data. Scope of review 1. Factors to consider in the choice of software for GWAS pathway analysis. 2. Examples of how pathway analysis is used to analyse rare variants, other “-omics” and interaction data. Major conclusions To choose appropriate software tools, factors for consideration include covariate compatibility, null hypothesis, one- or two-step analysis required, curation method of gene sets, size of pathways, and size of flanking regions to define gene boundaries. For rare variants, analysis performance depends on consistency between assumed and actual effect distribution of variants. Integration of other “-omics” data and interaction can better explain gene functions. General significance Pathway analysis methods will be more readily used for integration of multiple sources of data, and enable more accurate prediction of phenotypes.

Identification of genetic variations related to high myopia may advance our knowledge of the etiopathogenesis of refractive error. This study investigated the role of potassium channel gene (KCNQ5) polymorphisms in high myopia. We performed a case-control study of 1563 unrelated Han Chinese subjects (809 cases of high myopia and 754 emmetropic controls). Five tag single-nucleotide polymorphisms (SNPs) of KCNQ5 were genotyped, and association testing with high myopia was conducted using logistic regression analysis adjusted for sex and age to give Pasym values, and multiple comparisons were corrected by permutation test to give Pemp values. All five noncoding SNPs were associated with high myopia. The SNP rs7744813, previously shown to be associated with refractive error and myopia in two GWAS, showed an odds ratio of 0.75 (95% CI 0.63–0.90; Pemp = 0.0058) for the minor allele. The top SNP rs9342979 showed an odds ratio of 0.75 (95% CI 0.64–0.89; Pemp = 0.0045) for the minor allele. Both SNPs are located within enhancer histone marks and DNase-hypersensitive sites. Our data support the involvement of KCNQ5 gene polymorphisms in the genetic susceptibility to high myopia and further exploration of KCNQ5 as a risk factor for high myopia.

Purpose Acanthamoeba keratitis (AK), which is associated with noncompliant use of contact lenses, remains difficult to treat due to delayed diagnosis and paucity of therapeutic agents. Although improvements in activity against Acanthamoeba infection have been achieved in disinfecting solutions for soft contact lenses, such modifications have not been extended to those for special rigid gas permeable (RGP) contact lenses, which are increasingly used for myopia control in children. Phytochemicals present in herbs used for traditional Chinese medicine may be effective as therapeutic or preventive agents. The purpose of this study was to investigate amoebicidal properties of lead phytochemicals of Radix scutellariae alone and in combination with multipurpose (disinfecting) solutions (MPS) for RGP lenses. Methods Viability of Acanthamoeba castellani and A. polyphaga trophozoites was determined following exposure to four phytochemicals: baicalin, baicalein, wogonoside, and oroxylin A and both alone and in combination with four RGP MPS, using a modified stand-alone technique. Results As individual agents, wogonoside and oroxylin A showed highest activity against A. castellani and A. polyphaga trophozoites, respectively. For both organisms, the combination of baicalein and oroxylin A was superior. Effectiveness of MPS alone did not exceed 0.27 log reduction, but addition of combined baicalein and oroxylin A resulted in 0.92 and 0.64 log reductions of A. castellani and A. polyphaga, respectively. Conclusions The combination of baicalein and oroxylin A enhanced the activity of MPS for RGP contact lenses against trophozoites of two pathogens, A. castellani, and A. polyphaga, and offers a potential therapeutic and/or preventative agent for AK.

Objective To assess the association between awareness of diabetic retinopathy (DR) and actual attendance for DR screening. Design Cross-sectional study. Setting Two public general outpatient clinics. Participants The subjects were people with diabetes mellitus (DM) who participated in a randomised controlled trial, set up in 2008, to test the impact of a copayment on attendance for DR screening. Primary and secondary outcome measures The subjects’ awareness of DR was evaluated using a structured questionnaire conducted via a telephone interview. The attendance for screening was from the actual attendance data. Association between awareness and attendance for screening was determined using multivariate logistic regression model and was reported as ORs. Results A total of 2593 participants completed the questionnaire. A total of 42.9% (1113/2593) said they would worry if they had any vision loss and 79.6% (2063/2593) knew that DM could cause blindness. Only 17.5% (453/2593) knew that treatment was available for DR and 11.5% (297/2593) knew that early DR could be asymptomatic. The importance of having a regular eye examination was acknowledged by 75.7% (1964/2593), but 34% (881/2593) did not know how frequently their eyes should be examined. Worry about vision loss (OR=1.72, P

Myopia is the most common human eye disorder and it results from complex genetic and environmental causes. The rapidly increasing prevalence of myopia poses a major public health challenge. Here, the CREAM consortium performs a joint meta-analysis to test single-nucleotide polymorphism (SNP) main effects and SNP × education interaction effects on refractive error in 40,036 adults from 25 studies of European ancestry and 10,315 adults from 9 studies of Asian ancestry. In European ancestry individuals, we identify six novel loci (FAM150B-ACP1, LINC00340, FBN1, DIS3L-MAP2K1, ARID2-SNAT1 and SLC14A2) associated with refractive error. In Asian populations, three genome-wide significant loci AREG, GABRR1 and PDE10A also exhibit strong interactions with education (P, This report by the Consortium for Refractive Error and Myopia uses gene-environment-wide interaction study (GEWIS) to identify genetic loci that affect environmental influence in myopia development, and identifies ethnic specific genetic loci that attribute to eye refractive errors.