Yingyan Ma

Myopia screening: combining visual acuity and noncycloplegic autorefraction.

Purpose To explore the effectiveness of combining uncorrected visual acuity (UCVA) and noncycloplegic autorefraction (NCAR) for large-scale myopia screening in schoolchildren with a high prevalence of myopia. Methods A total of 1687 children aged between 6 and 12 years, from five primary schools in the Baoshan district of Shanghai participated in the study. We measured UCVA and autorefraction before and after cycloplegia by a Topcon KR-8800. We drew receiver operating characteristic curves to achieve the best cutoff points and their corresponding sensitivities and specificities for the UCVA and NCAR, respectively. We then combined the UCVA and NCAR in serial order to explore the optimal criterion and its effectiveness. A specificity of 90% was set to compare the sensitivities among the three tests. The children were divided into three age groups (aged 6 to 7, 8 to 10, 11 to 12 years) to further examine this new method. Results A total of 1639 children with an average age of 9.35 (SD, 1.6) years were finally included, among which 428 (26.11%) children were diagnosed as being myopic (spherical equivalent refraction (SER) less than or equal to −0.5 diopters [D]). For the UCVA, the cutoff point is 0.2 logarithm of the minimum angle of resolution (20/32), with a sensitivity and specificity of 63.6% and 94.0%, respectively. For NCAR, the cutoff point is SER less than or equal to −0.75 D, with a sensitivity and specificity of 88.6% and 86.1%, respectively. When UCVA is combined with NCAR, the best cutoff point is UCVA less than or equal to 0 logarithm of the minimum angle of resolution (20/20) and SER less than or equal to −0.75 D, with a sensitivity and specificity of 84.4% and 90.5%, respectively. At a specificity of 90%, the sensitivities are 63.55%, 78.50%, and 84.35%, respectively, for UCVA, NCAR, and the combination test. In all age groups, the combination test had the highest sensitivities among the three tests. Conclusions In a population with a high prevalence of myopia, combining the UCVA and NCAR in serial order achieved higher sensitivity than either of the two tests alone, when specificity was set at 90%.

Retinal Nerve Fiber Layer Thickness in Normal Chinese Students Aged 6 to 17 Years

PURPOSE We obtained retinal nerve fiber layer (RNFL) thickness measurements in normal Chinese students aged 6 to 17 years, and investigated the relationship between RNFL thickness and sex, eye laterality, age, axial length, and refractive error. METHODS A total of 4648 eyes in 2324 normal, randomly-selected Chinese students aged 6 to 17 years was examined in this study. The RNFL thickness was measured by optical coherence tomography. The effects of sex, eye laterality (left or right), age, refractive error, and axial length on RNFL thickness were assessed. RESULTS The average age of the subjects was 12.82 ± 3.11 years. The global average RNFL thickness (±SD) was 106.89 ± 12.84 μm. The thickest RNFL measurements were found at the superior (133.22 ± 19.48 μm) and inferior (129.23 ± 20.30 μm) quadrants of the retina, followed by the temporal (93.58 ± 29.15 μm) and nasal (77.10 ± 14.89 μm) quadrants. In the 1529 participants aged 12 to 17, there were no significant differences in RNFL thickness values between the right and left eyes (P > 0.05); significant differences in RNFL were found only in the inferior and temporal quadrants of the retina in different sex groups (P < 0.05). Linear regression analysis revealed that the RNFL thickness values were correlated independently with axial length and refractive error (P < 0.05). CONCLUSIONS For clinical assessment of RNFL thickness, the influence of refractive error and axial length should be taken into account.

Cost-Utility Analyses of Cataract Surgery in Advanced Age-Related Macular Degeneration.

Purpose To explore the cost-utility of cataract surgery in patients with advanced age-related macular degeneration (AMD). Methods Patients who were diagnosed as having and treated for age-related cataract and with a history of advanced AMD at the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, were included in the study. All of the participants underwent successful phacoemulsification with foldable posterior chamber intraocular lens implantation under retrobulbar anesthesia. Best-corrected visual acuity (BCVA) and utility value elicited by time trade-off method from patients at 3-month postoperative time were compared with those before surgery. Quality-adjusted life years (QALYs) gained in a lifetime were calculated at a 3% annual discounted rate. Costs per QALY gained were calculated using the bootstrap method, and probabilities of being cost-effective were presented using a cost-effectiveness acceptability curve. Sensitivity analyses were performed to test the robustness of the results. Results Mean logarithm of the minimum angle of resolution BCVA in the operated eye increased from 1.37 ± 0.5 (Snellen, 20/469) to 0.98 ± 0.25 (Snellen, 20/191) (p < 0.001); BCVA in the weighted average from both eyes (=75% better eye + 25% worse eye) was changed from 1.13 ± 0.22 (Snellen, 20/270) to 0.96 ± 0.17 (Snellen, 20/182) (p < 0.001). Utility values from both patients and doctors increased significantly after surgery (p < 0.001 and p = 0.007). Patients gained 1.17 QALYs by cataract surgery in their lifetime. The cost per QALY was 8835 Chinese yuan (CNY) (1400 U.S. dollars [USD]). It is cost-effective at the threshold of 115,062 CNY (18,235 USD) per QALY in China recommended by the World Health Organization. The cost per QALY varied from 7045 CNY (1116 USD) to 94,178 CNY (14,925 USD) in sensitivity analyses. Conclusions Visual acuity and quality of life assessed by utility value improved significantly after surgery. Cataract surgery was a cost-effective intervention for patients with coexistent AMD.

Corneal Thickness Profile and Associations in Chinese Children Aged 7 to 15 Years Old.

Corneal thickness (CT) maps of the central (2-mm diameter), para-central (2 to 5-mm diameter), peripheral (5 to 6-mm diameter), and minimum (5-mm diameter) cornea were measured in normal Chinese school children aged 7 to 15 years old using Fourier-domain optical coherence tomography. Multiple regression analyses were performed to explore the effect of associated factors [age, gender, refraction, axial length and corneal curvature radius (CCR)] on CT and the relationship between central corneal thickness (CCT) and intraocular pressure (IOP). A total of 1228 eyes from 614 children were analyzed. The average CCT was 532.96 ± 28.33 μm for right eyes and 532.70 ±28.45 μm for left eyes. With a 10 μm increase in CCT, the IOP was elevated by 0.37 mm Hg, as measured by noncontact tonometry. The CT increased gradually from the center to the periphery. The superior and superior nasal regions had the thickest CTs, while the thinnest points were primarily located in the inferior temporal cornea. The CCT was associated with CCR (p = 0.008) but not with gender (p = 0.075), age (p = 0.286), axial length (p = 0.405), or refraction (p = 0.985). In the para-central region and the peripheral cornea, increased CT was associated with younger age, male gender, and a flatter cornea.

Cataract surgery in patients with bilateral advanced age-related macular degeneration: Measurement of visual acuity and quality of life

Purpose To measure the change in visual acuity and vision‐related quality of life in patients with both age‐related cataract and bilateral age‐related macular degeneration (AMD) after cataract surgery. Setting Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China. Design Prospective case series. Methods Patients with age‐related cataract and bilateral advanced AMD who were diagnosed and treated between January 2006 and January 2012 were enrolled. The patients had successful phacoemulsification with foldable posterior chamber intraocular lens implantation. The corrected distance visual acuity (CDVA) and vision‐related quality of life measured by the Chinese‐version Low Vision Quality of Life (CLVQOL) questionnaire were collected. The Wilcoxon signed‐rank test was used to compare the differences. Binary logistic regression analysis was performed to explore potential factors associated with the change in CLVQOL scores. Results Sixty eyes of 51 patients were included. The CDVA improved significantly (median difference 0.30 logMAR; range 0 to 1.38 logMAR; P < .001). The CLVQOL composite scores and the 4 subscale scores improved significantly (all P < .001). A greater increase in the CLVQOL scores was associated with inferior preoperative logMAR CDVA in the more severely affected eye (regression coefficient 3.36; P < .001). Conclusions Cataract surgery improved visual acuity and the vision‐related quality of life in patients with both age‐related cataract and bilateral advanced AMD. Thus, it is beneficial for patients with coexistent advanced AMD to have cataract surgery. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Vision-related Quality of Life Outcomes of Cataract Surgery in Advanced Glaucoma Patients.

Purpose:To demonstrate longitudinal postoperative vision-related quality of life and visual acuity changes after cataract surgery in advanced glaucoma patients. Materials and Methods:In total, 93 patients who underwent cataract surgeries were collected from June 2010 through June 2013 in Shanghai First People’s Hospital, Shanghai Jiao Tong University, and were followed up for at least 3 months. Patients with advanced glaucoma, here defined as near total cupping of the optic nerve with severe visual field loss within 10 degrees of fixation, were enrolled. A standard phacoemulsification technique with the insertion of an intraocular lens was used. No complications occurred intraoperatively or postoperatively. Preoperative and 3-month postoperative vision-related quality of life were assessed in face-to-face interviews. The Chinese-version of the Low Vision Quality of Life Questionnaire (CLVQOL) was used. Wilcoxon signed-rank test was used to compare the differences in the best-corrected visual acuity (BCVA), weighted average LogMAR (WMAR), and CLVQOL scores. A binary logistic regression analysis was conducted to explore the potential factors associated with the change in CLVQOL scores. Results:The overall changes in the CLVQOL composite scores ranged between 4 and 42 (median=19). Statistically significant increases occurred in the composite scores of all of the subscales, the total CLVQOL, the BCVA in the surgery eye, and the WMAR (all P<0.001). Greater increases in the CLVQOL composite scores was associated with superior preoperative WMAR (odds ratio: 9.920, P<0.05), and age below 60 years (odds ratio: 9.905, P<0.05). Conclusions:Cataract surgery should be recommended for advanced glaucoma patients with stable intraocular pressure.

Cost-utility Analysis of Rhegmatogenous Retinal Detachment Surgery in Shanghai, China

Abstract Purpose: To perform a short-term and a long-term cost-utility analysis of rhegmatogenous retinal detachment (RRD) surgery in Shanghai, China Methods: A total of 117 patients who underwent RRD surgery at Shanghai First People’s Hospital, Affiliated Shanghai Jiaotong University, and then underwent follow-up for at least 1 year, were included in the study. Costs associated with RRD surgery and time trade-off utility values before and after surgery were recorded. Short-term analysis was made for 1 year. Quality-adjusted life years (QALYs) gained by RRD surgery over the lifetime were calculated at a 3% discount rate in the long-term analysis. This study used the bootstrap method in statistical analysis and one-way sensitivity analyses to test robustness of the results. Results: Compared with no treatment, the mean incremental costs of RRD surgery was 11,384 Chinese yuan (CN¥) (US

Design and methodology of the Shanghai child and adolescent large-scale eye study (SCALE)

1751); the mean additional QALYs gained was 0.05 (95% confidence interval [CI] 0.04–0.06) for 1 year and 0.88 (95% CI 0.64–1.13) for life expectancy; the incremental cost effectiveness ratio (ICER) was CN¥224,921 (US

Cost-Utility Analysis of Cataract Surgery in Advanced Glaucoma Patients.

34,603)/QALY for the short-term, and CN¥13,794 (US

Rhegmatogenous Retinal Detachment Surgery in Elderly People over 70 Years Old: Visual Acuity, Quality of Life, and Cost-Utility Values

2122)/QALY for the long-term. In short-term analysis, the ICER was CN¥150,087 (US