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Background/Purpose: To evaluate the relationship between refractive error and vision-related quality of life in 16-year-old students in Taiwan. Methods: A cross-sectional study was designed for 16-year junior-high-school students in Taiwan. Myopia was defined as a spherical refractive error (SRE) < −0.50 D, hyperopia as SRE > +1.0 D, and emmetropia as SRE −0.5–+1.0 D in the better eye. Vision-related quality of life was assessed using the Taiwan Chinese version of the 25-Item National Eye Institute Visual Functioning Questionnaire. Results: Of the 688 participants, 466 (68%) had myopia and 22 (3%) had hyperopia. In logistic-regression models adjusted for gender, parents’ education, family income, and parental refractive error, myopia was an independent risk factor of poorer vision-related quality of life for both near vision (odds ratio 1.73, 95% confidence interval 1.22–2.45) and distance vision (odds ratio 3.11, 95% confidence interval 2.23–4.35). Hyperopia was not associated with near- or distance-vision difficulty. Conclusion: In this study population, myopia was associated with difficulties in near and distance vision compared to emmetropia. Further studies are needed to confirm our findings in other populations.

Purpose Treatment of glaucoma has increasingly favored better intraocular pressure (IOP) lowering efficacy and safety of topical medications. The introduction of newer ocular hypotensive drugs (OHDs) has led changes in the prescribing patterns and treatment approaches. This study aimed to investigate the prescribing patterns, trends, and corresponding expenditures of OHDs in Taiwan over an 11-year period from 1997 to 2007. Patients and methods A nationally representative sample of 1 million ambulatory visits from the National Health Research Institute data sets was used. Patients with glaucoma who aged ≥18 years were identified with ICD-9-CM and A230 codes. Six categories of OHDs were used to describe the rates, patterns, expenditures, and changes of annual prescriptions for glaucoma patients. Results The number of OHD prescriptions has tripled during the 11 years. Although the prescribing trend was being away from monotherapy with β-blockers, this class remained the most commonly used OHD up to 2007. Prostaglandin analogs were the second most frequently prescribed OHDs since 2000. Changing prescribing patterns and increased patients were the main contributors to the rise in OHD expenditures. Part of increased expenditure was likely offset by reduced needs for laser and surgical interventions. Conclusions The prescriptions of OHDs are shifting to newer categories and combination therapy. These findings provided insights into recent trends in management of glaucoma patients in Taiwan and implied a similar trend toward recent clinical reports and practices recommendations in the guidelines.

Purpose Our aim was to conduct a cost-effectiveness analysis (CEA) of monofocal and multifocal intraocular lenses (IOLs) for cataract patients in Taiwan. Methods This prospective nonrandomized study was designed to evaluate the effectiveness of monofocal and multifocal IOLs by means of visual performance, visual quality, vision-related quality of life, and spectacle-independence rates. The direct costs were calculated using the payment points of the fee schedule for medical services multiplied by the treatment items. The concept of incremental cost effectiveness ratios was used to evaluate the costs of different types of IOLs in cataract surgery and postoperative outcomes in patients. Findings A total of 61 patients from the monofocal IOL group (n = 21), multifocal IOL group 1 (n = 22), and multifocal IOL group 2 (n = 18) who completed the study were included in the analysis. No significant differences were observed in mean ages or patient to eye ratio. Significant differences in effectiveness after the implantations of monofocal and multifocal IOLs were observed for spectacle-free rate and monocular contrast sensitivity under glare conditions only. The incremental cost-effectiveness ratios of monofocal versus multifocal IOLs indicated that it cost an additional $57 to $58 (US dollars) to increase each 1% of the spectacle-independence rate. Implications This study’s results indicated that multifocal IOLs provided better effectiveness on vision-related indicators like the incremental cost effectiveness ratios of postoperative spectacle-independence rate and binocular best-corrected visual acuity measurements at near vision. Our findings suggest that multifocal IOLs can be highly cost effective for patients who prefer to be spectacle free, so it is important to ensure that patients have realistic expectations when making choices between monofocal and multifocal IOLs.

Purpose Long-acting insulin analogues were developed to facilitate consistent glycemic control without excessive hypoglycemia. However, structural modifications of the insulin molecule can alter biological responses and binding characteristics with specific receptors. The aim of this study was to estimate the risk of sight-threatening diabetic retinopathy (STDR) associated with treatment using long-acting insulin analogues compared with intermediate-acting insulin in patients with type 2 diabetes mellitus (T2DM). Methods A retrospective cohort consisting of patients with T2DM aged 20 years of age and older with newly initiated treatment with long-acting insulin analogues (glargine and detemir) and intermediate-acting human insulin was identified from the National Health Insurance database between January 2004 and December 2006 and was subdivided into different cohorts. The risk of the development of STDR was determined by Cox regression models and compared between different cohorts. Findings Of the 46,739 eligible patients, initiators of insulin glargine, insulin detemir, and neutral protamine Hagedorn (NPH) insulin were identified for comparison using propensity-score matching methods. Long-acting insulin analogues were not associated with changed risk for STDR by intention-to-treat and time-varying use approaches between either matched or unmatched cohorts. Implications The strategies that aim at preventing diabetic retinopathy by treating T2DM patients with long-acting insulin analogues remain further prospective studies with longer follow-up period to validate our observations within an appropriate dosage range and to further evaluate the safety of long-acting insulin analogues on reducing the progression of diabetic retinopathy.

To assess the relationships between refractive error and ocular and general parameters in Taiwanese junior high school students and to identify the predictive factors associated with the changes in refractive error. This was a prospective, school-based study. A total of 687 students (357 boys and 330 girls) from a municipal junior high school in Taipei were enrolled. The students’ refractive status, intraocular pressure, and ocular parameters were measured first in 2010 and again 1 year later. Data were analyzed using multiple linear regression models and generalized estimating equations (GEEs). Significant differences were found between the baseline (2010) and 1-year follow-up (2011) mean anterior chamber depths, mean axial lengths, and mean horizontal and vertical corneal refractive powers. GEE models revealed that vertical and horizontal corneal refractive powers, axial length, and anterior chamber depth were significantly associated with refractive error change. Students with a longer axial length, steeper corneal radius, and shallower anterior chamber depth had an increased risk of myopic refractive errors.

The aim of this study was to report cases that had used mini-scleral lenses to manage keratoconus and post-laser-assisted in situ keratomileusis (LASIK) ametropia and keratectasia. The first patient was a 32-year-old man who came to our clinic seeking to correct his vision. Following the LASIK procedure, his refraction gradually shifted toward hyperopia. He initially tried wearing spectacles and traditional rigid gas permeable (RGP) lenses, neither of which showed improvement. The second patient was a 28-year-old woman who complained of gradually worsening vision in her right eye after having received LASIK. She was diagnosed with corneal ectasia after a complete ophthalmic examination. She tried wearing spectacles and soft contact lenses, but neither showed any improvement. The third patient was a 29-year-old man with a long history of poor vision. He was first diagnosed with keratoconus in our clinic. He initially tried wearing a Rose K contact lens for the keratoconus in his right eye, but the lens rode low. After the initial treatment attempts, all three patients tried mini-scleral lenses, and their visual acuity improved to between 20/50 and 20/20. They were all able to wear the lenses for more than 10 hours a day without feeling any discomfort. In conclusion, mini-scleral lenses provide better comfort and vision in patients with keratoconus and post-LASIK keratectasia and ametropia.

An advanced in situ pre-contact dry cleaning process with fluorine species has been comprehensively investigated to effectively remove the native oxide on the top surface of Ni-salicide layer for ensuring lower contact resistance (Rc) without the drawbacks, including the clipping of contact top opening, the formation of by-product re-deposition and severe Ni-salicide loss, of the conventional argon ion bombardment process. In this study, two kinds of in situ dry cleaning approaches, called saturation and low etch rate (LER) modes, have been evaluated to further reduce Rc and prevent the contact to poly short issue as keeping contact size scaling down to 28nm node. The Rc reduction of ~40% at 45nm and no contact to poly short issue at 28nm contact design rules can be simultaneously demonstrated by implementing optimized in situ saturation and LER dry cleaning conditions.

A through-silicon-via (TSV) chemical mechanical polishing (CMP) process with three polishing steps, including Cu polishing, Cu barrier/isolation layers polishing and dielectric SiN stop layer polishing, has been proposed to form the [email protected] deep with [email protected] diameter size via-middle TSV structures at 28nm technology node. The integrated process optimizations of pre-TSV CMP anneal and electrochemical deposition (ECD) of Cu have been evaluated to enlarge TSV CMP process window and prevent the formations of the Cu extrusion and voids post-back-end-of-line (BEOL) processes. Less than 150A of within wafer and within lot inter-layer dielectric (ILD) mapping thickness range control and less than 100A Cu extrusion level without voids post-TSV capping layer deposition can be achieved as implementing 400^oC for 10min pre-TSV CMP annealing condition and uniform TSV ECD profile electroplated in less impurity chemical solution.

Objectives The purpose of this study was to assess visual impairment and quality of life (QOL), the relationship between visual function and health-related and vision-related QOL, and to identify factors significantly impacting QOL for glaucoma patients. Methods One-on-one interviews of 280 glaucoma patients at a regional hospital in Taiwan from 1 April 2005 to 30 September 2005. Data collected included demographics, clinical examinations and treatment status. QOL data collected utilized the Chinese (Taiwanese) version of the Medical Outcomes Study Short-Form 36 Health Survey (SF-36) and the National Eye Institute Visual Function-25 (NEIVFQ-25). Results The majority of study participants had open-angle glaucoma (54.3%) and were classified as moderate stage (33.6%). The higher the health-related QOL scores for both questionnaires, the fewer difficulties experienced by the patients. Moderate correlation was found between the SF-36 and NEIVFQ-25 subscales and visual function. Significant predicting factors for the SF-36 were gender, age, employment status, presence of systemic disease, better-eye visual acuity and better-eye mean defect. For the NEIVFQ-25, these were general vision, near and distance activities, colour vision and peripheral vision scores. Conclusions A combination of demographic data, clinical examination and QOL questionnaires may help clinicians better ascertain the impact of disease severity on glaucoma patients' QOL. This information may help in patient education, treatment compliance and selection of treatment options.

Nanoparticle zinc-titanium oxide materials were prepared by the aerogel approach. Their structure, surface state and reactivity were investigated. Zinc titanate powders formed at higher zinc loadings possessed a higher surface area and smaller particle size. X-ray photoelectron spectroscopy (XPS) revealed a stronger electronic interaction between Zn and Ti atoms in the mixed oxide structure and showed the formation of oxygen vacancy due to zinc doping into titania or zinc titanate matrices. The 8–45 nm aerogel particles were evaluated as catalysts for methanol oxidation in an ambient flow reactor. Carbon dioxide was favorably produced on the oxides with anion defects. Titanium based oxides exhibited a high selectivity to dimethyl ether, so that a strong Lewis acidic character suggested for the catalysts was associated primarily with the Ti4+ center. Both methanol conversion and dimethyl ether formation rates increased with increasing the zinc content added to the oxide support. Results demonstrate that cubic zinc titanate phases produce new Lewis acid sites having also a higher reactivity and that the nature of the catalytic surface transforms from Lewis acidic to basic characters due to the presence of reactive oxygen vacancies.

In this study, nanotube arrays of nickel-phosphate have been developed by electroless deposition into sub-micro to nanometer sized pores of the porous alumina templates by hypophosphite electrolytic solution composed of NiSO4 ,N aH 2PO2 ,N aC 2H3O2 and Na3C6H5O7 at 80–100 ◦ C and pH = 3–6. The dimension of the formed nanotubes has 1 µm in length, 200–300 nm in diameter and 80–150 nm in thickness of tube walls. Transmission electron microscopy examination of the nanotubes clearly show amorphous hallow structure with a average grain size of ∼ 5 nm. The hysteresis loops of the nanotube arrays show a coercive field of about 200 Oe under treatment in 95%N 2/5%H2 atmosphere at 500 ◦ C as the magnetic field was applied along parallel and perpendicular to tube axis. The nanotube arrays also exhibit an anisotropic magnetic property with easier saturation along the perpendicular direction. However, both coercive field and saturation of remanent magnetization of the nanotube arrays become lower while continually increasing heat treatment temperature up to 900 ◦ C.

PURPOSE We evaluated the performance of the RK4 (reverse-geometry) contact lens in patients with flat central and steep peripheral corneal topography after penetrating keratoplasty (PK). METHODS A retrospective study was performed of post-PK patients fitted with RK4 lenses on the Cornea Service at Wills Eye Hospital, between March 2000 and February 2002. RESULTS Fifteen eyes of 13 post-PK patients were fitted with RK4 lenses and monitored for more than two months (range, 2.1-23.5 months; mean, 8.1 +/- 7.0 months). The average number of lens refits per eye was 1.0 +/- 1.2 (range, 0-4). Ninety-three percent (14/15) of the eyes that were fitted achieved at least 20/30 visual acuity, and 53% (8/15) of eyes achieved 20/20 visual acuity. A comparison of prefitted and post-fitted corrected visual acuity demonstrated a statistically significant improvement (P < 0.01). RK4 lenses were successfully worn full time or part time in all cases. CONCLUSIONS The RK4 lens can provide well-tolerated visual correction in cases with central flat, peripheral steep corneal contour following PK.

This study successfully demonstrates 50-80% NiSi defect reduction and P-FET 3% leakage improvement using Pt(10at.%) additive for 28nm node silicide process. Additionally, this study also discovers that lower thermal budget is required for getting same thick NiSi and better NiSi Rs distribution with higher concentration of Pt additive.

IMPORTANCE The prevalence of diabetic retinopathy (DR) is high in individuals with diabetes mellitus. Published estimates for sight-threatening DR (STDR) prevalence range widely. There is a need for precise contemporary estimates of the prevalence and incidence of STDR for providing optimal strategies of clinical management in Taiwan. OBJECTIVE To determine the precise contemporary estimates of the prevalence and incidence of STDR in patients with type 2 diabetes mellitus in Taiwan. DESIGN, SETTING, AND PARTICIPANTS Data were collected from a representative database, the Longitudinal Health Insurance Database 2005, from 2005 to 2011, on a total of 2926 incident cases of patients with STDR among 63,582 patients with type 2 diabetes. Sight-threatening DR was defined as clinically significant macular edema, severe nonproliferative DR, or proliferative DR according to the classification of the Early Treatment Diabetic Retinopathy Study research group. Sex-specific and age-adjusted incidence and prevalence rates of STDR were analyzed for patients with type 2 diabetes and STDR identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes and procedure codes. MAIN OUTCOMES AND MEASURES Procedure codes were used to determine the diagnosis of STDR. RESULTS The number of incident cases of STDR increased in line with the increasing diabetic population during 2005-2011. Sex differences in the age-adjusted incidence rates were observed, showing a declining trend from 10.84 (95% CI, 10.69%-10.99%) to 6.00 (95% CI, 5.86%-6.14%) per 1000 person-years for women (P < .001) contrasting with an increasing trend in men, from 14.86 (95% CI, 14.71%-15.01%) to 21.89 (95% CI, 21.76%-22.02%) per 1000 person-years (P < .001). The age-adjusted prevalence rates of STDR were in decreasing trends for both sexes, with a mean of 2.75% for women and 2.87% for men. Apart from apparent sex differences in prevalence rates of STDR, increasing trends were observed among younger patients (aged

A case of an "exploding" cataract (an iatrogenic posterior capsular rupture) following Nd:YAG laser iridectomy is described. Rapid cataract development was observed in the right eye of a 76-year-old woman following an iridectomy. B-scan ultrasonography documented cortical debris in the vitreous cavity. The patient underwent an extracapsular cataract extraction and intraocular lens implantation. During the cataract extraction, a posterior capsular tear extending from the 10-o'clock to the 4-o'clock position was noted, through which fluffy cortical material was floating in the vitreous.

Purpose To present a case in which an RK4 lens was fitted for a patient who developed flap striae resulting from laser-assisted in situ keratomileusis (LASIK). Methods Case report. Results A 44-year-old man underwent uncomplicated LASIK procedure for bilateral myopia and astigmatism. Visually significant flap striae (OS>OD) were noted postoperatively. The flaps were relifted, refloated, and stretched twice in each eye. In addition, OD enhancement laser treatment was performed. Nevertheless, decreased best-corrected visual acuity (OS>OD) persisted. One month after LASIK, the patient was referred to our office for a second opinion and further evaluation. To avoid additional manipulation of the flaps, we used an RK4 lens fitting to achieve a final corrected visual acuity of 20/20 OU. Conclusions Persistent, visually significant flap striae following flap, refloating, stretching, and smoothing techniques can make LASIK patients unhappy. An RK4 lens fitting is an alternative method for correcting postoperative irregular astigmatism and to achieve the best-corrected visual acuity.

Background The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients’ decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. Methods This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one’s own expense, overall patient satisfaction and postoperative visual clarity. Results The results showed that the patient’s gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. Conclusions Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients.