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American Journal of Ophthalmology Oct 2023To objectively quantify the lens opacity of posterior subcapsular cataracts (PSCs) using the swept-source optical coherence tomography (SS-OCT)-based devices including...
PURPOSE
To objectively quantify the lens opacity of posterior subcapsular cataracts (PSCs) using the swept-source optical coherence tomography (SS-OCT)-based devices including IOL Master 700 and CASIA-2.
DESIGN
Prospective cross-sectional study.
METHODS
A total of 101 eyes of 101 patients with PSCs were enrolled in Zhongshan Ophthalmic Center from 2021 to 2022. The IOL Master 700 and CASIA-2 were used to obtain lens images. The average posterior subcapsular density (APSD) and the maximum posterior subcapsular density (MPSD) within the pupil area (radius: 3 or 5 mm) were measured by Image J. Spearman and Pearson correlation analysis were performed to assess the associations.
RESULTS
APSD-3mm, APSD-5mm, MPSD-3mm, and MPSD-5mm had positive correlations with best corrected visual acuity (BCVA; r = 0.658, 0.641, 0.583, and 0.572, P < .001, respectively), all of which were higher than the correlation between LOCS-III P score and BCVA (r = 0.548, P < .001). Particularly, the APSD-3mm showed the highest correlation with BCVA. APSD could distinguish severe PSCs (LOCS-III P score ≥ 5) with an area under the receiver operating characteristic curve (AUC) of 0.836 (95% CI 0.743-0.930) for APSD-3mm and with AUC 0.758 (95% CI 0.643-0.873) for APSD-5mm, highlighting the better performance of APSD-3mm. The APSD-3mm of IOL Master 700 correlated strongly with that of CASIA-2 (r = 0.789, P < .001).
CONCLUSIONS
This study presented an objective method for quantifying PSCs using IOL Master 700 and CASIA-2. APSD-3mm can be used as a new accurate and objective index for the quantitative assessment of PSCs.
Topics: Humans; Visual Acuity; Cross-Sectional Studies; Prospective Studies; Cataract; Lens, Crystalline; Tomography, Optical Coherence
PubMed: 37327960
DOI: 10.1016/j.ajo.2023.06.003 -
Nature Communications Apr 2024Utilization of digital technologies for cataract screening in primary care is a potential solution for addressing the dilemma between the growing aging population and...
Utilization of digital technologies for cataract screening in primary care is a potential solution for addressing the dilemma between the growing aging population and unequally distributed resources. Here, we propose a digital technology-driven hierarchical screening (DH screening) pattern implemented in China to promote the equity and accessibility of healthcare. It consists of home-based mobile artificial intelligence (AI) screening, community-based AI diagnosis, and referral to hospitals. We utilize decision-analytic Markov models to evaluate the cost-effectiveness and cost-utility of different cataract screening strategies (no screening, telescreening, AI screening and DH screening). A simulated cohort of 100,000 individuals from age 50 is built through a total of 30 1-year Markov cycles. The primary outcomes are incremental cost-effectiveness ratio and incremental cost-utility ratio. The results show that DH screening dominates no screening, telescreening and AI screening in urban and rural China. Annual DH screening emerges as the most economically effective strategy with 341 (338 to 344) and 1326 (1312 to 1340) years of blindness avoided compared with telescreening, and 37 (35 to 39) and 140 (131 to 148) years compared with AI screening in urban and rural settings, respectively. The findings remain robust across all sensitivity analyses conducted. Here, we report that DH screening is cost-effective in urban and rural China, and the annual screening proves to be the most cost-effective option, providing an economic rationale for policymakers promoting public eye health in low- and middle-income countries.
Topics: Humans; Cost-Benefit Analysis; China; Cataract; Middle Aged; Mass Screening; Male; Digital Technology; Female; Markov Chains; Aged; Artificial Intelligence; Telemedicine
PubMed: 38688925
DOI: 10.1038/s41467-024-47211-w -
Experimental Eye Research Jan 2024Heterozygous mutation of PAX6 in humans leads to congenital aniridia (OMIM 106210) which is typified by congenital iris and foveal defects, and later onset glaucoma,...
Heterozygous mutation of PAX6 in humans leads to congenital aniridia (OMIM 106210) which is typified by congenital iris and foveal defects, and later onset glaucoma, aniridic keratopathy, and cataract. Mice heterozygous for Pax6 mutations phenocopy many aspects of aniridia including the iris defects, keratopathy and cataract, although Pax6 mutant mice have small lenses, a phenotype which is not typically reported in human aniridia, perhaps due to difficulties in measuring lens diameter during typical ophthalmic examinations as the lens periphery is shielded by the iris. In order to overcome this, records of patients diagnosed with congenital aniridia between April 2015 and May 2021 at the Necker-Enfants Malades Hospital, and genetically confirmed with a disease-causing PAX6 variant, were retrospectively reviewed for those with normal axial length whose iris defects allowed visualization of the lens margins and corneal diameter to allow calculation of a lens/corneal diameter ratio. This value was compared with values obtained from a cohort of patients with Sjödell grade IV oculocutaneous albinism type 1 (OCA1; OMIM 203100) which allowed visualization of the lens periphery via iris transillumination. This analysis revealed that patients with congenital aniridia had a significantly lower lens/corneal ratio when compared to those with albinism, suggesting that humans haploinsufficient for PAX6, like mice, rats, frogs, and zebrafish, exhibit reductions in lens size.
Topics: Humans; Mice; Rats; Animals; PAX6 Transcription Factor; Paired Box Transcription Factors; Retrospective Studies; Zebrafish; Aniridia; Mutation; Corneal Diseases; Cataract; Homeodomain Proteins; Eye Proteins
PubMed: 38056551
DOI: 10.1016/j.exer.2023.109746 -
Journal of Cataract and Refractive... Feb 2024To compare the postoperative visual acuity curves following 3 pseudophakic presbyopic correction techniques.
PURPOSE
To compare the postoperative visual acuity curves following 3 pseudophakic presbyopic correction techniques.
SETTING
Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
DESIGN
Prospective, randomized, comparative trial.
METHODS
For this study, patients with stage 2 Lens Opacities Classification System III cataract were divided into 3 study groups: (1) premium monovision group, including patients who received the Panoptix intraocular lens (IOL) in the recessive eye and Vivity IOL in the dominant one; (2) bilateral trifocal group, including those who received bilaterally the Panoptix IOL; and (3) bilateral xEDOF group, including patients who received bilaterally the Vivity IOL. Postoperative bilateral uncorrected distance visual acuity was measured at 25.5, 28, 33, 40, 50, 66, 100, 200, and 300 cm distances. Spline curve fitting was attempted, and areas of the curves (AOCs) and curvature k were calculated. All patients responded to the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25).
RESULTS
90 patients were equally divided into the 3 groups. Premium monovision and bilateral trifocal implantations delivered similar visual acuity (all AOC P > .05); however, the trifocal patients suffered from drops in vision acuity in certain distance ranges as expressed by negative curvature values. Bilateral xEDOF patients demonstrated worse near vision acuity ( P < .05). Premium monovision patients reported better scores in NEI-VFQ 25 ( P = .03) and in the near activities ( P = .02) and distant activities ( P = .04) subscales.
CONCLUSIONS
All surgical options provided impressive outcomes. Premium monovision appeared to deliver the best results.
Topics: Humans; Lens Implantation, Intraocular; Refraction, Ocular; Pseudophakia; Prospective Studies; Prosthesis Design; Lenses, Intraocular; Cataract; Patient Satisfaction; Phacoemulsification
PubMed: 37847127
DOI: 10.1097/j.jcrs.0000000000001336 -
Indian Journal of Ophthalmology Jan 2024
Topics: Humans; Cataract Extraction; Refraction, Ocular; Cataract; Refractive Surgical Procedures; Retrospective Studies; Refractive Errors
PubMed: 38131561
DOI: 10.4103/IJO.IJO_2767_23 -
Translational Vision Science &... Apr 2024The purpose of this study was to assess the current use and reliability of artificial intelligence (AI)-based algorithms for analyzing cataract surgery videos.
PURPOSE
The purpose of this study was to assess the current use and reliability of artificial intelligence (AI)-based algorithms for analyzing cataract surgery videos.
METHODS
A systematic review of the literature about intra-operative analysis of cataract surgery videos with machine learning techniques was performed. Cataract diagnosis and detection algorithms were excluded. Resulting algorithms were compared, descriptively analyzed, and metrics summarized or visually reported. The reproducibility and reliability of the methods and results were assessed using a modified version of the Medical Image Computing and Computer-Assisted (MICCAI) checklist.
RESULTS
Thirty-eight of the 550 screened studies were included, 20 addressed the challenge of instrument detection or tracking, 9 focused on phase discrimination, and 8 predicted skill and complications. Instrument detection achieves an area under the receiver operator characteristic curve (ROC AUC) between 0.976 and 0.998, instrument tracking an mAP between 0.685 and 0.929, phase recognition an ROC AUC between 0.773 and 0.990, and complications or surgical skill performs with an ROC AUC between 0.570 and 0.970.
CONCLUSIONS
The studies showed a wide variation in quality and pose a challenge regarding replication due to a small number of public datasets (none for manual small incision cataract surgery) and seldom published source code. There is no standard for reported outcome metrics and validation of the models on external datasets is rare making comparisons difficult. The data suggests that tracking of instruments and phase detection work well but surgical skill and complication recognition remains a challenge for deep learning.
TRANSLATIONAL RELEVANCE
This overview of cataract surgery analysis with AI models provides translational value for improving training of the clinician by identifying successes and challenges.
Topics: Humans; Artificial Intelligence; Reproducibility of Results; Algorithms; Software; Cataract
PubMed: 38618893
DOI: 10.1167/tvst.13.4.20 -
Behavioural Brain Research Jul 2023Cataract has been shown to be associated with an increased risk of cognitive impairment. However, the results of previous studies have been inconsistent. This systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cataract has been shown to be associated with an increased risk of cognitive impairment. However, the results of previous studies have been inconsistent. This systematic review and meta-analysis aimed to investigate the association between cataract and the incidence of cognitive impairment in older adults.
METHODS
A comprehensive search of electronic databases from inception to January 2023 was performed to identify relevant studies. Data were extracted from eligible studies and a meta-analysis was performed to calculate the pooled hazard ratio (HR) and 95% confidence interval (CI).
RESULTS
We included 13 studies with 25 study arms involving a total of 798,694 participants. Compared with participants without cataract, those with cataract had a higher risk of developing all-cause dementia (pooled HR: 1.22; 95 % CI: 1.08-1.38; I =86 %; 9 studies), Alzheimer's disease dementia (pooled HR: 1.18; 95 % CI: 1.07-1.30; I =0 %; 9 studies), vascular dementia (pooled HR: 1.21; 95 % CI: 1.02-1.43; I =77 %;3 studies) and mild cognitive impairment (pooled HR: 1.30; 95% CI: 1.13-1.50; I =0%;2 studies). There was no significant association between cataract and mixed dementia (pooled HR: 1.03; 95 % CI: 0.52-2.04; I =78 %;2 studies). We assessed the risk of bias of the included studies using the Newcastle-Ottawa Scale and found that most of them had a low or moderate risk of bias. The number of studies in each meta-analysis ranged from two to nine, with more studies available for all-cause dementia and Alzheimer's disease dementia than for vascular dementia and mixed dementia.
CONCLUSIONS
The findings suggest that cataract may be associated with cognitive impairment in older adults. However, the causal relationship between cataract and cognition remains unclear and requires further investigation.
Topics: Humans; Aged; Alzheimer Disease; Dementia, Vascular; Incidence; Cognitive Dysfunction; Cataract
PubMed: 37148915
DOI: 10.1016/j.bbr.2023.114455 -
JMIR Public Health and Surveillance Dec 2023Cataracts now account for the largest proportion of the global burden of blindness and vision loss. Understanding the changing trends in the global burden of cataracts...
BACKGROUND
Cataracts now account for the largest proportion of the global burden of blindness and vision loss. Understanding the changing trends in the global burden of cataracts over the past 30 years and the next 15 years is of clear significance for the prevention and control of cataracts in key populations. As far as we know, research on the future burden of cataracts is lacking.
OBJECTIVE
This study aims to assess the global burden of cataracts over the past 30 years by using age-period-cohort modeling and to estimate trends in the next 15 years.
METHODS
Data were obtained from the Global Burden of Disease Study 2019, the United Nations Development Programme, and the WHO (World Health Organization) Global Health Observatory data repository. The assessment of trends and disparities in the number and rate of disability-adjusted life years (DALYs) for cataracts from 1990 to 2019 was conducted. The association between the age-standardized DALY rate (ASDR) and the socio-demographic index (SDI), human development index (HDI), national levels of particulate matter <2.5 μm in diameter (PM), and ambient ultraviolet radiation (UVR) was determined using linear regression analysis. Additionally, we used the Nordpred (Harald Fekjær and Bjørn Møller) age-period-cohort model to predict the cataract burden from 2020 to 2034.
RESULTS
Globally, the number of DALYs due to cataract increased from 3,492,604 (95% uncertainty interval [UI] 2,481,846-4,719,629) in 1990 to 6,676,281 (95% UI 4,761,210-9,006,193) in 2019. The ASDRs due to cataract decreased from 93.17 (95% UI 66.14-125.32) in 1990 to 82.94 (95% UI 59.06-111.75) in 2019, with an average annual percentage change of -0.37 (95% CI -0.44 to -0.3; P<.001). Age, female sex, air pollution, smoking, high fasting plasma glucose levels, and a high body mass index were risk factors for the burden of cataracts. SDI and HDI were negatively correlated with ASDRs of cataracts, while PM and UVR were positively associated with them. Higher DALY rates were also associated with lower SDI (R=0.1939; P<.001), lower HDI (R=0.2828; P<.001), national PM concentration (R=0.1874; P<.001), and ambient UVR levels (R=0.2354; P<.001). The prediction model suggested that the number of DALYs due to cataract will continue to rise globally, while the cataract DALY rate will continue to decrease.
CONCLUSIONS
While the ASDR of cataracts has decreased, there has been a notable increase in the number of DALYs over the past 30 years. Projections suggest that the global burden of cataracts will continue to rise over the next 15 years. To address this challenge, appropriate prevention and treatment policies must be implemented.
Topics: Humans; Female; Adolescent; Quality-Adjusted Life Years; Global Burden of Disease; Retrospective Studies; Ultraviolet Rays; Global Health; Cataract; Particulate Matter
PubMed: 38051579
DOI: 10.2196/47349 -
Journal of Cataract and Refractive... Aug 2023To explore the distribution of lens volume (VOL) and its associated factors in noncataract adolescents and adults and patients with cataract in a Chinese population.
PURPOSE
To explore the distribution of lens volume (VOL) and its associated factors in noncataract adolescents and adults and patients with cataract in a Chinese population.
SETTING
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
DESIGN
Cross-sectional study.
METHODS
1674 eyes from 1674 Chinese participants (690 adolescents and 363 adults without cataract, and 621 patients with cataract) aged from 7 to 90 years were included. Lens thickness (LT) and lens diameter (LD) were measured using swept-source anterior segment optical coherence tomography (SS-AS OCT) to calculate VOL. Axial length (AL) was measured by IOL-Master 700. Pearson correlation analysis and multivariate linear regression models were used to evaluate the potential associated factors of lens dimensions.
RESULTS
The mean VOL was 167.74 ± 12.18 mm 3 in noncataract adolescents, 185.20 ± 14.95 mm 3 in noncataract adults, and 226.10 ± 49.25 mm 3 in patients with cataract. VOL had no significant correlation with AL in patients with cataract ( P > .05), neither in noncataract adolescents nor noncataract adults, when adjusted with LT, LD, age, and sex ( P > .05). On the other hand, eyes with longer ALs tended to have smaller LTs and larger LDs in all groups (all P -trend < .05). Larger VOL was associated with older age in all groups (all P < .001).
CONCLUSIONS
A data set of VOLs in Chinese eyes over a wide age range was presented. It is inaccurate to predict VOL, LT, and LD solely according to AL. The direct measurement and calculation of VOL in vivo and the establishment of the normal range of VOL could help predict the size of lens capsular bag and plan cataract surgery.
Topics: Adolescent; Adult; Humans; Cataract; Cross-Sectional Studies; East Asian People; Lens, Crystalline; Child; Young Adult; Middle Aged; Aged; Aged, 80 and over; Tomography, Optical Coherence
PubMed: 37067985
DOI: 10.1097/j.jcrs.0000000000001194 -
American Journal of Ophthalmology Jul 2024To explore the factors related to the diagnosis yield of syndromic congenital cataracts and describe the phenotype-genotype correlation in congenital cataract patients.
PURPOSE
To explore the factors related to the diagnosis yield of syndromic congenital cataracts and describe the phenotype-genotype correlation in congenital cataract patients.
DESIGN
Prospective cohort study.
METHODS
Setting: the participants from underwent clinical examinations between 2021 and 2022. Facial and anterior eye segment photographs, pre- and postoperative ocular parameters, and medical and family histories were recorded. Bioinformatics analysis was performed using whole-exome sequencing data. Statistical and correlation analyses were performed using the basic characteristics, deep phenotype, and genotype data.
PARTICIPANTS
115 patients with unrelated congenital cataract.
INTERVENTIONS
performing clinical examinations, whole-exome sequencing, and bioinformatics analysis for all participants.
MAIN OUTCOMES AND MEASURES
factors related to the genetic diagnosis yield of syndromic congenital cataracts.
RESULTS
Bilaterally asymmetrical cataracts were identified to be associated with syndromic congenital cataracts. The overall genetic diagnostic yield in the cohort was 72.2%. In total, 34.8% of the probands were early diagnosed with various syndromes with the help of genetic information. A phenotype-genotype correlation was detected for some genes and deep phenotypes.
CONCLUSIONS
We highlight the importance of screening syndromic diseases in the patients with asymmetrical congenital cataracts. Application of whole-exome sequencing helps provide early diagnosis and treatment for the patients with syndromic congenital cataracts. This study also achieved a high genetic diagnostic yield, expanded the genotypic spectrum, and found phenotype-genotype correlations. A comprehensive analysis of cataract symmetricity, family history, and deep phenotypes makes the genotype prediction of some congenital cataract patients possible.
Topics: Humans; Cataract; Male; Female; Prospective Studies; Exome Sequencing; Early Diagnosis; Child, Preschool; Infant; Child; Genetic Association Studies; Phenotype; Syndrome; Genotype; Genetic Testing
PubMed: 38184101
DOI: 10.1016/j.ajo.2023.10.022