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To investigate longitudinal changes in peripapillary choroidal thickness (pCT) and retinal nerve fiber thickness (pRNFLT) in patients with Type 2 diabetes mellitus.This was a prospective observational cohort study. Patients with Type 2 diabetes mellitus without diabetic retinopathy (DR) at baseline were recruited, followed up for three years, and further divided into an incident DR group and a non-DR group according to the outcome. The pCT and pRNFLT were measured through swept-source optical coherence tomography at 1-year interval, and the mean rates of pCT and pRNFLT thinning were compared between the DR groups.A total of 682 patients (682 eyes) were included in the final analysis. After 3-years follow-up, 122 (17.89%) developed DR. Both pCT and pRNFLT progressively thinned (-2.37 [-2.80 to -1.95] µm/year; -0.40 [-0.55 to -0.25] µm/year, respectively, P0.05) and accelerated thinning was observed in the incident DR group. The rates of pCT thinning (-3.92 [-4.96 to -2.88] µm/year, -2.03 [-2.49 to -1.57] µm/year, respectively) and pRNFLT loss (-1.03 [-1.31 to -0.76] µm/year, -0.26 [-0.43 to -0.09] µm/year, respectively) in the incident DR group were 1.93 and 3.96 times faster than those in the non-DR group, respectively. In addition, pCT and pRNFLT thinning were negatively related in Type 2 diabetes mellitus population, and faster pCT thinning indicated slower pRNFLT loss.Patients with Type 2 diabetes mellitus were at a higher risk of developing DR when accelerated pCT and pRNFLT thinning were present, indicating that heavier choroidal damage and retinal neurodegeneration precede clinical DR. The pCT and pRNFLT have the potential to serve as novel sensitive biomarkers of preclinical and early DR.

ObjectiveWe explored the feasibility of app-based HIV testing services (AHTS) among men who have sex with men (MSM) according to the perspectives of testing service providers.MethodsTwenty-one current or previous AHTS providers participated in a semi-structured interview which explored the facilitators and barriers to AHTS. Ten participants originating from the Center for Disease Control and Prevention (CDC) and 11 from the non-governmental organization (NGO) in Shijiazhuang, China took part in this study. Interviews was transcribed verbatim, and the socioecological model (SEM) was applied to thematic analysis.ResultsTwenty-one participants from AHTS services commented on the integration of online appointment schedules into HIV testing services. AHTS was deemed a convenient and efficient method for MSM and service providers to choose their preferred location and times. Moreover, it allowed for important HIV-related information to be accessed online and targeted toward at-risk individuals. Participants thought MSM may feel unsure about personal information security being stored within a privatized app and was considered a barrier to AHTS's usability. As such, they believed establishing a government-led national online platform for AHTS would allow for greater trust from MSM, rather than a social media app.ConclusionBy linking booking services to an online platform, AHTS was deemed a convenient and efficient method for HIV testing services, especially for young MSM who are familiar with smartphone applications. To improve the use of these services, AHTS apps should focus on ensuring the confidentiality of personal information and internet security to build trust between MSM and service providers.

To compare the treatment efficacy between repeated low-level red light (RLRL) therapy and 0.01% atropine eye drops for myopia control.A single-masked, single-center, randomized controlled trial was conducted on children 7 to 15 years old with cycloplegic spherical equivalent refraction (SER) ≤ -1.00 diopter (D) and astigmatism ≤ 2.50 D. Participants were randomly assigned to the RLRL group or low-dose atropine (LDA, 0.01% atropine eye drops) group and were followed up at 1, 3, 6, and 12 months. RLRL treatment was provided by a desktop light therapy device that emits 650-nm red light. The primary outcome was the change in axial length (AL), and the secondary outcome was the change in SER.Among 62 eligible children equally randomized to each group (31 in the RLRL group, 31 in the LDA group), 60 children were qualified for analysis. The mean 1-year change in AL was 0.08 mm (95% confidence interval [CI], 0.03-0.14) in the RLRL group and 0.33 mm (95% CI, 0.27-0.38) in the LDA group, with a mean difference (MD) of -0.24 mm (95% CI, -0.32 to -0.17; P0.001). The 1-year change in SER was -0.03 D (95% CI, -0.01 to -0.08) in the RLRL group and -0.60 D (95% CI, -0.7 to -0.48) in the LDA group (MD = 0.57 D; 95% CI, 0.40-0.73; P0.001). The progression of AL0.1 mm was 53.2% and 9.7% (P0.001) in the RLRL and LDA groups, respectively. For AL ≥ 0.36 mm, progression was 9.7% and 50.0% (P0.001) in the RLRL and LDA groups, respectively.In this study, RLRL was more effective for controlling AL and myopia progression over 12 months of use compared with 0.01% atropine eye drops.RLRL therapy significantly slows axial elongation and myopia progression compared with 0.01% atropine; thus, it is an effective alternative treatment for myopia control in children.

Background Aberrant epigenetic modifications such as DNA methylation may contribute to the pathogenesis of DR. We aimed at elucidating the role of novel DNA methylation modifications in diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) using an extreme phenotypic design. Methods/results Two consecutive studies were conducted. A cross-sectional study using an extreme phenotypic design was conducted to identify rare methylation modifications that might contribute to DR pathogenesis. A 2-year longitudinal nested case–control study was conducted to validate the results and assess whether these novel methylation modifications could be used as biomarkers for predicting DR onset. A large number of differentially methylated CpG sites were identified in the cross-sectional study, and two (cg12869254 and cg04026387) corresponding to known genes were replicated in the longitudinal study. Higher methylation of cg12869254 significantly correlated with macular RNFL thinning in the superior and nasal subregions, and that of cg04026387 correlated with reduced deep capillary plexus VD in the superior and inferior subregions after adjusting for covariates. Conclusions Cg12869254 and cg04026387 hypermethylation may complement the known risk factors that contribute to the pathogenesis of DR and as novel biomarkers for disease prediction.

Background Plasma metabolomic profile is disturbed in dementia patients, but previous studies have discordant conclusions. Methods Circulating metabolomic data of 110,655 people in the UK Biobank study were measured with nuclear magnetic resonance technique, and incident dementia records were obtained from national health registers. The associations between plasma metabolites and dementia were estimated using Cox proportional hazard models. The 10-fold cross-validation elastic net regression models selected metabolites that predicted incident dementia, and a 10-year prediction model for dementia was constructed by multivariable logistic regression. The predictive values of the conventional risk model, the metabolites model, and the combined model were discriminated by comparison of area under the receiver operating characteristic curves (AUCs). Net reclassification improvement (NRI) was used to estimate the change of reclassification ability when adding metabolites into the conventional prediction model. Results Amongst 110,655 participants, the mean (standard deviation) age was 56.5 (8.1) years, and 51 186 (46.3%) were male. A total of 1439 (13.0%) developed dementia during a median follow-up of 12.2 years (interquartile range: 11.5–12.9 years). A total of 38 metabolites, including lipids and lipoproteins, ketone bodies, glycolysis-related metabolites, and amino acids, were found to be significantly associated with incident dementia. Adding selected metabolites (n=24) to the conventional dementia risk prediction model significantly improved the prediction for incident dementia (AUC: 0.824 versus 0.817, p =0.042) and reclassification ability (NRI = 4.97%, P = 0.009) for identifying high risk groups. Conclusions Our analysis identified various metabolomic biomarkers which were significantly associated with incident dementia. Metabolomic profiles also provided opportunities for dementia risk reclassification. These findings may help explain the biological mechanisms underlying dementia and improve dementia prediction.

To determine the predictive value of the microcirculation of the optic nerve head by swept-source optical coherence tomography angiography for identifying individuals with high risk of diabetic retinopathy (DR) progression and diabetic macular edema (DME) development.Prospective observational cohort study.A total of 946 patients (1879 eyes) with type 2 diabetes mellitus were recruited who had no DR or mild nonproliferative DR at baseline, and no DME. All subjects underwent 3 × 3 mm swept-source optical coherence tomography angiography centered on the optic nerve head to generate angiograms in 4 layers: radial peripapillary plexus, superficial retinal capillary plexus (SCP), deep retinal capillary plexus, and choriocapillaris (CC). The CC flow deficit percentage (CC FD%), vessel density (VD), and perfusion density (PD) were quantified.During the 3 consecutive years of follow-up, 312 eyes (16.60%) experienced DR progression and 115 eyes (6.12%) developed DME. The DR progression was related to a lower VD of the SCP (relative risk per standard deviation decrease, 95% confidence interval): 1.30, 1.14-1.48; P.001), a lower PD of the SCP (1.41, 1.24-1.60; P.001), a lower VD of the radial peripapillary plexus (1.23, 1.08-1.40; P = .002), and an elevated CC FD% (1.62, 1.40-1.88; P.001). The DME occurrence was associated with a lower VD of SCP (1.35, 1.09-1.66; P = .005), a lower PD of SCP (1.29, 1.05-1.59; P = .016), and a higher CC FD% (1.29, 1.03-1.61; P.001). The CC FD% significantly improved the predictive power, with the increase of the C-statistic for DR progression and DME occurrence by 3.83% (P = .002) and 5.24% (P.001), respectively.This study provides the first longitudinal evidence suggesting that peripapillary CC FD% can improve the prediction of DR progression and DME development beyond traditional risk factors.

Complex regional pain syndrome type 1 (CRPS-I) is a devastating complication that can occur after limb extremity injuries. The effectiveness of vitamin C in preventing CRPS-I incidence is debatable. Therefore, we conducted a systematic review and meta-analysis to assess the role of vitamin C in CRPS-I prevention and its effect on pain score, functional outcomes and complications rate after wrist, ankle, and foot fractures.We searched Medline, Embase, the Cochrane Library, Clinicaltrial.gov, and Google Scholar from infinity to May 2021 for relevant studies comparing the incidence of CRPS-I with administration of perioperative vitamin C versus placebo after wrist, ankle, and foot fractures. Continuous data such as functional outcomes and pain scores were pooled as mean differences (MD), whist dichotomous variables such as the incidence of CRPS-I and complications were pooled as odds ratios (OR), with 95% confidence interval (CI). Data analyses was done using R software (meta package, version 4.9-0) for Windows.Eight studies, including two quasi-experimental studies, were included. The timeframe for vitamin C administration ranged from 42 to 50 days post-injury and/or surgical fixation and the dosage was either 500 mg or 1000 mg. The results showed that vitamin C was associated with a lower rate of CRPS-I relative to a placebo (OR 0.33, 95% CI [0.17, 0.63]). No significant difference was found between vitamin C and placebo in terms of complications (OR 1.90, 95% CI [0.99, 3.65]), functional outcomes (MD 6.37, 95% CI [-1.40, 14.15]), and pain scores (MD −0.14, 95% CI [-1.07, 0.79]).The findings demonstrate that when compared to placebo, at least 42 days of vitamin C prophylaxis is associated with prevention of CRPS-I following wrist, ankle, and foot fractures, irrespective of vitamin C dosage or fracture type. No significant differences were found with secondary outcomes.

To investigate association between keratoconus and allergic eye diseases, eye rubbing, and atopy.PubMed, Web of Science, Scopus, and Cochrane were searched for relevant published studies from inception to April 2021 without restrictions or filters. We included case-control, cohort, and cross-sectional studies that investigated eye allergy, atopy, or eye rubbing as possible risk factors for KC. Two authors independently screened all titles and abstracts against predefined inclusion and exclusion criteria. This study analysed keratoconus prevalence and risk factors including eye rubbing, family history of keratoconus, atopy, and allergic eye diseases. The National Institute of Health Study Quality Assessment tool was utilised. Pooled data were presented as odds ratio (OR) and 95% confidence intervals (CI). Analysis was conducted using RevMan version 5.3 software.Out of 573 articles, we excluded 161 duplicates than 361 articles by title and abstract screening. The remaining 51 articles underwent full-text screening, and 29 articles were excluded. Twenty-one studies were included in the qualitative synthesis and fifteen for quantitative synthesis. There was no significant association found between KC and allergic eye diseases (OR = 1.03, 95% CI [0.96, 1.11], p = 0.45), eye rubbing (OR = 1.59, 95% CI [0.70, 3.63], p = 0.27), or atopy (OR = 1.08, 95% CI [0.80, 1.44], p = 0.62).No significant association was observed between KC and allergic eye disease, eye rubbing, or atopy. Further prospective studies are needed to clarify and validate these findings.

Introduction retinal age derived from fundus images using deep learning has been verified as a novel biomarker of ageing. We aim to investigate the association between retinal age gap (retinal age–chronological age) and incident Parkinson’s disease (PD). Methods a deep learning (DL) model trained on 19,200 fundus images of 11,052 chronic disease-free participants was used to predict retinal age. Retinal age gap was generated by the trained DL model for the remaining 35,834 participants free of PD at the baseline assessment. Cox proportional hazards regression models were utilised to investigate the association between retinal age gap and incident PD. Multivariable logistic model was applied for prediction of 5-year PD risk and area under the receiver operator characteristic curves (AUC) was used to estimate the predictive value. Results a total of 35,834 participants (56.7 ± 8.04 years, 55.7% female) free of PD at baseline were included in the present analysis. After adjustment of confounding factors, 1-year increase in retinal age gap was associated with a 10% increase in risk of PD (hazard ratio [HR] = 1.10, 95% confidence interval [CI]: 1.01–1.20, P = 0.023). Compared with the lowest quartile of the retinal age gap, the risk of PD was significantly increased in the third and fourth quartiles (HR = 2.66, 95% CI: 1.13–6.22, P = 0.024; HR = 4.86, 95% CI: 1.59–14.8, P = 0.005, respectively). The predictive value of retinal age and established risk factors for 5-year PD risk were comparable (AUC = 0.708 and 0.717, P = 0.821). Conclusion retinal age gap demonstrated a potential for identifying individuals at a high risk of developing future PD.

Visual functioning evaluated by the Catquest-9SF questionnaire has shown to be a valid measure for assessing a patient's prioritization for cataract surgery. This study adapted Catquest-9SF for visual function outcomes post uni-lateral cataract surgery or bi-lateral cataract surgery.Visual functioning was assessed before and after uni-lateral or bi-lateral cataract surgery using the Catquest-9SF questionnaire. Patients were enrolled to this study prior to their cataract surgery between March 29 and April 30, 2021 at Shellharbour Hospital, Australia. Catquest-9SF questionnaires were completed prior to and 3 months post surgery. Resulting data were assessed for fit to a Rasch model using WINSTEPS software (version 4.2.0). Catquest-9SF data analysis of Chi-square, Wilcoxon sum test, and Fischer's test were performed in R (version 4.1.0). P valuelt;.05 was considered statistically significant.Sixty-one patients (mean age = 73.2 years, 62% female) were included for analysis. Catquest-9SF response thresholds, adequate precision (person separation index = 2.58, person reliability = 0.87, Cronbach's alpha = 0.74), uni-dimensionality, and no misfits (infit range 0.65-1.33; outfit range 0.64-1.31) were recorded. The mean of item calibration for patients was -0.22 post-operatively. There was significant (Plt;.05) improvement (16.3%) in visual functions across all nine Catquest 9-SF items. There was a significant mean visual function difference between patients with uni-lateral (10.1%) and bi-lateral cataract surgery (22.3%) pre-operatively and post-operatively.The Catquest-9SF questionnaire showed excellent psychometric properties and can assess visual functioning in an Australian population. There was a significant improvement in patient visual function post cataract surgery and higher functioning with bi-lateral cataract surgery.