Ching-Yao Tsai

The current status of visual disability in the elderly population of Taiwan

PurposeThis study was conducted to explore the prevalence and the associated factors of visual impairment and blindness among the elderly Taiwanese population.MethodsA nationwide population-based visual health care screening program of elderly people aged 65 years or older was conducted between 1 July 2002 and 31 December 2002 in Taiwan. Based on the same standardized protocol used by the Bureau of Health Promotion, Department of Health, and a stratified random sampling design, 3160 out of 5000 elderly subjects were selected by a two-stage visual care screening method. The overall response rate was 63.2%.ResultsThe mean age of the elderly participants was 72.4 ± 5.1 years. The overall prevalence of glaucoma, corneal diseases, trauma, cataracts, myopic or diabetic retinopathy, and age-related macular degeneration among the elderly population was 2.1%, 6.3%, 0.9%, 60.2%, 7.5%, and 2.9%, respectively. The overall prevalence of visual disability (visual acuity of the better eye <0.5) was 17.7%, including 17.1% with visual impairment and 0.6% with blindness. Based on logistic regression, the significant independent factors of visual disability (visual impairment plus blindness) were sex (male vs. female, odds ratio (OR) = 0.62, 95% confidence interval (CI), 0.51–0.76), age (70–74 years vs. 65–69 years, OR = 1.60, 95% CI, 1.24–2.06; 75–79 years vs. 65–69 years, OR = 2.52, 95% CI, 1.92–3.32, ≥80 yrs vs. 65–69 yrs, OR = 4.86, 95% CI, 3.52–6.70), corneal diseases (OR = 2.26, 95% CI, 1.61–3.16), myopic or diabetic retinopathy (OR = 1.69, 95% CI, 1.20–2.39), age-related macular degeneration (OR = 4.96, 95% CI, 3.16–7.78), and cataract (OR = 3.40, 95% CI, 2.67–4.33).ConclusionsThe geographic difference in the prevalence of vision-related eye disease, visual impairment, and blindness point to the importance of taking actions that suit local circumstances. Our results also revealed that visual impairment and blindness are important visual health problems in the elderly Taiwanese population. Age-related macular degeneration, cataracts, corneal diseases, myopic or diabetic retinopathy, female sex, and aging were the leading causes of visual disability. Further organized preventive strategies for eye care are recommended in this population.

Visual Outcomes and Associated Risk Factors of Cataract Surgeries in Highly Myopic Taiwanese

Aims: The purposes of this study were to describe the visual outcome of highly myopic eyes undergoing cataract surgery, to investigate associated risk factors for poor postoperative vision, and to assess postoperative complication frequency among the prevalent myopic Taiwanese population. Methods: We conducted a retrospective, noncomparative case series study at the Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taiwan. High myopia was defined as axial length of 26.0 mm. Main study outcomes were visual acuity for the initial 6-month postoperative period (including visual acuities and improvement of postoperative vision), and postoperative complications (including subsequent cataract formation and postoperative retinal detachment). Results: Fifty-two highly myopic eyes were registered between January 2002 and December 2004. Mean follow-up interval was 43.3 ± 20.2 weeks (range 25–103). Thirty-two eyes (61.5%) had good postoperative visual improvement (≧4 line Snellen chart). Thirty-seven eyes (71.2%) achieved good postoperative vision (20/40 or better). Fifteen eyes (28.8%) demonstrated poor postoperative vision. Pre-existing maculopathy was an independent risk factor for failure to achieve good postoperative vision (odds ratio, OR, 6.84, 95% confidence interval, CI: 1.12–41.8) and improvement (OR 16.1, 95% CI: 2.2–119.9). Diabetic history was considered another independent risk factor for poor postoperative vision (OR 15.6, 95% CI: 0.97–267.6). Six eyes (11.5%) developed subsequent posterior capsular opacification requiring Nd:YAG laser capsulotomy. Two eyes (3.8%) developed retinal detachment during follow-up. Conclusions: Most of highly myopic eyes achieved good visual improvement and good postoperative visual acuity after cataract surgery. Pre-existing maculopathy was an independent risk factor of postoperative visual improvement and status. It is crucial to examine retinal status prior to cataract surgery to prevent poor vision improvement, poor postoperative vision, or retinal complications.

Thermosensitive chitosan-based hydrogels for sustained release of ferulic acid on corneal wound healing

Oxidative damage to cornea can be induced by alkaline chemical burn which may cause vision loss or blindness. Recent studies showed that exogenous application of natural antioxidants may be a potential treatment for corneal wound healing. However, low ocular bioavailability and short residence time are the limiting factors of topically administered antioxidants. Ferulic acid (FA) is a natural phenolic compound and an excellent antioxidant. The study was aimed to investigate the effects of FA in corneal epithelial cells (CECs) under oxidative stress and evaluate the feasibility of use the thermosensitive chitosan-based hydrogel containing FA for corneal wound healing. The results demonstrated that post-treatment of FA on CECs could decrease the inflammation-level and apoptosis. In the rabbit corneal alkali burn model, post-treatment FA-loaded hydrogel may promote the corneal wound healing. The results of study suggest that FA-loaded hydrogel may have the potential applications in treating corneal alkali burn.

SirT1—A Sensor for Monitoring Self-Renewal and Aging Process in Retinal Stem Cells

Retinal stem cells bear potency of proliferation, self-renewal, and differentiation into many retinal cells. Utilizing appropriate sensors one can effectively detect the self-renewal and aging process abilities. Silencing information regulator (SirT1), a member of the sirtuin family, is a NAD-dependent histone deacetylase and an essential mediator for longevity in normal cells by calorie restriction. We firstly investigate the SirT1 mRNA expression in retinal stem cells from rats and 19 human eyes of different ages. Results revealed that SirT1 expression was significantly decreased in in vivo aged eyes, associated with poor self-renewal abilities. Additionally, SirT1 mRNA levels were dose-dependently increased in resveratrol- treated retinal stem cells. The expression of SirT1 on oxidative stress-induced damage was significantly decreased, negatively correlated with the level of intracellular reactive oxygen species production. Treatment with resveratrol could effectively further reduce oxidative stress induced by H2O2 treatment in retinal stem cells. Importantly, the anti-oxidant effects of resveratrol in H2O2-treated retinal stem cells were significantly abolished by knockdown of SirT1 expression (sh-SirT1). SirT1 expression provides a feasible sensor in assessing self-renewal and aging process in retinal stem cells. Resveratrol can prevent reactive oxygen species-induced damages via increased retinal SirT1 expression.

Optic Neuritis among National Health Insurance Enrollees in Taiwan, 2000–2004

Background: The objective was to examine the incidence of optic neuritis in Taiwan. A 5-year longitudinal, nationwide, population-based study was conducted. The participants were a random sample of 191,761 subjects, or about 1% of the enrollees in the National Health Insurance program of Taiwan. Methods: We identified subjects who had at least 1 service claim for ambulatory or inpatient care with a principal diagnosis of optic neuritis between 2000 and 2004. We calculated and statistically analyzed the rates of optic neuritis. The main outcome measures were the incidence rates of optic neuritis. Results: From 2000 to 2004, the total cumulative incidence was 1.33 per 1,000 (1.00 vs. 1.67 for male vs. female subjects; p < 0.001, χ2 test). The cumulative incidence rates for the age groups of 0–19, 20–39, 40–59 and ≧60 years were 0.33, 1.05, 2.16 and 2.81 cases per 1,000, respectively. Among the subjects aged 40–59 years, the cumulative incidence was higher in women than in men (p < 0.001, χ2 test). The incidence density of developing multiple sclerosis after optic neuritis was 0.41% per person-year, and the cumulative incidence of multiple sclerosis after a new diagnosis of optic neuritis was 0.78%. Conclusions: We believe our study is the first nationwide investigation of the incidence rates of optic neuritis in Taiwan. In our investigation, the cumulative incidence peaked among the subjects aged 40–59 years, especially in women. In Taiwan, patients with optic neuritis have a notably low rate of conversion to multiple sclerosis.

Correlation of MicroRNA-145 Levels and Clinical Severity of Pterygia

PURPOSE MicroRNA-145 (miR-145) has known anti-tumor properties and has been reported to be involved in regulating corneal epithelium differentiation. The exact role of miR-145 in ocular tissue remains unclear. In this study, we evaluate the effect of miR-145 expression levels on pterygium properties. SETTING Ophthalmology department of a tertiary medical center. DESIGN : Case series study. METHODS Information regarding patient age, pterygium recurrence and pterygium severity (extension [E], vascularity [V] and thickness [T]) were gathered from records. Expression levels of miR-145 were obtained through examination of excised pterygium tissue. Correlations between age, pterygium classification, and miR-145 levels were evaluated. RESULTS This study evaluated 253 patients (mean age 54.1±10.8 years). As pterygium severity increased, miR-145 levels decreased. Negative correlations were also found between miR-145 expression levels and pterygium extension (E) and vascularity (V). Thickness (T) had a weak negative correlation. There was only a mild negative correlation between patient age and miR-145 levels, which was only seen in patients with primary pterygium (not recurrent ones). Additionally, miR-145 expression was significantly higher in primary samples than in recurrent ones. CONCLUSIONS We demonstrated an association between miR-145 and pterygium characteristics, consistent with its known tumor suppression effect. Because the management of pterygium is often difficult, we suggest that miR-145 should be further studied as a potential treatment.

Severity of lens opacity, age, and correlation of the level of silent information regulator T1 expression in age-related cataract

PURPOSE: To evaluate the correlation between the severity of lens opacity, patient age, and the level of silent information regulator T1 (SirT1) expression in the lens epithelium of age‐related cataracts. SETTING: Department of Ophthalmology, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan. DESIGN: Case control study. METHODS: Patient age at the time of cataract surgery and lens opacity severity, classified using the modified version of the Lens Opacities Classification System III (LOCS III), were recorded. Lens epithelium samples were obtained, and the expression level of SirT1 mRNA was evaluated. RESULTS: The study evaluated 233 eyes with cataract. Older patients had higher nuclear (N), cortical (C), and posterior subcapsular (P) cataract LOCS III scores. The expression of SirT1 in lens opacity was significantly less in patients 51 years and older than in those younger than 51 years. The level of SirT1 expression was significantly negatively associated with patient age (r = −0. 746, P<.001). A significant correlation was also found between a higher N, C, and P cataract score and lower expression of SirT1 in patients with age‐related cataract (P<.001). CONCLUSIONS: The decreased expression of SirT1 in the lens epithelium was associated with higher cataract scores and patient age. The results suggest that a local SirT1 decrease in cataractous lens could be a risk factor for the initiation of age‐related cataract formation. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Prevalence and risk factors for myopia in second-grade primary school children in Taipei: A population-based study

Background High myopia is associated with multiple ocular morbidities that may lead to irreversible blindness. Because high myopia in an adult is thought to be related to onset of myopia in very early childhood, detecting myopia early and working to improve modifiable risk factors may help reduce the development of high myopia. In this study, we tried to evaluate the prevalence of myopia and associated risk factors in second‐grade primary school children in Taipei, Taiwan. Methods A questionnaire was distributed to the participants’ parents, and their written informed consent was obtained before performing eye examinations that included visual acuity testing and cycloplegic autorefraction. Multiple logistic regression models were applied to assess possible risk factors associated with myopia. Myopia was defined as spherical equivalent of −0.50 D or less in either eye. Results The prevalence of myopia in the second graders was 36.4%. After adjustment for other characteristics, the following variables were significantly associated with a higher risk of myopia: male sex [odds ratio (OR) = 1.24, p < 0.001]; suburban residence (vs. urban; OR = 1.10, p = 0.02); lower maternal education level (OR = 1.25, p < 0.001); the presence of myopia in one parent (OR = 1.66, p < 0.001) or both parents (OR = 2.82, p < 0.001); time spent on near‐work activity every day (OR = 1.21, p < 0.001); shorter visual distance when doing near‐work activity (OR = 1.17, p < 0.001); and participation in an after‐school tutorial program (OR = 1.20, p < 0.001). By contrast, resting after 30 minutes of near‐work activity (OR = 0.84, p < 0.001) and spending more time participating in outdoor activities on weekends (OR = 0.91, p = 0.03) were significantly associated with a lower risk of myopia. Conclusion Our findings indicate that lifestyle and reading habits impact the development of myopia during early childhood. Behavior modification, such as more time spent outside during the day and limited near‐work activity, may be a feasible strategy for curbing the increasingly high prevalence of myopia in Taipei.

Socioeconomic disparities in preventable hospitalization among adults with diabetes in Taiwan: a multilevel modelling approach

IntroductionLiterature shows socioeconomic disparities are related to various aspects of diabetes care. However, few studies have explored the relationship between socioeconomics and healthcare outcomes, particularly with regard to preventable hospitalization. This cohort study employed hierarchical modelling to evaluate the role of socioeconomics at both the individual and regional levels in order to examine disparities associated with the preventable hospitalization of diabetes patients in Taiwan.MethodsThis study employed the Longitudinal Health Insurance Database 2010, which provided a representative cohort comprising one million people enrolled in Taiwan’s National Health Insurance in 2010. All diabetes patients aged 18 and older who received regular care in 2010 were included in this study. The outcome examined in this study was diabetes-related preventable hospitalization during the period of 2010 to 2011. Socioeconomic status at the individual level was measured according to income and at the regional level according to level of urbanization and the proportion of residents who had completed college education. Control variables included age, gender, comorbidities, time of diabetes diagnosis, participated in the pay-for-performance program status, and the characteristics of regular sources of care, including the level of the facility (i.e., medical centre, regional hospital, local hospital, outpatient clinic) and ownership. Statistical analysis was performed using generalized linear mixed models.ResultsA total of 57,791 patients from 25 regions diagnosed with type-2 diabetes mellitus were identified in the National Health Insurance claim data for the year 2010. 1040 of these patients (1.8%) had at least one diabetes-related preventable hospitalization event during the period of 2010–2011. After controlling for the characteristics of patients and health care providers, our results show that dependents and patients in low and middle income brackets (OR = 2.48, 2.44, and 2.08 respectively) as well as those living in regions with a low, median, or high education bracket (OR = 1.32, 1.38, and 1.46 respectively) face a higher probability of preventable hospitalization.ConclusionsOur results demonstrate that the socioeconomic effects of higher education at the regional level as well as income at the individual level are important factors which affect disparities in diabetes-related preventable hospitalization.

Risk factors for myopia progression in second-grade primary school children in Taipei: a population-based cohort study

Purpose To evaluate the 1-year progression of myopia and associated risk factors in second-grade primary school children. Methods The myopia investigation study in Taipei provided semiannual visual acuity testing and cycloplegic refraction for all second-grade primary school children (mean age: 7.49 years) in Taipei who provided parental consent. A questionnaire was distributed to the participants’ parents before the first and third examinations. We evaluated 1-year follow-up data for children noted to have myopia on the first examination. Multinomial logistic regression models were applied to assess risk factors associated with myopia progression. Myopia progression was categorised, based on the change in spherical equivalent (ΔSE) over 1 year, as slow (ΔSE>−0.5 dioptres (D)), moderate (−1.0 D<ΔSE≤−0.5 D) or fast (ΔSE≤−1.0 D). Of the 4214 myopic children, data were analysed for 3256 (77.3%) who completed the 1-year follow-up evaluation. Results The baseline SE was −1.43±1.1 D. The average ΔSE was −0.42±0.85 D, with 46.96%, 28.50% and 24.54% of the study subjects showing slow, moderate and fast myopia progression, respectively. When compared with slow myopia progression, fast myopia progression was associated with a greater myopic SE at baseline (OR: 0.67, 95% CI: 0.61 to 0.72) and a shorter eye–object distance when doing near work (OR: 1.45, 95% CI: 1.18 to 1.78). More outdoor activity time and self-reported cycloplegic treatment were not associated with slow myopia progression. Conclusions Children with fast annual myopia progression were more myopic at baseline and had a shorter reading distance. Our study results highlight the importance of having children keep a proper reading distance.