Qi Sheng You

Major eye diseases and risk factors associated with systemic hypertension in an adult Chinese population: the Beijing Eye Study.

PURPOSE To assess the relationship of hypertension with major eye diseases and other ocular parameters. DESIGN Population-based study. PARTICIPANTS The Beijing Eye Study is a population-based study that included 4439 Chinese subjects examined at the baseline examination in 2001; there was a follow-up examination in 2006, in which 3251 subjects participated, of whom 3222 had blood pressure measurements. METHODS All participants underwent an ophthalmic examination, anthropometric measurements, and blood pressure measurement. Hypertension was defined as a systolic blood pressure >or=140 mmHg and/or diastolic blood pressure >or=90 mmHg, and/or self-reported current treatment for hypertension with antihypertensive medication. MAIN OUTCOME MEASURES Blood pressure and ocular parameters, including intraocular pressure and prevalence of major ophthalmic diseases. RESULTS Mean age of participants in the present study was 60.4+/-10.0 years. Hypertension was present in 1500 (46.6%) of the 3222 subjects who had their blood pressure measured. In multiple regression analysis, hypertension was associated with higher intraocular pressure (beta = 0.39; 95% confidence interval [CI], 0.12-0.66; P = 0.005), focal arteriolar narrowing (odds ratio [OR], 1.78; 95% CI, 1.34-2.36; P<0.001), arteriovenous nicking (OR, 1.50; 95% CI, 1.11-2.04; P = 0.009), generalized retinal arteriolar narrowing (OR, 1.65; 95% CI, 1.30-2.09; P<0.001), retinal vein occlusions (OR, 2.86; 95% CI, 1.21-6.80; P = 0.02), and diabetic retinopathy (OR, 1.90; 95% CI, 1.08-3.31; P = 0.02). Hypertension was not significantly associated with the prevalence of open-angle glaucoma (P = 0.19), angle-closure glaucoma (P = 0.15), age-related macular degeneration (AMD) (P = 0.73), nuclear cataract (P = 0.88), posterior subcapsular cataract (P = 0.30), cortical cataract (P = 0.10), or area of alpha zone (P = 0.05) or beta zone of parapapillary atrophy (P = 0.95). CONCLUSIONS In Chinese persons, while controlling for other systemic parameters, hypertension was associated with increased intraocular pressure, retinal microvascular abnormalities, and prevalence of retinal vein occlusion and diabetic retinopathy. Hypertension was not associated significantly with AMD, age-related cataract, or glaucoma.

The 10-Year Incidence and Risk Factors of Retinal Vein Occlusion: The Beijing Eye Study

OBJECTIVE To assess the 10-year incidence of retinal vein occlusions (RVOs) and associated factors in adult Chinese subjects. DESIGN Population-based, longitudinal study. PARTICIPANTS The Beijing Eye Study, which included 4439 subjects (age: 40+ years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). METHODS The study participants underwent a detailed ophthalmic examination. Fundus photographs were examined for the new development of RVOs, differentiated into branch RVOs (BRVOs) and central RVOs (CRVOs). MAIN OUTCOME MEASURES Incidence of RVOs. RESULTS Incident RVOs were detected in 51 eyes (49 subjects) with an incidence of 1.9 ± 0.1 per 100 persons and 1.0 ± 0.1 per 100 eyes. Incidence of BRVO was 1.6 ± 0.1 per 100 subjects (43 subjects [88% of patients with RVO]; 44 eyes), and incidence of CRVO was 0.3 ± 0.1 per 100 persons. Of 61 patients with an RVO in 2001 and 25 subjects reexamined in 2011, at least 4 subjects (7%) developed a second RVO. Incident BRVOs were located more often in the superior temporal quadrant and inferior temporal quadrant (32% and 34%, respectively) than in the superior nasal quadrant and inferior nasal quadrant (21% and 14%, respectively). In 35 eyes (80% of the BRVO eyes), the BRVO was located at an arteriovenous crossing. At the crossing sites, arterioles were found superficial to venules in 28 eyes (64% of the BRVO eyes). Macular edema was detected in 18 (37%) of all RVO eyes, including 13 (30%) of BRVO eyes. In multivariate logistic analysis, incident RVOs were associated with higher systolic blood pressure (P = 0.01; odds ratio [OR], 1.04), hypertension (P = 0.03; OR, 4.62), lower cognitive function score (P = 0.007; OR, 0.88), blood concentration of cholesterol ≥ 5.72 mmol/L (P = 0.007; OR, 3.29), and status after cerebral infarction/hemorrhage (P = 0.02; OR, 1.19). Incident RVOs were not significantly related to the intake of aspirin (P=0.37). CONCLUSIONS The 10-year incidence of RVOs in Greater Beijing (1.9 ± 0.1 per 100 persons) was similar to that in other studies on Caucasian populations. The 10-year incidence of RVOs was related to the known risk factors of arterial hypertension, hypercholesterolemia, and status after cerebral infarction/hemorrhage, as well as with a lower cognitive function score. Incident BRVO was approximately 6 times more frequent than incident CRVO. Macular edema was detected in approximately 30% of BRVO eyes.

Pseudoexfoliation: Normative Data and Associations: The Beijing Eye Study 2011

OBJECTIVE To assess the prevalence of pseudoexfoliation syndrome (PEX) and its associations in a population-based setting. DESIGN Population-based, cross-sectional cohort study. PARTICIPANTS Of 4403 eligible subjects with an age of ≥ 50 years, 3468 individuals (78.8%) participated in the Beijing Eye Study 2011 (mean age, 64.6 ± 9.8 years; range, 50-93 years). METHODS All study participants underwent a detailed ophthalmologic examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp-based biomicroscopy. MAIN OUTCOME MEASURES Prevalence and associations of PEX. RESULTS Slit-lamp examination results were available for 3022 study participants (87.1%). Definite pseudoexfoliation was observed in 72 of the 3022 subjects, with a prevalence of 2.38% (95% confidence interval [CI], 1.84-2.93). Suspected PEX was detected in 104 of the subjects (3.44%; 95% CI, 2.8-4.1). The overall prevalence of PEX (definite and suspected) was 176 of 3022 or 5.82% (95% CI, 4.99-6.66). In 80 subjects (45.5%), PEX was detected in both eyes, whereas it was detected only in the right eye in 42 subjects (23.9%) and only in the left eye in 54 (30.7%). The prevalence of PEX increased from 1.1% in among those 50 to 54 years old, to 3.5%, 5.7%, and 11.8% among those 60 to 64 years, 70 to 74 years, and ≥ 80 years, respectively. In multivariate analysis, presence of PEX was significantly associated with older age (P<0.001; odds ratio [OR], 1.08; 95% CI, 1.04-1.10), shorter axial length (P = 0.03; OR, 0.82; 95% CI, 0.68,0.98), and shallower anterior chamber (P = 0.03; OR, 0.59; 95% CI, 0.36-0.95). We found that PEX was not associated (all P>0.05) with sex, diabetes mellitus, blood pressure, psychological depression, smoking, dyslipidemia, body mass index, central corneal thickness, corneal diameter, optic nerve head measurements, choroidal thickness, retinal vessel diameters, early age-related macular degeneration, or retinal vein occlusion. CONCLUSIONS In a North Chinese population aged ≥ 50 years, the prevalence of definite PEX was 2.38% (95% CI, 1.84-2.93), suspect PEX was 3.4% (95% CI, 2.8-4.1) and overall PEX was 5.82% (95% CI, 4.99-6.66). We found PEX to be associated with older age, shorter axial length, and shallower anterior chamber. The relationship between PEX and glaucomatous optic neuropathy remained inconclusive among our population. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.

Retinal Nerve Fiber Layer Thickness. The Beijing Eye Study 2011

Purpose To measure retinal nerve fiber layer (RNFL) thickness in a population-based setting. Methods In the population-based Beijing Eye Study 2011 with 3468 individuals, RNFL thickness was measured in a subgroup of 1654 (47.7%) study participants by spectral domain optical coherence tomography (iVue SD-OCT). Results Mean RNFL thickness was significantly (P<0.001) higher in the inferior sector (131.4±20.6 µm) than the superior sector (126.1±19.1 µm), where it was higher than in the temporal sector (79.8±12.2 µm;P<0.001), where it was higher than in the nasal sector (75.1±12.6 µm;P<0.001). In multivariate analysis, mean global RNFL thickness (103.2±12.6 µm) increased significantly with younger age (standardized correlation coefficient beta:−0.30;P<0.001), larger neuroretinal rim area (beta:0.26;P<0.001), shorter axial length (beta:−0.21;P<0.001), thicker subfoveal choroidal thickness (beta:0.15;P<0.001), larger optic disc area (beta:0.10;P<0.001), less refractive lens power (beta:0.10;P<0.001), flatter anterior cornea (beta:0.07;P = 0.01) and female gender (beta:0.05;P = 0.03). In this population with an age of 50+ years, the age-related decline in RNFL thickness was 0.5 µm per year of life or 0.36% of an original RNFL thickness of 137 µm at baseline of the study at 50 years of age. Mean global RNFL thickness decreased by 2.4 µm for each mm enlargement of axial length. Conclusions The RNFL profile shows a double hump configuration with the thickest part in the inferior sector, followed by the superior sector, temporal sector and nasal sector. Factors influencing global RNFL thickness were younger age, larger neuroretinal rim, shorter axial length, thicker subfoveal choroid, larger optic disc, less refractive lens power, flatter anterior cornea and female gender. Beyond an age of 50+ years, RNFL decreased by about 0.3% per year of life at an age of 50+ years and by 2.4 µm per mm of axial elongation. These findings may be of interest for the knowledge of the normal anatomy of the eye and may be of help to diagnose diseases affecting the RNFL.

Ocular diseases and 10‐year mortality: The Beijing Eye Study 2001/2011

To examine the relationship between major ocular diseases and mortality.

Localized Retinal Nerve Fiber Layer Defects and Stroke

Background and Purpose— Because the blood circulation system of retina and brain are closely related to each other, we examined whether stroke is associated with localized retinal nerve fiber layer defects (RNFLDs). Methods— Patients with acute ischemic stroke as part of a hospital-based study group were compared with the participants of the population-based group Beijing Eye Study. The retina was imaged by spectral-domain optical coherence tomography for the detection of localized RNFLDs. Results— The study included 154 patients with acute ischemic stroke and 2890 subjects from the Beijing Eye Study for whom optical coherence tomographic images of the retinal nerve fiber layer and data on a previous cerebral stroke were available. In logistic regression analysis, acute stroke was significantly associated with localized RNFLDs (P<0.001; odds ratio, 6.23; 95% confidence interval, 4.17–9.30) after adjusting for age, male sex, arterial hypertension, diabetes mellitus, and higher concentration of the C-reactive protein. In a similar manner, previous stroke was associated with localized RNFLDs (P=0.04; odds ratio, 1.48; 95% confidence interval, 1.02–2.16) in multivariate analysis. In a reverse manner, presence of localized RNFLDs was associated with cerebral stroke (P<0.001; odds ratio, 3.54; 95% confidence interval, 2.68–4.67) after adjusting for age, sex, and prevalence of diabetes mellitus. Conclusions— Localized RNFLDs showed a strong association with previous or acute cerebrovascular stroke and vice versa after adjustment for other systemic and ocular factors. Localized RNFLDs that can be assessed by noninvasive optical coherence tomographic imaging may be added to the panoply of retinal morphological features of stroke.

Five-year change in intraocular pressure associated with changes in arterial blood pressure and body mass index. The beijing eye study.

Purpose To examine a potential association between longitudinal changes in intraocular pressure (IOP), arterial blood pressure and body mass index (BMI) in a population-based setting. Methods The longitudinal population-based Beijing Eye Study included 2355 subjects with an age of 45+ years who were examined in 2006 and in 2011. The participants underwent a detailed ophthalmic examination including tonometry and measurement of arterial blood pressure and BMI. Results Data on IOP, arterial blood pressure and BMI measured in 2006 and in 2011 were available for 2257 (95.8%) subjects with a mean age of 59.5±9.7 years. The mean change in IOP was −1.25±2.26 mm Hg, mean change in mean blood pressure −7.4±12.1 mmHg, and mean change in BMI was 0.01±2.04 kg/m2. In multivariate analysis, the 5-year change in IOP was significantly associated with a higher change in mean blood pressure (P<0.001; standardized regression coefficient Beta:0.11; regression coefficient B:0.02; 95% confidence interval (CI):0.01,0.03) after adjusting for younger age (P<0.001;Beta:−0.18;B:−0.04;95% CI:−0.05,−0.03), shorter body stature (P = 0.002;Beta:−0.06;B:−0.06;95% CI:−0.03,−0.01), thicker central corneal thickness (P<0.001;Beta:0.19;B:0.02;95% CI:0.01,0.02), deeper anterior chamber depth (P = 0.01;Beta:0.05;B:0.33;95% CI:0.07,0.60), and lower intraocular pressure at baseline (P<0.001;Beta:−0.56;B:−0.42;95% CI:−0.45,−0.39). If the analysis included only longitudinal parameters, the change in IOP was significantly associated with a higher change in mean arterial blood pressure (P<0.001;Beta:0.10;B:0.02;95% CI:0.01,0.03) and a higher change in body mass index (P<0.04;Beta:0.04;B:0.04;95% CI:0.01,0.09). Conclusions In the 5-year follow-up of our population-based sample, a change in IOP was associated with a corresponding change in arterial blood pressure and with a corresponding change in body mass index. These longitudinal data support the notion of a physiological relationship between arterial blood pressure, intraocular pressure and body mass index. These findings may be of interest for the discussion of the pathogenesis of glaucomatous optic neuropathy.

Localized retinal nerve fiber layer defects and arterial hypertension.

BACKGROUND We examined the relationship between arterial hypertension, localized retinal nerve fiber layer defects (RNFLDs), and retinal vascular abnormalities. METHODS The study included 359 patients with arterial hypertension and 331 individuals without hypertension as control subjects. Localized RNFLDs and retinal vascular abnormalities were assessed on fundus photographs. RESULTS After adjusting for blood concentrations of glycosylated hemoglobin (HbA1c), high-density lipoproteins, low-density lipoproteins, and hyperlipidemia in a multivariable analysis, localized RNFLDs were, in addition to arterio-venous nicking and generalized arteriolar narrowing, significantly associated with arterial hypertension. After adjusting for body mass index, waist/hip ratio, blood concentrations of glucose, HbA1c, triglycerides, high-density lipoproteins, low-density lipoproteins, and prevalence of diabetes mellitus and hyperlipidemia, categories of arterial blood pressure (optimal/normal/highly normal; mild, moderate and severe hypertension) were significantly associated with localized RNFLDs, which were present significantly more often in hypertension grades 2 and 3, with odds ratios (ORs) of 10.01 and 6.45, respectively. The corresponding ORs for arterio-venous nicking (hypertension grades 1, 2, and 3: ORs of 2.00, 1.68, and 1.99, respectively) and generalized arteriolar narrowing (hypertension grades 1 and 3; ORs of 4.60 and 4.32, respectively) were lower than those for localized RNFLDs. CONCLUSIONS Localized RNFLDs, in addition to retinal microvascular abnormalities such as focal and generalized arteriolar narrowing, were associated with different grades of arterial hypertension. Ophthalmoscopic examination for localized RNFLDs may be useful for the assessment of the retinal abnormalities associated with arterial hypertension and for the grading of arterial hypertension.

Posterior Scleral Reinforcement And Vitrectomy For Myopic Foveoschisis In Extreme Myopia

Purpose: To evaluate the effect of surgical posterior scleral reinforcement in extremely myopic patients (axial length ≥30 mm) with myopic foveoschisis. Methods: The retrospective interventional case series study included patients with an axial length ≥30 mm, posterior scleral staphyloma, and myopic foveoschisis, who were treated either by posterior scleral reinforcement and 23-gauge 3-port pars plana vitrectomy (posterior scleral reinforcement group) or by vitrectomy (vitrectomy group) alone. All eyes additionally underwent cataract surgery. Results: The study included 28 patients (28 eyes) with no significant (all P > 0.05) difference between the posterior scleral reinforcement group (n = 14) and the vitrectomy group (n = 14) in age, refractive error, axial length, and preoperative best-corrected visual acuity (BCVA). In addition to posterior scleral staphyloma and foveoschisis, a macular hole, a macular hole–associated retinal detachment, and a macular detachment without macular hole were present in three eyes, five eyes, and one eye, respectively in the study group and in three eyes, three eyes, and six eyes, respectively in the control group. In the study group, BCVA was significantly better after surgery than at baseline (P = 0.005) with an improvement in BCVA in 13 eyes, whereas BCVA was unchanged in 1 eye. In the control group, BCVA at baseline and at the end of follow-up did not differ significantly (P = 0.22). Gain in BCVA was marginally significantly higher in the study group than that in the control group (improvement by 0.69 ± 0.76 logMAR vs. 0.19 ± 0.54 logMAR; P = 0.05). The number of eyes with any improvement in BCVA (13 [93%] eyes vs. 11 [79%] eyes; P = 0.289) did not differ between both groups; an improvement in BCVA by more than 2 lines (10 [71%] eyes vs. 3 [21%] eyes; P = 0.009) was significantly higher in the study group than that in the control group. Anatomical success (defined as closure of macular holes and collapse of the foveoschisis) was achieved earlier in the study group (3.7 ± 3.2 months vs. 6.2 ± 3.0 months; P = 0.04). Conclusion: Posterior scleral reinforcement in association with vitrectomy, as compared with vitrectomy alone, was associated with a higher improvement in visual acuity in extremely myopic eyes with foveoschisis.

Diabetic Retinopathy and Estimated Cerebrospinal Fluid Pressure. The Beijing Eye Study 2011

Purpose The cerebrospinal fluid pressure (CSFP) is a major determinant of central retinal vein pressure and thus of retinal capillary pressure. We tested the hypothesis whether prevalence and severity of diabetic retinopathy are associated with CSFP. Methods The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years. A detailed ophthalmic examination was performed including fundus photography for the assessment of diabetic retinopathy according. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP[mmHg] = 0.44xBody Mass Index[kg/m2]+0.16 Diastolic Blood Pressure[mmHg]–0.18xAge[Years]−1.91. Results In binary regression analysis, presence of diabetic retinopathy was significantly associated with higher levels of HbA1c (P<0.001; regression coefficient B:0.25; odds ratio (OR):1.28; 95% confidence interval (CI):1.15,1.43), higher blood concentration of glucose (P<0.001; B:0.40;OR:1.49;95%CI:1.36,1.63), longer known duration of diabetes mellitus (P<0.001; B:0.14;OR:1.15; 95%CI:1.11,1.19), higher systolic blood pressure (P<0.001; B:0.03;OR:1.03;95%CI:1.02,1.04), lower diastolic blood pressure (P<0.001; B:−0.06;OR:0.94;95%CI:0.91,0.97), and higher CSFP (P = 0.002; B:0.13;OR:1.14;95%CI:1.05,1.24). Severity of diabetic retinopathy was significantly associated with higher HbA1c value (P<0.001; standardized coefficient beta: 0.19; correlation coefficient B: 0.07;95%CI:0.05,0.08), higher blood concentration of glucose (P<0.001; beta:0.18;B:0.04;95%CI:0.04,0.05), longer known duration of diabetes mellitus (P<0.001; beta:0.20;B:0.03;95%CI:0.02,0.03), lower level of education (P = 0.001; beta:−0.05;B:−0.02;95%CI:−0.03,−0.01), lower diastolic blood pressure (P = 0.002; beta:−0.08;B:−0.001;95%CI:−0.004,−0.001), higher systolic blood pressure (P = 0.006; beta:0.06;B:0.001;95%CI:0.000,0.001), and higher CSFP (P = 0.006; beta:0.06;B:0.006;95%CI:0.002,0.010). Conclusions Higher prevalence and severity of diabetic retinopathy were associated with higher estimated CSFP after adjusting for systemic parameters. Higher CSFP through a higher retinal vein pressure may lead to more marked retinal venous congestion and vascular leakage in diabetic retinae.