Progression of Myopic Maculopathy Based on the ATN Classification System.

INTRODUCTION: Myopic maculopathy is a sight-threatening disease, which causes irreversible vision faults and central vision loss. The purpose of this study is evaluating the risk factors of the myopic maculopathy progression according to the ATN classification system. METHODS: Clinic data of 69 high myopia patients aged older than 40 years with a follow-up time of more than 2 years, who underwent fundus photography and OCT examination were retrospectively collected. Fundus changes were evaluated with ATN classification at the first and last follow-up times. The related factors affecting progress including axial length (AL), spherical equivalence (SE), subfoveal choroidal thickness (SFCT), disc-foveal distance (DFD), optic disc tilt, and parapapillary atrophy (PPA) were analyzed. RESULTS: This study included 69 high-myopia patients with mean age 54.29 ± 10.41 years. The progression rate of myopic maculopathy (MM) was approximately 25.56%. Elongated DFD (5.37 ± 0.11 mm vs. 4.86 ± 0.37 mm; p < 0.001) and thinner SFCT (138.52 ± 29.38 µm vs. 184.87 ± 48.72 µm; p = 0.008) at baseline were linked with MM progression. In multiple logistic regression analysis, DFD was a substantial hazard risk factor (adjusted OR = 1.672, 95% CI: 1.135-2.498, p < 0.05) after adjusting for age, AL and SFCT. Receiver operating characteristic curve showed that DFD might serve as a predictor to discriminate the MM progression with a cut-off value of 5.15 mm and a substantial receiver operating characteristic curve area (AUC: 0.794). Compared with the non-progression group, the progression group had older age (p < 0.001), longer AL (p = 0.001), higher optic disc tilt rate (p < 0.001), and higher proportion of pre-existing PPA (p = 0.038) at baseline, the differences were statistically significant. CONCLUSION: Based on the ATN classification system, we found that the progression of MM was related to older age, longer AL, high disc tilt, pre-existing PPA, thinner SFCT, and longer DFD. The parameter of DFD was an important factor affecting the progression of MM, which is considered to have a higher probability of progression when the length is beyond 5.15 mm.

Expression of osteopontin and integrin αvß 3 receptor in retina of diabetic guinea pigs with high myopia.

INTRODUCTION: To investigate the effect of high myopia on the expression of retinal osteopontin (OPN) and integrin αVß 3 receptor in guinea pigs and determined the relationship between high myopia and diabetic retinopathy. METHODS: Ninety 3-week-old male guinea pigs were randomly divided into four groups that included normal control group (NOR，n=18), high myopia group (HM，n=24), diabetes group (DR，n=24), and diabetes with high myopia group (DR+HM，n=24). HM was induced by form deprivation (FDHM) in the right eye. The DR group was injected with 5% streptozotocin(STZ) 280 mg/kg intraperitoneally in the lower left abdomen of guinea pigs. The DRHM group was subjected to the same treatment as the HM and DR groups. Eighteen guinea pigs in each group were randomly selected to complete the experimental measurement. After enucleation of eyeballs, HE and immunohistochemical staining were performed to observe the retina morphology and count the positive rate of OPN and integrin αvß 3 receptor. RESULTS: Diabetic retinal changes were found in group DR and HM+DR. The degree of retinal change in group HM+DR was less than that in group DR. In the DR group, the morphology of retinal tissue was loose, the number of cells decreased, increased retinal microaneurysms, and a small amount of small artery embolism and venous thrombosis were observed. Although the retinal structure in the HM+DR group also became thinner, looser, and disordered, only a small number of microaneurysms were observed compared with the diabetic group. Immunohistochemical staining showed that the expression of OPN and integrin αvß 3 receptors in the diabetic groups (DR, HM+DR) was significantly higher than in the HM and NOR groups. The positive expression rates of OPN and integrin αvß 3 receptors in group HM+DR were significantly lower than those in group DR (P < 0.05). CONCLUSION: The expression of OPN and integrin αvß 3 receptor in the retina of diabetic guinea pigs with high myopia was lower than that of diabetic models, which may be due to the influence of high myopia on neovascularization in DR.

Cytokine Profiles and the Effect of Intravitreal Aflibercept Treatment on Experimental Choroidal Neovascularization.

PURPOSE: The purpose of our study was to investigate the profiles of inflammatory cytokines and the macrophage polarization gene in a choroidal neovascularization (CNV) mouse model before and after intravitreal aflibercept treatment. METHODS: The CNV mouse model was conducted by laser photocoagulation. A total of 58 cytokines were measured by the multiplex mouse cytokine antibody array. The macrophage polarization genes were tested by reverse transcription polymerase chain reaction. The relationship between the cytokines and the CNV lesion area was analyzed by correlation. RESULTS: MIP-1a on day 3 after laser photocoagulation, MCP-5 and Fas-L on day 7, and IL-15 and IL-7 on day 14 were significantly upregulated (p < 0.001, fold change >10.0). After the intravitreal aflibercept treatment, GM-CSF and MCP-1 on day 3 and TIMP-1 on days 7 and 14 were the most significantly upregulated cytokines (p < 0.001, fold change >10.0). MIP-1 on day 3, IL-13 and Fas-L on day 7, and Fas-L on day 14 were the most significantly downregulated cytokines after intravitreal aflibercept treatment (p < 0.001, fold change >5.0). M2 polarization and VEGFA genes were significantly increased in the CNV formation, whereas aflibercept suppressed M2 polarization and VEGFA genes. IL-7 was negatively related to the CNV lesion area on day 14 after intravitreal aflibercept treatment (r = -0.938, p = 0.006). CONCLUSION: The inflammatory cytokines and the M1/M2 macrophage genes significantly changed in the CNV mouse model. This result suggests that inflammatory cytokines and macrophages play a critical role in the physiopathology of CNV.

Predictors of visual recovery in patients with macular edema secondary to central retinal vein occlusion after treatment with Conbercept.

BACKGROUND: The use of Spectral domain optical coherence tomography (SD-OCT) to evaluate the predictors of visual acuity-recovery in patients treated with conbercept for macular edema (ME) secondary to central retinal vein occlusion (CRVO) has rarely been seen. We collected 26 CRVO-ME patients with different OCT measures at 6 months follow-up to identify the factors that are most strongly correlated with the best-corrected visual acuity (BCVA) post-treatment in CRVO-ME patients treated with conbercept. PURPOSE: To evaluate the effectiveness of intravitreal conbercept injections for the treatment of CRVO-ME and to determine the major predictors of best-corrected visual acuity (BCVA) post-treatment. METHODS: A retrospective study methodology was used. Twenty-six eyes from 26 patients with CRVO-ME were enrolled in the study. After an initial intravitreal injection of conbercept (0.5 mg/0.05 ml), monthly injections for up to 6 months were given following a 1 + PRN (pro re nata) regimen. Data collected at monthly intervals included measurements of the logMAR BCVA, central subfield thickness (CST), macular volume (MV), photoreceptor layer thickness (PLT), outer nuclear layer thickness (ONLT), and the disrupted ellipsoid zone (DEZ). The correlation between BCVA, before and after injections, and each of CST, MV, PLT, ONLT, DEZ was analyzed. RESULTS: The logMAR BCVA in months 3 and 6 post-injection was significantly improved relative to the baseline. In this same period the CST, MV, PLT, ONLT and DEZ were also significantly improved relative to the baseline. There was a negative correlation between PLT and logMAR BCVA at months 3 and 6 after treatment (r = - 0.549, P < 0.001; r = - 0.087, P < 0.001). CONCLUSION: Intravitreal injection of conbercept is an effective treatment for CRVO-ME. With 6 months of follow-up, logMAR BCVA and CST, MV, PLT, ONLT, DEZ improved. PLT was negatively correlated with the visual function in CRVO-ME patients after conbercept treatment, which may be a predictor of vision recovery in patients with CRVO-ME.

SERPINH1, Targeted by miR-29b, Modulated Proliferation and Migration of Human Retinal Endothelial Cells Under High Glucose Conditions.

AIM: In the present study, we performed bioinformatics studies and in vitro functional assays to explore the underlying role of serpin family H member 1 (SERPINH1) in the diabetic retinopathy. METHODS: Common differentially expressed genes (DEGs) between diabetic retinal tissues and normal retinal tissues were analyzed using Gene Expression Omnibus (GEO) database. The proliferation and migration of human retinal endothelial cells (HRECs) was evaluated by MTS, EdU and wound healing assays, respectively; the miRNA and mRNAs expression levels of hub genes in HRECs were determined using quantitative real-time PCR (qRT-PCR). Protein levels were determined using a Western blot assay. RESULTS: A total of 189 common DEGs were screened between two GEO datasets (GSE60436 and GSE94019), and ten potential hub genes that may link to the progression of diabetic retinopathy were detected. The qRT-PCR results showed that collagen, type I, alpha 1 (COL1A1), Collagen, type I, alpha 2 (COL1A2) and serpin family H member 1 (SERPINH1) mRNA expression levels were up-regulated in the HRECs after being exposed to high glucose for 48 h. Silence of SERPINH1 repressed the high glucose-induced increase in proliferation and migration of HRECs. SERPINH1 was a target of miR-29b and was suppressed by miR-29 in HRECs. SERPINH1 overexpression promoted HREC proliferation and migration. Furthermore, miR-29b suppressed HREC proliferation and migration under high-glucose stimulation, which was significantly attenuated by enforced expression of SERPINH1. CONCLUSION: In conclusion, by performing the integrated bioinformatics analysis, the present study suggested that 3 hub genes (COL1A1, COL1A2 and SERPINH1) may be associated with diabetic retinopathy pathophysiology. Further mechanistic studies indicated that miR-29b/SERPINH1 signaling participated in high glucose-induced enhancement in the proliferation and migration of HRECs.

Evaluation of retinal vascular density and related factors in youth myopia without maculopathy using OCTA.

To evaluate the retinal vascular flow density changes of myopic eyes of young adults using optical coherence tomography angiography and the factors affecting these changes. In this cross-sectional study, 90 eyes of 45 participants were analyzed and divided into three groups: mild, moderate, and high myopia (without pathological changes). Macular and radial peripapillary capillary flow densities were measured using optical coherence tomography angiography. Their relationships with the axial length, the spherical equivalent of the refractive error, and age were analyzed using analysis of variance, Pearson's correlation coefficient, and multivariate linear regression analysis. Superficial and deep macular vascular densities were significantly decreased in the high myopia group compared to the other groups. In the high myopia group, the nasal peripapillary flow density decreased, whereas the flow density inside the disc increased. The axial length negatively correlated with the superficial and deep macular vascular density, but positively correlated with the vascular density inside the disc. The spherical equivalent of the refractive error negatively correlated with the macular vascular density. The retinal vascular density decreased in the high myopia group. Hence, the microvascular network inside the disc may have a compensatory action in the hypoxic setting of high myopia.

Intra- and interobserver concordance of a new classification system for myopic maculopathy.

BACKGROUND: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with pathologic myopia (PM). However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system, known as the ATN grading and classification system, was proposed; it is based on the fundus photographs and optical coherence tomography (OCT) images and includes three variable components: atrophy (A), traction (T), and neovascularization (N). This study aimed to perform an independent evaluation of interobserver and intraobserver agreement for the recently developed ATN grading system for MM. METHODS: This was a retrospective study. Fundus photographs and OCT images of 125 patients (226 eyes) with various MMs were evaluated and classified using the ATN grading of the new MM classification system by four blinded and independent evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were randomly re-evaluated by the same observers after an interval of 6 weeks. The kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement. RESULTS: The interobserver agreement was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602-0.700), 0.734 (95% CI: 0.689-0.779), and 0.702 (95% CI: 0.649-0.755), respectively. The interobserver agreement when considering the subtypes was good or excellent, except for stages A1, A2, and N1, in which the weighted κ value was less than 0.6, with moderate agreement. The intraobserver agreement of types and subtypes was excellent, with κ > 0.8. No significant differences were observed between the attending ophthalmologists and residents for interobserver reliability or intraobserver reproducibility. CONCLUSIONS: The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented in clinical decision-making and disease progression assessments.

Effect of physical activity on reducing the risk of diabetic retinopathy progression: 10-year prospective findings from the 45 and Up Study.

OBJECTIVE: To examine the association of physical activities (PA) with diabetic retinopathy (DR) progression based on a 10-year follow-up of a large cohort of working-aged diabetic populations in Australia. METHODS: Nine thousand and eighteen working-aged diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5-14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through the Medicare Benefits Schedule, which was available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence. RESULTS: In the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend = 0.002; medium vs. low, hazard ratio (HR) = 0.78, 95% Confidence Interval (CI): 0.61-0.98; high vs. low, HR = 0.61, 95%CI: 0.36-0.84. In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC. CONCLUSIONS: Higher PA level was independently associated with a lower risk of DR progression among working-aged diabetic populations in this large cohort study.

Novel presentation of intraocular metastases in a patient with penile squamous cell carcinoma: a case report.

BACKGROUND: The choroid is the most common site for intraocular tumor metastasis because of its abundant vascular supply. However, choroidal metastasis in penile cancer is highly unusual. Here, we report the first case of diagnosis of choroidal metastasis at presentation in a patient with penile squamous cell carcinoma. CASE PRESENTATION: A 43-year-old Asian man with a 3-year history of penile cancer presented with metastasis in the right intraocular sites. Magnetic resonance imaging showed hyperintensity in the T1-weighted images and hypointensity in the T2-weighted images of the right eye. After enucleation of his right eye, histopathological analysis led to a diagnosis of metastatic, moderately differentiated penile squamous cell carcinoma. CONCLUSIONS: Penile cancer typically occurs as penile squamous cell carcinoma, and its most common metastatic sites are the inguinal lymph nodes. Hemorrhagic transfer of tumor cells is extremely rare, especially to intraocular sites. Intraocular metastatic tumors have a unique presentation on imaging, as observed on magnetic resonance imaging and histopathological analysis. This novel finding of intraocular metastasis in penile squamous cell carcinoma is of great significance to optic surgeons and oncologists as it has new implications in the diagnosis of and timely intervention for penile cancer metastasis.

Performance of Deep Transfer Learning for Detecting Abnormal Fundus Images.

PURPOSE: To develop and validate a deep transfer learning (DTL) algorithm for detecting abnormalities in fundus images from non-mydriatic fundus photography examinations. METHODS: A total of 1295 fundus images were collected to develop and validate a DTL algorithm for detecting abnormal fundus images. After removing 366 poor images, the DTL model was developed using 929 (370 normal and 559 abnormal) fundus images. Data preprocessing was performed to normalize the images. The inception-ResNet-v2 architecture was applied to achieve transfer learning. We tested our model using a subset of the publicly available Messidor dataset (using 366 images) and evaluated the testing performance of the DTL model for detecting abnormal fundus images. RESULTS: In the internal validation dataset (n = 273 images), the area under the curve (AUC), sensitivity, accuracy, and specificity of DTL for correctly classified fundus images were 0.997%, 97.41%, 97.07%, and 96.82%, respectively. For the test dataset (n = 273 images), the AUC, sensitivity, accuracy, and specificity of the DTL for correctly classifying fundus images were 0.926%, 88.17%, 87.18%, and 86.67%, respectively. CONCLUSION: DTL showed high sensitivity and specificity for detecting abnormal fundus-related diseases. Further research is necessary to improve this method and evaluate the applicability of DTL in community health-care centers.

Does daily dietary intake affect diabetic retinopathy progression? 10-year results from the 45 and Up Study.

BACKGROUND/AIMS: To evaluate the associations of dietary consumption with the 10-year incidence of diabetic retinopathy (DR) progression in working-aged Australians with diabetes. METHODS: We obtained longitudinal data of all diabetic subjects aged 45-65 years from the baseline of the 45 and Up Study and linked this data with Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme claims until 2016. Retinal photocoagulation (RPC), as determined based on the MBS data, was used as a proxy measure of DR progression. Dietary measurements were assessed via self-reported consumption of meat, dairy products, whole-meal bread, breakfast cereal, vegetables, fruit and fruit juice using a self-administered questionnaire at baseline. Cox regression was used to assess the association between dietary consumption and incident RPC during the follow-up period. RESULTS: A total of 8122 participants were included in the current analysis with a mean age of 57.2±5.2 years. During a mean follow-up of 8.6 years, 314 participants (3.8% of baseline) received RPC. Higher consumption of cheese and whole-meal bread was associated with a lower risk of incident RPC, with the HRs of the highest quartiles versus the lowest being 0.58 (95% CI 0.41 to 0.83; test for trend, p=0.007) and 0.64 (0.46 to 0.89; p=0.04), respectively. Body mass index, insulin treatment and gender were significant modifiers for the association between cheese/whole-meal bread and RPC. CONCLUSION: Consumption of cheese and whole-meal bread could reduce the risk of DR progression among the working-aged Australian population with diabetes.

Are smoking intensity and cessation related to cataract surgical risk in diabetic patients? Findings from the 45 and Up Study.

OBJECTIVES: To investigate if smoking was related to the risk of cataract surgery in diabetic patients. METHODS: A total of 9578 diabetic participants aged 45-65 years were enrolled from the 45 and Up Study, the largest population-based cohort study in Australia. Baseline questionnaire data were linked to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) database, which were both available from 2004 to 2016. Cataract surgery was determined according to the MBS. Smoking status were assessed by questionnaire. Cox regression was used to evaluate the association between smoking and incidence of cataract surgery during the follow-up. RESULTS: During a mean follow-up of 8.4 years, 995 participants underwent cataract surgery with a corresponding incidence of 12.4 cases per 1000 person-years. In all, 10.8% of participants were current smokers at baseline, 38.7% were former smokers, and 50.5% were never smokers. The incidence of cataract surgery was non-significantly higher in never-smoker compared to former or current smokers. Regression analysis showed no significant difference in cataract surgical risk among former, current, and never smokers. In addition, neither time since quitting of smoking nor age at quitting was associated with the risk of cataract surgery, although there was a marginally significant trend in a lower risk of cataract surgery with longer smoking cessation time for participant with normal weight (P for trend = 0.05). CONCLUSIONS: Despite that smoking was found to be related to the cataract and cataract surgery in the general population, we did not find any association between smoking and cataract surgery in diabetic patients.

Orbital metastasis from a gastrointestinal stromal tumor: A case report.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is the most common primary mesenchymal tumor. The most common metastasis sites are the liver and the surface of the peritoneum. In this study, we present a case of orbital GIST metastasis. CASE PRESENTATION: A 43-year-old woman who had a history of small intestinal stromal tumor 4 years ago suffered GIST metastasis to the left orbit. MRI confirmed the presence of a lacrimal gland lesion with isointense on T1 and hyperintense on T2 weighted images. Histopathology analysis of the tumor showed predominantly spindle or oval cells with nuclear pleomorphism and increased mitoses. The tumor also stained positive for c-KIT (CD117) upon immunochemistry, confirming the diagnosis. CONCLUSIONS: GISTs typically occur as sporadic solitary tumors, and their common metastasis sites are the liver and the surface of the peritoneum. Orbital involvement is extremely rare. The orbital GIST metastatic tumor has special imaging properties, as evidenced by histopathology, immunochemistry, and magnetic resonance imaging (MRI).

Associations between physical activity and cataract treated surgically in patients with diabetes: findings from the 45 and Up Study.

AIM: To investigate the association between physical activity (PA) and incidence of cataract surgery among patients with diabetes. METHODS: We obtained data from all diabetic subjects aged 45-65 years from the baseline of the prospective 45 and Up Study from 2006 to 2009 and linked to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) until 2016. Diabetes was defined as self-reported on questionnaire or diabetes medication history based on PBS. Cataract surgery was determined based on the MBS, and metabolic equivalent intensity level number of PA sessions per week was used to assess PA. Cox regression was used to assess the association between baseline PA and cataract surgery during the follow-up. RESULTS: A total of 9113 diabetic participants in the 45 and Up Study were included in the current analysis with a mean age of 57.3±5.2 years (43.6% female). During a mean follow-up of 8.8 years, 950 participants (10.4% of baseline) received cataract surgery with a corresponding incidence of 12.4/1000 person-years. Cox regression analysis showed that people with less PA (p=0.01), older age (p<0.001), female gender (p<0.001), higher educational level (p<0.001) and longer diabetic duration (p<0.001) had significantly higher cataract surgery risk. Participants with a PA level of ≥14 sessions per week had 19% decreased risk of cataract surgery compared to those with <5 sessions per week. Stratification analysis showed that participants with more obesity (p value for interaction=0.03), not taking insulin (p value for interaction=0.01) and without cardiovascular disease (p value for interaction=0.008) could benefit significantly more from PA in reducing their cataract surgery risk. CONCLUSIONS: More vigorous PA was independently associated with a reduced risk of cataract surgery in working-aged patients with diabetes.

Ten-year changes of intraocular pressure in adults: the Liwan Eye Study.

IMPORTANCE: Understanding the longitudinal intraocular pressure (IOP) changes and potential risk factors in adults is important for future glaucoma control in the aging society. BACKGROUND: Limited longitudinal studies exist in Asia investigating the longitudinal IOP changes and with varying results. DESIGN: Population-based cohort study. PARTICIPANTS: 1405 baseline participants from the Liwan Eye Study. METHODS: All baseline participants were invited for the 10-year follow-up examination in 2013. IOP (by Tonopen), central corneal thickness (CCT; by ultrasound), refractive error (by autorefractor), blood pressure, height and weight were measured per standardized protocol and the presence of hypertension or diabetes was collected by questionnaire. Follow-up examinations were conducted using the same equipment with proper calibration. Linear regression analysis was used to assess the association between IOP change and potential risk factors. MAIN OUTCOME MEASURES: 10-year IOP change. RESULTS: Of the 791 participants at the 10-year follow-up, IOP data were available for 602 participants with a mean age of 60.9 years (55.5% female). The average IOP change over 10 years was an increase of 1.44 mmHg (95% confidence interval, 1.12-1.75). Linear regression showed that 10-year IOP change was not associated with baseline age, gender, body mass index (BMI), CCT, spherical equivalence (SE), hypertension or diabetes. However, it was positively associated with longitudinal increase of BMI when longitudinal changes of BMI and SE were included in the model (P < 0.001). CONCLUSIONS AND RELEVANCE: We observed a small increase in IOP over 10 years in this adult Chinese population, which was positively related to the longitudinal change in BMI.

Impact of Diet on the Incidence of Cataract Surgery among Diabetic Patients: Findings from the 45 and Up Study.

OBJECTIVE: To examine the impact of diet on the incidence of cataract surgery among the working-aged diabetic population in Australia. METHODS: This cohort study was conducted among 8,752 participants with diabetes aged 45-65 years who were recruited to the 45 and Up Study from 2006 to 2016. The data was linked to the Medicare Benefits Schedule to obtain data on cataract surgery. Diabetes was defined as self-reported on questionnaire or diabetes medication history based on Pharmaceutical Benefits Scheme. Diet was assessed at baseline, using a self-administered questionnaire and healthy diet scores were calculated based on Australian Dietary Guidelines. Cox regression was used to evaluate the association between diet and the incidence of cataract surgery during the follow-up. RESULTS: During a mean follow-up of 8.4 years (73,431 person-years), 914 diabetic participants underwent cataract surgery with a corresponding rate of 12.4 cases per 1,000 person-years. After adjusting for age and gender, the hazard ratios (HR) of cataract surgery for the highest compared to the lowest intake quintile of red meat and poultry were 1.24 (95% CI, 1.00-1.55) and 1.24 (95% CI, 1.02-1.51), respectively. Further adjustment for demographic, lifestyle and dietary factors resulted in no significant difference between cataract surgery risk and healthy diet scores or specific diet groups. In gender-stratified analyses, increasing consumption of red meat (HR for highest versus lowest quintile, 1.39; 95% CI, 1.00-1.93; P for trend = 0.01) and poultry (HR for highest versus lowest quintile, 1.40; 95% CI, 1.05-1.87; P for trend = 0.01) were associated with a higher risk of cataract surgery in women after adjustment of age, gender, income, education level, body mass index, hypertension, cardiovascular disease, family history of diabetes, diabetes duration, insulin use, lifestyle, and other dietary factors. CONCLUSION: Higher consumption of red meat and poultry is related to an elevated risk of cataract surgery in the working-aged female population with diabetes.

[Population-based survey of refractive error in school-aged children in Liwan District, Guangzhou].

OBJECTIVE: To estimate the prevalence of refractive error in school-aged children in urban setting of Southern China. METHODS: In this population-based cross-sectional study, children aged 5 to 15 years old were randomly selected by clustering sampling and door-to-door survey, and were examined in 71 schools and 19 community stations from October 2002 to January 2003. The examination included visual acuity measurement, ocular motility evaluation, retinoscopy, autorefraction under cycloplegia and examination of the external eye, anterior segment, media, and fundus. RESULTS: Of 5053 children living in 4814 households enumerated, 4364 (86.4%) were examined. The prevalence of myopia (spherical equivalent, SE < -0.50 D) was 35.1% (95% CI: 33.2%-36.9%) with retinoscopy, this rate increased from 3. 3% in 5-year-old to 73.1% in 15-year-old. Females had a significantly higher risk of myopia (adjusted odds ratio: 1.29, 95% CI: 1.11-1.51). The prevalence of hyperopia (SE > or = + 2.00 D) was 5.8% (95% CI: 5.3%-6.3%) and decreased from 16.7% in 5-year-old to less than 1% in 15-year-old. Astigmatism (cylinder > or = 0.75 D) was presented in 33.6% of children examined with retinoscopy and in 42.7% with autorefraction. CONCLUSIONS: The prevalence of myopia is high in Chinese school-age children living in urban Guangzhou, representing an important public health problem. The coverage and quality of refractive correction in the children need to be improved.

[Repeatability of ETDRS visual acuity measurement in children].

PURPOSE: To evaluate repeatability of the ETDRS log MAR visual acuity measurement in children and the relative influence factors. METHODS: The children (n = 348) with visual acuity less than 0.5 (equal to 0.3 log unit) in either eye, or one tenth in children with normal visual acuity were chosen to do repeatable uncorrected VA measurement with Bland-Altman analysis and Kappa analysis using ETDRS acuity chart. RESULTS: The mean difference of visual acuity was 0.004 log +/- 0.07. There was a significant repeatability (k = 0.71) between two visual acuity examination. There were significant consistent results both on male and female patients (P = 0.845). A significant relationship was found between age and VA repeatability (P = 0.019). The VA repeatability could also be influenced by refractive error (P = 0.000). The acuity measurement in children with emmetropia (k = 0.82) had a higher repeatability than in the children with myopia (k = 0.66). CONCLUSIONS: The ETDRS visual acuity chart can provide a repeatable measure of visual acuity in children. It is recommended for clinic examination of children.

Slit lamp-simulated oblique flashlight test in the detection of narrow angles in Chinese eyes: the Liwan eye study.

PURPOSE: To assess a modified slit lamp-simulated oblique flashlight test in the identification of persons with suspected angle closure. METHODS: Standard oblique flashlight test (SOFT) and a modified slit lamp-simulated flashlight test (SSFT) were performed on participants identified as primary angle closure suspects and controls from a population-based study. SOFT graded the iris shadow on the nasal iris as shallow, medium, and deep. SSFT measured the length of iris shadow and corneal diameter by a slit lamp graticule eyepiece after standardizing the illumination parallel to the iris plane. RESULTS: SOFT yielded sensitivity and specificity of 76.3% and 80.7% for the detection of eyes with two or more quadrants of pigmented trabecular meshwork not observed on static gonioscopy. Proportions of subjects in the "shallow" category increased from 9.6% in Shaffer angle width grade 4 to 82.3% in grade 0 and were 72.1% in those with steep, 56.7% in those with plateau, and 13.9% in those with regular iris profiles. SSFT yielded 84.8% sensitivity and 76.7% specificity using a cutoff of 0.18 for the ratio between iris shadow length and corneal diameter. This ratio was monotonically associated with the axial anterior chamber depth, and it was significantly greater in eyes with Shaffer angle width grade lower than 2 and significantly less in eyes with Shaffer angle width grades 3 and 4. Reproducibility of SSFT was high (paired t-test; P > 0.05). CONCLUSIONS: More accurate measurement by controlling illumination and following a more precise method to measure shadow formation may improve the performance characteristics of this test. However, this method does not appear appropriate for community-based screening because of its relatively low specificity.