Si-Yan Zhan

Design, methodology and baseline data of a school-based cohort study in Central China: the Anyang Childhood Eye Study.

Abstract Purpose: To report the design, methods and baseline data of the Anyang Childhood Eye Study (ACES), aiming to determine the prevalence, incidence and risk factors of myopia and other ocular diseases in children in central China. Methods: The ACES was a school-based cohort study conducted in Anyang city. Students have been examined and will be followed-up annually for 3–5 years. Ocular examinations included visual acuity, identification of amblyopia and strabismus, ocular biometry, optical coherence tomography, retinal photography, cycloplegic autorefraction, accommodative response, peripheral refraction, visual perception and so on. A questionnaire survey was performed to collect risk factors for myopia including near work, outdoor activity, parental myopia, birth history, habits of wearing spectacles and reading, living habits, food habits and so on. Results: Of 3112 grade 1 and 2363 grade 7 students eligible for the ACES, 2893 (93.0%) and 2267 (95.9%) participated in the study, with a mean age of 7.1 years (range 5.7–9.3 years) and 12.7 years (range 10.0–15.9 years), and proportions of male to be 57.8% and 50.0%, respectively. The prevalence rates of myopia, high myopia, emmetropia and hyperopia were 3.9%, 0.1%, 72.9% and 23.3% in grade 1, and 67.3%, 2.7%, 31.4% and 1.2% in grade 7, respectively. Similar data were found in the children confined in 6-year-old and 12-year-old ages. Conclusions: The ACES is the first large-scale cohort study in China with baseline response rates over 90%. Continuous documentation of changes and risk factors of refractive errors in these cohorts would provide new insights into myopia control in school-aged children.

Time Outdoors and Myopia Progression Over 2 Years in Chinese Children: The Anyang Childhood Eye Study.

PURPOSE To investigate whether time outdoors and a range of other activities are associated with change in spherical equivalent (SE) and axial length in Chinese children over a period of 2 years. METHODS A total of 1997 children aged 12.7 ± 0.5 (10.9-15.6) years in the Anyang Childhood Eye Study (ACES) were examined annually (baseline and two follow-up visits). Myopia was defined as cycloplegic SE < -0.50 diopters (D). Questionnaires were administered to the students and parents at baseline to gauge time spent outdoors and on other tasks. We ran mixed linear models including age, sex, and years of follow-up. RESULTS In the full cohort of children there was a suggestive association between time spent outdoors and change in axial length; however, the effect size was very small (high versus low tertile: -0.016 mm/y, P = 0.053). The association was observed in children not myopic at baseline (high versus low tertile, -0.036 mm/y; P = 0.009) but not in those already myopic at baseline (high versus low tertile: -0.005 mm/y; P = 0.595). Time outdoors and change in SE showed similar, but nonsignificant, relationships (P > 0.05), perhaps due to insufficient statistical power. The other activities examined and parental myopia were not associated with changes in SE and axial length (P > 0.11). CONCLUSIONS Within the normal range of variation encountered in these Chinese children, a wide range of activities were largely unrelated to myopia progression at this age. However, there was suggestive evidence that greater time outdoors was associated with slower axial elongation in nonmyopic teenagers, but not in existing myopes.

Atropine slows myopia progression more in Asian than white children by meta-analysis

Purpose To conduct a meta-analysis on the effects of atropine in slowing myopia progression and to compare Asian and white children and randomized controlled trials (RCTs) and observational studies. Methods Randomized controlled trials and observational studies that assessed the effects of all concentrations of atropine in slowing myopia progression in children were searched from MEDLINE, EMBASE, and the Cochrane Library up to April 2013. Jadad scoring was used to evaluate the quality of RCTs, and the Newcastle-Ottawa Scale was used for observational studies. Results Four RCTs and seven cohort studies (a kind of observational study) with 1815 children aged 5 to 15 years were included. The children had a baseline refraction of −0.50 to −9.75 diopters (D) and were followed up for 22.0 months (range, 12.0 to 36.5 months). The weighted mean differences in myopia progression in RCTs and cohort studies of Asian children were 0.55 D per year (p < 0.01) and 0.54 D per year (p < 0.001), respectively, and 0.35 D per year (p = 0.01) in cohort studies of white children. Compared with placebo, the risk of fast myopia progression (>1.0 D per year) using atropine was significantly decreased in both RCTs (odds ratio [OR], 0.14; p < 0.01) and cohort studies (OR, 0.08; p < 0.01), and the benefit of slow myopia progression (<0.50 D per year) using atropine was significantly increased in both RCTs (OR, 6.73; p < 0.01) and cohort studies (OR, 22.10; p < 0.01). Conclusions Atropine could significantly slow myopia progression in children, with greater effects in Asian than in white children. Randomized controlled trials and cohort studies provided comparable effects.

Retinal Nerve Fiber Layer Thickness in a Population of 12- Year-Old Children in Central China Measured by iVue-100 Spectral-Domain Optical Coherence Tomography: The Anyang Childhood Eye Study

PURPOSE To study the distribution of peripapillary retinal nerve fiber layer (RNFL) thickness in a population of 12-year-old children in central China using iVue-100 spectral-domain optical coherence tomography (SD-OCT). METHODS Twelve-year-old students (n = 2105) from four randomly selected middle schools in Anyang, China, participated in the study. Each child underwent ocular examinations, including optical biometry, cycloplegic autorefraction, and SD-OCT (iVue-100). Glaucoma optic nerve head scan was performed to measure RNFL thickness. Only the children with a signal strength index higher than 45 were included in the analyses. Multivariate analyses were performed to examine the association of RNFL with demographic variables (e.g., sex, age, and body mass index [BMI]) and ocular variables (e.g., axial length and refractive error). RESULTS Optical coherence tomography scans of adequate quality were available for 1955 children (92.9%). The mean (SD) RNFL thickness was 103.08 (9.01) μm, with the mean (SD) thickest RNFL in the inferior quadrant (129.34 [14.90] μm), followed by the superior (126.19 [15.24] μm), temporal (82.98 [10.57] μm), and nasal (73.82 [13.89] μm) quadrants. The RNFL was thicker with shorter axial length (β = -1.53, P < 0.0001) and with higher hyperopia (β = 0.90, P < 0.0001). Girls had slightly thicker average RNFL thickness than boys (P < 0.0001). The RNFL thickness had no significant correlation with age or BMI. CONCLUSIONS This study establishes normative peripapillary RNFL values of 12-year-old Chinese children as measured by iVue-100 SD-OCT. The RNFL thickness decreased significantly with increasing axial length and higher myopia.

The association between HLA‐DQB1 polymorphism and antituberculosis drug‐induced liver injury: a Case–Control Study

Research on genetic factors associated with antitubercular drug‐induced liver injuries (ATLI) has been reported. However, most of the research has focused on genetic polymorphisms of genes encoding metabolic enzymes, including NAT2, GST and CYP450. It is probable that the immune system also contributes to the onset of drug adverse effects. A few small studies have explored the possible association of HLA genes with drug‐induced liver injuries (DILI), but more supportive evidence from larger studies or prospective cohort designs is needed. We aim to explore the possible association of HLA‐DQB1 gene polymorphisms with ATLI in a case–control study.

Multifocal Versus Single Vision Lenses Intervention to Slow Progression of Myopia in School-age Children: A Meta-analysis

Myopia in school-aged children is a major public health problem in Asians that has been extensively studied. Multifocal lenses (MLs) are advocated as a substitute for single vision lenses (SVLs) to slow myopia progression in children, but results vary greatly across studies. We systematically searched currently available randomized controlled trials that compared the effects of MLs and SVLs in children. A meta-analysis of nine of these trials showed that MLs with powers ranging from +1.50 to +2.00D were associated with a statistically significantly decrease in myopia progression in school-aged children compared with SVLs. The benefit was greater in children with a higher level of myopia at baseline and sustained for a minimum of 24 months. Asian children appeared to have greater benefit from intervention with MLs than white children.

The cardiovascular effects of glucagon-like peptide-1 receptor agonists: a trial sequential analysis of randomized controlled trials

Glucagon‐like peptide‐1 (GLP‐1) receptor agonists are a new class of antidiabetic drugs. Their wider use for the treatment of patients with type 2 diabetes mellitus has led to concerns about its cardiovascular effects. However, the robustness of data leading to those concerns is unclear. The purpose of this study is to systematically assess the robustness of the available evidence on the adverse cardiovascular effects of GLP‐1 receptor agonists in patients with type 2 diabetes.

Peripheral refraction in 7- and 14-year-old children in central China: the Anyang Childhood Eye Study

Purpose To determine the distribution of peripheral refraction, including astigmatism, in 7- and 14-year-old Chinese children. Methods 2134 7-year-old and 1780 14-year-old children were measured with cycloplegic central and horizontal peripheral refraction (15° and 30° at temporal and nasal visual fields). Results 7- and 14-year-old children included 9 and 594, respectively, with moderate and high myopia (≤−3.0 D), 259 and 831 with low myopia (−2.99 to −0.5 D), 1207 and 305 with emmetropia (−0.49 to +1.0 D), and 659 and 50 with hyperopia (>1.0 D), respectively. Myopic children had relative peripheral hyperopia while hyperopic and emmetropic children had relative peripheral myopia, with greater changes in relative peripheral refraction occurring in the nasal than the temporal visual field. The older group had the greater relative peripheral hyperopia and higher peripheral J180. Both age groups showed positive slopes of J45 across the visual field, with greater slopes in the older group. Conclusions Myopic children in mainland China have relative peripheral hyperopia while hyperopic and emmetropic children have relative peripheral myopia. Significant differences exist between 7- and 14-year-old children, with the latter showing more relative peripheral hyperopia, greater rate of change in J45 across the visual field, and higher peripheral J180.

Associations between cardiovascular risk factors and early age-related macular degeneration in a rural Chinese adult population.

Background: There have been a limited number of population-based studies investigating the associations between cardiovascular disease risk factors and early age-related macular degeneration (AMD). Methods: A total of 7,557 eligible people aged 30 or older were recruited from 2006 to 2007. Cardiovascular risk factors and serum lipids including total cholesterol, total triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and fasting plasma glucose, and urines were assessed. Digital photographs of the optic disk and macula fields (Early Treatment of Diabetic Retinopathy Study) were taken and graded after the modified Wisconsin Age-related Maculopathy Grading System. Logistic regression models were constructed to assess odds ratios and 95% confidence intervals. Cases of late AMD were excluded. Results: Of 6,577 subjects included in the analysis, there were 200 (3.04%) cases with early AMD. Multivariate analysis showed that higher age, untreated hypertension, coronary heart disease, and smoking were associated with an increased risk of early AMD. After adjusting for other variables in the final model, no variable was significantly associated with hyperpigmentation while smoking was significantly associated with an increased risk of hypopigmentation; higher age and any cardiovascular disease were associated with an increased risk of large drusen, and higher age, smoking, untreated hypertension, and coronary heart disease were associated with an increased risk of soft drusen. Conclusion: Our findings support the associations between smoking, coronary heart disease, and early AMD.

Paraxial Schematic Eye Models for 7- and 14-Year-Old Chinese Children.

PURPOSE To develop three-surface paraxial schematic eyes with different ages and sexes based on data for 7- and 14-year-old Chinese children from the Anyang Childhood Eye Study. METHODS Six sets of paraxial schematic eyes, including 7-year-old eyes, 7-year-old male eyes, 7-year-old female eyes, 14-year-old eyes, 14-year-old male eyes, and 14-year-old female eyes, were developed. Both refraction-dependent and emmetropic eye models were developed, with the former using linear dependence of ocular parameters on refraction. RESULTS A total of 2059 grade 1 children (boys 58%) and 1536 grade 8 children (boys 49%) were included, with mean age of 7.1 ± 0.4 and 13.7 ± 0.5 years, respectively. Changes in these schematic eyes with aging are increased anterior chamber depth, decreased lens thickness, increased vitreous chamber depth, increased axial length, and decreased lens equivalent power. Male schematic eyes have deeper anterior chamber depth, longer vitreous chamber depth, longer axial length, and lower lens equivalent power than female schematic eyes. Changes in the schematic eyes with positive increase in refraction are decreased anterior chamber depth, increased lens thickness, decreased vitreous chamber depth, decreased axial length, increased corneal radius of curvature, and increased lens power. In general, the emmetropic schematic eyes have biometric parameters similar to those arising from regression fits for the refraction-dependent schematic eyes. CONCLUSIONS The paraxial schematic eyes of Chinese children may be useful for myopia research and for facilitating comparison with other children with the same or different racial backgrounds and living in different places.