Trends and disparities in disease burden of age-related macular degeneration from 1990 to 2019: Results from the global burden of disease study 2019

Burdens and trends of age-related macular degeneration at global, regional, and national levels,1990-2021: findings from the 2021 global burden of disease study

OBJECTIVES

To assess global, regional, and national burdens and trends of age-related macular degeneration (AMD) from 1990 to 2021.

METHODS

Data from the Global Burden of disease Study 2021(GBD 2021) were used. The primary measurement were prevalent cases, years lived with disability (YLDs), age-standardised prevalence rate (ASPR) and age-standardised YLDs rate (ASYR), categorized by age and sociodemographic index (SDI). Trend analysis was measured by calculating average annual percentage change (AAPC) of ASPR and ASYR.

RESULTS

Globally, the prevalent AMD cases increased to 8,057,520.459 (95% uncertainty interval [UI], 6,705,283.83 to 9,823,237.34) in 2021, with associated YLDs rising to 577,984.5004 (95% UI, 401,188.20 to 797,657.63). AMD burdens varied across regions and countries, as well as level of SDI development. China, India, and the United States of America (USA) were the top three countries with AMD cases. Caribbean regions have significant lower ASPR and ASYR of AMD. The AMD burden peaked between ages 65-69. Females had a significantly higher burden of AMD compared to males. From 1990 to 2021, the global ASPR and ASYR showed downward trend (AAPC = -0.15, 95% confidence interval [CI], -0.19 to -0.12, P < 0.001; AAPC = -0.69, 95% CI, -0.71 to -0.67, P < 0.001) respectively. The USA is the only developed country showed decreasing AAPCs of ASPR and ASYR from 1990 to 2021 but increasing AAPCs of ASPR and ASYR from 2012 to 2021.

CONCLUSIONS

AMD burdens increased over 30 years, varying by age, sex, and SDI, guiding global strategies and public health interventions.

The effect of caffeine consumption on age-related macular degeneration: a systematic review and meta-analysis

PURPOSE

To explore the state-of-the-art evidence on the effect of caffeine consumption on the development and progression of age-related macular degeneration (AMD), a significant cause of blindness worldwide.

METHODS

Eligible primary clinical studies published up to 15 June 2024 were included and appraised using the Joanna Briggs Institute critical appraisal tools for cohort and case-control studies. The available data were then analyzed using random-effects meta-analysis and effect direction-based vote-counting (PROSPERO CRD42023451237).

RESULTS

Five studies (9318 patients) were included in this systematic review, three of which investigated the effect of caffeine intake on the development of AMD and two on AMD progression. Caffeine intake from coffee or other beverages showed no significant association with the occurrence of early (adjusted odds ratio 1.11 [95% confidence interval 0.93-1.33], I2 = 0.0%) or late AMD. On the other hand, vote-counting analysis indicated that caffeine consumption, mainly tea, may prevent and hinder disease progression, potentially in a dose-dependent manner.

CONCLUSION

The limited available evidence suggests that caffeine consumption may deter and impede the progression of AMD. In contrast, the protective effect of caffeine consumption on the development of AMD remains uncertain. Further prospective, large-scale studies exploring the effects and dose-response relationship of various caffeine beverages across a broader spectrum of AMD and populations are warranted to corroborate our findings.

An analysis of the global, regional, and national burden of blindness and vision loss between 1990 and 2021: the findings of the Global Burden of Disease Study 2021

Objectives

To evaluate the global burden of blindness and vision loss (BVL) from 1990 to 2021 using a retrospective analysis of epidemiological data from Global Burden of Disease (GBD) study 2021 and to project trends over the next 15 years.

Methods

This retrospective study analyzed data on years lived with disability (YLDs) and prevalence across 204 countries and territories. Trends over time were assessed using estimated annual percentage change (EAPC) of the age-standardized rates (ASR), while decomposition analysis quantified the contributions of population aging, growth, and epidemiological shifts. Socioeconomic disparities were evaluated using the Slope Index of Inequality and the Concentration Index. Future trends in age-standardized prevalence rates (ASPR) and age-standardized YLDs rates (ASYR) were projected using Bayesian age-period-cohort modeling.

Results

Between 1990 and 2021, global YLDs due to BVL more than doubled, increasing from 14.31 to 29.16 million. The prevalence of BVL surged by 246.8%, with a disproportionately higher burden observed among females. Regions with low to middle Socio-Demographic Index (SDI) scores exhibited the highest ASPR and ASYR. Population growth and aging were the primary drivers of the increasing burden, while epidemiological trends had mixed effects. Significant socioeconomic disparities persist, with a higher concentration of BVL burden in economically disadvantaged regions. Projections indicate a continued increase in BVL burden through 2036, particularly among women and older populations.

Conclusion

Despite advancements in healthcare, the global burden of BVL has substantially increased over the past 32 years, driven by demographic and socioeconomic factors. Persistent disparities highlight the urgent need for targeted public health interventions, equitable resource allocation, and policy initiatives to address the growing impact of BVL worldwide.

Potential to improve the burden of age-related macular degeneration: results from the Global Burden of Disease Study 2021

BACKGROUND

Age-related macular degeneration (AMD) is a critical public health issue, requiring prioritized public health strategies.

METHODS

Based on the Global Burden of Disease Study 2021, AMD burden and risk factors were analyzed, considering variables such as sex, age, and location. Age-standardized rates (ASR) were employed to evaluate and compare the burdens across different regions. Frontier analysis was used to determine the lowest achievable burden based on the Sociodemographic Index (SDI), while decomposition analysis revealed factors influencing age-related macular degeneration burden change.

RESULTS

Globally, in 2021, ASR of prevalence and disability-adjusted life years (DALYs) were 94.00 (95% UI 78.32, 114.42) per 100,000 and 6.78 (95% UI 4.70, 9.32) per 100,000 respectively. Additionally, a reduction of smoking exposure to its theoretical minimum risk exposure level (TMREL) would lead to an estimated 10.0% decrease in AMD DALYs in 2021. Frontier analysis suggested that Nepal, Iran (Islamic Republic of), and Nigeria were the top three countries with the most substantial potential for reducing disparities. Decomposition analysis indicated that population growth and aging are the primary driving factors for the increase in AMD DALYs.

CONCLUSIONS

We identify countries and territories with potential for improvement and emphasize the importance of equitable, cost-effective control strategies, particularly tobacco control.

Looking beyond the eyes of the patient: The importance of effective communication in the treatment of age-related macular degeneration

PURPOSE

Patients with exudative and nonexudative age-related macular degeneration (AMD) can experience physical, mental, social, administrative or financial burden that are associated with the treatment of this progressive chronic disease. The role of healthcare providers in supporting patients who experience high treatment burden can be important, especially when it comes to effective communication. Despite previous research underlining the need to improve patient-provider communication in AMD care, patient experiences with communication, and how these are related to perceived treatment burden, remain underexplored.

METHODS

A survey was distributed among Dutch patients with AMD, which contained questions on several aspects of communication with the patient's ophthalmologist, such as the Quality Of communication Through the patients' Eyes (QUOTE-COMM, including task-, affect- and therapy-oriented communication) questionnaire. Patients were primarily enlisted through a patient association.

RESULTS

A total of 162 patients completed the questionnaire, of which 133 provided fully completed responses. While patients reported positive experiences with affect-oriented communication of their ophthalmologist, they rated task- and therapy-oriented communication as below their expectations. Most patients wished to receive (additional) information on AMD-related costs (71%), future perspectives (71%) and coping with negative emotions pertaining to the disease (68%). Both lower experience scores on task- and affect-oriented communication and lower self-efficacy were associated with higher administrative burden and mental burden among patients.

CONCLUSION

Our study shows that current communication, information provision and decision-making do not fully meet patients' needs and preferences. Enhancing patient-provider communication seems important, as effective dialogue is likely to diminish patients' perceived treatment burden.

Risk factors for age-related macular degeneration: Updated systematic review and meta-analysis

BACKGROUND

Age-related macular degeneration (AMD) is a leading cause of irreversible visual loss in the elderly population, affecting millions of the people worldwide. AMD has a substantial effect on quality of life in older individuals. Understanding and identifying risk factors are crucial for developing preventive strategies.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive literature search across databases including PubMed, Scopus, and Web of Science up to January 28, 2024. Studies were selected using standardized inclusion and exclusion criteria, and the quality of the studies was assessed via the Newcastle Ottawa Scale. Meta-analysis was conducted using Review Manager software to pool the odds ratio (OR) of each included risk factors at the 95% confidence interval (CI).

RESULTS

Eighteen of the 2640 identified studies met the inclusion criteria for the meta-analysis. Older age compared to younger age, male gender compared to female gender, smoking, hypertension, cardiovascular diseases, and diabetes were statistically significant predictors for AMD occurrence, with ORs of 1.11 (95% CI = 1.06-1.15, P < .00001), 1.63 (95% CI = 1.13-2.35, P = .009), 1.86 (95% CI = 1.33-2.6, P = .0003), 1.24 (95% CI = 1.09-1.4, P = .0007), 1.44 (95% CI = 1.11-1.87, P = .006), and 1.44 (95% CI = 1.3-1.6, P < .00001), respectively. Other factors, such as body mass index, cerebrovascular diseases, cholesterol, and triglycerides, were not significantly associated with AMD.

CONCLUSION

This updated meta-analysis highlights the significance of modifiable risk factors for AMD, including smoking, hypertension, cardiovascular diseases, and diabetes. Early identification of AMD accompanied by strategic management of these modifiable risk factors may preserve patients' visual acuity without advancing to advanced stages.

The Burden of Blindness and Vision Impairment in the Middle East and North Africa: A Global Burden of Disease 2019 Perspective

PURPOSE

This study analyzes the prevalence, causes, and distribution of blindness and moderate-to-severe vision impairment (MSVI) in the Middle East and North Africa (MENA) using the Global Burden of Disease (GBD) 2019 dataset.

METHODS

The GBD 2019 dataset was used to analyze vision impairment across 21 countries in MENA according to the Snellen chart classification (moderate vision impairment with presenting visual acuity worse than 6/18, severe impairment worse than 6/60, blindness worse than 3/60). Age-standardized prevalence and regional variations were compared to global averages. An exponential linear regression model was used to forecast MSVI and blindness in the year 2050.

RESULTS

As of 2019, approximately 37.2 million people in MENA experienced blindness or vision loss. Although the age-standardized prevalence of vision impairment and blindness in MENA decreased from 1990 to 2019 due to improvements in healthcare, the absolute number has almost doubled (18.58 million in 1990 to 37.19 million in 2019) due to population growth and aging. Between 1990 to 2019, the population aged 70 and older in MENA grew from 7.2 million to over 19.2 million. Lastly, our predictions indicate an 86% increase in the number of individuals with vision loss by 2050.

CONCLUSION

The largest causes of moderate vision loss were refractive errors and cataracts, respectively, while the major causes of blindness were cataracts and glaucoma, respectively. The projection of increased vision impairment by 2050 underscores the urgent need for policy changes and efficient resource distribution to improve healthcare access and interventions.

Impact of Dry Age-Related Macular Degeneration on Daily Activities and Quality of Life: Interview Findings From Patients and Caregivers Relative to a General Population

Purpose

To investigate impacts of dry age-related macular degeneration (AMD) on patients and caregivers.

Patients and Methods

Semi-structured interviews were conducted with patients with dry AMD, caregivers, and controls (individuals without dry AMD, of similar age, sex, and comorbidity profile to patients) between March 2021 and June 2023. Patients aged ≥50 years, with a best corrected visual acuity (BCVA) score from the most recent eye exam after dry AMD diagnosis, were enrolled from the US and UK. Controls with mild visual impairment and unpaid adult caregivers of patients were also enrolled. Main outcomes were functional impairment impact on daily activities, quality of life (QoL), and mental health among patients relative to controls; dry AMD impact on patient daily activities from caregiver perspective; caregiver work productivity, QoL, and burden.

Results

Thirty patients, 20 controls, and 20 caregivers were interviewed. Patients had a mean age of 65.1 years; 63.3% were female, 83.3% were White, and 96.7% were from the US. Visual impairment based on BCVA score was mild in 70.0% and moderate to severe in 30.0% of patients. Most patients reported problems performing usual activities, whereas most controls experienced no or mild problems. More daily activities in the past month were affected by dry AMD in patients than by visual impairment in controls (mean 4.5 and 2.1), with reading, shopping, and hobbies being most commonly affected in patients. More patients than controls experienced emotional problems. Patients with moderate-to-severe visual impairment reported more impact on activities relative to those with mild visual impairment. Most caregivers were employed, with 46.2% reporting their work productivity was affected at least sometimes, and many experienced mental and emotional burdens and impacts on their daily lives.

Conclusion

Dry AMD impaired the functional ability of patients regardless of visual impairment level and posed significant burdens to caregivers.

Association Between C22:5-Containing Lipids and RPE Pathologies in Mice with Tmem135 Overexpression

Dysregulation of lipid metabolism has been linked with risk for age-related retinal diseases including age-related macular degeneration (AMD). However, how dysregulated lipid metabolism contributes to AMD development is unknown. In this study, we evaluated the retinal and plasma lipidomes of a mouse model displaying retinal pigmented epithelium (RPE) pathologies that are observed in AMD including RPE dysmorphia and degeneration. We found that the RPE phenotypes in mice overexpressing transmembrane protein 135 (Tmem135 TG) are correlated with retinal and plasma lipidome changes. While distinct lipid profiles were observed in the retina and plasma of Tmem135 TG mice, a common finding in both retinal and plasma lipidomes was an increase of lipids containing C22:5. This data suggests that accumulation of C22:5-containing lipids may contribute to the development of the RPE pathologies in Tmem135 TG mice.

Global burden of low vision and blindness due to age-related macular degeneration from 1990 to 2021 and projections for 2050

BACKGROUND

Age-related macular degeneration (AMD) is a leading cause of blindness and low vision worldwide. This study examines the global burden and trends in AMD-related low vision and blindness from 1990 to 2021, with projections through 2050.

METHODS

Data were obtained from the 2021 Global Burden of Disease (GBD 2021) study, covering 204 countries and regions. Key metrics, including the prevalent case numbers, annual disability-adjusted life years (DALYs), age-standardized prevalence rates (ASPR), and age-standardized DALY rates (ASDALYR), specific to low vision and blindness due to AMD, were calculated per 100,000 population. Trend analysis used the estimated annual percentage change (EAPC) method, and K-means clustering identified regions with similar burdens and trends. Autoregressive Integrated Moving Average(ARIMA) and Exponential Smoothing(ES) models provided future projections.

RESULTS

Globally, the total number of prevalent cases and DALYs has substantially increased. The number of prevalent cases of low vision and blindness due to AMD increased from 3,640,180 (95% UI: 3,037,098 - 4,353,902) in 1990 to 8,057,521 (95% UI: 6,705,284-9,823,238) in 2021. DALYs increased from 302,902 (95% UI: 206,475 - 421,952) in 1990 to 578,020 (95% UI: 401,241-797,570) in 2021. From 1990 to 2021, both the ASPR and ASDALYR for AMD-related low vision and blindness showed a downward trend. The ASPR was 94 (95% UI: 78.32-114.42) per 100,000 population, with an EAPC of -0.26 (95% CI: -0.31 to -0.22), and the ASDALYR was 6.78 (95% UI: 4.7-9.32) per 100,000 population, with an EAPC of -0.94 (95% CI: -1.01 to -0.88). The disease burden of AMD-related low vision and blindness increases with age, and the burden for female patients is slightly higher than for males. Regional stratification by the Socio-Demographic Index (SDI) shows that the burden of AMD-related low vision and blindness in areas with low SDI is higher than in areas with high SDI. From 1990 to 2021, notable increases in ASPR and ASDALYR were observed mainly in the southern and central regions of sub-Saharan Africa. Moreover, the increases in prevalence and DALYs vary by region, country, and level of socioeconomic development. The ARIMA model predicts that by 2050, the number of prevalent cases of low vision and blindness due to AMD will reach 13,880,610(95% CI: 9,805,575-17,955,645), and the DALYs will be 764,731(95% CI: 683,535-845,926). The ES model predicts that by 2050, the number of prevalent cases of AMD-related low vision and blindness will reach 9,323,124(95% CI: 5,222,474-13,423,774), and the DALYs will be 641,451 (95% CI: 383,588-899,318).

CONCLUSION

This study indicates that between 1990 and 2021, the global prevalent cases and DALYs caused by AMD-related low vision and blindness have increased over the past three decades, correlating with factors such as age, gender, socioeconomic status, and geographical location. Predictive models indicate that as the population ages, the number of patients with low vision and blindness due to AMD, along with associated DALYs, will continue to rise. By 2050, it is expected that over 9 million people worldwide will be affected by AMD-related vision loss, with women being particularly impacted. These findings can provide data support for public health planning, resource allocation, and the formulation of medical policies, ensuring an effective response to the challenges posed by the future increase in AMD-related low vision and blindness.

Recent advances in the application of artificial intelligence in age-related macular degeneration

Recent advancements in ophthalmology have been driven by the incorporation of artificial intelligence (AI), especially in diagnosing, monitoring treatment and predicting outcomes for age-related macular degeneration (AMD). AMD is a leading cause of irreversible vision loss worldwide, and its increasing prevalence among the ageing population presents a significant challenge for managing the disease. AI holds considerable promise in tackling this issue. This paper provides an overview of the latest developments in AI applications for AMD. However, current limitations include insufficient and unbalanced data, lack of interpretability in models, dependence on data quality and limited generality.

Efficacy and safety of intravitreal conbercept and triamcinolone acetonide for wet age-related macular degeneration in China: a meta-analysis

BACKGROUND

Several studies have investigated the efficacy and safety of Conbercept versus Triamcinolone acetonide for the treatment of wet age-related macular degeneration (wAMD), but the results are controversial. Therefore, this meta-analysis aims to evaluate the efficacy and safety of Conbercept versus Triamcinolone acetonide for the treatment of wAMD.

METHODS

A total of seven databases were searched for literature on the treatment of wAMD with Conbercept, with the search period from database inception to May 2024. Patients in the experimental group received Conbercept treatment, while patients in the control group received Triamcinolone acetonide treatment. The observed indicators included central macular thickness, incidence of adverse reactions, clinical efficacy, and best-corrected visual acuity. Relative risk (RR) and mean difference (MD) were used as effect measures.

RESULTS

A total of 12 studies with 864 patients were included in the meta-analysis. The results showed that the experimental group had a significantly better central macular thickness (MD =  - 42.68, 95% CI =  - 55.04 ~  - 30.32, P < 0.001), clinical response rate (RR = 1.25, 95% CI = 1.12 ~ 1.39, P < 0.001), and best-corrected visual acuity (MD = 0.16, 95% CI = 0.12 ~ 0.20, P < 0.001) compared to the control group. In terms of adverse events, the overall incidence of adverse events was lower in the experimental group (RR = 0.26, 95% CI = 0.14 ~ 0.51, P < 0.001) compared to the control group. Specifically, the incidence of intraocular pressure elevation (RR = 0.33, 95% CI = 0.12 ~ 0.94, P = 0.04) and intraocular inflammation (RR = 0.17, 95% CI = 0.03 ~ 0.97, P = 0.05) was lower in the experimental group compared to the control group, but there was no significant difference in the incidence of subconjunctival hemorrhage (RR = 0.7, 95% CI = 0.14 ~ 3.5, P = 0.66) and corneal edema (RR = 0.2, 95% CI = 0.04 ~ 1.12, P = 0.07).

CONCLUSION

Conbercept demonstrated superior efficacy in treating wAMD compared to triamcinolone acetonide, with a lower incidence of adverse reactions. However, the current meta-analysis included a limited number of studies, with only two studies evaluating best-corrected visual acuity (BCVA). Further high-quality randomized controlled trials (RCTs) are warranted to validate these findings.

Photobiomodulation efficacy in age-related macular degeneration: a systematic review and meta-analysis of randomized clinical trials

BACKGROUND

Age-related macular degeneration (AMD) is a leading cause of vision loss. Photobiomodulation (PBM) offers a controversial approach for managing dry AMD, aiming to halt or reverse progression through mitochondrial activity modulation. However, the efficacy and clinical relevance of PBM as a potential approach for managing dry AMD remain debated.

METHODS

We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing PBM versus a sham in patients with dry AMD. We performed trial sequential analysis (TSA) and minimal clinically important difference (MCID) calculations to assess statistical and clinical significance applying a random-effects model with 95% confidence intervals (CI).

RESULTS

We included three RCTs comprising 247 eyes. The pooled analysis showed that PBM significant improved BCVA (MD 1.76 letters; 95% CI: 0.04 to 3.48) and drusen volume (MD -0.12 mm³; 95% CI: -0.22 to -0.02) as compared with a sham control. However, the TSA indicated that the current sample sizes were insufficient for reliable conclusions. No significant differences were observed in GA area. The MCID analysis suggested that the statistically significant results did not translate into clinically significant benefits. In the quality assessment, all studies were deemed to have a high risk of bias.

CONCLUSION

This meta-analysis points limitations in the current evidence base for PBM in dry AMD treatment, with issues around small sample sizes. Statistically significant improvements do not translate into clinical benefits. The research underscores need for larger RCTs to validate PBM's therapeutic potential for dry AMD.

Burden of blindness and vision loss in China over the past 30 years: findings and predictions based on the Global Burden of Disease Study 2019

AIMS

To investigate the burden of blindness and vision loss (BVL) in China over the past 30 years according to year, age and sex, and to estimate future predictions.

METHODS

We analysed the years lived with disability (YLDs), number of cases, age-standardised YLD rates (ASYRs) and age-standardised prevalence rates (ASPRs) of BVL in China from 1990 to 2019. We focused on changes over time using estimated annual percentage changes (EAPCs). Additionally, we used the Bayesian age-period-cohort model to predict the BVL burden from 2020 to 2030.

RESULTS

The number of YLDs and prevalent cases due to BVL increased from 2.57 (95% uncertainty interval (UI) 1.74 to 3.72) and 90.76 million (95% UI 72.21 to 111.92) in 1990 to 5.42 (95% UI 3.61 to 8.02) and 211.67 million (95% UI 168.21 to 259.66) in 2019, respectively. The BVL ASYRs and ASPRs showed a decreasing trend, with EAPCs of -0.13 (95% CI -0.28 to 0.02) and -0.11 (95% CI -0.19 to -0.04), respectively. The elderly and female populations had a higher BVL burden. The numbers of YLDs and cases due to BVL are projected to continue rising to 7.74 and 279.49 million in 2030, respectively. The ASYRs and ASPRs also showed increasing trends.

CONCLUSION

While rates of BVL in China have decreased, there has been a notable increase in the number of YLDs and new cases over the past 30 years. Projections suggest that the burden of BVL will continue to rise over the next 11 years. To address this challenge, appropriate policies must be implemented.

VisionaryVR: An Optical Simulation Tool for Evaluating and Optimizing Vision Correction Solutions in Virtual Reality

In the rapidly advancing field of vision science, traditional research approaches struggle to accurately simulate and evaluate vision correction methods, leading to time-consuming evaluations with limited scope and flexibility. To overcome these challenges, we introduce 'VisionaryVR', a virtual reality (VR) simulation framework designed to enhance optical simulation fidelity and broaden experimental capabilities. VisionaryVR leverages a versatile VR environment to support dynamic vision tasks and integrates comprehensive eye-tracking functionality. Its experiment manager's scene-loading feature fosters a scalable and flexible research platform. Preliminary validation through an empirical study has demonstrated VisionaryVR's effectiveness in replicating a wide range of visual impairments and providing a robust platform for evaluating vision correction solutions. Key findings indicate a significant improvement in evaluating vision correction methods and user experience, underscoring VisionaryVR's potential to transform vision science research by bridging the gap between theoretical concepts and their practical applications. This validation underscores VisionaryVR's contribution to overcoming traditional methodological limitations and establishing a foundational framework for research innovation in vision science.

Intraoperative complications and visual outcomes of cataract surgery in neovascular age-related macular degeneration

PURPOSE

To compare the rate of intraoperative complications and visual outcomes in patients with neovascular age-related macular degeneration (NvAMD) and control eyes without NvAMD undergoing phacoemulsification.

SETTING

Multicenter study.

DESIGN

Retrospective, nonrandomized comparative study.

METHODS

Eyes were classified based on the presence or absence of an NvAMD diagnosis. The main outcomes were (1) the rate of intraoperative complications, (2) the logMAR visual acuity (VA) at 4 to 12 weeks postoperatively in both groups, and (3) the reinjection rate of intravitreal antivascular endothelial growth factor after phacoemulsification.

RESULTS

Preoperative VA was worse in the NvAMD group (0.9 ± 0.5) compared with the reference group (0.6 ± 0.5). We observed no difference in the rate of posterior capsule rupture (PCR) (2.90% vs 2.77%; P = .889), dropped lens fragments (0.46% vs 0.29%; P = .618), or zonular dialysis (0.46% vs 0.58%, P = .749) between the 2 groups. Receiving ≥10 intravitreal injections before cataract surgery predicted the likelihood of PCR with an odds ratio of 2.86 (P = .027). Proportions of eyes achieving a visual gain of ≥0.3 logMAR (∼3 Snellen lines equivalent) was lower in NvAMD eyes (39.2% vs 63.7%; P < .0001). We observed 203 eyes (73%) in the active treatment group and 139 eyes (36%) in the inactive treatment group received >1 intravitreal injection after phacoemulsification (P < .0001).

CONCLUSIONS

The risk for PCR was higher for eyes receiving ≥10 intravitreal injections before phacoemulsification. Only 39% of eyes with NvAMD had visual improvement by ≥3 Snellen lines.

Recent Advances in Our Understanding of Age-Related Macular Degeneration: Mitochondrial Dysfunction, Redox Signaling, and the Complement System

Age-related macular degeneration (AMD) is a prevalent degenerative disorder of the central retina, which holds global significance as the fourth leading cause of blindness. The condition is characterized by a multifaceted pathophysiology that involves aging, oxidative stress, inflammation, vascular dysfunction, and complement activation. The complex interplay of these factors contributes to the initiation and progression of AMD. Current treatments primarily address choroidal neovascularization (CNV) in neovascular AMD. However, the approval of novel drug therapies for the atrophic and more gradual variant, known as geographic atrophy (GA), has recently occurred. In light of the substantial impact of AMD on affected individuals' quality of life and the strain it places on healthcare systems, there is a pressing need for innovative medications. This paper aims to provide an updated and comprehensive overview of advancements in our understanding of the etiopathogenesis of AMD. Special attention will be given to the influence of aging and altered redox status on mitochondrial dynamics, cell death pathways, and the intricate interplay between oxidative stress and the complement system, specifically in the context of GA. Additionally, this review will shed light on newly approved therapies and explore emerging alternative treatment strategies in the field. The objective is to contribute to the ongoing dialogue surrounding AMD, offering insights into the latest developments that may pave the way for more effective management and intervention approaches.

Global, regional, and national burdens of intraocular foreign bodies in children and adolescents from 1990 to 2019: a trend analysis

BACKGROUND

This study aimed to evaluate trends in global, regional, and national burdens of intraocular foreign bodies among children and adolescents (aged 0 - 19 years) between 1990 and 2019 according to age, sex, and socio-demographic index.

METHODS

This study obtained data from the Global Burden of Disease Study 2019 and evaluated the number of cases, rates per 100,000 persons, and average annual percentage changes among children and adolescents. The annual percentage changes in the incidence and years lived with disability rates across various age groups were investigated using joinpoint software.

RESULTS

For intraocular foreign bodies in children and adolescents, the incidence and year lived with disability rates decreased in all age groups between 1990 and 2019. However, the number of incident cases and years lived with disability increased from 1091.94 [95% uncertainty interval (UI), 610.91-1839.52] and 89,245 (95% UI, 6.65-18.67) in 1990 to 1134.85 (95% UI, 665.01-1867.50) and 92,108 (95% UI, 32,052-192,153) in 2019, respectively. Age was positively correlated with the number of cases, incidence, and years lived with disability rates. However, there were significant decreases in both the incidence and years lived with disability rates among children and adolescents, especially in the 15-18 years age group, males, and most high-income regions. Notably, the incidence and years lived with disability rates were significantly decreased in middle and high-middle socio-demographic index regions but were increased in low and low-middle socio-demographic index regions.

CONCLUSIONS

Despite the remarkable progress between 1990 and 2019 in reducing the global burden of intraocular foreign bodies, there has been an increase in the number of cases, with substantial disparity across age groups, sexes, regions, and countries. Our results could inform more effective strategies for reducing the burden among children and adolescents.

Changing Trends in the Global Burden of Cataract Over the Past 30 Years: Retrospective Data Analysis of the Global Burden of Disease Study 2019

BACKGROUND

Cataracts now account for the largest proportion of the global burden of blindness and vision loss. Understanding the changing trends in the global burden of cataracts over the past 30 years and the next 15 years is of clear significance for the prevention and control of cataracts in key populations. As far as we know, research on the future burden of cataracts is lacking.

OBJECTIVE

This study aims to assess the global burden of cataracts over the past 30 years by using age-period-cohort modeling and to estimate trends in the next 15 years.

METHODS

Data were obtained from the Global Burden of Disease Study 2019, the United Nations Development Programme, and the WHO (World Health Organization) Global Health Observatory data repository. The assessment of trends and disparities in the number and rate of disability-adjusted life years (DALYs) for cataracts from 1990 to 2019 was conducted. The association between the age-standardized DALY rate (ASDR) and the socio-demographic index (SDI), human development index (HDI), national levels of particulate matter <2.5 μm in diameter (PM2.5), and ambient ultraviolet radiation (UVR) was determined using linear regression analysis. Additionally, we used the Nordpred (Harald Fekjær and Bjørn Møller) age-period-cohort model to predict the cataract burden from 2020 to 2034.

RESULTS

Globally, the number of DALYs due to cataract increased from 3,492,604 (95% uncertainty interval [UI] 2,481,846-4,719,629) in 1990 to 6,676,281 (95% UI 4,761,210-9,006,193) in 2019. The ASDRs due to cataract decreased from 93.17 (95% UI 66.14-125.32) in 1990 to 82.94 (95% UI 59.06-111.75) in 2019, with an average annual percentage change of -0.37 (95% CI -0.44 to -0.3; P<.001). Age, female sex, air pollution, smoking, high fasting plasma glucose levels, and a high body mass index were risk factors for the burden of cataracts. SDI and HDI were negatively correlated with ASDRs of cataracts, while PM2.5 and UVR were positively associated with them. Higher DALY rates were also associated with lower SDI (R2=0.1939; P<.001), lower HDI (R2=0.2828; P<.001), national PM2.5 concentration (R2=0.1874; P<.001), and ambient UVR levels (R2=0.2354; P<.001). The prediction model suggested that the number of DALYs due to cataract will continue to rise globally, while the cataract DALY rate will continue to decrease.

CONCLUSIONS

While the ASDR of cataracts has decreased, there has been a notable increase in the number of DALYs over the past 30 years. Projections suggest that the global burden of cataracts will continue to rise over the next 15 years. To address this challenge, appropriate prevention and treatment policies must be implemented.

A review of emerging tyrosine kinase inhibitors as durable treatment of neovascular age-related macular degeneration

INTRODUCTION

Current treatment for age-related macular degeneration poses a large burden on patients and the inability of patients to adhere to this immense burden can lead to worse visual outcomes. Novel treatments have been proposed to extend treatment intervals and reduce visit burden.

AREAS COVERED

This review article summarizes phase I and phase II clinical trials of tyrosine kinase inhibitors as durable treatment options for patient with neovascular age-related macular degeneration.

EXPERT OPINION

Tyrosine kinase inhibitors have shown substantial promise in reducing treatment burden while maintaining visual acuity and anatomic outcomes with favorable safety profiles. Several platforms have shown positive outcomes in initial trials and are currently moving toward phase III clinical trials.