Glaucoma In China Research Articles

Xiaoqing: A Q&A model for glaucoma based on LLMs

Glaucoma is one of the leading cause of blindness worldwide. Individuals affected by glaucoma, including patients and their family members, frequently encounter a deficit in dependable support beyond the confines of clinical environments. Seeking advice via the internet can be a difficult task due to the vast amount of disorganized and unstructured material available on these sites, nevertheless. This research explores how Large Language Models (LLMs) can be leveraged to better serve medical research and benefit glaucoma patients. We introduce Xiaoqing, a Natural Language Processing (NLP) model specifically tailored for the glaucoma field, detailing its development and deployment. To evaluate its effectiveness, we conducted two forms of experiments: comparative and experiential. In the comparative analysis, we presented 22 glaucoma-related questions in simplified Chinese to three medical NLP models (Xiaoqing LLMs, HuaTuo, Ivy GPT) and two general models (ChatGPT-3.5 and ChatGPT-4), covering a range of topics from basic glaucoma knowledge to treatment, surgery, research, management standards, and patient lifestyle. Responses were assessed for informativeness and readability. The experiential experiment involved glaucoma patients and non-patients interacting with Xiaoqing, collecting and analyzing their questions and feedback on the same criteria. The findings demonstrated that Xiaoqing notably outperformed the other models in terms of informativeness and readability, suggesting that Xiaoqing is a significant advancement in the management and treatment of glaucoma in China. We also provide a Web-based version of Xiaoqing, allowing readers to directly experience its functionality. The Web-based Xiaoqing is available at https://qa.glaucoma-assistant.com//qa.

What can we learn from a Chinese social media used by glaucoma patients?

PurposeOur study aims to discuss glaucoma patients’ needs and Internet habits using big data analysis and Natural Language Processing (NLP) based on deep learning (DL).MethodsIn this retrospective study, we used web crawler technology to crawl glaucoma-related topic posts from the glaucoma bar of Baidu Tieba, China. According to the contents of topic posts, we classified them into posts with seeking medical advice and without seeking medical advice (social support, expressing emotions, sharing knowledge, and others). Word Cloud and frequency statistics were used to analyze the contents and visualize the keywords of topic posts. Two DL models, Bidirectional Long Short-Term Memory (Bi-LSTM) and Bidirectional Encoder Representations from Transformers (BERT), were trained to identify the posts seeking medical advice. The evaluation matrices included: accuracy, F1 value, and the area under the ROC curve (AUC).ResultsA total of 10,892 topic posts were included, among them, most were seeking medical advice (N = 7071, 64.91%), and seeking advice regarding symptoms or examination (N = 4913, 45.11%) dominated the majority. The following were searching for social support (N = 2362, 21.69%), expressing emotions (N = 497, 4.56%), and sharing knowledge (N = 527, 4.84%) in sequence. The word cloud analysis results showed that ocular pressure, visual field, examination, and operation were the most frequent words. The accuracy, F1 score, and AUC were 0.891, 0.891, and 0.931 for the BERT model, 0.82, 0.821, and 0.890 for the Bi-LSTM model.ConclusionSocial media can help enhance the patient-doctor relationship by providing patients’ concerns and cognition about glaucoma in China. NLP can be a powerful tool to reflect patients’ focus on diseases. DL models performed well in classifying Chinese medical-related texts, which could play an important role in public health monitoring.

Factors Influencing Participation in Shared Decision-Making Among Patients with Glaucoma in China: A Cross-Sectional Study.

To explore the level of participation in shared decision-making by patients with glaucoma and identify influencing factors, to subsequently provide references to promote shared decision-making in ophthalmology, and achieve patient-centered care. A questionnaire was completed by 148 patients with glaucoma who had been admitted to a specialized ophthalmic hospital in China, between October 2021 and January 2022. The participants' responses to the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) and a general information survey were analyzed to determine their level of participation in shared decision-making and influencing factors. Multiple linear regression was used to identify factors that influence shared decision-making at the time of clinical practice. The mean score of SDM-Q-9 was 71.73±21.27 (n=140). Multiple linear regression analysis showed that patients with negative attitudes towards participation in decision-making (P=0.023) and those who had rural insurance (P=0.017) had significantly lower SDM-Q-9 scores than those with positive attitudes and those with medical insurance. Patients who were more satisfied with their medical service had higher SDM-Q-9 scores (P<0.05). Patients with glaucoma presented a high level of shared decision-making. Patients' attitudes towards participating in decision-making, the payment method of medical expenses, and the level of satisfaction with medical services are factors that influence their level of participation in shared decision-making.

Association between Serum Total Bilirubin Level and Patients with Primary Open-Angle Glaucoma in China: A Cross-Sectional, Case-Control Study.

To investigate the relationship between peripheral blood total bilirubin (TBIL) levels and the risk of primary open-angle glaucoma (POAG). This study was a cross-sectional, case-control study design. Between April 2021 and January 2022, 198 POAG patients and 205 healthy subjects were recruited from the EENT Hospital of Fudan University. Their clinical information (intraocular pressure, central corneal thickness, vertical cup-disk ratios (VCDR), and axial length) and demographic data were collected. Serum levels of TBIL were measured in enzymes using a Roche C702 biochemical analyzer. The POAG subgroups were classified by gender and VCDR: mild (VCDR ≤ 0.64), moderate (VCDR ≤ 0.85), and severe (VCDR > 0.85). Univariate and multivariate logistic regression analyses were performed. The level of TBIL (11.58 ± 5.16 μmol/L) in the POAG group was higher than that in the control group (10.18 ± 3.38 μmol/L; p < 0.05). In the male subgroup, TBIL was also significantly higher than in the normal control group; TBIL levels were lower in the mild subgroup (10.82 ± 4.48 μmol/L), followed by the moderate subgroup (12.00 ± 5.55 μmol/L) and the severe subgroup (14.47 ± 5.45 μmol/L). The results of the multivariate logistic regression analysis showed that high TBIL levels were a risk factor for male POAG, at 1.126 (95% CI 1.009-1.256). Pearson's analysis revealed that TBIL was positively correlated with intraocular pressure (r = 0.134, p = 0.012), VCDR (r = 0.142, p = 0.046), anterior chamber depth (r = 0.190, p = 0.014), and axial length (r = 0.179, p = 0.019) in the patients. However, no statistical difference (p < 0.05) was observed in the female patients with POAG. The results showed that high levels of TBIL may be related to the pathogenesis of POAG and that the severity of the disease is positively correlated, especially in male patients.

A Meta-Analysis: Safety and Efficacy of Phacoemulsification with Goniosynechialysis versus Trabeculectomy for Acute Angle Closure Glaucoma in China

A Meta-Analysis: Safety and Efficacy of Phacoemulsification with Goniosynechialysis versus Trabeculectomy for Acute Angle Closure Glaucoma in China

Prevalence and Risk Factors of Glaucoma Among Chinese People From the China Health and Retirement Longitudinal Study.

This study demonstrated the prevalence of self-reported glaucoma and its strong association with preexisting systemic chronic diseases in China using the baseline data from China Health and Retirement Longitudinal Study (CHARLS), a nationwide population-based cohort. The purpose of this study is to estimate the prevalence of self-reported glaucoma and its risk factors using data from the CHARLS. Data on age, sex, area of residence, education, marital status, health-related behaviors, and preexisting comorbidities for this cross-sectional study were retrieved from the CHARLS for 17,713 subjects who completed a questionnaire between June 2011 and March 2012. The prevalence of glaucoma was estimated, and a multivariate weighted analysis was performed to estimate the odds ratios (ORs) of its risk factors. Of 16,599 respondents (93.7%) who answered questions regarding glaucoma and their history of systemic chronic diseases, 314 (1.89%) reported having glaucoma before the index date. Qinghai and Beijing had the highest prevalence of glaucoma in China. Glaucoma was significantly associated with hypertension [OR: 1.362; 95% confidence interval (CI), 1.801-2.470], diabetes (OR: 2.597; 95% CI, 1.661-10.207), dyslipidemia (OR: 1.757; 95% CI, 1.157-3.650), lung disease (OR: 2.098; 95% CI, 1.674-6.527), stroke (OR: 5.278; 95% CI, 1.094-25.462), heart disease (OR: 1.893; 95% CI, 1.237-3.363), and health-related behaviors such as smoking and alcohol consumption after adjusting for age, sex, area, education, marital status, and medical insurance. Geographic variation in the prevalence of self-reported glaucoma and its strong association with preexisting systemic chronic diseases were observed, suggesting that in addition to ophthalmological examinations, regular physical examinations are necessary for glaucoma patients, especially in areas of high incidence. Appropriate strategies to improve preventive measures for glaucoma are recommended for the Chinese population.

Glaucoma in rural China (the Rural Epidemiology for Glaucoma in China (REG-China)): a national cross-sectional study

ObjectiveThis study aimed to investigate the prevalence of glaucoma with associated factors in the rural populations of 10 provinces in China.DesignA population-based cross-sectional study.MethodsAll participants aged 6 years or older...

Disease Burden of Glaucoma in China: Findings from the Global Burden of Disease 2019 Study

PurposeTo provide evidence for future strategies in preventing glaucomatous blindness by investigating the disease burden in terms of age, year, and gender from 1990 to 2019 in China.MethodsThe prevalence and disability-adjusted life years (DALYs) of blindness and vision loss due to glaucoma in China were extracted from the Global Burden of Disease (GBD) 2019 study. Age-standardized data is presented in comparison to China’s neighboring countries.ResultsFrom 1990 to 2019, the prevalent cases and DALYs number with glaucomatous blindness and vision loss increased by 129.53% and 67.29%, respectively. Overall, higher age-standardized prevalence and DALYs rate were detected in males than in females between 1990 and 2019, and people aged 60 to 89 years suffered from a higher DALY number than other age groups in 2019. Among the neighboring countries, China ranked from fourth in 1990 (88.52, 95% uncertainty interval [UI]: 74.62 to 103.24, per 100,000 population) to third in 2019 (71.14, 95% UI: 59.34 to 84.42, per 100,000 population) in age-standardized prevalence while from fourth in 1990 (10.13, 95% UI: 6.68 to 14.46, per 100,000 population) to sixth in 2019 (5.98, 95% UI: 4.14 to 8.42, per 100,000 population) in age-standardized DALYs. Compared with other GBD regions, the largest decrease in age-standardized DALY rate due to glaucoma was found in China (−40.87%, 95% UI: −43.97% to −37.82%). A higher percentage decrease in age-standardized prevalence was also found in China (−19.66%, 95% UI: −22.44% to −17.09%).ConclusionSubstantial increases in the prevalence of visual impairment and DALYs number of glaucoma were observed from 1990 to 2019. Efforts targeting glaucoma prevention and treatment in China are urgently required, especially for the elderly population and men.

Biometric indicators of anterior segment parameters before and after laser peripheral iridotomy by swept-source optical coherent tomography

BackgroundPrimary angle closure glaucoma (PACG) is the most common type of glaucoma in China. Laser peripheral iridotomy (LPI) is the primary choice to treat PAC: We aim to evaluate the changes of biometric parameters of anterior segment and to find possible biometric predictors of the effect of laser peripheral iridotomy (LPI) in primary angle closure (PAC) eyes using swept-source optical coherent tomography (OCT).MethodsLPI was performed in 52 PAC eyes of 28 participants. The change of intraocular pressure and anterior segment parameters, including angle opening distance (AOD500), AOD500 area, trabecular iris space area (TISA500), TISA500 volume, trabecular iris angle (TIA500), iridotrabecular contact (ITC) index, ITC area, anterior chamber volume (ACV), anterior chamber depth (ACD), lens vault (LV) and lens thickness (LT) before and 1 week after LPI were measured by Tomey CASIA2 anterior segment OCT. We also estimate and analyze potential associated factors possibly affecting the change of anterior chamber parameters.ResultsNo post-laser complications were found. The ACD, LV and LT did not change significantly 1 week after LPI. AOD500, AOD500 area, TISA500, TISA500 volume, TIA500, ACV increased significantly after LPI. There was significant decrease in ITC index and ITC area. LT was positively correlated to the change of ITC index (β = 0.239, *p = 0.045).ConclusionsThe anterior segment architecture significantly changed after LPI in PAC spectrum eyes. Crystalline lens measurements remained unchanged before and after LPI. AS-OCT can be used to follow anterior chamber parameter changes in PAC spectrum eyes. LT may play a role in the therapeutic effect of LPI.

Long-Term Visual Outcomes of Primary Congenital Glaucoma in China

Introduction: The aim of this study was to investigate the long-term visual outcomes and factors associated with vision loss in Chinese patients with primary congenital glaucoma (PCG) after successful intraocular pressure (IOP) control (IOP ≤21 mm Hg). Methods: PCG patients with IOP control who were examined in the glaucoma clinic at Zhongshan Ophthalmic Center from 2019 to 2020 were enrolled. The final visual outcome was evaluated by the best corrected visual acuity (VA). Univariate and multivariate analyses were used to investigate the associations of visual impairment with potential risk factors. The causes for decreased VA (<20/50) were also analyzed. Results: Fifty-nine patients (95 eyes) were included in the cohort, with a mean age of 8.7 years. The mean logMAR VA was 0.62 ± 0.64. The VAs of eyes treated for PCG were good (≥20/50) in 56%, fair (20/60–20/200) in 30%, and poor (<20/200) in 14%. The most common cause of decreased VA was amblyopia (64.3%). Multivariate logistic regression analysis showed that undergoing multiple surgeries (OR: 4.86, 95% CI: 1.11–21.16, p = 0.035) was significantly associated with visual impairment. Conclusion: The results showed that good VA was attainable in approximately half of PCG eyes under IOP control. Prompt and effective treatment of PCG, management of amblyopia and ocular comorbidities may be potential steps toward achieving good visual outcomes in PCG patients.

Design and Methodology of a Multi-Centre Clinical Trial of Low Dose Laser Cycloplasty for the Treatment of Malignant Glaucoma in China

ABSTRACT Purpose To summarize the design and methodology of a trial designed to evaluate the efficacy and safety of low dose laser cycloplasty (LCP) in treating malignant glaucoma. Methods Prospective, multicentre, non-controlled clinical trial. Subjects were recruited from eight ophthalmic centers in China. The target sample size was 34. Patients aged >18 years with a clinical diagnosis of malignant glaucoma inadequately controlled on medical therapy or malignant glaucoma recurrence after topical cycloplegics withdrawal were enrolled. All patients underwent LCP under retrobulbar anesthesia or sub-Tenon anesthesia. LCP is a treatment adopting few laser points (1100–2000 mW energy, 2000 milliseconds duration) that cauterizes and remodels the ciliary body over two clock hour-positions, which may relieve the ciliary ring block. Follow-up is planned for a period of 12 months. The primary outcome is the resolution of malignant glaucoma which is defined as central anterior chamber deepening after LCP. Conclusion The Malignant Glaucoma Treatment trial (MGTT) will be the first prospective trial providing evidence of a treatment for malignant glaucoma. It intends to provide clinicians an optional, easy and convenient treatment for malignant glaucoma patients. Detailed morphological and biometric information collected during the study period will also help provide experience for the outcomes of malignant glaucoma. Trial registration number ChiCTR1800017960.

The Profile of Secondary Glaucoma in China: A Study of Over 10,000 Patients.

Few studies have investigated the epidemiology of secondary glaucoma (SG) in China. This study analyzed the current profile of admitted patients with SG at the largest ophthalmic center in China. SG cases were retrieved retrospectively by International Classification of Disease-10 clinical coding data from January 2010 to December 2019. Demographic data, etiologies, and the management of SG were analyzed. The ratios of the etiologies were compared with previously reported data from other regions. The etiologies and management between the 2010 to 2014 group and the 2015 to 2019 group were compared. A total of 11,730 cases were enrolled. The mean age of the patients with SG was 44.45±19.45 years old. Men (66.94%) were more vulnerable than women (33.06%). The etiologies of SG in 2010 to 2019 were trauma (28%), vascular disease (18%), lens-induced (9%), inflammation (11%), drug-induced (2%), anterior segment surgery (7%), posterior segment surgery (11%), syndrome-associated (4%), and tumors (1%). Compared with other regions, our data have a higher proportion of trauma and vascular disease-associated SG. Compared with 2010 to 2014, trauma-induced SG declined, and drug-induced SG, anterior segment surgery, and syndrome-associated SG increased in 2015 to 2019 (P<0.001). Vascular disease-associated SG cases were older than trauma-induced SCs and had a higher percentage in retired patients (P<0.001), whereas trauma-induced SGs were more prevalent in pediatric patients than vascular disease-related SGs (P<0.001). In addition, the application of drainage device implantation, cataract surgery, and cyclophotocoagulation increased, whereas trabeculectomy and anterior chamber paracentesis and cyclocryotherapy decreased in 2015 to 2019 (P<0.005). Although the etiology spectrum has changed during the last 10 years, trauma and vascular disease are still common causes of SG in southern China. Traditional antiglaucoma surgery decreased gradually, and more advanced treatments emerged for its treatment. Up-to-date knowledge of SGs reflects the impact of economic development and ophthalmic service improvement on SGs and is of great value for ophthalmologists to detect SGs early and manage them in a timely manner.

Association between long-term exposure to fine particulate matter and diabetic retinopathy among diabetic patients: A national cross-sectional study in China

BackgroundWhile the relationship between ambient air pollution and diabetes mellitus has recently been reported, data on the association between fine particulate matter (PM2.5) and diabetic complications are limited, especially in microvascular diseases such as diabetic retinopathy. ObjectivesTo investigate the associations between long-term exposure to PM2.5 and the prevalence of diabetic retinopathy in adult diabetic patients in rural China. MethodsThe study population was based on the Rural Epidemiology for Glaucoma in China (REG-China), a national cross-sectional survey conducted in rural China. This analysis selected diabetic patients with or without diabetic retinopathy. A satellite-based spatiotemporal model was used to estimate personal PM2.5 exposure. Logistic regression models were used to investigate the effect of long-term PM2.5 exposure on diabetic retinopathy. ResultsThe analysis included 3111 diabetic participants, 329 of whom were diagnosed with diabetic retinopathy. The median level of exposure to PM2.5 from 2000 to2016 was 59.9 μg/m3. For each 10 μg/m3 increase in PM2.5, the adjusted odds ratio (95% confidence interval) for diabetic retinopathy was 1.41 (1.27, 1.57). In subgroup analyses, the effect of PM2.5 on diabetic retinopathy was significantly stronger in participants who self-reported alcohol consumption. ConclusionThese findings suggest that long-term exposure to high PM2.5 was associated with the risk of diabetic retinopathy among diabetic patients in rural China.

Study of the Association between Helicobacter Pylori Infection and Primary open angle Glaucoma in China

Study of the Association between Helicobacter Pylori Infection and Primary open angle Glaucoma in China

Paying attention to the promotion and evaluation of Chinese Glaucoma Guidelines (2020) after their release

Glaucoma is the leading cause of irreversible blindness worldwide. The Chinese Glaucoma Guidelines (2020) formulated important references and suggestions for the treatment of glaucoma, based on the basic national condition of China and considering the latest global progress. To fulfill their guiding effect on clinical work, publicity and promotion of the Guidelines should be intensified to prompt the communication and application. The ophthalmology specialists should pay attention to the quality assessment and reevaluation of the Guidelines regarding their reliability and applicability in clinical work, and promote the evidence-based practice of glaucoma. Continuous feedbacks from clinical practice would enable timely updates and improvement of the Guidelines, thus building a better evidence ecosystem and constantly optimizing the diagnosis and treatment of glaucoma in China. (Chin J Ophthalmol, 2021, 57:161-165).

Association Between Serum Lipid Levels and Patients With Primary Angle-Closure Glaucoma in China: A Cross Sectional, Case–Control Study

Objective: To evaluate the serum lipid levels of patients with primary angle-closure glaucoma (PACG) and to investigate the relationship between serum lipid levels and PACG.Methods: In this cross-sectional, case–control study, a total of 320 PACG subjects and 242 age- and sex-matched control subjects were recruited. Serum high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (SDLDL-C), triglyceride (TRIG), and cholesterol (CHOL) levels were measured using enzymatic colorimetry. Serum apolipoprotein A (APOA), apolipoprotein B (APOB), apolipoprotein E (APOE), and lipoprotein(a) (LPa) levels were measured by immunoturbidimetry.Results: The serum LDL-C, TRIG, HDL-C, APOE, LPa, CHOL, APOB, and APOA levels were significantly higher (p < 0.05) in the PACG group than in the control group. Multiple liner regression analyses revealed that there was a statistically correlation between HDL-C levels and mean deviation MD (B = 0.389, P = 0.002, 95% confidence interval [CI] = −1.249 to −0.624); LDL-C levels and MD (B = 0.190, P = 0.019, 95% CI = −5.632 to −1.306); and CHOL levels and MD (B = 0.364, P = 0.27, 95% CI = −7.727 to −1.839). Logistic regression analyses showed that high serum HDL-C (odds ratio [OR] = 11.01, 95% CI = 5.616–21.587), LDL-C (OR = 1.330, 95% CI = 1.079–1.640), SDLDL-C (OR = 1.007, 95% CI = 1.005–1.008), APOA (OR = 13.621, 95% CI = 7.251–25.591), APOB (OR = 2.243, 95% CI = 1.060–4.732), LPa (OR = 0.999, 95% CI = 0.998–1.00), and CHOL (OR = 1.131, 95% CI = 1.005–1.326) levels were significantly associated with PACG.Conclusions: High serum HDL-C, LDL-C, APOA, APOB, LPa, and CHOL levels were associated with PACG.

Glaucoma diagnosis in the Chinese context: An uncertainty information-centric Bayesian deep learning model

Glaucoma, a group of eye diseases, damages individual eye health by injuring the optic nerve, and this leads to inevitable vision loss. Although the symptoms of glaucoma can be observed by experts, the procedure for doing so is still complex and time-consuming. This problem has become more acute in China than in other locations due to its high population and limited medical resources. With the development of IT and health informatics, automatic diagnosis has been found to be effective for managing the diagnosis issues with regard to glaucoma. However, one crucial yet underexplored problem is how to improve the effectiveness of automatic diagnosis by considering uncertainty and gathering key information from multimodal data, including medical indicators, images, and texts. Therefore, this study proposes a Bayesian deep multisource learning (BDMSL) model to address these problems. Specifically, multisource learning is introduced to integrate data from multiple sources, while Bayesian deep learning is adopted to obtain model uncertainty information. Based on real medical data collected from one of the best eye hospitals in China, our research results show that the BDMSL model achieves better performance than other methods in terms of glaucoma detection. With the exploration of health informatics in terms of diagnosing glaucoma in China, the proposed model can be generalized to provide health services globally.

Prevalence and Risk Factors of Glaucoma in Rural China (the Rural Epidemiology for Glaucoma in China [REG-China]): A National Cross-Sectional Study

Background: Glaucoma is the commonest cause of irreversible blindness worldwide. The Rural Epidemiology for Glaucoma in China (REG-China) was conducted to investigate the present status of glaucoma in rural China. Methods: The REG-China Study is a cross-sectional study in a nationally representative sample of population aged 6 years or older from ten provinces, autonomous regions, and municipalities in rural areas of China. All participants underwent a comprehensive eye examination, including visual acuity, intraocular pressure, slit-lamp microscopy, direct ophthalmoscopy, and further investigations. Findings: From June to October 2018, 52 041 individuals were invited to participate, of whom 48 398 were included in the final analysis. The overall prevalence of glaucoma was 1·6% (95% CI 1·52–1·77) among the population aged 6 years or older. The prevalence of all types of glaucoma in persons aged 40 years or older was 2·0% (95% CI 1·96–2·85); 58·2%, and 19·8% had primary angle-closure glaucoma (PACG) or primary open-angle glaucoma (POAG), respectively. Increasing age, marital status, history of cerebral infarction, location areas and family history of glaucoma were significant risk factors for both PACG and POAG. The overall blindness rate of glaucoma was 31·1% (95% CI 25·91%-34·82%). Those who were older, men, and divorced/separated were more likely to become blindness due to glaucoma. Interpretation: Glaucoma should be included in chronic disease-management programs in China for long-term care and continuous management of high-risk cases. Funding Statement: This research was supported by the National Natural Science Foundation of China (grant no. 81830026) and the Natural Science Foundation of Tianjin (grant no. 18ZXDBSY00030). Declaration of Interests: The authors declare there are no competing interests. Ethics Approval Statement: The study protocol was approved by the ethics review committee of Tianjin Medical University and other participating institutes. We obtained written informed consent from all study participants.

Applications of Artificial Intelligence in the Screening of Glaucoma in China

Yue Zhang, Ningli Wang and Hanruo Liu* Author Affiliations Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, China Received: April 09, 2020 | Published: April 24, 2020 Corresponding author: Hanruo Liu, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, China DOI: 10.26717/BJSTR.2020.27.004476

Rural Glaucoma in China: Present Status and Future Directions

BACKGROUND: Glaucoma is the commonest cause of irreversible blindness worldwide. Factors associated with the development of glaucoma have been examined in several studies, but not in the Chinese rural population. The China Rural Glaucoma Cohort Study (China-RG Study) was conducted to investigate the present status of glaucoma in China. METHODS: The China-RG Study is a population-based study (June–October 2018) that included 22 rural areas from ten provinces in China and enrolled 52,041 individuals (age >6 years). Participants completed a comprehensive eye examination, including visual acuity, intraocular pressure (IOP), slit-lamp microscopy, direct ophthalmoscopy, and further investigations. Associations of demographics and medical factors with glaucoma were assessed using multiple logistic regression models. Disability (YLD) and quality-adjusted life-years (QALYs) were used to express adverse health outcomes of glaucoma; cost-effectiveness analysis was conducted to evaluate the superiority of glaucoma-screening program. FINDINGS: Overall prevalence of glaucoma was 1.6% (95% CI 1.52–1.77%); 58.2%, and 19.8% had primary angle-closure glaucoma (PACG) or primary open-angle glaucoma (POAG), respectively. Increasing age, history of cerebral infarction, marital status, location, and family history of glaucoma were significant risk factors for both PACG and POAG. Cost–benefit analysis indicated savings of approximately 286,56.57 million yuan in direct medical expenses nationwide by adopting the proposed screening mode. INTERPRETATION: Glaucoma should be included in chronic disease-management programs in China for long-term care and continuous management of high-risk cases. The scope and inclusions of basic public health services should be expanded, especially to include ophthalmic diseases. FUNDING STATEMENT: This research was supported by the National Natural Science Foundation of China (grant no. 81830026) and the Natural Science Foundation of Tianjin (grant no. 18ZXDBSY00030) DECLARATION OF INTERESTS: The authors declare there are no competing interests. ETHICS APPROVAL STATEMENT: Ethics approval for study conduct was obtained from the institutional ethics committee of Tianjin Medical University General Hospital; all participants provided written informed consent prior to study participation.