A Community-Based Study of the Relationship Between Insulin Resistance/Beta-Cell Dysfunction and Diabetic Retinopathy Among Type II Diabetics in Kinmen,Taiwan

Purpose: To explore whether insulin resistance and beta-cell dysfunction are both related to diabetic retinopathy (DR) in type II diabetics by using a community-based study in Kinmen, Taiwan. Methods: A screening program for DR was performed by a panel of ophthalmologists who used ophthalmoscopy and 45° color retinal photographs on dilated pupils to determine a consensus grade of diabetic retinopathy. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type II diabetes. The Homeostatis Model Assessment (HOMA) method was used to determine insulin resistance and beta-cell dysfunction. Results: Seven hundred twenty-five diabetics who attended ophthalmological fundus checkups were studied. The overall response rate was 75%. After excluding 10 insulin-treated diabetics, diabetic retinopathy at first eye screening among the remaining 715 diabetics was 18.5%. Based on the multiple logistic regression, DR was found to be strongly related to both baseline insulin resistance (IR) and beta-cell dysfunction regardless of duration of diabetes. The strength of the relationships was maintained after adjustment for confounders. Those who were in the 2nd, 3rd, and 4th quartile of HOMA IR had 1.38 times (95% CI: 0.62–3.05), 2.37 times (95% CI: 1.19–4.69), and 4.16 times (95% CI: 2.15–8.06) the risk for DR compared to that in the 1st quartile, respectively. A reduced risk for DR in relation to HOMA beta-cell dysfunction for the 2nd, 3rd, and 4th quartile were 64% (95% CI: 27%–82%), 82% (95% CI: 58%–92%), and 82% (95% CI: 60%–92%) compared to that in the 1st quartile, respectively. Conclusions: Insulin resistance and beta-cell dysfunction are both associated with diabetic retinopathy in type II diabetes.     

Population-Based Study of Nonproliferative Diabetic Retinopathy Among Type 2 Diabetic Patients in Kinmen, Taiwan

Purpose

This study was conducted to assess the prevalence and associated factors of nonproliferative diabetic retinopathy among type 2 diabetic patients in Kinmen, Taiwan.

Methods

From 1991 to 1993, 971 type 2 diabetic patients in Kinmen underwent diabetic retinopathy screening performed by a panel of ophthalmologists using indirect ophthalmoscopy and 45° color fundus retinal photographs.

Results

Of the 971 patients screened in 1991–1993, 578 (59.5%) were examined for this study. Diabetic retinopathy was diagnosed in 127 patients (22.0%), including nonproliferative diabetic retinopathy in 13.3%, proliferative diabetic retinopathy in 1.4%, legal blindness in 1.4%, and ungradable diabetic retinopathy in 5.9%. Significant associated factors of nonproliferative diabetic retinopathy based on multiple logistic regression analysis were fasting plasma glucose (FPG) at baseline [≥126?mg/dl vs. <126?mg/dl; odds ratio (OR) = 2.89; 95% confidence interval (CI), 1.01–9.09], 2-h postload at baseline (≥200 vs. <200?mg/dl; OR = 1.48; 95% CI, 1.09–2.07); HbA_1c at follow-up (≥7% vs. <7%; OR = 6.54; 95% CI, 3.01–14.20), duration of diabetes (≥15 years vs. <10 years; OR = 6.72; 95% CI, 2.13–21.18), and incremental systolic blood pressure between baseline and follow-up (OR = 1.02; 95% CI, 1.00–1.04).

Conclusions

In addition to the longer duration of type 2 diabetes, FPG at baseline, poorly controlled glucose concentration, and altered blood pressure may increase the risk of nonproliferative diabetic retinopathy in type 2 diabetic patients. Jpn J Ophthalmol 2006;50:44–52 © Japanese Ophthalmological Society 2006     

Refractive Errors in Low-Income Preschoolers

Purpose: To estimate the overall prevalence of refractive errors in a study population of low-income preschoolers in San Diego County. Methods: The study sample included 507 preschool children selected from a study population of all 3–5 year-old children in Head Start and San Diego Unified School District preschools (74% Latino). The sample was examined by optometrists in the mobile clinic of the University of California, San Diego, Department of Ophthalmology with retinoscopy under cycloplegia to assess the presence of refractive errors defined as myopia ≥2D in 3–4 year-olds and ≥1D in > 4 year-olds; hyperopia ≥4D in 3–4 year-olds and ≥3D in > 4 year-olds; and astigmatism ≥1.75D in 3–4 year-olds and ≥1.5D in > 4 year-olds. Anisometropia was defined as ≥1.25D difference between the eyes. Emmetropia was defined as refractive errors below these levels. Results: A total of 16% (n = 81 children) (95% confidence interval: 15.4–16.5) met study definitions of refractive errors in at least one eye. Myopia was found in 3%, (OD Mean Sphere = 2.4D); hyperopia in 7.5% (OD Mean Sphere = 3.8D); astigmatism in 5.5% (OD Mean Cylinder = 2.3D); and 84% were emmetropic (OD Mean Sphere = 1.3D). Conclusions: Hyperopia and astigmatism were the most frequent refractive errors in this sample of low-income preschoolers, most of whom were Latino.     

Prevalence and Associated Factors of Diabetic Retinopathy among Type 2 Diabetes Mellitus Patients in Brunei Darussalam: A Cross-sectional Study

PurposeTo determine the prevalence of diabetic retinopathy (DR) and the factors associated with retinopathy among type 2 diabetes mellitus (DM) patients in Brunei Darussalam.MethodsCross-sectional study of all type 2 DM patients who attended diabetic eye screening over a 3-month period at one of four government hospitals. We assessed association between DR with the following variables: age, sex, glycated hemoglobin (HbA1c), duration of DM, hypertension, hyperlipidemia, and microalbuminuria.ResultsThere were 341 patients (female, 58.9%; mean age, 55.3 ± 11.9 years) with a mean duration of DM of 9.4 ± 7.4 years and mean serum HbA1c of 8.4% ± 1.9%. The overall prevalence of any DR was 22.6% (95% confidence interval, 18.8–27.1) with prevalence rates of 4.1% (95% confidence interval, 2.1–6.4) for proliferative DR and 9.7% (95% confidence interval, 6.8–13.2) for vision-threatening DR. Multivariate analysis showed that DR was significantly associated with certain age groups (reduced in older age groups), longer duration of DM (11 years or more), poor control (HbA1c >9.0%) and presence of any microalbuminuria.ConclusionsDR affects one in five patients with DM in Brunei Darussalam, comparable to rates reported for other Asian populations. It is especially worrying that one in ten patients with DM had vision-threatening DR. DR was significantly associated with longer duration of DM, poor control and presence of microalbuminuria but reduced in older age groups. It is important to advocate good control right from the time of diagnosis of DM and institute timely and effective management of retinopathy. DR was significantly associated with longer duration of DM, poor control of diabetes, and presence of microalbuminuria but reduced in older age groups.     

Assessing the Natural Course of Diabetic Retinopathy: A Population-Based Study in Kinmen,Taiwan

Purpose: To explore the natural course of diabetic retinopathy among type 2 diabetics using the indirect ophthalmoscope and single-field fundus photographs in Kinmen, Taiwan. Methods: A screening program for diabetic retinopathy was carried out by a panel of ophthalmologists, who employed the ophthalmoscope and 45-degree retinal color photographs to examine the fundus after pupil dilation. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type 2 diabetes. A multi-state Markov model was used to assess the natural course of diabetic retinopathy among type 2 diabetics. Results: Among the 725 diabetes patients who attended at least two ophthalmological fundus check-ups and were screened, the overall response rate was about 75%. The mean duration of the disease states mild nonproliferative diabetic retinopathy, moderate nonproliferative diabetic retinopathy, severe nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy were 4.05 [95% confidence interval (CI): 3.28–5.32], 4.18 (95% CI: 3.18–6.06), 2.52 (95% CI: 1.78–4.27), and 4.22 (95% CI: 2.88–7.81) years, respectively. Compared to controls, the incidence of blindness reduction for annual, biennial, 3-year, 4-year, and 5-year screenings of diabetic retinopathy were approximately 94.4% (95% CI: 91.6%–96.3%), 83.9% (95% CI: 83.6%–84.2%), 70.2% (95% CI: 69.8%–70.7%), 57.2% (95% CI: 56.7%–57.7%), and 45.6% (95% CI: 45.0%–46.1%), respectively. Conclusions: In conclusion, the average time for the development of diabetic retinopathy from nonexistence to blindness was approximately 26.5 years. The present recommendation for annual screening in type 2 diabetics with nonproliferative diabetic retinopathy should be retained only for the mild form, not for the moderate or severe forms.     

Refractive Errors and Strabismus in Down's Syndrome in Korea

Purpose

The aims of this study were to examine the distribution of refractive errors and clinical characteristics of strabismus in Korean patients with Down''s syndrome.

Methods

A total of 41 Korean patients with Down''s syndrome were screened for strabismus and refractive errors in 2009.

Results

A total of 41 patients with an average age of 11.9 years (range, 2 to 36 years) were screened. Eighteen patients (43.9%) had strabismus. Ten (23.4%) of 18 patients exhibited esotropia and the others had intermittent exotropia. The most frequently detected type of esotropia was acquired non-accommodative esotropia, and that of exotropia was the basic type. Fifteen patients (36.6%) had hypermetropia and 20 (48.8%) had myopia. The patients with esotropia had refractive errors of +4.89 diopters (D, ±3.73) and the patients with exotropia had refractive errors of -0.31 D (±1.78). Six of ten patients with esotropia had an accommodation weakness. Twenty one patients (63.4%) had astigmatism. Eleven (28.6%) of 21 patients had anisometropia and six (14.6%) of those had clinically significant anisometropia.

Conclusions

In Korean patients with Down''s syndrome, esotropia was more common than exotropia and hypermetropia more common than myopia. Especially, Down''s syndrome patients with esotropia generally exhibit clinically significant hyperopic errors (>+3.00 D) and evidence of under-accommodation. Thus, hypermetropia and accommodation weakness could be possible factors in esotropia when it occurs in Down''s syndrome patients. Based on the results of this study, eye examinations of Down''s syndrome patients should routinely include a measure of accommodation at near distances, and bifocals should be considered for those with evidence of under-accommodation.     

Population-based study of cataract surgery among patients with type 2 diabetes in Kinmen, Taiwan

BACKGROUND: The purpose of this study was to assess the prevalence and associated factors of cataract surgery among patients with type 2 diabetes in Kinmen, Taiwan. METHODS: A community-based population survey between 1991 and 1993 identified 971 patients over the age of 30 years with type 2 diabetes. In 1999, a total of 578 patients (59.5%) with type 2 diabetes from the population were examined in an ophthalmic screening study. Two senior ophthalmologists employed slit-lamp biomicroscopy, indirect ophthalmoscopy, and retinal photographs with pupil dilatation to examine the patients' lenticular and retinal status. RESULTS: The prevalence of cataract surgery in one eye, both eyes, and any cataract surgery among patients with type 2 diabetes was 4.5%, 5.4%, and 9.9%, respectively. The prevalence of cataract surgery in women (11.3%) was not significantly higher than in men (7.7%), but there was a statistical increase with age (p = 0.001, chi2 trend test). Multiple logistic regression showed that age (OR 1.13, 95% CI 1.07-1.19) and diabetic retinopathy (OR 4.68, 95% CI 1.94-11.33) were independent factors associated with cataract surgery. INTERPRETATION: Age and diabetic retinopathy were associated with prevalence of cataract surgery among persons with type 2 diabetes.     

Prevalence and Risk Factors for Anisometropia in the Tehran Eye Study,Iran

Purpose: To determine the prevalence of anisometropia and its determinants in a population-based sample.

Methods: In a cross-sectional population-based study, stratified cluster sampling was carried out from the population of Tehran. Respondents were transferred to a clinic for an interview and ophthalmic examinations including tests for visual acuity with and without correction, cycloplegic refraction, the slit lamp examination, fundoscopy, and lensometry. Anisometropia was defined as unequal spherical equivalent cycloplegic refractions in the two eyes.

Results: Of 4565 participants, cycloplegic refraction was performed in both eyes of 3519 people. The mean age of the examinees was 31.5?±?18.0 (range, 5–86) years. The mean anisometropia was 0.34 diopter (D) (95% Confidence Interval (CI): 0.31–0.37). The prevalence rates of anisometropia more than 0.5, 1.0, 1.5 and 2.0 D were 18.5% (95% CI: 17.0–19.9), 6.7% (95% CI: 5.8–7.7), 3.8% (95% CI: 3.1–4.5) and 2.6% (95% CI: 2.1–3.1). The inter-gender difference in the prevalence of anisometropia ≥ 1.0D was not statistically significant (P?=?0.952). The prevalence of anisometropia increased after the age of 45 years. Overall, 15.7% of the examinees had anisomyopia and 4.7% had anisohypermetropia equal to or more than 1.0D. Anisometropia was more prevalent among patients with cataracts, amblyopia, and pseudophakia. The prevalence rates of spherical and cylindrical anisometropia in the studied sample were 8.0% and 7.1%, respectively.

Conclusions: The prevalence of anisometropia in the population of Tehran is beyond negligible. It showed a significant increase with age. Results also indicate that myopic patients are more likely to have anisometropia.     

Refractive Errors in Koreans: The Korea National Health and Nutrition Examination Survey 2008-2012

PurposeOur study provides epidemiologic data on the prevalence of refractive errors in all age group ≥5 years in Korea.MethodsIn 2008 to 2012, a total of 33,355 participants aged ≥5 years underwent ophthalmologic examinations. Using the right eye, myopia was defined as a spherical equivalent (SE) less than -0.5 or -1.0 diopters (D) in subjects aged 19 years and older or as an SE less than -0.75 or -1.25 D in subjects aged 5 to 18 years according to non-cycloplegic refraction. Other refractive errors were defined as follows: high myopia as an SE less than -6.0 D; hyperopia as an SE larger than +0.5 D; and astigmatism as a cylindrical error less than -1.0 D. The prevalence and risk factors of myopia were evaluated.ResultsPrevalence rates with a 95% confidence interval were determined for myopia (SE <-0.5 D, 51.9% [51.2 to 52.7]; SE <-1.0 D, 39.6% [38.8 to 40.3]), high myopia (5.0% [4.7 to 5.3]), hyperopia (13.4% [12.9 to 13.9]), and astigmatism (31.2% [30.5 to 32.0]). The prevalence of myopia demonstrated a nonlinear distribution with the highest peak between the ages of 19 and 29 years. The prevalence of hyperopia decreased with age in subjects aged 39 years or younger and then increased with age in subjects aged 40 years or older. The prevalence of astigmatism gradually increased with age. Education was associated with all refractive errors; myopia was more prevalent and hyperopia and astigmatism were less prevalent in the highly educated groups.ConclusionsIn young generations, the prevalence of myopia in Korea was much higher compared to the white or black populations in Western countries and is consistent with the high prevalence found in most other Asian countries. The overall prevalence of hyperopia was much lower compared to that of the white Western population. Age and education level were significant predictive factors associated with all kinds of refractive errors.     

Rationale and Methodology for a Community-Based Study of Diabetic Retinopathy in an Indonesian Population with Type 2 Diabetes Mellitus: The Jogjakarta Eye Diabetic Study in the Community

Purpose: There are no available data about diabetic retinopathy (DR) in the Indonesian population. This report summarizes the rationale and study design of the Jogjakarta Eye Diabetic Study in the Community (JOGED.COM), a community-based study to estimate the prevalence and risk factors of DR in persons with type 2 diabetes in Jogjakarta, Indonesia.

Methods: The JOGED.COM aimed to examine a cross-sectional sample of 1200 persons with type 2 diabetes aged 30 years and older residing in the study area. We identified 121 community health centers (CHCs) in Jogjakarta and listed 35 CHCs with non-communicable diseases facilities. Multi-stage, clustered random sampling was used to select 22 CHCs randomly. We included CHCs with coverage population >30,000, and excluded those classified as 100% rural. Lists of persons with diabetes confirmed by their family physician were provided from each CHC. Examinations procedures included detailed interviews, general and eye examinations, anthropometry and body composition scan, and dilated fundus photography.

Results: We collaborated with local health authorities, family physicians, and local health practitioners in the recruitment phase. A total of 1435 invitations were distributed, and 1184 people (82.5%) with type 2 diabetes participated in this study, of whom 1138 (79.3%) had completed data with gradable retinal images.

Conclusions: JOGED.COM is the first epidemiologic study of DR in an Indonesian population. This study will provide key information about the prevalence and risk factors of DR in the community. These data are very important for future health promotion programs to reduce the burden of DR in the population.     

广州市荔湾区学龄儿童屈光不正患病率的现况调查

目的 探讨广州市荔湾区5～15岁儿童的屈光不正患病率情况.方法 采用人群为基础的横断面调查方法.在2002年10月至2003年1月期间,中山大学巾山眼科中心对广州市荔湾区居住的全部5～15岁儿童,通过随机整群抽样和逐户登记确定样本与受检对象,在71个学校和19个社区检查点进行检查,眼部榆查包括视力、眼球运动、散瞳检影验光、自动验光、外眼、眼前段、屈光间质及眼底检查.屈光不正与儿童的年龄、性别及家长教育程度的关系采用多元回归模型进行分析.结果 在登记的5053名儿童中,实际检查4364人,受检率为86.4%.以等效球镜-0.50 D以下作为界定,近视的患病率为35.1%(95%可信区间:33.2%～36.9%),患病率从5岁的3.3%增加到15岁时的73.1%(根据检影验光);女性儿童具有较高的患病率,调整比数比为1.29(95%可信区间:1.11～1.51);以等效球镜+2.00 D以上作为界定,远视患病率为5.8%(95%可信区间:5.3%～6.3%),从5岁时16.7%减少到15岁时低于1.0%.散光(柱镜屈光度≥0.75 D)的患病率在视网膜检影法为33.6%,而在自动验光法为42.7%.Logistie回归模型显示近视与年龄(OR=1.52,95%可信区间:1.48～1.56)、女性(OR=1.29,95%可信区间:1.11～1.51)和父母教育程度(OR=1.22,95%可信区间:1.05～1.42)有关.结论 广州市荔湾区学龄儿童具有较高的近视患病率,近视已经成为重要的公共卫生问题,提高儿童屈光矫正的覆盖率和质量足当前的主要挑战.     

Comparison of the Refractive Measurements with Hand-held Autorefractometer,Table-mounted Autorefractometer and Cycloplegic Retinoscopy in Children

PurposeTo evaluate the performance of the hand-held and table-top autorefractokeratometer in measuring refractive errors by comparing them with cycloplegic retinoscopy.MethodsIncluded in the study were 112 eyes of 112 pediatric patients whose mean age was 6.78 ± 2.61 years (range, 2 to 12 years). The refractive errors of all the eyes were measured with and without cycloplegia using a hand held autorefractokeratometer (Retinomax K-plus 3), table top autorefractokeratometer (Canon RK-F1) and performing cycloplegic retinoscopy. The spherical equivalent, cylindrical axis and keratometer values were statistically compared.ResultsThe mean spherical equivalent obtained from the Retinomax K-plus 3 was significantly less hyperopic than that of Canon RK-F1 (p = 0.004) before cycloplegia. When the Bland Altman analysis was performed in comparisons of spherical equivalent values measured with the Retinomax K-plus 3, Canon RK-F1 and cycloplegic retinoscopy, it was seen that almost all of the differences between the measurements remained within the range of ±2 standard deviation. Good agreement was found between Retinomax K-plus 3 and Canon RK-F1 for the Jackson cross-cylinder values at axis 0° and 45°; keratometer values respectively.ConclusionsThe refractive error components were highly correlated between the two instruments and cycloplegic retinoscopy.     

2010年上海市宝山区小学生屈光不正和视力损伤的患病率调查

背景 流行病学调查表明,青少年视力损伤是一个全球性的公共卫生问题,其首要原因是未矫正的屈光不正,因此一定规模的流行病学调查对儿童屈光不正的矫正具有重要意义.目前尚缺乏上海市大规模儿童视力损伤和屈光不正的流行病学调查资料. 目的 调查上海市6 ～12岁小学生视力损伤与屈光不正的患病情况.方法 采用横断面调查研究设计,于2010年5月至2011年4月分层随机整群抽取上海市宝山区6所学校的4 686名小学生进行研究,眼部检查包括视力、外眼、眼前节、屈光间质、眼底和眼压检查,并记录睫状肌麻痹后电脑验光的结果和眼位.结果 实际受检学生4 594人,应答率为98.0％,接受睫状肌麻痹后验光者3 975人,占84.8％.双眼裸眼视力≤0.5者占14.4％（662/4 594）,其中343人配戴眼镜,占51.8％.所有受检者中,任一眼裸眼视力≤0.5者1 031人,占22.4％.受检的视力损伤者中屈光不正占96.9％（999/1 031）,弱视占3.6％（37/1 031）.接受睫状肌麻痹后验光的小学生中,近视、远视和散光的患病率分别为31.1％、4.3％和33.0％.公办学校的小学生近视患病率高于外来务工随迁子女学校的学生,差异有统计学意义（x2=5.46,P=0.02）.Logistic回归分析显示,年龄和女生与近视的发生及发展明显有关（年龄：OR=1.60,95％ CI：1.53 ～ 1.68,P＜0.01;女生：OR=1.33,95％CI：1.16～1.54,P＜0.01）. 结论 中国上海市小学生视力损害的主要原因是近视,应注意筛查并提高小学生屈光不正的矫正覆盖率.     

Prevalence of Granular Corneal Dystrophy Type 2 (Avellino Corneal Dystrophy) in the Korean Population

Purpose: This study investigates the prevalence of granular corneal dystrophy type 2 (GCD2; Avellino corneal dystrophy) in the Korean population.

Methods: GCD2 homozygotes were identified through a collaboration of Korean referral centers for corneal disease. The genetic status of the patients and their immediate families were verified by DNA analysis. A lower bound for the gene prevalence was calculated using a model based on the Hardy-Weinberg principle. A second population-based model was developed to correct for known underestimation in the primary model. The corrected model used population data from the 2005 Korean census and fertility rates from historical Korean census data.

Results: We identified 21 individuals homozygous for GCD2 (R124H mutation) from 16 Korean families. From this, we estimate that the overall prevalence (combining heterozygotes and homozygotes) is at least 8.25 affected persons/10,000 persons. Our corrected estimate for overall prevalence is 11.5 affected persons/10,000 persons.

Conclusion: We present the first estimate of the prevalence of GCD2. Although uncommon, the prevalence of GCD2 in Korea is greater than anticipated. We believe that our approach could potentially be applied to estimating the prevalence of other rare diseases.     

Refractive errors and cataract as causes of visual impairment in Brazil

Purpose To identify the main causes of visual impairment (VA = 0.2) within the population over 50 years of age examined in “Cataract Free Zone” projects sponsored by the University of Campinas from 1986 to 1995. Methods A retrospective review of the ophthalmic forms used for 60,404 patients examined in 74 Cataract Projects was performed. Through mass media information, adults of the target region or city were asked to self-test their vision. Patients with VA = 0.2 in the better eye were to come to a visual acuity test. Using Snellen charts, visual acuity testing was done by trained auxiliaries and medical students. The positive cases were then examined by ophthalmologists Criteria were established for the classification of the diagnoses and statistical analysis was performed. Results After the self-test of visual acuity, 60,404 patients came to have their visual acuity tested; 11,462 (18.97%) cases were considered positive and were submitted to complete eye examination; 5447 (42.7%) received spectacles for vision improvement, and 2704 (23.59%) had cataract surgery done. Other important causes of visual impairment were senile macular degeneration (5.4%) and glaucoma (4.02%). Conclusion The main causes of visual impairment were non-corrected refractive errors and senile cataract. Ophthalmic community-based campaigns to serve the older population are recommended in order to detect and treat the identified cases and to indicate possible changes in the health care system.     

糖尿病患者干眼与眼表异常的相关分析

目的 通过糖尿病患者干眼与眼表异常的相关分析,探讨多种眼表因素异常在糖尿病干眼发病中的作用.方法 收集106例乌鲁木齐市汉族2型糖尿病患者存在的干眼症状及有关的眼表因素（泪液基础分泌、泪膜稳定性、泪液性状、角膜上皮完整性）检查结果,量化后进行单因素及多因素的非条件Logistic回归分析.结果 泪膜稳定性下降（P=0.020,OR=12.268）、泪液基础分泌量减少（P=0.007,OR=5.398）与糖尿病人干眼发生呈显著正相关,具有统计学意义.结论 泪膜稳定性下降、泪液基础分泌量减少在汉族2型糖尿病患者干眼的发病中起一定作用.