Kaziwe Mollazadegan

A Population-Based Study of the Risk of Diabetic Retinopathy in Patients With Type 1 Diabetes and Celiac Disease

OBJECTIVE Celiac disease (CD) is associated with type 1 diabetes (T1D). In the current study, we examined whether CD affects the risk of diabetic retinopathy (DRP) in patients with T1D. RESEARCH DESIGN AND METHODS This was a population-based cohort study. Through the Swedish National Patient Register, we identified 41,566 patients diagnosed with diabetes in 1964–2009 and who were ≤30 years of age at diagnosis. CD was defined as having villous atrophy (Marsh stage 3) according to small intestinal biopsies performed between 1969 and 2008, with biopsy reports obtained from Sweden’s 28 pathology departments. During follow-up, 947 T1D patients had a diagnosis of CD. We used Cox regression analysis with CD as a time-dependent covariate to estimate adjusted hazard ratios (aHRs) for DRP in patients with T1D and CD and compared them with patients with T1D but no CD. RESULTS Duration of CD correlated with the risk of DRP. When results were stratified by time since CD diagnosis, individuals with T1D and CD were at a lower risk of DRP in the first 5 years after CD diagnosis (aHR 0.57 [95% CI 0.36–0.91]), followed by a neutral risk in years 5 to <10 (1.03 [0.68–1.57]). With longer follow-up, coexisting CD was a risk factor for DRP (10 to <15 years of follow-up, aHR 2.83 [95% CI 1.95–4.11]; ≥15 years of follow-up, 3.01 [1.43–6.32]). CONCLUSIONS Having a diagnosis of CD for >10 years is a risk factor for the development of DRP in T1D. Long-standing CD in patients with T1D merits intense monitoring of DRP.

Long-term coeliac disease influences risk of death in patients with type 1 diabetes

The aim of this study was to examine mortality in patients with both type 1 diabetes (T1D) and coeliac disease (CD).

A study of the correlation between patient-reported outcomes and clinical outcomes after cataract surgery in ophthalmic clinics

To analyse the relationship between patient‐reported outcome measures and clinical outcome measures in 42 individual Swedish cataract surgery settings.

Cross-cultural validation of the National Eye Institute Visual Function Questionnaire

Purpose To assess the native and the previously Rasch‐modified National Eye Institute Visual Function Questionnaire (NEI VFQ) scales in a Chinese population. Setting Eye Hospital of Wenzhou Medical University, Wenzhou, China. Design Questionnaire development. Methods Patients on the waiting list for cataract surgery completed the 39‐item NEI VFQ (NEI VFQ‐39). Rasch analysis was performed in 3 steps as follows: (1) Assess the psychometric properties of the original NEI VFQ. (2) Reassess the previously proposed Rasch‐modified NEI VFQ scales by Pesudovs et al. (2010) in Chinese populations. (3) Compare the scores of previously recommended scales of the NEI VFQ with new Rasch‐modified scales of the same questionnaire using Bland‐Altman plots. Results Four hundred thirty‐five patients (median age 70 years; range 35 to 90 years) completed the NEI VFQ‐39. Response categories for 4 question types were dysfunctional and therefore repaired. The original NEI VFQ‐39 and NEI VFQ‐25 showed good measurement precision. However, both versions showed multidimensionality, misfitting items, suboptimum targeting, and nonfunctioning subscales. Using the previously proposed Rasch‐modified scales of the NEI VFQ yielded valid measurement of each construct in the 39‐item and 25‐item questionnaire. Comparison between the earlier proposed NEI VFQ scales and the new versions developed in this population showed good agreement. Conclusions The original NEI VFQ was once again found to be flawed. The previously proposed Rasch‐analyzed versions of the NEI VFQ and the new Chinese versions showed good agreement. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Ocular comorbidity and self-assessed visual function after cataract surgery

Purpose To study the association between ocular comorbidities and the change in patient‐perceived visual function, postoperative patient‐perceived visual function, and visual satisfaction after cataract surgery. Setting Forty‐one Swedish cataract surgical units. Design Clinic‐based cross‐sectional study. Methods Patients who had cataract surgery from 2008 to 2011 completed the Catquest‐9SF questionnaire preoperatively and 3 months postoperatively. Questionnaire data were converted into interval data using Rasch analysis. Multiple regression and logistic regression models were used to examine possible predictors associated with self‐assessed visual function after cataract surgery. Results The total questionnaire was completed by 10 364 patients. Patients without diabetic retinopathy, corneal guttata, glaucoma, macular degeneration, any other comorbidity, or the presence of more than 1 ocular comorbidity had greater improvement in self‐assessed visual function than their counterparts. Patients with other factors such as young age, female sex, short preoperative surgical waiting time, and low preoperative and high postoperative corrected distance visual acuities (CDVAs) also had significantly greater improvement in self‐assessed visual function than their counterparts. Young patients and those with no specific ocular comorbidities, a short surgical waiting time, and low preoperative and high postoperative CDVAs had significantly higher self‐assessed postoperative visual function than their counterparts. Patients without the mentioned ocular comorbidities and a high postoperative CDVA had a higher odds ratio of general satisfaction rather than dissatisfaction than their counterparts. Conclusions Multiple ocular comorbidities, age, preoperative waiting time, and preoperative and postoperative CDVAs affected patients’ improvement and self‐assessed visual function after cataract surgery. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Increased risk of uveitis in coeliac disease : a nationwide cohort study

Background Case reports suggest a potential association between coeliac disease (CD) and uveitis, but larger well-controlled studies are lacking. The aim of this study was therefore to examine the risk of uveitis in patients with biopsy-verified CD. Methods Small intestinal biopsy reports performed between July 1969 and February 2008 were collected from all (n=28) pathology departments in Sweden. From these reports, 29 044 patients with CD (equals villous atrophy, Marsh 3) were identified. Uveitis was defined according to relevant International Classification of Disease codes in the Swedish National Patient Register. Cox regression was used to estimate HR for uveitis in individuals with CD compared with those in reference individuals matched for age, sex, county and calendar year. Results During follow-up, 148 patients with CD developed uveitis (expected count 112), corresponding to a HR of 1.32 (95% CI 1.10 to 1.58). The absolute risk of uveitis was 50/100 000 person-years in CD. The risk estimate did not change more than marginally when adjusted for type 1 diabetes, rheumatoid arthritis and autoimmune thyroid disease (HR 1.30; 95% CI 1.08 to 1.56). The risk of uveitis remained significantly increased even 5 years after CD diagnosis (HR 1.31; 95% CI 1.04 to 1.64). Conclusion A moderately increased risk of uveitis was found in patients with biopsy-verified CD. CD might be considered in patients with uveitis of unknown aetiology.

Celiac Disease Increases Risk of Thyroid Disease in Patients With Type 1 Diabetes: A Nationwide Cohort Study

OBJECTIVE Both type 1 diabetes (T1D) and celiac disease (CD) have been linked to autoimmune thyroid disease (ATD). We examined if individuals with both T1D and CD were at a higher risk of ATD than those with only T1D. RESEARCH DESIGN AND METHODS This study was a nationwide population-based cohort study. We defined T1D as having an inpatient or a hospital-based outpatient diagnosis of T1D at age ≤30 years in the Swedish National Patient Register between 1964 and 2009. Data on CD were obtained through small intestinal biopsy reports showing villous atrophy (Marsh histopathology grade III) between 1969 and 2008 at any of the 28 pathology departments in Sweden. ATD included hyperthyreosis and hypothyreosis, defined according to the Swedish National Patient Register. We identified 947 individuals with T1D and biopsy-verified CD. These were matched to 4,584 control subjects with T1D but no CD diagnosis. Cox regression then estimated the risk of ATD. RESULTS Among T1D, CD was a risk factor for later ATD. During follow-up, 90 T1D+CD patients developed ATD (expected n = 54). Adjusting for sex, age, and calendar period, this corresponded to a hazard ratio (HR) of 1.67 (95% CI 1.32–2.11; P < 0.001). This excess risk was highest in those who had CD for 10 years or more (HR 2.22 [95% CI 1.49–3.23]). Risk increases were seen in both males and females. CD was a risk factor for both hypothyreosis (HR 1.66 [95% CI 1.30–2.12]) and hyperthyreosis (HR 1.72 [95% CI 0.95–3.11]). CONCLUSIONS Among patients with T1D, CD is a risk factor for the later development of ATD.

Translation, cultural adaptation, and Rasch analysis of the visual function (VF-14) questionnaire

PURPOSE To translate, culturally adapt, and validate the original and previously validated shorter versions of the Visual Function Index (VF-14) questionnaire in a Chinese population. METHODS The VF-14 was completed by patients with cataract. The analysis was carried out in three phases: phase I, testing whether the VF-14 and its valid shorter versions,VF-8R and VF-11R, form valid scales in Chinese settings using Rasch analysis; phase II, developing completely new Chinese versions of the VF-14; phase III, testing whether the previously validated shorter versions of the VF-14 could be applied in a Chinese population. This was tested by assessing the agreement between the new Chinese (developed in phase II) and the previously validated shorter versions of the VF-14 using Bland-Altman plots. RESULTS A total of 456 patients (median age, 70 years; range, 40-92 years; females, 58%) completed the Chinese translated version of the VF-14. The VF-14 and the VF-11R demonstrated good Rasch based psychometric properties when a grossly misfitting item was removed. The VF-8R formed a valid scale without any modification. The scores of the VF-11R and the Chinese shorter version (VF-11RChin) showed very good agreement, with a mean difference of -0.18 logits and 95% limits of agreement between 0.11 and -0.47. CONCLUSIONS The Chinese translated VF-14, VF-11R, and VF-8R were valid and could be applied to assess cataract outcomes in Chinese settings. The existing shorter version had good agreement with the new Chinese version, which signifies that there was no need to develop a different version of the VF-14 in China.

Coeliac disease does not affect visual acuity: a study of young men in the Swedish national conscripts register.

Abstract Objective. Coeliac disease (CD) is associated with neurological disease, but there are little data on visual acuity in CD. The objective of this study was to examine visual acuity in undiagnosed and diagnosed CD. Material and methods. Visual acuity was evaluated in Swedish male conscripts: 69 with undiagnosed CD (diagnosed after the conscription), 996 with diagnosed CD (diagnosed before the conscription) and 6850 without a diagnosis of CD. Information on CD was obtained from the Swedish Inpatient Registry 1964–2003. Visual acuity was measured at conscription, and analyses were based on visual acuity test scores from 1983 to 2000 when conscription attendance rates were close to 100% among Swedish males. We defined the highest test score (9/9) as normal, and 0–8/9 as decreased visual acuity. Results. The mean (±SD) visual acuity score was similar in all three groups: reference individuals, 8.03±1.46; undiagnosed CD, 8.04±1.37; diagnosed CD, 8.02±1.50 (median test score in all three groups was 8/9). The prevalence of decreased visual acuity (0–8/9) did not differ according to CD status (reference individuals: 35.3%; undiagnosed CD: 36.2%; diagnosed CD: 36.0%) (p=0.890). Conclusion. In young men, CD does not affect visual acuity.

Type 1 Diabetes, Celiac Disease, and Neuropathy - A Nationwide Cohort Study

Objective: Both type 1 diabetes (T1D) and celiac disease (CD) have been linked to an increased risk of neuropathy. This study examined the risk of neuropathy in patients with T1D compared with patients with both T1D and CD. Methods: In a nationwide population-based cohort, T1D was defined as having a diagnosis of diabetes between 1964 and 2009 recorded in the Swedish National Patient Register in individuals ⩽30 years of age. CD was defined as having villous atrophy (Marsh histopathology stage III) on small intestinal biopsy. CD cases were identified through biopsies examined between 1969 and 2008 at any of Swedens 28 pathology departments. Nine hundred fifty-eight patients had both T1D and CD and were matched for sex, age, and calendar period with 4590 controls who only had T1D. Through Cox regression analysis, with CD as the time-dependent covariate, we estimated the risk of neuropathy in T1D patients with CD. Results: Fifty-four individuals with T1D and CD had later neuropathy (expected: n = 42). This corresponded to an adjusted hazard ratio of 1.27 (95% confidence interval = 0.95–1.71) compared with those who had T1D alone. The hazard ratio was statistically significant in the first 5 years with CD (1.67; 95% confidence interval = 1.13–2.47) but decreased to neutrality thereafter. Risk estimates were similar in men and women, and did not differ by age at CD onset. Conclusions: CD does not seem to influence the risk of neuropathy in individuals with T1D, although a small excess risk cannot be ruled out.