Eye Diseases In China Research Articles

Demographic and lifestyle factors associated with dry eye disease in China: A cross-sectional multi-center study

PurposeAssociations were assessed between demographic/lifestyle factors and tear film breakup time (TBUT) defined dry eye disease (DED) in China. MethodsThe cross-sectional study involved 50,280 subjects (54 ± 17 y) in 217 clinics (25 provinces). Data included sleep disorders; digital screen exposure; and use of cosmetics, contact lenses, and eye drops (for asthenopia). Clinical examinations included TBUT; Schirmer I test; meibomian gland plug status. TBUT-defined DED was TBUT <10 s, with TBUT ≤5 s also considered (i.e., short TBUT-type DED), either unilateral or bilateral. ResultsTBUT-defined DED was present in 81.6 % overall. The highest rates were in those 71 years or older, living in the north, with chronic daily sleep disorder, or daily cosmetic application; or daily digital screen exposure for 5 years, contact lenses 4 h, or 3 months eye drops. Compared with those without TBUT-defined DED, those with TBUT-defined DED showed lower Schirmer I results and more severe meibomian gland plug status (each, P < 0.001). Independent risk factors of DED were: aging; living in the southwest; daily digital screen exposure ≥3 h; and occasional cosmetic use. Risk factors of DED TBUT ≤5 s were: living in the southwest; wearing contact lenses (>3 y); and using eye drops. Rates of unilateral and bilateral DED were comparable. ConclusionsDED in China is more likely in the aged and those in the north/southwest. DED rates increase with digital screen exposure, and use of cosmetics, contact lenses, or eye drops for asthenopia. Unilateral DED should be treated as promptly as bilateral.

AI telemedicine screening in ophthalmology: health economic considerations

AI telemedicine screening in ophthalmology: health economic considerations

Economic evaluation of combined population-based screening for multiple blindness-causing eye diseases in China: a cost-effectiveness analysis

More than 90% of vision impairment is avoidable. However, in China, a routine screening programme is currently unavailable in primary health care. With the dearth of economic evidence on screening programmes for multiple blindness-causing eye diseases, delivery options, and screening frequencies, we aimed to evaluate the costs and benefits of a population-based screening programme for multiple eye diseases in China. We developed a decision-analytic Markov model for a cohort of individuals aged 50 years and older with a total of 30 1-year cycles. We calculated the cost-effectiveness and cost-utility of screening programmes for multiple major blindness-causing eye diseases in China, including age-related macular degeneration, glaucoma, diabetic retinopathy, cataracts, and pathological myopia, from a societal perspective (including direct and indirect costs). We analysed rural and urban settings separately by different screening delivery options (non-telemedicine [ie, face-to-face] screening, artificial intelligence [AI] telemedicine screening, and non-AI telemedicine screening) and frequencies. We calculated incremental cost-utility ratios (ICURs) using quality-adjusted life-years and incremental cost-effectiveness ratios (ICERs) in terms of the cost per blindness year avoided. One-way deterministic and simulated probabilistic sensitivity analyses were used to assess the robustness of the main outcomes. Compared with no screening, non-telemedicine combined screening of multiple eye diseases satisfied the criterion for a highly cost-effective health intervention, with an ICUR of US$2494 (95% CI 1130 to 2716) and an ICER of $12 487 (8773 to 18 791) in rural settings. In urban areas, the ICUR was $624 (395 to 907), and the ICER was $7251 (4238 to 13 501). Non-AI telemedicine screening could result in fewer costs and greater gains in health benefits (ICUR $2326 [1064 to 2538] and ICER $11 766 [8200 to 18 000] in rural settings; ICUR $581 [368 to 864] and ICER $6920 [3926 to 13 231] in urban settings). AI telemedicine screening dominated no screening in rural settings, and in urban settings the ICUR was $244 (-315 to 1073) and the ICER was $2567 (-4111 to 15 389). Sensitivity analyses showed all results to be robust. By further comparison, annual AI telemedicine screening was the most cost-effective strategy in both rural and urban areas. Combined screening of multiple eye diseases is cost-effective in both rural and urban China. AI coupled with teleophthalmology presents an opportunity to promote equity in eye health. National Natural Science Foundation of China.

Epidemiology, health policy and public health implications of visual impairment and age-related eye diseases in mainland China.

The prevalence of visual impairment (VI) and age-related eye diseases has increased dramatically with the growing aging population in mainland China. However, there is limited comprehensive evidence on the progress of ophthalmic epidemiological research in mainland China to enhance our awareness of the prevention of eye diseases to inform public health policy. Here, we conducted a literature review of the population-based epidemiology of VI and age-related eye diseases in mainland China from the 1st of January 1946 to the 20th of October 2021. No language restrictions were applied. There was significant demographic and geographic variation in the epidemic of VI and age-related eye diseases. There are several factors known to be correlated to VI and age-related eye diseases, including age, gender, family history, lifestyle, biological factors, and environmental exposures; however, evidence relating to genetic predisposition remains unclear. In addition, posterior segment eye diseases, including age-related macular degeneration and diabetic retinopathy, are amongst the major causes of irreversible visual impairments in the senile Chinese population. There remains a significant prevention gap, with only a few individuals showing awareness and achieving optimal medical care with regards to age-related eye diseases. Multiple challenges and obstacles need to be overcome, including the accelerated aging of the Chinese population, the lack of structured care delivery in many underdeveloped regions, and unequal access to care. Despite the progress to date, there are few well-conducted multi-center population-based studies following a single protocol in mainland China, which findings can hopefully provide valuable cues for governmental decision-making and assist in addressing and halting the incidence of VI and age-related eye diseases in China.

Class-Aware Attention Network for infectious keratitis diagnosis using corneal photographs

Infectious keratitis is one of the common ophthalmic diseases and also one of the main blinding eye diseases in China, hence rapid and accurate diagnosis and treatment for infectious keratitis are urgent to prevent the progression of the disease and limit the degree of corneal injury. Unfortunately, the traditional manual diagnosis accuracy is usually unsatisfactory due to the indistinguishable visual features. In this paper, we propose a novel end-to-end fully convolutional network, named Class-Aware Attention Network (CAA-Net), for automatically diagnosing infectious keratitis (normal, viral keratitis, fungal keratitis, and bacterial keratitis) using corneal photographs. In CAA-Net, a class-aware classification module is first trained to learn class-related discriminative features using separate branches for each class. Then, the learned class-aware discriminative features are fed into the main branch and fused with other feature maps using two attention strategies to assist the final multi-class classification performance. For the experiments, we have built a new corneal photograph dataset with 1886 images from 519 patients and conducted comprehensive experiments to verify the effectiveness of our proposed method. The code is available at https://github.com/SWF-hao/CAA-Net_Pytorch.

Analysis of Drug Clinical Trials for Eye Diseases in China.

Purpose: We systematically retrospected and analyzed the general characteristics of ophthalmic drug clinical trials (CTs) registered in China from January 2014 to December 2021. Methods: Data were retrieved from the Drug Trial Registration and Information Publication Platform and then standardized and statistically classified using bibliometric analysis. Results: We identified 201 drug CTs for eye diseases, including 24 international multicenter trials. The number of drug CTs for eye diseases has considerably increased since 2017 in parallel with new policies to encourage innovation in drugs and medical devices in China. The drug types consist of biologicals (48.26%), chemicals (45.77%), and traditional Chinese medicine/natural medicines (5.97%). The main indications were age-related macular degeneration (AMD; n = 47, 23.38%), macular edema (n = 32, 15.92%), and diabetic retinopathy (n = 19, 9.45%). The trials included those in phase I (n = 67, 33.33%), phase II (n = 33, 16.42%), and phase III (n = 72, 35.82%). The phase I trials comprised 24 innovative drug treatments for AMD and 6 novel drug treatments for neuromyelitis optica spectrum disorders, with 39 biologicals and 27 chemicals. The trials mostly followed a randomized (84.08%) or masked (67.16%) design, with 90.37% of the latter being double-masked trials. Conclusion: Research and development of ophthalmic drugs have substantially increased in recent years and are influenced by regulatory policies. Among these drugs, biologicals for AMD are the most prevalent, followed by biologicals for macular edema. Randomized double-masked research designs are often used and represent high-quality evidence.

Galectin-3 Is a Crucial Immunological Disease Marker in Patients with Fungal Keratitis.

Fungal keratitis, one of the most common infectious eye diseases in China, often results in a poor prognosis due to a delayed diagnosis and the insufficiency of effective therapy. There is an urgent need to identify specific biomarkers for the disease. In this study, we screened out tear proteins in patients with fungal keratitis by microsphere-based immunoassay analysis. Levels of cytokine expression were determined in both human corneal epithelial cell models in vitro and the corneas of patients by western blot, quantitative polymerase chain reaction (qPCR), and immunofluorescence analysis. Neutrophil activation was examined by flow cytometry analysis. The relationship between the cytokine expression and neutrophils was evaluated by immunofluorescence costaining and correlation analysis. These results demonstrated that the galectin-3 expression level was increased in both cell model and patient samples at the early and late stages of fungal keratitis. The neutrophils were significantly activated during the disease course of fungal keratitis. Meanwhile, colocalization and a positive correlation between galectin-3 and neutrophils were observed, suggesting that galectin-3 may play a crucial role in the recruitment of neutrophils and immune regulation of fungal keratitis. In conclusion, galectin-3 could be a key disease marker implying a beneficial immune response in the pathogenesis of fungal keratitis, which might be a target of therapeutic strategy in the future.

Eye diseases burden in China in the past 30 years.

To investigate the national burden of eye diseases in China from 1990 to 2019. The national burden of eye diseases in China, including case numbers, prevalence rate, age-standardized prevalence rate (ASR), disability-adjusted life year (DALY), DALY rate and age-standardized DALY rate (ASD) were calculated and stratified by sex and age. The trends of eye diseases burden from 1990 to 2019 and the correlation between eye diseases burden and human development index (HDI) were analyzed. In 2019, the total case number of eye diseases in China was 0.21 billion, the ASR was 9511/10, the total number of DALY was 4.72 million, and the ASD was 247.4/10. Near vision loss caused the greatest burden, followed by refraction disorders and cataract, with ASD being 73.8/10, 70.3/10 and 59.2/10, respectively. Men had lower risks of eye diseases than women. People aged old and old had the greatest burden of eye diseases. Compared with the year 1990, the total case number increased by 134.6% and DALY by 113.0% in 2019. The ASD of all decreased by 7.5%, and was negatively correlated with national HDI. Near vision loss, refraction disorders and cataract are of heavy disease burden in China. Although the ASD of eye diseases is decreased with the development of the national socioeconomic status, the eye diseases burden in China still increased with population growth and aging.

Long-term solid fuel use and risks of major eye diseases in China: A population-based cohort study of 486,532 adults.

Over 3.5 billion individuals worldwide are exposed to household air pollution from solid fuel use. There is limited evidence from cohort studies on associations of solid fuel use with risks of major eye diseases, which cause substantial disease and economic burden globally. The China Kadoorie Biobank recruited 512,715 adults aged 30 to 79 years from 10 areas across China during 2004 to 2008. Cooking frequency and primary fuel types in the 3 most recent residences were assessed by a questionnaire. During median (IQR) 10.1 (9.2 to 11.1) years of follow-up, electronic linkages to national health insurance databases identified 4,877 incident conjunctiva disorders, 13,408 cataracts, 1,583 disorders of sclera, cornea, iris, and ciliary body (DSCIC), and 1,534 cases of glaucoma. Logistic regression yielded odds ratios (ORs) for each disease associated with long-term use of solid fuels (i.e., coal or wood) compared to clean fuels (i.e., gas or electricity) for cooking, with adjustment for age at baseline, birth cohort, sex, study area, education, occupation, alcohol intake, smoking, environmental tobacco smoke, cookstove ventilation, heating fuel exposure, body mass index, prevalent diabetes, self-reported general health, and length of recall period. After excluding participants with missing or unreliable exposure data, 486,532 participants (mean baseline age 52.0 [SD 10.7] years; 59.1% women) were analysed. Overall, 71% of participants cooked regularly throughout the recall period, of whom 48% used solid fuels consistently. Compared with clean fuel users, solid fuel users had adjusted ORs of 1.32 (1.07 to 1.37, p < 0.001) for conjunctiva disorders, 1.17 (1.08 to 1.26, p < 0.001) for cataracts, 1.35 (1.10 to 1.66, p = 0.0046) for DSCIC, and 0.95 (0.76 to 1.18, p = 0.62) for glaucoma. Switching from solid to clean fuels was associated with smaller elevated risks (over long-term clean fuel users) than nonswitching, with adjusted ORs of 1.21 (1.07 to 1.37, p < 0.001), 1.05 (0.98 to 1.12, p = 0.17), and 1.21 (0.97 to 1.50, p = 0.088) for conjunctiva disorders, cataracts, and DSCIC, respectively. The adjusted ORs for the eye diseases were broadly similar in solid fuel users regardless of ventilation status. The main limitations of this study include the lack of baseline eye disease assessment, the use of self-reported cooking frequency and fuel types for exposure assessment, the risk of bias from delayed diagnosis (particularly for cataracts), and potential residual confounding from unmeasured factors (e.g., sunlight exposure). Among Chinese adults, long-term solid fuel use for cooking was associated with higher risks of not only conjunctiva disorders but also cataracts and other more severe eye diseases. Switching to clean fuels appeared to mitigate the risks, underscoring the global health importance of promoting universal access to clean fuels.

Chinese expert consensus on surgical treatment of primary glaucoma with cataract (2021)

Primary glaucoma with cataract is a common eye disease in China, and surgery is the main treatment. With the continuous advance of medical technology, the choice of surgical methods is controversial, and there is still a lack of consensus with general guiding significance in China. In order to standardize the clinical treatment, Chinese Glaucoma Society has formulated this consensus after a serious discussion. This consensus is aiming at guiding clinical practice and putting forward instructive opinions on the operation methods, perioperative and follow-up management of different types and stages of primary glaucoma with cataract surgery indications. (Chin J Ophthalmol, 2021, 57:166-170).

Strengthening basic and clinical research on ocular infection caused by coronavirus

This article was published ahead of print on the official website of Chinese Jounal of Ophthalmology on February 19, 2020. The prevention and treatment of coronavirus disease 2019 (COVID-2019) has reached the critical stage in China. Ocular surface represents a possible route for infection. Based on the previous studies and our own research, we summarize the potential transmission route and clinical symptoms of COVID-2019 in the eye, as well as the further prevention and research, with the expectation of contributing to the development in the field of infectious eye disease in China. (Chin J Ophthalmol, 2020, 56:250-252).

The development history of CAPOS and the diagnosis and treatment of pediatric eye diseases in China since 1949

On the occasion of the 70(th) anniversary of the founding of Chinese Journal of Ophthalmology, we review the establishment and development of Chinese Association for Pediatric Ophthalmology and Strabismus (CAPOS) and the major advances in the diagnosis and treatment of pediatric eye diseases in China since 1949, so as to remember our predecessors and inspire young generations, and to provide important reference for the future clinical and scientific research. (Chin J Ophthalmol, 2020, 56:161-165).

Prediction of Myopia in Adolescents through Machine Learning Methods.

According to literature, myopia has become the second most common eye disease in China, and the incidence of myopia is increasing year by year, and showing a trend of younger age. Previous researches have shown that the occurrence of myopia is mainly determined by poor eye habits, including reading and writing posture, eye length, and so on, and parents’ heredity. In order to better prevent myopia in adolescents, this paper studies the influence of related factors on myopia incidence in adolescents based on machine learning method. A feature selection method based on both univariate correlation analysis and multivariate correlation analysis is used to better construct a feature sub-set for model training. A method based on GBRT is provided to help fill in missing items in the original data. The prediction model is built based on SVM model. Data transformation has been used to improve the prediction accuracy. Results show that our method could achieve reasonable performance and accuracy.

Burden of visual impairment associated with eye diseases: exploratory survey of 298 Chinese patients

ObjectivesTo explore the economic burden, prevalence of catastrophic healthcare expenditure (CHE) and the quality of life (QoL) of Chinese patients with visual impairment (VI) associated with eye diseases.DesignA questionnaire survey...

RPE65 mutation frequency and phenotypic variation according to exome sequencing in a tertiary centre for genetic eye diseases in China.

PurposeRetinoid isomerohydrolase RPE65 has received a tremendous amount of attention due to successful clinical gene therapy for Leber congenital amaurosis (LCA) cases caused by RPE65 mutations. This study aimed to evaluate the frequency of RPE65 mutations and the associated phenotypes based on exome sequencing.Methods RPE65 variants were collected from exome sequencing data obtained from 2133 probands with different forms of hereditary retinal degeneration (HRD). Clinical data were collected from probands with homozygous or compound heterozygous variants in RPE65. Associated phenotypes were characterized based on clinical data.ResultsBiallelic RPE65 mutations were detected in 18 families, including eight with LCA, five with early‐onset retinal degeneration, four with fundus albipunctatus‐like (FA‐like) changes and one with high hyperopia. These cases accounted for approximately 3.0% (8/269) of LCA and 0.8% (18/2133) of HRD cases. An almost identical FA‐like change was identified in seven patients from four unrelated families with RPE65 mutations. Classification of mutations suggested that FA‐like changes may be associated with biallelic missense mutations in RPE65.ConclusionFundus albipunctatus‐like (FA‐like) change, a common characteristic fundus sign in RPE65 biallelic mutations, was unexpected but was confirmed by the finding that affected siblings from different families exhibited similar phenotypes. These results enrich our understanding of RPE65 mutation frequencies and their associated phenotypic variants.

Focusing on the methodology shift in epidemiological study of eye diseases

As chronic diseases gradually become the primary threat to the health of Chinese population and the rapid increase in the need of high eye health quality, the population-based epidemiological study of eye disease in China should be conducted in the following mode: large-scale, multicenter, and prospective cohort studies in different gender, age, ethnicity and living habits population, with new analytical models similar to generalized linear and nonlinear mixed effects to better analyze the interaction between environmental causes and individual internal factors.The systematic epidemiology and spatial epidemiology concepts are suggested to be included in eye research, in order to deconstruct the cause of eye disease diversification.All these facilitate precision prediction, diagnosis and treatment of individual patient. Key words: Epidemiology; Population; Cohort studies; Statistics; Precision medicine; Evidence-based medicine

Burden of vision loss associated with eye disease in China 1990–2020: findings from the Global Burden of Disease Study 2015

AimsTo assess the burden of vision loss due to eye disease in China between 1990 and 2015, and to predict the burden in 2020.MethodsData from the GBD 2015 (Global Burden...

Excessive medical problems in the treatment of common eye diseases in children

In this paper, some typical excessive medical problems in the treatment of common eye diseases in children were listed as follows: unnecessary examinations carried out for children with little or no corresponding complaints; prescription for spectacles for physiological hyperopia or astigmatism in children; over-diagnosis, over-or nonstandard-treatment for amblyopia; strabismus surgeries performed in children with esotropia but without full optical correction of hyperopic refractive error, in children with monocular strabismus and amblyopia but without standard cover therapy, in children with intermittent exotropia but without optical correction of myopic refractive errors and myopic anisometropia, and without evaluation of their fusional control ability; exaggerated the harm of myopia and the curative effect of Orthokeratology contact lenses without considering the patient's compliance; cataract surgery performed in infants with partial opacity of the lens that has little effect on the vision. Every ophthalmologist should work based on evidence-based preferred practice pattern, professional standards and expert consensus to promote the standardization of the diagnosis and treatment of children's common eye diseases in China. (Chin J Ophthalmol, 2016, 52: 561-564).

Pathogenesis and treatment of overwhelming inflammation induced by Pseudomonas aeruginosa keratitis in rabbit

Background Infectious keratitis is common blinding eye disease in China. Inflammatory runaway reaction often occurs in infectious keratitis, and its mechanism and treating approach are worthy of research. Objective This study was to investigate the clinical manifestation, mechanism and treatment outcome of doxycycline in overwhelming inflammation induced by Pseudomonas aeruginosa keratitis. Methods Pseudomonas aeruginosa suspension was intrastromal injected in 60 right eyes of 60 New Zealand white rabbits, and gatifloxacin eye drops was frequent instilled for consecutive 3 days to establish corneal inflammatory runaway reaction models, and 42 eyes with worse keratitis were defined as overwhelming inflammation. Then the models were randomly divided into gatifloxacin treatment group (15 rabbits), combined treatment group (gatifloxacin with doxycycline treatment, 15 rabbits) and balance salt solution (BSS) control group (12 rabbits), and corresponding eye drops was topically administered in the rabbits 8 times per day for 14 days. The symptoms of the models were observed under the slit lamp microscope on day 1, 3, 7 and 14 after treatment, and the corneal infiltration area was calculated. The corneal morphology was examined by using hematoxylin-eosin staining. The expressions of matrix metalloproteinase-2 (MMP-2) and MMP-9 in the corneal tissue were examined by immunohistochemistry. The contents of tumor necrosis factor α (TNF-α) and interleukin-1β (IL-1β) in corneal homogenate were detected by ELISA. The use and care of the animals complied with the ARVO Statement. Results The inflammatory scores were lower and infiltration area of cornea was smaller 7 days after treatment than those before treatment in the combined treatment group and gatifloxacin treatment group (both at P<0.05). Hematoxylin-eosin staining result showed that the inflammation response of cornea subsided 14 days in comparison with 5 days after treatment in the combined treatment group, with the proliferation and rearrangement of fiberal tissue. The MMP-2 and MMP-9 were strongly expressed in corneal tissue with overwhelming inflammation in day 5 after treatment, however, the expression intensity weakened in 14 days after treatment in the combined treatment, showing significant differences in the absorbance between them (all at P<0.05). ELISA assay showed that the contents of TNF-α and IL-1β in corneal tissue were significantly lower in the combined treatment group than those in the BSS group (P=0.00, 0.03). In addition, contents of TNF-α and IL-1β in corneal tissue were significantly declined at day 14 in comparison with day 5 and day 7 after treatment in the combined treatment group (all at P<0.05). Conclusions Overwhelming inflammatory keratitis models can be successfully established by corneal intrastromal injection of Pseudomonas aeruginosa suspension and immediately frequent 3-day instillation of gatifloxacin eye drops in rabbits. The topical application of doxycycline plays treating effect on overwhelming inflammatory keratitis by inhibiting the release of pro-inflammatory cytokines and MMPs. Key words: [Key words] Infectious eye disease, corneal; Bacteria; Pseudomonas aeruginosa; Antibacterial agents; Overwhelming inflammation; Keratitis/drug therapy; Doxycycline; Disease models, animal; Rabbits

Meibomian Gland Dropout in Patients with Dry Eye Disease in China

Purpose: To examine the morphological changes in the meibomian glands of eyes of patients with dry eye disease using the non-contact infrared meibography system and to assess their relationship with meibomian dropout, signs, and tear-film function.Methods: Subjects included 264 randomly selected patients (528 eyes) suffering from dry eye disease (95 males, 169 females; age range, 7–85 years; mean male age, 39.83 ± 19.17 years; mean female age, 46.16 ± 17.38 years). Tear-film break-up time (BUT) was measured and tear-film production was evaluated by the Schirmer test I (SIT). Subjective symptoms were also scored. The upper and lower eyelids were turned over, and the meibomian glands were observed using the non-contact meibography system. Partial or complete loss of the meibomian glands (meibomian dropout) was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area was >2/3 of the total meibomian gland area).Results: The average SIT result was 6.71 ± 6.13 mm (range 0–30 mm) and that for BUT was 3.13 ± 2.39 s (range 0–10 s). The average fluorescein staining score was 4.25 ± 4.05 (range 0–12). In addition, the mean meibomian gland photographic score was 4.35 ± 1.39. The correlation between the meibomian gland photographic scores and various ocular surface examinations were evaluated using Kendall’s correlation. SIT and BUT were significantly negatively correlated with the meibomian gland photographic score, whereas corneal fluorescein staining was positively correlated.Conclusions: The results suggest a large proportion of meibomian dropout cases among patients with dry eye disease, indicating that treatment targeted at the meibomian gland will become an important direction for treating dry eye disease. Meibography is recommended as a routine test for dry eye disease.