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Sencanic I, Dotlic J, Jaksic V, Grgurevic A, Gazibara T. Association of Smoking Patterns with Vision-Related Disability According to Glaucoma Subtypes. Ophthalmic Epidemiol 2024; 31:420-429. [PMID: 38085803 DOI: 10.1080/09286586.2023.2290007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/29/2023] [Accepted: 11/25/2023] [Indexed: 09/08/2024]
Abstract
OBJECTIVE The relationship between smoking and onset of glaucoma has been inconsistent. However, there is a gap in understanding whether tobacco smoking is linked to a worse visual impairment in different glaucoma subtypes. The objective of this study was to examine the association between smoking behavior and vision-related disability in people who have different glaucoma subtypes. METHODS A total of 283 people with primary open-angle glaucoma (POAG), primary angle closure glaucoma (PACG), normal tension glaucoma (NTG), and pseudo-exfoliative (PEX) were included in this cross-sectional study. The recruitment of study participants was organized in one of two tertiary centers for eye diseases in Belgrade, Serbia, during their regular eye checks. Information about the duration and quantity of smoking was self-reported. Vision-related impairment was quantified using a validated Glaucoma Quality of Life-15 (GQL-15) questionnaire. RESULTS A series of multiple linear regression models adjusted for age, gender, severity of glaucoma, lifestyle, and mobility, intraocular pressure level, visual parameters, previous and current therapy, and chronic illnesses suggested that a higher quantity of cigarettes smoked per day was associated with poorer vision-related quality of life only among people with NTG subtypes. This association was absent when smoking duration was tested in the adjusted linear regression model. CONCLUSION A higher number of cigarettes smoked daily was associated with poorer vision-related impairment among people who have NTG, but not other glaucoma subtypes. It is recommended that ophthalmologists and other health-care professionals work to improve their patients' understanding of harmful effects of tobacco smoke and quit smoking.
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Affiliation(s)
- Ivan Sencanic
- Service d'Ophtalmologie, Groupe Hospitalier de la région de Mulhouse et Sud Alsace, Mulhouse, France
| | - Jelena Dotlic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Gynecology, Clinic of Obstetrics and Gynecology Clinical Center of Serbia, Belgrade, Serbia
| | - Vesna Jaksic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Eye Disease "Prof. dr Ivan Stankovic", University Medical Center "Zvezdara", Belgrade, Serbia
| | - Anita Grgurevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Ayala M. Former smoking as a risk factor for visual field progression in exfoliation glaucoma patients in Sweden. Eur J Ophthalmol 2024; 34:1481-1488. [PMID: 38233361 PMCID: PMC11408981 DOI: 10.1177/11206721241226990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE The present study aimed to identify whether former smoking was a risk factor for visual field progression in exfoliation glaucoma patients. METHODS Prospective nonrandomised cohort study. The study included patients diagnosed with exfoliation glaucoma. All included patients were followed for three years (± three months) with reliable visual fields. At least five reliable visual fields needed to be included in the study. Exfoliation glaucoma was defined using the European Glaucoma Society Guidelines. The visual fields were tested using the 24-2 test strategy of the Humphrey Field Analyzer. Smoking was assessed through questionnaires. Outcomes: Visual field progression. Three different approaches were used: difference in mean deviation (MD), rate of progression (ROP), and guided progression analysis (GPA). RESULTS In total, n = 113 patients were included; among them, n = 57 were smokers. Smoking was a significant predictor for visual field progression in the three models (MD/ROP/GPA) studied (p = 0.01/p = 0.001/p ≤ 0.001), even adjusting for intraocular pressure (IOP). Other predictors were included in the MD model: IOP at diagnosis (p = 0.04) and selective laser trabeculoplasty (SLT) treatment (p = 0.01). Other predictors were in the ROP model: Visual field index (p = 0.005), number of medications (p = 0.001) and SLT treatment (p = 0.001). The number of medications was another predictor in the GPA model (p = 0.002). CONCLUSIONS Former smoking induced visual field deterioration in all models studied. Smoking status should be considered when establishing the glaucoma diagnosis. Increased glaucoma care should be provided to former smokers to slow the progression of the disease.
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Affiliation(s)
- Marcelo Ayala
- Eye Department, Skaraborg Hospital, Sahlgrenska Academy, Gothenburg University & Karolinska Institute, Skövde, Sweden
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Lidder AK, Vanner EA, Chang TC, Lum F, Rothman AL. Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight). Ophthalmology 2024; 131:780-789. [PMID: 38246424 DOI: 10.1016/j.ophtha.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To evaluate risk factors for intraocular pressure (IOP) spike after cataract surgery using the IRIS® Registry (Intelligent Research in Sight). DESIGN Retrospective clinical cohort study. PARTICIPANTS Adults with IRIS Registry data who underwent stand-alone phacoemulsification from January 1, 2013, through September 30, 2019. METHODS Intraocular pressure spike was defined as postoperative IOP of > 30 mmHg and > 10 mmHg from the baseline within the first postoperative week. Odds ratios (ORs) for demographic and clinical characteristics were calculated with univariable and multivariable logistic regression analyses. MAIN OUTCOME MEASURES Incidence and OR of IOP spike. RESULTS We analyzed data from 1 191 034 eyes (patient mean age, 71.3 years; 61.2% female sex; and 24.8% with glaucoma). An IOP spike occurred in 3.7% of all eyes, 5.2% of eyes with glaucoma, and 3.2% of eyes without glaucoma (P < 0.0001). Multivariable analyses of all eyes indicated a greater risk of IOP spike with higher baseline IOP (OR, 1.57 per 3 mmHg), male sex (OR, 1.79), glaucoma (OR, 1.20), Black race (OR, 1.39 vs. Asian and 1.21 vs. Hispanic), older age (OR, 1.07 per 10 years), and complex surgery coding (OR, 1.22; all P < 0.0001). Diabetes (OR, 0.90) and aphakia after surgery (OR, 0.60) seemed to be protective against IOP spike (both P < 0.0001). Compared with glaucoma suspects, ocular hypertension (OR, 1.55), pigmentary glaucoma (OR, 1.56), and pseudoexfoliative glaucoma (OR, 1.52) showed a greater risk of IOP spike and normal-tension glaucoma (OR, 0.55), suspected primary angle closure (PAC; OR, 0.67), and PAC glaucoma (OR, 0.81) showed less risk (all P < 0.0001). Using more baseline glaucoma medications was associated with IOP spike (OR, 1.18 per medication), whereas topical β-blocker use (OR, 0.68) was protective (both P < 0.0001). CONCLUSIONS Higher baseline IOP, male sex, glaucoma, Black race, older age, and complex cataract coding were associated with early postoperative IOP spike, whereas diabetes and postoperative aphakia were protective against a spike after stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on glaucoma subtype. The findings may help surgeons to stratify and mitigate the risk of IOP spike after cataract surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Alcina K Lidder
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A Vanner
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ta Chen Chang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Davidson O, Rajesh AE, Blazes M, Batchelor A, Lee AY, Lee CS, Huang LC. Sociodemographic and Visual Outcomes of Juvenile Idiopathic Arthritis Uveitis: IRIS ® Registry Study. Clin Ophthalmol 2024; 18:1257-1266. [PMID: 38741584 PMCID: PMC11089303 DOI: 10.2147/opth.s456252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/21/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose Understanding sociodemographic factors associated with poor visual outcomes in children with juvenile idiopathic arthritis-associated uveitis may help inform practice patterns. Patients and Methods Retrospective cohort study on patients <18 years old who were diagnosed with both juvenile idiopathic arthritis and uveitis based on International Classification of Diseases tenth edition codes in the Intelligent Research in Sight Registry through December 2020. Surgical history was extracted using current procedural terminology codes. The primary outcome was incidence of blindness (20/200 or worse) in at least one eye in association with sociodemographic factors. Secondary outcomes included cataract and glaucoma surgery following uveitis diagnosis. Hazard ratios were calculated using multivariable-adjusted Cox proportional hazards models. Results Median age of juvenile idiopathic arthritis-associated uveitis diagnosis was 11 (Interquartile Range: 8 to 15). In the Cox models adjusting for sociodemographic and insurance factors, the hazard ratios of best corrected visual acuity 20/200 or worse were higher in males compared to females (HR 2.15; 95% CI: 1.45-3.18), in Black or African American patients compared to White patients (2.54; 1.44-4.48), and in Medicaid-insured patients compared to commercially-insured patients (2.23; 1.48-3.37). Conclusion Sociodemographic factors and insurance coverage were associated with varying levels of risk for poor visual outcomes in children with juvenile idiopathic arthritis-associated uveitis.
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Affiliation(s)
- Oliver Davidson
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Anand E Rajesh
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Marian Blazes
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Ashley Batchelor
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Laura C Huang
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Division of Ophthalmology, Seattle Children’s Hospital, Seattle, WA, USA
| | - On behalf of the IRIS® Registry Analytic Center Consortium
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
- Division of Ophthalmology, Seattle Children’s Hospital, Seattle, WA, USA
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Becker S, L'Ecuyer Z, Jones BW, Zouache MA, McDonnell FS, Vinberg F. Modeling complex age-related eye disease. Prog Retin Eye Res 2024; 100:101247. [PMID: 38365085 PMCID: PMC11268458 DOI: 10.1016/j.preteyeres.2024.101247] [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: 08/15/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/18/2024]
Abstract
Modeling complex eye diseases like age-related macular degeneration (AMD) and glaucoma poses significant challenges, since these conditions depend highly on age-related changes that occur over several decades, with many contributing factors remaining unknown. Although both diseases exhibit a relatively high heritability of >50%, a large proportion of individuals carrying AMD- or glaucoma-associated genetic risk variants will never develop these diseases. Furthermore, several environmental and lifestyle factors contribute to and modulate the pathogenesis and progression of AMD and glaucoma. Several strategies replicate the impact of genetic risk variants, pathobiological pathways and environmental and lifestyle factors in AMD and glaucoma in mice and other species. In this review we will primarily discuss the most commonly available mouse models, which have and will likely continue to improve our understanding of the pathobiology of age-related eye diseases. Uncertainties persist whether small animal models can truly recapitulate disease progression and vision loss in patients, raising doubts regarding their usefulness when testing novel gene or drug therapies. We will elaborate on concerns that relate to shorter lifespan, body size and allometries, lack of macula and a true lamina cribrosa, as well as absence and sequence disparities of certain genes and differences in their chromosomal location in mice. Since biological, rather than chronological, age likely predisposes an organism for both glaucoma and AMD, more rapidly aging organisms like small rodents may open up possibilities that will make research of these diseases more timely and financially feasible. On the other hand, due to the above-mentioned anatomical and physiological features, as well as pharmacokinetic and -dynamic differences small animal models are not ideal to study the natural progression of vision loss or the efficacy and safety of novel therapies. In this context, we will also discuss the advantages and pitfalls of alternative models that include larger species, such as non-human primates and rabbits, patient-derived retinal organoids, and human organ donor eyes.
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Affiliation(s)
- Silke Becker
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Zia L'Ecuyer
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Bryan W Jones
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Moussa A Zouache
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Fiona S McDonnell
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Frans Vinberg
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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Stanescu N, Steinbuch L, Segev A, Kovalyuk N, Segev S, Maor E, Segev F. Low cardiorespiratory fitness is associated with elevated intraocular pressure among apparently healthy adults. PLoS One 2024; 19:e0302624. [PMID: 38683804 PMCID: PMC11057755 DOI: 10.1371/journal.pone.0302624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE To evaluate the association of cardiorespiratory fitness with elevated intraocular pressure (IOP) in healthy adults. METHODS In this cross-sectional study, we evaluated 17,990 asymptomatic self-referred adults free of diabetes or cardiovascular disease who were screened in a preventive healthcare setting. All subjects underwent measurement of IOP and completed a maximal exercise stress test according to the Bruce protocol. Fitness was categorized into age and sex-specific quintiles according to the treadmill time and dichotomized to low (lowest quintile) and non-low fitness groups. Elevated IOP was defined as ≥ 21 mmHg. RESULTS Median age was 45 (IQR 39-52) years and 12,073 (67%) were men. There were 3,351 (19%) subjects in the low fitness group. Median IOP was 14 mmHg (IQR 12-16) with elevated IOP documented in 188 (1%) subjects. Univariate binary logistic regression model demonstrated that compared with non-low fitness group, subjects in the low fitness group were 2.2 times more likely to have elevated IOP (95% CI 1.598-2.95, p<0.001). Multivariate binary logistic regression with adjustment to known cardiovascular risk factors (age, sex, hypertension, smoking, overweight, regular physical activity, low HDL cholesterol, high triglycerides, and fasting glucose levels) successfully demonstrated that lower fitness was independently and significantly associated with a 90% increased likelihood of elevated IOP (95% CI 1.37-2.61, p<0.001). Subgroup analysis revealed that the association was more pronounced among women compared with men (OR 3.8 vs. 1.6, p for interaction = 0.069). CONCLUSIONS Low cardiorespiratory fitness is independently associated with increased IOP among apparently healthy adults.
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Affiliation(s)
- Nir Stanescu
- Department of Ophthalmology, Samson Assuta Ashdod Medical Center, Ashdod, Faculty of Medicine, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Lioz Steinbuch
- Chaim Sheba Medical Center, Tel Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Division of Cardiology, Chaim Sheba Medical Center, Tel Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalya Kovalyuk
- Department of Ophthalmology, Samson Assuta Ashdod Medical Center, Ashdod, Faculty of Medicine, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Shlomo Segev
- The Institute of Medical Screening, Chaim Sheba Medical Center, Tel Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Division of Cardiology, Chaim Sheba Medical Center, Tel Hashomer, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fani Segev
- Department of Ophthalmology, Samson Assuta Ashdod Medical Center, Ashdod, Faculty of Medicine, Ben-Gurion University of the Negev, Beersheba, Israel
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Mahmoudinezhad G, Meller L, Moghimi S. Impact of smoking on glaucoma. Curr Opin Ophthalmol 2024; 35:124-130. [PMID: 38018801 PMCID: PMC10922564 DOI: 10.1097/icu.0000000000001023] [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] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW Assessing whether lifestyle related factors play a role in causing primary open-angle glaucoma (POAG) is of great value to clinicians, public health experts and policy makers. Smoking is a major global public health concern and contributes to ocular diseases such as cataracts, and age-related macular degeneration through ischemic and oxidative mechanisms. Recently, smoking has been investigated as a modifiable risk factor for glaucoma. In the presence of an association with glaucoma, provision of advice and information regarding smoking to patients may help reduce the burden of disease caused by POAG. Therefore, the aim of this review is to summarize the current evidence regarding the effect of smoking in the pathogenesis of glaucoma and its incidence, progression as well as the benefits of smoking cessation. RECENT FINDINGS While the association between glaucoma development and smoking history is controversial, in the last decade, several recent studies have helped to identify possible effects of smoking, especially heavy smoking, in regard to glaucomatous progression. Smoking cessation may possibly be protective against glaucoma progression. SUMMARY Smoking may play a role in glaucoma progression and long-term smoking cessation may be associated with lower glaucoma progression. The dose-response relationship between smoking and glaucoma as well as therapeutic potential of smoking cessation needs to be further validated with both preclinical and rigorous clinical studies.
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Affiliation(s)
- Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States
| | - Leo Meller
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States
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Stuart KV, Madjedi KM, Luben RN, Biradar MI, Wagner SK, Warwick AN, Sun Z, Hysi PG, Simcoe MJ, Foster PJ, Khawaja AP. Smoking, Corneal Biomechanics, and Glaucoma: Results From Two Large Population-Based Cohorts. Invest Ophthalmol Vis Sci 2024; 65:11. [PMID: 38170539 PMCID: PMC10768714 DOI: 10.1167/iovs.65.1.11] [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: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Smoking may influence measured IOP through an effect on corneal biomechanics, but it is unclear whether this factor translates into an increased risk for glaucoma. This study aimed to examine the association of cigarette smoking with corneal biomechanical properties and glaucoma-related traits, and to probe potential causal effects using Mendelian randomization (MR). Methods Cross-sectional analyses within the UK Biobank (UKB) and Canadian Longitudinal Study on Aging (CLSA) cohorts. Multivariable linear and logistic regression models were used to assess associations of smoking (status, intensity, and duration) with corneal hysteresis (CH), corneal resistance factor, IOP, inner retinal thicknesses, and glaucoma. Two-sample MR analyses were performed. Results Overall, 68,738 UKB (mean age, 56.7 years; 54.7% women) and 22 845 CLSA (mean age, 62.7 years; 49.1% women) participants were included. Compared with nonsmokers, smokers had a higher CH (UKB, +0.48 mm Hg; CLSA, +0.57 mm Hg; P < 0.001) and corneal resistance factor (UKB, +0.47 mm Hg; CLSA, +0.60 mm Hg; P < 0.001) with evidence of a dose-response effect in both studies. Differential associations with Goldmann-correlated IOP (UKB, +0.25 mm Hg; CLSA, +0.36 mm Hg; P < 0.001) and corneal-compensated IOP (UKB, -0.28 mm Hg; CLSA, -0.32 mm Hg; P ≤ 0.001) were observed. Smoking was not associated with inner retinal thicknesses or glaucoma status in either study. MR provided evidence for a causal effect of smoking on corneal biomechanics, especially higher CH. Conclusions Cigarette smoking seems to increase corneal biomechanical resistance to deformation, but there was little evidence to support a relationship with glaucoma. This outcome may result in an artefactual association with measured IOP and could account for discordant results with glaucoma in previous epidemiological studies.
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Affiliation(s)
- Kelsey V. Stuart
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Kian M. Madjedi
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Robert N. Luben
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mahantesh I. Biradar
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Siegfried K. Wagner
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alasdair N. Warwick
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Zihan Sun
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Pirro G. Hysi
- Department of Ophthalmology, St Thomas’ Hospital, King's College London, London, United Kingdom
- Department of Twin Research & Genetic Epidemiology, St Thomas’ Hospital, King's College London, London, United Kingdom
| | - Mark J. Simcoe
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Department of Ophthalmology, St Thomas’ Hospital, King's College London, London, United Kingdom
- Department of Twin Research & Genetic Epidemiology, St Thomas’ Hospital, King's College London, London, United Kingdom
| | - Paul J. Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Anthony P. Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - on behalf of the Modifiable Risk Factors for Glaucoma Collaboration and the UK Biobank Eye and Vision Consortium
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- Department of Ophthalmology, St Thomas’ Hospital, King's College London, London, United Kingdom
- Department of Twin Research & Genetic Epidemiology, St Thomas’ Hospital, King's College London, London, United Kingdom
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Rajesh AE, Davidson O, Lacy M, Chandramohan A, Lee AY, Lee CS, Tarczy-Hornoch K. Race, Ethnicity, Insurance, and Population Density Associations with Pediatric Strabismus and Strabismic Amblyopia in the IRIS® Registry. Ophthalmology 2023; 130:1090-1098. [PMID: 37331481 PMCID: PMC10527204 DOI: 10.1016/j.ophtha.2023.06.008] [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: 03/29/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE To evaluate the associations of sociodemographic factors with pediatric strabismus diagnosis and outcomes. DESIGN Retrospective cohort study. PARTICIPANTS American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before the age of 10 years. METHODS Multivariable regression models evaluated the associations of race and ethnicity, insurance, population density, and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery. MAIN OUTCOME MEASURES Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, and rate of and time to strabismus surgery. RESULTS The median age at diagnosis was 5 years (interquartile range, 3-7) for 106 723 children with esotropia (ET) and 54 454 children with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR], 1.05 for ET; 1.25 for XT; P < 0.01), as was residual amblyopia (OR, 1.70 for ET; 1.53 for XT; P < 0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR, 1.34; P < 0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR], 1.23 for ET; 1.21 for XT; P < 0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and received surgery later (all HRs < 0.87; P < 0.01), and Hispanic and Asian children were less likely to undergo XT surgery and received surgery later (all HRs < 0.85; P < 0.01). Increasing population density and clinician ratio were associated with lower HR for ET surgery (P < 0.01). CONCLUSIONS Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Anand E Rajesh
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Oliver Davidson
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Megan Lacy
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Arthika Chandramohan
- Department of Ophthalmology, Southern California Permanente Medical Group, San Diego, California
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington.
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Stuart KV, Pasquale LR, Kang JH, Foster PJ, Khawaja AP. Towards modifying the genetic predisposition for glaucoma: An overview of the contribution and interaction of genetic and environmental factors. Mol Aspects Med 2023; 93:101203. [PMID: 37423164 PMCID: PMC10885335 DOI: 10.1016/j.mam.2023.101203] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
Glaucoma, the leading cause of irreversible blindness worldwide, is a complex human disease, with both genetic and environmental determinants. The availability of large-scale, population-based cohorts and biobanks, combining genotyping and detailed phenotyping, has greatly accelerated research into the aetiology of glaucoma in recent years. Hypothesis-free genome-wide association studies have furthered our understanding of the complex genetic architecture underpinning the disease, while epidemiological studies have provided advances in the identification and characterisation of environmental risk factors. It is increasingly recognised that the combined effects of genetic and environmental factors may confer a disease risk that reflects a departure from the simple additive effect of the two. These gene-environment interactions have been implicated in a host of complex human diseases, including glaucoma, and have several important diagnostic and therapeutic implications for future clinical practice. Importantly, the ability to modify the risk associated with a particular genetic makeup promises to lead to personalised recommendations for glaucoma prevention, as well as novel treatment approaches in years to come. Here we provide an overview of genetic and environmental risk factors for glaucoma, as well as reviewing the evidence and discussing the implications of gene-environment interactions for the disease.
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Affiliation(s)
- Kelsey V Stuart
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jae H Kang
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
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Kulkarni A, Banait S. Through the Smoke: An In-Depth Review on Cigarette Smoking and Its Impact on Ocular Health. Cureus 2023; 15:e47779. [PMID: 38021969 PMCID: PMC10676518 DOI: 10.7759/cureus.47779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Smoking is a widespread and pervasive habit, impacting health across various care settings, including acute care, subacute care, home-based care, and long-term care. Smoking is a serious global public health concern that has been related to many chronic diseases. However, the effect of smoking on eye disorders has been less studied. Cigarette smoke contains a complex mixture of harmful constituents, including nicotine and toxic chemicals, which permeate the bloodstream, affecting ocular tissues. The oxidative stress and inflammation induced by smoking are central to its detrimental effects on ocular health. Age-related macular degeneration (AMD), a leading cause of vision loss, exhibits a strong association with smoking. Research consistently demonstrates that smokers face a heightened risk of both early and advanced AMD. Cataracts, another prevalent ocular condition, develop earlier and progress more rapidly in smokers. The oxidative stress on the lens and reduced antioxidants among smokers contribute to the increased severity of cataracts. Moreover, the health of the eyes may be compromised by smoking-related chemicals that reduce blood flow and/or hasten thrombus formation in ocular capillaries thus increasing the chance of acquiring glaucoma, cataracts, AMD, and Graves' eye disease. Beyond individual health concerns, the societal implications of smoking on ocular health are substantial, including increased healthcare costs and diminished quality of life for affected individuals. Understanding the underlying mechanisms can provide insights into potential therapeutic interventions for preventing and managing smoking-related ocular damage. Given the global prevalence of smoking, raising awareness about the ocular risks associated with smoking is crucial for promoting eye health. The review underscores the urgent need for comprehensive anti-smoking initiatives and smoking cessation programs to alleviate the burden of ocular diseases associated with smoking.
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Affiliation(s)
- Aryan Kulkarni
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shashank Banait
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wu JH, Radha Saseendrakumar B, Moghimi S, Sidhu S, Kamalipour A, Weinreb RN, Baxter SL. Epidemiology and factors associated with cannabis use among patients with glaucoma in the All of Us Research Program. Heliyon 2023; 9:e15811. [PMID: 37215923 PMCID: PMC10192773 DOI: 10.1016/j.heliyon.2023.e15811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/09/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose To examine the epidemiology and factors of cannabis use among open-angle glaucoma (OAG) patients. Methods In this cross-sectional study, OAG participants in the All of Us database were included. Cannabis ever-users were defined based on record of cannabis use. Demographic and socioeconomic data were collected and compared between cannabis ever-users and never-users using Chi-Square tests and logistic regression. Odds ratios (OR) of potential factors associated with cannabis use were examined in univariable and multivariable models. Results Among 3723 OAG participants, 1436 (39%) were cannabis ever-users. The mean (SD) age of never-users and ever-users was 72.9 (10.4) and 69.2 (9.6) years, respectively (P < 0.001). Compared to never-users, Black (34%) and male (55%) participants were better represented in ever-users, while Hispanic or Latino participants (6%) were less represented (P < 0.001). Diversity was also observed in socioeconomic characteristics including marital status, housing security, and income/education levels. A higher percentage of ever-users had a degree ≥12 grades (91%), salaried employment (26%), housing insecurity (12%), and history of cigar smoking (48%), alcohol consumption (96%), and other substance use (47%) (P < 0.001). In the multivariable analysis, Black race (OR [95% CI] = 1.33 [1.06, 1.68]), higher education (OR = 1.19 [1.07, 1.32]), and history of nicotine product smoking (OR: 2.04-2.83), other substance use (OR = 8.14 [6.63, 10.04]), and alcohol consumption (OR = 6.80 [4.45, 10.79]) were significant factors associated with cannabis use. Increased age (OR = 0.96 [0.95, 0.97]), Asian race (OR = 0.18 [0.09, 0.33]), and Hispanic/Latino ethnicity (OR = 0.43 [0.27, 0.68]) were associated with decreased odds of use (P < 0.02). Conclusions This study elucidated the previously uncharacterized epidemiology and factors associated with cannabis use among OAG patients, which may help to identify patients requiring additional outreach on unsupervised marijuana use.
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Affiliation(s)
- Jo-Hsuan Wu
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Bharanidharan Radha Saseendrakumar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Sophia Sidhu
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Alireza Kamalipour
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Robert N. Weinreb
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Sally L. Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
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13
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Oke I, Reshef ER, Elze T, Miller JW, Lorch AC, Hunter DG, Freitag SK. Smoking Is Associated With a Higher Risk of Surgical Intervention for Thyroid Eye Disease in the IRIS Registry. Am J Ophthalmol 2023; 249:174-182. [PMID: 36690290 PMCID: PMC10767645 DOI: 10.1016/j.ajo.2023.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE To describe the association of smoking status with surgical intervention for thyroid eye disease (TED) at the population-level. DESIGN Retrospective cohort study. METHODS This study included all adults (aged ≥18 years) with Graves disease in the Intelligent Research in Sight (IRIS) Registry (January 1, 2013, to December 31, 2020). The primary outcome was surgical intervention for TED, stratified into orbital decompression, strabismus surgery, and eyelid recession surgery. The Kaplan-Meier estimated 5-year cumulative probability for each surgical intervention was calculated. Multivariable Cox regression was used to evaluate the association between smoking status and each surgical intervention, adjusting for age, sex, race, ethnicity, and geographic region. RESULTS This study included 87,774 patients. Median age was 59 years (IQR, 48-68 years); 81% were female patients. Current smokers had a greater 5-year cumulative probability of orbital decompression (3.7% vs 1.9%; P < .001), strabismus surgery (4.6% vs 2.2%; P < .001), and eyelid recession (4.1% vs 2.6%; P < .001) compared to never smokers. After adjusting for demographic factors, current smokers were at greater risk for orbital decompression (hazard ratio [HR], 2.1; 95% CI, 1.8-2.4; P < .001), strabismus surgery (HR, 2.0; 95% CI, 1.8-2.3; P < .001), and eyelid recession (HR, 1.7; 95% CI, 1.5-1.9; P < .001) than never smokers. Former smokers were at higher risk for each type of surgery for TED, albeit at lower levels than current smokers. CONCLUSIONS Smoking was associated with increased risk of surgical intervention for TED in the IRIS Registry. Former smokers were at a lower risk than current smokers, supporting the role of smoking cessation on lowering the burden of surgical disease at the population-level.
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Affiliation(s)
- Isdin Oke
- From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
| | - Edith R Reshef
- From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tobias Elze
- Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Joan W Miller
- Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice C Lorch
- Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - David G Hunter
- From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne K Freitag
- From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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14
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Baş Z, Sharpe J, Yaghy A, Zhang Q, Shields CL, Hyman L. Prevalence of and Associated Factors for Eyelid Cancer in the American Academy of Ophthalmology Intelligent Research in Sight Registry. OPHTHALMOLOGY SCIENCE 2023; 3:100227. [PMID: 36439695 PMCID: PMC9692036 DOI: 10.1016/j.xops.2022.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To estimate the prevalence of eyelid cancers in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry and evaluate the associated factors. DESIGN Retrospective IRIS Registry database study. PARTICIPANTS All patients in the IRIS Registry between December 1, 2010, and December 1, 2018, with International Classification of Disease, ninth and 10th revisions, codes for eyelid cancers (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], malignant melanoma [MM], sebaceous carcinoma/other specified malignant neoplasm [SBC], melanoma in situ [MIS], and unspecified malignant neoplasm [UMN]). METHODS The prevalence of each eyelid cancer type was estimated overall and by age group, sex, race, ethnicity, and smoking status. The associations between any eyelid cancer (AEC) or each cancer type and possible risk factors were examined using univariate and multivariate logistic regression models. MAIN OUTCOME MEASURES Prevalence of and associated factors for each eyelid cancer type. RESULTS There were 82 136 patients with eyelid cancer identified. The prevalence of AEC was 145.1 per 100 000 population. The cancer-specific prevalence ranged from 87.9 (BCC) to 25.6 (UMN), 11.1 (SCC), 5.0 (SBC), 4.1 (MM), and 0.4 (MIS) per 100 000 population. The prevalence of AEC and each cancer type increased with increasing age (all P < 0.0001), and the prevalence of AEC, BCC, SCC, and MM was higher in males (all P < 0.0001), MIS (P = 0.02). The prevalence of BCC, SCC, MM, SBC, and AEC was highest in Whites versus that in patients of any other race (all P < 0.0001). In the multivariate logistic regression model with associated risk factors (age, sex, race, ethnicity, and smoking status), AEC was associated with older age groups ([< 20 years reference {ref.}]; odds ratio [95% confidence interval]: 20-39 years: 3.35 [1.96-5.72]; 40-65 years: 24.21 [14.80-39.59]; and > 65 years: 42.78 [26.18-69.90]), male sex (female [ref.]; 1.40 [1.33-1.48]), White race (inverse associations with African Americans [0.12 {0.09-0.16}], Asians [0.19 {0.13-0.26}], others [0.59 {0.40-0.89}]), and ethnicity (non-Hispanic [ref.]; Hispanic: 0.38 [0.33-0.45]; unknown: 0.81 [0.75-0.88]). Active smoking (never smoker [ref.]) was associated with AEC (1.11 [1.01-1.21]), BCC (1.27 [1.23-1.31]), SCC (1.59 [1.46-1.73]), and MM (1.26 [1.08-1.46]). CONCLUSIONS This study reports the overall and cancer-specific prevalence of eyelid cancers using a large national clinical eye disease database. Smoking was found to be associated with AEC, BCC, SCC, and MM, which is a new observation. This epidemiologic profile of on-eyelid cancers is valuable for identifying patients at a higher risk of malignancy, allocating medical resources, and improving cancer care.
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Key Words
- AAO, American Academy of Ophthalmolog
- AEC, any eyelid cancer
- AUC, area under the curve
- BCC, basal cell carcinoma
- Basal cell carcinoma
- CI, confidence interval
- ICD, International Classification of Disease
- IRIS Registry
- IRIS, Intelligent Research in Sight
- MIS, melanoma in situ
- MM, malignant melanoma
- Malignant melanoma
- OR, odds ratio
- SBC, sebaceous carcinoma or other specified malignant neoplasm
- SCC, squamous cell carcinoma
- Smoking
- Squamous cell carcinoma
- UMN, unspecified malignant neoplasm
- US, United States
- vs, versus
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Affiliation(s)
- Zeynep Baş
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James Sharpe
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Qiang Zhang
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Leslie Hyman
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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15
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Batchelor A, Lacy M, Hunt M, Lu R, Lee AY, Lee CS, Saraf SS, Chee YE. Predictors of Long-term Ophthalmic Complications after Closed Globe Injuries Using the Intelligent Research in Sight (IRIS®) Registry. OPHTHALMOLOGY SCIENCE 2023; 3:100237. [PMID: 36561352 PMCID: PMC9764252 DOI: 10.1016/j.xops.2022.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/08/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
Purpose To identify clinical factors associated with the need for future surgical intervention following closed globe ocular trauma. Design Retrospective cohort study. Subjects Participants and/or Controls Patients in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry with a diagnosis of closed globe ocular trauma occurring between 2013 and 2019, identified using International Classification of Disease, 10th Revision and Systematized Nomenclature of Medicine codes. Methods Diagnosis codes were used to identify multiple concomitant diagnoses present on the date of closed globe ocular trauma. Survival analyses were performed for each outcome of interest, and linear regression was used to identify clinical factors associated with the risk of surgical intervention. Main Outcome Measures Outcomes included retinal break treatment, retinal detachment (RD) repair, retinal break treatment or RD repair, glaucoma surgery, and cataract surgery. Results Of the 206 807 patients with closed globe ocular trauma, 9648 underwent surgical intervention during the follow-up period (mean, 444 days): 1697 (0.8%) had RD repair, 1658 (0.8%) had retinal break treatment, 600 (0.3%) had glaucoma surgery, and 5693 (2.8%) had cataract surgery. Traumatic cataract was the strongest risk factor for cataract surgery (hazard ratio, 13.0; 95% confidence interval, 10.8-15.6), traumatic hyphema showed highest risk for glaucoma surgery (7.24; 4.60-11.4), and vitreous hemorrhage was the strongest risk factor for retinal break treatment and detachment repair (11.01; 9.18-13.2 and 14.2; 11.5-17.6, respectively) during the first 60 days after trauma date. Vitreous hemorrhage was a risk factor for cataract surgery at > 60 days after trauma date only. Iris-angle injury was the strongest risk factor for glaucoma surgery > 60 days after trauma, while vitreous hemorrhage remained the strongest factor for retinal break treatment and detachment repair at > 60 days. Traumatic hyphema was a risk factor for all surgical outcomes during all follow-up intervals. Conclusions Diagnosis of concomitant traumatic cataract, vitreous hemorrhage, traumatic hyphema, and other risk factors may increase the likelihood of requiring surgical intervention after closed globe ocular trauma.
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Affiliation(s)
- Ashley Batchelor
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Megan Lacy
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Matthew Hunt
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Randy Lu
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Steven S. Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Yewlin E. Chee
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - IRIS Registry Analytic Center Consortium
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
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16
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Tran JH, Stuart KV, de Vries V, Vergroesen JE, Cousins CC, Hysi PG, Do R, Rocheleau G, Kang JH, Wiggs JL, MacGregor S, Khawaja AP, Mackey DA, Klaver CCW, Ramdas WD, Pasquale LR. Genetic Associations Between Smoking- and Glaucoma-Related Traits. Transl Vis Sci Technol 2023; 12:20. [PMID: 36786746 PMCID: PMC9932549 DOI: 10.1167/tvst.12.2.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Purpose The purpose of this study was to describe the genetic relationship between smoking and glaucoma. Methods We used summary-level genetic data for smoking initiation, smoking intensity (cigarettes per day [CPD]), intraocular pressure (IOP), vertical cup-disc ratio, and open-angle glaucoma (OAG) to estimate global genetic correlations (rg) and perform two-sample Mendelian randomization (MR) experiments that explored relations between traits. Finally, we examined associations between smoking genetic risk scores (GRS) and smoking traits with measured IOP and OAG in Rotterdam Study participants. Results We identified weak inverse rg between smoking- and glaucoma-related traits that were insignificant after Bonferroni correction. However, MR analysis revealed that genetically predicted smoking initiation was associated with lower IOP (-0.18 mm Hg per SD, 95% confidence interval [CI] = -0.30 to -0.06, P = 0.003). Furthermore, genetically predicted smoking intensity was associated with decreased OAG risk (odds ratio [OR] = 0.74 per SD, 95% CI = 0.61 to 0.90, P = 0.002). In the Rotterdam Study, the smoking initiation GRS was associated with lower IOP (-0.09 mm Hg per SD, 95% CI = -0.17 to -0.01, P = 0.04) and lower odds of OAG (OR = 0.84 per SD, 95% CI = 0.73 to 0.98, P = 0.02) in multivariable-adjusted analyses. In contrast, neither smoking history nor CPD was associated with IOP (P ≥ 0.38) or OAG (P ≥ 0.54). Associations between the smoking intensity GRS and glaucoma traits were null (P ≥ 0.13). Conclusions MR experiments and GRS generated from Rotterdam Study participants support an inverse relationship between smoking and glaucoma. Translational Relevance Understanding the genetic drivers of the inverse relationship between smoking and glaucoma could yield new insights into glaucoma pathophysiology.
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Affiliation(s)
- Jessica H. Tran
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kelsey V. Stuart
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Victor de Vries
- Departments of Ophthalmology and Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joëlle E. Vergroesen
- Departments of Ophthalmology and Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Clara C. Cousins
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Pirro G. Hysi
- Department of Ophthalmology, King's College London, St. Thomas’ Hospital, London, UK
- Department of Twin Research & Genetic Epidemiology, King's College London, St. Thomas’ Hospital, London, UK
| | - Ron Do
- Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ghislain Rocheleau
- Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jae H. Kang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Janey L. Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Stuart MacGregor
- Department of Statistical Genetics, QIMR Bergohofer Medical Research Institute, Brisbane, Australia
| | - Anthony P. Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - David A. Mackey
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Western Australia, Australia
| | - Caroline C. W. Klaver
- Departments of Ophthalmology and Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboudumc, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland
| | - Wishal D. Ramdas
- Departments of Ophthalmology and Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Louis R. Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Fowler S, Wang T, Munro D, Kumar A, Chitre AS, Hollingsworth TJ, Garcia Martinez A, St. Pierre CL, Bimschleger H, Gao J, Cheng R, Mohammadi P, Chen H, Palmer AA, Polesskaya O, Jablonski MM. Genome-wide association study finds multiple loci associated with intraocular pressure in HS rats. Front Genet 2023; 13:1029058. [PMID: 36793389 PMCID: PMC9922724 DOI: 10.3389/fgene.2022.1029058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/28/2022] [Indexed: 02/03/2023] Open
Abstract
Elevated intraocular pressure (IOP) is influenced by environmental and genetic factors. Increased IOP is a major risk factor for most types of glaucoma, including primary open angle glaucoma (POAG). Investigating the genetic basis of IOP may lead to a better understanding of the molecular mechanisms of POAG. The goal of this study was to identify genetic loci involved in regulating IOP using outbred heterogeneous stock (HS) rats. HS rats are a multigenerational outbred population derived from eight inbred strains that have been fully sequenced. This population is ideal for a genome-wide association study (GWAS) owing to the accumulated recombinations among well-defined haplotypes, the relatively high allele frequencies, the accessibility to a large collection of tissue samples, and the large allelic effect size compared to human studies. Both male and female HS rats (N = 1,812) were used in the study. Genotyping-by-sequencing was used to obtain ∼3.5 million single nucleotide polymorphisms (SNP) from each individual. SNP heritability for IOP in HS rats was 0.32, which agrees with other studies. We performed a GWAS for the IOP phenotype using a linear mixed model and used permutation to determine a genome-wide significance threshold. We identified three genome-wide significant loci for IOP on chromosomes 1, 5, and 16. Next, we sequenced the mRNA of 51 whole eye samples to find cis-eQTLs to aid in identification of candidate genes. We report 5 candidate genes within those loci: Tyr, Ctsc, Plekhf2, Ndufaf6 and Angpt2. Tyr, Ndufaf6 and Angpt2 genes have been previously implicated by human GWAS of IOP-related conditions. Ctsc and Plekhf2 genes represent novel findings that may provide new insight into the molecular basis of IOP. This study highlights the efficacy of HS rats for investigating the genetics of elevated IOP and identifying potential candidate genes for future functional testing.
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Affiliation(s)
- Samuel Fowler
- Hamilton Eye Institute Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, United states
| | - Tengfei Wang
- Department of Pharmacology, Addiction Science and Toxicology, University of Tennessee Health Science Center, Memphis, Tennessee, United states
| | - Daniel Munro
- Department of Psychiatry, University of California, San Diego, San Diego, California, United states
- Department of Integrative Structural and Computational Biology, Scripps Research, San Diego, California, United states
| | - Aman Kumar
- Hamilton Eye Institute Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, United states
| | - Apurva S. Chitre
- Department of Psychiatry, University of California, San Diego, San Diego, California, United states
| | - T. J. Hollingsworth
- Hamilton Eye Institute Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, United states
| | - Angel Garcia Martinez
- Department of Pharmacology, Addiction Science and Toxicology, University of Tennessee Health Science Center, Memphis, Tennessee, United states
| | - Celine L. St. Pierre
- Department of Psychiatry, University of California, San Diego, San Diego, California, United states
| | - Hannah Bimschleger
- Department of Psychiatry, University of California, San Diego, San Diego, California, United states
| | - Jianjun Gao
- Department of Psychiatry, University of California, San Diego, San Diego, California, United states
| | - Riyan Cheng
- Department of Psychiatry, University of California, San Diego, San Diego, California, United states
| | - Pejman Mohammadi
- Department of Integrative Structural and Computational Biology, Scripps Research, San Diego, California, United states
- Scripps Research Translational Institute, Scripps Research, San Diego, California, United states
| | - Hao Chen
- Department of Pharmacology, Addiction Science and Toxicology, University of Tennessee Health Science Center, Memphis, Tennessee, United states
| | - Abraham A. Palmer
- Department of Psychiatry, University of California, San Diego, San Diego, California, United states
- Institute for Genomic Medicine, University of California, San Diego, San Diego, California, United states
| | - Oksana Polesskaya
- Department of Psychiatry, University of California, San Diego, San Diego, California, United states
| | - Monica M. Jablonski
- Hamilton Eye Institute Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, United states
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Rothman AL, Chang TC, Lum F, Vanner EA. Intraocular Pressure Changes Following Stand-Alone Phacoemulsification: An IRIS Ɍ Registry Analysis. Am J Ophthalmol 2023; 245:25-36. [PMID: 36162536 DOI: 10.1016/j.ajo.2022.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To describe real-world intraocular pressure (IOP) changes following stand-alone cataract surgery by comparing postoperative IOP to phakic fellow eyes. DESIGN Retrospective clinical cohort study. METHODS A total of 1,334,868 patients (336,060 with glaucoma and 998,808 without glaucoma) in the IRIS® Registry (Intelligent Research in Sight) underwent stand-alone phacoemulsification from 1 January 2013 to 30 September 2019 with a fellow eye that had subsequent cataract surgery. Postoperative daily mean IOP was compared between surgical and control eyes from postoperative day 1 to 90. A generalized linear model determined when the postoperative daily mean IOP stabilized to calculate a final mean IOP, which was then compared to baseline IOP. RESULTS Postoperative daily mean IOP was initially greater for surgical than for control eyes because of an early postoperative IOP spike. By postoperative day 13, postoperative daily mean IOP was significantly lower for surgical than for control eyes every day through postoperative day 90 (P < .001). There was a mean (SD) decrease from baseline to final mean IOP of 1.55 (3.52) mm Hg or 7.79% for all surgical eyes, 1.91 (3.93) mm Hg or 8.89% for surgical eyes with glaucoma, and 1.37 (3.28) mm Hg or 7.24% for surgical eyes without glaucoma, respectively. There was a statistically significant decrease from baseline to the final mean IOP for all surgical eyes, surgical eyes without glaucoma, and all categories of pre-glaucoma and glaucoma (P < .0001 for all, excluding uveitic glaucoma [P = .0016]). CONCLUSIONS Eyes both with and without glaucoma that underwent stand-alone phacoemulsification had a significant decrease in IOP through the 90-day postoperative period compared to baseline and phakic fellow eyes.
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Affiliation(s)
- Adam L Rothman
- From the Bascom Palmer Eye Institute (A.L.R., T.C.C., E.A.V.), University of Miami, Miami, Florida, USA.
| | - Ta Chen Chang
- From the Bascom Palmer Eye Institute (A.L.R., T.C.C., E.A.V.), University of Miami, Miami, Florida, USA
| | - Flora Lum
- American Academy of Ophthalmology (F.L.), San Francisco, California, USA
| | - Elizabeth A Vanner
- From the Bascom Palmer Eye Institute (A.L.R., T.C.C., E.A.V.), University of Miami, Miami, Florida, USA
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Coster D, Rafie A, Savion-Gaiger N, Rachmiel R, Kurtz S, Berliner S, Shapira I, Zeltser D, Rogowski O, Shenhar-Tsarfaty S, Waisbourd M. The effect of body mass index reduction on intraocular pressure in a large prospective cohort of apparently healthy individuals in Israel. PLoS One 2023; 18:e0285759. [PMID: 37196013 DOI: 10.1371/journal.pone.0285759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To investigate the effect of change in body mass index (BMI) on intraocular pressure (IOP) in a large cohort of apparently healthy volunteers who underwent an annual comprehensive screening examinations. METHODS This study included individuals who were enrolled in the Tel Aviv Medical Center Inflammation Survey (TAMCIS) and had IOP and BMI measurements at their baseline and follow up visits. Relationships between BMI and IOP and the effect of change in BMI on IOP were investigated. RESULTS A total of 7,782 individuals had at least one IOP measurement at their baseline visit, and 2,985 individuals had ≥2 visits recorded. The mean (SD) IOP (right eye) was 14.6 (2.5) mm Hg and mean (SD) BMI was 26.4 (4.1) kg/m2. IOP positively correlated with BMI levels (r = 0.16, p<0.0001). For individuals with morbid obesity (BMI≥35 kg/m2) and ≥2 visits, a change in BMI between the baseline and first follow-up visits correlated positively with a change in the IOP (r = 0.23, p = 0.029). Subgroup analysis of subjects who had a reduction of at least 2 BMI units showed a stronger positive correlation between change in BMI and change in IOP (r = 0.29, p<0.0001). For this subgroup, a reduction of 2.86 kg/m2 of BMI was associated with a reduction of 1 mm Hg in IOP. CONCLUSIONS BMI loss correlated with reduction in IOP, and this correlation was more pronounced among morbidly obese individuals.
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Affiliation(s)
- Dan Coster
- Blavatnik School of Computer Science, Tel-Aviv University, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ariel Rafie
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Noam Savion-Gaiger
- Division of Ophthalmology, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Rony Rachmiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Ophthalmology, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Shimon Kurtz
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Ophthalmology, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Shlomo Berliner
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Internal Medicine, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itzhak Shapira
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Internal Medicine, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Zeltser
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Internal Medicine, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ori Rogowski
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Internal Medicine, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Internal Medicine, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Waisbourd
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Ophthalmology, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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20
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Armbrust KR, Kopplin LJ. Characteristics and Outcomes of Patients with Scleritis in the IRIS® Registry (Intelligent Research in Sight) Database. OPHTHALMOLOGY SCIENCE 2022; 2:100178. [PMID: 36245751 PMCID: PMC9559886 DOI: 10.1016/j.xops.2022.100178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To report patient characteristics and factors associated with poor visual acuity and abnormal intraocular pressure (IOP) in patients with scleritis in the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight). DESIGN Retrospective cohort study. PARTICIPANTS Patients in the IRIS Registry with at least 3 office visits associated with an International Classification of Diseases scleritis code from 2013 through 2019. METHODS We evaluated demographic and clinical characteristics in scleritis and scleritis subtype cohorts. We conducted Cox proportional hazards and multiple logistic regression analyses to assess associations with poor best-corrected visual acuity (BCVA), vision loss, and IOP abnormalities. MAIN OUTCOME MEASURES Patient characteristics, BCVA of 0.6 logarithm of the minimum angle of resolution (logMAR) or more, BCVA worsened by more than 3 logMAR units 6 months after presentation, IOP of 30 mmHg or more, and IOP of 5 mmHg or less. RESULTS In this cohort of 111 314 patients with scleritis, the mean ± standard deviation age was 58.5 ± 16.6 years, 66% were women, and 30% had bilateral scleritis. Patients with scleromalacia perforans were older and more likely to have bilateral disease. Multiple logistic regression analysis identified factors with increased odds for poor presenting BCVA (older age, male sex, Black race, Hispanic ethnicity, smoking, and scleritis subtypes) and at least 3 lines of vision loss 6 months after initial scleritis diagnosis (older age, smoking, and anterior scleritis). Cox proportional hazards regression modeling of BCVA of 0.6 logMAR or more showed older age (adjusted hazard ratio [aHR] per 10-year unit, 1.11), Black race (aHR, 1.19), Hispanic ethnicity (aHR, 1.22), active smoking (aHR, 1.39), former smoking (aHR, 1.26), and certain scleritis subtypes increase the risk of poor visual acuity development (P < 0.001 for all). Older age, male sex, Black race, Hispanic ethnicity, smoking, and scleritis subtypes increased the odds of IOP abnormality. CONCLUSIONS Older age, Black or Hispanic ancestry, smoking, and specific scleritis subtypes are risk factors for worse visual and IOP outcomes in patients with scleritis in the IRIS Registry. Closer follow-up may be appropriate for older, Black, or Hispanic patients with scleritis; smokers should receive smoking cessation assistance.
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Key Words
- BCVA, best-corrected visual acuity
- CI, confidence interval
- Database
- ICD, International Classification of Diseases
- ICD-10, International Classification of Diseases, Tenth Revision
- ICD-9, International Classification of Diseases, Ninth Revision
- IOP, intraocular pressure
- IRIS Registry
- IRIS, Intelligent Research in Sight
- Intraocular pressure
- OR, odds ratio
- SD, standard deviation
- Scleritis
- Visual acuity
- aHR, adjusted hazard ratio
- logMAR, logarithm of the minimum angle of resolution
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Affiliation(s)
- Karen R. Armbrust
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Laura J. Kopplin
- Department of Ophthalmology and Visual Sciences, University of Wisconsin—Madison, Madison, Wisconsin
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Denniston AK, Kale AU, Lee WH, Mollan SP, Keane PA. Building trust in real-world data: lessons from INSIGHT, the UK's health data research hub for eye health and oculomics. Curr Opin Ophthalmol 2022; 33:399-406. [PMID: 35916569 DOI: 10.1097/icu.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In this review, we consider the challenges of creating a trusted resource for real-world data in ophthalmology, based on our experience of establishing INSIGHT, the UK's Health Data Research Hub for Eye Health and Oculomics. RECENT FINDINGS The INSIGHT Health Data Research Hub maximizes the benefits and impact of historical, patient-level UK National Health Service (NHS) electronic health record data, including images, through making it research-ready including curation and anonymisation. It is built around a shared 'north star' of enabling research for patient benefit. INSIGHT has worked to establish patient and public trust in the concept and delivery of INSIGHT, with efficient and robust governance processes that support safe and secure access to data for researchers. By linking to systemic data, there is an opportunity for discovery of novel ophthalmic biomarkers of systemic diseases ('oculomics'). Datasets that provide a representation of the whole population are an important tool to address the increasingly recognized threat of health data poverty. SUMMARY Enabling efficient, safe access to routinely collected clinical data is a substantial undertaking, especially when this includes imaging modalities, but provides an exceptional resource for research. Research and innovation built on inclusive real-world data is an important tool in ensuring that discoveries and technologies of the future may not only favour selected groups, but also work for all patients.
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Affiliation(s)
- Alastair K Denniston
- INSIGHT Health Data Research hub for Eye Health
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Aditya U Kale
- INSIGHT Health Data Research hub for Eye Health
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham
| | - Wen Hwa Lee
- INSIGHT Health Data Research hub for Eye Health
- Action Against Age-Related Macular Degeneration, London
| | - Susan P Mollan
- INSIGHT Health Data Research hub for Eye Health
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham
| | - Pearse A Keane
- INSIGHT Health Data Research hub for Eye Health
- NIHR Biomedical Research Centre At Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
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22
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Prevalence and Risk Factors of Glaucoma Among Chinese People.From the China Health and Retirement Longitudinal Study. J Glaucoma 2022; 31:789-795. [PMID: 35980856 DOI: 10.1097/ijg.0000000000002094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
PRCIS This study demonstrated the prevalence of self-reported glaucoma and its strong association with pre-existing systemic chronic diseases in China using the baseline data from CHARLS, a nationwide population-based cohort. PURPOSE To estimate the prevalence of self-reported glaucoma and its risk factors using data from the China Health and Retirement Longitudinal Study (CHARLS). MATERIALS AND METHODS Data on age, sex, area of residence, education, marital status, health-related behaviors, and pre-existing comorbidities for this cross-sectional study were retrieved from the CHARLS for 17,713 subjects who completed a questionnaire between June 2011 and March 2012. The prevalence of glaucoma was estimated, and a multivariate weighted analysis was performed to estimate the odds ratios (ORs) of its risk factors. RESULTS Of 16,599 respondents (93.7%) who answered questions regarding glaucoma and their history of systemic chronic diseases, 314 (1.89%) reported having glaucoma before the index date. Qinghai and Beijing had the highest prevalence of glaucoma in China. Glaucoma was significantly associated with hypertension (OR 1.362 [95% confidence interval (CI) 1.801-2.470]), diabetes (OR 2.597 [95% CI 1.661-10.207]), dyslipidemia (OR 1.757 [95% CI 1.157-3.650]), lung disease (OR 2.098 [95% CI 1.674-6.527]), stroke (OR 5.278 [95% CI 1.094-25.462]), heart disease (OR 1.893 [95% CI 1.237-3.363]), and health-related behaviors such as smoking and alcohol consumption after adjusting for age, sex, area, education, marital status, and medical insurance. CONCLUSIONS Geographic variation in the prevalence of self-reported glaucoma and its strong association with pre-existing systemic chronic diseases were observed, suggesting that in addition to ophthalmological examinations, regular physical examinations are necessary for glaucoma patients, especially in areas of high incidence. Appropriate strategies to improve preventive measures for glaucoma are recommended for the Chinese population.
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Hall NE, Chang EK, Samuel S, Gupta S, Klug E, Elze T, Lorch AC, Miller JW, Solá-Del Valle D. Risk Factors for Glaucoma Drainage Device Revision or Removal Using the IRIS Registry. Am J Ophthalmol 2022; 240:302-320. [PMID: 35381206 DOI: 10.1016/j.ajo.2022.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To elucidate risk factors for revision or removal of glaucoma drainage devices (GDD) in glaucoma patients in the United States. DESIGN Retrospective cohort study. METHODS IRIS Registry (Intelligent Research in Sight) patients who underwent GDD insertion between January 1, 2013 and December 31, 2018 were included. Various demographic and clinical factors were collected. Kaplan-Meier survival plots, Cox proportional-hazard models utilizing Firth's Penalized Likelihood, and multivariate linear regression models were used. The main outcome measures were hazard ratios (HR) and beta coefficient (β) estimates. RESULTS A total of 44,330 distinct patients underwent at least 1 GDD implantation, and 3354 of these underwent subsequent GDD revision or removal surgery. With failure defined as GDD revision/removal, factors significantly associated with decreased failure included unknown race (HR = 0.83; P = .004) and unknown ethnicity (HR = 0.68; P < .001). Factors associated with increased risk of GDD revision/removal surgery included presence of chronic angle-closure glaucoma (HR = 1.32; P < .001) and dry eye disease (HR = 1.30; P = .007). Additionally, factors associated with a decreased average time (in days) to GDD revision/removal included male sex (β = -25.96; P = .044), unknown race (β = -55.28; P = .013), and right-eye laterality (β = -38.67; P = .026). Factors associated with an increased average time to GDD revision/removal included having a history of a past eye procedure (β = 104.83; P < .001) and being an active smoker (β = 38.15; P = .024). CONCLUSIONS The size and scope of the IRIS Registry allows for detection of subtle associations between risk factors and GDD revision or removal surgery. The aforementioned demographic and clinical factors may all have an impact on GDD longevity and can inform the treatment options available for glaucoma patients.
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Affiliation(s)
- Nathan E Hall
- From Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School (N.E.H, E.K.C, S.S, S.G, T.E, A.C.L, J.W.M, D.S-D.V)
| | - Enchi K Chang
- From Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School (N.E.H, E.K.C, S.S, S.G, T.E, A.C.L, J.W.M, D.S-D.V)
| | - Sandy Samuel
- From Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School (N.E.H, E.K.C, S.S, S.G, T.E, A.C.L, J.W.M, D.S-D.V)
| | - Sanchay Gupta
- From Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School (N.E.H, E.K.C, S.S, S.G, T.E, A.C.L, J.W.M, D.S-D.V)
| | - Emma Klug
- Massachusetts Eye and Ear, Department of Ophthalmology (E.K), Massachusetts Eye and Ear Glaucoma Service, Boston, Massachusetts, USA
| | - Tobias Elze
- From Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School (N.E.H, E.K.C, S.S, S.G, T.E, A.C.L, J.W.M, D.S-D.V)
| | - Alice C Lorch
- From Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School (N.E.H, E.K.C, S.S, S.G, T.E, A.C.L, J.W.M, D.S-D.V)
| | - Joan W Miller
- From Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School (N.E.H, E.K.C, S.S, S.G, T.E, A.C.L, J.W.M, D.S-D.V)
| | - David Solá-Del Valle
- From Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School (N.E.H, E.K.C, S.S, S.G, T.E, A.C.L, J.W.M, D.S-D.V).
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Skuta GL, Ding K, Lum F, Coleman AL. An IRIS® Registry-Based Assessment of Primary Open-Angle Glaucoma Practice Patterns in Academic versus Non-Academic Settings. Am J Ophthalmol 2022; 242:228-242. [PMID: 35469787 DOI: 10.1016/j.ajo.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare patient demographic data; level of severity; and clinical, diagnostic, and surgical practice patterns in patients with primary open-angle glaucoma (POAG) in an academic setting (AS) versus non-academic setting (NAS) using the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). METHODS A retrospective cohort study of IRIS® Registry data that included patients with POAG who were seen between January 2016 and December 2019 and had at least one year of follow-up. RESULTS Of 3,707,084 distinct eyes with POAG, 3% (109,920) were included in the academic subcohort and 97% (3,597,164) were included in the non-academic subcohort. Among the findings of greatest note (P < .0001 for all comparisons) were a higher proportion of eyes of Black patients, a higher proportion of eyes with level 3 severity, and a higher mean cup-to-disc ratio in eyes in the AS. The relative frequency of gonioscopy, pachymetry, and visual field testing in conjunction with new patient visits was also notably higher in the AS. For glaucoma surgical procedures, the greatest proportional differences in relative frequency were seen for tube shunt procedures (2.55-fold higher in the AS), iStent and Hydrus procedures (2.52-fold higher in the NAS), and endoscopic cyclophotocoagulation (5.80-fold higher in the NAS). CONCLUSIONS Based on IRIS® Registry data, notable differences appear to exist with regard to ethno-racial groups, glaucoma severity, and diagnostic and surgical practice patterns in AS versus NAS. By understanding these differences, potential opportunities exist in the development of educational programs related to clinical and surgical glaucoma care.
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25
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Hammond CL, Roztocil E, Gupta V, Feldon SE, Woeller CF. More than Meets the Eye: The Aryl Hydrocarbon Receptor is an Environmental Sensor, Physiological Regulator and a Therapeutic Target in Ocular Disease. FRONTIERS IN TOXICOLOGY 2022; 4:791082. [PMID: 35295218 PMCID: PMC8915869 DOI: 10.3389/ftox.2022.791082] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/08/2022] [Indexed: 12/22/2022] Open
Abstract
The aryl hydrocarbon receptor (AHR) is a ligand activated transcription factor originally identified as an environmental sensor of xenobiotic chemicals. However, studies have revealed that the AHR regulates crucial aspects of cell growth and metabolism, development and the immune system. The importance of the AHR and AHR signaling in eye development, toxicology and disease is now being uncovered. The AHR is expressed in many ocular tissues including the retina, choroid, cornea and the orbit. A significant role for the AHR in age-related macular degeneration (AMD), autoimmune uveitis, and other ocular diseases has been identified. Ligands for the AHR are structurally diverse organic molecules from exogenous and endogenous sources. Natural AHR ligands include metabolites of tryptophan and byproducts of the microbiome. Xenobiotic AHR ligands include persistent environmental pollutants such as dioxins, benzo (a) pyrene [B (a) P] and polychlorinated biphenyls (PCBs). Pharmaceutical agents including the proton pump inhibitors, esomeprazole and lansoprazole, and the immunosuppressive drug, leflunomide, activate the AHR. In this review, we highlight the role of the AHR in the eye and discuss how AHR signaling is involved in responding to endogenous and environmental stimuli. We also present the emerging concept that the AHR is a promising therapeutic target for eye disease.
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Affiliation(s)
| | | | | | | | - Collynn F. Woeller
- Flaum Eye Institute, Rochester, NY, United States
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
- *Correspondence: Collynn F. Woeller,
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26
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Lee CS. American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry and the IRIS Registry Analytic Center Consortium. OPHTHALMOLOGY SCIENCE 2022; 2:100112. [PMID: 36246182 PMCID: PMC9560568 DOI: 10.1016/j.xops.2022.100112] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Lacy M, Kung TPH, Owen JP, Yanagihara RT, Blazes M, Pershing S, Hyman LG, Van Gelder RN, Lee AY, Lee CS. Endophthalmitis Rate in Immediately Sequential versus Delayed Sequential Bilateral Cataract Surgery within the Intelligent Research in Sight (IRIS®) Registry Data. Ophthalmology 2022; 129:129-138. [PMID: 34265315 PMCID: PMC8755857 DOI: 10.1016/j.ophtha.2021.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/11/2021] [Accepted: 07/06/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare the rate of postoperative endophthalmitis after immediately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry database. DESIGN Retrospective cohort study. PARTICIPANTS Patients in the IRIS Registry who underwent cataract surgery from 2013 through 2018. METHODS Patients who underwent cataract surgery were divided into 2 groups: (1) ISBCS and (2) DSBCS (second-eye surgery ≥1 day after the first-eye surgery) or unilateral surgery. Postoperative endophthalmitis was defined as endophthalmitis occurring within 4 weeks of surgery by International Classification of Diseases (ICD) code and ICD code with additional clinical criteria. MAIN OUTCOME MEASURES Rate of postoperative endophthalmitis. RESULTS Of 5 573 639 IRIS Registry patients who underwent cataract extraction, 165 609 underwent ISBCS, and 5 408 030 underwent DSBCS or unilateral surgery (3 695 440 DSBCS, 1 712 590 unilateral surgery only). A total of 3102 participants (0.056%) met study criteria of postoperative endophthalmitis with supporting clinical findings. The rates of endophthalmitis in either surgery eye between the 2 surgery groups were similar (0.059% in the ISBCS group vs. 0.056% in the DSBCS or unilateral group; P = 0.53). Although the incidence of endophthalmitis was slightly higher in the ISBCS group compared with the DSBCS or unilateral group, the odds ratio did not reach statistical significance (1.08; 95% confidence interval, 0.87-1.31; P = 0.47) after adjusting for age, sex, race, insurance status, and comorbid eye disease. Seven cases of bilateral endophthalmitis with supporting clinical data in the DSBCS group and no cases in the ISBCS group were identified. CONCLUSIONS Risk of postoperative endophthalmitis was not statistically significantly different between patients who underwent ISBCS and DSBCS or unilateral cataract surgery.
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Affiliation(s)
- Megan Lacy
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Timothy-Paul H. Kung
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
| | - Julia P. Owen
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Ryan T. Yanagihara
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Marian Blazes
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Suzann Pershing
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California.,Veterans Affairs Palo Alto Health California System, Palo Alto, California
| | - Leslie G. Hyman
- The Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Russell N. Van Gelder
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
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Cataract Surgery Is Not Associated with Decreased Risk of Retinal Vein Occlusion. OPHTHALMOLOGY SCIENCE 2021; 1:100041. [PMID: 36275940 PMCID: PMC9562376 DOI: 10.1016/j.xops.2021.100041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/25/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
Purpose Design Participants Methods Main Outcome Measure Results Conclusions
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Lee CS, Brandt JD, Lee AY. Big Data and Artificial Intelligence in Ophthalmology: Where Are We Now? OPHTHALMOLOGY SCIENCE 2021; 1:100036. [PMID: 36249294 PMCID: PMC9560652 DOI: 10.1016/j.xops.2021.100036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Cecilia S. Lee
- Correspondence: Cecilia S. Lee, MD, MS, University of Washington, Box 359607, 325 Ninth Avenue, Seattle, WA 98104.
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30
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Li Y, Hall NE, Pershing S, Hyman L, Haller JA, Lee AY, Lee CS, Chiang M, Lum F, Miller JW, Lorch A, Elze T. Age, Gender, and Laterality of Retinal Vascular Occlusion: A Retrospective Study from the IRIS® Registry. Ophthalmol Retina 2021; 6:161-171. [PMID: 33991710 DOI: 10.1016/j.oret.2021.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/17/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Retinal vascular occlusion is a leading cause of profound irreversible visual loss, but the understanding of the disease is insufficient. We systematically investigated the age, gender, and laterality at the onset of retinal artery occlusion (RAO) and retinal vein occlusion (RVO) in the Intelligent Research in Sight (IRIS®) Registry. DESIGN Retrospective registry cohort. PARTICIPANTS Patients with retinal vascular occlusion participating in the IRIS® Registry. METHODS Patients who received a diagnosis of retinal vascular occlusion between 2013 and 2017 were included. Those with unspecified gender or laterality were excluded when conducting the relevant analyses. Patients were categorized into RAO, with subtypes transient retinal artery occlusion (TRAO), partial retinal artery occlusion (PRAO), branch retinal artery occlusion (BRAO), and central retinal artery occlusion (CRAO), and into RVO, with subtypes venous engorgement (VE), branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO). Age was evaluated as a categorical variable (5-year increments). We investigated the association of age, gender, and laterality with the onset frequency of retinal vascular occlusion subtypes. MAIN OUTCOME MEASURES The frequency of onset of RAO and RVO subtypes by age, gender and laterality. RESULTS A total of 1 251 476 patients with retinal vascular occlusion were included, 23.8% of whom had RAO, whereas 76.2% had RVO. Of these, 1 248 656 and 798 089 patients were selected for analyses relevant to gender and laterality, respectively. The onset frequency of all subtypes increased with age. PRAO, BRAO, CRAO, and CRVO presented more frequently in men (53.5%, 51.3%, 52.6%, and 50.4%, respectively), whereas TRAO, VE, and BRVO presented more frequently in women (54.9%, 56.0%, and 54.5% respectively). All RAO subtypes and BRVO showed a right-eye onset preference (TRAO, 51.7%; PRAO, 54.4%; BRAO, 53.5%; CRAO, 53.4%; and BRVO, 51.0%), whereas VE and CRVO exhibited a left-eye onset preference (53.3% and 50.9%, respectively). CONCLUSIONS Although retinal vascular occlusion incidence increases with age regardless of subtypes, we found various subtype-specific disease-onset differences related to gender and, in particular, ocular laterality. These findings may improve understanding of the specific cause of retinal vascular occlusions of different subtypes and their relationships with structural and anatomic asymmetries of the vascular system.
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Affiliation(s)
- Yangjiani Li
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Nathan E Hall
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzann Pershing
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA; Department of Ophthalmology, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Leslie Hyman
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Aaron Y Lee
- eScience Institute, University of Washington, Seattle, Washington, USA; Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Michael Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California, USA
| | - Joan W Miller
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Lorch
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
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