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Purpose To report the prevalence of preschool myopia after implementing a policy intervention promoting outdoor activities and the secular trend of myopia before and during the coronavirus disease 2019 (COVID-19) pandemic in a Taiwan preschool population. Design Repeated countywide population-based, cross-sectional surveys based on the Yilan Myopia Prevention and Vision Improvement Program (YMVIP). Participants Among 23 930 kindergarteners 5 to 6 years of age from 7 school-year cohorts in Yilan County from 2014 through 2020, a total of 21 761 children (90.9%) were included for analysis. Methods Since launching the YMVIP in August 2014, myopia prevention strategies, such as increasing outdoor activities (2 hours/weekday), have been promoted in all kindergartens, and countywide school-based eye examinations, including cycloplegic autorefraction, and caregiver-administered questionnaires have been carried out annually for all participants. Main Outcome Measures The prevalence of myopia (spherical equivalent, ≤ –0.5 D in either eye) in each of the 7 school-year cohorts of preschoolers 5 to 6 years of age. Results The prevalence of myopia continuously decreased for 2 years after implementing the YMVIP: 2014 cohort, 15.5% (95% confidence interval [CI], 14.2%–16.8%); 2015 cohort, 13.5% (95% CI, 12.3%–14.7%); and 2016 cohort, 8.4% (95% CI, 7.4%–9.4%). Subsequent cohorts were exposed maximally to these school-based myopia prevention strategies, and the prevalence of myopia remained relatively stable, between 8.5% and 10.3%, even during the COVID-19 pandemic. Multivariate logistic regression analysis showed a dose-dependent association between the duration of exposure to preventive strategies and the prevalence of myopia (up to 1-year YMVIP exposure, odds ratio, 0.86 [95% CI, 0.74–0.99]; up to 2-year YMVIP exposure, odds ratio, 0.56 [95% CI, 0.50–0.63]) after controlling other myopigenic factors. Conclusions This population-based evidence showed high prevalence of preschool myopia and an L-shaped decline after introducing strategies to promote outdoor activities in kindergartens. With undisrupted school-based preventive strategies, the prevalence of myopia can be kept stable, even during the COVID-19 pandemic.

To report the prevalence of preschool myopia after implementing a policy intervention promoting outdoor activities and the secular trend of myopia before and during the coronavirus disease 2019 (COVID-19) pandemic in a Taiwan preschool population.Repeated countywide population-based, cross-sectional surveys based on the Yilan Myopia Prevention and Vision Improvement Program (YMVIP).Among 23 930 kindergarteners 5 to 6 years of age from 7 school-year cohorts in Yilan County from 2014 through 2020, a total of 21 761 children (90.9%) were included for analysis.Since launching the YMVIP in August 2014, myopia prevention strategies, such as increasing outdoor activities (2 hours/weekday), have been promoted in all kindergartens, and countywide school-based eye examinations, including cycloplegic autorefraction, and caregiver-administered questionnaires have been carried out annually for all participants.The prevalence of myopia (spherical equivalent, ≤ -0.5 D in either eye) in each of the 7 school-year cohorts of preschoolers 5 to 6 years of age.The prevalence of myopia continuously decreased for 2 years after implementing the YMVIP: 2014 cohort, 15.5% (95% confidence interval [CI], 14.2%-16.8%); 2015 cohort, 13.5% (95% CI, 12.3%-14.7%); and 2016 cohort, 8.4% (95% CI, 7.4%-9.4%). Subsequent cohorts were exposed maximally to these school-based myopia prevention strategies, and the prevalence of myopia remained relatively stable, between 8.5% and 10.3%, even during the COVID-19 pandemic. Multivariate logistic regression analysis showed a dose-dependent association between the duration of exposure to preventive strategies and the prevalence of myopia (up to 1-year YMVIP exposure, odds ratio, 0.86 [95% CI, 0.74-0.99]; up to 2-year YMVIP exposure, odds ratio, 0.56 [95% CI, 0.50-0.63]) after controlling other myopigenic factors.This population-based evidence showed high prevalence of preschool myopia and an L-shaped decline after introducing strategies to promote outdoor activities in kindergartens. With undisrupted school-based preventive strategies, the prevalence of myopia can be kept stable, even during the COVID-19 pandemic.

PurposeTo report the surgical outcome and postoperative hypopigmented change around fovea among patients with high myopia who received human amniotic membrane (hAM) graft transplantation for macular hole (MH).MethodThis retrospective, interventional case series included 10 eyes of 10 consecutive patients (5 (50%) male) with high myopia (axial length over 26.5 mm) who received hAM graft to treat persisted or chronic MH with or without retinal detachment in two hospitals. Postoperative parafoveal atrophy was identified with colour fundus picture and structure optical coherent tomography. Baseline characteristics and short-term visual outcome were analysed.ResultsThe preoperative mean (±SD) axial length and MH diameter were 29.9 (±1.8) mm and 881.8 (±438.5) μm, respectively. After hAM transplantation, seven (70%) eyes had complete MH closure and the mean best-corrected visual acuity (BCVA) improved from 1.26 (±0.48) logarithm of minimal angle of resolution (logMAR) before operation to 1.11 (±0.44) logMAR on the last visit (p=0.074). Patchy atrophy-like depigmentation developed around the MH lesion in four (40.0%) eyes as early as in the first month after surgery. None of them had visual worsening. In terms of demographics, axial length, MH size, ocular history, preoperative BCVA and postoperative BCVA, there was no significant difference between those with and without the parafoveal atrophy. No graft rejection and inflammation happened during the follow-up.ConclusionParafovea atrophy, a rare complication in the conventional MH surgery, was observed in 40% of eyes with highly myopic MH after hAM graft transplantation. The pathogenesis and long-term consequence need further investigations.

AimTo investigate the protective behaviours of longer near work distance, discontinuing near work and more time outdoors in recess from parent self-report in the myopia prevalence and progression among myopic children aged 9–11 years.MethodsMyopia Investigation study in Taipei is a longitudinal population-based study that enrolled elementary school students in Taipei. We provided vision and refraction examination every 6 months. Spherical equivalent (SE) of cycloplegic refraction ≤−0.50 Diopter (D) is defined as myopia. Total 10 743 (70.4%) students completed 2-year refraction data and questionnaire. The myopia prevalence and progression (difference of SE) in baseline, 6, 12, 18 and 24 months were compared by generalised estimating equations.ResultsChildren with persistent protective behaviour had significant lower prevalence of myopia. The protective impact was statistically significant from 6 to 24 months. In 2 years follow-up, risk ratio after adjusting the background variables and the other two behaviours in near work distance, near work time and outdoor time were 0.71, 0.89 and 0.77. In SE analysis, after adjusting the other two behaviours, near work distance >30 cm (−0.7 vs −1.04 D; p<0.001), discontinuing near work every 30 min (−0.77 vs −0.96 D, p=0.005) and more time outdoors in recess from parent self-report (−0.75 vs −0.98 D; p=0.012) revealed protective impacts on diminishing myopia progression from 6 to 24 months.ConclusionIn myopic children aged around 10 years in Taipei, longer distance in near work, discontinuing near work every 30 min and more outdoor time from parent self-report are protective behaviours in myopia prevalence and progression in 6–24 months.

Background: High myopia is associated with multiple ocular morbidities that may lead to irreversible blindness. Because high myopia in an adult is thought to be related to onset of myopia in very early childhood, detecting myopia early and working to improve modifiable risk factors may help reduce the development of high myopia. In this study, we tried to evaluate the prevalence of myopia and associated risk factors in second-grade primary school children in Taipei, Taiwan. Methods: A questionnaire was distributed to the participants’ parents, and their written informed consent was obtained before performing eye examinations that included visual acuity testing and cycloplegic autorefraction. Multiple logistic regression models were applied to assess possible risk factors associated with myopia. Myopia was defined as spherical equivalent of −0.50 D or less in either eye. Results: The prevalence of myopia in the second graders was 36.4%. After adjustment for other characteristics, the following variables were significantly associated with a higher risk of myopia: male sex [odds ratio (OR)=1.24, p

Background To describe the study design, rationale and methodology of the Myopia Investigation Study in Taipei (MIT). Design The MIT was a citywide, population-based cohort study. Participants Participants were grade 2 students (Fall 2013) of all 153 elementary schools in Taipei City. Methods The baseline data on the risk factors for myopia development was collected by parent-administered questionnaire surveys covering demographics, medical history, parental myopia, time spent on near work and outdoor activities, reading habits and eye care-seeking behaviour. Ocular examinations focused on the measurement of visual acuity (unaided and best-corrected) and refractive status (before and after cycloplegia), which will be carried out for the eligible schoolchildren biannually for 3 years consecutively. Once myopic children are identified, case manager-led telecoaching for health-care instructions and reminders will be delivered to parents or caregivers. Main Outcome Measures To build a comprehensive database for prevalence, incidence and risk factors of early childhood myopia over a 3-year follow-up period. Results Of all 19 374 eight-year-old schoolchildren (10 210 [52.7%] boys) eligible for the MIT, 16 486 (85.1%) responded to the questionnaire, 12 019 (62.0%) were examined during the third quarter of 2013 and 11 590 (59.8%) (6267 [52.9%] boys) completed cycloplegic autorefraction on both eyes and were enrolled for further data analysis. There was no significant difference in terms of demographics between the analysed participants and all grade 2 students in Taipei City. Conclusions Data from the MIT will provide population-based information concerning the prevalence, incidence and risk factors for myopia development among young schoolchildren in a metropolitan area of Taiwan.

PurposeTo investigate the relationship between seasonal variation of daylight length and spherical equivalent (SE) progression among the schoolchildren participating in the Myopia Investigation Study in Taipei.MethodsWe used the first-year data from grade 2 schoolchildren who completed all the baseline and two follow-up examinations (n=6790). There were two 6-month intervals between visits over winter and summer, respectively. For each interval, we calculated average daily daylight length using data from Taiwan’s Central Weather Bureau and measured 6-month SE progression rate based on right eye cycloplegic autorefraction data. The midpoint month was defined as the month midway between two consecutive visits.ResultsBy the midpoint month, average daily daylight length was the shortest in December (671±7 min/day) and the longest (785±7 min/day) in June, and SE progression rate was the fastest (−0.23±0.48 D) in December and the slowest (−0.17±0.51 D) in June. Significant variation of SE progression rate with season can be observed only among the schoolchildren (n=1905) whose midpoint months for the winter and summer intervals were December and June (winter rate, −0.25±0.47 D; summer rate, −0.17±0.49 D; pConclusionOur data demonstrate a seasonal variation of minus shift in refractive error among Taipei schoolchildren who had significant daytime fluctuation during the 1-year follow-up. Of those, non-myopic children had significant and more pronounced variation of SE progression than myopic children.

Background Lifestyle behaviour may play a role in refractive error among children, but the association between near work habits and refractive anisometropia remains unclear. Methods We estimated the prevalence of refractive anisometropia and examined its association with near work activities among 23,114 children in the Myopia Investigation Study in Taipei who were grade 2 elementary school students at baseline in 2013 and 2014. Baseline data on demographics, medical history, parental history and near work habits were collected by parent-administered questionnaire survey. Refractive status was determined by cycloplegic autorefraction. Refractive anisometropia was defined as the spherical equivalent difference ≥ 1.0 diopter between eyes. Results The prevalence of refractive anisometropia was 5.3% (95% confidence interval [CI], 5.0% to 5.6%). The prevalence and severity of refractive anisometropia increased with both myopic and hyperopic refractive error. Multivariate logistic regression analysis revealed that refractive anisometropia was significantly associated with myopia (odds ratio [OR], 2.98; 95% CI, 2.53-3.51), hyperopia (OR, 2.37; 95% CI, 1.98-2.83), degree of astigmatism (OR, 1.005; 95% CI, 1.005-1.006), amblyopia (OR, 2.54; 95% CI, 2.06-3.12), male gender (OR, 0.88; 95% CI, 0.78-0.99) and senior high school level of maternal education (OR, 0.69; 95% CI, 0.52-0.92). Though anisometropic children were more likely to spend more time on near work (crude OR, 1.15; 95% CI, 1.02-1.29) and to have less eye-to-object distance in doing near work (crude OR, 1.15; 95% CI, 1.01-1.30), these associations became insignificant after additional adjustment for ocular, demographic and parental factors. Conclusions The present study provides large-scale, population-based evidence showing no independent association between refractive anisometropia and near work habits, though myopia is associated with refractive anisometropia.

Purpose: To investigate the incidence and risk factors for central serous chorioretinopathy (CSCR) in adults who use oral corticosteroids in Taiwan. Methods: This is a population-based nested case–control study between 2000 and 2008. From the Taiwan National Health Insurance Research Database, adults who were repetitively prescribed oral corticosteroids were included as the study cohort. Of those, newly diagnosed CSCR cases were identified and the CSCR incidence was calculated. Subjects matched for age, gender, and the enrollment time were randomly selected as the controls. Corticosteroids use was compared between the cases and controls. Poisson and conditional logistic regressions were used to analyze the potential risk factors for CSCR. Results: Among 142,035 oral corticosteroids users, 320 cases of CSCR were identified, and 1,554 matched controls were randomly selected. The incidence rate of CSCR was 44.4 (95% confidence interval, 39.5–49.3) cases per 100,000 person-years. Multivariate Poisson regression showed that male patients and those aged 35 years to 44 years had significantly higher incidence rates of CSCR. There were no differences in either median dosage or mean duration of systemic corticosteroid treatment between the cases and controls. After adjusting for other confounders, current use of oral corticosteroids was found to be significantly associated with the risk of CSCR (odds ratio, 2.40; 95% confidence interval, 1.49–3.89). Conclusion: Male gender, middle age, and current use of oral corticosteroids were found to be the risk factors for CSCR. However, oral corticosteroids dosage and treatment duration were not associated with the CSCR risk.

OBJECTIVE. Medical radiation–induced cataracts, especially those resulting from head and neck CT studies, are an issue of concern. The current study aimed to determine the risk of cataract associated with repeated radiation exposure from head and neck CT. MATERIALS AND METHODS. This study used information from a random sample of 2 million persons enrolled in the nationally representative Taiwan National Health Insurance Research Database. Exposed cases consisted of patients with head and neck tumor 10– 50 years old who underwent at least one CT between 2000 and 2009. The nonexposed control group was composed of subjects who were never exposed to CT studies but who were matched by time of enrollment, age, sex, history of coronary artery disease, hypertension, and diabetes. RESULTS. There were 2776 patients in the exposed group and 27,761 matched subjects in the nonexposed group. The exposed group had higher overall incidence of cataracts (0.97% vs 0.72%; adjusted hazard ratio [HR], 1.76; 95% CI, 1.18–2.63). Further stratifying the number of CT studies in the exposed group into one or two, three or four, and five or more revealed that cataract incidence increased gradually with increasing frequency of CT studies (0.79%, 0.93%, and 1.45%, respectively) (p = 0.001, adjusted for trend). Radiation exposure due to repeated head and neck CT studies was independently associated with an increased risk of developing cataracts when the cumulative CT exposure frequency involved more than four studies (adjusted HR, 2.12; 95% CI, 1.09–4.14). CONCLUSION. Repeated exposure to head and neck CT is significantly associated with increased risk of cataract.

To evaluate the 1-year progression of myopia and associated risk factors in second-grade primary school children.The myopia investigation study in Taipei provided semiannual visual acuity testing and cycloplegic refraction for all second-grade primary school children (mean age: 7.49 years) in Taipei who provided parental consent. A questionnaire was distributed to the participants' parents before the first and third examinations. We evaluated 1-year follow-up data for children noted to have myopia on the first examination. Multinomial logistic regression models were applied to assess risk factors associated with myopia progression. Myopia progression was categorised, based on the change in spherical equivalent (ΔSE) over 1 year, as slow (ΔSE-0.5 dioptres (D)), moderate (-1.0 DΔSE≤-0.5 D) or fast (ΔSE≤-1.0 D). Of the 4214 myopic children, data were analysed for 3256 (77.3%) who completed the 1-year follow-up evaluation.The baseline SE was -1.43±1.1 D. The average ΔSE was -0.42±0.85 D, with 46.96%, 28.50% and 24.54% of the study subjects showing slow, moderate and fast myopia progression, respectively. When compared with slow myopia progression, fast myopia progression was associated with a greater myopic SE at baseline (OR: 0.67, 95% CI: 0.61 to 0.72) and a shorter eye-object distance when doing near work (OR: 1.45, 95% CI: 1.18 to 1.78). More outdoor activity time and self-reported cycloplegic treatment were not associated with slow myopia progression.Children with fast annual myopia progression were more myopic at baseline and had a shorter reading distance. Our study results highlight the importance of having children keep a proper reading distance.

Background Central serous chorioretinopathy (CSCR) is a common maculopathy that features choroidal circulatory disturbance. This population-based cohort study aimed to explore the relationship between CSCR and the future development of ischaemic stroke. Methods Data were obtained from Taiwan's national health insurance research database. From 2000 to 2007, 1814 patients with newly diagnosed CSCR were eligible for inclusion in the study cohort. Using stratified random sampling, 9648 enrollees matched with the study subjects in terms of sex, age, monthly income, geographical location and time of enrolment were selected as the control group. Stroke-free survival analysis was assessed using a Kaplan–Meier method. Cox proportional hazard regressions were performed to calculate the HR of ischaemic stroke for the two groups after adjusting for possible confounding variables. Results Of the sampled patients, 45 (2.5%) from the CSCR cohort and 157 (1.6%) from the control group developed ischaemic stroke during a mean follow-up period of 3.9±2.2 years. CSCR patients had a significantly higher incidence of ischaemic stroke than those without a diagnosis of CSCR (p=0.003). After adjusting for age, sex and chronic comorbidities at baseline, CSCR patients were found to have a 1.56-fold (95% CI 1.11 to 2.18, p=0.010) greater risk of a subsequent ischaemic stroke than the matched controls. Conclusions CSCR is an independent indicator for the increased risk of subsequent ischaemic stroke development.

To measure the peripapillary retinal nerve fiber layer (RNFL) thickness in normal schoolchildren with spectral domain optical coherence tomography (SD-OCT), and to evaluate the effects of age, spherical equivalent (SE) refraction, OCT signal strength, and cycloplegic treatment on RNFL thickness. Comprehensive ophthalmic examinations were performed at a school visit. RNFL thicknesses were measured with RTVue-100 OCT. Refractive errors were measured by cycloplegic autorefraction. Four hundred seventy healthy schoolchildren aged 7 and 12 were enrolled. The average RNFL thickness (mean ± SD) was 109.4 ± 10.0 μm. The quadrant RNFL thicknesses were 90.4 ± 14.3 μm (temporal), 142.2 ± 19.5 μm (inferior), 71.1 ± 11.3 μm (nasal), and 133.9 ± 18.1 μm (superior). After controlling for age, gender, cycloplegic treatment, and signal strength index, multiple linear regression analysis disclosed that only SE refraction has a significant effect on RNFL thickness, (p

BACKGROUND:Growing evidence shows that sense of coherence (SOC) is related to health promotion. Knowledge of SOC among older adults in Taiwan is limited. The present study aimed to investigate SOC status and its relationship to personal and environmental factors among older adult residents of long-term care facilities (LTCFs) in northeastern Taiwan. METHODS:This cross-sectional study was performed in Yilan, Taiwan. With face-to-face interviews, we obtained data from 104 LTCF residents (aged 65 years and older) using the Chinese version of Antonovsky's short 13-item SOC scale. We also collected the information on personal characteristics, physical and social environmental resources. Multiple linear regression was used to analyze factors potentially influencing SOC. RESULTS:Of the participants, the mean score (±standard deviation) of SOC was 58.3 (±8.8), while scores on SOC subscales (comprehensibility, manageability, and meaningfulness) were 23.4 ±4.5, 17.9 ±3.8, and 17.0 ±3.2, respectively. Education level, activities of daily living and number of LTCF staff were found to be independently associated with SOC status after adjusting for demographic characteristics, health status, and environmental resources. In addition, interactions between personal and environmental factors had a crucial influence on SOC status. CONCLUSIONS:Participants in this study had relatively low SOC scores compared to their counterparts in Western countries. In addition to personal factors, environmental factors can play a significant role in SOC status among older adult LTCF residents. Comprehensive evaluation of SOC status should consider person-environment interaction effects.

To investigate the relationship between age-related macular degeneration (AMD) and future development of Alzheimer's disease (AD) or senile dementia.A longitudinal case-control study using the Taiwan National Health Insurance Research Database.From 2001 to 2009, the newly diagnosed AMD cases aged ≥65 years in the database were recruited as the AMD cohort (n=4993). Of those, there were 540 with and 4453 without exudative AMD diagnoses. Subjects without any AMD, matched for age, gender, and time of enrollment, were randomly sampled as the control cohort (n=24,965) for comparison.Alzheimer's disease/senile dementia-free survival analysis was assessed using a Kaplan-Meier method. Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of AD or senile dementia for the 2 cohorts after adjusting for preexisting comorbidities and number of clinical visits.The first-ever diagnosis of AD or senile dementia during the observation period.Of the 29 958 sampled subjects, 1589 (5.3%) were diagnosed with AD or senile dementia during a mean follow-up period of 4.4 years, including 294 (5.9%) from the AMD cohort and 1295 (5.2%) from the control cohort. The incidence of AD or senile dementia was higher in patients with AMD than in the controls (P=0.044), with an HR of 1.44 (95% confidence interval [CI], 1.26-1.64) after adjusting for covariates. The stratified analysis showed that the adjusted HR for AD or senile dementia was 1.35 (95% CI, 0.89-2.06) for exudative AMD versus the controls and 1.44 (95% CI, 1.26-1.65) for nonexudative AMD versus the controls.This study provides large-scale, population-based evidence that AMD, especially nonexudative AMD, is independently associated with an increased risk of subsequent AD or senile dementia development.

To describe the study design, rationale and methodology of the Myopia Investigation Study in Taipei (MIT).The MIT was a city-wide, population-based cohort study.Participants were grade 2 students (Fall 2013) of all 153 elementary schools in Taipei City.The baseline data on the risk factors for myopia development was collected by parent-administered questionnaire surveys covering demographics, medical history, parental myopia, time spent on near work and outdoor activities, reading habits and eye care-seeking behaviour. Ocular examinations focused on the measurement of visual acuity (unaided and best-corrected) and refractive status (before and after cycloplegia), which will be carried out for the eligible schoolchildren biannually for 3 years consecutively. Once myopic children are identified, case manager-led telecoaching for health-care instructions and reminders will be delivered to parents or caregivers.To build a comprehensive database for prevalence, incidence and risk factors of early childhood myopia over a 3-year follow-up period.Of all 19 374 eight-year-old schoolchildren (10 210 [52.7%] boys) eligible for the MIT, 16 486 (85.1%) responded to the questionnaire, 12 019 (62.0%) were examined during the third quarter of 2013 and 11 590 (59.8%) (6267 [52.9%] boys) completed cycloplegic autorefraction on both eyes and were enrolled for further data analysis. There was no significant difference in terms of demographics between the analysed participants and all grade 2 students in Taipei City.Data from the MIT will provide population-based information concerning the prevalence, incidence and risk factors for myopia development among young schoolchildren in a metropolitan area of Taiwan.

Background: To evaluate the safety and efficacy of verteporfin photodynamic therapy (PDT) in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods: We retrospectively reviewed the chart records and fluorescein angiography of patients with subfoveal CNV who were treated with verteporfin PDT between September 2001 and March 2003 and who completed at least 1 year of follow-up. The primary efficacy outcomes were the proportions of patients whose Snellen visual acuities had more than 1 line increase, no change or more than 1 line decrease 1 year after study entry compared with their baseline examinations. The secondary efficacy outcome was the changes in the logarithm of the minimum angle of resolution visual acuities at 1-year follow-up. Complications were monitored and tabulated. Results: Forty-eight eyes of 48 patients with subfoveal CNV secondary to AMD were enrolled in this study. The mean follow-up was 12.56 ± 1.37 months. At their last visit, 10.4% of eyes had more than 1 line improvement in Snellen visual acuity, 72.9% of eyes had no change, and 16.7% experienced more than 1 line of visual acuity loss (7 eyes lost < 3 lines of Snellen visual acuity, 1 eye lost between 3 and 6 lines). None experienced more than 6 lines of visual loss. There was no statistically significant difference between baseline and final visual acuity for eyes with predominantly classic CNV, minimally classic CNV and occult without classic CNV (Wilcoxon Signed Rank test, p = 0.59 ). There was a positive correlation between baseline visual acuity and final visual outcome (Kruskal-Wallis test, p = 0.002). No severe systemic and ocular adverse events were encountered. Conclusion: Of our patients with subfoveal CNV secondary to AMD, 83.3% could maintain or improve their visual acuity 1 year after verteporfin PDT. The risk of deterioration in visual acuity due to subfoveal CNV could be reduced by verteporfin PDT. Baseline visual acuity is significantly correlated with the final proportion of visual outcome. [J Chin Med Assoc 2005;68(9):419–424]

Purpose: To evaluate the long-term natural course and to identify the risk factors of a poor visual outcome in patients with retinal arterial macroaneurysms (MA). Methods: In this observational case series, we retrospectively evaluated the consecutive patients with MA at our institution over a 17-year period. The visual outcomes of the different types of MA (presented as predominantly hemorrhagic or exudative) were compared. Results: A total of 31 patients with 46 confirmed MA were identified. The ocular manifestations of MA included retinal hemorrhage (96.7%), retinal exudate (61.3%), macular involvement (77.4%) and vitreous hemorrhage (12.9%). Among the 10 cases of hemorrhagic-type MA, visual acuity improved by 2 or more lines in 9 (90%) and decreased in 1 patient (10%). In the 15 cases of exudative-type MA, 4 improved (26.7%), 8 remained stationary (53.3%) and 3 had decreased visual acuity (20.0%). The average vision change in the minimum angle of resolution improved by 0.59 log units in hemorrhagic MA and decreased by 0.07 log units in exudative MA (p < 0.01). With respect to change of vision, the eyes with hemorrhagic-type MA showed greater improvement than those with the exudative type, but the final visual outcome was not different in the 2 groups. Foveal exudate was a statistically significant risk factor for final vision equal to or worse than 6/30 (odds ratio = 6.93, p < 0.05). Conclusions: Different types of MA may have different clinical presentations. In the majority of MA, there is gradual and spontaneous involution. However, poor visual outcome may occur secondary to foveal exudates and subfoveal hemorrhage.

To determine the role of nitric oxide (NO) in the clinical manifestations of cataract in different age and etiological groups.Multicenter study, Taipei, Taiwan, Republic of China.Aqueous humor samples were obtained from 114 cataract patients in different etiological and age groups (eg, juvenile, traumatic, and age-related cataract). Using chemiluminescence assay, NO was detected through the light generated by ozone and NO interaction. The amount of NO production was calculated and compared among groups. The results were correlated with patient age.The NO levels in aqueous humor were highest in the 12 patients with traumatic cataract and lowest in the 15 patients with juvenile cataract (47.59 micromol/L +/- 12.81 [SD] and 7.66 +/- 2.62 micromol/L, respectively; P.001). Aqueous humor NO levels were correlated with age and were highest in patients older than 80 years (mean 38.78 +/- 6.29 micromol/L) and in those with mature cataract (mean 40.15 +/- 6.15 micromol/L) (P.05).The NO levels in the aqueous humor increased with age and traumatic events. The results suggest that NO could be a risk factor in cataract formation.

Though several studies have shown that the biochemical function of nitric oxide (NO) in the eye might play an important role in the regulation of intraocular pressure (IOP), local control of ocular blood flow and loss of retinal ganglion cells by apoptosis, it is unclear whether the role of NO is similar in the pathogenesis of different kinds of glaucoma: primary open-angle glaucoma (POAG), chronic closed-angle glaucoma (CCAG) and neovascular glaucoma (NVG). To further explore this issue, we measured the concentrations of NO in aqueous humor and plasma samples from patients with POAG (n = 31), CCAG (n = 76), NVG (n = 8) and cataract (n = 30). All of the NVG patients suffered from severe proliferative diabetic retinopathy, while other patients were free of any other systemic disease. The NO levels in both aqueous humor and plasma samples were assessed by chemiluminescence assay. We found that the NO levels in aqueous humor samples were greatly varied in patients with POAG (36.2 ± 3.3 µM), CCAG (47.7 ± 3.4 µM) and NVG (65.8 ± 5.4 µM), and all of them were significantly higher than in cataract patients (27.0 ± 2.9 µM; p < 0.05). Except NVG patients whose NO levels in plasma samples were highest (24.1 ± 3.5 µM) among all groups, the plasma NO levels were not significantly different between the other glaucoma patients and the cataract patients. We therefore concluded that significant variation of the elevated NO levels in aqueous humor samples from the patients with different types of glaucoma may reflect their differences in the pathogenesis.

Objectives The epidemiology of idiopathic central serous chorioretinopathy (CSCR) is not well understood in an Asian population. The present study aimed to investigate the incidence and risk factors for corticosteroid-unrelated CSCR using Taiwan’s National Health Insurance Research Database. Methods and Results From 2001 to 2006, a total of 786 patients (500 [63.6%] males) who were newly diagnosed with CSCR, aged from 20 to 64 years and had no history of corticosteroid prescription were identified as incident cases of idiopathic CSCR. 3606 age-, gender-, and enrollment time-matched subjects were randomly selected as the control group. The mean annual incidence was 0.21‰ (0.27‰ for males, and 0.15‰ for females; P

Purpose To investigate the annual incidence of myopia and associated factors among young schoolchildren in Taipei City. Methods The Myopia Investigation Study in Taipei was a citywide, population-based cohort study. During the fall 2013 semester (baseline), a total of 11,590 grade 2 schoolchildren completed ocular examination and were included for further analysis. A parent-completed questionnaire was administered to collect data on risk factors for myopia development. Follow-up visits were arranged biannually over 3 years. The first-year results are reported here. Schoolchildren who were emmetropic/hyperopic at baseline and had myopia (spherical equivalent ≤ -0.5 diopters) in either eye at follow-up were identified as having incident myopia. Results Among 7376 baseline nonmyopic participants, 6794 (92.1%) were examined during the first-year follow-up, and 1856 (25.2%) with incident myopia were identified. The incidence density of myopia was 31.7 (95% confidence interval [CI]: 30.6-32.8) per 100 person-years. Cox hazard proportional regression analysis revealed that participants who were emmetropic at baseline (hazards ratio [HR]: 19.37; 95% CI: 4.84-77.57), who had two myopic parents (HR: 1.21; 95% CI: 1.04-1.42), and who spent ≥5 hours every week on after-school tutoring programs (HR: 1.12; 95% CI: 1.02-1.22) had greater risk for incident myopia. By contrast, protective factors included suburban area of residence (HR: 0.91; 95% CI: 0.83-1.00) and spending ≥30 minutes outdoors after school every weekday (HR: 0.90; 95% CI: 0.82-0.99). Conclusions This study provides population-based data on the annual incidence of myopia among Taiwanese schoolchildren, and found that baseline refractive status, parental myopia, area of residence, time outdoors after school on weekdays, and time spent on after-school tutoring programs are associated with risk of new-onset myopia.

Purpose: Central serous chorioretinopathy (CSCR) mostly affects middle-aged men and has been associated with stress and hypercortisolism. We hypothesized that some factors prone to inducing CSCR could also have a harmful effect on erectile function. This study aimed to investigate the risk of subsequent erectile dysfunction after CSCR using Taiwan National Health Insurance Research Database. Methods: The study cohort (n = 1220) consisted of newly diagnosed CSCR men aged 19–64 years between 1999 and 2007, and men matched for age, monthly income and time of enrolment were randomly selected as the control group (n = 10870). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of clinically diagnosed erectile dysfunction (including organic origin and/or psychogenic origin) for the two groups. Erectile dysfunction-free survival analysis was assessed using a Kaplan–Meier method. Results: Twenty-five patients (2.0%) from the CSCR cohort and 103 (0.9%) from the control group were diagnosed erectile dysfunction clinically during a mean observation period of 4.3 years. Patients with CSCR had a significantly higher incidence of erectile dysfunction diagnosis than those without CSCR (p

Purpose To investigate the relationship between age-related macular degeneration (AMD) and future development of Alzheimer's disease (AD) or senile dementia. Design A longitudinal case-control study using the Taiwan National Health Insurance Research Database. Participants From 2001 to 2009, the newly diagnosed AMD cases aged ≥65 years in the database were recruited as the AMD cohort (n = 4993). Of those, there were 540 with and 4453 without exudative AMD diagnoses. Subjects without any AMD, matched for age, gender, and time of enrollment, were randomly sampled as the control cohort (n = 24 965) for comparison. Methods Alzheimer's disease/senile dementia-free survival analysis was assessed using a Kaplan–Meier method. Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of AD or senile dementia for the 2 cohorts after adjusting for preexisting comorbidities and number of clinical visits. Main Outcome Measures The first-ever diagnosis of AD or senile dementia during the observation period. Results Of the 29 958 sampled subjects, 1589 (5.3%) were diagnosed with AD or senile dementia during a mean follow-up period of 4.4 years, including 294 (5.9%) from the AMD cohort and 1295 (5.2%) from the control cohort. The incidence of AD or senile dementia was higher in patients with AMD than in the controls ( P = 0.044), with an HR of 1.44 (95% confidence interval [CI], 1.26–1.64) after adjusting for covariates. The stratified analysis showed that the adjusted HR for AD or senile dementia was 1.35 (95% CI, 0.89–2.06) for exudative AMD versus the controls and 1.44 (95% CI, 1.26–1.65) for nonexudative AMD versus the controls. Conclusions This study provides large-scale, population-based evidence that AMD, especially nonexudative AMD, is independently associated with an increased risk of subsequent AD or senile dementia development.

Because the blood flow is much more intense in the choroid than in the retina, it is interesting to explore whether choroidal neovascularization (CNV) is more influenced by plasma angiogenic factors than retinal neovascularization. The aim of this study was to investigate plasma profiles of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in patients with CNV due to age-related macular degeneration (AMD) and in those with retinal neovascularization due to proliferative diabetic retinopathy (PDR). Seventy-seven subjects with AMD, 22 with PDR, and 42 nondiabetic, non-AMD controls were enrolled in this comparative case series. AMD subjects were classified into three groups: dry type (dry AMD, n = 17), wet type with active CNV (CNV/AMD, n = 42), and disciform scar due to advanced wet AMD (scar/AMD, n = 18). Plasma VEGF and NO levels of each subject were measured with enzyme-linked immunosorbent assay and chemiluminescence, respectively. Plasma VEGF level in CNV/AMD (median 256.0 pg/ml, interquartile range 146.4–375.3 pg/ml) was significantly higher than in PDR (124.8 pg/ml, 75.7–215.3 pg/ml; p = 0.004) and controls (120.3 pg/ml, 82.8–168.2 pg/ml, p =0.001). CNV/AMD also had the highest VEGF level among the AMD subgroups. Plasma NO level was significantly elevated in PDR (137.4 µM, 63.7–240.1 µM) when compared with CNV/AMD (71.8 µM, 42.4–113.3 µM; p = 0.004) and controls (62.6 µM, 39.0–114.9 µM; p = 0.002). There was no significant difference in NO levels among the AMD subgroups. No significant correlation between VEGF and NO levels was noted. These findings indicate that both circulating VEGF and NO may play different roles in the pathogenesis of retinal neovascularization and CNV.

Abnormal nitric oxide (NO) synthesis has been implicated in the pathogenesis of diabetes mellitus. The aim of our study was to elucidate the relationship between the stages of diabetic retinopathy (DR) and the NO levels in aqueous humor and plasma. Using the chemiluminescence assay, we measured the concentrations of NO in aqueous humor and plasma samples obtained during intraocular surgery from 45 diabetic patients and 19 nondiabetic cataract patients. The patients with diabetes were classified into 4 groups: proliferative DR (PDR) with active neovascularization (active PDR; 9 cases), PDR with quiescent neovascularization (regressed PDR; 6 cases), background DR (BDR; 16 cases) and no DR (14 cases). We found that the aqueous NO levels (mean ± SE) of the active PDR group (83.2 ± 13.9 µM) were significantly higher than those of the BDR group (45.8 ± 6.0 µM, p = 0.049) and the diabetics without DR (33.3 ± 5.2 µM, p = 0.011), and, although not statistically significantly, they were also higher than those of the regressed PDR group (52.1 ± 10.3 µM, p = 0.224). However, no significant differences were observed between any of the diabetic subgroups in the plasma NO levels (p = 0.345). We therefore concluded that NO present in the ocular tissues may play important roles in the progression of DR.

Human cytomegalovirus (HCMV) retinitis is the most common ocular opportunistic infection in AIDS. It often leads to blindness if left untreated. The questions as to how HCMV infection causes retinal immunopathogenesis and visual destruction in AIDS patients have not been completely established. Here we reported that the nitric oxide (NO) levels in aqueous humor samples in 10 AIDS patients with CMV retinitis (104.3 ± 27.1 µM) were higher than the levels in 7 AIDS patients without CMV retinitis (36.1 ± 10.4 µM; p < 0.001). After ganciclovir treatment, the NO level in the vitreous body of 5 patients declined dramatically (53.4 ± 11.8 µM). By using immunohistochemistry assay, we found that the aggregates of macrophages infiltrated in the CMV-infected retina of 4 AIDS patients. Moreover, the expression of inducible-form NO synthase was detected in the infected retina of these patients. These results suggest that NO production in the eye may play a fundamental role in the immunopathogenesis of AIDS patients with CMV retinitis.

Purpose To explore the relationship of sleep apnea and the subsequent development of retinal vein occlusion (RVO). Design A retrospective nonrandomized, matched-control cohort study using the Taiwan National Health Insurance Research Database. Methods From 1997 through 2007, we identified newly diagnosed sleep apnea cases in the database. A control group without sleep apnea, matched for age, gender, and comorbidities, was selected for comparison. The 2 cohorts were followed up, and the occurrence of RVO was observed. Results Of the 35 634 sampled patients (5965 sleep apnea patients vs 29 669 controls), 52 (0.15%) experienced RVO during a mean follow-up period of 3.72 years, including 13 (0.22%, all branch RVO) from the sleep apnea cohort and 39 (0.13%, 39 branch RVO and 10 central RVO) from the control group. Kaplan-Meier analysis revealed the tendency of sleep apnea patients toward RVO development ( P = .048, log-rank test). Patients with sleep apnea experienced a 1.94-fold increase (95% confidence interval, 1.03 to 3.65; P = .041) in incident RVO, which was independent of age, gender, and comorbidities. Conclusions Sleep apnea may be an independent risk factor for RVO.