Association of Socioeconomics With Prevalence of Visual Impairment and BlindnessWang, Wei; Yan, William; Müller, Andreas; Keel, Stuart; He, Mingguang
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.3449pmid: 29049446
ImportanceVision loss is the third most common impairment worldwide. Although cost-effective interventions are available for preventing or curing most causes of vision loss, availability of these interventions varies considerably between countries and districts. Knowledge of the association between vision loss and socioeconomic factors is informative for public health planning.
ObjectivesTo explore correlations of the prevalence of visual impairment with socioeconomic factors at country levels and to model and estimate a socioeconomic-adjusted disease burden based on these data.
Design, Setting, and ParticipantsIn this cross-sectional study, the following data were collected from 190 countries and territories: the age-standardized prevalence of moderate to severe visual impairment (MSVI) and blindness from January 1 to December 31, 2010, across countries, human development index (HDI), gross domestic product (GDP) per capita, total health expenditure, total health expenditure as percentage of GDP (total health expenditure/GDP), public health expenditure as percentage of total health expenditure (public/total health expenditure), and out-of-pocket expenditure as percentage of total health expenditure (out-of-pocket/total health expenditure). Countries were divided into 4 levels (low, medium, high, and very high) by HDI. Data analysis was conducted from September 1, 2016, to July 1, 2017.
Main Outcomes and MeasuresThe correlations between prevalence data and socioeconomic indices were assessed.
ResultsA strong negative association between prevalence rates of MSVI and blindness and socioeconomic level of development was observed. The mean (SD) age-standardized prevalence of MSVI decreased from 4.38% (1.32%) in low-HDI regions to 1.51% (1.00%) in very-high-HDI regions (P < .001). The national HDI level was attributable to 56.3% of global variation in prevalence rates of MSVI and 67.1% of global variation in prevalence rates of blindness. Higher prevalence rates were also associated with lower total health expenditure per capita, total health expenditure/GDP (β = −0.236 [95% CI, −0.315 to −0.157] for prevalence of MSVI; β = −0.071 [95% CI, −0.100 to −0.042] for prevalence of blindness), public/total health expenditure (β = −0.041 [95% CI, −0.052 to −0.031] for prevalence of MSVI; β = −0.014 [95% CI, −0.018 to −0.010] for prevalence of blindness), and higher percentage of out-of-pocket/total health expenditure (β = 0.044 [95% CI, 0.032-0.055] for prevalence of MSVI; β = 0.013 [95% CI, 0.009-0.017] for prevalence of blindness). Countries with increased burden of visual impairment and blindness can be easily identified by the results of the linear models. Socioeconomic factors could explain 69.4% of the global variations in prevalence of MSVI and 76.3% of the global variations in prevalence of blindness.
Conclusions and RelevanceBurden of visual impairment and socioeconomic indicators were closely associated and may help to identify countries requiring greater attention to these issues. The regression modeling described may provide an opportunity to estimate appropriate public health targets that are consistent with a country’s level of socioeconomic development.
Optical Coherence Tomography Angiography for Assessment of the 3-Dimensional Structures of Polypoidal Choroidal VasculopathyChi, Yu-Tien; Yang, Chang-Hao; Cheng, Cheng-Kuo
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4360pmid: 29049501
Key PointsQuestionWhat is the 3-dimensional anatomy of polypoidal complexes in polypoidal choroidal vasculopathy?
FindingsIn this cohort study of 47 patients with polypoidal choroidal vasculopathy, optical coherence tomography angiography quantitatively demonstrated polypoidal complexes in 36.2% (polypoidal structures) and 55.3% (branching vascular networks). Branching vascular networks and vessels sprouting from the choriocapillaris level were arranged in a 3-dimensional architecture, with polypoidal structures within the inner part of the level of the retinal pigment epithelium reference plane, the branching vascular networks on the outer side of the retinal pigment epithelium reference plane, and a stalk even farther out into the choroidal level.
MeaningThese findings suggest that optical coherence tomography angiography identifies quantitative 3-dimensional structures of polypoidal lesions that may help understanding of the pathogenesis of polypoidal choroidal vasculopathy.
Quantitative Autofluorescence Intensities in Acute Zonal Occult Outer Retinopathy vs Healthy EyesBoudreault, Katherine; Schuerch, Kaspar; Zhao, Jin; Lee, Winston; Cabral, Thiago; Yannuzzi, Lawrence A.; Tsang, Stephen H.; Sparrow, Janet R.
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4499pmid: 29075777
Key PointsQuestionAre fundus autofluorescence intensities elevated at the border of acute zonal occult outer retinopathy lesions compared with intensities at the same fundus positions in healthy eyes?
FindingsIn a study of 6 patients diagnosed as having acute zonal occult outer retinopathy, measurement by quantitative fundus autofluorescence revealed that intensities were elevated compared with age and race/ethnicity–matched healthy eyes.
MeaningThese findings suggest that acute zonal occult outer retinopathy pathogenesis involves accelerated formation of bisretinoid fluorophores in impaired photoreceptor cells, leading to elevated fundus autofluorescence and potential for aggravated damage.
Clinicopathological Features of Ocular Adnexal Mantle-Cell Lymphoma in an International Multicenter CohortKnudsen, Marina K. H.; Rasmussen, Peter K.; Coupland, Sarah E.; Esmaeli, Bita; Finger, Paul T.; Graue, Gerardo F.; Grossniklaus, Hans E.; Khong, Jwu Jin; McKelvie, Penny A.; Mulay, Kaustubh; Ralfkiaer, Elisabeth; Sjö, Lene D.; Vemuganti, Geeta K.; Thuro, Bradley A.; Curtin, Jeremy; Heegaard, Steffen
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4810pmid: 29121219
Key PointsQuestionWhat are the clinical features of ocular adnexal mantle-cell lymphoma (OA-MCL)?
FindingsThis retrospective multicenter study included 55 patients, largely elderly and male, with stage IVE OA-MCL involving bilateral tumor masses (frequently affecting the orbit). Five-year disease-specific survival was 38%, which can potentially be improved through the addition of rituximab to the chemotherapy treatment.
MeaningOcular adnexal MCL tends to manifest as bilateral tumor masses of the orbit, most often in men; it has an aggressive clinical course with poor prognosis.
Accuracy of Next-Generation Sequencing for Molecular Diagnosis in Patients With Infantile Nystagmus SyndromeRim, John Hoon; Lee, Seung-Tae; Gee, Heon Yung; Lee, Byung Joo; Choi, Jong Rak; Park, Hye Won; Han, Sueng-Han; Han, Jinu
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4859pmid: 29145603
ImportanceInfantile nystagmus syndrome (INS) is a group of disorders presenting with genetic and clinical heterogeneities that have challenged the genetic and clinical diagnoses of INS. Precise molecular diagnosis in early infancy may result in more accurate genetic counseling and improved patient management.
ObjectiveTo assess the accuracy of genomic data from next-generation sequencing (NGS) and phenotypic data to enhance the definitive diagnosis of INS.
Design, Setting, and ParticipantsA single-center retrospective case series was conducted in 48 unrelated, consecutive patients with INS, with or without associated ocular or systemic conditions, who underwent genetic testing between June 1, 2015, and January 31, 2017. Next-generation sequencing analysis was performed using a target panel that included 113 genes associated with INS (n = 47) or a TruSight One sequencing panel that included 4813 genes associated with known human phenotypes (n = 1). Variants were filtered and prioritized by in-depth clinical review, and finally classified according to the American College of Medical Genetics and Genomics guidelines. Patients underwent a detailed ophthalmic examination, including electroretinography and optical coherence tomography, if feasible.
Main Outcomes and MeasuresDiagnostic yield of targeted NGS testing.
ResultsAmong the 48 patients (21 female and 27 male; mean [SD] age at genetic testing, 9.2 [10.3] years), 8 had a family history of nystagmus and 40 were simplex. All patients were of a single ethnicity (Korean). Genetic variants that were highly likely to be causative were identified in 28 of the 48 patients, corresponding to a molecular diagnostic yield of 58.3% (95% CI, 44.4%-72.2%). FRMD7, GPR143, and PAX6 mutations appeared to be the major genetic causes of familial INS. A total of 10 patients (21%) were reclassified to a different diagnosis based on results of NGS testing, enabling accurate clinical management.
Conclusions and RelevanceThese findings suggest that NGS is an accurate diagnostic tool to differentiate causes of INS because diagnostic tests, such as electroretinography and optical coherence tomography, are not easily applicable in young infants. Accurate application of NGS using a standardized, stepwise, team-based approach in early childhood not only facilitated early molecular diagnosis but also led to improved personalized management in patients with INS.
Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 DiabetesMan, Ryan Eyn Kidd; Fenwick, Eva K.; Gan, Alfred Tau Liang; Sabanayagam, Charumathi; Gupta, Preeti; Aravindhan, Amudha; Wong, Tien Yin; Tan, Gavin Siew Wei; Lamoureux, Ecosse L.
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4888pmid: 29145552
ImportanceA patient’s perceived barriers to diabetes self-management (DSM) may affect his or her risk of diabetic retinopathy (DR); however, few studies have examined this association.
ObjectiveTo examine the association between perceived barriers to DSM and the severity spectrum of DR in Asian patients with type 2 diabetes.
Design, Setting, and ParticipantsA cross-sectional clinic-based study, the Singapore Diabetes Management Project, was conducted from December 28, 2010, to March 20, 2013, at the Singapore National Eye Centre, a tertiary eye care institute. After excluding patients with type 1 diabetes and ungradable fundus images, 361 participants were included in the analyses. Statistical analysis was conducted from July 20 to September 8, 2017.
ExposureThe degree of perceived barriers to DSM was assessed using a 23-item questionnaire comprising items about knowledge of DSM, access to care, and confidence in health care professionals. Rasch analysis was used to optimize the scale’s psychometric properties, with lower scores indicating a higher degree of self-perceived barriers.
Main Outcomes and MeasuresDiabetic retinopathy was graded from 2-field retinal images into categories of no DR (Early Treatment Diabetic Retinopathy Study levels 10-15; n = 154), mild to moderate DR (levels 20-43; n = 112), and severe DR (levels ≥53 and/or presence of clinically significant macular edema; n = 95) using the modified Airlie House classification system of DR. Multinomial logistic regression models were used to assess the association between perceived barriers and severity of DR in the worse-affected eye.
ResultsAmong the 361 participants (105 women and 256 men; mean [SD] age, 57 [8] years), a greater magnitude of perceived barriers to DSM was independently associated with higher odds of having any DR (odds ratio, 1.32; 95% CI, 1.06-1.66), mild to moderate DR (odds ratio, 1.30; 95% CI, 1.01-1.68), and severe DR (odds ratio, 1.36; 95% CI, 1.03-1.79). This association was independent of diabetes control (hemoglobin A1c, blood pressure, and lipid levels), presenting visual acuity, and socioeconomic indicators.
Conclusions and RelevanceThese results suggest that greater perceived barriers to DSM are independently associated with severity of DR. Although longitudinal data are needed, these findings suggest that evidence-based interventions to reduce patient-, practitioner-, and system-related barriers to diabetes care may help reduce the risk of DR.
Corneal Endothelial Cell Loss 3 Years After Successful Descemet Stripping Automated Endothelial Keratoplasty in the Cornea Preservation Time StudyLass, Jonathan H.; Benetz, Beth Ann; Verdier, David D.; Szczotka-Flynn, Loretta B.; Ayala, Allison R.; Liang, Wendi; Aldave, Anthony J.; Dunn, Steven P.; McCall, Tyrone; Mian, Shahzad I.; Navarro, Lisa C.; Patel, Sanjay V.; Pramanik, Sudeep; Rosenwasser, George O.; Ross, Kevin W.; Terry, Mark A.; Kollman, Craig; Gal, Robin L.; Beck, Roy W.
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4970pmid: 29127432
Key PointsQuestionWhat is the relationship between cornea preservation time and endothelial cell loss 3 years after successful Descemet stripping automated endothelial keratoplasty?
FindingsIn a randomized clinical trial evaluating 945 eyes with graft success, endothelial cell loss was 37% with preservation time 0 to 7 days and 40% with preservation time 8 to 14 days, with mean endothelial cell density of 1722 and 1642 cells/mm2, respectively, at 3 years.
MeaningAlthough endothelial cell loss 3 years after Descemet stripping automated endothelial keratoplasty is greater with longer preservation time, the effect of preservation time on endothelial cell loss is comparable from 4 to 13 days of preservation time.
Effect of Cornea Preservation Time on Success of Descemet Stripping Automated Endothelial KeratoplastyRosenwasser, George O.; Szczotka-Flynn, Loretta B.; Ayala, Allison R.; Liang, Wendi; Aldave, Anthony J.; Dunn, Steven P.; McCall, Tyrone; Navarro, Lisa C.; Pramanik, Sudeep; Ross, Kevin W.; Stulting, R. Doyle; Terry, Mark A.; Tu, Elmer Y.; Verdier, David D.; Kollman, Craig; Gal, Robin L.; Beck, Roy W.; Lass, Jonathan H.
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4989pmid: 29127431
ImportanceDemonstrating that success of Descemet stripping automated endothelial keratoplasty is similar across donor cornea preservation times (PTs) could increase the donor pool.
ObjectiveTo determine whether the 3-year rate of graft success using corneal donor tissue preserved 8 to 14 days is noninferior to that of donor tissue preserved 7 days or less.
Design, Setting, and ParticipantsA multicenter, double-masked, randomized noninferiority clinical trial was conducted from April 16, 2012, to June 5, 2017, at 40 clinical sites (70 surgeons) in the United States, with donor corneas provided by 23 US eye banks. A total of 1090 individuals (1330 study eyes) underwent Descemet stripping automated endothelial keratoplasty (1255 eyes [94.4%] for Fuchs endothelial corneal dystrophy).
InterventionsDescemet stripping automated endothelial keratoplasty with random assignment of a donor cornea with a PT of 7 days or less (0-7d PT) or 8 to 14 days (8-14d PT).
Main Outcomes and MeasuresGraft success at 3 years.
ResultsOf the 1090 participants (1330 study eyes; 60.2% women and 39.8% men; median age at enrollment, 70 years [range, 42-90 years]), the 3-year cumulative probability of graft success was 95.3% (95% CI, 93.6%-96.9%) in the 0-7d PT group and 92.1% (95% CI, 89.9%-94.2%) in the 8-14d PT group (difference, 3.2%). The upper limit of the 1-sided 95% CI on the difference was 5.4%, exceeding the prespecified noninferiority limit of 4%. The difference was mostly owing to more primary donor failures in the 8-14d PT group, with the conditional probability of failure after the first month being 2.4% in the 0-7d PT group and 3.1% in the 8-14d PT group. In preplanned secondary analyses, longer PT was associated with a lower rate of graft success (unadjusted hazard ratio for graft failure per additional day of PT, 1.10; 95% CI, 1.03-1.18; P = .008 [PT analyzed as days]), with success rates of 96.5% (95% CI, 92.3%-98.4%) for PT of 4 days or less, 94.9% (95% CI, 92.5%-96.6%) for PT of 5 to 7 days, 93.8% (95% CI, 91.0%-95.8%) for PT of 8 to 11 days, and 89.3% (95% CI, 84.4%-92.7%) for PT of 12 to 14 days (P = .01 [PT analyzed as categorical variable]).
Conclusions and RelevanceThe 3-year success rate in eyes undergoing Descemet stripping automated endothelial keratoplasty was high irrespective of PT. However, the study was unable to conclude that the success rate with donor corneas preserved 8 to 14 days was similar to that of corneas preserved 7 days or less with respect to the prespecified noninferiority limit. Although longer PT was associated with a lower success rate, the difference in rates was small when PT was less than 12 days.
Trial Registrationclinicaltrials.gov Identifier: NCT01537393
Association Between the Severity of Diabetic Retinopathy and Falls in an Asian Population With DiabetesGupta, Preeti; Aravindhan, Amudha; Gan, Alfred T. L.; Man, Ryan E. K.; Fenwick, Eva K.; Mitchell, Paul; Tan, Nicholas; Sabanayagam, Charumathi; Wong, Tien Yin; Cheng, Ching-Yu; Lamoureux, Ecosse L.
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4983pmid: 29145583
This post hoc cross-sectional analysis investigates the associations of diabetes and diabetic retinopathy severity with the likelihood of falling in participants from the multiethnic (Malay, Chinese, and Indian individuals) population-based Singapore Epidemiology of Eye Disease study.
Risk of Extraocular Extension in Eyes With Retinoblastoma Receiving Intravitreous ChemotherapyFrancis, Jasmine H.; Abramson, David H.; Ji, Xunda; Shields, Carol L.; Teixeira, Luiz F.; Schefler, Amy C.; Cassoux, Nathalie; Hadjistilianou, Doris; Berry, Jesse L.; Frenkel, Shahar; Munier, Francis L.
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4600pmid: 29098285
Key PointsQuestionWhat is the risk of extraocular extension from injecting chemotherapy into eyes with retinoblastoma?
FindingsThis 10-center cohort study, with an accumulated 3553 injections in 655 patients, identified no events of extraocular tumor that could be attributed to prior intravitreous chemotherapy injections.
MeaningThese data suggest that the occurrence of extraocular tumor in eyes with retinoblastoma receiving intravitreous chemotherapy is possible but unlikely.
Molecular Characteristics of Conjunctival Melanoma Using Whole-Exome SequencingSwaminathan, Swarup S.; Field, Matthew G.; Sant, David; Wang, Gaofeng; Galor, Anat; Dubovy, Sander R.; Harbour, J. William; Karp, Carol L.
2017 JAMA Ophthalmology
doi: 10.1001/jamaophthalmol.2017.4837pmid: 29121185
Key PointsQuestionWhat mutations can be identified with whole-exome sequencing (WES) of conjunctival melanoma (CM)?
FindingsWith WES, CM was found to harbor mutations in BRAF, NRAS, and NF1; previously unreported mutations in EGFR, APC, TERT and other cancer-associated genes; and the C→T mutation signature consistent with UV-induced DNA damage. The most common chromosomal alteration was 6p gain.
MeaningWhole-exome sequencing might enable the detection of molecular mutations targetable by cancer therapies and provide insight into the pathogenesis of CM.