Several studies have found that transplantation of neural progenitor cells(NPCs)promotes the survival of injured neurons.However,a poor integration rate and high risk of tumorigenicity after cell transplantation limit...Several studies have found that transplantation of neural progenitor cells(NPCs)promotes the survival of injured neurons.However,a poor integration rate and high risk of tumorigenicity after cell transplantation limits their clinical application.Small extracellular vesicles(sEVs)contain bioactive molecules for neuronal protection and regeneration.Previous studies have shown that stem/progenitor cell-derived sEVs can promote neuronal survival and recovery of neurological function in neurodegenerative eye diseases and other eye diseases.In this study,we intravitreally transplanted sEVs derived from human induced pluripotent stem cells(hiPSCs)and hiPSCs-differentiated NPCs(hiPSC-NPC)in a mouse model of optic nerve crush.Our results show that these intravitreally injected sEVs were ingested by retinal cells,especially those localized in the ganglion cell layer.Treatment with hiPSC-NPC-derived sEVs mitigated optic nerve crush-induced retinal ganglion cell degeneration,and regulated the retinal microenvironment by inhibiting excessive activation of microglia.Component analysis further revealed that hiPSC-NPC derived sEVs transported neuroprotective and anti-inflammatory miRNA cargos to target cells,which had protective effects on RGCs after optic nerve injury.These findings suggest that sEVs derived from hiPSC-NPC are a promising cell-free therapeutic strategy for optic neuropathy.展开更多
Objective:Evidence pertaining to the associations between hyperuricemia and diabetic microvascular complications is limited and inconclusive.In this study,we aimed to prospectively investigate the independent associat...Objective:Evidence pertaining to the associations between hyperuricemia and diabetic microvascular complications is limited and inconclusive.In this study,we aimed to prospectively investigate the independent associations of hyperuricemia and retinopathy,nephropathy and neuropathy in individuals with type 2 diabetes mellitus(T2DM).Methods:This cohort study enrolled 25,094 participants from UK Biobank with T2DM and without microvascular complications at baseline.Hyperuricemia was defined as serum uric acid(SUA)higher than 420μmol/L.The incidence of diabetic microvascular complications was identified from hospital inpatient records that were coded according to the International Classification of Diseases(ICD)-10 coding system.Multivariable adjusted Cox proportional hazards regression models were used to calculate adjusted hazard ratios(aHR).Results:Among all participants,3,844(15.3%)were classified as having hyperuricemia at baseline.During a median follow-up of 14.0 years,555(14.4%)individuals with hyperuricemia developed diabetic microvascular complications,compared with 12.6%of individuals without hyperuricemia(P=0.002).In the multivariable-adjusted model accounted for socioeconomic status,lifestyle factors,physical and biochemical measurements,and medication use,when compared with individuals of T2DM who had a normal SUA level,those with hyperuricemia had an 82.9%higher risk of developing diabetic nephropathy(95%CI:1.41-2.38,P<0.001),and a 30.2%higher risk of diabetic neuropathy(95%CI:1.06-1.60,P=0.011).However,the association between hyperuricemia and diabetic retinopathy was not statistically significant(aHR:1.070,95%CI:0.94-1.22,P=0.320).Conclusions:Hyperuricemia was independently associated with diabetic nephropathy and neuropathy but not retinopathy in individuals with T2DM.These findings underscore the importance of monitoring SUA level in prevention of certain microvascular complications.展开更多
Myopia,a common cause of visual impairment,together with the global decline in physical fitness and increasing prevalence of childhood obesity,has become a prominent global health problem.The beneficial effect of incr...Myopia,a common cause of visual impairment,together with the global decline in physical fitness and increasing prevalence of childhood obesity,has become a prominent global health problem.The beneficial effect of increasing the time of outdoor activities on the incidence of myopia and physical well-being in children has been widely recognized.However,in countries with highly competitive education systems,such as China,parents and school administrators may be reluctant to increase their children's time for extracurricular outdoor activities for fear of affecting their academic performance.Therefore,it is crucial to accurately assess the role of after-school outdoor activities in preventing and controlling myopia,as well as in promoting the physical and mental development of adolescents.Schools and families should be encouraged to collaboratively support children’s engagement in outdoor activities to foster their healthy growth.Given the dual benefits of outdoor activities-improving visual health and promoting overall physical and mental well-being-it is essential to encourage schools and families to work together to support children's engagement in such activities.By doing so,it is hoped that a balanced environment can be created,one that values both academic achievement and healthy development.Policymakers,educators,and parents must recognize the long-term advantages of integrating outdoor activities into children's daily lives,as this approach can help alleviate the burden of myopia,enhance physical fitness,and support emotional and cognitive development.Ultimately,fostering a culture that views outdoor activities as an essential component of education and health will be key to ensuring the well-rounded development of future generations.展开更多
Dear Editor,Traumatic optic neuropathy(TON)is a severe vision-threatening condition,with an incidence rate ranging from 0.7% to 2.5%[1].The limited regenerative capacity of the optic nerve and the challenges of nerve ...Dear Editor,Traumatic optic neuropathy(TON)is a severe vision-threatening condition,with an incidence rate ranging from 0.7% to 2.5%[1].The limited regenerative capacity of the optic nerve and the challenges of nerve transplantation result in substantial and irreversible visual loss in patients with TON.展开更多
AIM:To describe the clinical manifestations,imaging features and surgical treatments in 5 cases of extraocular muscle(EOM)dysplasia presenting as orbital spaceoccupying lesions(SOL).METHODS:Records from the 5 cases wi...AIM:To describe the clinical manifestations,imaging features and surgical treatments in 5 cases of extraocular muscle(EOM)dysplasia presenting as orbital spaceoccupying lesions(SOL).METHODS:Records from the 5 cases with EOM dysplasia between 2004 and 2016 were retrospectively reviewed and clinical data were recorded including family history,age at onset,age at surgery,visual acuity,cycloplegic refraction,ocular alignment and motility,stereoacuity,exophthalmos,anterior segment and fundus,orbital computed tomography(CT)or magnetic resonance imaging(MRI)scan,surgical methods and final outcomes.RESULTS:All 5 cases(1 male,4 females)were unilateral(3 right,2 left eyes).The average age was 5.4y(range 4-6y)with no family history.Patients had unilateral strabismus(horizontal and vertical),restricted eye movement,and eyelid changes(abnormal fissures,lagophthalmos,and/or entropion)in the affected eye.None had proptosis;1 had 2-mm enophthalmos.Orbital CT/MRI showed irregular,ill-defined masses in EOM.Two anterior orbitotomies and 3 strabismus surgeries were performed,and pathology confirmed EOM dysplasia.After surgery,horizontal deviations,which ranged from exotropia(XT)10 prism diopter(PD)to esotropia(ET)10 PD(average 6 PD),decreased by an average of 18 PD,while vertical deviations,which ranged from 4 PD to 20 PD(mean 9.8 PD),decreased by an average of 23.2 PD.CONCLUSION:SOL from EOM dysplasia is non-familial and typically presenting unilaterally characterized by an irregular,diffusely infiltrating mass within the EOM.EOM involvement causes strabismus,restricted eye movement,eyelid changes,and enophthalmos likely due to cicatricial processes.展开更多
Objective:Strabismus is associated with a higher prevalence of idiopathic thoracic scoliosis(ITS)in children.This study aims to investigate whether superior oblique palsy(SOP)poses a higher risk for developing ITS amo...Objective:Strabismus is associated with a higher prevalence of idiopathic thoracic scoliosis(ITS)in children.This study aims to investigate whether superior oblique palsy(SOP)poses a higher risk for developing ITS among children and adolescents.Methods:A cross-sectional study.The study group comprised 347 consecutive candidates for SOP surgery aged 4 to 18 years;Patients within the same age range with ocular trauma were enrolled as the control group.Preoperative chest plain radiographs were used to measure the Cobb angle.Demographic information and clinical data,including diopter,best corrected visual acuity,deviation degree,and binocular function,were analyzed.Results:A significantly higher prevalence of ITS was found in study group compared with control group(12.68%vs 4.18%,P<0.001).Additionally,the mean Cobb angle was lagger in SOP group than that in control group(5.02°±3.87°vs 3.84°±3.09°,P<0.001).Males in SOP group showed a higher prevalence of ITS(12.9%vs 2.87%,P=0.007),but there was no significant difference in females between two groups(12.3%vs 7.69%,P=0.295).Good near stereopsis acuity was significantly associated with high prevalence of thoracic scoliosis(P<0.001).Multivariate logistic regression analysis revealed that a large distant magnitude of deviation(>20 PD)and near stereoacuity were significantly associated with ITS.Conclusions:Patients with SOP have a significantly higher risk of developing idiopathic thoracic scoliosis,especially those with good near stereoscopic and large distant magnitude of deviation.展开更多
Pediatric cataract,a leading cause of blindness in children globally,imposing a significant financial burden on both families and society.The extensive phenotypic heterogeneity of this condition means that the underly...Pediatric cataract,a leading cause of blindness in children globally,imposing a significant financial burden on both families and society.The extensive phenotypic heterogeneity of this condition means that the underlying mechanisms remain poorly understood,limiting the development of precise and effective treatments.The advent of omics technologies has provided potent tools for unraveling the pathogenesis of pediatric cataract.By mapping expression profiles across various molecular levels,these omics approaches enhance our understanding of the disease’s etiological mechanisms,aid in the identification of novel biomarkers and key pathways,and offer researchers new insights for the innovative strategies in disease diagnosis and targeted therapies.In this review,we summarize the application of omics approaches in clinical and basic research on pediatric cataract over the past decade,encompassing genomics,transcriptomics,proteomics,and metabolomics.Furthermore,we discuss the current challenges and future prospects of omics analyses in pediatric cataract studies.展开更多
AIM:To evaluate the accuracy of intraocular lens(IOL)power calculation formulas with/without preoperative aphakic anterior chamber depth(aph-ACD)in pediatric aphakia.METHODS:A total of 102 pediatric patients(150 eyes)...AIM:To evaluate the accuracy of intraocular lens(IOL)power calculation formulas with/without preoperative aphakic anterior chamber depth(aph-ACD)in pediatric aphakia.METHODS:A total of 102 pediatric patients(150 eyes)undergoing secondary IOL implantation were divided into two groups(in-the-bag or ciliary sulcus).Prediction error was calculated for 9 IOL power calculation formulas,including:1)not requiring ACD:Hoffer Q,Holladay 1,SRK/T;2)usable without or with entering ACD:Barrett Universal II(BUII),Emmetropia Verifying Optical(EVO)2.0,and Ladas Artificial Intelligence Super(Ladas AI);3)requiring ACD:Haigis,Kane,and Pearl-DGS.Mean prediction error(ME),mean absolute error(MAE),median absolute error(MedAE)and the percentage of eyes within±0.25,±0.50,±0.75,and±1.00 D were calculated.RESULTS:For the BUII,EVO 2.0,and Ladas AI,with aph-ACD demonstrated a higher MedAE compared to without aph-ACD(BUII:1.27 vs 1.13 D,EVO 2.0:1.26 vs 1.06 D,Ladas AI:1.30 vs 1.10 D;all P<0.05).Formulas requiring ACD(Haigis,Kane,and Pearl-DGS)exhibited larger MedAE than those not requiring aph-ACD(Hoffer Q,Holladay 1,and SRK/T;P<0.05).In the capsular group,the percentage of eyes within±1.00 D ranged from 44.83%to 74.14%,and it was 19.57%to 32.61%in the sulcus group.CONCLUSION:The introduction of aph-ACD does not improve the accuracy of IOL calculation for pediatric aphakia,regardless of in-the-bag or sulcus IOL secondary implantation.The relationship between aph-ACD and effective lens position in pediatric aphakia warrants further study.展开更多
AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who u...AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who underwent strabismus surgery between May 2014 to June 2019 was retrospectively reviewed.The control group included sensory exotropia patients without A-V pattern and concomitant A-V pattern exotropia patients with normal vision who undergone strabismus surgery over this same time period.Ocular alignment,best corrected visual acuity,oblique muscle function,and stereopsis records were collected.RESULTS:Among the 843 eligible patients,91(10.79%;39 males and 52 females)had A-pattern(54,6.4%)or V-pattern(37,4.4%).Age at onset of vision impairment was 4±5y and at the time of surgery was 25±9y.Statistically significant negative correlations were present between impaired visual acuity and the pre-operative exodeviation(r=-0.198,P=0.016)and patterns(r=-0.207,P=0.015).Age at surgery and exodeviation in patients with concomitant A-V pattern exotropia was significantly earlier as compared with that of sensory A-V pattern exotropia and sensory exotropia(both P<0.0001).There were no significant differences in these clinical variables between sensory exotropia with or without A-V pattern.Deviation and pattern were significantly reduced in patients receiving horizontal rectus surgery with or without oblique muscle surgery(both P<0.0001).CONCLUSION:The prevalence of sensory A-V pattern exotropia in our study is 10.79%.Visual acuity represents an important factor contributing to the occurrence and development of A-V pattern.Isolated horizontal rectus surgery can provide a good option for the correction of sensory A-V pattern exotropia.展开更多
Objective:To evaluate the performance of orthokeratology(ortho-k)lens reordering using software-designed system,so as to determine the feasibility of ortho-k lens reordering without discontinuing lens wear.Methods:Thi...Objective:To evaluate the performance of orthokeratology(ortho-k)lens reordering using software-designed system,so as to determine the feasibility of ortho-k lens reordering without discontinuing lens wear.Methods:This study is a retrospective analysis of data of ortho-k lens wearers who had a history of short-term discontinuation of lens wear.A total of 94 individuals aged over 8 years with spherical equivalent refraction ranging from-0.50 to-6.50 diopters were included.The corneal topography data at baseline(before ortho-k)and after lens wear discontinuation(cessation of ortho-k treatment)were imported separately into the lens-design software,along with corresponding refraction data.Subsequently,corneal and lens parameters were generated and compared.Intraclass correlation coefficients(ICC)were calculated,and Bland and Altman analyses were conducted.Results:All 94 children were involved in the retrospective analysis.Compared with baseline data,there was a high level of consistency between Rwo(without discontinuation)and Rwith(with discontinuation),with an ICC of 0.96(P<0.001).Furthermore,the comparison of lens parameters generated by the Easyfit software between baseline and after short-term discontinuation showed a high degree of consistency,with all of the ICC values exceeding 0.90.Similar results were obtained using the WAVE software,as both ICC values and Bland-Altman plots demonstrated a high level of consistency in lens parameters between two conditions(nearly all data points fell within the 95%LoAs).Conclusions:It is feasible to directly reorder new ortho-k lenses using software fitting approaches.However,further investigations are necessary to validate their practicability in a clinical setting.展开更多
Objective:Fengqing County,situated in Yunnan Province,is a high-altitude region known for its ethnic diversity and a notably high prevalence of pterygium.As a key area for Sun Yat-sen University's poverty alleviat...Objective:Fengqing County,situated in Yunnan Province,is a high-altitude region known for its ethnic diversity and a notably high prevalence of pterygium.As a key area for Sun Yat-sen University's poverty alleviation initiatives,this study aims to investigate the unique characteristics of pterygium in specific region.Methods:We analyzed data from hospitalized patients admitted to the Ophthalmology department of the People's Hospital of Fengqing in 2023.The data were extracted from medical records through the hospital information system.The chi-square test was used for statistical comparison,and multivariate logistic regression analysis was conducted to explore the factors influencing the onset of pterygium.A significance level of P<0.005 was set.Results:In 2023,out of 1137 ophthalmic inpatients,207(18.2%)underwent pterygium surgery.There was a significant female predominance,with a female-to-male ratio of 6.67:1(P<0.001).However,no significant ethnic variation was observed(P=0.57).The majority of patients were in the 46-55 age group(36.71%),and the recurrence rate was low at 1.71%.Female gender,increasing age,diabetes mellitus,age-related cataract,and meibomian gland dysfunction were identified as independent risk factors for pterygium in this region.Conclusion:Fengqing is likely to have intricate connections between the occurrence and treatment of pterygium and its local geography,culture,and socio-economic conditions.Medical assistance programs should take these factors into account and prioritize them in poverty alleviation initiatives.展开更多
Synaptic plasticity is essential for maintaining neuronal function in the central nervous system and serves as a critical indicator of the effects of neurodegenerative disease.Glaucoma directly impairs retinal ganglio...Synaptic plasticity is essential for maintaining neuronal function in the central nervous system and serves as a critical indicator of the effects of neurodegenerative disease.Glaucoma directly impairs retinal ganglion cells and their axons,leading to axonal transport dysfuntion,subsequently causing secondary damage to anterior or posterior ends of the visual system.Accordingly,recent evidence indicates that glaucoma is a degenerative disease of the central nervous system that causes damage throughout the visual pathway.However,the effects of glaucoma on synaptic plasticity in the primary visual cortex remain unclear.In this study,we established a mouse model of unilateral chronic ocular hypertension by injecting magnetic microbeads into the anterior chamber of one eye.We found that,after 4 weeks of chronic ocular hypertension,the neuronal somas were smaller in the superior colliculus and lateral geniculate body regions of the brain contralateral to the affected eye.This was accompanied by glial cell activation and increased expression of inflammatory factors.After 8 weeks of ocular hypertension,we observed a reduction in the number of excitatory and inhibitory synapses,dendritic spines,and activation of glial cells in the primary visual cortex contralateral to the affected eye.These findings suggest that glaucoma not only directly damages the retina but also induces alterations in synapses and dendritic spines in the primary visual cortex,providing new insights into the pathogenesis of glaucoma.展开更多
Objective:Accurate intraocular pressure(IOP)measurement is a cornerstone of glaucoma diagnosis and management.While Goldmann applanation tonometry(GAT)remains the accepted gold standard,technological advancements have...Objective:Accurate intraocular pressure(IOP)measurement is a cornerstone of glaucoma diagnosis and management.While Goldmann applanation tonometry(GAT)remains the accepted gold standard,technological advancements have introduced alternative methods such as noncontact tonometry(NCT)and the dynamic Scheimpflug-based Corvis ST(CST).This study aims to conduct a rigorous comparative analysis of IOP measurements obtained by NCT,GAT,and CST across a wide spectrum of intraocular pressures.The primary objectives were to evaluate the performance of these devices in both healthy and glaucomatous eyes,assess their intra-and interobserver variability,and determine their level of agreement with the established reference.Methods:In this prospective,comparative study,a total of 212 eyes from 212 subjects were enrolled,comprising 137 eyes of patients with glaucoma and 75 eyes of healthy individuals.All participants underwent IOP measurement using the three devices in a randomized order to minimize bias.Based on the initial GAT readings,eyes were systematically classified into one of four predefined IOP levels:Level A(low,<10 mmHg),Level B(normal range,10-21 mmHg),Level C(moderately elevated,>21 to 40 mmHg),and Level D(severely elevated,>40 mmHg).A mixed-model analysis of variance(ANOVA)was employed to statistically analyze the differences in IOP measurements among the three tonometers at each distinct pressure level.The agreement between each pair of devices(CST vs.GAT,CST vs.NCT,and NCT vs.GAT)was meticulously assessed using Bland-Altman plots,which provide metrics for bias(mean difference)and the 95%limits of agreement(LoA).Results:CST and GAT exhibited better intra-and interobserver variability compared to NCT.Significant differences in IOP measurements were observed among CST,NCT,and GAT at levels A and D(P<0.001,P=0.030).Bland-Altman analysis revealed biases between CST and GAT,CST and NCT,and NCT and GAT at different levels(level A:-0.61,0.94,and-1.55 mmHg;level B:0.16,-0.7,and 0.8;level C:0.5,0.5,and-0.1;level D:0.83,-3.4,and 4.2).Notably,NCT tended to overestimate IOP more at higher levels(level D)and underestimate at lower levels(level A)compared to CST.CST demonstrated better agreement with GAT than NCT did.Conclusions:This study confirms that the Corvis ST(CST)shows superior agreement with the Goldmann applanation tonometer than noncontact tonometry,particularly at low and high IOP ranges.It also exhibits greater measurement consistency.While NCT remains a useful screening tool,its significant over-and underestimation at pressure extremes is a critical limitation.The findings strongly suggest that CST may serve as a more suitable and reliable alternative to NCT for measuring IOP across a broad clinical range.However,the results underscore that these three methods are not directly interchangeable.Clinicians must therefore exercise careful interpretation of IOP values,taking into account the specific tonometer used and the patient's probable pressure level for accurate diagnosis and management of glaucoma.展开更多
AIM:To compare the proportion of rhegmatogenous retinal detachment(RRD)associated with choroidal detachment(RRDCD)in the emergency surgery group with the routine inpatient surgery group and determine risk factors for ...AIM:To compare the proportion of rhegmatogenous retinal detachment(RRD)associated with choroidal detachment(RRDCD)in the emergency surgery group with the routine inpatient surgery group and determine risk factors for RRDCD.METHODS:A total of 694 patients(694 eyes)diagnosed with RRD in the emergency surgery(the median duration of RRD was 5d)group were included from the Department of Ophthalmic Emergency,and 692 patients(eyes)in the routine inpatient surgery group(the median duration was 15d)were selected randomly from the Ocular Fundus Department.Demographics,refractive status,macular status,lens status,extent of retinal detachment,number of retinal breaks,duration of symptoms before surgery,and the incidence of RRDCD were compared.A logistic regression analysis was used to determine potential risk factors for RRDCD.RESULTS:Compared to the routine inpatient surgery group,the emergency surgery group had a significant less median time to surgery(P<0.001)and a decreased proportion of RRDCD(2.88%vs 10.84%,P<0.001).Logistic regression analysis revealed that a prolonged duration of RRD[OR 3.51,95%confidence interval(CI)1.98-6.23],pseudophakia/aphakia status[OR 2.74,95%CI(1.50-4.98)],multiple retinal breaks[OR 1.67,95%CI(1.03-2.70)],and a substantial extent of RRD[OR 11.58,95%CI(7.12-18.84)]were independent risk factors for RRDCD.CONCLUSION:Emergency surgical pattern of RRD demonstrates a lower incidence of RRDCD.The adoption of an expedited surgical approach has the potential to reduce the duration of RRD,possibly correlating with a decreased risk of RRDCD development.展开更多
Objective:Diabetic retinopathy(DR)screening using artificial intelligence(AI)has evolved significantly over the past decade.This study aimed to analyze research trends,developments,and patterns in AI-based fundus imag...Objective:Diabetic retinopathy(DR)screening using artificial intelligence(AI)has evolved significantly over the past decade.This study aimed to analyze research trends,developments,and patterns in AI-based fundus image DR screening from 2014 to 2024 through bibliometric analysis.Methods:The study used CiteSpace and Microsoft Excel to analyze 1,172 publications from the Web of Science Core Collection database.The analysis included publication trends over time,citation patterns,institutional collaborations,and the emergence of keywords.Results:From 2014-2022,there was a steady increase in the number of publications,reaching a peak in 2021.India(26%),China(20.05%),and the USA(9.98%)were the major contributors to research output in this field.Among the publication venues,IEEE ACCESS stood out as the leading one,with 44 articles published.The research landscape has evolved from traditional image processing techniques to deep learning approaches.In recent years,there has been a growing emphasis on multimodal AI models.The analysis identified three distinct phases in the development of AI-based DR screening:CNN-based systems(2014-2020),Vision Transformers and innovative learning paradigms(2020-2022),and large foundation models(2022-2024).Conclusions:The field has demonstrated a mature development in traditional AI approaches and is currently in the process of transitioning toward multimodal learning technologies.Future directions suggest an increased focus on the integration of telemedicine,innovative AI algorithms,and real-world implementation of these technologies in real-world settings.展开更多
Objective:To investigate the lifestyle and myopia among primary school students in urban areas of Fujian with the context of myopia prevention and control measures,aiming to provide scientific evidence for identifying...Objective:To investigate the lifestyle and myopia among primary school students in urban areas of Fujian with the context of myopia prevention and control measures,aiming to provide scientific evidence for identifying high-risk myopia population and formulating effective intervention strategies.Methods:A cross-sectional study was conducted from October to November 2023,enrolling 811 fourth-grade students from three primary schools in three cities across Fujian.Personal information and lifestyle-related pattern were collected using customized questionnaire.Participants underwent comprehensive ophthalmic assessments including distance visual acuity tests and refractive examinations.Logistic regression analysis was used to assess the impact of lifestyle on the onset of myopia.Results:The prevalence of myopia among fourth-grade students in urban primary schools in Fujian was 46.4%.Only 25.8%students engaged in outdoor activities for more than 2 hours daily,while63.3%participated in outdoor activities during class breaks.Multivariate Logistic regression analysis revealed that outdoor activities during class breaks(OR=0.646(95%confidence interval(CI):0.473-0.881),P=0.006)and daily time spent outdoors(2-3 hours,OR=0.682(95%CI:0.466-0.993),P=0.047;more than 3 hours,OR=0.403(95%CI:0.192-0.796),P=0.01)were independent protective factors against myopia.Lifestyle significantly enhanced the predictive performance for myopia(P=0.01).Additionally,parental myopia(one parent with myopia,OR=2.247(95%CI:1.612-3.145),P<0.001;both parents with myopia,OR=4.824(95%CI:3.262-7.204),P<0.001)emerged as a key risk factor for myopia.Conclusions:There is considerable scope for improving the lifestyle of primary school students in urban areas of Fujian.Lifestyle is strongly associated with myopia onset,highlighting the need for schools and families to actively encourage students to engage in more outdoor activities and take breaks outdoors to prevent and control myopia.Students with parents,especially both parents,having myopia should be considered as a key target group for myopia prevention efforts.展开更多
AIM:To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions.METHODS:This was a prospective observational study.We evaluated the control ab...AIM:To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions.METHODS:This was a prospective observational study.We evaluated the control ability of intermittent exotropia(IXT)patients in three conditions:natural 2D optotype viewing,2D optotype viewing with polarized glasses,and 3D optotype viewing with polarized glasses.Recording with a smartphone,we captured videos to analyze the accurate time of spontaneous exodeviation and subsequent realignment before and after breaking fusion.Additionally,the correlation of stereopsis were also analyzed.RESULTS:A total of 48 patients(age range:4-33y;54.17%male)participated in the study.When viewing 3D optotypes with polarized glasses,their median control scores were 1(interquartile range,0-4)at distance and 0(0-1)at near.These scores were significantly better than those observed under natural viewing conditions,which were 2.5(1-5)at a distance and 1(0-3)at near(Friedman test,P=0.049).Furthermore,those subjects who exhibited exophoria(realignment within 2 seconds)while viewing 3D optotypes with polarized glasses were more likely to have measurable stereo vision(Kendall’sτb=-0.344,P=0.018).CONCLUSION:IXT patients exhibit enhanced control ability when using polarized glasses to view 3D optotypes,notably improving realignment capabilities.This expands our understanding of current tests and offers a potentially sensitive method for assessing IXT severity.展开更多
Background:Blindness and vision impairment(BVI)continue to pose significant global public health challenges,disproportionately impacting vulnerable populations and further widening socioeconomic disparities.This study...Background:Blindness and vision impairment(BVI)continue to pose significant global public health challenges,disproportionately impacting vulnerable populations and further widening socioeconomic disparities.This study conducts a comprehensive evaluation of the global burden of BVI and the socioeconomic inequalities in its distribution from 1990 to 2021,aiming to provide insights for targeted intervention strategies.Methods:Using data from Global Burden of Disease 2021,this study performed a multiscale analysis of BVI burden,examining patterns at the global,regional and national levels.We quantified the disease burden using disability-adjusted life years DALY and prevalence rates.Temporal trends were analyzed by calculating estimated annual percentage changes(EAPC).Stratified assessments were carried out by sex and age group across 21 regions and 204 countries.The study also included comparative analyses of six major eye conditions and evaluated their associations with socio-demographic index(SDI).Results:Globally,the age-standardized prevalence of BVI increased from 12,453.52 per million(95%UI:10,287.58-15,226.09)in 1990 to 15,784.33 per million(12,761.44-19,502.32)in 2021,with an EAPC of 1.09%(95%UI:0.97-1.20).During this period,global DALYs attributable to BVI increased by 37.7%.Disease trends exhibited significant divergence,with near vision loss showing the steepest increase(EAPC:1.47%),while the prevalence of glaucoma declined(EAPC:-0.73%).Geographic disparities were pronounced,with substantial improvements observed in Equatorial Guinea(EAPC:-1.75)and worsening burdens in Benin(+0.54).Disease distribution demonstrated strong regional clustering,with near vision loss being predominant in Sub-Saharan Africa(64.47%)and East Asia(50.97%),while cataract was the most common condition in Oceania(33.86%).Females consistently bore a higher burden,particularly in South Asia(646.3 vs 563.2 DALYs).Moreover,we identified a strong inverse correlation between SDI and BVI burden(Ρ=-0.772 for DALYs).Conclusions:This study highlights the severe global burden of BVI and the significant cross-country inequality,particularly in low-and middle-income countries.It emphasizes the urgent need for targeted interventions and the integration of eye care into universal health policies to promote global health equity in the post-pandemic era.展开更多
AIM:To investigate the role of RNA methylation in retinal pigment epithelial(RPE)cells in age-related macular degeneration(AMD).METHODS:RNA methylation-related gene expression profiles of AMD patient and normal contro...AIM:To investigate the role of RNA methylation in retinal pigment epithelial(RPE)cells in age-related macular degeneration(AMD).METHODS:RNA methylation-related gene expression profiles of AMD patient and normal control retinal pigment epithelium were evaluated by single-cell transcriptome from 34 samples(11 from normal donors and 23 from AMD patients).The causal relationship between RNA methylation dysfunction and AMD was analyzed by summary-data-based Mendelian randomization(SMR)using AMD GWAS data and multi-omics quantitative trait loci(QTL),including expression QTLs(eQTLs),protein QTLs(pQTLs),splicing QTLs(sQTLs),and m^(6)A-QTLs(mQTLs).Additionally,machine learning models were applied to validate the causal association between RNA methylation dysfunction and AMD using Bulk RNA sequencing data from 31 normal donors and 37 AMD patients.RESULTS:The single-cell transcriptome data analysis revealed massive dysregulation of RNA methylationrelated methylationrelated gene expression in the RPE of AMD patients.SMR revealed causal associations between key RNA methylation regulators(METTL3,NSUN6,and MRM1,etc.)and AMD onset.Machine learning models further validated these findings and demonstrated a high accuracy of AMD risk prediction by using the above-identified RNA methylationrelated genes:METTL3,NSUN6,and MRM1.Furthermore,METTL3 and NSUN6 were found to have a protective effect,while MRM1 was associated with an increased risk of AMD.CONCLUSION:The results reveal the implication of dysregulation of RNA methylation-related gene expression in the RPE of AMD patients and further demonstrated a causal association between RNA methylation-related genes(METTL3,NSUN6,and MRM1)and AMD.These findings highlight the importance of RNA methylation in the pathogenesis of AMD and offer potential biomarkers and therapeutic targets for AMD management.展开更多
Objective:Diabetic retinopathy(DR)is a top leading cause of blindness worldwide,requiring early detection for timely intervention.Artificial intelligence(AI)has emerged as a promising tool to improve DR screening effi...Objective:Diabetic retinopathy(DR)is a top leading cause of blindness worldwide,requiring early detection for timely intervention.Artificial intelligence(AI)has emerged as a promising tool to improve DR screening efficiency,accessibility,and cost-effectiveness.This study conducted a systematic review of literature and meta-analysis on the economic outcomes of AI-based DR screening.Methods:A systematic review of studies published before September 2024 was conducted throughout PubMed,Scopus,Embase,the Cochrane Library,the National Health Service Economic Evaluation Database,and the Cost-Effectiveness Analysis Registry.Eligible studies were included if they were(1)conducted among type 1 diabetes mellitus or type 2 diabetes mellitus adult diabetic population;(2)studies compared AI-based DR screening strategy to non-AI screening;and(3)performed a cost-effectiveness analysis.Meta-analysis was applied to pool incremental net benefit(INB)across studies stratified by country income and study perspective using a random-effects model.Statistical heterogeneity among studies was assessed using the I2 statistic,Cochrane Q statistics,and meta regression.Results:Nine studies were included in the analysis.From a healthcare system/payer perspective,AI-based DR screening was significantly cost-effective compared to non-AI-based screening,with a pooled INB of 615.77(95%confidence interval[CI]:558.27-673.27).Subgroup analysis showed robust cost-effectiveness of AI-based DR screening in high-income countries(INB=613.62,95%CI:556.06-671.18)and upper-/lower-middle income countries(INB=1,739.97,95%CI:423.13-3,056.82)with low heterogeneity.From a societal perspective,AI-based DR screening was generally cost-effective(INB=5,102.33,95%CI:-815.47-11,020.13),though the result lacked statistical significance and showed high heterogeneity.Conclusions:AI-based DR screening is generally cost-effective from a healthcare system perspective,particularly in high-income countries.Heterogeneity in cost-effectiveness across different perspectives highlights the importance of context-specific evaluations,to accurately evaluate the potential of AI-based DR screening in reducing global healthcare disparities.展开更多
基金supported by the National Natural Science Foundation of China,No.82271114the Natural Science Foundation of Zhejiang Province of China,No.LZ22H120001(both to ZLC).
文摘Several studies have found that transplantation of neural progenitor cells(NPCs)promotes the survival of injured neurons.However,a poor integration rate and high risk of tumorigenicity after cell transplantation limits their clinical application.Small extracellular vesicles(sEVs)contain bioactive molecules for neuronal protection and regeneration.Previous studies have shown that stem/progenitor cell-derived sEVs can promote neuronal survival and recovery of neurological function in neurodegenerative eye diseases and other eye diseases.In this study,we intravitreally transplanted sEVs derived from human induced pluripotent stem cells(hiPSCs)and hiPSCs-differentiated NPCs(hiPSC-NPC)in a mouse model of optic nerve crush.Our results show that these intravitreally injected sEVs were ingested by retinal cells,especially those localized in the ganglion cell layer.Treatment with hiPSC-NPC-derived sEVs mitigated optic nerve crush-induced retinal ganglion cell degeneration,and regulated the retinal microenvironment by inhibiting excessive activation of microglia.Component analysis further revealed that hiPSC-NPC derived sEVs transported neuroprotective and anti-inflammatory miRNA cargos to target cells,which had protective effects on RGCs after optic nerve injury.These findings suggest that sEVs derived from hiPSC-NPC are a promising cell-free therapeutic strategy for optic neuropathy.
基金supported by the Guangzhou Basic Research Program,City&University(Institute)Joint Funding Project(2023A03J0174).
文摘Objective:Evidence pertaining to the associations between hyperuricemia and diabetic microvascular complications is limited and inconclusive.In this study,we aimed to prospectively investigate the independent associations of hyperuricemia and retinopathy,nephropathy and neuropathy in individuals with type 2 diabetes mellitus(T2DM).Methods:This cohort study enrolled 25,094 participants from UK Biobank with T2DM and without microvascular complications at baseline.Hyperuricemia was defined as serum uric acid(SUA)higher than 420μmol/L.The incidence of diabetic microvascular complications was identified from hospital inpatient records that were coded according to the International Classification of Diseases(ICD)-10 coding system.Multivariable adjusted Cox proportional hazards regression models were used to calculate adjusted hazard ratios(aHR).Results:Among all participants,3,844(15.3%)were classified as having hyperuricemia at baseline.During a median follow-up of 14.0 years,555(14.4%)individuals with hyperuricemia developed diabetic microvascular complications,compared with 12.6%of individuals without hyperuricemia(P=0.002).In the multivariable-adjusted model accounted for socioeconomic status,lifestyle factors,physical and biochemical measurements,and medication use,when compared with individuals of T2DM who had a normal SUA level,those with hyperuricemia had an 82.9%higher risk of developing diabetic nephropathy(95%CI:1.41-2.38,P<0.001),and a 30.2%higher risk of diabetic neuropathy(95%CI:1.06-1.60,P=0.011).However,the association between hyperuricemia and diabetic retinopathy was not statistically significant(aHR:1.070,95%CI:0.94-1.22,P=0.320).Conclusions:Hyperuricemia was independently associated with diabetic nephropathy and neuropathy but not retinopathy in individuals with T2DM.These findings underscore the importance of monitoring SUA level in prevention of certain microvascular complications.
文摘Myopia,a common cause of visual impairment,together with the global decline in physical fitness and increasing prevalence of childhood obesity,has become a prominent global health problem.The beneficial effect of increasing the time of outdoor activities on the incidence of myopia and physical well-being in children has been widely recognized.However,in countries with highly competitive education systems,such as China,parents and school administrators may be reluctant to increase their children's time for extracurricular outdoor activities for fear of affecting their academic performance.Therefore,it is crucial to accurately assess the role of after-school outdoor activities in preventing and controlling myopia,as well as in promoting the physical and mental development of adolescents.Schools and families should be encouraged to collaboratively support children’s engagement in outdoor activities to foster their healthy growth.Given the dual benefits of outdoor activities-improving visual health and promoting overall physical and mental well-being-it is essential to encourage schools and families to work together to support children's engagement in such activities.By doing so,it is hoped that a balanced environment can be created,one that values both academic achievement and healthy development.Policymakers,educators,and parents must recognize the long-term advantages of integrating outdoor activities into children's daily lives,as this approach can help alleviate the burden of myopia,enhance physical fitness,and support emotional and cognitive development.Ultimately,fostering a culture that views outdoor activities as an essential component of education and health will be key to ensuring the well-rounded development of future generations.
基金supported by Guangzhou Key Projects of Brain Science and Brain-Like Intelligence Technology(20200730009)the National Natural Science Foundation of China(81870656)the Natural Science Foundation of Guangdong Province of China(2017A030313610 and 2023A1515012397).
文摘Dear Editor,Traumatic optic neuropathy(TON)is a severe vision-threatening condition,with an incidence rate ranging from 0.7% to 2.5%[1].The limited regenerative capacity of the optic nerve and the challenges of nerve transplantation result in substantial and irreversible visual loss in patients with TON.
基金Supported by the National Natural Science Foundation of China(No.81670885).
文摘AIM:To describe the clinical manifestations,imaging features and surgical treatments in 5 cases of extraocular muscle(EOM)dysplasia presenting as orbital spaceoccupying lesions(SOL).METHODS:Records from the 5 cases with EOM dysplasia between 2004 and 2016 were retrospectively reviewed and clinical data were recorded including family history,age at onset,age at surgery,visual acuity,cycloplegic refraction,ocular alignment and motility,stereoacuity,exophthalmos,anterior segment and fundus,orbital computed tomography(CT)or magnetic resonance imaging(MRI)scan,surgical methods and final outcomes.RESULTS:All 5 cases(1 male,4 females)were unilateral(3 right,2 left eyes).The average age was 5.4y(range 4-6y)with no family history.Patients had unilateral strabismus(horizontal and vertical),restricted eye movement,and eyelid changes(abnormal fissures,lagophthalmos,and/or entropion)in the affected eye.None had proptosis;1 had 2-mm enophthalmos.Orbital CT/MRI showed irregular,ill-defined masses in EOM.Two anterior orbitotomies and 3 strabismus surgeries were performed,and pathology confirmed EOM dysplasia.After surgery,horizontal deviations,which ranged from exotropia(XT)10 prism diopter(PD)to esotropia(ET)10 PD(average 6 PD),decreased by an average of 18 PD,while vertical deviations,which ranged from 4 PD to 20 PD(mean 9.8 PD),decreased by an average of 23.2 PD.CONCLUSION:SOL from EOM dysplasia is non-familial and typically presenting unilaterally characterized by an irregular,diffusely infiltrating mass within the EOM.EOM involvement causes strabismus,restricted eye movement,eyelid changes,and enophthalmos likely due to cicatricial processes.
基金the National Natural Science Foundation of China grant NSFC(82070995).
文摘Objective:Strabismus is associated with a higher prevalence of idiopathic thoracic scoliosis(ITS)in children.This study aims to investigate whether superior oblique palsy(SOP)poses a higher risk for developing ITS among children and adolescents.Methods:A cross-sectional study.The study group comprised 347 consecutive candidates for SOP surgery aged 4 to 18 years;Patients within the same age range with ocular trauma were enrolled as the control group.Preoperative chest plain radiographs were used to measure the Cobb angle.Demographic information and clinical data,including diopter,best corrected visual acuity,deviation degree,and binocular function,were analyzed.Results:A significantly higher prevalence of ITS was found in study group compared with control group(12.68%vs 4.18%,P<0.001).Additionally,the mean Cobb angle was lagger in SOP group than that in control group(5.02°±3.87°vs 3.84°±3.09°,P<0.001).Males in SOP group showed a higher prevalence of ITS(12.9%vs 2.87%,P=0.007),but there was no significant difference in females between two groups(12.3%vs 7.69%,P=0.295).Good near stereopsis acuity was significantly associated with high prevalence of thoracic scoliosis(P<0.001).Multivariate logistic regression analysis revealed that a large distant magnitude of deviation(>20 PD)and near stereoacuity were significantly associated with ITS.Conclusions:Patients with SOP have a significantly higher risk of developing idiopathic thoracic scoliosis,especially those with good near stereoscopic and large distant magnitude of deviation.
基金supported by the General Program of Natural Science Foundation of Guangdong Province(2023A1515011102).
文摘Pediatric cataract,a leading cause of blindness in children globally,imposing a significant financial burden on both families and society.The extensive phenotypic heterogeneity of this condition means that the underlying mechanisms remain poorly understood,limiting the development of precise and effective treatments.The advent of omics technologies has provided potent tools for unraveling the pathogenesis of pediatric cataract.By mapping expression profiles across various molecular levels,these omics approaches enhance our understanding of the disease’s etiological mechanisms,aid in the identification of novel biomarkers and key pathways,and offer researchers new insights for the innovative strategies in disease diagnosis and targeted therapies.In this review,we summarize the application of omics approaches in clinical and basic research on pediatric cataract over the past decade,encompassing genomics,transcriptomics,proteomics,and metabolomics.Furthermore,we discuss the current challenges and future prospects of omics analyses in pediatric cataract studies.
基金Supported by the Joint Funding Project of Municipal Schools(Colleges)of Science and Technology Program of Guangzhou,China(No.2023A03J0188)the Construction Project of High-Level Hospitals in Guangdong Province(No.303020102)the Natural Science Fund of Guangdong Province(No.2023A1515011102).
文摘AIM:To evaluate the accuracy of intraocular lens(IOL)power calculation formulas with/without preoperative aphakic anterior chamber depth(aph-ACD)in pediatric aphakia.METHODS:A total of 102 pediatric patients(150 eyes)undergoing secondary IOL implantation were divided into two groups(in-the-bag or ciliary sulcus).Prediction error was calculated for 9 IOL power calculation formulas,including:1)not requiring ACD:Hoffer Q,Holladay 1,SRK/T;2)usable without or with entering ACD:Barrett Universal II(BUII),Emmetropia Verifying Optical(EVO)2.0,and Ladas Artificial Intelligence Super(Ladas AI);3)requiring ACD:Haigis,Kane,and Pearl-DGS.Mean prediction error(ME),mean absolute error(MAE),median absolute error(MedAE)and the percentage of eyes within±0.25,±0.50,±0.75,and±1.00 D were calculated.RESULTS:For the BUII,EVO 2.0,and Ladas AI,with aph-ACD demonstrated a higher MedAE compared to without aph-ACD(BUII:1.27 vs 1.13 D,EVO 2.0:1.26 vs 1.06 D,Ladas AI:1.30 vs 1.10 D;all P<0.05).Formulas requiring ACD(Haigis,Kane,and Pearl-DGS)exhibited larger MedAE than those not requiring aph-ACD(Hoffer Q,Holladay 1,and SRK/T;P<0.05).In the capsular group,the percentage of eyes within±1.00 D ranged from 44.83%to 74.14%,and it was 19.57%to 32.61%in the sulcus group.CONCLUSION:The introduction of aph-ACD does not improve the accuracy of IOL calculation for pediatric aphakia,regardless of in-the-bag or sulcus IOL secondary implantation.The relationship between aph-ACD and effective lens position in pediatric aphakia warrants further study.
文摘AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who underwent strabismus surgery between May 2014 to June 2019 was retrospectively reviewed.The control group included sensory exotropia patients without A-V pattern and concomitant A-V pattern exotropia patients with normal vision who undergone strabismus surgery over this same time period.Ocular alignment,best corrected visual acuity,oblique muscle function,and stereopsis records were collected.RESULTS:Among the 843 eligible patients,91(10.79%;39 males and 52 females)had A-pattern(54,6.4%)or V-pattern(37,4.4%).Age at onset of vision impairment was 4±5y and at the time of surgery was 25±9y.Statistically significant negative correlations were present between impaired visual acuity and the pre-operative exodeviation(r=-0.198,P=0.016)and patterns(r=-0.207,P=0.015).Age at surgery and exodeviation in patients with concomitant A-V pattern exotropia was significantly earlier as compared with that of sensory A-V pattern exotropia and sensory exotropia(both P<0.0001).There were no significant differences in these clinical variables between sensory exotropia with or without A-V pattern.Deviation and pattern were significantly reduced in patients receiving horizontal rectus surgery with or without oblique muscle surgery(both P<0.0001).CONCLUSION:The prevalence of sensory A-V pattern exotropia in our study is 10.79%.Visual acuity represents an important factor contributing to the occurrence and development of A-V pattern.Isolated horizontal rectus surgery can provide a good option for the correction of sensory A-V pattern exotropia.
基金supported by the National Natural Science Foundation of China(82371089).
文摘Objective:To evaluate the performance of orthokeratology(ortho-k)lens reordering using software-designed system,so as to determine the feasibility of ortho-k lens reordering without discontinuing lens wear.Methods:This study is a retrospective analysis of data of ortho-k lens wearers who had a history of short-term discontinuation of lens wear.A total of 94 individuals aged over 8 years with spherical equivalent refraction ranging from-0.50 to-6.50 diopters were included.The corneal topography data at baseline(before ortho-k)and after lens wear discontinuation(cessation of ortho-k treatment)were imported separately into the lens-design software,along with corresponding refraction data.Subsequently,corneal and lens parameters were generated and compared.Intraclass correlation coefficients(ICC)were calculated,and Bland and Altman analyses were conducted.Results:All 94 children were involved in the retrospective analysis.Compared with baseline data,there was a high level of consistency between Rwo(without discontinuation)and Rwith(with discontinuation),with an ICC of 0.96(P<0.001).Furthermore,the comparison of lens parameters generated by the Easyfit software between baseline and after short-term discontinuation showed a high degree of consistency,with all of the ICC values exceeding 0.90.Similar results were obtained using the WAVE software,as both ICC values and Bland-Altman plots demonstrated a high level of consistency in lens parameters between two conditions(nearly all data points fell within the 95%LoAs).Conclusions:It is feasible to directly reorder new ortho-k lenses using software fitting approaches.However,further investigations are necessary to validate their practicability in a clinical setting.
基金supported by Guangdong Basic Research Center of Excellence for Major Blinding Eye Diseases Prevention and Treatment(2024-YXGG-016).
文摘Objective:Fengqing County,situated in Yunnan Province,is a high-altitude region known for its ethnic diversity and a notably high prevalence of pterygium.As a key area for Sun Yat-sen University's poverty alleviation initiatives,this study aims to investigate the unique characteristics of pterygium in specific region.Methods:We analyzed data from hospitalized patients admitted to the Ophthalmology department of the People's Hospital of Fengqing in 2023.The data were extracted from medical records through the hospital information system.The chi-square test was used for statistical comparison,and multivariate logistic regression analysis was conducted to explore the factors influencing the onset of pterygium.A significance level of P<0.005 was set.Results:In 2023,out of 1137 ophthalmic inpatients,207(18.2%)underwent pterygium surgery.There was a significant female predominance,with a female-to-male ratio of 6.67:1(P<0.001).However,no significant ethnic variation was observed(P=0.57).The majority of patients were in the 46-55 age group(36.71%),and the recurrence rate was low at 1.71%.Female gender,increasing age,diabetes mellitus,age-related cataract,and meibomian gland dysfunction were identified as independent risk factors for pterygium in this region.Conclusion:Fengqing is likely to have intricate connections between the occurrence and treatment of pterygium and its local geography,culture,and socio-economic conditions.Medical assistance programs should take these factors into account and prioritize them in poverty alleviation initiatives.
基金supported by the National Natural Science Foundation of China,No.82271115(to MY).
文摘Synaptic plasticity is essential for maintaining neuronal function in the central nervous system and serves as a critical indicator of the effects of neurodegenerative disease.Glaucoma directly impairs retinal ganglion cells and their axons,leading to axonal transport dysfuntion,subsequently causing secondary damage to anterior or posterior ends of the visual system.Accordingly,recent evidence indicates that glaucoma is a degenerative disease of the central nervous system that causes damage throughout the visual pathway.However,the effects of glaucoma on synaptic plasticity in the primary visual cortex remain unclear.In this study,we established a mouse model of unilateral chronic ocular hypertension by injecting magnetic microbeads into the anterior chamber of one eye.We found that,after 4 weeks of chronic ocular hypertension,the neuronal somas were smaller in the superior colliculus and lateral geniculate body regions of the brain contralateral to the affected eye.This was accompanied by glial cell activation and increased expression of inflammatory factors.After 8 weeks of ocular hypertension,we observed a reduction in the number of excitatory and inhibitory synapses,dendritic spines,and activation of glial cells in the primary visual cortex contralateral to the affected eye.These findings suggest that glaucoma not only directly damages the retina but also induces alterations in synapses and dendritic spines in the primary visual cortex,providing new insights into the pathogenesis of glaucoma.
文摘Objective:Accurate intraocular pressure(IOP)measurement is a cornerstone of glaucoma diagnosis and management.While Goldmann applanation tonometry(GAT)remains the accepted gold standard,technological advancements have introduced alternative methods such as noncontact tonometry(NCT)and the dynamic Scheimpflug-based Corvis ST(CST).This study aims to conduct a rigorous comparative analysis of IOP measurements obtained by NCT,GAT,and CST across a wide spectrum of intraocular pressures.The primary objectives were to evaluate the performance of these devices in both healthy and glaucomatous eyes,assess their intra-and interobserver variability,and determine their level of agreement with the established reference.Methods:In this prospective,comparative study,a total of 212 eyes from 212 subjects were enrolled,comprising 137 eyes of patients with glaucoma and 75 eyes of healthy individuals.All participants underwent IOP measurement using the three devices in a randomized order to minimize bias.Based on the initial GAT readings,eyes were systematically classified into one of four predefined IOP levels:Level A(low,<10 mmHg),Level B(normal range,10-21 mmHg),Level C(moderately elevated,>21 to 40 mmHg),and Level D(severely elevated,>40 mmHg).A mixed-model analysis of variance(ANOVA)was employed to statistically analyze the differences in IOP measurements among the three tonometers at each distinct pressure level.The agreement between each pair of devices(CST vs.GAT,CST vs.NCT,and NCT vs.GAT)was meticulously assessed using Bland-Altman plots,which provide metrics for bias(mean difference)and the 95%limits of agreement(LoA).Results:CST and GAT exhibited better intra-and interobserver variability compared to NCT.Significant differences in IOP measurements were observed among CST,NCT,and GAT at levels A and D(P<0.001,P=0.030).Bland-Altman analysis revealed biases between CST and GAT,CST and NCT,and NCT and GAT at different levels(level A:-0.61,0.94,and-1.55 mmHg;level B:0.16,-0.7,and 0.8;level C:0.5,0.5,and-0.1;level D:0.83,-3.4,and 4.2).Notably,NCT tended to overestimate IOP more at higher levels(level D)and underestimate at lower levels(level A)compared to CST.CST demonstrated better agreement with GAT than NCT did.Conclusions:This study confirms that the Corvis ST(CST)shows superior agreement with the Goldmann applanation tonometer than noncontact tonometry,particularly at low and high IOP ranges.It also exhibits greater measurement consistency.While NCT remains a useful screening tool,its significant over-and underestimation at pressure extremes is a critical limitation.The findings strongly suggest that CST may serve as a more suitable and reliable alternative to NCT for measuring IOP across a broad clinical range.However,the results underscore that these three methods are not directly interchangeable.Clinicians must therefore exercise careful interpretation of IOP values,taking into account the specific tonometer used and the patient's probable pressure level for accurate diagnosis and management of glaucoma.
基金Supported by the Medical Scientific Research Foundation of Guangdong Province,China(No.C2022060).
文摘AIM:To compare the proportion of rhegmatogenous retinal detachment(RRD)associated with choroidal detachment(RRDCD)in the emergency surgery group with the routine inpatient surgery group and determine risk factors for RRDCD.METHODS:A total of 694 patients(694 eyes)diagnosed with RRD in the emergency surgery(the median duration of RRD was 5d)group were included from the Department of Ophthalmic Emergency,and 692 patients(eyes)in the routine inpatient surgery group(the median duration was 15d)were selected randomly from the Ocular Fundus Department.Demographics,refractive status,macular status,lens status,extent of retinal detachment,number of retinal breaks,duration of symptoms before surgery,and the incidence of RRDCD were compared.A logistic regression analysis was used to determine potential risk factors for RRDCD.RESULTS:Compared to the routine inpatient surgery group,the emergency surgery group had a significant less median time to surgery(P<0.001)and a decreased proportion of RRDCD(2.88%vs 10.84%,P<0.001).Logistic regression analysis revealed that a prolonged duration of RRD[OR 3.51,95%confidence interval(CI)1.98-6.23],pseudophakia/aphakia status[OR 2.74,95%CI(1.50-4.98)],multiple retinal breaks[OR 1.67,95%CI(1.03-2.70)],and a substantial extent of RRD[OR 11.58,95%CI(7.12-18.84)]were independent risk factors for RRDCD.CONCLUSION:Emergency surgical pattern of RRD demonstrates a lower incidence of RRDCD.The adoption of an expedited surgical approach has the potential to reduce the duration of RRD,possibly correlating with a decreased risk of RRDCD development.
基金supported by the National Natural Science Foundation of China(62402009)the Science and Technology Development Fund of Macao(0013-2024-ITP1).
文摘Objective:Diabetic retinopathy(DR)screening using artificial intelligence(AI)has evolved significantly over the past decade.This study aimed to analyze research trends,developments,and patterns in AI-based fundus image DR screening from 2014 to 2024 through bibliometric analysis.Methods:The study used CiteSpace and Microsoft Excel to analyze 1,172 publications from the Web of Science Core Collection database.The analysis included publication trends over time,citation patterns,institutional collaborations,and the emergence of keywords.Results:From 2014-2022,there was a steady increase in the number of publications,reaching a peak in 2021.India(26%),China(20.05%),and the USA(9.98%)were the major contributors to research output in this field.Among the publication venues,IEEE ACCESS stood out as the leading one,with 44 articles published.The research landscape has evolved from traditional image processing techniques to deep learning approaches.In recent years,there has been a growing emphasis on multimodal AI models.The analysis identified three distinct phases in the development of AI-based DR screening:CNN-based systems(2014-2020),Vision Transformers and innovative learning paradigms(2020-2022),and large foundation models(2022-2024).Conclusions:The field has demonstrated a mature development in traditional AI approaches and is currently in the process of transitioning toward multimodal learning technologies.Future directions suggest an increased focus on the integration of telemedicine,innovative AI algorithms,and real-world implementation of these technologies in real-world settings.
基金supported by the Science and Technology Planning Project of Guangdong Province(2023A1111120011)the Natural Science Foundation of Guangdong Province(2024A1515010801).
文摘Objective:To investigate the lifestyle and myopia among primary school students in urban areas of Fujian with the context of myopia prevention and control measures,aiming to provide scientific evidence for identifying high-risk myopia population and formulating effective intervention strategies.Methods:A cross-sectional study was conducted from October to November 2023,enrolling 811 fourth-grade students from three primary schools in three cities across Fujian.Personal information and lifestyle-related pattern were collected using customized questionnaire.Participants underwent comprehensive ophthalmic assessments including distance visual acuity tests and refractive examinations.Logistic regression analysis was used to assess the impact of lifestyle on the onset of myopia.Results:The prevalence of myopia among fourth-grade students in urban primary schools in Fujian was 46.4%.Only 25.8%students engaged in outdoor activities for more than 2 hours daily,while63.3%participated in outdoor activities during class breaks.Multivariate Logistic regression analysis revealed that outdoor activities during class breaks(OR=0.646(95%confidence interval(CI):0.473-0.881),P=0.006)and daily time spent outdoors(2-3 hours,OR=0.682(95%CI:0.466-0.993),P=0.047;more than 3 hours,OR=0.403(95%CI:0.192-0.796),P=0.01)were independent protective factors against myopia.Lifestyle significantly enhanced the predictive performance for myopia(P=0.01).Additionally,parental myopia(one parent with myopia,OR=2.247(95%CI:1.612-3.145),P<0.001;both parents with myopia,OR=4.824(95%CI:3.262-7.204),P<0.001)emerged as a key risk factor for myopia.Conclusions:There is considerable scope for improving the lifestyle of primary school students in urban areas of Fujian.Lifestyle is strongly associated with myopia onset,highlighting the need for schools and families to actively encourage students to engage in more outdoor activities and take breaks outdoors to prevent and control myopia.Students with parents,especially both parents,having myopia should be considered as a key target group for myopia prevention efforts.
基金Supported by the National Natural Science Foundation of China(No.82070995,No.82301256)Youth S&T Talent Support Programme of Guangdong Provincial Association for Science and Technology.
文摘AIM:To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions.METHODS:This was a prospective observational study.We evaluated the control ability of intermittent exotropia(IXT)patients in three conditions:natural 2D optotype viewing,2D optotype viewing with polarized glasses,and 3D optotype viewing with polarized glasses.Recording with a smartphone,we captured videos to analyze the accurate time of spontaneous exodeviation and subsequent realignment before and after breaking fusion.Additionally,the correlation of stereopsis were also analyzed.RESULTS:A total of 48 patients(age range:4-33y;54.17%male)participated in the study.When viewing 3D optotypes with polarized glasses,their median control scores were 1(interquartile range,0-4)at distance and 0(0-1)at near.These scores were significantly better than those observed under natural viewing conditions,which were 2.5(1-5)at a distance and 1(0-3)at near(Friedman test,P=0.049).Furthermore,those subjects who exhibited exophoria(realignment within 2 seconds)while viewing 3D optotypes with polarized glasses were more likely to have measurable stereo vision(Kendall’sτb=-0.344,P=0.018).CONCLUSION:IXT patients exhibit enhanced control ability when using polarized glasses to view 3D optotypes,notably improving realignment capabilities.This expands our understanding of current tests and offers a potentially sensitive method for assessing IXT severity.
基金supported by grants from the National Natural Science Foundation of China(82000901,82171084).
文摘Background:Blindness and vision impairment(BVI)continue to pose significant global public health challenges,disproportionately impacting vulnerable populations and further widening socioeconomic disparities.This study conducts a comprehensive evaluation of the global burden of BVI and the socioeconomic inequalities in its distribution from 1990 to 2021,aiming to provide insights for targeted intervention strategies.Methods:Using data from Global Burden of Disease 2021,this study performed a multiscale analysis of BVI burden,examining patterns at the global,regional and national levels.We quantified the disease burden using disability-adjusted life years DALY and prevalence rates.Temporal trends were analyzed by calculating estimated annual percentage changes(EAPC).Stratified assessments were carried out by sex and age group across 21 regions and 204 countries.The study also included comparative analyses of six major eye conditions and evaluated their associations with socio-demographic index(SDI).Results:Globally,the age-standardized prevalence of BVI increased from 12,453.52 per million(95%UI:10,287.58-15,226.09)in 1990 to 15,784.33 per million(12,761.44-19,502.32)in 2021,with an EAPC of 1.09%(95%UI:0.97-1.20).During this period,global DALYs attributable to BVI increased by 37.7%.Disease trends exhibited significant divergence,with near vision loss showing the steepest increase(EAPC:1.47%),while the prevalence of glaucoma declined(EAPC:-0.73%).Geographic disparities were pronounced,with substantial improvements observed in Equatorial Guinea(EAPC:-1.75)and worsening burdens in Benin(+0.54).Disease distribution demonstrated strong regional clustering,with near vision loss being predominant in Sub-Saharan Africa(64.47%)and East Asia(50.97%),while cataract was the most common condition in Oceania(33.86%).Females consistently bore a higher burden,particularly in South Asia(646.3 vs 563.2 DALYs).Moreover,we identified a strong inverse correlation between SDI and BVI burden(Ρ=-0.772 for DALYs).Conclusions:This study highlights the severe global burden of BVI and the significant cross-country inequality,particularly in low-and middle-income countries.It emphasizes the urgent need for targeted interventions and the integration of eye care into universal health policies to promote global health equity in the post-pandemic era.
基金Supported by the Key Research and Development Program of the Ministry of Science and Technology(No.2022YFF1202901)the National Natural Science Foundation of China(No.82171404)+6 种基金the Natural Science Foundation of Guangdong Province of China(No.2023A1515011529)the Science and Technology Planning Project of Guangzhou City(No.2023A03J0181No.2024A04J6481)the Fundamental Research Funds for the Central Universities(No.22yklj04)the Research Start-up Founds of Sun Yat-sen University(No.[2020]18)the Scientific Research Project of Hunan Provincial Health Commission(No.w20243051)Hunan Provincial Natural Science Foundation of China(No.2024JJ7003).
文摘AIM:To investigate the role of RNA methylation in retinal pigment epithelial(RPE)cells in age-related macular degeneration(AMD).METHODS:RNA methylation-related gene expression profiles of AMD patient and normal control retinal pigment epithelium were evaluated by single-cell transcriptome from 34 samples(11 from normal donors and 23 from AMD patients).The causal relationship between RNA methylation dysfunction and AMD was analyzed by summary-data-based Mendelian randomization(SMR)using AMD GWAS data and multi-omics quantitative trait loci(QTL),including expression QTLs(eQTLs),protein QTLs(pQTLs),splicing QTLs(sQTLs),and m^(6)A-QTLs(mQTLs).Additionally,machine learning models were applied to validate the causal association between RNA methylation dysfunction and AMD using Bulk RNA sequencing data from 31 normal donors and 37 AMD patients.RESULTS:The single-cell transcriptome data analysis revealed massive dysregulation of RNA methylationrelated methylationrelated gene expression in the RPE of AMD patients.SMR revealed causal associations between key RNA methylation regulators(METTL3,NSUN6,and MRM1,etc.)and AMD onset.Machine learning models further validated these findings and demonstrated a high accuracy of AMD risk prediction by using the above-identified RNA methylationrelated genes:METTL3,NSUN6,and MRM1.Furthermore,METTL3 and NSUN6 were found to have a protective effect,while MRM1 was associated with an increased risk of AMD.CONCLUSION:The results reveal the implication of dysregulation of RNA methylation-related gene expression in the RPE of AMD patients and further demonstrated a causal association between RNA methylation-related genes(METTL3,NSUN6,and MRM1)and AMD.These findings highlight the importance of RNA methylation in the pathogenesis of AMD and offer potential biomarkers and therapeutic targets for AMD management.
基金supported by the Global STEM Professorship Scheme(P0046113)Henry G.Leong Endowed Professorship in Elderly Vision Health.
文摘Objective:Diabetic retinopathy(DR)is a top leading cause of blindness worldwide,requiring early detection for timely intervention.Artificial intelligence(AI)has emerged as a promising tool to improve DR screening efficiency,accessibility,and cost-effectiveness.This study conducted a systematic review of literature and meta-analysis on the economic outcomes of AI-based DR screening.Methods:A systematic review of studies published before September 2024 was conducted throughout PubMed,Scopus,Embase,the Cochrane Library,the National Health Service Economic Evaluation Database,and the Cost-Effectiveness Analysis Registry.Eligible studies were included if they were(1)conducted among type 1 diabetes mellitus or type 2 diabetes mellitus adult diabetic population;(2)studies compared AI-based DR screening strategy to non-AI screening;and(3)performed a cost-effectiveness analysis.Meta-analysis was applied to pool incremental net benefit(INB)across studies stratified by country income and study perspective using a random-effects model.Statistical heterogeneity among studies was assessed using the I2 statistic,Cochrane Q statistics,and meta regression.Results:Nine studies were included in the analysis.From a healthcare system/payer perspective,AI-based DR screening was significantly cost-effective compared to non-AI-based screening,with a pooled INB of 615.77(95%confidence interval[CI]:558.27-673.27).Subgroup analysis showed robust cost-effectiveness of AI-based DR screening in high-income countries(INB=613.62,95%CI:556.06-671.18)and upper-/lower-middle income countries(INB=1,739.97,95%CI:423.13-3,056.82)with low heterogeneity.From a societal perspective,AI-based DR screening was generally cost-effective(INB=5,102.33,95%CI:-815.47-11,020.13),though the result lacked statistical significance and showed high heterogeneity.Conclusions:AI-based DR screening is generally cost-effective from a healthcare system perspective,particularly in high-income countries.Heterogeneity in cost-effectiveness across different perspectives highlights the importance of context-specific evaluations,to accurately evaluate the potential of AI-based DR screening in reducing global healthcare disparities.
