Shi Song Rong

Near work, outdoor activity, and their association with refractive error.

Purpose To assess the relationship between near work, outdoor activity, and refractive error in schoolchildren in Beijing. Methods The Beijing Myopia Progression Study is a hospital-based myopia study, in which 386 students from primary (aged 6 to 12 years) and secondary (aged 13 to 17 years) schools in the inner city of Beijing were enrolled. Cycloplegic refraction and a detailed questionnaire probing near, intermediate, and distance visual activities were completed. Results Three hundred seventy (95.9%) of 386 students with complete cycloplegic autorefraction and myopia questionnaire data were enrolled in this study. Children with more near work time did not exhibit a significantly more myopic refraction in both the primary and secondary school levels after adjusting for the children’s gender, outdoor activity time, and average parental refractive error. A significant association between outdoor activity time (in hours per day) and the children’s spherical equivalent (in diopters) was found in the primary school students (&bgr; = 0.27, p = 0.03) but not in the secondary school students (&bgr; = 0.04, p = 0.70) after adjusting for similar confounders. The time spent on outdoor sports and outdoor leisure in the primary school students was also significantly associated with the children’s spherical equivalent (&bgr; = 0.46, p = 0.04 and &bgr; = 0.31, p = 0.02, respectively). Primary school students with more time outdoors exhibited relatively less myopic refraction than their peers (ptrend = 0.0003), but this relation was not demonstrated in the secondary school children (ptrend = 0.53) after adjusting for similar confounders. Conclusions Higher levels of outdoor activity were associated with less myopic refraction in primary school students in the inner city of Beijing. Near work activity was not found to be associated with refraction at either school level.

Topical Cyclosporine in the Treatment of Allergic Conjunctivitis: A Meta-analysis

PURPOSE To assess the efficacy and safety of topical cyclosporine versus placebo in the treatment of allergic conjunctivitis. DESIGN Systematic review and meta-analysis. PARTICIPANTS Seven qualified studies incorporating 306 eyes of 153 patients were analyzed. METHODS Searches of randomized controlled trials were conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. MAIN OUTCOME MEASURES We assessed the methodologic quality of individual included trials and performed meta-analyses using the random effects model if P<0.1 in the test for heterogeneity, or otherwise used the fixed effects model. We assessed scores of composite signs and symptoms, reduction in steroid eye drop use in steroid-dependent patients, and safety outcomes (i.e., stinging or burning sensation). RESULTS At 2 weeks of follow-up or longer, evidence suggests a statistically significant improvement in the composite signs (standardized mean difference [SMD], -1.21; 95% confidence interval [CI], -1.80 to -0.62; I(2) = 71%) and symptoms (SMD, -0.84; 95% CI, -1.51 to -0.16; I(2) = 80%) after topical cyclosporine treatment for allergic conjunctivitis regardless of the dosage of treatment. There was a significant reduction (mean difference, -61.16; 95% CI, -101.61 to -20.72; I(2) = 58%) in the use of steroid eye drops in patients with steroid-dependent allergic conjunctivitis. Stinging or burning sensation (odds ratio, 2.56; 95% CI, 0.19-35.06; I(2) = 73%) was common in both the cyclosporine and placebo groups. CONCLUSIONS This systematic review and meta-analysis suggests topical cyclosporine could be an effective and safe treatment method for allergic conjunctivitis. Further randomized controlled trials with larger sample sizes and standardized outcome measurements, follow-up periods, and cyclosporine concentrations are warranted to determine the short- and long-term efficacy and safety and the minimal effective dosage of topical cyclosporine for allergic conjunctivitis.

Association of Genetic Variants with Polypoidal Choroidal Vasculopathy: A Systematic Review and Updated Meta-analysis.

TOPIC A systematic review and meta-analysis of the genetic association with polypoidal choroidal vasculopathy (PCV) and the genetic difference between PCV and neovascular age-related macular degeneration (nAMD). CLINICAL RELEVANCE To identify genetic biomarkers that are potentially useful for genetic diagnosis of PCV and for differentiating PCV from nAMD. METHODS We performed a literature search in EMBASE, PubMed, Web of Science, and the Chinese Biomedical Database for PCV genetic studies published before February 6, 2015. We then conducted a meta-analysis of all polymorphisms that had sufficient genotype/allele data reported in ≥2 studies and estimated the summary odds ratio (OR) and 95% confidence intervals (CIs) for PCV. We also compared the association profiles between PCV and nAMD, and performed a sensitivity analysis. RESULTS A total of 66 studies were included in the meta-analysis, involving 56 polymorphisms in 19 genes/loci. In total, 31 polymorphisms in 10 genes/loci (age-related maculopathy susceptibility 2 [ARMS2], high-temperature requirement factor A1 [HTRA1], complement factor H [CFH], complement component 2 [C2], CFB, RDBP, SKIV2L, CETP, 8p21, and 4q12) were significantly associated with PCV. Another 25 polymorphisms in 13 genes (ARMS2, HTRA1, C2, CFB, ELN, LIPC, LPL, ABCA1, VEGF-A, TLR3, LOXL1, SERPING1, and PEDF) had no significant association. Twelve polymorphisms at the ARMS2-HTRA1 locus showed significant differences between PCV and nAMD. The sensitivity analysis validated the significance of our analysis. CONCLUSIONS This study revealed 31 polymorphisms in 10 genes/loci that contribute to PCV susceptibility. Among them, ARMS2-HTRA1 also showed allelic diversity between PCV and nAMD. Our results confirm the gene variants that could affect the phenotypic expressions of PCV and nAMD.

Generational difference of refractive error in the baseline study of the Beijing Myopia Progression Study.

Aims To report the refractive error difference (RED) between parents and their children and the estimated single generational myopic shift in an urban area in China. Methods 395 children aged 6–17 years and their parents, who had been enrolled in the Beijing Myopia Progression Study were included. Cycloplegic and non-cycloplegic refraction of the children and parents were performed, respectively. RED was defined as the difference between the average parental spherical equivalent (SE) and the average SE of their children. Binomial fitted curves of RED were plotted as a function of the childrens age. Generational myopic shift was defined as the estimated RED according to the prediction model at the age of 18 years. Results 395 families were enrolled. The RED was positively correlated with the childrens age (rspearman=0.58, p<0.001). The RED (median (25th and 75th percentile)) was −1.88 (−3.23 to −1.00) dioptres (D) in children at 6.0–7.9 years of age, and it increased to 1.53 (−0.12 to 3.44) D in children at 16.0–17.9 years of age. The SE of the children approached the average SE of their parents at the age of 11 years. At the age of 18 years, the childrens estimated myopic shift would be 1.94 D. Conclusions In this sample, childrens refractive errors at the age of 11 years were already similar to their parents. Moreover, the estimated myopia in children at the age of 18 years would be up to 2.0 D higher than their parents. This remarkable single-generation myopic shift indicates that there are likely effects of environmental factors on myopia development in urban Chinese children.

Association between hyperglycemia and retinopathy of prematurity: a systemic review and meta-analysis

As the role of hyperglycemia in the development of retinopathy of prematurity (ROP) has not been well established, a meta-analysis of the association between hyperglycemia and ROP was conducted. Studies were identified through literature search in MEDLINE and EMBASE up to June 20, 2014 with keywords related to “hyperglycaemia” and “ROP”. Nine eligible studies involving 1939 neonates with 509 cases of ROP were included. Unadjusted analyses showed that hyperglycemia was significantly associated with ROP (Odds ratio [OR] = 4.16, P<0.0001). Comparing with the control, subjects in the ROP group had a significantly longer duration of hyperglycemia (Standardized mean difference [SMD] = 1.21, P< 0.0001), and higher mean glucose level. (SMD = 0.88, P = 0.0004) However, when combining the adjusted OR (after adjustment for birth weight, gestational age and other factors) provided from individual studies, only borderline significant association were observed on duration of hyperglycemia with ROP (adjusted OR 1.08, P = 0.03); and no significant association on mean glucose level with ROP (adjusted OR = 1.08, P = 0.15). Hence, hyperglycemia cannot be definitely considered as a risk factor for ROP, and further studies should adjust for potential confounding factors to clarify this association.

Does cigarette smoking alter the risk of pterygium? A systematic review and meta-analysis.

PURPOSE To determine the association of cigarette smoking with pterygium. METHODS Potentially eligible studies published from the year 1946 to December 28, 2013 were identified from MEDLINE, EMBASE, and Cochrane Library databases, and reference lists. All studies that evaluated smoking as an independent factor for pterygium were identified. Study-specific odds ratios (ORs) were combined using the random-effects model when P < 0.1 in the test for heterogeneity, or otherwise the fixed-effects model was used. Meta-regression, sensitivity analysis, and evaluation of potential biases were undertaken. The ORs with 95% confidence intervals (CIs) of smoking as an associated factor for pterygium were analyzed. RESULTS We included 24 articles incorporating 95,279 participants from 20 cross-sectional studies, 2 hospital-based case-control studies, and 2 population-based cohort studies. The combined OR of cigarette smoking (current or ever smoked) for risk of pterygium was 0.82 (95% CI, 0.69-0.97; P = 0.025). The results remained consistent among current smokers (OR, 0.68; 95% CI, 0.61-0.76; P = 4.57 × 10(-12)), but not in ex-smokers (OR, 1.05; 95% CI, 0.87-1.27; P = 0.59). The impact of ultraviolet light (UV) exposure (P = 0.082) and sex (P = 0.553) on the effect of smoking was insignificant in meta-regression. Sensitivity analysis confirmed the protective effect and nonrelevance of these two study-level variables. Beggs funnel plots and Eggers test showed minimal publication bias. CONCLUSIONS The results of this meta-analysis show that cigarette smoking was associated with a reduced risk of pterygium, especially in current smokers. This effect may be independent of UV exposure and sex. Investigations are needed to unveil its molecular basis serving therapeutic purposes.

Baseline characteristics of nearwork-induced transient myopia.

Purpose The purpose of the present study was to describe the baseline refractive and nearwork-induced transient myopia (NITM) characteristics of the Beijing Myopia Progression Study, a 3-year cohort study, that has three overall specific aims: to investigate the natural history of NITM in schoolchildren living in the inner city of Beijing aged between 7 and 17 years; to investigate the possible relation between NITM and permanent myopia; and to determine the possible associations with NITM (eg, parental history). Methods Three hundred eighty-six students (187 males and 199 females) were enrolled. The mean ages were 8.4 ± 1.1 years and 14.2 ± 1.6 years for the primary school and secondary school students, respectively. Baseline refractive aspects were determined clinically. Initial NITM and its decay were assessed objectively immediately after binocularly viewing and performing a sustained near task (5 minutes; 5 diopters [D]), incorporating a cognitive demand with full distance refractive correction in place. Results Initial NITM (mean ± SD) / decay time (median, first quartile, and third quartile) was 0.18 ± 0.16 D / 50 (20, 90) seconds, 0.09 ± 0.13 D / 30 (10, 40) seconds, and 0.10 ± 0.19 D / 20 (10, 40) seconds among the myopic, emmetropic, and hyperopic students, respectively, for the combined school levels. Initial NITM and decay time were significantly larger/longer in the myopic versus the other two refractive groups. Conclusions The present findings demonstrate that in a large sample of school-aged children with myopia, the initial NITM magnitude was significantly larger and the decay duration was significantly longer than that observed in age-matched children with either emmetropia or hyperopia. Follow-up for the next 3 years will provide insight into the possible role of NITM in the development of permanent myopia.

Diabetes mellitus and risk of age-related macular degeneration: a systematic review and meta-analysis.

Age-related macular degeneration (AMD) is a major cause of severe vision loss in elderly people. Diabetes mellitus is a common endocrine disorder with serious consequences, and diabetic retinopathy (DR) is the main ophthalmic complication. DR and AMD are different diseases and we seek to explore the relationship between diabetes and AMD. MEDLINE, EMBASE, and the Cochrane Library were searched for potentially eligible studies. Studies based on longitudinal cohort, cross-sectional, and case-control associations, reporting evaluation data of diabetes as an independent factor for AMD were included. Reports of relative risks (RRs), hazard ratios (HRs), odds ratio (ORs), or evaluation data of diabetes as an independent factor for AMD were included. Review Manager and STATA were used for the meta-analysis. Twenty four articles involving 27 study populations were included for meta-analysis. In 7 cohort studies, diabetes was shown to be a risk factor for AMD (OR, 1.05; 95% CI, 1.00–1.14). Results of 9 cross-sectional studies revealed consistent association of diabetes with AMD (OR, 1.21; 95% CI, 1.00–1.45), especially for late AMD (OR, 1.48; 95% CI, 1.44–1.51). Similar association was also detected for AMD (OR, 1.29; 95% CI, 1.13–1.49) and late AMD (OR, 1.16; 95% CI, 1.11–1.21) in 11 case-control studies. The pooled ORs for risk of neovascular AMD (nAMD) were 1.10 (95% CI, 0.96–1.26), 1.48 (95% CI, 1.44–1.51), and 1.15 (95% CI, 1.11–1.21) from cohort, cross-sectional and case-control studies, respectively. No obvious divergence existed among different ethnic groups. Therefore, we find diabetes a risk factor for AMD, stronger for late AMD than earlier stages. However, most of the included studies only adjusted for age and sex; we thus cannot rule out confounding as a potential explanation for the association. More well-designed prospective cohort studies are still warranted to further examine the association.

Association of paraoxonase gene polymorphisms with diabetic nephropathy and retinopathy

Emerging reports have revealed a potential association of paraoxonase (PON) gene polymorphisms with diabetic nephropathy (DN) and diabetic retinopathy (DR). However, the identification of susceptible genes and the quantification of associated risks are elusive owing to a lack of reproducibility. Therefore, a meta‑analysis was conducted in the present study to improve the understanding of the effect of PON1 and PON2 on DN and DR. A total of 10 articles, involving 2,877 patients and 3,246 controls met the inclusion criteria. Functional variants (n=4) were evaluated, including rs662 (p.Q192R) and rs854560 (p.L55M) in PON1; and rs7493 (p.S311C) and rs12026 (p.A148G) in PON2. Overall, PON1‑L55M was found to be significantly associated with DR in all the genetic models: allele [odds ratio (OR)=2.42; 95% confidence interval (CI), 1.91‑3.07]; dominant (OR=5.76; 95% CI, 3.14‑10.55), homozygote (OR=10.53; 95% CI, 5.59‑19.86), heterozygote (OR=3.62; 95% CI, 1.94‑6.74), and recessive (OR=3.56; 95% CI, 2.61‑4.86), with no evidence of between‑study heterogeneity. However, such associations were not detected in DN and the other three polymorphisms did not show any associations with DN or DR. The current meta‑analysis highlighted results for the risk of association of PON1‑55L with DR. The results also indicated that PON2 gene polymorphisms, as well as PON1‑Q192R, may not confer major genetic risk to DN or DR. Additional studies are required to enrich the understanding of PON genes, particularly for its functional role in DR.

Association of Gestational Hypertensive Disorders with Retinopathy of prematurity: A Systematic Review and Meta-analysis

The role of gestational hypertensive disorders, which includes both pre-eclampsia and gestational hypertension, in the development of retinopathy of prematurity (ROP) has been controversial. Therefore, this systematic review and meta-analysis is to evaluate the association between gestational hypertensive disoders and ROP. Eligible studies published up to June 5, 2016 were identified from MEDLINE and EMBASE that evaluated the association between the two conditions. Totally 1142 published records were retrieved for screening, 925 of them eligible for detailed evaluation. Finally 19 studies involving 45281 infants with 5388 cases of ROP met our criteria for meta-analysis. Gestational hypertensive disorders were not associated with ROP (unadjusted OR: 0.89; P = 0.38; adjusted OR: 1.35; P = 0.18). Subgroup analyses also revealed no significant association between ROP with pre-eclampsia (unadjusted OR: 0.85; P = 0.29; adjusted OR:1.29; P = 0.28) or with gestational hypertension (unadjusted OR: 1.10; P = 0.39; adjusted OR: 1.25; P = 0.60) separately. Sensitivity analysis indicated our results were robust. We concluded no significant association between gestational hypertensive disorders and ROP. More large scale well-conducted prospective cohorts on the topic are needed.