Search

To investigate the prevalence, associated factors, and inter-eye differences of myopia and astigmatism in an adult Japanese population-based cohort. A total of 4282 participants from the Tohoku Medical Megabank Organization Eye Study (ToMMo Eye Study) underwent comprehensive ocular examinations as well as extensive physiological tests and a lifestyle questionnaire. The spherical equivalent (SE) and cylinder power were obtained as refractive parameters. The age- and gender-stratified prevalences of high myopia (SE < −5D), myopia (SE < −0.5D), hyperopia (SE > 0.5D), astigmatism (cylinder power < −0.5D), and anisometropia (SE difference >1D) were calculated. Multivariable analyses were performed to identify associated factors for refractive error (RE). Distribution and associated factors of the inter-eye difference in RE were also investigated. The age-adjusted prevalence of high myopia, myopia, hyperopia, astigmatism, and anisometropia was 15.9%, 63.5%, 14.7%, 51.1%, and 14.7%, respectively. Both myopia and high myopia were more prevalent in the younger age group, while astigmatism was more prevalent in the older age group. Age, education, blood pressure, intraocular pressure, and corneal thickness are significantly associated with myopic refraction. Age, gender, intraocular pressure, and corneal thickness are correlated with astigmatism. Older age was associated with against-the-rule astigmatism. Older age, myopia, and longer education showed a significant correlation with large inter-eye differences in SERE. This study demonstrated the high prevalence of myopia in young Japanese, which may be caused by a generational shift. This study also confirmed the influence of age and education on both the prevalence and inter-eye differences of RE. [ABSTRACT FROM AUTHOR]

Japan has been known as a super-aged society, and ageing is a well-known risk factor for blinding eye diseases. However, epidemiological studies in ophthalmology are still scarce in Japan, and the sizes of the cohorts are relatively small. "Ganka-Ekigaku Network" (GEN, an acronym for the epidemiological network in ophthalmology in Japanese) is established to develop a capacity to boost each epidemiological study and enrich a potential inter-study collaboration to identify risk factors of visual impairment in aged society. We reviewed cohort studies in Japan with the inclusion criteria as: (1) at least n = 1000 at baseline, (2) multiple modalities of ophthalmic data, and (3) diagnosis reviewed by ophthalmologist(s), and (4) ophthalmologists are involved in the investigators group. As of January 2020, GEN includes 4 individual Japanese epidemiological studies namely, Hisayama study, Yamagata Study (Funagata), Tsuruoka Metabolomics Cohort study, and the Nagahama Prospective Genome Cohort for Comprehensive Human Bioscience. GEN includes approximately 25,000 Japanese participants. The baseline surveys started from 1998 to 2012, and since then the data has been prospectively collected approximately every 5 years. A variety of ophthalmic measurements and other factors have been collected in each study in GEN: ophthalmic measurements (fundus photography, optical coherence tomography, etc.), systemic conditions (laboratory data, etc.), and others (DNA, etc.). GEN is an open platform for observational ophthalmic epidemiological studies to share standardized methodologies. While each study in GEN pursues specific and original research questions, standardization of the methods will enable us to conduct reliable meta-analysis/pooled data analyses. [ABSTRACT FROM AUTHOR]

Purpose: There are no available data about diabetic retinopathy (DR) in the Indonesian population. This report summarizes the rationale and study design of the Jogjakarta Eye Diabetic Study in the Community (JOGED.COM), a community-based study to estimate the prevalence and risk factors of DR in persons with type 2 diabetes in Jogjakarta, Indonesia. Methods: The JOGED.COM aimed to examine a cross-sectional sample of 1200 persons with type 2 diabetes aged 30 years and older residing in the study area. We identified 121 community health centers (CHCs) in Jogjakarta and listed 35 CHCs with non-communicable diseases facilities. Multi-stage, clustered random sampling was used to select 22 CHCs randomly. We included CHCs with coverage population >30,000, and excluded those classified as 100% rural. Lists of persons with diabetes confirmed by their family physician were provided from each CHC. Examinations procedures included detailed interviews, general and eye examinations, anthropometry and body composition scan, and dilated fundus photography. Results: We collaborated with local health authorities, family physicians, and local health practitioners in the recruitment phase. A total of 1435 invitations were distributed, and 1184 people (82.5%) with type 2 diabetes participated in this study, of whom 1138 (79.3%) had completed data with gradable retinal images. Conclusions: JOGED.COM is the first epidemiologic study of DR in an Indonesian population. This study will provide key information about the prevalence and risk factors of DR in the community. These data are very important for future health promotion programs to reduce the burden of DR in the population. [ABSTRACT FROM PUBLISHER]

Purpose/Aim: To investigate the association between retinal vascular tortuosity and traditional- and vascular-related risk factors in persons with diabetes. Methods: We recruited 224 diabetic patients. Retinal vascular tortuosity was measured from fundus photographs. Association of tortuosity with the following factors was assessed after adjusting for significant co-factors: diabetes duration, HbA1c, systolic blood pressure (SBP), cholesterol and body mass index (BMI), flicker-light induced retinal vasodilatation, and markers of endothelial function and inflammation (skin microvacular responses to acetylcholine iontophoresis, soluble e-selectin, inter-cellular adhesion molecule-1, vascular cell adhesion molecule-1, endothelin-1, total nitrite, C-reactive protein). Results: Adjusting for age and gender, longer diabetes duration was associated with more tortuous retinal arterioles (mean difference in arteriolar tortuosity 5.85 × 10−5, 95% Confidence Interval 1.44–10.3 × 10−5;p = 0.016; ≤10 versus >10 years duration). Reduced flicker-light induced retinal vasodilatation was associated with tortuous arterioles and venules (mean difference in arteriolar tortuosity 5.62 × 10−5, 4.50–6.72 × 10−5;p < 0.001 and in venules 5.94 × 10−5, 3.33–8.55 × 10−5;p < 0.001; comparing highest versus lowest tertile of flicker-light vasodilatation). These associations remained after adjusting for co-factors. Diabetes duration explained about 36% and flicker-light vasodilatation 25% of the variation in retinal arteriolar tortuosity. No associations were found between retinal arteriolar or venular tortuosity and HBA1c, SBP, cholesterol, BMI and serum markers of endothelial function. Conclusions: Increased retinal arteriolar tortuosity was related to longer diabetes duration and reduced flicker-light induced vasodilatory response, suggesting that retinal vascular tortuosity in adults with diabetes may be influenced by multiple diabetes-related physio-pathological changes. [ABSTRACT FROM PUBLISHER]

Purpose: To evaluate the cost-effectiveness for a screening interval longer than 1 year detecting diabetic retinopathy (DR) through the estimation of incremental costs per quality-adjusted life year (QALY) based on the best available clinical data in Japan. Methods: A Markov model with a probabilistic cohort analysis was framed to calculate incremental costs per QALY gained by implementing a screening program detecting DR in Japan. A 1-year cycle length and population size of 50,000 with a 50-year time horizon (age 40-90 years) was used. Best available clinical data from publications and national surveillance data was used, and a model was designed including current diagnosis and management of DR with corresponding visual outcomes. One-way and probabilistic sensitivity analyses were performed considering uncertainties in the parameters. Results: In the base-case analysis, the strategy with a screening program resulted in an incremental cost of 5,147 Japanese yen (¥; US$64.6) and incremental effectiveness of 0.0054 QALYs per person screened. The incremental cost-effectiveness ratio was ¥944,981 (US$11,857) per QALY. The simulation suggested that screening would result in a significant reduction in blindness in people aged 40 years or over (−16%). Sensitivity analyses suggested that in order to achieve both reductions in blindness and cost-effectiveness in Japan, the screening program should screen those aged 53-84 years, at intervals of 3 years or less. Conclusions: An eye screening program in Japan would be cost-effective in detecting DR and preventing blindness from DR, even allowing for the uncertainties in estimates of costs, utility, and current management of DR. [ABSTRACT FROM AUTHOR]

Purpose: Retinal vascular fractal dimension, a measure of the density of the retinal vasculature, has been suggested as a marker of systemic microvascular disorders in diabetes. As hemoglobin concentration is tightly related to vascular physiology and hypoxia, the hypothesis was that hemoglobin concentration would be associated with retinal vascular fractals in a relevant population. Methods: In a cross-sectional study of 204 long-term type 1 diabetes patients from a population-based cohort, retinal digital photos were captured and graded for fractal dimension (Df) by International Retinal Imaging Software - Fractal (IRIS-Fractal). Df was calculated from a disc-centered retinal photo from the right eye. Hemoglobin concentrations were measured using routine equipment. Results: Of 175 patients with gradable images, median age was 57.7 years and median duration of diabetes was 42 years. Median retinal Df was 1.4606 (inter-quartile range 0.0264). A positive correlation was found between hemoglobin concentration and retinal vascular Df ( r = 0.23, p = 0.0018). In a multiple linear regression model, Df was associated with hemoglobin (coefficient 0.0054 per 1.0 mmol/L increase in hemoglobin, p = 0.01) and age (coefficient −0.0046 for each 10-year increase in age, p = 0.04). Conclusion: Hemoglobin correlated independently with retinal vascular fractals indicating a relationship between hemoglobin availability and retinal vascular structure. [ABSTRACT FROM AUTHOR]

Purpose/aim: To identify retinal vascular features that precede the development of branch retinal vein occlusion (BRVO) by comparing case eyes and fellow eyes. Materials and methods: We identified 25 persons who attended an annual health screening program at Osaka Health Science Center, Osaka, Japan, and then developed BRVO in one eye between 1995 and 2009. We retrospectively reviewed retinal images of these subjects taken 1-5 years prior to the development of BRVO and compared the prevalence of retinal vascular features between case eyes and contralateral fellow eyes. Potential local retinal vascular features considered were (1) severe arterio-venous (AV) nicking, (2) a smaller angle at the crossing of the arteriole and venule, (3) double crossing, (4) crossing near venular bifurcation and (5) isolated retinopathy. The central retinal artery equivalent (CRAE), vein equivalent (CRVE) and AV ratio (CRAE divided by CRVE) were quantitatively estimated using a standardized imaging software (University of Wisconsin). Results: Compared to the fellow eye, severe AV nicking (39.1% versus 2.6%, <0.001), isolated retinopathy (47.8% versus 7.69%, p < 0.001) and a smaller angle at the crossing site (82.6% versus 46.2%, p = 0.005) were more prevalent in eyes with BRVO compared with fellow eyes. Case eyes had a significantly smaller AV ratio at 1-5 years prior to the development of BRVO compared with fellow eyes (0.68 versus 0.73, p = 0.03). Conclusions: In addition to severe AV nicking, a well-known sign linked to BRVO, this study identified two new potential retinal vascular features - isolated retinopathy and a smaller angle at the crossing site - associated with BRVO development. We also found that a discrepancy in the AV ratio between eyes (i.e. a smaller AV ratio than the fellow eye) can be a quantitative indicator of a higher BRVO risk. These findings warrant further validation in longitudinal studies. [ABSTRACT FROM AUTHOR]

Aim: To examine retinal vessel calibre in autoimmune rheumatic disease. Materials and methods: Patients with autoimmune rheumatic disease were recruited from a Rheumatology clinic. Retinal vessel calibre was measured from fundus photographs, and summarised as the central retinal artery and vein equivalents (CRAE and CRVE) using a semi-automated computer-assisted method. Results: The 124 patients studied had rheumatoid arthritis ( n = 76, 61%), systemic lupus erythematosus ( n = 17, 14%), psoriatic arthritis ( n = 11, 9%) or another rheumatological disease ( n = 20, 16%). Retinal venular calibre was increased in patients with autoimmune rheumatic disease (+11.6 µm, 95% Confidence interval [CI] 3.8 - 19.3, p = 0.01) compared with other hospital patients, after adjusting for baseline differences. This increase was also present in the subgroup with rheumatoid arthritis ( p = 0.01). Patients with a rheumatic disease and elevated C-reactive protein (CRP) levels had wider retinal venules than those with a lower CRP (mean CRVE: 247.8 ± 28.0 versus 216.6 ± 25.3, p < 0.01), and than other hospital patients with increased CRP (mean CRVE: 247.8 ± 28.0 versus 216.4 ± 25.9, p < 0.01). Conclusions: Individuals with an autoimmune rheumatic disease have wider retinal venules than other hospital patients. This increase in calibre may be due to the underlying inflammatory activity. [ABSTRACT FROM AUTHOR]

Purpose: To assess the correlation and reproducibility of retinal vascular geometric measurements obtained from two stereo-paired fundus images. Methods: Thirty stereoscopic pairs of color optic disc-centered photographs from the Blue Mountains Eye Study were analyzed. Side-by-side grading was performed by a single grader, using semi-automated computer software to quantify the following retinal geometric parameters: (1) retinal arteriolar/venular caliber (CRAE/CRVE); (2) arteriole-to-venule ratio (AVR); (3) branching angle; and (4) tortuosity. We used Pearson correlation (r), intra-class correlation coefficient (ICC), and Bland-Altman plots to assess within-pair correlation and reproducibility for each parameter measured. Results: Inter- and intra-grader r and ICC were high (all r > 0.90 and ICC > 0.90), except for branching angle (ICCs between 0.69-0.83). There was no significant difference between within-pair means of all retinal vascular geometric parameters, before and after excluding poor quality images. CRAE, CRVE, AVR, and arteriolar and venular tortuosity showed very high within-pair correlation and agreement (all r > 0.80 and all ICC > 0.90 respectively). Arteriolar and venular branching angles demonstrated moderate within-pair correlation (r = 0.65 and r = 0.62, respectively) and within-pair agreement (ICC = 0.76 and ICC = 0.77, respectively). Conclusions: Use of computer-assisted software to measure retinal vascular geometric parameters from paired fundus images was highly repeatable and is robust to differences in photographic angles of paired stereo images. Such measurements can be applied to evaluate temporal changes in longitudinal studies. [ABSTRACT FROM AUTHOR]

Purpose: To compare the frequency and pattern of bilateral involvement of early and late age-related macular degeneration (AMD) between Asian Malays and Caucasians. Methods: We used cross-sectional data from the baseline examination for subjects aged 50-79 years in the Singapore Malay Eye Study (SiMES) ( N == 2,453) and the Blue Mountains Eye Study (BMES) ( N == 3,265). We assessed AMD signs using a common protocol modified from the Wisconsin Age-related Maculopathy Grading System at the University of Sydney. We compared frequencies or proportions of AMD cases with bilateral involvement between the two populations. Results: There were 173 cases and 169 cases with any AMD (either early or late AMD in at least one eye), and 78 cases (45.1%) and 52 cases (30.8%) with bilateral AMD in the BMES and the SiMES, respectively. Age-standardized frequency of bilateral involvement was comparable between the BMES (29.5%, 95% confidence interval(CI) 18.5-40.5%) and the SiMES (25.6%, 95%CI 17.0-34.0%). Older age was associated with higher risk of bilateral AMD (gender-adjusted odds ratio per 1 year for the BMES and the SiMES: 1.08 [95% CI 1.05-1.11] and 1.06 [95% CI 1.02-1.10], respectively). Conclusions: The frequency of bilateral AMD was comparable between Asian Malays in the SiMES and the Caucasian population of the BMES. Other than older age, we did not find any characteristics associated with the bilateral involvement of AMD. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between glucose metabolism and central corneal thickness (CCT) in Japanese adults. Methods: A sub-sample of 322 Japanese adults participating in the Funagata Study was included in this analysis. CCT was measured using a specular microscope. Glucose metabolism was examined using 75-g oral glucose tolerance test. Mean differences in CCT (μm) and 95% confidence intervals were estimated with univariate, age-sex-adjusted and multivariate models using multiple linear regression. Results: The mean (± standard deviation) age of the study sample was 63.7 ± 11.4 years and 44% were men. The mean fasting plasma glucose (FPG), 2-hour post-load plasma glucose (2hPG) and haemoglobin A1c (HbA1c) concentrations were 96.8 ± 12.6mg/dl, 123.6 ± 41.2mg/dl and 5.3 ± 0.4%, respectively. CCT was normally distributed in the study sample, and the mean CCT was 544.7 ± 34.6μm. After multivariate adjustment, characteristics associated with increased CCT were 2hPG and HbA1c concentrations, impaired glucose tolerance, diabetes, body weight or body mass index and current smoking. Conclusion: Impaired glucose tolerance, diabetes, obesity and current smoking are associated with increased CCT. Additional studies are required to examine whether interventions to affect these characteristics may reduce CCT. [ABSTRACT FROM AUTHOR]

Purpose: Dilation of retinal vessels in response to diffuse luminance flicker may reflect endothelial function. Although this has previously been shown to be reproducible in whites, there have been no similar data in Asians. We assess the reproducibility of repeated measurements of this response in Asians. Material and Methods: Healthy Asians ( n = 33) with normal vision and no history of glaucoma, age-related macular degeneration, cataract, or retinal arterial/venous occlusion participated in this study. Repeated measures from the same subjects were taken 30–60 min apart using the Dynamic Vessel Analyser (DVA, IMEDOS, Jena, Germany). Modification was made to the shape of the light source for Asian participants. Correlations of the first and second measures were assessed using Pearson correlation ( R2), and agreement between the two measures was shown using Bland–Altman plots. Results: After modification to the shape of the light source, almost perfect correlation was found between the 1st and 2nd measurements of baseline arteriolar ( R2 = 0.95) and venular diameters ( R2 = 0.98) of arteriolar maximum dilation ( R2 = 0.85). Substantially high correlation between the 1st and 2nd measurements of venular maximum dilation was found ( R2 = 0.80). Conclusions: Measurements of the dilation response of retinal vessels to diffuse luminance flicker an Asian sample using the DVA show high reproducibility for repeated measures over a short period of time. Such measurements may allow non-invasive quantification of endothelial function to study its association with systemic and ocular diseases. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo evaluate the association between quantitative parameters derived from volume analysis of optical coherence tomography (OCT) data and disease worsening in Vogt-Koyanagi-Harada disease (VKHD) and sympathetic ophthalmia (SO).This retrospective study, conducted at Osaka University Hospital, employed swept-source OCT scans from patients diagnosed with VKHD or SO between October 2012 and January 2021. The choroidal vessel structure was segmented and visualized in three dimensions, generating quantitative vessel volume maps. Region-specific choroidal vessel volume (CVV), choroidal volume (CV), and vessel index (VI) were scrutinized for their potential correlation with disease severity.Thirty-five eyes of 18 VKHD and 2 SO patient (8 females, 10 males) were evaluated. OCT-derived CVV maps revealed regional CV alterations in VKHD and SO patients. Two parameters, i.e. CV at 3- and 6-month follow-ups (p = 0.044, p = 0.040, respectively, with area under the ROC curve of 0.70) and CVV at 6 months (p = 0.046, area under the ROC curve of 0.71), were significantly higher in recurrent VKHD and SO compared to effectively treated cases.The volume analysis of OCT images facilitates a three-dimensional visualization of choroidal alterations, which may serve as a reflection of disease severity in VKHD and SO patients. Furthermore, noninvasive initial CVV or CV measurements may serve as potential biomarkers for predicting disease recurrence in VKHD and SO. [ABSTRACT FROM AUTHOR]