The prevalence of myopia remains stable under tighter COVID-19 social restriction in preschoolers receiving a school-based eyecare program.

PURPOSE: This study investigated the impact of different levels of COVID-19 social restrictions (social distancing in 2020, large-scale home confinement in 2021) on myopia prevalence and behaviours in a preschool population with school-based eyecare programme. METHODS: Repeated cross-sectional surveys were conducted between August and December in 2019, 2020 and 2021. Children aged 5-6 years received ocular examinations, and questionnaires were answered by caregivers before the day of the examination. The main outcome measures were the changes in after-school time spent on homework, screen-based devices and outdoors. Secondary outcome was the change in myopia prevalence (spherical equivalent [SE] ≤ -0.5 D in either eye after cycloplegia). RESULTS: A total of 9997 preschoolers were included in the analysis. Under tighter restrictions, more preschoolers spent ≥1 h/day on screen-based devices (42.8% in 2019, 45.2% in 2020, 48.9% in 2021, p < 0.001), and fewer preschoolers spent ≥30 min/day on after-school outdoor activities (49.5% in 2019, 46.0% in 2020, 41.0% in 2021, p < 0.001) on weekdays. A similar trend was found on weekends. While more preschoolers spent ≥2 h/day on screen-based devices (35.3% in 2019, 38.5% in 2020, 43.0% in 2021, p < 0.001), fewer preschoolers spent ≥2 h/day on outdoor activities (41.7% in 2019, 41.7% in 2020, 34.0% in 2021, p < 0.001). The mean SE and myopia prevalence were stable (9.1% in 2019, 10.3% in 2020, 9.4% in 2021, p = 0.707). CONCLUSION: Our study showed dose-dependent effect of social restrictions on near-work and outdoor behaviours at home. The prevalence of myopia did not increase significantly with short-term cessation of school-based eyecare programmes.

Risk factors for anisometropia in schoolchildren: A population-based, longitudinal cohort study.

PURPOSE: To investigate the incidence rate and risk factors for anisometropia among young schoolchildren. METHODS: A population-based cohort study, the Myopia Investigation Study in Taipei, was conducted in primary schools in Taipei City. Children were recruited for biannual comprehensive eye examinations over 2 years. Cycloplegic autorefraction and slit lamp examinations were performed biannually. Data on demographic information, parental history, lifestyle and near-work activities were collected using parent-administered questionnaires at the first and final visits. Anisometropia was defined as ≥1 D difference in the spherical equivalent (SE) refractive error. RESULTS: A total of 7035 8-year-old children completed the 2-year follow-up evaluations. The average annual incidence of anisometropia was 3.8%. Multivariable logistic regression analysis revealed that baseline SE (odds ratio [OR]: 0.87 95% CI: 0.80-0.95) and female sex (OR: 1.24, 95% confidence interval [CI]: 1.02-1.50) were significantly associated with incident anisometropia. Among lifestyle risk factors, spending <1 h per day in after-school outdoor activities on weekdays (OR: 1.38, 95% CI: 1.08-1.76) and performing near work at a distance <30 cm (OR: 1.33, 95% CI: 1.08-1.64) were significantly associated with an increased risk of incident anisometropia. In the multiple linear regression analysis, the inter-eye difference in SE increased significantly in children performing near work at distances <30 cm (adjusted ß = 0.03; p = 0.02). CONCLUSIONS: This study indicated the annual incidence of anisometropia in Taiwanese schoolchildren. Less time spent outdoors and shorter eye-to-object distances during near work increased the risk of incident anisometropia.

Premyopia at Preschool Age: Population-based Evidence of Prevalence and Risk Factors from a Serial Survey in Taiwan.

PURPOSE: Premyopia at a young age carries a great risk of developing early-onset myopia, especially in regions with myopia epidemics, such as the developed areas in East Asia. This study aims to report the prevalence of premyopia and its risk factors in a Taiwan preschool population and lifestyle changes among premyopic preschoolers before and during the Coronavirus Disease 2019 (COVID-19) pandemic. DESIGN: Repeated countywide population-based, cross-sectional study in Yilan County, northeastern Taiwan. PARTICIPANTS: From 2014 to 2020, a total of 23 930 kindergarteners aged 5 to 6 years were identified in the Yilan Myopia Prevention and Vision Improvement Program (YMVIP). Of those, 21 761 (11 335 [52.1%] boys; mean age, 5.15 ± 0.37 years) were included for final analysis. METHODS: Annual kindergarten-based eye examinations and myopia prevention strategies have been conducted since the commencement of the YMVIP in 2014. Refractive error was determined by cycloplegic autorefraction. The data of potential risk factors for myopia were gathered by caregiver-administered questionnaires. MAIN OUTCOME MEASURES: The prevalence of premyopia (spherical equivalent [SE] > -0.5 diopter [D] and ≤ +0.75 D in the eye with less SE value). RESULTS: The prevalence of myopia (SE ≤ -0.5 D), premyopia, and hyperopia (SE > +0.75) was 10.7% (95% confidence interval [CI], 10.3-11.1), 52.0% (95% CI, 51.3-52.7), and 37.3% (95% CI, 36.7-37.9), respectively. Multinomial logistic regression analysis showed that premyopia prevalence was significantly associated with male gender (odds ratio [OR], 1.25; 95% CI, 1.18-1.32), caregiver myopia (OR, 1.46; 95% CI, 1.37-1.56), screen time ≥ 1 hour per weekdays (OR, 1.10; 95% CI, 1.04-1.17), 2-year exposure to myopia prevention strategy (OR, 0.59; 95% CI, 0.54-0.65), and college or higher education level of caregiver (OR, 0.91; 95% CI, 0.85-0.96). Even without large-scale school closure in Taiwan, there was a slight upward trend of increased time spent on screen-based devices during the COVID-19 pandemic. CONCLUSIONS: Our findings showed that premyopia was the most common refractive error in a Taiwan preschool population. Premyopia was also associated with both parental and environmental myopiogenic factors. Longitudinal studies are warranted to examine the lifestyle change and myopic shift of premyopic preschoolers in the postpandemic era.

Prevalence Trend of Myopia after Promoting Eye Care in Preschoolers: A Serial Survey in Taiwan before and during the Coronavirus Disease 2019 Pandemic.

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.

Parafoveal atrophy after human amniotic membrane graft for macular hole in patients with high myopia.

PURPOSE: To 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). METHOD: This 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. RESULTS: The 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. CONCLUSION: Parafovea 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.

Comparison between Cryopreserved and Dehydrated Human Amniotic Membrane Graft in Treating Challenging Cases with Macular Hole and Macular Hole Retinal Detachment.

PURPOSE: To evaluate the surgical outcomes of cryopreserved and dehydrated human amniotic membrane (hAM) graft transplantation for macular hole (MH) and macular hole retinal detachment (MHRD) repair. MATERIALS AND METHODS: This retrospective, interventional case series was conducted in two hospitals. Two types of hAM grafts, namely, the dehydrated form (AmnioGen, HCT Regenerative, Taiwan) and the cryopreserved form (AmnioGraft, Bio-Tissue, Miami, FL), were consecutively used in MH surgeries. Anatomical and functional outcomes between the 2 types of hAM grafts were compared. RESULTS: Seventeen patients (mean age: 62.1 ± 10.0 years, 9 (52.9%) males) were enrolled. Of them, 11 patients had persistent MH, 3 had MH without prior surgery, and 3 had MHRD. A cryopreserved hAM graft was used in 10 patients, and a dehydrated hAM graft was used in 8 patients. One patient used a cryopreserved hAM in the first MH surgery and a dehydrated hAM in the second surgery for extramacular hole with retinal detachment. After a 6-month follow-up, 13 (76.5%) patients had sealed MHs. The average visual acuity (VA) of cases with sealed MHs improved from 1.38 ± 0.62 to 1.12 ± 0.47 logMAR (p=0.03). In the other 4 cases with persistent MH, 3 had graft dislocation and 1 had a reopened MH with graft contraction. There were no significant differences in closure rate (80.00% vs. 71.43%, p=0.68) or VA improvement (0.19 ± 0.37 logMAR vs. 0.15 ± 0.41 logMAR, p=0.85) between the 2 kinds of hAM graft. CONCLUSION: This preliminary case series showed that both cryopreserved hAM and dehydrated hAM are feasible alternative grafts for either persistent or recurrent MH. Both approaches have similar anatomical and functional outcomes.

The association between clinically diagnosed insomnia and age-related macular degeneration: a population-based cohort study.

PURPOSE: The decreased level of melatonin, the substance involved in the control of the sleep-wake cycle, has been reported among the patients with age-related macular degeneration (AMD). However, knowledge about the relationship between sleep disturbance and AMD is still limited. This longitudinal case-control study aims to investigate the risk of incident AMD among the patients with clinically diagnosed insomnia using the Taiwan National Health Insurance Research Database. METHODS: The insomnia cohort (n = 15 465) consisted of newly diagnosed insomnia cases aged ≥55 years between 2000 and 2009. Subjects without insomnia, matched for age, gender and enrolment time, were randomly sampled as the control cohort (n = 92 790). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of incident AMD for the two cohorts after adjusting for potential confounders. RESULTS: Of the 108 255 sampled subjects, 2094 (1.9%) were diagnosed with AMD, including 214 (0.2%) with neovascular AMD, during a mean follow-up period of 5.1 ± 2.8 years. Insomnia patients were more likely to have subsequent AMD than those without insomnia (2.5% versus 1.8%, p < 0.001). Further, the incidence of exudative AMD was also higher in the insomnia cohort than the control cohort (0.3% versus 0.2%, p = 0.002). The adjusted HR was 1.33 (95% confidence interval [CI], 1.18-1.48, p < 0.001) for AMD and 1.67 (95% CI, 1.20-2.33, p = 0.002) for exudative AMD. CONCLUSIONS: Clinically diagnosed insomnia is an independent indicator for the increased risk of subsequent AMD development.

Protective behaviours of near work and time outdoors in myopia prevalence and progression in myopic children: a 2-year prospective population study.

AIM: To 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. METHODS: Myopia 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. RESULTS: Children 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. CONCLUSION: In 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.

Seasonal variation of refractive error change among young schoolchildren in a population-based cohort study in Taipei.

PURPOSE: To 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. METHODS: We 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. RESULTS: By 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; p<0.001). Of those, the summer progression rate was approximately 80%, 65% and 61.5% of that measured in winter for myopic (p=0.252), emmetropic (p=0.012) and hyperopic (p=0.012) schoolchildren, respectively. CONCLUSION: Our 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.

Prevalence and association of refractive anisometropia with near work habits among young schoolchildren: The evidence from a population-based study.

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.

Risk factors for myopia progression in second-grade primary school children in Taipei: a population-based cohort study.

PURPOSE: To evaluate the 1-year progression of myopia and associated risk factors in second-grade primary school children. METHODS: 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 D<ΔSE≤-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. RESULTS: 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. CONCLUSIONS: 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.

Myopia Development Among Young Schoolchildren: The Myopia Investigation Study in Taipei.

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.

Prevalence and risk factors for myopia in second-grade primary school children in Taipei: A population-based study.

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<0.001]; suburban residence (vs. urban; OR=1.10, p=0.02); lower maternal education level (OR=1.25, p<0.001); the presence of myopia in one parent (OR=1.66, p<0.001) or both parents (OR=2.82, p<0.001); time spent on near-work activity every day (OR=1.21, p<0.001); shorter visual distance when doing near-work activity (OR=1.17, p<0.001); and participation in an after-school tutorial program (OR=1.20, p<0.001). By contrast, resting after 30 minutes of near-work activity (OR=0.84, p<0.001) and spending more time participating in outdoor activities on weekends (OR=0.91, p=0.03) were significantly associated with a lower risk of myopia. CONCLUSION: Our findings indicate that lifestyle and reading habits impact the development of myopia during early childhood. Behavior modification, such as more time spent outside during the day and limited near-work activity, may be a feasible strategy for curbing the increasingly high prevalence of myopia in Taipei.

Sense of Coherence among Older Adult Residents of Long-Term Care Facilities in Taiwan: A Cross-Sectional Analysis.

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.

Age-Related Macular Degeneration and Risk of Degenerative Dementia among the Elderly in Taiwan: A Population-Based Cohort Study.

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.

Study design, rationale and methods for a population-based study of myopia in schoolchildren: the Myopia Investigation study in Taipei.

BACKGROUND: To describe the study design, rationale and methodology of the Myopia Investigation Study in Taipei (MIT). DESIGN: The MIT was a city-wide, 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.

Risk of central serous chorioretinopathy in adults prescribed oral corticosteroids: a population-based study in Taiwan.

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.

The risk of cataract associated with repeated head and neck CT studies: a nationwide population-based study.

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.

Epidemiology of idiopathic central serous chorioretinopathy in Taiwan, 2001-2006: a population-based study.

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<0.001), with a male/female ratio of 1.74. The peak incidence was in the 35- to 39-year-old age group (0.30‰), followed by the 40- to 44-year-old age group (0.26‰). Males had a significantly higher mean annual incidence than female only in the middle age groups. Conditional logistic regression was used to estimate the odds ratios (ORs) for potential risk factors of idiopathic CSCR. Only exposure to anti-anxiety drugs (OR, 1.63; 95% confidence interval, 1.09-2.44) was found to be independently associated with idiopathic CSCR among males. No risk factors of idiopathic CSCR were found for females. CONCLUSIONS: This study provides the nationwide, population-based data on the incidence of idiopathic CSCR in adult Asians, and suggests that exposure to anti-anxiety drugs is an independent risk factor for idiopathic CSCR among males.

Increased risk of erectile dysfunction among males with central serous chorioretinopathy -- a retrospective cohort study.

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 < 0.001). After adjusting for age, geographic location, chronic comorbidities and medication habits, patients with CSCR were found to have a 2.22-fold [95% confidence interval (CI), 1.42-3.46] higher hazard ratio of a subsequent erectile dysfunction diagnosis than the matched controls. The adjusted HR for organic and psychogenic erectile dysfunction were 2.14 (95% CI: 1.34-3.44) and 3.83 (95% CI: 1.47-10.01), respectively. CONCLUSIONS: Central serous chorioretinopathy was independently associated with an increased risk of being diagnosed with erectile dysfunction.