Prevalence and risk factors of myopic maculopathy in rural southern China: the Yangxi Eye Study

Incidence, causes and risk factors of vision loss in rural Southern China: 6-year follow-up of the Yangxi Eye Study

PURPOSE

To report the 6-year incidence, causes and risk factors for vision loss (visual impairment (VI) and blindness), among elderly adults in rural southern China.

METHODS

Population-based, cohort study. Initiated in 2014, the study recruited participants aged 50 and older using random cluster sampling from Yangxi County. All eligible participants were invited to attend interviews and comprehensive eye examinations at the 6-year follow-up between November 2020 and March 2021. The WHO categories of vision loss were used to define incident cases of VI (3/60≤VA <6/12), moderate-to-severe VI (MSVI) (3/60≤VA<6/18) and blindness (VA <3/60) in the better-seeing eye.

RESULTS

Among the 5825 baseline participants, 3187 (64.4%) of 4946 surviving subjects participated in the 6-year follow-up. Based on presenting and best-corrected VA, respectively, the crude incidence rate of blindness was 0.8% (95% CI 0.5% to 1.1%) vs 0.3% (95% CI 0.1% to 0.5%), for MSVI 6.7% (95% CI 5.7% to 7.6%) vs 4.6% (95% CI 3.8% to 5.4%) and for any VI 16.1% (95% CI 14.5% to 17.6%) vs 12.9% (95% CI 11.6% to 14.1%). Cataract (48.3%) and refractive errors (44.4%) were the most common causes of vision loss. Factors significantly associated with greater incident vision loss were older age, female sex, less education, living alone and longer axial length (all p<0.05).

CONCLUSIONS

Substantial work is still required to reduce avoidable vision loss in rural China. Screening outreach and efforts to improve awareness which target the poorer and less educated are urgently needed to reduce the growing unmet need for eye care due to ageing.

Global trends and frontiers of research on pathologic myopia since the millennium: A bibliometric analysis

Background and purpose

Pathologic myopia (PM) is an international public health issue. This study aimed to analyze PM research trends by reporting on publication trends since 2000 and identifying influential journals, countries, authors, and keywords involved in PM.

Methods

A bibliometric analysis was performed to evaluate global production and development trends in PM since 2000 and the keywords associated with PM.

Results

A total of 1,435 publications were retrieved. PM has become a fascinating topic (with relative research interest ranging from 0.0018% in 2000 to 0.0044% in 2021) and a global public health issue. The top three countries with the highest number of publications were China, the USA, and Japan. The journals, authors, and institutions that published the most relevant literature came from these three countries. China exhibited the most rapid increase in the number of publications (from 0 in 2000 to 69 in 2021). Retina published the most papers on PM. Kyoko Ohno-Matsui and Tokyo Medical and Dental University contributed the most publications among authors and institutions, respectively. Based on keyword analysis, previous research emphasized myopic choroidal neovascularization and treatment, while recent hotspots include PM changes based on multimodal imaging, treatment, and pathogenesis. Keyword analysis also revealed that deep learning was the latest hotspot and has been used for the detection of PM.

Conclusion

Our results can help researchers understand the current status and future trends of PM. China, the USA, and Japan have the greatest influence, based on the number of publications, top journals, authors, and institutions. Current research on PM highlights the pathogenesis and application of novel technologies, including multimodal imaging and artificial intelligence.

Progression and associated factors of lacquer cracks/patchy atrophies in high myopia: the Beijing Eye Study 2001-2011

PURPOSE

To assess the development and progression of lacquer cracks/patchy atrophies (LCs/PAs) in high myopia.

METHODS

The case control study included highly myopic eyes (refractive error ≤  - 6.0 diopters), examined in the population-based Beijing Eye Study 2001/2011. Using fundus photographs taken in 2001 and 2011 and optical coherence tomographic images obtained in 2011, we assessed the incidence and enlargement of pre-existing LC/PAs.

RESULTS

The study included 89 highly myopic eyes (age: 65.0 ± 9.4 years). Newly developed or enlarged LC/PAs were detected in 17 (19.1%; 95% confidence interval (CI): 11.0, 27.0) eyes, with a new LC development without previous LCs, enlargement of a pre-existing LC, LC enlargement to a PA, development of a new PA without any previous LCs, and enlargement of a pre-existing PA detected in 3, 3, 5, 3, and 3 eyes, respectively. In 14 (82.4%; 95%CI: 62.3, 100) of the 17 eyes with LC/PA development or enlargement, the LC/PAs elongated perpendicularly to, and widened in, the direction of gamma zone enlargement. Higher prevalence of LC/PA enlargement was associated (multivariable analysis) with higher myopic maculopathy stage in 2001 (odds ratio (OR): 7.83; 95%CI: 2.65, 23.2; P < 0.001) and higher frequency of parapapillary delta zone enlargement (OR: 32.0; 95%CI: 3.07, 334; P < 0.001). Prevalence of LC/PA enlargement was lower than the prevalence of changes in other myopic maculopathy features (disc-fovea distance elongation: 71%; choroidal vessel shift: 55%; reduction in ophthalmoscopical disc size: 34%; ophthalmoscopic disc size enlargement: 25%). All eyes with LC/PA enlargement showed a pre-existing and enlarging gamma zone.

CONCLUSIONS

Development and enlargement of LC/PAs were associated with enlargement of parapapillary delta zone and often occurred in association with the direction of gamma zone enlargement.

Clinical Characteristics of Highly Myopic Patients With Asymmetric Myopic Atrophic Maculopathy-Analysis Using Multimodal Imaging

Purpose

To evaluate the factors associated with asymmetric myopic atrophic maculopathy (MAM) in highly myopic patients.

Methods

We enrolled highly myopic patients with asymmetric MAM according to the atrophy, traction, and neovascularization (ATN) classification. The results of color fundus photography, optical coherence tomography (OCT), OCT angiography, and corneal visualization Scheimpflug technology (Corvis ST tonometry) were reviewed. The association between inter-eye differences in clinical features and MAM grading was analyzed using logistic regression analysis.

Results

Among the 72 eyes of 36 patients 61.0 ± 9.3 years of age, 9, 33, 17, and 13 eyes had A1, A2, A3, and A4, respectively. The mean axial length was 30.44 ± 1.92 mm, and there was no significant difference between eyes with less severe and more severe MAM. The inter-eye differences in MAM grading were associated with the inter-eye differences in the presence of Bruch's membrane defects (P = 0.014), ellipsoid zone disruption (P = 0.013), vessel density of the deep retinal layer (P = 0.022), foveal avascular zone circularity (P = 0.012), foveal avascular zone area (P = 0.049), flow area of the choriocapillaris (P = 0.013), vessel diameter (P = 0.045), and fractal dimension (P = 0.015). No Corvis ST parameter was statistically significant. A higher difference in the choriocapillaris flow area (P = 0.013; adjusted odds ratio = 1.10 [1.02–1.18]) remained associated with higher inter-eye differences in MAM grading in the multivariable regression.

Conclusions

A smaller choriocapillaris flow area was associated with more severe MAM, suggesting that vascular factors play pivotal roles in MAM.

Prevalence and risk factors of myopic maculopathy: a cross-sectional study in Han and Uygur adults in Xinjiang, China

OBJECTIVES

To estimate the prevalence, ethnic differences and associated risk factors of myopic maculopathy in Han and Uygur adults in Xinjiang, China.

DESIGN AND SETTING

A cross-sectional study with multistage, stratified cluster sampling method was conducted in Xinjiang, China.

PARTICIPANTS

A total of 4023 Han and Uygur participants aged 40 years and older were eligible for the study.

OUTCOME MEASURES

The association between myopic maculopathy and its risk factors was screened using the generalised estimating equation (GEE) model. We also investigated whether ethnic differences exist between Han and Uygur populations affected by myopic maculopathy. Myopic maculopathy was defined in accordance with International Photographic Classification and Grading System for Myopic Maculopathy.

RESULTS

A total of 3044 subjects (5946 eyes) were included in our study (1736 Han and 1308 Uygur individuals). The participants consisted of 1256 (41.3%) men and 1788 (58.7%) women. The average age was 52.2±9.4 years, and the mean spherical equivalent (SE) was -0.18±2.31 dioptre (D). Myopic maculopathy was detected in 198 eyes of 138 participants. The age-adjusted prevalence of myopic maculopathy reached 5.8% (95% CI 4.8 to 6.8). In the GEE model, myopic maculopathy was significantly associated with old age (per year; OR: 1.16; 95% CI 1.13 to 1.19; p<0.001) and myopic SE (per -1 D; OR: 1.48; 95% CI 1.40 to 1.56; p<0.001). No ethnic differences were detected between Han (98, 5.7%) and Uygur population (40, 3.1%) in terms of the prevalence of myopic maculopathy (OR=0.89; 95% CI 0.53 to 1.48; p=0.64). Neither urbanisation (p=0.38) nor the level of education (p=0.92) was associated with myopic maculopathy.

CONCLUSIONS

A high age-adjusted prevalence of myopic maculopathy was observed in Han and Uygur populations in Xinjiang, China. Old age and high degree of myopic refraction were independent risk factors for myopic maculopathy. No ethnic differences were detected in Han and Uygur populations affected by myopic maculopathy.