Showing papers in "Ophthalmic Epidemiology in 2023"

Racial Differences in Retinopathy of Prematurity

Abstract: Purpose To delineate racial differences in the incidence and time course of ROP in a large cohort of premature infants.Methods The secondary analysis of data from the two Postnatal Growth and ROP Studies (G-ROP-1 and G-ROP-2) that were collected in 41 hospitals in North America from 2006 to 2017. According to self-reported maternal race, premature infants were classified into 3 groups: White (N = 5580), Black (N = 3252), and Asian (N = 353). Incidence, severity, and time course of ROP; plus disease; and postnatal weight gain rate were compared among racial groups.Results Black infants had significantly smaller BW (mean 1035 vs. 1131 vs.1144 grams, P < .001) and lower GA (28.2 vs. 28.6, vs. 29.1 weeks, P < .001) than White and Asian infants. However, Black infants had lower incidences of severe ROP (11.1% vs. 12.4% vs. 11.9%), ROP (42.1% vs. 43.2% vs. 30.6%), and plus disease (3.6% vs. 6.3%, vs. 5.9%) than White and Asian infants (BW and GA adjusted risk ratio for Black vs. White 0.69 for severe ROP, 0.83 for ROP, 0.44 for plus disease, all P < .0001). Mean daily-weight-gain on days of life 11–20 and 21–30 were similar across groups (P > .05), but lower in Black and Asian infants on days 31–40 (P < .001). There were no differences in the timing of severe ROP and ROP across racial groups.Conclusions Despite relatively lower GA, BW, and daily-weight-gain, Black preterm infants had lower incidences of ROP and plus disease than White preterm infants. The mechanisms for these differences require further investigation.

Intravitreal Injection Rates for Neovascular Age-Related Macular Degeneration in Australia During the 2020 COVID-19 Lockdowns.

Abstract: PURPOSE We investigate the impact of COVID-19 and lockdowns on anti-vascular endothelial growth factor (anti-VEGF) treatment for neovascular age-related macular degeneration (AMD) in Victoria (Australian state with highest burden of COVID-19 in 2020) and Australia, by examining anti-VEGF prescriptions supplied for AMD treatment between 2018 and 2020. METHODS We performed a retrospective, population-based analysis of aflibercept and ranibizumab prescriptions supplied for the treatment of AMD in Victoria and Australia between 1 January 2018 and 31 December 2020, as recorded by the Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS, the Australian Government program subsidising medication costs for Australian residents and veterans. Poisson models and univariate regression were used to descriptively examine trends in monthly anti-VEGF prescription rates with time and changes in monthly prescription rates (prescription rate ratios [RR]). RESULTS In 2020, anti-VEGF AMD prescription rates in Victoria decreased by 18% during the nationwide lockdown between March and May (RR 0.82, 95% CI: 0.80-0.85, p < .001), and by 24% during the Victorian-specific lockdown between July and October (RR 0.76, 95% CI: 0.73-0.78, p < .001). In Australia, prescription rates tended to decrease between January and October 2020, reducing by 25% (RR 0.75, 95% CI: 0.74-0.77, p < .001) between these months, including between March and April (RR 0.94, 95% CI: 0.92-0.95, p < .001) but not April and May (RR 1.10, 95% CI: 1.09-1.12, p < .001). CONCLUSION In 2020, anti-VEGF prescriptions for AMD treatment decreased modestly in Victoria during both lockdowns and in Australia during the year. Decreases may represent reduced treatment because of COVID-19, including public health orders, patients' self-limiting care, and ophthalmologists treating-and-extending to maximum intervals.

The Definition-Dependent Nature of Myopia Prevalence: A Nationwide Study of 1.5 Million Adolescents.

Abstract: PURPOSE The application of myopia definition varies considerably within the literature. The purpose of this study was to examine the relationship between different myopia and high myopia definitions and resultant prevalence estimates. METHODS A population-based cross-sectional study of 1,588,508 Israeli adolescents assessed for medical fitness before mandatory military service at the age of 17 years between 1993 through 2015. Participants underwent non-cycloplegic autorefraction. Nine definitions of myopia and seven definitions of high myopia were examined. Prevalence estimates for each definition were calculated and compared with the reference definition (right eye spherical equivalent (SE)≤-0.50D and ≤-6.00D for myopia and high myopia, respectively), to yield a rate ratio (RR) across definitions. RESULTS Applying the right eye SE≤-0.50D reference definition yielded 31.0% myopia prevalence. While some definitions resulted in similar prevalence estimates, using the right eye SE of ≤-0.75D; ≤-1.00D or least minus meridian of ≤-0.75D definitions yielded 28.8%, 26.3%, and 26.9% myopia prevalence, respectively, which corresponded to a 7.1%, 15.1% and 13.4% reduction in myopia RR, respectively. The prevalence of high myopia demonstrated considerable alternations, with a 1.7-fold increase in prevalence for the narrower threshold of SE≤-5.00D compared with SE≤-6.00D reference definition (4.2% and 2.4%, respectively). CONCLUSIONS The prevalence of myopia and especially high myopia varies between frequently applied definitions, considering diverse thresholds, eye lateralization, and spherical vs. astigmatic refractive components. This variability highlights the pressing need for standardization of myopia definition in ophthalmic research. The results of this study provide crude estimates of a "conversion rate" across data, allowing comparisons between studies that utilize different myopia definitions.

Association Between Serum Vitamin D Levels and Myopia in the National Health and Nutrition Examination Survey (2001-2006).

Abstract: PURPOSE To assess the relationship between serum vitamin D levels and myopia in people aged 12-50 years using the National Health and Nutrition Examination Survey (NHANES) database. METHODS Demographics, vision, and serum vitamin D levels from NHANES (2001-2006) were analyzed. Multivariate analyses were performed to examine the relationship between serum vitamin D levels and myopia while controlling for sex, age, ethnicity, education level, serum vitamin A, and poverty status. The main outcome was presence or absence of myopia, defined as a spherical equivalent of -1 diopters or more. RESULTS Of the 11669 participants, 5,310 (45.5%) had myopia. The average serum vitamin D concentration was 61.6 ± 0.9 nmol/L for the myopic group and 63.1 ± 0.8 nmol/L for the non-myopic group (p = .01). After adjusting for all covariates, having higher serum vitamin D was associated with lower odds of having myopia (odds ratio 0.82 [0.74-0.92], p = .0007). In linear regression modeling that excluded hyperopes (spherical equivalent > +1 diopters), there was a positive relationship between spherical equivalent and serum vitamin D levels. Specifically, as serum vitamin D doubled, spherical equivalent increased by 0.17 (p = .02) indicating a positive dose-response relationship between vitamin D and myopia. CONCLUSIONS Participants with myopia, on average, had lower serum concentrations of vitamin D compared to those without myopia. While further studies are needed to determine the mechanism, this study suggests that higher vitamin D levels are associated with lower incidence of myopia.

Factors Affecting Follow-Up Adherence of Glaucoma Patients.

Abstract: PURPOSE The objective of our study is to understand the factors associated with non-adherence to the physician's follow-up advice by persons with glaucoma. METHODS We use a four-year panel dataset containing demographic, clinical, and intervention details and doctor's advised follow-up date for a random sample of 2,622 glaucoma patients from an Indian tertiary eye care hospital. We model this unique "advised follow-up date" in multivariate logistic regressions to identify factors associated with patients' coming early or late as against on-time. An OLS regression also examines an association between delayed follow-up and declining visual acuity. RESULTS Demographic variables such as age, gender, distance to hospital, IOP, and visual acuity were not associated with delayed adherence to follow-up. Patients advised to review within 2 months (p < .001), paying patients (p < .001), and those habituated to routine follow-up (diabetes patients) (p < .01) are less likely to delay care-seeking. Patients are more likely to come on-time in visits immediately after clinical interventions relative to later ones (p < .001). Our second analysis reveals the presence of cataract and the very first post-surgery visit as factors influencing patients to come early. Our third analysis reveals that a higher proportion of delayed visits had resulted in worsening of vision in the glaucoma-affected eye. CONCLUSION Our results suggest that active counselling by doctors, especially for routine follow-up visits, can help in better follow-up adherence and prevention of glaucoma-related visual impairment.

County-level analysis of eye exam access and utilization in the united states.

Abstract: PURPOSE The eye exam is a critical tool for the prevention, screening, and diagnosis of ocular and systemic conditions. In this study, we characterize county-level variation in eye exam access and utilization for Medicare patients in the United States. METHODS This nationwide study uses the Medicare Physician & Other Practitioners - by Provider and Service dataset. We included all ophthalmologists and optometrists who performed eye exams on Medicare beneficiaries within a United States county in 2019. For every county where exams were performed, we calculated the number of practicing vision testing providers, percentage of providers classified as ophthalmologists, and the number of exams per 100 Medicare beneficiaries. Multiple linear regression was used to characterize associations between these variables and county characteristics, including measures of poverty, education, and income. RESULTS In 2019, 28937,540 eye exams were performed by 46,000 providers in 2,291 U.S. counties. In the median county, 34.9 eye exams were provided per 100 Medicare beneficiaries. The average county had 20.1 exam providers, 16.5% of whom were ophthalmologists. There were a median 6.6 eye exam providers for every 10,000 Medicare beneficiaries in the average county. The average provider performed 517.8 exams. Regression showed counties with lower median household incomes, higher poverty rates, or fewer high-school graduates had fewer eye exam providers per 10,000 Medicare beneficiaries and fewer eye exams performed per 100 Medicare beneficiaries. CONCLUSIONS We find significant county-level variation in eye exam utilization and provider availability. This reflects broader, well-recognized trends in socioeconomic health disparities in the U.S.

Visual Acuity Screening in North Indian Schools: Testing Accuracy and Cost of Alternate Screening Models.

Abstract: PURPOSE Our study compares the sensitivity, specificity and cost of visual acuity screening as performed by all class teachers (ACTs), selected teachers (STs) and vision technicians (VTs) in north Indian schools. METHODS Prospective cluster randomized control studies are conducted in schools in a rural block and an urban-slum of north India. Consenting schools, with a minimum of 800 students aged 6 to 17 years, within a defined study region in both locations, were randomised into three arms: ACTs, STs or VTs. Teachers were trained to test visual acuity. Reduced vision was defined as unable to read equivalent of 20/30. Optometrists, who were masked to results of initial screening, examined all children. Costs were measured for all three arms. RESULTS The number of students screened were 3410 in 9 ACT schools, 2999 in 9 ST schools and 3071 in 11 VT schools. Vision deficit was found in 214 (6.3%), 349 (11.6%) and 207 (6.7%), (p < .001) children in the ACT, ST and VT arms, respectively. The positive predictive value of VT screening for vision deficit (81.2%) was significantly higher than that of ACTs (42.5%) and STs (30.1%), (p < .001). VTs had significantly higher sensitivity of 93.3% and specificity of 98.7%, compared to ACTs (36.0% and 96.1%) and STs (44.3% and 91.2%). The cost of screening children with actual visual deficit by ACTs, STs and VTs, was found to be $9.35, $5.79 and $2.82 per child, respectively. CONCLUSION Greater accuracy and lower cost favours school visual acuity screening by visual technicians in this setting, when they are available.

The Prevalence of Trachomatous Trichiasis in People Aged 15 Years and Over in Six Evaluation Units of Gaoual, Labé, Dalaba and Beyla Districts, Guinea.

Abstract: PURPOSE Trachoma is a public health problem in 42 countries. Inflammation associated with repeated ocular infection with Chlamydia trachomatis can cause the eyelid to scar and turn inwards, resulting in the eyelashes rubbing against the eyeball, known as trachomatous trichiasis (TT). In Guinea, baseline surveys conducted in 2013 reported inflammatory trachoma prevalences below the World Health Organization (WHO) threshold for elimination, but TT prevalences above threshold. Given this epidemiological context and time since baseline survey, TT-only surveys were conducted in selected districts to determine current TT prevalence. The results of this study provide critical data for assessing Guinea's achievement of trachoma elimination targets. METHODS Four health districts, consisting of six evaluation units (EU), were surveyed. In each EU, field teams visited 29 clusters with a minimum 30 households included in each. Participants aged≥15 years were examined by certified graders trained to identify TT and determine whether management had been offered. RESULTS A total of 22,476 people were examined, with 48 TT cases across the six EUs identified. Five of six EUs had an age-and-gender adjusted TT-prevalence unknown to the health system less than 0.2%, whereas one EU, Beyla 2, had an adjusted TT prevalence of 0.24%. CONCLUSION These TT-only surveys, along with findings from other trachoma interventions, suggest that Guinea is close to achieving elimination of trachoma as a public health problem. This study demonstrates the value of undertaking TT-only surveys in settings where baseline surveys indicated active trachoma prevalences below WHO elimination threshold, but TT prevalences above it.

A Review of the Published Literature in Global Population-Based Studies of Childhood Blindness and Vision Impairment.

Abstract: PURPOSE Reducing childhood blindness and vision impairment (BVI) remains a global health priority. Our purpose was to summarize the peer-reviewed literature to date on measuring and reporting childhood BVI using population-based surveys and vision examinations. METHODS We conducted a scoping review of published studies that aimed to report BVI prevalence in children or studies that aimed to report BVI prevalence in the general population but which also included children. There were 201 articles identified for abstract review, and 86 studies were included in the final review. RESULTS There were 52 studies (60%) that specifically aimed to investigate prevalence of blindness and/or vision impairment among child populations, while the remaining 34 studies aimed to study BVI in the general population but still reported data for age ranges that included children. The majority of researchers used the WHO criteria for blindness and vision impairment, sometimes with modifications. Age definitions for children varied considerably, with maximum cutoffs ranging from 3 to 20 years. CONCLUSION The available literature on childhood blindness indicates that while there has been substantial progress towards establishing an evidence base, more remains to be accomplished in terms of addressing gaps in understanding of the true prevalence and impacts of childhood blindness and vision loss. All studies in this review cited the need for improved vision care services, either for all ages or for the childhood years in particular.

Air Pollution and Chronic Eye Disease in Adults: A Scoping Review.

Abstract: PURPOSE We conducted a scoping review of studies examining ambient air pollution as a risk factor for chronic eye disease influencing the lens, retina, and intraocular pressure in adults. METHODS Terms related to air pollution and eye disease outcomes were used to search for publications on Embase, Web of Science Core Collection, Global Health, PubMed, and the Cochrane Central Register of Controlled Trials from January 1, 2010, through April 11, 2022. RESULTS We identified 27 articles, focusing on the following non-mutually exclusive outcomes: cataract (n = 9), presbyopia (n = 1), retinal vein occlusion or central retinal arteriolar and venular equivalents (n = 5), intraocular pressure (IOP) (n = 3), glaucoma (n = 5), age-related macular degeneration (AMD) (n = 5), diabetic retinopathy (n = 2), and measures of retinal morphology (n = 3). Study designs included cross-sectional (n = 16), case-control (n = 4), and longitudinal (n = 7). Air pollutants were measured in 50% and 95% of the studies on lens and retina or IOP, respectively, and these exposures were assigned to geographic locations. Most research was conducted in global regions with high exposure to air pollution. Consistent associations suggested a possibly increased risk of cataract and retina-associated chronic eye disease with increasing exposure to particulate matter (PM2.5-PM10), NO2, NOx, and SO2. Associations with O3 were less consistent. CONCLUSIONS Accumulating research suggests air pollution may be a modifiable risk factor for chronic eye diseases of the lens and retina. The number of studies on each specific lens- or retina-related outcome is limited. Guidelines regarding the role of air pollution in chronic eye disease do not exist.

Evolution of Disparities in Outpatient Ophthalmic Care at a Tertiary Care Center in California at the Beginning of and One Year into the COVID-19 Public Health Emergency.

Abstract: PURPOSE To compare disparities in outpatient ophthalmic care during early and later periods of the COVID-19 public health emergency. METHODS This cross-sectional study compared non-peri-operative outpatient ophthalmology visits by unique patients at an adult ophthalmology practice affiliated with a tertiary-care academic medical center in the Western US during three time periods: pre-COVID (3/15/19-4/15/19), early-COVID (3/15/20-4/15/20), and late-COVID (3/15/21-4/15/21). Differences in participant demographics, barriers to care, visit modality (telehealth, in person), and subspeciality of care were studied using unadjusted and adjusted models. RESULTS There were 3095, 1172 and 3338 unique patient-visits during pre-COVID, early-COVID and late-COVID (overall age 59.5 ± 20.5 years, 57% female, 41.8% White, 25.9% Asian, 16.1% Hispanic). There were disparities in patient age (55.4 ± 21.8 vs. 60.2 ± 19.9 years), race (21.9% vs. 26.9% Asian), ethnicity (18.3% Hispanic vs. 15.2% Hispanic), and insurance (35.9% vs. 45.1% Medicare) as well as changes in modality (14.2% vs. 0% telehealth) and subspecialty (61.6% vs. 70.1% internal exam specialty) in early-COVID vs. pre-COVID (p < .05 for all). In late-COVID, only insurance (42.7% vs. 45.1% Medicare) and modality of care (1.8% vs. 0% telehealth) persisted as differences compared to pre-COVID. CONCLUSIONS There were disparities in patients receiving outpatient ophthalmology care during early-COVID that returned close to pre-COVID baseline one year later. These results suggest that there has not been a lasting positive or negative disruptive effect of the COVID-19 pandemic on disparities in outpatient ophthalmic care.

Antiviral and Anti-Inflammatory Therapeutic Interventions for Treating Herpes Stromal Keratitis: A Systematic Review.

Abstract: PURPOSE Herpes stromal keratitis (HSK) is an immune-mediated corneal inflammation that occurs after a herpes simplex virus infection. This paper aims to systematically identify and compare interventions for treating HSK and their patient outcomes. METHODS This systematic review followed the PRISMA methodology. Online databases were searched to obtain all relevant papers. Two independent reviewers screened through 168 records. Seven papers were included and used for data extraction. A qualitative analysis was conducted. RESULTS HSK patients receiving prednisolone phosphate and acyclovir showed a higher treatment success rate and significantly longer time to failure compared to patients receiving only acyclovir (P < .001). No difference in resolution time was found between oral and topical acyclovir. Between groups receiving dexamethasone and flurbiprofen, resolution occurred in 93% and 67% of patients, and BCVA (LogMAR) improved from 1.0 to 0.30 and 0.48, respectively. BCVA improved in both cyclosporine-A (P < .001) and its control (prednisolone) groups (P = .002). A tacrolimus treatment group showed greater improvement in BCVA compared to its control (prednisolone) group (P < .001). CONCLUSION Corticosteroids and antivirals managed HSK most effectively only when used concurrently. Oral acyclovir showed similar effectiveness to its ointment counterpart, a preferable alternative for easier administration. Corticosteroid use could induce greater therapeutic benefits when tapered in concentration and frequency and administrated for at least 10 weeks. Anti-inflammatory drugs including flurbiprofen, cyclosporine-A, and tacrolimus could be safe and effective for treating HSK. Future long-term follow-up and RCTs could provide insights on the therapeutic benefits of these potential alternatives.

Domestic Violence-Related Ocular Injuries Among Adult Patients: Data from the Nationwide Emergency Department Sample, 2008-2017.

Abstract: PURPOSE To investigate domestic violence (DV)-related ocular injuries among adult emergency department (ED) patients in the US. METHODS This was a retrospective, cross-sectional study of patients with a diagnosis of DV and diagnosis of ocular injury in the Nationwide Emergency Department Sample (NEDS) from 2008-2017. We identified patient- and hospital-level variables associated with DV-related ocular injuries. We calculated annual incidence rates using US Census data. Adjusting for inflation using the Consumer Price Index, we calculated mean and total charges. RESULTS From 2008-2017, there were 26,215 ED visits for ocular injuries related to DV with an average incidence of 1.09 per 100,000 adult population (female patients, 84.5%; mean age [SE], 34.3 [0.2]). DV-related ocular injuries were most prevalent among patients in the lowest income quartile (39.1%) and on Medicaid (37.4%). Most ED visits presented to metropolitan teaching (55.4%), non-trauma (46.7%), and south regional (30.5%) hospitals. The most common ocular injury was contusion of eye/adnexa (61.1%). The hospital admission rate was 5.2% with a mean hospital stay of 2.9 [0.2]. The inflation-adjusted mean cost for medical services was $38,540 [2,310.8] per encounter with an average increase of $2,116 per encounter, annually. The likelihood of hospital admission increased for patients aged ≥60 years old, on Medicare, and with open globes or facial/orbital fractures (all p < .05). CONCLUSION Contusion of the eye/adnexa was the most common ocular injury among patients with DV-related ED visits. To better facilitate referrals to social services, ophthalmologists should utilize DV screenings, especially towards women and patients of less privileged socioeconomic status.

Effects of Cost Sharing on Ophthalmic Care Utilization in the Affordable Care Act Marketplace.

Abstract: PURPOSE To determine the distribution and quantity of ophthalmic care consumed on Affordable Care Act (ACA) plans, the demographics of the population utilizing these services, and the relationship between ACA insurance coverage plan tier, cost sharing, and total cost of ophthalmic care consumed. METHODS This cross-sectional study analyzed ACA individual and small group market claims data from the Wakely Affordable Care Act (WACA) 2018 dataset, which contains detailed claims, enrollment, and premium data from Edge Servers for 3.9 million individual and small group market lives. We identified all enrollees with ophthalmology-specific billing, procedure, and national drug codes. We then analyzed the claims by plan type and calculated the total cost and out-of-pocket (OOP) cost. RESULTS Among 3.9 million enrollees in the WACA 2018 dataset, 538,169 (13.7%) had claims related to ophthalmology procedures, medications, and/or diagnoses. A total of $203 million was generated in ophthalmology-related claims, with $54 million in general services, $42 million in medications, $20 million in diagnostics and imaging, and $86 million in procedures. Average annual OOP costs were $116 per member, or 30.9% of the total cost, and were lowest for members with platinum plans (16% OOP) and income-driven cost sharing reduction (ICSR) subsidies (17% OOP). Despite stable ocular disease distribution across plan types, beneficiaries with silver ICSR subsidies consumed more total care than any other plan, higher than platinum plan enrollees and almost 1.5× the cost of bronze plan enrollees. CONCLUSIONS Ophthalmic care for enrollees on ACA plans generated substantial costs in 2018. Plans with higher OOP cost sharing may result in lower utilization of ophthalmic care.

Association Between Area Temperature and Severe Vision Impairment in a Nationally Representative Sample of Older Americans.

Abstract: PURPOSE Several small studies have associated exposure to elevated average temperature with specific vision problems. However, no large-scale studies have examined the relationship between vision impairment and average area temperature in the general population. We conducted a cross-sectional analysis of a large nationally representative sample of older adults to further explore this relationship. METHODS Secondary analysis of the American Community Survey (ACS). The survey was conducted through mail, telephone and in-person interviews. Data from six consecutive years of the cross-sectional survey were analysed (2012-2017). The subsample analysed included community-dwelling and institutionalized older adults aged 65 and older in the coterminous US who lived in the same state in which they were born (n = 1,707,333). The question on severe vision impairment was "Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?". Average annual temperature data from the National Oceanic and Atmospheric Administration was combined into a 100-year average and mapped to corresponding US Census Bureau's public use microdata areas from the ACS. RESULTS Higher average temperature is consistently associated with increased odds of severe vision impairment across all cohorts (i.e. age, sex, race, income, and educational attainment cohorts) with the exception of Hispanic older adults. Compared to those who lived in counties with average temperature of < 50 °F (< 10 °C) , the odds of severe vision impairment were 44% higher in counties with average temperature of 60 °F (15.5 °C) or above (OR 1.44; 95% CI 1.42-1.46). CONCLUSION If the association is found to be causal, the predicted rise in global temperatures could impact the number of older Americans affected by severe vision impairment and the associated health and economic burden.

Weather Patterns and the Frequency of Ophthalmology Consultations in the Emergency Setting.

Abstract: PURPOSE To determine if weather patterns are associated with the frequency of ophthalmology consultations in the Emergency Room (ER) and trauma settings. METHODS Hospital-based ophthalmology consultations between January 1, 2015 and December 31, 2020 at the University of Maryland Medical Center (UMMC) were included in the BALCITE (BALtimore Consultation, Inpatient, and Trauma of the Eye) database. Encounters were filtered to the general ER, the R. Crowley Adams Shock Trauma Center, and consultations within 24 h of admission where a delay was attributed to bed assignment. Weather data from the National Climatic Data Center (NCDC) for Baltimore, Maryland, was matched to the day of the initial encounter. RESULTS A total of 3,877 patients were included. Overall, there was a significant association between increasing daily average temperature (R2 = .152, p = 0.0003) and daily maximum temperature (R2 = .243, p < 0.001) with incidence of ophthalmology consultations. There was no significant decrease in consultations with increasing precipitation (R2 = -.007, p = 0.7477). For trauma-related consultations, there was not a significant association between consultation incidence and average daily temperature (R2 = .011, p = 0.2013), maximum daily temperature (R2 = -0.012, p = 0.6529), or precipitation levels (R2 = .075, p = 0.24). The months with the highest consultation volume were September, August, and July, and the lowest numbers in April, March, and February. CONCLUSIONS Emergency ophthalmology consultations increased with increasing daily temperature. Trauma-specific consultations did not show a significant association with weather patterns. This information may prove useful to ER providers and ophthalmologists in order to help predict frequency of consultations and better deploy personnel and resources.

Prevalence and Risk Factors of Major Depression in Patients with Diabetic Retinopathy in a Nationally Representative Survey.

Abstract: PURPOSE Evaluate the prevalence and risk factors of depression in diabetic retinopathy (DR). Compare subjective and objective measures of visual function predictivity of depression. METHODS National Health and Nutrition Examination Survey 2005-2008 participants aged ≥40 who underwent fundus photography, Patient Health Questionnaire (PHQ)-9, and Visual Function Questionnaire (VFQ-25) were included in the study. Multivariable logistic regression was used to evaluate whether DR was a significant risk factor for depression and to evaluate the risk factors for depression in those with DR. RESULTS A total of 5704 participants, 47% male, and mean age 56.5 years were included in this study. Persons with moderate, severe non-proliferative diabetic retinopathy (NPDR), or proliferative retinopathy (PDR) had higher prevalence of depression than participants with mild retinopathy or no retinopathy (14.3%, 6.9%, 7.0%). Moderate-to-severe NPDR or PDR (OR: 2.36, p = .04) was associated with depression. Among persons with DR, best-corrected visual acuity and HbA1c were not associated with depression. However, self-reported measures of vision were associated with depression: some of the time spent worrying about eyesight (OR: 4.59, p = .010), vision limit activities some of the time (OR: 8.52, p < .001), vision limits activities most/all of the time (OR: 6.99, p < .001). CONCLUSIONS A significant proportion of patients with DR in the NHANES population had co-morbid major depression. Best corrected visual acuity was not associated with depression in those with DR, while subjective, self-reported measures were associated with depression, suggesting subjective measures are a better determinant of poor mood and low functional status.

Prevalence of Trachoma in Four Evaluation Units in Yemen after Implementation of Trachoma Elimination Measures.

Abstract: BACKGROUND In baseline trachoma prevalence surveys, six districts in two governorates of Yemen were identified as requiring interventions. We set out to estimate the prevalence of trachoma 6-12 months after one round of antibiotic mass drug administration (MDA) and implementation of measures to encourage facial cleanliness. METHODS A population-based prevalence survey was conducted in each of the four evaluation units in October 2019. Contemporary World Health Organization recommendations for trachoma surveys were followed. Participants were selected using a two-stage cluster sampling process. The prevalence of inflammatory and late-stage trachoma was measured through eye examination. Water, sanitation, and hygiene facility access among visited households was estimated. RESULTS The prevalence of trachomatous inflammation-,follicular (TF) in 1-9-year-olds per EU was <5.0% in three EUs (Al Mighlaf, Al Munirah, and As Salif; Az Zaydiyah; and Mudhaykhirah districts) and 5.0-9.9% in one EU (Far Al Udayn District). The prevalence of TT unknown to the health system in ≥15-year-olds per EU was <0.2% in all four EUs. Per EU, the proportion of households with an improved drinking water source ranged from 40% to 100%; access to an improved drinking water source within 30-minute return journey of the household ranged from 45% to 100%; and with an improved latrine ranged from 32% to 83%. CONCLUSION An additional round of antibiotic MDA should be administered in Far Al Udayn district before it is resurveyed. In the other surveyed districts, pre-validation surveillance surveys should be conducted in 2 years' time to determine if the TF prevalence <5% has been maintained.

Nationwide Rapid Assessment of Avoidable Blindness (RAAB) in Armenia.

Abstract: PURPOSE This study aimed to estimate the prevalence and main causes of blindness and visual impairment in population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. METHODS The study team randomly selected 50 clusters (each consisting of 50 people) from all 11 regions of Armenia. Data on participants' demographics, presenting visual acuity, pinhole visual acuity, principal cause of presenting visual acuity, spectacle coverage, uncorrected refractive error (URE), and presbyopia were collected using the RAAB survey form. Four teams of trained eye care professionals completed data collection in 2019. RESULTS Overall, 2,258 people of 50 years and older participated in the study. The age- and gender- adjusted prevalence of bilateral blindness, severe and moderate visual impairment were 1.5% (95% CI: 1.0-2.1), 1.6% (95% CI: 1.0-2.2) and 6.6% (95% CI: 5.5-7.7), respectively.The main causes of blindness were cataract (43.9%) and glaucoma (17.1%). About 54.6% and 35.3% of participants had URE and uncorrected presbyopia, respectively. The prevalence of bilateral blindness and functional low vision increased with age and was the highest in participants 80 years and older. CONCLUSION The rate of bilateral blindness was comparable with findings from countries that share similar background and confirmed that untreated cataract was the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed aiming to further increase the volume and quality of cataract care in Armenia.

Baseline, Impact and Surveillance Trachoma Prevalence Surveys in Burundi, 2018-2021.

Abstract: PURPOSE Trachoma is an eye disease caused by the bacterium Chlamydia trachomatis (Ct). It can lead to permanent vision loss. Since 2007, Burundi has included trachoma elimination as part of its fight against neglected tropical diseases and blindness. This study presents the results of trachoma baseline, impact and surveillance surveys conducted in Burundi between 2018 and 2021. METHODS Areas were grouped into evaluation units (EU) with resident populations of between 100,000 and 250,000 people. Baseline surveys were conducted in 15 EUs, impact surveys in 2 EUs and surveillance surveys in 5 EUs; in each survey, 23 clusters of about 30 households were included. Consenting residents of those households were screened for clinical signs of trachoma. Access to water, sanitation and hygiene (WASH) was recorded. RESULTS A total of 63,800 individuals were examined. The prevalence of TF in 1-9-year-olds was above the elimination threshold of 5% in a single EU at baseline, but fell below the threshold in subsequent impact and surveillance surveys. The prevalence of TT was below the 0.2% elimination threshold in ≥15-year-olds in all EUs surveyed. A high proportion (83%) of households had access to safe drinking water, while only a minority (~8%) had access to improved latrines. CONCLUSION Burundi has demonstrated the prevalence levels necessary for trachoma elimination status. With continued effort and the maintenance of existing management plans, trachoma elimination in Burundi is within reach.

The Association Between the Severity of Trachomatous Scarring and Trachomatous Trichiasis Severity in Surgical Patients in Tanzania.

Abstract: PURPOSE To determine the association between the severity of trachomatous conjunctival scarring (TS) of the upper eyelid conjunctiva and trachomatous trichiasis (TT) severity in TT surgical patients. METHODS A cross-sectional study was conducted amongst adults with TT who were referred to surgical camps in Bahi District, Tanzania, for TT surgery. Participants underwent ocular examination. The presence and severity of TS was evaluated in photographs of the everted upper eyelid. TT severity was assessed at the time of the ocular exam based on the number of lashes touching the globe and/or evidence and extent of epilation. Ordinal logistic models were used to examine the association between the severity of TS and TT severity. RESULTS A total of 627 eyes of 388 participants were included. Mean age was 65 years (ranging from 21-98), 81% were females, and 62% had bilateral TT. 93% of eyes with any TT had at least moderate TS; 62% of eyes had severe TS. An increase in TS severity was associated with an increase in the severity of TT. Using as a reference eyes with none to mild TS, in eyes with moderate TS the odds of increased severity of TT was 1.30 (95% CI 0.67-2.51), in eyes with severe TS the odds was 4.20 (95% CI 2.23-7.92). CONCLUSION In cases of trachomatous trichiasis presenting for surgery, the severity of TT was significantly associated with the severity of TS with almost all cases of TT having moderate or severe scarring.

Rationale, Design and Methodology of a Population-Based Ocular Study in a Suburbanization Region in Tianjin, China: The Beichen Eye Study.

Abstract: PURPOSE The urbanization of suburbs has a significant impact on ocular health, however, the effect of this phenomenon on the epidemiology of eye diseases in the sub-urbanization region of China remains unclear. In this context, the population-based Beichen Eye Study (BCES) was conducted in the Beichen District of Tianjin, China. This article aims to summarize the background, design scheme and operation process of the study. The Chinese Clinical Trial Registry number was ChiCTR2000032280. METHODS In total, 8218 participants were randomly selected by a multi-stage sampling method. After their qualification was confirmed, participants were mainly invited to a centralized clinic via telephone interviews after promotion of the study in the community. Examinations included a standardized interview, anthropometric assessment, autorefraction, ocular biometry, visual acuity, anterior and posterior segment examinations, dry eye disease (DED), intra-ocular pressure, visual field testing, gonioscopy, and imaging of anterior segment, posterior segment, fundus, and optic disc. A peripheral venous blood sample was also collected for biochemical testing. For observational purposes, a community-based type II diabetes mellitus management mode was created and assessed for its effect in preventing the progression of diabetic retinopathy (DR). RESULTS Of the 8,218 residents, 7,271 were eligible for inclusion, and 5,840 (80.32%) subjects were enrolled in the BCES. Most of the participants were female (64.38%) with a median age of 63 years, and 98.23% representing Han Chinese descent. Conclusions: This study provides insights into the epidemiological characteristics of major ocular diseases and their moderators in a suburbanized region of China.

Health Care Disparities in Diabetes and Diabetic Retinopathy.

Abstract: PURPOSE To investigate prevalence of diabetes (DM), diabetic retinopathy (DR), and areas with highest rates of undetected DR. To quantify and map locations of disparities as they relate to poverty and minority populations. METHODS Retrospective cohort study from large regional health data repository (HealthLNK). Geographic Information System (GIS) analysis mapped rates of DM and DR in Chicago area ZIP Codes. RESULTS Of 1,086,921 adults who met the inclusion criteria, 143,790 with DM were identified. ZIP Codes with higher poverty rates were correlated with higher prevalence of DM and DR (Pearson's correlation coefficient 0.614, p < .05, 0.333, p < .05). Poverty was negatively correlated with likelihood of DR diagnosis (-0.638, p < .05). Relative risks of DM and DR were calculated in each ZIP Code and compared to actual rates. 36 high-risk ZIP Codes had both high-risk of DM and low DR detection. In high-risk ZIP Codes 85.4% of households self-identified as ethnic minority and 33.0% were below the Federal Poverty Level (FPL). Both percentages were significantly higher than the Chicago average of 50.5% minority and 19.9% below FPL (p < .05). 67 ideal ZIP Codes had both low risk of DM and high DR detection. In ideal ZIP Codes 32.6% of households self-identified as minority, and 10.2% were below the FPL (p < .05). CONCLUSIONS A health care disparity exists with regards to DM and DR. High-risk ZIP Codes are associated with higher poverty and higher minority population, and they are highly concentrated in just 17% of the ZIP codes in the Chicago area.

Erythropoiesis-Stimulating Agents and the Risk of Vision-Threatening Diabetic Retinopathy.

Abstract: PURPOSE Animal studies have suggested that Erythropoiesis-Stimulating Agents (ESAs) may increase vascular endothelial growth factor (VEGF)-related retinopathies, but this effect is unclear in humans. This study evaluates the risk of vision-threatening diabetic retinopathy (VTDR), defined as either diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR), in patients exposed to an ESA. METHODS Two analyses were performed. First, a retrospective matched-cohort study was designed using a de-identified commercial and Medicare Advantage medical claims database. The ESA cohort of non-proliferative diabetic retinopathy patients who were new users of an ESA from 2000 to 2022 was matched to controls up to a 3:1 ratio. Exclusion criteria included less than 2 years in the plan, history of VTDR or history of other retinopathy. Multivariable Cox proportional hazards regression with inverse proportional treatment weighting (IPTW) was used to assess the hazard of developing VTDR, DME, and PDR. The second analysis was a self-controlled case series (SCCS) evaluating the incidence rate ratios (IRR) of VTDR during 30-day periods before and after initiating an ESA. RESULTS After inclusion of 1502 ESA-exposed patients compared with 2656 controls, IPTW-adjusted hazard ratios found the ESA cohort had an increased hazard of progressing to VTDR (HR = 3.0 95%CI:2.3-3.8;p < .001) and DME (HR = 3.4,95%CI:2.6-4.4,p < .001), but not PDR (HR = 1.0,95%CI:0.5-2.3,p = .95). Similar results were found within the SCCS which demonstrated higher IRRs for VTDR (IRRs = 1.09-1.18;p < .001) and DME (IRRs = 1.16-1.18;p < .001), but not increased IRRs in PDR (IRR = 0.92-0.97,p = .02-0.39). CONCLUSION ESAs are associated with higher risks for VTDR and DME, but not PDR. Those studying ESAs as adjunctive therapy for DR should be cautious of possible unintended effects.

Prevalence, Associated Factors, and Inter-Eye Differences of Refractive Errors in a Population-Based Japanese Cohort: The Tohoku Medical Megabank Eye Study.

Abstract: PURPOSE To investigate the prevalence, associated factors, and inter-eye differences of myopia and astigmatism in an adult Japanese population-based cohort. METHODS A total of 4282 participants from the Tohoku Medical Megabank Organization Eye Study (ToMMo Eye Study) underwent comprehensive ocular examinations as well as extensive physiological tests and a lifestyle questionnaire. The spherical equivalent (SE) and cylinder power were obtained as refractive parameters. The age- and gender-stratified prevalences of high myopia (SE < -5D), myopia (SE < -0.5D), hyperopia (SE > 0.5D), astigmatism (cylinder power < -0.5D), and anisometropia (SE difference >1D) were calculated. Multivariable analyses were performed to identify associated factors for refractive error (RE). Distribution and associated factors of the inter-eye difference in RE were also investigated. RESULTS The age-adjusted prevalence of high myopia, myopia, hyperopia, astigmatism, and anisometropia was 15.9%, 63.5%, 14.7%, 51.1%, and 14.7%, respectively. Both myopia and high myopia were more prevalent in the younger age group, while astigmatism was more prevalent in the older age group. Age, education, blood pressure, intraocular pressure, and corneal thickness are significantly associated with myopic refraction. Age, gender, intraocular pressure, and corneal thickness are correlated with astigmatism. Older age was associated with against-the-rule astigmatism. Older age, myopia, and longer education showed a significant correlation with large inter-eye differences in SERE. CONCLUSIONS This study demonstrated the high prevalence of myopia in young Japanese, which may be caused by a generational shift. This study also confirmed the influence of age and education on both the prevalence and inter-eye differences of RE.

Risk Factors for Chalazion Diagnosis and Subsequent Surgical Excision.

Abstract: PURPOSE To identify factors associated with chalazion diagnosis and surgical excision. METHODS Patients with an incident chalazion diagnosis from 2002 to 2019 were compared 1:5 with matched controls. Multivariable logistic regression was performed to identify variables associated with diagnosis and surgical excision. RESULTS Chalazion patients (n = 134,959) and controls (678,160) were analyzed. Risk factors for diagnosis included female sex, non-white race, northeast location, conditions affecting periocular skin and tear film (blepharitis, meibomian gland dysfunction, rosacea, pterygium), non-ocular inflammatory conditions (gastritis, inflammatory bowel disease, sarcoidosis, seborrheic dermatitis, Graves' disease), and smoking (p < .001 for all comparisons). Thirteen percent of patients with chalazion underwent subsequent surgical excision. Diabetes and systemic sclerosis diagnoses decreased odds of diagnosis (p < .001). Male sex, rosacea diagnosis, Black and Hispanic race, antibiotic use, and doxycycline use increased odds of surgery (p < .001). CONCLUSION Female sex, non-white race, conditions affecting periocular skin and the tear film, several non-ocular inflammatory conditions, and smoking were risk factors for chalazion diagnosis. Male sex, rosacea diagnosis, Black and Hispanic race, antibiotic use, and doxycycline use were risk factors for surgical intervention for chalazion. Our results prompt further study of these variables and their relationship to chalazion diagnosis to understand physiology and improve clinical outcomes. Furthermore, the results of this study suggest early recognition and treatment of concomitant rosacea may serve an important role in the management of chalazion and in the prevention of surgical intervention.

Increased Number and Severity of Open Globe Injuries during COVID-19 Stay-at-home Orders.

Abstract: PURPOSE To evaluate the occurrence and outcome of open globe injury during state-mandated COVID-19 stay-at-home orders compared to historical averages at a tertiary medical center in Portland, Oregon. METHODS Open globe injury between January 1, 2015 and December 31, 2020 was identified using relevant procedure codes. The number of injuries, mechanism of trauma, and short-term outcomes of globes repaired during the study period of March 23, 2020 to July 6, 2020 when stay-at-home orders were in effect were compared to a cohort from the same 15-week time frame in 2015-2019. We also evaluated injuries occurring throughout 2020 as compared to the prior 5 years. RESULTS 263 consecutive open globe injuries were identified between January 2015 and December 2020. While Oregon's stay-at-home orders were in effect, we observed a significant increase in the number of open globe injuries treated compared to the prior 5 years (p = .004). Twenty-four cases identified during the study period represent a 2-fold increase over the 2015-2019 average of 11.8 globe repairs during the same 15-week time period. Visual acuity < 20/200 at 6 months (p = .008) and secondary enucleation (p < .001) were more frequent during stay-at-home orders, and severity of injury as calculated by the Ocular Trauma Scores (OTS) was higher. Time-to-repair was similar between the two cohorts. CONCLUSION At our center, there was an increased number and severity of open globe injury during the period of mandatory COVID-19 stay-at-home orders. Visual acuity outcomes and risk for secondary enucleation were poorer compared to the reference cohort.Abbreviations: Ocular Trauma Score (OTS), Open globe injury (OGI), Emergency department (ED), Oregon Health and Science University (OHSU).

Ocular Involvement and Treatment Pattern in Korean Patients with Marfan Syndrome: A Population-Based Study.

Abstract: PURPOSE This study aimed to investigate the incidence and prevalence of, and treatment patterns for ocular complications in Korean patients with Marfan syndrome. METHODS Incidence and prevalence of Marfan syndrome was calculated from 2010 to 2018, based on data from the Korean National Health Insurance Service (KNHIS). Diagnosis codes (for cataract, ectopia lentis, retinal detachment, etc.) and surgery reimbursement codes (lensectomy, phacoemulsification, buckling, vitrectomy, etc.) in the patients with Marfan syndrome were retrieved by complete enumeration of the data. RESULTS The annual prevalence of Marfan syndrome adjusted by age and sex was gradually increased from 2.44 per 100,000 in 2010 to 4.36 per 100,000 in 2018. The age group of 10-19 years showed the highest prevalence. The prevalence of ectopia lentis was 21.7%, of whom 43.0% underwent surgeries. Surgery for RD was performed in 253 (14.1%) of 2044 patients during the study period. CONCLUSION Although the most prevalent ophthalmologic manifestation was ectopia lentis, total prevalence rate of RD was more than 10% in the study period; thus, regular fundus examination is recommended for the patients with Marfan syndrome.

Increased Risk of Glaucoma in Patients with Sjögren's Syndrome: A Nationwide Population-Based Cohort Study.

Abstract: PURPOSE The risk of glaucoma in patients suffering from Sjögren's syndrome has not been elucidated. We aimed for evaluating the absolute incidence as well as the relative risk of glaucoma in patients with SS at the level of the whole country population. METHODS We conducted a retrospective cohort study using a national health insurance database in Taiwan from 2000 to 2013. We used International Classification of Diseases, Ninth Revision, to categorise medical conditions for study group and comparison group. We used Cox proportional hazard regression analysis to determine adjusted hazard ratios (aHRs) of glaucoma between study and comparison group after adjusting for sex, age, and comorbidities. RESULTS Among 17,398 patients with primary Sjögren's syndrome, 133 patients were diagnosis with glaucoma during follow-up. Of the 69,592 non-primary Sjögren's syndrome patients, 429 patients developed glaucoma. Glaucoma risk was elevated in patients with primary Sjögren's syndrome than in the non-Sjögren's syndrome group (adjusted hazard ratio [HR] 2.274, 95% in the confidence interval [95% CI] 1.847-2.800; P < .001). CONCLUSIONS The risk of glaucoma among the population having Sjögren's syndrome was higher than those did not have Sjögren's syndrome. It indicated the necessity of regular examination for glaucoma in patients with Sjögren's syndrome.