Search

Objectives: This study aimed to assess the association between the corneal biomechanical parameters and visual field (VF) loss in patients with asymmetric primary open-angle glaucoma (POAG). Methods: A total of 89 POAG patients (50 males, 56.2%) with asymmetric VF loss, aged 65.2 ± 13.3 years, were enrolled in this study. Asymmetric VF loss was defined as an interocular difference of the global index mean deviation (MD) >2 dB. Intraocular pressure (IOP), central corneal thickness (CCT), and corneal biomechanical parameters such as maximum amplitude at the apex of highest concavity (def ampl HC) were measured. The worse eye was defined as the eye with a smaller MD. Results: The worse eyes had lower MD (−11.9 ± 6.7 dB vs. −5.3 ± 5.0 dB; p < 0.001) and higher IOP (14.6 ± 3.3 vs.13.9 ± 2.6 mm Hg, p = 0.04) than the better eyes. There was no significant difference between the 2 groups for CCT. The interocular difference of MD (IDMD) was negatively correlated with the interocular difference of IOP (r = −0.22, p = 0.04), while positively correlated with the interocular difference of def ampl HC (r = 0.27, p = 0.01). In patients with moderate asymmetric VF loss (IDMD ≥6 dB), def ampl HC of the worse eyes group (1.07 ± 0.12 mm) was significantly lower than the better eyes group (1.10 ± 0.11 mm, p = 0.02). Conclusion: Asymmetric POAG was associated with asymmetry in IOP and corneal biomechanical parameters but not in CCT. Lower deflection amplitude and higher IOP were found in eyes with more severe VF damage in POAG patients.

Direct comparison data on spatial patterns of visual field (VF) defects among primary angle-closure glaucoma (PACG), high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) are not available. We aimed to compare the intraocular asymmetry of VF loss among patients with PACG, NTG and HTG across different severity levels. A total of 162 eyes of 114 patients with PACG, 111 eyes of 74 patients with HTG and 148 eyes of 102 patients with NTG were included. VF defects were categorized into 3 stages (early, moderate, and advanced), and each hemifield was divided into 5 regions according to the Glaucoma hemifield test (GHT). The mean total deviation (TD) of each GHT region was calculated. In the early stage, the paracentral, peripheral arcuate 1 and peripheral arcuate 2 regions in the superior hemifield in the NTG group had significantly worse mean TDs than their corresponding regions in the inferior hemifield. In the advanced stage, the central region in the superior hemifield in the PACG group had a significantly worse mean TD than that in the inferior hemifield. There was no significant difference in the mean TD for any of the five regions between hemifields across all severity levels in the in the HTG group. The superior hemifield was affected more severely than the inferior hemifield in all three subtypes of primary glaucoma. This asymmetric tendency was more pronounced in NTG than in PACG and HTG.

Purpose: To describe the rationale, design, methodology and baseline characteristics of Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), a community-based prospective cohort study in patients ...

Purpose To report the efficacy and safety of bleb-independent penetrating canaloplasty in the management of primary angle-closure glaucoma (PACG). Methods This single-centre prospective interventional case series enrolled 57 eyes from 53 PACG patients with medically uncontrolled intraocular pressure (IOP) and peripheral anterior synechiae of over 270°. Penetrating canaloplasty, mainly consisted of tensioning suture-aided Schlemm's canal dilation and a trabeculectomy, was performed to create a direct communication between the anterior chamber and the Schlemm's canal. Postoperative IOP, number of glaucoma medications and procedure-related complications were evaluated. Rate of success was defined as IOP ≤ 21, ≤18 and ≤15 mmHg, and a ≥30% IOP reduction without (complete) or with/without (qualified) IOP-lowering medications. Results A total of 45 eyes had 360° catheterization successfully completed. The mean preoperative IOP was 33.9 ± 11.7 mmHg (range, 13-59.6 mmHg), on 3.2 ± 0.8 glaucoma medications (range 2-5), which was decreased to 15.4 ± 3.7 mmHg (range, 8.6-22.5) and 0.2 ± 0.6 (range, 0-3) medications at 6 months and 14.8 ± 3.5 mmHg (range, 9-24) and 0.1 ± 0.3 (range, 0-1) medications at 12 months postoperatively. Complete success at 12 months were achieved in 78.9% (95% CI: 0.65-0.93), 71.1% (0.56-0.86) and 50.0% (0.33-0.67) eyes at IOP ≤ 21, ≤18 and ≤15 mmHg, respectively. Transient IOP elevation (>30 mmHg, 26.7%) and hyphema (11.1%) were the most common early surgical complications. Conclusion Penetrating canaloplasty in PACG appeared to have good efficacy and safety profiles in this pilot study. Further studies are justified.

Purpose To investigate the association between metabolic syndrome (MetS) and diabetic retinopathy (DR), as well as the association between MetS and retinal vessel caliber, among Chinese patients with type 2 diabetes mellitus in north-eastern China. Study design Cross-sectional study. Patients and methods The patients were recruited from a community-based study, the Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT). The presence of DR was determined using a modified version of the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. The central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE) were identified by use of Integrative Vessel Analysis software. The presence of MetS was defined according to the Joint Interim Statement proposed in 2009. Results The prevalence of DR was significantly higher among female patients with MetS than among those without it (47.2% vs 30.9%, P = 0.002), and it increased as the number of MetS components increased (P = 0.003). Furthermore, the presence of MetS (odds ratio 2.43, 95% CI 1.39-4.26) as well as higher numbers of MetS components were significantly associated with DR in female patients, after adjustment for potential risk factors. Patients with MetS (multivariate β coefficient, 95% CI - 6.9, - 10.0, to - 3.8) or a higher number of Mets components tended to have significantly smaller CRAE. Conclusion In this study cohort, female patients with MetS had a higher prevalence of DR. Patients tended to have thinner central retinal arterioles as the number of MetS components increased.

Purpose: To investigate the association between high myopia and diabetic retinopathy, and its possible mechanism, in a northeastern Chinese population with type 2 diabetic mellitus. Methods: Patients were included from Fushun Diabetic Retinopathy Cohort Study. High myopia was defined as spherical equivalent of autorefraction less than −5D. Results: A total of 1817 patients [688 (37.9%) diabetic retinopathy, 102 (5.6%) high myopia] were included. Compared to eyes without high myopia, the frequency of diabetic retinopathy and non-proliferative diabetic retinopathy was significantly less in eyes with high myopia (23.5% vs 38.7%, p = 0.002; 22.5% vs 35.3%, p = 0.005). Eyes with high myopia were less likely to have diabetic retinopathy (multivariate odds ratio, 95% confidence interval: 0.39, 0.22–0.68) or non-proliferative diabetic retinopathy (odds ratio, 95% confidence interval: 0.40, 0.23–0.70). High myopia was negatively associated with central retinal venular equivalent (multivariate β, 95% confidence interval: −37.1, −42.3 to −31.8, p Conclusions: High myopia was negatively associated with both diabetic retinopathy and non-proliferative diabetic retinopathy in this northeastern Chinese population. This protective effect may have been partially achieved via thinning retinal veins.

To investigate the relationship between visual resolution and cone parameters in eyes with different levels of best corrected visual acuity (BCVA). Seventeen eyes of 10 volunteers with BCVA of 20/12.5 or better (group 1) and 16 eyes of 10 volunteers with BCVA of 20/16 (group 2) were investigated in the study. Images of the cone photoreceptors at 1.5° from the fovea were obtained using an adaptive optics (AO) retinal camera. The BCVA was obtained following a subjective refraction using a standardized logMAR visual acuity chart. The mean cone density (29,570.96 ± 2489.94 cells/mm2) at 1.5° from the fovea in group 1 (BCVA ≥ 20/12.5, n = 17) was significantly greater (P

To investigate associations between central visual function and inner retinal structure in primary open-angle glaucoma (POAG). This study enrolled 78 POAG patients and 58 healthy controls. POAG was classified into early glaucoma and moderate to advanced glaucoma. The following tests were performed on all participants: isolated-check visual evoked potential (icVEP) testing, 24-2 standard automated perimetry (SAP), and Cirrus optical coherence tomography (OCT) examinations. Signal-to-noise ratio (SNR) measures obtained from icVEP responses to isolated checks presented at four depths of modulation (DOMs; 8%, 14%, 22%, and 32%) were explored. Mean macular sensitivity (mMS) was assessed by calculating the mean sensitivities of central 12 SAP points. Ganglion cell layer+ inner plexiform layer thickness (GCL+IPLT) and peripapillary retinal nerve fiber layer thickness (pRNFLT) were measured by OCT scanning. For each group of subjects, linear relationships among the following measures were analyzed: SNR, mMS, GCL+IPLT, and pRNFLT. SNR, mMS, GCL+IPLT, and pRNFLT were all more significantly decreased in glaucoma than in controls (P

Myopia is the most common eye problem and affects an estimated 28.3% of the global population. Its incidence is increasing annually. Myopia treatment is limited to correcting visual acuity. Acupuncture is one of the main therapies in traditional Chinese medicine and includes plum-blossom needling, which has been widely used for both the prevention and treatment of adolescent myopia. We hypothesized that plum-blossom needling would be effective in treating myopia compared with a tropicamide eye drops control.This is a crossover randomized controlled trial involving adolescents with myopia. Participants will be randomized 1∶1 to plum-blossom needle or tropicamide eye drops arms. Subjects in each arm will be treated for 20 d, followed by a 1-month washout period and treatment change for another 20 d. The primary outcome is uncorrected distance and cycloplegic refractive errors. The secondary outcomes comprise corneal curvature, lens thickness, axial length, ciliary body thickness, accommodation amplitude, the NRA/PRA (negative/positive relative accommodation), flexible adjustment, and near point of convergence. The outcome measures will be assessed at baseline, after the first treatment course (the first month), at the end of the washout period (the second month), after the second treatment course (the third month), and at follow-up (the sixth month).The results of the trial will help to provide evidence for the efficacy of plum-blossom needling for myopia in China.

To evaluate the safety and efficacy of a silicone tube miniature drainage device implanted under scleral flap for the surgical treatment of primary open-angle glaucoma (POAG).This is a non-randomized prospective study. Patients with a minimum follow-up of 12 months were analyzed. Demographic information, preoperative and postoperative data including intraocular pressure (IOP), number of medications and complications were recorded.A total of 33 eyes of 33 patients were included in the analysis. Mean postoperative follow-up was 29.5 ± 6.9 months (range 18-50 months). The mean preoperative IOP was 25.8 ± 7.3 mmHg and decreased to 14.9 ± 4.3, 14.2 ± 3.4 and 14.9 ± 3.3 mmHg at 1 year, 2 years and last follow-up after surgery. The number of medications was decreased from 3.1 ± 1.3 preoperatively to 0.2 ± 0.7, 0.4 ± 0.9 and 0.4 ± 1.0 at 1 year, 2 years and last follow-up, respectively, after surgery. Only six (18.2%) patients used glaucoma medications at last visit. The complete success rates were 87.9% and 78.6%, respectively, at 1 and 2 years postoperatively. The operation-related complications were rare.The silicone tube miniature drainage device implanted under the scleral flap was found to be a relatively safe and effective surgery for the treatment of POAG. Longer follow-up periods and larger sample sizes are expected.

The aim of this study was to determine the diagnostic accuracy, sensitivity and specificity of isolated-check visual evoked potentials (icVEP) in primary open-angle glaucoma (POAG). Ninety POAG patients and sixty-six healthy controls were recruited consecutively. All subjects underwent icVEP and visual field testing. Swept icVEP response functions were obtained by increasing contrast in six stimulus steps, recording the electroencephalogram synchronized to the stimulus display’s frame rate and calculating the corresponding signal-to-noise ratio (SNR) of the response at the fundamental frequency to evaluate visual function. Depth of modulation of the check luminance was increased as follows: 2, 4, 8, 14, 22 and 32%, about an equal level of standing contrast, so that the pattern appeared and disappeared at a frequency of 10.0 Hz. SNR above 0.85 was deemed to be significant at the 0.1 level and SNR above 1 significant at the 0.05 level. The results show that SNR is contrast dependent. It significantly rose as contrast increased. The areas under receiver-operating-characteristic curves (AUCs) indicating classification accuracy for all POAG cases in comparison with normal subjects were 0.790 (sensitivity 91.1%, specificity 69.7%) with the cutoff SNR of 0.85, and 0.706 (sensitivity 95.6%, specificity 51.5%) with the cutoff SNR of 1. The AUC of early glaucoma cases (EG) in comparison with normal subjects was 0.801 (sensitivity 93.3%, specificity 69.7%) with the cutoff SNR of 0.85, and 0.717 (sensitivity 97.8%, specificity 51.5%) with the cutoff SNR of 1. icVEP has good diagnostic accuracy (high sensitivity and moderate specificity) in distinguishing early POAG patients from healthy subjects. It might be a promising device to use in conjunction with complementary functional and structural measures for early POAG detection.

Importance Under-detection and late diagnosis are major causes of glaucoma-related visual impairment. Cost-effective opportunistic glaucoma screening is of great interest in the early identification and prevention of glaucoma. Background To describe the results of a health examination centre-based opportunistic glaucoma screening and referral model. Design This single centre cross-sectional study was conducted in a health examination centre affiliated to a tertiary hospital in Shenyang, northeastern China. Participants From 21 March to 30 September 2016, 14 367 individuals aged ≥ 30 years undergoing routine physical examinations were invited for this glaucoma screening. Methods Presenting visual acuity, non-contact pneumotonometry and non-mydriatic fundus photography were evaluated. Fundus photographs were classified as non-glaucoma, possible, probable and definitive glaucoma. Participants with probable and definite glaucomatous discs or intraocular pressure ≥ 24 mmHg were referred for definitive examinations. Main outcome measures Detection rate of glaucoma suspects and ocular hypertension (OHT). Cost to identify a single case with suspected and diagnosed glaucoma was also calculated. Results Altogether, 277 glaucoma suspects and 327 ocular hypertension suspects were identified. Among 190 participants with probable/definite glaucomatous discs, 93 (48.9%) accepted further examination. Among these, 78 were diagnosed as glaucoma, seven as suspects and eight were excluded. Only 98 ocular hypertension suspects (30.0%) accepted further examinations: eight had primary angle closure and 23 had confirmed ocular hypertension. The cost to identify a single glaucoma suspect and definite glaucoma case were US$135 and US$857, respectively. Conclusions and relevance This novel screening model provides opportunities to improve glaucoma detection at low cost. Interventions to improve follow-up are needed.

To investigate the influence of daily activities on myopic refractive change and myopic onset in Chinese urban students. The Beijing Myopia Progression Study was a 3-year cohort study. Cycloplegic refraction and a daily activity questionnaire were assessed at baseline and at follow-up examinations. Refractive change was defined as the difference in cycloplegic spherical equivalent (SE) between the final follow-up and baseline. 386 students were initially enrolled in the baseline study. At the final follow-up, 222 students (57.5 %) with completed refractive error and daily activity data were analyzed. These students spent 0.32 ± 2.33 h/day more on near work (p = 0.04), and 0.21 ± 1.31 h/day less on outdoor leisure (p = 0.02), than they did at baseline. In the multivariate analysis, the younger among the secondary students (β = 0.06, p

PURPOSE To compare the 24-hour ocular perfusion pressure (OPP) among patients with primary open angle glaucoma (POAG) and those with suspected POAG identified in a population-based study in China. METHODS Forty-seven patients with POAG and 35 with suspected POAG attended the 24-hour OPP study. Intraocular pressure (IOP) and blood pressure (BP) were measured at 2, 6, and 10 AM and 2, 6, and 10 PM. Subjects were not taking any medications to lower IOP, which was measured with Goldmann applanation in an upright sitting position. Blood pressure was measured in a supine position using a digital automatic BP monitor (OMRON, model HEM-907). Mean arterial pressure was calculated as diastolic BP + 1[Fraction Slash]3 × (systolic BP - diastolic BP). Mean OPP (MOPP) was defined as 2[Fraction Slash]3 × mean arterial pressure - IOP, systolic OPP (SOPP) was defined as 2[Fraction Slash]3 × systolic BP - IOP, and diastolic OPP (DOPP) was defined as 2[Fraction Slash]3 × diastolic BP - IOP. RESULTS After adjustment for age, sex, and IOP, the maximum, mean, and minimum SOPP, DOPP, and MOPP were statistically significantly lower in subjects with POAG than in those with suspected POAG (P < 0.05). The minimum MOPP, SOPP, and DOPP occurred from 10 AM to 2 PM in approximately 60% of eyes with POAG and between 20% and 30% of minimum MOPP, SOPP, and DOPP occurred around 10 PM. CONCLUSIONS Systolic OPP, DOPP, and MOPP were consistently lower in eyes with POAG than in those with suspected POAG, providing further evidence that OPP plays a role in the development of glaucoma.

To investigate regional alterations of macular microvasculature in primary open-angle glaucoma (POAG), and to determine the structure-function correlation between localized visual field defects and macular microvascular damage in matching sectors.Fifty-eight patients with POAG and 27 normal controls were recruited for this study. Optical coherence tomography angiography (OCTA) was used to measure retinal vascular microcirculation of the macula in superior, inferior, temporal, and nasal sectors. Visual field (VF) was tested using automated perimeter. Sensitivities of 16 central points of the VF were selected and divided into the 4 previously mentioned sectors. Structure-function correlation analysis was performed between localized visual field defects and the matching macular microvasculature damage. The relationship was also assessed using a previously described model.The temporal vascular density was thinner than those of the superior and inferior positions of parafovea in the control group (P 0.05). Vascular densities in all sectors were decreased in the POAG group compared with the normal control group (P 0.05). The structure-function correlation coefficients between sectors of VF sensitivity and the matched vascular densities ranged from 0.295 to 0.433 (P 0.01). The coefficient of determination between OCT derived vascular density measurements and the estimates using the previous model ranged from 0.08 to 0.19. The best fit was in the inferior sector.Compared with age-matched control subjects, vascular density of the parafoveal retina decreased in the POAG subjects. There is a moderate structure-function correlation between visual field sensitivity thresholds measured with automated perimeter and macular vascular density assessed by OCT.

ObjectiveTo investigate the validity and feasibility of a self-administered home vision examination programme in China.DesignCross-sectional study.SettingYueqing, China.ParticipantsA two-stage convenience sampling procedure was used to randomly select 600 households from 30 communities participating in the Yueqing Eye Study (YES). The aim of YES is to encourage home-based vision screening, reporting of visual acuity (VA) annually through social media and encouraging people to attend follow-up clinic appointments as a way to improve eye care access for adults with VA ≤+0.5 log of the minimum angle of resolution (logMAR).InterventionsHousehold screeners (one per household) who tested other family members’ VA completed a questionnaire on family structure, demographic information and knowledge about screening procedures. Other family members then underwent confirmatory VA testing by researchers.Outcome measuresThe completion rate of home-based VA screening, its sensitivity and specificity were used to evaluate validity. Factors that determined whether families participated in the self-VA screening were used to evaluate feasibility.Results345 (66%) of the 523 (87.2%) households with valid data form their home-based vision examinations also were retested by researchers. There was no statistically significant difference in scores on the family-administerd or researcher-administerd VA test (VA≤+0.5 logMAR, p=0.607; VA >+0.5 logMAR, p=0.612). The sensitivity and specificity of home-based vision screening were 80.5% (95% CI 70.2% to 86.9%) and 95.1% (95% CI 92.6% to 96.8%), respectively. 14.7% (77/523) of tested respondents had VA ≤+0.5 logMAR. Predictors of performing home screening for VA remaining in regression models included higher economic status (‘fair and above’ vs ‘poor’: OR 1.74; 95% CI 1.08 to 2.76; p=0.022), age (ConclusionSelf-administered home vision screening is reliable and highly accepted by Chinese adults.

PURPOSE: To assess differences in clinical and demographic characteristics between glaucoma patients identified by community screening and those newly diagnosed in hospital in a Chinese setting.DESIGN: Prospective comparative cohort study.METHODS: 373 patients identified with glaucoma among 27,000 persons undergoing community screening were enrolled as the Screening group. The Clinic group consisted of 119 consecutively-presenting, newly-diagnosed glaucoma patients in hospital.PRIMARY OUTCOME: mean deviation (MD), visual field index (VFI) and pattern standard deviation (PSD) on Humphrey Field Analyzer, and intraocular pressure (IOP). Disease severity was categorized into five stages based on MD.RESULTS: 89.6% (328/373) of Screening Group patients had IOP CONCLUSION: Glaucoma patients detected through community screening had significantly milder damage, and were more likely to include under-served groups (women, elderly) than those newly diagnosed in a clinic in this setting. Comparison with population studies suggests that cases of glaucoma with IOP < 21 mmHg are severely under-ascertained in China, which may be improved by screening.

BACKGROUND Recent studies showed that increased fresh fruit consumption is significantly associated with lower risks of diabetes, hypertension, and cardiovascular disease (CVD); other studies suggested that albuminuria is associated with diabetes, hypertension, and CVD. Therefore, we hypothesized that lower fresh fruit consumption is associated with higher risk of incident albuminuria among Chinese adults in rural areas, where fresh fruit consumption level is very low and prevalence of albuminuria is high. METHODS We tested the hypothesis in a village-based cohort study of 3574 participants aged ≥ 30 years from the Handan Eye Study conducted from 2006 to 2013. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥ 30 mg/g. RESULTS Overall, 35.4% of the participants never or rarely consumed fresh fruits, and 33.9, 21.6, and 9.1% consumed fresh fruits 1-3 times/month, 1-2 times/week, and ≥ 3 times/week, respectively. During a median follow-up period of 5.6 years, albuminuria developed in 17.6% (n = 629) of the participants. Compared with participants who consumed fresh fruits ≥ 3 times/week, the multivariable adjustment odds ratios (ORs) for incident albuminuria associated with fruit consumption 1-2 times/week, 1-3 times/month, and no or rare consumption were 1.58 (95% confidence intervals (CI), 1.05-2.40), 1.74 (95% CI, 1.17-2.58), and 1.78 (95% CI, 1.20-2.64), respectively. After excluding participants with diabetes, the association remained significant. CONCLUSIONS Lower fresh fruit consumption was significantly associated with higher risk of incident albuminuria, and fresh fruit consumption frequency could be an essential intervention target to prevent albuminuria in rural China.

Background The near work and outdoor activity are the most important environmental risk factors for myopia. However, data from Chinese rural children are relatively rare and remain controversial. Therefore, the purpose of this study was to evaluate the relationship of both near work and outdoor activities with refractive error in rural children in China. Methods In this cross-sectional study, 572 (65.1%) of 878 children (6–18 years of age) were included from the Handan Offspring Myopia Study (HOMS). Information from the parents on these children, as well as the parent’s non-cycloplegic refraction, were obtained from the database of the Handan Eye Study conducted in the years 2006–2007. A comprehensive vision examination, including cycloplegic refraction, and a related questionnaire, were assessed on all children. Results The overall time spent on near work and outdoor activity in the children was 4.8 ± 1.6 and 2.9 ± 1.4 h per day, respectively. Myopic children spent more time on near work (5.0 ± 1.7 h vs.4.7 ± 1.6 h, p = 0.049), while no significant difference was found in outdoor activity hours (2.8 ± 1.3 h vs. 3.0 ± 1.4 h, p = 0.38), as compared to non-myopic children. In the multiple logistic analysis, in general, no association between near work and myopia was found after adjusting for the children’s age, gender, parental refractive error, parental educational level, and daily outdoor activity hours [odds ratio (OR), 95% confidence interval (CI): 1.10, 0.94–1.27]. However, a weak protective effect of the outdoor activity on myopia was found (OR, 95% CI: 0.82, 0.70–0.96), after adjusting for similar confounders. Conclusions In general, no association between near work and myopia was found, except for the high near work subgroup with moderate outdoor activity levels. A weak protective effect of outdoor activity on myopia in Chinese rural children was observed. Electronic supplementary material The online version of this article (10.1186/s12886-017-0598-9) contains supplementary material, which is available to authorized users.

Objective To develop a new non-invasive risk score for predicting incident diabetes in a rural Chinese population. Methods Data from the Handan Eye Study conducted from 2006–2013 were utilized as part of this analysis. The present study utilized data generated from 4132 participants who were ≥30 years of age. A non-invasive risk model was derived using two-thirds of the sample cohort (selected randomly) using stepwise logistic regression. The model was subsequently validated using data from individuals from the final third of the sample cohort. In addition, a simple point system for incident diabetes was generated according to the procedures described in the Framingham Study. Incident diabetes was defined as follows: (1) fasting plasma glucose (FPG) ≥ 7.0 mmol/L; or (2) hemoglobin A1c (HbA1c) ≥ 6.5%; or (3) self-reported diagnosis of diabetes or use of anti-diabetic medications during the follow-up period. Results The simple non-invasive risk score included age (8 points), Body mass index (BMI) (3 points), waist circumference (WC) (7 points), and family history of diabetes (9 points). The score ranged from 0 to 27 and the area under the receiver operating curve (AUC) of the score was 0.686 in the validation sample. At the optimal cutoff value (which was 9), the sensitivity and specificity were 74.32% and 58.82%, respectively. Conclusions Using information based upon age, BMI, WC, and family history of diabetes, we developed a simple new non-invasive risk score for predicting diabetes onset in a rural Chinese population, using information from individuals aged 30 years of age and older. The new risk score proved to be more optimal in the prediction of incident diabetes than most of the existing risk scores developed in Western and Asian countries. This score system will aid in the identification of individuals who are at risk of developing incident diabetes in rural China.

Purpose: The Handan Offspring Myopia Study (HOMS) aims to investigate the familial associations of myopia between parents and their offspring. Methods: Children aged 6–18 years, residing in 6 villages where all people aged 30 years had participated in The Handan Eye Study in 2006–2007, were selected for the current eye study between March and June 2010. A mobile clinic was set up in the 6 villages for comprehensive eye examinations, including visual acuity, ocular biometry, cycloplegic autorefraction and retinal photography. Results: Of 1238 eligible individuals, 878 children (70.2%; 52.6% male) from 541 families were recruited. Mean age of the children was 10.5 ± 2.5 years. The prevalence of myopia (spherical equivalent refraction 50.5 diopter) was 23.5% (males 16.8%, females 30.8%). The prevalence of low vision (presenting visual acuity 20/400 but 520/60) in the better eye was 7.1%. A higher number of females had low vision at the time of presentation (9.2%) compared to males (5.2%, p = 0.02). The prevalence of low vision in the worse eye was 10.6% (males 6.7%, females 14.9%, p50.001). The majority of visual impairment in the better-seeing (56/62, 90.3%) as well as the worse-seeing (84/93, 90.3%) eye was correctable. Conclusions: The HOMS examined about 70% of eligible Han Chinese offspring of Handan Eye Study participants in a rural region of northern China. Results from the HOMS will provide key information about the prevalence of refractive errors and eye diseases in rural Chinese children.

To define the prevalence of blindness and visual impairment (VI) in people in rural Hainan using the rapid assessment of avoidable blindness (RAAB) and to report the outcomes of cataract surgery among the residents.Population-based, cross-sectional survey.A total of 6482 rural residents of the Hainan province.A total of 136 clusters, each of which consisted of 50 people aged ≥50 years, were selected through probability-proportionate-to-size sampling. Door-to-door visits were performed by 2 outreach teams. Visual acuity (VA) was measured on site, and those with VA6/18 in either eye were examined by an ophthalmologist. Causes of blindness and VI were determined. The causes of poor visual outcome after cataract surgery were evaluated. Information regarding barriers to receiving surgery was collected by trained interviewers.Prevalence and causes of blindness (VA3/60), severe VI (SVI) (VA6/60 but ≥3/60), and VI (VA6/18 but ≥6/60) based on presenting VA (PVA) were assessed. Outcomes of cataract surgery performed in public and private hospitals and charitable organizations were compared.A total of 6482 subjects were examined (response rate, 95.3%). The sample prevalence of blindness was 4.4% (95% confidence interval [CI], 2.0-6.8). The prevalence of SVI and VI was 1.9% (95% CI, 0-4.3) and 9.9% (95% CI, 7.6-12.2), respectively. Age and sex were associated with increased prevalence of blindness, SVI, and VI. Overall, cataract accounted for approximately 60% of blindness and SVI. Of the 524 eyes that had received cataract surgery, 87.2% had intraocular lenses implanted, 21% had a poor visual outcome (PVA6 /60), and 20% had a borderline visual outcome (PVA6/18 but ≥6/60). Eyes that received surgery in charitable organizations had a higher rate of intraocular lens implantation and good visual outcome (VA ≥6/18) compared with eyes that were operated on elsewhere.The prevalence of blindness, SVI, and VI was high among rural residents in Hainan. Cataract remained the leading cause of avoidable blindness. Outcomes of cataract surgery performed in public hospitals were suboptimal. Quality-control initiatives should be introduced to improve cataract surgery outcomes.

To assess the use of eye care services in a rural population in North China and to analyze the factors associated with underuse of these services.In a cross-sectional population-based study, demographic, health and vision-related information including use of eye care services were determined during a face-to-face interview. A single visit to an eye care provider qualified as "use" of eye care services.Of 6612 participants, 754 (11.4%, 95% confidence interval, CI, 8.7-14.1%) had used eye care services. The most common reason cited for not seeing an eye care provider was "no need" (n = 5754). Of the 5754 who thought that there was no need to see an ophthalmologist, 3458 (60.1%) were found to have one or more type of eye disease, including glaucoma (56, 1.0%), cataract (1056, 18.4%), age-related macular degeneration (AMD; 164, 2.9%) and refractive error (3048, 53.0%). Also, 74 (1.3%) and 409 (7.1%) of the 5754 participants had visual impairment (20/60) according to best-corrected visual acuity and presenting visual acuity, respectively. In a multiple regression model, participants who had glaucoma (adjusted odds ratio, OR, 4.0, 95% CI 3.0-5.4), AMD (adjusted OR 1.6, 95% CI 1.2-2.3) or refractive error (adjusted OR 1.4, 95% CI 1.1-1.8), were more likely to visit an eye care provider.A high proportion of the Chinese rural population had never used eye care services although three fifths had eye diseases. Further efforts towards better education of the general population about common eye problems as well as increasing the number of ocular health providers would be necessary in future.

Objective: To assess the magnitude of nearwork-induced transient myopia (NITM) under binocular viewing conditions separately in each eye of individuals with mild to moderate anisometropia to determine the relationship between NITM and their interocular refractive error. Methods: Forty-three children and young adults with anisometropia [cycloplegic spherical equivalent (SE) difference >1.00 D] were tested (ages 9-28 years). NITM was measured with binocular viewing separately in each eye after binocularly performing a sustained near task (5 D) for 5 min incorporating a cognitive demand using an open-field, infrared autorefractor (Grand-Seiko, WAM-5500). Data were averaged over 10 s bins for 3 min in each eye. Initial NITM, its decay time (DT), and its decay area (DA) were determined. A-scan ultrasound ocular biometry was also performed to determine the axial length of each eye. Results: The more myopic eye exhibited increased initial NITM, DT, and DA as compared to the less myopic eye (0.21 ± 0.16 D vs 0.15 ± 0.13 D, p = 0.026; 108.4 ± 64.3 secs vs 87.0 ± 65.2 secs, p = 0.04; and 17.6 ± 18.7 D*secs vs 12.3 ± 15.7 D*secs, p = 0.064), respectively. The difference in DA and the difference in SE between the more versus less myopic eye were significantly correlated (r = 0.31, p = 0.044). Furthermore, 63% (27/43), 56% (24/43), and 70% (30/43) of the more myopic eyes exhibited increased initial NITM, longer DT, and larger DA, respectively, than found in the less myopic eye. Conclusions: In approximately two-thirds of the anisometropic individuals, the initial NITM and its decay area were significantly increased in the more myopic eye as compared to the less myopic eye. NITM may play an important role in the development of interocular differences in myopia, although a causal relationship is yet to be established. Furthermore, the findings have potentially important implications regarding accommodative control and interocular accommodative responsitivity in anisometropia, in particular for anisomyopia.

Purpose. To investigate the relationship between parental refractive error and the nearwork-induced transient myopia (NITM) characteristics of their children. Methods. Three hundred sixty children (173 boys and 187 girls) aged 6 to 17 years were tested. Initial NITM and its decay time (DT) were assessed objectively (WAM-5500, Grand-Seiko) immediately after binocularly viewing and performing a sustained near task (5 diopters [D]) for 5 minutes, incorporating a cognitive demand with full distance refractive correction in place. The NITM was classified into three categories: low (G0.15 D), moderate (0.15 to 0.30 D), or high (Q0.30 D), whereas its decay was classified into two categories, namely, complete or incomplete. In addition, the children were divided into three groups based on the number of myopic parents (none, one, or two) and into four groups based on the level of parental myopia (no, low, moderate, or high). Results. Neither paternal nor maternal refractive error was associated with either their children’s initial NITM magnitude or its DT in the myopic, emmetropic, or hyperopic groups or the combined group. No significant differences (p 9 0.05) in the NITM magnitude, DT, or decay time constant were found as related to the number of myopic parents or level of parental myopia. Multiple odds ratio for incomplete decay of NITM did not change significantly (p 9 0.05) with either an increase in number of myopic parents or level of parental myopia. Conclusions. There was no association between parental refractive error and their children’s NITM characteristics. This suggests a primary environmental basis for the NITM characteristics in the children. (Optom Vis Sci 2013;90:00Y00)

Aims To report the refractive error difference (RED) between parents and their children and the estimated single generational myopic shift in an urban area in China. Methods 395 children aged 6–17 years and their parents, who had been enrolled in the Beijing Myopia Progression Study were included. Cycloplegic and non-cycloplegic refraction of the children and parents were performed, respectively. RED was defined as the difference between the average parental spherical equivalent (SE) and the average SE of their children. Binomial fitted curves of RED were plotted as a function of the children's age. Generational myopic shift was defined as the estimated RED according to the prediction model at the age of 18 years. Results 395 families were enrolled. The RED was positively correlated with the children's age (rspearman=0.58, p

Purpose: To quantify the effect of laser peripheral iridotomy (LPI) on angle widening in primary angle closure with and without peripheral anterior synechia (PAS). Patients and Methods: Prospective hospital-based study of 44 consecutive patients (69 eyes) with primary angle closure. Comprehensive ophthalmic examination and ultrasound biomicroscopy were performed at enrollment and 2 weeks following LPI. The following angle parameters: angle opening distance, trabecular-iris angle, and angle recess area were obtained. On the basis of the presence of PAS, angle quadrants were divided into 3 groups: group A comprised quadrants in PAS-negative eyes; group B, the unaffected quadrants in PAS-positive eyes; and group C, the quadrants with PAS in PAS-positive eyes. Correlation between PAS and angle width was determined and changes in angle parameters following LPI were compared between groups. Results: Sixty-six eyes of 42 patients (31 eyes with PAS) were available for analysis. Groups A, B, and C provided 140, 66, and 58 quadrants, respectively, for analysis. There was a moderate negative correlation between angle width changes (angle opening distance, trabecular-iris angle, angle recess area) after LPI and PAS extent at baseline (r=-0.46 to-0.39; P

Purpose. The purpose of the present study was to describe the baseline refractive and nearwork-induced transient myopia (NITM) characteristics of the Beijing Myopia Progression Study, a 3-year cohort study, that has three overall specific aims: to investigate the natural history of NITM in schoolchildren living in the inner city of Beijing aged between 7 and 17 years; to investigate the possible relation between NITM and permanent myopia; and to determine the possible associations with NITM (eg, parental history). Methods. Three hundred eighty-six students (187 males and 199 females) were enrolled. The mean ages were 8.4 +/- 1.1 years and 14.2 +/- 1.6 years for the primary school and secondary school students, respectively. Baseline refractive aspects were determined clinically. Initial NITM and its decay were assessed objectively immediately after binocularly viewing and performing a sustained near task (5 minutes; 5 diopters [D]), incorporating a cognitive demand with full distance refractive correction in place. Results. Initial NITM (mean +/- SD) / decay time (median, first quartile, and third quartile) was 0.18 +/- 0.16 D / 50 (20, 90) seconds, 0.09 +/- 0.13 D / 30 (10, 40) seconds, and 0.10 +/- 0.19 D / 20 (10, 40) seconds among the myopic, emmetropic, and hyperopic students, respectively, for the combined school levels. Initial NITM and decay time were significantly larger/longer in the myopic versus the other two refractive groups. Conclusions. The present findings demonstrate that in a large sample of school-aged children with myopia, the initial NITM magnitude was significantly larger and the decay duration was significantly longer than that observed in age-matched children with either emmetropia or hyperopia. Follow-up for the next 3 years will provide insight into the possible role of NITM in the development of permanent myopia. (Optom Vis Sci 2012; 89: 1725-1733)

Purpose To investigate the difference between cycloplegic and non-cycloplegic autorefraction and its association with the progression of refractive error in Beijing urban children. Methods A total of 386 children aged 6–17 years were enrolled in the baseline investigation of the Beijing Myopia Progression Study in 2010. They were invited for follow-up vision examinations in the years 2011, 2012, and 2013, including cycloplegic (cyclopentolate 1%, three times) autorefraction. We investigated the difference between the cycloplegic spherical equivalent (SE) and the non-cycloplegic SE (DSE) provided by autorefraction and its association with refractive error progression. The progression of refractive error was defined as the difference between the cycloplegic SE at follow-up and at baseline. Results Two hundred and nineteen children (57%) with completed refractive data (mean ± standard deviation: −1.36 ± 2.44 D at baseline) were ultimately enrolled. The DSE reduced from 0.51 ± 0.72 D at baseline to 0.19 ± 0.43 D in the third year of follow-up (p = 0.01). The baseline DSE was positively associated with the children's baseline cycloplegic refraction (β = 0.193 dioptre dioptre−1, p < 0.001). After further divided by refractive status, the DSE was consistently higher in the hyperopic group than in either the emmetropic or myopic groups at each follow-up (all p < 0.001). In the multivariate regression analysis, the myopic children with larger baseline DSE (β = −0.404 dioptre dioptre−1, p = 0.01) exhibited more myopic refractive change. However, baseline DSE was not found to be a significant risk factor (relative risk, 95% confidence interval: 1.06, 0.79–1.41) for those with newly developed myopia. Conclusion In this sample, the children's DSE was found to be increased as the hyperopic refraction increased. Furthermore, greater the DSE was associated with the progression of refractive error among the myopic children, but not with the onset of myopia.

Background Chinese traditional “eye exercises of acupoints” have been advocated as a compulsory measure to reduce visual symptoms, as well as to retard the development of refractive error, among Chinese students for decades. The exercises are comprised of a 5-min, bilateral eye acupoint self-massage. This study evaluated the possible effect of these eye exercises among Chinese rural students. Methods Eight hundred thirty-six students (437 males, 52.3 %), aged 10.6 ± 2.5 (range 6–17) years from the Handan Offspring Myopia Study (HOMS) who completed the eye exercises and vision questionnaire, the convergence insufficiency symptom survey (CISS) questionnaire, and had a cycloplegic refraction were included in this study. Results 121 (14.5 %) students (64 males, 52.9 %) performed the eye exercises of acupoints in school. The multiple odds ratio (OR) and 95 % confidence interval (CI) for those having a “serious attitude” towards performing the eye exercises (0.12, 0.03–0.49) demonstrated a protective effect for myopia, after adjusting for the children’s age, gender, average parental refractive error, and the time spent on near work and outdoor activity. The more frequently, and the more seriously, the students performed the eye exercises each week, the less likely was their chance of being myopic (OR, 95 % CI: 0.17, 0.03–0.99), after adjusting for the same confounders. However, neither the “seriousness of attitude” of performing the eye exercises (multiple β coefficients: -1.58, p = 0.23), nor other related aspects of these eye exercises, were found to be associated with the CISS score in this sample. Conclusions The traditional eye exercises of acupoints appeared to have a modest protective effect on myopia among these Chinese rural students aged 6–17 years. However, no association between the eye exercises and near vision symptoms was found. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1289-4) contains supplementary material, which is available to authorized users.

To describe the distribution of and factors related to intraocular pressure (IOP) in a healthy adult rural Chinese population in northern China.The Handan Eye Study is a cross-sectional, population-based study of eye diseases among 6,830 (90.4% response rate) rural Chinese persons aged 30+ years. Participants underwent an interviewer-administered questionnaire and a complete ocular examination, including standardized measurement of IOP with Perkins applanation tonometry.After excluding persons with glaucoma, or those with diseases that have a marked effect on IOP or that preclude accurate IOP measurement, 6,101 persons were included in the current analysis. Mean IOP (mean ± standard deviation) of the study population was 15.0 ± 2.8 mmHg. Men had lower IOP than women (14.6 ± 2.8 mmHg versus 15.4 ± 2.7 mmHg, t = -8.37, P 0.001). In the multivariate analysis younger age, female sex, presence of diabetes mellitus, higher blood pressure, higher body mass index, thicker central cornea and higher myopia were associated with higher IOP.Mean IOP among persons living in rural northern China was similar to that recently reported in southern China. IOP appeared to be lower with increasing age in Chinese subjects, which contrasts with results in white populations.

Our purpose was to determine the relationship of metabolic syndrome (MetS) and its components with retinal microvascular abnormalities in a rural Chinese population. The Handan Eye Study, a population-based survey, recruited 6,830 (90.4 % of eligible) rural Chinese ≥30 years of age. A diagnosis of metabolic syndrome was based on the International Diabetes Federation definition. Retinal microvascular signs and arteriolar and venular diameters were assessed from fundus photographs by graders who were trained at the Retinal Vascular Imaging Centre, University of Melbourne. After adjusting for age, gender, and smoking status, 5,519 participants with MetS, or with the specific components of large waist circumference, elevated blood pressure (BP), or elevated fasting blood glucose (FG), were more likely to have retinopathy, arteriovenous nicking, focal arteriolar narrowing, enhanced arteriolar wall reflex, and generalized retinal arteriolar narrowing than those without MetS or the corresponding component. Individuals with elevated triglycerides were significantly more likely to have arteriovenous nicking and retinopathy. These results show that individual components of MetS are associated with different retinal microvascular signs and with changes in retinal arteriolar and venular diameters.

Cataract remains the leading cause of blindness and visual impairment in the world and in China. However, data on the prevalence of cataract based on standardized lens grading protocols from mainland China are limited. This paper estimated the age- and gender-specific prevalence and risk factor for cataract In a population-based Chinese sample, participants underwent a comprehensive ophthalmic examination, including assessment of cortical, nuclear, posterior subcapsular (PSC) and mixed lens opacities from slit-lamp grading using the Lens Opacities Classification System III. Of the 7,557 eligible subjects, 6,830 took part in the study (90.4 % response rate), and 6,544 participants (95.8 %, mean age 52.0 ± 11.8 years) had lens data for analyses. The prevalence of any cataract surgery in at least one eye was 0.8 % (95 % confidence interval [CI], 0.62, 1.06), with similar rates between men and women. The overall prevalence of any cataract or cataract surgery was 20.8 % (95 % CI, 19.8, 21.8), higher in women than in men after adjusting for age (23.6 % vs 17.6 %; OR: 1.78; 95 % CI: 1.54–2.07). When distinct lens opacity was categorized in each eye as cortical, nuclear, PSC or mixed, based on one randomly selected eye, cortical cataract was the most common distinct subtype (12.3 %), followed by mixed (3.2 %), nuclear (1.7 %), and PSC (0.2 %) cataract. The prevalence of all lens opacities increased with age (P

Metabolic syndrome is a common risk factor for cardiovascular disease. Chronic kidney disease (CKD) is a worldwide public health problem. We investigated the association between metabolic syndrome and CKD in a rural Chinese population.This was a cross-sectional study using data from the Handan Eye Study.4944 of participants aged ≥ 30 y were included in this analysis. Participants with metabolic syndrome had a higher prevalence of CKD (20.9% vs.15.8%, P0.001) than those without. As the number of metabolic syndrome components increased, so did the prevalence of CKD (P0.001). The multivariate-adjusted odds ratio (OR) of chronic kidney disease in participants with metabolic syndrome was 1.293 (95% CI 1.093-1.529) compared with those without. In multivariate logistic regression analysis, high blood pressure (OR 1.348; 95% CI 1.122-1.619) and high fasting glucose (OR 1.501; 95% CI 1.235-1.794) were independently associated with the risk for CKD. Compared with participants without any component, multivariate adjusted OR for CKD was 1.316 (95%CI 1.004-1.723), 1.397(95%CI 1.038-1.882), 1.672 (95%CI 1.183-2.363) for those with 2, 3, 4 or 5 components, respectively.In this rural Chinese population aged ≥ 30 y, metabolic syndrome was associated with CKD.

Purpose To describe the prevalence of age-related degeneration (AMD) in a rural Chinese population and to assess its associations with age, gender, and smoking. Design Population-based cross-sectional. Participants Persons aged 30+ years, recruited between October 2006 and October 2007, from Yongnian County, Handan, Hebei Province, China. Methods All participants underwent a standardized interview and comprehensive eye examinations, including digital retinal photography of both eyes. Trained graders assessed the presence and severity of AMD lesions following the modified Wisconsin Age-related Maculopathy Grading System (WARMGS) used in the Blue Mountains Eye Study (BMES). Direct age standardization to the world population (year 2000) was performed to compare the prevalence across different populations. Main Outcome Measures AMD and WARMGS. Results Of 6830 participates, fundus photographs were gradable for 6581 persons (96.4%), including 4049 aged 50+ years. Early and late AMD prevalence rates were 3.0% and 0.1%, respectively, among participants. The age-standardized prevalence rates among participants aged 50+ years were 4.7% and 0.2%, respectively. After controlling for age, men had a higher prevalence of early (3.9% vs. 2.3%, odds ratio [OR] 1.7; 95% confidence interval [CI], 1.3–2.2) and late AMD (0.1% vs. 0.03%; OR 3.5; CI, 0.4–33.4) compared with women. Older age (sex-adjusted OR 1.7; CI, 1.3–2.2 per decade of age) and current smoking (age-sex-adjusted OR 1.4; CI, 1.0–2.1) were significantly associated with early AMD prevalence. The proportion of current smokers was substantially higher in men (58.7%) than in women (0.3%). The attributable risk of early AMD from smoking among Chinese men was 24.2%. After controlling for current smoking, the excess prevalence of early AMD in men compared with women reduced by 50% (OR 1.4; 95% CI, 0.9–2.0). Conclusions The prevalence of early AMD in this rural Chinese sample was similar to white persons in the BMES and Asian Malays in the Singapore Malay Eye Study. Late AMD prevalence, however, was lower. Higher prevalence rates for early and late AMD in men compared with women were largely attributed to substantially higher proportions of smokers in rural Chinese men than in women. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose: To describe risk factors associated with diabetic retinopathy (DR) in a population-based sample of rural Chinese with type 2 diabetes. Methods: The Handan Eye Study is a population-based cross-sectional study surveyed 6830 Chinese people aged 30+ years from 13 randomly selected villages in 2006–2007. All participants underwent a standardized interview and extensive examinations including ophthalmologic and systemic conditions. Diabetic retinopathy was graded from fundus photographs according to the modified Early Treatment Diabetic Retinopathy Study classification system. Logistic regression models were used to assess risk factors associated with DR. Results: Of 7577 eligible persons, 6830 (90.4%) participated, of which 5597 (81.9%) had fasting plasma glucose (FPG) data. There were 387 (6.9%) participants with diabetes, and 368 (95.1%) had gradable fundus photographs. The age-standardized prevalence of DR was 43.1%. In multivariable-adjusted logistic regression models for all diabetic participants, independent risk factors for DR were longer duration of diabetes (odds ratio [OR] 3.07, 95% confidence interval [CI] 1.94, 4.85, per 5 years of duration), higher FPG levels (OR 1.17; 95% CI: 1.08, 1.27, per mmol/l increase) and higher systolic blood pressure (OR 1.22; 95% CI: 1.08, 1.37, per 10 mmHg increase). For newly diagnosed diabetes, the only significant factor of DR was higher FPG levels (OR 1.17; 95% CI: 1.05, 1.29, per mmol/l increase). Conclusions: In rural Chinese persons with diabetes, longer diabetes duration, hyperglycaemia and elevated blood pressure are risk factors for DR. These findings underscore the importance of controlling classic risk factors for DR in developing countries, where diabetes prevalence is increasing.

To compare the efficacy and safety of laser peripheral iridotomy with or without laser peripheral iridoplasty in the treatment of eyes with synechial primary angle-closure or primary angle-closure glaucoma.Randomized, controlled clinical trial.Consecutive patients older than 40 years with synechial primary angle-closure or primary angle closure glaucoma were recruited. Eligible patients were randomized to 1 of 2 treatment options, iridotomy or iridotomy plus iridoplasty, and were followed up for 1 year. Main outcome measures were intraocular pressure (IOP), peripheral anterior synechiae, corneal endothelial cell count, and complications.Seventy-seven eyes (77 patients) were randomized to the iridotomy group, and 81 eyes (81 patients) were randomized to the iridotomy plus iridoplasty group. Sixty-one patients (79.2%) in the iridotomy and 65 patients (80.2%) from the iridotomy plus iridoplasty groups completed 1 year of follow-up. There were no significant differences between the groups in the baseline data. IOP was reduced from 24.66 +/- 13.76 mm Hg to 19.03 +/- 6.21 mm Hg in the iridotomy group (P.001) and from 27.96 +/- 13.06 mm Hg to 20.45 +/- 7.26 mm Hg in the iridotomy plus iridoplasty group (P.001). Extent of peripheral anterior synechiae was decreased by 1 more clock-hour after iridoplasty compared with that after iridotomy in the iridotomy plus iridoplasty group (P.001). There was no significant difference in IOP, medications, need for surgery, or visual function between groups at the 1-year visit.In eyes with synechial primary angle-closure or primary angle-closure glaucoma, both iridotomy alone or combined with iridoplasty provide a significant and equivalent reduction in IOP. There is also a possible reduction in peripheral anterior synechiae, more so in the iridoplasty group.

Background: Chronic kidney disease (CKD) is a worldwide public health problem. The purpose of this study was to investigate the prevalence of CKD and associated factors in a rural adult population in Northern China. Methods: This was a cross-sectional study using data from the Handan Eye Study. A total of 5,105 subjects aged ≧30 years were included in this analysis. Spot urine albumin-to-creatinine ratio was determined. Glomerular filtration rate was estimated with the modified Modification of Diet in Renal Disease equation. CKD was defined by the guidelines proposed by the Kidney Disease Outcomes Quality Initiative. The associations between age, gender, diabetes, hypertension, and kidney damage were examined. Results: Albuminuria and reduced renal function were detected in 16.8 and 0.4% of subjects, respectively. The age-standardized prevalence of albuminuria, reduced renal function and CKD was 14.9% (95% confidence interval (CI) 13.9–15.9), 0.38% (95% CI 0.21–0.55) and 15.2% (95% CI 14.2–16.2), respectively. The prevalence of CKD was greater in women than in men (16.7 vs. 12.9%, respectively, p < 0.001). The increased prevalence of CKD with increasing age was observed in both genders. Older age, female gender, diabetes and hypertension were independently associated with albuminuria. Older age was independently associated with reduced renal function. Conclusion: The prevalence of CKD in the rural Chinese population is relatively high. Factors associated with CKD are similar to those of urban areas in China and developed countries. CKD is a major public health problem in rural China.

To evaluate utility values among patients of primary angle closure/glaucoma (PAC/G) in a local hospital in China, and the factors influencing the quality of their lives.A cross-sectional study. Utility values were measured using the time trade-off (TTO) and standard gamble (gamble for blindness) methods. Standard face-to-face interviews were conducted. Results of ophthalmic examinations were recorded.One hundred and six patients were recruited, 16 (15.1%) male and 90 (84.9%) female, mean age 63.21 years (SD 7.46). Fifty-five (50.9%) patients had a history of acute angle closure (AAC). The mean duration from glaucoma diagnosed to the day of interview was 7.69 (3.30) months. All participants underwent laser therapy, and 12 patients (11.3%) also received trabeculectomies. The mean utility value was 0.75 (0.14) (95% CI 0.73 to 0.78) with the TTO technique and 0.80 (0.08) (95% CI 0.78 to 0.81) with the standard gamble (SG) technique. The correlation between the two values was significant (p0.001). Age, educational status, better best-corrected visual acuity (BCVA), worse BCVA and better visual field had significant effects on the utility values. Patients' self-evaluation of the impact of PAC/G upon their lives correlated with the TTO utility values (p = 0.008) and not with the SG utility values (p = 0.652).The mean TTO utility score of the studied population is 0.75. The utility value is directly dependent on age, the degree of visual function loss and educational status. It is likely that patients find the TTO method easier to comprehend than the SG method.

Background: To study the differences in ophthalmology resident training between China and the Hong Kong Special Administrative Region (HKSAR).Methods: Training programs were selected from among the largest and best-known teaching hospitals. Ophthalmology residents were sent an anonymous 48-item questionnaire by mail. Work satisfaction, time allocation between training activities and volume of surgery performed were determined.Results: 50/75 residents (66.7 %) from China and 20/26 (76.9 %) from HKSAR completed the survey. Age (28.9 ± 2.5 vs. 30.2 ± 2.9 years, p = 0.15) and number of years in training (3.4 ± 1.6 vs. 2.8 ± 1.5, p = 0.19) were comparable between groups. The number of cataract procedures performed by HKSAR trainees (extra-capsular, median 80.0, quartile range: 30.0, 100.0; phacoemulsification, median: 20.0, quartile range: 0.0, 100.0) exceeded that for Chinese residents (extra-capsular: median = 0, p 50 % of time on charts: 62.5 % versus 5.3 %, p

Purpose To identify clinical factors correlating with failure to control intraocular pressure (IOP) in primary angle-closure glaucoma (PACG) eyes with cataract after phacoemulsification or phacotrabeculectomy. Design Retrospective analysis of two prospective randomized controlled clinical trials. Methods Primary angle-closure glaucoma eyes with cataract received phacoemulsification or phacotrabeculectomy. Failure was defined as having IOP of 21mm Hg or greater, or requiring glaucoma drugs to maintain an IOP of less than 21 mm Hg, or having had additional IOP-lowering surgery. Factors correlating with failure at 24 months after surgery were identified using logistic regression model. Results One hundred twenty-three PACG eyes with cataract and receiving phacoemulsification (n = 62) and phacotrabeculectomy (n = 61) were analyzed. With univariate analysis, factors associated with failure included a higher preoperative IOP, a higher preoperative requirement for glaucoma drugs, absence of plateau iris configuration, and phacoemulsification alone. With multivariate analysis, factors associated with failure included a higher preoperative IOP [odds ratio (OR), 1.732 per increase in IOP of 5 mm Hg], a higher preoperative requirement for glaucoma drugs (OR, 1.913), and performance of phacoemulsification alone (OR, 10.24). Conclusions In PACG eyes with cataract, higher preoperative IOP and increased requirement for glaucoma drugs correlate with failure to control IOP after phacoemulsification or phacotrabeculectomy. Phacotrabeculectomy is more likely than phacoemulsification to achieve IOP control.

Objectives We estimated the prevalence of metabolic syndrome (MetS) and compared associations of different MetS definitions with coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD) in a rural Chinese population. Methods Among 4,748 residents (2,145 men and 2,603 women) aged 30+ years in rural China from 2006 to 2007, the prevalence of MetS was estimated by using five different definitions: modified World Health Organization (WHO), Chinese Diabetes Society (CDS), the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) for Asian-Americans, International Diabetes Federation (IDF), and Joint Interim Statement (JIS). Multivariable logistic regression analyses were implemented to estimate the association between MetS and the prevalence of CHD, stroke and PAD, respectively. Results Prevalence of MetS in men was 11.5% (WHO), 14.8% (CDS), 32.4% (NCEP-ATP III), 27.5% (IDF) and 39.7% (JIS) and in women was 15.7% (WHO), 20.7% (CDS), 54.2% (NCEP-ATP III), 51.5% (IDF) and 54.2% (JIS), respectively. Respective ORs (95% CI) for associating MetS with CHD in men were 1.79 (1.02-3.17), 1.25 (0.69-2.26), 1.61 (1.01-2.58), 1.84 (1.14-2.96), and 1.53 (0.96-2.43). Corresponding ORs (95% CI) for stroke in men were 2.18 (95% CI 1.20 to 3.97), 2.20 (95% CI 1.25 to 3.89), 1.71 (95% CI 1.02 to 2.84), 1.30 (95% CI 0.77 to 2.23), and 1.61 (95% CI 0.97 to 2.68), respectively. In women, CHD and stroke were significantly associated with MetS using all five definitions of MetS. In addition, PAD was associated with all five MetS definitions in men, but not in women. Only hyperglycemia and BMI were significantly associated with PAD in women. Conclusions In this rural Chinese population, the JIS, IDF and CDS criteria may not be more suitable than WHO and updated NCEP-ATPIII definitions for screening high-risk individuals and estimating the risk of CHD and stroke from MetS, especially in men.

Glaucoma is the second leading cause of blindness worldwide. To examine the relationship between angle closure and the retinal vessel diameter in Chinese adults, we conducted Handan Eye Study (HES), a large population-based cross-sectional study, which enrolled 6830 participants >30 year-old living in 13 randomly selected villages of Yongnian County. After adjusting for age, gender, spherical equivalent (SE), diabetes and hypertension, the mean central retinal artery equivalent (CRAE, μm) was 127.1 ± 7.0 and 145.6 ± 4.4 in primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG), respectively; narrower than that in normal control (156.1 ± 0.4), primary angle-closure suspect (PACS) (156.3 ± 1.1) or primary angle closure (PAC) (156.0 ± 3.4) (P = 0.001). The mean central retinal vein equivalent (CRVE, μm) was 229.0 ± 5.9 and 215.8 ± 9.5 in POAG and PACG, respectively; narrower than that in normal control (238.3 ± 0.5), PACS (241.2 ± 1.4) or PAC (242.2 ± 4.6) (P = 0.001). There was no significant difference in the mean CRAE or CRVE between PACG and POAG. Compared to the normal control (0.66), the mean arterio-venous ratio (AVR) was smaller in POAG (0.64) and PACG (0.59), whereas larger in PACS (0.65) and PAC (0.67) (P = 0.003). To conclude, PACG and POAG individuals have narrower retinal arteries and veins.

PURPOSE To evaluate patient-perceived quality of life with glaucoma and to assess whether ophthalmologists fully appreciate patients' perceptions through utility analysis. PATIENTS AND METHODS Utility values were obtained from 87 glaucoma patients by linear rating scale (RS), standard gamble for blindness (SG), and time trade-off (TTO) methods. Identical questionnaires were delivered to ophthalmologists (n=26) at the same center, who were asked to assume they had mild (MD in better-seeing eye ≥-6 dB) or moderate to severe (MD in better-seeing eye

Purpose.: To report the refractive error difference (RED) between parents and their children, and its risk factors, in a rural area of China. Methods.: Children (6–17 years) and their parents (36.2 ± 4.1 years) from the Handan Offspring Myopia Study (HOMS) were enrolled. Cycloplegic autorefraction (cyclopentolate 1%, Topcon KR8800) of the children and noncycloplegic autorefraction of their parents were assessed. A detailed vision-based questionnaire was also completed. Refractive error difference was defined as the difference between the parental spherical equivalent (SE) and their children's SE. Generational myopic shift was defined as the estimated RED when a child would be 18 years old according to a prediction model. Results.: Three hundred fifty-six pairs of parents and 585 children were enrolled. The RED (median, quartiles) increased from −1.33 (−1.99, −0.98) diopters (D) in children aged 6 to 7 years to 0.81 (−0.16, 2.28) D in children aged 16 to 17 years. The children's SE was predicted to approach the parental SE at 14 years of age. Moreover, the children's estimated myopic shift would be 1.03 D. Multiple linear regression revealed that older children (β = 0.23 D/y, P < 0.0001) and girls (β = 0.24, P = 0.01) tended to have a higher RED. Conclusions.: In this rural Chinese population, the children's refraction was estimated to be similar to the parental refraction at 14 years of age. Moreover, the generational myopic shift was estimated to be approximately 1 D at 18 years of age. These data suggest that the generational difference reflects the increasing prevalence of myopia in the younger generation, which is likely due to changes in environmental exposure.

Background There have been a limited number of population-based studies investigating the associations between cardiovascular disease risk factors and early age-related macular degeneration (AMD). Methods A total of 7,557 eligible people aged 30 or older were recruited from 2006 to 2007. Cardiovascular risk factors and serum lipids including total cholesterol, total triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and fasting plasma glucose, and urines were assessed. Digital photographs of the optic disk and macula fields (Early Treatment of Diabetic Retinopathy Study) were taken and graded after the modified Wisconsin Age-related Maculopathy Grading System. Logistic regression models were constructed to assess odds ratios and 95% confidence intervals. Cases of late AMD were excluded. Results Of 6,577 subjects included in the analysis, there were 200 (3.04%) cases with early AMD. Multivariate analysis showed that higher age, untreated hypertension, coronary heart disease, and smoking were associated with an increased risk of early AMD. After adjusting for other variables in the final model, no variable was significantly associated with hyperpigmentation while smoking was significantly associated with an increased risk of hypopigmentation; higher age and any cardiovascular disease were associated with an increased risk of large drusen, and higher age, smoking, untreated hypertension, and coronary heart disease were associated with an increased risk of soft drusen. Conclusion Our findings support the associations between smoking, coronary heart disease, and early AMD.

Assessment of the optic disc and retinal nerve fiber layer (RNFL) is essential for the diagnosis and monitoring of glaucoma. Knowledge of normal optic disc topography provides a benchmark for evaluating glaucomatous pathologic changes, especially in its early stages. The purpose of this study was to evaluate the characteristics and correlation factors of the optic disc parameters using the Heidelberg Retina Tomograph II (HRT II) in a large sample of normal eyes of adult Chinese subjects.Disc data were obtained from 6 830 subjects aged30 years from the Handan Eye Study. All participants underwent comprehensive eye examinations and physical examinations. The associations of gender, age, body mass index, blood pressure, waist-to-hip ratio; refractive error, intraocular pressure, axial length, and disc area were assessed using simple and multiple regression analysis. The correlation between HRT II parameters was evaluated.Of the 7 557 eligible subjects, 6 830 took part in the study (90.4% response rate) and 2 633 normal eyes with good-quality HRT II images were selected. The mean disc area was 2.28 mm(2) (standard deviation (SD) 0.43) and mean neural rim area was 1.80 mm(2) (SD 0.29). In multiple regression analysis, optic disc area significantly correlated with age, gender, and axial length (P0.001). All optic disc parameters showed a significant correlation with disc area (0.054r0.736, P0.01). The association between mean RNFL thickness and rim area is statistically significant but not strong (regression linear equation: rim area = 1.42 × mean RNFL thickness + 1.32 mm(2), P0.001; R(2) = 0.070). The global RNFL cross-sectional area was significantly associated with global rim area (regression linear equation: rim area = 1.14 × RNFL cross-sectional area + 0.44 mm(2), P0.001; R(2) = 0.271).The optic disc area in rural Chinese population is larger than reported in white and Japanese populations, similar to that of Indian population and urban Chinese population. Most optic disc measurements were moderately or weakly affected by disc area. In addition to the RNFL, there may be other factors affecting the rim area. The relationship between optic disc and axial length may suggest a link between larger disc area, thinning of the lamina cribrosa, and increased glaucoma susceptibility in myopic eyes.

To identify the reasons for poor uptake of cataract surgery in a program of outreach screening and low-cost surgery in Pucheng County, a rural area in northwestern China.Detailed interviews with a semi-structured questionnaire were conducted by telephone or face-to-face for participants who had been advised to attend a low-cost cataract surgery program but did not schedule the surgery within 3 months after the initial screening.Among 432 eligible subjects, 355 (82.2%) were interviewed (mean age 70.6 ± 6.6 years, 73.8% female). A total of 138 subjects (38.9%) were interviewed by phone and 217 (61.1%) were interviewed face-to-face. Lack of family support (n = 106, 29.9%) and failure to understand the need for surgery (n = 96, 27.0%) were the two main reasons for not undergoing cataract surgery. Other factors included fear of surgery (n = 62, 17.5%), lack of faith in doctors (n = 36, 10.1%), financial constraints (n = 25, 7.0%) and lack of transportation (n = 4, 1.1%).The principal barriers to low-cost cataract surgery uptake in rural China included lack of family support and failure to understand the need for surgery. Education targeting entire families to eliminate these barriers and development of community support systems at the family level are required to achieve greater uptake of low-cost cataract surgery programs in rural China.