Optical Coherence Tomography Angiography Biomarkers in Thai Patients With Diabetic Nephropathy: A Diabetic Eye and Kidney Diseases (DEK-D) Study.

Purpose: To identify optical coherence tomography angiography (OCTA) biomarkers to predict the diabetic nephropathy (DN) and their associations with 24-hour urine albumin levels in diabetic patients. Methods: This cross-sectional, observational study examined 186 eyes from 93 individuals subdivided into three groups according to 24-hour urine albumin levels: no DN, early DN, and late DN. Vessel density (VD), fractal dimension, foveal avascular zone area, intercapillary area, central retinal thickness, and subfoveal choroidal thickness were measured from OCTA images to determine their association with the DN stages. Results: VD values of the superficial capillary plexus, deep capillary plexus, and whole retina were significantly lower in the early DN group compared to the no DN group (adjusted P = 0.042, 0.016, and 0.008, respectively). VD values for the deep capillary plexus and whole retina were significantly decreased in the late DN group compared to the no DN group (adjusted P = 0.025 and 0.021, respectively). Mean fractal dimension, intercapillary area, foveal avascular zone area, central retinal thickness, and subfoveal choroidal thickness were not statistically different among the three groups. Conclusions: VD may be a useful parameter for the early non-invasive screening of DN. Further studies in larger populations are needed to establish a cutoff value for detection. Translational Relevance: This study investigated the association of each retinal vasculature measurement by OCTA and diabetic nephropathy status which could serve as an alternative way to screen for albuminuria.

Prevalence and Factors Associated with Suicidal Ideation Among Older People with Visual Impairments Attending an Eye Center During the COVID-19 Pandemic: A Hospital-Based Cross-Sectional Study.

Purpose: To evaluate the prevalence of suicidal ideation and associated factors among older people with visual impairments attending an eye center during the COVID-19 pandemic. Patients and Methods: A total of 314 older people aged 60 and above with visual impairments who attended an eye center were included in this study. This was a hospital-based cross-sectional study conducted from February to July, 2022. Data were collected in person. Suicidal ideation was measured using the Columbia-Suicide Severity Rating Scale (C-SSRS). Multivariable logistic regression analysis was used to explore associations between related factors and suicidal ideation. Results: Of 314 older people with visual impairments, the prevalence of suicidal ideation was 32.5%. Suicidal ideation was independently associated with diabetic retinopathy (adjusted odds ratio (AOR)=2.4, 95% confidence interval (CI): 1.0-5.8; p=0.038) and depression (AOR=6.3, 95% CI: 3.5-11.2; p<0.001). Conclusion: This study found a relatively high prevalence of suicidal ideation among older people with visual impairments. There was also a significant association between depression and suicidal ideation among these individuals. Visual impairments can lead to negative émotions. This underscores the importance of addressing the mental health needs of older individuals with visual impairments, including suicide prevention efforts tailored to their needs. Ophthalmologists should be equipped with the skills necessary to identify the early signs of suicidal ideation and refer patients to mental healthcare specialists for appropriate treatment.

Impact of COVID-19 on Depressive Symptoms Among Patients with Low Vision and Blindness.

Background: Disability is globally recognized as a key cause of depression. Likewise, the COVID-19 pandemic has significantly increased the vulnerability of patients with low vision to health and health-related issues, especially mental health. This study aimed to examine the association between the impact of COVID-19 and depressive symptoms in patients with low vision and blindness. Methods: This cross-sectional study was conducted between February and July 2022 and involved face-to-face interviews. Patients with low vision and blindness diagnosed with depression were excluded. The following items were included in the questionnaire: sociodemographic information, Multi-Dimensional Scale of Perceived Social Support (MSPSS), the impact of COVID-19, and The Center for Epidemiological Studies-Depression (CES-D). Hierarchical linear regression analysis was used to examine the association between the impact of COVID-19 and depression. Results: The prevalence of depression among patients with low vision and blindness was 43.0%. Three factors were associated with depressive symptoms: compliance with COVID-19 prevention strategies (ß = 0.16, p<0.01), anxiety during COVID-19 (ß = 0.24, p<0.001), and social support (ß = -0.16, p<0.01). Conclusion: The findings indicated that COVID-19 significantly increased depressive symptoms among patients with low vision and blindness. The psychological effects of the COVID-19 pandemic have been considered critical and emergent public health issues. Stakeholders, particularly public health organizations, need to urgently implement preventive and protective measures to help patients with physical and mental disabilities.

The sterility, stability and efficacy of repackaged ziv-aflibercept for intravitreal administration.

To evaluate the sterility, stability, and efficacy of repackaged ziv-aflibercept in 1-mL plastic tuberculin syringes for intravitreal injection after storage for up to 90 days at controlled (4 °C) and ambient (25.8 °C) temperature. A total of 168 tuberculin-type 1-mL syringes were prepared containing ziv-aflibercept (100 mg/4 mL). Samples were stored at 4 °C and 25.8 °C for 0, 3, 7, 14, 21, 28, 60, and 90 days. At each time point, four samples were evaluated for the stability and binding affinity of anti-VEGF to VEGF (efficacy) using enzyme-linked immunosorbent assays (ELISAs). All samples were analyzed for microbial growth. No microbial growth was obtained from any of the ziv-aflibercept samples during each time point, indicating that the repackaged ziv-aflibercept stored at 4 °C and 25.8 °C remained sterile. ELISA analysis revealed no significant decrease in concentration, and binding affinity was observed, indicating that the stability and efficacy were preserved. However, the concentration of ziv-aflibercept decreased less than the minimum expected concentration of 8 ng/mL after 60 days at 4 °C and after 30 days at 25.8 °C. The repackaged anti-VEGF drug ziv-aflibercept does not lose stability or efficacy and remains uncontaminated if prepared under sterile conditions and stored at 4 °C for up to 60 days or stored at 25.8 °C for up to 30 days.