Ching-Yu Cheng

Prevalence of dry eye among an elderly Chinese population in Taiwan: The Shihpai Eye Study

PURPOSEnTo describe the epidemiology of dry eye in an elderly Chinese population in Taipei, Taiwan.nnnDESIGNnA population-based cross-sectional study.nnnPARTICIPANTSnThe Shihpai Eye Study was a population-based survey of eye diseases in the elderly (> or =65 years) in Shihpai, Taipei, Taiwan. Noninstitutionalized residents, as of July 1999, were identified by using the official household registration database. A total of 2045 subjects were selected, and 1361 (66.6%) people participated in the study. Among them, 822 (60.4%) were men.nnnMETHODSnTrained interviewers administered a standardized questionnaire pertaining to dry-eye symptoms. Objective examinations of dry eye included tear film breakup time, Schirmer test, fluorescein stain of the cornea, and anatomic assessment of the meibomian glands via slit-lamp biomicroscopy.nnnMAIN OUTCOME MEASURESnFrequency of dry-eye symptoms and positive dry-eye tests.nnnRESULTSnIn this population, 33.7% (459/1361) were symptomatic, defined as reporting 1 or more dry-eye symptoms often or all of the time. Women were more likely to report frequent symptoms of dry eye (odds ratio, 1.49; 95% confidence interval, 1.19-1.87). Among those who were symptomatic, 78.9% (362/459) had a low tear film breakup time (< or =10 seconds), 62.5% (287/459) had a low Schirmer test result (< or =5 mm), and 61.7% (283/459) had abnormal anatomic features of the meibomian glands. Furthermore, 85.4% (392/459) were symptomatic and had either a low Schirmer score or an abnormal meibomian gland assessment. Of those symptomatic, 49.9% (229/459) indicated that they had visited an eye doctor, 5.4% (25/459) responded that they had been diagnosed with dry eye, and 47.5% (218/459) reported current use of eyedrops.nnnCONCLUSIONSnThis is the first report of population-based data of dry eye that includes symptoms and signs in elderly Asians. The prevalence of dry eye, although varied according to definition, is relatively higher in this study than that reported for whites. Further studies are needed to determine whether this is due to racial or environmental factors.

Prevalence and Associated Risk Factors of Age-Related Macular Degeneration in an Elderly Chinese Population in Taiwan : The Shihpai Eye Study

PURPOSEnTo assess the prevalence and associated risk factors of age-related macular degeneration (AMD) in an elderly Chinese population in Taiwan.nnnMETHODSnThe Shihpai Eye Study was a survey of vision and ocular disease in an elderly Chinese population 65 years of age or older residing in Shihpai, Taipei, Taiwan. Of 2045 elderly residents randomly sampled from the household registration databank, 1361 (66.6%) underwent a detailed ophthalmic examination that included fundus color slides by fundus camera after pupil dilatation. Photographs were graded according to the Wisconsin Age-Related Maculopathy Grading System.nnnRESULTSnFundus photographs were available for 1105 (54.0% in the eligible, 81.2% in the ocular examined) participants. The 47 (4.3%) participants who had ungradable fundus images were older and had more lens opacity. Of the 1058 gradable photographs, the prevalence of early AMD was 9.2% (95% confidence interval [CI], 7.8-10.8); of late AMD, 1.9% (95% CI, 1.3-2.7); of soft drusen, 42.2% (95% CI, 39.7-44.8); of soft indistinct drusen, 4.1% (95% CI, 3.1-5.2); and of any pigmentary change, 8.6% (95% CI, 7.2-10.2). Age was the most significant factor associated with both early and late AMD. The prevalence of early AMD rose from 5.0% in the 65- to 69-year age group to 24.4% in those 80 years of age and older; and for late AMD, from 1.0% to 9.0%. Those who currently drank alcohol had a lower rate of early AMD than did the nondrinker (adjusted odd ratio 0.32, 95% CI: 0.11-0.93, P = 0.037).nnnCONCLUSIONSnAMD is a common eye disease in the elderly Chinese people in Taiwan. The adjusted prevalence rate of exudative AMD is comparable to that in the Chinese people in the Multiethnic Study of Atherosclerosis (MESA) in the United States but is higher than in the Chinese people in the Beijing study in China. Further studies are needed to clarify the incidence and associated risk factors.

Epidemiologic study of age-related cataracts among an elderly chinese population in Shih-Pai, Taiwan

PURPOSEnThe purpose of this study was to determine the prevalence and risk factors for age-related cataracts in a metropolitan elderly Chinese population in Shihpai, Taipei, Taiwan.nnnDESIGNnPopulation-based cross-sectional study.nnnPARTICIPANTSnA total of 2045 subjects at least 65 years of age were invited to participate, and 1361 (66.6%) participated in the survey.nnnMETHODSnAn eye examination, including lens opacity grading, was conducted by ophthalmologists using the Lens Opacity Classification System III (LOCS III). A structured questionnaire was used for data collection. Interviewers also collected information on subjects blood pressure, lifestyle (cigarette smoking and alcohol intake), medical history, and waist and hip circumferences.nnnMAIN OUTCOME MEASURESnSubjects were defined as having age-related cataracts if there was any type of lens opacity with an LOCS III grade of more than 2 in one or both eyes. When both eyes of an individual had age-related cataracts, the more affected eye was used for analysis.nnnRESULTSnAmong the 1361 participants, 806 were diagnosed with age-related cataracts. The prevalence was 59.2% (95% confidence interval, 56.6%-61.8%). Women had a higher prevalence of cataracts than men (64.0% vs. 56.1%, P = 0.004). The prevalence of age-related cataracts increased with age (P = 0.001). Nuclear opacity was the most prevalent type (38.9%), followed by cortical opacity (21.9%) and posterior subcapsular opacity (9.2%). On the basis of the final logistic regression model, after controlling for all other covariates, increased age and female gender were factors that were associated with an increased risk for all types of cataracts. Besides age and gender, the most significant risk factor for nuclear cataracts was current cigarette smoking; the significant predictors for cortical cataracts were higher systolic blood pressure, a history of cigarette smoking in the past, and history of diabetes; the significant predictor for posterior subcapsular cataracts was higher systolic blood pressure.nnnCONCLUSIONSnThe increasing prevalence of age-related cataracts with age highlights the need to seek appropriate medical services and for preventative interventions. Elderly people often ignore the importance of seeking vision services and care to prevent blindness or visual impairment. These findings suggest that the elderly need to be educated regarding the importance of eye care by physicians and hygiene authorities in Taiwan.

Visual acuity and contrast sensitivity in different types of posterior capsule opacification

Purpose: To compare the visual acuity (VA) and contrast sensitivity in 2 types of posterior capsule opacification (PCO) in pseudophakic eyes before and after neodymium:YAG (Nd:YAG) capsulotomy and to evaluate vision test results after Nd:YAG capsulotomy. Setting: Department of Ophthalmology, Taipei Veterans General Hospital, National Yang‐Ming University, Taipei, Taiwan. Methods: Fourteen eyes with fibrosis‐type PCO and 15 eyes with Elschnig‐pearl‐type PCO were enrolled prospectively. Before and 1 week after Nd:YAG capsulotomy, VA and contrast sensitivity were assessed using the illiterate E version of the Bailey‐Lovie chart and the Vistech VCTS 6000 chart, respectively. Results: Before capsulotomy, the mean logMAR acuity in the group with Elschnig‐pearl‐type PCO was 0.47 ± 0.32 (SD) and in the group with fibrosis‐type PCO, 0.17 ± 0.07. The difference between the 2 groups was significant (P = .002). After capsulotomy, there was no significant between‐group difference (P gt; .05). Before capsulotomy, the contrast sensitivity was significantly worse (P < .01) at all spatial frequencies in the group with pearl‐type PCO, especially at 6 cycles per degree. After capsulotomy, there was no significant between‐group difference (P gt; .05) at any spatial frequency. Conclusions: After cataract surgery, patients with pearl‐type PCO had lower VA and contrast sensitivity than those with fibrosis‐type PCO. An Nd:YAG capsulotomy improved the VA and contrast sensitivity in patients with both types of PCO.

Prevalence and Associated Risk Factors of Myopic Maculopathy in Elderly Chinese: The Shihpai Eye Study

PURPOSEnTo assess the prevalence and associated risk factors of myopic maculopathy in an elderly Chinese population in Taiwan.nnnMETHODSnPopulation-based, cross-sectional study. A total of 1361 Chinese aged 65 years or older residing in Shihpai, Taipei, Taiwan, underwent a detailed ophthalmic examination. Of the 1361 participants, 1058 subjects had at least one gradable fundus photograph and were recruited for analysis. High myopia was defined as spherical equivalent of less than -6.0 diopter (D) in the phakic eyes or axial length greater than 26.5 mm in pseudophakic or aphakic eyes. Myopic maculopathy was defined as the appearance of lacquer cracks, focal area of deep choroidal atrophy and macular choroidal neovascularization, or geographic atrophy in the presence of high myopia.nnnRESULTSnThe prevalence of high myopia was 4.2% (44/1058). Signs of myopic maculopathy were present in 32 (72.7%) of the 44 high myopics, representing a prevalence of 3.0% (95% confidence interval, 2.0%-4.0%). Subjects with high myopia with myopic maculopathy had higher systolic blood pressure than those without maculopathy (146.4 ± 16.2 mm Hg vs. 127.0 ± 15.9 mm Hg, P = 0.001), and the difference persisted (P = 0.018) after adjustment for age, sex, smoking, body mass index, diastolic blood pressure, educational levels, alcohol drinking, and histories of diabetes or taking anti-hypertension medication. Of the 65 high myopic eyes, eyes with maculopathy had a greater myopic degree (-12.8 ± 5.1 D vs. -7.6 ± 1.5 D, P = 0.001) and poorer corrected visual acuity (logMAR 0.72 ± 0.6 vs. 0.27 ± 0.2, P = 0.001) than those without.nnnCONCLUSIONSnThe prevalence of high myopia and myopic maculopathy in this elderly Chinese population group was high. Of the major risk factors examined, high systolic blood pressure may be associated with myopic maculopathy.

The impact of visual impairment and use of eye services on health-related quality of life among the elderly in Taiwan: The Shihpai Eye Study

To evaluate the effect of impaired vision on health-related quality of life (HRQoL), the authors administered the Medical Outcomes Survey Short-Form 36 (SF-36) to the elderly in a metropolitan Taiwanese community and assessed their visual impairment status. A structured questionnaire was used for door-to-door data collection. Interviewers also collected information on demographics, medical history, and HRQoL. Those who were interviewed were invited to the study hospital for a detailed eye examination. An eye examination, including presenting visual acuity and best-corrected visual acuity, was conducted by ophthalmologists. Presenting visual acuity and best-corrected visual acuity were measured in the better eye. Impaired vision was defined as presenting visual acuity in the better-seeing eye worse than 6/12 (or 20/40) and was used to evaluate the correlation to HRQoL. A total of 1361 subjects at least 65 years of age participated in both the interview and eye examination. Internal-consistency and test–retest reliability of the eight scales were high. Based on the separate multiple regression model, after controlling for all other covariates, subjects in contact with vision services offered by an ophthalmologist had more positive scores on general health perceptions (β= 4.29; p < 0.001), vitality/energy (β= 2.73; p < 0.001), and mental health (β= 2.06; p= 0.01). Impaired vision was associated with significantly lower scores in physical functioning (β=−3.62; p < 0.001) and social functioning scales (β=−3.25; p= 0.015). The findings suggest that visual impairment is associated with lower quality of life and use of eye care services is associated with higher quality of life.

Visual Impairment and Falls in the Elderly: The Shihpai Eye Study

Background: To investigate the association between visual impairment and falls in a metropolitan elderly Chinese population. Methods: A population‐based cross‐sectional study of eye diseases among subjects 65 years of age and older was conducted in the Shihpai community of Taipei between July 1, 1999 and December 31, 2000. Results: Of the 2,045 subjects invited, 1,361 (66.6%) participated in both the questionnaire and the eye examination. Sixty‐two (4.6%; 95% confidence interval [CI], 3.4–5.7%) had experienced 2 or more falls in the previous 12 months. On univariate analysis, best‐corrected Snellen visual acuity of the better eye less than 6/12 (odds ratio [OR], 2.47; 95% CI, 1.18–5.18; p < 0.001), female gender (OR, 2.52; 95% CI, 1.49–4.26; p < 0.001), high waist‐to‐hip ratio (OR, 1.86; 95% CI, 1.00–3.47; p = 0.01), history of diabetes mellitus (OR, 3.88; 95% CI, 2.27–6.62; p < 0.001) and cardiovascular disease (OR, 2.26; 95% CI, 1.34–3.80; p = 0.04) were significantly related to falls. In the final multiple logistic regression model controlling for other covariates, visual impairment (OR, 1.98; 95% CI, 1.02–4.32; p < 0.001), female gender (OR, 2.34; 95% CI, 1.29–4.23; p < 0.01), history of diabetes (OR, 3.61; 95% CI, 2.03–6.40; p < 0.01) and cardiovascular disease (OR, 1.96; 95% CI, 1.13–3.40; p = 0.04) were significantly related to falls. Conclusion: Falls were significantly associated with a best‐corrected Snellen visual acuity of less than 6/12.

Clinical characteristics and factors associated the outcome of lacrimal canaliculitis.

Purpose:u2002 To analyze the clinical and microbiological characteristics and factors associated with the outcome of lacrimal canaliculitis.

Color Doppler imaging study of retrobulbar hemodynamics in chronic angle-closure glaucoma.

PURPOSEnTo evaluate the retrobulbar hemodynamics in patients with chronic angle-closure glaucoma (CACG) by using color Doppler imaging (CDI) and to correlate the degree of glaucomatous visual field loss with the hemodynamic parameters.nnnDESIGNnProspective case series.nnnPARTICIPANTS AND CONTROLSnTwenty-six Chinese patients with CACG and 26 age-matched and gender-matched normal subjects were recruited. All CACG patients had history of chronic intraocular pressure (IOP) elevation and asymmetric visual field defects between their fellow eyes. After receiving laser peripheral iridotomy and/or filtration surgery, all of them had bilateral medication-free controlled IOP before enrolling into the study.nnnMETHODSnEach subject underwent CDI measurement in the central retinal artery (CRA) and the nasal and temporal short posterior ciliary arteries (PCA). Visual fields of the CACG patients were obtained with Humphrey 24-2 program. The visual field defects were scored with the Advanced Glaucoma Intervention Study (AGIS) system. For each CACG patient, the eye with lower AGIS score was defined as the better eye and the eye with higher score as the worse eye.nnnMAIN OUTCOME MEASURESnPeak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were determined.nnnRESULTSnThe EDV in the CRA and the temporal PCA was decreased significantly (P = 0.041 and 0.023, respectively) in the worse eyes of CACG patients compared with those in the control eyes. The better eyes of CACG patients showed no significant change in hemodynamic parameters compared with the control eyes. While comparing the fellow eyes of CACG patients, the worse eyes had significantly lower EDV in the temporal PCA (P = 0.012) than the contralateral better eyes. In 11 CACG patients with a difference of at least 8 in AGIS visual field scores between their fellow eyes, the worse eyes had significantly lower EDV (P = 0.041) in the CRA and lower PSV (P = 0.018) and EDV (P = 0.018) in the temporal PCA compared with those in the contralateral eyes. In multivariate regression analysis, the AGIS scores were significantly correlated with the PSV in the CRA (P = 0.015) and with the EDV (P < 0.001) and RI (P = 0.027) in the temporal PCA in patients with CACG.nnnCONCLUSIONSnPatients with well-controlled CACG may have decreased retrobulbar blood flow velocities and increased vascular resistance in the CRA and temporal PCA. The degree of retrobulbar hemodynamic impairment was well correlated with the degree of glaucomatous visual field loss.

The Long-term Effect of Nd:YAG Laser Iridotomy on Intraocular Pressure in Taiwanese Eyes with Primary Angle-closure Glaucoma

Background: To investigate the long‐term effect of Nd:YAG laser iridotomy on intraocular pressure (IOP) in Taiwaneseeyes with primary angle‐closure glaucoma (PACG). Methods: The medical records of 81 patients (130 eyes) who were diagnosed with PACG and who had undergone Nd:YAG laser iridotomy between 1998 and 2002 were reviewed. According to the presence of symptomatic glaucomaattack, eyes were divided into an acute angle‐closure glaucoma (AACG) group and chronic angle‐closure glaucoma (CACG)group. In the AACG group, the acute episode was treated and resolved after Nd:YAG laser iridotomy. These eyes were diag‐nosed to have or developed glaucoma during the follow‐up period. All patients were followed‐up for at least 24 months. The presenting features, treatment and IOP during the follow‐up period were analyzed. Results: The mean follow‐up period was 44.1 ±17.8 months (median, 36 months). There were 27 eyes (from 25 patients)in the AACG group. Only 2 eyes (7.4%) did not require any treatment after Nd:YAG laser iridotomy. Eleven eyes (40.7%)eventually underwent filtering surgery at a mean of 3.2 months (median, 3 months) after Nd:YAG laser iridotomy. Therewere 103 eyes (from 56 patients) in the CACG group. Eighty‐five eyes (82.5%) required further medical treatment, ofwhich 21 eyes (20.4%) eventually received filtering surgery at a mean of 9.8 months (median, 5 months) after Nd:YAGlaser iridotomy. Conclusion: For most Taiwanese eyes with PACG after Nd:YAG laser iridotomy, additional medicine and surgery arerequired in the long term. Eyes in the AACG group needed more surgical intervention than those in the CACG group.