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Vujosevic S, Chew E, Labriola L, Sivaprasad S, Lamoureux E. Measuring Quality of Life in Diabetic Retinal Disease: A Narrative Review of Available Patient-Reported Outcome Measures. Ophthalmol Sci 2024; 4:100378. [PMID: 37868790 PMCID: PMC10585645 DOI: 10.1016/j.xops.2023.100378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 10/24/2023]
Abstract
Topic Several patient-reported outcome measures (PROMs) are available to measure health-related quality of life (HRQoL) in patients with late-stage clinical diabetic retinal diseases (DRDs). However, an understanding of the psychometric properties of PROMs is needed to assess how they could relate to severity levels of a revised DRD grading system. This narrative review assessed the available generic-, vision-, and DRD-related PROMs used in DRD research and highlights areas for improvement. Clinical Relevance Diabetic retinal disease is a common complication of diabetes and can lead to sight-threatening complications with a devastating effect on HRQoL. Methods The Quality of Life working group is one of 6 working groups organized for the DRD Staging System Update Effort, a project of the Juvenile Diabetes Research Foundation Mary Tyler Moore Vision Initiative. PubMed, Cochrane Library, Embase, and Google Scholar databases were searched using core keywords to retrieve ophthalmology-related review articles, randomized clinical trials, and prospective, observational, and cross-sectional studies in the English language. A detailed review of 12 PROMs (4 QoL questionnaires and 8 utilities) that met a minimum level of evidence (LOE) was conducted. The relevance of each PROM to DRD disease stage and Biomarker Qualification guidelines (Biomarkers, EndpointS, and other Tools) categories was also defined. Results The National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25), Impact of vision impairment-computerized adaptive testing, and Diabetic Retinopathy and Macular Edema Computerized Adaptive Testing System had a LOE of II in detecting change due to late-stage DRD (diabetic macular edema), although several areas for improvement (e.g., psychometrics and generalizability) were identified. Other PROMs, particularly the utilities, had a LOE of III due to cross-sectional evidence in late-stage clinical DRD. Although the NEI VFQ-25 has been the most widely used PROM in late-stage DRD, more work is required to improve its multidimensional structure and other psychometric limitations. No PROM was deemed relevant for subclinical or early/mid-DRD. Conclusion This narrative review found that the most commonly used PROM is NEI VFQ-25, but none meets the ideal psychometric, responsiveness, and clinical setting digital administration requirements that could be included in an updated DRD staging system for diagnosis and monitoring of DRD progression. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Emily Chew
- Division of Epidemiology and Clinical Applications, Clinical Trials Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Leanne Labriola
- Ophthalmology Department, Carle Foundation Hospital, Urbana, Illinois
- Surgery Department, University of Illinois College of Medicine, Urbana, Illinois
| | - Sobha Sivaprasad
- Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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Lamoureux E, Pagé MG. The Importance of Good Measurement: Development and Validation of a Measure of Disordered Eating Among Adults with Chronic Pain. Can J Pain 2024; 8:2284815. [PMID: 38425884 PMCID: PMC10900263 DOI: 10.1080/24740527.2023.2284815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- E. Lamoureux
- Research Center, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, Quebec, Canada
| | - M. G. Pagé
- Research Center, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
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Kwan YH, Fenwick E, Leung YY, Fong W, Woon TH, Xiang L, Lamoureux E, Thumboo J. Establishing language and ethnic equivalence for health-related quality of life item banks and testing their efficiency via computerised adaptive testing simulations. PLoS One 2024; 19:e0298141. [PMID: 38394320 PMCID: PMC10890744 DOI: 10.1371/journal.pone.0298141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/17/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE We aimed to (1) establish linguistic and ethnic equivalence (i.e. lack of bias) for the items in the English and Chinese versions of the Singapore Health and Well Being (SHAWS) Physical Functioning (PF), Positive Mindset (PM) and Social Relationship (SR) item banks (IBs); and (2) evaluate the preliminary efficiency of these IBs using Computer Adaptive Testing (CAT) simulations. METHODS In this cross-sectional study, 671, 670, and 672 subjects answered 55, 48 and 30 items of the PF, PM, and SR IBs, respectively. Rasch analysis was conducted to assess each IB's psychometric properties, particularly the presence of differential item functioning (DIF) for language and ethnicity. A set of performance criteria related to removing items that displayed notable DIF were employed. CAT simulations determined the mean number of items for high, moderate, and moderate-low measurement precisions (stopping rule: SEM 0.300, 0.387. 0.521, respectively). RESULTS Half of subjects were >50 years old (40.9% PF, 42.1% PM, 41.4% SR), Chinese (50.7% PF, 51.0% PM, 50.6% SR) and female (50.0% PF. 49.4% PM, 52.8% SR) respectively. Rasch analysis revealed 4 items with DIF for the PF IB, 9 items with DIF for the PM IB and 2 items with DIF for the SR IB. In CAT simulations, the mean number of items administered was 8.5, 21.6 and 14.5 for the PF, PM and SR IBs, respectively (SEM 0.300), 5.1, 13.0, 8.0 for PF, PM and SR IBs, respectively (SEM 0.387) and 3.1, 5.3 and 4.1 for PF, PM and SR IBs, respectively (SEM 0.521). CONCLUSION The PF, PM and SR IBs to measure health-related quality of life revealed minimal DIF for language and ethnicity after remedial efforts. CAT simulations demonstrated that these IBs were efficient, especially when the stopping rule was set at moderate precision, and support the implementation of the SHAWS IBs into routine clinical care.
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Affiliation(s)
- Yu Heng Kwan
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre of Population Health and Implementation Research, SingHealth Regional Health System, Singapore, Singapore
| | - Eva Fenwick
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- The University of Melbourne, Melbourne, Australia
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ting Hui Woon
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Ecosse Lamoureux
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- The University of Melbourne, Melbourne, Australia
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre of Population Health and Implementation Research, SingHealth Regional Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Peterson CL, Yap CL, Tan TF, Tan LLY, Sim KT, Ong L, Tan ZK, Tan YW, Man R, Fenwick E, Cheung G, Lamoureux E, Tan ACS. Monocular and Binocular Visual Function Assessments and Activities of Daily Living Performance in Age-Related Macular Degeneration. Ophthalmol Retina 2024; 8:32-41. [PMID: 37648064 DOI: 10.1016/j.oret.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the relationship between specific monocular and binocular visual function (VF) assessments with binocularly performed activities of daily living task tests (ADLTTs) in patients with age-related macular degeneration (AMD) and healthy controls. DESIGN Prospective case-control cohort study. SUBJECTS Thirty-six AMD patients and 36 controls. METHOD Visual field assessments included monocular and binocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), and monocular microperimetry testing for mean macula sensitivity, mean retina sensitivity (MRS), fixation area, and fixation distance from fovea (FDF). Age-related macular degeneration lesion area and sensitivity were measured on OCT and microperimetry, respectively. Participants performed 4 validated ADLTTs with binocular BCVA: (1) reading; (2) item-search; (3) money-counting; and (4) multi-step drink-making tasks. MAIN OUTCOME MEASURES Spearman correlations and multivariate regression analysis, adjusted for age, sex, and potential correlation between the 2 eyes, were used to assess the relationship between monocular and binocular VF assessments, and ADLTT performance in both groups. RESULTS Age-related macular degeneration patients had poorer VF (BCVA, CS, mean macula sensitivity, and MRS) compared with healthy controls. Monocular BCVA in both better- and worse-vision eyes was moderately correlated with the binocular reading speed and money-counting tasks in participants with AMD. In AMD, monocular worse eye CS, MRS, AMD lesion area on OCT, and lesion sensitivity on microperimetry showed moderate correlations to various ADLTTs, such as reading, money-counting, and drink-making. Similar findings were found in our AMD cohort on multivariate regression analysis. Fewer significant correlations were observed for the better-vision eye, whereas no correlations were observed for healthy controls between VF parameters and ADLTTs. In contrast, significant associations were observed between binocular BCVA and CS with binocular ADLTTs (reading and item-search tasks) but not in AMD patients. CONCLUSION Although monocular BCVA remains the most common measure of VF, CS and microperimetry testing also show significant correlations with ADLTTs performance in AMD patients, and should be considered as complimentary VF-outcome measures in both clinical and research settings. Unlike healthy subjects, AMD patients do not rely on binocular VF for ADLTT function, with the worse-vision eye impacting binocular ADLTT function more than the better-vision eye. Therefore, the worse-vision eye should not be neglected during the management of AMD. 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)
- Claire L Peterson
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | | | - Ting Fang Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore
| | | | | | - Lisa Ong
- Singapore National Eye Centre, Singapore
| | | | - Yan Wen Tan
- Department of Occupational Therapy, Singapore General Hospital, Singapore
| | - Ryan Man
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Eva Fenwick
- Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Anna C S Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore.
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Chua J, Wong D, Yow AP, Tan B, Liu X, Ismail MB, Chin CWL, Lamoureux E, Husain R, Schmetterer L. Segregation of neuronal and vascular retinal damage in patients with hypertension and diabetes. Ann N Y Acad Sci 2024; 1531:49-59. [PMID: 38084081 DOI: 10.1111/nyas.15089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
This study aimed to examine the impact of diabetes and hypertension on retinal nerve fiber layer (RNFL) thickness components. Optical coherence tomography (OCT) measurements do not consider blood vessel contribution, which this study addressed. We hypothesized that diabetes and/or hypertension would lead to thinner RNFL versus controls due to the vascular component. OCT angiography was used to measure the RNFL in 121 controls, 50 diabetes patients, 371 hypertension patients, and 177 diabetes patients with hypertension. A novel technique separated the RNFL thickness into original (vascular component) and corrected (no vascular component) measurements. Diabetes-only (98 ± 1.7 µm; p = 0.002) and diabetes with hypertension (99 ± 0.8 µm; p = 0.001) patients had thinner original RNFL versus controls (102 ± 0.8 µm). No difference was seen between hypertension-only patients (101 ± 0.5 µm; p = 0.083) and controls. After removing the blood vessel component, diabetes/hypertension groups had thinner corrected RNFL versus controls (p = 0.024). Discrepancies in diabetes/hypertension patients were due to thicker retinal blood vessels within the RNFL thickness (p = 0.002). Our findings suggest that diabetes and/or hypertension independently contribute to neurodegenerative thinning of the RNFL, even in the absence of retinopathy. The differentiation of neuronal and vascular components in RNFL thickness measurements provided by the novel technique highlights the importance of considering vascular changes in individuals with these conditions.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Ai Ping Yow
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
- Institute for Digital Molecular Analytics and Science (IDMxS), Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Xinyu Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Munirah Binte Ismail
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Calvin Woon Loong Chin
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
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Yow AP, Chua J, Tan B, Chong R, Nongpiur ME, Gupta P, Lamoureux E, Husain R, Schmetterer L, Wong D. Neurovascular segregation of the retinal nerve fiber layer in glaucoma. Ann N Y Acad Sci 2023; 1528:95-103. [PMID: 37571987 DOI: 10.1111/nyas.15043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
The imaging data of one eye from 154 healthy and 143 glaucoma participants were acquired to evaluate the contributions of the neuronal and vascular components within the retinal nerve fiber layer (RNFL) for detecting glaucoma and modeling visual field loss through the use of optical coherence tomography (OCT) and OCT angiography. The neuronal and vascular components within the circumpapillary RNFL were independently evaluated. In healthy eyes, the neuronal component showed a stronger association with age (r = -0.52, p < 0.001) compared to measured RNFL thickness (r = -0.46, p < 0.001). Using the neuronal component alone improved detection of glaucoma (AUC: 0.890 ± 0.020) compared to measured RNFL thickness (AUC: 0.877 ± 0.021; χ2 = 5.54, p = 0.019). Inclusion of the capillary components with the sectoral neuronal component resulted in a significant improvement in glaucoma detection (AUC: 0.927 ± 0.015; χ2 = 15.34, p < 0.001). After adjusting for potential confounders, AUC increased to 0.952 ± 0.011. Results from modeling visual field loss in glaucoma eyes suggest that visual field losses associated with neuronal thinning were moderated in eyes with a larger capillary component. These findings suggest that segregation of the neurovascular components could help improve understanding of disease pathophysiology and affect disease management in glaucoma.
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Affiliation(s)
- Ai Ping Yow
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Institute for Digital Molecular Analytics and Science (IDMxS), Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Bingyao Tan
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
| | - Rachel Chong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Monisha E Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Damon Wong
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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Vu TA, Fenwick E, Doshi K, Gupta P, Quek SY, Chen C, Ting S, Ng ASL, Yap P, Yeo D, Milea D, Lamoureux E. Feasibility, comprehensibility and acceptability of the VISION-Cog, a novel tool to assess cognitive impairment in visually impaired older adults: a cross-sectional pilot study in Singapore. BMJ Open 2023; 13:e072151. [PMID: 37657840 PMCID: PMC10476112 DOI: 10.1136/bmjopen-2023-072151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVES We pilot-tested the VISually Independent test battery Of NeuroCOGnition (VISION-Cog) to determine its feasibility, comprehensibility and acceptability in evaluating cognitive impairment (CI) in visually impaired older Asian adults. DESIGN The VISION-Cog was iteratively fine-tuned through pilot studies and expert-panel discussion. In the first pilot study (Stage 1), we recruited 15 visually impaired and cognitively normal participants aged ≥60 years to examine the pilot VISION-Cog's feasibility (length of time to administer), comprehensibility (clarity of instructions) and acceptability (participant burden). We then presented the pilot results to the expert panel (Stage 2) who decided via agreement on a revised version of the VISION-Cog. Subsequently, we conducted a second pilot study (Stage 3) on another four participants to ascertain improvement in feasibility, comprehensibility and acceptability of the revised version. SETTING Singapore Eye Research Institute. PARTICIPANTS Nineteen Asian adults aged ≥60 years with visual impairment (defined as near visual acuity worse than N8) were recruited. OUTCOME MEASURE Revised VISION-Cog. RESULT The VISION-Cog was deemed feasible, taking approximately 60 min to complete on average. All participants agreed that the test instructions were clear, and the battery did not cause undue discomfort or frustration. The data collector rated all tests as very user-friendly (score of 5/5). Minor modifications to the pilot VISION-Cog were suggested by the panel to improve its safety, clarity of instructions and content validity, which were incorporated and iteratively tested in the second pilot study until no further issues emerged. CONCLUSIONS Using an iterative mixed-methods process, we have developed a feasible, comprehensible and acceptable 5-domain and 9-item visually independent VISION-Cog test battery suitable to assist CI diagnosis in older adults with visual impairment. We will assess its diagnostic potential against clinician-based assessment of CI in subsequent phases.
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Affiliation(s)
- Tai Anh Vu
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Eva Fenwick
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Population Health Research, Singapore Eye Research Institute, Singapore
| | - Kinjal Doshi
- Department of Psychology, National University of Singapore, Singapore
| | - Preeti Gupta
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Population Health Research, Singapore Eye Research Institute, Singapore
| | - Shin Yi Quek
- Department of Psychology, Ng Teng Fong General Hospital, Singapore
| | - Christopher Chen
- Departments of Pharmacology and Psychological Medicine, National University of Singapore, Singapore
| | - Simon Ting
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Adeline S L Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Donald Yeo
- KALL Psychological & Counselling Services Pte Ltd, Singapore
| | - Dan Milea
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Population Health Research, Singapore Eye Research Institute, Singapore
- Rothschild Foundation Hospital, Paris, France
| | - Ecosse Lamoureux
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia
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Junxing C, Huynh VA, Lamoureux E, Tham KW, Finkelstein EA. Economic burden of excess weight among older adults in Singapore: a cross-sectional study. BMJ Open 2022; 12:e064357. [PMID: 36113947 PMCID: PMC9486358 DOI: 10.1136/bmjopen-2022-064357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To estimate the incremental per capita and aggregate direct and indirect costs of excess weight among older adults (aged 40-80) in Singapore. DESIGN Secondary data analysis of an existing cross-sectional survey SETTING: Residential districts in South-West Singapore PARTICIPANTS: 5848 older adults (aged 40-80) from Singapore's three dominant ethnic groups PRIMARY AND SECONDARY OUTCOME MEASURES: We used regression models to estimate per capita medical expenditures and absenteeism costs attributable to overweight and obesity based on WHO's body-mass index (BMI) classification. Per capita estimates were multiplied by prevalence to obtain aggregate costs. RESULTS The sample included 2467 Chinese, 2128 Indians and 1253 Malays. Indians and Malays are three to four times more likely to be obese (BMI≥30 kg/m2) than Chinese. Among Chinese, compared with those who are normal weight, individuals who are overweight missed one additional workday per year more (p<0.05). Individuals in the obese category had S$720 per year greater medical expenditures (p<0.05) but missed workdays were not statistically different from those in the normal weight category. Among Indians, differences were not significant between normal and overweight categories. Indians in the obese category incurred an additional S$310 per year (p<0.10) more than those of normal weight. For Malays, no significant differences by BMI category were identified. Aggregate burden is estimated at S$261M (million) (95% CI: 57M to 465M) with 68% from medical expenditures. Chinese, Malays and Indians make up 79%, 12% and 9% of the population, respectively, but account for 76%, 19% and 4% of the costs of excess weight respectively. CONCLUSION Excess weight imposes a substantial health and economic burden among older Singaporeans. Successful efforts to prevent and reduce obesity prevalence may generate both health and economic improvements.
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Affiliation(s)
- Chay Junxing
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Vinh Anh Huynh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Kwang Wei Tham
- Singapore Association for the Study of Obesity, Singapore
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Keay L, Ho KC, Rogers K, McCluskey P, White AJR, Morlet N, Ng JQ, Lamoureux E, Pesudovs K, Stapleton FJ, Boufous S, Huang‐Lung J, Palagyi A. The incidence of falls after first and second eye cataract surgery: a longitudinal cohort study. Med J Aust 2022; 217:94-99. [PMID: 35702892 PMCID: PMC9546129 DOI: 10.5694/mja2.51611] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare fall incidence, and visual acuity and refractive status, before surgery and after first and second eye cataract surgery. DESIGN, SETTING Prospective observational study in eight tertiary referral ophthalmology clinics in public hospitals in Sydney, Melbourne, and Perth. PARTICIPANTS People aged 65 years or more referred for bilateral age-related cataract surgery during 2013-16, followed for maximum of 24 months after study entry or until six months after second eye surgery, whichever was shorter. MAIN OUTCOME MEASURES Primary outcome: age- and sex-adjusted incidence of falls. SECONDARY OUTCOMES visual acuity and refractive error. RESULTS The mean age of the 409 included participants was 75.4 years (SD, 5.4 years); 220 were women (54%). Age- and sex-adjusted fall incidence prior to surgery was 1.17 (95% CI, 0.95-1.43) per year, 0.81 (95% CI, 0.63-1.04) per year after first eye surgery, and 0.41 (95% CI, 0.29-0.57) per year after second eye surgery. For the 118 participants who underwent second eye surgery and participated in all follow-up visits, age- and sex-adjusted incidence before (0.80 [95% CI, 0.55-1.15] falls per year) and after first eye surgery (0.81 [95% CI, 0.57-1.15] falls per year) was similar, but was lower after second eye surgery (0.32 [95% CI 0.21-0.50] falls per year). Mean habitual binocular visual acuity (logMAR) was 0.32 (SD, 0.21) before surgery, 0.15 (SD, 0.17) after first eye surgery, and 0.07 (SD, 0.15) after second eye surgery. CONCLUSIONS First eye surgery substantially improves vision in older people with cataract, but second eye surgery is required to minimise fall incidence. Timely cataract surgery for both eyes not only optimises vision in older people with cataract, but also reduces their risk of injury from falls.
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Affiliation(s)
- Lisa Keay
- The University of New South WalesSydneyNSW
- The George Institute for Global HealthSydneyNSW
| | - Kam Chun Ho
- The University of New South WalesSydneyNSW
- The University of CanberraCanberraACT
| | - Kris Rogers
- The George Institute for Global HealthSydneyNSW
| | | | - Andrew JR White
- Save Sight InstituteThe University of SydneySydneyNSW
- Westmead Institute for Medical ResearchSydneyNSW
| | | | | | | | | | | | - Soufiane Boufous
- Transport and Road Safety (TARS) Research CentreUniversity of New South WalesSydneyNSW
| | - Jessie Huang‐Lung
- The University of New South WalesSydneyNSW
- The George Institute for Global HealthSydneyNSW
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10
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Liu YC, Setiawan M, Chin JY, Wu B, Ong HS, Lamoureux E, Mehta JS. Randomized Controlled Trial Comparing 1-Year Outcomes of Low-Energy Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification. Front Med (Lausanne) 2022; 8:811093. [PMID: 34977102 PMCID: PMC8718704 DOI: 10.3389/fmed.2021.811093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/30/2021] [Indexed: 01/11/2023] Open
Abstract
Purpose: To compare 1-year clinical outcomes, phacoemulsification energy, aqueous profiles, and patient-reported outcomes of low-energy femtosecond laser-assisted cataract surgery (FLACS) vs. conventional phacoemulsification. Methods: The study is a randomized controlled trial (RCT) with paired-eye design. Eighty-five patients were randomized to receive FLACS (Ziemer LDV Z8) in one eye and conventional phacoemulsification in the fellow eye. Clinical data including phacoemulsification energy parameters (cumulative dissipated energy, phacoemulsification power, and phacoemulsification time), uncorrected and corrected distance visual acuities (UCDVA and BCDVA), manifest refraction spherical equivalent (MRSE), central corneal thickness (CCT), endothelial cell count (ECC), anterior chamber flare, and post-operative complications were obtained for 1 year. Aqueous humor was collected for the analysis of prostaglandin (PGE)2, cytokines and chemokines concentrations. Patients' reported-outcomes on surgical experiences were evaluated using an in-house questionnaire. Results: Compared to conventional phacoemulsification, the low-energy assisted FLACS group had significantly less ECC reduction at 3 months (1.5 ± 0.3% vs. 7.0 ± 2.4%; P < 0.01) and 1 year (8.2 ± 2.8% vs. 11.2 ± 3.6%; P = 0.03). There were no significant differences in the phacoemulsification energy parameters, UCDVA, BCDVA, MRSE, CCT, occurrence of post-operative complications between the 2 groups throughout post-operative 1 year. Patients' subjective surgical experiences, including the surgical duration and perceived inconvenience, were comparable between the 2 groups. FLACS resulted in significantly higher aqueous PGE2 (P < 0.01), interleukin (IL)-6 (P = 0.03), IL-8 (P = 0.03), and interferon (IFN)-γ (P = 0.04) concentrations and greater anterior chamber flare at 1 day (P = 0.02). Conclusions: Our RCT presented 1-year longitudinal clinical and laboratory data. The long-term ECC result was more favorable in low-energy FLACS. The rest of the intraoperative and post-operative outcomes, as well as patient-reported outcomes, were comparable between these two procedures.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Melina Setiawan
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Jia Ying Chin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Benjamin Wu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Hon Shing Ong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Population Health Group, Singapore Eye Research Institute, Singapore, Singapore.,Health Services and System Research Department, Population Health Research, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
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11
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Gunasekeran DV, Zheng F, Lim GYS, Chong CCY, Zhang S, Ng WY, Keel S, Xiang Y, Park KH, Park SJ, Chandra A, Wu L, Campbel JP, Lee AY, Keane PA, Denniston A, Lam DSC, Fung AT, Chan PRV, Sadda SR, Loewenstein A, Grzybowski A, Fong KCS, Wu WC, Bachmann LM, Zhang X, Yam JC, Cheung CY, Pongsachareonnont P, Ruamviboonsuk P, Raman R, Sakamoto T, Habash R, Girard M, Milea D, Ang M, Tan GSW, Schmetterer L, Cheng CY, Lamoureux E, Lin H, van Wijngaarden P, Wong TY, Ting DSW. Acceptance and Perception of Artificial Intelligence Usability in Eye Care (APPRAISE) for Ophthalmologists: A Multinational Perspective. Front Med (Lausanne) 2022; 9:875242. [PMID: 36314006 PMCID: PMC9612721 DOI: 10.3389/fmed.2022.875242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many artificial intelligence (AI) studies have focused on development of AI models, novel techniques, and reporting guidelines. However, little is understood about clinicians' perspectives of AI applications in medical fields including ophthalmology, particularly in light of recent regulatory guidelines. The aim for this study was to evaluate the perspectives of ophthalmologists regarding AI in 4 major eye conditions: diabetic retinopathy (DR), glaucoma, age-related macular degeneration (AMD) and cataract. Methods This was a multi-national survey of ophthalmologists between March 1st, 2020 to February 29th, 2021 disseminated via the major global ophthalmology societies. The survey was designed based on microsystem, mesosystem and macrosystem questions, and the software as a medical device (SaMD) regulatory framework chaired by the Food and Drug Administration (FDA). Factors associated with AI adoption for ophthalmology analyzed with multivariable logistic regression random forest machine learning. Results One thousand one hundred seventy-six ophthalmologists from 70 countries participated with a response rate ranging from 78.8 to 85.8% per question. Ophthalmologists were more willing to use AI as clinical assistive tools (88.1%, n = 890/1,010) especially those with over 20 years' experience (OR 3.70, 95% CI: 1.10-12.5, p = 0.035), as compared to clinical decision support tools (78.8%, n = 796/1,010) or diagnostic tools (64.5%, n = 651). A majority of Ophthalmologists felt that AI is most relevant to DR (78.2%), followed by glaucoma (70.7%), AMD (66.8%), and cataract (51.4%) detection. Many participants were confident their roles will not be replaced (68.2%, n = 632/927), and felt COVID-19 catalyzed willingness to adopt AI (80.9%, n = 750/927). Common barriers to implementation include medical liability from errors (72.5%, n = 672/927) whereas enablers include improving access (94.5%, n = 876/927). Machine learning modeling predicted acceptance from participant demographics with moderate to high accuracy, and area under the receiver operating curves of 0.63-0.83. Conclusion Ophthalmologists are receptive to adopting AI as assistive tools for DR, glaucoma, and AMD. Furthermore, ML is a useful method that can be applied to evaluate predictive factors on clinical qualitative questionnaires. This study outlines actionable insights for future research and facilitation interventions to drive adoption and operationalization of AI tools for Ophthalmology.
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Affiliation(s)
- Dinesh V Gunasekeran
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Feihui Zheng
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Gilbert Y S Lim
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Crystal C Y Chong
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Shihao Zhang
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Wei Yan Ng
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Stuart Keel
- Department of Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Aman Chandra
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | - Lihteh Wu
- Asociados de Macula, Vitreo y Retina de Costa Rica, San José, Costa Rica
| | - J Peter Campbel
- Casey Eye Institute, Oregon Health and Science, Portland, OR, United States
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | | | - Alastair Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Dennis S C Lam
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China.,C-MER International Eye Research Center of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Adrian T Fung
- Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, NSW, Australia
| | - Paul R V Chan
- Department of Ophthalmology, University of Illinois College of Medicine, Chicago, IL, United States
| | - SriniVas R Sadda
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, CA, United States
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Ponzan, Poland
| | | | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong (CUHK), Hong Kong, Hong Kong SAR, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong (CUHK), Hong Kong, Hong Kong SAR, China
| | - Pear Pongsachareonnont
- Vitreoretinal Research Unit, Department of Ophthalmology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Rajiv Raman
- Vitreo-Retinal Department, Sankara Nethralaya, Chennai, India
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | - Ranya Habash
- Bascom Palmar Eye Institute, Miami, FL, United States
| | - Michael Girard
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,Copenhagen University Hospital, Copenhagen, Denmark
| | - Marcus Ang
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | | | - Tien Y Wong
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Daniel S W Ting
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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12
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Foo LL, Lanca C, Wong CW, Ting D, Lamoureux E, Saw SM, Ang M. Cost of Myopia Correction: A Systematic Review. Front Med (Lausanne) 2021; 8:718724. [PMID: 34926485 PMCID: PMC8677936 DOI: 10.3389/fmed.2021.718724] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Myopia is one of the leading causes of visual impairment globally. Despite increasing prevalence and incidence, the associated cost of treatment remains unclear. Health care spending is a major concern in many countries and understanding the cost of myopia correction is the first step eluding to the overall cost of myopia treatment. As cost of treatment will reduce the burden of cost of illness, this will aid in future cost-benefit analysis and the allocation of healthcare resources, including considerations in integrating eye care (refractive correction with spectacles) into universal health coverage (UHC). We performed a systematic review to determine the economic costs of myopia correction. However, there were few studies for direct comparison. Costs related to myopia correction were mainly direct with few indirect costs. Annual prevalence-based direct costs for myopia ranged from $14-26 (USA), $56 (Iran) and $199 (Singapore) per capita, respectively (population: 274.63 million, 75.15 million and 3.79 million, respectively). Annually, the direct costs of contact lens were $198.30-$378.10 while spectacles and refractive surgeries were $342.50 and $19.10, respectively. This review provides an insight to the cost of myopia correction. Myopia costs are high from nation-wide perspectives because of the high prevalence of myopia, with contact lenses being the more expensive option. Without further interventions, the burden of illness of myopia will increase substantially with the projected increase in prevalence worldwide. Future studies will be necessary to generate more homogenous cost data and provide a complete picture of the global economic cost of myopia.
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Carla Lanca
- Singapore Eye Research Institute, Singapore, Singapore.,Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel Ting
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,NUS Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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13
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Tan B, Sim YC, Chua J, Yusufi D, Wong D, Yow AP, Chin C, Tan ACS, Sng CCA, Agrawal R, Gopal L, Sim R, Tan G, Lamoureux E, Schmetterer L. Developing a normative database for retinal perfusion using optical coherence tomography angiography. Biomed Opt Express 2021; 12:4032-4045. [PMID: 34457397 PMCID: PMC8367249 DOI: 10.1364/boe.423469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 05/25/2023]
Abstract
Visualizing and characterizing microvascular abnormalities with optical coherence tomography angiography (OCTA) has deepened our understanding of ocular diseases, such as glaucoma, diabetic retinopathy, and age-related macular degeneration. Two types of microvascular defects can be detected by OCTA: focal decrease because of localized absence and collapse of retinal capillaries, which is referred to as the non-perfusion area in OCTA, and diffuse perfusion decrease usually detected by comparing with healthy case-control groups. Wider OCTA allows for insights into peripheral retinal vascularity, but the heterogeneous perfusion distribution from the macula, parapapillary area to periphery hurdles the quantitative assessment. A normative database for OCTA could estimate how much individual's data deviate from the normal range, and where the deviations locate. Here, we acquired OCTA images using a swept-source OCT system and a 12×12 mm protocol in healthy subjects. We automatically segmented the large blood vessels with U-Net, corrected for anatomical factors such as the relative position of fovea and disc, and segmented the capillaries by a moving window scheme. A total of 195 eyes were included and divided into 4 age groups: < 30 (n=24) years old, 30-49 (n=28) years old, 50-69 (n=109) years old and >69 (n=34) years old. This provides an age-dependent normative database for characterizing retinal perfusion abnormalities in 12×12 mm OCTA images. The usefulness of the normative database was tested on two pathological groups: one with diabetic retinopathy; the other with glaucoma.
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Affiliation(s)
- Bingyao Tan
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yin Ci Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jacqueline Chua
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Dheo Yusufi
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Damon Wong
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ai Ping Yow
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Calvin Chin
- Duke-NUS Medical School, Singapore
- National Heart Centre Singapore, Singapore
| | - Anna C. S. Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Changi General Hospital, Singapore
| | - Chelvin C. A. Sng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, National University Hospital, Singapore
| | - Rupesh Agrawal
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Ralene Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Gavin Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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14
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Majithia S, Tham YC, Chee ML, Nusinovici S, Teo CL, Chee ML, Thakur S, Soh ZD, Kumari N, Lamoureux E, Sabanayagam C, Wong TY, Cheng CY. Corrigendum to: Cohort profile: The Singapore Epidemiology of Eye Diseases Study (SEED). Int J Epidemiol 2021; 50:1401. [PMID: 34179972 DOI: 10.1093/ije/dyab114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Majithia S, Tham YC, Chee ML, Nusinovici S, Teo CL, Chee ML, Thakur S, Soh ZD, Kumari N, Lamoureux E, Sabanayagam C, Wong TY, Cheng CY. Cohort Profile: The Singapore Epidemiology of Eye Diseases study (SEED). Int J Epidemiol 2021; 50:41-52. [PMID: 33393587 DOI: 10.1093/ije/dyaa238] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Shivani Majithia
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yih-Chung Tham
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Miao-Li Chee
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Simon Nusinovici
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Cong Ling Teo
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Miao-Ling Chee
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Sahil Thakur
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Zhi Da Soh
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Neelam Kumari
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Khoo Teck Puat Hospital, Singapore
| | - Ecosse Lamoureux
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Charumathi Sabanayagam
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Tien-Yin Wong
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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16
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Ye G, Qu B, Tham YC, Zhong Y, Jin L, Lamoureux E, Congdon N, Zheng Y, Liu Y. A decision aid to facilitate informed choices among cataract patients: A randomized controlled trial. Patient Educ Couns 2021; 104:1295-1303. [PMID: 33191060 DOI: 10.1016/j.pec.2020.10.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/13/2020] [Accepted: 10/31/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess the effect of a patient decision aid on the quality of decision-making for patients with age-related cataracts. METHODS 773 patients with cataracts aged 50-80 years were randomly assigned to receive either the intervention decision aid (including standard information, quantitative information on the possible outcomes of cataract surgery and a value clarification exercise) or the control booklet (including standard information). The primary outcome was informed choice (defined as adequate knowledge and congruency between attitudes and surgical intentions), which was assessed at 2 weeks after intervention via a telephone interview. RESULTS The decision aid increased the proportion of participants making an informed choice, from 5.68 % in the control group to 27.7 % in the intervention group (P < 0.001). Compared with controls, more participants in the intervention group had adequate overall knowledge about cataract surgery (36.8 % vs. 8.79 % in controls; P < 0.001), and fewer participants intended to undergo surgery (22.5 % vs. 34.1 % in controls; P < 0.001). CONCLUSION Use of the patient decision aid may increase the proportion of patients making informed choices. Importantly, it might also reduce the acceptance of operations. PRACTICE IMPLICATIONS Patient decision aids represent a simple and low-cost tool to facilitate informed choice among patients with cataracts.
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Affiliation(s)
- Guofang Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Bo Qu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Yuxin Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ecosse Lamoureux
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre for Public Health, Queen's University Belfast, Belfast, Ireland.
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Zheng Y, Wang W, Zhong Y, Wu F, Zhu Z, Tham YC, Lamoureux E, Xiao L, Zhu E, Liu H, Jin L, Liang L, Luo L, He M, Morgan I, Congdon N, Liu Y. A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e24316. [PMID: 33882021 PMCID: PMC8092026 DOI: 10.2196/24316] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/31/2021] [Accepted: 04/14/2021] [Indexed: 01/19/2023] Open
Abstract
Background The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. Objective The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children’s anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic. Methods In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality. Results On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root–transformed self-reported anxiety scores was greater in the intervention (–0.23, 95% CI –0.27 to –0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference –0.36, 95% CI –0.63 to –0.08; P=.02). There was a significant reduction in square-root–transformed eye strain in the intervention group (–0.08, 95% CI –0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference –0.15, 95% CI –0.26 to –0.03; P=.02). Change in sleep quality was similar between the two groups. Conclusions This digital behavior change intervention reduced children’s anxiety and eye strain during COVID-19–associated online schooling. Trial Registration ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097
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Affiliation(s)
- Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China.,Research Units of Ocular Development and Regeneration, Chinese Academy of Medical Sciences, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yuxin Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Liang Xiao
- Zhaoqing Education Bureau, Zhaoqing, China
| | - Erta Zhu
- Zhaoqing Education Bureau, Zhaoqing, China
| | - Haoning Liu
- Duanzhou District Education Bureau, Zhaoqing, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Linyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ian Morgan
- Research School of Biology, Australian National University, Canberra, Australia
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, Ireland
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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18
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Sankaridurg P, Tahhan N, Kandel H, Naduvilath T, Zou H, Frick KD, Marmamula S, Friedman DS, Lamoureux E, Keeffe J, Walline JJ, Fricke TR, Kovai V, Resnikoff S. IMI Impact of Myopia. Invest Ophthalmol Vis Sci 2021; 62:2. [PMID: 33909036 PMCID: PMC8083082 DOI: 10.1167/iovs.62.5.2] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 01/15/2023] Open
Abstract
The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden.
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Affiliation(s)
- Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Nina Tahhan
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Himal Kandel
- Save Sight Institute, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Thomas Naduvilath
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Haidong Zou
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai, China
| | - Kevin D. Frick
- Johns Hopkins Carey Business School, Baltimore, Maryland, United States
| | - Srinivas Marmamula
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - David S. Friedman
- Glaucoma Center of Excellence, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Ecosse Lamoureux
- Duke - NUS Medical School, Singapore; Singapore Eye Research Institute, Singapore
| | - Jill Keeffe
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Jeffrey J. Walline
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | | | - Vilas Kovai
- Health Promotion Service, Population Health, Liverpool Hospital, SWSLHD, Health - New South Wales, New South Wales, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
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19
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Keay L, Palagyi A, Do V, White A, Lamoureux E, Ivers RQ, Pesudovs K, Stapleton F, Boufous S, Mccluskey P. Vision and driving status of older Australians with cataract: an investigation of public hospital waiting lists. Clin Exp Optom 2021; 99:449-55. [DOI: 10.1111/cxo.12414] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/29/2016] [Accepted: 02/18/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lisa Keay
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
| | - Anna Palagyi
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
| | - Vu Do
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
- School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia,
| | - Andrew White
- Westmead Hospital, Sydney, New South Wales, Australia,
- Westmead Millennium Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
| | - Ecosse Lamoureux
- Centre for Eye Research Australia, The University of Melbourne, Melbourne, Victoria, Australia,
- Singapore Eye Research Institute, Singapore,
- Duke‐NUS Graduate Medical School, Singapore,
| | - Rebecca Q Ivers
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia,
| | - Konrad Pesudovs
- NHMRC Centre for Clinical Eye Research, Discipline of Optometry, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia,
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia,
| | - Soufiane Boufous
- Australia Transport and Road Safety Research, University of New South Wales, Kensington, New South Wales, Australia,
| | - Peter Mccluskey
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia,
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20
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Stolk-Vos A, De Korne D, Lamoureux E, Wai C, Busschbach JJ, van de Klundert JJ. Multi-stakeholder perspectives in defining health services quality indicators and dimensions: a concept mapping based comparison for cataract care between Singapore and The Netherlands. BMJ Open 2021; 11:e046226. [PMID: 33827846 PMCID: PMC8031691 DOI: 10.1136/bmjopen-2020-046226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study aims to advance understanding of globally valid versus country-specific quality dimensions and indicators, as perceived by relevant stakeholders. It specifically addresses patient-level indicators for cataract surgery. DESIGN A mixed-methods case study comparing Singapore and The Netherlands SETTING: Singapore (2017-2019) and The Netherlands (2014-2015). PARTICIPANTS Stakeholder representatives of cataract care in Singapore and The Netherlands. INTERVENTION Based on the previously identified complete set of stakeholders in The Netherlands, we identified stakeholders of cataract care in Singapore. Stakeholder representatives then established a multi-stakeholder perspective on the quality of cataract care using a concept mapping approach. This yielded a multidimensional cluster map based on multivariate statistical analyses. Consensus-based quality dimensions were subsequently defined during a plenary session. Thereafter, Singaporean dimensions were matched with dimensions obtained in The Netherlands to identify commonalities and differences. MAIN OUTCOME MEASURE Health-services quality dimensions of cataract care. RESULTS 19 Singaporean stakeholders representing patients, general practitioners, ophthalmologists, nurses, care providers, researchers and clinical auditors defined health-services quality of cataract care using the following eight dimensions: clinical outcome, patient outcomes, surgical process, surgical safety, patient experience, access, cost and standards of care. Compared with the Dutch results, 61% of the indicators were allocated to dimensions of comparable names and compositions. Considerable differences also existed in the composition of some dimensions and the importance attached to indicators. CONCLUSIONS AND RELEVANCE This study on cataract care in Singapore and The Netherlands shows that cataract care quality measurement instruments can share a common international core. At the same time, it emphasises the importance of taking a country-specific multi-stakeholder approach to quality definition and measurement. Complementing an international core set with country-specific measures is required to ensure that the included dimensions and indicators adequately capture the country-specific quality views.
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Affiliation(s)
- Aline Stolk-Vos
- ROI, Oogziekenhuis Rotterdam, Rotterdam, The Netherlands
- Erasmus School for Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Dirk De Korne
- Erasmus School for Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Ecosse Lamoureux
- Health Services and System Research Department, Duke-NUS Medical School, Singapore
| | - Charity Wai
- Executive Board, Singapore National Eye Centre, Singapore
| | - Jan Jv Busschbach
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Joel Joris van de Klundert
- Operations, Prince Mohammad Bin Salman College of Business and Entrepreneurship, King Abdullah Economic City, Saudi Arabia
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21
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Rangabashyam M, Koh SQ, Sultana R, Tan NC, Iyer NG, Soo KC, Fenwick E, Lamoureux E, Tan HK. Factors associated with returning to work in head and neck cancer survivors in Singapore: A preliminary exploratory mixed-methods approach study. Head Neck 2021; 43:1451-1464. [PMID: 33599355 DOI: 10.1002/hed.26644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/13/2020] [Accepted: 02/01/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Little is known about return-to-work (RTW) among Asian head and neck cancer (HNC) survivors. We investigated the prevalence and factors associated with RTW among HNC patients with in Singapore. METHODS In this cross-sectional mixed-methods study, 80 HNC patients, who had been working prior to diagnosis, completed questionnaires and 15 participated in qualitative interviews to explore perceived barriers and facilitators of RTW. Multivariate logistic regression was used to evaluate factors associated with not-returning-to-work (NRTW) within 6 months of treatment completion. RESULTS Thirty-five participants reported NRTW 43.8%. Multivariable analysis showed that patients with advanced stage (III-IV) cancer (odds ratios [OR] = 4.51, 95% confidence intervals [CI]: 1.15-13.28, p = 0.006), multi-modality treatment (OR = 4.62, 95% CI: 1.38-15.52, p = 0.013), and pink-collar jobs (OR = 9.30, 95% CI: 1.70-50.83, p = 0.010) had higher odds of NRTW. CONCLUSION The factors associated with employment after HNC treatment are complex. Identification of key modifiable factors may lead to improved RTW outcomes.
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Affiliation(s)
- Mahalakshmi Rangabashyam
- Department of Head and Neck Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Head and Neck Centre, SingHealth, Singapore
| | | | - Rehena Sultana
- Center for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Ngian Chye Tan
- Department of Head and Neck Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Head and Neck Centre, SingHealth, Singapore.,Duke-NUS Medical School, Singapore
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Head and Neck Centre, SingHealth, Singapore.,Duke-NUS Medical School, Singapore
| | - Khee Chee Soo
- Department of Head and Neck Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, National Cancer Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Eva Fenwick
- Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ecosse Lamoureux
- Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Hiang Khoon Tan
- Department of Head and Neck Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Head and Neck Centre, SingHealth, Singapore.,Duke-NUS Medical School, Singapore
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22
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Tham YC, Anees A, Zhang L, Goh JHL, Rim TH, Nusinovici S, Hamzah H, Chee ML, Tjio G, Li S, Xu X, Goh R, Tang F, Cheung CYL, Wang YX, Nangia V, Jonas JB, Gopinath B, Mitchell P, Husain R, Lamoureux E, Sabanayagam C, Wang JJ, Aung T, Liu Y, Wong TY, Cheng CY. Referral for disease-related visual impairment using retinal photograph-based deep learning: a proof-of-concept, model development study. The Lancet Digital Health 2021; 3:e29-e40. [DOI: 10.1016/s2589-7500(20)30271-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/14/2020] [Accepted: 10/24/2020] [Indexed: 11/26/2022]
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23
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Prem Senthil M, Lim L, Braithwaite T, Denniston A, Fenwick EK, Lamoureux E, Khadka J, Pesudovs K. The Impact of Adult Uveitis on Quality of Life: An Exploratory Study. Ophthalmic Epidemiol 2020; 28:444-452. [PMID: 33345711 DOI: 10.1080/09286586.2020.1856385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE: This exploratory qualitative research was conducted to understand the quality of life (QoL) impacts of adult uveitis to develop a uveitis QoL item bank, and we present here the results of qualitative analysis of uveitis patient experience.METHODS: A qualitative approach with phenomenological study design was employed to explore the common QoL domains in uveitis. Data were collected using focus groups and face-to-face interviews. The sessions were audio-recorded, transcribed verbatim, and analysed thematically. NViVo software was used to perform qualitative analysis.RESULTS: Eight focus groups and 10 interviews were conducted with 41 patients with uveitis. Seven QoL domains were identified, namely symptoms, emotional, activity limitation, health concerns, convenience, social, and economic impact. Although these QoL domains have been previously identified in other eye diseases, the sub-themes within each QoL domain were unique to uveitis. Participants described a variety of symptoms including increased light sensitivity, blurred vision, pain, redness, and tearing. Participants repeatedly described feeling frustrated due to prognostic uncertainty and associated discomfort. Participants were concerned about the frequent relapses of inflammation, as well as side-effects from long-term systemic medications. Uveitis affected their ability to perform daily tasks such as using computers, driving, and reading books. Direct financial impacts included reduced work hours and the costs of treatment and specialist care.CONCLUSION: Participants with uveitis experience many symptoms in addition to medication-related inconveniences and activity limitations. The QoL issues identified will be used to develop a uveitis-specific QoL item bank.
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Affiliation(s)
- Mallika Prem Senthil
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lyndell Lim
- Centre for Eye Research Australia, University of Melbourne, the Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | | | - Alastair Denniston
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK.,University of Birmingham, Birmingham, UK
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jyoti Khadka
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,University of South Australia Business School, Adelaide, Australia
| | - Konrad Pesudovs
- University of New South Wales, Sydney, Australia.,Anglia Ruskin University, Cambridge, UK
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24
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Rees G, McCabe M, Xie J, Constantinou M, Gan A, Holloway E, Man RE, Jackson J, Fenwick EK, Lamoureux E. High vision-related quality of life indices reduce the odds of depressive symptoms in aged care facilities. Aging Ment Health 2020; 24:1596-1604. [PMID: 31392896 DOI: 10.1080/13607863.2019.1650889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To examine the association between vision-related quality of life (VRQoL) and depressive symptoms in residents with vision impairment (VI) in aged care facilities.Methods: In this cross-sectional study using baseline data from a cluster-randomized controlled trial (ACTRN12615000587505) assessing the effectiveness of a novel eye care model, 186 English-speaking residents (mean age 84 years, SD[standard deviation] = 8.7; 33.9% male) with VI and moderate cognitive functioning or better were recruited from 38 facilities across Victoria, Australia. VRQoL was measured using Rasch-transformed scores from the 'Reading'; 'Mobility', and 'Emotional' scales of the Impact of Vision Impairment for Residential Care (IVI-RC) questionnaire. Outcomes were presence of depressive symptoms (binary score: Cornell Scale for Depression in Dementia [CSDD] > 0 vs. CSDD = 0) and severity of depressive symptoms (continuous CSDD score; sample range 1-21). Independent associations with presence and severity of depressive symptoms were examined using zero-inflated logistic and linear multivariable models, respectively.Results: Of the 186 participants, n = 79 (42.5%), n = 94 (50.5%) and n = 13 (7%) reported no, mild (scores 1-7), and clinically significant depressive symptoms (score ≥8), respectively. Better vision-related Mobility (OR = 0.64; 95% CI: 0.44, 0.95, p = 0.02) was associated with reduced odds of depressive symptoms. With every unit improvement in vision-related Reading (β=-0.48; 95% CI: -0.94, -0.01, p = 0.04) and Emotional (β=-0.56; 95% CI: -1.09, -0.02, p = 0.04), severity of depressive symptoms reduced, independent of sociodemographic and medical issues.Conclusion: Better VRQoL was independently associated with reduced depressive symptoms. Supporting older people in aged care to maintain optimal levels of vision-specific functioning, independence, and emotional well-being may protect their mental health.
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Affiliation(s)
- Gwyneth Rees
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Marita McCabe
- Institute for Health and Aging, Australian Catholic University, Australia
| | - Jing Xie
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Marios Constantinou
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Alfred Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Edith Holloway
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Ryan Ek Man
- Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jonathon Jackson
- Department of Ophthalmology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom.,Australian College of Optometry, Victoria, Australia
| | - Eva K Fenwick
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia.,Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ecosse Lamoureux
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia.,Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Department of Ophthalmology, National University of Singapore and National University Health System, Singapore
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Wong YL, Sabanayagam C, Wong CW, Cheung YB, Man REK, Yeo ACH, Cheung G, Chia A, Kuo A, Ang M, Ohno-Matsui K, Wong TY, Wang JJ, Cheng CY, Hoang QV, Lamoureux E, Saw SM. Six-Year Changes in Myopic Macular Degeneration in Adults of the Singapore Epidemiology of Eye Diseases Study. Invest Ophthalmol Vis Sci 2020; 61:14. [PMID: 32298432 PMCID: PMC7401489 DOI: 10.1167/iovs.61.4.14] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose To examine the 6-year incidence, progression, associated risk factors, and impact of myopic macular degeneration (MMD) in a myopic population in Singapore. Methods We examined myopic (spherical equivalent ≤-0.5 diopters) adults (N = 2157 persons and 3661 eyes) who were phakic at baseline and participated in both baseline and 6-year follow-up visits of the Singapore Epidemiology of Eye Diseases study. Eye examinations, including visual acuity, subjective refraction and axial length (AL) measurements, were performed. MMD was graded from fundus photographs following the META-PM classification. Vision-related quality of life was assessed with Rasch-transformed scores from reading, mobility, and emotional domains of the Impact of Vision Impairment questionnaire. Results The 6-year eye-specific incidence of MMD among myopic eyes was 1.2% (95% CI, 0.9%-1.6%). Older age, worse spherical equivalent, and longer AL at baseline were associated with MMD incidence (all P < 0.001). The 6-year eye-specific progression of MMD in 288 eyes with baseline MMD was 17.0% (95% CI, 12.6%-21.4%). More severe MMD at baseline, worse spherical equivalent, and longer AL (all P < 0.05) were associated with MMD progression. Patients with Meta-PM categories 3 and 4 had worse best-corrected visual acuity and poorer vision-related quality of life outcomes than those without MMD (all P < 0.05). Conclusions Over a 6-year period, one in 80 myopic eyes developed MMD and one in six with existing MMD had MMD progression. Myopia severity and AL were strong predictors of MMD development and progression. Eyes with severe MMD were at higher risk of MMD progression than those with less severe MMD, and were associated with poorer visual acuity and vision-related quality of life.
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Hong J, Tan B, Quang ND, Gupta P, Lin E, Wong D, Ang M, Lamoureux E, Schmetterer L, Chua J. Intra-session repeatability of quantitative metrics using widefield optical coherence tomography angiography (OCTA) in elderly subjects. Acta Ophthalmol 2020; 98:e570-e578. [PMID: 31833241 PMCID: PMC7496426 DOI: 10.1111/aos.14327] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/17/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To assess the repeatability of retinal vascular metrics using different postprocessing methods as obtained from the swept-source optical coherence tomography angiography (SS-OCTA). METHODS Thirty-two participants (63% males; mean [SD] age, 70 [7] years) underwent SS-OCTA imaging (PLEX® Elite 9000, Carl Zeiss Meditec, Inc., Dublin, USA). Each participant underwent 2 repeated scans of 2 scan protocols: a macular-centred 3 × 3-mm2 and a widefield 12 × 12-mm2 for a total of 4 acquisitions. Images of superficial vascular plexuses (SVP) and deep vascular plexuses (DVP) were processed using different filters to generate the perfusion density (PD) and vessel density (VD). Vessel enhancement filters ranged from vessel targeted (Hessian and Gabor filters), classical denoising (Gaussian filter), to a scale-selective adaption (modified Bayesian residual transform [MBRT]). Intra-session repeatability of the different filters and their correlation with the original data set were calculated with the intraclass correlation coefficient (ICC) and Pearson's r. RESULTS Of the 32 eyes, 17 and 15 were right and left eyes, respectively. For 3 × 3-mm2 scans, both MBRT and Gabor filters yielded very good repeatable PD and VD (both ICCs > 0.87) values. Gabor filter was the most correlated with the original data set for the OCTA metrics (r = 0.95-0.97). For 12 × 12-mm2 scans, MBRT filter produced good-to-moderate ICC values for SVP (ICC>0.89) and DVP (ICC>0.73) metrics. Both the MBRT and Gabor filters were highly correlated with the original 12 × 12-mm2 scan data set (r = 0.96-0.98). The ICCs for the agreement between 3 × 3-mm2 and cropped 12 × 12-mm2 were high only for the PD values at the SVP layer and were poor for the VD at SVP and DVP measurements (ICC < 0.50). CONCLUSION Our findings show that with the proper choice of postimaging processing methods, SS-OCTA metrics can be obtained with high repeatability, which supports its use in various clinical settings.
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Affiliation(s)
- Jimmy Hong
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
- Department of OphthalmologyLee Kong Chian School of MedicineNanyang Technological UniversitySingapore CitySingapore
| | - Bingyao Tan
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
| | - Nguyen Duc Quang
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
| | - Preeti Gupta
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
| | - Emily Lin
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
| | - Damon Wong
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
- School of Chemical and Biomedical EngineeringNanyang Technological UniversitySingapore CitySingapore
| | - Marcus Ang
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
- Academic Clinical ProgramDuke‐NUS Medical SchoolSingapore CitySingapore
| | - Ecosse Lamoureux
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
- Academic Clinical ProgramDuke‐NUS Medical SchoolSingapore CitySingapore
| | - Leopold Schmetterer
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
- Department of OphthalmologyLee Kong Chian School of MedicineNanyang Technological UniversitySingapore CitySingapore
- School of Chemical and Biomedical EngineeringNanyang Technological UniversitySingapore CitySingapore
- Academic Clinical ProgramDuke‐NUS Medical SchoolSingapore CitySingapore
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Jacqueline Chua
- Singapore Eye Research InstituteSingapore National Eye CentreSingapore CitySingapore
- Academic Clinical ProgramDuke‐NUS Medical SchoolSingapore CitySingapore
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Ye G, Qu B, Shi W, Chen X, Ma P, Zhong Y, Chen S, Lamoureux E, Zheng Y. Knowledge about benefits and risks of undergoing cataract surgery among cataract patients in Southern China. Int Ophthalmol 2020; 40:2889-2899. [PMID: 32601961 DOI: 10.1007/s10792-020-01473-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a theoretical framework for assessing knowledge about the possible outcomes of undergoing cataract surgery, and explore the association of knowledge level with psychological status and decision quality among patients with cataract in Southern China. METHODS The details of the knowledge scale were based on the health education information booklet provided by National Eye Institute, NIH. We used a theory-based approach to assess gist knowledge, which comprises 12 questions related to knowledge of the possible surgical outcomes. The scale was then used in a cross-sectional study to assess the association of knowledge score with psychological status and decision quality among cataract patients. RESULTS A total of 489 participants with age-related cataract were included in this study, and 10.2% (50/489) of them had adequate level of knowledge. The knowledge scale was significantly associated to the levels of worry (Odds Ratio (OR) = 0.36, 95%CI: 0.18, 0.70; P = 0.003), anxiety (beta coefficient = - 5.36, 95%CI - 8.88, - 1.84; P = 0.003), inaction regret (OR = 0.49, 95%CI: 0.28, 0.88; P = 0.016) and decision conflict (beta coefficient = - 7.93, 95%CI - 12.81, - 3.04; P = 0.002) in multivariate analyses adjusted for age, sex, education level and literacy level. CONCLUSION Knowledge adequacy with cataract surgery outcomes was negatively associated with cataract worry, anxiety and decisional conflict. Patients with adequate knowledge were more likely to postpone cataract surgery.
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Affiliation(s)
- Guofang Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Bo Qu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wen Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Pengjuan Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yuxin Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Shida Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ecosse Lamoureux
- Population Health and Epidemiology Program, Singapore Eye Research Institute (SERI), Singapore, Singapore
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
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Chew M, Tan NYQ, Lamoureux E, Cheng CY, Wong TY, Sabanayagam C. The associations of objectively measured sleep duration and sleep disturbances with diabetic retinopathy. Diabetes Res Clin Pract 2020; 159:107967. [PMID: 31805348 DOI: 10.1016/j.diabres.2019.107967] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 11/02/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022]
Abstract
AIMS To assess the associations between objectively measured sleep duration, sleep disturbances and diabetic retinopathy (DR). METHODS This cross-sectional study recruited 92 patients with diabetes from retinal clinics. Objective measurements of sleep duration, apnea-hypopnea index (AHI) and minimum oxygen saturations (SaO2) were obtained through polysomnography. The Epworth Sleepiness Scale and Insomnia Severity Index were administered. Retinal photographs were taken and graded according to the modified Airlie House Classification System. Regression analysis used to determine associations with outcomes including moderate DR, vision-threatening DR (VTDR) and diabetic macular edema (DME). RESULTS Mean age of participants was 57.6 ± 8.3 years. 29 (32%) of them had moderate DR, and 17 (18.5%) had VTDR. Higher AHI (Odds Ratio [OR] 1.04; 95% confidence interval [CI] 1.00, 1.07) and short sleep duration (OR 3.22; 95%CI 1.18, 8.79) were associated with moderate DR. VTDR was associated with moderate obstructive sleep apnea (OSA) (OR 4.73; 95%CI 1.46, 15.31), higher AHI (OR 1.06; 95%CI 1.02, 1.10) and lower minimum SaO2 (OR 0.89; 95%CI 0.83, 0.96). High risk for insomnia was associated with DME (OR 4.01; 95%CI 1.09, 14.73). CONCLUSIONS Short sleep duration was associated with moderate DR while OSA-related parameters and a high risk for insomnia were associated with moderate DR, VTDR and DME.
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Affiliation(s)
- Merwyn Chew
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, JurongHealth, National University Health System, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Y Q Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.
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Prem Senthil M, Fenwick EK, Lamoureux E, Khadka J, Pesudovs K. Identification and Evaluation of Items for Vitreoretinal Diseases Quality of Life Item Banks. Ophthalmic Epidemiol 2019; 26:448-458. [PMID: 31615298 DOI: 10.1080/09286586.2019.1678655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: We are developing item banks assessing the impact of retinal and vitreoretinal diseases (excluding age-related macular degeneration, diabetic retinopathy, and retinal detachment, covered elsewhere) on quality of life (QoL) for adults. This study outlines the first two phases of the multi-stage process: content development and item evaluation.Methods: We grouped retinal and vitreoretinal diseases into hereditary and acquired. Development of the item banks involved two phases: item identification and item evaluation. The items were extracted from three sources: (1) 17 pre-existing PRO instruments, (2) 4 qualitative studies and (3) 79 semi-structured interviews. Item evaluation involved three stages namely, binning (grouping) and winnowing (reduction), expert panel opinion and cognitive interviews.Results: The item identification phase yielded 1,217 items. After three sessions of binning and winnowing, items were reduced to a minimally representative set (n = 411) across nine QoL domains namely, activity limitation, emotional, social, health concerns, symptoms, economic, mobility, convenience, and coping. The hereditary group had a total of 345 items and the acquired group had a total of 257 items. After 23 cognitive interviews items were amended for hereditary diseases resulting in a final set of 345 items and 3 items were amended for acquired diseases, resulting in a final set of 254 items. Overall across nine domains 189 items were common to hereditary and acquired retinal and vitreoretinal diseases.Conclusion: As most of the items were unique to hereditary versus acquired retinal and vitreoretinal disease groups separate item banks are required to capture the QoL impacts for hereditary and acquired retinal and vitreoretinal diseases.
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Affiliation(s)
- Mallika Prem Senthil
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jyoti Khadka
- Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,University of South Australia Business School, Adelaide, Australia.,University of New South Wales, Sydney, Australia
| | - Konrad Pesudovs
- University of New South Wales, Sydney, Australia.,Anglia Ruskin University, Cambridge, UK
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Wong YL, Hysi P, Cheung G, Tedja M, Hoang QV, Tompson SWJ, Whisenhunt KN, Verhoeven VJM, Zhao W, Hess M, Wong CW, Kifley A, Hosoda Y, Haarman AEG, Hopf S, Laspas P, Sensaki S, Sim X, Miyake M, Tsujikawa A, Lamoureux E, Ohno-Matsui K, Nickels S, Mitchell P, Wong TY, Wang JJ, Hammond CJ, Barathi VA, Cheng CY, Yamashiro K, Young TL, Klaver CCW, Saw SM. Correction: Genetic variants linked to myopic macular degeneration in persons with high myopia: CREAM Consortium. PLoS One 2019; 14:e0223942. [PMID: 31600355 PMCID: PMC6786527 DOI: 10.1371/journal.pone.0223942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Wong YL, Hysi P, Cheung G, Tedja M, Hoang QV, Tompson SWJ, Whisenhunt KN, Verhoeven V, Zhao W, Hess M, Wong CW, Kifley A, Hosoda Y, Haarman AEG, Hopf S, Laspas P, Sensaki S, Sim X, Miyake M, Tsujikawa A, Lamoureux E, Ohno-Matsui K, Nickels S, Mitchell P, Wong TY, Wang JJ, Hammond CJ, Barathi VA, Cheng CY, Yamashiro K, Young TL, Klaver CCW, Saw SM. Genetic variants linked to myopic macular degeneration in persons with high myopia: CREAM Consortium. PLoS One 2019; 14:e0220143. [PMID: 31415580 PMCID: PMC6695159 DOI: 10.1371/journal.pone.0220143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate the roles of known myopia-associated genetic variants for development of myopic macular degeneration (MMD) in individuals with high myopia (HM), using case-control studies from the Consortium of Refractive Error and Myopia (CREAM). Methods A candidate gene approach tested 50 myopia-associated loci for association with HM and MMD, using meta-analyses of case-control studies comprising subjects of European and Asian ancestry aged 30 to 80 years from 10 studies. Fifty loci with the strongest associations with myopia were chosen from a previous published GWAS study. Highly myopic (spherical equivalent [SE] ≤ -5.0 diopters [D]) cases with MMD (N = 348), and two sets of controls were enrolled: (1) the first set included 16,275 emmetropes (SE ≤ -0.5 D); and (2) second set included 898 highly myopic subjects (SE ≤ -5.0 D) without MMD. MMD was classified based on the International photographic classification for pathologic myopia (META-PM). Results In the first analysis, comprising highly myopic cases with MMD (N = 348) versus emmetropic controls without MMD (N = 16,275), two SNPs were significantly associated with high myopia in adults with HM and MMD: (1) rs10824518 (P = 6.20E-07) in KCNMA1, which is highly expressed in human retinal and scleral tissues; and (2) rs524952 (P = 2.32E-16) near GJD2. In the second analysis, comprising highly myopic cases with MMD (N = 348) versus highly myopic controls without MMD (N = 898), none of the SNPs studied reached Bonferroni-corrected significance. Conclusions Of the 50 myopia-associated loci, we did not find any variant specifically associated with MMD, but the KCNMA1 and GJD2 loci were significantly associated with HM in highly myopic subjects with MMD, compared to emmetropes.
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Affiliation(s)
- Yee-Ling Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- R&D Vision Sciences AMERA, Essilor International, Singapore, Singapore
| | - Pirro Hysi
- Section of Academic Ophthalmology, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Milly Tedja
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Quan V. Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, United States of America
| | - Stuart W. J. Tompson
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison WI, United States of America
| | - Kristina N. Whisenhunt
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison WI, United States of America
| | - Virginie Verhoeven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wanting Zhao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Moritz Hess
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg—University Mainz, Mainz, Germany
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center—University of Freiburg, Freiburg, Germany
| | - Chee-Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Annette Kifley
- Department of Ophthalmology, Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Yoshikatsu Hosoda
- Department of Ophthalmology and Visual Sciences, University Graduate School of Medicine, Kyoto, Japan
| | - Annechien E. G. Haarman
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Susanne Hopf
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg—University Mainz, Mainz, Germany
| | - Panagiotis Laspas
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg—University Mainz, Mainz, Germany
| | - Sonoko Sensaki
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, University Graduate School of Medicine, Kyoto, Japan
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Stefan Nickels
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg—University Mainz, Mainz, Germany
| | - Paul Mitchell
- Department of Ophthalmology, Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | | | - Christopher J. Hammond
- Section of Academic Ophthalmology, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Veluchamy A. Barathi
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, University Graduate School of Medicine, Kyoto, Japan
- Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan
| | - Terri L. Young
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison WI, United States of America
| | - Caroline C. W. Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- * E-mail:
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Sultan M, Cruickshank B, Huynh T, Lamoureux E, Vidovic D, Dahn M, Giacomantonio C, Langille M, Marcato P. An in vivo genome-wide RNAi screen identifies novel mediators of paclitaxel response in breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Smith JD, Colville D, Lyttle N, Lamoureux E, Savige J. Increased microvascular disease in X-linked and autosomal recessive Alport syndrome: a case control cross sectional observational study. Ophthalmic Genet 2019; 40:129-134. [PMID: 30985254 DOI: 10.1080/13816810.2019.1589528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Retinal microvascular disease reflects, in part, poor blood pressure control and systemic microvascular disease contributes to renal failure progression. This study examined the retinal microvasculature in Alport syndrome. MATERIALS AND METHODS Retinal images from 28 males and 28 females with X-linked Alport syndrome, and 13 individuals with autosomal recessive disease were reviewed retrospectively for microvascular/ hypertensive retinopathy (Wong and Mitchell classification), and small vessel calibre (using a computerised semiautomated method and revised Knudtson formula). Data were compared with age and gender-matched individuals with normal blood pressure and renal function. RESULTS Microvascular/hypertensive retinopathy was more common in males and females with X-linked Alport syndrome than age- and gender-matched controls (23, 82% and 10, 36%, p < 0.01; and 21, 75% and 13, 48%, p = 0.05, respectively), and in individuals with autosomal recessive disease compared with controls (12, 92% and 16, 43%, p < 0.01). Moderate microvascular/hypertensive changes were present in males and females with X-linked or autosomal recessive disease but not controls. Arteriolar calibre was reduced in males with X-linked disease (142.5 ± 18.7 µm, and 150.7 ± 10.1 µm, p = 0.046) and in autosomal recessive disease (133.5 ± 11.10 µm and 149.1 ± 10.6 µm, p < 0.0001). Microvascular/hypertensive retinopathy and arteriolar narrowing in males with X-linked disease were not different after renal transplantation and before (p NS). CONCLUSIONS Microvascular/hypertensive retinopathy was more common and more severe in Alport syndrome than normotensive controls. Improved BP levels may further slow the rate of renal functional decline in Alport syndrome.
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Affiliation(s)
- James D Smith
- a Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Parkville , Australia
| | - Deb Colville
- a Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Parkville , Australia
| | - Nicolette Lyttle
- a Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Parkville , Australia
| | - Ecosse Lamoureux
- b Singapore Eye Research Institute, Yong Loo Lin School of Medicine , National University of Singapore , Singapore.,c Department of Ophthalmology, Centre for Eye Research Australia , The University of Melbourne , Melbourne , Australia.,d Duke-NUS Graduate Medical School, National University of Singapore , Singapore
| | - Judy Savige
- a Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Parkville , Australia
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Ting DSW, Cheung CY, Nguyen Q, Sabanayagam C, Lim G, Lim ZW, Tan GSW, Soh YQ, Schmetterer L, Wang YX, Jonas JB, Varma R, Lee ML, Hsu W, Lamoureux E, Cheng CY, Wong TY. Deep learning in estimating prevalence and systemic risk factors for diabetic retinopathy: a multi-ethnic study. NPJ Digit Med 2019; 2:24. [PMID: 31304371 PMCID: PMC6550209 DOI: 10.1038/s41746-019-0097-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/01/2019] [Indexed: 02/07/2023] Open
Abstract
In any community, the key to understanding the burden of a specific condition is to conduct an epidemiological study. The deep learning system (DLS) recently showed promising diagnostic performance for diabetic retinopathy (DR). This study aims to use DLS as the grading tool, instead of human assessors, to determine the prevalence and the systemic cardiovascular risk factors for DR on fundus photographs, in patients with diabetes. This is a multi-ethnic (5 races), multi-site (8 datasets from Singapore, USA, Hong Kong, China and Australia), cross-sectional study involving 18,912 patients (n = 93,293 images). We compared these results and the time taken for DR assessment by DLS versus 17 human assessors - 10 retinal specialists/ophthalmologists and 7 professional graders). The estimation of DR prevalence between DLS and human assessors is comparable for any DR, referable DR and vision-threatening DR (VTDR) (Human assessors: 15.9, 6.5% and 4.1%; DLS: 16.1%, 6.4%, 3.7%). Both assessment methods identified similar risk factors (with comparable AUCs), including younger age, longer diabetes duration, increased HbA1c and systolic blood pressure, for any DR, referable DR and VTDR (p > 0.05). The total time taken for DLS to evaluate DR from 93,293 fundus photographs was ~1 month compared to 2 years for human assessors. In conclusion, the prevalence and systemic risk factors for DR in multi-ethnic population could be determined accurately using a DLS, in significantly less time than human assessors. This study highlights the potential use of AI for future epidemiology or clinical trials for DR grading in the global communities.
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Grants
- This project received funding from National Medical Research Council (NMRC), Ministry of Health (MOH), Singapore (National Health Innovation Center, Innovation to Develop Grant (NHIC-I2D-1409022); Health Service Research Grant; SingHealth Foundation Research Grant (SHF/FG648S/2015), and the Tanoto Foundation. For Singapore Epidemiology of Eye Diseases (SEED) study, we received funding from NMRC, MOH (grants 0796/2003, IRG07nov013, IRG09nov014, STaR/0003/2008 & STaR/2013; CG/SERI/2010) and Biomedical Research Council (grants 08/1/35/19/550, 09/1/35/19/616). The Singapore Diabetic Retinopathy Program (SiDRP) received funding from the MOH, Singapore (grants AIC/RPDD/SIDRP/SERI/FY2013/0018 & AIC/HPD/FY2016/0912)
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Affiliation(s)
- Daniel S. W. Ting
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Quang Nguyen
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Gilbert Lim
- National University of Singapore, School of Computing, Singapore, Singapore
| | - Zhan Wei Lim
- National University of Singapore, School of Computing, Singapore, Singapore
| | - Gavin S. W. Tan
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Yu Qiang Soh
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ya Xing Wang
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jost B. Jonas
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Mannheim, Germany
| | - Rohit Varma
- University of Southern California Gayle and Edward Roski Eye Institute, Los Angeles, CA USA
| | - Mong Li Lee
- National University of Singapore, School of Computing, Singapore, Singapore
| | - Wynne Hsu
- National University of Singapore, School of Computing, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
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Ali F, Tacey M, Lykopandis N, Colville D, Lamoureux E, Wong TY, Vangaal W, Hutchinson A, Savige J. Microvascular narrowing and BP monitoring: A single centre observational study. PLoS One 2019; 14:e0210625. [PMID: 30870422 PMCID: PMC6417722 DOI: 10.1371/journal.pone.0210625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 12/28/2018] [Indexed: 01/13/2023] Open
Abstract
Introduction Half of all hypertensive individuals have inadequately-controlled BP because monitoring methods are ineffective. This single centre study examined consecutive subjects undergoing 24 hour BP measurements for clinic and ambulatory BP levels, and for end-organ damage (retinal microvascular abnormalities and left ventricular hypertrophy, LVH, > 1.1 cm). Retinal images were graded for microvascular retinopathy (Wong and Mitchell classification), and vessel calibre using a semiautomated method. Features were compared using chi-squared, Fisher’s exact or the student’s t test. Methods One hundred and thirty-one individuals (59 male, 45.0%, mean age 61.7 ± 14.5 years) were studied. Ninety-nine (76.2%) had a clinic BP ≥ 140/90 mm Hg, 84 (64.6%) had a mean awake systolic BP ≥ 135 mm Hg, 100 (76.9%) had a mean sleeping systolic BP ≥ 120 mm Hg, and 100 (76.2%) had abnormal nocturnal BP dipping patterns. Sixty-nine individuals had undergone echocardiography and 23 (33.3%) had LVH. Results All participants had a mild (88.5%) or moderate (11.5%) microvascular retinopathy. Moderate microvascular retinopathy was found in 86.7% of those with a mean awake systolic BP ≥135 mm Hg (p = 0.058) but was not associated with other abnormal BP measurements, abnormal dipping patterns or LVH. However retinal arteriole calibre was reduced in subjects with a mean 24 hour awake systolic BP ≥ 135 mm Hg (p = 0.05). Retinal arteriole calibre was smaller in subjects with LVH (128.1 ± 13.5 μm compared with 137.6 ± 14.1 μm in normals, p = 0.014). Venular calibre was also less in subjects with LVH (185.4 ± 24.6 μm compared with 203.0 ± 27.2 μm in normals, p = 0.016). Arteriole narrowing predicted an increased risk of LVH (AUC 0.69, 95%CI 0.55 to 0.83) that was comparable with 24 hour systolic BP ≥130 mm Hg (AUC 0.68, 95%CI 0.53 to 0.82) and mean awake systolic BP ≥135 mm Hg (AUC 0.68, 95%CI 0.54 to 0.83). Conclusions This study suggests that retinal arteriole narrowing may be equally accurate in predicting LVH as any clinic or ambulatory BP measurement. The convenience and accuracy of microvascular calibre measurement mean that it should be investigated further for a role in routine hypertension assessment and monitoring.
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Affiliation(s)
- Fariya Ali
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Mark Tacey
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Nick Lykopandis
- Department of Cardiology, Northern Health, Epping, Victoria, Australia
| | - Deb Colville
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Ecosse Lamoureux
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Tien Y. Wong
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - William Vangaal
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
- Department of Cardiology, Northern Health, Epping, Victoria, Australia
| | - Anastasia Hutchinson
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Judy Savige
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
- * E-mail:
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Prem Senthil M, Khadka J, Gilhotra JS, Simon S, Fenwick EK, Lamoureux E, Pesudovs K. Understanding quality of life impact in people with retinal vein occlusion: a qualitative inquiry. Clin Exp Optom 2019; 102:406-411. [PMID: 30695815 DOI: 10.1111/cxo.12875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 11/22/2018] [Accepted: 12/03/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although being the second most common sight-threatening retinal vascular disease after diabetic retinopathy, the patient-centred impact of retinal vein occlusion has not been well studied. This study aims to understand the quality of life issues in people with retinal vein occlusion using a qualitative methodology. METHODS In-depth semi-structured interviews were conducted with 17 patients with retinal vein occlusion. All the interviews were digitally recorded and transcribed verbatim. An inductive analytic approach based on the constant comparative method was used for coding, aggregation, and theme development. The qualitative analysis was done using the software NVivo. RESULTS Participants had a median age of 73 years (range 34-85 years; females, 71 per cent). Six quality of life themes were identified: concerns about the disease progression and treatment outcome (health concerns), emotional responses to the disease (emotional), experiencing a range of symptoms (symptoms), inability to do things as before (activity limitation), adapting to the visual loss (coping), and inconveniences due to the eye condition (convenience). Participants often felt that lasers and injections did not improve their vision. They feared that their eye condition may come back, or the other eye may be affected. They experienced a range of visual symptoms that affected their day-to-day performance, particularly reading small print, and driving at night. Having multiple treatments and frequent eye appointments were major sources of inconvenience. Patients adopted several coping strategies to manage the stress associated with visual loss. CONCLUSIONS This study shows that several aspects of quality of life are compromised in people with retinal vein occlusion. The findings of this study will be used to identify the item content for a vitreoretinal disease-specific quality of life item bank.
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Affiliation(s)
- Mallika Prem Senthil
- Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia
| | - Jyoti Khadka
- Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia
| | - Jagjit S Gilhotra
- Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sumu Simon
- Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Eva K Fenwick
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.,Duke-NUS, National University of Singapore, Singapore
| | - Ecosse Lamoureux
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.,Duke-NUS, National University of Singapore, Singapore
| | - Konrad Pesudovs
- Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia
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Goldstein JE, Fenwick E, Finger RP, Gothwal V, Jackson ML, Lamoureux E, Rees G, Massof R. Calibrating the Impact of Vision Impairment (IVI): Creation of a Sample-Independent Visual Function Measure for Patient-Centered Outcomes Research. Transl Vis Sci Technol 2018; 7:38. [PMID: 30619658 PMCID: PMC6314226 DOI: 10.1167/tvst.7.6.38] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/14/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Provide item calibrations estimated for the Impact of Vision Impairment (IVI) questionnaire by pooling data from several studies of people with vision impairment (VI) representing a variety of countries and causes of VI. Methods Eight data sets from six principal investigators representing responses to IVI items from 2867 VI patients were pooled for analysis. Eligible patients were 18 years or older and from Australia, India, and the United States. Rasch analysis, using the Andrich Rating Scale Model (Winsteps version 3.65), was performed on preintervention IVI responses to estimate item and person measures, reliability coefficients, and response category thresholds. Differential item functioning (DIF) analysis and analysis of variance (ANOVA) were used to examine the effects different data sets and covariates on item estimates. Results Patient age range was 18 to 103 years (median 62 years); 55% were male. Visual acuity ranged from 20/20 to no light perception and primary diagnosis was macular degeneration in 29% of patients. Item measure estimates showed good separation reliability (R2 = 0.99). DIF magnitude did not preclude use of all IVI-28 data. ANOVA showed VA (P < 0.001) and gender (P < 0.002) were predictors of visual ability. Conclusions Analysis from pooled data support the provision of calibrated IVI item measures for researchers and clinicians to use, thus better enabling direct comparisons of patients with VI. Translational Relevance Validity testing of the IVI show that we can combine disparate data sets of patient responses to calibrate item measures and response category thresholds, and provide to others for use in comparing patients across clinical trials and on an individual basis.
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Affiliation(s)
| | - Eva Fenwick
- Population Health, Singapore Eye Research Institute, Singapore, Singapore
| | | | - Vijaya Gothwal
- Deshpande Centre for Sight Enhancement Brien Holden Eye Research Centre - Patient Reported Outcomes Unit, Hyderabad, India
| | - Mary Lou Jackson
- University of British Columbia Department of Ophthalmology and Visual Sciences, Vancouver, BC, Canada
| | - Ecosse Lamoureux
- Population Health, Singapore Eye Research Institute, Singapore, Singapore
| | - Gwyneth Rees
- University of Melbourne, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Robert Massof
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
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38
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Wong YL, Sabanayagam C, Ding Y, Wong CW, Yeo ACH, Cheung YB, Cheung G, Chia A, Ohno-Matsui K, Wong TY, Wang JJ, Cheng CY, Hoang QV, Lamoureux E, Saw SM. Prevalence, Risk Factors, and Impact of Myopic Macular Degeneration on Visual Impairment and Functioning Among Adults in Singapore. ACTA ACUST UNITED AC 2018; 59:4603-4613. [DOI: 10.1167/iovs.18-24032] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Yee-Ling Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- R&D Vision Sciences AMERA, Essilor International, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Office of Research, Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Yang Ding
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Optometry and Ophthalmology, Wenzhou Medical College, Wenzhou, China
| | - Chee-Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Office of Research, Duke-NUS Medical School, Singapore
| | | | | | - Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Office of Research, Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Audrey Chia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Office of Research, Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Jie Jin Wang
- Office of Research, Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Office of Research, Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Quan V. Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Office of Research, Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Office of Research, Duke-NUS Medical School, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Office of Research, Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
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39
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Najjar RP, Sharma S, Atalay E, Rukmini AV, Sun C, Lock JZ, Baskaran M, Perera SA, Husain R, Lamoureux E, Gooley JJ, Aung T, Milea D. Pupillary Responses to Full-Field Chromatic Stimuli Are Reduced in Patients with Early-Stage Primary Open-Angle Glaucoma. Ophthalmology 2018; 125:1362-1371. [DOI: 10.1016/j.ophtha.2018.02.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/09/2018] [Accepted: 02/15/2018] [Indexed: 10/17/2022] Open
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40
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Holloway E, Sturrock B, Lamoureux E, Hegel M, Casten R, Mellor D, Rees G. Delivering problem-solving treatment in low-vision rehabilitation: A pilot feasibility study. Rehabil Psychol 2018; 63:349-356. [DOI: 10.1037/rep0000217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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41
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Li LJ, Tan KH, Aris IM, Man REK, Gan ATL, Chong YS, Saw SM, Gluckman P, Wong TY, Lamoureux E. Retinal vasculature and 5-year metabolic syndrome among women with gestational diabetes mellitus. Metabolism 2018; 83:216-224. [PMID: 29051041 DOI: 10.1016/j.metabol.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/03/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) are at greater risk of metabolic syndrome (MetS). We studied the association between second-trimester retinal microvasculature and 5-year MetS incidence in women with GDM. METHODS A total of 142 mothers with GDM were recruited and followed up 5years after delivery. Retinal photography was performed at 26-28weeks gestation and metabolic outcomes were assessed at the 5-year postpartum follow-up visit. GDM and MetS were defined based on World Health Organization (WHO) guidelines and Adults Treatment Panel (ATP) III guidelines, respectively. Modified-Poisson regression was applied to study the association between second-trimester retinal microvasculature and incident 5-year maternal MetS, after adjusting for major confounders. Area under the curve (AUC) was calculated based on the final model. RESULTS Our prospective cohort reported a 9.2% incidence rate of 5-year MetS among women with GDM. After adjusting for maternal age, ethnicity, college degree, pre-pregnancy BMI and fasting glucose at 26-28week gestation, each 10μm widening in retinal venular caliber was associated with an increased relative risk of 1.6 (95% confidence interval [CI]: 1.0, 2.8) in incident MetS. In addition to traditional risks of pre-pregnancy BMI and fasting glucose level at 26-28week gestation, retinal venular caliber mildly increased the prediction of 5-year maternal MetS by 1.8%. CONCLUSIONS Second-trimester retinal venular widening was associated with incident 5-year maternal MetS in women with GDM. Our study suggests that mother with GDM at risk of future MetS development may have already presented retinal microvascular abnormalities during pregnancy.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore.
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Yap Seng Chong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
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42
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Dai W, Tham YC, Chee ML, Tan NYQ, Wong KH, Majithia S, Sabanayagam C, Lamoureux E, Wong TY, Cheng CY. Falls and Recurrent Falls among Adults in A Multi-ethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study. Sci Rep 2018; 8:7575. [PMID: 29765104 PMCID: PMC5953929 DOI: 10.1038/s41598-018-25894-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/25/2018] [Indexed: 12/03/2022] Open
Abstract
We evaluated the rate and risk factors associated with falls and recurrent falls in a multi-ethnic Asian population. 10,009 participants aged ≥40 years (mean[SD] age = 58.9[10.4] years) underwent clinical examinations and completed interviewer-administered questionnaires. Participants who self-reported at least one fall or ≥2 falls in past 12 months were defined as fallers and recurrent fallers, respectively. Age-standardized rates for falls and recurrent falls were 13.8% (95%CI, 13.1–14.6%) and 4.6% (95%CI, 4.2–5.1%), respectively. Multivariable analyses showed older age (OR = 1.20; 95%CI, 1.11–1.30), female gender (OR = 1.79; 95%CI, 1.54–2.07), diabetes (OR = 1.22; 95%CI, 1.07–1.40), cardiovascular disease (CVD, OR = 1.37; 95%CI, 1.14–1.65), ≥3 systemic comorbidities (OR = 1.35; 95%CI, 1.09–1.67), lower European Quality of Life-5 Dimensions (EQ-5D) score (OR = 1.36; 95%CI, 1.29–1.44), alcohol consumption (OR = 1.41, 95%CI, 1.11–1.78) and presenting visual impairment (VI, OR = 1.23; 95%CI, 1.02–1.47) were associated with falls. For recurrent falls, female gender (OR = 2.27; 95%CI, 1.75–2.94), diabetes (OR = 1.28; 95%CI, 1.03–1.61), CVD (OR = 2.00; 95%CI, 1.53–2.62), ≥3 systemic comorbidities (OR = 1.69; 95%CI, 1.19–2.39), lower EQ-5D score (OR = 1.47; 95%CI, 1.35–1.59), living in 1–2 room public flat (OR = 1.57; 95%CI, 1.05–2.33), monthly income <2000 Singapore Dollar (OR = 1.62; 95%CI, 1.13–2.31), alcohol consumption (OR = 1.81, 95%CI, 1.23–2.66) and presenting VI (OR = 1.34; 95%CI, 1.01–1.79) were significant risk factors. These findings will be useful for the formulation of fall prevention programs.
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Affiliation(s)
- Wei Dai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Miao-Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Nicholas Y Q Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Kah-Hie Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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43
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Cheng L, Barlis P, Gibson J, Colville D, Hutchinson A, Gleeson G, Lamoureux E, VanGaal W, Savige J. Microvascular retinopathy and angiographically-demonstrated coronary artery disease: A cross-sectional, observational study. PLoS One 2018; 13:e0192350. [PMID: 29738542 PMCID: PMC5940193 DOI: 10.1371/journal.pone.0192350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/22/2018] [Indexed: 11/24/2022] Open
Abstract
Epidemiological studies suggest retinal microvascular abnormalities predict cardiac events. This study examined microvascular features associated with coronary artery abnormalities. This was a single-centre, cross-sectional, observational study of 144 consecutive subjects undergoing coronary angiography for clinical indications. Their angiograms were deidentified and graded for disease (Leaman score, LAD stenosis ≥ 70%, number of vessels stenosed ≥ 70%), and Thrombolysis in Myocardial Infarction (TIMI) blush score. Subjects also underwent retinal photography (KOWA non-mydriatic camera, Japan), and their deidentified retinal images were graded for hypertensive microvascular retinopathy (Wong and Mitchell classification), vessel calibre using a computer-assisted method (IVAN, U Wisconsin), and diabetic retinopathy (modified Airlie House scheme) independently by a trained grader and an ophthalmologist. Retinal abnormalities were compared between subjects with high and low angiography scores using one way ANOVA, Chi squared and logistic regression analysis (StataCorp, Texas). Subjects had a mean age of 61 years (range 32–88), and included 101 males (70%). Seventeen (12%) had Leaman scores > 10.5, 46 (32%) had LAD stenosis, 13 (9%) had ≥ 3 arteries stenosed, and 20 (14%) had TIMI blush scores < 1. Twenty-six subjects (18%) had a retinal hemorrhage, and 115 (74%) a mild or moderate hypertensive retinopathy. Fifty-five (38%) had diabetes, and 24 (17%) a background (n = 20) or proliferative (n = 4) diabetic retinopathy. A retinal hemorrhage (p = 0.046), moderate microvascular retinopathy (p = 0.08) and proliferative diabetic retinopathy (p = 0.04) were all associated with a higher Leaman score. Venular calibre was increased with triple vessel disease (205.7 ± 21.6 μm, and 193.7 ± 22.3 μm in normals, p = 0.03). Diabetic retinopathy correlated with an increased TIMI blush score (p = 0.01). Retinal microvascular imaging warrants further evaluation in identifying the presence, extent and nature of coronary artery disease.
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Affiliation(s)
- Lisa Cheng
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Peter Barlis
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Joel Gibson
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Deb Colville
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Anastasia Hutchinson
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Geoff Gleeson
- Department of Cardiology, Northern Health, Melbourne, Australia
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, National University of Singapore, Singapore, Singapore
| | - William VanGaal
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
- Department of Cardiology, Northern Health, Melbourne, Australia
| | - Judy Savige
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
- The University of Melbourne Department of Medicine, Melbourne Health, Melbourne, Australia
- * E-mail:
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Abdullah HR, Sim YE, Sim YTM, Lamoureux E. Preoperative ANemiA among the elderly undergoing major abdominal surgery (PANAMA) study: Protocol for a single-center observational cohort study of preoperative anemia management and the impact on healthcare outcomes. Medicine (Baltimore) 2018; 97:e10838. [PMID: 29794778 PMCID: PMC6392554 DOI: 10.1097/md.0000000000010838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Preoperative anemia and old age are independent risk factors for perioperative morbidity and mortality. However, despite the high prevalence of anemia in elderly surgical patients, there is limited understanding of the impact of anemia on postoperative complications and postdischarge quality of life in the elderly. This study aims to investigate how anemia impacts elderly patients undergoing major abdominal surgery in terms of perioperative morbidity, mortality and quality of life for 6 months postoperatively. METHODS AND ANALYSIS We will conduct a prospective observational study over 12 months of 382 consecutive patients above 65 years old, who are undergoing elective major abdominal surgery in Singapore General Hospital (SGH), a tertiary public hospital. Baseline clinical assessment including full blood count and iron studies will be done within 1 month before surgery. Our primary outcome is presence of morbidity at fifth postoperative day (POD) as defined by the postoperative morbidity survey (POMS). Secondary outcomes will include 30-day trend of POMS complications, morbidity defined by Clavien Dindo Classification system (CDC) and Comprehensive Complication Index (CCI), 6-month mortality, blood transfusion requirements, days alive out of hospital (DaOH), length of index hospital stay, 6-month readmission rates and Health Related Quality of Life (HRQoL). HRQoL will be assessed using EuroQol five-dimensional instrument (EQ-5D) scores at preoperative consult and at 1, 3, and 6 months. ETHICS AND DISSEMINATION The SingHealth Centralised Institutional Review Board (CIRB Ref: 2017/2640) approved this study and consent will be obtained from all participants. This study is funded by the National Medical Research Council, Singapore (HNIG16Dec003) and the findings will be published in peer-reviewed journals and presented at academic conferences. Deidentified data will be made available from Dryad Repository upon publication of the results.
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Affiliation(s)
- Hairil Rizal Abdullah
- Department of Anaesthesiology, Singapore General Hospital
- DukeNUS Medical School, Singapore, Singapore
| | | | | | - Ecosse Lamoureux
- Academic Medicine Research Institute (AMRI), DukeNUS Medical School, Singapore, Singapore
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Ansah JP, Koh V, de Korne DF, Bayer S, Pan C, Thiyagarajan J, Matchar DB, Lamoureux E, Quek D. Projection of Eye Disease Burden in Singapore. Ann Acad Med Singap 2018; 47:13-28. [PMID: 29493707 DOI: 10.47102/annals-acadmedsg.v47n1p13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Singapore's ageing population is likely to see an increase in chronic eye conditions in the future. This study aimed to estimate the burden of eye diseases among resident Singaporeans stratified for age and ethnicity by 2040. MATERIALS AND METHODS Prevalence data on myopia, epiretinal membrane (ERM), retinal vein occlusion (RVO), age macular degeneration (AMD), diabetic retinopathy (DR), cataract, glaucoma and refractive error (RE) by age cohorts and educational attainment from the Singapore Epidemiology of Eye Diseases (SEED) study were applied to population estimates from the Singapore population model. RESULTS All eye conditions are projected to increase by 2040. Myopia and RE will remain the most prevalent condition, at 2.393 million (2.32 to 2.41 million) cases, representing a 58% increase from 2015. It is followed by cataract and ERM, with 1.33 million (1.31 to 1.35 million), representing an 81% increase, and 0.54 million (0.53 to 0.549 million) cases representing a 97% increase, respectively. Eye conditions that will see the greatest increase from 2015 to 2040 in the Chinese are: DR (112%), glaucoma (100%) and ERM (91.4%). For Malays, DR (154%), ERM (136%), and cataract (122%) cases are expected to increase the most while for Indians, ERM (112%), AMD (101%), and cataract (87%) are estimated to increase the most in the same period. CONCLUSION Results indicate that the burden for all eye diseases is expected to increase significantly into the future, but at different rates. These projections can facilitate the planning efforts of both policymakers and healthcare providers in the development and provision of infrastructure and resources to adequately meet the eye care needs of the population. By stratifying for age and ethnicity, high risk groups may be identified and targeted interventions may be implemented.
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Affiliation(s)
- John P Ansah
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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46
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Palagyi A, Morlet N, McCluskey P, White A, Meuleners L, Ng JQ, Lamoureux E, Pesudovs K, Stapleton F, Ivers RQ, Rogers K, Keay L. Visual and refractive associations with falls after first-eye cataract surgery. J Cataract Refract Surg 2017; 43:1313-1321. [DOI: 10.1016/j.jcrs.2017.07.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 10/18/2022]
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Ang M, Man R, Fenwick E, Lamoureux E, Wilkins M. Impact of type I Boston keratoprosthesis implantation on vision-related quality of life. Br J Ophthalmol 2017; 102:878-881. [DOI: 10.1136/bjophthalmol-2017-310745] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/02/2017] [Accepted: 09/08/2017] [Indexed: 11/04/2022]
Abstract
AimTo determine the impact of type I Boston keratoprosthesis (KPro) implantation on vision-related quality of life (VRQoL).MethodsProspective study in 33 patients (mean age 56±12 years, 67% male) with bilateral corneal blindness, who underwent a KPro implantation at a single tertiary eye hospital (June 2011–July 2015). VRQoL was evaluated using the Impact of Vision Impairment Questionnaire (IVI) at baseline and at 3–6 months postsurgery, after stabilisation of best-corrected visual acuity (BCVA). Rasch analysis was used to transform the IVI responses into interval-level measures comprising the ‘reading’, ‘mobility’ and ‘emotional’ subscales with effect sizes calculated for pre-post VRQoL scores.ResultsMean preoperative BCVA was counting-fingers at 2 feet in the operated eye (20/240 fellow eye). Preoperative VRQoL scores: −2.27, –2.91 and −3.06 logits for the reading, mobility and emotional subscales, respectively. Device retention rate was 90% over the follow-up period (mean 26±12 months). We observed large gains for reading and mobility of 1.92 logits (effect size 0.88), and 2.64 logits (effect size 0.89) respectively, with a moderate gain in the emotional subscale of 2.11 logits (effect size 0.59). These improvements did not vary significantly with BCVA on multivariate analysis (all p>0.05).ConclusionWe observed a differential short-term improvement to VRQoL after KPro implantation with a significant impact on emotional well-being, which may not be fully explained by visual improvement alone. Further studies are required to confirm if these improvements in VRQoL are sustained in the long-term and are generalisable to other populations.
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Affiliation(s)
- M. Wong
- Singapore Eye Research Institute; Human Services Research; Singapore Singapore
| | - R. Man
- Singapore Eye Research Institute; Human Services Research; Singapore Singapore
| | - P. Gupta
- Singapore Eye Research Institute; Human Services Research; Singapore Singapore
| | - E. Fenwick
- Singapore Eye Research Institute; Human Services Research; Singapore Singapore
| | - L.J. Li
- Singapore Eye Research Institute; Human Services Research; Singapore Singapore
| | - E. Lamoureux
- Singapore Eye Research Institute; Human Services Research; Singapore Singapore
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Petrillo J, Bressler NM, Lamoureux E, Ferreira A, Cano S. Development of a new Rasch-based scoring algorithm for the National Eye Institute Visual Functioning Questionnaire to improve its interpretability. Health Qual Life Outcomes 2017; 15:157. [PMID: 28807029 PMCID: PMC5556345 DOI: 10.1186/s12955-017-0726-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 07/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The NEI VFQ-25 has undergone psychometric evaluation in patients with varying ocular conditions and the general population. However, important limitations which may affect the interpretation of clinical trial results have been previously identified, such as concerns with reliability and validity. The purpose of this study was to evaluate the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and make recommendations for a revised scoring structure, with a view to improving its psychometric performance and interpretability. METHODS Rasch Measurement Theory analyses were conducted in two stages using pooled baseline NEI VFQ-25 data for 2487 participants with retinal diseases enrolled in six clinical trials. In stage 1, we examined: scale-to-sample targeting; thresholds for item response options; item fit statistics; stability; local dependence; and reliability. In stage 2, a post-hoc revision of the scoring structure (VFQ-28R) was created and psychometrically re-evaluated. RESULTS In stage 1, we found that the NEI VFQ-25 was mis-targeted to the sample, and had disordered response thresholds (15/25 items) and mis-fitting items (8/25 items). However, items appeared to be stable (differential item functioning for three items), have minimal item dependency (one pair of items) and good reliability (person-separation index, 0.93). In stage 2, the modified Rasch-scored NEI VFQ-28-R was assessed. It comprised two broad domains: Activity Limitation (19 items) and Socio-Emotional Functioning (nine items). The NEI VFQ-28-R demonstrated improved performance with fewer disordered response thresholds (no items), less item misfit (three items) and improved population targeting (reduced ceiling effect) compared with the NEI VFQ-25. CONCLUSIONS Compared with the original version, the proposed NEI VFQ-28-R, with Rasch-based scoring and a two-domain structure, appears to offer improved psychometric performance and interpretability of the vision-related quality of life scale for the population analysed.
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Affiliation(s)
| | - Neil M Bressler
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ecosse Lamoureux
- Centre for Eye Research Australia, the Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC, Australia
- Singapore Eye Research Institute, Singapore, Singapore
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Sabanayagam C, Lye WK, Januszewski A, Banu Binte Mohammed Abdul R, Cheung GCM, Kumari N, Wong TY, Cheng CY, Lamoureux E. Urinary Isoprostane Levels and Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2017; 58:2538-2543. [PMID: 28492872 DOI: 10.1167/iovs.16-21263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Oxidative stress, characterized by an excessive production of reactive oxygen intermediates has been suggested to play a role in the pathogenesis of age-related macular degeneration (AMD). We examined the association of urinary F2-isoprostanes (F2-IsoPs), a marker of lipid peroxidation and the most reliable marker of oxidative damage with AMD. Methods We included 238 adults with AMD and 390 age- and sex-matched controls without AMD who participated in a population-based cross-sectional study in Singapore (Singapore Chinese Eye Study, 2009-2011). AMD was graded from retinal photographs using the Wisconsin Age-Related Maculopathy Grading System. Urinary-free F2-IsoPs (pmol/mmol of creatinine) were measured by gas chromatography mass spectrometry (GC-MS). The association between F2-IsoPs and AMD was examined using unconditional logistic regression models adjusted for potential confounders including smoking, body mass index (BMI), blood pressure, total and high-density lipoprotein cholesterol, and history of cardiovascular disease. Results Higher levels of F2-IsoPs were associated with AMD independent of potential confounders. Compared to quartile 1 (Q1) of F2-IsoPs, the multivariable odds ratio (95% confidence interval) of AMD in quartiles 2, 3, and 4 were 2.05 (1.26-3.32), 1.80 (1.10-2.94), and 1.76 (1.06-2.94), respectively. In subgroup analyses comparing Q4 to Q1, this association was stronger in women, those with BMI less than 25 kg/m2 and those with hypertension, but no significant interaction was found (P interaction > 0.1 for each strata). Conclusions Higher levels of urinary F2-IsoPs levels were associated with AMD independent of potential confounders in Chinese adults.
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Affiliation(s)
- Charumathi Sabanayagam
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore 2Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 3Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Weng Kit Lye
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Andrzej Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia
| | | | - Gemmy Chui Ming Cheung
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore 2Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Tien Y Wong
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore 2Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore 2Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 3Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore 2Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
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