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Hartmann A, Grabitz SD, Wagner FM, Wild PS, Müller-Nurasyid M, Lackner KJ, Beutel ME, Münzel T, Tüscher O, Schattenberg JM, Pfeiffer N, Schuster AKG. Bi-Gaussian analysis reveals distinct education-related alterations in spherical equivalent and axial length-results from the Gutenberg Health Study. Graefes Arch Clin Exp Ophthalmol 2024; 262:1819-1828. [PMID: 38446204 PMCID: PMC11106185 DOI: 10.1007/s00417-024-06395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/26/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
PURPOSE The aim of this study is to investigate the distribution of spherical equivalent and axial length in the general population and to analyze the influence of education on spherical equivalent with a focus on ocular biometric parameters. METHODS The Gutenberg Health Study is a population-based cohort study in Mainz, Germany. Participants underwent comprehensive ophthalmologic examinations as part of the 5-year follow-up examination in 2012-2017 including genotyping. The spherical equivalent and axial length distributions were modeled with gaussian mixture models. Regression analysis (on person-individual level) was performed to analyze associations between biometric parameters and educational factors. Mendelian randomization analysis explored the causal effect between spherical equivalent, axial length, and education. Additionally, effect mediation analysis examined the link between spherical equivalent and education. RESULTS A total of 8532 study participants were included (median age: 57 years, 49% female). The distribution of spherical equivalent and axial length follows a bi-Gaussian function, partially explained by the length of education (i.e., < 11 years education vs. 11-20 years). Mendelian randomization indicated an effect of education on refractive error using a genetic risk score of education as an instrument variable (- 0.35 diopters per SD increase in the instrument, 95% CI, - 0.64-0.05, p = 0.02) and an effect of education on axial length (0.63 mm per SD increase in the instrument, 95% CI, 0.22-1.04, p = 0.003). Spherical equivalent, axial length and anterior chamber depth were associated with length of education in regression analyses. Mediation analysis revealed that the association between spherical equivalent and education is mainly driven (70%) by alteration in axial length. CONCLUSIONS The distribution of axial length and spherical equivalent is represented by subgroups of the population (bi-Gaussian). This distribution can be partially explained by length of education. The impact of education on spherical equivalent is mainly driven by alteration in axial length.
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Affiliation(s)
- Alica Hartmann
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Stephanie Desirée Grabitz
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Mathias Wagner
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp Sebastian Wild
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Preventive Cardiology and Preventive Medicine - Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Institute of Molecular Biology (IMB), Mainz, Germany
| | | | - Karl Johannes Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred Elmar Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Oliver Tüscher
- Institute of Molecular Biology (IMB), Mainz, Germany
- Clinic for Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Jörn Markus Schattenberg
- Metabolic Liver Research Center, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Ezinne NE, Roodal D, Ekemiri KK, Persad T, Mashige KP. Ocular parameters and anthropometry in Indo-Trinidadians. Medicine (Baltimore) 2023; 102:e36763. [PMID: 38206703 PMCID: PMC10754602 DOI: 10.1097/md.0000000000036763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024] Open
Abstract
To assess ocular parameters and their association with anthropometric measurements in Indo-Trinidadians adults. This was a clinical, descriptive, cross-sectional study of ocular parameters and anthropometry in adults Trinidadians of South Asian descent (Indo-Trinidadian). Ocular parameters were measured using optical coherence tomography, intraocular lens master biometer, and an autorefractor. Weight, height, and body mass index (BMI) were measured by anthropometry. Univariable and multivariable linear regressions were used to determine the association between demographic variables, anthropometric and ocular parameters. A total of 149 participants (298 eyes) comprising of 90 females (60.6%) and 59 males (39.4%). Aged 18 to 67 participated in the study. Males were taller, heavier, and had longer axial lengths than females which were statistically significant (P < .05). Age was negatively correlated with central corneal thickness (CCT) (r = -0.353, P = .044) and retinal nerve fiber layer thickness (r = -0.348, P = .047) but positively correlated with lens thickness (R = 0.881, P < .001). Education level was positively associated with CCT (R = 0.408, P = .018) but negatively associated with lens thickness (r = -0.521, P = .002). Weight was negatively correlated with corneal topography (r = -0.427, P = .013). Height was negatively correlated with cup-to-disc ratio (r = -0.410, P = .018), CCT (r = -0.382, P = .028), and corneal topography (r = -0.453, P = .008). There was no correlation between BMI, ocular parameters and CCT. There was a significant difference in the ocular parameters between males and females of South Asian descent in Trinidad and Tobago. Weight was negatively associated with the corneal topography. Height was negatively associated with the cup-to-disc ratio, central corneal thickness, and corneal topography. BMI had no statistically significant association with the ocular parameters investigated.
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Affiliation(s)
- Ngozika E. Ezinne
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago
- University of KwaZulu-Natal, Durban, South Africa
| | - Denielle Roodal
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago
| | - Kingsley K. Ekemiri
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago
- University of KwaZulu-Natal, Durban, South Africa
| | - Tamara Persad
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago
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Marx-Gross S, Fieß A, Münzel T, Wild PS, Beutel ME, Schmidtmann I, Lackner KJ, Pfeiffer N, Schuster AKG. Much higher prevalence of keratoconus than announced results of the Gutenberg Health Study (GHS). Graefes Arch Clin Exp Ophthalmol 2023; 261:3241-3247. [PMID: 37314521 PMCID: PMC10264871 DOI: 10.1007/s00417-023-06132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/15/2023] Open
Abstract
Keratoconus appears to be a rare corneal disease with a prevalence previously estimated at 1:2000. The aim of our study was to investigate the prevalence of keratoconus in a large German cohort and to evaluate possible associated factors. METHOD In the population-based, prospective, monocentric cohort study, Gutenberg Health Study, 12,423 subjects aged 40-80 years were examined at the 5-year follow-up. Subjects underwent a detailed medical history and a general and ophthalmologic examination including Scheimpflug imaging. Keratoconus diagnosis was performed in two steps: all subjects with conspicuous TKC analysis of corneal tomography were included in further grading. Prevalence and 95% confidence intervals were calculated. Logistic regression analysis was carried out to investigate association with age, sex, BMI, thyroid hormone, smoking, diabetes, arterial hypertension, atopy, allergy, steroid use, sleep apnea, asthma, and depression. RESULTS Of 10,419 subjects, 75 eyes of 51 subjects were classified as having keratoconus. The prevalence for keratoconus in the German cohort was 0.49% (1:204; 95% CI: 0.36-0.64%) and was approximately equally distributed across the age decades. No gender predisposition could be demonstrated. Logistic regression showed no association between keratoconus and age, sex, BMI, thyroid hormone, smoking, diabetes, arterial hypertension, atopy, allergy, steroid use, sleep apnea, asthma, and depression in our sample. CONCLUSION The prevalence of keratoconus disease in a mainly Caucasian population is approximately tenfold higher than previously reported in the literature using latest technologies (Scheimpflug imaging). Contrary to previous assumptions, we did not find associations with sex, existing atopy, thyroid dysfunction, diabetes, smoking, and depression.
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Affiliation(s)
- Susanne Marx-Gross
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
- Artemis Augenzentrum Wiesbaden, Wiesbaden, Germany.
- MVZ of University Medical Center of the Johannes Gutenberg-University Mainz GmbH, Mainz, Germany.
| | - Achim Fieß
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology , Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp Sebastian Wild
- Preventive Cardiology and Preventive Medicine - Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Institute of Molecular Biology (IMB), Mainz, Germany
| | - Manfred Elmar Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biometry, Epidemiology and Informatics (IMBEI), Mainz, Germany
| | - Karl Johannes Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Alexander Karl-Georg Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
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Wolfram C, Vu TPL, Klemm M, Spitzer M, Beuse A, Grohmann C. [Use of antiglaucomatous drugs in the urban adult population : New Insights into the prevalence of glaucoma from the Hamburg City Health Study]. DIE OPHTHALMOLOGIE 2023; 120:1098-1106. [PMID: 37874364 DOI: 10.1007/s00347-023-01942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Glaucoma is a widespread ophthalmological disease. Knowledge about the spread of the disease in the population is necessary with respect to further questions on comorbidities, risk factors and the provision of care. OBJECTIVE An analysis of the use of glaucoma medications and the prevalence of glaucoma in an urban adult population was carried out. MATERIAL AND METHODS The Hamburg City Health Study (HCHS) is a prospective, long-term, population-based cohort study that includes a random sample of 45,000 participants aged between 45 and 79 years from the general population of Hamburg, Germany. Apart from various medical parameters, data include premedication and the medical history of the participants. The use of antiglaucomatous medication among the first 10,000 study participants was analyzed and the prevalence of glaucoma was estimated according to the use of medications as well as by the self-reported history of glaucoma. Descriptive analysis and logistic regression analysis were performed to analyze the data and to calculate correlations by age and gender. RESULTS In the study population 319 persons were on medication to lower the intraocular pressure (IOP, mean age 67.1 years, SD = 7.57 years), which is equivalent to an estimated prevalence of 3.35% (95% confidence interval, CI 3.00-3.70%). A positive correlation was observed between age and the use of IOP-lowering medication, which is statistically highly significant (p = < 0.001). The analysis by gender showed a slightly higher prevalence among women, which was not statistically significant. The estimated prevalence according to glaucoma medication and history were only partly congruent. DISCUSSION This estimated prevalence of glaucoma is comparable to other epidemiological studies. The study results cover not only patients with manifest glaucoma but also persons who were treated for ocular hypertension. The inconsistency between the prevalence of glaucoma medication and the diagnosis of glaucoma can be explained by different treatment strategies and also by information deficits.
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Affiliation(s)
- Christian Wolfram
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Tran Phuong Linh Vu
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Maren Klemm
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Martin Spitzer
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Ansgar Beuse
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Carsten Grohmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
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Rosner AK, Closs EI, Habermeier A, Gericke A, Binder H, Scharrer I, Pfeiffer N, Ponto KA. [Asymmetric dimethylarginine (ADMA) in retinal vein occlusion-Results from the Gutenberg RVO study]. Ophthalmologe 2020; 118:684-690. [PMID: 32940851 DOI: 10.1007/s00347-020-01223-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/29/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Asymmetric dimethylarginine (ADMA) is considered an independent cardiovascular risk factor (cvRF) and thus represents a potential new biomarker for retinal vein occlusion (RVO). METHODS Overall, 92 patients with RVO and the same number of matched controls were included in the Gutenberg RVO study. All patients underwent a standardized examination for cvRF at the study center of the population-based Gutenberg health study (GHS) as well as ophthalmological examinations and intensive laboratory tests. This article presents a substudy of patients (≤65 years old) and the controls in whom ADMA was additionally determined by high performance liquid chromatography (HPLC) at baseline and 4-6 weeks later. RESULTS Out of 44 patients with RVO 22 had central retinal vein occlusion (CRVO), 15 had branch retinal vein occlusion (BRVO) and 7 had hemiretinal vein occlusion (hemi-RVO). The ADMA levels were 0.383 ± 0.094 µM (mean ± standard deviation) in RVO patients at baseline and 0.380 ± 0.093 µM (p = 0.514, initial vs. follow-up) after the follow-up period versus 0.360 ± 0.077 µM (p = 0.175, controls vs. RVO) in controls (n = 44). Arterial hypertension was the most prevalent risk factor in 22 (50%) of the patients and in 11 (25%) of the controls (odds ratio, OR 2.77, 95% confidence interval, CI 0.97-7.95; p = 0.058). The ADMA values above the 95th percentile (>0.530 µM) were detected in 4 patients with RVO (9.1%) but not in any of the controls (p = 0.041, RVO vs. controls). CONCLUSION Hypertension is the most important risk factor for RVO. Due to the high number of hypertensive patients in the cohort, the relevance of ADMA as an independent risk factor could neither be confirmed nor disproved.
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Affiliation(s)
- Ann K Rosner
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.,Klinik für Anästhesiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Ellen I Closs
- Institut für Pharmakologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Alice Habermeier
- Institut für Pharmakologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Adrian Gericke
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Harald Binder
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin Mainz, Mainz, Deutschland.,Institut für Medizinische Biometrie und Statistik (IMBI), Medizinische Fakultät und Klinikum, Universität Freiburg, Freiburg, Deutschland
| | - Inge Scharrer
- III. Medizinische Klinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Norbert Pfeiffer
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Katharina A Ponto
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland. .,Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland.
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Elbaz H, Schuster AK, Nickels S, Nagler M, Ponto KI, Münzel T, Wild PS, Beutel ME, Schmidtmann I, Lackner KJ, Pfeiffer N, Peto T. Epidemiologic Analysis of Asteroid Hyalosis and Associations: The Gutenberg Health Study. Ophthalmology 2020; 128:328-330. [PMID: 32652202 DOI: 10.1016/j.ophtha.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Hisham Elbaz
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Ophthalmology, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stefan Nickels
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Markus Nagler
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katharina I Ponto
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Department of Biomedical Statistics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, Centre for Public Health, Institute of Clinical Sciences, School of Medicine, Queen's University Belfast, Belfast, United Kingdom
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Hypertension and multiple cardiovascular risk factors increase the risk for retinal vein occlusions: results from the Gutenberg Retinal Vein Occlusion Study. J Hypertens 2020; 37:1372-1383. [PMID: 31145709 DOI: 10.1097/hjh.0000000000002057] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although several risk factors for retinal vein occlusion (RVO) are known, what triggers RVO is unclear in many cases. We aimed to evaluate the relevance of multiple risk factors in patients with RVO. METHODS The Gutenberg RVO Study is an observational case-control study that assessed thrombophilic, cardiovascular, ophthalmic, and drug-related risk factors in participants with RVO and the same number of matched controls. Conditional logistic regression analysis was chosen to estimate the risk of RVO due to several risk factors. RESULTS Of 92 patients with RVO, 46 (50%) had central RVO, 31 (33.7%) had branch RVO, and 15 (16.3) had hemi-RVO. Systemic hypertension was associated with RVO [any RVO: odds ratio (OR): 1.81; 95% confidence interval (CI): 1.14-2.88; branch RVO: OR: 2.56; 95% CI: 1.08-6.10]. The most frequent combinations of risk factors were hypertension with dyslipidemia (33 of 92, 35.9%) and hyperhomocysteinemia and high levels of factor VIII (10 of 92, 10.9%). An increase in the risk sum score by one additional risk factor corresponded to ORs of 1.74 (95% CI: 1.31-2.32) for cardiovascular risk factors, 1.38 (95% CI: 1.04-1.82) for thrombophilic risk factors, and 1.43 (95% CI: 1.20-1.70) for the total number of risk factors for RVO. CONCLUSION Cardiovascular risk factors are more important than other risk factors for the presence of RVO. The risk of RVO increased by approximately 40% with any additional risk factor and by 70% with any additional cardiovascular risk factor.
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Wolfram C, Schuster AK, Elflein HM, Nickels S, Schulz A, Wild PS, Beutel ME, Blettner M, Münzel T, Lackner KJ, Pfeiffer N. The Prevalence of Visual Impairment in the Adult Population. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:289-295. [PMID: 31196384 DOI: 10.3238/arztebl.2019.0289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/07/2018] [Accepted: 03/06/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The distribution of visual impairment is an indicator of the health status of the population and for the frequency of diseases of the eye. METHODS The Gutenberg Health Study (GHS) is a population-based cohort study in Germany concerning adults aged 35 to 74. 15 010 subjects from the Mainz-Bingen region underwent general medical and ophthalmological examination, with measurement of the distance-corrected visual acuity in each eye separately. As per the World Health Organization criteria, visual impairment was defined as an acuity below 0.3 in the better eye, and blindness as an acuity below 0.05. All patients who were found to be visually impaired or blind underwent further individual study with clinical history-taking, split-lamp examination, and fundus photography. RESULTS Data from 14 687 subjects were evaluated. The mean age of the partici- pants was 55.0 years (standard deviation, 11.1 years). The prevalence of visual im- pairment was 0.37% (95% confidence interval [0.28; 0.49]) (n = 55) and was higher in women (0.44%) than in men (0.31%). Blindness was present in 0.05% [0.03; 0.11] (n = 8) of the subjects. The prevalence of visual impairment from age 65 on- ward was 0.79%, three times higher than in the younger age groups. 54.5% of the visually impaired subjects had multiple underlying ophthalmological pathologies. CONCLUSION The causes of visual impairment are manifold. Loss of vision is often the combined effect of multiple pathological factors. The etiology of visual impair- ment is thus a more complex matter than is commonly assumed.
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Affiliation(s)
- Christian Wolfram
- Department of Ophthalmology, Medical Center, University of Mainz; Department of Ophthalmology, University Hospital Hamburg-Eppendorf (UKE); Preventive Cardiology and Medical Prevention, Cardiology I, Medical Center, University of Mainz; Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Mainz; Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Medical Center, University of Mainz; Institute of Clinical Chemistry and Laboratory Medicine, Medical Center, University of Mainz
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Elbaz H, Schulz A, Ponto KA, Nickels S, Pfeiffer N, Mirshahi A, Peto T. Posterior segment eye lesions: prevalence and associations with ocular and systemic parameters: results from the Gutenberg Health Study. Graefes Arch Clin Exp Ophthalmol 2019; 257:2127-2135. [PMID: 31321522 DOI: 10.1007/s00417-019-04416-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To estimate the prevalence of posterior segment eye lesions and to identify their ocular and systemic associations within the Gutenberg Health Study (GHS) in Germany. METHODS Assessment and grading of fundus images as well as physical examination and history taking were performed in the cross-sectional analysis of 15,010 subjects (aged 35-74 years) using standardised procedures to determine the prevalence and associations of various posterior segment eye lesions. RESULTS Fundus photographs of both eyes were available for 12,782 (85.2%; 50% female) subjects. The prevalence weighted to the region of Mainz and Mainz-Bingen in Germany was for choroidal nevi 2.4%, drusen of the optic nerve head 0.2%, tilted discs 1.5%, chorioretinal scars suggestive of toxoplasmosis 0.2%, retinitis pigmentosa 0.04% and persistent hyaloid artery 0.02%. Choroidal nevi were positively associated with a history of myocardial infarction (OR = 2.7, 95% confidence interval 1.2-6.2, p value = 0.017). Tilted discs were positively associated with increased intraocular pressure (OR = 1.09 per mm Hg (1.02-1.16), p = 0.011) and negatively associated with smoking (OR 0.4 (0.3-0.7), p = 0.0022). Participants with tilted discs had a mean spherical equivalent of - 3.6 dioptres (standard deviation 4.0) compared with - 0.4 dioptres (2.4) to those without. CONCLUSION Our study is-to the best of our knowledge-the first to determine the prevalence of drusen of optic nerve head among Caucasians, to show a positive association between tilted discs and increased intraocular pressure and questions a possible link between choroidal nevi and myocardial infarction. It also showed that participants with tilted discs had a lower mean spherical equivalent than those without.
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Affiliation(s)
- Hisham Elbaz
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,Department of Ophthalmology, University of Montreal, Quebec, Canada.,Ophthalmology Department of the Philipps University of Marburg, Marburg, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine/Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Katharina A Ponto
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Thrombosis and Hemsostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Stefan Nickels
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Alireza Mirshahi
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,Dardenne Eye Hospital, Bonn-Bad Godesberg, Germany
| | - Tunde Peto
- NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
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Marx-Gross S, Laubert-Reh D, Schneider A, Höhn R, Mirshahi A, Münzel T, Wild PS, Beutel ME, Blettner M, Pfeiffer N. The Prevalence of Glaucoma in Young People. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:204-210. [PMID: 28407842 DOI: 10.3238/arztebl.2017.0204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/06/2016] [Accepted: 12/12/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Earlier information on the prevalence of glaucoma among children in Germany was based solely on estimates. Reported values for congenital glaucoma range from 1 in 10 000 to 1 in 68 000 depending on ethnic origin. The estimate for juvenile glaucoma is 1 in 44 000. METHODS The Gutenberg Health Study is a populationbased, prospective, monocentric cohort study with 15 010 participants aged 35 to 74. To determine the history-based prevalence of childhood glaucoma, participants were asked about the diagnosis of glaucoma, any operations for glaucoma that were performed, regular use of drugs for glaucoma, and the age of onset of glaucoma. The affected individuals were classified in four groups based on the age of onset: congenital (<2 years), juvenile (2 to <18 years), late juvenile (18 to <40 years), and early adult (40 to <45 years). In the identified glaucoma patients, the visual acuity, intraocular pressure, corneal thickness, visual fields, and optic discs were evaluated. RESULTS 352 persons were identified from their medical history as having glaucoma. The weighted prevalences in the four groups were 0% in the congenital group, 0.01% (95% confidence interval [0, 0.03]) in the juvenile group, 0.16 % ([0.09; 0.23]) in the late juvenile group, and 0.17% ([0.15; 0.19]) in the early adult group. For participants over age 45, the weighted prevalence of glaucoma was 1.98% [1.7; 2.2]. CONCLUSION In our cohort, the history-based prevalence of juvenile glaucoma was 0.01% (2 patients). The prevalence was an order of magnitude higher (0.16%) between the ages of 18 and 40, and two orders of magnitude higher at later ages (1.98%). The burden of disease seems to be markedly higher than previously assumed.
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Affiliation(s)
- Susanne Marx-Gross
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz; Department of Preventive Cardiology and Preventive Medicine, Cardiology I,University Medical Center of the Johannes Gutenberg University Mainz; Department of Opththalmology, Inselspital, University of Bern, Switzerland; Dardenne Eye Hospital; Cardiology I,University Medical Center of the Johannes Gutenberg University Mainz; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz; German Center for Cardiovascular Disease (DZHK), Mainz; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz; Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz; Artemiskliniken, Frankfurt
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Elflein HM, Fresenius S, Lamparter J, Pitz S, Pfeiffer N, Binder H, Wild P, Mirshahi A. The prevalence of amblyopia in Germany: data from the prospective, population-based Gutenberg Health Study. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:338-44. [PMID: 26043421 DOI: 10.3238/arztebl.2015.0338] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Amblyopia is due to insufficient development of the visual system in early childhood and is a major source of lifelong impairment of visual acuity. Too little is known about the prevalence of amblyopia in Germany and the frequency of its various causes. METHODS The Gutenberg Health Study of the University of Mainz Faculty of Medicine is an ongoing population-based, prospective, monocentric cohort study with 15 010 participants aged 35 to 74. All participants are examined for the presence of ocular, cardiovascular, neoplastic, metabolic, immunologic, and mental diseases. 3227 participants aged 35 to 44 underwent ophthalmological examination from 2007 to 2012. Amblyopia was defined as impaired visual acuity in the absence of any organic pathology capable of explaining the condition, and in the presence of a known risk factor for amblyopia. RESULTS Amblyopia, when defined as a visual acuity less than or equal to 0.63, was present in 182 participants (5.6%, 95% confidence interval [CI] 4.9-6.5%), 120 of whom had a visual acuity less than or equal to 0.5 (3.7%, 95% CI 3.3-5.2%). A narrower definition of amblyopia requiring, in addition, an interocular difference in acuity of at least two lines yielded slightly lower prevalence figures: 5.0% (95% CI 4.2-5.8%) and 3.7% (95% CI 3.1-4.4%), respectively. The causes of amblyopia (visual acuity ≤ 0.63) were anisometropia (different refractive strengths of the two eyes) in 49% of participants, strabismus (a squint) in 23%, both of these factors in 17%, and visual deprivation in 2%. 3 patients (2%) had relative amblyopia due to a traumatic cataract sustained in early childhood. 7% of the participants with amblyopia had binocular amblyopia. CONCLUSION This study yielded a prevalence figure of 5.6% for amblyopia in Germany-a higher figure than in other, comparable population-based studies, which have generally yielded figures of ca. 3% for visual acuity ≤ 0.63. The distribution of the causes of amblyopia is similar across studies.
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Affiliation(s)
- Heike M Elflein
- Department of Ophthalmology at the University Medical Center of the Johannes Gutenberg University Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) at the University Medical Center of the Johannes Gutenberg University Mainz, Department of Germany Preventive Cardiology and Preventive Medicine, Center for Thrombosis and Hemostasis, German Center for Cardiovascular Disease (DZHK) at the University Medical Center of the Johannes Gutenberg University Mainz
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Zocher MT, Rozema JJ, Oertel N, Dawczynski J, Wiedemann P, Rauscher FG. Biometry and visual function of a healthy cohort in Leipzig, Germany. BMC Ophthalmol 2016; 16:79. [PMID: 27268271 PMCID: PMC4895813 DOI: 10.1186/s12886-016-0232-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/05/2016] [Indexed: 11/23/2022] Open
Abstract
Background Cross-sectional survey of ocular biometry and visual function in healthy eyes across the life span of a German population aged 20 to 69 years (n = 218). Subject number in percent per age category reflected the percentage within the respective age band of the population of Leipzig, Germany. Methods Measurements obtained: subjective and objective refraction, best-corrected visual acuity, accommodation, contrast sensitivity, topography and pachymetry with Scheimpflug camera, axial length with non-contact partial coherence interferometry, and spectral-domain optical coherence tomography of the retina. Pearson correlation coefficients with corresponding p-values were given to present interrelationships between stature, biometric and refractive parameters or their associations with age. Two-sample T-tests were used to calculate gender differences. The area under the logarithmic contrast sensitivity function (AULCSF) was calculated for the analysis of contrast sensitivity as a single figure across a range of spatial frequencies. Results The results of axial length (AL), anterior chamber depth (ACD) and anterior chamber volume (ACV) differed as a function of the age of the participants (rho (p value): AL −0.19 (0.006), ACD −0.56 (< 0.001), ACV-0.52 (< 0.001)). Longer eyes had deeper ACD (AL:ACD 0.62 (< 0.001), greater ACV (AL:ACV 0.65 (< 0.001) and steeper corneal radii (AL:R1ant; R2ant; R1post; R2post 0.40; 0.35; 0.36; 0.36 (all with (< 0.001)). Spherical equivalent was associated with age (towards hyperopia: 0.34 (< 0.001)), AL (−0.66 (< 0.001)), ACD (−0.52 (< 0.001)) and ACV (−0.46 (< 0.001)). Accommodation was found lower for older subjects (negative association with age, r = −0.82 (< 0.001)) and contrast sensitivity presented with smaller values for older ages (AULCSF −0.38, (< 0.001)), no change of retinal thickness with age. 58 % of the study cohort presented with a change of refractive correction above ±0.50 D in one or both eyes (64 % of these were habitual spectacle wearers), need for improvement was present in the young age-group and for older subjects with increasing age. Conclusion Biometrical data of healthy German eyes, stratified by age, gender and refractive status, enabled cross-comparison of all parameters, providing an important reference database for future patient-based research and specific in-depth investigations of biometric data in epidemiological research. Trial registration ClinicalTrials.gov # NCT01173614 July 28, 2010
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Affiliation(s)
- Maria Teresa Zocher
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany
| | - Jos J Rozema
- Department of Ophthalmology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Department of Medicine and Health Science, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Nicole Oertel
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany
| | - Jens Dawczynski
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany
| | - Peter Wiedemann
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany
| | - Franziska G Rauscher
- Department of Ophthalmology, Leipzig University Hospital, Liebigstrasse 10-14, 04103, Leipzig, Germany.
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Ponto KA, Elbaz H, Peto T, Laubert-Reh D, Binder H, Wild PS, Lackner K, Pfeiffer N, Mirshahi A. Prevalence and risk factors of retinal vein occlusion: the Gutenberg Health Study. J Thromb Haemost 2015; 13:1254-63. [PMID: 25894549 DOI: 10.1111/jth.12982] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/22/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the age- and sex-specific prevalence and determinants of retinal vein occlusions (RVOs) in a large population-based German cohort. METHODS The investigation included 15,010 participants (aged 35-74 years) from the Gutenberg Health Study. We determined the prevalence of RVO (central retinal vein occlusion [CRVO] and branch retinal vein occlusion [BRVO]) for the local population by assessing fundus photographs of 12 954 (86.3%; 49.8% women and 50.2% men) participants. Further, we analyzed the associations of RVO with cardiovascular, anthropometric, and ophthalmic parameters. RESULTS The weighted prevalences of RVO, CRVO, and BRVO were 0.40%, 0.08%, and 0.32%, respectively. Men were 1.7 times more frequently affected by RVO than were women. Prevalence of RVO was 0.2% in participants aged 35-44 and 45-54 years, respectively, 0.48% in those aged 55-64 years, and 0.92% in those aged 65-74 years. Of persons with RVO, 91.5% had one or more cardiovascular risk factor or disease vs. 75.9% of persons without RVO. BRVO was associated with arterial hypertension (odds ratio 2.69, 95% confidence interval 1.27-5.70) and atrial fibrillation (3.37, 1.24-9.12) and CRVO with higher age (7.02, 1.63-30.19) and a family history of stroke (4.64, 1.18-18.25). Median visual acuity (base 10 logarithm of minimum angle of resolution) was 0.2 in persons with RVO vs. 0.05 in those without. CONCLUSION The prevalence of RVO in this German population was 0.4%, and men were 1.7 times more frequently affected than women. CRVO was associated with higher age and a family history of stroke, and BRVO was associated with arterial hypertension and atrial fibrillation.
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Affiliation(s)
- K A Ponto
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - H Elbaz
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Department of Ophthalmology, University of Marburg, Marburg, Germany
| | - T Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - D Laubert-Reh
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - H Binder
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - P S Wild
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RhineMain, Mainz, Germany
| | - K Lackner
- Institute for Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - N Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - A Mirshahi
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Dardenne Eye Hospital, Bonn-Bad Godesberg, Mainz, Germany
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Raum P, Lamparter J, Ponto KA, Peto T, Hoehn R, Schulz A, Schneider A, Wild PS, Pfeiffer N, Mirshahi A. Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study. PLoS One 2015; 10:e0127188. [PMID: 26075604 PMCID: PMC4468098 DOI: 10.1371/journal.pone.0127188] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 04/12/2015] [Indexed: 12/14/2022] Open
Abstract
Objective Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany. Research Design and Methods The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases. Results Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955–0.992]; p = 0.006) arterial hypertension (1.90 [1.190–3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504–7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068–1.114]; p<0.0001 and 1.18 [1.137–1.222]; p<0.0001, respectively). Conclusions Our calculations suggest that more than a quarter-million persons have vision-threatening diabetic retinal disease in Germany. Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus.
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Affiliation(s)
- Philipp Raum
- Department of Ophthalmology, University Medical Center, Mainz, Germany
| | - Julia Lamparter
- Department of Ophthalmology, University Medical Center, Mainz, Germany
| | - Katharina A. Ponto
- Department of Ophthalmology, University Medical Center, Mainz, Germany
- Center for thrombosis & haemostasis (CTH), University Medical Center, Mainz, Germany
| | - Tunde Peto
- NIHR Biomedical Research Center at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - René Hoehn
- Department of Ophthalmology, University Medical Center, Mainz, Germany
| | - Andreas Schulz
- Biomedical statistics, University Medical Center, Mainz, Germany
| | - Astrid Schneider
- Biomedical statistics, University Medical Center, Mainz, Germany
| | - Philipp S. Wild
- Center for thrombosis & haemostasis (CTH), University Medical Center, Mainz, Germany
- Department of Medicine II, University Medical Center, Mainz, Germany
- German Center for Heart and Circulations System Research (DZHK), University Medical Center, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center, Mainz, Germany
| | - Alireza Mirshahi
- Department of Ophthalmology, University Medical Center, Mainz, Germany
- Dardenne Eye Hospital, Bonn, Germany
- * E-mail:
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Höhn R, Kottler U, Peto T, Blettner M, Münzel T, Blankenberg S, Lackner KJ, Beutel M, Wild PS, Pfeiffer N. The ophthalmic branch of the Gutenberg Health Study: study design, cohort profile and self-reported diseases. PLoS One 2015; 10:e0120476. [PMID: 25775251 PMCID: PMC4361691 DOI: 10.1371/journal.pone.0120476] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/22/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose This paper describes the study design, methodology, cohort profile and self-reported diseases in the ophthalmological branch of the Gutenberg Health Study (GHS). Methods The GHS is an ongoing, prospective, interdisciplinary, single-center, population-based cohort study in Germany. The main goals of the ophthalmological section are to assess the prevalence and incidence of ocular diseases and to explore risk factors, genetic determinants and associations with systemic diseases and conditions. The eye examination at baseline included a medical history, self-reported eye diseases, visual acuity, refractive errors, intraocular pressure, visual field, pachymetry, keratometry, fundus photography and tear sampling. The 5-year follow-up visit additionally encompassed optical coherence tomography, anterior segment imaging and optical biometry. The general examination included anthropometry; blood pressure measurement; carotid artery ultrasound; electrocardiogram; echocardiography; spirometry; cognitive tests; questionnaires; assessment of mental conditions; and DNA, RNA, blood and urine sampling. Results Of 15,010 participants (aged 35-74 years at the time of inclusion), ocular data are available for 14,700 subjects (97.9%). The mean visual acuity (standard deviation), mean spherical equivalent, median decimal visual acuity, and mean intraocular pressure were 0.08 (0.17) logMar, -0.42 (2.43) diopters, 0.9 and 14.24 (2.79) mm Hg, respectively. The frequencies of self-reported strabismus, glaucoma, surgery for retinal detachment and retinal vascular occlusions were 2.7%, 2.3%, 0.2% and 0.4%, respectively. Conclusions The GHS is the most extensive dataset of ophthalmic diseases and conditions and their risk factors in Germany and one of the largest cohorts worldwide. This dataset will provide new insight in the epidemiology of ophthalmic diseases and related medical specialties.
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Affiliation(s)
- René Höhn
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
- Klinik Pallas, Olten, Switzerland
- * E-mail:
| | - Ulrike Kottler
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Tunde Peto
- NIHR Biomedical Research Center at Moorfields Eye Hospital, NHS Foundation Trust, and UCL Institute of Ophthalmology, London, United Kingdom
| | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Preventive Cardiology and Preventive Medicine / Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl J. Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine / Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
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Mirshahi A, Ponto KA, Hoehn R, Zwiener I, Zeller T, Lackner K, Beutel ME, Pfeiffer N. Myopia and level of education: results from the Gutenberg Health Study. Ophthalmology 2014; 121:2047-52. [PMID: 24947658 DOI: 10.1016/j.ophtha.2014.04.017] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 03/17/2014] [Accepted: 04/18/2014] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To analyze the association between myopia and educational level in an adult European cohort. DESIGN Population-based cross-sectional study. PARTICIPANTS A cohort of the Gutenberg Health Study, including 4658 eligible enrollees between 35 and 74 years of age. METHODS We applied a standardized protocol entailing a comprehensive questionnaire; thorough ophthalmic, general, cardiovascular, and psychological examinations; and laboratory tests, including genetic analyses. We documented achievement levels in school education and post-school professional education. The spherical equivalent (SE) was determined by noncycloplegic autorefractometry. We fitted mixed linear models including age, gender, and 45 myopia-associated single nucleotide polymorphisms (SNP) as covariates. MAIN OUTCOME MEASURES Prevalence and magnitude of myopia in association with years spent in school and level of post-school professional education. RESULTS Individuals who graduated from school after 13 years were more myopic (median, -0.5 diopters [D]; first quartile [Q1]/third quartile [Q3], -2.1/0.3 D) than those who graduated after 10 years (median, -0.2 D; Q1/Q3, -1.3/0.8 D), than those who graduated after 9 years (median, 0.3 D; Q1/Q3, -0.6/1.4 D), and than those who never finished secondary school (median, 0.2 D; Q1/Q3, -0.5/1.8 D; P<0.001, respectively). The same holds true for persons with a university degree (median, -0.6 D; Q1/Q3, -2.3/0.3 D) versus those who finished secondary vocational school (median, 0 D; Q1/Q3, -1.1/0.8 D) or primary vocational school (median, 0 D; Q1/Q3, -0.9/1.1 D) versus persons without any post-school professional qualification (median, 0.6 D; Q1/Q3, -0.4/1.7 D; P<0.001, respectively). Of persons who graduated from school after 13 years, 50.9% were myopic (SE, ≤-0.5 D) versus 41.6%, 27.1%, and 26.9% after 10 years, in those who graduated after 9 years, and in those who never graduated from secondary school, respectively (P<0.001). In university graduates, the proportion of myopic persons was higher (53%) than that of those who graduated from secondary (34.8%) or primary (34.7%) vocational schools and than in those without any professional training (23.9%; P<0.001, respectively). In multivariate analyses: higher school and professional levels of education were associated with a more myopic SE independent of gender. There was a small effect of age and SNPs. CONCLUSIONS Higher levels of school and post-school professional education are associated with a more myopic refraction. Participants with higher educational achievements more often were myopic than individuals with less education.
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Affiliation(s)
- Alireza Mirshahi
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.
| | - Katharina A Ponto
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - René Hoehn
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Isabella Zwiener
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Tanja Zeller
- University Heart Center Hamburg, Hamburg, Germany
| | - Karl Lackner
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
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Abstract
This article describes the role of outcomes and health services research in the field of ophthalmology in Germany. First, the need for more information and data on the performance of ophthalmic care in Germany is explored. The concept, goals and methods of outcomes and health services research are explained and illustrated by examples of already existing research projects in ophthalmology. Future topics for research projects are highlighted. The article also describes how the field of outcomes and health services research can become a more important part within the scientific ophthalmological community in Germany.
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Affiliation(s)
- C Wolfram
- Augenklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland,
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Korb CA, Kottler UB, Wolfram C, Hoehn R, Schulz A, Zwiener I, Wild PS, Pfeiffer N, Mirshahi A. Prevalence of age-related macular degeneration in a large European cohort: results from the population-based Gutenberg Health Study. Graefes Arch Clin Exp Ophthalmol 2014; 252:1403-11. [PMID: 24566902 DOI: 10.1007/s00417-014-2591-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/23/2014] [Accepted: 02/04/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study was to describe the sex- and age-specific prevalence of age-related macular degeneration (AMD) and its correlation with urban or rural residence in a large and relatively young European cohort. METHODS We evaluated fundus photographs from participants in the Gutenberg Health Study (GHS), a population-based, prospective, observational, single-centre study in the Rhineland-Palatine region in midwestern Germany. The participants were 35-74 years of age at enrolment. The fundus images were classified as described in the Rotterdam Study and were graded independently by two experienced ophthalmologists (CK and UBK) based on the presence of hard and soft drusen, retinal pigmentary abnormalities, and signs of atrophic or neovascular age-related macular generation (AMD). RESULTS Photographs from 4,340 participants were available for grading. Small, hard drusen (<63 μm, stages 0b and 0c) were present in 37.4% of participants (95% confidence interval [CI], stage 0b, 31.6% [30.3-33.7]; stage 0c, 5.8% [5.1-6.5]). Early AMD (soft drusen, pigmentary abnormalities, stages 1-3) was present in 3.8% of individuals in the youngest age group (35-44 years) (95% CI, stage 1a, 0.4% [0.3-0.5%]; stage 1b, 3.2% [2.9-3.5%]; stage 2a, 0.1% [0.1-0.2%]; stage 2b, 0% [0-0.0%]; stage 3, 0.1% [0.1-0.2%]), whereas late AMD (stages 4a and 4b) did not appear in the youngest age group. In all age groups, signs of early AMD were detected in 11.9% of individuals (stage 1a, 2.1% [1.7-2.6]; stage 1b, 8.0% [7.2-8.8]; stage 2a, 1.0% [0.7-1.3]; stage 2b, 0.5% [0.3-0.7]; stage 3, 0.3% [0.2-0.6]). Late AMD (geographic atrophy or neovascular AMD) was found in 0.2% of individuals (stage 4a, 0.1 % [0.0-0.2]; stage 4b, 0.1% [0.0-0.2]). AMD increased significantly with age (odds ratio [OR], 1.09; 95% CI, 1.08-1.10). Sex, iris colour, and residence (rural vs. urban) were not associated with different rates of AMD. CONCLUSIONS In this study, the prevalence of AMD increased dramatically with age; however, although AMD is usually thought to occur after age 50, signs of early AMD were found in 3.8% of individuals in the youngest age group (younger than 45 years). This population-based sample is the first to provide substantial epidemiologic data from a large German cohort, including data on macular degeneration in younger age groups and incidence data after recall.
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Affiliation(s)
- Christina A Korb
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany,
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