Chao Chien Hu

Obstructive sleep apnea and increased risk of glaucoma: A population-based matched-cohort study

PURPOSE Previous studies had reported an increased prevalence of glaucoma in patients with obstructive sleep apnea (OSA). However, the risk of open-angle glaucoma (OAG) among patients with OSA remains unclear. Using a nationwide, population-based dataset in Taiwan, this study aimed to examine the prevalence and risk of OAG among patients with OSA during a 5-year follow-up period after a diagnosis of OSA. DESIGN A retrospective, matched-cohort study. PARTICIPANTS AND CONTROLS This study used data sourced from the Longitudinal Health Insurance Database 2000. We included 1012 subjects with OSA in the study cohort and randomly selected 6072 subjects in the comparison group. METHODS Each subject in this study was individually traced for a 5-year period to identify those subjects who subsequently received a diagnosis of OAG. Cox proportional hazards regression was performed to calculate the 5-year risk of OAG between the study and comparison cohorts. MAIN OUTCOME MEASURES The incidence and risk of OAG between the study and comparison groups. RESULTS During the 5-year follow-up period, the incidence rate per 1000 person-years was 11.26 (95% confidence interval [CI], 8.61-14.49) and 6.76 (95% CI, 5.80-7.83) for subjects with and without OSA, respectively. After adjusting for monthly income, geographic region, diabetes, hypertension, coronary heart disease, obesity, hyperlipidemia, renal disease, hypothyroidism, and the number of outpatient visits for ophthalmologic care during the follow-up period, stratified Cox proportional hazards regression revealed that the hazard ratio for OAG within the 5-year period for subjects with OSA was 1.67 (95% CI, 1.30-2.17; P<0.001) that of comparison subjects. CONCLUSIONS Our results suggest that OSA is associated with an increased risk of subsequent OAG diagnosis during a 5-year follow-up period. FINANCIAL DISCLOSURES(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

A one-year follow-up study on the incidence and risk of endophthalmitis after pyogenic liver abscess

PURPOSE Although endophthalmitis secondary to pyogenic liver abscess (PLA) is becoming a globally emerging infectious disease, population-based investigations evaluating the relationship between PLA and endogenous endophthalmitis remain scarce. This study aimed to investigate the incidence and risk of endogenous endophthalmitis in patients with PLA compared with unaffected individuals by using a nationwide, population-based dataset. DESIGN Retrospective, cohort study. PARTICIPANTS AND CONTROLS This study used data sourced from Taiwans National Health Insurance Research Database. In total, 12 727 patients with PLA were included in the study group and 63 635 matched subjects were randomly extracted as a comparison group. METHODS Stratified Cox proportional hazards regressions were performed to assess the effect of PLA on the hazard of developing endogenous endophthalmitis. MAIN OUTCOME MEASURES The incidence and risk of endogenous endophthalmitis between the study group and comparison group. RESULTS Of the total sample, 148 subjects (0.10%) were diagnosed with endophthalmitis during the 1-year follow-up period. Endophthalmitis was found in 106 patients (0.84%) with PLA and 42 comparison patients (0.07%). After adjusting for patient monthly income, geographic location, and urbanization level, those suffering from PLA were found to have a greater likelihood of developing endophthalmitis during the 1-year follow-up period than comparison patients (hazard ratio [HR], 12.83; 95% confidence interval, 8.94-18.41). Stratification did not reveal any large differences in the adjusted HRs for endophthalmitis between PLA patients suffering from diabetes and those in whom diabetes was absent. We further analyzed the etiology of cases with endogenous endophthalmitis in this investigation and found Klebsiella pneumonia to be the causative organism among 75.5% of the cases but only 33.4% of the comparison group. CONCLUSIONS We found that the incidence and risk of developing endophthalmitis was significantly higher among patients with PLA compared with matched controls irrespective of diabetes status.

Reduction in admissions of patients with acute primary angle closure occurring in conjunction with a rise in cataract surgery in Taiwan

Purpose:  Using 8 year nationwide administrative data, this study sets out to investigate the relationship between the total number of cataract operations undertaken in Taiwan and admissions for acute primary angle closure (APAC).

Increased Risk of Co-morbid Eye Disease in Patients with Chronic Renal Failure: A Population-based Study

Purpose: A large-scale population-based study on ophthalmic disorders among patients suffering from chronic renal failure (CRF) is lacking in the literature. This study examined the prevalence and risk of selected ocular co-morbidities (including retinal disorders, uveitis, glaucoma, cataract, and dry eye) in patients with CRF. Methods: Data were sourced from the Taiwan Longitudinal Health Insurance Database. 9,149 patients with CRF were included in the study group, and 27,447 matched patients in the comparison group (age 40-98 years). We calculated the prevalence of retinal disorders, uveitis, glaucoma, cataract, and dry eye for patients with and without CRF. Conditional logistic regression analyses were also performed to compare the risk of ophthalmic disorders for patients with and without CRF, after taking into consideration sex, age group, diabetes, hypertension, monthly income, geographic region, and level of urbanization of the patient’s community. Results: In this study, patients with CRF had significantly higher prevalence of retinal disorders (16.62% vs. 9.70%), uveitis (1.38% vs. 0.95%), glaucoma (7.56% vs. 5.70%), and cataract (33.08% vs. 28.90%) than patients without CRF (all p < 0.001). However, no significant difference was observed in the prevalence of dry eye between these two groups. After adjusting for potential confounders, patients with CRF had higher odds of retinal disorder (odds ratio, OR, 1.84, 95% confidence interval, CI, 1.72–1.98), uveitis (OR 1.33, 95% CI 1.07–1.66), glaucoma (OR 1.35, 95% CI 1.23–1.48), and cataract (OR 1.24, 95% CI 1.18–1.31) than patients without CRF. Conclusion: We conclude that patients with CRF had a significantly higher prevalence of retinal disorders, uveitis, glaucoma, and cataract compared with patients without CRF.

Increased Risk of Parkinson Disease Following a Diagnosis of Neovascular Age-Related Macular Degeneration: A Retrospective Cohort Study

PURPOSE To investigate the risk for Parkinson disease during a 3-year follow-up period after a diagnosis of neovascular age-related macular degeneration (AMD) using a nationwide population-based dataset in Taiwan. DESIGN A retrospective matched-cohort study. METHODS We identified 877subjects with neovascular AMD as the study cohort and randomly selected 8770 subjects for a comparison cohort. Each subject was individually followed for a 3-year period to identify those who subsequently developed Parkinson disease. Stratified Cox proportional hazard regressions were performed as a means of comparing the 3-year risk of subsequent Parkinson disease between the study and comparison cohorts. RESULTS The incidence rate of Parkinson disease was 5.32 (95% confidence interval [CI]: 3.03-8.72) per 1000 person-years in patients with neovascular AMD and 2.09 (95% CI: 1.59-2.70) per 1000 person-years in comparison patients. The log-rank test indicated that subjects with neovascular AMD had a significantly lower 3-year Parkinson disease-free survival rate than comparison subjects (P < .001). After censoring cases in which patients died during the follow-up period and adjusting for monthly income, geographic region, hypertension, diabetes, hyperlipidemia, and coronary heart disease, the hazard ratio of Parkinson disease during the 3-year follow-up period for subjects with neovascular AMD was 2.57 (95% CI: 1.42-4.64) that of comparison subjects. CONCLUSION In this study, subjects with neovascular AMD were found to be at a significant risk of Parkinson disease during a 3-year follow-up period after their diagnosis among Taiwanese Chinese. Further study is needed to confirm our findings and explore the underlying pathomechanism.

Seasonality of Retinal Detachment Incidence and Its Associations With Climate: An 11-Year Nationwide Population-Based Study

This study aimed to examine the seasonal variability of retinal detachment (RD) in Taiwan by using an 11-yr nationwide population database. This study also investigated the association of weather conditions, i.e., ambient temperature, relative humidity, rainfall, monthly hours of sunshine, and atmospheric pressure, with RD. Data were retrospectively collected from the Taiwan National Health Insurance Research Database. The study sample included 23 718 RD hospitalizations between January 1999 and December 2009. The incidence rate of RD/100 000 people over the 132 months was computed according to sex and age groupings of <20, 20–39, 40–59, and ≥60 yrs. Then, the association between climatic factors and the monthly RD incidence rate was examined. The ARIMA (autoregressive integrated moving average) method was also employed to test the seasonality of RD incidence rates and their association with climatic factors. The annual RD incidence rates were between 7.8 and 10.8 cases/100 000 people during the study period. A fairly similar seasonal pattern of monthly RD incidence rates was apparent for males and females and males and females combined. Rates were highest August through October, decreasing in November, and lowest in February. After adjusting for time, trend, and month, the ARIMA regression models for the male, female, and males and females combined consistently revealed the monthly RD incidence rate was significantly and positively associated with ambient temperature, but negatively associated with atmospheric pressure. The authors conclude that the monthly RD incidence rates were significantly associated with seasonality. The monthly RD incidence rates were positively associated with ambient temperature and negatively associated with atmospheric pressure. (Author correspondence: henry11111@tmu.edu.tw)

Open-Angle Glaucoma and the Risk of Erectile Dysfunction : A Population-based Case-control Study

PURPOSE Open-angle glaucoma (OAG) is associated with systemic metabolic and cardiovascular disorders, and both share common risk factors with erectile dysfunction (ED). However, few studies have investigated the association of ED with OAG. This study aimed to estimate the association of ED with prior OAG by using a nationwide, population-based data with a retrospective case-control cohort design in Taiwan. DESIGN Age-matched case-control study. PARTICIPANTS AND CONTROLS We identified 4605 patients with ED as the cases and randomly selected 23 025 subjects as the controls (5 controls to 1 case). METHODS We used conditional logistic regression analysis to estimate the odds ratio and 95% confidence interval of having previously been diagnosed with OAG according to the presence/absence of ED after adjusting for patients monthly income, geographical location, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse. MAIN OUTCOME MEASURES We identified OAG cases not only based on an International Classification of Diseases, Ninth Revision, Clinical Modification code, but also by the prescription of topical antiglaucoma medication. RESULTS In total, prior OAG was found among 137 subjects (0.5 %); 53 individuals (1.1% of the ED patients) from the cases and 84 individuals (0.4% of patients without ED) from the controls. Conditional logistic regression analysis demonstrated that, after adjusting for potential confounders, patients with ED were more likely to have prior OAG than controls (odds ratio, 2.85; 95% confidence interval, 2.10-4.07). CONCLUSIONS This study identifies a novel association between ED and prior OAG.

Increased risk of anterior uveitis following herpes zoster: A nationwide population-based study

OBJECTIVE To investigate the relationship between herpes zoster (HZ) and the subsequent risk of anterior uveitis during the year following an HZ diagnosis, using a nationwide population-based data set. METHODS This study used the Taiwan National Health Insurance Research Database. The study cohort consisted of 314,405 patients who received a diagnosis of HZ. The comparison cohort comprised 943,215 randomly selected patients. We tracked each patient for a 1-year period from their index ambulatory care visit to identify those who subsequently received a diagnosis of anterior uveitis. Stratified Cox proportional hazard regressions were performed to compute the adjusted 1-year uveitis-free survival rate, after adjusting for patients age, sex, and geographic region and the presence of rheumatoid arthritis, psoriasis, mumps, systemic lupus erythematosus, tuberculosis, ankylosing spondylitis, and human immunodeficiency syndrome/AIDS. RESULTS During the 1-year follow-up period, 2515 (0.2%) of 1,257,620 sampled patients were diagnosed with anterior uveitis: 908 from the study cohort (0.3% of the patients with HZ) and 1607 from the comparison cohort (0.2% of patients without HZ). After adjusting for potential confounders, the hazard ratio of anterior uveitis during the 1-year follow-up period was 1.67 for patients with HZ (P < .001) compared with the comparison cohort. In addition, the hazard ratio of anterior uveitis for patients with HZ ophthalmicus was 13.06 (P < .001) when compared with patients without HZ. CONCLUSIONS The risk of anterior uveitis increased in the year following a diagnosis of HZ. We suggest that patient eye condition be evaluated following diagnosis with HZ.

A 7-Year Population Study of Primary Angle Closure Glaucoma Admissions and Climate in Taiwan

Purpose: Using data from seven years of hospital admissions in Taiwan, this study sets out to investigate meteorological factors associated with primary angle closure glaucoma (PACG). We investigated the relationship between PACG admissions and five different climate indices. Method: Hospital admissions data from the Taiwan National Health Insurance Research Database (1997 to 2003) provided monthly PACG admission rates (per 100,000 population). We categorized the 4,722 PACG cases by gender and age (including four subgroups: 40–49, 50–59, 60–69, and ≥ 70 years). After adjusting for the time-trend effect, the Auto-Regressive Integrated Moving Average regression method was performed to evaluate the effects of climatic and monthly factors on PACG admission rates. Results: The mean annual rate of PACG admissions across the entire study period was 9.48/100,000 and higher in females than males (11.28 vs. 7.80/100,000). The PACG admissions were significantly higher in March for male patients, and for the 60 to 69-year-old and > 69-year-old age groups (p < 0.05). After adjustment for seasonality, month, and time-trend, a significant association between relative humidity and monthly PACG admission rates was observed for the total data set, for males, and for the 60- to 69-year-old (p < 0.05) populations. No such relationship existed with temperature, rainfall, barometric pressure or hours of sunshine. Conclusion: This is the largest, nationwide, population-based study to investigate the dependence of PACG admission rates on meteorological conditions. PACG admission rates were significantly higher in March and with increased relative humidity. We recommend data be collected from other regions and from other ethnic groups to determine the general pattern worldwide.

Neovascular age-related macular degeneration is not associated with coronary heart disease in a Chinese Population: a population-based study.

This case–control study aimed to explore the association between prior coronary heart disease (CHD) and neovascular age‐related macular degeneration (AMD) using a population‐based data set in Taiwan.